Enhancing Well-Being: A Comparative Study of Virtual Reality Chromotherapy Rooms with Static, Dynamic, and Empty Environments.

Chromotherapy rooms (CRs) are physical spaces with colored lights able to enhance an individual's mood, well-being, and, in the long term, their health. Virtual reality technology can be used to implement CR (VRCRs) and provide higher flexibility at lower costs. However, existing VRCRs are limited to a few use cases, and they do not fully explore the potential and pitfalls of the technology. This work contributes by comparing three VRCR designs: empty, static, and dynamic. Empty is just a void but a blue-colored environment. Static adds static abstract graphics (flowers and sea texture), and dynamic adds dynamic elements (animated star particle systems, fractals, and ocean flow). All conditions include relaxing low-beta and ocean sounds. We conducted a between-subject experiment (n = 30) with the three conditions. Subjects compiled a self-perceived questionnaire and a mathematical stress test before and after the VRCR experience. The results demonstrated that the dynamic condition provided a higher sense of presence, while the self-perceived stress level was insignificant. Dynamic VR conditions are perceived as having a shorter duration, and participants declared that they felt more involved and engaged than in the other conditions. Overall, the study demonstrated that VRCRs have a non-trivial behavior and need further study of their design, especially considering their role in a future where VR will be an everyday working interface.

Immersive and desktop virtual reality in virtual fashion stores: a comparison between shopping experiences.

With the high growth and prosperity of e-commerce, the retail industry needs to explore new technologies that improve digital shopping experiences. In the current technological scenario, Virtual Reality (VR) emerges as a tool and an opportunity for enhancing shopping activities, especially for the fashion industry. This study explores whether using Immersive Virtual Reality (IVR) technologies enhances the shopping experience in the fashion industry compared to Desktop Virtual Reality (DVR). A within-subject experiment was carried out involving a sample of 60 participants who completed a simulated shopping experience. In the first mode (DVR), a desktop computer setup was used to test the shopping experience using a mouse and keyboard for navigation. The second mode (IVR) exploited a Head-Mounted Display (HMD), and controllers, that allowed navigation while seated on a workstation to avoid sickness. Participants had to find a bag in the virtual shop and explore its features until they were ready to purchase it. Post-hoc measures of time duration of the shopping experience, hedonic and utilitarian values, user experience, and cognitive load were compared. Results showed that participants experienced higher hedonism and utilitarianism in the IVR shop compared to DVR. The cognitive load was comparable in both modes, while user experience was higher in IVR. In addition, the time duration of the shopping experience was higher in IVR, where users stayed immersed and enjoyed it for longer. This study has implications for fashion industry research, as the use of IVR can potentially lead to novel shopping patterns by enhancing the shopping experience. Supplementary Information: The online version contains supplementary material available at 10.1007/s10055-023-00806-y.

A multicenter evaluation of the accuracy of prehospital eFAST by a physician-staffed helicopter emergency medical service.

PURPOSE: The purpose of this study is to report the relative accuracy of prehospital extended focused assessment with sonography in trauma (eFAST) examinations performed by HEMS physicians. METHODS: Trauma patients who received prehospital eFAST by HEMS clinicians between January 2013 and December 2017 were reviewed. The clinician's interpretations of these ultrasounds were compared to gold standard references of CT imaging or operating room findings. The outcomes measured include the calculated accuracy of eFAST for detecting intraperitoneal free fluid (IPFF), pneumothorax, hemothorax, and pericardial fluid compared to available gold standard results. RESULTS: Of the 411 patients with adequate data for comparison, the median age was 39.5 years with 73% male and 98% sustaining blunt force trauma. For the detection of IPFF, eFAST had a sensitivity of 25% (95% CI 16-36%) and specificity of 96% (95% CI 93-98%). Sensitivities and specificities were calculated for pneumothorax (38% and 96% respectively), hemothorax (17% and 97% respectively), and pericardial effusion (17% and 100% respectively). These results did not change significantly when reassessed with several sensitivity analyses. CONCLUSION: Prehospital eFAST is reliable for detecting the presence of intraperitoneal free fluid. This finding should inform receiving trauma teams to prepare for early definitive care in these patients. The low sensitivities across all components of the eFAST highlight the importance of cautiously interpreting negative studies while prompting the need for further studies. TRIAL REGISTRATION: ACTRN12618001973202 (Registered on 06/12/2018).

High Acuity of Postoperative Consults to Emergency General Surgery at an Urban Safety Net Hospital.

BACKGROUND: Emergency general surgery (EGS) has high rates of morbidity, mortality, and readmission. Therefore, it might be expected that an EGS service fields many consultations for postoperative patients. However, with the known overutilization of emergency department visits for nonurgent conditions, we hypothesized most postoperative consults received by an EGS service would be nonurgent and could be appropriately managed as an outpatient. METHODS: We reviewed all EGS consults at a single urban safety net hospital over a 12-month period, screening for patients who had undergone surgery in the previous 12 mo. This included consultations from the emergency room and inpatient setting. Demographics, admission status, procedures performed, and other details were abstracted from the chart and Vizient reports. Consultation questions were categorized and then reviewed by an expert panel to determine if conditions could have been managed as an outpatient. RESULTS: The EGS service received a total of 1112 consults, with 99 (9%) for a postoperative condition. Overall, 85% of postoperative consults were admitted after consultation, 19% underwent surgery and 21% underwent a procedure with gastroenterology or interventional radiology. Expert review classified slightly over one-third (36%) of consults as nonurgent. CONCLUSIONS: Most postoperative consults seen at our urban safety net hospital represent true morbidity that required admission, intervention, or surgery. Despite this high acuity, one-third of postoperative consults could have been managed as an outpatient. Efforts to improve discharge instructions and set patient expectations could limit unnecessary postoperative emergency department visits.

Nanoindentation of mesenchymal stem cells using atomic force microscopy: effect of adhesive cell-substrate structures.

The procedure commonly adopted to characterize cell materials using atomic force microscopy neglects the stress state induced in the cell by the adhesion structures that anchor it to the substrate. In several studies, the cell is considered as made from a single material and no specific information is provided regarding the mechanical properties of subcellular components. Here we present an optimization algorithm to determine separately the material properties of subcellular components of mesenchymal stem cells subjected to nanoindentation measurements. We assess how these properties change if the adhesion structures at the cell-substrate interface are considered or not in the algorithm. In particular, among the adhesion structures, the focal adhesions and the stress fibers were simulated. We found that neglecting the adhesion structures leads to underestimate the cell mechanical properties thus making errors up to 15%. This result leads us to conclude that the action of adhesion structures should be taken into account in nanoindentation measurements especially for cells that include a large number of adhesions to the substrate.

The Palliative Performance Scale predicts mortality in hospitalized patients with COVID-19.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has a substantial mortality risk with increased rates in the elderly. We hypothesized that age is not sufficient, and that frailty measured by preadmission Palliative Performance Scale would be a predictor of outcomes. Improved ability to identify high-risk patients will improve clinicians' ability to provide appropriate palliative care, including engaging in shared decision-making about life-sustaining therapies. AIM: To evaluate whether preadmission Palliative Performance Scale predicts mortality in hospitalized patients with COVID-19. DESIGN: Retrospective observational cohort study of patients admitted with COVID-19. Palliative Performance Scale was calculated from the chart. Using logistic regression, Palliative Performance Scale was assessed as a predictor of mortality controlling for demographics, comorbidities, palliative care measures and socioeconomic status. SETTING/PARTICIPANTS: Patients older than 18 years of age admitted with COVID-19 to a single urban public hospital in New Jersey, USA. RESULTS: Of 443 admitted patients, we determined the Palliative Performance Scale score for 374. Overall mortality was 31% and 81% in intubated patients. In all, 36% (134) of patients had a low Palliative Performance Scale score. Compared with patients with a high score, patients with a low score were more likely to die, have do not intubate orders and be discharged to a facility. Palliative Performance Scale independently predicts mortality (odds ratio 2.89; 95% confidence interval 1.42-5.85). CONCLUSIONS: Preadmission Palliative Performance Scale independently predicts mortality in patients hospitalized with COVID-19. Improved predictors of mortality can help clinicians caring for patients with COVID-19 to discuss prognosis and provide appropriate palliative care including decisions about life-sustaining therapy.

A Body Tracking-Based Low-Cost Solution for Monitoring Workers' Hygiene Best Practices during Pandemics.

Since its beginning at the end of 2019, the pandemic spread of the severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2) caused more than one million deaths in only nine months. The threat of emerging and re-emerging infectious diseases exists as an imminent threat to human health. It is essential to implement adequate hygiene best practices to break the contagion chain and enhance society preparedness for such critical scenarios and understand the relevance of each disease transmission route. As the unconscious hand-face contact gesture constitutes a potential pathway of contagion, in this paper, the authors present a prototype system based on low-cost depth sensors able to monitor in real-time the attitude towards such a habit. The system records people's behavior to enhance their awareness by providing real-time warnings, providing for statistical reports for designing proper hygiene solutions, and better understanding the role of such route of contagion. A preliminary validation study measured an overall accuracy of 91%. A Cohen's Kappa equal to 0.876 supports rejecting the hypothesis that such accuracy is accidental. Low-cost body tracking technologies can effectively support monitoring compliance with hygiene best practices and training people in real-time. By collecting data and analyzing them with respect to people categories and contagion statistics, it could be possible to understand the importance of this contagion pathway and identify for which people category such a behavioral attitude constitutes a significant risk.

Optimal Load for Bone Tissue Scaffolds with an Assigned Geometry.

Thanks to the recent advances of three-dimensional printing technologies the design and the fabrication of a large variety of scaffold geometries was made possible. The surgeon has the availability of a wide number of scaffold micro-architectures thus needing adequate guidelines for the choice of the best one to be implanted in a patient-specific anatomic region. We propose a mechanobiology-based optimization algorithm capable of determining, for bone tissue scaffolds with an assigned geometry, the optimal value Lopt of the compression load to which they should be subjected, i.e. the load value for which the formation of the largest amounts of bone is favoured and hence the successful outcome of the scaffold implantation procedure is guaranteed. Scaffolds based on hexahedron unit cells were investigated including pores differently dimensioned and with different shapes such as elliptic or rectangular. The algorithm predicted decreasing values of the optimal load for scaffolds with pores with increasing dimensions. The optimal values predicted for the scaffolds with elliptic pores were found higher than those with rectangular ones. The proposed algorithm can be utilized to properly guide the surgeon in the choice of the best scaffold type/geometry that better satisfies the specific patient requirements.

Nanoindentation characterisation of human colorectal cancer cells considering cell geometry, surface roughness and hyperelastic constitutive behaviour.

Characterisation of the mechanical behaviour of cancer cells is an issue of crucial importance as specific cell mechanical properties have been measured and utilized as possible biomarkers of cancer progression. Atomic force microscopy certainly occupies a prominent place in the field of the mechanical characterisation devices. We developed a hybrid approach to characterise different cell lines (SW620 and SW480) of the human colon carcinoma submitted to nanoindentation measurements. An ad hoc algorithm was written that compares the force-indentation curves experimentally retrieved with those predicted by a finite element model that simulates the nanoindentation process and reproduces the cell geometry and the surface roughness. The algorithm perturbs iteratively the values of the cell mechanical properties implemented in the finite element model until the difference between the experimental and numerical force-indentation curves reaches the minimum value. The occurrence of this indicates that the implemented material properties are very close to the real ones. Different hyperelastic constitutive models, such as Arruda-Boyce, Mooney-Rivlin and Neo-Hookean were utilized to describe the structural behaviour of indented cells. The algorithm was capable of separating, for all the cell lines investigated, the mechanical properties of cell cortex and cytoskeleton. Material properties determined via the algorithm were different with respect to those obtained with the Hertzian contact theory. This demonstrates that factors such as: the cell geometry/anatomy and the hyperelastic constitutive behaviour, which are not contemplated in the Hertz's theory hypotheses, do affect the nanoindentation measurements. The proposed approach represents a powerful tool that, only on the basis of nanoindentation measurements, is capable of characterising material at the subcellular level.

The Mixed Tangible Catalog: Toward Tangible and Sustainable B2B Metaverse Fashion Showrooms.

The metaverse, driven by mixed reality (MR), is positioned as the future market, revolutionizing product exploration in virtual space. Existing literature on this subject mainly focuses on business-to-consumer perspectives, leaving a gap in understanding business-to-business (B2B) applications, particularly in the fashion industry. This article introduces a "Mixed Tangible Catalog" (MTC) for B2B that combines a physical, foldable cardboard booth with an MR application linked to a head-mounted display. Targeting the fashion sector's need for high standards in material evaluation, the MTC allows retailers and distributors to browse garments, customize material attributes, and receive visual and tangible feedback. Evaluation through a focus group of 10 industry experts revealed positive feedback. The MTC maintains the tangibility of traditional B2B showrooms and reduces the environmental impact by minimizing transportation, samples, and waste. This innovative approach offers an efficient and sustainable alternative to conventional physical showrooms, enhancing both economic and ecological aspects.

Precise Tool to Target Positioning Widgets (TOTTA) in Spatial Environments: A Systematic Review.

TOTTA outlines the spatial position and rotation guidance of a real/virtual tool (TO) towards a real/virtual target (TA), which is a key task in Mixed reality applications. The task error can have critical consequences regarding safety, performance, and quality, such as surgical implantology or industrial maintenance scenarios. The TOTTA problem lacks a dedicated study and it is scattered in different domains with isolated designs. This work contributes to a systematic review of the TOTTA visual widgets, studying 70 unique designs from 24 papers. TOTTA is commonly guided by the visual overlap -an intuitive, pre-attentive "collimation" feedback- of simple shaped widgets: Box, 3D Axes, 3D Model, 2D Crosshair, Globe, Tetrahedron, Line, Plane. Our research discovers that TO and TA are often represented with the same shape. They are distinguished by topological elements (e.g., edges/vertices/faces), colors, transparency levels, and added. shapes, widget quantity, and size. Meanwhile some designs provide continuous "during manipulation feedback" relative to the distance between TO and TA by text, dynamic color, sonification, and amplified graphical visualization. Some approaches trigger discrete "TA reached feedback" such as color alteration, added sound, TA shape change, and added text. We found the lack of golden standards, including in testing procedures, as current ones are limited to partial sets with different and incomparable setups (different target configurations, avatar, background, etc.). We also found a bias in participants: right-handed, young male, non-color impaired.

The Importance of Early Femoral Access When REBOA Catheter Must Be Removed Prior to Hemorrhage Control.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a tool for hemorrhage control. We describe a case where the REBOA Catheter needed to be removed prior to hemorrhage control. The patient is a 40-year-old man that presented following motor vehicle collision. A REBOA Catheter was placed via the right common femoral artery (CFA). CT scan demonstrated extravasation from the left inferior epigastric artery. The Interventional Radiology (IR) team would only be able to perform angioembolization via contralateral access where the REBOA Catheter was in place. Prior to removing the REBOA Catheter on the right, left CFA access was obtained in the event a new catheter needed to be deployed. Ultimately, IR performed angioembolization without a second REBOA Catheter. In gaining contralateral access prior to removing the REBOA Catheter, this case provides a strategy for expeditious replacement of REBOA Catheters in situations where the catheter interferes with hemorrhage control procedures.

Sitting or Standing in VR: About Comfort, Conflicts, and Hazards.

This article examines the choices between sitting and standing in virtual reality (VR) experiences, addressing conflicts, challenges, and opportunities. It explores issues such as the risk of motion sickness in stationary users and virtual rotations, the formation of mental models, consistent authoring, affordances, and the integration of embodied interfaces for enhanced interactions. Furthermore, it delves into the significance of multisensory integration and the impact of postural mismatches on immersion and acceptance in VR. Ultimately, the article underscores the importance of aligning postural choices and embodied interfaces with the goals of VR applications, be it for entertainment or simulation, to enhance user experiences.

Co-Designing Dynamic Mixed Reality Drill Positioning Widgets: A Collaborative Approach with Dentists in a Realistic Setup.

Mixed Reality (MR) is proven in the literature to support precise spatial dental drill positioning by superimposing 3D widgets. Despite this, the related knowledge about widget's visual design and interactive user feedback is still limited. Therefore, this study is contributed to by co-designed MR drill tool positioning widgets with two expert dentists and three MR experts. The results of co-design are two static widgets (SWs): a simple entry point, a target axis, and two dynamic widgets (DWs), variants of dynamic error visualization with and without a target axis (DWTA and DWEP). We evaluated the co-designed widgets in a virtual reality simulation supported by a realistic setup with a tracked phantom patient, a virtual magnifying loupe, and a dentist's foot pedal. The user study involved 35 dentists with various backgrounds and years of experience. The findings demonstrated significant results; DWs outperform SWs in positional and rotational precision, especially with younger generations and subjects with gaming experiences. The user preference remains for DWs (19) instead of SWs (16). However, findings indicated that the precision positively correlates with the time trade-off. The post-experience questionnaire (NASA-TLX) showed that DWs increase mental and physical demand, effort, and frustration more than SWs. Comparisons between DWEP and DWTA show that the DW's complexity level influences time, physical and mental demands. The DWs are extensible to diverse medical and industrial scenarios that demand precision.

Comparison of thoracic epidural catheter and continuous peripheral infusion for management of traumatic rib fracture pain.

BACKGROUND: Thoracic epidural catheters (TECs) are useful adjuncts to multimodal pain regimens in traumatic rib fractures. However, TEC placement is limited by contraindications, patient risk profile, and provider availability. Continuous peripheral infusion of ketamine and/or lidocaine is an alternative that has a modest risk profile and few contraindications. We hypothesized that patients with multiple traumatic rib fractures receiving TECs would have better pain control, in terms of daily morphine milligram equivalents (MMEs) and mean pain scores (MPSs) when compared with continuous peripheral infusions of ketamine and/or lidocaine. METHODS: We retrospectively analyzed traumatic rib fracture admissions to a level 1 trauma center between January 2018 and December 2020. We evaluated two treatment groups: TEC only and continuous infusion only (drip only). A linear mixed-effects model evaluated the association of MME with treatment group. An interaction term of treatment group by time (days 1-7) was included to allow estimating potential time-dependent treatment effect on MME. A zero-inflated Poisson mixed-effects model evaluated the association of treatment with MPS. Both models adjusted for confounders. RESULTS: A total of 1,647 patients were included. After multivariable analysis, a significant, time-varying dose-response relationship between treatment group and MME was found, indicating an opioid-sparing effect favoring the TEC-only group. The opioid-sparing benefit for TEC-only therapy was most prominent at day 3 (27.4 vs 36.5 MME) and day 4 (27.3 vs 36.2 MME) (p < 0.01). The drip-only group had 1.21 times greater MPS than patients with TEC only (p < 0.001). CONCLUSION: Drip-only analgesia is associated with higher daily MME use and MPS, compared with TEC only. The maximal benefit of TEC therapy appears to be on days 3 and 4. Prospective, randomized comparison between groups is necessary to evaluate the magnitude of the treatment effect. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III.

IEEE ISMAR 2022 Report: Toward Better Mixed Realities.

On October 21, 2022, the 21st IEEE International Symposium on Mixed and Augmented Reality (ISMAR 2022) was successfully completed in Singapore. ISMAR is the leading international conference in the fields of augmented reality, mixed reality, and virtual reality. This was the first time that ISMAR was held in Southeast Asia and the first time in hybrid mode. ISMAR 2022 achieved a historically high number of papers and attendees, witnessing the steady growth of the community and the scientific contributions. In this article, we report the key outcomes, impressions, research trends, and lessons learned from the conference.

Stercoral Perforation in the Setting of Chronic Antipsychotic Use: A Case Report.

Stercoral perforation is a rare form of colonic perforation with limited reports in the literature, accounting for less than 140 documented cases. This complication occurs due to increased intraluminal pressure created by fecal impaction, ultimately causing colonic ulceration and necrosis. It is most often seen in elderly or debilitated patients with chronic constipation. The long-term use of drugs or medications with side effects of chronic constipation such as opioids, antispasmodics, tricyclic antidepressants, and calcium channel blockers have been implicated in these cases. Here we present a case of stercoral perforation in a patient with short-term opioid use following an orthopedic procedure, but more likely complicated by long-term use of antipsychotics and antidepressants.

More Arrows in the Quiver: Investigating the Use of Auxiliary Models to Localize In-View Components with Augmented Reality.

The creation and management of content are among the main open issues for the spread of Augmented Reality. In Augmented Reality interfaces for procedural tasks, a key authoring strategy is chunking instructions and using optimized visual cues, i.e., tailored to the specific information to convey. Nevertheless, research works rarely present rationales behind their choice. This work aims to provide design guidelines for the localization of in-view and not occluded components, which is recurrent information in technical documentation. Previous studies revealed that the most suited visual cues to convey this information are auxiliary models, i.e., abstract shapes that highlight the space region where the component is located. Among them, 3D arrows are widely used, but they may produce ambiguity of information. Furthermore, from the literature, it is unclear how to design auxiliary model shapes and if they are affected by the component shapes. To fill this gap, we conducted two user studies. In the first study, we collected the preference of 45 users regarding the shape, color, and animation of auxiliary models for the localization of various component shapes. According to the results of this study, we defined guidelines for designing optimized auxiliary models based on the component shapes. In the second user study, we validated these guidelines by evaluating the performance (localization time and recognition accuracy) and user experience of 24 users. The results of this study allowed us to confirm that designing auxiliary models following our guidelines leads to a higher recognition accuracy and user experience than using 3D arrows.

The Geriatric Patient One Year After Trauma: Palliative Performance Scale Predicts Functional Outcomes.

INTRODUCTION: Frailty in trauma has been found to predict poor outcomes after injury including additional in-hospital complications, mortality, and discharge to dependent care. These gross outcome measures are insufficient when discussing long-term recovery as they do not address what is important to patients including functional status and quality of life. The purpose of this study is to determine if the Palliative Performance Scale (PPS) predicts mortality and functional status one year after trauma in geriatric patients. MATERIAL AND METHODS: Prospective observational study of trauma survivors, age ≥55 years. Patients were stratified by pre-injury PPS high (>70) or low (≤70). Outcomes were functional status at 1 year measured by Glasgow Outcome Scale Extended (GOSE), Euroqol-5D and SF-36. Adjusted relative risks (aRR) were obtained using modified Poisson regression. RESULTS: Follow-up was achieved on 215/301 patients. Mortality was 30% in low PPS group vs 8% in the high PPS group (P<0.001). A greater percentage of patients in the high group had a good functional outcome at one year compared to patients in the low group (78% vs 30% p<0.001). The high PPS patients were more likely to have improvement of GOSE at 1 year from discharge compared to low group (66% vs 27% P<0.001). Low PPS independently predicted poor functional outcome (aRR, 2.64; 95% confidence interval, 1.79-3.89) and death at 1 year (aRR, 3.64; 95% confidence interval 1.68-7.92). An increased percentage of low PPS patients reported difficulty with mobility (91% vs 46% p<0.0001) and usual activities (82% vs 56% p=0.002). Both groups reported pain (65%) and anxiety/depression (47%). CONCLUSION: Low pre-Injury PPS predicts mortality and poor functional outcomes one year after trauma. Low PPS patients were more likely to decline, rather than improve. Regardless of PPS, most patients have persistent pain, anxiety, and limitations in performing daily activities.

What, How, and Why are Visual Assets Used in Industrial Augmented Reality? A Systematic Review and Classification in Maintenance, Assembly, and Training (From 1997 to 2019).

Industrial Augmented Reality (iAR) has demonstrated its advantages to communicate technical information in the fields of maintenance, assembly, and training. However, literature is scattered among different visual assets (i.e., AR visual user interface elements associated with a real scene). In this work, we present a systematic literature review of visual assets used in these industrial fields. We searched five databases, initially finding 1757 papers. Then, we selected 122 iAR papers from 1997 to 2019 and extracted 348 visual assets. We propose a classification for visual assets according to (i) what is displayed, (ii) how it conveys information (frame of reference, color coding, animation), and, (iii) why it is used. Our review shows that product models, text and auxiliary models are, in order, the most common, with each most often used to support operating, checking and locating tasks respectively. Other visual assets are scarcely used. Product and auxiliary models are commonly rendered world-fixed, color coding is not used as often as expected, while animations are limited to product and auxiliary model. This survey provides a snapshot of over 20 years of literature in iAR, useful to understand established practices to orientate in iAR interface design and to present future research directions.