Is Artificial Intelligence (AI) Friend or Foe to Patients in Healthcare?

Failure to appropriately measure Value is one of the reasons for slow reform in health. Value brings together quality and cost, both defined around the patient. With technology we can measure value in the new ways: commercially developed algorithms are capable of mining large, connected data sets to present accurate information for patients and providers. But how do we align these new capabilities with clinical and operational realities, and further with individual privacy? The right amount of information, shared at the right time, can improve practitioners' ability to choose treatments, and patients' motivation to provide consent and follow the treatment. Dynamic Consent, where IT is used to determine just what patients are consenting to share, can address the inherent conflict between the demand from AI for access to data and patients' privacy principles. This chapter describes a pragmatic Commercial Development framework for building digital health tool. It overlays Value Model for healthcare IT investments with Patient Activation Measures and innovation management techniques.

Promoting Physical Activity and Fitness with Exergames

This updated systematic review of systematic reviews evaluates the effectiveness of exergaming on physical fitness and physical activity. A systematic literature search was conducted on 10 databases, first in 2014 and then repeated in 2016. In total, 1040 and 287 articles were identified. 68 and 31 articles were found potentially relevant and selected for closer screening. The quality of all relevant articles was evaluated using the AMSTAR tool. After the duplicates were removed and inclusion, exclusion, and quality criteria were implemented, six and three articles remained for review. The results indicate that exergaming is generally enjoyed and can evoke some benefits for physical fitness and physical activity, but the current evidence does not support the ability of exergaming to increase physical fitness or physical activity levels sufficiently for significant health benefits. This systematic review also revealed gaps in previous research. Additional high-quality research and systematic reviews concerning exergaming are needed.

Digital Divide

With a growing body of work demonstrating the power of games to transform players' attitudes, behaviors, and cognitions, it is crucial to understand the potentially divergent experiences and outcomes afforded by digital and non-digital platforms. In a recent study, we found that transferring a public health game from a non-digital to a digital format profoundly impacted players' behaviors and the game's impact. Specifically, players of the digital version of the game, despite it being a nearly identical translation, exhibited a more rapid play pace and discussed strategies and consequences less frequently and with less depth. As a result of this discrepancy, players of the non-digital version of the game exhibited significantly higher post-game systems thinking performance and more positive valuations of vaccination, whereas players of the digital game did not. We propose several explanations for this finding, including follow-up work demonstrating the impact of platform on basic cognitive processes, that elucidate critical distinctions between digital and non-digital experiences.

An Experiment on Anonymity and Multi-User Virtual Environments

Little prior research has empirically examined anonymity in learning. In this study, we manipulated learner identity by experimentally assigning learners to participate in online discussion either anonymously or using their actual name, crossed with learning medium (OpenSim/Second Life vs. real-time chat), with the goal of determining if anonymous discussion in multi-user virtual environments (MUVE) provides unique value to learning (a 2x2 between-subjects design). Results from a quantitative hierarchical multiple regression analysis revealed both main effects: participants who were anonymous scored lower (d = -0.46) and participants discussing in a MUVE scored lower (d = -0.47) on the learning measure without interactive effect, suggesting that anonymizing participants during content-related discussion may reduce learning under certain circumstances. We suggest instructors encourage learners to represent themselves authentically in any VEs to maximize learning and also discourage instructors from adopting MUVEs if their only reason to do so is to host synchronous discussion.

Computer-Presented and Physical Brain-Training Exercises for School Children

This chapter reviews the neuroscience foundation for understanding and harnessing neuroplastic processes that shape the structure and function of the human brain after birth, describes a newly developed, integrated series of computer presented and physical exercises to promote activity-related development of neurocognitive systems of attention and executive function in elementary school children, and reviews evidence of the efficacy of the program. The computer-presented brain exercises have new functionalities that more fully shape the training to each user's individual profile of cognitive strengths and weaknesses than was previously possible. The programs also provide assessments of each child's cognitive strengths and weaknesses based on built in formal tests of cognition and error analytic algorithms applied to 15-20,000 responses from each child while using the brain training program.

Making Learning Fun

We examine the use of a ludic simulation designed for middle school space science to support students' learning and motivation. A total of 383 sixth graders and 447 seventh graders participated in this study. The findings showed that sixth- and seventh-graders perceived the simulation as having substantial ludic characteristics and educational value. The results indicated that having a playful experience is important for this age group and that participating in a ludic simulation can help motivate students to learn school subjects. Results also indicated that incorporating ludus into the learning experience can improve students' attitudes toward the subject matter. Implications of policy, research, and practice with regard to using ludic simulations to support classroom-based learning were discussed.

Teaching Childbirth Support Techniques Using the Prepared Partner and Digital Birth

In today's California, a mother's primary social support person in childbirth is her partner, guiding her through a multidimensional experience, helping her make sense of unforgettable emotions and sensations. Preparing the partner is an integral step to making sure that the mother is well-supported in her birth. Because the mother's experience is influenced by the support she receives, and because birth partners need more support than is recognized, we target birth partners with a learning intervention. We investigate video games as a vehicle for knowledge transfer to the birth partner, both as currently available and as a positive learning tool. To address the problem of limited access to childbirth preparation methods, we investigated, designed, and evaluated two games: The Prepared Partner, an online Flash game, and Digital Birth, an iPhone application. Both games allow the user to practice various supportive actions in the realm of childbirth support for a mother in labor. We found that players of The Prepared Partner met learning goals while enjoying the game.

Games and Other Training Interventions to Improve Cognition in Healthy Older Adults

Many of the cognitive declines in healthy aging are moderated by experience, suggesting that interventions may be beneficial. Goals for aging outcomes include improving performance on untrained tasks, remediating observed cognitive declines, and ensuring preservation of functional ability. This selective review evaluates current progress towards these goals. Most research focuses on untrained tasks. Interventions associated with this outcome include games and exercises practicing specific cognitive skills, as well as aerobic exercise, and modestly benefit a relatively narrow range of cognitive tasks. Few studies have directly tested improvements in tasks on which individuals have been shown to experience longitudinal decline, so this goal has not been realized, though remediation can be examined rather easily. Little work has been done to develop psychometrically strong functional outcomes that could be used to test preservation of independence in everyday activities. Virtual reality approaches to functional assessment show promise for achieving the third goal.

Beyond Gaming

The interest around the utilization of video games as a component of rehabilitative therapy has dramatically increased over the past decade. Research efforts have confirmed the positive effects of repetitive gaming in improving visual outcomes; however, there is limited knowledge on the mechanism of action delivered by repetitive gaming. Utilizing knowledge of the visual system, including targeting specific cells in the retina with visual stimuli, the authors captured the training effects of gaming to augment pre-selected skills. Specifically, the authors embedded a homerun derby style baseball game with a contrast threshold test, to stimulate parvocellular retinal ganglion cells. Parvocellular cells are the first line of the ventral, or “what” pathway of visual processing. Repetitive stimulation of the parvocellular system shows promising preliminary results in improving batting performance.

Using Serious Gaming to Improve the Safety of Central Venous Catheter Placement

Serious gaming a tool that can be used to train new physicians in a manner that keeps patients out of harm's way. This is especially true when teaching procedures, which in the medical community if often done in a “see one, do one, teach one” manner. Additionally, many teachers focus on technical aspects of the procedure and may leave out or de-emphasize non-technical portions of the procedure such as hand washing and patient positioning. This chapter per the authors investigates the utility of serious gaming in teaching physicians technical procedures. The chapter begins with game development and will end with a discussion of the results of the prospective randomized study.