Remote interspecies interactions: Improving humans and animals wellbeing through mobile playful spaces

[EN] Play is an essential activity for both humans and animals as it provides stimulation and favors cognitive, physical and social development. This paper proposes a novel pervasive playful environment that allows hospitalized children to participate in remote interspecies play with dogs in a dog daycare facility, while it also allows the dogs to play by themselves with the pervasive system. The aim of this playful interactive space is to help improving both children¿s and animal¿s wellbeing and their relationships by means of technologically mediated play, while creating a solid knowledge base to define the future of pervasive interactive environments for animals.This work is supported by the European Development Regional Fund (EDRF-FEDER), Spain and Spanish MINECO (TIN2014-60077-R). The work of Patricia Pons is supported by the Spanish MECD (FPU13/03831). Special thanks to the dogs and children who participated in our study, the dogs' owners and the children's families. The authors also gratefully acknowledge the teachers of the Unidad Pedagogica Hospitalaria La Fe and Oncologia Pediatrica La Fe and also Olga and Astrid from Buma's Doggy Daycare facility, for their invaluable support, collaboration and dedication.Pons Tomás, P.; Carrion-Plaza, A.; Jaén Martínez, FJ. (2019). Remote interspecies interactions: Improving humans and animals wellbeing through mobile playful spaces. Pervasive and Mobile Computing. 52:113-130. https://doi.org/10.1016/j.pmcj.2018.12.003S1131305

Towards Intelligent Playful Environments for Animals based on Natural User Interfaces

Tesis por compendioEl estudio de la interacción de los animales con la tecnología y el desarrollo de sistemas tecnológicos centrados en el animal está ganando cada vez más atención desde la aparición del área de Animal Computer Interaction (ACI). ACI persigue mejorar el bienestar de los animales en diferentes entornos a través del desarrollo de tecnología adecuada para ellos siguiendo un enfoque centrado en el animal. Entre las líneas de investigación que ACI está explorando, ha habido bastante interés en la interacción de los animales con la tecnología basada en el juego. Las actividades de juego tecnológicas tienen el potencial de proveer estimulación mental y física a los animales en diferentes contextos, pudiendo ayudar a mejorar su bienestar. Mientras nos embarcamos en la era de la Internet de las Cosas, las actividades de juego tecnológicas actuales para animales todavía no han explorado el desarrollo de soluciones pervasivas que podrían proveerles de más adaptación a sus preferencias a la vez que ofrecer estímulos tecnológicos más variados. En su lugar, estas actividades están normalmente basadas en interacciones digitales en lugar de explorar dispositivos tangibles o aumentar las interacciones con otro tipo de estímulos. Además, estas actividades de juego están ya predefinidas y no cambian con el tiempo, y requieren que un humano provea el dispositivo o la tecnología al animal. Si los humanos pudiesen centrarse más en su participación como jugadores de un sistema interactivo para animales en lugar de estar pendientes de sujetar un dispositivo para el animal o de mantener el sistema ejecutándose, esto podría ayudar a crear lazos más fuertes entre especies y promover mejores relaciones con los animales. Asimismo, la estimulación mental y física de los animales son aspectos importantes que podrían fomentarse si los sistemas de juego diseñados para ellos pudieran ofrecer un variado rango de respuestas, adaptarse a los comportamientos del animal y evitar que se acostumbre al sistema y pierda el interés. Por tanto, esta tesis propone el diseño y desarrollo de entornos tecnológicos de juego basados en Interfaces Naturales de Usuario que puedan adaptarse y reaccionar a las interacciones naturales de los animales. Estos entornos pervasivos permitirían a los animales jugar por si mismos o con una persona, ofreciendo actividades de juego más dinámicas y atractivas capaces de adaptarse con el tiempo.L'estudi de la interacció dels animals amb la tecnologia i el desenvolupament de sistemes tecnològics centrats en l'animal està guanyant cada vegada més atenció des de l'aparició de l'àrea d'Animal Computer Interaction (ACI) . ACI persegueix millorar el benestar dels animals en diferents entorns a través del desenvolupament de tecnologia adequada per a ells amb un enfocament centrat en l'animal. Entre totes les línies d'investigació que ACI està explorant, hi ha hagut prou interès en la interacció dels animals amb la tecnologia basada en el joc. Les activitats de joc tecnològiques tenen el potencial de proveir estimulació mental i física als animals en diferents contextos, podent ajudar a millorar el seu benestar. Mentre ens embarquem en l'era de la Internet de les Coses, les activitats de joc tecnològiques actuals per a animals encara no han explorat el desenvolupament de solucions pervasives que podrien proveir-los de més adaptació a les seues preferències al mateix temps que oferir estímuls tecnològics més variats. En el seu lloc, estes activitats estan normalment basades en interaccions digitals en compte d'explorar dispositius tangibles o augmentar les interaccions amb estímuls de diferent tipus. A més, aquestes activitats de joc estan ja predefinides i no canvien amb el temps, mentre requereixen que un humà proveïsca el dispositiu o la tecnologia a l'animal. Si els humans pogueren centrar-se més en la seua participació com a jugadors actius d'un sistema interactiu per a animals en compte d'estar pendents de subjectar un dispositiu per a l'animal o de mantenir el sistema executant-se, açò podria ajudar a crear llaços més forts entre espècies i promoure millors relacions amb els animals. Així mateix, l'estimulació mental i física dels animals són aspectes importants que podrien fomentar-se si els sistemes de joc dissenyats per a ells pogueren oferir un rang variat de respostes, adaptar-se als comportaments de l'animal i evitar que aquest s'acostume al sistema i perda l'interès. Per tant, esta tesi proposa el disseny i desenvolupament d'entorns tecnològics de joc basats en Interfícies Naturals d'Usuari que puguen adaptar-se i reaccionar a les interaccions naturals dels animals. Aquestos escenaris pervasius podrien permetre als animals jugar per si mateixos o amb una persona, oferint activitats de joc més dinàmiques i atractives que siguen capaces d'adaptar-se amb el temps.The study of animals' interactions with technology and the development of animal-centered technological systems is gaining attention since the emergence of the research area of Animal Computer Interaction (ACI). ACI aims to improve animals' welfare and wellbeing in several scenarios by developing suitable technology for the animal following an animal-centered approach. Among all the research lines ACI is exploring, there has been significant interest in animals' playful interactions with technology. Technologically mediated playful activities have the potential to provide mental and physical stimulation for animals in different environmental contexts, which could in turn help to improve their wellbeing. As we embark in the era of the Internet of Things, current technological playful activities for animals have not yet explored the development of pervasive solutions that could provide animals with more adaptation to their preferences as well as offering varied technological stimuli. Instead, playful technology for animals is usually based on digital interactions rather than exploring tangible devices or augmenting the interactions with different stimuli. In addition, these playful activities are already predefined and do not change over time, while they require that a human has to be the one providing the device or technology to the animal. If humans could focus more on their participation as active players of an interactive system aimed for animals instead of being concerned about holding a device for the animal or keep the system running, this might help to create stronger bonds between species and foster better relationships with animals. Moreover, animals' mental and physical stimulation are important aspects that could be fostered if the playful systems designed for animals could offer a varied range of outputs, be tailored to the animal's behaviors and prevented the animal to get used to the system and lose interest. Therefore, this thesis proposes the design and development of technological playful environments based on Natural User Interfaces that could adapt and react to the animals' natural interactions. These pervasive scenarios would allow animals to play by themselves or with a human, providing more engaging and dynamic playful activities that are capable of adapting over time.Pons Tomás, P. (2018). Towards Intelligent Playful Environments for Animals based on Natural User Interfaces [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/113075TESISCompendi

Interactive spaces for children: gesture elicitation for controlling ground mini-robots

[EN] Interactive spaces for education are emerging as a mechanism for fostering children's natural ways of learning by means of play and exploration in physical spaces. The advanced interactive modalities and devices for such environments need to be both motivating and intuitive for children. Among the wide variety of interactive mechanisms, robots have been a popular research topic in the context of educational tools due to their attractiveness for children. However, few studies have focused on how children would naturally interact and explore interactive environments with robots. While there is abundant research on full-body interaction and intuitive manipulation of robots by adults, no similar research has been done with children. This paper therefore describes a gesture elicitation study that identified the preferred gestures and body language communication used by children to control ground robots. The results of the elicitation study were used to define a gestural language that covers the different preferences of the gestures by age group and gender, with a good acceptance rate in the 6-12 age range. The study also revealed interactive spaces with robots using body gestures as motivating and promising scenarios for collaborative or remote learning activities.This work is funded by the European Development Regional Fund (EDRF-FEDER) and supported by the Spanish MINECO (TIN2014-60077-R). The work of Patricia Pons is supported by a national grant from the Spanish MECD (FPU13/03831). Special thanks are due to the children and teachers of the Col-legi Public Vicente Gaos for their valuable collaboration and dedication.Pons Tomás, P.; Jaén Martínez, FJ. (2020). Interactive spaces for children: gesture elicitation for controlling ground mini-robots. 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Potilaskokemus kuvina: Valokuvausmenetelmä lasten kokemusten tutkimiseksi Lastensairaalassa

Healthcare organizations have recently started to collect information about the experiences of their patients. The current feedback methods have been developed mainly for adult participants and the organizations are lacking appropriate instruments for collecting perceptions of children. Also, children’s patient experience has yet received little attention in the academic literature. This thesis focused on exploring how children’s patient experience can be studied at the Children’s Hospital. The study was conducted as a part of LAPSUS research project. The research questions were the following: (1) Which research approaches and techniques are applicable for studying 6- to 10-year-old children’s patient experience? (2) Based on the empirical study, how suitable is the photo elicitation technique for studying children’s patient experience? Four potential research techniques were identified in the literature study and evaluated with medical experts. For the empirical study, photo elicitation technique was chosen and tested in two different units of Children’s Hospital in Helsinki. Eight child patients participated in the study. The data consisted of qualitative photo elicitation interviews and 64 photographs portraying children’s positive and negative experiences during hospitalization. In the analysis, the data were thematically categorized and additionally, feedback from the participants and hospital personnel were scrutinized. The results of the study demonstrate the importance of engaging children in studies pertaining to their care. Children have unique experiences which can be utilized in improving the healthcare service. The positive photographs indicated that children value toys and other entertainment, good hospital facilities, friendly nursing staff and painless procedures. Respectively, the negative photographs emphasized the unpleasant nature of invasive operations and the hospital environment. This thesis provided Children’s Hospital a novel way to access patients’ perceptions in an age-appropriate manner. The photo elicitation technique will help the hospital identify gaps in the service and improve the child-friendliness of the care. Utilizing photography is applicable and fun both from the perspectives of patients and hospital personnel. Future work is needed to fit the photographing technique to the routines in the hospital and to make necessary adjustments to the instrument.Terveyspalveluita tuottavat organisaatiot ovat alkaneet kerätä tietoa potilaiden kokemuksista palveluidensa parantamiseksi. Nykyiset potilastyytyväisyyskyselyt keskittyvät palautteen keräämiseen aikuisilta, mutta organisaatioilta puuttuvat instrumentit lapsipotilaiden kokemusten selvittämiseen. Lisäksi akateemisesta kirjallisuudesta löytyy vain vähän tietoa lasten potilaskokemuksesta ja sen tutkimisesta. Tässä diplomityössä selvitettiin miten Lastensairaala voi kerätä tietoa lasten potilaskokemuksesta. Työ toteutettiin osana LAPSUS–tutkimushanketta. Tutkimuskysymykset olivat: (1) Mitkä tutkimusmenetelmät soveltuvat kirjallisuuden mukaan 6–10-vuotiaiden lasten potilaskokemuksen tutkimiseen? (2) Kuinka hyvin valokuvamenetelmä soveltuu empiirisen tiedon perusteella lasten potilaskokemuksen tutkimiseen? Kirjallisuudesta löydettiin neljä potentiaalista tutkimusmenetelmää, joista asiantuntijahaastatteluiden perusteella valokuvausmenetelmä valittiin empiirisen tutkimuksen kohteeksi. Tutkimukseen osallistui kahdeksan lasta Helsingin Lastensairaalan kahdesta yksiköstä. Aineisto koostui laadullisista valokuvahaastatteluista sekä 64 valokuvasta, jotka kuvasivat lasten positiivisia ja negatiivisia kokemuksia sairaalassa. Tulokset analysoitiin teemoittelua hyödyntäen. Tutkimuksen tulokset vahvistavat käsitystä lasten osallistamisen merkityksestä. Lapsilla on ainutlaatuisia kokemuksia, joita voidaan hyödyntää organisaation toiminnan kehittämisessä. Lasten positiivisissa kokemuksissa korostuivat lelut ja muut viihdykkeet, tilat ja palvelut, ystävällinen hoitohenkilökunta sekä kivuttomat hoitotoimenpiteet. Vastaavasti negatiivisissa kokemuksissa painottuivat etenkin invasiiviset operaatiot sekä sairaalaympäristön tylsyys. Valokuvamenetelmä tarjoaa Lastensairaalalle uudenlaisen ja lapsilähtöisen tavan kerätä palautetta potilailta. Menetelmän avulla voidaan tunnistaa palvelun ongelmakohtia ja kehittää sairaalan toimintaa lapsiystävällisemmäksi. Jatkotutkimuksen aiheita ovat valokuvausmenetelmän käyttöönoton suunnittelu sekä tutkimusinstrumentin jatkokehitys

A systematic review of game technologies for pediatric patients

[EN] Children in hospital are subjected to multiple negative stimuli that may hinder their development and social interactions. Although game technologies are thought to improve children's experience in hospital, there is a lack of information on how they can be used effectively. This paper presents a systematic review of the literature on the existing approaches in this context to identify gaps for future research. A total of 1305 studies were identified, of which 75 were thoroughly analyzed according to our review protocol. The results show that the most common approach is to design mono-user games with traditional computers or monitor-based video consoles, which serve as a distractor or a motivator for physical rehabilitation for primary school children undergoing fearful procedures such as venipuncture, or those suffering chronic, neurological, or traumatic diseases/injures. We conclude that, on the one hand, game technologies seem to present physical and psychological benefits to pediatric patients, but more research is needed on this. On the other hand, future designers of games for pediatric hospitalization should consider: 1. The development for kindergarten patients and adolescents, 2. Address the psychological impact caused by long-term hospitalization, 3. Use collaboration as an effective game strategy to reduce patient isolation, 4. Have purposes other than distraction, such as socialization, coping with emotions, or fostering physical mobility, 5. Include parents/caregivers and hospital staff in the game activities; and 6. Exploit new technological artifacts such as robots and tangible interactive elements to encourage intrinsic motivation.This work is supported by the Spanish Ministry of Economy and Competitiveness and the European Development Regional Fund (EDRF-FEDER) with Project TIN2014-60077-R.El Jurdi, S.; Montaner-Marco, J.; García Sanjuan, F.; Jaén Martínez, FJ.; Nácher-Soler, VE. (2018). A systematic review of game technologies for pediatric patients. Computers in Biology and Medicine. 97:89-112. https://doi.org/10.1016/j.compbiomed.2018.04.019S891129

Patient Engagement to Improve Medication Safety in the Hospital

Purpose: There is a pressing need to enhance patient safety in the hospital environment. While there are many initiatives that focus on improving patient safety, few have studied engaging patients themselves to participate in patient safety efforts. This work was motived by the belief that patients can contribute valuable information to their care and when equipped with the right tools, can play a role in improving medication safety in the hospital. Methods: This research had three aims and used a mixed-methods approach to better understand the concept of engaging patients to improve medication safety. In order to gain insight into whether patients could beneficially contribute to the safety of their hospital care, my first aim was to understand current perspectives on the sharing of clinical information with patients while they were in the hospital. To accomplish this aim, I conducted surveys with clinicians and enrolled patients in a short field study in which they received full access to their clinical chart. In Aim 2, I conducted a study to establish that the Patient Activation Measure (PAM), a common measure of patient engagement in the outpatient setting, showed reliability and validity in the inpatient setting. Building on the knowledge from Aim 1 and using the PAM instrument from Aim 2, my third aim evaluated the impact of providing patients with access to a medication review tool while they were preparing to be admitted to the hospital. Aim 3 was achieved through a randomized controlled trial (RCT) involving 65 patients I recruited from the emergency department at Columbia University Medical Center. I also conducted a survey of admitting clinicians who had patients participate in the trial to identify the impact on clinician practices and to elicit feedback on their perceptions of the intervention. Results: My research findings suggest that increased patient information sharing in the inpatient setting is beneficial and desirable to patients, and generally acceptable to clinicians. The clinician survey from Aim 1 showed that most respondents were comfortable with the idea of providing patients with their clinical information. Some expressed reservations that patients might misunderstand information and become unnecessarily alarmed or offended. In the patient field study from Aim 1, patients reported perceiving the information they received as highly useful, even if they did not fully understand complex medical terms. My primary contribution in Aim 2 was to provide sound evidence that the Patient Activation Measure is a valid and reliable tool for use in the inpatient setting. Establishing the validity and reliability of the PAM instrument in inpatient setting was essential for conducting the RCT in Aim 3, and it will provide a foundation for future clinicians and research investigators to measure and understand hospital patients’ levels of engagement. The results from the RCT in Aim 3 did not support my primary hypothesis that clinicians who had patients participate in their medication review process using an informatics tool would make more changes to the home medication list than clinicians who had patients in the control group. However, the results did suggest that most hospital patients are knowledgeable, willing, and able to contribute useful and important information to the medication reconciliation process. Interestingly, the clinicians I surveyed seemed far less convinced that their patients would be able to beneficially participate in the medication reconciliation process due to low health literacy and other barriers. Nevertheless, the clinicians did seem to believe that in theory, at least, patient involvement in the medication reconciliation process could have positive impacts on their workflow and potentially save them time. Conclusion: The overall theme resulting from my research is that patients can be a valuable resource to improve patient safety in the hospital. Patients are generally knowledgeable and willing to more actively participate in their hospital care. By developing the structures and processes to facilitate greater patient engagement, hospitals can provide an extra layer of safety and error prevention, particularly with respect to the medications patients take at home. As with any medical treatment, active participation in patient safety efforts may not be possible for all patients. However, I believe that if the culture of a hospital encourages openness and transparency, and if patients are given the proper tools and information, the quality and safety of hospital care will improve

Rafigh: A Living Media System for Motivating Target Application Use for Children

Digital living media systems combine living media such as plants, animals and fungi with computational components. In this dissertation, I respond to the question of how can digital living media systems better motivate children to use target applications (i.e., learning and/or therapeutic applications)? To address this question, I employed a participatory design approach where I incorporated input from children, parents, speech language pathologists and teachers into the design of a new system. Rafigh is a digital embedded system that uses the growth of a living mushrooms colony to provide positive reinforcements to children when they conduct target activities. The growth of the mushrooms is affected by the amount of water administered to them, which in turn corresponds to the time children spend on target applications. I used an iterative design process to develop and evaluate three Rafigh prototypes. The evaluations showed that the system must be robust, customizable, and should include compelling engagement mechanisms to keep the children interested. I evaluated Rafigh using two case studies conducted in participants homes. In each case study, two siblings and their parent interacted with Rafigh over two weeks and the parents identified a series of target applications that Rafigh should motivate the children to use. The study showed that Rafigh motivated the children to spend significantly more time on target applications during the intervention phase and that it successfully engaged one out of two child participants in each case study who showed signs of responsibility, empathy and curiosity towards the living media. The study showed that the majority of participants described the relationship between using target applications and mushrooms growth correctly. Further, Rafigh encouraged more communication and collaboration between the participants. Rafighs slow responsivity did not impact the engagement of one out of two child participants in each case study and might even have contributed to their investment in the project. Finally, Rafighs presence as an ambient physical object allowed users to interact with it freely and as part of their home environment

Wearable continuous vital sign monitoring for deterioration detection and clinical outcomes in hospitalised patients

 Current practice uses physiological early warning scoring (EWS) systems to monitor “standard” vital signs, including heart rate (HR), respiratory rate (RR), blood pressure (BP), oxygen saturations (SpO2) and temperature, coupled with a graded response such as referral for a senior review or increasing monitoring frequency. Early detection of the deteriorating patient is a known challenge within hospital environments, as EWS is dependent on correct frequency of physiological observations tailored to specific patient needs, that can be time consuming for healthcare professionals, resulting in missed or incomplete observations. Wearable monitoring systems (WMS) may bring the potential to fill the gap in vital sign monitoring between traditional intermittent manual measurements and continuous automatic monitoring. However, evidence on the feasibility and impact of WMS implementation remains scarce. The virtual High Dependency Unit (vHDU) project was designed to develop and test the feasibility of deploying a WMS system in the hospital ward environment. This doctoral work aims to critically analyse the roadmap work of the vHDU project, containing ten publications distributed throughout 7 chapters. Chapter 1 (with 3 publications) includes a systematic review and meta-analysis identifying the lack of statistical evidence of the impact of WMS in early deterioration detection and associated clinical outcomes, highlighting the need for high-quality randomised controlled trials (RCTs). It also supports the use of WMS as a complement, and not a substitute, for standard and direct care. Chapter 2 explores clinical staff and patient perceptions of current vital sign monitoring practices, as well as their early thoughts on the use of WMS in the hospital environment through a qualitative interview study. WMS were seen positively by both clinical and patient groups as a potential tool to bridge the gap between manual observations and the traditional wired continuous automatic systems, as long as it does not add more noise to the wards nor replaces direct contact from the clinical staff. In chapter 3, the wearability of 7 commercially available wearables (monitoring HR, RR and SpO2) was assessed, advocating for the use of pulse oximeters without a fingertip probe and a small chest patch to improve worn times from the patients. Out of these, five devices were submitted to measurement accuracy testing (chapter 4, with 3 publications) under movement and controlled hypoxaemia, resulting in the validation of a chest patch (monitoring HR and RR) and proving the diagnostic accuracy of 3 pulse oximeters (monitoring pulse rate, PR and SpO2) under test. These results were timely for the final selection of the devices to be integrated in our WMS, namely vHDU system, explored in chapter 5, outlining the process for its development and rapid deployment in COVID-19 isolation wards in our local hospital during the pandemic. This work is now converging in the design of a feasibility RCT to test the impact of the vHDU system (now augmented with blood pressure and temperature monitoring, completing all 5 vital signs) versus standard care in an unbiased environment (chapter 6). This will also ascertain the feasibility for a multicentre RCT, that may in the future, contribute with the much-needed statistical evidence to my systematic review and meta-analysis research question, highlighted in chapter 1. Finally, chapter 7 includes a critical reflection of the vHDU project and overall doctoral work, as well as its contributions to the field of wearable monitoring.<p class="MsoNormal"/