An exploration of the value of computer-based virtual environments in the management of visible disfigurement

avatar face with disfigurementSummary

We asked three participants to inhabit an avatar in Second Life, first without and then with an overlay mimicking a facial burn. We reviewed comments about the virtual world, the impact of the scar, and responses to facial disfigurement questionnaires.

First published by Ether Books, October 2013.

 

Second Life

We used Second Life (SL), a widely accessible online virtual environment (VE) (Au, 2008), the utility of which has been described elsewhere (Hall, Conboy-Hill, and Taylor 2011). The validity of VEs to model human behaviour is underpinned by extensive research by Bailenson and his team (see  Blascovich & Bailenson, 2011). We felt the environment would be suitable for this study because it would balance field versus laboratory (control v realism) issues, and eliminate the need to recruit people with facial disfigurement (FD) or ask participants to wear a prosthetic.

 

Presence

‘Presence’ is an important VE concept reflecting a user’s sense of being in a VE. The Proteus Effect (Yee & Bailenson, 2007) is a phenomenon whereby changes to a user’s avatar impacts on both in-world and real life behaviours. This impact is described as transformational and underpins much of the theoretical and empirical structures informing VE research. For VEs to be effective as a clinical or research tools, ‘presence’ and transformational capability seem essential.

 

 

Disfigurement

The experience of disfigurement is generally negative, and so people tend to avoid social situations (Kent 2000). Hence, there is likely to be a demand for interventions and support online for socially or geographically isolated people but FaceIT, (Bessell, Clarke, Harcourt, Moss & Rumsey, 2010) is the only one currently available.

Virtual reality is increasingly being used for a variety of other psychological difficulties (Parsons & Mitchell 2002; Parsons, Leonard & Mitchell 2006; Price and Anderson 2006; Inan 2008). This study is a small scale exploration of the feasibility of a VE for FD research and support.

 

Design

In a case study design, we asked three people without FD to use SL with a facial burn attached to their avatar. We explored a priori themes via semi-structured interviews based on existing research on VE immersion and disfigurement. These were:

  • Identification with the avatar and SL ‘presence’ prior to the FD being attached.
  • Participants’ reactions to the change to their avatar’s face
  • Social interactions in SL before and after the FD is attached.

 

Method

Participants

The three participants (2 male: P1 & P3; 1 female: P2) were aged 22-23, and had no visible disfigurement in real life. Two were Sussex University students, whilst the third was in full time employment. They were paid £15 on completion of two separate one hour sessions.

 

Materials

The latest version of Second Life Viewer was installed on a desktop computer that had a broadband internet connection and an ATI Radeon HD 4800 graphics card installed. There was an on-screen inventory that permitted a guided exploration of options available to participants in SL. The sessions where the FD was attached began in a VE area that was sparsely populated.

 

We used a generic, customisable avatar that could appear as either gender, and dressed it in the wardrobe described by SL as ‘student’. It was labelled ‘RD1’.

 

The FD was a bitmap representing a radiation burn which earlier feedback had suggested was realistic. It could be applied easily by the researcher (Corrie Neilson – CN) by clicking on it in the avatar’s inventory.

 

Interviews were recorded on a digital voice recorder, and notes made as a contemporaneous record of people’s responses. After the second session, we asked participants to complete a Body Image Coping Strategies Inventory (BICSI – Cash 2005) which measures cognitive and behavioural coping strategies adopted by people to deal with body image challenges.

 

Measures

These were the 29 items of the BICSI. They identify three main coping styles: appearance fixing, positive personal acceptance, and avoidance. We adapted the wording to reflect the hypothetical nature of the questions so that “what do you do?” became “what would you do?”.

 

Procedure

The sessions were designed to facilitate open discussion in a semi-structured context. Prior to each first session, we modified the gender of the avatar to mirror that of the participant, although they could change this if they wished.

 

Session One

The main focus of this session was familiarisation with SL. Participants could explore the VE with guidance (CN), e.g. editing the look of their avatar and navigating the interface. During this session, participants were asked about their impressions of SL through an ongoing semi-structured interview.

 

Session Two

Where possible, we edited each avatar to look as it had at the end of each participant’s first session. If the interval between sessions exceeded two days, we gave people a little time to re-acquaint themselves with SL.

 

Once re-familiarised, participants left the room while we attached the FD. They had not been aware that a disfiguring scar would be attached and so now saw it for the first time. We said they could remove the burn if they wished, and explored participants’ reactions to the disfigurement over the remaining hour. They completed the BICSI at the end of the session and left after debriefing.

 

Results

The interviews were transcribed verbatim, and analysed by two separate researchers, using Pope, Ziebland & Mays (2000) method of Framework Analysis. Focus was on the content in accordance with the previously identified a priori themes.

 

Identification with the avatar and ‘presence’

The experience of the virtual environment differed for each participant. P1 and P3’s perceptions of their real life identity influenced their avatar editing choices. P1 wanted to create an avatar that mirrored his real life look, spending twenty minutes choosing an outfit that he “might realistically wear”, and adjusting the hair to mirror his own. He joked about how “picky” he was being, but continued to adjust the appearance before he was happy to use SL for anything else. He then gave his own name to the modified avatar, and addressed it by that name throughout session one. When asked about his choices, P1 said that he would feel more “comfortable and honest” with an avatar that looked like him. Following this, P1’s immersion within the virtual environment was apparent when RD1 was left momentarily naked in front of others. He responded with embarrassment and announced “This has new player written all over it”.

 

In contrast, P3 removed all traces of an appearance that might reflect his own – “I hate things that look like me”. He concluded that the modified avatar was “who I wanna be”. P3 edited the face by attaching a beard but kept the everything else as before. On observation, the modified avatar seemed to look like P3, plus the beard.

 

P2 spent least time modifying the avatar. She kept the shape and facial features, but changed the outfit. Her first comment  was that “she doesn’t look like a student”, referring to the outfit provided by SL. She then spent time changing the clothes to ones she said she “wouldn’t wear in real life” but she felt “alright” about. She made frequent remarks about how “fake” the VE felt.

 

Social Interactions and other avatars

Participants responded differently to SL’s social opportunities. P1 was relatively at ease, engaging in local and private chat with other avatars. He was confident in his ability to be socially attractive to other residents, and commented about getting “a second life girlfriend”.

 

P2 and P3 were less confident and approached social interactions by reading ongoing public chats amongst the other SL residents, P2 commenting that “they say stupid things”. She questioned whether people form friendships in-world and talk about “controversial issues…like politics”. She observed others but did not initiate any conversations.

 

P3 did initiate conversations, but spent time choosing the most appropriate avatar with whom to engage, basing suitability on screen name and overall appearance. P3 seemed anxious in-world and uncertain in his real life behaviours. He said that if there was no response from people he approached in-world, he would feel “rejected”. He demonstrated this by walking his avatar into the sea when he “couldn’t handle” an ongoing conversation.

 

All three participants wanted to authenticate the identity of the other SL residents, and both P1 and P3 commented on their assumptions about the real life identity of “sexy” (P1) or “scantily clad” (P3) female avatars. They were both adamant that these avatars were likely owned, in real life, by a “bloke” (P1) or “some weird guy” (P3). They also both said that those avatars who appeared “normal” (P1) were more likely to reflect the look of the corresponding user. P2 reserved judgement and reflected instead on whether other avatars were controlled by “real people”.

 

Reaction to the FD

All three participants agreed to use SL with the FD attached to their avatar. Both P1 and P3 said that, knowing they could remove it lessened any social anxieties they might have felt. P1 commented that he was “using [RD1] for the sake of an experiment” and would not “choose” to put the burn on his own avatar. P3 similarly commented that “these characters can be changed and that’s the key point for me”. P2 on the other hand, showed little response to the scar because “it’s not me”, and so a facial scar in SL “wouldn’t really matter”. This reflected her behaviours in session one, in which she spent least time modifying the avatar, and said she felt the environment was “fake”.

 

All three participants now identified less with the avatar they were using. Both P1 and P3 distanced themselves from any previous ownership; P1 referred to the avatar as “RD1”, rather than his own name and also said that “…yesterday I saw him as being this kind of smart cool guy, whereas now I feel sorry for him”. Similarly, in response to seeing the scar again, P3 laughed saying “I’ll admit I kind of want to take it off”. However, none of the participants did actually ask to remove the scar.

 

The participants’ social behaviours in-world with the FD did not differ from their first session. P1 continued to engage in the social element of SL to “see how my new face reacts”. His behaviours though, seemed confrontational and an attempt to get a reaction from other residents – “I just want someone to proactively ask me about it” – and he was disappointed when this did not occur. As a result, he asked people whether they noticed anything “wrong” with his appearance. He received friendly comments that the look was original. Both P2 and P3 avoided social interactions for the same reasons as before, saying they had nothing to talk about.

 

Results of the BICSI

The three participants identified different real life coping behaviours they felt they would adopt.  P1 predicted he would follow a positive rational acceptance style (mean score 1.81) if living with disfigurement. Whereas P2 speculated that she would adopt an appearance fixing approach (mean score 1.9) and P3 would adopt more avoidant coping behaviours (mean score 2.13). These were not consistent with the behaviours they adopted in-world when using the disfigured avatar, as no participant removed the scar or tried to fix the avatar’s appearance once the scar was attached.

 

Discussion

‘Presence’ without FD

Evidence of virtual presence prior to attaching the facial scar was apparent in the social and appearance adjusting behaviours of the participants. All modified  RD1 early in the initial session to illustrate their personal preferences. For one, this included claiming ownership by giving the avatar his own name.

 

At times, each participant showed emotional investment in the social content of the virtual environment. Specifically, feelings of rejection, embarrassment or social anxiety were reported by all, which resulted in one participant avoiding any virtual conversations. P2, whilst ostensibly maintaining a social distance, was nevertheless concerned about what her avatar ‘felt’ or ‘wanted’.

 

‘Presence’ with FD

Following the attachment of the FD, two participants re-defined their virtual identity and used the on-screen name for the avatar. This distancing seemed to highlight their changed perceptions, and led one participant to adopt a more confrontational stance towards other SL residents.

 

The behaviour of one participant in particular seemed avoidant following the attachment of the FD. He referred to the avatar as RD1, whereas previously he had given it his own name. Two participants expressed sympathy for the avatar, where they had previously felt a sense of personal affinity. This reflects earlier research detailing avoidant coping behaviours of people with visible disfigurement (Kent 2000).

 

Transformational potential

We found differences among the coping styles identified by participants’ responses on the BICSI and their behaviours in-world. One participant’s scores favoured appearance fixing behaviours, and yet these behaviours were not demonstrated in-world. The two participants who said they would not attach such a feature out of choice, did not identify appearance fixing as their preferred coping. The discrepancies between the BICSI scores and behaviours in-world suggest future research directions evaluating the longstanding problem of divergent expressed and reported attitudes (e.g. Gahagan, 1980).

 

Conclusion

We explored the use of SL for FD research, looking for evidence of ‘presence’ in the VE to support validity of experience. We believe this was demonstrated sufficiently to justify further focus on VEs for clinical research. There was also indication of inconsistency between attitudes expressed and corresponding behaviours, which promises better clinical evaluation of this confounding factor in effecting change.

 

References

Au, W. J. (2008). Notes from the new world: The making of second life. New York, NY:  Harper Collins Publishers, pp IX – X and 252.  

Bessell, A., Clarke, A., Harcourt, D., Moss, T. P. & Rumsey, N. (2010). Incorporating user perspectives in the design of an online intervention tool for people with visible differences: Face IT.  Behavioural and Cognitive Psychotherapy, 38, 577-596.

Blascovich, J. & Bailenson, J .(2011). Avatars, eternal life, new worlds and the dawn of the virtual revolution: Infinite reality. New York, NY: HarperCollins Publishers, pp 102- 115.

Cash, T. F. (2005). Manual for the body image coping strategies inventory, purchased from http://www.body-images.com/assessments/bicsi.html  (29/10/2010 at 16.17).

Gahagan, D. (1980). Attitudes. In: Radford, J. and Govier, E. A Textbook of Psychology, Ch 27. Sheldon Press.

Hall, V., Conboy-Hill, S. & Taylor, D (2011). Using virtual reality to provide health care information to people with learning disabilities: acceptability, usability, & potential utility The Journal of Medical Internet Research, 13 (4) e109. http://www.jmir.org/2011/4/e91/

Inan, F. (2008). Virtual reality and social phobia: Recreating a social situation in virtual reality. Unpublished Masters, Delft University of Technology.

Kent, G. (2000). Understanding experiences of people with disfigurement: An integration of four models of social and psychological functioning. Psychology, Health and Medicine, 5, 117-129.

Parsons, S. & Mitchell, P. (2002). The potential of virtual reality in social skills training for people with autistic spectrum disorders. Journal of Intellectual Disability Research, 46, 430-443.

Parsons, S., Leonard, A. & Mitchell, P. (2006). Virtual environments for social skills training: Comments from two adolescents with autistic spectrum disorder. Computers & Education, 47, 186-206.

Pope, C., Ziebland, S. & Mays, N. (2000). Qualitative research in healthcare: Analysing qualitative data. British Medical Journal, 320, 114-116.

Price, M. & Anderson, P. (2006). The role of presence in virtual reality exposure therapy. Journal of Anxiety Disorders, 21, 742-751.

Yee, N. & Bailenson, J. (2007). The Proteus effect: The effect of transformed self-representation on behaviour. Human Communication Research, 33, 271-290.

 

2499 words

Acknowledgments

This work was completed as part of the first author’s MSc in Foundations of Clinical Psychology and Mental Health with the university of Sussex. We would like to thank Dr Kate Cavanagh for her support throughout.

 

Affiliations

Corrie Neilson: 33 Handsworth Avenue, London. Email: corrie.neilson@gmail.com

Suzanne Conboy-Hill: Consultant Psychologist, Sussex Partnership NHS Foundation Trust, & Visiting Clinical Research Fellow, University of Brighton.

 

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Imperial College London | Treet TV

treet tv homepage

Imperial College London | Treet TV.

Imagine making a live TV show with a bunch of potentially maverick scientists and a studio audience. Nervous? Good. Now imagine that you’re going to do this in a virtual world with all your presenters and guests represented as avatars and communicating using text, in-world voice, and VOIP. Not to mention you need them to face front at the right time, have in-world voice turned on but not up so you get lip sync without echo, and nobody’s connection cracks up. That’s the challenge faced by the Treet TV team that followed Dave Taylor, Robin Winter and me through the various sets in which medical training, research and development takes place in Second Life.

I am not at all sure what I had expected and, as all of this kind of interaction often takes place in one’s own very familiar environment at home, there is always the risk of being slightly ‘off duty’, as it were and forgetting that you need to sit up straight and pay attention. In my case, I had to get rid of the sheep helicopter that had followed me from an earlier steam punk exhibition and stop the cat purring into my microphone. I should also have ditched the hat and remembered to park my cursor so that my avatar held her head up instead of  peering intently into an invisible gutter.

Clearly, marshalling amateurs like us is what this team does supremely well although at least one of us, (Mr Taylor, mentioning no names), had to be constrained to stop rushing around and just please stand still. Of course it was essentially the Imperial College Show and the build and animations designed and produced by Dave and Robin, the in-house 3D designer, were the stars. I have known about this work for some time but even so, I was astonished at the complexity of the models and interactivity available to trainee doctors and nurses in these realistic environments. In theatre, we looked at the workings of intricate positioning equipment for different operations as Robin ran through the animations and, on a ward, we saw the trail of information designed to alert nursing staff to developing risks.

Later, Dave demonstrated a patient examination animation in which lab tests could be ordered and treatmenttreet tv clip2 applied after palpating the patient’s abdomen. The chap even demanded water after perking up with his newly applied salbutamol nebuliser although this is plainly unrealistic. In my experience as a nurse it was always the loo they needed just as you got them kitted out with their tubes and lines. Maybe in the next iteration!

Meanwhile, I was hanging about, microphone muted so as not to introduce spurious and alarming domestic noises, outside the waiting room of the Royal Sussex County where we had run our study on consent last year. That was where I discovered I was still carrying my sonic screwdriver and also where I realised just how difficult it is to be spontaneous to order. Thank goodness my avatar was handling the hair, makeup and motion end of things or I would probably have tangled my feet, walked into the lamppost and delivered a glassy spinach-in-the-teeth beam to the air. Instead of which, my hat hid most of me while I examined the pavement in minute detail then walked sideways into the door frame.

Once successfully indoors, Saffia Widdershins and I did the tour of the examination room, operating theatre, and recovery room treet tv clip3where we had taken twenty adults with learning disabilities in late 2009.  This was an unscripted Q&A guided only by our run-through earlier in the evening.  I should not have been surprised at how elements of our casual conversation were woven into that scene to give the impression of a planned interview. That’s professionalism.

Today, seeing the final product (see link above), I was struck by how much less ‘real’ it seemed as video than it had at the time and that, precisely, is the value of an immersive interactive virtual environment. However good a video presentation, and this is a remarkable production for so many reasons, it does not have the sense of co-presence, the personal volition, the capacity to change at will one’s perspective or some element of the environment. It does not involve because it is passive. Virtual technology is active, allows for change, capitalises on the social psychology of human interaction, and is responsive to the presence of its inhabitants. That’s why we use it for research, for training, for development of human services, and for management of risk.

That and the sheep helicopters.

Virtual Worlds Research: interview on Australian radio

Australia

Image via Wikipedia

Future Tense‘ is a networked programme coming from ABC, the Australian Broadcasting Corporation, and fronted by the superb Antony Funnell. It focuses on developments in technology and, if its presenter’s level of knowledge, interest and awareness is anything to go by, it has a discerning and informed audience. This episode includes an update on our virtual world study and it’s in the extremely good company of studies of distraction therapy using gaming for children with severe pain, a technique called the Decision Tree to help people engage with and monitor their own health, and medical self-tracking. These programmes, which cover a wide variety of topics including ‘Resilience Science’, ‘Our Aging Future’ and ‘Is Frugal Still the New Black?’ to quote just three recent episode titles, are available as podcasts and you can access them via FTs RSS feed.

If you are a researcher and Antony and Future Tense come looking for you to talk about your work, say yes and have confidence in their quality, professionalism, and genuine interest. As to the quality of my own performance, I’ll leave you to judge but neither ABC nor I should be blamed for the dodgy sound as it was the best we could get from all available lines, a signal booster and standing rigidly in a corner of the kitchen holding the metaphorical coat hanger up to the ceiling!

When people fall out of the sky and you’re sitting next to a crow

There can’t be many conferences where delegates spontaneously generate, sit on your head, arrive stark naked, or drop out of the sky into their seats but, at yesterday’s Virtual Worlds twenty-four hour global event, that was pretty much the norm. Hosted in the UK by the Open University, renowned specialists in technology, health care, and social applications in education & learning had begun presenting in Hong Kong at 1 a.m. UK time, handed over to us at 9 a.m. and concluded with the US timezone from 5 p.m. It is almost more difficult to imagine bringing speakers of such calibre across such distances to a real world conference as it is to be sitting next to a crow while watching a video about holography coming from somewhere else in Europe.

Announced in The Metaverse Journal, the event was picked up by The Independent:

Rough calculations, allowing two-thirds of delegates to be one-third of the planet away from the conference home in Milton Keynes, suggest 500,000 miles will be travelled virtually on 15 September. This reduces the environmental footprint of the conference, and saves on the time and cost of being out of the office for days either side of the main event, and the conference fees needed to fund physical facilities. Even better, for one small delegate fee, colleagues can share a single avatar, or project the conference on to a large screen for group viewing.

in-world image of programmeThe down-side is still the technology and, for many (myself included), the lack of support for SL in organisations. For me, this translated into having to present from home so that, when my sound failed, I had no-one to hand to assist. It was remedied but not without an interruption to a key part of the presentation. That this happened also to other speakers made me feel less of a twerp but we could all have done without that. On the other hand, these kinds of glitches had the effect of establishing an informality and accessibility that other major conferences cannot easily replicate. Standing mouthing in silence while wearing spikey blue hair and with your shoes missing militates somewhat against the inflated ego and so a relaxed attitude is pretty much guaranteed.

Sessions ranged from the very technical discussion of holographic and augmented reality developments through studies of the social impact of virtual worlds, including a ‘back channel’ discussion of the Proteus Effect and transformational (two-way) qualities of avatar identification and empathy. Dave Taylor and I were there to present the more applied clinical and medical training work being done through Imperial College, Sussex Partnership, and Brighton University and, sound problems notwithstanding, showed an international audience something of the potential SL has for developing important learning and research scenarios for the NHS.

A unique feature of a conference held in SL and one I had not anticipated, was the ability all of us had to converse by text throughout presentations without interrupting the speaker. This meant that a response or comment by a delegate across the room became available to anyone who wanted to respond and could be picked up by the chair of the session to be included in questions for the speaker at the end. By this means, a genuine sense of conference was achieved as ideas sprang into view above the heads of avatars, and links and contacts were exchanged as discussions ran parallel to the presentation. I found this enormously liberating and exhilarating; a very far cry from the sometimes stifling experience of being trapped in the middle of a row, balancing coffee in one hand, notepad, glasses and bag in the other, and knowing I will have more chance of winning the lottery than asking a question.

Demo of BP equipment

SL demo of BP equipment

There are plans to repeat the event next year and I will certainly be attending. I hope by then I will have been able to persuade my organisation to invest in the technology to support SL and a number of other key users so that I can bring colleagues with me. I hope too that I will have been able to discuss the introduction of  more clinical research to the conference and to have a number of Sussex Partnership presentations on this or a separate programme. I hope also that, when I re-rezz after a crash, I will be fully dressed instead of stark naked, that I will not be on stage at the time, and that when I finally get seated (and decent) another naked person does not sit for several minutes on my head before moving off to a seat of his own. I’m betting the next BPS get-together in Glasgow won’t be able to offer challenges of that calibre!

What Havok and Smurfs can do for you

Remember my post about Havok7 and things tumbling about in virtual worlds? Well this week, events in my real world have been tumbling about too! First up, I played football in Second Life with Dave Taylor (Our Man at Imperial College ) using an on-the-spot created ball by way of a demonstration of what the current version of Havok can do. We already have bump, jiggle, and dislodge, it seems so next time we can maybe incorporate it into our build. That’s the value of teams – Dave knew what could be done but not that it might be useful, and I knew what might be useful but not that it could be done.  One short game of footie later and we’re both clued up although I doubt I’ll be troubling Fabio any time soon.

Then there was our meeting as a nascent research community with Dame Sally Davies, Director General of Research and Development and Chief Scientific Adviser for the Department of Health and NHS, who set up the National Institute of Health Research (NIHR). This was a huge compliment to the efforts of our director of research and to the Trust itself for having the foresight to place research at the heart of its activity. This meeting also gave us an oppportunity to discuss directly some of the glitches and anomalies that seem to beset applications and the positive response we received to those was extremely encouraging. I’ll say more about that when we have tangible results about which we can wave flags.

Well if all that wasn’t mind-boggling enough, I just participated in a seminar in Second Life, touring a group of post graduates and medical specialists from Imperial College around our Brighton simulation. It is quite a bizarre experience, knowing that there are unseen others ‘out there’  listening to me sitting here in Sussex (with the dogs safely stowed out of bark and holler range) but seeing ‘me’ in my SL representation. Dave was also in-world and so I was not alone although it’s an interesting notion that the presence of one bunch of pixels is reassuring to the driver of another bunch when neither is actually there. The authenticity of the engagement was illustrated for me when Dave said goodbye and took his audience off to another part of the simulation and I stood in our empty waiting room wondering whether to go home or not. What if there were stragglers?

The power of 3D experiences is likely to become increasingly apparent as this is introduced into film and TV with greater sophistication and ease of popular access. Interactive 3D will then be such a short step away as to be almost an essential in the process of information giving by services and organisations wanting people to understand their product. What the giant smurfs started…!

James Cameron's Avatar

Electro-wetting: no, not an embarrassing disorder!

screenshot of e-reader Most of us have heard of Amazon’s Kindle e-reader, Sony’s alternative product, and the various other challengers for the electronic library market. If you set aside the disadvantages of being largely monochromatic, generally wedded to particular publishing outlets, and not much cop in the bath, this tech seems to be on the verge of mass indispensability.

BBC ‘Click’ highlighted Dutch firm, Liquavista, which is bringing that position closer to reality by not only developing colour and video capability, but also working on incorporating the oil-based system into flexible plastic sheets. Imagine, your whole library+ mag and newspaper subscriptions rolled up and slotted into the gap in your bag between the Volvic and the organic Pret butty!

A Luxurious indulgence? Maybe, for now. But with tech buzz about advancing the use of 3D environments and integrating virtual environments into what today are graphic intensive, interactive but standard internet fare, you start to see how pervasive this might eventually become. Add to this the Havok7 development that allows simulated impact effects and suddenly the potential for sophisticated virtual interactivity in your pocket starts to look like a runner.

How does this affect research and clinical practice? Two ways right off the top of my head: I could stop lugging hefty folders of documents or the tech to display them from site to site and still have what I need right to hand, and we could equip patients, clients, participants with highly mobile, less fragile, and more interactive devices that they can use anywhere cheaply and safely.

The downside? No idea where your Volvic or your sarnie’s going to go if you ditch the bag. Whatever happened to those pill-only diets we were all going to be on in the 21st century? Same place as the silver suits and the domestic robots that look like maids? Oh! Well, while we’re talking bots