Immersive virtual reality (VR) allows learners to interact with anatomical structures in three dimensions, potentially improving spatial understanding compared to traditional instructional methods. While VR is increasingly incorporated into medical curricula, prospective studies evaluating both learning outcomes and experiential measures remain limited. This study aimed to evaluate the impact of a single immersive VR anatomy session on knowledge acquisition, learner confidence, cognitive workload, and perceived immersion among first-year medical students. In this prospective educational intervention, first-year medical students at Kansas City University completed a standardized immersive VR anatomy module. Anatomy knowledge was assessed using a 20-item multiple-choice examination administered pre-session, immediately post-session, and at a 20-day follow-up. Learner confidence was measured using a 5-point Likert scale. Cognitive workload was assessed using the NASA Task Load Index (NASA-TLX), and immersion was measured using validated presence and usability items. Anatomy knowledge improved significantly from pre- to post-intervention (mean increase 7.2% points, 95% CI [3.9, 10.6], p < 0.001). However, scores declined at delayed follow-up (mean change - 15.3% points from post, 95% CI [-19.8, -10.7], p < 0.001), falling below baseline mean levels. Confidence demonstrated a significant upward shift in distribution (p = 0.018), although change in confidence was not associated with knowledge gain (p = 0.863). Cognitive workload was not significantly associated with learning outcomes, while small negative correlations were observed between knowledge gain and both presence (r = -0.31, p = 0.022) and usability (r = -0.28, p = 0.034). Immersive VR produces significant short-term improvements in anatomy knowledge and learner confidence but does not sustain retention following a single exposure. While effective for enhancing short-term anatomy knowledge and learner engagement, these findings suggest that immersive VR may be most effective when integrated as a complementary component within a multimodal anatomy curriculum rather than used as a standalone instructional modality.
Motivational orientation and immersive tendency describe complementary questionnaire-based dimensions of player characterization. Motivation instruments capture why players report engaging with games, whereas immersive-tendency instruments describe individual predispositions toward absorption, involvement, and attention focusing in mediated environments. To support reuse in questionnaire-based player modelling, we created an open, item-level, single-cohort survey dataset linking Bartle Test responses, ITQ-18 responses, demographics, and self-reported gaming preferences among IT students and teachers. The dataset contains a single comma-separated values (CSV) file (one record per participant), with n = 175 and 64 variables. It includes: demographics (age, gender); self-reported weekly gaming time (total and excluding mobile); preferred mode (single-player or multiplayer); binary genre indicators with the most popular genre; item-level responses from the 30-item Bartle Test of Gamer Psychology with response options Achiever, Socializer, Explorer, Killer; and 18 items from the Immersive Tendencies Questionnaire rated on a seven-point Likert scale. The dataset is fully anonymized, contains no free-text fields, and uses categorical codes to facilitate reuse.
Stroke is a leading cause of disability, with upper limb dysfunction affecting the majority of survivors. Non-immersive virtual reality (NIVR) has emerged as an accessible and engaging adjunctive therapy that may address the limitations of conventional rehabilitation and promote motor recovery. This systematic review and meta-analysis, conducted in accordance with PRISMA guidelines, included 12 randomized controlled trials (RCTs) involving 498 stroke patients. The included studies compared NIVR combined with conventional therapy versus conventional therapy alone. Primary outcome measures were upper limb motor function, assessed using the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) and the Box and Block Test (BBT), and activities of daily living (ADL), assessed using the Barthel Index (BI), Modified Barthel Index (MBI), and Functional Independence Measure (FIM). Dose matching was reported in nine of the 12 studies; three studies provided extra therapy time to NIVR groups. The search was limited to PubMed, Web of Science, and Scopus, potentially missing studies from other databases (e.g., CENTRAL, Embase, CINAHL) and trial registries. NIVR was associated with significantly improved upper limb motor function [FMA-UE: MD = 5.40, 95% CI (1.58, 9.22); BBT: MD = 4.57, 95% CI (0.35, 8.79)] and FIM scores [MD = 5.99, 95% CI (2.27, 9.71)]. Pooled BI/MBI analysis showed a marginal effect that reached statistical significance [MD = 5.47, 95% CI (0.30, 10.63), p = 0.04]. However, this finding should be interpreted with caution, as neither the BI subgroup analysis [3 studies, MD = 3.88, 95% CI (-1.64, 9.41), p = 0.17] nor the MBI subgroup analysis [5 studies, MD = 5.94, 95% CI (-1.75, 13.64), p = 0.13] individually reached statistical significance. This discrepancy likely reflects limited statistical power in subgroup analyses and heterogeneity in scale administration across studies, rather than a robust treatment effect. NIVR as an adjunct is associated with better upper limb function and global ADL. However, dose imbalance in 3/12 studies and limited database search (PubMed, Web of Science, Scopus) warrant cautious interpretation. Findings need confirmation via dose-matched, broader-search trials.
Emotional experience and the regulation thereof are typically studied using picture inventories or short films to induce and modify affective states. These approaches, however, lack ecological validity due to their passive and receptive nature. Recent innovations in virtual reality and mobile neurophysiological technologies have enabled researchers to study the behavioral and neural correlates of more ecologically valid emotional responses. In this preregistered study, 58 healthy participants were randomly assigned to either use cognitive reappraisal (intervention) or to immerse themselves in their senses and surroundings (control) while walking across a wooden plank suspended 80 stories above the ground in virtual reality. We measured subjective fear ratings, salivary alpha amylase and cortisol levels, as well as frontal brain asymmetries, captured using mobile electroencephalography (EEG). Across both conditions, we found decisive evidence of increased subjective fear and salivary alpha amylase, a marker of sympathetic activation. However, we found no increase in cortisol levels following the task suggesting that subjective fear alone is not sufficient to trigger a cortisol response. In contrast to our hypotheses, the reappraisal group did not show any difference compared to the control group for neither emotional, endocrine nor neural measures. On the one hand, our findings may suggest that reappraisal might not be a suitable strategy to regulate realistic and intensely frightening situations. On the other hand, further analyses also indicated that the control group may have also regulated their emotions due to increased mindfulness of their inner states and their environment. Future studies are needed to confirm these observations and ascertain the efficacy of cognitive reappraisal on fear in realistic settings.
Virtual reality (VR)-based interventions are increasingly applied in sports training and musculoskeletal rehabilitation. However, their potential role in modifying lower-extremity injury-related risk factors in athletic populations remains incompletely understood. Following PRISMA guidelines, PubMed, Scopus, Web of Science, and SportDiscus were searched up to September 25th, 2025. Eligible studies included randomized, controlled, quasi-experimental, or within-subject experimental designs evaluating immersive, semi-immersive, or non-immersive VR interventions in junior to young-adult athletes. Comparator conditions included conventional training, alternative exercise interventions, no-intervention controls, placebo conditions, or non-VR comparisons. Outcomes addressed biomechanical, neuromuscular, functional, perceptual-cognitive, or psychological factors potentially relevant to sports injury risk. Methodological quality was assessed using the Downs and Black checklist. Thirty studies met the inclusion criteria. Interventions ranged from single-session biofeedback exposure to 4-16-week neuromuscular, balance, perceptual-cognitive, or sensorimotor programs across multiple sports. Most studies reported improvements in at least one biomechanical, neuromuscular, functional, perceptual-cognitive, or psychological outcome; particularly, in lower-extremity movement control, balance, coordination, and reaction efficiency. However, several acute studies demonstrated transiently less favorable movement mechanics during highly immersive or cognitively demanding tasks. Importantly, no included study evaluated injury incidence as a primary preventive outcome. Downs and Black scores ranged from 14 to 26 (mean = 19.6 ± 3.1), indicating overall fair-to-good methodological quality. The evidence suggests that VR-based training can effectively modify several surrogate lower-extremity injury-related risk factors; particularly, those associated with biomechanics and neuromuscular control. Nevertheless, the lack of longitudinal data and the scarcity of injury-incidence outcomes limit conclusions regarding real-world preventive efficacy. VR-based interventions may represent a promising adjunct to conventional neuromuscular and perceptual-cognitive training approaches for modifying surrogate lower-extremity injury-related factors. Nevertheless, substantial heterogeneity, limited longitudinal follow-up, and the absence of injury-incidence outcomes restrict conclusions regarding definitive preventive efficacy. Future adequately powered randomized trials with standardized protocols and verified injury outcomes are required. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251163302, identifier CRD420251163302.
Acquired brain injury (ABI) can result in reduced activities of daily living (ADL) performance. Virtual reality (VR) is a novel rehabilitation intervention for ABI. The Saebo-VR is a non-immersive platform for practicing ADL tasks. To explore the implementation of a VR-based intervention for ADLs to improve function after ABI. A pre- and post-intervention study was conducted using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Data from both groups were used to evaluate all domains of the RE-AIM framework. Participants with ABI completed 12 30-minute Saebo-VR sessions over 3-weeks to practice ADLs. The Saebo-VR is a non-immersive VR device programmed with ADLs. Fifteen participants (mean age 46.5, 10 male) with ABI and 5 occupational therapists (mean age 37.8, all female) participated. For reach, 23% people with ABI participated. For effectiveness, a linear mixed-effects model was conducted to assess changes in Nottingham Extended Activities of Daily Living (NADL) scores from baseline to post-intervention. There was a statistically significant improvement in NADL scores [b = 9.4, SE = 3.1, t(23.9) = 3.1, p = 0.005, 95% CI (3.4, 15.4)], exceeding the MCID. For adoption, perceived benefits and challenges respectively included benefits to physical function and technical issues and negative impacts. Implementation indicators were partially met. For maintenance, only 60% of clinicians reported they would use VR clinically in the future. Exploring the implementation of VR interventions with the ABI population provides key information on the clinical use of VR.
Dual-task gait paradigms are widely used to assess cognitive-motor integration, however considerable methodological heterogeneity remains. Fixed-speed locomotion and limited assessment of repeatability have contributed to inconsistent baseline findings in healthy adults, complicating interpretation of dual-task effects reported in clinical populations. This study aimed to examine the reliability and baseline gait behaviour associated with a dual-task paradigm combining non-immersive virtual reality (VR)-based self-paced treadmill walking and parametrically modulated working memory load. The purpose was to establish a robust reference profile in healthy adults to support subsequent clinical and reliability and baseline characterisation studies. Twenty-three healthy adult males (34.56 ± 5.12 years) completed two gait assessment sessions using a self-paced treadmill within a non-immersive VR environment. Walking was assessed under three conditions: single-task walking, dual-task walking with a 1-back task, and dual-task walking with a 2-back task. Spatiotemporal gait parameters and dual-task costs were analysed across sessions and task conditions to evaluate between-session consistency and sensitivity to graded cognitive demand. Most spatiotemporal gait parameters demonstrated good consistency between sessions, with no statistically significant differences observed across days or task conditions (p ≥ 0.05). A reduction in step length was observed during dual-task walking in the first session (p = 0.02), alongside consistent directional modulation of stride-related measures with increasing cognitive load. These changes were modest and consistent with adaptive gait regulation in neurologically intact adults. The findings demonstrate that a self-paced treadmill VR dual-task gait protocol yields stable and repeatable gait measures following familiarisation in healthy adults. Rather than establishing criterion validity, this study provides baseline characterisation and reliability evidence necessary for future work evaluating clinical sensitivity, diagnostic utility, and intervention responsiveness in patient populations.
Psychedelic compound N,N-Dimethyltryptamine (DMT) is renowned for inducing highly immersive experiences, often including encounters with seemingly sentient presences. While such phenomena are well documented, immersion under psychedelics remains conceptually underdefined and phenomenologically underexplored. Here we apply micro-phenomenology to characterize immersion under DMT as a structured continuum from subtle to gross forms of immersion, and to examine how perceived presences arise within this continuum. Twenty-three participants received 20 mg intravenous DMT during simultaneous fMRI-EEG acquisition, followed by detailed micro-phenomenological interviews focused on the temporal unfolding of experience. Micro-phenomenological analysis methods yielded 125 phenomenological categories describing structural dimensions, including sensory and amodal faculties, spatial organisation, self-world configuration, and modes of social relatedness. Dynamic analysis revealed reliable developmental patterns, with bodily effects typically preceding visual and auditory ones, and perceived presences emerging only after multisensory integration and 3D spatial characteristics had developed, illustrating a hierarchical relationship between subtle and gross forms of immersion. Perceived presences varied widely in sensory modality, semantic complexity, and relational mode. These findings show immersion under DMT as a dynamic, constructive process, providing precise structural features for future neurophenomenological modelling, and supporting the view that DMT research may inform our understanding of immersive experience across other aetiologies, including ordinary experience of the world.
Background: Virtual reality (VR) has been increasingly used in motor rehabilitation over the past two decades, but the overall research landscape of this field has not been fully mapped from a bibliometric perspective. Objective: This study aimed to conduct a bibliometric analysis to determine the development of research on VR for motor rehabilitation, focusing on its knowledge structure, major research topics, and temporal changes in the field. Methods: A topic-based search combining VR- and motor rehabilitation-related terms was conducted in the Web of Science Core Collection for the period from 2005 to 2025, yielding 1232 publications. VOSviewer, CiteSpace, R, and Scimago Graphica were used to analyze publication trends, country and institutional contributions, author collaboration, journal and reference co-citation, keyword co-occurrence, citation bursts, and thematic evolution. Results: Publications increased in three stages: slow exploration, steady growth, and rapid expansion. The United States, Italy, China, and Canada were the leading contributors, with McGill University as the most productive institution. Research hotspots included gait and neurological rehabilitation, post-stroke upper-limb recovery, robotics- and neuroscience-integrated rehabilitation, and the rise of immersive VR technology. Conclusions: This study provides a bibliometric overview of research progress in the application of virtual reality technology to motor rehabilitation, offering systematic insights into the field's knowledge structure, core research themes, evolutionary trajectory, and future research directions.
Traditional lecture-based learning (LBL) is often insufficient for cultivating the practical decision-making skills required in high-stakes environments like Emergency Medical Response (EMR). While game-based learning (GBL) offers an immersive alternative, it can lack immediate expert guidance. This study addresses this gap by exploring the integration of generative Artificial Intelligence (AI) as an "intelligent tutor" within GBL. The objective was to evaluate and compare the effectiveness of LBL, GBL, and generative AI-powered game-based learning (AI-GBL) on medical students' knowledge acquisition, retention, learning motivation, and cognitive load in an EMR course. A retrospective, comparative study was conducted with 86 medical students from three consecutive cohorts (2022-2024), each exposed to one of the three teaching modalities (n = 29 LBL, n = 28 GBL, n = 29 AI-GBL). Knowledge was assessed via pre-test, post-test, and final-test scores with a maximum score of 10 points. Student feedback was collected for learning motivation, cognitive load, and technology acceptance. For immediate knowledge acquisition, both GBL (mean difference = 1.124/10 points; 95% CI [0.297, 1.952]; P = 0.008) and AI-GBL (mean difference = 0.897/10 points; 95% CI [0.076, 1.717]; P = 0.033) significantly outperformed LBL. For delayed knowledge retention, the AI-GBL group demonstrated significantly superior retention compared to both the GBL group (mean difference = 0.689 points; unadjusted 95% CI [0.080, 1.299]) and the LBL group (mean difference = 1.310 points; unadjusted 95% CI [0.706, 1.915]). The AI-GBL group also reported significantly lower cognitive load than the GBL group (mean difference = -0.273 points; unadjusted 95% CI [-0.456, -0.090]). Finally, students perceived the AI-powered approach as significantly more useful than the standard game-based approach (mean difference = 0.513 points; unadjusted 95% CI [0.137, 0.889]). The AI-enhanced GBL model for EMR training improves knowledge acquisition and retention while reducing cognitive load, representing a promising approach for developing proficiency in complex, high-stakes medical competencies.
People living with and beyond cancer frequently experience cognitive and psychosocial difficulties, yet structured rehabilitation remains limited. Extended reality offers immersive and adaptable tools that may help address these supportive care needs. To synthesise evidence on extended reality interventions for cognitive and psychosocial rehabilitation in cancer care. An integrative review was conducted using Whittemore and Knafl's framework. Literature published between 2014 and 2025 was identified through searches of major electronic databases and manual reference screening. Study quality was appraised using the Mixed Methods Appraisal Tool, and findings were synthesised thematically. A total of 14 studies met the inclusion criteria. Two primary functional domains emerged: cognitive rehabilitation, including improvements in attention, executive function and psychosocial rehabilitation, including reductions in anxiety, depression, fatigue and improvements in quality of life. Across studies, extended reality interventions-predominantly virtual reality-were generally feasible, well accepted and associated with high engagement and minimal adverse effects, although methodological heterogeneity remained substantial. Extended reality, particularly virtual reality, shows promise as a feasible and acceptable approach to supporting cognitive and psychosocial rehabilitation in cancer care. Extended reality, particularly virtual reality, may be considered as a complementary approach to support cognitive and psychosocial rehabilitation in people living with and beyond cancer. Clinicians may consider integrating extended reality into supportive cancer care while recognising that further high-quality evidence is needed to inform routine clinical implementation.
Successful speech communication in multi-talker scenarios requires a skillful combination of sustained attention and rapid attention switching. While the neurophysiology literature offers detailed insights into the neural underpinnings of sustained attention, there remains considerable uncertainty on how attention switching takes place. In this study, using EEG recordings from normal-hearing adults in an immersive multi-talker environment, we measured the neural encoding of two competing speech streams amid background babble. Participants were cued to switch attention between streams every 15-30 s. Neural tracking was assessed via Temporal Response Functions (TRF), confirming reliable decoding of attentional focus. Our results indicate asymmetric disengagement and engagement processes during attention switches, where the neural tracking of the new target stream emerges before disengaging from the previous target, revealing a transient simultaneous encoding of two speech streams. That transition was closely mirrored by a reduction in EEG alpha power, informing on the cognitive effort during different phases of the attention switch. We then isolated cortical activity reflecting lexical prediction mechanisms to determine how lexical context is updated after an attention switch, comparing four context-accumulation strategies that were constructed using Large Language Models. Our findings elucidate both the temporal and contextual mechanisms underlying auditory attention shifts, pointing to the possibility that listeners carry out a reset in lexical context after switching attention. By focusing on dynamic attentional reallocation, this study offers insights into the brain's capacity for flexible speech processing in complex listening environments.
The rapid integration of Artificial Intelligence (AI) into healthcare necessitates a paradigm shift in pharmacy education to prepare future-ready professionals. However, the global trajectory of this educational evolution and the distinct strategic approaches between different regions remain under-explored. This study aims to systematically map the global and Chinese research landscapes, identifying evolutionary trends, pedagogical shifts, and core competency requirements in the intelligence era. A comparative visualization analysis was conducted using CiteSpace (6.4.R1) on literature retrieved from the Web of Science (WoS) Core Collection and China National Knowledge Infrastructure (CNKI) covering publications up to December 31, 2025 (data retrieval was conducted in early 2026). We employed co-occurrence clustering and burst detection to analyze publication trends, institutional collaborations, and keyword evolution. The study specifically examined the divergence and convergence of educational strategies between global and Chinese contexts. A total of 240 English and 118 Chinese high-relevance articles were analyzed, revealing a rapid growth trajectory characterized by a logarithmic pattern, with universities as primary research hubs. The analysis identified three critical pedagogical transitions: Assessment Transformation: A shift from rote memorization to complex clinical reasoning, driven by Gen AI tools; Pedagogical Innovation: The integration of "Virtual Reality" and "Immersive Teaching," signaling a move toward technology-enhanced experiential learning; and Competency Redefinition: A pivot from traditional pharmacology knowledge to "Digital Literacy" and "Interdisciplinary Abilities." Notably, comparative analysis revealed that while global research focuses heavily on the technical integration of AI in clinical practice, Chinese literature demonstrates a stronger orientation toward policy-driven curriculum reform and top-level design. AI is increasingly recognized as a key catalyst associated with pedagogical evolution rather than merely a technological adjunct. Notably, while global efforts prioritize the technical integration of AI into clinical tools, Chinese initiatives emphasize top-level policy-driven curriculum reform. To bridge the gap between education and practice, institutions must transition from tool-based instruction to a deep integration of AI ethics, data logic, and clinical decision-making. This study provides an evidence-based roadmap for educators to align curricula with the accelerating digital transformation of the pharmacy profession.
Electroencephalography (EEG) is a noninvasive tool used by healthcare professionals to measure brain electrical activity. EEG analysis can indicate various anomalies linked to different brain pathologies, including seizures. Traditionally, the analysis is confined to two-dimensional displays and relies exclusively on the visual modality, limiting a comprehensive overview. EEG analysis through visualisation is challenging and time-consuming, and artificial intelligence (AI) is increasingly used to aid the process of seizure detection. However, the educational value of AI-assisted seizure detection models depends on the explainability of the underlying models. Explainable AI can help learners understand the features and patterns associated with seizure detection and also support informed use of AI-based decision support systems. M2EEG-VR leverages the focus and immersive capabilities of virtual reality (VR) with the aim of developing a multi-modal platform for EEG seizure detection analysis with a human-in-the-loop. The ability to understand EEG and seizure patterns is key to addressing and effectively treating many neurological conditions. Neonatal seizure detection is particularly challenging where seizure patterns are subtle and context dependent. This study advances toward multi-modal analysis by encoding EEG signals into auditory representations using AI that aids in the acoustic detection of the presence of neonatal seizures in EEG. The platform also introduces a 3D brain model with a spatial mapping of seizure regions. In a user study (N = 20, 4 prior EEG experience, 16 no prior EEG experience), participants achieved higher seizure detection accuracy in the combined visual and auditory condition (mean = 7.6 ± 1.2) than in visual-only or audio-only modes. These preliminary findings suggest that a multi-modal environment may improve the accuracy of detection. However, further controlled studies are needed to ascertain the performance benefits. Usability was rated excellent (SUS = 83 ± 11), and task load remained moderate (NASA-TLX = 36.6). The findings suggest that VR multi-modal interaction can reduce cognitive load and enhance the explainability of complex EEG data in a focused virtual environment. The analysis of the diagnostic accuracy showed that participants without prior EEG knowledge performed similarly across all modalities to those with prior EEG knowledge. This implies that the accessibility barrier is reduced for novice users using the tool for the EEG review/detection task. This, together with high usability and moderate task load scores, indicates that the tool may be suitable for medical training applications. A multi-modal EEG in VR may prove useful in education and also be used as a test bench to further explore AI with human-in-the-loop paradigms for seizure detection.
Mass casualty incidents (MCIs) are community threats prompting recommendations for formal MCI training among health care professionals, including physician assistant/associate (PA) students. In response, two accredited PA graduate programs collaborated on an immersive MCI training day aimed at improving student preparedness and confidence in responding to an MCI in the community. In this prospective cohort study, didactic-year PA students (n = 45) participated in a novel MCI curriculum that involved practical skills stations and large-scale simulations. Preliminary data on program effectiveness were assessed pretraining and post-training via surveys assessing knowledge and self-reported preparedness and confidence in responding to an MCI. Paired samples t-tests were used to determine if differences were seen between pre and post assessments. We describe the development and implementation of MCI training in detail, including curricular design, personnel, set-up, and administration. Initial analyses showed statistically significant improvements in knowledge gained (42.4 ± 14 vs. 86 ± 12, P ≤ .0001), perceived preparedness (1.8 ± 0.8 vs. 4.3 ± 0.5, P ≤ .0001), and perceived confidence (2.9 ± 1.3 vs. 4.3 ± 0.6, P ≤ .0001) after implementation of the MCI curriculum. The development and execution of an MCI curriculum is described and can be used as a template for PA educators wishing to incorporate this training into the curriculum. Training significantly enhanced PA students' knowledge, preparedness, and confidence in community-based disaster response. These findings support the integration of formal MCI training in PA education to prepare future providers for real-world disaster response.
3D Gaussian Splatting (3DGS) has recently emerged as an effective representation for immersive 3D scene rendering, providing high visual fidelity and real-time rendering efficiency. To support interoperable compression of trained 3DGS content, the Moving Picture Experts Group (MPEG) is exploring Gaussian Splat Coding (GSC), which mainly targets already trained 3DGS models following the INRIA reference format. The current video-based GSC anchor reorders 3DGS attributes into 2D attribute maps using Parallel Assignment Linear Sorting (PLAS) and compresses the resulting maps using High Efficiency Video Coding (HEVC). However, higher-order spherical harmonic coefficients (SH-AC) often remain irregular and exhibit low local spatial correlation even after PLAS reordering, limiting the coding efficiency of conventional video codecs. This paper proposes a VQ-HEVC hybrid compression framework that is structurally compatible with the video-based GSC anchor framework, in which SH-AC coefficients are represented by vector quantization (VQ) indices, while the remaining attributes are encoded using the same HEVC-based procedure as the GSC anchor. The proposed method adopts a two-stage VQ scheme that combines coarse VQ and product-quantization-based residual quantization, together with zero-masked residual VQ and flexible PQ grouping, to improve index-map coding efficiency across rate points. The generated VQ indices are packed into YUV400 index-map sequences and encoded using HEVC lossless coding, while the corresponding codebooks are transmitted as metadata. Experimental results on the Bartender and Cinema sequences of the MPEG GSC CTC demonstrate consistent rate-distortion improvements over the video-based GSC anchor across multiple objective quality metrics within the evaluated setting. In terms of RGB-PSNR, the proposed method achieves BD-rate reductions of 22.3% and 18.5% for the Bartender and Cinema datasets, respectively. These results suggest that, for the evaluated GSC CTC sequences, VQ-based SH-AC representation can effectively complement PLAS-based video coding while maintaining consistency with the existing GSC coding structure.
Technology is rapidly reshaping paediatric healthcare, offering unprecedented opportunities to improve outcomes, personalise care, and extend reach beyond traditional clinical settings. From AI-driven diagnostics and wearable monitoring to immersive therapeutics and digital mental health tools, innovation is enabling more proactive, child-centred models of care. In the UK, initiatives such as the National Centre for Child Health Technology (NCCHT) and the NIHR HealthTech Research Centre in Paediatrics and Child Health are driving strategic adoption, while international networks including, KidsUp in the US, EPTRI, i4Kids in Spain, ISPI, the WHO's Global Digital Health Strategy and EU-funded paediatric innovation consortia are fostering cross-border collaboration and knowledge exchange. Despite this momentum, significant challenges remain. Fragmented infrastructure, limited interoperability, and uneven digital literacy across the workforce hinder widespread implementation. Regulatory frameworks often lag behind technological advances, particularly in areas like AI, where transparency, bias mitigation, and safeguarding are critical. Moreover, funding pathways for paediatric-specific technologies remain underdeveloped compared to adult-focused innovation. Children and young people (CYP) are increasingly vocal about their expectations for health tech. They value tools that are intuitive, inclusive, and respectful of their autonomy. Feedback from CYP engagement exercises highlights a desire for technologies that support mental wellbeing, facilitate communication with clinicians, and offer personalised insights, without feeling intrusive or overtly clinical. However, concerns persist around data privacy, digital exclusion, and the potential for technology to replace human connection. Ethical considerations are also central to paediatric digital health. AI applications must be transparent, accountable, and co-designed with children and families to ensure they reflect lived experience and avoid unintended harm. Equity must be embedded from the outset, ensuring that innovation does not widen disparities in access, outcomes, or trust. To realise the full potential of technology in paediatrics, we must build inclusive, ethically grounded ecosystems that centre children's voices, support the workforce, and enable safe, scalable innovation. This requires sustained investment, cross-sector collaboration, and a commitment to embedding digital transformation within the broader goals of child health equity and empowerment.
The metaverse is transforming global supply chain operations by enhancing resilience and performance through immersive system environments and advanced interface design strategies. However, its adoption and effectiveness remain underexplored in emerging economies. This study investigates the impact of metaverse adoption on supply chain resilience and performance in Pakistan and China, examining the mediating roles of agility, risk management, and transparency, along with the moderating effect of data security design mechanisms. Using a hybrid analytical approach combining partial least squares structural equation modelling (PLS-SEM) and artificial neural networks (ANN), data from 411 supply chain professionals in Pakistan and 475 in China were analysed. The findings confirm that metaverse adoption significantly enhances supply chain resilience and performance in both contexts, with agility and transparency serving as key mediating factors, while risk management shows only partial mediation. The moderating analysis reveals that the data security design mechanism does not significantly moderate the relationship between metaverse adoption and resilience, but it does positively strengthen the link between metaverse adoption and performance. ANN results across both countries identify transparency, agility, and metaverse adoption as the most influential design-integrated determinants. The study offers theoretical and practical implications for advancing metaverse-enabled, design-driven supply chains in emerging Asian economies.
Anxiety is a prevalent issue among cancer patients undergoing chemotherapy, significantly impacting their treatment and quality of life. Virtual reality (VR) has emerged as a promising nonpharmacological intervention to reduce anxiety by providing immersive, distraction-based experiences. This study introduces a VR application featuring the Seribu Islands, designed to alleviate anxiety through exposure to natural environments. To assess the effectiveness of the VR Seribu Island in reducing anxiety, evaluate user experience (UX), and identify potential cybersickness symptoms among healthy participants. A mixed-methods design was used to evaluate 30 healthy participants who interacted with the VR Seribu Island. Pre and Postexposure anxiety levels were measured using the State-Trait Anxiety Inventory (STAI). UX was assessed via a questionnaire, and semi-structured interviews explored participant perceptions. Cybersickness symptoms were evaluated using the Cybersickness Syndrome Questionnaire (CSQ-VR). Post-VR anxiety scores were significantly lower than pre-VR scores (median difference = 8.0, 95% CI [4.39, 8.61], p = 0.001, r = 0.83), indicating a reduction in anxiety. Participants reported high satisfaction with the VR experience, with an average score of 4.48 out of 5. Cybersickness symptoms were minimal, with low severity reported across most metrics. The VR Seribu Island significantly reduced anxiety and was well received by participants. This preliminary study supports further investigation of VR as a therapeutic tool for anxiety management in clinical populations.
Laser cavitation peening (LCP) is a novel material surface treatment method. In this study, we investigated the electrochemical corrosion performance of LCP-treated HT250 gray cast iron, with and without a coverage layer, under various laser energies, defocusing amounts, and immersion times. In the LCP process, a 0.04 mm aluminum coverage layer was employed. The influence of the coverage layer on LCP processing was analyzed. The results show that the presence of a coverage layer during the LCP treatment improves the specimen's anti-corrosion ability, with this alignment corresponding with an increase in laser energy. In comparison with laser energy, the effect of a coverage layer on corrosion resistance at various defocusing amounts is not very significant, and at a smaller defocusing amount, the treated specimen presents higher corrosion resistance. The corrosion resistance of gray cast iron in the case with a coverage layer first increases with the increase in laser energy and then decreases. The presence of a coverage layer helps to avoid laser ablation and cavitation erosion.