Comparative Cost of Virtual Reality Training and Live Exercises for Training Hospital Workers for Evacuation.

Adoption of virtual reality technology may be delayed due to high up-front costs with unknown returns on that investment. In this article, we present a cost analysis of using virtual reality as a training tool. Virtual reality was used to train neonatal intensive care workers in hospital evacuation. A live disaster exercise with mannequins was also conducted that approximated the virtual experience. Comparative costs are presented for the planning, development, and implementation of both interventions. Initially, virtual reality is more expensive, with a cost of $229.79 per participant (total cost $18 617.54 per exercise) for the live drill versus $327.78 (total cost $106 951.14) for virtual reality. When development costs are extrapolated to repeated training over 3 years, however, the virtual exercise becomes less expensive with a cost of $115.43 per participant, while the cost of live exercises remains fixed. The larger initial investment in virtual reality can be spread across a large number of trainees and a longer time period with little additional cost, while each live drill requires additional costs that scale with the number of participants.

Effectiveness of Two Varying Levels of Virtual Reality Simulation.

AIM: The aim of the study was to assess two levels of immersive virtual reality simulation (VRS) to teach the skill of decontamination. BACKGROUND: Little is known about the use of VRS in providing disaster education, including retention. METHOD: Quasiexperimental design with repeated measures, supplemented by qualitative data, using a convenience sample of senior baccalaureate nursing students (n = 197) from four Midwest campuses was used. Students were randomly assigned to a group (two levels of immersive VRS and a control group) to learn the skill of decontamination. Cognitive learning, performance, and performance time were measured pre/post and at six months. RESULTS: Outcome measures were significant with immediate postintervention improvements and lower retention scores at six months. No significant differences were noted between groups. Students were satisfied with the VRS but found immersive VRS more interactive. CONCLUSION: VRS provides another alternative for simulated learning experiences; best practice approaches for its use still need to be explored.

Strategies for Intravenous Fluid Resuscitation in Trauma Patients.

Intravenous fluid management of trauma patients is fraught with complex decisions that are often complicated by coagulopathy and blood loss. This review discusses the fluid management in trauma patients from the perspective of the developing world. In addition, the article describes an approach to specific circumstances in trauma fluid decision-making and provides recommendations for the resource-limited environment.

Hemoglobin glutamer-250 (bovine) in South Africa: consensus usage guidelines from clinician experts who have treated patients.

Hemopure (hemoglobin glutamer-250 [bovine]; HBOC-201) is a hemoglobin (Hb)-based oxygen carrier registered with the Medicines Control Council of South Africa. It is indicated for the treatment of adult patients who are acutely anemic, for the purpose of maintaining tissue oxygen delivery thus eliminating, delaying, or reducing the need for allogeneic red blood cells (RBCs). Hemopure is a volume expander, and circulatory volume must be carefully monitored for signs of fluid overload. Hemopure is not as effective as RBCs for restoring Hb content and concentration, but in cases of severe anemia where allogeneic blood is not an option or is unavailable, it may offer an immediate alternative for improving oxygen transport. This document provides clinical recommendations on the safe and effective use of Hemopure based on the postmarketing experience in South Africa as well as a better understanding of Hemopure properties reflected in recent publications.

Learning and Retention Using Virtual Reality in a Decontamination Simulation.

AIM: The purpose of this study was to examine the longitudinal effects of virtual reality simulation (VRS) on learning outcomes and retention. BACKGROUND: Disaster preparation for health care professionals is seriously inadequate. VRS offers an opportunity to practice within a realistic and safe environment, but little is known about learning and retention using this pedagogy. METHOD: A quasiexperimental design was used to examine the use of VRS with baccalaureate nursing students in two different nursing programs in terms of the skill of decontamination. RESULTS: Results indicate that VRS is at least as good as traditional methods and is superior in some cases for retention of knowledge and performance of skills. CONCLUSION: VRS may provide a valuable option for promoting skill development and retention. More research is needed to determine how to prepare nurses for skills that may not be required until months or even years after initial introduction.

WeaVR: a self-contained and wearable immersive virtual environment simulation system.

We describe WeaVR, a computer simulation system that takes virtual reality technology beyond specialized laboratories and research sites and makes it available in any open space, such as a gymnasium or a public park. Novel hardware and software systems enable HMD-based immersive virtual reality simulations to be conducted in any arbitrary location, with no external infrastructure and little-to-no setup or site preparation. The ability of the WeaVR system to provide realistic motion-tracked navigation for users, to improve the study of large-scale navigation, and to generate usable behavioral data is shown in three demonstrations. First, participants navigated through a full-scale virtual grocery store while physically situated in an open grass field. Trajectory data are presented for both normal tracking and for tracking during the use of redirected walking that constrained users to a predefined area. Second, users followed a straight path within a virtual world for distances of up to 2 km while walking naturally and being redirected to stay within the field, demonstrating the ability of the system to study large-scale navigation by simulating virtual worlds that are potentially unlimited in extent. Finally, the portability and pedagogical implications of this system were demonstrated by taking it to a regional high school for live use by a computer science class on their own school campus.

Creation of a virtual triage exercise: an interprofessional communication strategy.

Virtual reality simulation as a teaching method is gaining increased acceptance and presence in institutions of higher learning. This study presents an innovative strategy using the interdisciplinary development of a nonimmersive virtual reality simulation to facilitate interprofessional communication. The purpose of this pilot project was to describe nursing students' attitudes related to interprofessional communication following the collaborative development of a disaster triage virtual reality simulation. Collaboration between and among professionals is integral in enhancing patient outcomes. In addition, ineffective communication is linked to detrimental patient outcomes, especially during times of high stress. Poor communication has been identified as the root cause of the majority of negative sentinel events occurring in hospitals. The simulation-development teaching model proved useful in fostering interprofessional communication and mastering course content. Mean scores on the KidSIM Attitudes Towards Teamwork in Training Undergoing Designed Educational Simulation survey demonstrated that nursing students, after simulation experience,had agreement to strong agreement inall areas surveyed including interprofessional education, communication, roles and responsibilities of team members, and situational awareness. The findings indicate that students value interprofessional teamwork and the opportunity to work with other disciplines.

Evaluation of two simulation methods for teaching a disaster skill.

Introduction: With increasing use of virtual reality simulation (VRS) in nursing education, there is a paucity of research exploring learning outcomes following training with VRS as compared with traditional mannequin-based simulation. Given the resource intensive nature of mannequin-based simulation, especially for disaster education, understanding outcomes from newer technologies like VRS are needed. Methods: A quasi-experimental design was used to examine the differences in learning outcomes for the disaster skill of decontamination, based on type of simulation. The study was framed by the National Leage for Nursing (NLN) Jeffries Simulation Theory, with participant outcomes identified by the framework (satisfaction, self-confidence and performance). Outcomes were measured using the NLN Student Satisfaction and Self- Confidence in Learning scale and a Decontamination Checklist. Senior nursing students in the final semester of a baccalaureate nursing programme were recruited to participate during one of their scheduled laboratory days. Following a didactic presentation, students were randomly assigned to one of two treatment groups (VRS or mannequin-based simulation training) to learn the skill of decontamination. Results: A total of 121 participants took part in the study. No statistically significant results were noted for any of the study outcomes: performance (accuracy and time), satisfaction and self-efficacy. Results of the study demonstrate that VRS is as effective as mannequin-based simulation in training participants for the skill of decontamination. Conclusions: Simulation-based education experiences must be matched to learning outcomes and evaluated for effectiveness. As evidence emerges regarding use of newer technologies, like VRS, educators will have more options for providing students with opportunities that best match available resources.

Multi-User Redirected Walking and Resetting Using Artificial Potential Fields.

Head-mounted displays (HMDs) and large area position tracking systems can enable users to navigate virtual worlds through natural walking. Redirected walking (RDW) imperceptibly steers immersed users away from physical world obstacles allowing them to explore unbounded virtual worlds while walking in limited physical space. In cases of imminent collisions, resetting techniques can reorient them into open space. This work introduces categorically new RDW and resetting algorithms based on the use of artificial potential fields that "push" users away from obstacles and other users. Data from human subject experiments indicate that these methods reduce potential single-user resets by 66% and increase the average distance between resets by 86% compared to previous techniques. A live multi-user study demonstrates the viability of the algorithm with up to 3 concurrent users, and simulation results indicate that the algorithm scales efficiently up to at least 8 users and is effective with larger groups.

Effects of Virtual Reality Simulation on Worker Emergency Evacuation of Neonates.

OBJECTIVE: This study examined differences in learning outcomes among newborn intensive care unit (NICU) workers who underwent virtual reality simulation (VRS) emergency evacuation training versus those who received web-based clinical updates (CU). Learning outcomes included a) knowledge gained, b) confidence with evacuation, and c) performance in a live evacuation exercise. METHODS: A longitudinal, mixed-method, quasi-experimental design was implemented utilizing a sample of NICU workers randomly assigned to VRS training or CUs. Four VRS scenarios were created that augmented neonate evacuation training materials. Learning was measured using cognitive assessments, self-efficacy questionnaire (baseline, 0, 4, 8, 12 months), and performance in a live drill (baseline, 12 months). Data were collected following training and analyzed using mixed model analysis. Focus groups captured VRS participant experiences. RESULTS: The VRS and CU groups did not statistically differ based upon the scores on the Cognitive Assessment or perceived self-efficacy. The virtual reality group performance in the live exercise was statistically (P<.0001) and clinically (effect size of 1.71) better than that of the CU group. CONCLUSIONS: Training using VRS is effective in promoting positive performance outcomes and should be included as a method for disaster training. VRS can allow an organization to train, test, and identify gaps in current emergency operation plans. In the unique case of disasters, which are low-volume and high-risk events, the participant can have access to an environment without endangering themselves or clients. (Disaster Med Public Health Preparedness. 2019;13:301-308).

A dedicated system for in situ testing of gamma ray induced optical absorption and emission in optical materials.

Serious radiation damage due to the high energy neutron/gamma fluxes is expected for optical materials such as scintillators, windows, and lenses which will be part of the plasma diagnostics in future fusion devices. Radiation induced absorption represents a major concern for these components for which experimental validation under as near as possible reactor conditions becomes essential. A new experimental system has been developed at the CIEMAT Nayade 60Co gamma irradiation facility for in situ radiation induced optical absorption measurements, covering a spectral range between 370 and 730 nm. This setup consists in a rotating sample holder which allows one to collect incident light (reference signal) and transmitted light through the material to be tested as a function of irradiation dose. This is an advanced and robust system which overcomes the important experimental difficulties that radiation involves providing a valuable testing capability for transmission components and scintillators under realistic fusion conditions. A detailed description of the experimental arrangement, together with preliminary tests carried out for system validation is given in this paper.

Lack of set size effects in spatial updating: Evidence for offline updating.

Four experiments required participants to keep track of the locations of (i.e., update) 1, 2, 3, 4, 6, 8, 10, or 15 target objects after rotating. Across all conditions, updating was unaffected by set size. Although some traditional set size effects (i.e., a linear increase of latency with memory load) were observed under some conditions, these effects were independent of the updating process. Patterns of data and participant strategies were inconsistent with the common view of spatial updating as an online process. Instead, the authors concluded that participants formed enduring, long-term memory representations of the layouts at learning that were used to reconstruct spatial information about the layouts as needed (i.e., offline updating). These results support M. Amorim, S. Glasauer, K. Corpinot, and A. Berthoz's (1997) 2-system model of spatial updating that includes both online and offline updating.

Transient and enduring spatial representations under disorientation and self-rotation.

Current theories of environmental cognition typically differentiate between an online, transient, and dynamic system of spatial representation and an offline and enduring system of memory representation. Here the authors present additional evidence for such 2-system theories in the context of the disorientation paradigm introduced by R. F. Wang and E. S. Spelke (2000). Several experiments replicate the finding that disorientation results in a decrease in the precision of people's estimates of relative directions. In contrast to the typical interpretation of this effect as indicating the primacy of a transient spatial system, the present results are generally more consistent with an interpretation of it as indicating a switch from a relatively precise online representation to a relatively coarse enduring one. Further experiments examine the relative precision of transient and enduring representations and show that switching between them does not require disorientation, but can also be produced by self-rotations as small as 135 degrees .

Virtual reality disaster training: translation to practice.

Disaster training is crucial to the mitigation of both mortality and morbidity associated with disasters. Just as clinical practice needs to be grounded in evidence, effective disaster education is dependent upon the development and use of andragogic and pedagogic evidence. Educational research findings must be transformed into useable education strategies. Virtual reality simulation is a teaching methodology that has the potential to be a powerful educational tool. The purpose of this article is to translate research findings related to the use of virtual reality simulation in disaster training into education practice. The Ace Star Model serves as a valuable framework to translate the VRS teaching methodology and improve disaster training of healthcare professionals. Using the Ace Star Model as a framework to put evidence into practice, strategies for implementing a virtual reality simulation are addressed. Practice guidelines, implementation recommendations, integration to practice and evaluation are discussed. It is imperative that health educators provide more exemplars of how research evidence can be moved through the various stages of the model to advance practice and sustain learning outcomes.

Decontamination training: with and without virtual reality simulation.

Nurses must be prepared to care for patients following a disaster, including patients exposed to hazardous contaminants. The purpose of this study was to examine the use of virtual reality simulation (VRS) to teach the disaster-specific skill of decontamination. A quasi-experimental design was used to assign nursing students from 2 baccalaureate nursing programs to 1 of 2 groups to learn the disaster skill of decontamination-printed written directions or VRS. Performance, knowledge, and self-efficacy were outcome measures. Although students in the treatment group had significantly lower performance scores than the control group (p = 0.004), students taking part in VRS completed the skill in a significantly shorter amount of time (p = 0.008). No significant group differences were found for self-efficacy (p = 0.172) or knowledge (p = 0.631). However, students in the VRS treatment group reported high levels of satisfaction with VRS as a training method. The disaster-specific skill of decontamination is a low-volume, high-risk skill that must be performed with accuracy to protect both exposed patients and providers performing decontamination. As frontline providers for casualties following a disaster event, emergency nurses must be prepared to perform this skill when needed. Preparation requires cost-effective, timely, and evidence-based educational opportunities that promote positive outcomes. Further investigation is needed to determine the benefits and long-term effects of VRS for disaster education.

Performance of redirected walking algorithms in a constrained virtual world.

Redirected walking algorithms imperceptibly rotate a virtual scene about users of immersive virtual environment systems in order to guide them away from tracking area boundaries. Ideally, these distortions permit users to explore large unbounded virtual worlds while walking naturally within a physically limited space. Many potential virtual worlds are composed of corridors, passageways, or aisles. Assuming users are not expected to walk through walls or other objects within the virtual world, these constrained worlds limit the directions of travel and as well as the number of opportunities to change direction. The resulting differences in user movement characteristics within the physical world have an impact on redirected walking algorithm performance. This work presents a comparison of generalized RDW algorithm performance within a constrained virtual world. In contrast to previous studies involving unconstrained virtual worlds, experimental results indicate that the steer-to-orbit keeps users in a smaller area than the steer-to-center algorithm. Moreover, in comparison to steer-to-center, steer-to-orbit is shown to reduce potential wall contacts by over 29%.

The Durban World Congress Ethics Round Table Conference Report: II. Withholding or withdrawing of treatment in elderly patients admitted to the intensive care unit.

INTRODUCTION: Life-sustaining treatment (LST) limitation for elderly patients is highly controversial. In that context, it is useful to evaluate the attitudes to LST in the elderly among experienced intensive care unit (ICU) physicians with different backgrounds and cultures. METHODS: A panel of 22 international ICU physicians from 13 countries responded to a questionnaire related to withholding (WH) and withdrawing (WD) LST in elderly patients using a semi-Likert scale. RESULTS: Most experts disagree or strongly disagree (77%) that age should be used as the sole criterion for WH or WD LST, and almost all disagree (91%) that there should be a specific age for such decision making. However, the vast majority (91%) acknowledge that age should be an important consideration in conjunction with other factors. Disagreement for consideration of prioritizing the young over the old in normal ICU operations was reported in 68%, whereas in an emergency triage situation, disagreement dropped to 18%. CONCLUSIONS: There is a consensus among ICU physicians that age cannot be the sole criterion on which health care decisions should be made. In that perspective, it is important to provide data showing that outcome differences between elderly and nonelderly patients are partly related to decisions to forgo LSTs.

The Durban World Congress Ethics Round Table Conference Report: III. Withdrawing Mechanical ventilation--the approach should be individualized.

PURPOSE: The purpose of this study is to determine the approaches used in withdrawing mechanical ventilator support. MATERIALS AND METHODS: Speakers from the invited faculty of the World Federation of Societies of Intensive and Critical Care Medicine Congress in 2013 with an interest in ethics were asked to provide a detailed description of individual approaches to the process of withdrawal of mechanical ventilation. RESULTS: Twenty-one participants originating from 13 countries, responded to the questionnaire. Four respondents indicated that they do not practice withdrawal of mechanical ventilation, and another 4 indicated that their approach is highly variable depending on the clinical scenario. Immediate withdrawal of ventilation was practiced by a large number of the respondents (7/16; 44%). A terminal wean was practiced by just more than a third of the respondents (6/16; 38%). Extubation was practiced in more than 70% of instances among most of the respondents (9/17; 53%). Two of the respondents (2/17; 12%) indicated that they would extubate all patients, whereas 14 respondents indicated that they would not extubate all their patients. The emphasis was on tailoring the approach used to suit individual case scenarios. CONCLUSIONS: Withdrawing of ventilator support is not universal. However, even when withdrawing mechanical ventilation is acceptable, the approach to achieve this end point is highly variable and individualized.

Comparing four approaches to generalized redirected walking: simulation and live user data.

Redirected walking algorithms imperceptibly rotate a virtual scene and scale movements to guide users of immersive virtual environment systems away from tracking area boundaries. These distortions ideally permit users to explore large and potentially unbounded virtual worlds while walking naturally through a physically limited space. Estimates of the physical space required to perform effective redirected walking have been based largely on the ability of humans to perceive the distortions introduced by redirected walking and have not examined the impact the overall steering strategy used. This work compares four generalized redirected walking algorithms, including Steer-to-Center, Steer-to-Orbit, Steer-to-Multiple-Targets and Steer-to-Multiple+Center. Two experiments are presented based on simulated navigation as well as live-user navigation carried out in a large immersive virtual environment facility. Simulations were conducted with both synthetic paths and previously-logged user data. Primary comparison metrics include mean and maximum distances from the tracking area center for each algorithm, number of wall contacts, and mean rates of redirection. Results indicated that Steer-to-Center out-performed all other algorithms relative to these metrics. Steer-to-Orbit also performed well in some circumstances.

Optimizing constrained-environment redirected walking instructions using search techniques.

A goal of redirected walking (RDW) is to allow large virtual worlds to be explored within small tracking areas. Generalized steering algorithms, such as steer-to-center, simply move the user toward locations that are considered to be collision free in most cases. The algorithm developed here, FORCE, identifies collision-free paths by using a map of the tracking area's shape and obstacles, in addition to a multistep, probabilistic prediction of the user's virtual path through a known virtual environment. In the present implementation, the path predictions describe a user's possible movements through a virtual store with aisles. Based on both the user's physical and virtual location / orientation, a search-based optimization technique identifies the optimal steering instruction given the possible user paths. Path prediction uses the map of the virtual world; consequently, the search may propose steering instructions that put the user close to walls if the user's future actions eventually lead away from the wall. Results from both simulated and real users are presented. FORCE identifies collision-free paths in 55.0 percent of the starting conditions compared to 46.1 percent for generalized methods. When considering only the conditions that result in different outcomes, redirection based on FORCE produces collision-free path 94.5 percent of the time.