>> WELCOME TO THE THIRD ADA LOVELACE LECTURE AT THE NATIONAL LIBRARY OF MEDICINE SPONSORED BY THE INTRAMURAL RESEARCH PROGRAM HERE AT THE NATIONAL LIBRARY OF MEDICINE. I'M DAVID [INDISCERNIBLE] AND I WILL INTRODUCE THE SERIOUS AND THEN FLORENCE WILL INTRODUCE THE SPEAKER. JUST A LITTLE BIT OF A HISTORY HERE ABOUT THE SPEAKER WAS SCHEDULED ACTUALLY TO GIVE HER TALK IN MARCH AS THE FIRST OF THE ADA LOVELACE LECTURES AND UNFORTUNATELY WE GOT HIT BY THE COVID PANDEMIC AND DELAYED IT WITH THE INTENTION MUCH HER BEING HERE AT THE NIH HERE IN BETHESDA AND BEING IN-PERSON FIRST LECT AND YOU ARE WE DECIDED TO CHANGE THAT AND SUE GRACIOUSLY ACCEPTED THE TALK ONLINE TODAY. SO WE'RE HAPPY TO HAVE--TO LET ME INTRODUCE THAT IF YOU WONDERED WHY WE CHOSE ADA LOVELACE, IF YOU LOOK IT UP IN THE ENCYCLOPEDIA BRITANNICCA, YOU FIND THAT ADA LOVELACE, ORIGINAL NAME WAS AUGUSTA ADA BYRON, LADY BYRON, BORN DECEMBER 1815 IN PICADILLY, IN LONDON, AS IT GREW IT BECAME CALLED LONDON AND SHE DIED IN 1852 IN [INDISCERNIBLE] LONDON, SHE WAS A ENGLISH MATHEMATICIAN ASSOCIATE WIDE CHARLD BABBAGE, SHE CREATED A PROGRAM. SHE HAS BEEN CALLED THE FIRST COMPUTER PROGRAMMER SO AFTER ADA LOVELAS PINTAS WAS 60 YEARS OLD WHEN HE PASSED BUT SHE CHES THOUGHT FOR BEING THE FIRST COMPUTER PROGRAMMER AND FIND THIS A REMARKABLE ACHIEVEMENT AND I QUOTE AGAIN, ADA LOVELACE DISCOVERED THAT A COMPUTER COULD FOLLOW A SEQUENCE OF INSTRUCTIONS, A PROGRAM AND IN HER WRITING ABOUT CHARLES BACK O BABBAGES COMPUTER SHE SHOWED THAT THE COMPUTER COULD TELL A SERIES OF STEPS TO MAKE COMPLEX CALCULATIONS AND SHE SPECULATED THAT SUCH PROGRAMS COULD WORK WITH OTHER THINGS BESIDES NUMBERS. I CAN HEAR ALL OF YOU AI PEOPLE AND MACHINE LEARNING PEOPLE CHUCKLING RIGHT NOW. SHE CERTAINLY WAS A VERY EARLY PROFIT OF THE COMPUTER AGE. SHE MARRIED IN 1838 AND BECAMELET COUNTIES OF LOVELACE WHICH HER HUSBAND WAS CREATED [INDISCERNIBLE] ADA LOVELACE WAS THE DAUGHTER OF ANABELLA BYRON AND LORD BYRON WHO WERE LEGALLY SEPARATED 2 MONTHS AFTER SHE WAS BORN AND SHE NEVER SAW HIM AGAIN. WHY DO I MENTION THIS BECAUSE I THINK THAT ANNA BELLA MUST HAVE BEEN AN EXTRAORDINARY MOTHER, SHE COACHED HER DAUGHTER ON A VARIETY OF CHALLENGING TOPICS AND MANAGED TO OBTAIN FOR HER SEVERAL TUTORS IN MATHEMATICS INCLUDING AUGUST CANNED WHAT. I THINK ANNA BELLA WAS WAY AHEAD OF HER TIME AND INVITING HER DAUGHTER DOMINATED BY MEN, EVEN IN 2020 TODAY, THIS IS A MAJOR LESSON TO BE LEARNED. ENCOURAGE YOUR DAUGHTERS AND SONS IN STEM AT EARLY LEVELS ESPECIALLY EARLY ON, EVEN ELEMENTARY SCHOOL. ADA THE PROGRAMMING LANGUAGE WAS NAMED FROM--ON WHICH THE ENGINEERING AND MATHEMATICS I SUGGEST, WE DID HAVE AN ADA LOVELACE LECTURE ON THAT OF OCTOBER 2020 PARTICULARLY THE NAME FOR THIS LECTURE SERIES WAS SUGGESTED BY [INDISCERNIBLE] COMPUTER TESTIFIES AT NCBIs COMPUTATIONAL BIOLOGY BRANCH AND INTRAMURAL RESEARCH PROGRAM FURTHER MORE NLM HAS SEVERAL ONGOING SPEAKER SERIES IN COMP OWITATIONAL BIOLOGY AND RELATED AREAS. ADA LOVE LACE LECTURE SERIES WILL BRING THIS TOGETHER AND EMPHASIS NLM'S RESEARCH FOCUS ON COMPUTATIONAL RESEARCH INFORMATION AS A MEANS TOWARDS IMPROVED HEALTH AND BETTER UNDERSTANDING OF BIOLOGY AND MEDICINE. THIS WILL INTERWEAVE RESEARCHERS AT THE NLM INTRAMURAL RESEARCH PROGRAM WITH THOSE IN EXTRAMURAL PROGRAMS AS WELL AS THE BROADER NIH RESEARCH COMMUNITY. I LOOK FORWARD TO TODAY'S SPEAKER SUE BAKKEN WHO WILL BE INTRODUCED BY VALENTINEDRY FLORENCE. I JUST WANT TO ADD IN THAT YOU CAN POP QUESTIONS INTO THE E-MAIL THAT BECAME PART OF THE--IS THAT ON THE--NO IT'S NOT ON THE SLIDE. BUT THERE'S AN E-MAIL ADDRESS THAT WAS ON THE INVITATION TO THE--TO ATTEND THIS LECTURE AND YOU CAN SEND E-MAILS TO THAT ADDRESS AND I WILL READ THEM TO SUE AT THE END OF TODAY'S LECTURE. SO VALERIE PLEASE INTRODUCE THE SPEAKER. >> THANK YOU DAVID. AND I AM VALERIE FLORENCE, I HEAD UP THE EXTRAMURAL PROGRAMS AT NLM AND I HAVE THE HONOR OF INTRODUCING OUR ADA LOVELACE LECTURE. DR. SUZANNE BAKKEN, DR. BAKKEN IS THE NURSING AND BIOMEDICAL PROFESSOR AT COLUMBIA UNIVERSITY, SHE COMPLETED POST DOCTORAL FELLOWSHIP IN MEDICAL INFORMATICS AT STAND FORD UNIVERSITY, 1 OF NLM'S INFORMATICS TRAINING PROGRAMS I AM HAPPY TO SAY, FOR MORE THAN 30 YEARS, HER PROGRAM OF RESEARCH HAS FOCUSED ON THE INTERSECTION OF INFORMATICS AND HEALTH EQUITY. AT COLUMBIA NURSING SHE LEADS PRECISION AND SYMPTOM SELF-MANAGEMENT CENTER IN REDUCING HEALTH DISPARITIES THROUGH INFORMATICS PREAND POST DOCTORAL TRAINING PROGRAM, BOTH FUNDED BY THE NATIONAL INSTITUTE OF NURSING RESEARCH DR. BAKKENE HAS WRITTEN ABOUT 300 PAPERS AND SUPPORTED BY A NUMBER OF AGENCIES AND YOU HEARD NINR, THE AGENCY FOR HEALTHCARE RESEARCH AND QUALITY. NATIONAL INSTITUTE OF MENTAL HEALTH, NATIONAL CANCER INSTITUTE, AND THE NATIONAL LIBRARY OF MEDICINE. SHE'S ALSO INCLUDED THE AWARD FROM THE AMERICAN INFORMATICS ASSOCIATION, MOST RECENTLY THE FIRST NURSERY RECIPIENT OF THE [INDISCERNIBLE] AWARD FROM THE INTERNATIONAL MEDICAL INFORMATICS ASSOCIATION. SHE'S A FELLOW OF THE AMERICAN ACOOED ME OF NURSING THE MEDICAL COLLEGE OF INFORMATICS, THE NATIONAL AKD--SALLY ME OF HEALTH SCIENCES INFORMATICS AND A MEMBER OF THE NATIONAL ACADEMY OF MEDICINE. SHE CURRENTLY SERVES AS EDITOR IN CHIEF OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION AND IS A MEMBER OF THE BOARD OF REEJENTENTENTS AT THE NATIONAL LIBRARY OF MEDICINE FOR WHICH WE ARE GRATEFUL. SO THE TITLE OF DR. BAKKEN'S TALK TODAY AND IMPLICATIONS OF POETICAL SCIENCE FOR ADVANCING HEALTH EQUITY THROUGH INFORMATION VISUALIZATION, RELATES TO THIS NOTION THAT ADA LOVELACE DEVELOPED OF POLITICAL SCIENCE WHICH EMPHASIZED THE IMPORTANCE OF INTUITION AND IMAGE IN MATHEMATICS AND SCIENCE. IN HER TALK, SHE WILL USE THE LENS OF SCIENCE TO DESCRIBE THE PROGRAM OF RESEARCH FOCUSED ON ADMIN RECORDS AND VANCEING HEALTH EQUITY OF URBAN LATINOS THROUGH THE USE OF INFORMATION VISUALIZATION. THIS WILL INCLUDE INTEGRATING PERSPECTIVES FROM THE FIELDS OF HEALTH EQUITY, NURSING SCIENCE, HEALTH LITERACY, HEALTH COMMUNICATION AND INFORMATION VISUALIZATION. DOCTOR BAKKEN, WELCOME, WE ARE EXCITED TO HEAR YOUR PRESENTATION, THE FLOOR IS YOURS SO TO SPEAK. >> THANK YOU SO MUCH, THANKS TO DOCTORS FLORENCE FOR THIS INVITATION AND I'M ALSO VERY PLEASED TO SEE IF I WAS NOMINATED BY SOME OF THE SCIENTISTS IN THE INTRAMURAL RESEARCH DIVISION AT THE NNLM. I WILL START OWF AND I WILL WEAVE A FEW THINGS ABOUT--WOMAN, AND I HAVE OUR PICTURES NEXT TO EACH OTHER FROM OUR EARLY YEARS, I THINK IN MY PICTURE I'M PROBABLY ABOUT 5 YEARS OLDER THAN ADA WAS IN HER PORTRAIT AND I'M THINKING WHAT DO THESE WOMEN--2 WOMEN POSSIBLY HAVE IN COMMON BECAUSE UNLIKE ADA I'M NOT A MATH GENIUS AND I'M ALSO NOT A COMPUTER PROGRAMMER, WELL, WE'RE BOTH WEARING INTERESTING THINGS ON OUR HEAD, ADA AS DAVID MENTIONED WAS THE DAUGHTER OF LORD BRIAN BUT SHE NEVER REALLY KNEW HIM BUT 1 OF THE THINGS ABOUT HER REMARKABLE MOTHER WHO WAS ALSO QUITE TALENTED IN PATH IS 1 OF THE REASONS SHE ENDED UP PUSHING ADA TOWARDS MATH AND SCIENCE IS BECAUSE SHE DIDN'T WANT HER TO BE AS CRAZY AS HER FATHER AND SHE REALLY FELT LIKE ART WAS BAD AND SHE REALLY WANTED HER DAUGHTER TO EXCEL IN MATH AND SCIENCE. AND SO SHE HIRED TUTORS TO DO THAT. I WAS BORN IN NORTH DAKOTA FROM SMALL TOWN PEOPLE, SOMEWHAT RURAL UPBRINGING AMONG THE FARMING COMMUNITIES AND OIL WELLS OF THE NORTH DAKOTA. AND 1 OF THE THINGS THOUGH, I WANTED TO PARTICULARLY MINGZ WAS NOT SO MUCH MY--MENTION WAS NOT SO MUCH MY PERSONAL FAMILY BUT IN THE FAMILY OF DISCIPLINES, AND PARTICULARLY INTERESTING QUOTE FOR FLORENCE NIGHTINGALE, SO NEVER LOSE AN OPPORTUNITY FOR URGING OF A PRACTICAL BEGINNING HOWEVER SMALL, WOBDERFUL AND OFTEN IN SUCH MATTERS THE MUSTARD SEED GERMINATES IN GREATNESS ITSELF. BECAUSE I THINK A LOT OF WHAT YOU WILL SEE THROUGHOUT MY TALK IS THERE'S A LOT OF JUST KIND OF GET PRACTICAL AND DO IT. AS I WAS--I READ SEVERAL BOOKS ABOUT ADA LOVELACE IN PREPARATION FOR THIS TALK TO TRY TO UNDERSTAND WHERE SHE WAS COMING FROM AND WHERE THERE MIGHT BE SOME COMMON GROUND. AND I THINK ALONG WITH MANY SCIENTISTS I THINK WE PROBABLY, MOST OF US RESONATE WITH THE FOLKS WITH HER, I NEVER SATISFIED ANYTHING BECAUSE I'M JUST UNDERSTAND IT WELL AS I MAY, MY COMPREHENSIVE CAN ONLY BE [INDISCERNIBLE] THAT I WANT TO UNDERSTAND. AND SO I GUESS THE OTHER THING I SHARE WITH ADA IS WE BOTH WERE [INDISCERNIBLE] BECAUSE OF MY RURAL LOCATION AND SHE WAS BORN A FEW YEARS BEFORE ME. BUT WE HAVE IN COMMON THAT WE WERE--WE WERE BOOK WORMS. BUT 1 OF THE THINGS THAT SHE DID VERY OFTEN AND THIS COMES TO THE IDEA ABOUT THE IMPORTANCE OF OBSERVATION WHICH WAS TRUE FOR HER THROUGHOUT THE YEAR AND SHE WAS AN ACUTE OBSERVER AND THEN SHE WOULD TRY THINGS OUT AND IN PARTICULAR EARLY ON SHE WAS BOUND AND DETERMINED TO CREATE A FLYING MACHINE BASED ON HER OBSERVATIONS OF BIRDS AND WAS CREATING--ATTEMPTING TO FLY BY JUMPING OFF THE ROOF AND TRY TO DO THOSE KINDS OF THINGS [INDISCERNIBLE]. HER FAMILY RESOURCES AND HER MOTHER KIND OF BEGUN TO HIRE TUTORS THAT WOULD STRETCH ADA IN BOTH MATH AND SCIENCE. FOR ME, IT WAS MAINLY THE CATHOLIC NUN WHO IS GIVE YOU A SLAP ON THE HAND WITH THE RULER IF YOU--IF YOU WEREN'T PERFORMING AS EXPECTED ALONG THE WAY. WHERE I--IN MY READINGS WHERE I BEGAN TO SEE POTENTIALLY SOME COMMON GROUND WAS IN HER NOTION OF POETICAL SCIENCE AND 1 OF THE BIG THINGS, THE NOTIONS IS REALLY BACK, THE DIVISION BETWEEN SCIENCE AND ART IS ARTIFICIAL AND SHE DIDN'T BELIEVE THAT TO BE TRUE AND POETICAL SCIENCE EMPHASIZES THE IMPORTANCE OF INTUITION AND IMAGE AND MATHEMATICS AND SCIENCE AND I WILL SAY I AM USING HER WORD INTUITION ALTHOUGH I ACTUALLY AM MORE INCLINED TO CALL IT INCREDIBLY FAST INFORMATION PROCESSING, THAT APPEARS TO BE INTUITION AND 3--OBSERVATION, IMPORTANCE OF INTERPRETATION AND THE IMPORTANCE OF INTEGRATION, SO I WANT TO TALK ABOUT EACH OF THOSE THINGS A BIT, DR. LANSMAN IN HIS INTRODUCTION OF THE SERIES MENTIONED THE BABBAGE'S ANALYTICAL MACHINE AND SO HERE'S A PICTURE OF IT. AND THEN NEXT TO IT, IS A PICTURE OF THE JAKAR WEAVING MACHINE, THIS IS SOMETHING SHE OBSERVED WITH--ACTUALLY WITH CHARLES BABBAGE ON A FIELD TRIP AND SO WE FIRST WERE--THERE WERE INSTRUCTIONS ON PUNCH CARDS THAT WOULD RELAY THE PATTERN OF THE TAPESTRY THAT WAS BEING WOVEN AND SO WHAT SHE DID WAS REALLY ABSTRACT AND THEN APPLY THAT IDEA TO THE ANALYTICAL MACHINE AND BABBAGES EARLIER WORK THAT THE DIFFERENCE MACHINE WAS A MORE SINGLE PURPOSE COMPUTATION AND SHE REALLY WAS THE 1 THAT SAW A MUCH BROADER USE OF SOMETHING LIKE THIS AND IN PARTICULAR SHE REALLY THOUGHT ABOUT THE ANALYTERAL MACHINE AS THE WEAVING OF ALGERONTOLOGYSTS BRIANA MAHONNIC EQUATIONS, SO THAT'S AN EXAMPLE OF TAKING AN IDEA FROM OBSERVATION AND THERE WAS A RECENT ACTUALLY A BLOG POST BY SOMEONE FROM OPERATIONS RESEARCH, THAT REALLY BROUGHT, ACTUALLY MADE THE LINK BETWEEN NURSING AND ADA LOVELACE AND IT WAS THROUGH FLORENCE NIGHTINGALE AND HER VERY FAMOUS DIAGRAM WHICH SOME PEOPLE WOULD CALL ROSE DIAGRAM AND OTHERS WOULD CALL A FAN DIAGRAM IN WHICH SHE TOOK NUMBERS AND CAME UP WITH VISUAL WAYS TO DISPLAY THEM IN A WAY THAT WAS MORE COMPREHENSIBLE AND ACCESSIBLE AND AFFECT THE DRIVE FOR DECISION MAKING. PARTICULARLY BECAUSE I WAS NOMINATED FOR THIS TALK, BY SOME JUNIOR SCIENTISTS, I WANTED TO JUST START OUT WITH SOME EXAMPLES [INDISCERNIBLE] FOR KEY OBSERVATION IN MY EARLY CAREER AND SO I START WITH INTEGRATING ASPECTS OF A SCIENCE FROM HEALTH EQUITY, NURSING SCIENCE ASK INFORMATICS AND THESE WERE MY, WHAT I CALL MY EARLY YEARS AT UNIVERSITY OF CALIFORNIA SAN FRANCISCO AND I DO POINT OUT PARTICULARLY A SMALL BUT VERY MEANINGFUL CONTRACT THAT I DID RECEIVE FROM THE NATIONAL LIBRARY OF MEDICINE AND IT WAS TO FACILITATE INFORMATION RETRIEVAL IN THE AREA OF HIV/AIDS AT CLYDE MEMORIAL CHURCH AND THIS WAS REALLY 1 OF MY FIRST STUDIES THAT INCLUDED DIRECT COMMUNITY ENGAGEMENT. AND SO THE--KIND OF THE LESSONS I'VE SUMMARIZED FROM THESE PARTICULAR YEARS WERE SOME OF THE EARLY RO1S REALLY FOCUSED ON THE IMPORTANCE OF REPRESENTING WHAT NURSES DO IN A COMPUTABLE MANNER. ALSO A KEY OBSERVATION AT THAT PERIOD OF TIME WAS REALLY STRESSING THE IMPORTANCE OF INFORMATION TECHNOLOGY AS AN EXTENSION OF NURSING PRACTICE, NOT A SEPARATE NURSING PRACTICE. AND THEN PARTICULARLY FROM THE WORK THAT THE GLIDE MEMORIAL CHURCH, IT WAS CLEAR THAT PEOPLE WITH POOR DIGITAL LITERACY AND MANY DISPARITIES RELATED TO WHAT WE NOW CALL SOCIAL DETERMINANTS OF HEALTH, ARE ABLE TO ACCESS IMTHE DIGITAL RESOURCES SUCH AS THOSE PRODUCED BY THE NLM WHICH WAS THE FOCUS OF THIS PARTICULAR PROGRAM, THAT THEY HAD SUFFICIENT TRAINING AND OUR INSTANCE THE TRAINING AND THE SUPPORT WAS FROM A NURSE COACH. IN WHAT I BEGIN TO CALL MY COLUMBIA YEARS, BEGINNING IN 2000, I CONTINUED WITH THAT HEALTH EQUITY NURSING SCIENCE AND INFORMATICS BUT BEGAN ADD ASPECTS OF HEALTH LITERACY AND HEALTH KEY IN A PATIENT INTO MY WORK AND THIS IS REPRESENTED BY A SERIES OF CENTERS, CENTER GRANDS, RO1S, OTHER GRANT MECHANISMS INCLUDING A RESOURCE GRANT OF THE NATIONAL LIBRARY OF MEDICINE. MY KIND OF KEY NRVEGZS FROM THIS PERIOD--GOALS WHEN I CAME TO A COLUMBIA AND I GUESS THEY WEREN'T VERY MODEST GOALS BUT WHEY WANTED TO DO WAS TO FIGURE OUT WHAT EVERY ADVANCED PRACTICE NURSE SHOULD KNOW ABOUT INFORMATICS AND FACILITATE THEIR INTEGRATION OF INFORMATICS TOOLS IN PRACTICE AND I WANTED TO BUILD A PREAND A POST DOCTORAL TRAINING PROGRAM THAT WOULD PREPARE NURSE SCIENTISTS AND WANTED VERY MODESTLY TO DO THAT AND I WAS VERY LUCKY THAT NINR INVESTED IN A NUMBER OF THESE IDEAS BUT PARTICULARLY THE LAST IDEA AND WE'RE IN YEAR 19, OF A CONTINUOUS FUNDING OF OUR T-32 FOCUSED ON REDUCING HEALTH DISPARITIES THROUGH INFORMATICS BUT KEY OBSERVATIONS AND LESSONS FROM THESE YEARS WAS REALLY THINKING ABOUT ADVANCED PRACTICE NURSES AS INTERVENTIONISTS TO DECREASE HEALTH DISPARITIES IN PRACTICE FOR THE ASSISTANCE AND INFORMATICS TOOLS. REALLY IT BECAME VERY CLEAR IN THE WORK WE WERE DOING THIS TIME INCLUDING DOING SOME MOBILE DECISION SUPPORT THAT HAD PATIENTS FACING ASPECT--AS SPECTS TO IT THAT IT WAS VERY IMPORTANT THAT WE PRODUCE HEALTH LIT RASE MODEL SKPE BAKUGAN SCHOOLS FOR PATIENT PROVIDER COMMUNICATION BUT ALSO DIRECTLY FOR PATIENT AND CONSUMER SELF-MANAGEMENT. DURING THIS PERIOD OF TIME, WE REALLY--THE WORK REALLY HIGHLIGHTED THE IDEA OF NURSE SCIENTISTS AND INTERDISCIPLINARY INFORMATICS TRAINING AS BEING DESIGNERS OF--DESIGNERS OF TOOLS AND REALLY THE CENTRAL TIT'VE USER CENTERED PARTICIPATORY DESIGN WAS MUCH MORE HIGHLIGHTED THAN IT HAS BEEN IN PREVIOUS ASPECTS. SOMETIMEs AS I MENTIONED EARLIER ABOUT THE GLIDE CONTRACT FROM NLM, SOMETIMES YOU HAVE--ARE INVOLVED IN SOMETHING RELATIVELY SMALL THAT CAN END UP HAVING A BIG IMPACT ON YOU AND THE WAY THAT YOUR SCIENCE IS MOVED. AND FOR ME, THIS WAS OUR--THIS WAS A CTSA SUPPLEMENT THEY WAS INVOLVED IN UPON AS A CO-INVESTIGATOR AND THIS IS WHERE WE STARTED TO SEE A LOT MORE PREDOMINANCE OF COMMUNITY ENGAGED RESEARCH AND SPECIFICALLY OUR COLUMBIA CTSA, IRVING INSTITUTE WAS FUNDED IN THE FIRST ROUND OF CTSAs AND THE FIRST SUPPLEMENT OFFERED WAS TRYING TO ADVANCE PRACTICE BASED RESEARCH NETWORKS PARTICULARLY COMMUNITY, WITH MIXED METHOD STUDY TO DETERMINE THE LEVEL OF INTEREST IN VARIOUS FACILITATORS TO PARTICIPATION IN CLINICAL RESEARCH IN OUR COMMUNITY OF WASHINGTON HEIGHTS INWOOD IN [INDISCERNIBLE]. AS PARTICIPANTS WE HAD CLINICIANS, COMMUNITY MEMBERS, COMMUNITY LEADERS INCLUDING POLICY MEMBERS, POLICY MAKERS, AND THE VERY IMPORTANT THING THAT I LEARNED FROM THIS WORK AND FROM THE COMMUNITY IS THAT RESEARCH STUDIES SHOULD ALWAYS DEMONSTRATE KEY MESSAGES TO 4 KEY AUDIENCES THAT WE JUST CAN'T TALK TO SCIENTISTS. SO OF COURSE WE WANT TO DO THE SCIENTIFIC DISSEMINATION ISSUE, BUT IT WAS ALSO IMPORTANT THAT THERE IS DISSEMINATION OF RELEVANCE TO CLINICIANS WHO PARTICIPATED IN THE RESEARCH BUT ALSO TO CLINICIANS IN GENERAL AND IT WAS VERY IMPORTANT TO MAKE SURE THAT RESEARCH PARTICIPANTS AND OTHER PATIENTS AND COMMUNITY MEMBERS UNDERSTOOD THAT THE KEY FINDINGS FROM THE RESEARCH THAT THEY PARTICIPATED IN AND THESE DAYS WITH ALL OF US IN PLACE, THIS DOESN'T SOUND LIKE MUCH OF A DISCOVERY, BUT THIS WAS ABOUT 7 YEARS BEFORE ALL OF US, SO, IT WAS A LITTLE BIT I WOULD SAY AHEAD OF ITS TIME AND ALSO IMPORTANTLY SHOULD ALSO BE THINKING ABOUT WHAT WE'RE--THE RESEARCH--THE LOCAL, REGIONAL, STATE AND NATIONAL POLICIES. SEE THE NUMBERS KIND OF ERA I WANT TO TALK ABOUT IS WHERE WE BEGIN TO SEE THE EMERGENCE OF IMAGE AND SO WHEN I THINK ABOUT THE DIFFERENT SCIENCES THAT WERE INTEGRATED IN THIS ASPECTS, THIS IS THE FIRST TIME IN WHAT I'VE BEEN TALKING ABOUT THAT YOU REALLY SEE INFORMATION DIGITALIZATION AND THIS WAS FACILITATED BY 2 OF OUR GRANTS THAT ARE LISTED HERE ON THIS SLIDES. AND THIS WAS THE BEGINNING OF REALLY SEEING THE EMERGENCE OF A NEED FOR VISUAL COMMUNICATION AND I WILL SAY MORE ABOUT VISUAL COMMUNICATION IN A MINUTE BUT THE BASIC IDEA OF THE FIRST GRANT OF WHICH I WILL CALL WISER, AND IT REALLY WAS THE BRAIN CHILD OF ADAM WILCOX AND I WAS WITH THE GRANT FROM THE BEGINNING AND THEN TOOK IT OVER ABOUT MIDWAY THROUGH AND WAS SBI AND ALSO THE PI, OF THE FOLLOW-ON GRANT BUT THE BASIC IDEA IS JUST IMAGINE THE FRAMINGHAM STUDY BUT DOING IT ENABLED BY INFORMATICS PROCESSES AND HEALTH INFORMATION TECHNOLOGY AND INSTEAD OF DOING IT IN FRAMINGHAM MASSACHUSETTS, DOING IT IN A COMMUNITY PRIMARILY LATINO WITH LOTS OF HEALTH DISPARITIES IN NEW YORK CITY BUT THE BASIC IDEA, AS YOU CAN SEE, THERE'S A PATIENT WHO HAS MANY DIFFERENT DATA SOURCES, SOME GENERATED BY THE VARIOUS CLINICIANS, THEY MAY SEE OVER THE COURSE OF IT THERE AT DIFFERENT POINTS IN TIME BUT ALSO MANY OF THEM MAY ALSO HAVE RESEARCH ENCOUNTERS THAT COULD BE SURVEYS, IT COULD BE TRIALS AND THERE ARE LOCAL DATABASES FOR THAT BUT THE IDEA WAS--THE BIG IDEA WAS TO PULL ALL THAT TOGETHER INTO A RESEARCH DATA WAREHOUSE AND BUILD A WAY FOR RESEARCHERS TO ACCESS THAT DATA. IT'S CALLED RESEARCH DATA EXPLORE AND THIS WOULD BE A MORE EFFICIENT WAY THAT INSTEAD OF HAVING A RESEARCHER GO THROUGH A DATA ACCESS EXPERT, THAT THE RESEARCHER WOULD BE ABLE TO DIRECTLY ACCESS DATA WITH APPROPRIATE IRB APPROVAL, ET CETERA. BUT WHAT WAS IMPORTANT WAS THE RESEARCHERS THIS WEREN'T ATTACHED TO THE WAREHOUSE AND THEY WERE SIMPLY DATA PROVIDERS AND THEY PARTICIPATE INDEED A SURVEYRIA RELATED TO OUR PROJECT AND I WANTED TO REALLY GIVE THE INDIVIDUAL RESEARCH PARTICIPANT THEIR DATA BACK, I THOUGHT IT WAS IMPORTANT TO BUILDING TRUST BETWEEN THE UNIVERSITY AND THE COMMUNITY. I THOUGHT IT WAS IMPORTANT FOR ENHANCING COMMUNITY MEMBERS OF SELF-MANAGEMENT SKILLS SO WE UNDERTOOTH THE JOURNEY TO DO THAT. AND SO, THE BACKGROUND FROM THIS IS WE HAD DOCUMENTED HEALTH DISPARITIES, BROAD DISPARITIES IN WASHINGTON AND INWOOD DESPITE HAVING COLUMBIA HOSPITAL RIGHT IN THE MIDST OF THE COMMUNITY. IN ADDITION TO THOSE ELECTRONIC DATA THAT WERE AVAILABLE THROUGH VARIOUS TYPES OF ELECTRONIC HEALTH RECORDS WE SURVEYED ABOUT 5800 PEOPLE IN THE COMMUNITY PRIMARILY LATINO, MORE THAN 85% OF THE OUR DATA COLLECTION WAS DONE IN SPANISH. WE USED COMMUNITY HEALTH WORKERS AND PROVIDED MEANINGFUL INCENTIVES FOR PARTICIPATING IN THE RESEARCH. WE KNEW FROM THE DATA COLLECTED THAT THE MAJORITY OF THOSE AND LIMITED HEALTH LIT RASE MODEL SKPE BAKUGAN ALSO LOW EDUCATIONAL--EDUCATION LEVELS. THEY ALSO HAD HIGH LEVELS OF HYPER TENSION WHICH WAS THE CLINICAL FOCUS OF PFIZER AND OTHER TYPES OF HEALTH DISPARITIES. SO, I WANT AT THIS POINT--AND IECIALIZATION FROM THIS, IT WAS REALLY TO THINK ABOUT THE DIFFERENCE BECAUSE MANY OF US IN INFORMATICS MAY DO VISUAL ANALYTICS BUT VISUALIZATION AND COMMUNICATION IS DIFFERENT FOR SEVERAL REASONS. OFTEN WE HAVE MORE MORE GBL RECIPIENTS OF COMMUNICATION, OR MORE GENERAL COMMUNICATION VERSUS WHEN WE'RE DOING VISUAL ANALYTICS WE OFTEN HAVE SPECIALIST USERS OF THE DESIGNS THAT WE PRODUCE. OFTEN WHEN WE'RE DOING VISUALIZATION FOR RESEARCH PARTICIPANTS OR FOR PATIENTS IN GENERAL OR COMMUNITY MEMBERS IN GENERAL. WE MAY NOT KNOW A LOT ABOUT USER GOALS AND DESIGNS WHERE IN VISUAL ANALYTICS THERE'S USUALLY INFORMATION WITH THAT IN TIME AND IMPORTANTLY VERY VISUAL ANALYTICS OFTEN YOUR USERS HAVE A HIGH LEVEL OF VISUAL LITERACY AND WHEN YOU'RE DOING VISUAL COMMUNICATION, YOU ARE IN A SITUATION WHERE THERE'S GOING TO BE VARYING LEVELS OF VISUAL LITERACY AND OFTEN IT CAN BE QUITE LOW, PARTICULARLY WHEN IT COMES TO GRAPH PRODUCING. AND SO IN THINKING ABOUT VISUAL COMMUNICATION IN GENERAL IT'S A CONVEYANCE OF IDEAS AND FORMS THAT CAN BE SEEN. FOR US IT WAS IMPORTANT THAT THERE WERE THESE ARK DITIONAL CHARACTERISTICS. WE NEEDED TO BE PRODUCING THINGS THAT COULD BE COMPREHENDED THAT ACCOUNTED BE ACTED ON FOR SELF-MANAGEMENT AND COMMUNICATION AND PROVIDED BY THOSE--BY INDIVIDUALS WITH VARYING LEVELS OF HEALTH LITERACY AND IT WAS CRITICAL TO THE PROJECT THAT WE DO THAT EVERYTHING HAD TO BE NOT ONLY IN ENGLISH BUT ALSO IN SPANISH. AND SO THIS GETS TO 1 OF THE REASONS WHY I PUT THAT PRACTICAL QUOTE UP FROM FLORENCE NIGHTINGALE AT THE BEGINNING OF THE TALK. HITHIS IDEA THAT I WANT TO GIVE THE DAILY BASIS THEA BACK TO MY COMMUNITY BECAUSE OF THE HEALTH LITERACY CONCERNS, I THOUGHT IT WAS IMPORTANT WE USE VISUALIZATION SO I JUST--I CAN BE IN A VISUALIZATION WORKING GROUP THAT WAS OPEN TO FACULTY AND TRAINING BEYOND OUR WISER TIME. INTERESTINGLY, AMONG THE PEOPLE WHO ATTENDED WE GET GET PEOPLE, ALTHOUGH EVERYONE HAD AN INFORMATICS BACKGROUND AND MANY OF THEM ALSO NURSES SEVERAL OF THEM HAD INCLUDE CAREERS THAT HAD BACKGROUNDS IN SCIENCE AND SOMEONE WAS A JEWELRYY DID SIGNER, ANOTHER HAD BEEN A FASHION DESIGNER, THERE WAS THEATER DESIGN, GRAPHIC DESIGN AND PEOPLE FROM STRONG [INDISCERNIBLE] BACKGROUNDS. SO I CONVENED THE GROUP, GOT PEOPLE TOGETHER, WHOEVER WANTED TO COME, I BOUGHT BOOKS AND SAID WE NEED TO FIGURE OUT HOW TO DO THIS. AND AT THE--AT THIS PARTICULAR PERIOD OF TIME, OUR PRIMARY CONCEPTUAL INFLUENCES WERE ELABORATION LIKELIHOOD MODEL AND TAYLORED HEALTH COMMUNICATION AND JUST THE IDEA THAT IF YOU CAN GIVE--IF YOU CAN CONVEY INFORMATION IN A WAY THAT IS INDIVIDUALIZED AND MEANINGFUL TO THE MESSAGE RECIPIENT THAT THE MORE LIKELY TO ATTEND TO IT AND ACT UPON IT. SO WE DECIDED TO TURN THE DATA TO THE COMMUNITY AND JUST A FEW MORE IDEAS ABOUT THAT. I PUT QUOTES AROUND EXPERT BECAUSE I FIRST SAID WE WERE CALLING EXPERT DESIGN BUT WE WERE IN MANY INSTANCES WE WERE LEARNING AS WE WERE GOING. SO WE STARTED WITH CREATING A MESSAGE PURPOSE TAXONOMY, CREATING MULTIPLE DESIGNS, TOOK INTO CONSIDERATION HEALTH LITERACY AND NUMERACY AND THEN WE WENT INTO OUR PARTICIPATORY DESIGN SESSIONS AND WE DID AND WE DID ABOUT A 20 DESIGN SESSIONS WITH MORE THAN A HUNDRED PARTICIPANTS IN THEM. I BELIEVE 18 GROUPS WERE IN SPANISH AND 2 WERE IN ENGLISH SO THAT I COULD ATTEND THE INITIAL 1S AND--MOST WERE CONDUCTED IN SPANISH AND IN ADDITION TO THESE--THIS PARTICIPATORY DESIGN IN LINE WITH THIS BEING AND WHAT I WOULD CALL COMMUNITY ENGAGEMENT PROJECT, ILESS ALSO SHARE OUR COMMUNITY BASED ORGANIZATION AND AFFILIATED HEALTH SYSTEM SO THAT THEY CAN USE DATA TO IMPROVE HEALTH IN THE COMMUNITIES AND BUT ALSO TO IMPROVE THE SERVICES. ALONG THE WAY, YOU WILL SEE THIS DIAGRAM OVER AND OVER AGAIN BECAUSE IT WAS VERY IMPORTANT. WE WANTED TO FORMALIZE OUR--WE WANTED TO FORMALIZE OUR PROCESS AS WE WERE--AS WE WERE MOVING ALONG. AND SO 1 OF OUR FIRST ARTIFACTS WAS THIS METHOD FOR DEVELOPMENT OF DATA VISUALIZATION THEY MENTIONED EARLIER THAT WE TOOK THE GOALS AND YET GAVE SOME EXAMPLES OF THE TYPE OF VISUAL--TYPE OF DAT ATYPE OF VISUALIZATION, ET CETERA WITH THAT. AND I WANT TO QUICKLY JUST SO YOU SOME OF THE VISUALIZATIONS THAT WE PRODUCED IN WISER, THIS IS A OUTCOME SCORE WHICH USES A NUMBER OF LINES. THIS IS A FINAL DESIGN. IT HAS--IT USES COLORS, NUMBERS, IT USES CONTEXTUALIZING TERMS SUCH AS BETTER AVERAGE, WORSE, AND GIVES THE INDIVIDUAL THEIR SCORE AS WELL. WE USE A LOT OF METAPHORS AND ANALOGIES FOR STRESS, WE USED A PRESSURE GAUGE AND IT--PRACTICALLY IT MADE SENSE TO US. WE WILL TALK A LITTLE BIT MORE LATER ON, ALSO ANOTHER THING THAT WORKED WELL, IN TERMS OF IMAGERY WAS FOR FATIGUE AND A BATTERY WORKED VERY WELL IN THAT REGARD BECAUSE PEOPLE WERE FAMILIAR FOR EXAMPLE WITH PHONE BATTERIES AND THOSE TYPES OF THINGS FOR BODY MASS INDEX, THESE ARE SOME OF THE THINGS THAT YOU WOULD SEE IN OUR ANXIETY DESIGN AND THAT WE USE A NUMBER LINE AND USE SIMILAR--SIMILAR COLORS IN RED/GREEN, WE CHOOSE RED AND GREEN COLORS THAT ARE OKAY FOR PEOPLE WITH RED GREEN COLOR BLINDNESS, YOU CAN SEE THE MEMBERS HIGHLIGHTED. YOU HAVE A LITTLE DEFINITION OF WHAT BMI WAS, WE INCLUDED A BODY--BODY SHAPES AND THEN INCLUDED THE BMI IN THAT. WE TRIED A NUMBER OF ICONS TO RAISE, FOR VARIOUS CONCEPTS WE WERE TRYING TO REPRESENT BUT 1 OF THE 2 THAT ENDED UP WORKING WELL WAS THE SENSE OF OVERALL HEALTH AND DOING STAR RATINGS AND IN THIS WE WERE TRYING TO--WE WERE COMPARING INDIVIDUAL'S HEALTH AGAINST OTHER EMPLOYMENT PROGRAMS BUT PEOPLE WERE QUITE FAMILIAR WITH THE STAR--WHICH STARS FROM RESTAURANT REVIEWS AND MOVIE REVIEWS AND THOSE TYPES OF THINGS. WE ALSO WANTED TO BE ABLE TO SHOW A SET OF MEASURES ON A COMMON SCALE AND THIS WAS THE FINAL DESIGN FOR THE CDC 30 DATE MEASURES, SO IF PEOPLE COULD SEE HOW THEY WERE DOING ON SOME DIFFERENT MEASURES. BUT I WAS VERY SET ON ALSO WANTING TO COME UP WITH A WAY TO--SO, DIFFERENT ASPECTS OF HEALTH THAT WERE--THAT CAME FROM SCALES WITH DIFFERENT TYPES OF DENOMINATORS. SO THIS SHOWS AN EXAMPLE OF A DESIGN THAT WE HAD, WE ITERATED THROUGH MANY OF THE DESIGN SESSIONS UNTIL IT WAS JUDGED AS COMPREHENSIBLE. SO YOU SEE ON THE LEFT, INDIVIDUAL VALUES, THINGS THAT MADE IT EASIER FOR PEOPLE TO INTERPRET. WE'RE HAVING THE DOTTED LINES FOR IDEAL AROUND IT IN PARTICULAR BECAUSE OTHERWISE IT'S VERY HARD TO KIND OF JUDGE THE PROPORTION OR FIND OUT HOW FAR AWAY FROM IDEAL YOU WERE AND THEN THEY ALSO PREFERRED TO HAVE A FLUSHED OUT DIAGRAM. SINCE OUR CLINICAL FOCUS OF WICER, AND WICER REVIEW, WAS HYPER TENSION, WE DID MANY, MANY DESIGNS FOR BLOOD PRESSURE INCLUDING MANY OF THEM QUITE SIMPLE, NUMBER LINES, STOP LIGHTS AND THAT KIND OF THING AND IN THE END, OUR PARTICIPANTS PREFERRED THE MOST COMPLEX STEPS TAKEN BUT ALSO INCLUDED THE RISKS AND IF YOU LOOK ON THE RISK SIDE WE PURPOSELY PUT A COLLOQUIAL TERM ALONG WITH A FORMAL TERM BECAUSE WE THOUGHT PHYSICIANS WOULD BE SPEAKING TO INDIVIDUALS STILL WITH THE FORMAL TERM. AND WHEN WE DID THIS, WE GAVE ALL THE DESIGNS OUT TO THE PARTICIPANTS ON VERY NICE CARD STOCK SO THEY COULD WRITE ON IT, THEY COULD COMMENT ON IT, THEY COULD GIVE IT BACK TO US IF THEY WANTED BUT ALMOST UNIVERSALLY THIS 1 WAS TAKEN HOME BECAUSE EVEN IF SOMEONE DIDN'T HAVE HIGH BLOOD PRESSURE, THEY KNEW SOMEONE WHO HAD AND THEY THOUGHT IT WAS AN IMPORTANT COMMUNICATION. AND THEN IN SOME INSTANCES WE TRIED MANY DIFFERENT WAYS TO REPRESENT PHYSICAL ACTIVITY AND IN THE END, WE WENT WITH A SIMPLE BAR GRAPHS, BUT ALSO DID RECOMMENDATIONS FOR ACTIVITIES. BECAUSE THE IDEA WAS TO GIVE THESE DATA BACK AT SCALE, WE DEVELOPED A SOFTWARE FRAMEWORK CALLED ENTICE 3, AND THAT STAND FIST ARE ELECTRONIC TAYLORED INFO GRAPHICS FOR COMMUNITY ENGAGE, EDUCATION, EMPOWERMENT AND THE BASIC IDEA IS THAT YOU TAKE DATA IN, YOU PROCESS IT AGAINST A GRAPHICAL COMPONENTS REPOSITORY AND ATTACH SOME BETA DATA AND PRODUCE AN INDIVIDUALIZED GRAPHIC IN THAT. WE PLANNED TO RETURN INFO GRAPHICS ELECTRONICALLY, WE GOT A--IT HAPPENED THAT THE INSTITUTION RECEIVED A HIPAA FINE AND NOT RELATED TO OUR PROJECT BUT THEY WERE A LITTLE MORE CONSERVATIVE ON OUR APPROACH AT THAT POINT IN TIME. SO WE ENDED UP DOING TOWN HALLS, WE DID THEM ALL IN SPANISH AND I SPOKE AT THEM IN ENGLISH BUT WITH SPANISH SLIDES. WE GAVE THE INDIVIDUAL BACK THEIR TAYLORED INFO GRAPHICS. THEY HAD KNOWA OPPORTUNITY TO RECEIVE EDUCATION, ASK QUESTIONS RNTION AND WE DID THIS JUST A FEW MONTHS AFTER THE ANNOUNCEMENT OF THE PRECISION MEDICINE INITIATIVE. SO WE WERE ABLE TO TALK ABOUT WHAT THEY HAD DONE IN WICER IN TERMS OF THE PRECISION MEDICINE THEY ACTUALLY DID AND ALTHOUGH ABOUT 1500 MEMBERS OF OUR WICER COHORT CONTRIBUTED SPECIMEN THEY HAD AN OPPORTUNITY TO PARTICIPATE AND ADD MORE, IF THEY HAD NOT DONE SO. SO WE HAD KEY LESSONS FROM THIS PERIOD OF TIME FROM THIS QUICK STUDY WE DID OVER ABOUT 6 YEARS, 1 IS SOMETIMES MORE AND MORE, THE TENDENCYY TO SIMPLIFY THE VISUALIZATIONS, WE FOUND FOR OUR PRIMARILY--OUR PRIMARILY LOW LITERACY PARTICIPANT THAT DATA WITHOUT CONTEXT LACKED MEANING. WE NEEDED TO BE VERY CAREFUL ABOUT USE OF ICONS TO RAISE BECAUSE THEY WERE INTERPRETED VERY LITERAL, IT WORKED WELL TO GET BACK THE DATA AND THE INFO GRAPHICS VIA TOWN HALLS AND DEFINITELY AUTOMATION IS ESSENTIAL UPPER SCALE AND WE WILL TALK ABOUT MORE--I WILL TALK ABOUT MORE AUTOMATION IN A WHILE. THE OTHER LESSON I WANT TO BRING UP IS THAT IN THE SESSIONS WE WANTED TO DO OBJECTIVE COMPREHENSION PROTOCOL AND THE IDEA IN THAT WAS WE TOOK GROUPS OF MESSAGES THAT WOULD USE SIMILAR DESIGN AND THEN WE GROUPED ITEMS AND PEOPLE WERE RANDOMIZED TO EITHER GROUP A OR GROUP B FOR EXAMPLE, AND YOU CAN SEE THE GROUP A 1 THEY HAVE STRESS AS A TEXT MESSAGE AND THEY HAVE DEPRESSION WITH A VISUALIZATION AND THEN IN GROUP B, THEY HAVE STRESS AS A VISUALIZATION AND THEN THEY HAVE DEPRESSIVE SYMPTOMS AS TEXT. AND WHAT WE FOUND OVER TIME, BETWEEN THE EXPERIENCE OF THE PEOPLE DOING THIS COMPREHENSION PROTOCOL IS IT SEEMED TO BE OVERLY COMPLEX FOR THE RESEARCH PARTICIPANT THAT WE WERE DEALING WITH AND WE WERE GETTING DIFFERENT IMPRESSIONS FROM THE WAY THEY WERE DOING THIS ON THE COMPUTER AND WHAT THEY WERE VERBALIZING DURING IT. FROM THIS PERIOD OF TIME WE STARTED TO--WE CONTINUED TO ADD TO OUR VISUALIZATION ARTIFACTS, ASK WITH THE ENTICE, 1 OF THE IMPORTANT THINGS WAS A GUIDE TO COMMUNICATE WITH THE PROGRAMMERS. THEN WE MOVED THROUGH A PERIOD OF TIME WHERE WE EXTENDED THIS RESEARCH TO DEMENTIA CARE GIVING AND HERE ARE SOME SAMPLES OF SOME VISUALIZATIONS WE DESIGNED DURING THAT PERIOD OF TIME. WE USE SIMILAR METHODS FOR THE DESIGN BUT WE ENDED UP USING MORE QUALITATIVE METHODS FOR THE EVALUATION OF THE DESIGNS AND SO WE CAPTURED VARIOUS THINGS, REACTIONS TO THE DESIGNS, STATEMENTS ABOUT SELF-MANAGEMENT, IMPRESSIONS OF SPECIFIC DESIGN ELEMENTS, PREFERRED TO DESIGNS AND THEN ONCE AGAIN AS WE HAD CONTINUED IN THE PREVIOUS STUDIES WE ITERATED THE DESIGNS AND THERE WERE SOME ADDITIONAL THINGS THAT WERE FOUND IN THESE--THESE SET OF STUDIES, AND PARTICULARLY THE KIND OF INTERWE'VING OF THE LABELS AND THE IMAGES WAS OCCURRED TO BE IMPORTANT AND THE IMPORTANCE OF CONSIDERATIONING WHO'S RECEIVING THEM BECAUSE IN THIS PARTICULAR INSTANCE, ALL DESIGNS WERE NEW TO THE FRAME OF THE INEVITABLE DECLINE OF THE PERSON WITH DIMENSION, WE ARE MOVING FORWARD WITH THIS, WITH A FHIR APP, RESULTS ARE SHOWN AND PRESENTED IN A PAPER. WE ALSO DID A LITTLE BIT OF WORK THAT WAS SPECIFICALLY FOCUSED ON CULTURE AND THIS WAS A STUDY IN WHICH WE MENTIONED CAREGIVERS, CREATE COLLAGES AND INVENT METHODS FOR EXAMINING DIFFERENCES IN THE COLLAGES, AND THE BIG FINDING OF THE STUDY WAS ALTHOUGH EVERYONE WAS LATINO, THERE WERE CONSISTENT DIFFERENCES BETWEEN ENGLISH SPEAKING AND SPANISH PEEKING LATINOS SO WE NEED TO CONSIDER THAT IN OUR DESIGN. SO ONCE AGAIN WE CONTINUE TO BUILD ARTIFACTS TO OUR TOOL BOX AND WE'RE ABLE TO PULL THE VARIOUS THINGS WE'VE DONE THROUGH THE YEARS INTO A CENTER WHICH WE CALL THE DECISION AND SYMPTOM SELF-MANAGEMENT CENTER WHICH IS FOCUSED ON SYMPTOM--THE SCIENCE OF SYMPTOM SELF-MANAGEMENT AND 1 OF THE INNOVATIVE ASPECTS OF OUR CENTER WAS TO HAVE A VISUALIZATION DESIGNED STUDIO. SO WE CONTINUE SOME OF THE TYPES OF THINGS AND MORE FORMALIZED THEM AND WE FOCUSED ON SOME DIFFERENT--SOME BROADENING OF THE TYPES OF THINGS WE'RE REPRESENTING. IT WAS OUR FIRST FORAY INTO ANYTHING GENETIC AND WE'RE CONTINUING TO WORK ON THAT AREA. THIS WAS INTERACTIVE VISUALIZATION, JANET WOOLLEN'S COLLABORATION FOR VISUALIZATION FOR FAMILIAL HYPER CHOLESTEROLEMIA AND WE ADD TO THE ARTIFACTS WITH ADDITIONAL PROTOCOLS AND INFO GRAPHICS. I WANT TO MENTION I JUST CAN'T HELP IT BECAUSE TRAINING IS SO IMPORTANT TO ME, THE OTHER KIND OF HEART ATTACK WAS A 3 COURSE--3 CREDIT COURSE THAT ALL OUR DOCTORAL STUDENTS AND NURSING STUDENTS TOOK, FOCUSED ON INFORMATION VISUALIZATION AND WE HAD 4 K99 R00 AWARDS THAT HAVE COME OUT OF OUR VISUALIZATION GROUP AND I'M PLEASED WITH THAT. THIS IS AN EXAMPLE OF RECENT PUBLICATION IN THAT REGARD. THERE WERE THINGS THAT I WISH I HAD KNOWN ABOUT SOONER, 1 WAS AN ISOSTANDARD FOR TESTING COMPREHENSION BUT WE LEARNED ABOUT THAT LATE OR AND ADRIANA GARCIA 1 OF KEY PLAYERS IN OUR GROUP AND A VISUALIZATION GROUP LED IT PAPER AND WE CONTINUED TO USE THIS METHOD FOR VISUALIZATION. IN 2018 THERE WAS A PAPER WRITTEN ON CONCEPT Y'ALL METAPHOR THEORY AS A FOUNDATION FOR VISUALIZATION DESIGN, THIS ACTUALLY EXPLAINS THE REASON WHY THE TYPES OF ANALOGIES THAT WE'RE USING PRESSURE GAUGES AND BATTERIES WERE AND PROVIDES A FOUNDATION OUT OF LINGUISTICS HOW TO DO IT BETTER OVERTIME AND THERE'S A GREAT CONFERENCE CALLED IEEE [INDISCERNIBLE] WHICH IS MUCH OF THE BASIC SCIENCE AND VISUALIZATION IS THERE. AND THIS WAS AN INFLUENTIAL PAPER WRITTEN BY PEOPLE I KNOW AND PEOPLE I WORK WITH BUT IT'S IMPORTANT TO FRAMING WHAT I'VE BEEN DOING THE LAST FEW YEARS AND THE BASIC IDEA WHICH BUILDS ON THE W. H. O. SOCIAL DETERMINANTS OF HEALTH MODEL IS FOR INFORMATICS TO REALLY HAVE AN INFLUENCE ON HOW EQUITY INTERVENTIONS SO WE NEED TO MOVE FROM DOING INDIVIDUAL LEVEL INTERVENTIONS TO MORE MISO AND MACROLEVEL INTERVENTION AND SO, MOST OF THE WORK THAT I'VE SHOWN YOU IS--ALL THE WORK I'VE SHOWN YOU IN FACT HAS BEEN MORE THE INDIVIDUAL LEVEL AND THIS MEANS WE'RE REALLY ACTING UPON THE DIFFERENTIAL SOCIAL AND ECONOMIC HEALTH CONQUENCES INIQUITIES BUT I WANT TO TURN THE LAST FEW MINUTES TO FINALLY REMOVE TO MISO LEVEL INTERVENTION AND SPECIFICALLY TO TALK ABOUT THE READY USE TOOL BOX WHICH IS A RADX-UP THAT WE'RE JUST BEGINNING AND OUR GRANT BUILDS UPON COVID WATCHER WHICH IS A CITIZEN SCIENCE INITIATIVE DEVELOPED BY INVESTIGATORS AT COLUMBIA AND THE IDEA BETWEEN THESE 2 PROJECTS IS, WE'RE MOVING TO THE MISO LEVEL INSTEAD OF ONLY FOCUSING ON THE KIND OF THE DIFFERENTIAL CONSEQUENCES THAT WE FOCUS ALSO ON TRYING TO IMPACT DIFFERENCES IN VULNERABILITIES AND DIFFERENCES IN RESOURCES READY, THIS TOOL BOX OR REACHING COMMUNITIES, DESIGN OF INFORMATION, VISUALIZATION, RETURNING COVID-19 RESULTS REALLY BROUGHT EVERYTHING EVERYTHING I'VE BEEN DOING FOR THE LAST 25 YEARS TOGETHER AND THE BASIC IDEA BEHIND IT IS IF WE ARE GOING TO REDUCE HEALTH DISPARITIES RELATED TO COVID-19, WE NEED TO MAKE SURE THAT WE ARE PRODUCING HEALTH LITERATE INFO GRAPHICS TO FACILITATE THE RETURN OF RESULTS, COMPREHENSION OF RESULTS AND MOTIVATES APPROPRIATE BEHAVIORS. THIS WAS FUNDED ON NOVEMBER 16th SO WE'RE NOT VERY FAR ALONG THE ROAD. WE'RE WORKING WITH THE ASSOCIATION AND THESE ARE VERY EXCITING COLLABORATIONS AND SO BASICALLY WHAT WE'RE DOING OVERALL IS WITH OUR COMMUNITY PARTNER, WE ARE BUILDING THE REDIVIS TOOL BOX WHICH WILL TAKE THE DATA AS OUTPUT TAYLORED INFO GRAPHICS USUALLY INDIVIDUAL, WE ARE TAKING THE SOFTWARE WE DEVELOPED BEFORE AND ALL THE ARTIFACTS WE'RE BUILDING FOR THE LAST 15 YEARS AND PUTTING THEM INTO A TOOL BOX THAT FOR USE BY CLINICIANS, HEALTHCARE ORGANIZATIONS, COMMUNITY ORGANIZATIONS, AND RESEARCHERS AND OUR INTENT IS THAT THIS WILL BE SOMETHING THAT WILL BE ABLE TO BE USED BY OTHER RAD X UP GRANTEES. AND WE'RE DOING THAT THROUGH THE TYPE OF METHODS, I'VE TALKED ABOUT BEFORE, COMMUNITY ENGAGED RESEARCH, PARTICIPATORY DESIGN FOR THE INFO GRAPHICS THAT WERE PRODUCED AND TECHNICAL IMPLEMENTATION OF THE TOOL BOX WITH A LARGE, RELATIVELY LARGE AMOUNT OF TIME PLANNED FOR DISSEMINATION OF THE TOOL BOX TO TO POETIC TEBTIAL USERS SO IN CONCLUSION THROUGH THE IDEA POETICAL SCIENCE, ADA LOVELACE EMPHASIZED IMPORTANCE OF INFLU ENGZ AND IMPORTANCE INCLUDING MATHEMATICS AND SCIENCE, INFORMATION VISUALIZATION WAS CULTURALLY FUNDAMENTAL CONGRUENT TO EDUCATION. TO DEVELOP COMMUNICATION AND APPLICATION REQUIRES RESEARCH IN BASIC SCIENCE APPROACHES, AND MUCH OF WHAT I'VE SHARED IS APPLIED RESEARCH AND THERE'S A LOT GOING ON IN BOTH COGNITIVE SCIENCE AND NEUROSCIENCE THAT HAVE HAD MAJOR IMPLICATIONS FOR PRODUCING EFFECTIVE VISUALIZATION AND I FIRMLY BELIEVE THAT EFFECTIVE VISUAL COMMUNICATION CAN CONTRIBUTE TO BOTH DOWN STREAM AND UPSTREAM HEALTH EQUITY INTERVENTIONS 32 YOU REDUCING DIFFERENCES IN THE IMPACT OF SOCIAL ECONOMIC AND OUTCOME CONSEQUENCES, REDUCING VULNERABILITY TO DECREASING VULNERABILITIES THESE ARE MY FUNDING RESOURCES RKSZ VISUALIZATION EXPERT WHO IS WORKED WITH ME CLOSELY AND WE'VE ABSOLUTELY DONE THIS WORK TOGETHER AND I'M JUST THE 1 THAT GETS TO TALK ABOUT IT AND I WANT TO LET YOU KNOW HEALTH ASK AND CULTURE EXPERT, AND I WILL END WITH DISPLAYING THIS IS--YOU'VE SEEN THE VIEW FROM MY OFFICE WHICH IS BEHIND ME BUT THIS IS THE VIEW ON THE WALL IN MY OFFICE, I HAVE A SMALL OFFICE AND 1 WALL IS TAKEN UP BY A VINCENT VANGOGH STARY NIGHTS REPLICA WHICH GIVES ME GREAT PLEASURE TO LOOK AT AND IT'S VERY INSPIRING. AND WITH THAT, I THINK I HAVE A BRIEF PERIOD OF TIME FOR A FEW QUESTIONS FROM THE AUDIENCE. >> HI, THANK YOU. >> THANK YOU VERY MUCH, SUE, CAN YOU UNSHARE YOUR BEAUTIFUL SLIDE YOU HAVE THERE SO THAT I CAN SHARE--I JUST WANT TO ADD TO SHARE THE E-MAIL FOR SENDING TO--IF YOU HAVE QUESTIONS SEND AN E-MAIL TO THIS E-MAIL ADDRESS, NOW ALL MY CHATS DISAPPEARED. >> YEAH, IT LOOKS LIKE THERE MAY BE SOME QUESTIONS IN THE CHAT AS WELL. >> YEAH, I WAS GOING TO READ THEM BUT I CAN'T FIND THEM NOW. >> I CAN--LET ME SEE, OKAY. >> LET ME JUST TRY AND FIND THEM. I'M GOING TO STOP SHARING AND THEN YOU CAN-- >> DO THE STOP SHARING OR OTHERWISE I WILL HELP IF YOU NEED IT. >> OKAY, SO I HAVE THE FIRST QUESTION FROM ADA M WHAT WOULD YOU RECOMMEND AS GOOD BUCS OR SOURCES TO READ. >> YES, THERE ARE A NUMBER OF--THERE ARE A NUMBER OF CLASSIC BOOKS ON VISUALIZATION AND SO, I'M HAPPY TO SHARE A LIST, I THINK IT'S PROBABLY TOO LONG--TO ALONG OF LIST TO PUT TOGETHER SO THERE ARE CLASSIC BOOKS ON VISUALIZATION. WE'VE ALSO TRIED TO PULL OUR METHODS TOGETHER. THAT'S 1 CHAPTER IN THE CONSUMER HEALTH INFORMATICS BOOK SO I WOULD BE HAPPY TO SEND A LIST AND I THINK PERHAPS IT COULD BE SHARED ON THE SAME WEBSITE WHERE THERE'S GOING TO BE THE RECORDINGS. >> WE HAVE ANOTHER QUESTION, ARE THE PATIENTS EASY, UNDERSTANDABLE AND [INDISCERNIBLE] MORE LIKELY TO TAKE HEALTH MEASURES FOR EXAMPLE, IN MANAGING MENTAL HEALTH OR BLOOD PRESSURE. >> YES, IN THE STUDIES THAT WE'VE DONE, WE DON'T KNOW YET AND BECAUSE WE HAVE BEEN ON, BUILDING INFO GRAPHICS, BUILDING THE TOOLS AND WE NEED COLLABORATION WITH OTHER TYPES OF SCIENTISTS WHO ARE MORE EXPERT IN BEHAVIOR CHANGE TO THINK ABOUT HOW TO BUILD THEM INTO THEIR PARTICULAR INTERVENTIONS. WE HAVE SOME--WE HAVE SOME EVIDENCE--WE HAVE BEGINNING EVIDENCE FROM SOME OF THE K99 R00S THAT HAVE BEEN FUNDED THAT THERE IS AN INFLUENCE AT LEAST IN HIV/AIDS ON BOTH CD4 COUNT AND VIRAL LOAD. >> I HAD A QUESTION, TOO SINCE WE'RE WAITING IF ARE MORE QUESTIONS. BY THE WAY, I LIKED THE DESIGN, MANY OF YOUR DESIGNS VERY MUCH AND VISUALIZATION IS A KEY ASPECT OF INFORMATION THAT YOU CONVEY, WHICH IS TOWARD PATIENTS BUT ALSO IN THE AREAS OF RESEARCH THAT I'M INTERESTED IN AND MANY OF THE INTRA MURAL RESEARCH PROGRAMS PEOPLE ARE INTERESTED IN AS WELL AS THE INFORMATION COME OUT OF THE NLM, SO IMPROVING OUR--CONTINUING IMPROVING OUR VISUALIZATION IS ESSENTIAL AND WE TRY AND DO THAT AND THE KEY QUESTION IS THAT IF YOU MAKE CHANGES AND THAT'S WHAT LEADS TO LAWRENCE'S QUESTION AS WELL, IS THERE A STANDARD WAY OF MEASURING THESE THINGS OR HARD TO FIND IT? >> YEAH, AND SO WE KNOW THROUGH OUR USE OF VARIOUS METHODS INCLUDING THIS MODIFIED ISOSTANDARD THAT WE'RE AT A POINT WHERE THE DESIGN--WHERE MEASURING [INDISCERNIBLE] AND WE'RE MEASURING BEHAVIORIAL INTENT BUT WE DON'T HAVE THE LENGTH TO AN ACTUAL BEHAVIOR CHANGE AND THE KINDS OF THINGS WE'VE BEEN DOING AT THE MOMENT AND 1 OF THE THINGS THAT WE'RE HOPEFUL WITH THE RADX-UP COLLABORATION BEING AMONG THE MAIN KEY SYSTEM THAT SOME OF THE GRANTEES WOULD BE ABLE TO TAKE OUR TOOL BOX AND OUR DESIGNS AND USE THEM IN SOME OF THE BEHAVIOR--BEHAVIORIAL CHANGE INTERVENTIONS THAT THEY'RE DOING TO ENHANCE THESE AS WELL. >> ONE OF THE REASONS I ASKED, ABOUT 6 WEEKS AGO, I GOT AN E-MAIL FROM MY BANK SAYING THEY ARE GOING TO UPGRADE THE WEBSITE TO MAKE IT VERY NICE AND THEY DID THAT ON THIS PAST WEEKEND, NONAPOPTOTIC YOU I'M TRYING TO WORK OUT WHETHER THEY DID ANYTHING. >> WELL IT GETS INTERESTING, I THINK ABOUT THE GENERAL REMARK ABOUT THE IMPORTANCE OF VISUALIZATION FOR DIFFERENT PURPOSES BECAUSE AS A JOURNAL EDITOR, I'M VERY INTERESTED IN GRAPHICAL ABSTRACTS AND THE JOURNAL I EDIT, THE JOURNAL OF AMERICAN MEDICAL INFORMATICS ASSOCIATION NOW ALLOWS VISUAL ABSTRACTS SO WE'RE TRYING TO FIGURE OUT WHAT THOSE MIGHT LOOK LIKE AND AUTHORS ARE BEGINNING TO SUBMIT THEM BUT I THINK OFTEN WHEN PARTICULARLY THINKING OF SOCIAL MEDIA INCLUDING SOMETHING LIKE TWITTER, IT'S VERY NICE WHEN YOU HAVE A SCIENTIFIC ARTICLE IF YOU CAN TWEET WITH A VISUAL ABSTRACT IN ADDITION TO A BRIEF SCIENCE ABOUT IT BECAUSE I THINK IT STATES TO AUDIENCE DIFFERENTLY. AT THE MOMENT GRAPHICAL ABSTRACTS ARE NOT INDEXED IN PUBMED SO THEY'RE NOT--SO THEY'RE BROAD PERSISTENCE AND ACCESSIBILITY ISN'T THERE YET BUT I THINK THAT'S A CHANGE IN SCIENTIFIC PUBLICATION THAT MAY HAPPEN OVER TIME. >> SO THERE'S ANOTHER QUESTION FROM [INDISCERNIBLE]. HAVE YOU SEEN ANY OPPORTUNITIES TO GO IN REVERSE WHERE THE LESSONS LEARNED IN PRODUCING INFO GRAPHICS FOR MORE GENERAL [INDISCERNIBLE] DATA TYPES CAN HELP TO PRODUCE VISUALIZATION ESPECIALLY WORKING WITH LARGE [INDISCERNIBLE]? >> YES, ABSOLUTELY, I THINK THERE ARE SOME COMMON THINGS--SOME COMMON THINGS ABOUT DISPLAYS, AND I THINK DISPLAYS SHOULD ALWAYS TAKE THE USERS INTO,A COUNT BUT I THINK SOME OF THE THINGS WE'VE LEARNED ABOUT LAY OUTS AND COLORS AND DIFFERENT TYPE OF MEDICAL WORDS COULD WORK SCIENTIFICALLY--COULD WORK SCIENTIFICALLY AS WELL. >> ANY OTHER QUESTIONS? I DON'T SEE ANY. WELL, I THANK YOU VERY MUCH. SINCE THERE ARE NO MORE QUESTIONS COMING INOT CHAT BOX, SUE AND I APOLOGIZE FOR RESCHEDULING THIS A FEW TIMES FOR THINGS THAT WERE OUT OF MY CONTROL REALLY BUT I'M VERY PLEASED WE KEPT YOU ON THE SCHEDULE AND VERY THANKFUL THAT YOU GAVE SUCH A GOOD TALK ABOUT THINGS THAT YOU DON'T THINK ABOUT ENOUGH. >> AND DAVID, IF THOSE QUESTIONS THAT COME IN VIA E-MAIL, IF THEY CAN JUST BE FORWARDED TO ME, I WILL ANSWER THEM--I'LL ANSWER THEM INDIVIDUALLY. >> OKAY, IF THERE ARE MORE QUESTIONS PLEASE SEND THEM AND WE WILL GET THEM TO SUE 1 WAY OR ANOTHER OUT OF THE CHAT BOX. THANK YOU VERY MUCH. >> OKAY, MY GREAT PLEASURE. THANK YOU FOR INVITING ME.