Intraocular pressure increases after complex simulated surgical procedures in residents: an experimental study

Influence of meteorological factors on intraocular pressure variability using a large-scale cohort

The effects of meteorological conditions on IOP using a large-scale health examination cohort were investigated. There were a total of 811,854 measurements from 126,630 eyes of 63,839 subjects in 9 years from a health checkup cohort followed up annually for age, sex, body height, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), and IOP. The effects of these variables and the meteorological data of daily average temperature (TP), daily average local atmospheric pressure (AP), daily average volumetric humidity (VH), and daily amount of rainfall (RF) on the day of IOP measurement on IOP were investigated. Several variables were significantly associated with IOP, including sex, age, body height, BMI, SBP, DBP, average TP, average AP, average VH, RF, white blood cell count, red blood cell count, hemoglobin, aspartate aminotransferase, alanine aminotransferase, guanosine triphosphate, calcium, and HbA1c. This study indicated a correlation between meteorological factors and IOP. Higher AP and RF were associated with elevated IOP, whereas higher TP and VH were associated with decreased IOP.

Theoretical foundations and implications of augmented reality, virtual reality, and mixed reality for immersive learning in health professions education

BACKGROUND

Augmented Reality (AR), Virtual Reality (VR) and Mixed Reality (MR) are emerging technologies that can create immersive learning environments for health professions education. However, there is a lack of systematic reviews on how these technologies are used, what benefits they offer, and what instructional design models or theories guide their use.

AIM

This scoping review aims to provide a global overview of the usage and potential benefits of AR/VR/MR tools for education and training of students and professionals in the healthcare domain, and to investigate whether any instructional design models or theories have been applied when using these tools.

METHODOLOGY

A systematic search was conducted in several electronic databases to identify peer-reviewed studies published between and including 2015 and 2020 that reported on the use of AR/VR/MR in health professions education. The selected studies were coded and analyzed according to various criteria, such as domains of healthcare, types of participants, types of study design and methodologies, rationales behind the use of AR/VR/MR, types of learning and behavioral outcomes, and findings of the studies. The (Morrison et al. John Wiley & Sons, 2010) model was used as a reference to map the instructional design aspects of the studies.

RESULTS

A total of 184 studies were included in the review. The majority of studies focused on the use of VR, followed by AR and MR. The predominant domains of healthcare using these technologies were surgery and anatomy, and the most common types of participants were medical and nursing students. The most frequent types of study design and methodologies were usability studies and randomized controlled trials. The most typical rationales behind the use of AR/VR/MR were to overcome limitations of traditional methods, to provide immersive and realistic training, and to improve students' motivations and engagements. The most standard types of learning and behavioral outcomes were cognitive and psychomotor skills. The majority of studies reported positive or partially positive effects of AR/VR/MR on learning outcomes. Only a few studies explicitly mentioned the use of instructional design models or theories to guide the design and implementation of AR/VR/MR interventions.

DISCUSSION AND CONCLUSION

The review revealed that AR/VR/MR are promising tools for enhancing health professions education, especially for training surgical and anatomical skills. However, there is a need for more rigorous and theory-based research to investigate the optimal design and integration of these technologies in the curriculum, and to explore their impact on other domains of healthcare and other types of learning outcomes, such as affective and collaborative skills. The review also suggested that the (Morrison et al. John Wiley & Sons, 2010) model can be a useful framework to inform the instructional design of AR/VR/MR interventions, as it covers various elements and factors that need to be considered in the design process.

The intraocular pressure lowering-effect of low-intensity aerobic exercise is greater in fitter individuals: a cluster analysis

This study aimed to determine the influence of physical fitness level and sex on intraocular pressure (IOP) during the low-intensity aerobic exercise. Forty-four participants (twenty-two men) cycled 30 minutes at low intensity (10% of the maximal power). Maximal power was determined by asking participants to perform maximal sprints of 6 seconds against 3-4 different resistances separated by 3 minutes of rest. The IOP was measured on 9 occasions (1) prior to the warm-up, (2) after the warm-up, (3-7) every 6 minutes during the low-intensity cycling task, and (8-9) 5 and 10 minutes after the cycling task. Low-intensity aerobic exercise had a lowering effect on IOP, being the beneficial effect more accentuated and prolonged in the High-fit group (IOP reduction compared to baseline lasted 30 minutes) than in the Low-fit group (IOP was only reduced at 6 minutes of exercise compared to baseline). Participants´ sex had no effect on the IOP behaviour at any time point (p = 0.453). These findings indicate that individuals who need to reduce IOP levels (i.e., glaucoma patients or those at risk) should increase or maintain a high fitness level to benefit more from the IOP lowering effect during low-intensity aerobic exercises.

Intraocular pressure responses to a virtual reality shooting simulation in active-duty members of the Spanish Army: The influence of task complexity

Ocular physiology is sensitive to cognitively demanding tasks. However, it is unknown whether the intraocular pressure is also affected by the cognitive demands of military operations. The main objective was to determine the impact of a virtual reality shooting simulation with two levels of complexity on intraocular pressure levels in military personnel. Eighteen active-duty members of the Spanish Army and eighteen civilians performed two 4 min simulated shooting tasks with two levels of complexity using a virtual reality. In the "easy" task participants performed a simulated shoot when the stimulus (military with a rifle) appeared, while in the "difficult" task the stimulus randomly was a military with a rifle or with his hands on the air and participants were instructed to respond only when the military with a rifle appeared. Intraocular pressure was measured with a rebound tonometer before and immediately after each task. Complementarily, perceived levels of mental load and shooting performance (reaction time) were assessed. Intraocular pressure was greater after completing the more complex task in both military personnel (p-value < 0.01, Cohen´s d = 1.19) and civilians (p-value < 0.01, Cohen´s d = 1.16). Also, perceived levels of task load and reaction time were higher in the difficult compared to the easy shooting tasks (both p < 0.001). The rise in intraocular pressure is positively associated with the cognitive demands of simulated military operations. The potential application of this finding is the development of objective tools based on intraocular pressure for the evaluation of the mental state in real-world contexts, permitting to improve soldiers´ safety and performance.

The Validity of Physiological Measures to Identify Differences in Intrinsic Cognitive Load

A sample of 33 experiments was extracted from the Web-of-Science database over a 5-year period (2016-2020) that used physiological measures to measure intrinsic cognitive load. Only studies that required participants to solve tasks of varying complexities using a within-subjects design were included. The sample identified a number of different physiological measures obtained by recording signals from four main body categories (heart and lungs, eyes, skin, and brain), as well as subjective measures. The overall validity of the measures was assessed by examining construct validity and sensitivity. It was found that the vast majority of physiological measures had some level of validity, but varied considerably in sensitivity to detect subtle changes in intrinsic cognitive load. Validity was also influenced by the type of task. Eye-measures were found to be the most sensitive followed by the heart and lungs, skin, and brain. However, subjective measures had the highest levels of validity. It is concluded that a combination of physiological and subjective measures is most effective in detecting changes in intrinsic cognitive load.