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People often anticipate feared, negative future events but still fail to take preventive action-simply imagining feared outcomes does not reliably prompt behavior change. Research has shown that mental contrasting-imagining a negative future and then reflecting on a positive reality in the present-can translate this fear into action. However, the psychological mechanisms underlying this effect remain unexplored. Across five experiments (two cross-sectional and three longitudinal with 1-month follow-ups), we examined how mental contrasting of a negative future promotes preventive behavior by altering interpretations of current reality. Supporting our hypothesis, participants who engaged in mental contrasting evaluated their reality as more precious than those engaged in reverse contrasting (Studies 1 and 3) and those in the valence control condition (Study 2). These shifts in evaluations of reality predicted greater preventive behavior over the following month (Studies 1 and 3). In addition, mental contrasting changed implicit evaluations of reality in the same direction, as measured by the extrinsic affective Simon task (Studies 4 and 5). These implicit changes further predicted preventive action 1 month later (Study 5). Our research identifies a key mechanism by which mental contrasting converts fear into action: It changes how people explicitly and implicitly evaluate the meaning of their current reality. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

While osteochondromas are the most common benign bone tumors, spinal involvement remains uncommon. In patients with hereditary multiple exostosis (HME), spinal osteochondromas predominantly affect posterior elements. Anterior vertebral body involvement is unusual, and anterior C3 osteochondroma with parapharyngeal extension in an adult has not been previously reported in the literature. Management of complex anterior cervical tumors near critical neurovascular structures presents significant surgical challenges. The authors present the first documented case of anterior C3 vertebral body osteochondroma with parapharyngeal space extension in a 20-year-old patient with HME presenting with progressive dysphagia. Preoperative imaging and advanced surgical planning utilizing patient-specific 3D-printed models and immersive virtual reality (VR) enabled detailed visualization of tumor anatomy. Intraoperative fluoroscopic volumetric navigation was used to guide precise osteotomy cuts in proximity to the vertebral artery. Complete tumor resection was achieved without neurological or vascular complications and without breach of the upper aerodigestive tract, with complete resolution of dysphagia and no recurrence at the 3-month follow-up. Advanced preoperative planning using 3D printing and VR provide significant value for rare and anatomically complex spinal pathology, especially when multiple surgical services are involved. The addition of intraoperative volumetric navigation enabled safe resection of the tumor adjacent to critical neurovascular structures. https://thejns.org/doi/10.3171/CASE26134.

Virtual reality (VR)-based education is increasingly used in infection prevention and control (IPC) training, yet its impact on real-world practice remains unclear. This systematic review evaluated the impact of VR or immersive simulation-based educational interventions on IPC practices and systematically identified educational design and implementation factors associated with variability in intervention effects. Following the PRISMA 2020 guidelines, PubMed and Scopus were searched for English-language studies published between 2015 and 2025. Ten studies met the inclusion criteria. Most studies targeted students or trainees and assessed proximal outcomes, including knowledge, simulated performance, and self-efficacy. VR-based IPC education improved learner-centered outcomes, but evidence for sustained practice-level behavior change was limited and inconsistent, partly because practice-level outcomes were insufficiently assessed and generally restricted to short-term follow-up. These findings suggest that the translation of learning gains into practice may depend on whether VR-based learning experiences are supported by theory-informed educational design, reinforced over time, and evaluated longitudinally.

Opioid use disorder (OUD), which leads to thousands of deaths per year, continues to pose a tremendous challenge to health care systems. While medications for opioid use disorder (MOUDs), such as buprenorphine and methadone, are the most effective treatments for OUD, the initial patient conversation and decision to engage in MOUDs remain major barriers. Decision-making is strongly influenced by the patients' current emotional state. While the emergency department (ED) is a promising access point for initiating MOUDs, patients' readiness to engage in treatment can be limited, in part, by the negative emotions and experiences associated with the ED visit. We co-designed and developed a novel emotion-based virtual reality (VR) intervention to increase patient readiness to engage in shared decision-making for treatment with MOUDs following an ED admission for an opioid-related overdose. This paper describes a 3-stage, iterative process involving 59 stakeholders, including people with lived experience (LE), to design and develop an intervention that resulted in a VR app and preliminary assessments of user experience. Our process incorporated the perspectives of LE stakeholders across all aspects of the design and refinement of the VR platform VR-Choice. VR-Choice consists of a VR journey up a mountain ("Mountain Journey"), culminating in the presentation of nine 180-degree videos showing different positive aspects of life during recovery ("Possible Worlds"). Of the 20 participants who experienced the final platform version, none reported more than slight motion sickness symptoms. Nineteen of the 20 participants stated they liked the videos shown in the final version, considered it to be potentially helpful for patients in the emergency room after an opioid-involved overdose, and thought the experience should be offered to those patients. All participants agreed that the program was easy to use, and only 1 participant described it as confusing. To our knowledge, this is the first effort to use feedback from participants with LE to design an engaging VR experience for people in the ED who may be candidates for MOUDs. Participants' feedback was positive, and we will move forward with development.

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental condition affecting approximately 7% to 8% of children and adolescents, characterized by persistent inattention, hyperactivity, and impulsivity. Adolescence represents a period of heightened vulnerability, during which pharmacological treatments are frequently limited by adverse effects, suboptimal adherence, and partial response. Physical exercise, particularly high-intensity interval training (HIIT), has demonstrated superior effects on inhibitory control and inattention compared with moderate-intensity continuous exercise. However, the repetitive nature and high perceived exertion of traditional HIIT protocols result in poor adherence, especially in individuals with ADHD. Virtual reality (VR)-based exergames have been proposed as a strategy to sustain vigorous physiological demands while maintaining intrinsic motivation. Despite this potential, the existing literature is predominantly limited by passive control conditions, which prevent adequate control for the effects of VR immersion and cognitive engagement, limiting causal inference regarding the specific contribution of physiological exertion. This paper presents the protocol for a randomized clinical trial designed to evaluate whether an HIIT-based VR exergame produces greater improvements in inhibitory control and inattention symptoms compared with an active, nonexercise VR control condition in adolescents with ADHD. This multisite, parallel-group, single-blind randomized clinical trial will recruit 98 adolescents aged 12 to 17 years with a confirmed diagnosis of ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, from 2 outpatient centers in Brazil. Participants will be allocated 1:1 to an HIIT-based VR exergame intervention (Move Sapiens) or an active control condition using the same VR platform without vigorous physical exertion. The intervention comprises 20 sessions over 4 weeks delivered in a home-based format following supervised laboratory familiarization. Primary outcomes are Swanson, Nolan, and Pelham Rating Scale version IV inattention subscale scores and go/no-go commission errors. Secondary outcomes include working memory, cognitive flexibility, processing speed, impulsivity, sleep quality, and anxiety symptoms. Analyses will follow an intention-to-treat approach using linear mixed-effects models. The trial is ongoing. Funding was granted in October 2024. As of April 2026, 58 participants have been enrolled across 2 sites, of whom 46 (79.3%) have completed the full intervention protocol. Data collection is expected to be completed by October 2026, with results anticipated by December 2026. This trial will provide controlled evidence on the efficacy of an HIIT-based VR exergame for adolescents with ADHD using an active control condition matched for technological immersion. The design will enable examination of whether vigorous physical exertion beyond VR immersion and digital engagement constitutes an essential active component for improvements in inhibitory control and inattention in this population. If effective, the intervention may offer an engaging, home-based adjunctive treatment option for adolescents with ADHD. ClinicalTrials.gov NCT06632249; https://clinicaltrials.gov/study/NCT06632249. DERR1-10.2196/94797.

Virtual reality (VR) has a long history in stroke rehabilitation. In this News and Perspectives article, JMIR Correspondent Jenna Congdon reports on one person's journey back to driving after a stroke, highlighting the strengths, limitations, and future of VR in rehabilitation.

Attention-deficit/hyperactivity disorder (ADHD) is associated with variability in attentional and executive functioning, and individuals with ADHD frequently present problematic patterns of internet use. Virtual-reality (VR)-based assessments have been proposed to improve ecological evaluation of cognitive performance. This pilot study explored cognitive performance variations in adults with ADHD, examining associations with problematic internet-use during routine clinical treatment. A pilot study was conducted in 17 adults with ADHD and clinically relevant problematic internet use. Participants were evaluated at baseline (T0) and after 4 weeks (T1) using the Barkley Adult ADHD Rating Scale-IV (BAARS-IV), the Internet Addiction Test (IAT), and an immersive VR continuous performance test (Nesplora Aquarium) assessing attentional and executive-function indices. Comparison between T0 and T1 revealed a significant improvement in working memory (Z = -2.638, p = 0.008) and a reduction in IAT scores (Z = -2.392, p = 0.017). Conversely, attention scores showed a decline (Z = -2.899, p = 0.004). At baseline, a positive correlation was found between IAT scores and working memory, which disappeared after treatment. These results provide preliminary evidence supporting the feasibility of VR-based cognitive monitoring in adults with ADHD and require confirmation in larger controlled studies.

Cognitive impairments resulting from traumatic brain injury (TBI) may be detected using the Automated Neuropsychological Assessment Metrics (ANAM) test. Following mild TBI, the Progressive Return to Activity pathway requires exertional testing before ANAM testing, yet there is currently a lack of simulated military operational demands before return to duty (RTD) clearance. RehabXR (formerly Praxis; BlueHalo, Germantown, MD, United States), a novel virtual reality (VR) system, can deliver VR-based, immersive first-person shooting scenarios that may be clinically useful; however its relationship to established neuropsychological assessments has not been well characterized. Therefore, the purpose of this feasibility and exploratory convergent-validity pilot study was to (1) explore the correlations between ANAM scores and performance on 2 RehabXR VR-based RTD scenarios (Stroop Target Shoot and Directional Memorization) and (2) determine tolerance to RehabXR testing in healthy Reserve Officers' Training Corps (ROTC) cadets. Twenty-six healthy ROTC cadets (16 male, 10 female; age 20.2&#x2009;&#xb1;&#x2009;1.2 years) completed the ANAM and 4 rounds of 2 RehabXR scenarios. The relationship between select ANAM scores (from 8 tests) and performance on RehabXR VR-based joint cognitive and sensory RTD training scenarios were explored using the Spearman's rank correlation coefficient (r). To control for multiple comparisons, a false-discovery rate (FDR) correction was applied. Participants reported symptoms (headache, dizziness, nausea, and fogginess) before and after each RehabXR scenario. Performance on 5 of the ANAM tests (Spatial Processing, Matching to Sample, Simple Reaction Time, Code Substitution with Delay, and Procedural Reaction Time) correlated with the mean response time (RT) metric on the RehabXR scenarios (|r| = 0.42-0.48; P&#x2009;<&#x2009;.05); for example, mean RT in Stroop Target Shoot correlated with mean RT and throughput (number of correct responses per minute) in Spatial Processing with an r of 0.48 and -0.46, respectively. However, when corrected for multiple comparisons, correlations remained statistically significant only under a lenient FDR threshold (&#x2265;0.4), indicating a higher tolerance for false-positive findings. These findings may suggest that the small sample size influenced these exploratory findings. Four healthy cadets reported mild transient symptoms of headache/dizziness after the RehabXR scenarios. These results provide preliminary evidence that RehabXR VR-based RTD scenarios may correlate with the ANAM test, particularly measures of RT, memory, and spatial processing. Healthy cadets tolerated RehabXR testing well, with minimal self-reported symptoms. Although these findings provide preliminary insight into potential relationships between traditional neuropsychological measures and VR-based cognitive performance metrics, the results should be interpreted cautiously given the small sample size and lack of statistical significance after conventional FDR correction. Further studies in larger samples and in individuals with mTBI are needed to determine the clinical relevance of VR-based cognitive assessments.

Virtual reality (VR) technology has emerged as an innovative teaching and training tool across numerous educational domains, yet its potential impact in community health education, particularly for culturally sensitive topics like prostate cancer (PCa), remains insufficiently explored. The aim of this study was to assess the effectiveness of a multi&#x2011;sensory, learning-based VR health education tool (M&#x2011;PCP) on PCa knowledge, cognitive load and satisfaction among men in the community. A parallel-group two&#x2011;arm randomized controlled trial was carried out in a community center in Shandong Province, China. Ninety-six male subjects aged 45-75&#xa0;years were randomly divided into two groups, the experimental group (VR&#x2011;based M&#x2011;PCP (48)) and the control group (traditional multimedia lecture (48)). Results included PCa knowledge (pre-test/post-test), cognitive load (mental load and mental effort), and satisfaction with the learning experience. The VR-based method showed that the health knowledge of the learners was significantly increased (mean 22.34 vs. 18.76, p&#x2009;=&#x2009;.003, &#x3b7;2&#x2009;=&#x2009;0.087) compared to health lectures, satisfaction was significantly higher (p&#x2009;<&#x2009;.001) and cognitive load was significantly lower (mental load: d&#x2009;=&#x2009;1.78; mental effort: d&#x2009;=&#x2009;2.45). All effect sizes (d) were medium to large. The findings indicate that VR technology can enhance the learning outcomes in the short term community health education around PCa awareness. Long-term retention, behavioral change and scalability into various settings should be explored in future research.

This protocol describes a randomized controlled trial designed to evaluate the efficacy of Virtual Reality (VR) as a non-pharmacological intervention for pain management in the immediate postoperative period of cardiac and thoracic surgeries. Postoperative pain in these major procedures is often intense and historically managed with high doses of opioids, which are associated with significant side effects and potential dependence. By leveraging the "limited capacity theory of attention," this study uses immersive and passive VR environments to compete with painful stimuli for cognitive resources, thereby aiming to reduce total opioid consumption. &#x2022; This protocol establishes a standardized three-arm methodology to compare active VR immersion, passive VR contemplation, and conventional multimodal analgesia in a high-complexity surgical setting. &#x2022; It provides a detailed framework for integrating digital distraction technology into intensive care unit (ICU) routines, including a rigorous equipment hygiene protocol to ensure patient safety. &#x2022; The study focuses on a specific younger demographic (16-40 years) to evaluate the impact of VR on recovery outcomes, opioid sparing, and patient satisfaction.

Against the backdrop of global population aging, the development of low-burden and widely acceptable interventions to support emotional health in older adults has become a critical research priority. Virtual reality (VR) has been increasingly applied in medical rehabilitation and psychological interventions due to its immersive and interactive features. However, its potential as a form of digital therapy that integrates cultural content and artistic design remains underexplored, particularly with respect to the mechanisms through which such experiences facilitate emotional regulation in older populations. Empirical studies combining subjective emotional outcomes with objective physiological indicators are especially scarce. This study aimed to examine the emotional regulation effects of an artistic cultural heritage-based VR experience among older adults and to explore its underlying mechanisms by integrating subjective psychological assessments with objective physiological responses. A mixed methods experimental design was adopted using the United Nations Educational, Scientific and Cultural Organization Historic Centre of Macao as the study context. Two VR conditions were developed for comparison: (1) an artistic cultural heritage VR environment and (2) a conventional photorealistic replica VR environment. A total of 49 participants aged 60 years and older were recruited. During the VR experience, electrodermal activity (EDA) was continuously recorded to capture emotional arousal. Physiological data were triangulated with pre- and postintervention psychological questionnaires assessing emotional states, as well as semistructured interviews. Compared with the realistic replication VR condition, the cultural heritage VR condition was associated with significantly higher positive affect and lower negative affect (P<.05). At the physiological level, a significant between-group difference was observed in mean normal-to-normal interval (P=.01; Cohen d=0.91), whereas no significant differences were found in EDA measures (all P>.05). EDA results showed notable interindividual variability but did not demonstrate consistent group-level effects. These findings suggest that emotional changes may be more prominently reflected in subjective experience than in physiological arousal. By integrating subjective and physiological measures, this study provides preliminary empirical evidence that cultural heritage VR is associated with improved emotional outcomes in older adults. The findings propose a conceptual interpretative pathway linking digital cultural experience, emotional engagement, and psychological well-being, while highlighting the importance of individual variability in physiological responses. This study contributes to the development of content- and experience-oriented approaches in digital therapeutics and provides an evidence-based framework for emotion-supportive design in digital heritage and aging-related contexts.

Nanoparticle radiosensitizers have attracted considerable attention in radiation oncology owing to their capacity to enhance the therapeutic ratio of radiotherapy. Metal-based, biodegradable, and multifunctional composite nanoparticles exploit high atomic number elements to amplify local radiation dose deposition, generate reactive oxygen species, and modulate the tumor microenvironment. Preclinical studies have consistently demonstrated improved tumor control with reduced normal tissue toxicity across multiple experimental models. However, the trajectory from laboratory discovery to clinical adoption remains slow and platform-dependent. This critical review systematically examines the mechanistic landscape of nanoparticle radiosensitization, encompassing physical dose enhancement, oxidative stress-mediated damage, DNA repair interference, cell cycle modulation, hypoxia reversal, and immune activation. We then evaluate major nanoparticle classes through a translational lens, explicitly distinguishing platforms that have reached prospective clinical testing-most notably hafnium dioxide nanoparticles (NBTXR3/Hensify)-from those still confined to preclinical investigation. Key translational barriers are analyzed, including challenges in tumor-specific biodistribution, long-term toxicity, scalable manufacturing with batch consistency, and regulatory qualification. A comparative framework is provided to help readers assess the readiness level of different nanoplatforms. Rather than offering an exhaustive catalog of published studies, this review aims to identify critical roadblocks and prioritize research directions that can accelerate meaningful clinical deployment of nanoparticle radiosensitizers in cancer radiotherapy.

To provide information that can aid patients with prostate cancer (PCa) and their uro-oncologists in shared decision-making discussions about androgen deprivation therapy (ADT), with transdermal oestradiol (tE2) as one option. We do so by summarising recent literature on breast growth in genetic males undergoing treatment with exogenous E2. Based on the amount of breast development observed in this population, we estimate the maximum amount of breast growth that patients with PCa can expect, if they elect tE2 for ADT. We also present data on risks and management of mastalgia associated with tE2. We summarise findings from five studies involving a total of 480 trans women (i.e., genetic males) undergoing gender-affirming hormone treatment with exogenous oestrogen. Exogenous E2 typically induces less than an A-cup size among trans women. The majority of breast growth occurs within the first year of treatment. We present this evidence to illustrate that the degree of gynaecomastia patients with PCa can expect if they elect tE2 for ADT is quite modest. This information can allay the often-heightened concern patients with PCa and their uro-oncologists may have regarding gynaecomastia induced by tE2 when used for ADT. Development of breast tissue in genetic males taking exogenous E2 tends to be mild and typically results in less than A-cup size. Mastalgia in the form of breast and nipple sensitivity is common with E2 treatment in patients with PCa but is transient in most cases, responds to topical anti-inflammatory agents, and can be managed with neurectomy in severe cases. This information can help clinicians provide accurate counselling and mitigate misconceptions that may dissuade patients from considering tE2 for their ADT.

[This corrects the article DOI: 10.1007/s40670-025-02476-8.].

&#x2028;Prehospital transfusion using Rhesus D antigen (RhD)-positive low-titer group O whole blood (LTOWB) or red blood cells is increasingly common when RhD-negative blood products are not available. However, concerns remain regarding D-alloimmunization in RhD-negative females of childbearing potential (FCPs), which could lead to future hemolytic disease of the fetus and newborn (HDFN). The magnitude of these risks, and their policy implications, have been the subject of recent investigation. To summarize the biological and epidemiological impacts and post-exposure management of RhD-positive transfusion in FCPs in hemorrhagic shock. &#x2028;This narrative review synthesizes the literature on the rate of D-alloimmunization, describes the results of modeling studies on the risk of HDFN following RhD-positive transfusion to FCPs, and examines epidemiologic studies estimating the HDFN risk at local, regional, and national levels. The D-alloimmunization risk mitigation strategies and current clinical guidelines are also reviewed. &#x2028;Several factors, including the low prevalence of RhD-negative individuals, the low rate of D-alloimmunization itself, potentially reduced pregnancy rates post-trauma, and advances in modern perinatal care decrease the overall risk of HDFN following the transfusion of RhD-positive blood products to FCPs in trauma. Some modeling studies estimated that fetal death due to anti-D-mediated HDFN would occur in fewer than 0.1% of FCPs exposed to RhD-positive blood products. Timely prehospital transfusion has demonstrated survival benefits for injured adults and children. National and regional epidemiological studies support the safety and utility of RhD-positive blood product use in emergency settings. Risk mitigation strategies include Rh immune globulin (RhIg) administration and structured post-exposure follow-up to detect alloimmunization and reduce potential future pregnancy harm. &#x2028;RhD-positive transfusion in FCPs during hemorrhagic shock when RhD-negative products are not available is supported by current evidence and ethical considerations. The risk of future HDFN is low and favorable perinatal outcomes can be achieved when the woman has access to modern prenatal health care. Risk may be further mitigated through post-exposure protocols. Prehospital transfusion policies should reflect this risk-benefit balance by enabling access to RhD-positive blood products for all trauma patients, including FCPs, if RhD-negative blood products are not available.

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Despite ongoing criticism, the practice of involuntary admissions to locked units remains widespread globally. In this paper, we focus on secure units within residential social care institutions in Slovenia, which are intended to provide special protection for individuals deemed dangerous to themselves or others. We conducted semi-structured individual and group interviews with institutional management, secure unit staff, and residents in all secure units across the country. The findings reveal three key issues. First, the spatial congregation of residents within secure units tends to exacerbate, rather than reduce, risk. Second, instead of addressing the specific risks that prompted admission, secure units often implement generalized restrictions aimed at maintaining internal safety. Third, the overall institutional structure significantly limits the provision of individualized care and constrains both staff and resident agency. Although secure units are formally defined as protective environments, the study suggests that they function primarily as institutional containers. As such, they are not only in violation of human rights but are also ineffective in fulfilling their intended purpose due to inherent institutional limitations. We argue that secure units should be abolished and replaced by community-based services.

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