Search

Abstract Background Extracorporeal circulation causes a systemic inflammatory response, that may cause postoperative haemodynamic instability and end-organ dysfunction. This study aimed to investigate the impact of minimal invasive extracorporeal circulation (MiECC) on the systemic inflammatory response compared with conventional extracorporeal circulation (CECC). Methods Patients undergoing coronary artery bypass grafting were randomized to MiECC (n = 30) and CECC (n = 30). Primary endpoint was tumor necrosis factor-α. Secondary endpoints were other biochemical markers of inflammation (IL1β, IL6 and IL8, C-reactive protein, leukocytes), and markers of inadequate tissue perfusion and tissue damage (lactate dehydrogenase, lactate and creatine kinase-MB). In addition, we registered signs of systemic inflammatory response syndrome, haemodynamic instability, atrial fibrillation, respiratory dysfunction, and infection. Results Patients treated with MiECC showed significantly lower levels of tumor necrosis factor-α than CECC during and early after extracorporeal circulation (median: MiECC 3.4 pg/mL; CI 2.2–4.5 vs. CECC 4.6 pg/mL; CI 3.4–5.6; p = 0.01). Lower levels of creatine kinase-MB and lactate dehydrogenase suggested less tissue damage. However, we detected no other significant differences in any other markers of inflammation, tissue damage or in any of the clinical outcomes. Conclusions Lower levels of TNF-α after MiECC compared with CECC may reflect reduced inflammatory response, although other biochemical markers of inflammation were comparable. Our results suggest better end-organ protection with MiECC compared with CECC. Clinical parameters related to systemic inflammatory response were comparable in this study. Clinical registration number NCT03216720.

Abstract Background Existing traditional cognitive screening tools for dementia have various limitations, including overreliance on tests assessing verbal memory and, to a lesser extent, on some aspects of executive functioning. Comprehensive neuropsychological assessment is sensitive to impairment but time-intensive and expensive. Virtual reality may provide a dynamic and unique understanding of cognitive performance and increase the ecological validity of cognitive assessment. The use of virtual reality in screening for cognitive function in older persons is promising, but evidence for its use remains sparse. Objective Our primary aim was to examine the feasibility and acceptability of a newly developed, virtual reality assessment module, ‘Leaf Café’, a computer-based program that assesses cognition in an engaging, efficient, and ecologically relevant way. The secondary aim was to assess the ability of the module to discriminate between performances of younger and older adults. Methods A cross-sectional study was carried out in Sydney, Australia, targeting adults aged 18 years and above. Participants completed a traditional cognitive screening tool (Telephone Interview for Cognitive Status-Modified, TICS-M) and Leaf Café, a low-immersive virtual reality module designed to evaluate learning and memory, perceptual-motor function, and executive functioning. The total performance score for each participant, ranging from 0 to 180, was correlated with their cognitive performance assessed by TICS-M, using Pearson’s correlation coefficient. Following module completion, participants were presented with an open and closed-question survey to capture their perceptions, attitudes, and feedback on the module, encompassing practicality, acceptability, and enjoyment. Both descriptive and content analyses were employed to interpret the obtained data. Results A sample of 131 participants (mean age 54.9 years, SD = 20.8, range 20–85) took part. The majority were female (71.8%) and born in an English-speaking country (75.8%). The mean amount of time spent in the module was 32.8 min (SD = 13.3) with a mean module score of 107.6 (SD = 38.7). Most participants completed the highest level (5; 80.5%). There was a significant correlation between Leaf Café total scores with TICS-M cognitive scores overall, and for both younger (aged 18–64 years) and older adult (aged 65 + years) groups. No significant difference was found on performance between age groups on TICS-M performance, however, younger adults had significantly better performance on the Leaf Café module than older adults (M = 124.1 vs 95.9; p

Purpose – Cybersecurity vulnerabilities are often due to human users acting according to their own ethical priorities. With the goal of providing tailored training to cybersecurity professionals, the authors conducted a study to uncover profiles of human factors that influence which ethical principles are valued highest following exposure to ethical dilemmas presented in a cybersecurity game. Design/methodology/approach – The authors’ game first sensitises players (cybersecurity trainees) to five cybersecurity ethical principles (beneficence, non-maleficence, justice, autonomy and explicability) and then allows the player to explore their application in multiple cybersecurity scenarios. After playing the game, players rank the five ethical principles in terms of importance. A total of 250 first-year cybersecurity students played the game. To develop profiles, the authors collected players' demographics, knowledge about ethics, personality, moral stance and values. Findings – The authors built models to predict the importance of each of the five ethical principles. The analyses show that, generally, the main driver influencing the priority given to specific ethical principles is cultural background, followed by the personality traits of extraversion and conscientiousness. The importance of the ingroup was also a prominent factor. Originality/value – Cybersecurity professionals need to understand the impact of users' ethical choices. To provide ethics training, the profiles uncovered will be used to build artificially intelligent (AI) non-player characters (NPCs) to expose the player to multiple viewpoints. The NPCs will adapt their training according to the predicted players’ viewpoint.

Abstract Background This paper explores the extent to which the implementation and evaluation of a collaborative care model of face-to-face service delivery for people with severe mental illness was viable during the first UK lockdown associated with COVID-19. The PARTNERS2 cluster randomised controlled trial and process evaluation were co-designed with service users and carers. The aim of this paper is to explore whether digital adaptation of the PARTNERS model for people with severe mental illness during the COVID-19 lockdown was equitable, in terms of fostering collaboration and trust in a vulnerable population. Results We collected qualitative data from multiple sources during lockdown and subsequently constructed case-studies of participating secondary care workers. We adopted Bauman’s notions of liquid modernity to inform our analysis, and identified that digital adaptation during lockdown was only successful where organisational policies, care partner skills and service users’ existing resources were optimal. Conclusion PARTNERS2 can be delivered digitally by a care partner to support people with severe mental illness to identify and work towards their goals when existing resources are optimal. However, at a time of increased need, we identified that people who are very unwell and living with limited access to resources and opportunities, remained disenfranchised at great cost. Trial registration ISRCTN 95702682, registered 26.10.2017

Virtual agents (VAs) have been used effectively for psychoeducation. However, getting the VA’s design right is critical to ensure the user experience does not become a barrier to receiving and responding to the intended message. The study reported in this paper seeks to help first-year psychology students to develop knowledge and confidence to recommend emotion regulation strategies. In previous work, we received negative feedback concerning the VA’s lip-syncing, including creepiness and visual overload, in the case of stroke patients. We seek to test the impact of the removal of lip-syncing on the perception of the VA and its ability to achieve its intended outcomes, also considering the influence of the visual features of the avatar. We conducted a 2 (lip-sync/no lip-sync) × 2 (human-like/cartoon-like) experimental design and measured participants’ perception of the VA in terms of eeriness, user experience, knowledge gain and participants’ confidence to practice their knowledge. While participants showed a tendency to prefer the cartoon look over the human look and the absence of lip-syncing over its presence, all groups reported no significant increase in knowledge but significant increases in confidence in their knowledge and ability to recommend the learnt strategies to others, concluding that realism and lip-syncing did not influence the intended outcomes. Thus, in future designs, we will allow the user to switch off the lip-sync function if they prefer. Further, our findings suggest that lip-syncing should not be a standard animation included with VAs, as is currently the case.

Purpose – To protect information and communication technology (ICT) infrastructure and resources against poor cyber hygiene behaviours, organisations commonly require internal users to confirm they will abide by an ICT Code of Conduct. Before commencing enrolment, university students sign ICT policies, however, individuals can ignore or act contrary to these policies. This study aims to evaluate whether students can apply ICT Codes of Conduct and explores viable approaches for ensuring that students understand how to act ethically and in accordance with such codes. Design/methodology/approach – The authors designed a between-subjects experiment involving 260 students’ responses to five scenario-pairs that involve breach/non-breach of a university’s ICT policy following a priming intervention to heighten awareness of ICT policy or relevant ethical principles, with a control group receiving no priming. Findings – This study found a significant difference in students’ responses to the breach versus non-breach cases, indicating their ability to apply the ICT Code of Conduct. Qualitative comments revealed the priming materials influenced their reasoning. Research limitations/implications – The authors’ priming interventions were inadequate for improving breach recognition compared to the control group. More nuanced and targeted priming interventions are suggested for future studies. Practical implications – Appropriate application of ICT Code of Conduct can be measured by collecting student/employee responses to breach/non-breach scenario pairs based on the Code and embedded with ethical principles. Social implications – Shared awareness and protection of ICT resources. Originality/value – Compliance with ICT Codes of Conduct by students is under-investigated. This study shows that code-based scenarios can measure understanding and suggest that targeted priming might offer a non-resource intensive training approach.

Relational cues are extracts from actual verbal dialogues that help build the therapist–patient working alliance and stronger bond through the depiction of empathy, respect and openness. ECAs (Embodied conversational agents) are human-like virtual agents that exhibit verbal and non-verbal behaviours. In the digital health space, ECAs act as health coaches or experts. ECA dialogues have previously been designed to include relational cues to motivate patients to change their current behaviours and encourage adherence to a treatment plan. However, there is little understanding of who finds specific relational cues delivered by an ECA helpful or not. Drawing the literature together, we have categorised relational cues into empowering, working alliance, affirmative and social dialogue. In this study, we have embedded the dialogue of Alex, an ECA, to encourage healthy behaviours with all the relational cues (empathic Alex) or with none of the relational cues (neutral Alex). A total of 206 participants were randomly assigned to interact with either empathic or neutral Alex and were also asked to rate the helpfulness of selected relational cues. We explore if the perceived helpfulness of the relational cues is a good predictor of users’ intention to change the recommended health behaviours and/or development of a working alliance. Our models also investigate the impact of individual factors, including gender, age, culture and personality traits of the users. The idea is to establish whether a certain group of individuals having similarities in terms of individual factors found a particular cue or group of cues helpful. This will establish future versions of Alex and allow Alex to tailor its dialogue to specific groups, as well as help in building ECAs with multiple personalities and roles.

Vacant land in residual urban areas is a crucial resource to tackle the current climate and housing crises. In this study, we present the development of a geodatabase to determine the occurrence of vacant land in the urban core of Oklahoma City, USA (OKC), and assess its potential for infill housing. As a starting point, we define urban vacant land through a literature review. We present a description of the case study’s social and urbanistic context by highlighting its relevance to this study. We explain the methodology for the development of the geodatabase to quantify residual urban land in OKC’s urban core. We examine the spatial distribution and recurring characteristics of vacant parcels using QGIS, Python scripting for Rhinoceros 3D, and aerial imagery. We find that small parcels have higher vacancy rates than average-sized parcels and there is a correlation between higher vacancy rates and proximity to downtown and brownfields. Finally, we discuss the implications of the findings by assessing the urban vacant land potential for residential development and its contribution to OKC’s housing provision. Under all the proposed scenarios, the considered developable vacant land in the urban core could entirely fulfill the need for new housing units for the entire city.

Embodied Conversational Agents (ECAs) are virtual agents that exhibit humanlike verbal and non-verbal behaviours. When it comes to eHealth, ECAs can provide vital support to patients by being more reachable. In order to make ECAs more effective, humanlike empathy expressed during conversation through relational cues is essential. Empathy revolves around a wide range of verbal and non-verbal behaviours that include, for example, the choice of words in social dialogues. Owing to the COVID-19 situation, there was an opportunity to record online consultations in the Incontinence Clinic and Sleep Clinic at the Children’s Hospital at Westmead in Sydney, Australia. The present study analysed these human dialogues using qualitative research methods to understand the role of empathic dialogue used by the medical team. The qualitative analysis of the live calls used psychology-based relational cues derived from conversational characteristics of humans to build a coding framework around the most relevant themes. Statistical analysis was used to compare relational cue usage between healthcare roles. Finally, using the framework dialogues of the medical team and two ECAs known as Dr Evie (eVirtual Agent for Incontinence and Enuresis) and SAM (Sleep Adherence Mentor) were compared to provide recommendations for health practitioners and future ECA dialogue development.

BackgroundHealth care and well-being are 2 main interconnected application areas of conversational agents (CAs). There is a significant increase in research, development, and commercial implementations in this area. In parallel to the increasing interest, new challenges in designing and evaluating CAs have emerged. ObjectiveThis study aims to identify key design, development, and evaluation challenges of CAs in health care and well-being research. The focus is on the very recent projects with their emerging challenges. MethodsA review study was conducted with 17 invited studies, most of which were presented at the ACM (Association for Computing Machinery) CHI 2020 conference workshop on CAs for health and well-being. Eligibility criteria required the studies to involve a CA applied to a health or well-being project (ongoing or recently finished). The participating studies were asked to report on their projects’ design and evaluation challenges. We used thematic analysis to review the studies. ResultsThe findings include a range of topics from primary care to caring for older adults to health coaching. We identified 4 major themes: (1) Domain Information and Integration, (2) User-System Interaction and Partnership, (3) Evaluation, and (4) Conversational Competence. ConclusionsCAs proved their worth during the pandemic as health screening tools, and are expected to stay to further support various health care domains, especially personal health care. Growth in investment in CAs also shows the value as a personal assistant. Our study shows that while some challenges are shared with other CA application areas, safety and privacy remain the major challenges in the health care and well-being domains. An increased level of collaboration across different institutions and entities may be a promising direction to address some of the major challenges that otherwise would be too complex to be addressed by the projects with their limited scope and budget.

Despite the challenges associated with virtually mediated communication, remote collaboration is a defining characteristic of online multiplayer gaming communities. Inspired by the teamwork exhibited by players in first-person shooter games, this study investigated the verbal and behavioral coordination of four-player teams playing a cooperative online video game. The game, Desert Herding, involved teams consisting of three ground players and one drone operator tasked to locate, corral, and contain evasive robot agents scattered across a large desert environment. Ground players could move throughout the environment, while the drone operator’s role was akin to that of a “spectator” with a bird’s-eye view, with access to veridical information of the locations of teammates and the to-be-corralled agents. Categorical recurrence quantification analysis (catRQA) was used to measure the communication dynamics of teams as they completed the task. Demands on coordination were manipulated by varying the ground players’ ability to observe the environment with the use of game “fog.” Results show that catRQA was sensitive to changes to task visibility, with reductions in task visibility reorganizing how participants conversed during the game to maintain team situation awareness. The results are discussed in the context of future work that can address how team coordination can be augmented with the inclusion of artificial agents, as synthetic teammates.

Whilst the use of digital interventions to assist patients with self-management involving embodied conversational agents (ECA) is emerging, the use of such agents to support stroke rehabilitation and recovery is rare. This iTakeCharge project takes inspiration from the evidence-based narrative style self-management intervention for stroke recovery, the ‘Take Charge’ intervention, which has been shown to contribute to significant improvements in disability and quality of life after stroke. We worked with the developers and deliverers of the ‘Take Charge’ intervention tool, clinical stroke researchers and stroke survivors, to adapt the ‘Take Charge’ intervention tool to be delivered by an ECA (i.e., the Taking Charge Intelligent Agent (TaCIA)). TaCIA was co-designed using a three-phased approach: Stage 1: Phase I with the developers and Phase II with people who delivered the original Take Charge intervention to stroke survivors (i.e., facilitators); and Stage 2: Phase III with stroke survivors. This paper reports the results from each of these phases including an evaluation of the resulting ECA. Stage 1: Phase I, where TaCIA V.1 was evaluated by the Take Charge developers, did not build a good working alliance, provide adequate options, or deliver the intended Take Charge outcomes. In particular, the use of answer options and the coaching aspects of TaCIA V.1 were felt to conflict with the intention that Take Charge facilitators would not influence the responses of the patient. In response, in Stage 1: Phase II, TaCIA V.2 incorporated an experiment to determine the value of providing answer options versus free text responses. Take Charge facilitators agreed that allowing an open response concurrently with providing answer options was optimal and determined that working alliance and usability were satisfactory. Finally, in Stage 2: Phase III, TaCIA V.3 was evaluated with eight stroke survivors and was generally well accepted and considered useful. Increased user control, clarification of TaCIA’s role, and other improvements to improve accessibility were suggested. The article concludes with limitations and recommendations for future changes based on stroke survivor feedback.

There is growing awareness that effective emotion regulation is critical for health, adjustment and wellbeing. Emerging evidence suggests that interventions that promote flexible emotion regulation may have the potential to reduce the incidence and prevalence of mental health problems in specific at-risk populations. The challenge is how best to engage with at risk populations, who may not be actively seeking assistance, to deliver this early intervention approach. One possible solution is via digital technology and development, which has rapidly accelerated in this space. Such rapid growth has, however, occurred at the expense of developing a deep understanding of key elements of successful program design and specific mechanisms that influence health behavior change. This paper presents a detailed description of the design, development and evaluation of an emotion regulation intervention conversational agent (ERICA) who acts as a digital coach. ERICA uses interactive conversation to encourage self-reflection and to support and empower users to learn a range of cognitive emotion regulation strategies including Refocusing, Reappraisal, Planning and Putting into Perspective. A pilot evaluation of ERICA was conducted with 138 university students and confirmed that ERICA provided a feasible and highly usable method for delivering an emotion regulation intervention. The results also indicated that ERICA was able to develop a therapeutic relationship with participants and increase their intent to use a range of cognitive emotion regulation strategies. These findings suggest that ERICA holds potential to be an effective approach for delivering an early intervention to support mental health and wellbeing. ERICA’s dialogue, embedded with interactivity, therapeutic alliance and empathy cues, provide the basis for the development of other psychoeducation interventions.

IntroductionBehaviour change interventions represent key means for supporting healthy ageing and reducing dementia risk yet brief, scalable behaviour change interventions targeting dementia risk reduction in older adults is currently lacking. Here we describe the aims and design of the three-month Brain Bootcamp initiative that seeks to target multiple dementia risk and protective factors (healthy eating, physical, social and cognitive inactivity), through the use of multiple behaviour change techniques, including goal-setting for behaviour, information about health consequences and physical prompts to change behaviours that reduce dementia risk among older adults. Our secondary aim is to understand participants' views of dementia prevention and explore the acceptability and integration of this campaign into daily life.MethodsBrain Bootcamp is a pre-post feasibility trial conducted in Sydney, Australia beginning in January 2021 until late August. Participants aged ≥65 years living independently in the community (n = 252), recruited through social media and flyers, will provide information about their demographics, medical history, alcohol consumption, smoking habits, mental health, physical activity, cognitive activity, and diet to generate a dementia risk profile at baseline and assess change therein at three-month follow-up. During the intervention, participants will receive a resource pack containing their individual risk profile, educational booklet on dementia risk factors and four physical items designed to prompt physical, social and mental activity, and better nutrition. Outcome measures include change in dementia risk scores, dementia awareness and motivation. A qualitative process evaluation will interview a sample of participants on the acceptability and feasibility of the intervention.DiscussionThis will be the first short-term multi-domain intervention targeting dementia risk reduction in older adults. Findings will generate a new evidence base on how to best support efforts targeting lifestyle changes and to identify ways to optimise acceptability and effectiveness towards brain health for older adults.Trial registration numberACTRN 381046 (registered 17/02/2021); Pre-results.

The use of intelligent virtual agents (IVA) to support humans in social contexts will depend on their social acceptability. Acceptance will be related to the human’s perception of the IVAs as well as the IVAs’ ability to respond and adapt their conversation appropriately to the human. Adaptation implies computer-generated speech (synthetic speech), such as text-to-speech (TTS). In this paper, we present the results of a study to investigate the effect of voice type (human voice vs. synthetic voice) on two aspects: (1) the IVA’s likeability and voice impression in the light of co-presence, and (2) the interaction outcome, including human–agent trust and behavior change intention. The experiment included 118 participants who interacted with either the virtual advisor with TTS or the virtual advisor with human voice to gain tips for reducing their study stress. Participants in this study found the voice of the virtual advisor with TTS to be more eerie, but they rated both agents, with recorded voice and with TTS, similarly in terms of likeability. They further showed a similar attitude towards both agents in terms of co-presence and building trust. These results challenge previous studies that favor human voice over TTS, and suggest that even if human voice is preferred, TTS can deliver equivalent benefits.

Infographics are visual storytelling techniques used to communicate complex information. However, infographics can be misleading if they are not created ethically. When universities teach how to create infographics, they often do so without emphasizing the ethical issues underlying infographics. To address this gap, we designed a study to educate statistics and data science students about the ethics of infographics by using Rest model's three stages: awareness, orientation, and intention. Students' awareness of the ethical issues underlying infographics was captured before and after sensitizing them to five ethical principles derived from the AI4People's framework applied to a data science context. The students were then exposed to scenarios with ethical dilemmas. Their identification of the ethical principles in these scenarios was measured. The results showed a significant increase in students' awareness of the ethical issues underpinning the interpretation of infographics, suggesting that ethical training of current users and future designers would be beneficial.

Conversational agents offer promise to provide an alternative to costly and scarce access to human health providers. Particularly in the context of adherence to treatment advice and health behavior change, they can provide an ongoing coaching role to motivate and keep the health consumer on track. Due to the recognized importance of face-to-face communication and establishment of a therapist-patient working alliance as the biggest single predictor of adherence, our review focuses on embodied conversational agents (ECAs) and their use in health and well-being interventions. The article also introduces ECAs who provide explanations of their recommendations, known as explainable agents (XAs), as a way to build trust and enhance the working alliance towards improved behavior change. Of particular promise, is work in which XAs are able to engage in conversation to learn about their user and personalize their recommendations based on their knowledge of the user and then tailor their explanations to the beliefs and goals of the user to increase relevancy and motivation and address possible barriers to increase intention to perform the healthy behavior.

Virtual agents that improve the lives of humans need to be more than user-aware and adaptive to the user’s current state and behavior. Additionally, they need to apply expertise gained from experience that drives their adaptive behavior based on deep understanding of the user’s features (such as gender, culture, personality, and psychological state). Our work has involved extension of FAtiMA (Fearnot AffecTive Mind Architecture) with the addition of an Adaptive Engine to the FAtiMA cognitive agent architecture. We use machine learning to acquire the agent’s expertise by capturing a collection of user profiles into a user model and development of agent expertise based on the user model. In this paper, we describe a study to evaluate the Adaptive Engine, which compares the benefit (i.e., reduced stress, increased rapport) of tailoring dialogue to the specific user (Adaptive group) with dialogues that are either empathic (Empathic group) or neutral (Neutral group). Results showed a significant reduction in stress in the empathic and neutral groups, but not the adaptive group. Analyses of rule accuracy, participants’ dialogue preferences, and individual differences reveal that the three groups had different needs for empathic dialogue and highlight the importance and challenges of getting the tailoring right.

Effective communication in task-oriented situations requires high-level interactions. For human–agent collaboration, tasks need to be coordinated in a way that ensures mutual understanding. Speech Act Theory (SAT) aims to understand how utterances can be used to achieve actions. SAT consists of three components: locutionary act, illocutionary act, and perlocutionary act. This paper evaluates the agent’s verbal communication while collaborating with humans. SAT was used to anatomize the structure of the agent’s speech acts (locutionary acts), the agent’s intention behind the speech acts (illocutionary acts), and the effects on the human’s mental state (perlocutionary acts). Moreover, this paper studies the impact of human perceptions of the agent’s speech acts on the perception of collaborative performance with the agent.

There is an increasing interest in the use of intelligent virtual agents (IVAs) to work in teams with humans. To achieve successful outcomes for these heterogeneous teams, many of the aspects found in successful human teams will need to be supported. These aspects include behavioural (i.e., multimodal communication), cognitive (i.e., a shared mental model (SMM)), and social (trust and commitment). Novelly, this paper aims to investigate the impact of IVA’s multimodal communication on the development of a SMM between humans and IVAs. Moreover, this paper aims to explore the impact of the developed SMM on a human’s trust in an IVA’s decisions and a human’s commitment to honour his/her promises to an IVA. The results from two studies involving a collaborative activity showed a significant positive correlation between team multimodal communication (i.e., behavioural aspect) and a SMM between teammates (i.e., cognitive aspect). Moreover, the result showed that there is a significant positive correlation between the developed SMM and a human’s trust in the IVA’s decision and the human’s commitment to honour his/her promises (the establishment of the social aspect of teamwork). Additionally, the results showed a cumulative effect of all of these aspects on human–agent team performance. These results can guide the design of human–agent teamwork multimodal communication models.

When the ABC Four Corners programme 'Bush Bugarup' about the timber industry in Papua New Guinea was shown in May 1994, it stirred a controversy in the country and headlines in the press. but it was not mentioned by the Rimbunan Hijau-associated National daily newspaper. This is an edited extract from the script, published for the first time.