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Real-Time Affective Measurements in Medical Education, Using Virtual and Mixed Reality
Abstract
Emotion greatly affects learning. Affective states, such as motivation, interest and attention, have been identified to cause changes in brain and body activity. Heart Rate (HR), Electro-Dermal Activity (EDA), and Electroencephalography (EEG) reflect physiological expressions of the human body that change according to emotional changes. In reverse, changes of bio-signal recordings can be linked to emotional changes. Virtual/Mixed Reality (V/MR) applications can be used in medical education to enhance learning. This work is a proof of application study of wearable, bio-sensor based affect detection in a learning processes, that includes the Microsoft HoloLens V/MR platform. Wearable sensors for HR, EDA and EEG signals recordings were used during two educational scenarios run by a medical doctor. The first was a conventional scenario-based Virtual Patient case for the participant’s bio-signal baselines canonization. The second was a V/MR exploratory educational neuroanatomy resource. After pre-processing and averaging, the HR and EDA recordings displayed a considerable increase during the V/MR case against the baseline. The alpha rhythm, of the EEG, had a borderline degrease and the theta over beta ration a borderline increase. These results indicate an increased attention/concentration state. They also demonstrate that the usage of bio-sensors assist in the detection the emotional state and could provide real-time, affective learning analytics using V/MR in medical education.
... In that environment, immersive experiential technologies find fertile grounds to grow and support medical education. Virtual patients, chatbots, and Virtual, Augmented, or Mixed reality (VR/AR/MR; under the umbrella term eXtended Reality XR) have proven to impact both the educational and the affective state of the healthcare student's [2][3][4][5] increasing engagement. Additionally, taking cues from different disciplines such as physics and chemistry educational content has proved effective-with students able to visualize abstract laws in an almost tangible way [6][7][8]. ...
Immersive experiential technologies find fertile grounds to grow and support healthcare education. Virtual, Augmented, or Mixed reality (VR/AR/MR) have proven to be impactful in both the educational and the affective state of the healthcare student’s increasing engagement. However, there is a lack of guidance for healthcare stakeholders on developing and integrating virtual reality resources into healthcare training. Thus, the authors applied Bardach’s Eightfold Policy Analysis Framework to critically evaluate existing protocols to determine if they are inconsistent, ineffective, or result in uncertain outcomes, following systematic pathways from concepts to decision-making. Co-creative VR resource development resulted as the preferred method. Best practices for co-creating VR Reusable e-Resources identified co-creation as an effective pathway to the prolific use of immersive media in healthcare education. Co-creation should be considered in conjunction with a training framework to enhance educational quality. Iterative cycles engaging all stakeholders enhance educational quality, while co-creation is central to the quality assurance process both for technical and topical fidelity, and tailoring resources to learners’ needs. Co-creation itself is seen as a bespoke learning modality. This paper provides the first body of evidence for co-creative VR resource development as a valid and strengthening method for healthcare immersive content development. Despite prior research supporting co-creation in immersive resource development, there were no established guidelines for best practices.
... As the philosophy of education is being constantly updated with the reform progress of education system, now educationalists have paid more attention to students' values on sentiment attitudes and new social abilities [1][2][3][4][5][6][7]. Affective education can help students develop emotional habits and have a healthy mental state, which is very meaningful for cultivating students' social adaptability and interpersonal skills in the future [8][9][10][11][12][13][14][15][16][17]. ...
When teachers are giving affective education, their emotional communication with students is a kind of state or process during which teachers’ work pressure can be alleviated when they are cultivating students’ sentiment, in the meantime, they also could attain positive mental quality and a sense of vocational happiness. Regarding the relationship between young teachers’ vocational happiness and their Affective Education Ability (AEA), only 1-2 articles have discussed it from the perspective of a single ability, there isn’t complete research on the AEA system of teachers. Therefore, to fill in this research blank, this paper aims to measure the coupling and coordination between the development of young teachers’ vocational happiness and their AEA, in the hopes of providing a piece of useful evidence for relevant research. The theory of emotional intelligence and positive psychology serve as the theoretical basis of this paper. In the second chapter, this paper builds a framework for young teachers’ affective education and an AEA training model, and employs Artificial Neural Network (ANN) to extract the time series data features of the divided six evaluation indexes of young teachers’ AEA. In the third chapter, this paper uses the Coupling Coordination Degree (CCD) to measure the coupling and coordination of the development level young teachers’ vocational happiness and their six kinds of AEA, and gives the quantification process. In the fourth chapter, this paper adopts the Grey Relational Analysis (GRA) to quantify the influence degree of all indexes on young teachers’ vocational happiness and their six kinds of AEA, thereby realizing the quantitative measurement of each evaluation index on the comprehensive development of the two. At last, experimental results are drawn to verify the measurement and analysis results of the coupling and coordination of the two.
Learning Analytics (LA) are constantly evolving in the analysis and representation of data related to learners and educators to improve the learning and education process. Data obtained by sensors or questionnaires are processed employing new technologies. The emotional experiences of learners constitute a significant factor in the assimilation of knowledge about the learning process. The emerging technology of Emotional Learning Analytics (ELA) is increasingly being considered in educational settings. In this work, the significance and contribution of ELA in educational data processing are discussed as an integral part of designing and implementing computational models reflecting the learning process. In addition, a comprehensive overview of different methods and techniques for both LA and ELA is provided, while a conceptual model of ELA is proposed in parallel. Moreover, advantages, disadvantages, and challenges are highlighted. The final focus of the chapter is on ethical issues and future research directions.
This encyclopedia entry provides insight into the justification of pedagogy in the context of extended reality (XR), which itself encompasses virtual reality (VR), augmented reality (AR), and mixed/hybrid reality (MR), and how all have evolved into an ongoing source of complex ambiguity over the last decade, which the COVID-19 pandemic only highlighted and radically exacerbated. Being able to understand and operationalize each in the context of health professions pedagogy and scholarship became a necessity, which few would now ever question but which still raises issues in relation to the practices of risk assessment and management in professional fields of practice such as medicine, nursing, midwifery, and allied health professions practice.
This chapter delves into the cutting-edge domain of extended reality (XR) technology and its profound implications for mental health treatment and support. XR, encompassing immersive virtual and augmented reality experiences, has emerged as a powerful tool with the capability to revolutionize therapeutic practices and open new dimensions within the field of mental health. This chapter critically examines the transformative potential of XR in mental health, addressing its ability to provide safe and controlled spaces for therapeutic interventions and self-exploration. By allowing individuals to immerse themselves in alternate realities, XR creates an environment conducive to addressing various psychological challenges, such as anxiety, trauma, and social difficulties. The exploration within XR offers a range of possibilities, from tranquil natural environments for relaxation to simulated social interactions for skill development.
Introduction
The expansive curricular volume of healthcare education makes a necessity the incorporation of innovative methods and immersive media in it. The core challenge in such approaches is the timely development of relevant immersive content such as Virtual, Augmented or Mixed Reality (VR/AR/MR) resources for healthcare topics. There is currently significant interest in the use of co-creative methods for streamlining immersive content development.
Methods
A core research pursuit in this translational research field is the formulation of evidence-based, optimized workflows that streamline immersive content creation allowing for rapid expansion of innovative educational approaches in healthcare curricula. The purpose of this paper is to aggregate the perceptions of healthcare technologists and educators who participated in a series of co-creation sessions in order to elicit their best practice insights for design and development of XR educational resources using co-creative methods.
Results
According to our thematic analysis, findings of the qualitative study demonstrated that a rigorous organizational approach is required to maintain a constructive exchange of information and to keep the design process alive for both content and technical experts. In addition, rapid prototype and display of co-created features can empower their contributions and help them design more efficiently.
Discussion
Co-creative content production can benefit from adaption of existing frameworks and lightweight authoring environments that can facilitate generalized XR content development use cases.
This chapter explores the key epistemologies or ways of knowing, from a theoretical perspective, that can be used to ensure the level of authenticity necessary to highlight the pedagogical shifts in the application of learning theory which now characterise responsive curriculum design and adaptation to accommodate extended reality (XR) in practice. The necessity to integrate pedagogical principles of XR in experiential learning is now an integral part of the new paradigmatic sufficiency which will characterise curriculum justification, development, and implementation. This chapter also highlights the need for consideration of the situated nature of learning, alongside the interprofessional and multi-disciplinary contexts within which it takes place.
This chapter provides an insight into the theoretical perspectives which form the foundation of extended reality (XR) and its emergence in practice as a fundamental part of science curricula. Issues such as the authenticity of learning, the validity and reliability of XR within processes of assessment, and the theoretical underpinnings of pedagogical approaches in health professions pedagogy are illuminated. Also considered are the implications of XR within the context of science-based learning and the delineation of cognitive, affective, and psychomotor domains of learning in relation to patient outcomes at the front line of care in applied scientific practice. The Covid-19 pandemic, which has impacted all science based pedagogic practice since March 2020, is also considered in the context of moves to ensure that science education can continue, albeit via hybrid models of learning as opposed to traditional pedagogical approaches which have remained little altered over the last century.
Background:
Digital education has expanded since the COVID-19 pandemic began. A substantial amount of recent data on how students learn has become available for learning analytics (LA). LA denotes the "measurement, collection, analysis, and reporting of data about learners and their contexts, for purposes of understanding and optimizing learning and the environments in which it occurs."
Objective:
This scoping review aimed to examine the use of LA in health care professions education and propose a framework for the LA life cycle.
Methods:
We performed a comprehensive literature search of 10 databases: MEDLINE, Embase, Web of Science, ERIC, Cochrane Library, PsycINFO, CINAHL, ICTP, Scopus, and IEEE Explore. In total, 6 reviewers worked in pairs and performed title, abstract, and full-text screening. We resolved disagreements on study selection by consensus and discussion with other reviewers. We included papers if they met the following criteria: papers on health care professions education, papers on digital education, and papers that collected LA data from any type of digital education platform.
Results:
We retrieved 1238 papers, of which 65 met the inclusion criteria. From those papers, we extracted some typical characteristics of the LA process and proposed a framework for the LA life cycle, including digital education content creation, data collection, data analytics, and the purposes of LA. Assignment materials were the most popular type of digital education content (47/65, 72%), whereas the most commonly collected data types were the number of connections to the learning materials (53/65, 82%). Descriptive statistics was mostly used in data analytics in 89% (58/65) of studies. Finally, among the purposes for LA, understanding learners' interactions with the digital education platform was cited most often in 86% (56/65) of papers and understanding the relationship between interactions and student performance was cited in 63% (41/65) of papers. Far less common were the purposes of optimizing learning: the provision of at-risk intervention, feedback, and adaptive learning was found in 11, 5, and 3 papers, respectively.
Conclusions:
We identified gaps for each of the 4 components of the LA life cycle, with the lack of an iterative approach while designing courses for health care professions being the most prevalent. We identified only 1 instance in which the authors used knowledge from a previous course to improve the next course. Only 2 studies reported that LA was used to detect at-risk students during the course's run, compared with the overwhelming majority of other studies in which data analysis was performed only after the course was completed.
This chapter provides an insight into the justification of pedagogical principles within the contexts of extended reality. The global COVID-19 pandemic served to exacerbate the complex ambiguity surrounding XR in practice. Training for the strategic management of risk in healthcare practice in situated contexts of healthcare provision has been a key focus in the use of XR in practice. It involves rational aspects of cognitive knowledge or the purist demonstration of psychomotor skills and affective domain learning . This is achieved via the exploration of the key epistemologies or ways of knowing, from a theoretical perspective, which can be used to ensure the level of authenticity necessary to highlight the pedagogical shifts in the application of learning theory which now characterise responsive curriculum design and adaptation to accommodate XR in practice.
The HoloLens (Microsoft Corp., Redmond, WA), a head-worn, optically see-through augmented reality (AR) display, is the main player in the recent boost in medical AR research. In this systematic review, we provide a comprehensive overview of the usage of the first-generation HoloLens within the medical domain, from its release in March 2016, until the year of 2021. We identified 217 relevant publications through a systematic search of the PubMed, Scopus, IEEE Xplore and SpringerLink databases. We propose a new taxonomy including use case, technical methodology for registration and tracking, data sources, visualization as well as validation and evaluation, and analyze the retrieved publications accordingly. We find that the bulk of research focuses on supporting physicians during interventions, where the HoloLens is promising for procedures usually performed without image guidance. However, the consensus is that accuracy and reliability are still too low to replace conventional guidance systems. Medical students are the second most common target group, where AR-enhanced medical simulators emerge as a promising technology. While concerns about human-computer interactions, usability and perception are frequently mentioned, hardly any concepts to overcome these issues have been proposed. Instead, registration and tracking lie at the core of most reviewed publications, nevertheless only few of them propose innovative concepts in this direction. Finally, we find that the validation of HoloLens applications suffers from a lack of standardized and rigorous evaluation protocols. We hope that this review can advance medical AR research by identifying gaps in the current literature, to pave the way for novel, innovative directions and translation into the medical routine.
This year we are pleased to present our inaugural Practitioner Proceedings volume, which includes twenty-nine submissions from the Practitioner's track, at the 8th International Conference of the Immersive Learning Research Network (iLRN 2022). This Practitioner Proceedings volume is published by iLRN and separately from the IEEE-technically sponsored Academic Proceedings.
Proceedings available at: https://publications.immersivelrn.org/index.php/practitioner/issue/view/iLRN2022
This chapter provides an insight into the theoretical perspectives which form the foundation of extended reality (XR) and its emergence in practice as a fundamental part of medical and healthcare curricula. Issues such as the authenticity of learning, the validity and reliability of XR within processes of assessment, and the theoretical underpinnings of pedagogical approaches in health professions pedagogy are illuminated. Also considered are the implications of XR within the context of non-patient-based learning and the delineation of cognitive, affective, and psychomotor domains of learning in relation to patient outcomes at the front line of care in applied practice. The COVID-19 pandemic, which has impacted all global higher education institutional (HEI) learning since March 2020, is also considered in the context of moves to ensure that medical and healthcare education can continue, albeit via hybrid models of learning as opposed to traditional pedagogical approaches, which have remained little altered over the last century.
The incorporation of virtual, augmented, and, recently, mixed reality (VR/AR/MR) technologies greatly impacted the immersive medical education field. In surgery, there is a significant body of literature for both the efficacy and the specific technologies implemented for VR/AR visualizations. Additional features such as haptic technologies and suites of sensors (e.g., hand and finger tracking) have been implemented for all aspects of surgical training and education. Recent advances in technology have also moved the field of application for Information and Communication Technologies from the intangible (AR/VR/MR) to tangible easily accessible 3D print capabilities and applications. This work aims to present the state of the art of the newly emergent 3D print technology in medical/surgical applications while presenting a viable roadmap for participatory AR/VR/MR content co-creation. As such, it aims to become a useful tool for the medical/surgical educator and technologist incorporating faster and easier AR/VR/MR content in their curricula.
Soft skills training is considered important for employees to be successful at work. Several companies are offering immersive virtual soft skills training with head-mounted displays. The main contribution of this paper is to provide an overview of the research literature within the field of using immersive virtual soft skills learning and training of employees. The results of this preliminary scoping review show that there is a lack of research literature and empirical studies within this topic.
The 7th International Conference of the Immersive Learning Research Network (iLRN 2021) is an innovative and interactive virtual gathering for a strengthening global network of researchers and practitioners collaborating to develop the scientific, technical, and applied potential of immersive learning. It is the premier scholarly event focusing on advances in the use of virtual reality (VR), augmented reality (AR), mixed reality (MR), and other extended reality (XR) technologies to support learners across the full span of learning—from K-12 through higher-education to workbased, informal, and lifelong learning contexts.
Following the success of iLRN 2020, our first fully online and in-VR conference, this year’s
conference was once again based on the iLRN Virtual Campus, powered by ©Virbela, but with a range of activities taking place on various other XR simulation, gaming, and other platforms.
Scholars and professionals working from informal and formal education settings as well as those representing diverse industry sectors are invited to participate in the conference, where they may share their research findings, experiences, and insights; network and establish partnerships to envision and shape the future of XR and immersive technologies for learning; and contribute to the emerging scholarly knowledge base on how these technologies can be used to create experiences that educate, engage, and excite learners.
Background:
Virtual Patients (VPs) may improve cognitive and behavioral skills better than traditional methods do. The aim of this paper was to investigate challenges faced by teachers and students in order to effectively implement VPs across undergraduate and postgraduate curricula. In addition, differences in student and teacher perceptions that could impact curricular integration of VPs were explored.
Methods:
A two-phase descriptive study was performed: 1) evaluation of the VP design process and curricular integration, conducted upon academic medical teachers; 2) evaluation of learning and clinical reasoning experiences with VPs, from the students' perspective.
Results:
The results of this study document high acceptance of VPs by both medical teachers and students (n = 252).VPs seem to fulfill most needs as set by course directors, while they satisfy student needs and create perceptions of improved knowledge and clinical skills reasoning.
Conclusions:
Medical educators have encountered educational challenges upon transforming the curriculum. To develop VPs, academic institutions have to pay equal attention to the needs of potential adopters and VP authors. Strategic development and use of VPs may motivate more widespread integration of VPs and lead to a high quality medical education system.
The issue of preparedness of medical students to work as junior doctors has come under increasing scrutiny. One of the key challenge for tomorrow’s doctors is the capacity and engagement for continuing professional learning and development, as well as, appropriate decision making. consequently, medical schools are exploring various ways in which technology can support this and this includes preparing students for work-based learning as well as enhancing the work-based learning placements. This includes the augmentation of the learning process with the development and consumption of digital content and electronic resources of interactive character to support issues around complex problem solving, decision-making and clinical management. Virtual patients and scenario based learning activities as well as the concept of Living Labs may be used in the preparation for the workplace activity, and thus to enhance the effectiveness of medical student work-placements. Mobile learning, reflective learning and coaching tools are being used to support students’ reflections and action planning whilst on work-based learning placements. The scope of this paper is to provide a vision as to how related technologies and associated pedagogical models may be engaged to augment workplace learning and professional development and to digitally empower the medical professional. Emphasis is placed on technology enhanced self-regulation and decision-making for tomorrow’s medical professionals through innovative use cases practiced at the Leeds Institute of Medical Education, in the UK and the Medical School of the Aristotle University of Thessaloniki in Greece. The expected institutional and societal impacts are considered in the relevant timescales of addressing the problem and in view of forthcoming technological innovations.
Virtual Reality environments in combination with brain activity recordings using electroencephalography (EEG) offer a fruitful method to investigate the emergence of specific experiential events in response to the built environment. However, real-world experimental settings involve dynamic and complex conditions which are difficult to be controlled in order to test specific hypothesis that are related to neurophysiology. We discuss here several factors that should be taking into account when designing ecological EEG experiments such as a reflective approach on the human spatial experience, consideration of first-person perspectives and a quantitative analysis of the spatial context. The focus of this paper is to propose a methodology that may facilitate the design of virtual reality EEG experiments that aim to investigate the human experience and cognition within and of the built environment. A pilot virtual reality case study is presented to illustrate how the experience of 'suddenly knowing where one is' could be approached. In this case the isovist measurements of area and revelation along participants' paths offer a useful 'tool' that allows us to isolate and study with further analysis of the EEG signal, the moment that this experience might be manifested as neuronal firing patterns in the human brain.
Education has tapped into gaming to increase engagement and facilitate knowledge retention through experiential modalities. There have been several high technological intensity digital laboratories where learners are engaged with the subject matter through various activities. There are also several low intensity web-based solutions that familiarize learners with curriculum material but in less experientially intensive manners. A ubiquitous approach to highly impactful, low cost, high reusability gamified educational approach is a versatile mixed reality educational environment. Using prolific technologies such as inexpensive augmented reality (AR) headsets and a versatile low maintenance database (DB) back-ends, a real-world environment can be transformed with 3D graphics and audio to various educational spaces of highly impactful content. Such a simple implementation is presented here for virtual patients in medicine. A simple DB back-end supports a presentation front-end developed in Unity, utilizing the “vuforia”-mixed reality platform. Based on this implementation, future directions are explored.
This paper presents a discursive review of the dimensions pleasure, arousal and dominance that Mehrabian and Russell developed in 1974 to assess environmental perception, experience, and psychological responses. Since then numerous researchers applied these dimensions to assess the experience of the physical environment and its perceived qualities. Although the dimensions appeared to be useful, there is a longlasting
debate going on among environmental psychologists about the interpretation of pleasure, arousal and dominance and its underlying mechanisms. Due to the lack of clarity researchers use different adjectives to describe environmental experiences, which makes any comparison between research findings difficult. This paper shows that the three dimensions can be linked to the current ABC Model of Attitudes: pleasure, arousal and dominance can be respectively related to affective, cognitive and conative responses, i.e. Affect, Cognition and Behaviour (ABC). In addition, connecting the three dimensions to the triad feeling, thinking and acting, can also help to improve our understanding, interpretation and measurement of pleasure, arousal and dominance. Based on this review, it is proposed to re-introduce the three dimensions and to replace the nowadays often used two dimensional model with pleasure and arousal by a three dimensional model, including dominance as a third dimension, to represent the complete range of human responses.
Background:
Since their inception, virtual patients have provided health care educators with a way to engage learners in an experience simulating the clinician's environment without danger to learners and patients. This has led this learning modality to be accepted as an essential component of medical education. With the advent of the visually and audio-rich 3-dimensional multi-user virtual environment (MUVE), a new deployment platform has emerged for educational content. Immersive, highly interactive, multimedia-rich, MUVEs that seamlessly foster collaboration provide a new hotbed for the deployment of medical education content.
Objective:
This work aims to assess the suitability of the Second Life MUVE as a virtual patient deployment platform for undergraduate dental education, and to explore the requirements and specifications needed to meaningfully repurpose Web-based virtual patients in MUVEs.
Methods:
Through the scripting capabilities and available art assets in Second Life, we repurposed an existing Web-based periodontology virtual patient into Second Life. Through a series of point-and-click interactions and multiple-choice queries, the user experienced a specific periodontology case and was asked to provide the optimal responses for each of the challenges of the case. A focus group of 9 undergraduate dentistry students experienced both the Web-based and the Second Life version of this virtual patient. The group convened 3 times and discussed relevant issues such as the group's computer literacy, the assessment of Second Life as a virtual patient deployment platform, and compared the Web-based and MUVE-deployed virtual patients.
Results:
A comparison between the Web-based and the Second Life virtual patient revealed the inherent advantages of the more experiential and immersive Second Life virtual environment. However, several challenges for the successful repurposing of virtual patients from the Web to the MUVE were identified. The identified challenges for repurposing of Web virtual patients to the MUVE platform from the focus group study were (1) increased case complexity to facilitate the user's gaming preconception in a MUVE, (2) necessity to decrease textual narration and provide the pertinent information in a more immersive sensory way, and (3) requirement to allow the user to actuate the solutions of problems instead of describing them through narration.
Conclusions:
For a successful systematic repurposing effort of virtual patients to MUVEs such as Second Life, the best practices of experiential and immersive game design should be organically incorporated in the repurposing workflow (automated or not). These findings are pivotal in an era in which open educational content is transferred to and shared among users, learners, and educators of various open repositories/environments.
Psychophysiological methods are becoming more popular in game research as covert and reliable measures of affective player experience, emotions, and cognition. Since player experience is not well understood, correlations between self-reports from players and psychophysiological data may provide a quantitative understanding of this experience. Measurements of electrodermal activity (EDA) and heart rate (HR) allow making inferences about player arousal (i.e., excitement) and are easy to deploy. This paper reports a case study on HR and EDA correlations with subjective gameplay experience, testing the feasibility of these measures in commercial game development contexts. Results indicate a significant correlation (p < 0.01) between psychophysiological arousal (i.e., HR, EDA) and self-reported gameplay experience. However, the covariance between psychophysiological measures and self-reports varies between the two measures. The results are consistent across three different contemporary major commercial first-person shooter (FPS) games (Prey, Doom 3, and Bioshock).
The use of the computer as a model, metaphor, and modelling tool has tended to privilege the 'cognitive' over the 'affective' by engendering theories in which thinking and learning are viewed as information processing and affect is ignored or marginalised. In the last decade there has been an accelerated flow of findings in multiple disciplines supporting a view of affect as complexly intertwined with cognition in guiding rational behaviour, memory retrieval, decision-making, creativity, and more. It is time to redress the imbalance by developing theories and technologies in which affect and cognition are appropriately integrated with one another. This paper describes work in that direction at the MIT Media Lab and projects a large perspective of new research in which computer technology is used to redress the imbalance that was caused (or, at least, accentuated) by the computer itself.
Factor-analytic evidence has led most psychologists to describe affect as a set of dimensions, such as displeasure, distress, depression, excitement, and so on, with each dimension varying independently of the others. However, there is other evidence that rather than being independent, these affective dimensions are interrelated in a highly systematic fashion. The evidence suggests that these interrelationships can be represented by a spatial model in which affective concepts fall in a circle in the following order: pleasure (0), excitement (45), arousal (90), distress (135), displeasure (180), depression (225), sleepiness (270), and relaxation (315). This model was offered both as a way psychologists can represent the structure of affective experience, as assessed through self-report, and as a representation of the cognitive structure that laymen utilize in conceptualizing affect. Supportive evidence was obtained by scaling 28 emotion-denoting adjectives in 4 different ways: R. T. Ross's (1938) technique for a circular ordering of variables, a multidimensional scaling procedure based on perceived similarity among the terms, a unidimensional scaling on hypothesized pleasure–displeasure and degree-of-arousal dimensions, and a principal-components analysis of 343 Ss' self-reports of their current affective states. (70 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The form factors of handheld computers make them increasingly popular among K-12 educators. Although some compelling examples
of educational software for handhelds exist, we believe that the potential of this platform are just being discovered. This
paper reviews innovative applications for mobile computing for both education and entertainment purposes, and then proposes
a framework for approaching handheld applications we call “augmented reality educational gaming.” We then describe our development
process in creating a development platform for augmented reality games that draws from rapid prototyping, learner-centered
software, and contemporary game design methodologies. We provide a narrative case study of our development activities spread
across five case studies with classrooms, and provide a design narrative explaining this development process and articulate
an approach to designing educational software on emerging technology platforms. Pedagogical, design, and technical conclusions
and implications are discussed.
Facial expression are widely used for emotion recognition. Facial expressions may be expressed differently by different people subjectively, inaccurate results are unavoidable. Nevertheless, physiological reactions are non-autonomic nerves in physiology. The physiological reactions and the corresponding signals are hardly to control while emotions are excited. Therefore, an emotion recognition system with consideration of physiological signals is proposed in this paper. A specific designed mood induction experiment is performed to collect physiological signals of subjects. Five biosensors including electrocardiogram, respiration, galvanic skin responses (GSR), blood volume pulse, and pulse are used. Then a Support Vector Regression (SVR) is used to train three regression curves of three emotions (sad, fear, and pleasure). Experimental results show that the proposed method based on SVR emotion recognition has a good performance in accuracy.
In recent years, there has been significant uptake of meditation and related relaxation techniques, as a means of alleviating stress and maintaining good health. Despite its popularity, little is known about the neural mechanisms by which meditation works, and there is a need for more rigorous investigations of the underlying neurobiology. Several electroencephalogram (EEG) studies have reported changes in spectral band frequencies during meditation inspired by techniques that focus on concentration, and in comparison much less has been reported on mindfulness and nondirective techniques that are proving to be just as popular.
The present study examined EEG changes during nondirective meditation. The investigational paradigm involved 20 minutes of acem meditation, where the subjects were asked to close their eyes and adopt their normal meditation technique, as well as a separate 20-minute quiet rest condition where the subjects were asked to close their eyes and sit quietly in a state of rest. Both conditions were completed in the same experimental session with a 15-minute break in between.
Significantly increased theta power was found for the meditation condition when averaged across all brain regions. On closer examination, it was found that theta was significantly greater in the frontal and temporal-central regions as compared to the posterior region. There was also a significant increase in alpha power in the meditation condition compared to the rest condition, when averaged across all brain regions, and it was found that alpha was significantly greater in the posterior region as compared to the frontal region.
These findings from this study suggest that nondirective meditation techniques alter theta and alpha EEG patterns significantly more than regular relaxation, in a manner that is perhaps similar to methods based on mindfulness or concentration.
Professionally significant enhancement of music and dance performance and mood has followed training with an EEG-neurofeedback protocol which increases the ratio of theta to alpha waves using auditory feedback with eyes closed. While originally the protocol was designed to induce hypnogogia, a state historically associated with creativity, the outcome was psychological integration, while subsequent applications focusing on raising the theta-alpha ratio, reduced depression and anxiety in alcoholism and resolved post traumatic stress syndrome (PTSD). In optimal performance studies we confirmed associations with creativity in musical performance, but effects also included technique and communication. We extended efficacy to dance and social anxiety. Diversity of outcome has a counterpart in wide ranging associations between theta oscillations and behaviour in cognitive and affective neuroscience: in animals with sensory-motor activity in exploration, effort, working memory, learning, retention and REM sleep; in man with meditative concentration, reduced anxiety and sympathetic autonomic activation, as well as task demands in virtual spatial navigation, focussed and sustained attention, working and recognition memory, and having implications for synaptic plasticity and long term potentiation. Neuroanatomical circuitry involves the ascending mescencephalic-cortical arousal system, and limbic circuits subserving cognitive as well as affective/motivational functions. Working memory and meditative bliss, representing cognitive and affective domains, respectively, involve coupling between frontal and posterior cortices, exemplify a role for theta and alpha waves in mediating the interaction between distal and widely distributed connections. It is posited that this mediation in part underpins the integrational attributes of alpha-theta training in optimal performance and psychotherapy, creative associations in hypnogogia, and enhancement of technical, communication and artistic domains of performance in the arts.
By means of two-stage, nonlinear multivariate pattern recognition, electroencephalograms (EEG's) were analyzed during performance
of verbal and spatial tasks. Complex scalp distributions of theta-, beta-, and, to a lesser extent, alpha-band spectral intensities
discriminated between the two members of a pair of tasks, such as writing sentences and Koh's block design. Small EEG asymmetries
were probably attributable to limb movements and other uncontrolled noncognitive aspects of tasks. Significant EEG differences
beteeen cognitive tasks were eliminated when controls for inter-task differences in efferent activity, stimulus characteristics,
and performance-related factors were introduced. Each controlled task was associated with an approximately 10 percent reduction,
as compared with visual fixation, in the magnitude of alpha- and beta-band spectral intensity. This effect occurred bilaterally
and was approximately the same over occipital, parietal, and central regions, with some minor difference over the frontal
region in the beta band. With these controls, no evidence for lateralization of different cognitive functions was found in
the EEG.
We examined the neural substrates involved when subjects encountered an event linked verbally, but not experientially, to an aversive outcome. This instructed fear task models a primary way humans learn about the emotional nature of events. Subjects were told that one stimulus (threat) represents an aversive event (a shock may be given), whereas another (safe) represents safety (no shock will be given). Using functional magnetic resonance imaging (fMRI), activation of the left amygdala was observed in response to threat versus safe conditions, which correlated with the expression of the fear response as measured by skin conductance. Additional activation observed in the insular cortex is proposed to be involved in conveying a cortical representation of fear to the amygdala. These results suggest that the neural substrates that support conditioned fear across species have a similar but somewhat different role in more abstract representations of fear in humans.
Evidence for a differential involvement of the human left and right amygdala in emotional and cognitive behaviour is reviewed, with a particular emphasis on functional imaging results and case reports on patients with amygdalar damage. The available evidence allows one to conclude that there is definitely a hemisphere specific processing difference between the left and right amygdala. However, between studies the direction of the asymmetry is partly incongruent. In spite of this, the following tentative proposals are made: the left amygdala is more closely related to affective information encoding with a higher affinity to language and to detailed feature extraction, and the right amygdala to affective information retrieval with a higher affinity to pictorial or image-related material. Furthermore, the right amygdala may be more strongly engaged than the left one in a fast, shallow or gross analysis of affect-related information.
Event-related desynchronization (ERD) and event-related synchronization (ERS) of the 1-20Hz EEG frequencies were studied using wavelet transforms in young (n = 10, mean age 22) and elderly subjects (n = 10, mean age 65) performing an auditory Sternberg memory task with words as stimuli. In both age groups, encoding of the four-word memory set elicited ERS in the theta and alpha frequency range. Theta ERS, and ERD in the alpha and beta bands were observed during retrieval. During encoding, the elderly showed greater alpha ERS and smaller theta ERS. During retrieval, smaller alpha ERD and theta ERS was found in the elderly subjects. Also, in the elderly, beta ERD was elicited in the late time window during retrieval. The statistically significant differences between the age groups were more marked during retrieval than during encoding. The results indicate that although the two groups performed equally well behaviorally in the task and the elderly subjects were cognitively intact, normal aging affects oscillatory theta, alpha and beta responses particularly during retrieval from working memory. The ERD/ERS patterns of the elderly resemble those of children found in a recent study, which might suggest that those memory-related brain processes that evolve later in childhood are the first to be affected in older age.
The circumplex model of affect proposes that all affective states arise from cognitive interpretations of core neural sensations that are the product of two independent neurophysiological systems. This model stands in contrast to theories of basic emotions, which posit that a discrete and independent neural system subserves every emotion. We propose that basic emotion theories no longer explain adequately the vast number of empirical observations from studies in affective neuroscience, and we suggest that a conceptual shift is needed in the empirical approaches taken to the study of emotion and affective psychopathologies. The circumplex model of affect is more consistent with many recent findings from behavioral, cognitive neuroscience, neuroimaging, and developmental studies of affect. Moreover, the model offers new theoretical and empirical approaches to studying the development of affective disorders as well as the genetic and cognitive underpinnings of affective processing within the central nervous system.
Very few studies in humans have quantified the effect obtained after direct electrical stimulation of the amygdala, in terms of both emotional and physiological responses. We tested patients with drug-resistant partial epilepsies who were explored with intracerebral electrodes in the setting of presurgical evaluation. We assessed the effects of direct electric stimulations in either the right or the left amygdala on verbally self-reported emotions (Izard scale) and on psychophysiological markers of emotions by recording skin conductance responses (SCRs) and by measuring the electromyographic responses of the corrugator supercilii (EMGc). According to responses on Izard scales, electrical stimulations of the right amygdala induced negative emotions, especially fear and sadness. In contrast, stimulations of the left amygdala were able to induce either pleasant (happiness) or unpleasant (fear, anxiety, sadness) emotions. Unpleasant states induced by electrical stimulations were accompanied by an increase in EMGc activity. In addition, when emotional changes were reported after electrical stimulation, SCR amplitude for the positively valenced emotions was larger than for the negative ones. These findings provide direct in vivo evidence that the human amygdala is involved in emotional experiences and strengthen the hypothesis of a functional asymmetry of the amygdala for valence and arousal processing.
Accidents caused by errors and failures in human performance among traffic fatalities have a high death rate and become an important issue in public security. They are mainly caused by the failures of the drivers to perceive the changes of the traffic lights or the unexpected conditions happening accidentally on the roads. In this paper, we devised a quantitative analysis for assessing driver's cognitive responses by investigating the neurobiological information underlying electroencephalographic (EEG) brain dynamics in traffic-light experiments in a virtual-reality (VR) dynamic driving environment. The VR technique allows subjects to interact directly with the moving virtual environment instead of monotonic auditory and visual stimuli, thereby provides interactive and realistic tasks without the risk of operating on an actual machine. Independent component analysis (ICA) is used to separate and extract noise-free ERP signals from the multi-channel EEG signals. A temporal filter is used to solve the time-alignment problem of ERP features and principle component analysis (PCA) is used to reduce feature dimensions. The dimension-reduced features are then input to a self-constructing neural fuzzy inference network (SONFIN) to recognize different brain potentials stimulated by red/green/yellow traffic events, the accuracy can be reached 87% in average eight subjects in this visual-stimuli ERP experiment. It demonstrates the feasibility of detecting and analyzing multiple streams of ERP signals that represent operators' cognitive states and responses to task events.
Although the issues around emotions and learning are not new, the term affective learning has only recently been defined as the learning that relates to the learner’s interests, attitudes, and motivations. In the digital age we live though, affective learning is destined to be technology driven or at least enhanced. Having overemphasised the cognitive and relatively neglecting the affective dimension in the past, technology enhanced learning is now enforced by new neuroscience findings that confirmed that affect is complexly intertwined with thinking, and performing important functions that may guide rational behaviour, assist memory retrieval, support decision-making and enhance creativity. To cope with personalised learning experiences in such models of learners though, intelligent tutoring systems must now contain “emotion, affect and context”, in analogy to successful human tutors. However, measuring and modelling learners’ emotional and affective states remains a difficult task, especially when real-time interactions are envisaged. In this paper, the concept of affective learning is furnished with case studies where the roles of technologies, neuroscience, learning and education are interwoven. Medical education is borrowed as a domain of reference. Neuroscientific emphasis is placed in the synergy of two perspectives, namely, the detection and recording of emotions from humans and ways to facilitate their elicitation and their subsequent exploitation in the decision-making process. The paper concludes with a visionary use case towards affective facilitation of training against medical errors and decision making by intelligent, self-regulated systems that could exploit scenario based learning to augment medical minds for tomorrow’s doctors.
Elderly carer training either formal or informal, imposes a long term healthcare and economical cost. Age, work patterns and overall demographic realities make ordinary approaches of teaching cumbersome and at times, even counterproductive. Scenario based learning has already been proven a reliable modality for self-directed education both in formal and informal context. Within this context, virtual environments have also been established as immersive experiential platforms for delivering such educational scenarios to learners. Additionally, with the advent of emerging technologies like Augmented and Virtual Reality (AR/VR) immersion and overlap between the real and the digital become ever increasing. This work describes the evolution of design and implementation innovations that originated in the EU funded DISCOVER project. Specifically, after a brief overview of design guidelines and previous implementation endeavors in virtual environments, the transition of this kind of educational content into the realm of mixed reality is described. Then, an evaluation strategy for such an approach is explored. Finally, the place of such a work in the roadmap of an educational living lab design and implementation is discussed.
In this paper, we first regard the discrete emotion recognition as a pattern recognition problem, the idea of combinational mode optimization is employed on emotion recognition. For collecting physiological signals in four different affective states, joy, anger, sadness, pleasure. We used a music induction method which elicits natural emotional reactions from the subject, Four-channel biosensors are used to obtain electromyogram(EMG), electrocardiogram(ECG), skinconductivit y(SC) and respiration changes. After calculating a sufficient amount of features from the raw signals, the genetic algorithm and the K-neighbor methods are tested to extract a new feature set consisting of the most significant features for improving classification performance. Finally, the numerical results show that the performance is feasible and effective. It also turned out that it was much easier to separate emotions along the arousal axis than along the valence axis.
Gray's two‐factor learning theory postulates a behavioral activation system (BAS), a behavioral inhibition system (BIS), and a nonspecific arousal system receiving excitatory inputs from both the BAS and the BIS. The BAS initiates behavior in response to conditioned stimuli for reward (approach) or for relieving nonpunishment (active avoidance). The BIS, which is viewed as an anxiety system, inhibits behavior in response to cues for punishment (passive avoidance) or frustrative nonreward (extinction), and its activity is decreased by the anti‐anxiety drugs (alcohol, barbiturates, minor tranquilizers). Thus, the BIS is an arousal system which inhibits rather than energizes behavior.
A review of the literature suggests that heart rate (HR) is strongly associated with activity of the BAS. This interpretation subsumes the previous findings of cardiac‐somatic coupling, incentive effects on HR, and increased HR in connection with active coping in the face of threat. Electrodermal activity (EDA), on the other hand, increases when there is an activation of the BIS. A consideration of these differing effects on HR and EDA permits a specification of conditions in which these two measures will or will not show directional fractionation.
With this theoretical model it is possible to relate the clinical features of psychopathy to the psychophysiological data with the single assumption that primary psychopaths have a deficient BIS. As a result, they show normal approach, active avoidance, and HR, but they suffer from poor passive avoidance and extinction with reduced EDA in response to threatening stimuli.
Established in 1982 as the leading reference on electroencephalography, Drs. Niedermeyer's and Lopes da Silva's text is now in its thoroughly updated Fifth Edition. An international group of experts provides comprehensive coverage of the neurophysiologic and technical aspects of EEG, evoked potentials, and magnetoencephalography, as well as the clinical applications of these studies in neonates, infants, children, adults, and older adults. This edition includes digital EEG and advances in areas such as neurocognition. Three new chapters cover the topics of Ultra-Fast EEG Frequencies, Ultra-Slow Activity, and Cortico-Muscular Coherence. Hundreds of EEG tracings and other illustrations complement the text.
This experiment was designed to distinguish possible EEG correlates of the cognitive components of tasks from EEG patterns associated with stimulus characteristics, limb and eye movements, and performance-related factors such as subjects' ability and effort. Thirty-two right-handed adults each performed 30 trials, lasting 6-15 sec each, of four simplified, controlled tasks: mental rotation of geometric forms, serial addition of a column of signed digits, substitution of letters with subsequent word recognition and visual fixation. The first three tasks could not be differentiated from each other. Each of these tasks could be differentiated from visual fixation by approximately 10% generalized reductions in alpha and beta band intensities, and slight increases in theta band intensities frontally and occipitally. We conclude that the EEG patterns which differentiated the complex tasks described in Part I were due to inter-task differences in stimulus characteristics, efferent activities and/or performance-related factors, rather than to cognitive differences. With these controls, no evidence for lateralization of different types of cognitive activity was found in the EEG.
This paper presents a methodology which uses nonlinear pattern recognition to study the spatial distribution of EEG patterns accompanying higher cortical functions. The multivariate decision rules reveal the essential EEG patterns which differentiate performance of two tasks. Cross-validation classification accuracy measures the generality of the findings. Using this method, EEG patterns were derived from a group of 23 adults during performance of several complex tasks, including Koh's block design, writing sentences, mental paper folding, and reading silently. These patterns discriminate between the tasks, are consistent with, and extend the results of, visual EEG interpretations and univariate analysis of spectral intensities. Since writing sentences could not be distinguished from mere scribbling, it is unclear whether the EEG patterns found to distinguish complex behaviors were related to the cognitive components of tasks, or to sensory-motor and performance-related factors.
The present paper combines a review of event-related potentials (ERPs) with empirical data concerning the question: what are the differences between auditory evoked potentials (EPs) and two types of ERPs with respect to their frequency components? In this study auditory EPs were elicited by 1500 Hz tones. The first type of ERPs was responses to 3rd attended tones in an omitted stimulus paradigm where every 4th stimulus was omitted. The second type of ERPs was responses to rare 1600 Hz tones in an oddball paradigm. The amplitudes of delta and theta components of EPs and ERPs showed significant differences: in responses to 3rd attended tones there was a significant increase in the theta frequency band (frontal and parietal locations; 0-250 ms). In the delta frequency band there was no significant change. In contrast a diffuse delta increase occurred in oddball responses and an additional prolongation of theta oscillations was observed (late theta response: 250-500 ms). These results are discussed in the context of ERPs as induced rhythmicities. The intracranial sources of ERPs, their psychological correlates and the role of theta rhythms in the cortico-hippocampal interaction are reviewed. From these results and from the literature a working hypothesis is derived assuming that delta responses are mainly involved in signal matching, decision making and surprise, whereas theta responses are more related to focused attention and signal detection.
Happiness, sadness, and disgust are three emotions that differ in their valence (positive or negative) and associated action tendencies (approach or withdrawal). This study was designed to investigate the neuroanatomical correlates of these discrete emotions.
Twelve healthy female subjects were studied. Positron emission tomography and [15O]H2O were used to measure regional brain activity. There were 12 conditions per subject: happiness, sadness, and disgust and three control conditions, each induced by film and recall. Emotion and control tasks were alternated throughout. Condition order was pseudo-randomized and counterbalanced across subjects. Analyses focused on brain activity patterns for each emotion when combining film and recall data.
Happiness, sadness, and disgust were each associated with increases in activity in the thalamus and medial prefrontal cortex (Brodmann's area 9). These three emotions were also associated with activation of anterior and posterior temporal structures, primarily when induced by film. Recalled sadness was associated with increased activation in the anterior insula. Happiness was distinguished from sadness by greater activity in the vicinity of ventral mesial frontal cortex.
While this study should be considered preliminary, it identifies regions of the brain that participate in happiness, sadness, and disgust, regions that distinguish between positive and negative emotions, and regions that depend on both the elicitor and valence of emotion or their interaction.
Evidence is presented that EEG oscillations in the alpha and theta band reflect cognitive and memory performance in particular. Good performance is related to two types of EEG phenomena (i) a tonic increase in alpha but a decrease in theta power, and (ii) a large phasic (event-related) decrease in alpha but increase in theta, depending on the type of memory demands. Because alpha frequency shows large interindividual differences which are related to age and memory performance, this double dissociation between alpha vs. theta and tonic vs. phasic changes can be observed only if fixed frequency bands are abandoned. It is suggested to adjust the frequency windows of alpha and theta for each subject by using individual alpha frequency as an anchor point. Based on this procedure, a consistent interpretation of a variety of findings is made possible. As an example, in a similar way as brain volume does, upper alpha power increases (but theta power decreases) from early childhood to adulthood, whereas the opposite holds true for the late part of the lifespan. Alpha power is lowered and theta power enhanced in subjects with a variety of different neurological disorders. Furthermore, after sustained wakefulness and during the transition from waking to sleeping when the ability to respond to external stimuli ceases, upper alpha power decreases, whereas theta increases. Event-related changes indicate that the extent of upper alpha desynchronization is positively correlated with (semantic) long-term memory performance, whereas theta synchronization is positively correlated with the ability to encode new information. The reviewed findings are interpreted on the basis of brain oscillations. It is suggested that the encoding of new information is reflected by theta oscillations in hippocampo-cortical feedback loops, whereas search and retrieval processes in (semantic) long-term memory are reflected by upper alpha oscillations in thalamo-cortical feedback loops.
In a series of [15O]PET experiments aimed at investigating the neural basis of emotion and feeling, 41 normal subjects recalled and re-experienced personal life episodes marked by sadness, happiness, anger or fear. We tested the hypothesis that the process of feeling emotions requires the participation of brain regions, such as the somatosensory cortices and the upper brainstem nuclei, that are involved in the mapping and/or regulation of internal organism states. Such areas were indeed engaged, underscoring the close relationship between emotion and homeostasis. The findings also lend support to the idea that the subjective process of feeling emotions is partly grounded in dynamic neural maps, which represent several aspects of the organism's continuously changing internal state.
Dynamic changes in spectral theta power (TP) in the EEG over frontal regions were reported previously during the processing of visually presented spatial and verbal tasks [Cereb. Cortex, 7 (1997) 374-385]. Lower TP was found at the beginning compared to the end of processing. In order to test another modality, we examined theta power during the exploration of haptic stimuli with different complexity. A linear correlation between theta power and mean exploration time (as a measure of stimulus complexity) was found at the end of exploration but not at its beginning. These data are in line with our hypothesis since one could expect minimal load of working memory independent of stimulus complexity at the beginning of exploration whereas working memory would have integrated the stimuli of differing complexity into a perceptual model at the end of exploration.
Frontal midline theta rhythm (Fm theta), recognized as distinct theta activity on EEG in the frontal midline area, reflects mental concentration as well as meditative state or relief from anxiety. Attentional network in anterior frontal lobes including anterior cingulate cortex is suspected to be the generator of this activity, and the regulative function of the frontal neural network over autonomic nervous system (ANS) during cognitive process is suggested. However no studies have examined peripheral autonomic activities during Fm theta induction, and interaction of central and peripheral mechanism associated with Fm theta remains unclear. In the present study, a standard procedure of Zen meditation requiring sustained attention and breath control was employed as the task to provoke Fm theta, and simultaneous EEG and ECG recordings were performed. For the subjects in which Fm theta activities were provoked (six men, six women, 48% of the total subjects), peripheral autonomic activities were evaluated during the appearance of Fm theta as well as during control periods. Successive inter-beat intervals were measured from the ECG, and a recently developed method of analysis by Toichi et al. (J. Auton. Nerv. Syst. 62 (1997) 79-84) based on heart rate variability was used to assess cardiac sympathetic and parasympathetic functions separately. Both sympathetic and parasympathetic indices were increased during the appearance of Fm theta compared with control periods. Theta band activities in the frontal area were correlated negatively with sympathetic activation. The results suggest a close relationship between cardiac autonomic function and activity of medial frontal neural circuitry.
Recent theoretical work has suggested that brain oscillations in the theta band are involved in active maintenance and recall of working memory representations. To test this theoretical framework we recorded neuromagnetic responses from 10 subjects performing the Sternberg task. Subjects were required to retain a list of 1, 3, 5 or 7 visually presented digits during a 3-s retention period. During the retention period we observed ongoing frontal theta activity in the 7-8.5-Hz band recorded by sensors over frontal brain areas. The activity in the theta band increased parametrically with the number of items retained in working memory. A time-frequency analysis revealed that the task-dependent theta was present during the retention period and during memory scanning. Following the memory task the theta activity was reduced. These results suggest that theta oscillations generated in frontal brain regions play an active role in memory maintenance.
The amygdala receives multi-modal sensory inputs and projects to virtually all levels of the central nervous system. Via these widespread projections, the amygdala facilitates consolidation of emotionally arousing memories. How the amygdala promotes synaptic plasticity elsewhere in the brain remains unknown, however. Recent work indicates that amygdala neurons show theta activity during emotional arousal, and various types of oscillations during sleep. These synchronized neuronal events could promote synaptic plasticity by facilitating interactions between neocortical storage sites and temporal lobe structures involved in declarative memory.
This paper discusses the findings of a literature review of case based learning (CBL) from a multidisciplinary health science education perspective and attempts to draw comparisons with the available literature relating to prehospital education and CBL.
CBL is an exciting educational prospect in which to develop research capacity, strategies, and opportunities. This paper provides an examination of the literature exploring the major consistencies and inconsistencies, and reveals areas of potential future research for prehospital education institutions.
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Available from: http://psycnet.apa.org/record/1981-25062-001