Delight in Baltimore

Last day in Baltimore for a while. I'm getting rather fond of the place, despite its reputation and the painful divide between privileged and impoverished.

Today I spent the entire morning in my hotel room. I intentionally had not set my alarm, but then awoke in a panic at 7.15am, remembering that I had a skype meeting with people in London... but was it at 7am or 8am? I hadn't a clue! With the many small time-changes I've had on this trip, I had completely lost track of what time the meeting was meant to be. It turned out I was OK, and had 45 minutes to turn from a sleepy person into a professional one. Whew!

Much of the day was then filled with "invisible work", meaning that at 2pm (when I left my hotel room) I had no real idea of what I had achieved in the past 6 hours, other than having a meeting with people in London and clearing a backlog of email. Oh: and writing up some of the notes from many meetings and presentations over the past week or so. Got some way to go on that activity though...

The walk from the hotel to the Armstrong Institute is not far. The following two photos show the hotel from the AI offices (hotel on the far left on the horizon of the left-hand photo) and, conversely, the AI offices from the hotel (AI offices are 15th floor of the tower block next to the canal):










I chose to walk a different way to the offices today, and was delighted when I came across a "homonym path": a section of pavement where some of the paving blocks had had words carved on them, and homonyms had been juxtaposed:

Some of the homonyms only work if you speak American, but it was so surprising (in a very positive way) to encounter this playful pavement that it really brightened up my afternoon.

Postscript (just to add to the time confusion): I have just realised that all the posts in this blog appear to be time-stamped west-coast time. As far as I'm concerned, I've posted this entry at 8.28pm, and yet it is time-stamped 17.28. Whoa! Where am I?!?

WICU, SICU and a stranded lighthouse

Morning: went to look around two of the intensive care units at the local hospital here in Baltimore. Even in such a well resourced and well appointed environment, they need to be alert to vulnerabilities in the system, as exemplified by the notice on the back of one door, reminding staff to take care not to confuse anticoagulant with antibiotic.

Walking back from the Armstrong Institute to my hotel, I passed a lighthouse on stilts. I couldn't really work out why it was there, since there didn't seem to be a particular threat to shipping so close into the harbour. Apparently, it was moved there some time ago from its original position about 5 miles away, where it actually was alerting ships to danger, to bring all of the quaint historical landmarks of Baltimore within easy walking distance of each other. I guess the alternative would have been to provide decent public transport links between all the monuments... and that is hardly an American approach to travel.

I don't think anyone has tried moving the shot tower, which I thought looked like the offspring of a chimney and a small castle, but was apparently once the tallest building in the US. Used simply to drop molten lead from a great height to create pistol shot and cannon balls.

Baltimore apparently got caught up in the Civil War (hence the need for lots of shot, presumably), and is the scene of the first massacre of the war, where soldiers alighting from a train were ambushed by people who sympathised with the southerners. There were two stations in Baltimore, one each side of the centre, because trains were considered too polluting and dirty to cross through the city centre, so everyone had to alight from the one train to take horse-drawn carriages to the other station to continue their journeys. This is what the soldiers should have done...

And my last of what Pete called "LKBBFs, Little Known But Boring Facts" and I consider to be "LKBFFs, Little Known But Fascinating Facts" for the evening: the cobblestones that pave many of Baltimore's streets  around the harbour area were delivered here as ships' ballast when this was a thriving port, so they originate from all corners of the globe.

Thank you to Pete and Mahiyar for a very entertaining and also highly informative evening!

HFES and Grand Rounds

Morning: the last session of the HFES Healthcare Symposium. I chose to go to the presentations from three people from the FDA, who were all presenting different aspects of the Human Factors regulatory system. As an outsider to the system, I found this very striking for at least two reasons:

1) Tony Watson presented a pretty frank history of human factors in the FDA. Medical Devices are, of course, not a central focus for the organisation, but there has only been one HF specialist in the FDA for 15 years... and only two (and a couple of other people whose primary responsibility lies elsewhere) for the past 4 years or so. That's it! Those two people set policy and direction for the US... and the US, in turn, sets policy and direction for most of the rest of the world. That gives those two people more power and responsibility (and a much bigger workload) than I imagine they want. Last week, one of the people I was working with introduced me to a new acronym: PAMP: Problem Above My Paygrade. It seems to me that the HF folk at the FDA are dealing with a PAMP in spades!

2) They were all here! The key Human Factors specialists at the FDA, who set policy and manage practice in the regulation of all interactive medical devices, were at a conference that involved manufacturers and usability specialists and academics. And they were around to chat, to listen, to engage with their community. As a British researcher, I have better contact with the people who regulate medical devices in the US than I do with any such people in the UK.

Lunchtime: I gave a talk at the Armstrong Institute of Patient Safety Grand Rounds. It was in a large and imposing lecture theatre in the Johns Hopkins hospital, and felt quite like an inaugural lecture, except that half the audience were wearing scrubs and surgical masks.

Afternoon: meeting with Chris Gibbons, who is studying how to use new technologies to make healthcare more accessible to disadvantaged communities in the US. Baltimore is, of course, a divided city where a significant part of the community needs better access to healthcare, while much of the rest has excellent access. So a great place to do such studies.

HFES Healthcare Symposium Day 2

Another busy day in Baltimore, where my brain has got full to overflowing, and I have met yet more interesting and engaging people.

I cannot imagine a conference like this, which really brings together practitioners and researchers, regulators and manufacturers, MDs and PhDs (and people with other kinds of qualifications), happening in the UK. Not on an equal footing, anyway. It's not a highly academic conference: I haven't come away with great new scientific insights. But I have heard about a lot of research and practice, and experiences that resonate well with the findings from our studies. And I feel I have a better sense of the pressures and practices that shape healthcare and the design and use of interactive technologies in North America.

And some good news: after it has started, the Royal Society has awarded a travel grant for the trip – better late than never (I applied for it last October...). And two members of my research team have had journal papers accepted (subject to small changes) this week. Lots to celebrate when I get home.

Apropos of nothing, here's the view from my hotel room during the day (the greenish buildings are the Johns Hopkins medical campus / hospital) and at night (said buildings covered in lights).

HFES Healthcare Symposium Day 1

I am actually too tired to write much today, and I have no photos at all, but lots of notes scribbled in my notebook which I will have to make sense of when I have the time and the mental energy. I have met lots of interesting people, many whose work I have read but never met in person before. My brain is full to overflowing. And I still have a paper to review and a talk to finish writing this evening. Oh dear!

A sunny day in Baltimore

Today has been warm (almost t-shirt weather) in Baltimore -- a sharp contrast with Chicago yesterday, which was numbingly cold. I went for a short walk to Fells Point, which was lovely. Lots of people were out on the streets just enjoying the sunshine and warmth.

I just did a google search for Fells Point, and the first two pictures that appear are almost exactly the same as one of the pictures I took -- I'll opt for thinking of this as great minds thinking alike. See photo on the right of a street (which is actually cobbled, though you can't tell that from the photo) overlooking the harbour.

That part of town is Quaint: lots of interesting buildings in unlikely places. Twice, I just glanced down side-streets to see old buildings at the ends of the streets (see photo on left). Also, lots of Irish pubs; I think next weekend (St Patrick's Day) is going to be very green and very lively here...

This evening, I went out with the research group from Toronto, who have mostly been looking at multiple line infusions. I don't think we do many of those in the UK (an example of different practices in the different countries), so something that is a major human factors challenge in North America isn't such a focus for concern in Europe.

Errors, delight and delays

Friday: gave a talk to the HF group at Baxter. I gave an example of resilience (intentionally leaving night clothes in the safe with passport and other items to make sure that I would not leave passport etc.). This is a strategy I've used before. At the time of giving the talk, I was oblivious to the fact that I had left my handbag (containing passport, credit card, phone, car keys...: all those physically small things on which modern life and international travel depend) on the back of a chair in the reception area. Imagine the level of panic when, two hours later, I realised that, although I seemed to be carrying a ridiculous number of things, those things did not include said handbag. Too much to think about, too many physical objects in hands. Where had I left it? Reception? Seminar room? Ladies loo? Cafeteria? Of course, the last we checked was reception... but all's well that ends well (to quote someone famous). And apart from that panic, the meeting was great. I particularly liked the visit to their simulation lab (even if the mannequins were slightly spooky).

Friday evening: drove to Chicago downtown. All went fine (though I did resort to valet parking because I didn't have the emotional energy to do anything else). Dinner was wonderful, though I never cease to be amazed and appalled about how large the portions are.

Saturday morning: wonderful, but very cold, walk around Chicago, as it set out to confirm its reputation as the "windy city". The Naval Pier was impressive, but was completely overshadowed by my visit to the Bean. This looks quite innocuous until approached closely, but is just delightful on close encounter. We (and I quote Pat) "circumnavigated the bean" to savour it from all angles. If you look closely at the photo (left) you will see me facing both left and right in the image while I am in fact facing straight ahead taking the photo. Freaky!

The journey back to Baltimore was stressful in terms of both navigation and delays. You are on the freeway at an intersection, knowing that you want to turn North, but the options are East or West. Which to take (in the split second that you have to make the decision)? The wrong one, of course. Thank goodness for a reasonably detailed map of the city that made it possible to do a big loop around to the starting position and have a second go at it. Turned out I didn't need to worry about being late for the flight because it was a mere two hours late. Both of my neighbours on the plane had connecting flights; I do hope they made them...