All right, folks, sorry about that. We're having some technical difficulties, but honestly, we can just take a show of hands. To me, that works just as well. So what do you all think of when you think of the word metaverse? Just put some words out there. I'm sorry? Okay. Anyone else? Okay. Any other words that come to mind? Okay. Fear, okay. Yes. Okay. Yes. So really, the metaverse is a new concept. A lot of us don't really have a good grasp as to what it is, what the potential implications are, how it's going to impact our practice. So really, our job today is to at least provide some insights, and hopefully, as an organization, we can start to kind of craft our decision-making around how we incorporate the metaverse into our respective clinical practices. So I do have a video here, so bear with us. I know we have a lot of high-tech stuff going on here today, but we wanted to make sure we could at least share some information about metaverse and its impact on sustainability efforts. So there we go. All right. We're doing that. You might be able to download the full ED. Oh, yeah. That'd be great. You can't get away with the buffering, right, guys? Do we have internet on here as well to download stuff? It's connected to the internet. I missed the plan. Yeah, because we're trying to download something else, too. That's okay. That's okay. Don't worry about it. So technology is great when it works, right? But when it doesn't, you should have redundancy built in, and we'll talk about that, too. Absolutely. It's all good, folks. So let's keep this party going. We got the music. I know, right? Yes. All right. So you all can see that. So we'll stick with our standard slides here. So what exactly is the metaverse? I know some folks had brought up some terms to the conversation. But really, at least from our technological counterparts, the metaverse is really an immersive future environment where we can incorporate the physical with the virtual and really try to drive interactions across multiple spheres around the world. And what is planetary health? So I've been, as many of you may know, really trying to focus on ways we can promote climate change efforts across the U.S. and internationally and how we can reduce our carbon footprint. And planetary health really kind of incorporates a lot of these concepts. You can see the definition here. So really focusing on transdisciplinary interactions with our colleagues in the environmental health sciences, in the engineering worlds, as well as ensuring that we're able to communicate with these folks and looking at how we can better enhance our health worldwide. So thinking about the metaverse, I'm not sure how many of you may know what it takes to actually keep this type of virtual world running. So clearly there's a lot of energy that's required. I know this can kind of look like they're kind of diametrically opposed because to be able to have environmental sustainability, you need to have a reliable source of energy that's not necessarily coming from coal, for instance, or one of the more traditional fossil fuel generators. So this is where we really have to kind of think and figure out how we're going to maintain such a world that is going to be carbon neutral. But really there are ways that we can do that. There are many renewable energy sources like solar, wind, and the technology advancements in the last decade have been phenomenal. And I'm really hopeful that in the next couple of decades we can continue to scale that type of energy production and really sustain the metaverse potential when it comes to environmental sustainability. Oh, that actually works. So I just wanted to have a revolving globe just to kind of, again, drill down on this concept of climate change and incorporating some of these new technological advancements to kind of take a different perspective when it comes to climate mitigation efforts. We all live on this planet. I plan to be on this planet. And we want to make sure that we can continue to have our future generations really enjoy all the benefits that we currently enjoy. So this is really important to continue to focus on efforts where we can keep our planet in good shape. So I'm not sure if this is going to play, but I'm going to give it a shot because I did embed this. Let me go back to the next slide. Oh, apologies. It's very sensitive. What if the world had a digital twin that had the potential to make our physical world a better one? A virtual model that could protect the environment in real time. A world in which environmental inspections, audits, and reporting could be done from the comfort of your own home. A world with the data to make eco-friendly decisions easy. So managing tasks like due diligence, investments, property reviews, and permit preparation could come at the click of a button. With the technology to collaborate with others, not just on a screen, but within a 3D model. And the ability to spot environmental problems before they happen, making for a smarter and healthier planet. This is the EnviroVerse. And EnviroAI is setting its sights high to unlock everything that it has to offer. So I really like that video because it kind of gives a general overview of how this EnviroVerse is going to kind of work. So the way that I conceptualize the EnviroVerse is that we're taking the basic principles of environmental protection and incorporating this new virtual reality into the metaverse. And like I said, this is still an evolving field. We don't necessarily know the potential short-term and long-term implications of incorporating the EnviroVerse in various facets of how we practice. Clearly, occupational and environmental medicine has so much to offer, not only our patients, but really our corporate clients and other stakeholders who really want to ensure that they're doing their part when it comes to protecting the environment. So stay tuned. There's a lot happening in this space. All right. So I'm going to incorporate some definitions here because I feel that there's still a lot of moving parts when it comes to understanding a lot of these technological concepts. So this is a concept of the digital twin. So clearly we all have our physical presence. We're inhabiting space. We're physically here. But then there's this whole concept of having a digital twin or a virtual twin, really trying to really incorporate a lot of the physical presence into this virtual sphere. And clearly with all the technological advancements in artificial intelligence, we have all these satellites, sensors, all these ways where we can track data in real time. There is a lot of potential applications to a variety of different fields, specifically at least with context of this presentation to climate change mitigation efforts. So I apologize. The font here is not the best. But really this is just an example that I kind of put together here. So disaster preparedness, this is something that a lot of us understand, especially when it comes to, say, an event like a flood. So how can we ensure that municipalities, state and local governments, as well as the federal government, how are these entities able to come up with a response? So there is a potential to be able to have virtual as well as physical presence at these specific disaster locations and ensuring that emergency services are being delivered both physically as well as in a consultative capacity virtually. With respect to other applications of the metaverse as it applies to planetary health and climate change mitigation efforts, we can really use the metaverse as a teaching tool. I know we have over 40 countries represented at this conference, which is amazing. And how can we actually educate our fellow colleagues in Africa, Asia and other continents that they may not have all the expertise when it comes to developing their climate change mitigation strategies? So incorporating some of these virtual reality, augmented reality applications when it comes to educating our counterparts, as well as the potential incorporation of such technology when it comes to educating our undergraduate and graduate medical education realms, I think there's a lot of potential for us to really make our mark in this space. And I'm hoping I can pique your interest to continue to look into this, and hopefully as an organization we can really make our mark. So now Kenji is going to take over. Thanks. Good morning. So just get an idea of the audience. How many people work in academia in here? Government? Corporate? Ah, great. Any other industries I missed in here? What other industries? International organizations. Sorry, I hear international. I hear the World Bank. Clinics. What was that? Clinics, yes. Occupational clinic, that makes sense. Great. Okay, so I want to talk about how it's been applied right now and today, and I think how this is going to change in the future as well, and the different opportunities we have around what we can do. So any FAA medical examiners in here? Wonderful, we have one. Two, great, so I can say whatever I want now. Three, this is great. So anybody know what plainness is? It's a Cirrus. Yep, it's a Cirrus. Yep, exactly. So it's one of the newer planes. So I teach at a local flight school human factors courses for them, and as part of that, I get to learn how to fly. And I was like, how exciting is that as a physician to say, I'm going to not only take care of pilots, but have the opportunity to be able to fly a plane. And I thought, okay, I'm going to go fly this plane and figure out how this works. And if you look inside the cockpit, this is what it looks like. And they were like, do you know how much it costs roughly to fly a plane, just to fly one to train? How much do you think it usually costs? $20, $30, hundreds of dollars, thousands of dollars? Thousands. Thousands, right? It's quite expensive. The fuel itself is about $250 an hour, just that cost. Flying instructor is about another $150 or so. And you need at least 40 hours just to get a private license, and you need thousands of hours to finally fly commercial planes. So you can imagine the impact on the planet when we have flight schools that use these different opportunities to fly planes like they traditionally do. And this is one of the newer ones that's been electrified, so it's partially ran through a lot of these avionics that didn't exist before. When I started flying almost 10 years ago, it was all based on Cessna airplanes, which is still what we used in World War I. So the fuel consumption is horrible, and they used leaded fuel for a while into this past couple of years. So you can imagine the impact on the planet when we have planes that were not efficient, used leaded gasoline and jet fuel, and were flying it multiple times throughout the day with private pilots, commercial pilots. So the impact was huge. So I talked to the school and said, well, what are you going to do differently? What can we do to not only mitigate the environmental impact that we're having in northern Maine, and this is where this is at, but also to maybe improve flight patterns and training amongst pilot students? And we thought, well, let's take it to the metaverse. Let's take it to the virtual reality. So we took that cockpit and designed it with Cirrus and said, can we do something where we can take the avionics, put it into a computer system, and maybe somehow gamify it, but at the same time make it look like a virtual reality where we can put a headset on and recreate and simulate that environment for them? This will only help cut down training time. We wouldn't have to fly as much. We would be able to do a lot of virtual simulation and training before we actually fly the real plane. And lo and behold, we're capturing the data right now, so hopefully we'll be able to share that next year with some good data we're collecting around student aviation time and whether they're training quicker, flying better, and have higher success rates in passing their exams. So it's quite amazing. It's basically a little headset that you have here. You put it on, and these headsets are getting better and better. You saw some of the videos where it's huge goggles, and it's quite heavy. Has anybody used one of these virtual reality headsets before? Can you show of hands? So it's not too much, maybe like a third of the room. It's quite a new technology, but it's been here for almost a decade. Right? Oculus came out with one of the first ones, and then it was acquired by Facebook and now called Meta, and they developed the Oculus headsets. They were supposed to introduce a new one this year. Most likely they're waiting because Apple is supposed to release one as well. And as you're probably aware, Google released their lens a couple years ago as well that kind of didn't really take off too much. The idea of this is just so new to a lot of people, and like we asked earlier, what are your thoughts about Metaverse? And, you know, some people said, well, it's scary. It's something new. There's a lot of people around it because this technology hasn't been really adopted yet. And last year I was thinking this is going to be the biggest thing that's going to hit this year, and I usually go to the Consumer Electronics Show every year in Vegas in January where they introduce technology for the next year, and it wasn't there this year. Last year it was huge, and all of a sudden Meta kind of tanked. They spent billions of dollars on the Metaverse, and all of a sudden Metaverse is no longer a cool kid on a block like it was last year. This year it's more about AI. Has anybody heard about chat GPT? Probably, right? I love chat GPT. So we'll talk about that too because that is all tied in, right? The technology is advancing right now, and I think health care has a huge proponent into that is what can we do to sort of maximize workload, improve efficiency, and actually help decrease some burnout? Because a lot of what we do right now has manual and repetitive processes to that that could be automated, and the automation could occur whether it's in a virtual world like the Metaverse or in a real world where we're doing some mixed reality work. And one area we kind of played around with this is in sort of the behavioral health or cognitive health world as well. So you can imagine these goggles, once they get smaller, and we're getting some ergonomic issues actually with neck issues that people use it for a couple hours too. So we tried balancing. We did multiple things playing around with these devices, but the companies are taking the feedback pretty seriously. So I've seen some prototypes of the Apple goggles that they're going to be coming out with, and I think you'll be quite impressed with what they're going to come out with probably at their worldwide development. I think it's going to happen in the next couple months and then released probably this fall. So it will be interesting to see what we can do. But one example I'll share with you is what we've done already with cognitive behavioral therapy in a virtual world and using the Metaverse as an example and how we sort of gamify some of the virtual reality to help decrease some of the pain symptoms. Some of these have been published. Most of them are still in the peer review process. So this is just preliminary data. And full disclosure, I do have stocks and shareholder, and some of these companies are going to advertise. So there is a conflict there. But like I said, it's not peer reviewed yet, but it will be once it's been published. But I'll share with you at least preliminary data just to pique your interest a little bit and hopefully encourage you to maybe start some of these projects, and maybe we can do some studies together as well. So in the world of cognitive health, it's quite interesting where we can simulate environments like this where traditionally you would have to take some time off and travel to these remote worlds where people can actually feel more relaxed. And relaxation is very different for different people. Maybe you want to be up in the Alps and skiing. So we have different gamification techniques that we can do that now. So when we're looking for sort of positive experiences around reducing stress or improving mood, a lot of folks this year have focused on behavioral health as their sort of primary goal for their well-being programs and the strategic planning around doing that. So a lot of people have asked now, what can we do using technology to reach the masses and be able to help prevent some of these pain symptoms? And even looking specifically within workers' compensation, can we get these employees back to work sooner using virtual reality and different modalities for treatment of pain? And I'll talk about some of those results we've seen as well. And it also gives the patient a way to really, in the short term, get some relief that could be instantaneous once you put these goggles on and immerse them in an environment that they're not used to being, especially in a state of heightened pain. So one of the ideas around pain symptoms is distraction. And we have good imaging studies that show what part of the brain are specifically activated when using fMRI technology and how our brain reacts and responds to maladaptive behaviors like pain symptoms that may or may not be organic in nature. So I think it really helps to understand, at least from a physiologic and anatomic perspective, how do we develop habits? And people are trying to crack this code right now, right? And if you look at some of the interesting sort of neural networks that people are looking at with artificial intelligence, it's how do we design this network and understand this in zeros and ones? And computer coders and programmers are very close now to developing and mapping what that neural network looks like as they look at how AI is developing and how technology like CHAT-GPT, especially the fourth version of that, is really showing us that neural network and how it's amazing that the brain and how simulations of AI are starting to replicate what we're seeing here and how different parts of the brain are starting to activate. So that's a whole new world that we're going to be looking at. We also look at meditation. There are some really good studies. You've probably seen cover of Time magazine when the Dalai Lama was on there meditating doing fMRI studies and seeing different parts of the brain activate and deactivate at the same time as we practice mindfulness. So there's really good literature now around some evidence supporting how meditation helps with mindfulness and behaviors to reduce stress and increase some of the meditative states that they try to reach, especially around some of the orbital frontal cortexes, the thalamus, and some of the reticular activating systems as well. So that's a whole lecture in itself, but I'm just going to just summarize that here, saying that we do know meditation helps, and there's different ideas of how the brain do simulate different patterns when we're in good mindfulness training and meditation training as well. So taking all that into account, this is, like I said, a non-pre-reviewed study. This is preliminary data we're looking at using PROMIS, which is one of the validated surveys that we've done with ACOM and with Promise around how do we measure pain intensity, pain behavior, and sort of pain interference. As you can see, with VX therapy, with like virtual reality therapy, we were able to show some of those averages going down over time with a number of sessions. And these sessions are all virtual. So you get the goggle in the mail within a couple of days. We try to overnight that to the patient. And as soon as they get it, they put this goggle on and select a program that's coordinated with a case manager around what pain symptoms they're seeing. And we're using the data we have now to say, well, if it's back pain versus upper thoracic shoulder, joint pain, then we know different programs that would help with them. And we gamify that within the session. I'll show you a couple pictures of what that looks like. It's a little hard to simulate in two dimension, but I encourage you if you get a chance to be able to put a goggle on and try it. There's plenty of other apps right now available online. But what we're seeing is overall, with the distraction techniques that we see for people putting the goggles on, they're able to see that there is a decrease in pain symptoms overall. And this is using that PROMIS pain scale. Even people with legacy pain, and what kind of anxiety relief they get from that as well. And this is more subjective in nature. But we're starting to see here that the longer they use it, because we're able to track now when they put the goggles on and turn the app on, the number of touches they get, how long they use it, and what they're accessing. So we're still in the middle of trying to deep dive into the data around what programs. Is it the games that help a little bit? And the games we have is like cutting fruits or shooting targets. So it's basically taking your mind off of different concepts of pain and actually using the VR to play different games that distract you from the pain symptoms overall. And that's what we're seeing here. It does take away their mind around anxiety and helps alleviate some of those symptoms as well from what we're seeing here from the survey studies. Same thing with depression, which we all know goes hand in hand with anxiety and depression. As we increase the amount of touch points with the virtual world, we're starting to see somewhat decreases of that. And depending on what's going on, we do some see dips right now. So this is just highly correlative, but not causative at all in nature. But we're just seeing this trend, which is interesting, we thought. So maybe this is a good pilot to hopefully take this to the next step and do a little bit more. And one of the things we always like to focus on too, especially within the wellbeing realm, is around sleep. And I think that's going to be just as important, if not more important, is to say, well, if they're getting good relief in anxiety and depression, does that help with their sleep and regenerative phases as well? So we're starting to see that there are some improvement in sleep, and this is using wearable technology as well. How many people have watches as wearable? Anybody use wearable devices in here? Most of us are starting to, right? It's almost like 70, 80% of us. So the question is, what are we doing with that data, right? How do we use that when they take it to the clinic and show it to their primary care doctors? Or if they bring it to the occupational health clinic, what are your nurses and you doing about it? And that's going to be interesting to see, like, as we track sleep, we track heart rate. You know, a lot of those watches now are using AI to calculate heart rate variability. How do we use those kind of data to interpret anxiety? How do we use that to interpret sleep patterns, and how do we advise and help the patients understand, well, can we help improve sleep overall? And this is what kind of phase of sleep is this, right? We're still trying to do the deep dive, but overall, from what we're seeing from the wearable devices is that, yes, they're starting to get more sleep as well. So in summary, this is what we're showing, that there are some improvements, especially if you have improvement in pain intensity, which makes sense. If you're in less pain, you should be able to get more sleep. If you have less anxiety, less depression, you should be able to get more sleep. So it's just basically telling us the hypothesis maybe is pointing in the right direction, but now we need more numbers to power the study to actually show any kind of correlation. So this to me is just indicative just of what we think might be possible with virtual reality and how cognitive behavioral therapy is addressing this right now. And we're slowly getting more data from this, but I think as we get into the hundreds of thousands of people and hours of usage, I think we'll get there. Recently, the company had a contract and agreement with the VA system. So I think that's going to give you a big boost of data that we'll get over the next year. Once most of the veterans starts using this, we'll be able to share this data, hopefully in a peer review format next year. But I just wanted to share the idea that at least we know now that somewhat virtual reality is helping. The question is at what point and how much, but at least we know the directionality of it. So I'm curious to see what others have done in this room as well. So if you have any experiences you'd like to share, please come up to the microphone as well. I'd like to hear and make this more interactive, because I think a lot of this is just new territory, new technology, but we want to be able to help share some of the ideas and best practices and maybe design some better studies around this in the future as well. Like I said, this is just truly a pilot, but at least we're seeing a directionality and I'll be curious to see if anybody else is using artificial intelligence in their practice. Just out of curiosity, just a raise of hands too, since our polling is not working, how many people are using virtual reality to augment your practice right now? One. Wonderful. Do you mind sharing what you do or how are you using virtual reality? Because I'll be curious to see. My name is Steve Eilley, Jaguar Land Rover. So we've been trying virtual reality as part of a program, looking at how we can use some of the programs to implement relaxation in particular. So for a lot of our executives, we found that they didn't have the time to do that. So we've been trying virtual reality as part of a program, looking at how we can use some of the programs to implement relaxation in particular. So for a lot of our executives, we found that they didn't have the time to do that. So we've been trying virtual reality as part of a program, looking at how we can use some of the programs to implement relaxation in particular. So for a lot of our executives, we found that they didn't have the time, or necessarily the impetus, to go and use meditation techniques, a lot of the wellness activities they didn't really relate to. But being an engineering technological company, they did relate to some of the virtual reality. So we've used virtual reality headsets as some of the things that we do. So we've been trying virtual reality as part of a program, looking at how we can use some of the programs to implement relaxation in particular. So for a lot of our executives, we found that they didn't have the time, or necessarily the impetus, to go and use meditation techniques, a lot of the wellness activities they didn't really relate to. 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Because at some point, if you're next, if you get some Nextstrain, you'll most likely take the goggles off and take a little break from it, because you're right, that activation of the reward system, just like any other drug, I'm not sure if I want to use that right word to use that, but anything that's stimulating, like smoking, like, and we're starting to see MRI studies of this as well. And we see this a lot of the gaming studies that we've done. Right? And we see a lot of folks that, and I think the DSM-5 now has almost a diagnosis for people with addictive behaviors around gaming. So I think it's very similar in nature. And you want to do some sort of correlative study there. I think that's where we'll see an association, is that how do we deal with this dopamine reward system and minimize that, perhaps using built-in safeguards, whether you turn it off, or when we do the gamification piece of it, have a downturn and cool-down period, just like we do when we physical workout. You know, we have the cool-down method that we now, we know from musculoskeletal recovery period. I think we're going to need something similar in the brain as well. We need that recovery period from all the stimulation and all the distraction that's going on. Because you're right, we're going to hit that tipping point. And as we do the study a little longer, I'm not sure if you remember seeing that little dip in anxiety actually go up after nine hours or so of use. So we're starting to see, like, what you're saying. And we're seeing that around eight to nine hours, people are starting to say, hey, you know what, I'm starting to burn myself out from distractions alone. And we're seeing that with the gamers as well. But I suspect that's a little longer than normal. I would suspect within a two to three-hour period, our brain systems need to switch and have that mindfulness sort of kick in as well and say, take a breath, relax, and then move on to the next one as well. Do you mind coming up to the microphone, please, and introduce yourself? Hi. I'm Taysir Mustafa. Actually, as you correctly said, we're working for a virtual hospital project. But also, I'm working with a company based here in Washington, actually. It's called SciTech VR. And to your point, actually, they developed already, I think they've been in the market for about a couple of years now. And they literally operate like any psychology clinic. So everything is timed. It's not like you just put it and you put it forever. But no, it's prescriptive. So from that point of view, I think your point has been tackled already. OK. Yeah. And I think there's going to be more to come on that, too. Because I think the safety piece, right now, it's not regulated at all, right? It's not an FDA-approved device. There's no study to show the efficacy or safety of these devices either, because they're used mostly for consumer purposes. So as more health care industries and technology starts to adopt it, similar to like the Apple watches or any other wearable watches, everybody wants that FDA kind of clearance and standard as well as a medical device. It hasn't happened yet. But a lot of people are starting to apply for that, like the peripheral devices that Carl was talking about. As you kind of move into the EKG realm, we're starting to see this. Because even at the FAA, they don't allow some of the virtual EKGs to be used for pilots. And there's a reason for that. Because we don't know the safety and the sensitivities and the validity of these studies either. And I think, similarly, if we treat some of these virtual therapies that are going to come out in the future the same way, the same rigors of the testing and the validity and the safety of it, I think that might be one way of looking at it to help preserve some of the safety data that we might get from that. That's a really good point. The UK, anybody from the UK here? I think we might have one or two. They actually have one of the first virtual occupational health clinics I saw in the metaverse. They bought the land, but they never built it. So I'm curious to see whether it's just a real estate investment. But I've been trying to watch them carefully and see what's going to happen, you know, as different technologies, we're adopting real estate in the metaverse. But if anybody's seen anything else, please let me know. Because I'm trying to see what's going on in that world right now as people start to buy real estate. But the prices have really tanked this past year. So maybe it's an opportunity, or maybe it's going to go away. I'm not really sure. Any other questions or comments? Well, as my boss Michael Hodgson used to say, I'm pretty snarky. So what happens when the enviroverse figures out that humans are the most toxic thing to the planet? Yeah, that's a great point. This is why we really need to kind of jump into this space. We all have the knowledge base to be able to kind of dictate how this enviroverse should work. From my standpoint, I think we need to really look at the potential applications as well as set the compliance parameters. So really the enviroverse is incorporating how we envision our world to be for future generations and having a regulatory component to that so that all of us have some skin in the game and we're held accountable. So I really think that we all should, you know, come together as an organization, really try to determine how we're going to develop this enviroverse concept, and then really try to educate our colleagues. I mean, we're occupational and environmental medicine, and I think we have a lot of state in how this develops, and hopefully developing partnerships with technological folks who have the expertise to create this vision that we have to optimize planetary health. So happy to chat with you all further about that. I think that's also an ethical question that needs to be addressed philosophically as well as a society because I think overall, if you look at it, there's a lot of philosophy or principles around, you know, the trolley problem, is anybody familiar with that? You know, understanding, you know, how do we get to a solution? So if you're on a railway and you can see there's a split in the railway, one is going to lead to one person dying, the other one will lead to five person dying, which way would you throw the switch? That kind of scenario needs to be played out in our mind as a society, how do we answer that? Because if you don't program that in to some of the AI, they'll make the decision as the shortest point of success because programming is to, it's efficient, right? It's designed to get to a solution as the quickest way possible, and sometimes that might not be the most ethical way to do it. So I think as long as we look at those parameters and put in scenarios like you're mentioning when they're saying, hey, you know what? Humans are the problem. It sounds like a sci-fi movie, right? I mean, I'm not sure Tanya's here, our chief health officer at Netflix, but I was like, let's pitch that as a movie maybe. But it'll be interesting, right, because I think the concept is interesting and intriguing to think about, but in reality, I think I would love academia to really answer that question for us, play those scenarios through and get those case studies out there because the reality is it's here now. They're beta testing this year, and I've already seen it being used at some architectural firms around the built environment because we know now in occupational and environmental medicine, we've been consulted around how to design buildings of the future, right? The idea of sick building syndrome doesn't exist anymore, hopefully. We're trying to teach that away and saying that we need to be able to engineer that out. So as we build new buildings, they should be coming to us as healthcare professionals saying, how would you want to design this hospital? How would you want to design this office space? Does natural lighting matter? Does the sound or the noise we hear in this environment matter? Does the color, the lighting, does it all matter? Yes, it does. We know that all affects human health, right? So we need to be able to adopt and incorporate some of those built technology and built environment concepts into buildings like architectural firms, and as companies develop new manufacturing sites around the world, can they design stuff out that we know causes injury? Can we design stuff in that would help with behavior or cognitive health? And we know there's some good studies pointing that there are. So as physicians, there's a role for us in that world as well, and I encourage you, as we look at the environers and metaverse as well as to incorporate those learnings we've had, how do we use best practice to help them guide that technology and environment as it grows? Yes, next question. Sure. Thank you. Also, if you haven't seen the Terminator movies, I think that's kind of what you were talking about for the previous commenter. But anyway, so I was just thinking of some ideas of a practical application of virtual reality in the metaverse. So I was actually thinking about that the options in the virtual environment are almost limitless. You can fly, you can go to other planets, theoretically speaking. But I was also thinking in terms of health and occupations and occupational therapy and physical therapy, there are patients that are limited physically and have disabilities. Some are expected to recover and others are not. So I think applications there could be very useful, for example, in a physical therapy environment. As you said, there is some preliminary evidence, not being reviewed, but to reduce pain perception in the virtual environment, that may be useful for patients that are trying to do rehab, to try to get back their functionality, because in physical therapy, they're told to push past the pain at times, and pain is usually limiting. So if you can reduce pain and give them motivation in a game sort of scenario, to push past their limits and recover, potentially they can recover faster, that's what I was thinking. Also there are patients that are never expected to recover from their disability, if they're in a car accident or something, they'll never be able to walk, maybe they're never able to move at all, except for maybe their head. So the virtual environment may also potentially be useful for them to try to combat maybe depression, anxiety, which is prevalent in those populations. So I was thinking, yeah, the virtual environment may have great applications in those areas. I was curious about your thoughts as well. Great idea, and if you thought about that maybe three, four years ago, you'd be very rich right now. And the reason I'm saying that is there's actually several companies now doing exactly what you're saying around rehab and rehabilitation medicine, physical therapy, occupational therapy. So they send devices out for you as patients now, as an employer that I worked with in the past, we actually hired this company to pilot their program, they send you a device to help measure your range of motion, because it's sometimes kind of hard to see on video, so they actually measure that, and they can actually measure your muscle tension as well and some of the strength that you can do. So they do physical and occupational therapy virtually for that reason, and the data they had was mixed in the beginning, but as the devices got better and were able to secure the devices, it actually measured good range of movement. Everything you could do in physical therapy was done in a virtual world during a pandemic. And now I think they had over 100,000 data points now to show, and they haven't published yet. I told them to submit it to a peer review, but I think they might publish it as a white paper. I'm hoping to do a peer review route, because that'll give it better standing in the academic world. But it's showing that, yes, you actually can improve range of motion quicker. I think it was almost a reduction by like 20% of time for recovery, but more importantly, encouraging them to use PROMIS. Like I was telling you earlier with the data validity test we did with Dr. Muller is here. Dr. Muller did a great project looking at function instead of disease when we get people back to work, and a lot of people are using that scale now to show that your recovery period might be different, but what's important for us in occupational health is your return to work. If you're able to return to work sooner, even if it's with accommodations or restrictions, it's better than no work at all. So getting away from no work capacity to at least limited restricted duty where they can come back and be accommodated for that in the long term is actually more beneficial for them from a functional status, even if they might not recover to baseline. So the idea I think is there. It's helping cognitively as well as physically from the early preliminary data showing that. So I think that technology is only going to get better as we look at the metaverse in three dimension now. I mentioned video telemedicine works, but when you're in 2D, sometimes it's hard to tell good range of motion, especially when it's spinal injuries or other recovery. So I think it's going to have to be a hybrid to show the best techniques, because if you don't have a technician on site for some of the device we're hoping to deploy, it's not going to be as useful. But as it becomes more consumer friendly, and this is where I'm seeing a lot of collaboration between consumer product companies with healthcare technology company, is that how do we deliver healthcare to a consumer without any kind of medical knowledge? And that's going to be the key bridge that I think is going to be the next breakthrough is how do we do that? And technology to help with that, and I think AI is going to help a lot with that. And I think as future physicians, if you don't use AI or are too scared to use it, you won't be around, I'm sorry. Just to be honest. Look at computer programmers, right? They use AI to augment what they do in coding. I mean, a lot of what you do now, you can ask chat GPT to code it for you. Like, I think I had a friend who used Python. He said, code for me X, Y, Z in Python, and they had it done in like 30 seconds, where it would have taken days for a coder to do. So likewise, as physicians and healthcare practitioners in the future, if we don't use AI as a tool, like we do with our stethoscope, it's not going to help us. It's not going to help patients like we're talking about here to get back to work sooner. So thank you for your question. Oh, thank you. I loved what you said. Hi. My name's Anna. I am an occupational environmental medicine resident from Australia and currently studying a master's in clinical informatics management, so digital health and innovation at Stanford. Oh yeah, we already knew that. I've been chewing over this idea of health equity with new technologies recently. In particular, we have seen that a couple of organizations who are currently investing in new technologies such as VRXR, generative AI, tend to be those that have a little bit of extra cash, right? So how do we bridge the gap between providing technology and access to medical care to communities that truly need them, while we also don't give them the impression of being experimented on? Because this is still relatively new technology. Right. No, great question. Sure, I can take a stab at that. So I think these are very pertinent topics. Clearly, health equity is something that I care about very deeply. I used to work at a safety net hospital in Boston, and I actually was seeing patients through the thick of the pandemic. And I have to say, most of my patients, irrespective of where they came from, they all have some technological savvy. I kid you not, I would say 90% to 95% of my patients at the time had a smartphone. And I feel that if we're able to provide digital literacy to these folks and really give them the tools that they need to utilize the technology, and making sure that they have access to digital broadband and high-speed internet, I think that's something that would be required. Clearly, there are infrastructure issues that we deal with in the United States. I'm not sure what things look like in Australia. But I think this is going to require multiple stakeholders to be involved to ensure that we can have digital health for the masses. And I'm hopeful that with good infrastructure, high-speed internet, and ensuring that all folks have access to digital literacy tools, I do think that people of color and anyone who wants to be able to utilize the technology will be able to. Go ahead. I think knowledge is the equalizer. It truly is. We're all here at a conference. We're sharing knowledge. But that knowledge could be shared in a greater population if we offered this in a different modality. But I think you're right. First, we need infrastructure, because without infrastructure, it's pointless. And I assume in Australia, like most of rural America, not everybody have good access to even broadband, let alone internet. That infrastructure plan needs to be built up by, hopefully, a good public-private relationship. Because usually when governments do it themselves, it's hard to do. Cost goes out of control. But if you partner with private entities and maybe NGOs, non-governmental organizations, I think that's going to be the wave of the future to design. Just like we have access to water or food, internet and technology and structure for that needs to be as part of the basic utility needs for people and humankind overall. Because once we have that, knowledge on the internet and also the metaverse and everywhere else is going to be the true equalizer. The challenge is what's true and what's not. The level of evidence. Fake news, right? Everything that's permeated the U.S. we see globally. It's a shame, right? And we see data now that iterative AI is generating, but we don't know the validity or truth of that. So to me, we need to actually educate the population on levels of evidence, like what we do in this room here. We all do preventive medicine. We understand levels of evidence. And reading data from a raw data perspective to really form our own thoughts about it. But once iterative AI is out there, which is already out there now, they generate all kinds of data for us that we don't know is true or not. To be able to teach that and the truthfulness of certain data is going to be so important. So to me, that's what I meant by knowledge as equalizer. Because once people understand how to read data themselves and make their own formula, make their own judgment, I think that's going to be the key to do that. And the only way, and you mentioned equity, I think it's going to be important is it needs to be open. And the whole concept of ChatGPT was supposed to be open AI. So do you think they truly are open? Are they free? How much do you think open AI is worth now? Is it zero because truly they're a nonprofit that makes no profit and is willing to give this to the world for free? No. It's bought by Microsoft for a reason. They're valued at $1.2 billion since they released ChatGPT version 4. People like Elon Musk make complaints about it. He invested, what, $50 million or something to this company saying it's supposed to be open, but now you're valuing yourself at $1.2 billion. There's got to be an equity in there as well. I'm not sure if regulation is the right answer because I think regulatory agencies sometimes can have their own hurdles. But the question is we should decide as society what those parameters are. How do we make this truly open source? If the concept is open source, it should stay open source. But if you're going to be open and all of a sudden get all these investors and now you're valued at $1 billion, it's now a business. It's going to be like a Google. What does Google do with all the data they have right now? We don't know. It's going to be quite interesting. But I think you're asking the right questions. So please keep on pressing those questions because you're going to have to answer those questions in your generation as well. No pressure. I think we have time for one more question. Please, sir. This may be opening up a broader subject than we have time for. But I just want to raise the question of psychopharmacology and states of consciousness. You showed meditation and brainwaves in your earlier slide. So right now another hot topic is the use of psychedelics in order to treat chronic depression, PTSD, et cetera. So we're using a chemical to alter consciousness to produce healing. Can you imagine virtual reality altering consciousness in order to change chemicals in the brain to produce healing? Any thoughts on that? Brilliant question, Dr. Peterson. So I think yes. If you look at some of the earlier LSD studies that we did in the 70s, could you imagine like, hey, college students, you want to try something new and come by for a fun time to recruit subjects easily? We'll talk about the ethics of that at some other point as well. But luckily we have fMRI studies, spec studies that actually look at some of the anatomical studies of the brain. And we know now, you're right, the pharmacology changes and adapts to that. So there are some VR companies out there trying to see if they can simulate the, and I think the question will be here too about the reward system. Like, how does VR challenge and change that neural pathway? That study hasn't been published yet, so I haven't had the privy of looking at the early data on that too. But I suspect, like you said, it's going to change it in very similar ways. So perhaps we should treat VR like a pharmaceutical and say, is there an intervention that might be similar? And if so, do we regulate it in the same way, like the FDA regulates medications? Psilocybin is actually interesting. I think a lot of states now are starting to legalize it, like THC in the past. So I think that's going to be the next marijuana for us doing MRO work. It's going to be quite interesting, right? How do you measure impairment in some of these psilocybin and other psychedelics that are being introduced to the market right now? And I think you're right. VR has that potential eventually, especially with the reward system that we know it activates. It's very similar. If you look at some of the blood flow studies too, it's going right to the same area of the brains of the reward system, dopaminergic responses and whatnot too. So I suspect, and we don't have data to support this right now, but it would be a good study to look for in the future is we should treat it in the same way. And in occupational environmental medicine, it's all impairment, right? That's what we care about, function and impairment. So if you look at it from that perspective, don't be scared about these new technologies or new pharmaceuticals that come out, because we've been trained to understand impairment. If you can understand that, they can throw anything at you. We're still human at the end of the day. The physiology is still the same. Understand that we're going to look at function and impairment the same way. It'll help at least guide you. And let the researchers, let the scientists tell us the mechanism of action and the side effects and what do we do in response to that. But for us as a practitioner, I think it's really important to go back to the basics. Remember, we've been trained to understand human anatomy, human physiology, and how that really impairs or doesn't impair the worker. Thank you for great questions. All right, folks. Thank you. This was very exciting. Thank you. Great job.

metaverse

environmental sustainability

renewable energy sources

digital twin

virtual reality

cognitive health

pain management

physical therapy

health equity

altering consciousness