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Virtual Reality in Language Instruction 

Kevin A. Richards, Ph.D. (ASC Tech/Dept. of Germanic L&L) 

 

Introduction  

What advantages are there to using a headset in language instruction and how can we leverage the technology to benefit student learning? How does immersion into other spaces improve the effectiveness of a communicative approach? And how do we maximize the potential immersive effects of the technology for different learners, class sizes and learning goals? These are some of the questions we’ll be looking at as we delve into the possible roles that simulated reality could come to play in future language and culture instruction and learning. 

 

Technology 

One of the key advantages of adopting a virtual, augmented, and mixed reality headset for instruction is that it can provide a strong sense of presence for the user with immersive content. If you have not yet experienced virtual reality, it will be hard to conceptualize the extent to which such devices transport users to a different space (and time). I would suggest trying out an untethered headset (like the Oculus Quest) to get a feeling for how the device can ‘hijack’ your nervous system and convince you that you are occupying another space. This immersion can benefit learners by allowing for more constructive, communicative opportunities through a convincing physicality (over distance), which studies have indicated to provide several benefits, not the least of which is better retention of the studied material through kinesthetic cultural learning and increased motivation. The technology offers a distinct advantage that sets it apart from other media in its ability to provide convincing input that the user is in the virtually constructed space and language is necessary for successful navigation of the space. In the following review of virtual reality and 360 videos, I won't consider google cardboard or other phone VR/360 platforms, but rather focus on the dedicated devices and apps. As we look to the future, real eye definition, high refresh rates, more powerful mobile chips/boards and streaming 5G content will all lead to more innocuous, comfortable and immersive experiences.

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Immersive Video (1) 

With 360 videos/images, users are surrounded by the image in a way that feels like they are on-site and have the freedom to move their head around and choose what they want to focus on in the image or film. These films and images vary in fidelity and correspondingly in their degree of immersion, which depends upon 1) the camera, sometimes 2) the editing software, and, if streamed, 3) the hosting server, and finally, 4) the screen resolution and rendering/playback capabilities of the headset. Videos and images come in two primary perspectives: 360 and 180 and as a rule of thumb, 360 videos and images are recommended to be shot and played back in 4k resolution and above, with a preference of 8-16k for near photorealistic imagery, while a 180 degree video or image would only would need half this resolution to achieve the same result. (2) Cameras can capture images in varying levels of dimensions. Monoscopic (or ‘flat’) images provide a good sense of immersion based upon their resolution, while Stereoscopic (3D) images implement two or more camera lenses that work simultaneously to record from slightly different angles and then alongside software result in a very near approximation of what the human eye can see. (3) These cameras provide a very distinct three-dimensional image that is highly immersive, but that often needs more consideration in shot setup to avoid visual distortions and experiences of vertigo. 

 

Leveraging Presence 

An often used utilization of virtual or simulated spaces in instruction is to bring students together into a virtual space to overcome some of the logistical barriers of distance learning. By creating a shared environment, students and instructors can share/inhabit a virtual space in real-time. Much of the experimentation in Second Life that developed around this idea of presence, the virtual reality further heightens the immersion in social apps like Rec RoomVRChat, Facebook Horizon and a slew of others. At the time of writing this, Rec Room is the easiest for new users to create free spaces for, allowing both students and instructors to easily create, move, manipulate/use objects, create trigger boxes, basic AI, circuits, scripting for non-player characters to give instructions, and can host private created rooms with large numbers of players on various platforms.(4)

  

Virtual reality can take advantage of this sense of presence in leading group field trips with apps like Wander.(5) Wander provides an easy map, marking interface for up to 6 people to occupy a room to view hi-definition, contemporary 360 images taken by google street view.(6) Akin to the Wander app in its ability to offer space for group instruction is the social app Big Screen, which can be used to share your computer screen in a variety of venues from Imax to home theater in a variety of rooms both private and public.(7) If you have access to a high-end VR setup, then google earth offers an incredible flyover experience of their maps rendered into 3D that can drop down into street view at any time. These maps are also adopted by third-party developers to create interactive content. The most ambitious project is Facebook Livemaps that will integrate locally sourced content to create an up-to-date 3D construction of the world through the integration of AR glasses and robust map features.    

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Immersive Media 

While presence overcomes logistical barriers, virtual reality also affords students incredible insight into social spaces that they would otherwise never be afforded. For example, virtual reality allows for instruction on culture, customs, language and in getting first-time travelers ready for their experience abroad.  ‘Anthropological’ films and live feeds offer students the opportunity to observe mannerisms, traditions, modes of life, dialectical differences, specialized and everyday language use wherever a 360 camera is set up.  There are also free online hosting sites with abilities near those of high-end licensed training software (storyline), such as VeeR Experience. Our institution has a site licensing agreement with Adobe for use of their creative cloud so that apps like Premiere, Aftereffects and Animate can be used and these offer different degrees of VR interactivity - other training software offers annotation and sometimes site mapping for more specialized, spatial training. At the moment, the free training software like the VeeR experience that provides a platform to create immersive tours by connecting 360 images with hotspots (links) and allowing tags (clickable pop-ups) to contain images, texts, and embedded videos.(8) There are already apps that offer fixed dialog training in choose-your-own-adventure format, working with video and tags/hotspots that offer various responses, something similar could be filmed and constructed with the VeeR Experience.(9) Mondly VR offers vocabulary and dialog training (train ride, coffee shop, taxi ride, etc.) on a variety of VR platforms with several imitators offering competing dialog training software in the near future.

   

Applied Instruction in Other Fields       

The earliest use of reality simulation in the U.S. was for the military (in the modern era with flight simulation) in order to minimize risk to machinery and well-being as well as save costs with cadets training on high-value equipment. The low-stakes of virtual reality have been looked at in business training and translates well to the challenges some students face with learning foreign languages since students can feel freer to take risks when practicing interviews (dialogs), small talk and public speaking. Augmented reality was also first implemented by the military in the form of the HUD (heads up display) that allowed pilots to be able to read data while flying at high speeds and headsets now continue to be developed for remotely piloted vehicles (including drones). Connecting these augmented information technologies into the foreign languages, we can foresee the reintroduction of the google glasses (Apple, Google, Facebook, and other competitors are developing AR/MR glasses) to identify and provide vocabulary training, instant translation, etc. for its wearer, which can be a valuable learning tool replacing the sticky note labeling of dorm rooms of the 90s.

  

In Medicine, particularly psychology, virtual reality, and 360-degree video has been implemented in desensitization studies and has garnered some success in treating anxiety created by phobias (Krijn et al., 2007), symptoms in PTSD (Gerardi et al., 2008), the anxiety and onset of panic disorder symptoms (Botella et al., 2007), coupled with biofeedback measures to increase awareness for the self-management of generalized anxiety disorder (Repetto et al., 2009, 2013bRepetto and Riva, 2011), and in the general treatment of stress management (Gaggioli et al., 2014). More recent studies have seen dramatic effects in the role of virtual reality in improving performance in physical therapy, better outcomes in the treatment of depression and in reducing reliance on pain killers by what has been described as a ‘hijacking’ the nervous system and the associated release of dopamine that extends pain resilience up to five hours after use (Gold et al., 2018). There has been some crossover from the initial studies in medicine towards language learning and instruction in the field of neuroscience, where virtual reality has been seen to aid in the retention of iconic gestures (embodied language) (Bohil et al., 2011). Further research has been made possible by the Educause “Campus of the Future” grants. 

 

The Educause campus of the future grants have provided over a dozen institutions (10) the opportunity to explore and implement virtual reality in applied instruction. Most of the projects focus on experiential and active learning, augmenting real-world examples, and increasing access to the subject matter, concepts or locations. The projects were spread across disciplines and included those that sought to recreate historical spaces, build malleable (prototype) models, understand the construction of (architectural, chemical) structures, anatomy (spatial/functional relationship of organs), using overlays to reveal/illustrate things we cannot observe with the naked eye (augmented phone app), demonstrate the function of structures inside of cells, touring of structures/sites, designing, revising virtual objects for printing, etc.  

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The State of Virtual Reality at the University (2019) 

Implementation of virtual reality and 360 film in higher education is on the rise.  According to a 2018 study, 46% of all colleges in the U.S. employ some form of virtual reality in their instruction and/or admissions (Patterson - Education Dive June 11, 2018). (11) This follows a broader pattern of growing acceptance and awareness and implementation of virtual reality and 360 videos in other sectors, such as tourism, film, live events, home design, gaming, and education. It has even become a major at Chapman University and at the University of Washington. Some institutions, such as the University of British Columbia’s Law School, have offered virtual lectures through the VRChat app (cross-platform space with custom rooms). At Indiana University, virtual reality has been used to bring students to different places while teaching (taking advantage of the cross-platform Wander app that utilizes google street view) and with google cardboard, elementary schools take advantage of teacher lead field trips for students to visit historical sites, ocean floors, cell interiors, etc. 

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The technology has the potential to make a great impact on every area of study and with the mobile, affordable Oculus Quest and its further development ( as well as possible other mobile high-end headsets like Apple has announced), virtual reality is set to have a breakthrough year in 2019 (2000,000+ Quest headsets have been sold in the first three quarters after its introduction). In Chemistry, using virtual labs saves on materials, space, is safer and students have reported reduced anxiety and improved confidence using virtual reality simulations because there is lower risk, dangers, peer involvement in this practice. This is translatable to the language classroom, where using the target language can make such exercises less risk and improve confidence. In biology, cameras can be used to study animals in their natural habitat without human presence, or with virtual reality and artificial intelligence, programs can run simulations of evolution, visualizing DNA on microscopic levels,(12) or deforestation over time, the impact of climate change in the future. In medicine, students can learn about anatomy and identify organs, dissect/vivisect - pulling organs out from virtual bodies,(13) or train procedures – whether it be intake, crisis or a complex surgery.(14) Family, professionals, and others can use virtual reality for empathy training (reducing stigma) through immersive films that provide a glimpse into the illness suffered, such as schizophrenia.(15)

 

Moving from educational use to practical applications, allowing for therapeutic tools in special education – focusing attention and gamifying physical therapy, where at Stanbridge College, VR has been used to circumvent the tedium patients often experience during treatment. Gamifying content could be used in language instruction to help motivate, encourage learners while immersing them in the context and necessity to communicate. This could help move students through more tedious, knowledge readings by allowing for the visualization of grammar, abstract concepts, assist in reading conceptual cues, iconic gestures and specific language of a discipline. Vocational training could benefit highly from the implementation of virtual reality and firms like Matterport who specialize in training videos in VR, but also firefighters, police, paramedics, lifeguards and others who would potentially have to brave hazardous situational training, including de-escalation and procedural training, forklift and heavy equipment training, or plumbing, chemical, laboratory or electrical instruction (among others) taught at Fox Valley Technical College.    

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A number of business schools already use virtual reality to practice the soft skills that could converge with language instruction. These activities include public speaking practice in VR at Hastings College (low stakes, running through speech with virtual bodies/people reacting to your speaking, allows for a type of desensitization or exposure therapy). At the MIT Sloan School of Management, students get to adopt the role of a U.N. Delegate and participate in large scale ‘World Climate’ talks with their peers.  The LEAD program at Stanford University Graduate School of Business has a virtual campus for their distance learners, including lecture ‘rooms’ and community spaces. The virtual classroom (borrowed from second life) allows for a student at home and abroad at the Rady School of Management and Waseda University to attend class in the same space. Other examples of virtual instruction include leadership training at Fordham Univ. Gabelli School of Business, where Plank16 is used to overcome the fear of heights and push students in their mode of taking on, thinking about challenges. As Virtual Reality becomes more integrated into the training of corporations at Honeywell, Walmart, Volkswagen, UPS, etc. it will be of great benefit for students to have encountered and worked with the technology.

 

Other areas that are ready for language instruction adoption are distance learning, collaboration, and cultural content creation. The online international learning program at Coventry University allows for ‘virtual mobility’ experiences in which group work/projects are completed virtually between two teams. In foreign language instruction, partner universities could benefit from having their students meet each other in virtual space and conduct an interview, solve puzzles, present, etc. Engineering and graduate education students at Harvard collaborate on prototypes, implementing simulations for automated vehicles, inspecting bridges and working at the nanoscale.

  

At Brown University, history lectures are augmented with virtual and in 360 photorealistic images, especially lesser-known historical events, or extending the students insight into other cultures with ‘anthropological films’ like Nomads (2016), Leviathan (2012), A History of Cuban Dance (2016), The Act of Killing (2012), The Look of Silence (2014), or exploring sacred centers in India.(17)  These 360 films feel more like experiences than games or content that is viewed and can save expenses and add additional space where space is limited.(18) 

  

Implementation of film and virtual reality can provide new avenues for research and content creation. In terms of research, tracking focus of attention with heat map overlays looks at what people concentrate on, or provide choices through hotspots allowing for user interaction, or tack other user preferences and behavior. The company Unimersiv specializes in creating virtual tours of ancient cities, but these tours could be more tailored to language programs through self-creation, and cameras in the hands of students could provide interesting assignments on cultural sites that could then be experienced by other students, or report back on a study abroad experience. Other student assignments featuring content creation can include recreating historical sites (with Mission V), designing buildings /architecture, tour museums (Stanford), read/view the news (NY Times, Economist), use tools for art and save on material costs by using  Google’s Tilt Brush, sculpture tools (low cost), sketching practice (low cost), or studying 3D objects.

 

Virtual Reality and Interactive 360 Video Implementation 

As mentioned, there are two primary routes of instructional use that differ in their degree of immersion and best use cases. The following is a list of apps and possible activities. 

 

Apps 

Rec Room is an online meeting, gaming cross-platform virtual reality space. What sets this app apart from others is that it is free and incredibly easy to create rooms while in VR (including assigning values, traits to objects, setting trigger boxes, ai to NPCs and other ‘gaming' attributes). With mobile devices like the Quest, one could imagine cooperative activities between those in VR and those watching the ‘cast’ on their phone or tablet, directing the student in the space to solve puzzles cooperatively and/or competitively against other teams of students. Similar possibilities are available in other social VR apps, this app offers more in terms of creation by students and instructors. This could serve as a space for dialog training, context training, TPR, and cultural learning through interaction.

 

VRChat is a free app much akin to Rec Room and allows users to construct rooms in Unity and upload to be hosted and occupied  (privately through invitation before public) and has been implemented in ASL instruction and distant lecturing. This requires some time to develop a usable space with the SDK and Unity engine.

 

Veer Experience is free to use web-based service that allows users to upload and connect their 360 videos and images in interactive ways. Using other tools to create videos, images and sound used in ‘cards’ spread about the 360 image/video, users can find out more about what they are seeing, answer quizzes, and move from place to place (image to image) via hotspots.

 

Unity and Unreal Game Engines both offer free, easy to use tools that are used by top game developers to construct a world to be inhabited. Both of these come with free tutorials and documentation and basic sets of assets (things you can add to your game world) all of which can be exported to be used on a VR headset. To create something substantial would take longer than a room in Rec Room, but could be much more targeted for what it is being used for.

   

Words in Motion is an app that focuses on cultural communication through iconic gestures and items, so that the text hovers momentarily and the sound relays the pronunciation when looking at particular objects. https://www.media.mit.edu/posts/kinesthetic-language-learning-in-virtual-reality/ 

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While Google Glasses vocabulary (wordsense) marks the return on Google Glasses that when set to another language, can identify items that are looked at and provide the vocabulary pop-ups that match the item with some accuracy. (dual-coding), whether this works out remains to be seen. Competitors like Oculus are a couple of years away from developing their own AR glasses for market and their half-dome 3 already looks like they are well on their way to a high-end, AR/VR solution that is lightweight. 

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Wander (Google Street View) allows for an immersive trekking trip to anywhere the google street view cameras can go. The Oculus Quest version allows groups of 6 headset wearers to occupy the same room and view places simultaneously with voice chat. This could provide small groups an opportunity to tour a site or gather up information/compare places.

  

Crystallize is a VR game that helps people learn Japanese by collecting words to reuse in-game, then using these stashed words to make friends, get jobs, etc. The dialogs are often missing a phrase, a word, or offers multiple choices. If you are missing the appropriate vocabulary, you will need to overhear other conversations to find/collect them. The game has also been used to teach non-verbal cues like bowing. 

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Virtual Speech is offered as part of a Business English Course that incorporates virtual reality for practicing interviews, public speaking, impromptu speaking, networking practice, small talk, etc. It could be used as a model to film and produce content for business or field-specific courses/ chapters in other languages. It also offers slides on cultural knowledge. https://virtualspeech.com/courses/?referral=blog_footer 

Avakin Life is an app that offers a Sims-like social virtual space where one can chat to others while adopting an online persona. A virtual chatroom that has a strong presence in Europe.

 

Rumii is a platform that allows for distance learning lecture hall, where you can stream HD content, present a powerpoint/ share the computer, in-room chat, room codes (public/private) interact with 3D objects and is free for up to 5 users. 

 

 

Subscription and Production Services 

Alelo Enskill is a virtual application used by the military for learning languages that combine artificial intelligence and virtual reality. There are also sandbox tools that allow institutions to create their own designed learning and will shape the program to develop the specific skills you would like to focus on/train. https://www.youtube.com/watch?v=P6FkL_KoMws&t=10s 

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Immerse Me is developing content for language learning for VR to be released in late 2019. It has already established itself on the web and operates on an annual subscription base. The content includes real locations, native speakers, ordering coffee, food, greetings, etc. 

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STRIVR creates training specific interactive videos that blend the immersion of 360 videos with the menus, interactive hands and clickable objects of unity engine offering effective, highly polished experiences. They gamify much of their training in order to create time tasks and puzzle-like situations that the user needs to figure out. This could be useful to look at for our own content creation in what kinds of techniques make the immersion more subtle, fade into the background because the user focuses in on a timed task. 

 

QB VR tailors experiences for training in fully rendered virtual reality, meaning objects are manipulable/useable for whatever use is requested. Their work could be interesting in seeing how certain situations that require communication, collaboration to complete a task could be performed in a virtual situation (allowing for an immersive context), in comparison with STRIVR the fully 3D modeled content losing some immersive quality. 

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ClassVR produces lesson plans that structure the virtual experience for elementary classrooms (over 500 lessons). They offer hardware that can be controlled by the teacher with lessons in a variety of subjects and simple hand gesture tracking (thumbs up) to confirm a selection. 

 
Filming 

Annotation is a common practice in which virtual notes/cards are positioned on 360 videos and images or in mixed reality/augmented reality contexts. For example, scanning over a designated space with an app on your phone then produces a digital note, image, 3D model or animation. 

 

VIAR 360 (REWO) offers software for content creation using 360 videos. The software annotates 360 videos and allows for simulations, immersive learning and training scenarios, all of which could be directly used by language instructors to create episodic, dialog training in a polished way. They host the videos and then charge for storage space. $300 or $500 monthly. 

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Live Streaming is now become more popular and easy (free) to use with cameras that stitch 360 4k videos and above synchronous to the event. Some cameras like the Vuze+ can Livestream 360 stereoscopically, or the Insta360 Pro II. This allows users to attend important events, lectures, concerts, tours, etc. The user can also sometimes choose their vantage point if multiple cameras are set up, and they are also free to choose what they look at. Headsets are not necessary to view the video but allow for more immersion. 

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(1) Immersive Video is not considered to be the same as virtual reality (although they both produce the ‘trick’ that gives the sense of being somewhere else to different degrees). The primary difference is that videos/images are from fixed positions and your position is not tracked as it is in virtual reality  – in other words, you can’t move through space in the video, but you have a fixed position. In computer-generated virtual reality, your position is tracked and your environment is rendered in accordance with your shifting perspective and devices to interact with that ‘reality’ usually rendered as hands. Augmented reality renders images (typically through a visor/glasses projection or mobile phone/gaming screen) to map digital objects onto physical space. Mixed reality combines the two technologies to place digital objects in physical space and then have them able to be manipulated with hands.    

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(2) The k in 4k refers to the number of pixels or dots that make up an image. Another factor is the frame rate, which for still video, is acceptable at 30fps, but preferred to be 60fps (frames per second), while action footage should have a higher refresh rate – something 90fps would be ideal. Without refreshing, movement can cause nausea. Movement also requires software  (amount of pixels (dots) that make of the image and for videos the refresh rate should be at least 60fps (frames per second). Frame rates of the video need to match the refresh rate on devices (many have variable rates) in order to avoid a flickering distortion. For 180-degree video/images to be photorealistic, it needs to be between 4k to 8k. Most VR headsets don’t playback at 8k, but are typically in the 4-6k range. New headsets being developed this year are set to change this dramatically. For example, advanced headsets that are currently out offer 651ppi (pixels per inch) and these are set to jump to 2,000+ with new screens. 

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(3) There are many different degrees of lenses that can be used. The simplest of solutions are options like the I-phone nano, a second lens that works in coordination with the onboard lens to create 3D images quickly and simply. Mirror and lens splitting attachments are available for other phones, as well as 360 video attachments – most of these are sold under $100, but few if any produce an acceptable image in a headset. There are cameras that offer a two-in-one solution with a 360 monoscopic camera that then folds to create a 180 stereoscopic camera. One mid-range camera is the Vuze Humaneyze camera that uses 4 sets of stereoscopic lenses (8 in all) to capture 360 degrees of stereoscopic images and can live-stream 30fps, and stitch in-camera at 60fps. Top of the line cameras like the Google Jump camera offers 3D-360 Video that synchronizes multiple cameras together like the Yi Halo (17 cameras) or the Go-Pro Odyssey (16 GoPro Heroes) to offer unparalleled performance and visual fidelity.    

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(4) Rec Room connects players from all major formats of headsets (for free) as well as the mobile Quest device and PC screen (2D) with easy creation of rooms with prefabricated objects, props, gadgets, etc. We tested this out, using the mobile Quest’s ability to cast to phone or tablet, we could have students interacting/direction those in the virtual world on what they needed to do to accomplish their task – combining TPR with competitive gaming and practicing vocabulary, two-way prepositions, etc. VRChat works with Unity Development Software and their own development kit for anyone to create a private room, that can become public if so wished. Other social apps include Rec Room, where users can meet up to converse while bowling, playing frisbee, paintball, etc., while other apps like Big Screen allow for virtual cinemas to be inhabited while streaming whatever you have on your pc to various venues (Imax to home theater). There are more virtual social apps here to be considered and one of the primary reasons Facebook has put so much money into the development of VR for the masses. These can also be ideal spots for students to seek out speaking partners and where clubs could perform outreach beyond the university to like-minded, interested parties.

 

(5) Wander is an app for VR headsets that uses a license from google maps-street view to allow several people (up to 6) to view/occupy a single 'guide' in VR. Google maps is also an alternative for tethered units or devices that could stream from a cloud computer (but would suffer from possible latency, corrupt images)

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(6) Instructors could map out their tour with favorites, create treasure hunts, etc. Currently, there is a six person limit, but that would expected to be expanded in the future.

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(7) Big Screen offers private or public rooms and can provide a space for viewing a power point, film, images while allowing for simultaneous lecture or discussion. In addition, these spaces could be potentially used for virtual office hours, make up speaking exams, etc.  

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(8) The problem with using a free online source is the right to recover/keep the material on the site if it ever goes down. Even still, it offers an inexpensive way for students and instructors to work with the 360 images they have created and construct a larger instructional project from them.  

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(9) The VeeR Experience offers a simple way to build ‘choose your own adventure’ style dialog trees with video or images, as well as create informative tours, training and other walkthroughs via connecting hotspots, cards, images and embedded video. https://veer.tv/landing/experience

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(10) Florida IU, CWRU, Dartmouth, Gallaudet Univ., Harvard Univ. Grad. School of Education, Lehigh Univ, MIT - Scheller Teacher Ed Program, Univ. of San Diego, Yale, Hamilton College, Syracuse Univ., Yale Univ. 

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(11) With almost half of all institutions in the U.S. adopting a online virtual campus tour (including Ohio State) and with many foreign institutions (including museums and historical sites) adopting the same, for language learners either creating a tour in the target language or visiting a campus tour in the target language can be an engaging, immersive experience when paired with a headset. Some stand-out tours include Trinity College, SCAD, University of Hartford, Regis University, Princeton Univ. (multilingual), Kent State, and an animated tour for Bates College. Savannah College of Art and Design that has campuses in Georgia, Hong Kong, and France distributes Google Cardboard (ca. 30,000) as part of admissions recruiting and recorded a 26 % increase in admissions from the previous year. If you are looking for a specific institution, some sites cater to this, such as  https://www.youvisit.com/collegesearch/   

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(12) There are a variety of platforms that visualize the nanoscale, in particular, genetic code and data. BioVR for professional use or AXS studios gamified DNA edu-title ‘Guardians of the Genome.’

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(13) There are many apps that use VR to take advantage of this, almost every medical school in the U.S. has adopted a form of virtual reality for anatomy training. (Hamilton College, John Hopkins, were early adopters)

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(14) OssO VR specializes in virtual reality surgical training and assessment. (https://ossovr.com/), initial studies have shown increased proficiency, those training with VR typically outperform traditionally trained students, gain practice/review in rarely performed surgeries. 

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(15) Silva, Rafael, etc. “Reducing the Schizophrenia Stigma: A New Approach Based on Augmented Reality” (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5727661/)

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(16) Plank is a game that challenges players to overcome walking a plank extending from a skyscraper – often augmented with an uneven board to make the experience even more harrowing. 

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(17) A project at Hamilton College gains access to many centers typically off-limits to visitors.  

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(18) Virtual stacks for libraries is currently under development. 

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