Publications

@article{barrett_force_2024,

title = {Force plate assessments in reconnaissance marine training company},

author = {Trevor Barrett and Robert Faulk and Army Master Sergeant and Jill Boberg and Matthew Bartels and Marine Lieutenant Colonel and Leslie A. Saxon},

url = {https://bmcsportsscimedrehabil.biomedcentral.com/articles/10.1186/s13102-023-00796-z},

doi = {10.1186/s13102-023-00796-z},

issn = {2052-1847},

year  = {2024},

date = {2024-01-01},

urldate = {2024-01-22},

journal = {BMC Sports Sci Med Rehabil},

volume = {16},

number = {1},

pages = {16},

abstract = {Abstract 

 The ability to obtain dynamic movement assessments using force plate technology holds the promise of providing more detailed knowledge of the strength, balance and forces generated by active-duty military personnel. To date, there are not well-defined use cases for implementation of force plate assessments in military training environments. We sought to determine if force plate technology assessments could provide additional insights, related to the likelihood of graduation, beyond that provided by traditional physical fitness tests (PFT’s), in an elite Marine training school. Serial force plate measures were also obtained on those Marines successfully completing training to determine if consistent measures reflecting the effects of training on muscle skeletal load-over-time could be accurately measured. A pre-training force plate assessment performed in 112 Marines did not predict graduation rates. For Marines who successfully completed the course, serial measures obtained throughout training were highly variable for each individual and no firm conclusions could be drawn related to load imposed or the fitness attained during training.},

keywords = {MedVR, UARC},

pubstate = {published},

tppubtype = {article}

}

@article{spiegel_what_2024,

title = {What Is Medical Extended Reality? A Taxonomy Defining the Current Breadth and Depth of an Evolving Field},

author = {Brennan M. R. Spiegel and Albert Rizzo and Susan Persky and Omer Liran and Brenda Wiederhold and Susan Woods and Kate Donovan and Korak Sarkar and Henry Xiang and Sun Joo and Rohan Jotwani and Min Lang and Margot Paul and Mike Senter-Zapata and Keith Widmeier and Haipeng Zhang},

url = {https://www.liebertpub.com/doi/10.1089/jmxr.2023.0012},

doi = {10.1089/jmxr.2023.0012},

issn = {2994-1520},

year  = {2024},

date = {2024-01-01},

urldate = {2024-02-20},

journal = {Journal of Medical Extended Reality},

volume = {1},

number = {1},

pages = {4–12},

keywords = {MedVR, UARC},

pubstate = {published},

tppubtype = {article}

}

@article{gibson_does_2023,

title = {Does early detection of atrial fibrillation reduce the risk of thromboembolic events? Rationale and design of the Heartline study},

author = {C. Michael Gibson and Steven Steinhubl and Dhanunjaya Lakkireddy and Mintu P. Turakhia and Rod Passman and W. Schuyler Jones and T. Jared Bunch and Anne B. Curtis and Eric D. Peterson and Jeremy Ruskin and Leslie Saxon and Michael Tarino and Khaldoun G. Tarakji and Nassir Marrouche and Mithun Patel and Ante Harxhi and Simrati Kaul and Janeta Nikolovski and Stephanie Juan and Kevin Wildenhaus and C. V. Damaraju and John A. Spertus},

url = {https://www.sciencedirect.com/science/article/pii/S0002870323000145},

doi = {10.1016/j.ahj.2023.01.004},

issn = {0002-8703},

year  = {2023},

date = {2023-05-01},

urldate = {2023-03-31},

journal = {American Heart Journal},

volume = {259},

pages = {30–41},

abstract = {Background 

The impact of using direct-to-consumer wearable devices as a means to timely detect atrial fibrillation (AF) and to improve clinical outcomes is unknown. 

Methods 

Heartline is a pragmatic, randomized, and decentralized application-based trial of US participants aged ≥65 years. Two randomized cohorts include adults with possession of an iPhone and without a history of AF and those with a diagnosis of AF taking a direct oral anticoagulant (DOAC) for ≥30 days. Participants within each cohort are randomized (3:1) to either a core digital engagement program (CDEP) via iPhone application (Heartline application) and an Apple Watch (Apple Watch Group) or CDEP alone (iPhone-only Group). The Apple Watch Group has the watch irregular rhythm notification (IRN) feature enabled and access to the ECG application on the Apple Watch. If an IRN notification is issued for suspected AF then the study application instructs participants in the Apple Watch Group to seek medical care. All participants were “watch-naïve” at time of enrollment and have an option to either buy or loan an Apple Watch as part of this study. The primary end point is time from randomization to clinical diagnosis of AF, with confirmation by health care claims. Key secondary endpoint are claims-based incidence of a 6-component composite cardiovascular/systemic embolism/mortality event, DOAC medication use and adherence, costs/health resource utilization, and frequency of hospitalizations for bleeding. All study assessments, including patient-reported outcomes, are conducted through the study application. The target study enrollment is approximately 28,000 participants in total; at time of manuscript submission, a total of 26,485 participants have been enrolled into the study. 

Conclusion 

The Heartline Study will assess if an Apple Watch with the IRN and ECG application, along with application-facilitated digital health engagement modules, improves time to AF diagnosis and cardiovascular outcomes in a real-world environment. 

Trial registration 

ClinicalTrials.gov Identifier: NCT04276441.},

keywords = {MedVR, UARC},

pubstate = {published},

tppubtype = {article}

}

@article{rothbaum_virtual_2023,

title = {Virtual Reality Exposure Therapy Compared to Prolonged Exposure Therapy With and Without D-Cycloserine},

author = {Barbara Rothbaum and JoAnn Difede and Albert Rizzo and Katarzyna Wyka and Lisa Spielman and Christopher Reist and Michael Roy and Tanja Jovanovic and Seth Norrholm and Judith Cukor and Megan Olden and Charles Glatt and Francis Lee},

url = {https://linkinghub.elsevier.com/retrieve/pii/S0006322323001622},

doi = {10.1016/j.biopsych.2023.02.088},

issn = {00063223},

year  = {2023},

date = {2023-05-01},

urldate = {2023-08-24},

journal = {Biological Psychiatry},

volume = {93},

number = {9},

pages = {S28–S29},

keywords = {MedVR},

pubstate = {published},

tppubtype = {article}

}

@article{hsu_virtual_2023,

title = {A virtual reality program to assess cognitive function in multiple sclerosis: A pilot study},

author = {Wan-Yu Hsu and Joaquin A. Anguera and Albert Rizzo and Richard Campusano and Nancy D. Chiaravalloti and John DeLuca and Adam Gazzaley and Riley M. Bove},

url = {https://www.proquest.com/docview/2787027204/abstract/BEA88F7BB72B4623PQ/1},

doi = {10.3389/fnhum.2023.1139316},

year  = {2023},

date = {2023-03-01},

urldate = {2023-03-31},

journal = {Frontiers in Human Neuroscience},

abstract = {Introduction: Cognitive impairment is a debilitating symptom in people with multiple sclerosis (MS). Most of the neuropsychological tasks have little resemblance to everyday life. There is a need for ecologically valid tools for assessing cognition in real-life functional contexts in MS. One potential solution would involve the use of virtual reality (VR) to exert finer control over the task presentation environment; however, VR studies in the MS population are scarce. Objectives: To explore the utility and feasibility of a VR program for cognitive assessment in MS. Methods: A VR classroom embedded with a continuous performance task (CPT) was assessed in 10 non-MS adults and 10 people with MS with low cognitive functioning. Participants performed the CPT with distractors (ie. WD) and without distractors (ie. ND). The Symbol Digit Modalities Test (SDMT), California Verbal Learning Test – II (CVLT-II), and a feedback survey on the VR program were administered. Results: People with MS exhibited greater reaction time variability (RTV) compared to non-MS participants, and greater RTV in both WD and ND conditions was associated with lower SDMT. Conclusions: VR tools warrant further research to determine their value as an ecologically valid platform for assessing cognition and everyday functioning in people with MS.},

note = {Place: Lausanne, Switzerland 

Publisher: Frontiers Research Foundation 

Section: ORIGINAL RESEARCH article},

keywords = {MedVR, UARC},

pubstate = {published},

tppubtype = {article}

}

@article{vlake_reporting_2023,

title = {Reporting the early stage clinical evaluation of virtual-reality-based intervention trials: RATE-VR},

author = {Johan H. Vlake and Jasper Bommel and Giuseppe Riva and Brenda K. Wiederhold and Pietro Cipresso and Albert Skip Rizzo and Cristina Botella and Lotty Hooft and O. Joseph Bienvenu and Bart Geerts and Evert-Jan Wils and Diederik Gommers and Michel E. Genderen},

url = {https://www.nature.com/articles/s41591-022-02085-7},

doi = {10.1038/s41591-022-02085-7},

issn = {1546-170X},

year  = {2023},

date = {2023-01-01},

urldate = {2023-03-31},

journal = {Nat Med},

volume = {29},

number = {1},

pages = {12–13},

note = {Number: 1 

Publisher: Nature Publishing Group},

keywords = {MedVR, UARC},

pubstate = {published},

tppubtype = {article}

}

@article{goel_framework_2023,

title = {Framework for Accurate Classification of Self-Reported Stress From Multisession Functional MRI Data of Veterans With Posttraumatic Stress},

author = {Rahul Goel and Teresa Tse and Lia J. Smith and Andrew Floren and Bruce Naylor and M. Wright Williams and Ramiro Salas and Albert S. Rizzo and David Ress},

url = {http://journals.sagepub.com/doi/10.1177/24705470231203655},

doi = {10.1177/24705470231203655},

issn = {2470-5470, 2470-5470},

year  = {2023},

date = {2023-01-01},

urldate = {2023-12-07},

journal = {Chronic Stress},

volume = {7},

pages = {24705470231203655},

abstract = {Background: Posttraumatic stress disorder (PTSD) is a significant burden among combat Veterans returning from the wars in Iraq and Afghanistan. While empirically supported treatments have demonstrated reductions in PTSD symptomatology, there remains a need to improve treatment effectiveness. Functional magnetic resonance imaging (fMRI) neurofeedback has emerged as a possible treatment to ameliorate PTSD symptom severity. Virtual reality (VR) approaches have also shown promise in increasing treatment compliance and outcomes. To facilitate fMRI neurofeedback-associated therapies, it would be advantageous to accurately classify internal brain stress levels while Veterans are exposed to trauma-associated VR imagery. Methods: Across 2 sessions, we used fMRI to collect neural responses to trauma-associated VR-like stimuli among male combat Veterans with PTSD symptoms (N = 8). Veterans reported their self-perceived stress level on a scale from 1 to 8 every 15 s throughout the fMRI sessions. In our proposed framework, we precisely sample the fMRI data on cortical gray matter, blurring the data along the gray-matter manifold to reduce noise and dimensionality while preserving maximum neural information. Then, we independently applied 3 machine learning (ML) algorithms to this fMRI data collected across 2 sessions, separately for each Veteran, to build individualized ML models that predicted their internal brain states (self-reported stress responses). Results: We accurately classified the 8-class self-reported stress responses with a mean (± standard error) root mean square error of 0.6 (± 0.1) across all Veterans using the best ML approach. Conclusions: The findings demonstrate the predictive ability of ML algorithms applied to whole-brain cortical fMRI data collected during individual Veteran sessions. The framework we have developed to preprocess whole-brain cortical fMRI data and train ML models across sessions would provide a valuable tool to enable individualized real-time fMRI neurofeedback during VR-like exposure therapy for PTSD.},

keywords = {MedVR, UARC},

pubstate = {published},

tppubtype = {article}

}

@article{difede_enhancing_2022,

title = {Enhancing exposure therapy for posttraumatic stress disorder (PTSD): a randomized clinical trial of virtual reality and imaginal exposure with a cognitive enhancer},

author = {JoAnn Difede and Barbara O. Rothbaum and Albert A. Rizzo and Katarzyna Wyka and Lisa Spielman and Christopher Reist and Michael J. Roy and Tanja Jovanovic and Seth D. Norrholm and Judith Cukor and Megan Olden and Charles E. Glatt and Francis S. Lee},

url = {https://www.nature.com/articles/s41398-022-02066-x},

doi = {10.1038/s41398-022-02066-x},

issn = {2158-3188},

year  = {2022},

date = {2022-12-01},

urldate = {2022-09-13},

journal = {Transl Psychiatry},

volume = {12},

number = {1},

pages = {299},

abstract = {Abstract Posttraumatic stress disorder (PTSD) is a significant public health issue. Yet, there are limited treatment options and no data to suggest which treatment will work for whom. We tested the efficacy of virtual reality exposure (VRE) or prolonged imaginal exposure (PE), augmented with D-cycloserine (DCS) for combat-related PTSD. As an exploratory aim, we examined whether brain-derived neurotrophic factor (BDNF) and fatty acid amide hydrolase (FAAH) moderated treatment response. Military personnel with PTSD ( n = 192) were recruited into a multisite double-blind randomized controlled trial to receive nine weeks of VRE or PE, with DCS or placebo. Primary outcome was the improvement in symptom severity. Randomization was stratified by comorbid depression (MDD) and site. Participants in both VRE and PE showed similar meaningful clinical improvement with no difference between the treatment groups. A significant interaction ( p = 0.45) suggested VRE was more effective for depressed participants (CAPS difference M = 3.51 [95% CI 1.17–5.86]},

keywords = {DTIC, MedVR, Virtual Humans},

pubstate = {published},

tppubtype = {article}

}

@article{maihofer_rare_2022,

title = {Rare copy number variation in posttraumatic stress disorder},

author = {Adam X. Maihofer and Worrawat Engchuan and Guillaume Huguet and Marieke Klein and Jeffrey R. MacDonald and Omar Shanta and Bhooma Thiruvahindrapuram and Martineau Jean-louis and Zohra Saci and Sebastien Jacquemont and Stephen W. Scherer and Elizabeth Ketema and Allison E. Aiello and Ananda B. Amstadter and Esmina Avdibegović and Dragan Babic and Dewleen G. Baker and Jonathan I. Bisson and Marco P. Boks and Elizabeth A. Bolger and Richard A. Bryant and Angela C. Bustamante and Jose Miguel Caldas-de-Almeida and Graça Cardoso and Jurgen Deckert and Douglas L. Delahanty and Katharina Domschke and Boadie W. Dunlop and Alma Dzubur-Kulenovic and Alexandra Evans and Norah C. Feeny and Carol E. Franz and Aarti Gautam and Elbert Geuze and Aferdita Goci and Rasha Hammamieh and Miro Jakovljevic and Marti Jett and Ian Jones and Milissa L. Kaufman and Ronald C. Kessler and Anthony P. King and William S. Kremen and Bruce R. Lawford and Lauren A. M. Lebois and Catrin Lewis and Israel Liberzon and Sarah D. Linnstaedt and Bozo Lugonja and Jurjen J. Luykx and Michael J. Lyons and Matig R. Mavissakalian and Katie A. McLaughlin and Samuel A. McLean and Divya Mehta and Rebecca Mellor and Charles Phillip Morris and Seid Muhie and Holly K. Orcutt and Matthew Peverill and Andrew Ratanatharathorn and Victoria B. Risbrough and Albert Rizzo and Andrea L. Roberts and Alex O. Rothbaum and Barbara O. Rothbaum and Peter Roy-Byrne and Kenneth J. Ruggiero and Bart P. F. Rutten and Dick Schijven and Julia S. Seng and Christina M. Sheerin and Michael A. Sorenson and Martin H. Teicher and Monica Uddin and Robert J. Ursano and Christiaan H. Vinkers and Joanne Voisey and Heike Weber and Sherry Winternitz and Miguel Xavier and Ruoting Yang and Ross McD Young and Lori A. Zoellner and Rany M. Salem and Richard A. Shaffer and Tianying Wu and Kerry J. Ressler and Murray B. Stein and Karestan C. Koenen and Jonathan Sebat and Caroline M. Nievergelt},

url = {https://www.nature.com/articles/s41380-022-01776-4},

doi = {10.1038/s41380-022-01776-4},

issn = {1476-5578},

year  = {2022},

date = {2022-12-01},

urldate = {2023-03-31},

journal = {Mol Psychiatry},

volume = {27},

number = {12},

pages = {5062–5069},

abstract = {Posttraumatic stress disorder (PTSD) is a heritable (h2 = 24–71%) psychiatric illness. Copy number variation (CNV) is a form of rare genetic variation that has been implicated in the etiology of psychiatric disorders, but no large-scale investigation of CNV in PTSD has been performed. We present an association study of CNV burden and PTSD symptoms in a sample of 114,383 participants (13,036 cases and 101,347 controls) of European ancestry. CNVs were called using two calling algorithms and intersected to a consensus set. Quality control was performed to remove strong outlier samples. CNVs were examined for association with PTSD within each cohort using linear or logistic regression analysis adjusted for population structure and CNV quality metrics, then inverse variance weighted meta-analyzed across cohorts. We examined the genome-wide total span of CNVs, enrichment of CNVs within specified gene-sets, and CNVs overlapping individual genes and implicated neurodevelopmental regions. The total distance covered by deletions crossing over known neurodevelopmental CNV regions was significant (beta = 0.029},

note = {Number: 12 

Publisher: Nature Publishing Group},

keywords = {MedVR, UARC},

pubstate = {published},

tppubtype = {article}

}

@article{harvey_technology_2022,

title = {Technology and Mental Health: State of the Art for Assessment and Treatment},

author = {Philip D. Harvey and Colin A. Depp and Albert A. Rizzo and Gregory P. Strauss and David Spelber and Linda L. Carpenter and Ned H. Kalin and John H. Krystal and William M. McDonald and Charles B. Nemeroff and Carolyn I. Rodriguez and Alik S. Widge and John Torous},

url = {http://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.21121254},

doi = {10.1176/appi.ajp.21121254},

issn = {0002-953X, 1535-7228},

year  = {2022},

date = {2022-12-01},

urldate = {2023-08-22},

journal = {AJP},

volume = {179},

number = {12},

pages = {897–914},

keywords = {MedVR, UARC},

pubstate = {published},

tppubtype = {article}

}

@article{korand_association_2022,

title = {The Association Between Multitasking and Multi-Patient Care Skills in a Simulated Patient Care Video Game Among Second Year Medical Students Based on Specialty Choice},

author = {Sridevi Korand and Cha Chi Fung and Sammy Cohen and Thomas B. Talbot and Susan Fischer and Cindy Luu and Mariam Sargsyan and Eyal Ben-Isaac and Juan Espinoza and Todd P. Chang},

url = {http://journals.sagepub.com/doi/10.1177/10468781221103460},

doi = {10.1177/10468781221103460},

issn = {1046-8781, 1552-826X},

year  = {2022},

date = {2022-08-01},

urldate = {2022-09-21},

journal = {Simulation & Gaming},

volume = {53},

number = {4},

pages = {335–352},

abstract = {Background and Objective Healthcare providers require multitasking and multi-patient care skills, and training programs do not formally incorporate curricula specifically for multitasking skills to trainees. The medical education community is in equipoise on whether multitasking ability is a fixed trait. Furthermore, it is unclear whether multitasking ability affects those who gravitate toward careers that demand it, particularly among medical students deciding on a specialty. We sought to define the association between specialty choice, multitasking abilities and multi-patient care delivery among pre-clinical medical students. For this study, we examined both efficiency and accuracy metrics within multitasking and whether they were different between students choosing specialties. Methods This was a planned cross-sectional sub-study focused on 2nd year medical students (MS-IIs) within a parent study evaluating multi-patient care skills using a serious game (VitalSigns:ED TM ) depicting a pediatric emergency department. Subjects completed a Multitasking Ability Test (MTAT) and five VitalSigns:ED gameplays. The predictor variable was specialty choice, categorized into multitasking and non-multitasking groups. Outcome variables measuring efficiency and diagnostic accuracy were obtained from the MTAT and the game. The primary analysis was a Mann–Whitney U test, and secondary analyses employed Spearman Rank correlations. Results Twelve students applied to multitasking specialties and 18 applied to others. Those in the multitasking specialties had faster MTAT completions than the other cohort (29.8 vs. 59.7 sec, 95%CI difference -0.9 to -39.8 sec). Differential diagnoses were higher in multitasking specialties in VitalSigns:ED (2.03 vs. 1.06, 95%CI difference +0.05 to +1.54) but efficiency metrics in the game did not differ. Conclusion Multitasking and multi-patient care performance show some association with preferred specialty choices for MS-IIs prior to clinical exposure.},

keywords = {MedVR},

pubstate = {published},

tppubtype = {article}

}

@article{schweitzer_virtual_2022,

title = {Virtual Reality and ADHD: Clinical Assessment and Treatment in the Metaverse},

author = {Julie B. Schweitzer and Albert “Skip” Rizzo},

url = {https://guilfordjournals.com/doi/abs/10.1521/adhd.2022.30.3.1},

doi = {10.1521/adhd.2022.30.3.1},

issn = {1065-8025},

year  = {2022},

date = {2022-05-01},

urldate = {2022-09-13},

journal = {The ADHD Report},

volume = {30},

number = {3},

pages = {1–9},

keywords = {MedVR, VR},

pubstate = {published},

tppubtype = {article}

}

@article{stokes_measuring_2022,

title = {Measuring Attentional Distraction in Children With ADHD Using Virtual Reality Technology With Eye-Tracking},

author = {Jared D. Stokes and Albert Rizzo and Joy J. Geng and Julie B. Schweitzer},

url = {https://www.frontiersin.org/articles/10.3389/frvir.2022.855895},

issn = {2673-4192},

year  = {2022},

date = {2022-01-01},

urldate = {2022-09-13},

journal = {Frontiers in Virtual Reality},

volume = {3},

abstract = {Objective: Distractions inordinately impair attention in children with Attention-Deficit Hyperactivity Disorder (ADHD) but examining this behavior under real-life conditions poses a challenge for researchers and clinicians. Virtual reality (VR) technologies may mitigate the limitations of traditional laboratory methods by providing a more ecologically relevant experience. The use of eye-tracking measures to assess attentional functioning in a VR context in ADHD is novel. In this proof of principle project, we evaluate the temporal dynamics of distraction via eye-tracking measures in a VR classroom setting with 20 children diagnosed with ADHD between 8 and 12 years of age.Method: We recorded continuous eye movements while participants performed math, Stroop, and continuous performance test (CPT) tasks with a series of “real-world” classroom distractors presented. We analyzed the impact of the distractors on rates of on-task performance and on-task, eye-gaze (i.e., looking at a classroom whiteboard) versus off-task eye-gaze (i.e., looking away from the whiteboard).Results: We found that while children did not always look at distractors themselves for long periods of time, the presence of a distractor disrupted on-task gaze at task-relevant whiteboard stimuli and lowered rates of task performance. This suggests that children with attention deficits may have a hard time returning to tasks once those tasks are interrupted, even if the distractor itself does not hold attention. Eye-tracking measures within the VR context can reveal rich information about attentional disruption.Conclusions: Leveraging virtual reality technology in combination with eye-tracking measures is well-suited to advance the understanding of mechanisms underlying attentional impairment in naturalistic settings. Assessment within these immersive and well-controlled simulated environments provides new options for increasing our understanding of distractibility and its potential impact on the development of interventions for children with ADHD.},

keywords = {MedVR, VR},

pubstate = {published},

tppubtype = {article}

}

@article{aster_responsivity_2022,

title = {Responsivity of the Striatal Dopamine System to Methylphenidate—A Within-Subject I-123-β-CIT-SPECT Study in Male Children and Adolescents With Attention-Deficit/Hyperactivity Disorder},

author = {Hans-Christoph Aster and Marcel Romanos and Susanne Walitza and Manfred Gerlach and Andreas Mühlberger and Albert Rizzo and Marta Andreatta and Natalie Hasenauer and Philipp E. Hartrampf and Kai Nerlich and Christoph Reiners and Reinhard Lorenz and Andreas K. Buck and Lorenz Deserno},

url = {https://www.frontiersin.org/articles/10.3389/fpsyt.2022.804730},

issn = {1664-0640},

year  = {2022},

date = {2022-01-01},

urldate = {2022-09-13},

journal = {Frontiers in Psychiatry},

volume = {13},

abstract = {Background:Methylphenidate (MPH) is the first-line pharmacological treatment of attention-deficit/hyperactivity disorder (ADHD). MPH binds to the dopamine (DA) transporter (DAT), which has high density in the striatum. Assessments of the striatal dopamine transporter by single positron emission computed tomography (SPECT) in childhood and adolescent patients are rare but can provide insight on how the effects of MPH affect DAT availability. The aim of our within-subject study was to investigate the effect of MPH on DAT availability and how responsivity to MPH in DAT availability is linked to clinical symptoms and cognitive functioning.MethodsThirteen adolescent male patients (9–16 years) with a diagnosis of ADHD according to the DSM-IV and long-term stimulant medication (for at least 6 months) with MPH were assessed twice within 7 days using SPECT after application of I-123-β-CIT to examine DAT binding potential (DAT BP). SPECT measures took place in an on- and off-MPH status balanced for order across participants. A virtual reality continuous performance test was performed at each time point. Further clinical symptoms were assessed for baseline off-MPH.ResultsOn-MPH status was associated with a highly significant change (−29.9%) of striatal DAT BP as compared to off-MPH (t = −4.12},

keywords = {MedVR},

pubstate = {published},

tppubtype = {article}

}

@article{ionescu_360_2021,

title = {360° Videos for Immersive Mental Health Interventions: a Systematic Review},

author = {Alina Ionescu and Tom Van Daele and Albert Rizzo and Carolyn Blair and Paul Best},

url = {https://doi.org/10.1007/s41347-021-00221-7},

doi = {10.1007/s41347-021-00221-7},

issn = {2366-5963},

year  = {2021},

date = {2021-12-01},

urldate = {2022-09-13},

journal = {J. technol. behav. sci.},

volume = {6},

number = {4},

pages = {631–651},

abstract = {Virtual reality is increasingly recognized as a powerful method for clinical interventions in the mental health field, but has yet to achieve mainstream adoption in routine mental healthcare settings. A similar, yet slightly different technology, immersive 360° videos might have the potential to cover this gap, by requiring both lower costs and less technical skills to construct and operate such virtual environments. This systematic review therefore aims to identify, evaluate, and summarize mental health interventions using immersive 360° videos to support an understanding of their implementation in daily clinical practice. The quality of the 14 selected studies was evaluated using a critical appraisal tool, addressing populations with clinical levels of psychopathological symptoms, somatic conditions associated with psychological implications, and other at-risk groups. Immersive 360° videos successfully increased users’ feelings of presence, given their realistic features, and therefore yielded positive outcomes in clinical interventions where presence is considered as an essential precondition. Because the technical skills required to create immersive 360° video footage are fairly limited, most of the interventions using this approach have been created by mental health researchers or clinicians themselves. Immersive 360° videos are still in an early phase of implementation as a tool for clinical interventions for mental health, resulting in high heterogeneity in focus, procedures, and research designs. An important next step for making use of this technology may therefore involve the creation of standardized procedures, as a means to increase the quality of research and evidence-based interventions.},

keywords = {MedVR, VR},

pubstate = {published},

tppubtype = {article}

}

@article{talbot_advances_2021,

title = {Advances in Affective Computing for Psychological Applications: From the Fundamentals to the Future of Emotional Cognizant Artificial Intelligence Entities},

author = {Thomas B. Talbot and Albert S. Rizzo and Mohammed Soleymani},

url = {https://tmb.apaopen.org/pub/zm0la9di/release/1},

doi = {10.1037/tms0000011},

year  = {2021},

date = {2021-11-01},

urldate = {2023-03-31},

journal = {Technology, Mind, and Behavior},

abstract = {Keywords: Affective Computing, Emotion Perception, Virtual Humans, Conversational Simulations},

keywords = {MedVR, UARC},

pubstate = {published},

tppubtype = {article}

}

@article{rizzo_recent_2021,

title = {Recent advances in virtual reality and psychology: Introduction to the special issue.},

author = {Albert “Skip” Rizzo and Grace J. Goodwin and Alyssa N. De Vito and Joshua D. Bell},

url = {http://doi.apa.org/getdoi.cfm?doi=10.1037/tps0000316},

doi = {10.1037/tps0000316},

issn = {2332-2179, 2332-2136},

year  = {2021},

date = {2021-09-01},

urldate = {2022-09-13},

journal = {Translational Issues in Psychological Science},

volume = {7},

number = {3},

pages = {213–217},

keywords = {DTIC, MedVR, VR},

pubstate = {published},

tppubtype = {article}

}

@article{rizzo_combat_2021,

title = {From Combat to COVID-19 – Managing the Impact of Trauma Using Virtual Reality},

author = {Albert “Skip” Rizzo and Arno Hartholt and Sharon Mozgai},

url = {https://doi.org/10.1080/15228835.2021.1915931},

doi = {10.1080/15228835.2021.1915931},

issn = {1522-8835},

year  = {2021},

date = {2021-07-01},

urldate = {2023-03-31},

journal = {Journal of Technology in Human Services},

volume = {39},

number = {3},

pages = {314–347},

abstract = {Research has documented the efficacy of clinical applications that leverage Virtual Reality (VR) for assessment and treatment purposes across a wide range of domains, including pain, phobias, and posttraumatic stress disorder (PTSD). As the field of Clinical VR matures, it is important to review its origins and examine how these initial explorations have progressed, what gaps remain, and what opportunities the community can pursue. We do this by reflecting on our personal scientific journey against the backdrop of the field in general. In particular, this paper discusses how a clinical research program that was initially designed to deliver trauma-focused VR exposure therapy (VRET) for combat-related PTSD has been evolved to expand its impact and address a wider range of trauma sources. Such trauma sources include sexual trauma and the needs of first responders and healthcare professionals serving on the frontlines of the COVID-19 pandemic. We provide an overview of the field and its general trends, discuss the genesis of our research agenda and its current status, and summarize upcoming opportunities, together with common challenges and lessons learned.},

note = {Publisher: Routledge 

_eprint: https://doi.org/10.1080/15228835.2021.1915931},

keywords = {MedVR, UARC, VHTL, Virtual Humans},

pubstate = {published},

tppubtype = {article}

}

@article{doran_addition_2021,

title = {The Addition of a Defibrillator to Resynchronization Therapy Decreases Mortality in Patients With Nonischemic Cardiomyopathy},

author = {Bethany Doran and Chaoqun Mei and Paul D. Varosy and David P. Kao and Leslie A. Saxon and Arthur M. Feldman and David DeMets and Michael R. Bristow},

url = {https://www.jacc.org/doi/abs/10.1016/j.jchf.2021.02.013},

doi = {10.1016/j.jchf.2021.02.013},

year  = {2021},

date = {2021-06-01},

urldate = {2023-03-31},

journal = {JACC: Heart Failure},

volume = {9},

number = {6},

pages = {439–449},

note = {Publisher: American College of Cardiology Foundation},

keywords = {MedVR, UARC},

pubstate = {published},

tppubtype = {article}

}

@article{gramlich_psychophysiology_2021,

title = {Psychophysiology during exposure to trauma memories: Comparative effects of virtual reality and imaginal exposure for posttraumatic stress disorder},

author = {Michael A. Gramlich and Derek J. Smolenski and Aaron M. Norr and Barbara O. Rothbaum and Albert A. Rizzo and Frank Andrasik and Emily Fantelli and Greg M. Reger},

url = {https://onlinelibrary.wiley.com/doi/10.1002/da.23141},

doi = {10.1002/da.23141},

issn = {1091-4269, 1520-6394},

year  = {2021},

date = {2021-03-01},

urldate = {2021-04-14},

journal = {Depression and Anxiety},

pages = {da.23141},

abstract = {Background: This investigation involved an in‐depth examination of psychophysiological responses during exposure to the trauma memory across 10 sessions among active duty soldiers with combat‐related posttraumatic stress disorder (PTSD) treated by Prolonged Exposure (PE) or Virtual Reality Exposure (VRE). We compared psychophysiological changes, session‐by‐session, between VRE and traditional imaginal exposure. Methods: Heart rate (HR), galvanic skin response (GSR), and peripheral skin temperature were collected every 5 min during exposure sessions with 61 combat veterans of Iraq/Afghanistan and compared to the PTSD Checklist (PCL‐C) and Clinician‐Administered PTSD Scale (CAPS) outcomes using multilevel modeling. Results: Over the course of treatment, participants in the PE group had higher HR arousal compared to participants in the VRE group. With reference to GSR, in earlier sessions, participants demonstrated a within‐session increase, whereas, in later sessions, participants showed a within‐session habituation response. A significant interaction was found for GSR and treatment assignment for within‐session change, withinperson effect, predicting CAPS (d = 0.70) and PCL‐C (d = 0.66) outcomes. Conclusion: Overall, these findings suggest that exposure to traumatic memories activates arousal across sessions, with GSR being most associated with reductions in PTSD symptoms for participants in the PE group.},

keywords = {MedVR},

pubstate = {published},

tppubtype = {article}

}

@article{mozgai_user-centered_2021,

title = {User-Centered Design Model for Mobile Health (mHealth) Applications: A Military Case Study in Rapid Assessment Process (RAP)},

author = {Sharon Mozgai and Brian Femminella and Arno Hartholt and Skip Rizzo},

url = {https://uploads-ssl.webflow.com/5f11f7e80d5a3b6dfdeeb614/5f9b3284d3d73e1da6a8f848_CHI_2021_Battle%20Buddy.pdf},

year  = {2021},

date = {2021-01-01},

pages = {10},

abstract = {CCS Concepts: • Human-centered computing → Ubiquitous and mobile computing design and evaluation methods; HCI design and evaluation methods; User centered design; • Applied computing → Military; • Computing methodologies → Intelligent agents.},

keywords = {ARL, MedVR, VHTL},

pubstate = {published},

tppubtype = {article}

}

@article{pallavicini_editorial_2021,

title = {Editorial: Virtual Reality, Augmented Reality and Video Games for Addressing the Impact of COVID-19 on Mental Health},

author = {Federica Pallavicini and Irene Alice Chicchi Giglioli and Gerard Jounghyun Kim and Mariano Alcañiz and Albert Rizzo},

url = {https://www.frontiersin.org/articles/10.3389/frvir.2021.719358},

issn = {2673-4192},

year  = {2021},

date = {2021-01-01},

urldate = {2023-03-31},

journal = {Frontiers in Virtual Reality},

volume = {2},

keywords = {MedVR, UARC},

pubstate = {published},

tppubtype = {article}

}

@article{reger_virtual_2020,

title = {Virtual Standardized Patients vs Academic Training for Learning Motivational Interviewing Skills in the US Department of Veterans Affairs and the US Military: A Randomized Trial},

author = {Greg M. Reger and Aaron M. Norr and Albert “Skip” Rizzo and Patrick Sylvers and Jessica Peltan and Daniel Fischer and Matthew Trimmer and Shelan Porter and Pamela Gant and John S. Baer},

url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2771733},

doi = {10.1001/jamanetworkopen.2020.17348},

issn = {2574-3805},

year  = {2020},

date = {2020-10-01},

journal = {JAMA Network Open},

volume = {3},

number = {10},

abstract = {OBJECTIVE To evaluate the efficacy of training with a VSP on the acquisition and maintenance of MI skills compared with traditional academic study. DESIGN, SETTING, AND PARTICIPANTS This study was a 2-group, parallel-training randomized trial of 120 volunteer health care professionals recruited from a Department of Veterans Affairs and Department of Defense medical facility. Motivational interviewing skill was coded by external experts blinded to training group and skill assessment time points. Data were collected from October 17, 2016, to August 12, 2019. INTERVENTIONS After a computer course on MI, participants trained during two 45-minute sessions separated by 3 months. The 2 randomized training conditions included a branching storyline VSP, which provided MI skill rehearsal with immediate and summative feedback, and a control condition, which included academic study of content from the computerized MI course. MAIN OUTCOMES AND MEASURES Measurement of MI skill was based on recorded conversations with human standardized patients, assessed using the Motivational Interviewing Treatment Integrity 4.2.1 coding system, measured at baseline, after training, and after additional training in the randomized condition 3 months later. RESULTS A total of 120 volunteers (83 [69%] women), with a mean (SD) of 13.6 (10.3) years of health care experience, participated in the study; 61 were randomized to receive the intervention, and 59 were randomized to the control group. Those assigned to VSP training had significantly greater posttraining improvement in technical global scores (0.23; 95% CI, 0.03-0.44; P = .02), relational global scores (0.57; 95% CI, 0.33-0.81; P = .001), and the reflection-to-question ratio (0.23; 95% CI, 0.15-0.31; P = .001). Differences were maintained after the 3-month additional training session, with more improvements achieved after the 3-month training for the VSP trainees on the reflection-to- question ratio (0.15; 95% CI, 0.07-0.24; P = .001). CONCLUSIONS AND RELEVANCE This randomized trial demonstrated a successful transfer of training from a VSP to human standardized patients. The VSP MI skill outcomes were better than those achieved with academic study and were maintained over time. Virtual standardized patients},

keywords = {MedVR},

pubstate = {published},

tppubtype = {article}

}

@article{yeh_virtual-reality_2020,

title = {A Virtual-Reality System Integrated With Neuro-Behavior Sensing for Attention-Deficit/Hyperactivity Disorder Intelligent Assessment},

author = {Shih-Ching Yeh and Sheng-Yang Lin and Eric Hsiao-Kuang Wu and Kai-Feng Zhang and Xu Xiu and Albert Rizzo and Chia-Ru Chung},

url = {https://ieeexplore.ieee.org/document/9123917/},

doi = {10.1109/TNSRE.2020.3004545},

issn = {1534-4320, 1558-0210},

year  = {2020},

date = {2020-09-01},

journal = {IEEE Transactions on Neural Systems and Rehabilitation Engineering},

volume = {28},

number = {9},

pages = {1899–1907},

abstract = {Attention-deficit/Hyperactivity disorder (ADHD) is a common neurodevelopmental disorder among children. Traditional assessment methods generally rely on behavioral rating scales (BRS) performed by clinicians, and sometimes parents or teachers. However, BRS assessment is time consuming, and the subjective ratings may lead to bias for the evaluation. Therefore, the major purpose of this study was to develop a Virtual Reality (VR) classroom associated with an intelligent assessment model to assist clinicians for the diagnosis of ADHD. In this study, an immersive VR classroom embedded with sustained and selective attention tasks was developed in which visual, audio, and visual-audio hybrid distractions, were triggered while attention tasks were conducted. A clinical experiment with 37 ADHD and 31 healthy subjects was performed. Data from BRS was compared with VR task performance and analyzed by rank-sum tests and Pearson Correlation. Results showed that 23 features out of total 28 were related to distinguish the ADHD and non-ADHD children. Several features of task performance and neuro-behavioral measurements were also correlated with features of the BRSs. Additionally, the machine learning models incorporating task performance and neuro-behavior were used to classify ADHD and non-ADHD children. The mean accuracy for the repeated cross-validation reached to 83.2%, which demonstrated a great potential for our system to provide more help for clinicians on assessment of ADHD.},

keywords = {MedVR},

pubstate = {published},

tppubtype = {article}

}

@article{luu_development_2020,

title = {Development and Performance Assessment of a Digital Serious Game to Assess Multi-Patient Care Skills in a Simulated Pediatric Emergency Department},

author = {Cindy Luu and Thomas B. Talbot and Cha Chi Fung and Eyal Ben-Isaac and Juan Espinoza and Susan Fischer and Christine S. Cho and Mariam Sargsyan and Sridevi Korand and Todd P. Chang},

url = {http://journals.sagepub.com/doi/10.1177/1046878120904984},

doi = {10.1177/1046878120904984},

issn = {1046-8781, 1552-826X},

year  = {2020},

date = {2020-08-01},

journal = {Simulation & Gaming},

volume = {51},

number = {4},

pages = {550–570},

abstract = {Objective. Multi-patient care is important among medical trainees in an emergency department (ED). While resident efficiency is a typically measured metric, multi-patient care involves both efficiency and diagnostic / treatment accuracy. Multi-patient care ability is difficult to assess, though simulation is a potential alternative. Our objective was to generate validity evidence for a serious game in assessing multi-patient care skills among a variety of learners.},

keywords = {MedVR},

pubstate = {published},

tppubtype = {article}

}

@article{rakofsky_virtual_2020,

title = {A Virtual Standardized Patient–Based Assessment Tool to Evaluate Psychiatric Residents’ Psychopharmacology Proficiency},

author = {Jeffrey J. Rakofsky and Thomas B. Talbot and Boadie W. Dunlop},

url = {http://link.springer.com/10.1007/s40596-020-01286-x},

doi = {10.1007/s40596-020-01286-x},

issn = {1042-9670, 1545-7230},

year  = {2020},

date = {2020-07-01},

journal = {Academic Psychiatry},

abstract = {Objectives A virtual standardized patient-based assessment simulator was developed to address biases and practical limitations in existing methods for evaluating residents’ proficiency in psychopharmacological knowledge and practice. Methods The simulator was designed to replicate an outpatient psychiatric clinic experience. The virtual patient reported symptoms of a treatment-resistant form of major depressive disorder (MDD), requiring the learner to use various antidepressants in order for the patient to fully remit. Test scores were based on the proportion of correct responses to questions asked by the virtual patient about possible side effects, dosing, and titration decisions, which depended upon the patient’s tolerability and response to the learner’s selected medications. The validation paradigm included a novice-expert performance comparison across 4th year medical students, psychiatric residents from all four post-graduate year classes, and psychiatry department faculty, and a correlational analysis of simulator performance with the PRITE Somatic Treatments subscale score. Post-test surveys evaluated the test takers’ subjective impressions of the simulator. Results Forty-three subjects completed the online exam and survey. Total mean scores on the exam differed significantly across all the learner groups in a step-wise manner from students to faculty (F = 6.10},

keywords = {MedVR, UARC},

pubstate = {published},

tppubtype = {article}

}

@article{malta_development_2020,

title = {Development of a virtual reality laboratory stressor},

author = {Loretta S. Malta and Cezar Giosan and Lauren E. Szkodny and Margaret M. Altemus and Albert A. Rizzo and David A. Silbersweig and JoAnn Difede},

url = {http://link.springer.com/10.1007/s10055-020-00455-5},

doi = {10.1007/s10055-020-00455-5},

issn = {1359-4338, 1434-9957},

year  = {2020},

date = {2020-07-01},

journal = {Virtual Reality},

abstract = {This research report describes the development of a virtual reality (VR) laboratory stressor to study the effects of exposure to stressful events. The aim of the research was to develop a VR simulation that would evoke stressor responses at a level that was tolerable for participants. Veterans with and without warzone-related posttraumatic stress disorder (PTSD) were presented with VR simulations of combat stressors. There was one complaint of feeling hot during simulations but no incidents of simulator sickness. Participants denied experiencing the simulations as overly distressing, and there were no reports of any distress or problems related to study participation when they were contacted two weeks after the VR challenge. Simulations elicited moderate levels of anxiety and mild levels of dissociation that were significantly greater in Veterans with PTSD. Simulations were less successful in eliciting differential heart rate reactivity and stress hormone secretion, though history of civilian trauma exposure was associated with elevated heart rates during the second simulation. The study demonstrated that the VR paradigm was feasible and tolerable and that it holds promise as a new method with which to conduct controlled laboratory research on the effects of exposure to stressful events.},

keywords = {MedVR},

pubstate = {published},

tppubtype = {article}

}

@article{hilty_review_2020,

title = {A Review of Telepresence, Virtual Reality, and Augmented Reality Applied to Clinical Care},

author = {Donald M. Hilty and Karan Randhawa and Marlene M. Maheu and Alastair J. S. McKean and Richard Pantera and Matthew C. Mishkind and Albert “Skip” Rizzo},

url = {http://link.springer.com/10.1007/s41347-020-00126-x},

doi = {10.1007/s41347-020-00126-x},

issn = {2366-5963},

year  = {2020},

date = {2020-06-01},

journal = {Journal of Technology in Behavioral Science},

volume = {5},

number = {2},

pages = {178–205},

abstract = {This scoping review article explores the application of telepresence (TPr), virtual reality (VR), and augmented reality (AR) to clinical care. A literature search of key words was conducted from January 1990 through May 2019 of the following databases: PubMed/ Medline, American Psychological Association PsycNET, Pubmed/Medline, Cochrane, Embase, PsycINFO, Web of Science, Scopus, OTSeeker, ABI/INFORM, computer-mediated communication (CMC), technology-mediated communications, Arts & Humanities Citation Index, Project Muse, ProQuest Research Library Plus, Sociological abstracts, Computers and Applied Sciences Complete and IT Source. It focused on concept areas: (1) TPr related to technologies; (2) virtual, augmented, reality, environment; (3) technology or computer-mediated communication; (4) clinical therapeutic relationship (boundaries, care, communication, connect, engagement, empathy, intimacy, trust); (5) telebehavioral health; (6) psychotherapy via technology; and (7) medicine/health care. Inclusion criteria were concept area 1 in combination with 2–7 and 2 or 3 in combination with any of 4–7. From a total of 5214 potential references, the authors found 512 eligible for full-text review and found 85 papers directly relevant to the concepts. From papers’ references and a review of books and popular literature about TPr, virtual reality (VR), and augmented reality (AR), 13 other sources of information were found. The historical evolution of TPr, VR, and AR shows that definitions, foci of studies (e.g., social neuroscience to business), and applications vary; assessments of TPr also vary widely. Studies discuss VR, AR, and TPr in medicine (e.g., rehabilitation, robotics), experimental psychology (laboratory, field, mixed), and behavioral health. Virtual environment (VE) designs aid the study of interpersonal communication and behavior, using standardized social interaction partners, virtual standardized patients, and/or virtual humans—all contingent on the participants’ experience of presence and the ability to engage. Additional research is needed to standardize experimental and clinical interventions, while maintaining ecological validity. Technology can significantly improve quality of care, access to new treatments and training, if ethical and reimbursement issues are better explored.},

keywords = {MedVR},

pubstate = {published},

tppubtype = {article}

}

@article{malta_predictors_2020,

title = {Predictors of involuntary and voluntary emotional episodic memories of virtual reality scenarios in Veterans with and without PTSD},

author = {Loretta S. Malta and Cezar Giosan and Lauren E. Szkodny and Margaret M. Altemus and Albert A. Rizzo and David A. Silbersweig and JoAnn Difede},

url = {https://www.tandfonline.com/doi/full/10.1080/09658211.2020.1770289},

doi = {10.1080/09658211.2020.1770289},

issn = {0965-8211, 1464-0686},

year  = {2020},

date = {2020-05-01},

journal = {Memory},

pages = {1–17},

abstract = {This study investigated predictors of involuntary and voluntary memories of stressful virtual reality scenarios. Thirty-two veterans of the two Persian Gulf Wars completed verbal memory tests and diagnostic assessments. They were randomly assigned to a Recounting (16) or a Suppression (16) condition. After immersion in the VR scenarios, the Recounting group described the scenarios and the Suppression group suppressed thoughts of the scenarios. One week later, participants completed surprise voluntary memory tests and another thought suppression task. The best predictors of voluntary memory were verbal memory ability, dissociation, and to a lesser extent, physiological arousal before and after scenarios. Dissociation and physiological stress responses selectively affected memory for neutral elements. Higher distress during scenarios impaired voluntary memory but increased the frequency of involuntary memories. Physiological stress responses promoted more frequent involuntary memories immediately after the scenarios. More frequent initial involuntary memories, tonic physiological arousal, and stronger emotional responses to dangerous events predicted difficulty inhibiting involuntary memories at follow-up. The effects of thought suppression were transient and weaker than those of other variables. The findings suggest that posttraumatic amnesia and involuntary memories of adverse events are more related to memory ability and emotional and physiological stress responses than to postexposure suppression.},

keywords = {MedVR},

pubstate = {published},

tppubtype = {article}

}

@article{chang_examining_2020,

title = {Examining the Effects of HMDs/FSDs and Gender Differences on Cognitive Processing Ability and User Experience of the Stroop Task-Embedded Virtual Reality Driving System (STEVRDS)},

author = {Chen-Wei Chang and Mengtong Li and Shih-Ching Yeh and Yijing Chen and Albert Rizzo},

url = {https://ieeexplore.ieee.org/document/8959194/},

doi = {10.1109/ACCESS.2020.2966564},

issn = {2169-3536},

year  = {2020},

date = {2020-04-01},

journal = {IEEE Access},

volume = {8},

pages = {69566–69578},

abstract = {The advent of virtual reality technology has provided a new approach for assessing and training cognitive processing ability, with the design of simulations used to replicate real events in everyday lives. To better understand how head mounted displays/flat screen displays (HMDs/FSDs) and differences in the individuals who use them affect cognitive performance and the use of VR systems, our research group created the Stroop task-embedded virtual reality driving system (STEVRDS) and conducted a 2 × 2 between-group factorial design experiment among college students. The study examined the effects of HMDs and FSDs that differ in monovision/stereovision and field of view, the impact of gender (males vs. females) on users’ performances in virtual driving and Stroop trials, and users’ psychophysiological responses while using the system. The participants’ subjective perceptions toward STEVRDS were also assessed to support the analyses/interpretations of cognitive performance, as well as provide empirical data relating to user experiences. The statistical analyses showed both main and interaction effects of HMDs/FSDs and gender on task performance, psychophysiological responses, and user evaluations of the system. The psychophysiological patterns exhibited during the use of STEVRDS further extended the findings. Overall, our results were comparable with cognitive phenomena reported in other studies/in real-life experiences or explained by logical reasoning, which suggests that the design/development of the STEVRDS is suitable for cognitive assessment/training. Practical implications are discussed for the application of HMDs and FSDs in evaluating and enhancing cognitive processing ability and the need for specific tailoring for male and female users.},

keywords = {MedVR},

pubstate = {published},

tppubtype = {article}

}

@article{katz_changes_2020,

title = {Changes in physiological reactivity in response to the trauma memory during prolonged exposure and virtual reality exposure therapy for posttraumatic stress disorder.},

author = {Andrea C. Katz and Aaron M. Norr and Benjamin Buck and Emily Fantelli and Amanda Edwards-Stewart and Patricia Koenen-Woods and Kimberlee Zetocha and Derek J. Smolenski and Kevin Holloway and Barbara O. Rothbaum and JoAnn Difede and Albert Rizzo and Nancy Skopp and Matt Mishkind and Gregory Gahm and Greg M. Reger and Frank Andrasik},

url = {http://doi.apa.org/getdoi.cfm?doi=10.1037/tra0000567},

doi = {10.1037/tra0000567},

issn = {1942-969X, 1942-9681},

year  = {2020},

date = {2020-04-01},

journal = {Psychological Trauma: Theory, Research, Practice, and Policy},

abstract = {This study is among the first to examine how physiological processes change throughout PTSD treatment and the first to compare standard exposure therapy to therapy augmented with virtual reality (VR) in active-duty soldiers with PTSD. Results showed that soldiers in VR therapy had smaller physical reactions to trauma memories compared to those who did not receive treatment, whereas those who got standard treatment did not. These findings provide insight into possible mechanisms of PTSD treatment, point to potential objective indicators of early treatment response in active-duty soldiers, and suggest that VR treatment might lead to earlier symptom reduction.},

keywords = {MedVR, UARC},

pubstate = {published},

tppubtype = {article}

}

@article{saredakis_factors_2020,

title = {Factors Associated With Virtual Reality Sickness in Head-Mounted Displays: A Systematic Review and Meta-Analysis},

author = {Dimitrios Saredakis and Ancret Szpak and Brandon Birckhead and Hannah A. D. Keage and Albert Rizzo and Tobias Loetscher},

url = {https://www.frontiersin.org/article/10.3389/fnhum.2020.00096/full},

doi = {10.3389/fnhum.2020.00096},

issn = {1662-5161},

year  = {2020},

date = {2020-03-01},

journal = {Frontiers in Human Neuroscience},

volume = {14},

pages = {96},

abstract = {The use of head-mounted displays (HMD) for virtual reality (VR) application-based purposes including therapy, rehabilitation, and training is increasing. Despite advancements in VR technologies, many users still experience sickness symptoms. VR sickness may be influenced by technological differences within HMDs such as resolution and refresh rate, however, VR content also plays a significant role. The primary objective of this systematic review and meta-analysis was to examine the literature on HMDs that report Simulator Sickness Questionnaire (SSQ) scores to determine the impact of content. User factors associated with VR sickness were also examined. A systematic search was conducted according to PRISMA guidelines. Fifty-five articles met inclusion criteria, representing 3,016 participants (mean age range 19.5–80; 41% female). Findings show gaming content recorded the highest total SSQ mean 34.26 (95%CI 29.57–38.95). VR sickness profiles were also influenced by visual stimulation, locomotion and exposure times. Older samples (mean age ≥35 years) scored significantly lower total SSQ means than younger samples, however, these findings are based on a small evidence base as a limited number of studies included older users. No sex differences were found. Across all types of content, the pooled total SSQ mean was relatively high 28.00 (95%CI 24.66–31.35) compared with recommended SSQ cut-off scores. These findings are of relevance for informing future research and the application of VR in different contexts.},

keywords = {MedVR},

pubstate = {published},

tppubtype = {article}

}

@article{an_heart_2019,

title = {Heart Rate Variability as an Index of Resilience},

author = {Capt Eric An and Anne A T Nolty and Stacy S Amano and Albert A Rizzo and J Galen Buckwalter and Jared Rensberger},

url = {https://academic.oup.com/milmed/advance-article/doi/10.1093/milmed/usz325/5586497},

doi = {10.1093/milmed/usz325},

issn = {0026-4075, 1930-613X},

year  = {2019},

date = {2019-10-01},

journal = {Military Medicine},

abstract = {Introduction: Resilience is the ability to maintain or quickly return to a stable physical and psychological equilibrium despite experiencing stressful events. Flexibility of the autonomic nervous system is particularly important for adaptive stress responses and may contribute to individual differences in resilience. Power spectrum analysis of heart rate variability (HRV) allows measurement of sympathovagal balance, which helps to evaluate autonomic flexibility. The present study investigated HRV as a broad index of resilience. Materials and Methods: Twenty-four male participants from the Army National Guard Special Forces completed psychological measures known to relate to resilience and had HRV measured while undergoing stressful virtual environment scenarios. Pearson product-moment correlations were used to explore the relationships between HRV and resilience factors. All research was conducted with the oversight of the Human Subjects Review Committee of Fuller Theological Seminary. Results: Trends toward significance were reported in order to provide results that would reasonably be expected in a study of higher power. Trends between resilience factors and HRV were found only during specific stress-inducing simulations (see Tables III). Conclusion: Greater resilience to stress was associated with HRV during nonstress periods. Higher levels of resilience to traumatic events were associated with HRV during circumstances that were more stressful and emotionally distressing. Post hoc analysis revealed that specific factors including flexibility, emotional control, and spirituality were driving the relationship between general resilience and HRV following emotionally laden stressors. Less stress vulnerability was associated with HRV following intermittent brief stressors. In sum, HRV appears to represent some aspects of an individual’s overall resilience profile. Although resilience remains a complex, multidimensional construct, HRV shows promise as a global psychophysiological index of resilience. This study also offers important perspectives concerning ways to optimize both physical and psychological health.},

keywords = {MedVR, UARC},

pubstate = {published},

tppubtype = {article}

}

@article{difede_enhanced_2019,

title = {Enhanced exposure therapy for combat-related Posttraumatic Stress Disorder (PTSD): Study protocol for a randomized controlled trial},

author = {JoAnn Difede and Barbara O. Rothbaum and Albert A. Rizzo and Katarzyna Wyka and Lisa Spielman and Tanja Jovanovic and Christopher Reist and Michael J. Roy and Seth D. Norrholm and Charles Glatt and Francis Lee},

url = {https://linkinghub.elsevier.com/retrieve/pii/S1551714419305725},

doi = {10.1016/j.cct.2019.105857},

issn = {15517144},

year  = {2019},

date = {2019-10-01},

journal = {Contemporary Clinical Trials},

pages = {105857},

abstract = {Background: PTSD, which has been identified in up to 23% of post-9-11 veterans, often results in a chronic, pernicious course. Thus, effective treatments are imperative. The Institute of Medicine (IOM) concluded that the only intervention for PTSD with sufficient evidence to conclude efficacy is exposure therapy. This Phase III trial compares the efficacy of exposure therapy for combat-related PTSD delivered in two different formats- via virtual reality exposure therapy (VRE) or prolonged exposure therapy (PE)- combined with D-Cycloserine (DCS), a cognitive enhancer shown to facilitate the extinction of fear.},

keywords = {MedVR},

pubstate = {published},

tppubtype = {article}

}

@article{mozgai_systematic_2019,

title = {Systematic Representative Design and Clinical Virtual Reality},

author = {Sharon Mozgai and Arno Hartholt and Albert “Skip” Rizzo},

url = {https://www.tandfonline.com/doi/full/10.1080/1047840X.2019.1693873},

doi = {10.1080/1047840X.2019.1693873},

issn = {1047-840X, 1532-7965},

year  = {2019},

date = {2019-10-01},

journal = {Psychological Inquiry},

volume = {30},

number = {4},

pages = {231–245},

abstract = {The authors of the article, “Causal Inference in Generalizable Environments: Systematic Representative Design”, boldly announce their core point in the opening line of the abstract stating that, “Causal inference and generalizability both matter.” While a surface glance might suggest this to be a simple notion, a closer examination reveals the complexity of what they are proposing. This complexity is apparent when one considers that the bulk of human experimental research has always been challenged in its inability to concurrently deliver on both of these aims. This is no slight on the tens of 1000’s of human researchers and behavioral scientists who have devoted long careers to highly controlled human psychological and social science laboratory research. Rather, it reflects the sheer enormity of the challenges for conducting human studies designed to specify human function with physics-informed lab methods, while at the same time producing results that lead to enhanced understanding and prediction of how people will operate in the complex and ever-changing contexts that make up everyday life. At the core of this issue is a methodological and philosophical challenge that is relevant to all areas of human subjects’ research, beyond the social science focus of the Miller et al. (this issue) article. It is our aim to discuss the central topics in their article through the lens of our own work using Virtual/Augmented Reality and Virtual Human simulation technologies for clinical and training applications},

keywords = {MedVR, UARC, VHTL, Virtual Humans},

pubstate = {published},

tppubtype = {article}

}

@article{bond_virtual_2019,

title = {Virtual Standardized Patient Simulation},

author = {William F Bond and Theresa J. Lynch and Matthew J. Mischler and Jessica L. Fish and Jeremy S. McGarvey and Jason T. Taylor and Dipen M. Kumar and Kyle M. Mou and Rebecca A. Ebert-Allen and Dilip N. Mahale and Thomas B. Talbot and Meenakshy Aiyer},

url = {https://journals.lww.com/simulationinhealthcare/Fulltext/2019/08000/Virtual_Standardized_Patient_Simulation__Case.6.aspx#pdf-link},

year  = {2019},

date = {2019-08-01},

journal = {Simulation in Healthcare},

volume = {14},

number = {4},

pages = {10},

abstract = {Introduction: High-value care (HVC) suggests that good history taking and physical examination should lead to risk stratification that drives the use or withholding of diagnostic testing. This study describes the development of a series of virtual standardized patient (VSP) cases and provides preliminary evidence that supports their ability to provide experiential learning in HVC. Methods: This pilot study used VSPs, or natural language processing–based patient avatars, within the USC Standard Patient platform. Faculty consensus was used to develop the cases, including the optimal diagnostic testing strategies, treatment options, and scored content areas. First-year resident physician learners experienced two 90-minute didactic sessions before completing the cases in a computer laboratory, using typed text to interview the avatar for history taking, then completing physical examination, differential diagnosis, diagnostic testing, and treatment modules for each case. Learners chose a primary and 2 alternative “possible” diagnoses from a list of 6 to 7 choices, diagnostic testing options from an extensive list, and treatments from a brief list ranging from 6 to 9 choices. For the historytaking module, both faculty and the platform scored the learners, and faculty assessed the appropriateness of avatar responses. Four randomly selected learner-avatar interview transcripts for each case were double rated by faculty for interrater reliability calculations. Intraclass correlations were calculated for interrater reliability, and Spearman ρ was used to determine the correlation between the platform and faculty ranking of learners' historytaking scores. Results: Eight VSP cases were experienced by 14 learners. Investigators reviewed 112 transcripts (4646 learner query-avatar responses). Interrater reliability means were 0.87 for learner query scoring and 0.83 for avatar response. Mean learner success for history taking was scored by the faculty at 57% and by the platform at 51% (ρ correlation of learner rankings = 0.80},

keywords = {MedVR},

pubstate = {published},

tppubtype = {article}

}