A theoretical review of the Proteus effect: understanding the underlying processes.

Humans' inherent fascination for stories can be observed throughout most of our documented history. If, for a long time, narratives were told through paintings, songs, or literature, recent technological advances such as immersive virtual reality have made it possible for us to interact with storylines and characters in a completely new manner. With these new technologies came the need to study how people interact with them and how they affect their users. Notably, research in this area has revealed that users of virtual environments tend to display behaviors/attitudes that are congruent with the appearance of the avatars they embody; a phenomenon termed the Proteus effect. Since its introduction in the literature, many studies have demonstrated the Proteus effect in various contexts, attesting to the robustness of the effect. However, beyond the first articles on the subject, very few studies have sought to investigate the social, affective, and cognitive mechanisms underlying the effect. Furthermore, the current literature appears somewhat disjointed with different schools of thought, using different methodologies, contributing to this research topic. Therefore, this work aims to give an overview of the current state of the literature and its shortcomings. It also presents a critical analysis of multiple theoretical frameworks that may help explain the Proteus effect. Notably, this work challenges the use of self-perception theory to explain the Proteus effect and considers other approaches from social psychology. Finally, we present new perspectives for upcoming research that seeks to investigate the effect of avatars on user behavior. All in all, this work aims to bring more clarity to an increasingly popular research subject and, more generally, to contribute to a better understanding of the interactions between humans and virtual environments.

The Relationship between Sense of Presence, Emotional Response, and Clinical Outcomes in Virtual Reality-Based Therapy for Treatment-Resistant Schizophrenia: An Exploratory Correlational Study.

Avatar therapy (AT) is a novel virtual reality-based psychotherapy that has been developed to treat auditory verbal hallucinations (AVH) in treatment-resistant schizophrenia. Various psychotherapeutic components, such as emotions and sense of presence, could contribute to clinical outcomes. However, the interplay between sense of presence, emotions, and clinical response has seldom been investigated. This study aimed to explore the relations between sense of presence, emotions, and clinical outcomes in AT. To conduct this investigation, data from previous and ongoing AT trials were used. Sense of presence and emotions were assessed using standardized questionnaires. AVH were evaluated using the Psychotic Symptom Rating Scales. While sense of presence was positively associated with positive emotions such as control and serenity, no significant associations were found for negative emotions. Moreover, a higher level of sense of presence was associated with a bigger decrease in AVH. Overall, positive emotions seem to be associated with sense of presence in AT. Sense of presence also seems to be involved in the therapeutic outcome, thereby suggesting that this could be an important component related to clinical response. More studies are needed to confirm these trends, which could be generalized to other virtual reality-based psychotherapies.

A burden shared: The evolutionary case for studying human deafness in Drosophila.

Hearing impairment is the most prevalent sensory disease in humans and can have dramatic effects on the development, and preservation, of our cognitive abilities and social interactions. Currently 20 % of the world's population suffer from a form of hearing impairment; this is predicted to rise to 25 % by 2050. Despite this staggering disease load, and the vast damage it inflicts on the social, medical and economic fabric of humankind, our ability to predict, or prevent, the loss of hearing is very poor indeed. We here make the case for a paradigm shift in our approach to studying deafness. By exploiting more forcefully the molecular-genetic conservation between human hearing and hearing in morphologically distinct models, such as the fruit fly Drosophila melanogaster, we believe, a deeper understanding of hearing and deafness can be achieved. An understanding that moves beyond the surface of the 'deafness genes' to probe the underlying bedrock of hearing, which is shared across taxa, and partly shared across modalities. When it comes to understanding the workings (and failings) of human sensory function, a simple fruit fly has a lot to offer and a fly eye might sometimes be a powerful model for a human ear. Particularly the use of fly avatars, in which specific molecular (genetic or proteomic) states of humans (e.g. specific patients) are experimentally reproduced, in order to study the corresponding molecular mechanisms (e.g. specific diseases) in a controlled yet naturalistic environment, is a tool that promises multiple unprecedented insights. The use of the fly - and fly avatars - would benefit humans and will help enhance the power of other scientific models, such as the mouse.

Pilot study of the relation between various dynamics of avatar experience and perceptual characteristics.

In recent years, due to the prevalence of virtual reality (VR) and human-computer interaction (HCI) research, along with the expectation that understanding the process of establishing sense of ownership, sense of agency, and limb heaviness (in this study, limb heaviness is replaced with comfort level) will contribute to the development of various medical rehabilitation, various studies have been actively conducted in these fields. Previous studies have indicated that each perceptual characteristics decrease in response to positive delay. However, it is still unclear how each perceptual characteristic changes in response to negative delay. Therefore, the purpose of this study was to deduce how changes occur in the perceptual characteristics when certain settings are manipulated using the avatar developed in this study. This study conducted experiments using an avatar system developed for this research that uses electromyography as the interface. Two separate experiments involved twelve participants: a preliminary experiment and a main experiment. As observed in the previous study, it was confirmed that each perceptual characteristics decreased for positive delay. In addition, the range of the preliminary experiment was insufficient for the purpose of this study, which was to confirm the perceptual characteristics for negative delay, thus confirming the validity of conducting this experiment. Meanwhile, the main experiment showed that the sense of ownership, sense of agency, and comfort level decreased gradually as delay time decreased, (i.e., this event is prior to action with intention, which could not be examined in the previous study). This suggests that control by the brain-machine interface is difficult to use when it is too fast. In addition, the distribution of the most strongly perceived settings in human perceptual characteristics was wider in regions with larger delays, suggesting this may lead to the evaluation of an internal model believed to exist in the human cerebellum. The avatar developed for this study may have the potential to create a new experimental paradigm for perceptual characteristics.

Staying connected: implementing avatar robots at schools in Germany and Japan.

Introduction: With advancements in communication technologies and internet connectivity, avatar robots for children who cannot attend school in person due to illness or disabilities have become more widespread. Introducing these technologies to the classroom aims to offer possibilities of social and educational inclusion. While implementation is still at an experimental level, several of these avatars have already been introduced as a marketable service. However, various obstacles impede widespread acceptance. Methods: In our explorative qualitative case study we conducted semi-structured interviews with eight individuals involved in the implementation of the avatar robots AV1 in Germany and eleven participants involved with implementing OriHime in Japan. We analyzed and compared implementation processes, application areas, access and eligibility, and the potential and limitations of avatars at schools. Results: We identified structural similarities and differences in both countries. In the German cases the target is defined as temporary use for children who cannot attend school in person because of childhood illness, with the clear goal of returning to school. Whereas in Japan OriHime is also implemented for children with physical or developmental disabilities, or who cannot attend school in person for other reasons. Discussion: Our study suggests that avatar technologies bear high potential for children to stay socially and educationally connected. Yet, structures need establishing that grant equal access to avatar technologies. These include educational board regulations, budgets for funding avatar technologies and making them accessible to the public, and privacy protection standards that are adequate, yet do not create implementation hurdles that are too high. Furthermore, guidelines or training sessions on technical, educational and psychosocial aspects of including avatar technologies in the classroom for teachers are important for successful implementation. Since our Japanese cases suggest that expanding the area of application beyond childhood illness is promising, further research on the benefits for different groups is needed.

Exploring the Relationship Between Avatar Ego Types and Communication: A Comparative Study of South Korea and the United States Based on the Expectation Confirmation Model.

This research explores the significance of avatar communication in the virtual world, where individuals can create new identities and establish relationships beyond real-world limitations. Avatar users engage in virtual interactions to fulfill their desires, enjoy entertainment, and experience surrogate satisfaction. This study integrates the Expectation Confirmation Model (ECM) and Impression Management Theory (IMT) to investigate the impact of various avatar ego types on communication satisfaction and continued intention to use. Two surveys (n = 600) were administered using South Korean and American samples. The results suggest a significant relationship between expectancy confirmation and perceived usefulness. Specifically, high perceived usefulness leads to increased communication satisfaction. Also, when pre-experience expectancy confirmation is low, it positively affects communication satisfaction. In addition, the study highlights differences between Western and Eastern cultural contexts in avatar ego type's expression. This study contributes to the understanding of virtual interactions, offering theoretical insights through the integration of ECM and IMT. Theoretical and practical implications are discussed.

Examining how gamers connect with their avatars to assess their anxiety: A novel artificial intelligence approach.

Research has supported that a gamer's attachment to their avatar can offer significant insights about their mental health, including anxiety. To assess this hypothesis, longitudinal data from 565 adult and adolescent participants (Mage = 29.3 years, SD = 10.6) was analyzed at two points, six months apart. Respondents were assessed using the User-Avatar Bond (UAB) scale and the Depression Anxiety Stress Scale (DASS) to measure their connection with their avatar and their risk for anxiety. The records were processed using both untuned and tuned artificial intelligence [AI] classifiers to evaluate present and future anxiety. The findings indicated that AI models are capable of accurately and autonomously discerning cases of anxiety risk based on the gamers' self-reported UAB, age, and duration of gaming, both at present and after six months. Notably, random forest algorithms surpassed other AI models in effectiveness, with avatar compensation emerging as the most significant factor in model training for prospective anxiety. The implications for assessment, prevention, and clinical practice are discussed.

Qualitative Exploration of Anesthesia Providers' Perceptions Regarding Philips Visual Patient Avatar in Clinical Practice.

The Philips Visual Patient Avatar, a user-centered visualization technology, offers an alternative approach to patient monitoring. Computer-based simulation studies indicate that it increases diagnostic accuracy and confidence, while reducing perceived workload. About three months after the technology's integration into clinical practice, we conducted an assessment among anesthesia providers to determine their views on its strengths, limitations, and overall perceptions. This single-center qualitative study at the University Hospital of Zurich examined anesthesia providers' perceptions of the Philips Visual Patient Avatar after its implementation. The study included an online survey to identify medical personnel's opinions on the technology's strengths and areas for improvement, which were analyzed using thematic analysis. A total of 63 of the 377 invited anesthesia providers (16.7%) responded to the survey. Overall, 163 comments were collected. The most prevalent positive themes were good presentation of specific parameters (16/163; 9.8%) and quick overview/rapid identification of problems (15/163; 9.2%). The most common perceived area for improvement was the ability to adjust the visualization thresholds of Visual Patient Avatar, which represent the physiological upper and lower vital-sign limits (33/163; 20.3%). The study showed that users consider Philips Visual Patient Avatar a valuable asset in anesthesia, allowing for easier identification of underlying problems. However, the study also revealed a user desire for the ability to freely adjust the thresholds of the Visual Patient Avatar by the handling caregivers, which were fixed to the departmental standard during the study.

The experience of a tele-operated avatar being touched increases operator's sense of discomfort.

Recent advancements in tele-operated avatars, both on-screen and robotic, have expanded opportunities for human interaction that exceed spatial and physical limitations. While numerous studies have enhanced operator control and improved the impression left on remote users, one area remains underexplored: the experience of operators during touch interactions between an avatar and a remote interlocutor. Touch interactions have become commonplace with avatars, especially those displayed on or integrated with touchscreen interfaces. Although the need for avatars to exhibit human-like touch responses has been recognized as beneficial for maintaining positive impressions on remote users, the sensations and experiences of the operators behind these avatars during such interactions remain largely uninvestigated. This study examines the sensations felt by an operator when their tele-operated avatar is touched remotely. Our findings reveal that operators can perceive a sensation of discomfort when their on-screen avatar is touched. This feeling is intensified when the touch is visualized and the avatar reacts to it. Although these autonomous responses may enhance the human-like perceptions of remote users, they might also lead to operator discomfort. This situation underscores the importance of designing avatars that address the experiences of both remote users and operators. We address this issue by proposing a tele-operated avatar system that minimizes unwarranted touch interactions from unfamiliar interlocutors based on social intimacy.

Fear of Sexual Victimization in Metaverse: A Comparison of Adolescent and Adult Female Users.

Metaverse platforms have gained worldwide popularity in recent years. This increase in popularity has also heightened safety concerns, as virtual sexual assault against children and the youth is on the rise. The issue of sexual abuse in the metaverse is becoming increasingly controversial due to the gaps in the current regulatory framework that result from the uncertain consequences of such virtual crimes. Drawing on an online survey of female users of Zepeto (n = 343), a metaverse social network platform where users interact with others while creating personalized avatars and virtual spaces, this study aims to explore how female users interpret the risk of sexual harassment in Zepeto, examining the triggers of emotional distress and behavioral change that result from such risk assessments by users. It investigates how these interpretations and responses vary depending on their sense of presence and engagement in the virtual environment and identification with their avatars and how all these processes differ between adolescent and adult female users. Overall, this study provides insights into the complex dynamics of virtual victimization. The findings could inform the development of regulatory frameworks that protect users from virtual sexual assault and create a safer environment for all users, especially the youngest generations.

Two New Genera and Species of the Parasitic Copepod Family Chondracanthidae Milne Edwards, 1840 (Copepoda: Cyclopoida) from Deep-Sea Fishes Off Suruga Bay, Japan.

PURPOSE: The present paper describes two new genera and species of the parasitic copepod family Chondracanthidae Milne Edwards, 1840 based on specimens collected from two species of deep-sea fishes at a depth of 212 m off Suruga Bay, Japan. Avatar nishidai gen. et sp. nov. is described from the host fish Chaunax abei Le Danois, 1978 (Chaunacidae). Kokeshioides surugaensis gen. et sp. nov. is described from the host fish Setarches longimanus (Alcock, 1894) (Setarchidae). METHODS: Fresh specimens of chondracanthids were collected from the buccal cavity of two species of deep-sea fishes (fish hosts were frozen), Chaunax abei Le Danois, 1978 (Lophiiformes: Chaunacidae) and Setarches longimanus (Alcock, 1894) (Perciformes: Setarchidae), caught at a depth of 212 m in Suruga Bay, Japan (34° 37'48.87″ N, 138° 43'2.958″ E). Both the species are described and illustrated based on ovigerous females. RESULTS: The genus Avatar gen. nov. can readily be distinguished from all other chondracanthid genera by the following combination of features: cephalothorax slightly wider than long with anterior pair of large and posterior pair of small lateral lobes, and two pairs of ventro-lateral processes; the very posteriormost part of the first pedigerous somite contributes to the neck; cylindrical trunk with two pairs of blunt proximal fusiform processes; antennule with small knob terminally; antenna bearing distal endopodal segment; labrum protruding ventrally; two pairs of biramous legs each with 2-segmented rami. Kokeshioides gen. nov. has the following combinations of features that distinguish it from other chondracanthid genera: body flattened, without lateral processes; cephalothorax much wider than long, with paired anterolateral and posterolateral lobes, folded ventrally; the very posteriormost part of the first pedigerous somite contributes to the neck; mandible elongate; legs unique, heavily sclerotized, represented by two pairs of acutely pointed processes. CONCLUSION: With the addition of two new genera presently reported, the family Chondracanthidae currently includes 52 valid genera. Among the described genera Avatar gen. nov. seems to be very primitive, while Kokeshioides gen. nov. is highly advanced. The deduced evolutionary history of chondracanthid genera is also discussed.

Impact of using virtual avatars in educational videos on user experience.

Popularization of knowledge is of considerable importance and necessity, and traditional knowledge popularization activities suffer from high cost and low acceptance, which affect their effectiveness and coverage. Applying virtual avatars to educational videos may be an effective way to solve the problem. This study investigates the impact of applying virtual avatars to educational videos on user experience. Constructed a model of the impact of user experience on educational videos with virtual avatars, collected data from the target population, and analyzed it empirically. The video quality and virtual avatar expressiveness dimensions of the influencing factors have a significant positive effect on the learning effect, emotional experience and user engagement dimensions of user experience; the content quality dimension of the influencing factors has a significant negative effect on the three dimensions of user experience. The video quality and virtual avatar expressiveness dimensions of the influencing factors have a significant positive effect on the learning effect, emotional experience and user engagement dimensions of user experience; the content quality dimension of the influencing factors has a significant negative effect on the three dimensions of user experience.

Effects of self-avatar cast shadow and foot vibration on telepresence, virtual walking experience, and cybersickness from omnidirectional movie.

Human locomotion is most naturally achieved through walking, which is good for both mental and physical health. To provide a virtual walking experience to seated users, a system utilizing foot vibrations and simulated optical flow was developed. The current study sought to augment this system and examine the effect of an avatar's cast shadow and foot vibrations on the virtual walking experience and cybersickness. The omnidirectional movie and the avatar's walking animation were synchronized, with the cast shadow reflecting the avatar's movement on the ground. Twenty participants were exposed to the virtual walking in six conditions (with/without foot vibrations and no/short/long shadow) and were asked to rate their sense of telepresence, walking experience, and occurrences of cybersickness. Our findings indicate that the synchronized foot vibrations enhanced telepresence as well as self-motion, walking, and leg-action sensations, while also reducing instances of nausea and disorientation sickness. The avatar's cast shadow was found to improve telepresence and leg-action sensation, but had no impact on self-motion and walking sensation. These results suggest that observation of the self-body cast shadow does not directly improve walking sensation, but is effective in enhancing telepresence and leg-action sensation, while foot vibrations are effective in improving telepresence and walking experience and reducing instances of cybersickness.

Virtual food exposure with positive mood induction or social support to reduce food anxiety in anorexia nervosa: A feasibility study.

OBJECTIVE: Aversive emotions toward food and the consequences of eating are at the core of anorexia nervosa. Exposure therapy is effective to reduce anxiety and avoidance toward feared stimuli. Based on the inhibitory learning framework, this study examined the feasibility to induce social support or positive mood to enhance the impact of a single session virtual food exposure on food-related anxiety in anorexia nervosa. METHOD: One hundred and forty-five patients were randomized to: (1) virtual food exposure (i.e., baseline condition), (2) virtual food exposure plus positive mood induction (i.e., positive mood condition), or (3) virtual food exposure plus social support (i.e., social support condition). They completed self-report assessments of anxiety toward virtual foods, general anxiety, positive mood, social support, and hunger, before and after virtual food exposure. Number of eye gazes and touches toward foods were recorded during the virtual reality exposure. RESULTS: Patients had lower levels of anxiety toward virtual foods in the positive mood condition, compared to the baseline condition [F(2,141) = 4.36, p = .015; medium effect size]. They also touched food items more often in the baseline condition. No other significant changes were found. DISCUSSION: Virtual food exposure enhanced by positive mood induction seems a feasible approach to strengthen the impact of food exposure in anorexia nervosa. PUBLIC SIGNIFICANCE: This research contributes to the understanding of how patients with anorexia nervosa can be supported to overcome fear and anxiety around food. Virtual reality enables patients to expose themselves to difficult situations (e.g., kitchen with foods of various calorie contents) while experiencing positive stimuli, such as a loving and kind pet or a supportive avatar.

Machine Ethics in Care: Could a Moral Avatar Enhance the Autonomy of Care-Dependent Persons?

It is a common view that artificial systems could play an important role in dealing with the shortage of caregivers due to demographic change. One argument to show that this is also in the interest of care-dependent persons is that artificial systems might significantly enhance user autonomy since they might stay longer in their homes. This argument presupposes that the artificial systems in question do not require permanent supervision and control by human caregivers. For this reason, they need the capacity for some degree of moral decision-making and agency to cope with morally relevant situations (artificial morality). Machine ethics provides the theoretical and ethical framework for artificial morality. This article scrutinizes the question how artificial moral agents that enhance user autonomy could look like. It discusses, in particular, the suggestion that they should be designed as moral avatars of their users to enhance user autonomy in a substantial sense.

Gut microbiome-derived butyrate inhibits the immunosuppressive factors PD-L1 and IL-10 in tumor-associated macrophages in gastric cancer.

Early detection and surgical treatment are essential to achieve a good outcome in gastric cancer (GC). Stage IV and recurrent GC have a poor prognosis. Therefore, new treatments for GC are needed. We investigated the intestinal microbiome of GC patients and attempted to reverse the immunosuppression of the immune and cancer cells of GC patients through the modulation of microbiome metabolites. We evaluated the levels of programmed death-ligand 1 (PD-L1) and interleukin (IL)-10 in the peripheral blood immunocytes of GC patients. Cancer tissues were obtained from patients who underwent surgical resection of GC, and stained sections of cancer tissues were visualized via confocal microscopy. The intestinal microbiome was analyzed using stool samples of healthy individuals and GC patients. Patient-derived avatar model was developed by injecting peripheral blood mononuclear cells (PBMCs) from advanced GC (AGC) patients into NSG mice, followed by injection of AGS cells. PD-L1 and IL-10 had higher expression levels in immune cells of GC patients than in those of healthy controls. The levels of immunosuppressive factors were increased in the immune and tumor cells of tumor tissues of GC patients. The abundances of Faecalibacterium and Bifidobacterium in the intestinal flora were lower in GC patients than in healthy individuals. Butyrate, a representative microbiome metabolite, suppressed the expression levels of PD-L1 and IL-10 in immune cells. In addition, the PBMCs of AGC patients showed increased levels of immunosuppressive factors in the avatar mouse model. Butyrate inhibited tumor growth in mice. Restoration of the intestinal microbiome and its metabolic functions inhibit tumor growth and reverse the immunosuppression due to increased PD-L1 and IL-10 levels in PBMCs and tumor cells of GC patients.

Translating the user-avatar bond into depression risk: A preliminary machine learning study.

Research has shown a link between depression risk and how gamers form relationships with their in-game figure of representation, called avatar. This is reinforced by literature supporting that a gamer's connection to their avatar may provide broader insight into their mental health. Therefore, it has been argued that if properly examined, the bond between a person and their avatar may reveal information about their current or potential struggles with depression offline. To examine whether the connection with an individuals' avatars may reveal their risk for depression, longitudinal data from 565 adults/adolescents (Mage = 29.3 years, SD = 10.6) were evaluated twice (six months apart). Participants completed the User-Avatar-Bond [UAB] scale and Depression Anxiety Stress Scale to measure avatar bond and depression risk. A series of tuned and untuned artificial intelligence [AI] classifiers analyzed their responses concurrently and prospectively. This allowed the examination of whether user-avatar bond can provide cross-sectional and predictive information about depression risk. Findings revealed that AI models can learn to accurately and automatically identify depression risk cases, based on gamers' reported UAB, age, and length of gaming involvement, both at present and six months later. In particular, random forests outperformed all other AIs, while avatar immersion was shown to be the strongest training predictor. Study outcomes demonstrate that UAB can be translated into accurate, concurrent, and future, depression risk predictions via trained AI classifiers. Assessment, prevention, and practice implications are discussed in the light of these results.

How storytelling through the use of avatars could help Fukushima evacuees express themselves: digital archive for people in the diaspora.

The Memorytalk online platform allows users to upload animated human stories. They may also choose to display related photos/characters and construct scenarios. Memorytalk may thus constitute a useful collaborative format for survivors of the Great East Japan Earthquake, especially evacuees from the town of Namie, who are now relocated in different areas across Japan, particularly as they are hesitant to talk about where they are from. This study examined various narrated animations created by Namie high school students within the Memorytalk platform, specifically for the purpose of investigating their storytelling methods based on Erving Goffman's role-distance theory. Memorytalk not only allows avatars that provide users with anonymity when expressing a wide range of memories, it also creates (1) opportunities for face-to-face workshops in the context of computer-mediated communication and (2) the therapeutic benefits of being humorous. In sum, the platform may provide users with a form of role distancing in which people in the diaspora can more freely express themselves and also store valuable local memories.

Development and evaluation of a software system for medical students to teach and practice anamnestic interviews with virtual patient avatars.

BACKGROUND AND OBJECTIVES: Taking a medical history is a core competence of the diagnostic process. At the beginning of their study medical students need to learn and practice the necessary techniques, initially focusing on good structuring and completeness. For this purpose, an interactive software system (ViPATalk) was developed in which the student can train to pose questions to virtual patient avatars in free conversation. At the end, the student receives feedback on the completeness of the questioning and an explanation of the essential items. The use of this software was compared to the traditional format of student role play in a randomized trial. METHODS: The central component of ViPATalk is a chatbot based on the AI language AIML, which generates an appropriate answer based on keywords in the student's question. To enable a realistic use, the student can enter the question via microphone (speech-to-text) and the answer generated by the chatbot is presented as a short video sequence, where the avatar is generated from a real image. Here, the transition between the sequences is seamless, resulting in a continuous movement of the avatar during the conversation. RESULTS: The learning success by practicing with ViPATalk was tested in an anamnestic interview with actors as simulated patients. The completeness of the conversation was evaluated with regard to numerous aspects and also certain behaviors during the conversation. These results were compared with those after practicing using peer role play. CONCLUSIONS: It was found that practicing with ViPATalk was mostly equivalent to the students' role play. In the subsequent survey of the students, the wish was expressed that the ViPATalk software should also be used as an online tool for self-study and that there should be more cases for practicing.