Bleeding in the upper gastrointestinal tract is a common and potentially life-threatening emergency that requires rapid and highly precise endoscopic intervention. As supervised hands-on training is limited and often restricted to living animal models, an immersive virtual reality (VR) simulation offers a risk-free and accessible alternative. A novel open-source VR training simulator, OPTESK, was developed for the treatment of upper gastrointestinal (GI) bleeding. The system consists of a combination of conventional endoscopes used in routine clinical practice, which can be operated in conjunction with commercially available head-mounted displays and the in-house developed OPTESK hardware. The simulator covers two scenarios: the treatment of a non-bleeding angiodysplasia with argon plasma coagulation (APC) and the treatment of a bleeding angiodysplasia starting with the injection of adrenaline followed by APC therapy. The simulator was evaluated in a multicenter user study in terms of workload, usability, immersion, cybersickness, and face, content, and construct validity. User performance was assessed via scores on time, amount of treated area, and correctly applied APC intensity. In total, 44 participants from more than 20 centers were included in the study. Successful hemostatic control in the second scenario was achieved by 97.4
Cochlear implants are the flagship sensory neural prosthetic, enabling improved hearing and speech perception in >1 million patients with hearing loss. Despite over three decades of active work and innovations in cochlear implants, hearing performance for complex tasks such as speech-in-noise and music appreciation are still quite limited, putatively due to the challenge of selectively stimulating the auditory nerve with intracochlear electrodes through the bony cochlear wall. Our approach is to more selectively evoke hearing percepts through the development of an Auditory Nerve Implant (ANI) device that uses penetrating microelectrodes placed directly in the nerve for stimulation, and which will be evaluated through psychophysical testing as part of a first-in-human study. Stability and integrity of ANI electrodes during passive soaking and stimulation are needed to support initiation of the clinical trial, which we evaluated through thermal accelerated saline soak testing and stimulation stability testing. The ANI electrode stability in saline was assessed by accelerated aging at ≥ 67 ^∘ C with a 1.5-year equivalent endpoint using electrode impedance and microscopy to characterize outcomes. Stimulation stability testing evaluated electrode integrity after 6.3 billion pulses at 100 μ A, which is the maximum clinical stimulation intensity, for a one-year equivalent use, and 1200 μ A, for a high-dose protocol. Electrode impedance, longitudinal stimulation voltage, and microscopy outcomes were used to the quantify results. All electrodes had stable impedances around 2 k Ω at the end of the accelerated soak test, except for three with higher impedances but still below the 70 k Ω failure criteria. All but one electrode survived stimulation stability testing. Optical and electron microscopy largely showed little to no change during testing, indicating no observable tip degradation, with the exception of one soak-test device. The outcomes from the studies indicate that ANI electrodes exhibit a high degree of integrity and impedance stability. Microscopy characterization proved effective for evaluating electrodes, providing complementary information to standard Backscattered Scanning Electron Microscopy (BSEM). This study suggests the ANI device tolerate a 1.5 year in-dwelling period for a 1 year perceptual study of stimulation evoked percepts, paving the way for clinical translation.
The NIH Common Fund's SPARC (Stimulating Peripheral Activity to Relieve Conditions) program was launched in 2015 to catalyze bioelectronic medicine by advancing foundational knowledge of the autonomic nervous system (ANS) and enabling clinical translation of novel bioelectronic medicines. While the program officially ended in 2025, activities related to the program are still ongoing through no-cost extensions, data sharing, and derivative efforts. We provide here an overview of the major outcomes of SPARC under its four focus areas: Anatomical and Functional Mapping, Technology Development, Translational Research, and Data/Modeling Infrastructure. In the Anatomical and Functional Mapping focus areas, teams generated cross-species, cross-organ ANS connectivity datasets, detailed nerve anatomy, along with detailed maps and connectivity resources to support query, visualization, and hypothesis-generation. Under the Technology Development focus area, teams developed new tools for recording and stimulating autonomic pathways and built computational pipelines for realistic neuromodulation simulations. Within the Translational Research, teams conducted pre-clinical and clinical proof-of-concept studies and used prize-driven efforts to accelerate clinically ready neuromodulation solutions. Data/Modeling Infrastructure teams built a durable open-science ecosystem enabling FAIR sharing, exploration, and reuse of SPARC datasets, models, and workflows by the broader community. Together, SPARC's integrated approach has lowered barriers to precision neuromodulation research and established reusable resources to sustain the field beyond the program.
Abstract Background Virtual Reality (VR) has previously been found to provide both an effective and enjoyable learning environment for users to develop a wide range of skills. However, despite uptake in fields such as medicine and veterinary medicine, there is little research into the use of VR for diagnostics training with Orthoptists. Methods This study compared students’ experiences of a collaborative VR learning environment with the Strabismus desktop computer simulation for practicing the diagnosis of ocular deviations and limitations. The VR system provided stereoscopic depth and natural controller-based interaction, enabling students to practice diagnostic procedures with greater spatial realism than 2D simulators. Thirty one first year and twenty one second year Orthoptics students from the University of Liverpool were tasked with diagnosing simulated patients in both learning environments. After completing their diagnoses, students’ user experience, sense of presence, comfort with patient proximity, and their thoughts on the use of VR in higher education (SHEQ) were measured. Results Students reported higher hedonic user experience scores for VR, whereas pragmatic user experience scores were higher for the desktop simulation. SHEQ responses indicated a general preference for VR as a learning tool. However, there were no significant differences in sense of presence, or comfort with proximity to patient scores. Conclusions This study shows how commodity VR hardware can be adapted for specialist healthcare training. Although VR did not demonstrate advantages across all measured outcomes, students generally perceived it positively and preferred it over using 2D displays as a learning tool within higher education. These findings suggest that VR may have potential as a supplementary educational resource for Orthoptics training. However, further research is required to determine whether these positive perceptions translate into real world improvements in learning, diagnostic performance, and clinical practice.
The National Institutes of Health (NIH) Common Fund supports bold scientific programs that catalyze discovery across all biomedical and behavioral research to address high priority challenges for the NIH as a whole and make a broader impact in the scientific community. In 2015, the NIH Common Fund established the Stimulating Peripheral Activity to Relieve Conditions (SPARC) program. This program’s overall goal was to accelerate the development of neuromodulation, a field of study that uses bioelectronic devices to deliver electrical current to nervous system tissues to produce therapeutic effects in patients. Because the nervous system impacts all bodily functions, neuromodulation therapies have the potential to treat a variety of health conditions by regulating nerves that innervate affected bodily tissues and organs, with high specificity and few side effects. The SPARC program aimed to capitalize on recent advances in technology to deliver detailed, integrated functional and anatomical neural circuit maps for organs and to provide the necessary scientific foundation for clinical translation of more effective and advanced neuromodulation devices and stimulation protocols. Here we outline the SPARC program’s contribution to the field of neuromodulation over the past ten years, laying a comprehensive foundation of knowledge to inspire future research and accelerate translation. We discuss the reasoning behind the formation of the program, its structure, and outcomes.
