The Role of Personalization in the User Experience, Preferences and Engagement with Virtual Reality Environments for Relaxation.

Virtual Reality Environments (VREs) are widely deployed in mental health treatments, often associated with relaxation techniques. The personalization of natural VR-based scenarios is a key element that can further facilitate users' sense of presence and relaxation. This study explored the role of VREs' personalization in the user experience with an environment supporting relaxation, by deploying mixed methods. METHODS: A non-clinical sample of 20 individuals participated in exposure to a supportive body-scan-guided relaxation VRE. In the personalized conditions, the participants had the option of choosing the context (e.g., sea, mountain, or countryside) and including in the scenario different types of sounds, visual elements, and changing the time of day and weather. In the standard conditions, individuals were exposed to a relaxing VRE, but they could choose neither the context nor the auditory and visual elements. The order of presentation of the personalized vs non-personalized environments was randomized. Measures regarding relaxation, state-anxiety perceived levels, VRE-related symptoms, the usability of the Virtual Reality (VR) setting, sense of presence, pleasure, activation, engagement, and level of immersion experienced were collected before and after exposure to the VR environments. RESULTS: Findings showed that personalized VREs were preferred by users. Participants generally preferred to experience a greater immersivity, pleasure, engagement, and relaxation in the personalized virtual settings. CONCLUSION: The study further confirms the role of personalization as a component positively contributing to relaxation and engagement. Future research may further assess this effect in the context of large-scale controlled studies involving clinical and non-clinical populations.

Multiple Chemical Sensitivity.

Multiple Chemical Sensitivity (MCS), a condition also known as Chemical Sensitivity (CS), Chemical Intolerance (CI), Idiopathic Environmental Illness (IEI) and Toxicant Induced Loss of Tolerance (TILT), is an acquired multifactorial syndrome characterized by a recurrent set of debilitating symptoms. The symptoms of this controversial disorder are reported to be induced by environmental chemicals at doses far below those usually harmful to most persons. They involve a large spectrum of organ systems and typically disappear when the environmental chemicals are removed. However, no clear link has emerged among self-reported MCS symptoms and widely accepted objective measures of physiological dysfunction, and no clear dose-response relationship between exposure and symptom reactions has been observed. In addition, the underlying etiology and pathogenic processes of the disorder remain unknown and disputed, although biologic and psychologic hypotheses abound. It is currently debated whether MCS should be considered a clinical entity at all. Nevertheless, in the last few decades MCS has received considerable scientific and governmental attention in light of the many persons reporting this illness. In this review, we provide a general overview of the history, definition, demographics, prevalence, and etiologic challenges in defining and understanding MCS.

Concomitant recovery from left spatial neglect and inflammatory dysfunction of white-matter pathways in a case of acute disseminated encephalo-myelitis (ADEM).

Spatial neglect is an invalidating neuropsychological syndrome characterized by the inability of paying attention to the side of space contralateral to a unilateral brain damage. Recent studies have suggested that lesion of white-matter pathways plays an important role in producing spatial neglect by causing a widespread functional breakdown of the network of cortical and subcortical structures that regulates orienting of spatial attention. Nonetheless, this conclusion is largely based on the study of patients who suffer combined grey and white matter damage and should be better corroborated by the study of cases with selective or predominant white matter dysfunction. Here, we describe the clinical and MRI follow-up of a patient who suffered left spatial neglect due to inflammatory Acute Disseminated Encephalo-Myelitis (ADEM) that affected the white matter. Recovery from neglect was matched with recovery from inflammatory white-matter dysfunction, despite a concomitant and progressive increase in cortical atrophy and ventricular dilatation. These findings confirm the role of white matter lesion/dysfunction in the pathogenesis of left spatial neglect.

Idiopathic sudden sensorineural hearing loss and ménière syndrome: The role of cerebral venous drainage.

OBJECTIVES: To evaluate the influence of cerebral venous drainage on the pathogenesis of idiopathic sudden sensorineural hearing loss (ISSHL) and Ménière syndrome (MD). DESIGN: Observational, prospective, cohort study. SETTING: ENT and Cardiology Departments (University of Bari, Policlinico Hospital, Bari, Italy). PARTICIPANTS: We enrolled 59 consecutive patients (32 males, mean age 53.05 + 15.37 years): 40 ISSHL and 19 MD. MAIN OUTCOME MEASURE: All patients underwent physical examination, biochemical evaluation (glycemic and lipid profile, viral serology, C reactive protein, etc), audiometric (tonal, vocal, vestibular evoked myogenic potentials and auditory brainstem response test) and impedentiometric examination. The pure tone average (PTA) was calculated for the following frequencies: 250, 500, 1000, 2000, 3000, 4000, 8000. An echo-color Doppler evaluation of the venous cerebral veins, internal jugular (IJV) and vertebral veins (VV) at supine and 90° position was performed. RESULTS: No morphological alterations were found both in patients and controls. There were no signs of stenosis, blocked flow, membranes, etc. We found lower minimum, mean and maximum velocities in distal IJVs (P = .019; P = .013; P = .022; respectively) and left VVs (P = .027; P = .008; P = .001; respectively) in supine (0°) position in both MD and ISSHL patients as compared to controls. The same was for orthostatic position (90°). We found negative correlations between the velocities in extracranial veins and PTA values: therefore, the worst the audiometric performance of the subjects, the lower the velocities in the venous cerebral drainage. CONCLUSIONS: Idiopathic sudden sensorineural hearing loss and Ménière syndrome patients showed altered venous flow in IJVs and VVs as compared to controls, independently from posture. This different behavior of venous tone control can influence the ear performance and may have a role in the pathogenesis of both diseases.

Olfactory asymmetric dysfunction in early Parkinson patients affected by unilateral disorder.

INTRODUCTION: Parkinson's disease (PD) often first presents with asymmetric motor symptoms. A number of studies have now established that sensory deficits can also be similarly asymmetric. It is well established that PD is associated with marked olfactory dysfunction, but whether this too present asymmetrically is a currently contentious question. METHODS: To address this, we recruited 12 early stage Parkinson patients with right-sided motor symptoms and compared them to 12 healthy age-matched controls on tests of olfactory identification and recognition, administered separately to each nostril. RESULTS: Data analyses indicated that Parkinson patients performed worse with the left nostril on both tasks, while no nostril-related differences were observed for the healthy age-matched control group on the same comparisons. CONCLUSION: These findings support the idea that asymmetric deficits do extend into olfactory performance in PD-as they do into other sensory domains-and we examine the possibility that they might be a particular feature of right-sided motor symptom presentation.

Test-retest reliability and validity of the Sniffin' TOM odor memory test.

Few attempts have been made to develop an olfactory test that captures episodic retention of olfactory information. Assessment of episodic odor memory is of particular interest in aging and in the cognitively impaired as both episodic memory deficits and olfactory loss have been targeted as reliable hallmarks of cognitive decline and impending dementia. Here, 96 healthy participants (18-92 years) and an additional 19 older people with mild cognitive impairment were tested (73-82 years). Participants were presented with 8 common odors with intentional encoding instructions that were followed by a yes-no recognition test. After recognition completion, participants were asked to identify all odors by means of free or cued identification. A retest of the odor memory test (Sniffin' TOM = test of odor memory) took place 17 days later. The results revealed satisfactory test-retest reliability (0.70) of odor recognition memory. Both recognition and identification performance were negatively affected by age and more pronounced among the cognitively impaired. In conclusion, the present work presents a reliable, valid, and simple test of episodic odor recognition memory that may be used in clinical groups where both episodic memory deficits and olfactory loss are prevalent preclinically such as Alzheimer's disease.

From blindsight to blindsmell: a mini review.

This mini-review briefly documents the phenomenon of blindsight and investigates evidence for a comparable state in olfaction. Blindsight evokes an appropriate response to a visual stimulus without any conscious visual experience or awareness of that event. For olfaction, we describe many routine aspects of perception that may occur without conscious awareness, arguably paralleling key aspects of blindsight. We then describe the limited neuropsychological evidence suggesting that people can apparently respond appropriately to odours that they cannot subjectively smell - what we would term "blindsmell".

An observational retrospective/horizontal study to compare oxygen-ozone therapy and/or global postural re-education in complicated chronic low back pain.

Acute low back pain (LBP) is the fifth most common reason for physician visits and about nine out of ten adults experience back pain at some point in their life. In a large number of patients LBP is associated with disc herniation (DH). Recently, oxygen-ozone (O2O3) therapy has been used successfully in the treatment of LBP, reducing pain after the failure of other conservative treatments. The aim of this study was to assess the effects of O2O3 therapy in back pain rehabilitation, comparing three groups of patients suffering from chronic back pain associated with DH submitted to three different treatments: intramuscular O2O3 infiltrations, global postural An observational retrospective/horizontal study to compare oxygen-ozone therapy and/or global postural re-education in complicated chronic low back pain re-education (GPR), or a combination of the two (O2O3+GPR). The data show that pain severity before treatment was significantly lower in the patients treated with GPR alone (VAS score 7.4) than in the O2O3+GPR patients (VAS score 8.5) and the O2O3 patients (VAS score 8.6). At the end of treatment, pain severity was lower in the O2O3 patients than in the GPR-alone patients. After some years of follow-up only the difference between O2O3+GPR and GPR-alone remained significant.

The influence of short-term memory on standard discrimination and cued identification olfactory tasks.

BACKGROUND: Amongst the techniques to assess olfactory functions, discrimination and cued identification are those most prone to the influence of odour short-term memory (STM). Discrimination task requires participants to detect the odd one out of three presented odourants. As re-smelling is not permitted, an un-intended STM load may generate, even though the task purports to assess discrimination ability. Analogously, cued identification task requires participants to smell an odour, and then select a label from three or four alternatives. As the interval between smelling and reading each label increases this too imposes a STM load, even though the task aims to measure identification ability. NEW METHOD: We tested whether modifying task design to reduce STM load improve performance on these tests. We examined five age-groups of participants (Adolescents, Young adults, Middle-aged, Elderly, very Elderly), some of whom should be more prone to the effects of STM load than others, on standard and modified tests of discrimination and identification. RESULTS: We found that using a technique to reduce STM load improved performance, especially for the very Elderly and Adolescent groups. COMPARISON WITH EXISTING METHODS: Sources of error are now prevented. CONCLUSIONS: Findings indicate that STM load can adversely affect performance in groups vulnerable from memory impairment (i.e., very Elderly) and in those who may still be acquiring memory-based representations of familiar odours (i.e., Adolescents). It may be that adults in general would be even more sensitive to the effects of olfactory STM load reduction, if the odour-related task was more difficult.

Odour perception following bilateral damage to the olfactory bulbs: a possible case of blind smell.

INTRODUCTION: Unconsciously detected chemicals may affect human behaviour (Kirk-Smith et al., 1983; Stern and McClintock, 1998; Zucco et al., 2009), likeability judgements (Li et al., 2007) and brain activity (Lorig et al., 1990; Sobel et al., 1999). No studies, however, have investigated blind smell - the hypothetical olfactory counterpart of blindsight (Weiskrantz et al., 1974). METHODS: In this report, free and cued olfactory identification of suprathreshold odorants varying in irritancy (i.e., low or no irritant odours versus irritant odours), and taste identification abilities, were examined in patient MB who had undergone surgery for a meningioma. Post-operative imaging revealed encephalomalacia in the left gyrus rectus, with ablation of the left olfactory bulb and damage to the right, subcortical abnormality on the left near the orbital cortex, and damage to a small section of the right gyrus rectus. RESULTS: On free identification MB, while denying a capacity to smell the odours, still correctly identified some and detected others significantly above chance. In contrast, awareness always accompanied correct detections of irritant odours. Cued odour identification was at chance and no taste impairments were observed. CONCLUSIONS: We suggest, tentatively, that MB's unusual pattern of awareness when detecting and identifying odours relative to irritant odours may represent an example of 'blind smell'.

Odor-evoked autobiographical memories: age and gender differences along the life span.

Odors are powerful in bringing back old and vivid memories bearing emotional content. This inherent hedonic property of olfactory stimuli makes this sensory modality particularly suitable for studying autobiographical memory. In the present work, adolescents (first experiment), young adults (second experiment), and elderly (third experiment) of both sexes were asked to smell 10 familiar odorants and to report if these odorants evoked personal autobiographical memories or referential memories (i.e., names and objects). The participants were then required to link these memories to triplets of words using the progressive elaboration method of the Loci mnemonic. The aim of the study was to investigate whether 1) odorants evoking autobiographical memories led to faster reaction times (RTs) and to a greater number of correct responses in the recall of the items associated to such memories than do odorants evoking referential memories, 2) females differed from males on the above tasks along with the life span, and 3) the preferential codes (i.e., autobiographical or referential) attributed to the odorants vary according to gender and age. In general, it was observed that the way in which the odorants were encoded affected the subsequent retrieval. Indeed, data analyses have shown that odorants evoking autobiographical memories lead to faster RTs (experiments 2 and 3) and that females outperform males (experiments 1 and 2). However, these effects are greatly age and gender dependent. Furthermore, females are more prone than males to code the odorants autobiographically (as shown by the higher amount of autobiographical experiences that they have provided at all ages relative to males). Results are discussed in terms of developmental differences and odor-emotion links and the possible role of odors and autobiographical memory in learning and retrieval of other items.

Labeling, identification, and recognition of wine-relevant odorants in expert sommeliers, intermediates, and untrained wine drinkers.

In this study we examined the development of wine expertise. We asked four groups--untrained wine drinkers, second- and third-level trainee sommeliers, and professional sommeliers--to engage in a range of olfactory tasks to assess perceptual and semantic aspects of expertise. These tasks included identification, recognition, and description of a range of domain-specific and common odour stimuli, including wines. Trainee sommeliers were significantly poorer at identification of wine-relevant odours than untrained wine drinkers and professional sommeliers. Trainee and professional sommeliers were, however, significantly better than untrained wine drinkers in a delayed matching-to-sample wine-recognition task, but not in the case of other odorous stimuli. The wine-description task demonstrated a degree of skill, in terms of specificity and quantity of wine-relevant descriptors, as a function of expertise. These results, of one of the first studies of examining wine expertise by a cross-sectional developmental approach, indicate that perceptual aspects of expertise are probably rapidly acquired, being present even in the second- and third-level trainees, while semantic expertise is slower to develop, and may incur time for the identification of wine-specific odorants during training.

Odour recognition memory and odour identification in patients with mild and severe major depressive disorders.

Olfactory deficits, in detection, recognition and identification of odorants have been documented in ageing and in several neurodegenerative and psychiatric conditions. However, olfactory abilities in Major Depressive Disorder (MDD) have been less investigated, and available studies have provided inconsistent results. The present study assessed odour recognition memory and odour identification in two groups of 12 mild MDD patients (M age 41.3, range 25-57) and 12 severe MDD patients (M age, 41.9, range 23-58) diagnosed according to DSM-IV criteria and matched for age and gender to 12 healthy normal controls. The suitability of olfactory identification and recognition memory tasks as predictors of the progression of MDD was also addressed. Data analyses revealed that Severe MDD patients performed significantly worse than Mild MDD patients and Normal controls on both tasks, with these last groups not differing significantly from one another. The present outcomes are consistent with previous studies in other domains which have shown reliable, although not conclusive, impairments in cognitive function, including memory, in patients with MDD, and highlight the role of olfactory identification and recognition tasks as an important additional tool to discriminate between patients characterised by different levels of severity of MDD.

Cognitive factors in odor detection, odor discrimination, and odor identification tasks.

The purpose of this study was to determine cognitive correlates of olfactory performance across three different tasks. A total of 170 men and women (30-87 years of age) were assessed in olfactory sensitivity, discrimination, and identification. Also, participants were tested in a range of cognitive tests covering executive functioning, semantic memory, and episodic memory. Hierarchical regression analyses showed that proficiency in executive functioning and semantic memory contributed significantly to odor discrimination and identification performance, whereas all of the cognitive factors proved unrelated to performance in the odor threshold test. This pattern of outcome suggests that an individual's cognitive profile exerts a reliable influence on performance in higher order olfactory tasks.

Discriminating between organic and psychological determinants of multiple chemical sensitivity: a case study.

Multiple chemical sensitivity (MCS) is a controversial disorder characterized by a diverse set of debilitating symptoms purportedly induced by environmental chemicals. Many cases of putative MCS are believed to have a strong psychogenic component, making it difficult to differentiate between organic and psychogenic causes. In this case report we describe a procedure that can aid in this differentiation. A patient who met a strict set of criteria for MCS was tested on two test occasions. On the first, the patient was found to have no olfactory dysfunction, as determined from standardized olfactory tests. On the second, odorants, as well as a blank stimulus, were presented to the patient with instructions as to whether they were harmful or harmless. The patient's task was to estimate the intensity of each odorant and report any induced MCS-related symptoms. Potentially harmful odorants presented as harmless were judged significantly less intense, and triggered fewer symptoms, than harmless odorants presented as harmful. When an odorless stimulus was presented as harmful, the patient provided higher intensity evaluations and exhibited more symptoms than when it was presented as harmless. These phenomena were not present in three non-MCS controls. This straight-forward procedure allowed us to determine that the MCS symptoms of this patient were largely psychological and may be of general value for identifying psychogenic cases of MCS.

Cross-modal interactions between olfaction and vision when grasping.

This study used kinematics to investigate the integration between vision and olfaction during grasping movements. Participants were requested to smell an odorant and then grasp an object presented in central vision. The results indicate that if the target was small (e.g., a strawberry), the time and amplitude of maximum hand aperture were later and greater, respectively, when the odor evoked a larger object (e.g., an orange) than when the odor evoked an object of a similar size as the target or no odor was presented. Conversely, the time and amplitude of maximum hand aperture were earlier and reduced, respectively, when the target was large (e.g., a peach) and the odor evoked a smaller sized object (e.g., an almond) than when the odor evoked an object of a similar size as the target or no odor was presented. Taken together, these results support the evidence of cross-modal links between olfaction and vision and extend this notion to goal-directed actions.

Olfactory deficits in patients affected by minimal hepatic encephalopathy: a pilot study.

Minimal hepatic encephalopathy (MHE) is the earliest stage of hepatic encephalopathy and is associated with changes in cognitive functions, in electrophysiological parameters, and in cerebral neurochemical/neurotransmitter homeostasis. MHE can be observed in patients with cirrhosis who have no clinical evidence of hepatic encephalopathy (HE). At present, no data are available on a possible olfactory dysfunction in such a syndrome, although the pathophysiology of HE may alter olfactory functions since some of the neurotransmitters impaired in the syndrome are involved in the transmission of olfactory information. In the present paper, we performed a preliminary study aimed at detecting whether identification and recognition odor memory is altered in patients with MHE. Twelve patients diagnosed as MHE on the basis of their scores at the portosystemic encephalopathy (PSE)-syndrome test battery, and 12 age-matched controls were studied. Consistent with the hypothesis, patients performed significantly worse than controls for both odor identification and recognition tasks. In addition, a significant correlation between the two olfactory tests and the PSE-syndrome test score was found. This pattern supports the notion that olfactory alterations related to cognitive dysfunction in patients with MHE may be linked to the pathophysiology of HE.