An Online Birthday Party!

15 06 2009

15-6-2009 18-05-22 BD poes kaart kleinToday is my birthday. And although I stayed home with a headache and other small complaints, and although I don’t really celebrate it any longer (except for the real round figures, like 50-60), the day started out pretty bright just around midnight with all kinds of virtual birthday wishes.

It started with an e-card (left) from Ramona Bates, plastic surgeon and quilter from the USA (hence her blog Suture for a Living), followed by many other birthday wishes.

Robin of Survive the Journey was so kind to send a song via blip.fm and then to organize a “twitter-party” by using the twitter-tool QuoteURL I had just reviewed on my blog (see here).

The start of the Twitter party  is shown below. Here is the link: http://www.quoteurl.com/r1e27

Suture for a Living

  1. rlbates
  2. drval
    drval Happy Birthday to @laikas, our favorite Dutch medical librarian. 🙂
  3. Ves Dimov, M.D.
  4. Deirdre
  5. Vijay
    scanman @laikas Happy Birthday Jacqueline 🙂
  6. Laika (Jacqueline)
    laikas @scanman: @laikas Happy Birthday Jacqueline 🙂 Thanks vijay. Wish we could have a Twitter birthday party with cake or so.
  7. Marilyn Mann
  8. Laika (Jacqueline)
    laikas @MarilynMann thanks Marilyn. It is very nice to begin your birthday with all those kind birthday-twishes.
  9. Robin
    staticnrg @Laikas Oh, happy birthday!! Hope it is a wonderful one!! ♫ http://blip.fm/~88du0
  10. Laika (Jacqueline)
    laikas @staticnrg: “@Laikas Oh, happy birthday!! Hope it is a wonderful one!!” – Well the start is all right – thnx! ♫ http://blip.fm/~88e8a

this quote was brought to you by quoteurl (pity that WordPress transforms the style)

Later I received more birthday and get-well wishes from Twitter, Hyves, Facebook, and Fabulously 40 (and beyond). I even received a e-card with “happy birthday” in Chinese!happy-birthday in chinese

Although my friends are virtual (?) and the cards and wishes are virtual, it feels like I’m having a real birthday party with real friends. The only thing that was missing was real coffee, cake or wine. 😉

15-6-2009 18-29-23 tweet rlbates

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#CECEM Bridging the Gap between Evidence Based Practice and Practice Based Evidence

15 06 2009

cochrane-symbol A very interesting presentation at the CECEM was given by the organizer of this continental Cochrane meeting, Rob de Bie. De Bie is Professor of Physiotherapy Research and director of Education of the Faculty of Health within the dept. of Epidemiology of the Maastricht University. He is both a certified physiotherapist and an epidemiologist. Luckily he kept the epidemiologic theory to a minimum. In fact he is a very engaging speaker who keeps your attention to the end.

Guidelines

While guidelines were already present in the Middle Ages in the form of formalized treatment of daily practice, more recently clinical guidelines have emerged. These are systematically developed statements which assists clinicians and patients in making decisions about appropriate treatement for specific conditions.

Currently, there are 3 kinds of guidelines, each with its own shortcomings.

  • Consensus based. Consensus may be largely influenced by group dynamics
    Consensus = non-sensus and Consensus guidelines are guidelies.
  • Expert based. Might be even worse than consensus. It can have all kind of biases, like expert and opinion bias or external financing.
  • Evidence based. Guideline recommendations are based on best available evidence, deals with specific interventions for specific populations and are based on a systematic approach.

The quality of Evidence Based Guidelines depends on whether the evidence is good enough, transparent, credible, available, applied and not ‘muddled’ by health care insurers.
It is good to realize that some trials are never done, for instance because of ethical considerations. It is also true that only part of what you read (in the conclusions) has actually be done and some trials are republished several times, each time with a better outcome…

Systematic reviews and qualitatively good trials that don’t give answers.

Next Rob showed us the results of a study ( Jadad and McQuay in J. Clin. Epidemiol. ,1996) with efficacy as stated in the review plotted on the X-axis and the Quality score on the Y-axis. Surprisingly meta-analysis of high quality were less likely to produce positive results. Similar results were also obtained by Suttorp et al in 2006. (see Figure below)

12066264  rob de bie CECEM

Photo made by Chris Mavergames

There may be several reasons why good trials not always give good answers. Well known reasons are  the lack of randomization or blinding. However Rob focused on a less obvious reason. Despite its high level of evidence, a Randomized Controlled Trial (RCT) may not always be suitable to provide good answers applicable to all patients, because RCT’s often fail to reflect the true clinical practice. Often, the inclusion of patients in RCT’s is selective: middle-aged men with exclusion of co-morbidity. Whereas co-morbidity occurs in > 20% of the people of 60 years and older and in >40% of the people of 80 years and older (André Knottnerus in his speech).

Usefulness of a Nested Trial Cohort Study coupled to an EHR to study interventions.

Next, Rob showed that a nested Trial cohort study can be useful to study the effectiveness of  interventions. He used this in conjunction with an EHR (electronic health record), which could be accessed by practitioner and patient.

One of the diseases studied in this way, was Intermittent Claudication. Most commonly Intermittent Claudication is a manifestation of  peripheral arterial disease in the legs, causing pain and cramps in the legs while walking (hence the name). The mortality is high: the 5 year mortality rates are in between those of colorectal cancer and Non-Hodgkin Lymphoma. This is related to the underlying atherosclerosis.

There are several risk factors, some of which cannot be modified, like hereditary factors, age and gender. Other factors, like smoking, diet, physical inactivity and obesity can be tackled. These factors are interrelated.

Rob showed that, whereas there may be an overall null effect of exercise in the whole population, the effect may differ per subgroup.

15-6-2009 3-06-19 CI 1

  • Patients with mild disease and no co-morbidity may directly benefit from exercise-therapy (blue area).
  • Exercise has no effect on smokers, probably because smoking is the main causative factor.
  • People with unstable diabetes first show an improvement, which stabilized after a few weeks due to hypo- or hyperglycaemia induced by the exercise,
  • A similar effect is seen in COPD patients, the exercise becoming less effective because the patients become short of breath.

It is important to first regulate diabetes or COPD before continuing the exercise therapy. By individually optimizing the intervention(s) a far greater overall effect is achieved: 191% improval in the maximal (pain-free) walking distance compared to for instance <35% according to a Cochrane Systematic Review (2007).

Another striking effect: exercise therapy affects some of the prognostic factors: whereas there is no effect on BMI (this stays an important risk factor), age and diabetes become less important risk factors.

15-6-2009 3-35-10 shift in prognostic factors

Because guidelines are quickly outdated, the findings are directly implemented in the existing guidelines.

Another astonishing fact: the physiotherapists pay for the system, not the patient nor the government.

More information can be found on https://www.cebp.nl/. Although the presentation is not (yet?) available on the net, I found a comparable presentation here.

** (2009-06-15) Good news: the program and all presentations can now be viewed at: https://www.cebp.nl/?NODE=239





QuoteURL: a new Twitter Tool to Quote, Save and Publish Tweets

14 06 2009

Ever tried to catch and publish a twitter conversation? Hard, isn’t it, especially at WordPress.com where the lay-out is often difficult to control, if you just copy and paste.
Tweets also tend to disappear after approximately 3-4 weeks.  Thus if you want to capture them you should do it (relatively) soon after they have been tweeted.

A month ago I gave a presentation where I showed medical students a real fancy twitter-application with tweets of  doctors, patients and nurses giving them advice on how to use web 2.0 tools in medicine. Now the tweets have all gone….14-6-2009 0-13-00 Qoute URL logo

But the new Twitter Tool QuoteURL, developed by Fabricio Zuardi, offers a perfect solution.

It is a very intuitive and easy tool that allows you to collect several tweets, for instance answers to a question. A maximum of 4 tweets per quote are allowed for unregistered tweeps and 10 after free registration. The 10-tweet limit is only meant to keep Twitter API quotas under control, but you can twitter @fczuardi or email fabricio at fabricio dot org to ask for an exception (source: comment of Fabricio at onlinejournalismblog.com)

You can collect tweets in two ways:

1. Enter the Twitter status URL or ID (click on the date or on “view tweet”, depending on the interface). For instance http://twitter.com/laikas/statuses/2115296397. You can easily gather the tweets in a text or word file, till you need them. This is for instance suitable for the series Top of the Tweets, where I collect funny tweets over time.

14-6-2009 15-27-56 CECEM tweet 12

Method 1: copy/paste permalink

2. Drag or drop the tweet-URL’s from a split screen that shows pop-ups of  Twitter Home or Twitter Search in a separated window. Perform a search (figure) or go to your Twitter home page to drag permalinks into the text-field. Just drag the line that would show the url when you click on it.

Method 2. Drag and drop from spilt window

Method 2. Drag and drop from split window (click to enlarge)

QuoteURL arranges tweets chronologically, so you can drag them in in any order.

After you have collected the tweets you press the Save button and the permalink is created. To embed the Quote in your blogpost just copy the <!– QuoteURL styled embed start –> (lower right) in the HTML-view of your blog and the code appears)

Summary.

  • Tweets can be collected by copy-pasting of the tweet URL’s or by dragging and dropping.
  • Tweets are ordered chronologically
  • The Quote can be saved as a permalink
  • You can mail the URL to someone or you can post it directly on your blog by copy-pasting of the embedded code
  • The individual tweet-URL’s can still be produced (click on dates).

Below is an example of a Quote made with QuoteURL. I thought it would be nice to show a recent discussion with the maker of QuoteURL @fczuardi. The permalink is: http://www.quoteurl.com/by608
WordPress.com shrinks the lay-out after saving. Other hosts may let the style intact. Still I find the result pretty awesome.

  1. laikas @fczuardi Hi, I like your Quoteurl – although the lay-out becomes less when saved on WordPress. Questions: can you add tweets (days) later??
  2. laikas @fczuardi Q2: do the quotes remain stable over time? (tweets normally disappear after 3-4 weeks) ; and the avatars?
  3. fczuardi @laikas regarding the layout on wordpress, you can get the unstyled version of the embed code and use your own CSS
  4. fczuardi @laikas the avatars breaking later is a known issue, the right thing to do would to cache those images, but the code does not do it yet

this quote was brought to you by quoteurl

The video gives more details about the whole procedure.

Vodpod videos no longer available.

more about “QuoteURL“, posted with vodpod





#CECEM David Tovey -the Cochrane Library’s First Editor in Chief

13 06 2009

cochrane-symbolThis week I was attending another congress, the Continental European Cochrane Entities Meeting (CECEM).

This annual meeting is meant for staff from Cochrane Entities, thus Centre Staff, RGC’s (Review Group Coordinators), TSC’s (Trial Search Coordinators) and other staff members of the Cochrane Collaboration based in Continental Europe.

CECEM 2009 was held in Maastricht, the beautiful old Roman city in the South of the Netherlands. The city where my father was born and where I spend many holidays.

One interesting presentation was by Cochranes’ 1st Editor in chief, David Tovey, previously GP in an urban practice in London for 14 years and  Editorial Director of the BMJ Group’s ‘Knowledge’ division (responsible for BMJ Clinical Evidence and its sister product Best Treatments, see announcement in Medical News Today)

David began with saying that the end user is really the key person and that the impact of the Cochrane Reviews is most important.

“How is it that a Senior health manager in the UK may shrug his shoulders when you ask him if he has ever heard of Cochrane?”

“How do we make sure that our work had impact? Should we make use of user generated content?”

Quality is central, but quality depends on four pillars. Cochrane reviews should be reliable, timely, relevant and accessible.

Cochrane Tovey wit

How quality is perceived is dependent on the end users. There are several kinds of end users, each with his own priorities.

  1. doctor: wants comprehensive and up-to-date info, wants to understand and get answers quickly.
  2. patient: trustworthiness, up-to-date, wants to be able to make sense of it.
  3. scientist: wants to see how the conclusions are derived.
  4. policy and guideline-makers.

Reliable: Several articles have shown Cochrane Systematic Reviews to be more reliable then other systematic reviews  (Moher, PLOS BMJ)*

Timely: First it takes time to submit a title of a Cochrane Review and then it takes at least 2 years before a protocol becomes a review. Some reviews take even longer than 2 years. So there is room for improvement.

Patients are also very important as end user. Strikingly, the systematic review about the use of cranberry to prevent recurrent urinary tract infection is the most frequently viewed article,- and this is not because the doctors are most interested in this particular treatment….

Doctors: Doctors often rely on their colleagues for a quick and trustworthy answer. Challenge: “can we make consulting the Cochrane Library as easy as asking a colleague: thus timely and easy?”

Solutions?

  • making plain language summaries more understandable
  • Summary of Findings
  • podcasts of systematic reviews (very successful till now), .e. see an earlier post.
  • Web 2.0 innovations

Key challenges:

  • ensure and develop consistent quality
  • (timely) updating
  • putting the customer first: applicability & prioritization
  • web delivery
  • resources (not every group has the same resources)
  • make clear what an update means and how important this update is: are there new studies found? are these likely to change conclusions or not? When was the last amendment to the search?

I found the presentation very interesting. What I also liked is that David stayed with us for two days -also during the social program- and was easy approachable. I support the idea of a user-centric approach very much. However, I had expected the emphasis to be less on the timeliness (of updates for instance), but more on how users (patients, doctors) can get more involved and how we review the subjects that are most urgently needed. Indeed, when I twittered that Tovey suggested that we “make consulting the Cochrane Library as easy as asking a colleague”, Jon Brassey of TRIP answered that a lot has to be done to fulfill this, as the Cochrane only answers 2 out of 350+ questions asked by GPs in the UK, a statement that appeared to be based on his own experience (Jon is founder of the TRIP-database).

But in principle I think that Jon is correct. Right now too few questions (in the field of interventions) are directly answered by Cochrane Systematic Reviews and too little is done to reach and involve the Cochrane Library users.

13-6-2009 15-43-17 twitter CECEM discussion

click to enlarge

During the CECEM other speakers addressed some of these issues in more detail. André Knottnerus, Chair of the Dutch Health Council, discussed “the impact of Cochrane Reviews”, and Rob the Bie of the Rehabilitation & Related Therapies field discussed “Bridging the  gap between evidenced based practice and practice based evidence”, while Dave Brooker launched ideas about how to implement Web 2.0 tools. I hope to summarize these (and other) presentations in a blogpost later on.

*have to look this up

NOTE (2009-11-10).

I had forgotten about this blank “citation” till this post was cited quite in another context (see comment: http://e-patients.net/archives/2009/11/tell-the-fda-the-whole-story-please.html) and someone commented that the asterisk to the “the amazing statement” had still to be looked up,  indirectly arguing that this statement thus was not reliable- and continuing by giving an example of a typically flawed Cochrane Review that hit the headlines 4 years ago, a typical exception to the rule that “Cochrane systematic reviews are more reliable than other systematic reviews”. Of course when it is said that A is more trustworthy than B it is meant on average. I’m a searcher, and on average the Cochrane searchers are excellent, but when I do my best I surely can find some that are not good at all. Without doubt that also pertains to other parts of Cochrane Systematic Reviews.
In addition -and that was the topic of the presentation- there is room for improvement.

Now about the asterisk, which according to Susannah should have been (YIKES!) 100 times bigger. This was a post based on a live presentation and I couldn’t pick up all the references on the slides while making notes. I had hoped that David Tovey would have made his ppt public, so I could have checked the references he gave. But he didn’t and so I forgot about it. Now I’ve looked some references up, and, although they might not be identical to the references that David mentioned, they are in line with what he said:

  1. Moher D, Tetzlaff J, Tricco AC, Sampson M, Altman DG, 2007. Epidemiology and Reporting Characteristics of Systematic Reviews. PLoS Med 4(3): e78. doi:10.1371/journal.pmed.0040078 (free full text)
  2. The PLoS Medicine Editors 2007 Many Reviews Are Systematic but Some Are More Transparent and Completely Reported than Others. PLoS Med 4(3): e147. doi:10.1371/journal.pmed.0040147 (free full text; editorial coment on [1]
  3. Tricco AC, Tetzlaff J, Pham B, Brehaut J, Moher D, 2009. Non-Cochrane vs. Cochrane reviews were twice as likely to have positive conclusion statements: cross-sectional study. J Clin Epidemiol. Apr;62(4):380-386.e1. Epub 2009 Jan 6. [PubMed -citation]
  4. Anders W Jørgensen, Jørgen Hilden, Peter C Gøtzsche, 2006. Cochrane reviews compared with industry supported meta-analyses and other meta-analyses of the same drugs: systematic review BMJ  2006;333:782, doi: 10.1136/bmj.38973.444699.0B (free full text)
  5. Alejandro R Jadad, Michael Moher, George P Browman, Lynda Booker, Christopher Sigouin, Mario Fuentes, Robert Stevens (2000) Systematic reviews and meta-analyses on treatment of asthma: critical evaluation BMJ 2000;320:537-540, doi: 10.1136/bmj.320.7234.537 (free full text)

In previous posts I regularly discussed that (Merck’s Ghostwriters, Haunted Papers and Fake Elsevier Journals and One Third of the Clinical Cancer Studies Report Conflict of Interest) that pharma-sponsored trials rarely produce results that are unfavorable to the companies’ products [e.g. see here for an overview, and many papers of Lisa Bero].

Also pertinent to the abovementioned discussion at E-patient-Net is my earlier post: The Trouble with Wikipedia as a Source for Medical Information. (references still not in the correct order. Yikes!)

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#EAHIL2009 Web 2.0 and Health Information – Chris Mavergames

4 06 2009

2-6-2009 23-11-41 EAHIL 2009

I’m in Dublin to attend the EAHIL workshop 2009.
The EAHIL is the European Association for Health Information and Libraries.

The EAHIL -workshop 2009 really started Wednesday afternoon. Tuesday morning, as a foretaste of the official program I attended a Continuing Education Course, namely the Web 2.0 and Health Information course by Chris Mavergames.

Chris Mavergames is currently the Web Operation Manager/Information Architect for the Cochrane Collaboration. Before, he worked in the field of information and library science.

So Chris and I are really colleagues, but we didn’t realize until we “met” on Twitter.

On this hot day in June I was pleased that the workshop was held in the cool Berkeley Library of Trinity College.
They have chosen real good locations for this EAHIL workshop. Most presentations are in the Dublin Castle, another place at the Heart of the Irish History.

The workshop took approximately 3 hours and consisted of two presentations, followed by short Q&A’s and an open forum afterwards.

The presentations:

  • Web 2.0 and Health Information“,
  • A case study of the experiences of implementing and using these technologies in a large, non-profit organization (Cochrane Collaboration).

Eighteen people could attend. Each of us had a computer, which raised expectations that they were needed during the workshop. They were not, but they were handy anyway to look up things and to draft a post. And.. I could post this message on Twitter before Chris loaded a photo of his class on TwitPic.  LOL.

4-6-2009 9-46-55 chris is making a photo

10848362 class chriss mavergames

Web 2.0 versus web 1.0
Chris began with asking the audience how many people either have used ..or at least have heard of Facebook, LinkedIn or any other social networking service. And then he asked which tools were being used. Afterwards he admitted he had checked everyone’s presence on various social bookmarking sites. Hilarious.

To my surprise, quite a number of people were familiar with most of the web 2.0 services and sources. Indeed, weren’t librarians the first to embrace web 2.0?

I got the impression Twitter was the least well known/appreciated tools. Most people were either on Facebook or Linkedin, not on both. This presumably has to do with separation of professional and personal things.

Chris first explained the difference between Web 1.0 and Web 2.0: Web 1.0 is a one way interaction, static. Web 2.0 is: “more finding or receiving, less searching”. It has a dynamic aspect: there is more interaction, the possibility to ‘comment, subscribe, post, add, share or as Chris puts it: “Web 2.0 allows you to have information “pushed” at you vs. you having to “pull”.

Another characteristic of web 2.0 is that technology has become easier. It is now more about content.

As an example he showed the Cochrane website from 2004 (web 1.0) and the current website. The first was just a plain web site where you could search, browse and email, the second has social bookmarking tools and is more dynamic and active: you can add comments, post on websites etc.. In addition the Cochrane Collaboration is now on Twitter and Facebook and produces podcasts of a selection of systematic reviews.

Another example of web 2.0 interfaces are MyNCBI of PubMed (for saving your searches) and i-Google.

Social Networking services
These services allow you to create an online profile so that you can interact with others, share and integrate.

Examples are Facebook, LinkedIn and 2 Collab. What is used most, differs around the world. Linkedin is more a professional site, an “online resume” and Facebook is for more general stuff. “You’re mother is on facebook too, so..”. Most young people don’t realize what others can read. However, Facebook offers the possibility to select precisely who can see exactly what.

Twitter
Twitter is a microblogging system, that allows a 140 chracter message (tweet). At first, Chris wasn’t very much interested. He only knew Twitter through the automatic updates on Facebook, but “wasn’t really interested in a  friend in New York eating a scrambled egg.”

It is as easy to subscribe to one’s updates as it is to unsubscribe. Chris uses Tweetdeck to filter for keywords that are of interest. But as he showed me later, he uses the i-phone to easily catch what people (he follows) are tweeting.

Although Twitter was created as a social tool it is now much more than that. It creates a so called “ambient awareness” and as such it is a perfect example of “push” technology: you won‘t see every tweet, but you will l be ambiently aware of the conversation (of your “friends” or the subject you follow). Twitter is also very useful for getting a real fast answer to your question. This is how Chris learned the value of Twitter. He had a question at a meeting. Someone said: just put it on Twitter with the hashtag of the congress (an agreed upon keyword with #in front, like #EAHIL2009). He did it and within 3 minutes he got an answer. Twitter is also very useful for sharing and finding links.
There are many “Twitter apps” around. Just search Google for it.

For professional use within a company the twitter look-alike Yammer can be a useful alternative, because only people in the company are able to follow the updates.

My personal experience is also very positive. Twitter and other web 2.0 tools can work synergistically, dependent on your Twitter community and how you use it.

Social bookmarking:
Although librarians aren’t always very happy with user generated tagging, social bookmarking tools are and easy way of allowing users to share a collections of links.
Links used (directly or indirectly) for his presentation are available at del.icio.us/mavergames under the tag EAHIL.

Blogs, Wiki’s
A blog can give a good summary of interesting articles in a particular field. Chris began a blog 2 months ago (http://mavergames.net) about  a very specific subject he is involved in: Drupal. For him is it just an open notebook: a platform to share your ideas with others.
It is possible receiving updates via RSS (push).

Wiki’s are a very powerful knowledge gathering tool,  a way to collaboratively create a resource, based on the principle of “Crowd sourcing” (The Wisdom of Crowds).

Examples of the two are:

  1. https://laikaspoetnik.wordpress.com/ (this blog)
  2. http://scienceroll.com/ (of the Hungarian Medical Student Bertalan Mesko)
  3. http://www.medpedia.com/ (not yet fully developped medical wiki)
  4. http://twictionary.pbwiki.com/ (a fun wiki with the Twitter Vocabulary)
  5. cochrane.org/ideas
  6. http://mavergames.net (Chris’s blog on Drupal)

Subscription services: RSS
Via RSS Really Simple Syndication you can push information from a variety of sources:

  • Podcasts, for instance cochrane.org/podcasts
  • Saved searches, like in PubMed
  • News feeds cochrane.org/news
  • Updates to sites
  • Updates to collections of bookmarks
  • Updates to flickr photos
  • Etcetera

Platforms can vary from Google Reader, Yahoo, Bloglines, but you can also use i-Google or a specilized medical page where you can find links to all kinds of sources, like blogs, podcasts and journals. Perssonalized Medicine (http://www.webicina.com/rss_feeds/) is especially recommended.

Somebody from the audience added that Medworm is a good (and free) medical RSS feed provider as well. For an overview of several of such platforms, including Medworm, i-Google and www.webicina.com see an earlier post on this blog:  Perssonalized Medicine and its alternatives (2009-02-27).

A typical Web 2.0 scenario:

  1. Chris visits Laika’s MedlibLog and reads Cochrane PodCasts are available.
  2. He finds it interesting , goes to the Cochrane website and subscribes to the Cochrane podcasts with RSS.
  3. He want to share this finding with others, so he decides to tweet that Cochrane podcasts are available.
  4. He gets a response: Hé do you know the Cochrane is on Facebook, so he visits Facebook joins and posts the news on facebook again. And so on.

Not only did Chris give a nice overview of Web 2.0 tools, but there was ample opportunity for discussions and remarks.

The two most common questions were: [1] When can you find time for this? and [2] what can you do when the IT-departments don’t allow access to web 2.0 tools like YouTube, Facebook, RSS? It really seamed the main barrier for librarians from many countries to the use of web 2.0. Nevertheless, Chris engaging presentation seemed to encourage many people to try the tools that were new to them at home. Afterwards I only heard positive comments on this workshop.

The slidecasts of the two presentations are now online on http://www.slideshare.net/mavergames.

The slidecast I’ve reviewed is below.