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Michael Craven

University of Nottingham, Electrical and Electronic Engineering, Post-Doc

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Dr. Michael Craven is Senior Research Fellow at the University of Nottingham in the NIHR MindTech MedTech Co-operative, http://mindtech.org.uk specialising in technology design and evaluation in healthcare and currently focussed on mental health and dementia and more generally with medical devices and digital tools. He has over 25 years of research experience spanning healthcare, electronic engineering, computer science, health economics and with teaching

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New England Complex Systems Institute

University of Kentucky

Tufts University

Simon Baron-Cohen

University of Cambridge

Sudesh Sivarasu

University of Cape Town

Mohammad Mehrmohammadi

Wayne State University

Krystyna Gielo-Perczak

University of Connecticut

University of Management and Technology

Peter Delobelle

University of Cape Town

Trinity College Dublin

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Papers by Michael Craven

Estimating the Economic Value of Automated Virtual Reality Cognitive Therapy for Treating Agoraphobic Avoidance in Patients With Psychosis: Findings From the gameChange Randomized Controlled Clinical Trial

Journal of Medical Internet Research

Background An automated virtual reality cognitive therapy (gameChange) has demonstrated its effec... more Background An automated virtual reality cognitive therapy (gameChange) has demonstrated its effectiveness to treat agoraphobia in patients with psychosis, especially for high or severe anxious avoidance. Its economic value to the health care system is not yet established. Objective In this study, we aimed to estimate the potential economic value of gameChange for the UK National Health Service (NHS) and establish the maximum cost-effective price per patient. Methods Using data from a randomized controlled trial with 346 patients with psychosis (ISRCTN17308399), we estimated differences in health-related quality of life, health and social care costs, and wider societal costs for patients receiving virtual reality therapy in addition to treatment as usual compared with treatment as usual alone. The maximum cost-effective prices of gameChange were calculated based on UK cost-effectiveness thresholds. The sensitivity of the results to analytical assumptions was tested. Results Patients ...

Correction: The impact of data from remote measurement technology on the clinical practice of healthcare professionals in depression, epilepsy and multiple sclerosis: survey

BMC Medical Informatics and Decision Making, Dec 10, 2023

used by more than three quarters of their patients". The statement should have read: "RMT was use... more

Making remote measurement technology work in multiple sclerosis, epilepsy and depression: survey of healthcare professionals

BMC Medical Informatics and Decision Making, May 7, 2022

Background: Epilepsy, multiple sclerosis (MS) and depression are long term, central nervous syste... more Background: Epilepsy, multiple sclerosis (MS) and depression are long term, central nervous system disorders which have a significant impact on everyday life. Evaluating symptoms of these conditions is problematic and typically involves repeated visits to a clinic. Remote measurement technology (RMT), consisting of smartphone apps and wearables, may offer a way to improve upon existing methods of managing these conditions. The present study aimed to establish the practical requirements that would enable clinical integration of data from patients' RMT, according to healthcare professionals. Methods: This paper reports findings from an online survey of 1006 healthcare professionals currently working in the care of people with epilepsy, MS or depression. The survey included questions on types of data considered useful, how often data should be collected, the value of RMT data, preferred methods of accessing the data, benefits and challenges to RMT implementation, impact of RMT data on clinical practice, and requirement for technical support. The survey was presented on the JISC online surveys platform. Results: Among this sample of 1006 healthcare professionals, respondents were positive about the benefits of RMT, with 73.2% indicating their service would be likely or highly likely to benefit from the implementation of RMT in patient care plans. The data from patients' RMT devices should be made available to all nursing and medical team members and could be reviewed between consultations where flagged by the system. However, results suggest it is also likely that RMT data would be reviewed in preparation for and during a consultation with a patient. Time to review information is likely to be one of the greatest barriers to successful implementation of RMT in clinical practice. Conclusions: While further work would be required to quantify the benefits of RMT in clinical practice, the findings from this survey suggest that a wide array of clinical team members treating epilepsy, MS and depression would find benefit from RMT data in the care of their patients. Findings presented could inform the implementation of RMT and other digital interventions in the clinical management of a range of neurological and mental health conditions.

The impact of data from remote measurement technology on the clinical practice of healthcare professionals in depression, epilepsy and multiple sclerosis: survey

BMC Medical Informatics and Decision Making, Oct 13, 2021

Background: A variety of smartphone apps and wearables are available both to help patients monito... more Background: A variety of smartphone apps and wearables are available both to help patients monitor their health and to support health care professionals (HCPs) in providing clinical care. As part of the RADAR-CNS consortium, we have conducted research into the application of wearables and smartphone apps in the care of people with multiple sclerosis, epilepsy, or depression. Methods: We conducted a large online survey study to explore the experiences of HCPs working with patients who have one or more of these conditions. The survey covered smartphone apps and wearables used by clinicians and their patients, and how data from these technologies impacted on the respondents' clinical practice. The survey was conducted between February 2019 and March 2020 via a web-based platform. Detailed statistical analysis was performed on the answers. Results: Of 1009 survey responses from HCPs, 1006 were included in the analysis after data cleaning. Smartphone apps are used by more than half of responding HCPs and more than three quarters of their patients use smartphone apps or wearable devices for health-related purposes. HCPs widely believe the data that patients collect using these devices impacts their clinical practice. Subgroup analyses show that views on the impact of this data on different aspects of clinical work varies according to whether respondents use apps themselves, and, to a lesser extent, according to their clinical setting and job role. Conclusions: Use of smartphone apps is widespread among HCPs participating in this large European survey and caring for people with epilepsy, multiple sclerosis and depression. The majority of respondents indicate that they treat patients who use wearables and other devices for health-related purposes and that data from these devices has an impact on clinical practice.

Developing mHealth Apps with Researchers: Multi-Stakeholder Design Considerations

Lecture Notes in Computer Science, 2014

The authors have been involved with developing a number of mHealth smartphone Apps for use in hea... more The authors have been involved with developing a number of mHealth smartphone Apps for use in health or wellness research in collaboration with researchers, clinicians and patient groups for clinical areas including Sickle Cell Disease, Attention Deficit Hyperactivity Disorder, asthma and infertility treatment. In these types of applications, end-users self-report their symptoms and quality of life or conduct psychometric tests. Physiological data may also be captured using sensors that are internal or external to the device. Following a discussion of the multiple stakeholders that are typically involved in small scale research projects involving end-user data collection, four Apps are used as case studies to explore the issue of non-functional requirements.

Clinical Perspectives on Using Remote Measurement Technology in Assessing Epilepsy, Multiple Sclerosis, and Depression: Delphi Study

JMIR Neurotechnology

Background Multiple sclerosis (MS), epilepsy, and depression are chronic central nervous system c... more Background Multiple sclerosis (MS), epilepsy, and depression are chronic central nervous system conditions in which remote measurement technology (RMT) may offer benefits compared with usual assessment. We previously worked with clinicians, patients, and researchers to develop 13 use cases for RMT: 5 in epilepsy (seizure alert, seizure counting, risk scoring, triage support, and trend analysis), 3 in MS (detecting silent progression, detecting depression in MS, and donating data to a biobank), and 5 in depression (detecting trends, reviewing treatment, self-management, comorbid monitoring, and carer alert). Objective In this study, we aimed to evaluate the use cases and related implementation issues with an expert panel of clinicians external to our project consortium. Methods We used a Delphi exercise to validate the use cases and suggest a prioritization among them and to ascertain the importance of a variety of implementation issues related to RMT. The expert panel included clini...

Computer Games for User Engagement in Attention Deficit Hyperactivity Disorder (ADHD) Monitoring and Therapy

State-of-the-art computer games and psychological tests for symptom monitoring and therapy in Att... more State-of-the-art computer games and psychological tests for symptom monitoring and therapy in Attention Deficit Hyperactivity Disorder (ADHD) are explored and reviewed. Three foci for research studies are identified: task (human performance) focus; educational focus; medical/clinical focus. It is found that game designs in the literature include a variety of tests of cognition mostly dependent on attention and executive functions (inhibitory motor control, working memory, interference suppression) which involve reactions to stimuli on computer (or mobile phone) screens. In addition, based on the measurement of neural pathways that can be accessed by Brain Computer Interfaces, there are several applications of games that employ biofeedback and demand the user to control aspects of their brain activity to play them, with the aim of improving function. A number of games have been used in clinical studies for self-monitoring and therapy, some of these controlled with comparators such as treatment as usual or cognitive therapies, or with the individual as their own control, where efficacy is evaluated by measuring behavioural and functional outcomes on measurement instruments such as ADHD or behavioural trait questionnaires or other cognitive tests. Other applications of games include education and raising awareness of mental health conditions to reduce stigma. The paper then presents and proposes designs of new games that are based on psychological tests or tasks that aim to monitor or improve attention, inhibitory and/or motor activity including Continuous Performance Tests, Go/No-go and Stop-signal tasks.

Developing mHealth Remote Monitoring Technology for Attention Deficit Hyperactivity Disorder: A Qualitative Study Eliciting User Priorities and Needs

Jmir mhealth and uhealth, Mar 23, 2016

Background: Guidelines in the United Kingdom recommend that medication titration for attention de... more Background: Guidelines in the United Kingdom recommend that medication titration for attention deficit hyperactivity disorder (ADHD) should be completed within 4-6 weeks and include regular reviews. However, most clinicians think that weekly clinic contact is infeasible, and audits have shown that this timeline is rarely achieved. Thus, a more effective monitoring and review system is needed; remote monitoring technology (RMT) may be one way to improve current practice. However, little is known about whether patients with ADHD, their families, and clinicians would be interested in using RMT. Objective: To explore patients', parents', and health care professionals' views and attitudes toward using digital technology for remote monitoring during titration for ADHD. Methods: This was a qualitative study, and data were collected through 11 focus groups with adults and young people with ADHD, parents of children with ADHD, and health care professionals (N=59). Results: All participant groups were positive about using RMT in the treatment of ADHD, but they were also aware of barriers to its use, especially around access to technology and integrating RMT into clinical care. They identified that RMT had the most potential for use in the ongoing management and support of ADHD, rather than during the distinct titration period. Participants identified features of RMT that could improve the quality of consultations and support greater self-management. Conclusions: RMT has the potential to augment support and care for ADHD, but it needs to go beyond the titration period and offer more to patients and families than monitoring through outcome measures. Developing and evaluating an mHealth app that incorporates the key features identified by end users is required.

Using Patient and Public Involvement to elicit opinion on Gamified Cognitive Training and Assessment for People living with Dementia (Preprint)

<sec> <title>UNSTRUCTURED</title> <p>This paper reports on a series of Pa... more <sec> <title>UNSTRUCTURED</title> <p>This paper reports on a series of Patient and Public Involvement (PPI) workshops with people living with dementia and carers where they discussed cognitive training and screening technologies designed to reduce the risk of dementia and identify changes in cognition. Little is known about the factors influencing the acceptance of such technologies. Four linked workshops were conducted with the same group, each focusing on a specific topic: meaningful improvement, learning and motivation, trust in digital diagnosis and barriers to technology adoption. Participants in the workshops included local Involvement Team members as well as those recruited via Join Dementia Research and researcher took part in some activities. The group activities were recorded, and transcripts were analyzed using thematic analysis with a combination of a priori and data-driven themes. Several important findings emerged, including the importance the group placed on maintaining good cognitive health, the importance of community activities within dementia and self-care and need for more support after a dementia diagnosis. The implications for researchers and technology developers are discussed.</p> </sec> <sec> <title>INTERNATIONAL REGISTERED REPORT</title> <p>RR2-10.1007/978-3-030-49065-2_4</p> </sec>

Early Stage Economic Evaluation with a Small Medical Device Start-Up Company Using a Markov Model

Journal of Medical Devices-transactions of The Asme, Jun 1, 2011

A synergistic experimental and numerical investigation has provided quantitative information on t... more A synergistic experimental and numerical investigation has provided quantitative information on the response of human tissue temperatures to misalignment of the implant and antenna of neuromodulation devices during recharging. It was found that misalignment increases tissue temperatures for all of the investigated devices. These increases ranged from 0.5°C to 2.7°C. Notwithstanding these increases, the lowest temperatures were attained by the Restore Ultra device for all operating conditions. The temperature levels achieved by the Precision Plus and Eon Mini devices were found to be greater than those for the Restore Ultra, but their relative rankings depend on the thermal boundary conditions and the duration of the recharging period.

Cardiac training simulator using pump with electronic pressure sensor to trigger ventricular fibrillation

Cardiac surgery training in a realistic surgical environment is assisted by a simulator based on ... more Cardiac surgery training in a realistic surgical environment is assisted by a simulator based on an electromechanical pneumatic pump with associated control and display software. In this paper we describe a feedback mechanism for controlling the beating mode of the simulator by means of a electronic pressure sensor incorporated into the :pneumatic pump. The sensor was incorporated into an electronic data acquisition board and was u;ed to trigger a ventricular fibrillation (cardiac arrest) mode in the pump control system when the heart attached to the pump is handled by the trainee surgeon, as is typically experienced in a real operation. The mode change also results in changes to simulated vital signs including ECG and pressure traces which are displayed on a monitor within the surgical training environment. Software is described which was designed to drive the pump at various beating rates, display the vital signs, and respond to pressure sensor measurements. The work described is the continuation of a collaboration between the University Hospital of the West Indies (UHWI),

Broadcasting On-Line Social Interaction as Inhabited Television

Springer eBooks, 1999

Inhabited TV combines collaborative virtual environments (CVEs) with broadcast TV so that on-line... more Inhabited TV combines collaborative virtual environments (CVEs) with broadcast TV so that on-line audiences can participate in TV shows within shared virtual worlds. Three early experiments with inhabited TV raised fundamental questions concerning the extent to which it is possible to establish fast-pace social interaction within a CVE and produce a coherent and engaging broadcast of this action. This paper presents a fourth more recent experiment, Out of This World that directly addressed these questions. We describe how the formulation of inhabited TV design principles, combined with the use of dedicated production software, for constraining and directing participants' actions and for controlling virtual cameras, enabled us to create a fastmoving and coherent show. We conclude that our experiments to date demonstrate the technical feasibility of inhabited TV, but that greater attention needs to be paid to developing appropriate formats and content for this new medium before it becomes truly engaging. We also suggest that our real time production and camera software may be useful in other areas of CSCW.

Power Up: Patient and public involvement in developing a shared decision-making app for mental health

The Journal of Health Design, Mar 22, 2018

Up: Patient and public involvement in developing a shared decision-making app for mental health.

To the Castle! A comparison of two audio guides to enable public discovery of historical events

Personal and Ubiquitous Computing, Oct 30, 2012

(2013). To the Castle! A comparison of two audio guides to enable public discovery of historical ... more

In this paper we describe and analyse the community building process for Ages of Avatar, a set of... more In this paper we describe and analyse the community building process for Ages of Avatar, a set of on-line Collaborative Virtual Environments created in Microsoft Virtual Worlds, which form part of an ongoing experiment in Inhabited Television, aiming to merge CVEs and broadcast media. We describe the means by which the CVEs were launched, promoted and supported alongside a television broadcast channel, and how actions of viewers acting as inhabitants in the CVE can be used to provide broadcast material. We explain how the world content and their superstructure were managed to encourage the growth of a community over a short period of time. Using logs of activities in the worlds we deduce some of the characteristics of the community which was formed.

Using Patient and Public Involvement to Elicit Opinion on Cognitive Training Games and Assessment Technologies for Dementia (Preprint)

JMIR serious games, Jul 29, 2021

Background Cognitive training and assessment technologies offer the promise of dementia risk redu... more Background Cognitive training and assessment technologies offer the promise of dementia risk reduction and a more timely diagnosis of dementia, respectively. Cognitive training games may help reduce the lifetime risk of dementia by helping to build cognitive reserve, whereas cognitive assessment technologies offer the opportunity for a more convenient approach to early detection or screening. Objective This study aims to elicit perspectives of potential end users on factors related to the acceptability of cognitive training games and assessment technologies, including their opinions on the meaningfulness of measurement of cognition, barriers to and facilitators of adoption, motivations to use games, and interrelationships with existing health care infrastructure. Methods Four linked workshops were conducted with the same group, each focusing on a specific topic: meaningful improvement, learning and motivation, trust in digital diagnosis, and barriers to technology adoption. Participants in the workshops included local involvement team members acting as facilitators and those recruited via Join Dementia Research through a purposive selection and volunteer sampling method. Group activities were recorded, and transcripts were analyzed using thematic analysis with a combination of a priori and data-driven themes. Using a mixed methods approach, we investigated the relationships between the categories of the Capability, Opportunity, and Motivation–Behavior change model along with data-driven themes by measuring the φ coefficient between coded excerpts and ensuring the reliability of our coding scheme by using independent reviewers and assessing interrater reliability. Finally, we explored these themes and their relationships to address our research objectives. Results In addition to discussions around the capability, motivation, and opportunity categories, several important themes emerged during the workshops: family and friends, cognition and mood, work and hobbies, and technology. Group participants mentioned the importance of functional and objective measures of cognitive change, the social aspect of activities as a motivating factor, and the opportunities and potential shortcomings of digital health care provision. Our quantitative results indicated at least moderate agreement on all but one of the coding schemes and good independence of our coding categories. Positive and statistically significant φ coefficients were observed between several coding themes between categories, including a relatively strong positive φ coefficient between capability and cognition (0.468; P&lt;.001). Conclusions The implications for researchers and technology developers include assessing how cognitive training and screening pathways would integrate into existing health care systems; however, further work needs to be undertaken to address barriers to adoption and the potential real-world impact of cognitive training and screening technologies. International Registered Report Identifier (IRRID) RR2-10.1007/978-3-030-49065-2_4

Try to see it my way: exploring the co-design of visual presentations of wellbeing through a workshop process

Perspectives in Public Health, Apr 8, 2019

Try to see it my way: exploring the co-design of visual presentations of wellbeing through a work... more Try to see it my way: exploring the co-design of visual presentations of wellbeing through a workshop process PEER REVIEW IntroductIon Digital technology is readily available in the hands of many individuals. It holds promise for supporting improved public health through the exploitation of its sophisticated and user-friendly multimedia functions as well as its always-on connectivity. The deployment of digital technology in healthcare, typically termed e-Health (electronic) and more recently m-Health (mobile), is to be found on platforms such as personal computers, smartphones, tablet and wearables. In recent years, a strong focus on digital mental health has emerged. 1 In the UK, the NewMind network, 2 funded by the Engineering and Physical Sciences Research Council (EPSRC), was founded to explore 'the potential for technology to transform the management & treatment of mental health conditions, whilst seeking to address underlying EPS research challenges'. The definition of mental health in the national 'No

Factors influencing wider acceptance of Computer Assisted Orthopaedic Surgery (CAOS) technologies for Total Joint Arthroplasty

Computer-assisted orthopaedic surgery (CAOS) promises to improve outcomes of joint arthroplasty t... more Computer-assisted orthopaedic surgery (CAOS) promises to improve outcomes of joint arthroplasty through better alignment and orientation of implants, but take up has so far been modest. Following an overview of CAOS technologies covering image-guided surgery, image-free and robotic systems, several factors for lack of penetration are identified. These include poor validation of accuracy, lack of standardisation, inappropriate clinical outcomes measures for assessing and comparing technologies, unresolved debate about the effectiveness of minimally invasive surgery, and issues of medical device regulations, cost, autonomy of surgeons to choose equipment, ergonomics and training. The paper concludes that dialogue between surgeons and manufacturers is needed to develop standardised measurements and outcomes scoring systems that are more appropriate for technology comparisons, and encourages an increased awareness of user requirements. Table 1: A selection of commercially available CAOS systems and components Company System name Classification and description Acrobot (The Acrobot Company Ltd.) Acrobot, MI-Navigation Semi-active robotic assistant, planning software. Resurfacing. Aesculap Orthopilot Image-less TKA and ACL, planning and navigation BrainLAB VectorVision Image-free and CT-based planning and navigation.

Towards a framework for the appraisal of digital products for mental health - Martin et al. - Slides to accompany abstract

Games to engage: increasing mental health awareness

To the extent reasonable and practicable the material made available in Nottingham ePrints has be... more

Estimating the Economic Value of Automated Virtual Reality Cognitive Therapy for Treating Agoraphobic Avoidance in Patients With Psychosis: Findings From the gameChange Randomized Controlled Clinical Trial

Journal of Medical Internet Research

Background An automated virtual reality cognitive therapy (gameChange) has demonstrated its effec... more Background An automated virtual reality cognitive therapy (gameChange) has demonstrated its effectiveness to treat agoraphobia in patients with psychosis, especially for high or severe anxious avoidance. Its economic value to the health care system is not yet established. Objective In this study, we aimed to estimate the potential economic value of gameChange for the UK National Health Service (NHS) and establish the maximum cost-effective price per patient. Methods Using data from a randomized controlled trial with 346 patients with psychosis (ISRCTN17308399), we estimated differences in health-related quality of life, health and social care costs, and wider societal costs for patients receiving virtual reality therapy in addition to treatment as usual compared with treatment as usual alone. The maximum cost-effective prices of gameChange were calculated based on UK cost-effectiveness thresholds. The sensitivity of the results to analytical assumptions was tested. Results Patients ...

Correction: The impact of data from remote measurement technology on the clinical practice of healthcare professionals in depression, epilepsy and multiple sclerosis: survey

BMC Medical Informatics and Decision Making, Dec 10, 2023

used by more than three quarters of their patients". The statement should have read: "RMT was use... more

Making remote measurement technology work in multiple sclerosis, epilepsy and depression: survey of healthcare professionals

BMC Medical Informatics and Decision Making, May 7, 2022

Background: Epilepsy, multiple sclerosis (MS) and depression are long term, central nervous syste... more Background: Epilepsy, multiple sclerosis (MS) and depression are long term, central nervous system disorders which have a significant impact on everyday life. Evaluating symptoms of these conditions is problematic and typically involves repeated visits to a clinic. Remote measurement technology (RMT), consisting of smartphone apps and wearables, may offer a way to improve upon existing methods of managing these conditions. The present study aimed to establish the practical requirements that would enable clinical integration of data from patients' RMT, according to healthcare professionals. Methods: This paper reports findings from an online survey of 1006 healthcare professionals currently working in the care of people with epilepsy, MS or depression. The survey included questions on types of data considered useful, how often data should be collected, the value of RMT data, preferred methods of accessing the data, benefits and challenges to RMT implementation, impact of RMT data on clinical practice, and requirement for technical support. The survey was presented on the JISC online surveys platform. Results: Among this sample of 1006 healthcare professionals, respondents were positive about the benefits of RMT, with 73.2% indicating their service would be likely or highly likely to benefit from the implementation of RMT in patient care plans. The data from patients' RMT devices should be made available to all nursing and medical team members and could be reviewed between consultations where flagged by the system. However, results suggest it is also likely that RMT data would be reviewed in preparation for and during a consultation with a patient. Time to review information is likely to be one of the greatest barriers to successful implementation of RMT in clinical practice. Conclusions: While further work would be required to quantify the benefits of RMT in clinical practice, the findings from this survey suggest that a wide array of clinical team members treating epilepsy, MS and depression would find benefit from RMT data in the care of their patients. Findings presented could inform the implementation of RMT and other digital interventions in the clinical management of a range of neurological and mental health conditions.

The impact of data from remote measurement technology on the clinical practice of healthcare professionals in depression, epilepsy and multiple sclerosis: survey

BMC Medical Informatics and Decision Making, Oct 13, 2021

Background: A variety of smartphone apps and wearables are available both to help patients monito... more Background: A variety of smartphone apps and wearables are available both to help patients monitor their health and to support health care professionals (HCPs) in providing clinical care. As part of the RADAR-CNS consortium, we have conducted research into the application of wearables and smartphone apps in the care of people with multiple sclerosis, epilepsy, or depression. Methods: We conducted a large online survey study to explore the experiences of HCPs working with patients who have one or more of these conditions. The survey covered smartphone apps and wearables used by clinicians and their patients, and how data from these technologies impacted on the respondents' clinical practice. The survey was conducted between February 2019 and March 2020 via a web-based platform. Detailed statistical analysis was performed on the answers. Results: Of 1009 survey responses from HCPs, 1006 were included in the analysis after data cleaning. Smartphone apps are used by more than half of responding HCPs and more than three quarters of their patients use smartphone apps or wearable devices for health-related purposes. HCPs widely believe the data that patients collect using these devices impacts their clinical practice. Subgroup analyses show that views on the impact of this data on different aspects of clinical work varies according to whether respondents use apps themselves, and, to a lesser extent, according to their clinical setting and job role. Conclusions: Use of smartphone apps is widespread among HCPs participating in this large European survey and caring for people with epilepsy, multiple sclerosis and depression. The majority of respondents indicate that they treat patients who use wearables and other devices for health-related purposes and that data from these devices has an impact on clinical practice.

Developing mHealth Apps with Researchers: Multi-Stakeholder Design Considerations

Lecture Notes in Computer Science, 2014

The authors have been involved with developing a number of mHealth smartphone Apps for use in hea... more The authors have been involved with developing a number of mHealth smartphone Apps for use in health or wellness research in collaboration with researchers, clinicians and patient groups for clinical areas including Sickle Cell Disease, Attention Deficit Hyperactivity Disorder, asthma and infertility treatment. In these types of applications, end-users self-report their symptoms and quality of life or conduct psychometric tests. Physiological data may also be captured using sensors that are internal or external to the device. Following a discussion of the multiple stakeholders that are typically involved in small scale research projects involving end-user data collection, four Apps are used as case studies to explore the issue of non-functional requirements.

Clinical Perspectives on Using Remote Measurement Technology in Assessing Epilepsy, Multiple Sclerosis, and Depression: Delphi Study

JMIR Neurotechnology

Background Multiple sclerosis (MS), epilepsy, and depression are chronic central nervous system c... more Background Multiple sclerosis (MS), epilepsy, and depression are chronic central nervous system conditions in which remote measurement technology (RMT) may offer benefits compared with usual assessment. We previously worked with clinicians, patients, and researchers to develop 13 use cases for RMT: 5 in epilepsy (seizure alert, seizure counting, risk scoring, triage support, and trend analysis), 3 in MS (detecting silent progression, detecting depression in MS, and donating data to a biobank), and 5 in depression (detecting trends, reviewing treatment, self-management, comorbid monitoring, and carer alert). Objective In this study, we aimed to evaluate the use cases and related implementation issues with an expert panel of clinicians external to our project consortium. Methods We used a Delphi exercise to validate the use cases and suggest a prioritization among them and to ascertain the importance of a variety of implementation issues related to RMT. The expert panel included clini...

Computer Games for User Engagement in Attention Deficit Hyperactivity Disorder (ADHD) Monitoring and Therapy

State-of-the-art computer games and psychological tests for symptom monitoring and therapy in Att... more State-of-the-art computer games and psychological tests for symptom monitoring and therapy in Attention Deficit Hyperactivity Disorder (ADHD) are explored and reviewed. Three foci for research studies are identified: task (human performance) focus; educational focus; medical/clinical focus. It is found that game designs in the literature include a variety of tests of cognition mostly dependent on attention and executive functions (inhibitory motor control, working memory, interference suppression) which involve reactions to stimuli on computer (or mobile phone) screens. In addition, based on the measurement of neural pathways that can be accessed by Brain Computer Interfaces, there are several applications of games that employ biofeedback and demand the user to control aspects of their brain activity to play them, with the aim of improving function. A number of games have been used in clinical studies for self-monitoring and therapy, some of these controlled with comparators such as treatment as usual or cognitive therapies, or with the individual as their own control, where efficacy is evaluated by measuring behavioural and functional outcomes on measurement instruments such as ADHD or behavioural trait questionnaires or other cognitive tests. Other applications of games include education and raising awareness of mental health conditions to reduce stigma. The paper then presents and proposes designs of new games that are based on psychological tests or tasks that aim to monitor or improve attention, inhibitory and/or motor activity including Continuous Performance Tests, Go/No-go and Stop-signal tasks.

Developing mHealth Remote Monitoring Technology for Attention Deficit Hyperactivity Disorder: A Qualitative Study Eliciting User Priorities and Needs

Jmir mhealth and uhealth, Mar 23, 2016

Background: Guidelines in the United Kingdom recommend that medication titration for attention de... more Background: Guidelines in the United Kingdom recommend that medication titration for attention deficit hyperactivity disorder (ADHD) should be completed within 4-6 weeks and include regular reviews. However, most clinicians think that weekly clinic contact is infeasible, and audits have shown that this timeline is rarely achieved. Thus, a more effective monitoring and review system is needed; remote monitoring technology (RMT) may be one way to improve current practice. However, little is known about whether patients with ADHD, their families, and clinicians would be interested in using RMT. Objective: To explore patients', parents', and health care professionals' views and attitudes toward using digital technology for remote monitoring during titration for ADHD. Methods: This was a qualitative study, and data were collected through 11 focus groups with adults and young people with ADHD, parents of children with ADHD, and health care professionals (N=59). Results: All participant groups were positive about using RMT in the treatment of ADHD, but they were also aware of barriers to its use, especially around access to technology and integrating RMT into clinical care. They identified that RMT had the most potential for use in the ongoing management and support of ADHD, rather than during the distinct titration period. Participants identified features of RMT that could improve the quality of consultations and support greater self-management. Conclusions: RMT has the potential to augment support and care for ADHD, but it needs to go beyond the titration period and offer more to patients and families than monitoring through outcome measures. Developing and evaluating an mHealth app that incorporates the key features identified by end users is required.

Using Patient and Public Involvement to elicit opinion on Gamified Cognitive Training and Assessment for People living with Dementia (Preprint)

<sec> <title>UNSTRUCTURED</title> <p>This paper reports on a series of Pa... more <sec> <title>UNSTRUCTURED</title> <p>This paper reports on a series of Patient and Public Involvement (PPI) workshops with people living with dementia and carers where they discussed cognitive training and screening technologies designed to reduce the risk of dementia and identify changes in cognition. Little is known about the factors influencing the acceptance of such technologies. Four linked workshops were conducted with the same group, each focusing on a specific topic: meaningful improvement, learning and motivation, trust in digital diagnosis and barriers to technology adoption. Participants in the workshops included local Involvement Team members as well as those recruited via Join Dementia Research and researcher took part in some activities. The group activities were recorded, and transcripts were analyzed using thematic analysis with a combination of a priori and data-driven themes. Several important findings emerged, including the importance the group placed on maintaining good cognitive health, the importance of community activities within dementia and self-care and need for more support after a dementia diagnosis. The implications for researchers and technology developers are discussed.</p> </sec> <sec> <title>INTERNATIONAL REGISTERED REPORT</title> <p>RR2-10.1007/978-3-030-49065-2_4</p> </sec>

Early Stage Economic Evaluation with a Small Medical Device Start-Up Company Using a Markov Model

Journal of Medical Devices-transactions of The Asme, Jun 1, 2011

A synergistic experimental and numerical investigation has provided quantitative information on t... more A synergistic experimental and numerical investigation has provided quantitative information on the response of human tissue temperatures to misalignment of the implant and antenna of neuromodulation devices during recharging. It was found that misalignment increases tissue temperatures for all of the investigated devices. These increases ranged from 0.5°C to 2.7°C. Notwithstanding these increases, the lowest temperatures were attained by the Restore Ultra device for all operating conditions. The temperature levels achieved by the Precision Plus and Eon Mini devices were found to be greater than those for the Restore Ultra, but their relative rankings depend on the thermal boundary conditions and the duration of the recharging period.

Cardiac training simulator using pump with electronic pressure sensor to trigger ventricular fibrillation

Cardiac surgery training in a realistic surgical environment is assisted by a simulator based on ... more Cardiac surgery training in a realistic surgical environment is assisted by a simulator based on an electromechanical pneumatic pump with associated control and display software. In this paper we describe a feedback mechanism for controlling the beating mode of the simulator by means of a electronic pressure sensor incorporated into the :pneumatic pump. The sensor was incorporated into an electronic data acquisition board and was u;ed to trigger a ventricular fibrillation (cardiac arrest) mode in the pump control system when the heart attached to the pump is handled by the trainee surgeon, as is typically experienced in a real operation. The mode change also results in changes to simulated vital signs including ECG and pressure traces which are displayed on a monitor within the surgical training environment. Software is described which was designed to drive the pump at various beating rates, display the vital signs, and respond to pressure sensor measurements. The work described is the continuation of a collaboration between the University Hospital of the West Indies (UHWI),

Broadcasting On-Line Social Interaction as Inhabited Television

Springer eBooks, 1999

Inhabited TV combines collaborative virtual environments (CVEs) with broadcast TV so that on-line... more Inhabited TV combines collaborative virtual environments (CVEs) with broadcast TV so that on-line audiences can participate in TV shows within shared virtual worlds. Three early experiments with inhabited TV raised fundamental questions concerning the extent to which it is possible to establish fast-pace social interaction within a CVE and produce a coherent and engaging broadcast of this action. This paper presents a fourth more recent experiment, Out of This World that directly addressed these questions. We describe how the formulation of inhabited TV design principles, combined with the use of dedicated production software, for constraining and directing participants' actions and for controlling virtual cameras, enabled us to create a fastmoving and coherent show. We conclude that our experiments to date demonstrate the technical feasibility of inhabited TV, but that greater attention needs to be paid to developing appropriate formats and content for this new medium before it becomes truly engaging. We also suggest that our real time production and camera software may be useful in other areas of CSCW.

Power Up: Patient and public involvement in developing a shared decision-making app for mental health

The Journal of Health Design, Mar 22, 2018

Up: Patient and public involvement in developing a shared decision-making app for mental health.

To the Castle! A comparison of two audio guides to enable public discovery of historical events

Personal and Ubiquitous Computing, Oct 30, 2012

(2013). To the Castle! A comparison of two audio guides to enable public discovery of historical ... more

In this paper we describe and analyse the community building process for Ages of Avatar, a set of... more In this paper we describe and analyse the community building process for Ages of Avatar, a set of on-line Collaborative Virtual Environments created in Microsoft Virtual Worlds, which form part of an ongoing experiment in Inhabited Television, aiming to merge CVEs and broadcast media. We describe the means by which the CVEs were launched, promoted and supported alongside a television broadcast channel, and how actions of viewers acting as inhabitants in the CVE can be used to provide broadcast material. We explain how the world content and their superstructure were managed to encourage the growth of a community over a short period of time. Using logs of activities in the worlds we deduce some of the characteristics of the community which was formed.

Using Patient and Public Involvement to Elicit Opinion on Cognitive Training Games and Assessment Technologies for Dementia (Preprint)

JMIR serious games, Jul 29, 2021

Background Cognitive training and assessment technologies offer the promise of dementia risk redu... more Background Cognitive training and assessment technologies offer the promise of dementia risk reduction and a more timely diagnosis of dementia, respectively. Cognitive training games may help reduce the lifetime risk of dementia by helping to build cognitive reserve, whereas cognitive assessment technologies offer the opportunity for a more convenient approach to early detection or screening. Objective This study aims to elicit perspectives of potential end users on factors related to the acceptability of cognitive training games and assessment technologies, including their opinions on the meaningfulness of measurement of cognition, barriers to and facilitators of adoption, motivations to use games, and interrelationships with existing health care infrastructure. Methods Four linked workshops were conducted with the same group, each focusing on a specific topic: meaningful improvement, learning and motivation, trust in digital diagnosis, and barriers to technology adoption. Participants in the workshops included local involvement team members acting as facilitators and those recruited via Join Dementia Research through a purposive selection and volunteer sampling method. Group activities were recorded, and transcripts were analyzed using thematic analysis with a combination of a priori and data-driven themes. Using a mixed methods approach, we investigated the relationships between the categories of the Capability, Opportunity, and Motivation–Behavior change model along with data-driven themes by measuring the φ coefficient between coded excerpts and ensuring the reliability of our coding scheme by using independent reviewers and assessing interrater reliability. Finally, we explored these themes and their relationships to address our research objectives. Results In addition to discussions around the capability, motivation, and opportunity categories, several important themes emerged during the workshops: family and friends, cognition and mood, work and hobbies, and technology. Group participants mentioned the importance of functional and objective measures of cognitive change, the social aspect of activities as a motivating factor, and the opportunities and potential shortcomings of digital health care provision. Our quantitative results indicated at least moderate agreement on all but one of the coding schemes and good independence of our coding categories. Positive and statistically significant φ coefficients were observed between several coding themes between categories, including a relatively strong positive φ coefficient between capability and cognition (0.468; P&lt;.001). Conclusions The implications for researchers and technology developers include assessing how cognitive training and screening pathways would integrate into existing health care systems; however, further work needs to be undertaken to address barriers to adoption and the potential real-world impact of cognitive training and screening technologies. International Registered Report Identifier (IRRID) RR2-10.1007/978-3-030-49065-2_4

Try to see it my way: exploring the co-design of visual presentations of wellbeing through a workshop process

Perspectives in Public Health, Apr 8, 2019

Try to see it my way: exploring the co-design of visual presentations of wellbeing through a work... more Try to see it my way: exploring the co-design of visual presentations of wellbeing through a workshop process PEER REVIEW IntroductIon Digital technology is readily available in the hands of many individuals. It holds promise for supporting improved public health through the exploitation of its sophisticated and user-friendly multimedia functions as well as its always-on connectivity. The deployment of digital technology in healthcare, typically termed e-Health (electronic) and more recently m-Health (mobile), is to be found on platforms such as personal computers, smartphones, tablet and wearables. In recent years, a strong focus on digital mental health has emerged. 1 In the UK, the NewMind network, 2 funded by the Engineering and Physical Sciences Research Council (EPSRC), was founded to explore 'the potential for technology to transform the management & treatment of mental health conditions, whilst seeking to address underlying EPS research challenges'. The definition of mental health in the national 'No

Factors influencing wider acceptance of Computer Assisted Orthopaedic Surgery (CAOS) technologies for Total Joint Arthroplasty

Computer-assisted orthopaedic surgery (CAOS) promises to improve outcomes of joint arthroplasty t... more Computer-assisted orthopaedic surgery (CAOS) promises to improve outcomes of joint arthroplasty through better alignment and orientation of implants, but take up has so far been modest. Following an overview of CAOS technologies covering image-guided surgery, image-free and robotic systems, several factors for lack of penetration are identified. These include poor validation of accuracy, lack of standardisation, inappropriate clinical outcomes measures for assessing and comparing technologies, unresolved debate about the effectiveness of minimally invasive surgery, and issues of medical device regulations, cost, autonomy of surgeons to choose equipment, ergonomics and training. The paper concludes that dialogue between surgeons and manufacturers is needed to develop standardised measurements and outcomes scoring systems that are more appropriate for technology comparisons, and encourages an increased awareness of user requirements. Table 1: A selection of commercially available CAOS systems and components Company System name Classification and description Acrobot (The Acrobot Company Ltd.) Acrobot, MI-Navigation Semi-active robotic assistant, planning software. Resurfacing. Aesculap Orthopilot Image-less TKA and ACL, planning and navigation BrainLAB VectorVision Image-free and CT-based planning and navigation.

Towards a framework for the appraisal of digital products for mental health - Martin et al. - Slides to accompany abstract

Games to engage: increasing mental health awareness

To the extent reasonable and practicable the material made available in Nottingham ePrints has be... more