The Essential Role of Technology in the Public Health Battle Against COVID-19.

Technology has played an important role in responding to the novel coronavirus (SARS-CoV-2) and subsequent COVID-19 pandemic. The virus's blend of lethality and transmissibility have challenged officials and exposed critical limitations of the traditional public health apparatus. However, throughout this pandemic, technology has answered the call for a new form of public health that illustrates opportunities for enhanced agility, scale, and responsiveness. The authors share the Microsoft perspective and illustrate how technology has helped transform the public health landscape with new and refined capabilities - the efficacy and impact of which will be determined by history. Technologies like chatbot and virtualized patient care offer a mechanism to triage and distribute care at scale. Artificial intelligence and high-performance computing have accelerated research into understanding the virus and developing targeted therapeutics to treat infection and prevent transmission. New mobile contact tracing protocols that preserve patient privacy and civil liberties were developed in response to public concerns, creating new opportunities for privacy-sensitive technologies that aid efforts to prevent and control outbreaks. While much progress is still needed, the COVID-19 pandemic has highlighted technology's importance to public health security and pandemic preparedness. Future multi-stakeholder collaborations, including those with technology organizations, are needed to facilitate progress in overcoming the current pandemic, setting the stage for improved pandemic preparedness in the future. As lessons are assessed from the current pandemic, public officials should consider technology's role and continue to seek opportunities to supplement and improve on traditional approaches.

Virtual reality as a clinical tool in mental health research and practice
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Virtual reality (VR) is a potentially powerful technology for enhancing assessment in mental health. At any time or place, individuals can be transported into immersive and interactive virtual worlds that are fully controlled by the researcher or clinician. This capability is central to recent interest in how VR might be harnessed in both treatment and assessment of mental health conditions. The current review provides a summary of the advantages of using VR for assessment in mental health, focusing on increasing ecological validity of highly controlled environments, enhancing personalization and engagement, and capturing real-time, automated data in real-world contexts. Considerations for the implementation of VR in research and clinical settings are discussed, including current issues with cost and access, developing evidence base, technical challenges, and ethical implications. The opportunities and challenges of VR are important to understand as researchers and clinicians look to harness this technology to improve mental health outcomes.
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La realidad virtual (RV) es una tecnología potencialmente poderosa para mejorar la evaluación en salud mental. En cualquier momento o lugar, las personas pueden ser transportadas y quedar inmersos en mundos virtuales interactivos que están totalmente controlados por el investigador o el clínico. Esta capacidad es parte fundamental del interés reciente por la manera en cómo se podría aprovechar la RV tanto en el tratamiento como en la evaluación de las condiciones de salud mental. Esta revisión proporciona un resumen de las ventajas del empleo de la RV para la evaluación en salud mental, enfocándose en el aumento de la validez ecológica de entornos altamente controlados, en mejorar la personalización y el compromiso, y capturar datos automatizados en tiempo real en contextos del mundo real. Se discuten las consideraciones para la implementación de la realidad virtual en investigación y en situaciones clínicas, incluidos los problemas actuales de costo y acceso, el desarrollo en base a la evidencia, los desafíos técnicos y las implicancias éticas. Es importante comprender las oportunidades y los desafíos de la realidad virtual, ya que los investigadores y los médicos buscan aprovechar esta tecnología para mejorar los resultados de salud mental.

L'évaluation de la santé mentale pourrait bénéficier de la puissance de la technologie de la réalité virtuelle (RV). Les sujets peuvent être transportés en immersion à tout moment ou en tout lieu dans des mondes virtuels interactifs totalement contrôlés par le chercheur ou le médecin. C'est ce qui motive l'intérêt récent sur la façon d'exploiter la RV à la fois dans le traitement et l'évaluation des maladies mentales. Notre présentation résume les avantages de la RV dans ce cadre ; elle est centrée sur la validité écologique renforcée des environnements très contrôlés, sur une meilleure personnalisation et participation du sujet, et sur la saisie de données automatisées en temps et contextes réels. Nous analysons les conditions de l'introduction de la RV en recherche et en clinique, y compris les enjeux actuels de coût et d'accès, le développement d'une base de données, les défis techniques et les questions éthiques. Chercheurs et médecins souhaitent expérimenter la réalité virtuelle pour améliorer les résultats dans le contexte de la santé mentale, il est donc important d'en comprendre les opportunités et les difficultés.

Impact of Fire Arms Training in a Virtual Reality Environment on Occupational Performance (Marksmanship) in a Polytrauma Population.

INTRODUCTION: Polytrauma, to include major limb amputation, in a military population presents unique rehabilitation challenges with the overarching goal of restoring function leading to the primary question, "Is this Service Member (SM) capable of returning to duty following rehabilitation?" The US military has a vested interest in maximizing injured SMs occupational performance to allow for return to duty. The purpose of this report is to describe marksmanship (shot grouping and weapon qualification) and return to duty outcomes following a course of VRE-based firearm training in a polytrauma patient population. METHODS: The medical records, stored in the Armed Forces Health Longitudinal Technology Application (AHLTA), of all patients who received rehabilitative care at the Center for the Intrepid (CFI) to include VRE-based firearms training between 01OCT2015 and 01AUG2016 were manually reviewed for inclusion. Subjects included all adult (18 years and older) SMs (active duty at time of admission) with a diagnosis of polytrauma who had been referred to and treated (received additional services such as physical and or occupational therapy) at the CFI. Approval for this research was received from the Brooke Army Medical Center Department of Clinical Investigation Office of the Institutional Review Board. RESULTS: Medical records of 30 SMs with a polytrauma diagnosis met the inclusion criteria. Mean shot group sizes for the M9 and M4 weapon decreased between initial and post training time points for the M9 zero (p = 0.009) and M4 zero (p = 0.020). There was no significant difference between initial and post training time points at the other shooting distances with either weapon. There was an 89% qualification rate for both the M9 (n = 18) and M4 (n = 19) weapons for those who attempted qualification; 43% of the population (n = 13) did not attempt qualification with either weapon. CONCLUSION: SMs with polytrauma demonstrated a high rate of weapon qualification (accuracy) following VRE-based firearm training. Shot group size (precision) at short distances with a M9 pistol and M4 rifle also improved with training. While overall marksmanship appeared to improve, high return to duty rates were not directly related to firearm training or marksmanship. Future efforts need to focus on consistent clinical documentation of firearm training procedure and the establishment of psychometric properties for marksmanship outcome measures.

A meta-analytic examination of attrition in virtual reality exposure therapy for anxiety disorders.

A proposed advantage of virtual reality exposure therapy for anxiety disorders is that people will be less likely to drop out of treatment prematurely if the treatment involves facing one's fear in a virtual world rather than the real world, but this has yet to be empirically tested. The present meta-analyses assess the odds of dropout from virtual reality exposure therapy compared to in vivo exposure therapy, estimate the overall rate of dropout from virtual reality exposure treatment, and test potential moderating variables. The odds ratio meta-analysis indicated that there was no significant difference in the likelihood of attrition from virtual reality exposure therapy relative to in vivo exposure therapy. The overall attrition rate for virtual reality exposure therapy across 46 studies with a combined sample size of 1057 participants was 16%. This rate is slightly lower than other estimates of dropout from in vivo therapy and from cognitive-behavioral therapy for anxiety disorders. Incorporation of between-session intervention (i.e., homework) was identified as a moderator; specifically, inclusion of between-session interventions in the treatment was associated with better retention. Overall, the findings of the present study indicate that virtual reality exposure and in vivo exposure therapy show similar rates of attrition.

Metabolic Cost and Exercise Intensity During Active Virtual Reality Gaming.

OBJECTIVE: The aim of this study was to investigate the exercise intensity of active virtual reality games (AVRGs) by oxygen consumption (VO2), heart rate (HR), and rating of perceived exertion (RPE). A second aim was to compare the AVRG intensities to current American College of Sports Medicine exercise guidelines using metabolic equivalents (METs) and %VO2 reserve (%VO2R). MATERIALS & METHODS: HR, VO2, and RPE were collected on participants (N = 41; age: 25.2 ± 4.4 years) during 10-minutes of supine rest and while the participants played each of the following AVRGs for 10 minutes: Thrill of the Fight (TOF), Audioshield (AS), and Holopoint (HP). RESULTS: Compared to resting values of HR (63 ± 10 bpm) and VO2 (4.9 ± 0.6 mL/[kg·min]), there were significant elevations in these variables during TOF (149 ± 16 bpm and 32.5 ± 7.1 mL/[kg·min]), AS (131 ± 24 bpm and 19.1 ± 5.9 mL/[kg·min]), and HP (135 ± 22 bpm and 24.8 ± 6.6 mL/[kg·min]). Based on 95% confidence intervals (CI) of %VO2R, TOF was classified vigorous (68.6% ± 2.8%), HP moderate (49.7% ± 2.7%), and AS light intensity (35.7% ± 2.4%). The 95% CI of METs indicated that TOF was classified vigorous (9.3 ± 0.3 METs), HP moderate to vigorous (7.1 ± 0.3 METs), and AS moderate intensity (5.5 ± 0.3 METs). Lastly, 95% CI of RPE led to TOF being classified as moderate (12.7 ± 0.4), whereas HP (10.5 ± 0.4) and AS (9.3 ± 0.3) were light intensity. CONCLUSIONS: These data suggest that these AVRGs can elicit significant increases in VO2 that are game-dependent, indicating increased energy expenditure. Furthermore, each game had a lower intensity categorization based on RPE compared to %VO2R or METs. These data provide information on the metabolic cost of movement-specific games and may aid consumers and fitness specialists in developing exercise programs with AVRGs.

Use of Virtual Technology as an Intervention for Wheelchair Skills Training: A Systematic Review.

OBJECTIVE: To provide a comprehensive description of the current state of knowledge regarding the use of virtual technology (VT) for wheelchair skills training. DATA SOURCES: The Cochrane Library, MEDLINE, CINAHL, Embase, ACM, IEEE Xplore, Inspec, and Web of Science databases were searched for relevant articles from 1990 to February 2016. STUDY SELECTION: We included peer-reviewed studies or long conference proceedings that examined the use of VT as a medium to provide a wheelchair skills training intervention for any population with any diagnosis using any research design. One investigator screened the titles and abstracts, then 2 investigators independently reviewed the full-text articles. Disagreements regarding inclusion were resolved by consensus or a third reviewer. Ten studies were included out of 4994 initially identified. DATA EXTRACTION: Two investigators extracted data to systematically assess the studies' findings into 5 tables (study design and participant characteristics, equipment and technology used, intervention characteristics, outcome measures, and outcomes). DATA SYNTHESIS: Most studies demonstrated that VT wheelchair skills training showed improved outcomes (eg, simulation score, completion time, number of collisions) in the virtual environment and/or in the real world. However, subject characteristics, equipment, virtual environment, intervention tasks, and outcome measures varied across the studies. CONCLUSIONS: There are a variety of studies using VT as an intervention for wheelchair skills training. Given the positive outcomes for most of the studies, it appears as though VT may indeed be a solution that can help to alleviate barriers to wheelchair skills training and subsequently improve wheelchair user skill.

Augmented Reality: A Brand New Challenge for the Assessment and Treatment of Psychological Disorders.

Augmented Reality is a new technological system that allows introducing virtual contents in the real world in order to run in the same representation and, in real time, enhancing the user's sensory perception of reality. From another point of view, Augmented Reality can be defined as a set of techniques and tools that add information to the physical reality. To date, Augmented Reality has been used in many fields, such as medicine, entertainment, maintenance, architecture, education, and cognitive and motor rehabilitation but very few studies and applications of AR exist in clinical psychology. In the treatment of psychological disorders, Augmented Reality has given preliminary evidence to be a useful tool due to its adaptability to the patient needs and therapeutic purposes and interactivity. Another relevant factor is the quality of the user's experience in the Augmented Reality system determined from emotional engagement and sense of presence. This experience could increase the AR ecological validity in the treatment of psychological disorders. This paper reviews the recent studies on the use of Augmented Reality in the evaluation and treatment of psychological disorders, focusing on current uses of this technology and on the specific features that delineate Augmented Reality a new technique useful for psychology.