Immersive Mixed Reality Research Articles

Visual Guidance for User Placement in Avatar-Mediated Telepresence Between Dissimilar Spaces.

Rapid advances in technology gradually realize immersive mixed-reality (MR) telepresence between distant spaces. This paper presents a novel visual guidance system for avatar-mediated telepresence, directing users to optimal placements that facilitate the clear transfer of gaze and pointing contexts through remote avatars in dissimilar spaces, where the spatial relationship between the remote avatar and the interaction targets may differ from that of the local user. Representing the spatial relationship between the user/avatar and interaction targets with angle-based interaction features, we assign recommendation scores of sampled local placements as their maximum feature similarity with remote placements. These scores are visualized as color-coded 2D sectors to inform the users of better placements for interaction with selected targets. In addition, virtual objects of the remote space are overlapped with the local space for the user to better understand the recommendations. We examine whether the proposed score measure agrees with the actual user perception of the partner's interaction context and find a score threshold for recommendation through user experiments in virtual reality (VR). A subsequent user study in VR investigates the effectiveness and perceptual overload of different combinations of visualizations. Finally, we conduct a user study in an MR telepresence scenario to evaluate the effectiveness of our method in real-world applications.

Using Mixed Reality for Control and Monitoring of Robot Model Based on Robot Operating System 2

This article presents the design and implementation of an innovative human–machine interface (HMI) in mixed reality for a robot model operating within Robot Operating System 2 (ROS 2). The interface is specifically developed for compatibility with Microsoft HoloLens 2 hardware and leverages the Unity game engine alongside the Mixed Reality Toolkit (MRTK) to create an immersive mixed reality application. The project uses the Turtlebot 3 Burger model robot, simulated within the Gazebo virtual environment, as a representative mechatronic system for demonstration purposes. Communication between the mixed reality application and ROS 2 is facilitated through a publish–subscribe mechanism, utilizing ROS TCP Connector for message serialization between nodes. This interface not only enhances the user experience by allowing for the real-time monitoring and control of the robotic system but also aligns with the principles of Industry 5.0, emphasizing human-centric and inclusive technological advancements. The practical outcomes of this research include a fully functional mixed reality application that integrates seamlessly with ROS 2, showcasing the potential of mixed reality technologies in advancing the field of industrial automation and human–machine interaction.

Immersive Cross-Cultural Journeys: Enhancing Museum Experiences Through Mixed Reality

Mixed reality technology is employed to develop immersive experiences, enhancing visitor engagement within museum environments. There are challenges in interface design and sensory accuracy for such mixed-reality applications. This study explored integration of mixed reality technology in museums, emphasizing the enhancement of cross-cultural understanding and visitor engagement. Using advanced three-dimensional printing, significant artifacts from various cultures, including a notable Korean artifact from the Goryeo period, were replicated and digitized. These artifacts were the core of a mixed reality environment that was created using Unity and the MR Software Development Kit and experienced through a HoloLens 2 Head-Mounted Display. This immersive mixed reality experience, comprising three interactive segments, incorporated eye- and hand-tracking technologies to enable deeper engagement with cultural artifacts. The impact of mixed reality on visitor engagement and cross-cultural comprehension was evaluated, revealing a significant increase in visitor involvement and appreciation of cultural diversity. Notably, this study contributes to the evolving narrative of digital cultural heritage by highlighting the role of mixed reality in fostering a cross-cultural understanding and shaping future museum experiences.

Evaluation of Point-to-Point Reaching Performance in Mixed Reality and Virtual Reality

Abstract Recent immersive mixed reality (MR) and virtual reality (VR) displays enable users to use their hands to interact with both veridical and virtual environments simultaneously. Therefore, it becomes important to understand the performance of human hand-reaching movement in MR. Studies have shown that different virtual environment visualization modalities can affect point-to-point reaching performance using a stylus, but it is not yet known if these effects translate to direct human-hand interactions in mixed reality. This paper focuses on evaluating human point-to-point motor performance in MR and VR for both finger-pointing and cup-placement tasks. Six performance measures relevant to haptic interface design were measured for both tasks under several different visualization conditions (“MR with indicator”, “MR without indicator”, and “VR”) to determine what factors contribute to hand-reaching performance. A key finding was evidence of a trade-off between reaching motion confidence” measures (indicated by throughput, number of corrective movements, and peak velocity) and “accuracy” measures (indicated by end-point error and initial movement error). Specifically, we observed that participants tended to be more confident in the “MR without Indicator” condition for finger-pointing tasks. These results contribute critical knowledge to inform the design of VR/MR interfaces based on the application's user performance requirements.

Examining How Mixed Reality Technology Can Facilitate Immersive Learning in Digital Transformation Practices in English Language Education

Abstract Abstract In the digital era, mixed reality technology is widely used in several fields, especially in education. After exploring the application of mixed-reality technology in the field of education, this paper introduces it to English teaching, constructs an English immersive mixed-reality teaching model, and develops an online English platform based on mixed-reality technology. Taking the English majors of a school as the experimental subjects, the English immersive mixed reality teaching mode is put into teaching practice, and the application effect of the mixed reality teaching mode is evaluated through the data analysis of test indicators and students’ attitudes. Then, using structural equation modeling, a study was conducted on how mixed reality technology promotes immersive learning in English teaching. Students found the English immersion teaching model based on mixed technology to be more satisfactory, with evaluation scores exceeding 4 for each indicator. The promotion effect of mixed reality technology on learning immersion is moderate (0.46~0.58), and it further promotes students’ English learning immersion through the enhancement effects of spatial proximity, realism, interaction, and social proximity.

Mixed Reality: A Tool for Investigating the Complex Design and Mechanisms of a Mechanically Actuated Digital Pump

Digital hydraulics is a discrete technology that integrates advanced dynamic system controls, digital electronics, and machine learning to enhance fluid power systems’ performance, overall efficiency, and controllability. A mechanically actuated inline three-piston variable displacement digital pump was previously proposed and designed. The inline three-piston pump incorporates complex mechanical and hydraulic subsystems and highly coupled mechanisms. The complexity of the utilized subsystems poses challenges when assessing the viability of the conceptual design. Therefore, this work focuses on designing, developing, and implementing a collaborative virtual platform involving a digitized module showcasing the internal mechanical structure of the digital pump utilizing mixed reality (MR) technology. MR technology is acknowledged as the forthcoming evolution of the human–machine interface in the real–virtual environment utilizing computers and wearables. This technology permits running simulations that examine the complexity of highly coupled systems, like the digital pump, where understanding the physical phenomenon is far too intricate. The developed MR platform permits multiple users to collaborate in a synchronized immersive MR environment to study and analyze the applicability of the pump’s design and the adequacy of the operated mechanisms. The collaborative MR platform was designed and developed on the Unity game engine, employing Microsoft Azure and Photon Unity Networking to set up the synchronized MR environment. The platform involves a fully interactive virtual module on the digital pump design, developed in multiple stages using Microsoft’s Mixed Reality Tool Kit (MRTK) for Unity and deployed in the synchronized MR environment through a HoloLens 2 MR headset. A research study involving 71 participants was carried out at Purdue University. The study’s objective was to explore the impact of the collaborative MR environment on understanding the complexity and operation of the digital pump. It also sought to assess the effectiveness of MR in facilitating collaboration among fluid power stakeholders in a synchronized digital reality setting to study, diagnose, and control their complex systems. Surveys were designed and completed by all 71 participants after experiencing the MR platform. The results indicate that approximately 75% of the participants expressed positive attitudes toward their overall MR platform experience, with particular appreciation for its immersive nature and the synchronized collaborative environment it provided. More than 70% of the participants agreed that the pump’s collaborative MR platform was essential for studying and understanding the complexity and intricacy of the digital pump’s mechanical structure. Overall, the results demonstrate that the MR platform effectively facilitates the visualization of the complex pump’s internal structure, inspection of the assembly of each of the involved subsystems, and testing the applicability of the complicated mechanisms.

Digital Integration-Twins using Mixed Reality for smart Product Integration in the context of System of Systems

This contribution presents a concept for the integration of multi-disciplinary smart products into a comprehensive smart product ecosystem in order to fulfill an additional product-overreaching function or service. One of the key elements of the proposed concept is the use of specific digital product twins from the existing smart product ecosystem in operation. These “digital integration-twins" of the smart products in the product ecosystem are systematically created. They are described by a subset of the respective digital product twins, with a specific focus on product integration. These digital integration-twins contain integration-relevant processes, methods, and product data (e.g. partial product models, and usage data in the information technology sense) which are managed and distributed by a comprehensive system of the system integration platform. The current use of the new smart product is virtually visualized, integrated, and implemented within the real product integration context and the existing (physically operating) smart product ecosystem supported by immersive mixed reality techniques. This enables fast, easy and goal-oriented development of cross-product functionality in a hybrid way (mixture of physical and virtual products) already in the virtual product development phase (e.g. virtual user-centered validation of functional interaction in interactive sprints) and iterative optimization. Finally, the presented concept is implemented for a real existing use case.

Mixed reality simulation for peripheral intravenous catheter placement training

BackgroundDespite the advantages of simulation-based training, trainees are typically unable to view internal anatomical structures. This limitation can be overcome by using mixed reality (MR) wherein 3-D virtual anatomical images can be projected. This study was designed to evaluate the efficacy of an MR trainer for peripheral intravenous catheter (PIVC) placement.MethodsSixty-two participants used projected images of arm veins to place a PIVC in a mannequin arm. Participants were evaluated using a checklist on their ability to successfully place the PIVC. Participants completed a survey to elicit demographic information and perceptions of the trainer. A follow-up survey at two-weeks assessed clinical experiences with PIVC placement since using the MR trainer.ResultsFirst attempt catheter placement was successful in 48 (77.4%) cases. Only 11 (17.7%) and 3 (4.8%) of participants caused ‘extravasation’ and ‘hematoma’ formation on their first attempt, respectively. Fifty-nine participants (95.2%) agreed that ability to see internal structures was useful, and 58 (93.5%, respectively) agreed that the interactivity promoted learning and that MR should be included in training.ConclusionsResults of this study showed that use of a novel MR trainer for PIVC placement appears to provide an environment conducive to successful learning. Most participants were successful at PIVC placement on their first attempt and an overwhelming number found it helpful in identifying landmarks and confirming correct needle angles for insertion. Given the increasing emphasis on simulation training, highly immersive MR tools appear to offer promise to close the gap between classroom instruction and clinical experience.

BioLumin: An Immersive Mixed Reality Experience for Interactive Microscopic Visualization and Biomedical Research Annotation

Many recent breakthroughs in medical diagnostics and drug discovery arise from deploying machine learning algorithms to large-scale data sets. However, a significant obstacle to such approaches is that they depend on high-quality annotations generated by domain experts. This study develops and evaluates BioLumin, a novel immersive mixed reality environment that enables users to virtually shrink down to the microscopic level for navigation and annotation of 3D reconstructed images. We discuss how domain experts were consulted in the specification of a pipeline to enable automatic reconstruction of biological models for mixed reality environments, driving the design of a 3DUI system to explore whether such a system allows accurate annotation of complex medical data by non-experts. To examine the usability and feasibility of BioLumin, we evaluated our prototype through a multi-stage mixed-method approach. First, three domain experts offered expert reviews, and subsequently, nineteen non-expert users performed representative annotation tasks in a controlled setting. The results indicated that the mixed reality system was learnable and that non-experts could generate high-quality 3D annotations after a short training session. Lastly, we discuss design considerations for future tools like BioLumin in medical and more general scientific contexts.

Exploring Immersive Mixed Reality Simulations and Its Impact on Climate Change Awareness

Purpose: To combat widespread climate change misconceptions that halt mitigation efforts, we investigate Mixed Reality’s applicability in helping contextualize climate change consequences.
 Design/methodology/approach: We propose an immersive Mixed Reality system that simulates personally-relevant experiences relating to climate change disasters. To evaluate our methods, we conducted a pilot study with the constructed Mixed Reality system and analyzed collected statistics.
 Findings: Participants reported heightened motivation to adopt more sustainable practices as a result of Mixed Reality system use; collected statistics display increased levels of stress and ratings of immersion from system use. Results display prominent applicability of Mixed Reality systems in climate change contextualization.
 Research limitations/implications: Due to the lack of accessible Head-Mounted Displays, the pilot study is confined to a Mixed Reality format. Future work can examine effects of more realistic and localized approaches on stress and inclination levels; these effects may include real-time scanning and geographical mapping, dynamic object placement, information prompting, and improved spatialized audio.
 Originality/value: We evaluate the relative effectiveness of current communication mediums and propose a novel MR system as a solution to global mitigation challenges. We evaluate the effectiveness of conveying climate change awareness topics through Mixed Reality with a pilot study.

Political Engagement in Carne y Arena by Alejandro González Iñárritu

Created by Mexican awarded director Alejandro González Iñárritu, Carne y Arena is an immersive mixed-reality installation that allows visitors to experience traumatic and violent incidents with illegal immigrants crossing the Mexican–US border. Carne y Arena’s mixed reality combines VR experience with physical components, turning it into a multisensory, bodily immersive experience. As part of the art installation, the whole VR arena is surrounded by the remains of a wall’s border; while inside, actual immigrants’ clothes and objects are also exhibited. Another component is the documentary aspect, where real-life characters recount their stories through video testimonies. Iñárritu immerses and makes the visitors experience refugees’ stories first-hand while exploring their emotional reactions to traumatic realities through a spiral of corporeal sensations and entertainment spectacle. According to Iñárritu, the intent is to subordinate technology to the human condition. Technology does mean nothing unless it can reveal or denounce people’s situations. Therefore, technology must be subordinated to humans, humanity, and art. “I despise technology,” says the filmmaker. But, has film lost the power to engage the viewers emotionally? Can virtual reality simulate refugees’ dispossession (the sense of the self) and alleviate society’s consciousness? In this paper, I examine the role of a museum installation featuring refugees’ discourses; the VR technology in bringing forward the visitor’s social engagement; and the issues the filmmaker address, such as the refugee’s experience in contemporary global society.

UTAUT in Metaverse: An “Ifland” Case

Since 2021, big tech companies have been interested in metaverse platforms and services. Metaverse is the permanent, immersive mixed-reality world where people and people and people and objects can synchronously interact, collaborate, and live beyond the limitations of time and space, using avatars and the immersion-supporting devices, platforms, and infrastructures. On metaverse platforms, people can merge the real world and the virtual world. Because the metaverse has only recently begun to be studied, there are only dozens of studies on the metaverse published in qualified academic journals. There are few empirical studies on the extent to which metaverse platforms will be accommodated in the lives of information system users from an integrated perspective. Therefore, this paper aimed to empirically verify user acceptance of metaverse platforms by referring the unified theory of acceptance and use of technology (UTAUT). This study was conducted in two stages. (1) The concept and research trends of the metaverse platform were examined, and (2) the UTAUT model was introduced in “Ifland”, one of the metaverse platforms, to verify its acceptance of information system users. I conducted a laboratory experiment while complying with the quarantine rules. Participants were required to watch a 15 min lecture on artificial intelligence on the metaverse platform “Ifland” for a sufficient time, then they discussed the impacts of artificial intelligence with others in the lecture. A total of 120 valid data points, excluding insincere responses, were collected, and hypotheses were verified through PLS analysis. Results indicate that performance expectancy, effort expectancy, and social influence of the metaverse platform significantly increased satisfaction, usage intention, purchase intention, and word-of-mouth intention. Facilitating conditions had no significant impact on satisfaction. The results of this study provide implications for how the metaverse platform should be designed and what factors should be emphasized to increase user acceptance of metaverse platforms.

Mixed Reality for an Enhanced Laboratory Course on Microfluidics

Natural sciences can be difficult to grasp because physical and chemical phenomena can take place across time and length scales that are beyond the reach of human perception. This problem is particularly true for students attempting to learn about microfluidics, a discipline that involves intricate engineering methods and fluid phenomena that are unintuitive and unique to the microscopic scale. New learning paradigms that combine established principles from the learning sciences and mixed reality (MR) technologies may facilitate the understanding of microfluidics and help connect the experimental methods to the underlying physical and chemical processes. Yet only a few studies have implemented learning sciences principles into the design of MR experiences for university laboratory courses. We thus created ALETHA, an interactive and immersive MR learning platform to help students learn about microfluidics and microfabrication techniques. We designed ALETHA to include scaffolding, gamification, control-of-variables, and multimodal representation strategies that are known to enhance intuition building and learning. We hypothesized that MR will enhance student understanding of microfluidics and microfabrication and help them build intuitions about the processes involved at that scale. To test whether ALETHA improved affective learning outcomes, we employed quizzes and surveys and compared the performance of students that participated in the course with MR to that of a cohort using traditional paper protocols. Overall, we measured a greater building of intuition and engagement for MR students. Our new learning platform provides a useful and practical example of how MR can be implemented to learn challenging interdisciplinary topics such as microfluidics.

Teleoperated Service Robot with an Immersive Mixed Reality Interface

Teleoperated service robots can perform more complex and precise tasks as they combine robot skills and human expertise. Communication between the operator and the robot is essential for remote operation and strongly affects system efficiency. Immersive interfaces are being used to enhance teleoperation experience. However, latency or time delay can impair the performance of the robot operation. Since remote visualization involves transmitting a large amount of video data, the challenge is to decrease communication instability. Then, an efficient teleoperation system must have a suitable operation interface capable of visualizing the remote environment, controlling the robot, and having a fast response time. This work presents the development of a service robot teleoperation system with an immersive mixed reality operation interface where the operator can visualize the real remote environment or a virtual 3D environment representing it. The virtual environment aims to reduce the latency on communication by reducing the amount of information sent over the network and improve user experience. The robot can perform navigation and simple tasks autonomously or change to the teleoperated mode for more complex tasks. The system was developed using ROS, UNITY 3D, and sockets to be exported with ease to different platforms. The experiments suggest that having an immersive operation interface provides improved usability for the operator. The latency appears to improve when using the virtual environment. The user experience seems to benefit from the use of mixed reality techniques; this may lead to the broader use of teleoperated service robot systems.

Developing culturally responsive practice using mixed reality (XR) simulation in Paramedicine Education

The department of Paramedicine at Auckland University of Technology is committed to establishing informed evidence and strategies representative of all ethnicities. The MESH360 team propose that immersive mixed reality (XR) can be employed within the learning environment to introduce critical elements of patient care through authentic environmental and socio-cultural influences without putting either students, educators, practitioners or patients at risk.
 Clinical simulation is a technique that replicates real-world scenarios in a controlled and non-threatening environment. However, despite the legal and moral obligations that paramedics have to provide culturally competent care, a lack of evidence and guidelines exist regarding how to adequately integrate simulation methods for cultural competence training into paramedicine education. In our curriculum, clinical simulation has been used mainly to teach the biomedical aspects of care with less focus on the psychological, cultural, and environmental contexts. A potential, therefore, exists for high-fidelity clinical simulation and XR as an effective teaching strategy for cultural competence training by providing learners with the opportunity to engage and provide care for patients from different cultural backgrounds, ethnic heritages, gender roles, and religious beliefs (Roberts et al., 2014). This is crucial preparation for the realities of professional practice where they are required to care for patients that represent the entirety of their community.
 This presentation explores the MESH360 project and the development of a theoretical framework to inform the design of critical thinking in enhanced culturally diverse simulation clinical scenarios (ResearchGate, n.d.). The project aims to develop a transferable methodology to triangulate participant subjective feedback upon learning in high stress environments within a wide range of cultural-responsive environments. The implications for practice and/or policy are the redefinition of the role of simulation in clinical health care education to support deeper critical learning and paramedic competency within cross-cultural environments within XR.
 The aim of the research is to develop simulation based real-world scenarios to teach cultural competence in the New Zealand paramedicine curriculum. Using a Design-Based Research framework in healthcare education the project explores the impact of culturally-responsive XR enhanced simulation for paramedicine students through the triangulation of participant subjective feedback, observation, and participant biometric data (heart rate) (Cochrane et al., 2017). Data analysis will be structured around the identification and description of the overarching elements constituting the cultural activity system in the study, in the context of XR in paramedicine education (Engeström, 1987).
 Our research objective focuses upon using XR to enable new pedagogies that redefine the role of the teacher, the learner, and of the learning context to:
 
 Develop clinically appropriate and contextually relevant simulation-based XR scenarios that teach students how to respect differences and beliefs in diverse populations whose world view may be different from ones’ own.
 
 
 Inform culturally-responsive teaching and learning in paramedicine education research and practice.
 
 
 Implementation of pedagogical strategies in paramedicine critical care simulation to enhance culturally-responsive understandings and practice.

Enhancing Immersiveness in Paramedicine Education XR Simulation Design

The Multiple Environments Simulation Hub (MESH360) research cluster was established in 2016 to explore ways of making critical care simulation environments more authentic learning experiences for students (Cochrane et al., 2016). Since its establishment, three cycles of data collection have occurred exploring immersive mixed reality (XR) to enhance traditional clinical simulation methodologies in Paramedicine education (Aguayo et al., 2018; Cochrane et al., 2020). Using a design-based research (DBR) methodology focused on prototyping in practice to generate design principles (Cochrane et al., 2017; McKenney & Reeves, 2019), along with a mixed-methods and multimodal approach to data collection and analysis in educational research (Cohen, Manion & Morrison, 2011; Lahat, Adali & Jutten, 2015), led the MESH360 team to develop a framework for designing immersive reality enhanced clinical simulation (Cochrane et al., 2020).
 
 Building upon this work, a set of design principles permitted to augment the immersive experience of participants through a case study involving an XR enhanced rescue helicopter simulation experience. Two key components of this enhanced simulation are: (1) a focus on combining XR design principles merging real environment elements with digital affordances (possibilities offered by digital tools and platforms) to provide a range of ‘learning points’ for different types of learners (i.e., from novice to experienced participants) (Aguayo, Eames & Cochrane, 2020); and (2) a focus on the embodiment of the experience (Aguayo et al., 2018) to maximize the interactivity, authenticity, and realism of the enhanced immersive reality through a sequence of experiences including virtual reality (VR) helicopter ride, simulated manikin work, and critical environmental soundscapes.
 
 Findings from the third cycle indicate an increase in spatial and context awareness across all types of participants, in relation to the authenticity of the XR environment when compared to traditional Paramedicine simulation training. Furthermore, participants also reported an enhanced realism of the ‘emergency response’ helicopter VR ride, as the sequence of experiences permitted participants to plan their response based on audio cues and information updates while virtually ‘traveling to the scene’. This iterative research work has led the MESH360 project to validate the set of transferable design principles and implementation framework for the design of authentic critical care simulation environments in Paramedicine education. 
 
 Here we present and discuss a series of implications and benefits from the third MESH360 cycle in Paramedicine education emerging from the framework for designing XR enhanced clinical simulation. Anecdotic yet relevant data in relation to participant demographics and VR anxiety has led the MESH360 team to explore culturally-responsive practice in XR simulation in Paramedicine education (see Aiello et al., 2021). Future directions and transferability to other health and medical contexts are also discussed.

Immersive telepresence on the operation of unmanned vehicles

Unmanned ground vehicles are usually deployed in situations, where it is too dangerous or not feasible to have an operator onboard. One challenge faced when such vehicles are teleoperated is maintaining a high situational awareness, due to aspects such as limitation of cameras, characteristics of network transmission, and the lack of other sensory information, such as sounds and vibrations. Situation awareness refers to the understanding of the information, events, and actions that will impact the execution and the objectives of the tasks at the current and near future of the operation of the vehicle. This work investigates how the simultaneous use of immersive telepresence and mixed reality could impact the situation awareness of the operator and the navigation performance. A user study was performed to compare our proposed approach with a traditional unmanned vehicle control station. Quantitative data obtained from the vehicle’s behavior and the situation awareness global assessment technique were used to analyze such impacts. Results provide evidence that our approach is relevant when the task requires a detailed observation of the surroundings, leading to higher situation awareness and navigation performance.

Eyes-free Target Acquisition During Walking in Immersive Mixed Reality.

Reaching towards out-of-sight objects during walking is a common task in daily life, however the same task can be challenging when wearing immersive Head-Mounted Displays (HMD). In this paper, we investigate the effects of spatial reference frame, walking path curvature, and target placement relative to the body on user performance of manually acquiring out-of-sight targets located around their bodies, as they walk in a spatial-mapping Mixed Reality (MR) environment wearing an immersive HMD. We found that walking and increased path curvature negatively affected the overall spatial accuracy of the performance, and that the performance benefited more from using the torso as the reference frame than the head. We also found that targets placed at maximum reaching distance yielded less error in angular rotation and depth of the reaching arm. We discuss our findings with regard to human walking kinesthetics and the sensory integration in the peripersonal space during locomotion in immersive MR. We provide design guidelines for future immersive MR experience featuring spatial mapping and full-body motion tracking to provide better embodied experience.

Fire in the Operating Room: Use of Mixed Reality Simulation with Nurse Anesthesia Students

Background: The occurrence of a fire when implementing anesthesia is a high-risk, low-frequency event. The operating room is a high-stakes environment that has no room for error. Mixed reality simulation may be a solution to better prepare healthcare professionals. The purpose of this quantitative, descriptive study was to evaluate the technical and non-technical skills of student registered nurse anesthetists (SRNAs) who participated in a mixed reality simulation of an operating room fire. Methods: Magic Leap OneTM augmented reality headsets were used by 32 student registered nurse anesthetists to simulate an emergent fire during a simulated tracheostomy procedure. Both technical and non-technical skills were evaluated by faculty members utilizing a checklist. Results: The SRNAs’ overall mean technical skill performance was 18.16 ± 1.44 out of a maximum score of 20, and the mean non-technical skill performance was 91.25% out of 100%. Conclusions: This study demonstrated the utility and limitations in applying novel technology in simulation. Participants demonstrated a strong performance of technical and non-technical skills in the management of a simulated operating room fire. Recommendations for future applications include the use of multiple sensory inputs into the scenario design and including all core team members in the immersive mixed reality environment.

Virtually Present, Physically Invisible: Alejandro G. Iñárritu’s Mixed Reality InstallationCarne y Arena

This article proposes a media and philosophical analysis of Carne y Arena (2017), an immersive mixed reality installation by Mexican director Alejandro G. Iñárritu. Drawing from Chouliaraki’s notion of the “distant sufferer,” the article compares the medium specificity of television with the characteristics of mixed reality to question whether the gap between spectator and migrant can be bridged. The article analyzes how Carne y Arena positions its users not as spectators but as visitors or participants, thereby turning the “distant” sufferer into a “close and proximate” sufferer. To better understand how this immediacy effect is realized, the article introduces the concept of “intuition,” as theorized by the French philosopher Henri Bergson (1859–1941). In its closing section, the article discusses the ways in which Iñárritu’s work is part of a political intervention that proposes to challenge the limits of mediation and to promote social justice through feeling, acting, and knowing otherwise.