Wired for Health

This post was due up last week, then the news about Samantha Backler came through. She deserved her time in the spotlight.

On March 17th, an extraordinary event took place at the Lighthouse in Brighton’s North Laines. The R&D department at Sussex Partnership has been developing ideas for projects – research and clinical practice – that seeks digital solutions to health care problems. Second Life is already a research environment for some of us, and more projects are either underway or at the work-up stage. We are also keen to capitalise on social media for communication with staff and service users, and to make use of apps for community support. For clinicians, the ideas come from practice. We can see the problems up close and we know what we need to do to address them We’re not that tech savvy though. We are not developers or designers. On the other hand, the tech savvy digital community doesn’t necessarily know what kinds of products we need, or how to access a user group to trial prototypes. From a very understated meeting with Phil Jones of Wired Sussex at which we speculated about a meeting of clinicians, academics, and entrepreneurial developers, came Wired for Health. Phil took that basic idea and produced an event that exceeded all expectations. No, I’m not going to be cool about it, this was very very exciting! Chaired by John Worth (Worth Digital)and Lynn Smith (NHS South East Coast), presentations from the health and business communities preceded a superb networking session from which we pretty much had to be evicted as no one wanted to stop talking when time was up. We heard from Sarah Pearson (Health Psychologist), about the difference between what people say they do and what they actually do (e.g. belieiving they watch very little live TV and, in fact, watching over 60% live TV), which has implications for self report about health issues. We also heard from Ribot, a small company that has developed a phone app to assist people with dexterity problems (the Threedom phone). In fact, this was the occasion of its formal launch, so the glasses of wine that were waiting upstairs could easily have been deployed ahead of time for a rollicking good crack over the bows! Dave Taylor (Imperial College) and I presented a live look at the medical training environment and our Brighton simulation, used for the study with people with learning disabilities. This being a digitally capable venue, there was no trouble getting a good broadband connection and even Second Life behaved itself, so that the audience got a good look at the potential of virtual worlds in health care and research.

Upstairs in the foyer of the Lighthouse, Jo Roberts (Wired Sussex) had set up media nooks for particular interests. Virtual worlds, social networking (and yes, we’re on twitter), and webs and apps. Somewhere, I saw small food items being passed around but was never able to shut up long enough to take advantage. If you can measure success in terms of the croakiness of your voice the day after, this was off the scale. Mine was a husky growl for two days as a result of all the talking.

And the outcome? Wired Sussex is preparing a report for their funding body. Productive relationships were begun and are bearing fruit. Ribot is in touch with a posse of service users whose dexterity is challenged by motor, anatomical, and brain injury factors. We, R&D, can begin to hope for some major steps forward in our digital research and product development capability.

Thank you John, Phil, Lynn, and Jo.

Photos by Wired Sussex

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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!

Goodbye friends and family!

Until mid June at any rate! For some reason, all the calls for new research funding bids are open now and have to be submitted in the next few weeks, come Hull, Hell or Halifax! Along with that is the mandatory report on our virtual world study, delayed by Christmas, snow, and participants who would rather go line dancing (who can blame them?) than talk to us. We pleaded for an extension. Computer said no. Resoundingly. So today I went into free-fall over the data for the recent study, had an apoplectic moment over my mean squares while trying to model the design for the next study, and pretty much dissolved into an isotonic puddle over the finance form for our investigation into positive psychology and challenging behaviour. Don’t even get me started on the brain-ache of trying to coordinate two Trusts, two strategic health authorities and two universities at different ends of the country in the interests of the fourth proposal! With any luck, we can circumscribe that one and limit its remit to a smaller care group so that fewer august bodies need to sign up but actually, it would be pretty good if we could pull off the whole shebang.

Panic aside, and as I’m pretty new at this panic is a realistic prospect, the potential of these studies is just breath-taking. Imagine if, in a few years time, we can all log into a virtual world and take a tour of a proposed procedure without scaring the bejabbers out of ourselves. And what if people with learning disabilities whose frustration and distress has always led to interventions designed to prevent these expressions could begin to live their lives with the prospect of increased well-being and positivity instead? Then supposing, when we become vulnerable but want to keep our independence, there’s a whole technology built into our homes to let us do that? If we’re successful in these bids, those are some of the prospects and it will be some of our best NHS clinicians working with some of our best academics that clear the way for it to happen. Worth a few weeks of social purdah, I reckon so keep your fingers crossed. Oh, and if you know why my ‘within groups’ mean squares are bigger than they should be, please put me out of my misery. Two way independent randomised groups ANOVA. Go on, you know you can!

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