Music, Poetry and AI - A troubadour's final word

 

I have been exploring the use of AI to write songs to accompany my poems. This is a remarkable time for the creative arts. We need to figure out how to certify authenticity and protect IP, image, and privacy. It is still a wild place out there -- but a fascinating place.

This will be my last presentation of AI in this matter because it doesn't age well and the technology and implications are changing very quickly.

A final word from a 21st century troubadour

Here are some links to my music channel with the outcome of this work

   / @utlandersongs  

and   / tom-ask-479096822   Here is an earlier discussion of AI and music:    • Song vs poetry - and a new remix!   AI and personal style:    • Style versus AI   AI and ideation:    • Death of Ideation Sketches  

Usefulness: Cheap Art and Authenticity

 

Forty dollars for a framed painting? Sixty-five dollars for a hand knit sweater? This is what people charge when they seek usefulness over income. When they enjoy commerce over wealth, when they seek satisfaction over sustainability. 

I was visiting an affluent retirement community where I attended an arts and craft festival. The artists and crafters were talented and had a voice to share. They didn't want their work stacked up in a dusty basement. They wanted others to enjoy their work, their art, their voice. But they wanted a small affirmation of value. They wanted commerce, an exchange of money for their hard work and well-seasoned talent. The pricing did not represent true value, but for me, the pricing was shouting, My work has value! I don't need the money, I just want appreciative homes.

The need for purpose, when money isn’t important, appears in our desire to create.

When branded art becomes excessively valuable, when AI handles the landscapes and portraits, we still seek authenticity. Authenticity is art now. The rules of composition, the use of allegory, and the extension of famous artists’ oeuvre can be managed by generative AI. But art that is authentic will have a home. It will be squeezed between the mass-produced AI generated decorative arts and the wares of lesser talented artists. Authenticity and the human connection between the artist and the viewer will be interesting to watch over these next years. The critics and authenticators might only be asking, Where are the surprises? Where are the mistakes?

 

Venezuela, Sailboats, and World War 1: Amateur Radio Articles I wrote for Worldradio

Here are two articles I wrote for Worldradio in the 1990s about events in the 1980s-90s. The first is about a neighbor experimenting with radios in the 1910s, the second is about my experience getting a reciprocal license in Venezuela in 1985, and the last article is about a sailboat delivery that went awry. A little sliver of history...

Getting on the air in Venezuela  Worldradio, August 1995  [recalling my time in Venezuela in 1985]

Fresh coffee was handed to me as I settled into one of the waiting room's tan leather chairs. I eagerly accepted the delicious brew and was ready to wait a long time to see the Venezuelan official who would give me my reciprocal ham license. I had just finished panning across the walls of windows that revealed the bright green mountains which encircle Caracas when I was introduced to the radio licensing manager. With a friendly handshake he led me to his office. Fresh coffee was brought in and we were ready to conduct business Venezuelan style.

I was managing an oil exploration crew in southern Venezuela and while in Caracas on my leave from the crew, I got into an ancient Chevrolet with foot-thick doors and made my way to the radio communication office to get my YV2 call. I had worked with Venezuelan officialdom in my job with mixed results. Although "collaboration" fees are required by some petty officials in Venezuela, generally they have a wonderful style of business. It starts with warm hospitality and evolves into learning the nature and disposition of their guest. The introductory chit-chat lasts much longer than in the U.S. and a cordial atmosphere is quickly developed as you debate whether to invite your new friend over for Christmas.

Back in the radio office we finally got to business. I quickly got my license certificate and the radio licensing manager even paid for the fancy stamps that made it all legal.

Continuing our conversation, he tells me about some other "American radio people" from the U.S. He introduces me to them and it turns out they were with the U.S. Department of Commerce and were working on spectrum management. They were not too impressed at meeting an expatriate ham.

In trying to involve myself with the Venezuelan ham community—which I would not be able to do in my remote camp—I visited the Caracas ham radio club. There I was warmly greeted by the well-dressed crowd. Their "International Chairman," who spoke excellent English, immediately befriended me. We were seated in the front row and watched the whole proceeding. At the end of the meeting, new officers were installed. This procedure included the officers raising their hands as they took an oath to comply with their assigned duties. A very formal and serious approach to ham radio indeed.

After the meeting, I was given a tour of the club station which consisted of the best Collins equipment available. I left my newfound friends, once again appreciating the fraternity of ham radio community and the wonderful state of ham radio in Venezuela.

Interpreting Silence  Worldradio, March 1990 [Recalling my sailboat delivery in 1988]

The engine didn't work, the batteries were nearly dead and we had 15 days of cold North Atlantic sailing to go.

"How much radio time do you think we have?"

"I'd estimate 10 minutes of transmit time on sideband. "

An unfortunate but wholly prudent decision was agreed upon.

The job was to deliver a 38 ft. sailboat, the Ishmael, from Cape May, NJ, to Falmouth, England. Onboard the delivery were the owner, a professional skipper, myself and another crew member.

All but the skipper were volunteers but we all had our own reasons for participating on this trip. In addition to the charm of arriving in Europe by sea, I was motivated by a desire to further my ocean sailing experience and to visit with family and friends in Norway.

The boat was a nine-year-old sloop equipped with the requisite equipment for a transatlantic passage, including a 100W channelized, general coverage SSB transceiver. And that, of course, meant that ham radio was coming along!

Although I am not a particularly active ham, there have been occasions when I have pulled out the old ticket, blown the dust off it and had it serve me well.

With the help of Vince West, W90PY, and Jay Gooch, W9YRV, we set up a program to monitor the boat's passage and to handle messages. Vince (living in Illinois) set up several relay stations in strategically located areas. Most helpful were G0DOD in northern England and VO1CA in Newfoundland, Canada.

Vince and I went over the radio system so he was familiar with what we had to work with. The radio system, including spares, included: One ICOM M700, general coverage SSB transceiver; one automatic antenna tuner; three deep cycle batteries; two alternators and one four-cylinder, Perkins diesel engine. The primary antenna was the backstay, which is the supporting cable that extends from the top of the mast to the back of the boat.

The backstay was insulated at both ends and attached to the antenna tuner by means of the center conductor of a RG-58 cable spliced into the stainless-steel stay. The stay was oriented at a about a 70-degree angle to the horizon and this nearly vertical orientation with the Atlantic Ocean as a ground plane, provided a good antenna system for such a small space.

The backup antenna had to be strong enough to handle storm conditions, yet be compact enough to store easily. Moreover, the antenna had to be small enough to rig on a 38 ft. sailboat.

The compromise was met by the venerable dipole cut for 15M and made of a stranded phospor-bronze wire that Jay had saved from one of his far-flung radio tests. With heavy duty insulators, RG-58 feedline and lots of silicone, the antenna rolled up into a nice, small ring.

In addition to the SSB, the boat had a VHF-FM, marine band transceiver and an Emergency Position Indicating Radio Beacon. The EPIRB transmits a beacon on the aircraft distress frequencies of 121.5 and 243.0 MHz (they will soon be able to work on the satellite monitored frequency of 406.025 MHz also).

All the large metal parts of the boat were electrically attached and grounded to the lead keel. This system provides a fine RF ground — especially in salt water. If this ground had been inadequate, we had available the lifelines that go around the boat, which could have been fashioned into a counterpoise.

Vince and I set up primary and backup frequencies, as well as the names of relatives in case we used AT&T's High Seas service to call a relative and wanted to coordinate that information.

We embarked on our trip on a warm, sunny day in May and headed out to sea with the eagerness of sled dogs. On the first day the weather quickly went from T-shirts to sweaters and fog descended upon us. All this, even before we were out of sight of land.

We established a watch schedule based on a two hour on, six hour off, pattern, giving us each three watches per day.

The days slid by quickly, getting continually colder as we sailed north by northeast. Even the warm waters of the Gulf Stream didn't seem to resurrect that moment of summer we had aboard when we first embarked.

I was amazed at how much wildlife there was to see. Every day I would see something: Birds, porpoises and even whales. I was most impressed with a small black and white gull that looked a lot like a sparrow. This bird would venture out into any kind of frigid sea, swooping into the deepest troughs, searching for some unfortunate, edible thing. I never saw them catch anything, but their game of ocean-tag must have been entertaining sailors for centuries.

On our sixth day, as we moved with the Gulf Stream, we arrived at a unique waves place called the Grand Banks. This is one of the richest fishing grounds in the world. The ocean floor rises to less than a 200 ft. depth and the Labrador Current, originating from cold polar waters, just begins to engage the Gulf Stream in its losing battle.

Although the Labrador is not allowed to venture far from the Canadian coastline, its interaction with the Gulf in this shallow water creates a rich environment for marine growth. I saw ocean going trawlers every day in this area, leaving a trail of dead fish in their wake.

The seascape took a different form here too. The odd combination of waves produced a sea that reminded me of the rolling hills of northwester Illinois. Sometimes the waves were quite steep and the boat would surf down them with water foaming and boiling around the hull.

Daily life had fallen into a slow speed routing; sleeping, eating, steering, fixing things and then sleeping again. The sleeping always seemed to be in short supply; even though I had a lot of “free” time it was hard getting used to

waking up at 2 a.m. to stand in wet, freezing air for two hours. The two hour watches in cold weather and sometimes stressful sailing conditions really took a lot of energy. We ate well, however, as the boat was stocked with good food and everyone except me was talented in its preparation.

The sked with Vince, Jay and the gang went well. Every other day I would call in and was greeted by familiar voices. Propagation to Illinois wasn't too good, but it was passable. Contact with VO1CA was impossible on 20M and the backstay was too short to load well on bands below 20M.

However, G0DOD's voice boomed in on both 20 and 15M, with a calmness and gentility that provided a refreshing contrast to our wet, sloshing environment. Unfortunately, because we didn't have a lot of diesel fuel available for battery charging, I couldn't do much ragchewing; just a hello, our position, bearing, speed, weather and overall condition. The Maritime Mobile Net was also very helpful, although our tiny signal was sometimes not heard.

As we passed the Grand Banks, our environment became dominated by sounds and coldness. The boat made sounds as it worked through the seas. The waves made sounds; the wind, rigging, and even the coldness itself contributed to the cacophony of nautical serenity.

Only on one occasion, when the boat was drifting under a light wind, was the sound changed. Three curious porpoises circled the boat for 10 minutes, blowing air and contributing the beautiful sound of living pipe organs to the stillness.

Once a day we would intrude our mechanical noise-maker into our simple life. Around 10 a.m. every morning we would run the diesel for an hour or two to charge up the batteries.

On the eleventh day of the trip the diesel did not start. The batteries were already low and the repeated cranking produced no results. We finally found that a Thermos bottle had fallen over, hit and opened a pet cock on the primary filter in the diesel fuel line causing all the fuel to run out of the engine. I was able to use the lift pump to prime fuel all the way to the pump, but I could not get it to flow the injectors.

We cranked a bit more to prime the injectors, but with no luck. Given this unfortunate condition I assessed how much battery charge remained and guessed that we had 10 minutes of transmit time left on SSB. We quickly decided that we would give up on the engine and save our batteries for emergency use only.

We took the additional measure of disconnecting the terminals of one of the batteries to assure it did not leak through the electrical system.

However, with the deep concern for battery reserves, it was also evident that we should not even make one last transmission on our regular sked to inform Vince and the relays of our condition. When out at sea you have to be very careful in considering contingencies and it is better to have worried friends than to be one second short on transmit time when your life may depend on it.

Vince knew that we only had one engine (and one radio) so he would be able to figure out that we had lost one or the other. On the other hand, he could have also thought that we had lost the boat and our EPIRB — an equally valid assumption.

All I could do was try to think through how Vince would interpret this unplanned silence — an interesting mental exercise. I thought that Vince would be able to figure out that there had been no storms or unusual sea conditions in our area and he also knew that the boat and the crew were in good shape as of our last sked, only two days prior.

We proceeded on to England with a self-imposed power blackout: No radios, radio navigation (LORAN), freezer, lights or autopilot (which was not working well in these seas anyhow). The weather on this trip had generally been bad, meaning we had overcast days and nights which limited our celestial navigation abilities.

Since the fastest way to England is via the Gulf Stream, which corresponds nicely with the great circle route, we were actually close enough to Canada during the first part of the trip to pick up their LF LORAN signals. We would be able to pick up LORAN chains from Iceland and England as we progressed eastwards.

With our batteries in storage, we would need to rely on celestial navigation and therefore be subject to the whims of the clouds.

The day the engine had failed to start was a relatively calm one. However, the next day the winds shifted so that we were going into the wind and the waves. This slowed us down because we lost some of our sail power and had additional hull resistance from the ramming of the bow into the waves.

The second day after the engine failure, we noticed sea water seeping into the boat through the bow. Each time we would bang into a wave, water would ooze through the inside mat of the fiberglass hull. We quickly cleared the bow section of all the wet odds and ends that were stored there, making a terrible mess of the boat in the process, in order to find from where the leak was coming.

The water was coming through the fiberglass in a 1 X 2 ft. section of the bow. The amount of seepage would increase substantially when we hit the waves, but we could not find any single source of the leaking.

The amount of seepage was very small, well within the capabilities of our bilge pump, but what was happening to the hull? Was there a small crack in the hull? Was the nine-year-old fiberglass delaminating?

With the boat banging into each wave and spray flying over the bow, it was impossible to check the outside of the hull at the bow. It seemed that no matter what was causing the leak it was possible that it could get much worse.

We put the EPIRB and some food and water into bags and attached them to life preservers and set them out in the cockpit. Our choices were to continue on to England, which would involve 10 days or so of battering seas, or to head to the nearest point of land and assess the boat's condition there. We decided to head to land, once again a pretty easy choice.

The closest land was Newfoundland, Canada. It was less than 200 miles west. We turned the boat around and headed for it.

It took two days to get to Newfoundland, and the sight of the barren land on the horizon provided a mixed welcome. We sailed into St. Johns Harbor and, while docking under sail, smashed the bow into the concrete wharf—the solid feel of land.

We put in fresh batteries and were able to easily start the engine. Could we have done that with ours? Who knows?

After five days of radio silence, I turned on the radio and heard Vince talking about me. They were not sure what had happened to us. I jumped in to tell them that we were all right and in St. Johns. Much to my dismay, a well-intended but confused ham who had heard their repeated calling for me said that he thought he had heard me two days prior! A bad and possibly dangerous mistake.

Because ham radio was the only way we were communicating with anyone, we relied on its accuracy. If we were in danger, surely no news would have been more helpful than false news.

Fortunately, Vince had seen through it all, discounting the erroneous report and assuming we had radio trouble. In his concern, however, he had recruited several big guns to call and listen for us.

When we arrived, one of the crew members went home, having lost confidence in the boat, and the owner decided that he didn't want to continue to England.

Upon inspection, it turned out that the leak was caused by a separation of the anchor well bulkhead from the deck. After repairing the boat as best we could the three of us tried to sail it down to Sydney, Nova Scotia, but were turned back by adverse wind.

The boat was finally berthed in Conception Bay (a days sail northwest of St. Johns) and I flew to Norway to get a short vacation out of the trip anyway.

 

 

AI and the Return of Oral Exams

 

I am a fan of AI.

so much so, that I quit my job in February 1992 (yes 1992!) to devote myself to developing an early form of AI, called expert systems. I had started this work at my employer in 1991. I saw it as the future. With youthful exuberance, I quit my job as a Senior Engineer at Ingersoll-Rand and started my consultancy. I became very busy, but I wasn’t making much money. I finally had to pull the plug on this job and get a regular salaried job again. Maybe I took this leap too early (before the internet made data cheap and assessable), but I probably wasn’t the best businessman out there.

Now I teach

Many years ago, I taught an undergraduate engineering design class over the summer. I tried something different. I made the final exam an oral exam. I tried to make it gracious and conversational. I tried to make the grading fair. I was amazed at the insight I learned about each student’s capabilities. The exam involved both theory and mathematical computations, but I could unpack incorrect answers and learn the source of errors.

I never did an oral exam again.

Why? They are very difficult to grade and they take forever. If the student gave the wrong answer, it took a long time to find out the source of the student’s misunderstanding. However, we are now being forced back to this ancient method of assessment in coursework where personal, non-AI generated competence must be clearly proven.

ChatGPT and the whole category of generative AI, which is turning any class with a writing assignment on its head. It’s also causing all of us rethink how we conduct classes and grade assignments.

I have taught writing-enriched classes and know how to use Turnitin.com. I have caught people plagiarizing. But it seems now AI-fueled writing, problem solving, and image generation are going to be buried in everything and swamp instructors.

The rationalizations are already starting:

• ·       Money and class structure: Without AI assist, some families will enjoy outside help, while others won’t. Rich students will hire ghost writers, poor students won’t.
• ·        Personalities: Extraverted students with a network of capable friends will do better than introverts.
• ·      Relativism: Everyone is doing it.

There will be many more rationalizations. There is no battle to win--honor systems create wicked ethical environments for many students, and threats are shallow (what amount of AI generated content would result in an assignment failure or course dismissal? One hundred percent?). The battle is lost.

How do we provide excellent education?

I have always been a fan of project-based learning, but that works well in my area of design. It doesn’t work as well in writing and anatomy classes. If your doctor or nurse hasn’t memorized anatomical terms, he or she can’t even join in a serious conversation with peers. The ability to quickly synthesize information is required in all intellectual discourse and debate. So what do we do in those areas?

Oral exams.

It seems to be the only way to offset the role of AI is real time presentation of knowledge and skills. Remote facial observation and applications that can detect AI usage are never going to be perfect. Do you fail someone who has apparently used 86 percent of his or her writing from ChatGPT? Do you turn all instructors into lawyers? Do your grades reward the AI users and punish the non-AI users? That's what will happen. How do we acknowledge those who do not use AI assistance?

Watermarking

Classes that require extensive writing have it the toughest. In-class writing of any length is weird, it doesn’t give students a chance to reflect on work and write at their own pace. I remember a class I took which had lots of writing assignments. One week we had to write a thirty-page paper on five Andalusian poems. I am a fan of Andalusian poetry, but thirty pages is a lot. I couldn’t write that much about five poems, so I offered presentations of Andalusian culture and Islam to fill the pages before I wrote about the five poems I analyzed. This assignment was decades before generative AI. Now, the paper could be written in five minutes and probably be better than mine.

One of the joys of my educational journey was defending my dissertation. I worked very hard on it. My work was the result of several years of research. I knew my topic well, I prepared well, and I was ready. I was at the top of my form and very ready for my defense. One could never be in that position if ChatGPT did most of the work. Each thought and syllable of my dissertation were mine. This is also true of my books and articles. A system of digitally watermarked non-AI generated content would be useful in ensuring authenticity. The dates of publication sort of point to that, but that will not be the case in the future. What is to be done with works after 2021?

Students need to have their integrity protected by some sort of digital watermarking. So do all the others, such as authors, scholars, artists, and all who push content into the culture. If one uses AI, that’s okay, it just needs to be acknowledged.

Authenticity

has a value and needs to be protected. AI will quickly be buried in much of what we do. It will become seamless, with guiding prompts and shortcuts that are difficult to ignore. Responding with verification of authenticity against this new generation of content creation must be done quickly. People value sacrifice. They value authenticity.

Steps toward integrative palliative care in the developing world

This was previously published by the Design for All Institute of India

Steps toward integrative palliative care in the developing world

Thomas Ask, John Boll, Alexander Nesbitt

Abstract

Treatment for suffering in low resource areas can benefit from easy access to medicines that treat pain, gasping, terminal secretions, nausea, anxiety, and delirium.  Because suffering needs to be contextualized within prevailing cultural forces, individuals with communal connections with the patients must be empowered to administer these medications and provide caregiving services.

Additionally, developing low cost medical dispensing systems allows a wider range of treatment.  Artificial intelligence can be coupled to voice recognition for both patient diagnosis and medical products to improve efficacy of treatment.

 Introduction

Design can address complex problems through inquiry, synthesis and creative exploration.  Problems that lie outside mechanistic solutions are fertile areas for design processes that strive to creatively motivate improvements.  Improving healthcare is a type of problem that challenges deductive logic and benefits from ‘design thinking’.   This inquiry recognizes the resource driven model of healthcare has overwhelmed the relational needs required for palliative patient care.  This article wishes to extend the medical discourse beyond the well understood effects of disease and the positivistic validations of pharmacology.  While it is presumptuous for those steeped in US medical traditions to assert appropriate systems of palliative care in the developing world, this reflection on palliative treatment intends to offer a different perspective that appropriate local decision makers may find helpful.

Palliative care can consider three tracks: medical, relational and spiritual.  The medical realm can include adjuncts to pharmaceuticals while the relational can cover areas of concern ranging from the relationship between caregiver and patient to the effect of patient pain and psychosis on family members.  The spiritual realm addresses deeply held beliefs about the patient’s relationship to a deity in their faith tradition.

Background

Reducing suffering requires identifying a cultural framework that connects pain and suffering.  The acceptance of pain and the expectations of palliative care requires a subjectivist, interpretive epistemology. This epistemology draws upon the humanist arguments against exclusive positivistic approaches that highlight limitations of the scientific method and its inappropriateness for assessing human thought and actions (Feyerabend 1993).

A theoretical construct for understating the relational component of palliative care, beyond pharmaceutical approaches, lies with the integration of psychological and sociological theories. The identity theories, along with the phenomenological perspective of an ideal self, suggest that when people identify as part of a group they will deeply nurture each other’s attributes that tend to maintain the group identity.  Motivation for the cooperative exercise of caretaking can be founded on the development of an identity associated with a group. The identity theory asserts that one’s self-esteem is derived from the identity developed from social interactions. The sense of self is based on the roles that one assumes in a society or group with which one identifies (West 2014, Stets and Burke 2000).  A shared group identity can promote a desire to protect against those in other groups.

 Pain is connected to both social and individual identification.  Illich notes:

Pain is shaped by culture into a question that can be expressed in words, cries, and gestures, which are often recognized as desperate attempts to share the utter confused loneliness in which pain is experienced (Illich 1976, p. 140).

Reducing pain and suffering is more complex than medicinal treatment.  Addressing palliation requires deference to cultural motivators, self-identity and other powerful, foundational forces.  An effective system for palliative care moves beyond medicine and includes encouragement of relationally-rooted interaction between the patient and caregiver as well as spiritual nurturing. The caregiver’s personal connection with the patient is a key factor in reducing patient anxiety and maintaining patient dignity.  This caregiver relationship is especially important for terminally ill patients.  The medical treatment considers medication appropriate for treating pain, gasping, terminal secretions, nausea, anxiety, and delirium.

 

Clinical pain in the developing world

Pain is the most commonly feared symptom listed by individuals contemplating their eventual terminal illness and death. Unfortunately, throughout much of the developing world, this fear is realized daily by hundreds of thousands of people. The World Health Organization estimates that more than 30 million people each year are in need of care to support them and palliate their symptoms during their terminal illness, but the vast majority cannot get this care. Millions suffer from untreated pain annually.  This includes more than 5.5 million who die from cancer and more than one million from end stage AIDS (NGO 2011).  Opioids are one essential class of medication to treat such pain, but access to these medications is very limited in much of the developing world. Efforts to improve appropriate access to this class of medications is an important part of the worldwide palliative care movement.  In addition, increasing access to non-opioid medications and non-medication analgesic measures is also an important component in the effort to reduce worldwide suffering in the sick and terminally ill.

Comfort kit

In established palliative care systems, providing patients with an emergency symptom kit (or 'comfort kit') is a routine component of preparing for the common forms of suffering which afflict humans contending with advanced illness. The most common such symptoms are pain, dyspnea (air hunger), nausea and vomiting, delirium (an acute confusional state) and anxiety.  Medications that are commonly included to treat these symptoms include non-opioid pain medications (such as paracetamol or diclofenac), anti-anxiety medication (such as lorazepam or diazepam), anti-emetic (vomiting) medications (such as prochlorperazine), and anti-psychotic medications (such as haloperidol). Some such packs also include anticholinergic medications to treat the terminal secretions ('the death rattle') that often accompanies the terminal state. Provision of a comfort kit including these inexpensive medications alone, or even better, including simple commonly needed care items such as simple dressings, a urinal, and perhaps antibiotic ointment, would greatly enhance the comfort and the dignity for those who are ill and suffering.

Interpersonal relations

Medical practitioners typically enroll medications to ameliorate acute symptoms.  However, the notion of pain is contextual and culturally moderated.  Therefore, palliative care must rely most deeply upon the personal relationship between the caregiver and patient.  The patient must conclude that the caregiver understands the patient’s suffering.  The caregiver must ask the question, “What would you most like me to know about you so that I can take care of you?”  This inquiry is easy to present in the abstract but the patient – caregiver relationship is an entanglement comprised of a web of values, history, social norms, and regulatory requirements. 

A caregiver will never fully understand their patient’s suffering but must rely upon a deeply held sense of personal responsibility in treating and comforting the patient.  This type of relationship is more naturally derived from family relationships than from the medical community.  In addition, the patient’s expectations can motivate the approach to palliation. Consequently, the attending physician must understand:

• ·         Social and cultural norms.
• ·         Pain is contextual and subjective.
• ·         Patient recognizes not all suffering will be lifted.
• ·         Relationship between patient and caregivers.
• ·         Effect of illness on family.

Spiritual

Faith traditions are important in contextualizing suffering and identifying a purpose to pain.  Given that the experience of suffering frequently challenges the core of an individual such faith traditions can be an important aspect of providing care both to the patient and their family.  Through the values and meaning in a faith tradition suffering can represent a means to develop character and hope in the midst of an illness.  Alternatively, patients can believe the purpose of their pain is for discipline or correction or an indiscernible purpose but still governed by their deity.  Therefore, addressing the spiritual can be an important part of palliation and subsequent comfort for the suffering individual.

 Artificial Intelligence

Artificial intelligence (AI) can democratize access to patient assessment and guide dispensation of medicine.  Computing systems incorporate AI, such as expert systems and artificial neural networks, that strive to model human thought in a manner that can be processed on a computer and accessed by a non-expert user.  However, sharing human knowledge and expertise is a difficult task.  People use very sophisticated and intricate thought processes to solve problems, recall information, and make decisions.  Although expert systems are an excellent technology to save and disseminate knowledge, transferring that knowledge from the domain expert to the computer is difficult.  Acquiring knowledge for an expert system is the art of structuring human instincts, experience, heuristics (“rules of thumb"), guesswork and all the other words which never can quite explain the human thought process.  Expert systems use fuzzy logic to make decisions.  That is, the confidence of an output is quantified and that value can be handled separately from the output.  The confidence output is then used in determining the best, final decision of the expert system.  The combination of outputs and the confidence associated with them adds intelligence to the system.  In this way the “degree of truth” of information can be managed. 

Neural networks use a large number of processors with each artificial neuron dedicated to a specific task.  The neural networks organize the links between inputs, outputs and hidden intermediate layers of decision making.  Sensory or database information is fed through this network with each neuron processing the data independently and progressing its results through the network.  Generally, a feed forward approach is used where information flows from the input neurons, through the intermediate neurons and finally to the output without a feedback mechanism.  In this manner, large amounts of information are processed to identify relationships and therefore create a dynamic algorithm that can accurately develop conclusions from salient inputs.

Voice recognition is often coupled with AI allowing computing systems to recognize natural language usage and discern emotion.  AI driven voice recognition allows simplified access to computing power.  Currently voice systems are more than 97 percent accurate in identifying individual words and are being quickly implemented due to commercial interests (Brown 2016).  However, reliance upon AI driven voice recognition has potential problems with error and abuse.

Systemic approaches

Improving the quality of life for people contending with the symptoms of serious illness requires the care best offered through those who have a personal connection to the patient.  Medical approaches typically involve a professional caregiving team who develop and execute a plan of care (Ferris 2002).  However, where this resource intensive approach is not possible, a system of palliative care requires altruistic volunteers to provide treatment and personal support for the patient. These volunteers are educated and authorized to give support, evaluate and treat using prescribed protocols.  The volunteers are given comfort kits through the medical establishment.  If a volunteer from a family, community, or religious group is unable to provide care, a paraprofessional would need to be engaged; however, this is not the optimal arrangement because the altruism becomes distorted by financial forces.

The comfort kit would need to be issued specifically for one patient; however, the comfort kits have value and therefore present potential for misuse.  The contents could be resold, which is the most direct problem with the effective distribution of comfort kits.  In addition to financial gain, the distribution system provides power over the patient that could be misused.  Additionally, administration of medicine could be met by resistance within the medical establishment as well as social forces that resist a lay person’s ability to dispense medicine.  Control of medicine delivery could be addressed by technical solutions such as time release containers, drone deliveries or other ‘just in time’ systems.   However, these delivery systems are vulnerable to theft and abuse.

Caregiver training and adjuncts can improve suitability of treatment.  The caregiver adjuncts can range from video supervision by a physician to cards with photographs and corresponding treatment protocols.  The medical community must recognize untreated, acute pain can develop into chronic pain.  Therefore, aggressive treatment of acute pain through opioid and other medicines is recommended so that chronic pain will be reduced.

Future approaches

While relationships and spiritual connections will always be key components of palliative care, mechanistic designs can provide helpful improvements.  These can range from AI guided medicine dispensing systems to human powered refrigeration compressors.  In addition to AI guided and remotely based medical supervision, advanced design approaches would call for low cost/high impact devices.   Some technologies are seemingly difficult to develop such as systems that deter opiate abuses and secure medicine distribution. 

Improvements can be more product specific, such as refrigeration and fluid delivery systems.  If patients have refrigeration available they can store and dispense a broader range of medications   Appropriate technologies may include human powered refrigeration compressors, solid state thermoelectric refrigeration, high thermal mass systems, and minimized volume super-insulated storage systems. Low cost, easy to use fluid and drug delivery systems such as infusional subcutaneous and syringe driver systems would also aid treatment.  Usage of medical products can be facilitated using AI driven voice recognition.  Additionally, drone delivered medicine and radio and video communication allows treatment in remote areas.

Conclusion

Palliative care transcends medicine and technology.  The spiritual and interpersonal relationships infuse into patient care in forms that are difficult to characterize.  However, in low resource or remote populations the administration of medicine and care is best administered by altruistic individuals such as those affiliated with the patient by family, community or religion.  These caregivers need to be richly empowered to provide treatment necessary to address issues of pain, dyspnea, nausea and vomiting, delirium, and anxiety. 

Comfort kits should be provided to these caregivers that would include non-opiate pain killers such as paracetamol and diclofenac.  Other medications would include paracetamol, diclofenac, lorazepam, diazepam, prochlorperazine, and haloperidol.  Other items such as bandaging and a urinal would also be provided. 

Within the realm of product and systems designs, technical advances that allow remote monitoring and AI guidance can provide improved diagnosis and treatment.  Moreover, low cost versions of refrigeration and drug delivery systems will aid in treatment options.  Developing non-addictive pain medicines have been largely unsuccessful; however, customizing pharmaceuticals such as abuse deterrent opiates designed to genomically key to the individual could reduce abuse.

Palliative care in the developing world can be improved by empowering nonmedical personnel who are communally connected with the patient.  These individuals can best answer the question, “What would you most like me to know about you so that I can take care of you?”

 

References

Brown, A. (2016), Talk to Me. American Society of Mechanical Engineers (ASME) Mechanical Engineering, No. 11, 138, Nov. 2016, pp. 32-37.

Ferris FD, Balfour HM, Bowen K, Farley J, Hardwick M, Lamontagne C, Lundy M, Syme A, West P. (2002), A Model to Guide Hospice Palliative Care. Ottawa, ON: Canadian Hospice Palliative Care Association.

Feyerabend, P. (1993), Against Method. New York: Verso.

Illich, I. (1976), Medical Nemesis: The expropriation of health. Bantam Books/Random House.

NGO Human Rights Watch, (2011) [Online] Global State of Pain Treatment-Access to Medicines and Palliative Care.

Stets, J. & Burke, P. (2000), Identity Theory and Social Identity Theory. Social Psychology Quarterly 63, 2.

West, R. (2014), “Communities of innovation: Individual, group, and organizational characteristics leading to greater potential for innovation: A 2013 AECT Research & Theory Division Invited Paper.” TechTrends 58.5, (9), pp. 53-61.

Death of Ideation Sketching

 

Most of my ideation "sketches" just flow through my mind--little maquettes dancing with flashes of imagery. Requiring a specific number of ideation sketches, never lifting your pen, working with two colors—these are all fine to the extent they are useful.* However, design educators should not be pedantic about these things.

In a few minutes I littered the blog above and below with ideation sketches using DALL-E 2. This will only get easier and “better” with time. These sketches of toasters, helmets, blenders, coffee makers, and door handles may not be to your liking, but I generated all of them in less than ten minutes of typing. They are done in marker, colored pencil, and graphite. Easy stuff.

Interesting issues arise for the designer/educator/student to consider in the AI universe. One of them is personal style. While our personal style seems independent of AI’s ability to identify patterns that nurture rule creation, it is influenced by the world we encounter, much of which will be increasingly generated by AI or flattened by the globalization of cultural standards.

Unlike AI, people have the ability to 1) change their style and 2) incorporate influences serendipitously. The randomness and mistakes people make do not rest in the datasets that machine learning requires. Moreover, people respond and appreciate the sacrificial time expended by other people. People hold hands and converse. AI can converse, but it doesn’t sacrifice its time in the process.

What is personal style and how much of it is simply a product of cultural imputation and the copying of influencers? Do we own our own sense of style? These are unanswerable questions; however, people can take surprising actions that upset rule-based approaches. People have the ability to shed rules and explore new ways of thinking and acting. Additionally, people can be exposed to events that modifies their personal style. This serendipitous stumbling can lead to a surprising randomness in style.

I do take joy knowing that imagination is greater than knowledge, imagination is an untethered rocket and a sweeping cool wind that carries thoughts wherever it will!  Maybe my technology-enabled works are only decorative, but I own them. They are my voice. Being able to present my voice is all I can ask. I can’t ask for fame or money, no one owes me that.

In this next chapter of design, the dogma should continue to crumble and distinctive human abilities should shine brighter while we swim in what AI is flooding at our feet.

The most beautiful emotion we can experience is the mysterious. It is the fundamental emotion that stands at the Cradle of all true art and science. Key to whom this emotion is a stranger, who can no longer Wonder at stand wrapped in awe, is as good as dead, a snuffed-out candle. Albert Einstein 1930

* I like tradition. My students and I have crawled into a dark room under one of our campus buildings to do blind contour drawings. Weird and intriguing, but I really don't know how useful it is for the aspiring designer.

More ideation sketches! How many do you want? I have a few more minutes.

All images are from Dall-E 2 (and I)