Advanced Visualization Branch

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The purpose of the AVB is to improve self-management among persons with complex chronic disease. The primary research instrument we use is immersive virtual reality (IVR, VR), which allows the participant to experience familiar community-like environments and conduct self-management activities in a highly controlled space that allows for precise measurement of movement and assessment of the cognitive and behavioral task effort. To this aim, we develop virtual environments that depict scenes familiar to the lay person (homes, grocery stores) and ensure that these are accessible to a broad range of individuals including those with limited digital experience, across a broad age-range, diverse backgrounds, and potentially those with some cognitive or physical limitation. Now that we have demonstrated that the virtual shopping environment and interface works for a broad range of individuals, we will submit additional protocols using IVR to evaluate specific aspects of self-management. We are in the process of preparing presentations and manuscripts to disseminate the findings of our Phase 1 usability study. The results of our first study support our aims to create accessible experiences to a broad range of participants, even those with minor disabilities. Phase 2 of the study is due to launch in September 2023. We already have an extensive waitlist of individuals wanting to participate. We employ standard measures for social determinants of health, cognitive function, grocery shopping behaviors, and past virtual reality experience. For outcome assessment we utilize validated instruments to identify cognitive fatigue (VAS-Fatigue), task burden (NASA TLX), and simulator sickness assessment (VRSQ). We employ observational measures such as time to perform tasks, duration of IVR immersion, perceptions of reality, spatial presence and immersion in the virtual space, footfalls, and navigation patterns during task completion. Further, participant interviews are used to identify positive, neutral, and negative sentiments to better understand the strengths and challenges experienced. This year, in preparation for our next protocol which aims to examine how people under dietary restrictions (e.g., sodium restriction, low fat, low carb, low potassium, etc.) shop for food with particular interest attention to nutrition labels, we conducted additional key informant interviews that included racially and ethnically diverse individuals to identify gaps in product availability within our grocery store and categorize what additional items are needed. Further, we identified validated instruments which aid in identifying those who experience food and nutrition insecurity, as those factors influence how an individual shops for food. Additionally, we are evaluating a third-party eye-tracking application to determine, from a technical standpoint, how well we can capture eye movement and gaze fixation. Our second environment, used to assess participants abilities to perform medication self-management within the home environment, remained paused due to the increased resource requirement to modify and execute the Phase 2 protocol using the grocery store. This virtual environment and pill-sorting task are a jumping off point for a future protocol evaluating the cognitive and environmental factors influencing medication management. Our lab has a strong commitment to training, including hosting two post-bac trainees and two summer interns. Trainees participate in all phases of design and evaluation of our IVR environments, and gain additional experiences using big data, and supporting common data elements work. Dr Susan Persky (NHGRI) welcomes our trainees to her weekly lab meetings and they are active participants. Our trainees also participate in journal clubs and NIH poster sessions. Once Post-Bac published an article describing our virtual environments as a novel mechanism for showing patient data. We presented posters at the American Medical Informatics Association annual meeting, thus integrating VR into the biomedical informatics community. Our trainees each have an experience proposing and answering questions using the All of Us Researchers workbench. These data provided a platform for training in research statistics using existing data and scientific presenting. Additionally, our studies have included data that supports NINR common data elements and initiatives including the social determinants of health and PROMIS measures. We are interested in extending our research through collaborations and are exploring options with NIMHD, NIDA, NIA, and NIDCD. Our current staff includes the Principal Investigator, a staff scientist, two post-bac trainees, two summer interns and 3 remote contractors including a full-time graphic designer, a part-time engineer, and a part-time clinical informatics nurse. Our team is geographically spread across the country in different time zones and varying work schedules. We hired a new staff scientist but have been unsuccessful in recruiting a computer engineer. Despite a small staff, under mostly remote telework, the AVB has moved forward with a complex research agenda and has completed proof of concept that immersive technology has potential to be a useful tool in the healthcare arena. We anticipate an acceleration of our scientific program over the next year.