Contemporary society faces a growing set of complex global issues representing significant human health, well-being, and sustainability threats. Human Factors and Ergonomics (HFE) has a critical role to play in responding to these issues; however, there remain a set of grand challenges that require resolution. This paper presents and discusses six grand challenges for HFE and related key research thrust areas for each of the challenges. The grand challenges are (1) Evolution in Societal Thinking; (2) Future of Human Work in Industry 5.0; (3) Climate Change and Sustainability; (4) Future of Education and Training; (5) Future of Personalized Health, and (6) Life, Technology, and the Metaverse. These grand challenges and key research thrust areas were derived by twenty HFE professionals who are the authors of this paper. The implications of these grand challenges for education, training, research, and implementation of HFE principles and methods for the benefit of humankind are discussed.

Immersive technologies such as virtual reality (VR) and augmented reality (AR) are becoming ever more popular, and as the availability of these low-cost, high-quality wearables and mobile displays grows, so too does the range of application areas for these technologies. Previously focused in the traditional gaming genres, application areas for immersive technologies are expanding, especially in training and education. As the acceptance and utilization of immersive technologies expand into the operational space, it is critical that these immersive platforms be designed and used with a clear understanding of their benefits and limitations. Cybersickness during and following prolonged exposure to immersive training environments is not only possible, it is quite probable due to several factors such as restricted field of view and vergence–accommodation mismatches. It is thus crucial for the scientific and research communities to fully understand and characterize the potential for and magnitude of any cybersickness symptoms that may be imparted by either VR or AR systems. This chapter provides an overview of cybersickness symptoms, individual factors, design mitigation strategies, and usage protocols.

Large shipsShips, both military and commercial, are dependent on many complex and interdependent systems, necessitating notoriously intensive maintenance regimens. For instance, low event rates, ambiguous problem presentation, temporal stressors, and high working memory demands are common challenges for shipboard maintenance and repair personnelPersonnel. Operational support systems are often employed in this context to supplement or fill training gaps at the point-of-need. Such support, however, has traditionally been heavily dependent on insight and input from subject matter experts, which places a steep premium on personal experience. Recent advancesAdvances in augmentedAugmented reality (AR), especially head-worn displays (HWDs), present a promising avenue for improving the efficacy of operational support by leveraging multimodal interactions and displays. Multimodal solutions provide an opportunity to present support information, in a more veridical form, and, if carefully designed, without increasing demand on operatorsOperators. Real-world spatialization of such information sources via AR is one technique that can be used to increase the level of operational support while simultaneously reducing short-term memory demands imposed by traditional operational support tools, the latter of which require mental transformation from the medium of the support tool (e.g., a technical manual) to the operator’sOperators environment. The broad range of capabilities of AR HWDs also affords tailoring operational support tools to the unique sensory needs of each use case and, in conjunction with adaptive training techniques and advancesAdvances in AI, to the needs of each operatorOperators. Herein, we provide an overview of how multimodal AR can be implemented within operational support tools; best practices for the design and development of multimodal interactions and displays within AR are discussed.

While virtual, augmented, and mixed reality technologies are being used for military medical training and beyond, these component technologies are oftentimes utilized in isolation. eXtended Reality (XR) combines these immersive form factors to support a continuum of virtual training capabilities to include full immersion, augmented overlays that provide multimodal cues to personalize instruction, and physical models to support embodiment and practice of psychomotor skills. When combined, XR technologies provide a multi-faceted training paradigm in which the whole is greater than the sum of the constituent capabilities in isolation. When XR applications are adaptive, and thus vary operational stressors, complexity, learner assistance, and fidelity as a function of trainee proficiency, substantial gains in training efficacy are expected. This paper describes a continuum of XR technologies and how they can be coupled with numerous adaptation strategies and supportive artificial intelligence (AI) techniques to realize personalized, competency-based training solutions that accelerate time to proficiency. Application of this training continuum is demonstrated through a Tactical Combat Casualty Care training use case. Such AI-enabled XR training solutions have the potential to support the military in meeting their growing training demands across military domains and applications, and to provide the right training at the right time.

Early virtual reality (VR) systems introduced abnormal visual-vestibular integration and vergenceaccommodation, causing cybersickness (McCauley and Sharkey, 1992) reminiscent of simulator sickness reported bymilitary pilots, e.g., having some shared causes and overlapping (Lawson, 2014a) but distinguishable symptoms (Stanney et al., 1997). Improved processing, head tracking, and graphics were expected to overcome cybersickness (Rheingold, 1991), yet it persists in today’s muchimproved VR (Stanney et al., 2020a, 2020b). This must be resolved, because VR and Augmented Reality (AR) are proliferating for training for stressful tasks, exposure therapy for post-traumatic stress, remote assistance/control, and operational situation awareness (Hale and Stanney, 2014; Beidel et al., 2019; Stanney et al., 2020b, 2021; NATO Science and Technology Office, 2021). Experts considered the cybersickness problem recently at a 2019 Cybersickness Workshop and a 2020 Visually-Induced Motion Sensations meeting. Military aspects were discussed during 2019–2021 meetings of a Cybersickness Specialist Team (NATO Science and Technology Office, 2021). The Bárány Society’s Classification Committee just developed relevant international symptom standards for visually-induced motion sickness (VIMS; Cha et al., 2021). Finally, >40 authors produced twelve articles comprising this Frontiers Research Topic initiated by Dr. Stanney. Below, we summarize their work and provide recommendations.

Augmented reality technology holds great promise for extending and enhancing users' capabilities across numerous applications in both work and personal life. It would be easy to see AR, then, as a panacea, but thoughtful design is required if the benefits are to be realized without also realizing the nascent technology's great potential for harm. Current applications in commercial, military, and education and training settings are herein reviewed, along with consideration of potential future directions. This chapter also identifies hazards posed by poor design or haphazard application and provides recommendations and best practices for those engaged in the design of AR that seek to maximize the human utility of this rapidly maturing technology.

Augmented reality technology holds great promise for extending and enhancing users' capabilities across numerous applications in both work and personal life. It would be easy to see AR, then, as a panacea, but thoughtful design is required if the benefits are to be realized without also realizing the nascent technology's great potential for harm. Current applications in commercial, military, and education and training settings are herein reviewed, along with consideration of potential future directions. This chapter also identifies hazards posed by poor design or haphazard application and provides recommendations and best practices for those engaged in the design of AR that seek to maximize the human utility of this rapidly maturing technology.

CHAPTER 30 EXTENDED REALITY (XR) ENVIRONMENTS Kay M. Stanney, Kay M. Stanney Design Interactive, Inc., Orlando, FloridaSearch for more papers by this authorHannah Nye, Hannah Nye Design Interactive, Inc., Orlando, FloridaSearch for more papers by this authorSam Haddad, Sam Haddad Design Interactive, Inc., Orlando, FloridaSearch for more papers by this authorKelly S. Hale, Kelly S. Hale Draper, Cambridge, MassachusettsSearch for more papers by this authorChristina K. Padron, Christina K. Padron Dynepic, Inc., Orlando, FloridaSearch for more papers by this authorJoseph V. Cohn, Joseph V. Cohn Defense Health Agency, Washington, DCSearch for more papers by this author Kay M. Stanney, Kay M. Stanney Design Interactive, Inc., Orlando, FloridaSearch for more papers by this authorHannah Nye, Hannah Nye Design Interactive, Inc., Orlando, FloridaSearch for more papers by this authorSam Haddad, Sam Haddad Design Interactive, Inc., Orlando, FloridaSearch for more papers by this authorKelly S. Hale, Kelly S. Hale Draper, Cambridge, MassachusettsSearch for more papers by this authorChristina K. Padron, Christina K. Padron Dynepic, Inc., Orlando, FloridaSearch for more papers by this authorJoseph V. Cohn, Joseph V. Cohn Defense Health Agency, Washington, DCSearch for more papers by this author Book Editor(s):Gavriel Salvendy, Gavriel Salvendy University of Central Florida, Orlando, FloridaSearch for more papers by this authorWaldemar Karwowski, Waldemar Karwowski University of Central Florida, Orlando, FloridaSearch for more papers by this author First published: 13 August 2021 https://doi.org/10.1002/9781119636113.ch30Citations: 1 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Summary This chapter begins with a perspective on the technology, providing an overview of the basic system requirements for extended reality (XR), discussing how advances in hardware, software, and related capabilities continue to enable ever more realistic and immersive experiences. eXtended Reality solutions are computer-generated immersive environments that provide a spectrum of experiences, including: augmented reality, mixed reality, virtual reality, and XR blended. Software development of XR systems has evolved from traditional backgrounds of both game development, as well as computer programming. While many conventional human-computer interaction techniques can be used to design and implement XR systems, there are unique design and implementation considerations that must be addressed. Audio within XR, as with films and video games, has proven to be important in creating an immersive experience. The health and safety risks associated with XR exposure complicate usage protocols and lead to products liability concerns. Citing Literature HANDBOOK OF HUMAN FACTORS AND ERGONOMICS, Fifth Edition RelatedInformation

Immersive technologies, such as virtual and augmented reality, initially failed to live up to expectations, but have improved greatly, with many new head-worn displays and associated applications being released over the past few years. Unfortunately, 'cybersickness' remains as a common user problem that must be overcome if mass adoption is to be realized. This article evaluates the state of research on this problem, identifies challenges that must be addressed, and formulates an updated cybersickness research and development (R&D) agenda. The new agenda recommends prioritizing creation of powerful, lightweight, and untethered head-worn displays, reduction of visual latencies, standardization of symptom and aftereffect measurement, development of improved countermeasures, and improved understanding of the magnitude of the problem and its implications for job performance. Some of these priorities are unresolved problems from the original agenda which should get increased attention now that immersive technologies are proliferating widely. If the resulting R&D agenda is carefully executed, it should render cybersickness a challenge of the past and accelerate mass adoption of immersive technologies to enhance training, performance, and recreation.

Given the sometimes disparate findings and the increasing application of AR in both training and operations, as well as increased affordability and availability, it is important for researchers, user interface and user experience (UI/UX) designers, and AR technology developers to understand the factors that impact the utility of AR. To increase the potential for realizing the full benefit of AR, adequately detailing the interrelated factors that drive outcomes of different AR usage schemes is imperative. A systematic approach to understanding influential factors, parameters, and the nature of the influence on performance provides the foundation for developing AR usage protocols and design principles, which currently are few. Toward this end, this work presents a theoretical model of factors impacting performance with AR systems. The framework of factors, including task, human, and environmental factors, conceptualizes the concept of “AR Receptivity”, which aims to characterize the degree to which the application of AR usage is receptive to the technology design and capabilities. The discussion begins with a brief overview of research efforts laying the foundation for the model’s development and moves to a review of receptivity as a concept of technology suitability. This work provides details on the model and factor components, concluding with implications for application of AR in both the training and operational settings.

Augmented reality (AR) is rapidly being adopted by industry leaders and militaries around the globe. With the Defense Health Agency pushing AR as a solution to the distributed learning problem, along with AR applications being explored within primary care and operational medical settings, it is crucial for these immersive platforms to have a standardized, scientifically based paradigm on which they are designed and used. One area of particular concern is the potential for physiological maladaptation following prolonged AR exposure, which is expected to vary from that associated with virtual reality exposure. Such maladaptation is potentially driven by limitations that exist with regard to the types and extent of perceptual issues characteristic of AR head-worn displays (e.g., mismatches between visually displayed information and other senses, restricted field of view, mismatched interpupillary distance). Associated perceptual limitations can reduce training effectiveness or impose patient and/or trainee safety concerns. Thus, while AR technology has the potential to advance simulation training, there is a need to approach AR-based research—particularly that which relates to long-exposure-duration scenarios—from a bottom-up perspective, where its physiological impact is more fully understood. In the hopes of assisting this process, this study presents a comparison of cybersickness between two common forms of AR displays. Specifically, by comparing the Microsoft HoloLens, a head-worn display that has seen rapid adoption by the scientific community, with an AR Tablet–based platform within the context of long-duration AR training exposure, it will be possible to determine what differences, if any, exist between the two display platforms in terms of their physiological impact as measured via cybersickness severity and symptom profile. Results from this psychometric assessment will be used to evaluate the physiological impact of AR exposure and develop usage protocols to ensure AR is safe and effective to use for military medical training.

The aim of this study was to assess what drives gender-based differences in the experience of cybersickness within virtual environments. In general, those who have studied cybersickness (i.e., motion sickness associated with virtual reality [VR] exposure), oftentimes report that females are more susceptible than males. As there are many individual factors that could contribute to gender differences, understanding the biggest drivers could help point to solutions. Two experiments were conducted in which males and females were exposed for 20 min to a virtual rollercoaster. In the first experiment, individual factors that may contribute to cybersickness were assessed via self-report, body measurements, and surveys. Cybersickness was measured via the simulator sickness questionnaire and physiological sensor data. Interpupillary distance (IPD) non-fit was found to be the primary driver of gender differences in cybersickness, with motion sickness susceptibility identified as a secondary driver. Females whose IPD could not be properly fit to the VR headset and had a high motion sickness history suffered the most cybersickness and did not fully recover within 1 h post exposure. A follow-on experiment demonstrated that when females could properly fit their IPD to the VR headset, they experienced cybersickness in a manner similar to males, with high cybersickness immediately upon cessation of VR exposure but recovery within 1 h post exposure. Taken together, the results suggest that gender differences in cybersickness may be largely contingent on whether or not the VR display can be fit to the IPD of the user; with a substantially greater proportion of females unable to achieve a good fit. VR displays may need to be redesigned to have a wider IPD adjustable range in order to reduce cybersickness rates, especially among females.

With the U.S. Army pushing augmented reality (AR) as a solution to its distributed learning problem and other industries adapting its use in domains where there is a high demand for accelerated workforce reskilling, scalable transfer of tacit knowledge, or human error associated with fatal consequences, it is crucial to develop AR usage protocols that ensure its efficacy and safety. One area of particular concern is the safety of long duration AR exposure. Many studies have evaluated the adverse effects of virtual reality (VR) exposure and demonstrated that the severity of maladaptations is generally proportional to exposure duration. Will AR be the same? While much of the industry has assumed the adverse effects associated with AR are less problematic than VR exposure because the latter presents with much more overt symptoms, there is limited research in this area to date. This paper suggests a need exists to fully comprehend both the impact that AR has on the human perceptual experience and the physiological maladaptations that result from its use. A few basic recommendations for hardware specifications are also provided, which should assist with mitigating some of the known AR maladaptations by minimizing the discrepancy between how the human processes stimuli and how information is displayed within AR systems.

Live training is a vital component of military training. Unfortunately it can be expensive, resource intensive, of limited accessibility or impossible to achieve due to the risks involved. Virtual environment (VEs) training environments can provide trainees with opportunities to practice key skills and work out performance issues in a more cost effective environment, which may lead to more efficient use of live training time. The current study explored this premise by conducting a transfer of training study that examined the question of whether pre-training in low and/or high fidelity VEs can lead to time savings and improved performance in live training environments. In this study, four-person teams received training on a room clearing task either on a low fidelity VE, a high fidelity VE, or no pre-training at all, after receiving familiarisation on the task. After training, all groups transferred to a live shoothouse for 20 test trials. Results suggest that high fidelity VE pre-training may facilitate both faster skill acquisition and better performance in a transfer environment. Although sample size may have prevented the findings from reaching statistical significance, the effects were consistent and of moderate to high effect sizes, suggesting an effect is present.

OBJECTIVE:The purpose of this study was to investigate the potential of developing an EHR-based model of physician competency, named the Skill Deficiency Evaluation Toolkit for Eliminating Competency-loss Trends (Skill-DETECT), which presents the opportunity to use EHR-based models to inform selection of Continued Medical Education (CME) opportunities specifically targeted at maintaining proficiency.METHODS:The IBM Explorys platform provided outpatient Electronic Health Records (EHRs) representing 76 physicians with over 5000 patients combined. These data were used to develop the Skill-DETECT model, a predictive hybrid model composed of a rule-based model, logistic regression model, and a thresholding model, which predicts cognitive clinical skill deficiencies in internal medicine physicians. A three-phase approach was then used to statistically validate the model performance.RESULTS:Subject Matter Expert (SME) panel reviews resulted in a 100% overall approval rate of the rule based model. Area under the receiver-operating characteristic curves calculated for each logistic regression curve resulted in values between 0.76 and 0.92, which indicated exceptional performance. Normality, skewness, and kurtosis were determined and confirmed that the distribution of values output from the thresholding model were unimodal and peaked, which confirmed effectiveness and generalizability.CONCLUSIONS:The validation has confirmed that the Skill-DETECT model has a strong ability to evaluate EHR data and support the identification of internal medicine cognitive clinical skills that are deficient or are of higher likelihood of becoming deficient and thus require remediation, which will allow both physician and medical organizations to fine tune training efforts.

The U.S. workforce, including those in the health care sector, is in the midst of a workforce burnout crisis. For the past 20 years, annual surveys consistently show that organizations with employees reporting higher energy at work have greater customer satisfaction, increased productivity, higher profit margins, lower employee turnover, and fewer accidents. 1 Yet, with demand for our time and energy increasingly exceeding our capacity in a leaner, highly competitive, post-recession workforce, both personal and professional burnout has become ubiquitous. This burnout, or complete draining of one's energy due to overwork or overstress, is negatively impacting organizations. In a 2014 Insights Study of 160,000 employees across a broad spectrum of the U.S. workforce, the most important factor driving employee engagement was an employee's ability to manage stress. 2 This factor may explain why of the approximately 100 million people in America who hold full-time jobs, only about 30 million (30%) are engaged and inspired at work, with professional workers (e.g., nurses) mirroring the national trend. Active disengagement (20%) costs the United States $ 450 billion to $ 550 billion per year according to a 2013 Gallup study. 3 Beyond cost, the health care industry is also charged with ensuring patient safety. When nurse vigilance declines, strict observance of safety protocols may be reduced. In fact, research has shown that higher nurse burnout is associated with significantly higher rates of infection. 4 Despite increased executive awareness, a human energy crisis continues to plague the health care sector as well as the entire U. S. workforce.