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(Sara Burnell):
Good afternoon everyone.
I'm (Sara Briss-Burnell)
and on behalf
of the National Cancer
Institute, I would
like to welcome everyone
to the November Research
to Reality cyber seminar.
In early summer we issued a call
for abstracts asking community
members to share their
experiences using new
and social media tools
in an innovative
and effective ways.
We were so delighted
by the strength
of the submissions
that we decided
to hold a two-part series
on this important topic.
Today's session will highlight
two diverse programs
that use software as a median
for community research
and education.
With the ubiquity
of smart phones most
of us use mobile applications
or apps designed to run
on smart phones, tablets
and other mobile devices
on a daily basis.
Some may be familiar
with second life,
a free virtual world
where users can socialize,
connect and create
and share services using voice
and text chat.
Today's cyber seminar will
highlight how these platforms
have been used
to engage audiences
around key cancer
control initiatives.
(Debra Wolmer-Valkey)
of the Texan A&M school
of world public health,
and the Texas Life Science
Foundation will join us
to share an overview
of the AYA healthy
survivorship app.
Designed for adolescents
and young adult cancer
survivors, this (unintelligible)
application allows users
to assess their health habits
using theory-based interactive
tool, and gives survivors
individual scores for lifestyle,
nutrition and well-being among
other indicators.
Dr. Versie Johnson-Mallard
of the University
of South Florida will
demonstrate the virtual
environment second life
and how it was used
as educational intervention
to increase the knowledge
of HPV.
Dr. Johnson-Mallard will discuss
the ethicacy of second life
as an educational intervention
in improving knowledge of HPV,
a virus linked
to causing cervical cancer.
The final part
of the Webinar will be dedicated
to Q&A and discussion,
and will offer you the
opportunity to engage
with the presenters
and share your own experiences,
thoughts and lessons learned.
Full bios for each
of today's speakers are also
available on the research
to reality dot cancer dot gov,
where you will also be able
to engage in discussion form
on today's topic,
as well as view the archive
of our previous cyber seminars.
As always, the final part
of this call will be devoted
to your questions and comments.
At any time during the
presentation please press star
one to be placed in the queue
to ask your question live during
question and answer portion
of this seminar,
or if you prefer,
you can also submit your
questions using the Q&A feature
at the top of your screen,
just type in your question
and hit ask.
We thank you all
for joining us today,
and look forward
to this important
and informative topic.
With that I'll turn it
over to Miss (Debra Valkey)
to start us off.
(Debra)? (Debra Wolmer-Valkey):
Yes, thank you so much (Sara).
Thank you for the opportunity
to do this.
As usual, I have no conflicts
to disclose.
What I'd like to do is kind
of walk through
today's discussion.
First of all I'll provide
background on AYA,
or adolescent young adult cancer
survivors, and why we selected
this population
for our application development.
I'll give a brief overview
of the emerging field
of (M-health)
and the application
of health behavior theories;
and also discuss some
opportunities
for what we believe are the need
for some new theoretical
or framework development.
I'll review the development
of the app itself including the
budget, the technology
and our collaborators,
and how we worked interactively
with them.
Then we'll give a brief tour
of the app itself,
and finally some
of our lessons learned
and the next steps.
So why an app for AYAs,
adolescent young adults,
which I continue to refer
to as AYAs, are cancer survivors
in the ages ranging from 15
to 39 years of age,
which is a pretty broad group.
They've been a focus
of national investigation
in the U.S.
and actually internationally
for the past eight years,
since the National Cancer
Institute and Live Strong
Foundations first joint progress
review group
on young adolescent young adult
oncology was convened.
FYI, this group was reconvened
on a member of it,
and there'll be a new report
coming out soon.
In the U.S. we diagnose
about 75,000 AYAs a year.
We think there about 20 million
of them globally.
Overall, unlike older
and pediatric cancer survivors,
there has been little
improvement
in survivorship among AYAs
in the past two decades.
The cause of this lack
of survival continues
to be explored
with consideration
of both biological
and social factors
that affect survivorship.
Clearly, quality
of life among AYA survivors is
an area of concern,
especially due
to the lasting effects
of chemotherapy
and radiation treatment,
and the effects especially
on younger bodies.
If you consider
that older cancer survivors
that are diagnosed generally
around the ages of 60 to 65,
may only have 20 years
of survivor.
That's important
survivorship too.
It's concerning.
For the AYAs diagnosed
in their teens
or twenties may have 40
or 50 more years
of survivorship.
There is a longer period of time
for late effects to emerge
and require attention.
Clearly, we believe there is
some health behavior changes
that can improve the quality
of life among AYAs.
That was one of our rationales
for selecting that population,
or this population
for the app development.
The other is clearly (Sara)
mentioned how ubiquitous smart
phones are for all of us.
In the U.S. smart phone
adoption, and also globally is
among the highest
in this age group according
to the (pew) Internet
and American life
research study.
Additionally,
this population also has the
highest adoption
of what we call (in-health)
or mobile health apps
for physical activity and diet.
We approached our app
development with a desire
to look at both evidenced-based
interventions,
and a strong
theoretical grounding.
The elements
of current health behavior
and communication theories
and framework
such as social cognitive theory,
health behavior change,
and elaboration likelihood
provided us
with a strong theoretical
background for many
of the behavioral elements
functionality and aspects
of the Healthy Survivorship Act,
including the assessment,
the daily tips,
and the provision
of health education materials.
As we were developing this app,
we really became aware
that the current set
of theories don't quite support
some of the behavioral aspects
of the app design.
Mobile health or M-health
as I'll refer to it,
includes a range
of functionalities
and capabilities
that didn't really exist
when any of our theories were
being developed.
Functions like (entra),
individual tailoring,
ecological momentary
involvement,
that means that they've got
their phone in their hands,
and their getting messages
and acting on them
in the moment, tailors feedback
in their own time
and sensitive interactive
and adaptive aspects
of mobile-enabled health
behavior tools,
suggest that there may be need
for new theoretical paradigms,
that our current set just aren't
quite up to the task.
That said, we did look at a lot
of interventions and research
in M-health
from other chronic disease areas
including cancer,
asthma and diabetes.
Our development process is what
I would consider
extremely iterative.
The initial funding
for the project came as a grant
from the Texas A&M School
of Public Health, TTX cares,
which is a CDC cancer prevention
and control network project.
The CTX cares PI,
principal investigator Dr.
(Marsha Oree) provided the
funding, and was absolutely
vital to the development
of the project all the
way along.
We were able
to leverage the initial 40K,
40,000 with an additional 2,000
in marketing funds
from a (ceton) healthcare
facility grant
for AYA professional
and public education.
Our technology decision
to use IOS platform was based
partially on the budget amount.
We didn't have the funds
to do both an iPhone
and an Android app.
We knew we wanted
to reach the largest
possible audience.
So this was two years ago,
and at that point
in time there were more iPhone
apps than there were
Android apps.
Actually, that continues
to be the place, the situation.
We also wanted to make sure
that some of our applications;
our functionality was available
to a broader audience at times
when they might not have
their phone.
So we developed what we call a
hybrid approach
to native phone app.
Native means
that the application is native
or lives on the phone,
and most of the activities occur
on the phone.
We mixed it
with a responsive Web site.
Responsive in a Web site means
that the Web site can be seen
and used by both mobile devices,
using mobile browser,
or a desktop or laptop.
What the responsive Web site
does is it actually tailors the
size of the image to the device
that you're using.
Most importantly we leveraged
the professional and advocate
and survivor AYA support groups
from our (ceton) grant,
and they provided us guidance
and insight into the design,
and helped us
as we developed our requirements
and our use cases
for the project.
Our health care professionals
included nationally recognized
AYA cancer researchers
and oncologists.
Our advocates included AYA
survivors and cancer advocates
from groups like Livestrong,
Critical Mass, Komen,
and I'm Too Young For This.
I really cannot say enough
about the value and the insights
from these advisory groups
in the development of the app.
So this is a screen shot
of the Web site,
healthy survivorship dot org.
Dr. (Ross Glasgow) recently
of NCI and now
with the University of Colorado,
I think considers projects
like this as pragmatic research.
We wanted to be able
to quickly test whether
and if cancer survivors were
interested in using health
behavior change apps.
We wanted to explore how best
to engage diverse groups
of researchers, advocates,
oncologists
and technology professors
in the creation of the app.
Pragmatic research
by its nature implies
trade-offs, so you learn
that some things--
you learn some things,
you can gather some data,
some metrics, but it's not
like a randomized,
controlled trial.
You're not getting the same kind
of information.
Not all the functions
and the capabilities
of the app were available to us.
So with that, let's take a look
at the app itself.
I spoke about our collaborators,
and again we wanted
to recognize them in the app.
This is an information page
on the app.
Once the user downloads the app
from the Apple app store,
it opens to a disclaimer page
and the user has to agree
to the terms of use, privacy
and security to go forward.
Then they never see
that page again,
but they can find information
on it again on the iPage.
Building healthy survivorship
really did take a village.
We engaged with a great number
of collaborators,
both in developing
as we continue
to disseminate the AYA app.
I think that all
of these groups deserve,
and continue
to deserve a lot of credit.
Many of their materials were
used throughout the app.
This is the homepage,
the screen shot of the homepage
if you will of the app.
So it shows the iPhone
functions, (entro) and health,
which kind of gives the user
guidance on how to use the app,
the survivorship assessment,
screening and late effects,
survivorship planning tools
and tips and community.
We've spent a lot of time
on the look and the feel
of the app.
We really wanted
to have a clean, modern image.
Our advisory groups weighed
in on almost every element,
what the functions would be,
what the icon looked like,
what colors were used.
We really wanted the assessment
questions to be user friendly,
unlike some
of the health assessments
that you might see in a hospital
or any kind of clinic.
We want it to be something
that the users would actually
engage in and think about.
We built the app
in about 80 days.
For the most part,
we would build one section
at a time, send it out, test it,
play with it, us it,
make adjustments,
and then go
onto the next section.
I think that my having a
software development background
helped immensely, and being able
to make the trade-offs
and negotiate among what the AYA
survivors told us they wanted,
what the advisors
and oncologists thought we
should do, the opinions
and suggestions
of the graphic designer,
and the technology co-developers
who worked with us.
It was constant conversation.
I'm going to skip this one
and come back to it.
So these are some screen shots
of three of the app areas.
The health assessment,
you'll notice
that there are different icons
in the upper corner.
So there was an icon
for well being,
there was an icon
for healthy habits,
one for healthy diet
and physical activity.
Healthy habits,
we consider things
like not smoking,
not binge drinking;
achieving energy balance,
things like that.
In the healthy diet connection
and healthy diet group
of questions, I think there are
about 27-30 questions overall.
We provided a BMI calculator.
As an example of the kind
of discussions we had,
the technology group wanted
to show a little figure
in the results that would shrink
or swell based
on the user's BMI.
So if the user had a high BMI,
well it'd kind of look
like the Michelin Man.
We didn't think
that was quite user appropriate.
So what we ended
up with was just a scale showing
the different ranges of BMI
and the weight status.
Actually, this is one
of the more popular--
from feedback we've heard
that this is one
of the more popular areas
of the assessment.
The individual's assessment
history itself--
so these are the opening page,
and then the final assessment
score on the right;
the app keeps the very first
assessment the user makes,
the most recent one
and then the current assessment.
So three different scores are
available at all times once the
user starts.
It allows the users the ability
to track improvements
or changes over time.
There's a score--
if you look at the--
on the right hand side you'll
see on the bottom their scores
for each of the areas.
Then those are kind
of combined together
in an algorithm
that provides the user
with an overall assessment
of their healthy survivorship.
Following their assessment,
they get a page
of tips and kudos.
Again, this is
where we began working more
with the whole idea
of mobile persuasion providing
tips and information
to drive change
or to encourage change.
The algorithm that works
with the tools
and the information
in the assessment also drives a
tailored tip and kudos.
So in this one the tip is
related to changing one's diet
and eating more healthy fruits
and vegetables.
The kudos is based on something
that the user did well
or had a higher score in.
So the tips
and kudos are again examples
of building on the theory
and the evidence
to make the app a driver
of health behavior change
and mobile persuasion.
Additionally,
the user can choose or can agree
to be delivered
with a daily phone set.
These pop up on the phone one
time a day.
They're in each of the areas,
well-being, physical activity,
diet and nutrition.
They're kind
of in your hand reminders tips
of things the users can do.
This is about using fat
free milk.
There's also one
on using the stairs,
which I find is
very influential.
This gives you the example
of really one--
what I believe is one
of the most powerful aspects
in functionality and health.
The phone's in your hand,
it's in your purse or pocket,
these reminders can come to you
in a moment,
and actually may change
or influence behavior change.
Actually, this was another area
where our users gave us
valuable feedback.
The tips used
to be delivered at 11 pm.
One of the users
in the advisory group called,
and asked me
if we could make a change
to the time of delivery
of the daily tip.
I said sure, what time
and by the way why do you want
it to change?
She said, he slept
with his phone
and the tip woke him up,
and it pings whenever it was
delivered, and he felt he just
had to pick it up
and look at it.
So we knew they were using them.
Now, this is--
I skipped this earlier,
but I want to come back to it,
I mentioned how important
and how critical the late
effects are
for cancer survivors,
and many of them have almost a
PTSD syndrome
where they constantly think
that there's something wrong
with them, that the cancer is
going to reoccur.
This is not unusual
for cancer survivors.
This area of the app has two
functions; one is
routine screenings.
Again, these came
from the documents
of the cancer--
the children's oncology group.
They are the evidence-based
guidelines for AYA screening.
For example,
female AYAs who had mental
or chest area radiation have a
startling high incidence
of breast cancer
as a second cancer.
They need to be screened eight
years after treatment
or at age 25,
whichever is later.
They may not know this.
So again, this was an
educational aspect.
Eventually the children's
oncology group generously
allowed us the use
of their help links.
Here, it's probably kind of hard
to see, but the help links are
easily accessed (pedia).
They're kind of one-page briefs,
written in very plain language
on a variety of late effects
that may be experienced by AYAs.
Many of these are available
in both English and Spanish.
Again, the ability
to disseminate
and communicate these broadly
to this audience was really a
very, very important thing.
We are so enormously grateful
to the children's oncology group
for allowing us
to put these directly
into the hands of the AYAs.
The other element,
one of the other functions
with the app is encourage the
survivors to develop their own
survivorship plan.
Actually, this is an area that's
being updated
in the next few weeks.
We originally planned
for the survivors
to use a cloud-based database
to login and create their
survivorship plans,
but our concerns
for HIPPA compliance
and Texas-specific legislations,
and concerns for privacy
and security changed our minds.
Now what we do is we provide
links to both the Live Strong
and the Journey Forward plans.
So, this is a screen shot
from Live Strong,
which they can link directly to,
or they can link directly
to survivorship care plans
by Journey Forward.
We also wanted
to have a community.
Again, this is based
on social behavior theory,
for them to respond to.
We thought about at first
creating a private social
network, but in the end it is
like using Facebook.
So the users have a Facebook
page they can go to
and they share information
on the app and on other things.
Our current utilization,
remember that I had said
with the app being native it's
only so much information
that you actually get
from the (unintelligible).
It's slim.
This is a snapshot
of current utilization.
We have 650 users.
Fifty-three users
have downloaded.
I hope we have more after today.
Sixty-six percent
of them use the assessment.
Users take an assessment
on the average 2.12 times.
Some of them take it a lot more;
some of them take it,
never go back to it.
The average user visits the app
about 2.87 times.
So, kind of in summary,
the AYA app is really an example
I think of pragmatic research,
and it's an intervention
that applies evidence-based
functions, and applies a number
of health behavior change
theories in trying
to provide increased health
related quality of life
for AYA survivors.
We're continuing
to explore communication
and dissemination of the app
with our partners
and collaborators,
including a number
of advocacy groups and nurses
in AYA clinics.
Our app is a hybrid,
and we can continue
to explore building hybrids,
but kind of in a reversal.
We're now building light
versions of the apps
with the main elements
and functionality to be kept
in databases.
So we actually can have more
access to the information,
kind of lessons and learned
and next steps for us.
You need to plan
for ongoing maintenance
and updates.
Apps aren't a build once
and forget about it.
There's always something
that needs to be improved
or updated.
You want to keep it fresh
and add new functions
to engage the users.
Given this, it's important
to choose your technology
partner wisely.
It's also a good idea
to keep your own copy
of the code
so that you can change
or adapt the app
if for some reason you need
to find a new
technology partner.
As I suggested there is kind
of a lack of data
for researchers
from the native apps or apps
that run on the phone,
which is why we're advising our
health behavior researchers
and those who want
to create apps to look
at hybrid models
that include some lightweight
apps that can be marketed
and downloaded
on the iPhone app store
and the Android
(unintelligible) Plus.
This also provides
for greater security and privacy
of data in case the user loses
his phone.
In talking about where we're
going, in the meantime
since AYA was developed,
we developed two additional apps
for cancer survivors using
geographic information
technology or GIS.
I can fit is a research project
that encourages goal setting
and provides a GIS locator
for healthy places
for physical activity.
The (unintelligible) locator,
which was developed
for life beyond cancer
foundation,
is an interactive mobile map
for non-clinical resources.
We're also beginning to look
at sensors and using sensors
and GIS together.
I think that (unintelligible)
have great potential
for health behavior change,
and we think it kind
of gives us a brave new world.
I hope that all
of you are considering it,
pursue them,
and I'll always be glad
to provide any guidance or help
that I can.
That concludes my presentation.
So what I'd
like to do now is turn the
slides over to Dr. Versie
Johnson-Mallard
from the University
of South Florida.
Versie? Versie Johnson-Mallard:
(Debra) thank you so much.
That is such an exciting
and useful technology.
Please allow me
to introduce myself again.
I'm Versie Johnson-Mallard.
I bring to you greetings
from the University
of South Florida
and our (unintelligible)
(Diane Morresett-Beatty).
I have no conflicts to share.
I'm going to spend a few minutes
talking about technology,
specifically second life
that I've used to--
as a virtual environment
to increase knowledge
around HPV.
HPV is strongly linked
to cervical cancer,
and we'll talk a little bit
about this just briefly.
We know that HPV is a virus,
with that being said,
there's no cure.
What we do know is
that HPV is strongly linked,
and HPV high-risk strains are
strongly linked to cervical,
***, oral and *** cancer.
We're learning more
and more every day
about orthogonal cancer.
We also know that it's linked
to genital warts.
We do have prophylactic
vaccines, Bivalent
and Quadrivalent vaccines.
The Bivalent vaccine is actually
marketed as an orthogenic
vaccine, not licensed for men.
The Quadrivalent vaccine is
marketed as orthogenic
and wart prevention
that is marketed for men
and both women.
While we're here today is
to talk about second life,
and how this internet-based
application plays a role
in cancer prevention,
specifically the sequel of HPV.
Well, there's 20 million users
of second life as of today,
20 million or more.
Among those 20 million each one
has a unique avatar.
Avatars are digital personas
in which-- once they enter the
3D world, they can become an
animal, the can stay a person,
a female can become a male,
ethnicity, gender,
anything that you can image can
be changed within your personal
persona, which works well for me
because my population was
college students.
My hope is that for them to take
on a different persona
that was actually made them
comfortable moving
around within this environment
to learn about this viral STI.
The great thing is
that the Internet is everywhere
and anywhere.
You can be at a park,
you can be at coffee shop,
you can be in your own bedroom.
When we're talking
about this platform,
sexually transmitted infections
are a private matter.
So wherever you want
to gain this information,
increase your knowledge,
it's that person's call.
It's real time.
Second life is real time.
It also allowed me
to get real time information
and immediate response
from my study participants
as they move
through this first pilot test.
So again just a little bit
about the sample, the majority
of them were females
within their second year
of college.
Again, this is just a depiction
of some of the personal personas
that the college students took
on while they were
in this virtual world.
Here you can see,
this is when you first come
into second life and go
into our island,
this is the entrance
into our platform.
Before you could actually enter
this, because it was a study,
a research study,
I did provide a disclosure.
As you can read here,
we talked about stages
of diseases, and we talked
about several different
viral STIs.
Today we're going
to focus on HPV.
So before the study participant
can enter this 3D world,
they had to read and accept
that Not everyone is familiar
with second life,
and how to manipulate
your avatar.
Again, there was a video
that was embedded
into second life
so that the study participants
could learn to walk,
and learn to fly
around in second life.
Putting one foot in front
of the other is not that easy
in second life
if you do not have some
experience with it.
So within that this video was
embedded and it could go
forward, fast-forward through it
or repeat any sections
that they felt the need to,
to learn how to use the avatar
within this world.
Once they entered the world,
there was one entrance
and one exit.
The 3D world was set
up like a maze.
So as they move
through it there were invisible
sensors there.
I use the sensors
to capture my data.
I could tell how long they would
stay at certain teaching areas
or teaching platforms
within this.
There were educational boards.
Once they interacted
with these boards, walked away,
within 10 seconds there was a
timer that would re-close--
that would recover the boards
so the next person came through.
For example,
this is what I call an
HPV patch.
So within this HPV patch the
minute (Inga) lands there,
the sensor senses her
and provides me with information
such as how long she's--
how much time did she spend
walking around this patch
looking at genital warts
on the pupas of a ***
or within the ***?
Then as you look up,
which you can't really see,
but depicted here,
again more information.
That is (Inga) wanted
to support what she was seeing,
there was more visual
information there.
As long as (Inga) was there the
timers captured how long she
was there.
This is another example
of an information board.
This board actually showed
external genital warts from mild
to severe on the ***
of a female.
Then when whomever was there,
once they walked away,
this board was automatically
become covered again
in ten seconds.
So it was more than just kind
of walking around
and then reading information.
We attempted
to also make it interesting
and find ways
to make it stimulating.
So this is a simulation,
first it starts off
with just kind
of giving them information
about the external warts.
Then it gives instructions
to walk into the simulation.
It makes it clear to walk
into the simulation of a ***.
Once they reach the end
of this ***
that there's a ***
with different stages,
moderate to mild dysplasia.
So the avatar again will enter
this vaginal canal.
Then they would end
up facing the *** here.
So the time
and the minute they entered the
canal, the timer started
and I would then allow them
to have the ability
to capture how long they stayed
and viewed this
cervical dysplasia.
Here's another example again
where they were
more interactive.
So as they moved around,
again this was a maze
so they couldn't skip any part
of it.
They move from one area
to the other.
At a minimum they had to touch
or interact
with whatever's there
for seconds or minutes,
however the timer was before
they could move
onto the next section.
Here they were instructed to--
they would tap here with HPV.
Then they would try to match HPV
with cervical cancer,
or hepatitis B with jaundice.
Each time they did this matching
correctly, they earn points
or their scores increase.
This was again a test
of their knowledge
about viral STIs.
Not only did I get the
(unintelligible) back
to the correct number they got
correct, but also the time
that they spent there,
and if they came back
to manipulate that.
This was research study.
This was the second part
to a first--
there was a first part
where there was a
research study.
Then the control groups were
invited to enter this
pilot study.
I don't expect
that you can read this,
but this is just a process flow
as to how that research
study went.
So there was (Belinda)
who was a research assistant,
would get the emails
of these participants.
The participants then would be
emailed a URL.
This URL was a token,
in second life we use the
term token.
So once they received these
tokens they could go in,
register within second life
and change their email
to something other
than their university email,
and then this email was not
tracked with their avatar.
The avatar that they created is
now their avatar going forth
and forever.
Then they would get the token,
and once they received the
token, created the avatar,
they were now allowed to enter,
and make sure
that it was again clear,
they would receive an adult
consent form informing them
that they were now agreeing
to become part
of a research study.
That's kind
of how the process went.
Again, this was just a process
flow to kind
of give you an idea how
this works.
Now, the programming,
none of this can be possible
without a strong team.
So the programmer (Lissa) and I,
we used live survey,
and live survey it's a free,
open-source online survey,
in which we use.
This provided the adult
participants the adult
consent form.
Then we also use (Moodle).
(Moodle) is
where the study participants,
once they've chosen an avatar
and named that avatar,
all of that information was
stored there and matched
with their email address.
So that was kind of the way.
Again, this was a
pre-test/post-test study,
so we needed a way to follow
that through.
We had to restrict access
to this because second life is a
virtual open world.
Our island,
we restricted it to--
the only way you could get
to our island was
that once you receive
that token,
then that token allowed you
to enter our island,
so that our data was not skewed
in any way.
This type of research,
this type of platform does
require high-speed Internet,
and Web hosting.
I've shared with you
that my sequel and PHP was used
as a Web hosting
supporting browsers.
There are many, from Firefox
to MS Internet Explorer.
The later the software the
better this seems to run.
Budget. So in order
to capture this
and to maintain it we rented an
island, a new island eight.
We rented this island for--
this study was 12 months
in length.
It costs us 1,100 dollars
to rent this island,
which is about 1000
U.S. dollars.
The programmer I hired
and the researchers I hired
as OPS, hourly wage.
The programmers used her
instructional design along
with my health care background
to create the games,
the platforms.
I knew what I wanted.
She knew how to make
that happen in design.
Each and everything that you saw
in this platform took time.
It wasn't like you could take
wallpaper and kind
of just put it up.
Everything that instructional
designer actually built.
So she set up the domain,
did the configurations,
build and exhibited it,
and then she hosted it the
entire time
that we were running this study.
So as part of the--
at the end again you see another
token to exit it.
At that point they would email
the survey,
and the survey results
with this pilot study provided
me with useful information
in the sense that the majority
of the participants had no
experience with second life,
but again about more
than 40 percent of them said
that they found this type
of platform
for research very useful.
Quickly, the next steps,
I would like to now move
from a pilot study
to a feasibility study.
This study was A-synchronized.
I would like to use this
amphitheater here to build a--
if you can imagine it,
it can happen.
So I imagine making this more
of a synchronized session,
much like we're doing today,
a set date, a set topic
and invite the avatars,
these personas to join the topic
and dialogue real time
with questions and answers
and an information session.
So that's the next step
for second life and how I plan
to use this as a research study.
Nothing happens alone.
Nothing happens
on our island by itself.
This is the research group
that I-- this is the research
team that I had the pleasure
of working with.
(Lissa) is the programmer
with (Belinda) being the
research assistant
and my research team there.
None of this would have been
possible without the funding
of the rebel,
which (unintelligible)
scholars program.
So with that said,
I will turn it over to (Sara),
and we'll open it
up for questions.
Thank you.