@article{BergauerAkbasBraunetal.2023, author = {Bergauer, Lisa and Akbas, Samira and Braun, Julia and Ganter, Michael T. and Meybohm, Patrick and Hottenrott, Sebastian and Zacharowski, Kai and Raimann, Florian J. and Rivas, Eva and L{\´o}pez-Baamonde, Manuel and Spahn, Donat R. and Noethiger, Christoph B. and Tscholl, David W. and Roche, Tadzio R.}, title = {Visual Blood, visualisation of blood gas analysis in virtual reality, leads to more correct diagnoses: a computer-based, multicentre, simulation study}, series = {Bioengineering}, volume = {10}, journal = {Bioengineering}, number = {3}, issn = {2306-5354}, doi = {10.3390/bioengineering10030340}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-310979}, year = {2023}, abstract = {Interpreting blood gas analysis results can be challenging for the clinician, especially in stressful situations under time pressure. To foster fast and correct interpretation of blood gas results, we developed Visual Blood. This computer-based, multicentre, noninferiority study compared Visual Blood and conventional arterial blood gas (ABG) printouts. We presented six scenarios to anaesthesiologists, once with Visual Blood and once with the conventional ABG printout. The primary outcome was ABG parameter perception. The secondary outcomes included correct clinical diagnoses, perceived diagnostic confidence, and perceived workload. To analyse the results, we used mixed models and matched odds ratios. Analysing 300 within-subject cases, we showed noninferiority of Visual Blood compared to ABG printouts concerning the rate of correctly perceived ABG parameters (rate ratio, 0.96; 95\% CI, 0.92-1.00; p = 0.06). Additionally, the study revealed two times higher odds of making the correct clinical diagnosis using Visual Blood (OR, 2.16; 95\% CI, 1.42-3.29; p < 0.001) than using ABG printouts. There was no or, respectively, weak evidence for a difference in diagnostic confidence (OR, 0.84; 95\% CI, 0.58-1.21; p = 0.34) and perceived workload (Coefficient, 2.44; 95\% CI, -0.09-4.98; p = 0.06). This study showed that participants did not perceive the ABG parameters better, but using Visual Blood resulted in more correct clinical diagnoses than using conventional ABG printouts. This suggests that Visual Blood allows for a higher level of situation awareness beyond individual parameters' perception. However, the study also highlighted the limitations of today's virtual reality headsets and Visual Blood.}, language = {en} } @article{PerraRiccardoDeLorenzoetal.2023, author = {Perra, Alessandra and Riccardo, Chiara Laura and De Lorenzo, Valerio and De Marco, Erika and Di Natale, Lorenzo and Kurotschka, Peter Konstantin and Preti, Antonio and Carta, Mauro Giovanni}, title = {Fully immersive virtual reality-based cognitive remediation for adults with psychosocial disabilities: a systematic scoping review of methods intervention gaps and meta-analysis of published effectiveness studies}, series = {International Journal of Environmental Research and Public Health}, volume = {20}, journal = {International Journal of Environmental Research and Public Health}, number = {2}, issn = {1660-4601}, doi = {10.3390/ijerph20021527}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-304948}, year = {2023}, abstract = {Background: Cognitive Remediation (CR) programs are effective for the treatment of mental diseases; in recent years, Virtual Reality (VR) rehabilitation tools are increasingly used. This study aimed to systematically review and meta-analyze the published randomized controlled trials that used fully immersive VR tools for CR programs in psychiatric rehabilitation. We also wanted to map currently published CR/VR interventions, their methods components, and their evidence base, including the framework of the development intervention of CR in fully immersive VR. Methods: Level 1 of evidence. This study followed the PRISMA extension for Scoping Reviews and Systematic Review. Three electronic databases (Pubmed, Cochrane Library, Embase) were systematically searched, and studies were included if they met the eligibility criteria: only randomized clinical trials, only studies with fully immersive VR, and only CR for the adult population with mental disorders. Results: We found 4905 (database) plus 7 (manual/citation searching articles) eligible studies. According to inclusion criteria, 11 studies were finally reviewed. Of these, nine included patients with mild cognitive impairment, one with schizophrenia, and one with mild dementia. Most studies used an ecological scenario, with improvement across all cognitive domains. Although eight studies showed significant efficacy of CR/VR, the interventions' development was poorly described, and few details were given on the interventions' components. Conclusions: Although CR/VR seems to be effective in clinical and feasibility outcomes, the interventions and their components are not clearly described. This limits the understanding of the effectiveness and undermines their real-world implementation and the establishment of a gold standard for fully immersive VR/CR.}, language = {en} } @article{PerraGalettiZacchedduetal.2023, author = {Perra, Alessandra and Galetti, Alessia and Zaccheddu, Rosanna and Locci, Aurora and Piludu, Federica and Preti, Antonio and Primavera, Diego and Di Natale, Lorenzo and Nardi, Antonio Egidio and Kurotshka, Peter Konstantin and Cossu, Giulia and Sancassiani, Federica and Stella, Giusy and De Lorenzo, Valerio and Zreik, Thurayya and Carta, Mauro Giovanni}, title = {A recovery-oriented program for people with bipolar disorder through virtual reality-based Cognitive Remediation: results of a feasibility randomized clinical trial}, series = {Journal of Clinical Medicine}, volume = {12}, journal = {Journal of Clinical Medicine}, number = {6}, issn = {2077-0383}, doi = {10.3390/jcm12062142}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-311201}, year = {2023}, abstract = {Background: Cognitive impairment is a frequent consequence of bipolar disorder (BD) that is difficult to prevent and treat. In addition, the quality of the preliminary evidence on the treatment of BD through Cognitive Remediation (CR) with traditional methods is poor. This study aims to evaluate the feasibility of a CR intervention with fully immersive Virtual Reality (VR) as an additional treatment for BD and offers preliminary data on its efficacy. Methods: Feasibility randomized controlled cross-over clinical study, with experimental condition lasting three months, crossed between two groups. Experimental condition: CR fully immersive VR recovery-oriented program plus conventional care; Control condition: conventional care. The control group began the experimental condition after a three months period of conventional care (waiting list). After the randomization of 50 people with BD diagnosis, the final sample consists of 39 participants in the experimental condition and 25 in the control condition because of dropouts. Results: Acceptability and tolerability of the intervention were good. Compared to the waitlist group, the experimental group reported a significant improvement regarding cognitive functions (memory: p = 0.003; attention: p = 0.002, verbal fluency: p = 0.010, executive function: p = 0.003), depressive symptoms (p = 0.030), emotional awareness (p = 0.007) and biological rhythms (p = 0.029). Conclusions: The results are preliminary and cannot be considered exhaustive due to the small sample size. However, the evidence of efficacy, together with the good acceptability of the intervention, is of interest. These results suggest the need to conduct studies with larger samples that can confirm this data. Trial registration: ClinicalTrialsgov NCT05070065, registered in September 2021}, language = {en} } @article{HeinLatoschikWienrich2022, author = {Hein, Rebecca M. and Latoschik, Marc Erich and Wienrich, Carolin}, title = {Inter- and transcultural learning in cocial virtual reality: a proposal for an inter- and transcultural virtual object database to be used in the implementation, reflection, and evaluation of virtual encounters}, series = {Multimodal Technologies and Interaction}, volume = {6}, journal = {Multimodal Technologies and Interaction}, number = {7}, issn = {2414-4088}, doi = {10.3390/mti6070050}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-278974}, year = {2022}, abstract = {Visual stimuli are frequently used to improve memory, language learning or perception, and understanding of metacognitive processes. However, in virtual reality (VR), there are few systematically and empirically derived databases. This paper proposes the first collection of virtual objects based on empirical evaluation for inter-and transcultural encounters between English- and German-speaking learners. We used explicit and implicit measurement methods to identify cultural associations and the degree of stereotypical perception for each virtual stimuli (n = 293) through two online studies, including native German and English-speaking participants. The analysis resulted in a final well-describable database of 128 objects (called InteractionSuitcase). In future applications, the objects can be used as a great interaction or conversation asset and behavioral measurement tool in social VR applications, especially in the field of foreign language education. For example, encounters can use the objects to describe their culture, or teachers can intuitively assess stereotyped attitudes of the encounters.}, language = {en} } @article{LandeckAlvarezIgarzabalUnruhetal.2022, author = {Landeck, Maximilian and Alvarez Igarz{\´a}bal, Federico and Unruh, Fabian and Habenicht, Hannah and Khoshnoud, Shiva and Wittmann, Marc and Lugrin, Jean-Luc and Latoschik, Marc Erich}, title = {Journey through a virtual tunnel: Simulated motion and its effects on the experience of time}, series = {Frontiers in Virtual Reality}, volume = {3}, journal = {Frontiers in Virtual Reality}, issn = {2673-4192}, doi = {10.3389/frvir.2022.1059971}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-301519}, year = {2022}, abstract = {This paper examines the relationship between time and motion perception in virtual environments. Previous work has shown that the perception of motion can affect the perception of time. We developed a virtual environment that simulates motion in a tunnel and measured its effects on the estimation of the duration of time, the speed at which perceived time passes, and the illusion of self-motion, also known as vection. When large areas of the visual field move in the same direction, vection can occur; observers often perceive this as self-motion rather than motion of the environment. To generate different levels of vection and investigate its effects on time perception, we developed an abstract procedural tunnel generator. The generator can simulate different speeds and densities of tunnel sections (visibly distinguishable sections that form the virtual tunnel), as well as the degree of embodiment of the user avatar (with or without virtual hands). We exposed participants to various tunnel simulations with different durations, speeds, and densities in a remote desktop and a virtual reality (VR) laboratory study. Time passed subjectively faster under high-speed and high-density conditions in both studies. The experience of self-motion was also stronger under high-speed and high-density conditions. Both studies revealed a significant correlation between the perceived passage of time and perceived self-motion. Subjects in the virtual reality study reported a stronger self-motion experience, a faster perceived passage of time, and shorter time estimates than subjects in the desktop study. Our results suggest that a virtual tunnel simulation can manipulate time perception in virtual reality. We will explore these results for the development of virtual reality applications for therapeutic approaches in our future work. This could be particularly useful in treating disorders like depression, autism, and schizophrenia, which are known to be associated with distortions in time perception. For example, the tunnel could be therapeutically applied by resetting patients' time perceptions by exposing them to the tunnel under different conditions, such as increasing or decreasing perceived time.}, language = {en} } @article{GlemarecLugrinBosseretal.2022, author = {Gl{\´e}marec, Yann and Lugrin, Jean-Luc and Bosser, Anne-Gwenn and Buche, C{\´e}dric and Latoschik, Marc Erich}, title = {Controlling the stage: a high-level control system for virtual audiences in Virtual Reality}, series = {Frontiers in Virtual Reality}, volume = {3}, journal = {Frontiers in Virtual Reality}, issn = {2673-4192}, doi = {10.3389/frvir.2022.876433}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-284601}, year = {2022}, abstract = {This article presents a novel method for controlling a virtual audience system (VAS) in Virtual Reality (VR) application, called STAGE, which has been originally designed for supervised public speaking training in university seminars dedicated to the preparation and delivery of scientific talks. We are interested in creating pedagogical narratives: narratives encompass affective phenomenon and rather than organizing events changing the course of a training scenario, pedagogical plans using our system focus on organizing the affects it arouses for the trainees. Efficiently controlling a virtual audience towards a specific training objective while evaluating the speaker's performance presents a challenge for a seminar instructor: the high level of cognitive and physical demands required to be able to control the virtual audience, whilst evaluating speaker's performance, adjusting and allowing it to quickly react to the user's behaviors and interactions. It is indeed a critical limitation of a number of existing systems that they rely on a Wizard of Oz approach, where the tutor drives the audience in reaction to the user's performance. We address this problem by integrating with a VAS a high-level control component for tutors, which allows using predefined audience behavior rules, defining custom ones, as well as intervening during run-time for finer control of the unfolding of the pedagogical plan. At its core, this component offers a tool to program, select, modify and monitor interactive training narratives using a high-level representation. The STAGE offers the following features: i) a high-level API to program pedagogical narratives focusing on a specific public speaking situation and training objectives, ii) an interactive visualization interface iii) computation and visualization of user metrics, iv) a semi-autonomous virtual audience composed of virtual spectators with automatic reactions to the speaker and surrounding spectators while following the pedagogical plan V) and the possibility for the instructor to embody a virtual spectator to ask questions or guide the speaker from within the Virtual Environment. We present here the design, and implementation of the tutoring system and its integration in STAGE, and discuss its reception by end-users.}, language = {en} } @article{SteinhaeusserOberdoerfervonMammenetal.2022, author = {Steinhaeusser, Sophia C. and Oberd{\"o}rfer, Sebastian and von Mammen, Sebastian and Latoschik, Marc Erich and Lugrin, Birgit}, title = {Joyful adventures and frightening places - designing emotion-inducing virtual environments}, series = {Frontiers in Virtual Reality}, volume = {3}, journal = {Frontiers in Virtual Reality}, issn = {2673-4192}, doi = {10.3389/frvir.2022.919163}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-284831}, year = {2022}, abstract = {Virtual environments (VEs) can evoke and support emotions, as experienced when playing emotionally arousing games. We theoretically approach the design of fear and joy evoking VEs based on a literature review of empirical studies on virtual and real environments as well as video games' reviews and content analyses. We define the design space and identify central design elements that evoke specific positive and negative emotions. Based on that, we derive and present guidelines for emotion-inducing VE design with respect to design themes, colors and textures, and lighting configurations. To validate our guidelines in two user studies, we 1) expose participants to 360° videos of VEs designed following the individual guidelines and 2) immerse them in a neutral, positive and negative emotion-inducing VEs combining all respective guidelines in Virtual Reality. The results support our theoretically derived guidelines by revealing significant differences in terms of fear and joy induction.}, language = {en} } @article{KiserGromerPaulietal.2022, author = {Kiser, Dominik P. and Gromer, Daniel and Pauli, Paul and Hilger, Kirsten}, title = {A virtual reality social conditioned place preference paradigm for humans: Does trait social anxiety affect approach and avoidance of virtual agents?}, series = {Frontiers in Virtual Reality}, volume = {3}, journal = {Frontiers in Virtual Reality}, issn = {2673-4192}, doi = {10.3389/frvir.2022.916575}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-293564}, year = {2022}, abstract = {Approach and avoidance of positive and negative social cues are fundamental to prevent isolation and ensure survival. High trait social anxiety is characterized by an avoidance of social situations and extensive avoidance is a risk factor for the development of social anxiety disorder (SAD). Therefore, experimental methods to assess social avoidance behavior in humans are essential. The social conditioned place preference (SCPP) paradigm is a well-established experimental paradigm in animal research that is used to objectively investigate social approach-avoidance mechanisms. We retranslated this paradigm for human research using virtual reality. To this end, 58 healthy adults were exposed to either a happy- or angry-looking virtual agent in a specific room, and the effects of this encounter on dwell time as well as evaluation of this room in a later test without an agent were examined. We did not observe a general SCPP effect on dwell time or ratings but discovered a moderation by trait social anxiety, in which participants with higher trait social anxiety spent less time in the room in which the angry agent was present before, suggesting that higher levels of trait social anxiety foster conditioned social avoidance. However, further studies are needed to verify this observation and substantiate an association with social anxiety disorder. We discussed the strengths, limitations, and technical implications of our paradigm for future investigations to more comprehensively understand the mechanisms involved in social anxiety and facilitate the development of new personalized treatment approaches by using virtual reality.}, language = {en} } @article{Halbig Babu Gatter etal.2022, author = {Halbig , Andreas and Babu , Sooraj K. and Gatter , Shirin and Latoschik , Marc Erich and Brukamp, Kirsten and von Mammen , Sebastian}, title = {Opportunities and challenges of Virtual Reality in healthcare - a domain experts inquiry}, series = {Frontiers in Virtual Reality}, volume = {3}, journal = {Frontiers in Virtual Reality}, issn = {2673-4192}, doi = {10.3389/frvir.2022.837616}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-284752}, year = {2022}, abstract = {In recent years, the applications and accessibility of Virtual Reality (VR) for the healthcare sector have continued to grow. However, so far, most VR applications are only relevant in research settings. Information about what healthcare professionals would need to independently integrate VR applications into their daily working routines is missing. The actual needs and concerns of the people who work in the healthcare sector are often disregarded in the development of VR applications, even though they are the ones who are supposed to use them in practice. By means of this study, we systematically involve health professionals in the development process of VR applications. In particular, we conducted an online survey with 102 healthcare professionals based on a video prototype which demonstrates a software platform that allows them to create and utilise VR experiences on their own. For this study, we adapted and extended the Technology Acceptance Model (TAM). The survey focused on the perceived usefulness and the ease of use of such a platform, as well as the attitude and ethical concerns the users might have. The results show a generally positive attitude toward such a software platform. The users can imagine various use cases in different health domains. However, the perceived usefulness is tied to the actual ease of use of the platform and sufficient support for learning and working with the platform. In the discussion, we explain how these results can be generalized to facilitate the integration of VR in healthcare practice.}, language = {en} } @article{OberdoerferSchraudtLatoschik2022, author = {Oberd{\"o}rfer, Sebastian and Schraudt, David and Latoschik, Marc Erich}, title = {Embodied gambling — investigating the influence of level of embodiment, avatar appearance, and virtual environment design on an online VR slot machine}, series = {Frontiers in Virtual Reality}, volume = {3}, journal = {Frontiers in Virtual Reality}, issn = {2673-4192}, doi = {10.3389/frvir.2022.828553}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-284662}, year = {2022}, abstract = {Slot machines are one of the most played games by players suffering from gambling disorder. New technologies like immersive Virtual Reality (VR) offer more possibilities to exploit erroneous beliefs in the context of gambling. Recent research indicates a higher risk potential when playing a slot machine in VR than on desktop. To continue this investigation, we evaluate the effects of providing different degrees of embodiment, i.e., minimal and full embodiment. The avatars used for the full embodiment further differ in their appearance, i.e., they elicit a high or a low socio-economic status. The virtual environment (VE) design can cause a potential influence on the overall gambling behavior. Thus, we also embed the slot machine in two different VEs that differ in their emotional design: a colorful underwater playground environment and a virtual counterpart of our lab. These design considerations resulted in four different versions of the same VR slot machine: 1) full embodiment with high socio-economic status, 2) full embodiment with low socio-economic status, 3) minimal embodiment playground VE, and 4) minimal embodiment laboratory VE. Both full embodiment versions also used the playground VE. We determine the risk potential by logging gambling frequency as well as stake size, and measuring harm-inducing factors, i.e., dissociation, urge to gamble, dark flow, and illusion of control, using questionnaires. Following a between groups experimental design, 82 participants played for 20 game rounds one of the four versions. We recruited our sample from the students enrolled at the University of W{\"u}rzburg. Our safety protocol ensured that only participants without any recent gambling activity took part in the experiment. In this comparative user study, we found no effect of the embodiment nor VE design on neither the gambling frequency, stake sizes, nor risk potential. However, our results provide further support for the hypothesis of the higher visual angle on gambling stimuli and hence the increased emotional response being the true cause for the higher risk potential.}, language = {en} }