Search Results (209)

Introduction: Multiple sclerosis (MS) is a chronic neurodegenerative disease that entails high costs, progressive disability, and reduced quality of life (QoL). Telerehabilitation (TR), supported by new technologies, is emerging as an alternative or complement to in-person rehabilitation, potentially lowering socioeconomic impact and improving QoL. Aim: The objective of this study was to evaluate the effect of TR on the QoL of people with MS compared with in-person rehabilitation or no intervention. Materials and methods: A systematic review of randomized clinical trials was conducted (March–May 2025) following PRISMA guidelines. Searches were run in the PubMed-Medline, EMBASE, PEDro, Web of Science, and Dialnet databases. Methodological quality was assessed with the CASP scale, risk of bias with the Risk of Bias 2 tool, and evidence level and grade of recommendation with the Oxford Classification. The protocol was registered in PROSPERO (CRD420251110353). Results: Of the 151 articles initially found, 12 RCTs (598 total patients) met the inclusion criteria. Interventions included (a) four studies employing video-controlled exercise (one involving Pilates to improve fitness, another involving exercise to improve fatigue and general health, and two using exercises focused on the pelvic floor muscles); (b) three studies using a monitoring app to improve manual dexterity, symptom control, and increased physical activity; (c) two studies implementing an augmented reality system to treat cognitive deficits and sexual disorders, respectively; (d) one platform with a virtual reality headset for motor and cognitive training; (e) one study focusing on video-controlled motor imagery, along with the use of a pain management app; (f) a final study addressing cognitive training and pain reduction. Studies used eight different scales to assess QoL, finding similar improvements between groups in eight of the trials and statistically significant improvements in favor of TR in four. The included trials were of good methodological quality, with a moderate-to-low risk of bias and good levels of evidence and grades of recommendation. Conclusions: TR was more effective in improving the QoL of people with MS than no intervention, was as effective as in-person treatment in patients with EDSS ≤ 6, and appeared to be more effective than in-person intervention in patients with EDSS between 5.5 and 7.5 in terms of QoL. It may also eliminate some common barriers to accessing such treatments. Full article

Telerehabilitation is an effective, accessible addition or alternative to conventional rehabilitation for fracture management, especially in older adults after hip fractures, leveraging video visits, mHealth apps, virtual reality (VR), and wearable sensors to deliver exercise, education, and monitoring at home with high satisfaction and adherence. Across non-surgical and surgical contexts, telemedicine shows feasibility and cost benefits, with mixed superiority but consistent non-inferiority for functional outcomes versus in-person care. In hip fracture populations, randomized and non-randomized studies indicate improvements in functional independence measure (FIM), Timed Up and Go test (TUG), Activities of Daily Living/Instrumental Activities of Daily Living (ADLs/IADLs), and quality of life, with some evidence for reduced anxiety and depression, while effects on mobility, pain, and adverse events remain uncertain overall. In patients with upper-limb fractures, telerehabilitation appears to improve function and pain, though strength gains may lag compared with in-person therapy in some trials; adjuncts like motor imagery and virtual reality may enhance outcomes and motivation. Application is facilitated by user-friendly platforms, caregiver involvement, and simple modalities such as structured phone follow-up. Limitations include small samples, heterogeneous protocols, scarce long-term data, and a predominance of non-inferiority or complementary designs, warranting larger, definitive trials. This technology can lead to improved patient management at home, effortlessly verifying treatment compliance, efficacy, and safety, while simultaneously reducing the need for hospitalization, promoting a more peaceful recovery. Here, we have undertaken a narrative review of the medical–scientific literature in this field. Full article

Digital transformation has fundamentally altered how individuals manage their finances. The expansion of financial technologies and the digitalization of banking services underscore the need for digital financial literacy, defined as the ability to safely use financial applications and make informed decisions within virtual environments. This study examined the perceptions of financial application use across age groups and their corresponding level of digital financial literacy. This exploratory study used a convenience sample of 41 semi-structured interviews conducted in 2025. The data were analyzed using content analysis and descriptive statistics. The findings indicated that most participants prioritized digital apps over traditional channels and expressed confidence in their use, although concerns about data security remained. Participants identified key advantages, including convenience, efficiency, and centralized access, yet few used apps for financial planning. Most respondents demonstrated an intermediate level of digital knowledge, with limited proficiency in executing complex financial tasks. Perceptions revealed both optimism and apprehension: while participants valued the practicality of digital tools, they also recognized risks such as fraud, exclusion of vulnerable groups, and technological dependence. The limited and non-representative sample limits generalization, suggesting the need for broader surveys. Enhanced public policies promoting digital financial education in Brazil are recommended. Full article

Cultural heritage tourism is a vital part of Malaysia’s tourism sector, attracting visitors to iconic UNESCO sites like George Town and Melaka. However, these heritage sites face growing challenges from overcrowding and environmental degradation, which accelerate the deterioration of historic architecture and cultural artifacts. Preservation efforts often require site closures, which negatively impact tourist experiences and satisfaction. Thus, augmented reality (AR) offers a solution by supporting heritage management and preservation, allowing visitors to engage with virtual representations via mobile AR apps, thereby enhancing visitor engagement and travel experience. Despite global adoption, mobile AR apps often suffer from low user retention, with many users abandoning them shortly after downloading them. Understanding what drives continued usage is crucial for successful AR implementation. This study integrates the expectation confirmation model (ECM) and the unified theory of acceptance and use of technology 2 (UTAUT2) to examine the determinants affecting user’s experiential satisfaction and continued usage intention of mobile AR apps. An online survey of 450 domestic tourists in George Town and Melaka was conducted. Data analysis using structural equation modeling with SmartPLS 4.0 revealed that the integrated model offers a stronger predictive power and significantly outperforms ECM and UTAUT2 individually. The findings contribute valuable insights for researchers, app developers, tourism stakeholders, and policymakers. Full article

Background: Effective dentist–patient communication is pivotal for quality dental care and patient satisfaction. Advances in technology, such as the application of digital dentistry, have modernized how dentists and patients interact. Objective: The objective of this study is to review traditional and modern communication methods and how the latter enhance patient engagement. Methods: A systematic search of PubMed, Scopus, and Web of Science (2000–2025) was conducted using keywords related to dental communication methods. Eligible studies underwent critical appraisal based on methodological clarity and relevance, and review quality was assessed using the SANRA framework. Results: While traditional methods remain foundational, digital advancements have significantly expanded communication channels. Teledentistry improves access through virtual consultations, electronic health records empower patients with transparency, and mobile apps facilitate convenient messaging and monitoring. Social media and interactive educational content enhance patient understanding and practice engagement. AI-driven tools further personalize patient interactions and automate administrative tasks. However, these modern strategies require careful implementation to ensure they meet clinical needs and adhere to strict privacy and security regulations. Conclusions: In conclusion, technological advancements have re-shaped dentist–patient communication, making it more flexible and efficient, thus enhancing patient engagement, satisfaction, and overall dental care quality. Future research should focus on conducting comparative and longitudinal studies to evaluate patient outcomes, satisfaction, and the long-term impact on the dentist–patient relationship across different hybrid communication models. Full article

Infrastructure as code (IaC) is essential for modern cloud development, enabling teams to define, deploy, and manage infrastructure in a consistent and repeatable manner. As organizations migrate to Azure, selecting the right approach is crucial for managing complexity, minimizing errors, and supporting DevOps practices. This paper examines the use of Azure Bicep with GitHub Actions to automate infrastructure deployment for an application in the Azure cloud. It explains how Bicep improves readability, modularity, and integration compared to traditional ARM templates and other automation tools. The solution utilizes a modular Bicep design to deploy resources, including virtual networks, managed identities, container apps, databases, and AI services, with environment-specific parameters for development, QA, and production. GitHub Actions workflows automate the building, deployment, and tearing down of infrastructure, ensuring consistent deployments across environments. Security considerations include managed identities, private networking, and secret management in continuous integration (CI) and continuous delivery (CD) pipelines. This paper provides a detailed architectural overview, workflow analysis, and implementation guidance to help teams adopt a robust, automated approach to Azure infrastructure deployment. By leveraging automation tooling and modern DevOps practices, organizations can streamline delivery and maintain secure, maintainable cloud environments. Full article

Unbalanced accelerations occurring during tram travel have a significant impact on passenger comfort and safety, as well as on the rate of wear and tear on infrastructure and rolling stock. Ideally, these dynamic forces should be monitored continuously in real-time; however, traditional systems require high-precision accelerometers and proprietary software—investments often beyond the reach of municipally funded tram operators. To this end, as part of the research project “Accelerometer Measurements in Rail Passenger Transport Vehicles”, pilot measurement campaigns were conducted in Poland on tram lines in Gdańsk, Toruń, Bydgoszcz, and Olsztyn. Off-the-shelf smartphones equipped with MEMS accelerometers and GPS modules, running the Physics Toolbox Sensor Suite Pro app, were used. Although the research employs widely known methods, this paper addresses part of the gap in affordable real-time monitoring by demonstrating that, in the future, equipment equipped solely with consumer-grade MEMS accelerometers can deliver sufficiently accurate data in applications where high precision is not critical. This paper presents an analysis of a subset of results from the Gdańsk tram network. Lateral (x) and vertical (z) accelerations were recorded at three fixed points inside two tram models (Pesa 128NG Jazz Duo and Düwag N8C), while longitudinal accelerations were deliberately omitted at this stage due to their strong dependence on driver behavior. Raw data were exported as CSV files, processed and analyzed in R version 4.2.2, and then mapped spatially using ArcGIS cartograms. Vehicle speed was calculated both via the haversine formula—accounting for Earth’s curvature—and via a Cartesian approximation. Over the ~7 km route, both methods yielded virtually identical results, validating the simpler approach for short distances. Acceleration histograms approximated Gaussian distributions, with most values between 0.05 and 0.15 m/s², and extreme values approaching 1 m/s². The results demonstrate that low-cost mobile devices, after future calibration against certified accelerometers, can provide sufficiently rich data for ride-comfort assessment and show promise for cost-effective condition monitoring of both track and rolling stock. Future work will focus on optimizing the app’s data collection pipeline, refining standard-based analysis algorithms, and validating smartphone measurements against benchmark sensors. Full article

Background: Colonoscopy is an important and essential diagnostic and screening tool for colorectal cancer and other pathologies in the colon. High-quality bowel preparation (BP) is a key quality measure of colonoscopy and is critical for maximizing its effectiveness, including enhancing adenoma detection rates. However, inadequate bowel preparation (IBP) remains a frequent challenge and is influenced by multiple factors. This review aims to summarize and evaluate educational and technological interventions implemented before colonoscopy to improve BP quality. Methods: The methodology comprised a structured narrative review of studies published in English, including randomized controlled trials, prospective studies, observational cohorts, and meta-analyses. Interventions were categorized by their delivery mode and impact on BP adequacy. Interventions included written materials, internet-based education modules, short message service (SMS) reminders, visual aids, instructional videos, verbal communication, telephone support, smartphone applications, and virtual reality (VR) platforms. Results: Most studies reported significant improvements in BP quality with enhanced patient education, particularly with the use of instructional videos and smartphone applications. Verbal communication and telephone support also demonstrated positive outcomes but were limited by resource availability. VR represents a promising emerging technology, though its implementation remains costly and complex. Conclusions: Enhanced educational interventions are proven methods to optimize BP quality. The selection of an appropriate modality should consider patient characteristics, technological accessibility, and institutional resources. Personalized strategies targeting high-risk populations can further reduce IBP rates and improve overall colonoscopy outcomes. Full article

Presence is widely recognized as a key quality metric for immersive virtual reality (IVR) experiences. However, research on factors contributing to presence is impeded by the plethora of identified factors, contradictory results, and unclear interactions. Based on the analysis of the current literature, we propose a two-step research methodology combining exploratory and confirmatory paradigms to address these issues. As existing IVR study tools do not focus on presence and its determinants, we developed our own tool consisting of two components: an IVR app, based on Unreal Engine for designing and displaying IVR scenarios, and a browser-based experimenter interface using Vue.js, enabling precise control over presence factors and study procedure. The methodology and study tool underwent a formative expert evaluation (N = 6) and a first practical application within the AgeVR research project (N = 115). Their feasibility was confirmed by expert feedback, as well as data from 115 successfully completed exploratory studies with participants of various ages. The exploratory study procedure works for general presence, involvement, and plausibility illusion. Measures that will enable the seamless investigation of the remaining presence subcomponents are proposed. Our next step is to develop and test hypotheses in the confirmatory studies. The study tool was made publicly available as an open source project. Full article

Our society is becoming increasingly dependent on technology, with immersive virtual worlds such as Extended Reality (XR) transforming how we connect and interact. XR technologies enhance communication and operational efficiency. They have been adopted in sectors such as manufacturing, education, and healthcare. However, the immersive and interconnected nature of XR introduces security risks that span from technical and human to psychological vulnerabilities. In this study, we examined security threats in XR environments through a scenario-driven risk assessment, using a hybrid approach combining Common Vulnerability Scoring System (CVSS) metrics and a custom likelihood model to quantify risks. This methodology provides a comprehensive risk evaluation method, identifying critical vulnerabilities such as Remote Code Execution (RCE), social engineering, excessive permission exploitation, unauthorized access, and data exfiltration. The findings reveal that human vulnerabilities, including users’ susceptibility to deception and excessive trust in familiar interfaces and system prompts, significantly increase attack success rates. Additionally, developer mode, once enabled, remains continuously active, and the lack of authentication requirements for installing applications from unknown sources, coupled with poor permission management on the part of the users, creates security gaps that attackers can exploit. Furthermore, permission management in XR devices is often broad and persistent and lacks real-time notifications, allowing malicious applications to exploit microphone, camera, and location access without the users knowing. By leveraging CVSS scores and a structured likelihood-based risk assessment, we quantified the severity of these threats, with RCE, social engineering, and insecure app installation emerging as the greatest risks. This study highlights the necessity of implementing granular permission controls, formalized developer mode restrictions, and structured user education programs to mitigate XR-specific threats. Full article

This study investigates the integration of digital technologies in leading European museums to enhance heritage interpretation, increase visitor engagement, and contribute to sustainable tourism. As museums increasingly adapt to the digital age, they seek innovative solutions to enrich the visitor experience while promoting sustainability. This research uses a content analysis approach to examine the strategies employed by four prominent museums—the Louvre, the British Museum, the Prado Museum, and the Rijksmuseum. Key digital initiatives, including virtual tours, educational apps, and online collections, are identified as central components of their efforts to improve accessibility, facilitate interactive learning, and attract a wider global audience. Our findings highlight that these digital innovations not only provide visitors with more engaging and informative experiences but also align with sustainability objectives such as reducing carbon footprints and supporting cultural preservation. This study concludes that by leveraging smart technologies, museums are evolving into dynamic, globally connected institutions that strike a balance between conservation and visitor engagement, thereby fostering a more sustainable and inclusive approach to heritage tourism. Full article

Humans interact with virtual environments for a variety of purposes, and the use of telemedicine services and e-health platforms has become increasingly significant in recent years. Telepsychology is an emerging service and is understood as the provision of psychological aid and counseling through the use of telecommunication technologies. This study investigates the impact of visual backgrounds in a mental health simulation app and explores the decision-making of potential patients for telepsychology. In this experimental study, we developed an instrument to assess the preferences for manipulated features of photomontages and portraits. A total of 310 participants from diverse backgrounds were surveyed about their preferences regarding visual backgrounds and silhouettes for this hypothetical service, with key independent variables such as complexity, naturalness, and color hues being manipulated. Our findings represent the first example of data collected on background preferences in telepsychology. The results suggest a preference for backgrounds with medium complexity and naturalness for clinical settings. Additionally, we observed variations in preferences based on gender and age. These findings highlight the importance of customizing visual elements to enhance patient engagement in telepsychology. Full article

Technological advances continually reduce the effort to digitally transform health-related activities such as rehabilitation and training. Exemplary systems use tracking and vital sign monitoring to assess physical condition and training progress. This paper presents a system for body stability training and coordination evaluation, using cost-efficient tracking and monitoring solutions. It implements the use case of app-guided back posture tracking on the ICAROS Pro training device via SteamVR Tracking 2.0, with pulse and respiration rate monitoring via Zephyr BioHarness 3.0. A longitudinal study on training effects with 20 subjects was conducted, involving a representative procedure created with a sports manager. Posture errors served as the main progress indicator, and pulse and respiration rates as co-indicators. Outcomes suggest the system’s capabilities to foster comprehension of effects and steering of exercises. Further, a secondary study presents a self-developed VR-based exergame demo for future system expansion. The Empatica EmbracePlus smartwatch was used as an alternative for vital sign acquisition. The user experiences of five subjects gathered via a survey highlight its motivating and entertaining character. For both the main and secondary studies, a thorough discussion elaborates on potentials and current limitations. The developed training system can serve as template and be adjusted for further use cases, and the exergame’s reception revealed prospective extension directions. Software components are available via GitHub. Full article

The enactive approach offers a powerful theoretical lens for designing artificial intelligence (AI) systems intended to support the health and well-being of non-neurotypical individuals, including those on the autism spectrum and those with with ADHD, dyslexia, or other forms of neurodivergence. By emphasizing embodiment, relationality, and participatory sense-making, enactivism encourages AI-based interventions that are highly personalized, context-sensitive, and ethically aware. This paper explores how existing AI applications—ranging from socially assistive robots and virtual reality (VR) therapies to language-processing apps and personalized treatment planning—may be enhanced by incorporating enactivist principles. Despite their promise, practical adoption of AI technologies in real-world clinical practice remains limited, and persistent challenges such as algorithmic bias, privacy concerns, and the tendency to overlook subjective dimensions raise cautionary notes. Drawing on relevant philosophical literature, empirical studies, and cross-disciplinary debates (including the friction and potential synergies between predictive processing and enactivism), we argue that AI solutions grounded in enactivist thinking can more effectively honor user autonomy, acknowledge the embodied nature of neurodiverse cognition, and avoid reductive standardizations. This expanded, revised version integrates insights on neurodiversity, mental health paradigms, and the ethical imperatives of AI deployment, thereby offering a more comprehensive roadmap for researchers, clinicians, and system developers alike. Full article

This paper addresses the potential of extended reality (XR) to foster art students’ learning and creativity with specially developed applications for the creation of art exhibitions. This study is based on the EU-funded research project ‘Scaffolding Creativity of Arts Students: Framework, Toolchain, and Educational Material on how to Create their Own Virtual Exhibitions’ (CREAMS). CREAMS develops interconnected virtual reality (VR), augmented reality (AR), and mixed reality (MR) indoor and outdoor exhibition creation applications. The article puts emphasis on the issue of what evaluation methodology is more adequate to assess the efficacy of such applications, and pertinent challenges, as well as related research, are discussed. In this context, ways in which Fine Art School undergraduates can benefit from the creation of XR/VR exhibitions are explored. Such uses of XR are primarily examined in terms of their potential to enhance learning, and foster students’ skills. The potential of adding multimodal resources that contextualize exhibited artworks is examined to foster viewers’ meaningful engagement. Art students’ ability to communicate the underlying concepts/ideas of their art through XR apps is also addressed. Moreover, this paper investigates how XR technologies can foster the collaboration of tutors and students in Fine Art Schools through specially developed platforms embedded in the XR applications. The ability of the CREAMS VR application to foster such cooperation between students and their tutors is also evaluated. The scientific contribution of this paper relates to the evaluation methodology of XR art exhibition applications that have an educational role. Full article