The HoloLens in Medicine: A systematic Review and Taxonomy

The HoloLens (Microsoft Corp., Redmond, WA), a head-worn, optically see-through augmented reality display, is the main player in the recent boost in medical augmented reality research. In medical settings, the HoloLens enables the physician to obtain immediate insight into patient information, directly overlaid with their view of the clinical scenario, the medical student to gain a better understanding of complex anatomies or procedures, and even the patient to execute therapeutic tasks with improved, immersive guidance. In this systematic review, we provide a comprehensive overview of the usage of the first-generation HoloLens within the medical domain, from its release in March 2016, until the year of 2021, were attention is shifting towards it's successor, the HoloLens 2. We identified 171 relevant publications through a systematic search of the PubMed and Scopus databases. We analyze these publications in regard to their intended use case, technical methodology for registration and tracking, data sources, visualization as well as validation and evaluation. We find that, although the feasibility of using the HoloLens in various medical scenarios has been shown, increased efforts in the areas of precision, reliability, usability, workflow and perception are necessary to establish AR in clinical practice.Comment: 35 pages, 11 figure

Usability analysis of contending electronic health record systems

In this paper, we report measured usability of two leading EHR systems during procurement. A total of 18 users participated in paired-usability testing of three scenarios: ordering and managing medications by an outpatient physician, medicine administration by an inpatient nurse and scheduling of appointments by nursing staff. Data for audio, screen capture, satisfaction rating, task success and errors made was collected during testing. We found a clear difference between the systems for percentage of successfully completed tasks, two different satisfaction measures and perceived learnability when looking at the results over all scenarios. We conclude that usability should be evaluated during procurement and the difference in usability between systems could be revealed even with fewer measures than were used in our study. © 2019 American Psychological Association Inc. All rights reserved.Peer reviewe

The Role of Connected Health Technologies in Supporting the Psychosocial Wellbeing of Families Impacted by Paediatric Cancer

Survival rates for paediatric cancers are increasing. With this comes a growing need to investigate the factors which impact the wellbeing and quality of life (QOL) of children and families affected. Across a series of eight interconnected studies, this research examined the impact of paediatric cancer on the psychosocial wellbeing of families, and the potential of Connected Health (CH) to mitigate burden and increase wellbeing. CH is defined as any technology which gathers, analyses and interprets user data in a manner intended to support health outcomes, and includes Electronic Health Records (EHRs), Mobile Health (mHealth), and sensor technologies, amongst others. Studies are presented across four sections, which outline a) the current evidence in relation to CH; b) the unmet needs of families impacted by paediatric cancer; c) the barriers and facilitators to CH use in paediatric cancer; and d) a pilot psychosocial CH intervention for families of children with cancer. The first two studies, presented in Section A, explored the current role of CH for families impacted by paediatric cancer. As CH may derive from both empirical and commercial sources, both forms were analysed to determine the current availability and efficacy of such tools. Study 1 involved a systematic review of the literature regarding CH use in supporting families with paediatric cancer, while Study 2 consisted of a content analysis of commercially available CH mobile applications (apps). Positive effects across both commercially available and empirically driven CH were found. However, the limited number of CH interventions, alongside the high volume of feasibility and acceptability analyses, suggests that further experimental analysis is needed to determine the efficacy of CH. Next, Section B explored the unmet needs of families living with paediatric cancer in Ireland, through the lens of parents and healthcare providers (HCPs). Study 3 involved in-depth interviews with parents and supportive personnel (specifically HCPs and hospital volunteers) to determine families’ unmet needs. The results of this qualitative analysis highlighted the vast array of interconnected challenges encountered by families, across both family and individual functioning. This in turn allowed attention to be directed to several domains in which support may be meaningfully targeted. For CH to effectively address the needs of families, technologies must be accessible to those for whom they are designed. To this end, the studies presented in Section C examined the factors which facilitate or inhibit CH use by families. Using secondary analysis of the Health Information National Trends dataset, Study 4 examined the impact of the digital divide on efficacy in health information seeking for caregivers of children with illness, while Study 5 explored its impact on CH use. Next, to determine the technological pre-requisite skills required to effectively use CH, Study 6, a survey of parents and HCPs, examined the role of eHealth literacy, technology use and attitude on the ability to identify higher quality CH. Following this, Study 7 explored barriers and facilitators to CH use from the perspectives of parents and HCPs in Ireland through in-depth interviews conducted in tandem with Study 3. While positive perspectives on CH were found, the results obtained demonstrate the impact of the digital divide and technological pre-requisite skills on CH access for parents. Avenues through which CH may offer support included communication, care individualisation and information sharing, though data security and pace of change presented as hesitations to use. Finally, drawing upon the results of Studies 1 to 7, and guided by public and patient involvement (PPI), the efficacy of an online self-paced Acceptance and Commitment Therapy (ACT) programme to support families living with paediatric cancer is presented in Section D. In addition to exploring the feasibility and acceptability of this CH mediated psychosocial programme, Study 8 sought to examine the role of psychological flexibility on parental wellbeing through this online mediated ACT programme. Specifically, a repeated measures design was used to explore the impact of the CH mediated intervention on the psychological flexibility, burden and wellbeing of parents of children with cancer. Results indicated acceptability of the programme and positive effects on wellbeing, burden and psychological flexibility, though challenges with post-intervention data collection was noted. Findings suggested a key role of cognitive defusion on the psychological flexibility of parents, suggesting a need for additional analysis in this area. Taken as a whole, this research demonstrates the utility of CH to support families impacted by paediatric cancer and identifies key factors which should be considered to facilitate uptake in practice. Further, it presents a model through which CH may be meaningfully applied to effectively address the needs of families impacted by paediatric cance

Beyond the screen – The potential of smartphone apps and immersive technologies in exposure-based interventions for phobias

Specific phobias are extremely common among adults. They are characterized by strong emotional reactions and avoidance behavior when exposed to the feared stimuli. Specifically fears concerning heights or animals such as spiders are highly prevalent, followed by fear of social situations such as fear of public speaking. The gold standard in treating specific phobias is exposure-based therapy. However, exposure-based therapy is limited in its practicability in clinical routine and poses a high hurdle for affected individuals. Virtual and augmented reality (VR/AR) smartphone apps offer attractive platforms to simulate exposure situations and by that increase the accessibility of mental health services in general. Thus, novel smartphone-based treatments hold the potential to facilitate the dissemination of exposure-based treatments for specific phobias. The studies presented as part of this thesis aimed at investigating three newly developed interventions for fear of heights, fear of public speaking and fear of spiders, using the currently available advanced technologies. In the first study (Bentz et al., 2021), a stand-alone, automated and gamified VR exposure app Easyheights was developed using 360° images. The app’s effectiveness to reduce fear of heights and avoidance behavior was investigated in a randomized controlled trial in an adult population with clinical and subclinical fear of heights. The repeated use of the app led to reduced fear and avoidance behavior in a real-life situation on a tower. For the second study (Müller, Fehlmann et al., 2022), the developed stand-alone, automated and gamified VR exposure app Fearless Speech aimed at reducing public speaking anxiety (PSA) and avoidance of eye contact. A virtual audience with 360° videos was used for the exposure and gaze control for the eye contact training. The app was investigated in a randomized controlled trial in healthy adults with subclinical PSA. After the repeated use of the app, participants showed reduced fear and improved eye contact in a real-life speech situation. The third study (Zimmer et al., 2021) examined the developed stand-alone, automated and gamified AR exposure app Phobys. In comparison to VR, AR has only recently been introduced to clinical research. The app was designed to reduce fear, disgust and avoidance behavior in adults with clinical and subclinical fear of spiders. The results of the randomized controlled trial showed that repeatedly using the app led to reduced fear, disgust and avoidance behavior in a real-life situation with a real spider. The results of these studies support the potential of stand-alone, automated VR and AR interventions delivered through smartphone apps. The developed apps allow for a high-quality user experience with a highly realistic environment, gaze control for an easy navigation as well as the possibility of interaction. In addition, gamification elements foster engagement with the apps. All three investigated apps offer low-threshold and low-cost treatment for individuals affected by specific phobias. Testing the effectiveness of these newly developed apps in real-life settings sets them apart from previous studies. Hence, this thesis highlights the potential of using smartphone apps with immersive technologies to advance and disseminate exposure-based treatments for specific phobias

Human Computer Interaction and Emerging Technologies

The INTERACT Conferences are an important platform for researchers and practitioners in the field of human-computer interaction (HCI) to showcase their work. They are organised biennially by the International Federation for Information Processing (IFIP) Technical Committee on Human–Computer Interaction (IFIP TC13), an international committee of 30 member national societies and nine Working Groups. INTERACT is truly international in its spirit and has attracted researchers from several countries and cultures. With an emphasis on inclusiveness, it works to lower the barriers that prevent people in developing countries from participating in conferences. As a multidisciplinary field, HCI requires interaction and discussion among diverse people with different interests and backgrounds. The 17th IFIP TC13 International Conference on Human-Computer Interaction (INTERACT 2019) took place during 2-6 September 2019 in Paphos, Cyprus. The conference was held at the Coral Beach Hotel Resort, and was co-sponsored by the Cyprus University of Technology and Tallinn University, in cooperation with ACM and ACM SIGCHI. This volume contains the Adjunct Proceedings to the 17th INTERACT Conference, comprising a series of selected papers from workshops, the Student Design Consortium and the Doctoral Consortium. The volume follows the INTERACT conference tradition of submitting adjunct papers after the main publication deadline, to be published by a University Press with a connection to the conference itself. In this case, both the Adjunct Proceedings Chair of the conference, Dr Usashi Chatterjee, and the lead Editor of this volume, Dr Fernando Loizides, work at Cardiff University which is the home of Cardiff University Press

Validation of design artefacts for blockchain-enabled precision healthcare as a service.

Healthcare systems around the globe are currently experiencing a rapid wave of digital disruption. Current research in applying emerging technologies such as Big Data (BD), Artificial Intelligence (AI), Machine Learning (ML), Deep Learning (DL), Augmented Reality (AR), Virtual Reality (VR), Digital Twin (DT), Wearable Sensor (WS), Blockchain (BC) and Smart Contracts (SC) in contact tracing, tracking, drug discovery, care support and delivery, vaccine distribution, management, and delivery. These disruptive innovations have made it feasible for the healthcare industry to provide personalised digital health solutions and services to the people and ensure sustainability in healthcare. Precision Healthcare (PHC) is a new inclusion in digital healthcare that can support personalised needs. It focuses on supporting and providing precise healthcare delivery. Despite such potential, recent studies show that PHC is ineffectual due to the lower patient adoption in the system. Anecdotal evidence shows that people are refraining from adopting PHC due to distrust. This thesis presents a BC-enabled PHC ecosystem that addresses ongoing issues and challenges regarding low opt-in. The designed ecosystem also incorporates emerging information technologies that are potential to address the need for user-centricity, data privacy and security, accountability, transparency, interoperability, and scalability for a sustainable PHC ecosystem. The research adopts Soft System Methodology (SSM) to construct and validate the design artefact and sub-artefacts of the proposed PHC ecosystem that addresses the low opt-in problem. Following a comprehensive view of the scholarly literature, which resulted in a draft set of design principles and rules, eighteen design refinement interviews were conducted to develop the artefact and sub-artefacts for design specifications. The artefact and sub-artefacts were validated through a design validation workshop, where the designed ecosystem was presented to a Delphi panel of twenty-two health industry actors. The key research finding was that there is a need for data-driven, secure, transparent, scalable, individualised healthcare services to achieve sustainability in healthcare. It includes explainable AI, data standards for biosensor devices, affordable BC solutions for storage, privacy and security policy, interoperability, and usercentricity, which prompts further research and industry application. The proposed ecosystem is potentially effective in growing trust, influencing patients in active engagement with real-world implementation, and contributing to sustainability in healthcare