Virtual Frontier: A New Reality

Extended-Reality Technologies: An Overview of Emerging Applications in Medical Education and Clinical Care.

Background Sustained attention is essential for effective learning, especially in virtual reality (VR) environments with a high degree of operational freedom. Electroencephalogram (EEG) feedback has proven effective in terms of monitoring and regulating students' attentional states. However, EEG feedback faces implementation challenges in VR environments. Auditory feedback may interfere with voice‐based learning content, while visual feedback can exacerbate the cognitive load in visually rich environments. Objective The aim was to explore methods that would help students maintain attention in the VR learning environment (including voice learning or voice guidance from virtual characters), thereby enhancing learning effectiveness. Method This study proposed and integrated a vibration‐based EEG feedback mechanism into a VR learning system. Grounded in the Cognitive Theory of Multimedia Learning, this approach leverages tactile prompts to avoid sensory conflict. A quasi‐experiment involving 64 university students was subsequently conducted in an English for Geography course. Of the participants, 32 were exposed to a VR environment incorporating the vibration‐based EEG feedback, while the other 32 used the same VR environment without the feedback. The data collection included students' attention levels, performance, and learning behaviours. Systematic records and interviews were used to retrace the students' states when the vibration feedback was triggered. Results and Conclusions Results showed that students in the VR learning system with vibration‐based EEG feedback exhibited higher attention levels, improved vocabulary memory and retention, and more structured behaviour patterns such as review and evaluation, planned learning and refocusing after EEG feedback. This study innovates EEG feedback in VR environments, providing a design reference to promote VR‐based learning. In addition, the results of identified scenarios and subjective reasons for inattention will help in the design of future language VR environments and learning activities.

Controlling characters in a virtual reality (VR) environment can lead to the interiorization of their body dimensions by the recipients. The possible preservation of these distortions in their psyche will indicate a high degree of psychological impact of a VR on a person and the potential danger of developing depersonalization of the recipients and their dependence on such stimulation. The study of the stability of these distortions is necessary in the context of ensuring the safety of the impact of VR environments on the human psyche. The main focus of the study is on the perception distortions of human body dimensions, as they are sensed by people immersed in a VR environment, and their dynamics depending on the number of immersions. The impact of the virtual reality environment was simulated using the Freedom Locomotion VR application. One virtual reality immersion session took 15 minutes. To obtain psychometric indicators of the subjects perception of their own body dimensions, the technique Measurements according to M. Feldenkrais was used. All the participants (N = 45, three experimental groups) underwent a mandatory preliminary measurement using this technique (several hours before exposure) and a final measurement (one day after the last exposure). At the same time, the results of preliminary measurements were taken as indicators of the subjects habitual perception of their own body dimensions and were considered in each data processing as a comparison group. Free movement in a VR environment leads to distortions in the subjects perception of their own body dimensions. In all the experimental groups, there was a tendency to exaggerate body dimensions immediately after immersions, which indicates the qualitative similarity of these distortions. The effect of repetitive immersion in a VR environment on the perception of body dimensions is that it increases awareness in perceiving body parts that are least active at the time of immersion. Controlling an anthropomorphic character in a VR leads to an increase in the subjective significance of the recipients own body perception and an increased concentration of attention on the parameters least involved in immersion. The results of the study show that an increased level of awareness in perceiving their own bodies is characteristic of the subjects who have experience of repetitive immersions in a VR environment in the guise of an anthropomorphic character. Controlling a bodily projection in a VR headset does not cause its long-term interiorization, but has a positive effect on the formation of personal corporeality.

Virtual reality (VR) is a rapidly growing concept in the field of medical education, offering significant potential for innovation. Assessing how VR is used in ophthalmology to teach medical students, residents, and attendings will help identify areas where VR can be further developed. Moreover, analyzing the strengths and limitations of VR in medical education, surgical training, and patient education within ophthalmology will provide valuable insights into its impact on the field.This scoping review aimed to (1) map the current applications of VR across ophthalmology education, (2) analyze the effectiveness of VR interventions for different learner groups, (3) identify gaps in current VR implementation, and (4) assess the quality of evidence supporting VR use in ophthalmology education.A literature review was performed by scanning databases including PubMed, IEEE Xplore®, and Education Resources Information Center (ERIC). Relevant articles published from 2015 to 2023 were identified through the databases. Inclusion and exclusion criteria were formed for the articles to be further analyzed for eligibility. Articles were further categorized based on their VR application and target learners.Most studies targeted the education of ophthalmology residents, highlighting a gap in VR use among students, other healthcare personnel, and patients. Future research should focus on expanding VR applications to these underrepresented groups. The rapid growth of VR in other areas of medical education suggests similar potential to enhance ophthalmology knowledge and skills across a more comprehensive audience. Research in the application of VR in ophthalmology education should extend beyond surgical training for residents to maximize its potential in improving patient care. For example, studies could explore how VR training improves the ophthalmic diagnostic skills of medical students, evaluate whether VR-based patient education enhances understanding of ophthalmic conditions and leads to improved patient outcomes, and whether VR training for opticians aids in the early detection of specific conditions like diabetic retinopathy. This review is limited by excluding grey literature, which may limit the material analyzed and overlook insights from non-peer-reviewed sources.

Art in Surgery: A Review of Art-based Medical Humanities Curricula in Surgical Residency

This study introduces AffectiVR, a dataset designed for periocular biometric authentication and emotion evaluation in virtual reality (VR) environments. To maximize immersion in VR environments, interactions must be seamless and natural, with unobtrusive authentication and emotion recognition technologies playing a crucial role. This study proposes a method for user authentication by utilizing periocular images captured by a camera attached to a VR headset. Existing datasets have lacked periocular images acquired in VR environments, limiting their practical application. To address this, periocular images were collected from 100 participants using the HTC Vive Pro and Pupil Labs infrared cameras in a VR environment. Participants also watched seven emotion-inducing videos, and emotional evaluations for each video were conducted. The final dataset comprises 1988 monocular videos and corresponding self-assessment manikin (SAM) evaluations for each experimental video. This study also presents a baseline study to evaluate the performance of biometric authentication using the collected dataset. A deep learning model was used to analyze the performance of biometric authentication based on periocular data collected in a VR environment, confirming the potential for implicit and continuous authentication. The high-resolution periocular images collected in this study provide valuable data not only for user authentication but also for emotion evaluation research. The dataset developed in this study can be used to enhance user immersion in VR environments and as a foundational resource for advancing emotion recognition and authentication technologies in fields such as education, therapy, and entertainment. This dataset offers new research opportunities for non-invasive continuous authentication and emotion recognition in VR environments, and it is expected to significantly contribute to the future development of related technologies.

In this paper, we provide an approach for authenticating users in virtual reality (VR) environments by tracking the behavior of users as they perform goal-oriented tasks, such as throwing a ball at a target. With the pervasion of VR in mission-critical applications such as manufacturing, navigation, military training, education, and therapy, validating the identity of users using VR systems is becoming paramount to prevent tampering of the VR environments, and to ensure user safety. Unlike prior work, which uses PIN and pattern based passwords to authenticate users in VR environments, our approach authenticates users based on their natural interactions within the virtual space by matching the 3D trajectory of the dominant hand gesture controller in a display-based head-mounted VR system to a library of trajectories. To handle natural differences in wait times between multiple parts of an action such as picking a ball and throwing it, our matching approach uses a symmetric sum-squared distance between the nearest neighbors across the query and library trajectories. Our work enables seamless authentication without requiring the user to stop their activity and enter specific credentials, and can be used to continually validate the identity of the user. We conduct a pilot study with 14 subjects throwing a ball at a target in VR using the gesture controller and achieve a maximum accuracy of 92.86% by comparing to a library of 10 trajectories per subject, and 90.00% by comparing to 6 trajectories per subject.

The Development of Virtual Reality as a Tool to Investigate Eating Behavior

Does walking in a virtual environment induce unstable gait?: An examination of vertical ground reaction forces

The effectiveness of the learning process in the virtual reality (VR) environment and the presence and immersion components of the VR environment are among the most important variables for students to feel as if they are part of the 3D environment and function in the environment. The objective of this chapter is to determine and compare the presence and usability levels of primary school students participating in VR environments with different immersion characteristics (immersive and non-immersive). According to the findings, there was no significant difference between immersive and non-immersive VR environments in terms of presence and usability. It was also determined that the level of presence of students in both groups did not vary depending on usability. The results are regarded to be useful to educators, researchers, and instructional designers who want to integrate VR technology into their educational environments.

The personalization of user experiences through recommendation systems has been extensively explored in Internet applications, but this has yet to be fully addressed in Virtual Reality (VR) environments. The complexity of managing geometric 3D data, computational load, and natural interactions poses significant challenges in real-time adaptation in these immersive experiences. However, tailoring VR environments to individual user needs and interests holds promise for enhancing user experiences. In this paper, we present Virtual Reality Environment Adaptation through Recommendations (VR-EAR), a framework designed to address this challenge. VR-EAR employs customizable object metadata and a hybrid recommendation system modeling implicit user feedback in VR environments. We utilize VR optimization techniques to ensure efficient performance. To evaluate our framework, we designed a virtual store where product locations dynamically adjust based on user interactions. Our results demonstrate the effectiveness of VR-EAR in adapting and personalizing VR environments in real time. domains.

Few studies have been carried out to examine the relation between postural stability and subjective reports or feelings of motion sickness. Two views seem to exist on the relation between immersion in a virtual reality (VR) environment and subjective feelings of motion sickness. One predicts that the immersion induces both postural instability and motion sickness. Another view is that preimmersion postural instability predisposes people to motion sickness. However, these views are not supported by empirical research. Longer immersions in a VR environment may induce higher levels of postural instability and symptoms of motion sickness. In this study, effects of long-hours immersion in a VR environment on postural stability were examined to approach the underlying mechanism of postural instability and motion sickness using force platform measurement and self-reported questionnaire on motion sickness. As a result, it was suggested that longer immersion in a VR environment induced postural instability and symptoms of motion sickness.

BackgroundExtended reality, which encompasses virtual reality (VR), augmented reality (AR), and mixed reality (MR), is increasingly used in medical education. Studies assessing the effectiveness of these new educational modalities should measure relevant outcomes using outcome measurement tools with validity evidence.ObjectiveOur aim is to determine the choice of outcomes, measurement instruments, and the use of measurement instruments with validity evidence in randomized controlled trials (RCTs) on the effectiveness of VR, AR, and MR in medical student education.MethodsWe conducted a systematic mapping review. We searched 7 major bibliographic databases from January 1990 to April 2020, and 2 reviewers screened the citations and extracted data independently from the included studies. We report our findings in line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.ResultsOf the 126 retrieved RCTs, 115 (91.3%) were on VR and 11 (8.7%) were on AR. No RCT on MR in medical student education was found. Of the 115 studies on VR, 64 (55.6%) were on VR simulators, 30 (26.1%) on screen-based VR, 9 (7.8%) on VR patient simulations, and 12 (10.4%) on VR serious games. Most studies reported only a single outcome and immediate postintervention assessment data. Skills outcome was the most common outcome reported in studies on VR simulators (97%), VR patient simulations (100%), and AR (73%). Knowledge was the most common outcome reported in studies on screen-based VR (80%) and VR serious games (58%). Less common outcomes included participants’ attitudes, satisfaction, cognitive or mental load, learning efficacy, engagement or self-efficacy beliefs, emotional state, competency developed, and patient outcomes. At least one form of validity evidence was found in approximately half of the studies on VR simulators (55%), VR patient simulations (56%), VR serious games (58%), and AR (55%) and in a quarter of the studies on screen-based VR (27%). Most studies used assessment methods that were implemented in a nondigital format, such as paper-based written exercises or in-person assessments where examiners observed performance (72%).ConclusionsRCTs on VR and AR in medical education report a restricted range of outcomes, mostly skills and knowledge. The studies largely report immediate postintervention outcome data and use assessment methods that are in a nondigital format. Future RCTs should include a broader set of outcomes, report on the validity evidence of the measurement instruments used, and explore the use of assessments that are implemented digitally.

At present, the research on emotion in the virtual environment is limited to the subjective materials, and there are very few studies based on objective physiological signals. In this article, the authors conducted a user experiment to study the user emotion experience of virtual reality (VR) by comparing subjective feelings and physiological data in VR and two-dimensional display (2D) environments. First, they analyzed the data of self-report questionnaires, including Self-assessment Manikin (SAM), Positive And Negative Affect Schedule (PANAS) and Simulator Sickness Questionnaire (SSQ). The result indicated that VR causes a higher level of arousal than 2D, and easily evokes positive emotions. Both 2D and VR environments are prone to eye fatigue, but VR is more likely to cause symptoms of dizziness and vertigo. Second, they compared the differences of electrocardiogram (ECG), skin temperature (SKT) and electrodermal activity (EDA) signals in two circumstances. Through mathematical analysis, all three signals had significant differences. Participants in the VR environment had a higher degree of excitement, and the mood fluctuations are more frequent and more intense. In addition, the authors used different machine learning models for emotion detection, and compared the accuracies on VR and 2D datasets. The accuracies of all algorithms in the VR environment are higher than that of 2D, which corroborated that the volunteers in the VR environment have more obvious skin electrical signals, and had a stronger sense of immersion. This article effectively compensated for the inadequacies of existing work. The authors first used objective physiological signals for experience evaluation and used different types of subjective materials to make contrast. They hope their study can provide helpful guidance for the engineering reality of virtual reality.

Perception of safe robot idle time in virtual reality and real industrial environments