Realidade virtual na reabilitação de doentes com acidente vascular cerebral: uma scoping review / Virtual reality in the rehabilitation of stroke patients: a scoping review

Introdução: O AVC constitui-se como um dos principais desafios de saúde pública a nível mundial acarretando um elevado impacto em diferentes níveis. A intervenção do Enfermeiro Especialista em Enfermagem de Reabilitação assume um papel preponderante nos cuidados ao doente após AVC. A evolução da tecnologia, os avanços da ciência e da terapêutica no tratamento do AVC, tem vindo a evidenciar-se com repercussões na melhoria da qualidade de vida dos doentes. Com esta evolução surge a Realidade Virtual como um recurso terapêutico com a capacidade de gerar ambientes flexíveis e adequados no processo de recuperação. Objetivo: Mapear o efeito da Realidade Virtual na Reabilitação de Doentes com Acidente Vascular Cerebral. Metodologia: Estudo de revisão, scoping review, sustentada na metodologia de Joanna Briggs Institute. Definindo a População (P), Conceito (C) e Contexto (C) em que P: doentes adultos com AVC, independentemente do género, (C) realidade virtual e (C) reabilitação motora, cognitiva e/ou sensorial. Formulada a questão de revisão: "Qual o Efeito da Realidade Virtual na Reabilitação de Doentes com AVC?". Realizada pesquisa nas seguintes bases de dados: PubMed, CINAHL complete, EBSCO, SciELO e RCAAP com espaço temporal de publicação de janeiro de 2012 a dezembro de 2022. Resultados: Foram incluídos trinta e quatro estudos com diferentes metodologias e natureza de estudo. A análise dos estudos revelou que a integração da realidade virtual conduziu a ganhos nos domínios da reabilitação motora, cognitiva e sensorial com influência na qualidade de vida, podendo ser considerada como um método eficaz e um importante coadjuvante dos programas de reabilitação convencional. Conclusões: Evidenciada a utilidade do uso da realidade virtual no processo de reabilitação, nomeadamente nos programas específicos concebidos e implementados pelo Enfermeiro Especialista em Enfermagem de Reabilitação. Podemos então considerar que o efeito da realidade virtual na reabilitação de doentes com AVC parece ser positivo.

Introduction: Stroke is one of the main public health challenges worldwide, causing a high impact at different levels. The intervention of the Specialist Nurse in Rehabilitation Nursing plays a preponderant role in the care of patients after a stroke. The evolution of technology, advances in science and therapy in the treatment of stroke, have been evident with repercussions in improving the life quality of patients. With this evolution Virtual Reality emerges as a therapeutic resource with the ability to generate flexible and appropriate environments in the recovery process. Objective: Map the effect of Virtual Reality in the Rehabilitation of Patients with Stroke. Methodology: Review study, a scoping review, based on the Joanna Briggs Institute methodology. Defining the Population (P), Concept (C) and Context (C) in which (P): adult stroke patients, regardless of gender, (C) virtual reality and (C) motor, cognitive and/or sensory rehabilitation. The review question was formulated: "What is the Effect of Virtual Reality on the Rehabilitation of Stroke Patients?". Research was carried out in the following databases: PubMed, CINAHL complete, EBSCO, SciELO and RCAAP with publication timeframe from January 2012 to December 2022. Results: Thirty-four studies with different methodologies and study nature were included. The analysis of the studies revealed that the integration of virtual reality led to gains in the areas of motor, cognitive and sensory rehabilitation with an influence on quality of life and can be considered as an effective method and an important adjunct to conventional rehabilitation programs. Conclusions: The usefulness of using virtual reality in the rehabilitation process was highlighted, particularly in specific programs designed and implemented by Specialist Nurse in Rehabilitation Nursing. We can thus consider that the effect of virtual reality on the rehabilitation of stroke patients appears to be positive.

The Use of Immersive Virtual Reality Training for Developing Nontechnical Skills Among Nursing Students: Multimethods Study.

BACKGROUND: Immersive virtual reality (IVR) is a niche technology rising in popularity in nursing education. Although there is an abundance of evidence to demonstrate the effect of virtual reality (VR) on desired learning outcomes, this evidence is limited to technical or procedural skills or managing a single patient with clinical problems. Nontechnical skills (NTS), such as communication, decision-making, teamwork, situation awareness, and managerial skills, have not been explored using IVR technology. OBJECTIVE: This study aimed to (1) investigate the potential efficacy of the IVR system virtual reality hospital (VR-Hospital, or VR-Hosp), a single-user game we developed, on nursing students' NTS, sense of presence in the virtual clinical environment, and satisfaction and self-confidence in learning; (2) identify variables that predict NTS; and (3) explore students' experience in using VR-Hosp. METHODS: A multimethods design with a quantitative and qualitative approach was adopted. Participants were provided with VR-Hosp with 3 scenarios in training. VR-Hosp adopted a multibed, multipatient, multitask approach and was embedded with various clinical situations. Learning outcomes were measured after the training, followed by group interviews. RESULTS: In total, 202 students joined the study. Results revealed high levels of satisfaction and self-confidence in learning. Significant achievement in NTS was perceived by the students. The levels of satisfaction and self-confidence in learning and the involvement and sensory fidelity domains in the sense of presence were positive predictors of NTS. CONCLUSIONS: The promising results offer a basis for designing IVR activities for nursing education. Further investigations are imperative to determine the impact of IVR technology on learning outcomes in clinical practice.

Effects of pulse shape on pitch sensitivity of cochlear implant users.

Contemporary cochlear implants (CIs) use cathodic-leading symmetric biphasic (C-BP) pulses for electrical stimulation. It remains unclear whether asymmetric pulses emphasizing the anodic or cathodic phase may improve spectral and temporal coding with CIs. This study tested place- and temporal-pitch sensitivity with C-BP, anodic-centered triphasic (A-TP), and cathodic-centered triphasic (C-TP) pulse trains on apical, middle, and basal electrodes in 10 implanted ears. Virtual channel ranking (VCR) thresholds (for place-pitch sensitivity) were measured at both a low and a high pulse rate of 99 (Experiment 1) and 1000 (Experiment 2) pulses per second (pps), and amplitude modulation frequency ranking (AMFR) thresholds (for temporal-pitch sensitivity) were measured at a 1000-pps pulse rate in Experiment 3. All stimuli were presented in monopolar mode. Results of all experiments showed that detection thresholds, most comfortable levels (MCLs), VCR thresholds, and AMFR thresholds were higher on more basal electrodes. C-BP pulses had longer active phase duration and thus lower detection thresholds and MCLs than A-TP and C-TP pulses. Compared to C-TP pulses, A-TP pulses had lower detection thresholds at the 99-pps but not the 1000-pps pulse rate, and had lower MCLs at both pulse rates. A-TP pulses led to lower VCR thresholds than C-BP pulses, and in turn than C-TP pulses, at the 1000-pps pulse rate. However, pulse shape did not affect VCR thresholds at the 99-pps pulse rate (possibly due to the fixed temporal pitch) or AMFR thresholds at the 1000-pps pulse rate (where the overall high performance may have reduced the changes with different pulse shapes). Notably, stronger polarity effect on VCR thresholds (or more improvement in VCR with A-TP than with C-TP pulses) at the 1000-pps pulse rate was associated with stronger polarity effect on detection thresholds at the 99-pps pulse rate (consistent with more degeneration of auditory nerve peripheral processes). The results suggest that A-TP pulses may improve place-pitch sensitivity or spectral coding for CI users, especially in situations with peripheral process degeneration.

The facilitators and barriers to implementing virtual visits in intensive care units: A mixed-methods systematic review.

BACKGROUND: Visitation has a positive effect on patients and families, yet, it can disrupt intensive care unit (ICU) care and increase the risk of patient infections, which previously favoured face-to-face visits. The coronavirus disease 2019 (COVID-19) pandemic has raised the importance of virtual visits and led to their widespread adoption globally, there are still many implementation barriers that need to be improved. Therefore, this review aimed to explore the use of ICU virtual visit technology during the COVID-19 pandemic and the barriers and facilitators of virtual visits to improve virtual visits in ICUs. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, six databases (CINAHL, China National Knowledge Infrastructure [CNKI], PubMed, Cochrane, VIP and Wang Fang databases) were searched for empirical studies published between 1 January 2020 and 22 October 2023. Studies that investigated and reported barriers to and facilitators of implementing virtual visits in ICUs during the COVID-19 pandemic were included. Evidence from the included studies was identified and thematically analysed using Thomas and Harden's three-step approach. Study quality was appraised with the Mixed-Methods Appraisal Tool. RESULTS: A total of 6770 references were screened, of which 35 studies met the inclusion criteria after a full-text review. Eight main barriers to virtual visits use were identified: technical difficulties; insufficient resources; lack of physical presence and nonverbal information; low technical literacy; differences in families' perceptions of visual cues; privacy and ethics issues; inequitable access and use of virtual visit technology; and lack of advance preparation. Four facilitating factors of virtual visit use were identified: providing multidimensional professional support; strengthening coordination services; understanding the preferences of patients and their families; and enhancing privacy and security protection. In the quality appraisal of 35 studies, 12 studies were rated as low, five as medium and 18 as high methodological quality. CONCLUSION: This review identified key facilitating factors and barriers to ICU virtual visits, which can foster the development of infrastructure, virtual visiting workflows, guidelines, policies and visiting systems to improve ICU virtual visiting services. Further studies are necessary to identify potential solutions to the identified barriers.

School modality, race and ethnicity, and mental health of U.S. adolescents during the COVID-19 pandemic.

BACKGROUND: While minoritized ethnoracial groups were most likely to be in online learning during the COVID-19 pandemic, the impact of these ethnoracial disparities on adolescent mental health is unclear. Since past studies do not directly examine whether the association between school modality and self-reported mental health outcomes varied by race and ethnicity among U.S. adolescents during the COVID-19 pandemic, this study addresses the gap. METHODS: Adolescents aged 13 to 17 years old (n = 510) were surveyed for self-reports of anxiety and depression symptoms using the 4-item Patient Health Questionnaire during Spring 2021. Seemingly unrelated regressions were used to estimate the differential association between school modality and mental health by respondents' race and ethnicity. RESULTS: Estimates without interaction between school modality and race and ethnicity suggested that Latino respondents reported a significantly higher frequency of depressive symptoms than their White counterparts (b = 0.459; p < 0.05). Similarly, the estimates without the interaction suggested respondents reporting hybrid learning had a higher frequency of depressive symptoms than in-person learning (b = 0.504; p < 0.05). Estimates with interaction between school modality and race and ethnicity suggested fully online learning was associated with poorer mental health only among White respondents and better mental health among Black respondents. Among adolescents attending school fully online, Black adolescents reported fewer mental health symptoms than their White counterparts (anxiety, b =- 1.364; p < 0.05, and depression, b =- 1.647; p < 0.05). CONCLUSIONS: Fully online learning may have benefitted the mental health of Black adolescents during the COVID-19 pandemic, perhaps because it buffered racial discrimination and social anxiety in schools. Additional interventions should be explored to promote in-person school environments that better support the mental health of Black adolescents. Moreover, prioritizing equitable access to broadband internet will provide better access to online learning and ensure positive mental health, particularly for adolescents from minoritized ethnoracial groups during instances of future pandemics. Future research should continue to consider the race and ethnicity of adolescents to promote mental well-being in schools across learning modalities.

The influence of travel time on perceived traveled distance varies by spatiotemporal scale.

The influence of travel time on perceived traveled distance has often been studied, but the results are inconsistent regarding the relationship between the two magnitudes. We argue that this is due to differences in the lengths of investigated travel distances and hypothesize that the influence of travel time differs for rather short compared to rather long traveled distances. We tested this hypothesis in a virtual environment presented on a desktop as well as through a head-mounted display. Our results show that, for longer distances, more travel time leads to longer perceived distance, while we do not find an influence of travel time on shorter distances. The presentation through an HMD vs. desktop only influenced distance judgments in the short distance condition. These results are in line with the idea that the influence of travel time varies by the length of the traveled distance, and provide insights on the question of how distance perception in path integration studies is affected by travel time, thereby resolving inconsistencies reported in previous studies.

Beyond code: Consumer response to chatbots.

Chatbots, a type of virtual AI entity designed to emulate human conversation, are gaining prominence in business and consumer domains. This research aims to consolidate extant literature focusing on a pivotal aspect: the human-likeness of chatbots. Employing three fundamental themes as organizational pillars - chatbot as a non-human entity, chatbot as a human-like entity, and chatbot as an ambiguous agent - we aim to not only spotlight important findings but also chart out potential trajectories for future exploration. By delving into the intricacies of chatbot-consumer interaction, we seek to shed light on unexplored dimensions of marketing research, ultimately enhancing our understanding of this evolving field.

The Discovery of Novel α2a Adrenergic Receptor Agonists Only Coupling to Gαi/O Proteins by Virtual Screening.

Most α2-AR agonists derived from dexmedetomidine have few structural differences between them and have no selectivity for α2A/2B-AR or Gi/Gs, which can lead to side effects in drugs. To obtain novel and potent α2A-AR agonists, we performed virtual screening for human α2A-AR and α2B-AR to find α2A-AR agonists with higher selectivity. Compound P300-2342 and its three analogs significantly decreased the locomotor activity of mice (p < 0.05). Furthermore, P300-2342 and its three analogs inhibited the binding of [3H] Rauwolscine with IC50 values of 7.72 ± 0.76 and 12.23 ± 0.11 µM, respectively, to α2A-AR and α2B-AR. In α2A-AR-HEK293 cells, P300-2342 decreased forskolin-stimulated cAMP production without increasing cAMP production, which indicated that P300-2342 activated α2A-AR with coupling to the Gαi/o pathway but without Gαs coupling. P300-2342 exhibited no agonist but slight antagonist activities in α2B-AR. Similar results were obtained for the analogs of P300-2342. The docking results showed that P300-2342 formed π-hydrogen bonds with Y394, V114 in α2A-AR, and V93 in α2B-AR. Three analogs of P300-2342 formed several π-hydrogen bonds with V114, Y196, F390 in α2A-AR, and V93 in α2B-AR. We believe that these molecules can serve as leads for the further optimization of α2A-AR agonists with potentially few side effects.

Wearable Robot Design Optimization Using Closed-Form Human-Robot Dynamic Interaction Model.

Wearable robots are emerging as a viable and effective solution for assisting and enabling people who suffer from balance and mobility disorders. Virtual prototyping is a powerful tool to design robots, preventing the costly iterative physical prototyping and testing. Design of wearable robots through modelling, however, often involves computationally expensive and error-prone multi-body simulations wrapped in an optimization framework to simulate human-robot-environment interactions. This paper proposes a framework to make the human-robot link segment system statically determinate, allowing for the closed-form inverse dynamics formulation of the link-segment model to be solved directly in order to simulate human-robot dynamic interactions. The paper also uses a technique developed by the authors to estimate the walking ground reactions from reference kinematic data, avoiding the need to measure them. The proposed framework is (a) computationally efficient and (b) transparent and easy to interpret, and (c) eliminates the need for optimization, detailed musculoskeletal modelling and measuring ground reaction forces for normal walking simulations. It is used to optimise the position of hip and ankle joints and the actuator torque-velocity requirements for a seven segments of a lower-limb wearable robot that is attached to the user at the shoes and pelvis. Gait measurements were carried out on six healthy subjects, and the data were used for design optimization and validation. The new technique promises to offer a significant advance in the way in which wearable robots can be designed.

IAVRS-International Affective Virtual Reality System: Psychometric Assessment of 360° Images by Using Psychophysiological Data.

Virtual Reality is an effective technique for eliciting emotions. It provides immersive and ecologically valid emotional experiences while maintaining experimental control. Recently, novel VR forms like 360° videos have been used successfully for emotion elicitation. Some preliminary databases of 360° videos for emotion elicitation have been proposed, but they tapped mainly into an emotional dimensional approach and did not include a concurrent physiological assessment of an emotional profile. This study expands on these databases by combining dimensional and discrete approaches to validate a new set of 360° emotion-inducing images. Twenty-six participants viewed 46 immersive images, and their emotional reactions were measured using self-reporting, psychophysiological signals, and eye tracking. The IAVRS database can successfully elicit a wide range of emotional responses, including both positive and negative valence, as well as different levels of arousal. Results reveal an important correspondence between the discrete and dimensional models of emotions. Furthermore, the images that exhibit convergence between the dimensional and discrete emotional models are particularly impactful regarding arousal and valence values. The IAVRS database provides insights into potential relationships between physiological parameters and emotional responses. This preliminary investigation highlights the complexity of emotional elicitation processes and their physiological correlates, suggesting the need for further research to deepen our understanding.

Convolutional Neural Network Model for Intestinal Metaplasia Recognition in Gastric Corpus Using Endoscopic Image Patches.

Gastric cancer (GC) is a significant healthcare concern, and the identification of high-risk patients is crucial. Indeed, gastric precancerous conditions present significant diagnostic challenges, particularly early intestinal metaplasia (IM) detection. This study developed a deep learning system to assist in IM detection using image patches from gastric corpus examined using virtual chromoendoscopy in a Western country. Utilizing a retrospective dataset of endoscopic images from Sant'Andrea University Hospital of Rome, collected between January 2020 and December 2023, the system extracted 200 × 200 pixel patches, classifying them with a voting scheme. The specificity and sensitivity on the patch test set were 76% and 72%, respectively. The optimization of a learnable voting scheme on a validation set achieved a specificity of 70% and sensitivity of 100% for entire images. Despite data limitations and the absence of pre-trained models, the system shows promising results for preliminary screening in gastric precancerous condition diagnostics, providing an explainable and robust Artificial Intelligence approach.

Rationale and methodology for examining the combination of aerobic exercise and cognitive rehabilitation on new learning and memory in persons with multiple sclerosis and mobility disability: Protocol for a randomized controlled trial.

BACKGROUND: This paper describes the protocol for a Phase I/II, parallel-group, single-blind randomized controlled trial (RCT). The RCT investigates the combined effects of 12-weeks of aerobic exercise training (AET) integrated with virtual reality (VR) and cognitive rehabilitation (CR) on new learning and memory in 78 persons with multiple sclerosis (MS) who have mobility disability and objective impairments in learning and memory. METHODS: Participants will undergo baseline assessments consisting of neuropsychological testing, neuroimaging, self-report questionnaires, and cardiorespiratory fitness. Participants will then be randomized into one of two conditions using concealed allocation: aerobic cycling exercise that incorporates VR combined with CR or stretching and toning (i.e., active control; S/T) combined with CR. Participants will be masked regarding the intent of the conditions. After 7-weeks of exercise alone, the 5-week Kessler Foundation modified Story Memory Technique (KF-mSMT®) will be integrated into the training. After the 12-week training period, participants will complete the same measures as at baseline administered by treatment-blinded assessors. Primary study outcomes include new learning and memory (NLM) measured by a small battery of neuropsychological assessments that assess list learning (California Verbal Learning Test-II), prose memory (Memory Assessment Scale), visuospatial memory (Brief Visuospatial Memory Test-Revised), and everyday memory (Ecological Memory Simulations). Secondary study outcomes include neuroimaging outcomes of hippocampal structure, function, and connectivity. CONCLUSION: If successful, this trial will provide the first Class I evidence supporting the unique combination of aerobic cycling exercise with VR and CR for treating MS-related learning and memory impairments in persons with mobility disability.

Virtual Reality for Preoperative Surgical Planning in Complex Pediatric Oncology.

Background: Virtual reality modeling (VRM) is a 3-dimensional simulation created from patient-specific 2-dimensional (2D) imaging. VRM creates a more accurate representation of the patient anatomy and can improve anatomical perception. We surveyed surgeons on their operative plan in complex pediatric oncology cases based on review of 2D imaging and subsequently after review of VRM. We hypothesized that the confidence level would increase with the use of virtual reality and that VRM may change the operative plan. Methods: Patients were selected and enrolled based on age (<18) and oncological diagnosis. VRM was created based on the 2D imaging. Surgeons identified surgical plans based on 2D imaging and again after VRM. A blinded surgeon not involved with the case also gave opinions on surgical plans after viewing both the 2D and the VRM imaging. These assessments were compared with the actual operation. Results: A total of 12 patients were enrolled. Diagnoses included six neuroblastomas, two Wilms tumors, one Ewing's sarcoma, one pseudopapillary tumor of the pancreas, one rhabdomyosarcoma, and one mediastinal germ cell tumor. VRM increased the operating surgeon's confidence 63% of the time. The operative plan changed 8.3% of the time after VRM. Conclusion: VRM is useful to help clarify operative plans for more complex pediatric cases.

Factors Associated With Continuous Use of a Cancer Education Metaverse Platform: Mixed Methods Study.

BACKGROUND: Early detection of cancer and provision of appropriate treatment can increase the cancer cure rate and reduce cancer-related deaths. Early detection requires improving the cancer screening quality of each medical institution and enhancing the capabilities of health professionals through tailored education in each field. However, during the COVID-19 pandemic, regional disparities in educational infrastructure emerged, and educational accessibility was restricted. The demand for remote cancer education services to address these issues has increased, and in this study, we considered medical metaverses as a potential means of meeting these needs. In 2022, we used Metaverse Educational Center, developed for the virtual training of health professionals, to train radiologic technologists remotely in mammography positioning. OBJECTIVE: This study aims to investigate the user experience of the Metaverse Educational Center subplatform and the factors associated with the intention for continuous use by focusing on cases of using the subplatform in a remote mammography positioning training project. METHODS: We conducted a multicenter, cross-sectional survey between July and December 2022. We performed a descriptive analysis to examine the Metaverse Educational Center user experience and a logistic regression analysis to clarify factors closely related to the intention to use the subplatform continuously. In addition, a supplementary open-ended question was used to obtain feedback from users to improve Metaverse Educational Center. RESULTS: Responses from 192 Korean participants (male participants: n=16, 8.3%; female participants: n=176, 91.7%) were analyzed. Most participants were satisfied with Metaverse Educational Center (178/192, 92.7%) and wanted to continue using the subplatform in the future (157/192, 81.8%). Less than half of the participants (85/192, 44.3%) had no difficulty in wearing the device. Logistic regression analysis results showed that intention for continuous use was associated with satisfaction (adjusted odds ratio 3.542, 95% CI 1.037-12.097; P=.04), immersion (adjusted odds ratio 2.803, 95% CI 1.201-6.539; P=.02), and no difficulty in wearing the device (adjusted odds ratio 2.020, 95% CI 1.004-4.062; P=.049). However, intention for continuous use was not associated with interest (adjusted odds ratio 0.736, 95% CI 0.303-1.789; P=.50) or perceived ease of use (adjusted odds ratio 1.284, 95% CI 0.614-2.685; P=.51). According to the qualitative feedback, Metaverse Educational Center was useful in cancer education, but the experience of wearing the device and the types and qualities of the content still need to be improved. CONCLUSIONS: Our results demonstrate the positive user experience of Metaverse Educational Center by focusing on cases of using the subplatform in a remote mammography positioning training project. Our results also suggest that improving users' satisfaction and immersion and ensuring the lack of difficulty in wearing the device may enhance their intention for continuous use of the subplatform.

From Plastic Models to Virtual Reality Headsets: Enhancing Molecular Structure Education for Undergraduate Students.

The comprehension of molecular structure is pivotal in chemistry education. Over the past decade, Mahidol University International College has employed various teaching tools for the introductory chemistry laboratory class. This paper outlines our evolutionary shift from traditional tools, such as plastic and plasticine models, to the integration of computer software, and ultimately to augmented reality (AR) and virtual reality (VR) tools-specifically, MoleculARweb and MolecularWebXR developed by École Polytechnique Fédérale de Lausanne researchers. In this paper, we detail the implementation of these tools in our classes and present the outcomes of student surveys. Our instructional focus encompasses VSEPR, Atomic Orbitals, Molecular Orbitals, Skeletal Formula, and Enantiomers. This paper not only serves as a model for educators in general chemistry at secondary school or university levels to incorporate technology into their classrooms but also showcases a collaborative endeavor between Swiss and Thai researchers.

A proof of concept model to calculate white and grey matter AIS injuries in pedestrian collisions.

In the real world, the severity of traumatic injuries is measured using the Abbreviated Injury Scale (AIS) and is often estimated, in finite element human computer models, with the maximum principal strains (MPS) tensor. MPS can predict when a serious injury is reached, but cannot provide any AIS measures lower and higher from this. To overcome these limitations, a new organ trauma model (OTM2), capable of calculating the threat to life of any organ injured, is proposed. The OTM2 model uses a power method, namely peak virtual power, and defines brain white and grey matters trauma responses. It includes human age effect (volume and stiffness), localised impact contact stiffness and provides injury severity adjustments for haemorrhaging. The focus, in this case, is on real-world pedestrian brain injuries. OTM2 model was tested against three real-life pedestrian accidents and has proven to reasonably predict the post mortem (PM) outcome. Its AIS predictions are closer to the real-world injury severity than the standard maximum principal strain (MPS) methods currently used. This proof of concept suggests that OTM2 has the potential to improve forensic predictions as well as contribute to the improvement in vehicle safety design through the ability to measure injury severity. This study concludes that future advances in trauma computing would require the development of a brain model that could predict haemorrhaging.

The Growing Role of Telerehabilitation and Teleassessment in the Management of Movement Disorders in Rare Neurological Diseases: A Scoping Review.

Background: People with rare neurological diseases (RNDs) often experience symptoms related to movement disorders, requiring a multidisciplinary approach, including rehabilitation. Telemedicine applied to rehabilitation and symptom monitoring may be suitable to ensure treatment consistency and personalized intervention. The objective of this scoping review aimed to emphasize the potential role of telerehabilitation and teleassessment in managing movement disorders within RNDs. By providing a systematic overview of the available literature, we sought to highlight potential interventions, outcomes, and critical issues. Methods: A literature search was conducted on PubMed, Google Scholar, IEEE, and Scopus up to March 2024. Two inclusion criteria were followed: (1) papers focusing on telerehabilitation and teleassessment and (2) papers dealing with movement disorders in RNDs. Results: Eighteen papers fulfilled the inclusion criteria. The main interventions were home-based software and training programs, exergames, wearable sensors, smartphone applications, virtual reality and digital music players for telerehabilitation; wearable sensors, mobile applications, and patient home video for teleassessment. Key findings revealed positive outcomes in gait, balance, limb disability, and in remote monitoring. Limitations include small sample sizes, short intervention durations, and the lack of standardized protocols. Conclusion: This review highlighted the potential of telerehabilitation and teleassessment in addressing movement disorders within RNDs. Data indicate that these modalities may play a major role in supporting conventional programs. Addressing limitations through multicenter studies, longer-term follow-ups, and standardized protocols is essential. These measures are essential for improving remote rehabilitation and assessment, contributing to an improved quality of life for people with RNDs.

Exploring Relations Between Unique Patient Characteristics and Virtual Reality Immersion Level on Anxiety and Pain in Patients Undergoing Venipuncture: Secondary Analysis of a Randomized Control Trial.

BACKGROUND: Virtual reality (VR) is a well-researched digital intervention that has been used for managing acute pain and anxiety in pediatric patients undergoing various medical procedures. This study focuses on investigating the role of unique patient characteristics and VR immersion level on the effectiveness of VR for managing pediatric pain and anxiety during venipuncture. OBJECTIVE: The purpose of this study is to determine how specific patient characteristics and level of immersion during a VR intervention impact anxiety and pain levels for pediatric patients undergoing venipuncture procedures. METHODS: This study is a secondary data analysis of 2 combined, previously published randomized control trials on 252 pediatric patients aged 10-21 years observed at Children's Hospital Los Angeles from April 12, 2017, to July 24, 2019. One randomized clinical trial was conducted in 3 clinical environments examining peripheral intravenous catheter placement (radiology and an infusion center) and blood draw (phlebotomy). Conditional process analysis was used to conduct moderation and mediation analyses to assess the impact of immersion level during the VR intervention. RESULTS: Significant moderation was found between the level of immersion and anxiety sensitivity when predicting postprocedural anxiety (P=.01). Patients exhibiting the highest anxiety sensitivity within the standard of care yielded a 1.9 (95% CI 0.9-2.8; P<.001)-point elevation in postprocedural anxiety relative to individuals with high immersion levels. No other significant factors were found to mediate or moderate the effect of immersion on either postprocedural anxiety or pain. CONCLUSIONS: VR is most effective for patients with higher anxiety sensitivity who report feeling highly immersed. Age, location of the procedure, and gender of the patient were not found to significantly impact VR's success in managing levels of postprocedural pain or anxiety, suggesting that immersive VR may be a beneficial intervention for a broad pediatric population. TRIAL REGISTRATION: ClinicalTrials.gov NCT04268901; https://clinicaltrials.gov/study/NCT04268901.

Computational fluid dynamics (CFD), virtual rhinomanometry, and virtual surgery for neonatal congenital nasal pyriform aperture stenosis.

OBJECTIVES: Investigate the implications of Congenital Nasal Pyriform Aperture Stenosis (CNPAS) on neonatal nasal airflow through computational fluid dynamics (CFD), create a virtual rhinomanometry, and simulate the prospective outcomes post-virtual surgical intervention. METHODS: CT scanning of a neonate diagnosed with CNPAS and a control model were used to execute CFD simulations. The segmentation file of the CNPAS underwent manual modifications to simulate a virtual surgical procedure, resulting in a geometry that mirrors a post-operatively corrected patient. Virtual rhinomanometry was reconstructed, and airflow dynamics within the nasal cavity were systematically assessed. The results of the three models were compared. RESULTS: In the CNPAS model, airflow dynamics underwent discernible alterations, with the principal airflow corridor confined to the nasal cavity's upper region. There was a marked pressure drop around the nasal valve, and diminished velocities. This first model of virtual surgery has allowed us to observe that the airflow parameters trended toward the control model, reintroducing an airflow trajectory between the lower and middle turbinates. Virtual rhinomanometry presented near-complete nasal obstruction in the CNPAS model, which showed considerable improvement after the virtual surgery. CONCLUSION: CFD highlights the aerodynamic changes resulting from CNPAS. It also allows for the creation of virtual rhinomanometry and the performance of virtual surgeries. Virtual surgery confirms the therapeutic potential of pyriform aperture enlargement techniques used in clinical practice to improve nasal respiratory function. Future research will investigate additional surgical scenarios and the application of these findings to optimize surgical interventions for CNPAS.

Exploratory subgroup identification in the heterogeneous Cox model: A relatively simple procedure.

For survival analysis applications we propose a novel procedure for identifying subgroups with large treatment effects, with focus on subgroups where treatment is potentially detrimental. The approach, termed forest search, is relatively simple and flexible. All-possible subgroups are screened and selected based on hazard ratio thresholds indicative of harm with assessment according to the standard Cox model. By reversing the role of treatment one can seek to identify substantial benefit. We apply a splitting consistency criteria to identify a subgroup considered "maximally consistent with harm." The type-1 error and power for subgroup identification can be quickly approximated by numerical integration. To aid inference we describe a bootstrap bias-corrected Cox model estimator with variance estimated by a Jacknife approximation. We provide a detailed evaluation of operating characteristics in simulations and compare to virtual twins and generalized random forests where we find the proposal to have favorable performance. In particular, in our simulation setting, we find the proposed approach favorably controls the type-1 error for falsely identifying heterogeneity with higher power and classification accuracy for substantial heterogeneous effects. Two real data applications are provided for publicly available datasets from a clinical trial in oncology, and HIV.