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- Key principles involving ethical and deontological issues in military stress management training in virtual reality environmentsPublication . Gomes, Paulo Veloso; Vianez, Ana; Curado, Henrique; Marques, António; Pereira, Javier; Machado Veloso Gomes, Paulo Sérgio; Pereira da Silva Marques, António José; Curado, HenriqueThe integration of Virtual Reality in military contexts, which simulates realistic combat and high-risk operational scenarios, provides a controlled environment for developing various skills and psychological resilience. This technology has proven to be a valuable tool for enhancing soldiers’ training and preparedness. The creation and use of VR programs, especially those involving the collection of biofeedback data to study military stress, carry significant ethical and deontological responsibilities. This study examines the regulation of using powerful algorithms to analyse biofeedback data to study military stress, emphasizing informed consent, privacy and confidentiality, beneficence and nonmaleficence, transparency in data usage and compliance with legal and regulatory standards.
- Virtual immersive training model with mixed reality for prosthesis application in orthopedicsPublication . Alves, Diogo; Gomes, Paulo Veloso; Magalhães, Renato; Pereira, João; Vilaça, Adélio; Marques, António; Machado Veloso Gomes, Paulo Sérgio; Pereira da Silva Marques, António JoséTraining medical professionals in Orthopedics faces several technical challenges. The equipment required for practical, hands-on training is often restricted to operating rooms. This constraint presents a significant issue, as developing the necessary skills to perform surgeries requires substantial practice time. This work developed a virtual training model using mixed reality, using a QR code to generate a virtual opaque hemisphere, within which the user operates two virtual tools that simulate an endoscope and a drill. A virtual monitor displays the endoscope’s view to the user, who must then navigate the drill tip to successfully touch specific target cubes. The application has the potential to significantly enhance the orthopedic learning experience by reducing the time and resources.
- Virtual reality exposure therapy for Arachnophobia: A pilot studyPublication . Lopes, Inês; Almeida, Raquel Simões de; Gomes, Paulo Veloso; Sá, Vítor J.; Oliveira, Gonçalo; Marques, António; Machado Veloso Gomes, Paulo Sérgio; Sá, Vítor J.; Pereira da Silva Marques, António José; Simões de Almeida, RaquelArachnophobia is a chronic disorder leading to significant avoidance of spider-related situations. This pilot study examines the effectiveness of Virtual Reality Exposure Therapy (VRET) for treating arachnophobia. The study included 25 participants who completed fear questionnaires and avoidance tests before, after and two weeks after the intervention. The intervention consisted of a session of progressive exposure to a novel and gamified virtual environment containing spiders. The results showed a significant reduction in fear and anxiety in relation to the phobic stimulus, suggesting that VRET is a promising approach for treating phobias, in controlled and safe environments.
- Effectiveness of virtual reality in reducing public speaking anxiety: A pilot studyPublication . Oliveira, Maria; Almeida, Raquel Simões de; Gomes, Paulo Veloso; Donga, João; Marques, António; Teixeira, Bruno; Pereira, Javier; Simões de Almeida, Raquel; Machado Veloso Gomes, Paulo Sérgio; Rucha das Dores da Costa Donga, João Paulo; Pereira da Silva Marques, António JoséPublic speaking anxiety (glossophobia) is a manifestation of social anxiety that affects a significant portion of the population, jeopardizing performance in academic, professional, and social contexts. This pilot study examines the effectiveness of virtual reality (VR) as a therapeutic tool for reducing public speaking anxiety. Over six VR simulation sessions, the physiological responses of 30 participants, including heart rate (HR) and electrodermal activity, were monitored alongside psychometric assessments. Results demonstrated a significant reduction in HR and improved self-efficacy. These findings recommend combining VR with traditional therapeutic approaches and emerging neuroscience-based methods, such as neurofeedback, to create more personalized treatment interventions.
- Interaction devices for multi-sensory exploration in immersive environmentsPublication . Donga, João; Gomes, Paulo Veloso; Sá, Vitor; Marques, António; Pereira, Javier; Machado Veloso Gomes, Paulo Sérgio; Sá, Vítor J.; Pereira da Silva Marques, António JoséImmersive environments, such as virtual reality (VR) and augmented reality (AR), provide users with experiences that blend digital and physical worlds. Interaction devices play a critical role in facilitating these experiences by engaging multiple human senses—sight, sound, touch, smell, taste and vestibular. This paper explores the various interaction devices designed for multi-sensory exploration, their applications, and the challenges associated with creating a fully immersive multi-sensory experience. We analyze input and output devices, hybrid systems, and emerging technologies while addressing the challenges in synchronization, user comfort, and accessibility.
- Mixed reality in surgery: Development of a mixed reality application for surgical trainingPublication . Lima, Ana Carolina; Vilaça, Adélio; Veloso, Rita; Marques, António; Pereira, Javier; Magalhaes, Renato; da Silva Veloso, Rita Sofia; Pereira da Silva Marques, António José; Magalhães, RenatoMixed reality (MR) technology combines the real and the virtual world in an innovative way, where the users can see and interact with both worlds at the same time, having several applications in surgical practice, planning, and training. A MR application was developed to be used in a head mounted display (Microsoft HoloLens 2) for surgical training of the anterior cruciate ligament reconstruction surgery, with the aim of indicating the position of the femoral tunnel. This application was tested by 11 surgeons of the Centro Hospitalar Universitário de Santo António, who have all completed the simulation successfully, with an average time of under a minute. These surgeons answered an inquiry of satisfaction, where they all highlighted the potential that MR has in surgical training.
- Aprendizagem com recurso a pacientes, na perspectiva dos estudantes e alumniPublication . Faias, Joaquim; Trigueiro, Maria JoãoNo âmbito do ensino e da avaliação de habilidades clínicas, a utilização de pacientes constitui um recurso complementar que tem como objetivo preparar os estudantes para uma pratica mais intensiva, assegurando assim que as atividades pedagógicas sejam desenvolvidas repetidamente com mais segurança e menor desgaste para os estudantes e os pacientes.
- An unobtrusive multimodal stress detection model & recommender systemPublication . Ferreira, Simão; Correia, Hugo; Rodrigues, Fátima; Rodrigues, Matilde; Rocha, NunoStudies estimate that about 50% of all lost workdays are related to occupational stress. In recent years, several solutions for mental health management, including biofeedback applications, have emerged as a way to enhance employee mental health. Solutions to mitigate risk factors related to the working settings present an enormous potential and a clear contribution. However, most of the work that has been developed is limited to laboratory environments and does not suit real-life needs. Our study proposes an unobtrusive multimodal approach for detecting work-related stress combining videoplethysmography and self-reported measures for stablishing the ground truth in real-life settings. The study involved 28 volunteers over a two-month period. Various physiological signals were collected through a videopletismography solution, while users were performing daily working, for approximately eight hours a day. In parallel, selfreported measures were collected via a pop-up application (developed by the research team) that periodically retrieved the user's perceived stress (amongst other variables) in order to label the physiological data. In order to develop the stress detection model, we pre-processed the data and performed Heart Rate Variability (HRV) feature extraction. Then, we experimented with several machine learning models, utilizing both individual and combined physiological signals to explore all available alternatives. After rigorous evaluation, the best-trained model achieved an accuracy of over 80% and an F1 Score of over 85%. With the stress detection model in place, we are developing a structured intervention model to help reduce stress. This intervention model integrates two interconnected dimensions through digital coaching, which prioritizes personalized recommendations based on user preferences. Our top priority is to ensure user engagement, and we believe that adherence to and adoption of recommended interventions are more likely when users receive recommendations that align with their preferences. Thus, we prioritize personalized recommendations that are tailored to each individual's unique model. After detecting immediate stress peaks and providing real-time feedback on stress levels, our alarm system goes a step further by offering customized recommendations for brief stress relief. The digital coach (intervention model) offers various recommendations and active lifestyle changes such as exercise, task management, weight management, better sleep habits, structured pauses, and other critical interventions. These critical interventions are also based on user preferences, allowing our system to prevent future stress-related incidents and, most importantly, mitigate long-term stress. This project and its methodology demonstrate that truly unobtrusive stress detection is possible and can be performed within the scope of ethical demands. In future work, we will evaluate the responses and beneficial outcomes of implementing a recommender system.
- Impact of a virtual reality-based simulation on empathy and knowledge toward MisophoniaPublication . Lopes, Inês; Simões De Almeida, Raquel; Marques, AntónioVirtual Reality (VR) is considered a powerful resource for developing empathy and pro-social behaviors since it allows individuals to experience a situation that is close to reality from another person's perspective. This quasi-experimental study was designed to measure the impact that a VR simulation which mimics the experience of misophonic symptoms, while performing a cognitive task, has on empathy and knowledge for this condition, compared to simply reading the descriptive vignette of the same simulation. The sample consisted of 98 higher education health students, randomly assigned to the experimental and control groups. The impact of the program was measured by filling out questionnaires on levels of empathy and knowledge about misophonia. Both methods (VR and vignette) were effective. However, the vignette proved to be more effective in some domains. These results suggest that not only VR, but also vignette texts may be interesting strategies for increasing empathy and knowledge towards people with misophonia in this population.
- Sleep stage detection: a clinical validation study of a custom-built single-channel in-ear EEG sensorPublication . Borges, Daniel Filipe; Soares, Joana I.; Silva, Heloísa; Felgueiras, João; Batista, Carla; Ferreira, Simão; Rocha, Nuno; Leal, AlbertoIntroduction:Sleep is vital for health. It has regenerative and protective functions, and its disruption reduces the quality of life and increases susceptibility to disease. During sleep, there is a cyclicity of distinct phases that are studied using polysomnography (PSG), a costly and technically demanding method that compromises the quality of natural sleep. The search for simpler devices for recording biological signals at home addresses some of these issues. Objective: To clinically validate a custom-built single-channel in-ear EEG sensor for sleep classification by assessing various sleep metrics and staging decisions with simultaneously recorded PSG. Methods: Prospective cross-sectional study with 28 participants, divided into two groups: healthy volunteers and clinical patients. In both groups, PSG, individual in-ear EEG- with two different electrode configurations- and actigraphic recordings (only in the healthy group) were performed simultaneously for a whole night. Statistical analysis focussed on the four main sleep metrics: TRT (total recording time), TST (total sleep time), SE (sleep efficiency), SL (sleep latency) and the 5-class classifications (wakefulness, N1, N2, N3 and REM sleep). This included correlation analyses between methods and Bland-Altman plots, Cohen’s K coefficient, and confusion matrices aiming 30-second epoch-wise agreement with an automatic sleep classification algorithm using visual sleep classification by an ERSR-certified human expert as the gold standard according to current AASM guidelines. Results: The analysed sleep data comprised 30960 epochs. The correlation analysis revealed strong positive correlations (0.90) for all variables for the in-ear sensor. The Bland-Altman plots show a high level of agreement and consistency (+- 1.87 SD), with minimal bias between methods. The average kappa values (0.75) and the confusion matrices with each method's sensitivity and specificity also show a very high level of concordance.Conclusions: In both groups, the in-ear EEG sensor showed strong correlation, agreement and reliability with the gold standard, supporting accurate sleep classification.