Virtual Reality, Seeing-In, and Twofoldness

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

The Medical Metaverse, Part 1: Introduction, Definitions, and New Horizons for Neuropsychiatry.

In the field of surgery, major changes that have occurred include the advent of minimally invasive surgery and the realization of the importance of the ‘systems’ in the surgical care of the patient (Pierorazio & Allaf, 2009). Challenges in surgical training are two-fold: (i) to train the surgical residents to manage a patient clinically (ii) to train them in operative skills (Singh & Darzi,2013). In Pakistan, another issue with surgical training is
 that we have the shortest duration of surgical training in general surgery of four years only, compared to six to eight years in Europe and America (Zafar & Rana, 2013). Along with it, the smaller number of patients to surgical residents’ ratio is also an issue in surgical training. This warrants formal training outside the operation room. It has been reported by many authors that changes are required in the current surgical training system due to the significant deficiencies in the graduating surgeon (Carlsen et al., 2014; Jarman et al., 2009; Parsons, Blencowe, Hollowood, & Grant, 2011). Considering surgical training, it is imperative that a surgeon is competent in clinical management and operative skills at the end of the surgical training. To achieve this outcome in this challenging scenario, a resident surgeon should be provided with the opportunities of training outside the operation theatre, before s/he can perform procedures on a real patient. The need for this training was felt more when the Institute of Medicine in the USA published a report, ‘To Err is Human’ (Stelfox, Palmisani, Scurlock, Orav, & Bates, 2006), with an aim to reduce medical errors. This is required for better training and objective assessment of the surgical residents. The options for this training include but are not limited to the use of mannequins, virtual patients, virtual simulators, virtual reality, augmented reality, and mixed reality. Simulation is a technique to substitute or add to real experiences with guided ones, often immersive in nature, that reproduce substantial aspects of the real world in a fully interactive way. Mannequins, virtual simulators are in use for a long time now. They are available in low fidelity to high fidelity mannequins and virtual simulators and help residents understand the surgical anatomy, operative site and practice their skills. Virtual patients can be discussed with students in a simple format of the text, pictures, and videos as case files available online, or in the form of customized software applications based on algorithms. In a study done by Courtielle et al, they reported that knowledge retention is increased in residents when it is delivered through virtual patients as compared to lecturing (Courteille et al., 2018).But learning the skills component requires hands-on practice. This gap can be bridged with virtual, augmented, or mixed reality. There are three types of virtual reality (VR) technologies: (i) non-immersive, (ii) semi-immersive, and (iii) fully immersive. Non-immersive (VR) involves the use of software and computers. In semi-immersive and immersive VR, the virtual image is presented through the head-mounted display(HMD), the difference being that in the fully immersive type, the virtual image is completely obscured from the actual world. Using handheld devices with haptic feedback the trainee can perform a procedure in the virtual environment (Douglas, Wilke, Gibson, Petricoin, & Liotta, 2017). Augmented reality (AR) can be divided into complete AR or mixed reality (MR). Through AR and MR, a trainee can see a
 virtual and a real-world image at the same time, making it easy for the supervisor to explain the steps of the surgery. Similar to VR, in AR and MR the user wears an HMD that shows both images. In AR, the virtual image is transparent whereas, in MR, it appears solid (Douglas et al., 2017). Virtual augmented and mixed reality has more potential to train surgeons as they provide fidelity very close to the real situation and require fewer physical resources and space compared to the simulators. But they are costlier, and affordability is an issue. To overcome this, low-cost solutions to virtual reality have been developed. It is high time that we also start thinking on the same lines and develop this means of training our surgeons at an affordable cost.

Reality for Cybernauts Sergio Sismondo Introduction: virtual reality as a metaphysical laboratory Virtual reality (VR) is a wonderfully successful misnomer. To the extent that VR is reality, there is little virtual about it. I should qualify those claims right away: virtual reality is virtual in the derivative sense in which “virtual” has come to be a synonym for computer-based, but that sense is a result rather than a precondition of VR’s cultural success. VR has provided a path from an old meaning of “virtual” to a new one. The old meaning, what we could call virtual(1), is: in effect, but not actual. The meaning that is new to the last decades of the 20th century is virtual(2): simulated on or mediated by a computer. Many cybernauts have realized that VR is not merely virtually(1) real—an oxymoron?—and therefore are arguing that it is virtual(2) reality, real but computer-based. In so doing they have not merely added a new meaning to the term “virtual,” but have revamped talk of reality. At a time when skeptical humanists and others are more and more cautious about reality, VR enthusiasts are giving new life to words like “real” and “reality,” using them constantly, and with a variety of meanings. The best VR is described as “really real” and is contrasted with “real reality,” yet neither phrase fully makes sense without at least some confusion about meanings of “real.” At the same time, some cyberphiles and cybercritics have been proclaiming the death of reality. If we could create environments that have the look and feel that we expect from everyday reality, what is left of the “real” thing? Why should we care about it? Michael Heim says that “with its virtual environments and simulated worlds, cyberspace is a metaphysical laboratory, a tool for examining our very sense of reality” (83). Heim may be right that cyberspace—or in my case VR—is a metaphysical laboratory, but his laboratory is largely unbuilt. Currently-available VR, for example, is more crude as a metaphysical laboratory than are our imaginations, literature, and thought experiments. For my purposes the limitations of existing VR are unimportant: my intention here is, following Heim, to use VR to examine “our very sense of reality,” but in that I want to look at our use of the term “reality” and the presuppositions of that use. Along the way I take issue with some of the wilder claims about VR’s effects on reality. Although there is no one consistent picture of reality implicit in talk about VR, there are at least some common images. Some of those images are exactly what are needed to revamp talk of reality, and some are misguided. Some VR talk, for example, reinforces an impoverished sense of reality in its dominating images of levels and degrees; my preferred images are more chaotic and multi-dimensional. In order to show why we should prefer some images of reality, in the second half of this essay I put forward a general account of reality talk. That account makes space for (though does not guarantee) the reality of VR, and much more besides. For my project here we do not have to be full-fledged cybernauts. That is a good thing, because this essay is written by yet another interloper into VR. I haven’t made the tours of labs where systems like RB2 (“Reality Built for Two”) or gadgets like the DataGlove have been developed. I spend little of my time browsing Mondo 2000, and have tested out only the most publicly available virtual environments, computer games like “Doom,” and high-tech video games like “Dactyl Nightmare.” Donning the latter’s 3-D video helmet and battling its schematic pterodactyls even put me off-balance and made me slightly nauseous. All of that should place me as a text-based critic whose access to VR and cyberculture is largely through the guidance of texts. Therefore my text displays many signs of my interloper status, in the form of references to the canonizers and the canonized agents of the history of VR. The virtualization of reality? Our point is thus a very elementary...

Smith and Smitherson’s Theatre of the Absurd

The study aimed to systematically review available literature regarding the safety of virtual reality (VR) use via head-mounted display in children under 14 years of age. The study was a systematic review including all study designs. A search was conducted in January 2023 in PubMed and EMBASE using key terms referring to 'virtual reality', 'paediatrics' and 'safety'. Following title and abstract and full-text screening, data were extracted and a narrative synthesis undertaken. Twenty-six studies met criteria for inclusion in the final review. Limited data suggest that VR may cause mild cybersickness symptoms (not severe enough to cause participants to discontinue use of VR) and that for children with existing amblyopia using VR may result in double vision, which resolves on cessation of VR exposure. Two randomised control trials did not report differences in adverse events between the intervention (VR use) and control groups. Reporting of safety data was poor; only two studies used a validated measure, and in the remaining studies, it was often unclear how adverse events were defined (if at all), how they were categorised in terms of severity and how they were recorded. Conclusion: There is limited evidence regarding any potential harms from short exposure to VR in children under 14 years under supervision. Additional research is required to understand increases in cybersickness during and after VR exposure, and the impact of repeated exposure. Adverse events need to be accurately and routinely recorded to determine any hitherto unknown safety concerns for children < 14 years using VR. What is Known: • Virtual reality (VR) is increasingly being applied in paediatrics, with benefits in terms of anxiety reduction, improved pain management associated with procedures, as an adjunct to physiotherapy and supporting treatments in autistic spectrum disorder.. •Safety guidance in relation to VR use, particularly in younger children, is limited. What is New: • A systematic review of available literature regarding the safety of VR use via head-mounted display in children under 14 years of age demonstrated limited evidence regarding any potential harms from short exposure to VR.. • Studies rarely report safety data and adverse side effects are poorly defined, measured and/or reported. • The lack of a validated measure for evaluating VR-associated symptoms in children compounds the challenging ethical issues of undertaking research into the effects of VR on younger children.

Case report - IntroductionNeedle phobia is a common issue amongst children, particularly with long-term illnesses requiring repeated interventions. Psychological interventions such as coping strategies and distraction techniques can be effective in many of these children, but is not universally successful. Recent research has reportedthat the use of virtual reality (VR) headsets as a distraction technique can be effective at alleviating both pain and fear in children receiving intravenous (IV) injections, cannulation and venepuncture. Although use of VR distraction is becoming more widespread in some disciplines (such as paediatric oncology/A&E), it is yet to be widely adopted in paediatric rheumatology.Case report - Case descriptionWe report the case of a 9-year-old boy (ME) who in early 2019 developed psoriatic juvenile idiopathic arthritis (JIA) and an associated severe, widespread plaque psoriasis causing him substantial discomfort and distress. He has been treated with subcutaneous adalimumab biosimilar 40 mg fortnightly and oral methotrexate 20 mg weekly, alongside Keppra 1000 mg twice daily for epilepsy. Although he is just tolerating the subcutaneous adalimumab, he is requiring intermittent steroid joint injections under general anaesthetic for recurrent flares of his polyarticular arthritis and regular monitoring phlebotomy. He has been developing progressive needle phobia over the past 8 months, with superimposed anxiety about general anaesthetics with particular fear of the anaesthetic provoking an epileptic seizure.Despite psychological intervention to teach coping strategies and standard play therapy distraction techniques, both phlebotomy and cannulation for general anaesthetics have become more distressing and challenging for him. During two recent day case admissions for joint injections, despite premedication with sedatives, distraction techniques and psychology interventions, he became so distressed that attempts to anaesthetise him had to be abandoned. This has resulted in prolonged periods of continuing joint inflammation and pain. Discussion with local paediatric oncology colleagues resulted in a suggestion of using recently acquired VR headsets as an effective distraction technique. He has had a previous positive experience of using VR headsets in a play environment. He is receiving VR training intervention from the oncology team and is now fully engaged with the idea of using VR to distract him from negatively focussing on his next planned general anaesthetic intervention.Case report - DiscussionUnmanaged needle-related procedural pain in children is associated with increasing pain and stress in subsequent procedures and fear/avoidance of medical care which can affect compliance in chronic disease management. The psychological distress for children with needle phobia can add to existing psychological impact from JIA and increase family stress of caring for an ill child. The cost of poor management of needle-phobic children can be considerable, with cancelled or increased time for procedural interventions and restricted therapeutic interventions. Needle phobias in childhood may persist into adulthood.Employing distraction techniques when children undergo medical procedures can help them reduce anxiety. VR is a method of captivating an individual’s interest in a virtual environment and can help divert attention from potentially distressing situations in the real world. Recent studies have reported VR as an effective distraction technique in children. Chan (2019) reports that VR significantly decreased the pain and post procedural anxiety experienced by children aged 4—11 years old during venepuncture/IV cannulation compared to controls. The majority of children in the VR group expressed interest in utilising VR again in the future, to improve their experience of IV injections. Chen (2020) subsequently reported a randomised controlled trial which significantly reduced pain and fear experienced from IV injections by the children in the VR group.There are cost implications to both buying VR headsets/software and training play specialists/specialist nurses to use the equipment effectively. Furthermore, the acceptability of using VR with regards to the child’s age, engagement with age-appropriate software packages and whether a passive VR or a more interactive ‘gaming’ experience is preferred should be considered. The use of VR is not a panacea, but is potentially effective as an additional new tool in clinicians’ efforts to reduce the impact of needle phobia.Case report - Key learning pointsAddressing needle phobia in children can require novel strategies.VR has shown success as a distraction technique to alleviate pain and fear in children undergoing needle related procedures.The implementation of VR in paediatric rheumatology has cost and staff training implications.The use of age-appropriate software and an individual child’s preference for passive/active interaction with VR should be considered.

Patient-specific virtual and mixed reality for immersive, experiential anatomy education and for surgical planning in temporal bone surgery

The perceptual behavior of consumers on a product displayed in the market has a vital role in analyzing the importance given to that product. Therefore, various strategies have been developed to understand this consumer behavior in the selection of products. Immersive technologies like virtual, augmented, and mixed reality are among them. With the foremost feature of immersion in the virtual world and interaction of users with virtual objects, virtual reality, and augmented reality have unlocked their potential in research and a user-friendly tool for analyzing consumer behavior. In addition to these technologies, mixed reality also has a significant role in investigating consumer behavior. Studies on immersive technologies in food applications are vast, hence this review focuses on the applications of virtual, augmented, and mixed reality in the food selection behavior of consumers. The behavioral studies are elicited to develop new products based on consumer needs, to understand the shopping behavior in supermarkets for real-time usage, and to know the influence of emotions in a selection of products. The findings suggest that virtual, augmented, and mixed reality induce immersion of the users in food selection behavioral studies. Information on the technological advancements in the tools used for bringing immersion and interaction are discussed for its futuristic applications in food. Though immersive technology gives users a realistic virtual environment experience, its application in food systems is in the budding stage. More research on human response studies would contribute to its innovative and inevitable application in the future.

In civil circulation, due to its digitalization, virtual objects that, unlike a real object of the surrounding world in its usual sense, have a digital form wihout a real shell, are widespread. The civil law regime of virtual objects is not defined in the current legislation. Meanwhile, in the context of the development of metaverse concepts, this problem and the search for ways to solve it is becoming increasingly urgent. Determining the legal regime of objects created by the user of the platform on which access to virtual reality is provided, augmented reality objects, as well as objects existing and created within the metaverse, where the user’s usual activities can be carried out, is ambiguous in scholarship and jurisprudence. This study was undertaken to determine the features of the civil law regime of objects created in virtual reality, augmented reality, and in the metaverse. It was concluded that the regimes of familiar civil law objects (property, results of intellectual activity, intangible benefits, services) can be extended to the objects under consideration. However, the material legal concept does not fully reflect the legal nature of the objects under study. Therefore, virtual objects that copy things of the physical world, in essence, can be recognized as other property rights. At the same time, the intellectual property rules can be applied to these objects only if they are created as a result of a person’s creative efforts.

Virtual reality three-dimensional echocardiographic imaging for planning surgical atrioventricular valve repair

As virtual reality technology matures and popular, it is gradually applied in art design.Virtual reality is constructed by high-tech means of the artificial environment.How best to achieve the user in the virtual world of realistic experience, has become a new research hotspot.In view of the present virtual reality technology and virtual aesthetics can improve the effect of the simulation are faced with the problem, in this paper, the study of virtual reality in art and design.Put forward the integration of technology and art technique can improve the virtual reality visual properties and the degree of match user requirements, improve the effect of the simulation.

Virtual Reality (VR) and 360-degree video are reshaping the media landscape, creating a fertile business environment. During 2016 new 360-degree cameras and VR headsets entered the consumer market, distribution platforms are being established and new production studios are emerging. VR is evermore becoming a hot topic in research and industry and many new and exciting interactive VR content and experiences are emerging. The biggest gap we see in these experiences are social and shared aspects of VR. In this demo we present our ongoing efforts towards social and shared VR by developing a modular web based VR framework, that extends current video conferencing capabilities with new functionalities of Virtual and Mixed Reality. It allows us to connect two people together for mediated audio-visual interaction, while being able to engage in interactive content. Our framework allows to run extensive technological and user based trials in order to evaluate VR experiences and to build immersive multi-user interaction spaces. Our first results indicate that a high level of engagement and interaction between users is possible in our 360-degree VR set-up utilizing current web technologies.

The Reality of Virtual Reality in Echocardiography Education?

The convergence of the Internet of Things (IoT) and interactive systems will enable future interactive environments which transcend physical and virtual reality. Embedded Things provide sensors and actuators to virtualize the physical environment, while Interactive Things extend the virtualized environment with modalities for human interaction, ranging from tangible and wearable interfaces to immersive virtual and augmented reality interfaces. We introduce the Transreality Interaction Platform (TrIP) to enable service ecosystems which situate virtual objects alongside virtualized physical objects and allow for novel ad-hoc interactions between humans, virtual, and physical objects in a transreality environment. TrIP provides a generalized middleware platform addressing the unique challenges that arise in complex transreality systems which have yet to be fully explored in current IoT or HCI research. We describe the system architecture, data model, and query language for the platform and present a proof-of-concept implementation. We evaluate the performance of the implementation and demonstrate its use integrating embedded and interactive things for seamless interaction across physical and virtual realities.