Feasibility of a walking virtual reality system for rehabilitation: objective and subjective parameters

[EN] Background: Even though virtual reality (VR) is increasingly used in rehabilitation, the implementation of walking navigation in VR still poses a technological challenge for current motion tracking systems. Different metaphors simulate locomotion without involving real gait kinematics, which can affect presence, orientation, spatial memory and cognition, and even performance. All these factors can dissuade their use in rehabilitation. We hypothesize that a marker-based head tracking solution would allow walking in VR with high sense of presence and without causing sickness. The objectives of this study were to determine the accuracy, the jitter, and the lag of the tracking system and its elicited sickness and presence in comparison of a CAVE system. Methods: The accuracy and the jitter around the working area at three different heights and the lag of the head tracking system were analyzed. In addition, 47 healthy subjects completed a search task that involved navigation in the walking VR system and in the CAVE system. Navigation was enabled by natural locomotion in the walking VR system and through a specific device in the CAVE system. An HMD was used as display in the walking VR system. After interacting with each system, subjects rated their sickness in a seven-point scale and their presence in the Slater-Usoh-Steed Questionnaire and a modified version of the Presence Questionnaire. Results: Better performance was registered at higher heights, where accuracy was less than 0.6 cm and the jitter was about 6 mm. The lag of the system was 120 ms. Participants reported that both systems caused similar low levels of sickness (about 2.4 over 7). However, ratings showed that the walking VR system elicited higher sense of presence than the CAVE system in both the Slater-Usoh-Steed Questionnaire (17.6 +/- 0.3 vs 14.6 +/- 0.6 over 21, respectively) and the modified Presence Questionnaire (107.4 +/- 2.0 vs 93.5 +/- 3.2 over 147, respectively). Conclusions: The marker-based solution provided accurate, robust, and fast head tracking to allow navigation in the VR system by walking without causing relevant sickness and promoting higher sense of presence than CAVE systems, thus enabling natural walking in full-scale environments, which can enhance the ecological validity of VR-based rehabilitation applications.The authors wish to thank the staff of LabHuman for their support in this project, especially José Miguel Martínez and José Roda for their assistance. This study was funded in part by Ministerio de Economia y Competitividad of Spain (Project NeuroVR, TIN2013-44741-R and Project REACT, TIN2014-61975-EXP), by Ministerio de Educacion y Ciencia of Spain (Project Consolider-C, SEJ2006-14301/PSIC), and by Universitat Politecnica de Valencia (Grant PAID-10-14).Borrego, A.; Latorre Grau, J.; Llorens Rodríguez, R.; Alcañiz Raya, ML.; Noé, E. (2016). Feasibility of a walking virtual reality system for rehabilitation: objective and subjective parameters. Journal of NeuroEngineering and Rehabilitation. 13:1-9. https://doi.org/10.1186/s12984-016-0174-1S1913Lee KM. Presence. Explicated Communication Theory. 2004;14(1):27–50.Riva G. Is presence a technology issue? Some insights from cognitive sciences. Virtual Reality. 2009;13(3):159–69.Banos RM, et al. Immersion and emotion: their impact on the sense of presence. Cyberpsychol Behav. 2004;7(6):734–41.Llorens R, et al. 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Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

OPTICAL INSTABILITIES AND COHERENCE IN THE FREE-ELECTRON-LASER

We report new theoretical and numerical results in the following areas of FEL physics : A) Long pulse propagation. Numerical propagation of optical and electron pulses long compared to the slippage has been carried out. The optical pulses break up under condition of moderate saturation into a series of spikes with period and width comparable to the slippage. At higher power one finds further break-up associated with the appearance of spectral features below resonance by approximately the frequency of synchrotron oscillation. Suppression of the break-up has been achieved by spectral filtering of the FEL output at the low-frequency end of the spectrum. B) Periodic solutions with constant current. By imposing periodic boundary conditions in slow time in an FEL with constant current, we have been able to study the break-up phenomenon in a simpler context than pulse propagation, as well as to calculate the likely behavior of actual constant-current FEL's at moderate power. We find that single-frequency operation is generally stable at low power. At moderate power one instead find that several frequencies mode-lock together to produce a simple periodic waveform. Periods close to the slippage are favored. Under extremely saturating conditions the waveform becomes complex and period doubling is observed.C) Injection Locking. We have carried out numerical calculations for a pulsed FEL operating in a ring resonator with an external cw signal injected into the cavity. Detuning between the cw frequency and the cavity modes is an important factor, although zero detuning is not necessarily optimal. Suppression of break-up in short pulses has been obtained with injected power about 10-4 of the pulse power in the cavity. Only partial suppression of break-up has so far been achieved with pulses long compared to the slippage. D) Analytical solution for small signal pulse propagation. This exact solution for pulse propagation in the uniform wiggler involves a set of three generalized hypergeometric functions. E) Shot Noise. A theory incorporating the effects of shot noise on FEL operation is under development. The shot noise is due to the random injection times and transverse positions of individual electrons, and is responsible for starting the lasing process. A three-dimensional theory has been formulated by transforming the Maxwell equation to the frequency domain, where the paraxial approximation can be made. In the case of small filling factor, a one-dimensional theory can be obtained by projecting onto the fundamental Gaussian mode of the resonator at each frequency. The equations can then readily be transformed back to the time domain. After the neglect of certain terms, the small-signal equations can be solved in terms of the generalized hypergeometric functions. Contribution to the field after one pass are found proportional to all powers of the number of electrons. This indicates that coherence is beginning to develop. These contributions unfortunately include infinite self-energy terms

A Vlasov approach to bunching and selfordering of particles in optical resonators

We develop a Vlasov type continuum density description for the coupled nonlinear dynamics of polarizable particles moving in the light field of a high Q optical resonator. The intracavity light field, which exerts optical forces on the particles, depends itself on the dynamics of the particle density, which constitutes a time dependent refractive index. This induces mode frequency shifts, losses and coupling. For typical geometries we find solid analytic criteria for the stability of an initial homogeneous particle density for a wide class of initial velocity distributions including thermal distributions. These agree with previously found bunching and self-ordering instabilities but are extended to a wider range of parameters and initial conditions. Using a linear perturbation expansion we calculate the growth exponents of small density perturbations in the parameter region beyond this instability threshold. Numerical solutions of the full equations as well as simulations of the underlying many particle trajectories confirm these results. In addition the equations allow to extract analytical scaling laws to extrapolate cavity cooling and selfordering dynamics to higher particle numbers