Yeah, so the meeting is in recording. So in today's webinar, we have the parent labs. And is a hyperlapse project and is contributed by the boss. And there is another German company. Yeah. This is this is a render. So in this webinar, you will have getting hands on the parent stretch channels, which is a hyperlapse project. And we have Matthews, yes, software architect for the polycrypt and the monology software engineer boss. And so this is a kind of contribution to the hyperlapse and in the session, we will cover the basic about the parent stretch channels and getting hands on and how the IOT could be integrated with this parent stretch channels. So yeah, over to you. Okay. Hello all. Good morning. Good afternoon. So I'll just share my screen. You can save it once it's visible. It's my screen visible now. Yeah, looks good. Okay. Yeah, welcome you all to this talk. In this talk, myself, I'm an orange. I work at Bosch as software engineer and have my colleague here, Matthias who works at polycrypt GmbH in Germany. So we will together be presenting you on our approach towards scaling problem and blockchain. And the background or premise of this work is the observation that it is very expensive to do transactions on chain now. For example, if you look at the transaction throughput of Ethereum, it's roughly around 15 or 15 to 20 transactions per second. And it takes quite a long amount of time in our minutes of five minutes or so. And costs are also too high, too high in the sense that it does not allow many applications like you want to go to shop, buy something and pay for it with cryptos. Then it's not possible because the transaction costs and confirmation times are not suitable for that. Also, you can see the graph on the right, which shows the gas price over time for Ethereum. So gas prices like how you pay for your costs on Ethereum blockchain. And this is also fluctuating, which means the cost of transaction is also not stable. So this actually makes blockchains insufficient for many use cases. For example, you want to do, as I said, for data trading, if you want to buy something and then pay for it with cryptos, it's difficult. Or if you want to do, say, micropayments. So you want to do a large number of small payments over a small amount of time, then also this is not possible or same goes for high frequency trading. So we thought we will come up with some solution to address this problem. Also, one of the more particular and special premise that we want to focus on is industrial IoT use cases. So in industrial IoT, we actually have a range of devices, such as a car to car charger transactions, or you're using any tool that is very expensive and they're like you're renting the tool for usage and then using it and paying for it. Or within a factory where many people share a shared shop floor, where there are machines from different companies, you want to make transaction between these two machines. So these are certain use cases that we are looking at. And in these kinds of use cases, if you see, there are three properties. One, the transaction value and frequency. So the transaction value is very small because you want to ensure that you are taking little risks. For example, if you're charging for one hour, maybe you will not pay upfront for one hour, but you will pay for every minute for the energy that you consume. And so you have a low value transaction and these transactions need to be doing at high frequency. Second is the connectivity aspect. So when we talk about Internet of Things, we have a range of devices, some like that are always connected to the cloud like highly connected devices. Some are residing in some local network like a company VPN or a corporate network such that they cannot access the direct internet but have a limited accessibility. A third set of devices could be that they do not have internet access at all, but they're able to talk to some parent device and through that get some internet access. For example, you can think of your smartwatch. Most smartwatches don't have internet access, but they do get data from internet through your mobile phone. So we have a range of connectivity options that we should support. And the third is the resource constraints. So in most cases, IoT devices are tailored towards certain use cases and they are computing power and memory are mostly confined only to that use case. So we do not have the option to have a large code print code print. So we also need our solution to have a very minimal code print on the device side. So these is a background on which we base our work on. I'll hand over to Mathias who will explain how the Perun protocol is what it is and how it works and how it addresses these constraints that I've described. Yeah. Thank you. So yeah, let me try to explain a bit how the technology works at a high level and then also go into detail what we implemented and how the Perun framework looks like in terms of implemented components and how you can use it and Manu will then go even more into detail and show you a demo. So how does the technology work at a high level? The goal is because transactions on the layer one on the blockchain itself, which is the upper part, are costly. We want to shift as much of the transactions to the layer two, which is an off chain part and this is a direct communication between two potential clients. So now when they, these two clients now decide to open such an off chain channel, they have to transmit an on chain deposit and open the channel by that. So there's one on chain transaction for opening the channel. And now once the channel is open, they can transact basically with the same security guarantees as on the layer one, as if they were at a transaction on the blockchain, but now they can do it peer to peer with the Perun channel technology. And there are basically no transactions costs because you're transacting off chain. And you basically have no transaction limits in terms of throughput or confirmation times because as soon as you agree on a new state off chain basically this just involves two signatures by both parties. And the transaction is confirmed. And once you're happy with the off chain state, let's say after a few transactions, then you can decide to register your state on the blockchain. And then it will be materialized on the public blockchain again, and your funds will be available once you settle the register state. So this is a general idea so all the basic transaction or the, the valuable transactions will go to the second layer and only opening and settling the channel will be on the blockchain itself. And the important part is that our protocols guarantee that this happens with the same security guarantees as if you were transacting directly on the blockchain, almost the same security guarantees. You also get some certain certain level of privacy for your transaction because the blockchain will not see how many transactions you did and what amount was there they will own the blockchain will only see the end result. And furthermore, this allows us to do some interesting other. I applied to some interesting other use cases where maybe client one. So Alice here, for example, on the left side and Bob is the client to on the other side, and they may actually sit on different blockchain so Alice may, maybe on a Ethereum blockchain and Bob may be on a hyper ledger that blockchain on a hyper ledger fabric. And they can still open the channel with this technology load. This is a pretty cool side effect of this technology. With that, I think then, of course, our one of our challenges the project, especially the use case that Bosch is addressing is that we want to port it to the IOT use case that a man was was explaining was describing. And this now our clients are not human users, but they may be machines such as a car and a charger so the car wants to pay the charger in small amounts depending on how to charge us. And the car might not be directed directly connected to the blockchain, but it may be connected to a note which acts on behalf of it and has the blockchain connection. And these are some abstractions that we need to implement in order to make this technology work for this IOT use case. So, concretely was does the framework consists of at the moment. So here we want to give you an overview at the core we have this includes the core protocol logic. Then we have an implementation of Ethereum smart contracts for running this protocols on the Ethereum blockchain. The clients can either if they are have a lot of resources they can run directly using the state channel SDK the GoPro library, or if they are light clients they can use the Perot note which was developed particularly by Bosch to make light clients work and make the burden. Basically the connected connect really get removed some of the connectivity requirements from the clients and also take some low additional load from the clients to connect to the blockchains and this is what the what the Perot note achieves. And one, I think important aspect of our library of the core library how we decided is that we decided with modularity in mind so we have decided the components of our library which is a blockchain interface. And a logging interface in an abstract way so that the core logic of the of the framework the protocol logic does not depend on any specific implementation or any specific blockchain, but it only depends on this very abstract interface and this allows us to either plug in the Ethereum blockchain but also you could plug in a hyper ledger fabric blockchain and the same goes for the persistence the logging and the network layer so you can either plug in a simple TCP IP socket dialer, or you can plug in a lippy to P dialer which gives you additional connectivity option. So this is a core feature of our framework how we designed it. And I think this is it from my part and now Manu will go a bit more into detail what they have been implementing for the Bosch use case. Yeah, as Mathias explained before, the node offer the intimacy co state channel logic, like the Peron SDK implements the co state channel logic and node on top of that provides some user facing functionalities. For example, if you need to, if there are two people Alice and Bob and they need to talk to each other, they should know who they are their identity should be confirmed so you need some mechanism to get how to contact them off chain and what is their on chain address and things like that. So for that we have a component called option identity provider. So this component provides the identity of whom you're interacting with, and it can source anything from different so places for example currently we use simple file where you put all the details in a file and then provided to the node, but this can also be an external service, say some identity service or even some identity based blockchains like Hyperletter Indie which provides an SI based networks. Second is key handling. So for creating signatures on the states that are created by the SDK we need to use some kind of wallet that can be like a local Ethereum wallet a key store wallet or an external service again. So those kinds of functionalities are offered by the key handling module. And on top of that we provide a session so the session kind of manages all the channels belonging to the user and manages the state of it so that the user need not maintain any state he can just interact with what information he has. So on top of that we provide a user API, which kind of has an easy way to interact with the node and the clients interact with the node through the user API. If we get just one step deeper, what we do is that in the user session, we still keep the channels as generic state channel so you can implement any kind of logic if you want game channels, then you can implement the game logic or the payment channels what we will show later in the demo that also can be implemented. And on top of that the user API we have an app specific API, which actually just translates this user API does not maintain any state, but it just translates what the generic state is to that application specific state. And when any changes made to that state, it tries to validate the application specific logic. And we have a remote interface. So if you have the option to use the Perot node in two ways, one you can directly import it as a go package. It's the first implementation is in Golang. And you can use the package directly from the use a app specific API, or you can just run the Perot node in as a like a Damon software and then interact it with a remote interface. So in the demo I will be showing both these ways how to use Perot node in both of these ways and also point you to resources where you can write out on your local setups. Yeah, one addition here which which I forget to mention is that you cannot just send payments as a manual hinted. You can also impose arbitrary transaction logic so you can also play a game on depending on the on the outcome of the game that is played off chain payments will be done so there's arbitrary transaction logic possible on the afternoon there as well. Yeah, sorry. Yeah, sure. Yeah, that is something we currently support so I will also show you later after the demo through the event that during the code interview how you can actually plug in your logic without modifying any kind of Perot or blockchain specific code. So in the demo, I will present four splits of the screen. So bottom two splits will be Alice and Bob respectively, and in the top split we will have blockchain on one side and then we will have Perot node on the other side. So now I'll present my demo screen. So as I said we will start up Perot node here in the screen. And then we will start the blockchain node here so I'm using ganache CLI node, just the demo purpose. So yeah so we have the ganache CLI node here. So once we start the node I think we should deploy the contract one so this deployment is done at once only once. So if you're using a public blockchain then the contract is already deployed and this is a singleton instance. So what you will basically do is always use that contract but since we are using a local setup I used to deploy for the first time. So here's the connect screen where this client is completely independent of Perot node. So this actually interacts with only the remote interface. And now I'm connecting to the node from both these clients which will set up the key handling and the identity provider and everything for these two clients and then present us with a screen where we can do some transactions. Yeah so if you look at the screen on the top we have the address or on-chain address of the user and then we also have the on-chain balance. So it's currently 99.94 ethers because we some ethers for you was used for sending the contracts and then we have the time so this time we will use it as reference later. So in the command box you can type whatever command for example actually the auto supported commands are provided as placeholder text in the command box. So first we can open a channel with Alice with say initial balance of 10 and 20. So you can see that both of them got a notification. So here it says it's waiting for peer and here it says it's waiting for user and it's blinking. So I can accept this channel. What you can see is that once I accept there are two on-chain transactions that are created. So one each for each party. So one transaction is for funding of Alice and other is for funding of Bob. So once the channels are funded they move to the transact phase and the balance of these parties are shown here. So I will open just one more channel so that I can show demo easier way open with Alice another channel with five and six of initial balance and I will accept this channel as well. So once the channels actually we have two channels in the transact phase so to send payments we can use send API so send on channel number one, say one ethers and we can also request instead of sending like getting money from the other users or request on channel number three ethers. So then I can accept or reject so I will accept one of the request and I will reject the other one. So you saw that once I accept the transaction the status is marked as accepted for both parties and then the current is the proposed balance is made as the current balance. But when I reject that state just reminds for the user to be shown but you can see that the latest state reminds the oldest state itself and the version is zero. The other thing is that if you I you can also like not just not to respond for example I'm sending on channel one to Bob, say point to ethers. And you can see that there's a time out in the second field which says 142611 so we will wait until the time out expires. So then you can see that it will also be said that we are as rejected. So this time out is flexible we can set any time out like from seconds to minutes to hours depending on the use case. And if the other user is not responding within the time out which happens in this case, then the channel will the party who sent will recognize that the peer has rejected because he has chosen not to respond. So this way you can actually make a large number of transactions I think since we are using the GUI it is very like it is limited on how fast we can enter the transactions. But if you use a code to interact with the Perot node and make this transaction then you can make thousands of transactions per second. So once we have made the transactions and you want to close the channel we can say I want to close channel number one. So once I issue the close command the other party this is special update so I will just accept the update and then explain you what's happening. So in that special update you can see that the version is marked as 2f. So f means final. So the final update implies that the other party has chosen to close the channel and he has asked Alice to agree if that channel can be closed on the blockchain as the final state. The advantage is that if we agree to that state then the blockchain understands all the involved parties have agreed that what the final state of the channel should be and it allows the channel to be directly closed. If you see in the first slide we had four phases open transact register and settle. If we agree to the final state then the final state can directly be registered on the blockchain without waiting for a time period so it was very fast like we can see how it happens if we don't agree. I will close channel 2 and in this case I will reject the update I don't agree it. So when I reject you can see that it's waiting for a time out to expire. So the idea of this time out is that once we want to close a channel and one party both parties have not agreed what is the final state of the channel. Anyone party can directly post the latest state to the blockchain and the blockchain will provide a time out duration for both parties. It will say there is a fixed time in this case it is 10 seconds but we can make it also into days or hours. For this amount of time you can wait and if any other party has the latest state that the first party is misbehaving or posting older state then you can challenge the registered state on the blockchain and that challenge will be handled by the smart contract. So once that state expires then the channel will be settled and the balances will be withdrawn. So that is the difference you can see that the second channel was settled with a newer state to it but the first channel was settled with the actual state which is zero. So I think this is the end of the demo. So this tool we have published in our code repository we also have readme so you can check out our project and try it on your systems as well. Now moving to the demo part so in this part you saw that we had a GUI where we did this demo in which we were using a remote gRPC interface. As I explained you before we have a session which handles state channels in a very generic way and in top of that we build applications so that you can find in the app directory and so this is a payment tab that we have currently now. And for example you want to say send payment so say for example you want to open payment channel. So the only thing the what app does is that it gets the user data and then translate it into the generic data which the session API expects and then sends the request so it is a very simple logic and a very lightweight layer. So if you have any arbitrary logic that you want to implement all you want to do is that you can add a simple app here and this should be like very few lines of code and it involves only your logic nothing more than that. And rest all is handled by the core abstractions so you can see this app is very lightweight and a very simple logic one. So this way you can actually implement things and you also have an example that we have described so you can find it as payment underscore test. So in this example we have described how to use the app API directly without running a node so you can just import this package and use it. So that you can actually try it out and you can run this on your system as well for example I will run it now. So here we will start. I will just close this one. And then in this we will run the test. So what this test does is that it actually does what we just tried out in the GUI but in a scripted way. So it will open a session for both Aliz and Bob, and then it will open a channel between them and trans out and transack on the channel and then close the channel. Yeah, so these two transactions are corresponding to the deployment of contracts. Now it is the setup phase. Yeah, now we have Alice session is open. Yeah, now we have session for Bob and Alice and Bob have opened the channel. They have made one transaction so you can see the update balances here. Then they have registered to the blockchain and closed. So you can if you want to develop any app then you can just copy the payment app to in the app folder and then modify the logic and then try the testing system and then integrate it with other systems that you want to use. Yeah, so the second abstraction is the remote interface that you saw in the previous slide. So this app is just a code way and then you have an API package in which we have currently implemented the gRPC interface. And this is also a very lightweight layer. So what this does is that it, for example, we will again see the open payment channel API how it is. So what this does is that it just calls the app API as you can see here with two to three lines of code just to call the API check the error and that's all you need not do anything more. And then package it according to your remote interface. For example, here I am packaging it according to the gRPC interface. So by having these two lightweight layers, it allows us to implement a large number of arbitrary app logics on a very abstract core framework that we have designed. So this way it is very extensible for a large number of use cases. So coming back to the slide, we are at the end of the presentation. To sum it up, I think we assured how the SDK and the node are designed in modular ways. And some of the features that we are planning to come up with are additional blockchain back ends support for some other blockchains. Second is ability to do cross chain transactions. This is a work in progress. And third is the light node or library for embedded devices. So what you saw was that in the previous slide, if you looked here, the car and the charger might be in a remote area. For example, if the charger will be a stationary thing that it might always have connectivity to the cloud. So it can always listen to blockchain and everything, but the car might not be the case. So what we do is that we want to split the parent software into two pieces. One is the transacting piece, which is using only the transaction phase and put it into the car. And then the remaining phase for the funding or for the registering phase put it in the cloud. So then the car can contact the cloud for funding the channel or for watching for changes in the channel. But the transaction alone it can do directly with whichever party it wants. One of the interesting approaches if we look at enterprise use cases, for example, fleet management, etc. Because if you're having a fleet of 1000 cars, then there is no need to put money store money in every car's wallet. You can always use the funding and registering in the cloud and you can just give the car the access to transact off chain, which also is a better security. So that brings us to the end of presentation. And in general, this is an open source project that we have posted under hyper ledger labs. So you we welcome everyone who is interested to participate in the project and start contributing in terms of using the project is a great contribution in itself. And you can also start getting involved. And I think we have, we are open to question answers now. Yeah, okay. Thank you. So I have some questions. So I think this project being using so many, any boss applications in the maybe manufacturing process in IoT with IoT or just the kind of kind of music kind of open source project. What is the status actually. So this project itself is completely independent. It is not relating to any internal Bosch component. But we are using it in some of the other research showcases. So there is a project, research project in Germany called RNA 2030. So the idea of this project is that you have a very advanced shared shop floor where different companies will have their machines. And this machines are designed to not produce a single product, but they can be configured to produce variety of products. So they have to interact with each other and make a large number of transactions and do a lot of contracts. So in that context, we want to use, we are using this better note to handle the contracting and transaction, transacting capabilities. This will work along with other things. For example, each mission will have its own identity on an SSI network say SSI is self sovereign identity. So this will work in constellation with the SSI networks and agent framework. So each machine can have also have software agents which will make decisions on behalf of it. So this will plug into that whole ecosystem and in that research showcase. Okay, okay. And another question, I think there's a question like, can you please share the link for this project you just mentioned. That's okay. And another thing, so this parent channels is a blockchain agnostic, right? So it's only support the Ethereum or support the any hyper-legible any other projects too? Or is it just only Ethereum? No, in design, it is completely blockchain agnostic. As Matthew explained, the core logic is led in a way that does not depend on any blockchains. And currently it supports Ethereum, like you can try it out, whatever demo I showed was based on Ethereum blockchain. But we are also working right now, we have started working on another blockchain back in and soon you can see support for the second back end as well, which is non Ethereum back end. You will soon see support. So we are currently working on a blind foreground for implementing a polka dot back end. And also, yeah, potential other back ends are planned about it depends a bit if we get funding for this and what are our priorities so nothing determined yet polka dot is one of the interesting candidates and type alleged fabric is something that we are also considering what not sure how the funding situation there is. So as a company, we also need to basically look where we where we can get grants and have the development supported. So this influences our decision. So one other aspect is that it depends on community interest if there is somebody who is interested in using a particular blockchain back end with their own. Then we can also consider implementing that. I have a question. Yeah, yeah. Hi, it was a nice presentation. Thank you. And I wanted to know how is the reconciliation happening is it part of the beer and framework or is it the underlying blockchain reconciliation itself will work. Reconciliation in the sense like if there is a any transaction before accepting it, the other party disconnects or whatever the network disconnects something like that. Yeah, so what happens is that for initial phase so when the both parties want to open a channel they communicate with each other, and only when they respond they agree to what the initial state of the channel should be. Then they contact with the blockchain so then deposit their particular amounts what they agreed and the initial state that they agreed to the blockchain. So once this is done it's in a transact phase and the transact phase it does not matter so if you have connection you can make transaction if the other party was not responding in the demo I showed one place where the transaction expired. So you can consider that case where the connection has been lost so you sent a transaction to other party, but the connection is lost. In this case what you can do is that you can speak outside of the system to other party to say tell him to come on back come back online, and then respond to this transaction. But if that is not possible if that is not at all possible then what you can do is that you still have the latest state which is agreed the previous state. That state you can post to the blockchain without even talking to other party. So when you post that state to the blockchain what happens is that blockchain will register the state as the state that is to be settled and then wait for a time out. So this time out provides a window for the other party to come and check the online check the blockchain, whether older state or other malicious state for example they have transacted three states. And if Alice is posting a second state, which is actually malicious behavior, then Bob can during the waiting period come online check that an older state was posted and then post the latest agreed state which is three. And then blockchain will see that which is the latest state based on version numbers because version numbers are monotonically increasing. So based on that it will resolve what is the latest state and then settle that state. So this dispute handling happens on the blockchain. It is not the pre-run framework, it is basically the underlying blockchain itself will handle it. No, that just happens in the current contracts on the blockchain framework. So blockchain framework has two parts. One is the SDK that is running, providing you a way to interact with the blockchain and an SDK that is allowing you to transact with the other party. The second component is the smart contracts that reside on the blockchain. And whatever I say I'm talking to blockchain it means I'm talking to these current smart contracts. The framework is, I'm sorry, yeah. Basically, yeah, so the last resort is going to the blockchain. So when you're not able to resolve and the framework is helping you in the first approach would be you resolve the current state of chain. Once you send the state and you get a signed update and the state is agreed. But if the other party is not responding off chain, then you would tell the framework. Now you have to go on chain. And the framework does that for you. But there, you basically have to decide as a user when is the moment when you want to go on chain and So you're adding an extra logic on the framework itself to do to resolve the initial conflict is what you're trying to do. Yes. It's pretty simple. I mean, you propose an update, and either you get a response and if you don't get a response, you will notice it and then you have to decide do you want to basically dispute that now. Yes, or do you maybe try to update again. That's that's up to you. And the dispute process will be will be done for by the framework for you so we just to the state. And then the framework will wait for a bit, and then you can. Okay, so what is the condition on which the framework will transfer the dispute to the underneath blockchain. Yeah. Was I audible. Yeah, so the condition is that so when you want to close the state so all this dispute resolution and everything happens only when you want to close the state. So in the demo I showed that we can transact for a number of times. But once we decide we want to close we just send a close command which actually instructs the framework that you have to close the state. And the first thing the framework will try is to send a closing update to other party which you saw with a symbol, which actually says that the state is final. And if the party is responding in the time period then it acts with that state like it directly settles. But if the framework sees that the other party is not responding or he's missing, then it automatically goes for settling the channel on chain, like register and then waiting out for the time period and then closing. Okay, that is one part. So the second part is that on the other parties side also one core requirement for the Peron protocol to work is that the parties Peron node should be running at all times. Because if you're not watching the blockchain at all times then you're at risk because when this dispute resolution is happening your blockchain your Peron node should be watching. So your Peron node keeps watching on the back end and when it is watches that the wrong state is registered it is not intimidating the user it will just go on dispute that wrong state because there is nothing the user should tell the Peron framework already knows that if that state is not responding. Okay, I'm totally with you guys what you told me now. But why have this reconciliation on two levels, why not have only on one level because if let's say if the framework was not able to resolve, let's abandon it there and there why do you want to give another chance to the underneath blockchain or in another case if the framework is not able to why not give the condition to only the underneath blockchain to resolve it and then bring it back to framework. Why are you doing double checking is my next question. Yeah, sure. That is a very good question. So the reason why we are trying to finalize the state of chain and then registering on blockchain is that that is to save both cost and time. So when you're so if you see the actual dispute resolution logic we just assume we are not agreeing any of chain final state we just registered to the blockchain. In that case what we have to do is that first we have to register so that involves one blockchain transaction. Second we have to wait for a time period. So this window provides all other participants to see if the registered state was final and dispute if there is there is not final. So that window period is there. Third, once that window period expires we have to settle the channel. So that is second blockchain call. So here we have two blockchain calls and one large time window. So if we agree to the final state on the blockchain on the off chain, then we can do away with this we can directly set in the channel because both the parties have agreed offline and we also don't have the window because these parties have agreed so it is an optimization. We have reduced time and we have reduced cost. Okay, got you. Thank you. Thank you. Thank you. Thank you. It was a very good question. Thank you. It was a very good question. We can go ahead. Manjiri right or Yeah, I think we have one answer from Manjiri Nanda Kumar sorry. Yeah, there is a question from Bankata. Where will this recording be available. Okay, that will be available on the Hyperledger YouTube channel. Hello, can you hear me. Yeah. Sorry. So, I have like four questions. So let me start. So the first question is about the motivation you have. So, can you explain me the performance you got after implementing this platform protocol. Okay, so we haven't deployed it to our actual use case. But if you just run the tests on your system, you can see that your transactions are like the order of thousands or maybe 10,000 per second. It really depends only the only restricting factor is how fast you can communicate at the party and how fast you can make signatures only that is the time constraint. There is no other time component involved. And, I mean, can you, did you do something like how many offline transactions per minute is possible for the person not to handle something like that. Did you do something. Yeah, I think we have some tests, but not in the real scenario, maybe in that scenario I think we had thousands of transactions per second. Yeah, so we have. Let's see. So, actually, I don't have specific performance tests on a large scale system but we have performance tests on a Raspberry Pi and even there you get over 50 transactions per seconds. Okay, and I think what we have seen on larger devices with with other tests that you can do 1000 signatures or more per second. So, if you take this number and translate it to the general setup. So, definitely on a larger system than a Raspberry Pi you definitely get more and I would expect in the realm of 1000 transactions per second but it's a good point to be we should actually verify that once again and maybe some of my colleagues have done that and I'm not aware of that. So this is the number that we've seen in some scenarios where signatures were involved and where basically, yeah, which, which gives you an idea how many signatures you can generate and this is what we think is the performance bottleneck and the communication and what is the underlying signature scheme you're using is like ethereum or it's something. Yeah, exactly. For this, the most we are using ethereum signatures itself for option science. Okay. Okay, so ECDSA basically. Yes. Okay. Are you considering using some other signature schemes in the future. And so one thing one advantage with using a CDSA is that when we want to verify the signature so when we post the states go to a blockchain for register open face, then that means we done signature verification also happens. So like verifying ethereum complaint signatures is much easier on chain in terms of both cost and implementation. So we are sticking to it now but if the need arises that by using some other signature scheme we get an advantage then it's quite possible. Okay, and as Perun is working offline so how does the transaction validation happens offline. Yeah, so the Perun app so the Perun node, as I showed you in the previous thing that we have a core state channel logic that any session and on top of that we have an app. So this app is what defines your logic so how you can make the next state and everything is defined by this app. Perun node itself is not doing anything about the validation. No in the Perun node there are different components one component is where so in the Perun node the app component is responsible for doing all this validation. Okay. And it can be modified you mean. Yes, it can be modified we can make any kind of. Okay, okay, okay. And okay the second question is how does the light clients trust the Perun node basically. Yes, that's a very good question. So the light clients are not usable in all use cases so if you look at the previous use case that I was talking about for example of leak management or platonic. These are very industry specific or industrial issues use cases where a company has a large number of devices or assets under its control, and it wants each of the asset to have its own transaction capability with other devices. So in this scenario you can see that there is always no reason for the devices to trust its companies designated person. So we can use some identity logic say self or not certificates to designate whom it should trust, and then we can establish that trust environment. So that is how we actually see that the light notes can trust the funding and the watching notes which interact with the blockchain in actual the further step we're currently looking into the scenario where the light client doesn't trust the note and this would be something like a web browser which doesn't trust the server to basically you want to keep the keys with the client in the in the browser wallet. Basically, you can still do that, but then you, the note should do a call back a signature call back to the client so whenever the note will need a signature, it will not have the keys for that. But it will ask the client to sign this on central section. So basically this then releases or removes this trust assumption on on the note. Yeah. Okay. And then the important question for the last is you explained in the first the second slide saying that scaling challenges right. So how does and you are mentioning about industrial IOT also so consider there is a smart factory, or I don't know a smart city for example, and there are IOT devices installed across the city and they are sending data consider it as the data so they're sending continuous data to this blockchain network. So, I mean, implementing this scaling solution as a pattern. So, do you already have that use case in mind or is it already developed. I don't know the status right now. Yeah, sure. With regarding to your question I think one of the use case that we are very focused we working on is a shared shop floor use case. So that is actually a huge, so it's a multi company project it's called I blocks. Yeah. So I also presented a talk before you can I will present the link to this talk after this call. So in that we have explained about that use case also in detail. So there what we try to do is that there are different companies, for example, Bosch is there Daimler is there then BMW is there. And there are a lot of big companies and these big companies have big shares in that shop floor like huge missionaries and production lines. And when some order comes in that is a very customized order. So this machine will then make contracts to each other that I will finish this component and give you at this point of time for this cost and all of these things happen. And we have an agent framework a software agent for doing that. And once that is done, then this transacting layer so making this contract and agreeing to what is the state and everything is implemented on this parent layer, and then the actual big production begins. So once all the production is done and the payment happens again the parent layer is invoked and the payments all happens, and it's resolved so that is one use case I think we are working on to refer to that resource if you are like more interested in the details of that use case. Yeah, thank you. Yeah, also you can contact us through email, we can get in touch for further discussions too. Okay, yeah, so I mean I was considering the existing ethereum and there are light clients. So, we need this pattern in between, like a pattern node to to make the system work for high volumes of transactions and that's the motive I was also looking for like IoT devices and data and how the underlying blockchain could handle, I don't know, 1000s more than 1000 requests per second or per minute. So, yeah, because light client light client is completely dependent on the full node, and full node, suppose the full node has like only 50% of its capability to handle the light clients. So, that's kind of a performance issue also, you know, it can drop a light client or it can just don't serve serve the request coming from the light client so that was a basic issue. Yeah, you refer to the Ethereum light client or. Yeah, Ethereum light client. Okay, I think that is exactly the place we are looking at and that is also the reason we keep the framework in a very flexible way. For example, if you're having a more powerful device say a little more powerful than Raspberry Pi, then you can actually run the parent node also like you can just import this go package, and then directly run the parent node so you don't have a note to interact with you can just use the parent package. So, but if you're having a very constricted device say your smartwatch which is very less capable. You can run the node on your smartphone, and then your very transacting client on your smartwatch and then you can make them interact via a Bluetooth for like funding and resolving or something like that you can. It supports all of those fancy constellation so that is the thing we are looking at when we are designing this framework. Okay, yeah, yeah I mean sounds sounds good and looks like there is a lot of things that could be possible to do in this scenarios. Yeah. Thank you. Thank you so much. It was very good. Thank you. Thank you. So, any other questions from anyone else? Okay, I think no. Just a question you haven't shared the link of the project you mentioned at last. Yeah, sure. Thank you. I can chat it on the chat and we can also push like post it back in the meetup page as well. The links to the project and other resources that I was referring to. I can post all back into the meetup page. Yeah, thank you. Yeah, sure. Yeah, okay. Yes, then I think then we can wrap up right. Yeah. So, thank you. Thank you for the presentation. So, this recording will be uploaded to the hyper ledger YouTube channel and said I will set the link on the internet. Okay, thank you very much for hosting us. Yeah, thank you very much. It was really interesting discussions and yeah, thanks for the question that's right. And yeah, contact us if you want to more details or want to work with us or work with the product if you have questions about the framework. Yeah. The project link is on the screen but we also share it as like text links in the meetup page.


Well and one of the ways we can get them more comfortable is because it's a simulation and the patient is either a mannequin patient or an actor patient who's not going to be harmed or hurt by what's done or not done is we could literally and we do come in in the middle of that situation we literally press pause we're like pause patient's not going to get any better not going to get any worse let's just think this through what are the signs and symptoms you're concerned about what are the signs and symptoms you're concerned about yes how are you thinking about moving forward how are you thinking about moving forward so they can hear each other's plans they can calm down a little bit talk it out and then we literally rewind a minute or two start it back up so it's sort of like a live video game yes and they can reorganize themselves boom what's up everyone welcome to simulation i'm your host on sake and very excited we are in boston massachusetts we are going to be talking about healthcare simulation we are at the center for medical simulation we are sitting down with dr jenny rudolf hello good to meet you alan thank you so much for coming on the show and it's great that matthew your brother ended up introducing us and i'm very excited to talk to you i just had an incredible experience here at your center for medical simulation where i experienced one myself and it was very inspiring for me and we'll have some videos embedded that will show people what this is like we're going to be breaking this down for those that don't know jenny's background she's the executive director at the center for medical simulation where she creates learning oriented cultures in healthcare she's also on the faculty at massachusetts general hospital in the department of anesthesia critical care and pain medicine as well as in the department of anesthesia at harvard medical school and you can find the link in the bio to harvardmedsim.org as well as jenny's linkedin her twitter and the medical simulation twitter account as well all right so let's start things off with our one of our favorite ways to start things off which is we love asking our guests we find ourselves as stewards of earth what is your current take on the state of humanity i'd say my biggest concern for us right now is certainty too many of us are certain we're right and are not curious enough about other people's perspectives and i think that gets us in a whole where it's really hard for us to understand what other people care about and therefore much harder for us to bridge from our point of view to somebody else's and so i think as my mom susanne hober Rudolph wrote about that can cause people in different countries to get very solid views of each other that are very hard to move they can cause people within our own country to get very rigid ways of viewing each other it makes it very hard for us to come to compromise invent new policies that might help with global warming or with income inequality et cetera and i think if we can learn to be curious about each other's point of view hold each other in high regard those kinds of things could be bridged better and Jenny has this really cool acronym wtf which instead of what the she has is what the frame what's the frame and that's great because then it gets people to think behind the other person's perspective what is their frame what is their perspective why do they potentially think the way they do and i like how you said certainty when we see things as a probability curve we see a lot of people saying i'm a hundred percent certain that this is the right way and then they can't have discourse about about things and so if you think that hey maybe i can be humble i can be curious i can say i don't know everything and that we can maybe tackle some of these challenging issues of wealth and quality climate change global cohesion on these complex exponential technologies that are occurring that was a wonderful answer Jenny let's jump into your journey so you're born here in the boston area and then you find yourself getting into uh excited about medicine at university chicago then at harvard and then now here as the executive director doing some professorship along the way teach us about this journey and how you picked up your interests sure so it really came from being i think a lifelong athlete i played basketball in college i played basketball in high school and i rode crew on the us team one day when i was watching the 34th video of myself rowing down the charles river something occurred to me i was like wow only we could practice and watch videos and rehearse on things that really matter like healthcare or any complex technology or industry and so uh not long after that i was doing a phd in organizational behavior and i thought wow is there anywhere any places where people are practicing and of course there are a lot in maritime uh shipping in aviation and nuclear power and in healthcare so i thought how can i get to play basically for a living and i think simulating practicing trying doing it over video is a form of play which i also think is very generative for us adults who tend to take ourselves too seriously so that was kind of how i got into it yeah this is a cool story because you you know you're we when you're in boston you see this charles river and you see these the teams of of rowing they're you know in their long what do you call the boat shells they're in their long shells and there's seven eight of them yeah so they vary there's eights fours twos eight four twos and you see like eight of them really like you know rowing and they're moving quite fast yeah and you were on the us team which of the us crew for rowing which is really interesting and then when you're doing that you like you said this 34th replay of watching yourself and you're like let's apply this to to real world ways of of becoming better in you know healthcare simulation in aviation simulation is already happening and so we're now seeing this in engineering software we're seeing this in manufacturing simulation of designing certain parts of aviation all these all these different fields of aerospace engineering it's in biotechnology it's now getting more and more popular you know the show is called simulation and it's becoming more and more popular for us to figure out what is the highest greatest fit for in a case and in your case it was how do we how do we maximize the the experience of of of the patient and the practitioners the physicians the nurses that are working on the patient and there's so much nuance and complexity that we'll get into i'm really happy that that the story makes so much cool sense on you getting involved in this and then so now tell us about this um this trajectory for you once you saw it how did you envision implementing it so in my phd program i got really interested in industrial safety and a particularly perhaps because of my athletics background i was really interested in what we're called high hazard industries sometimes called high reliability industry depending on your point of view so high hazard industries are generally ones where things are tightly coupled and somewhat complex so you've got processes that have to go just perfectly for everything to line up and everybody to stay safe for example in nuclear power or chemical processing and i realized that without mindfulness and awareness it was really easy to make mistakes because vigilance is almost impossible to maintain so i was interested in the systems part of that you can't maintain vigilance it's basically impossible there's research on quote unquote normal accidents that they will happen sometimes regardless of all of our best planning because things line up in unexpected ways but i was really interested in the human performance part of it and so i started looking around for where could i study that what could i do with that and i started by learning about how do we prevent and learn from accident and error in these high hazard industries during that period um um my partner was pregnant with our first baby and i thought i need something to study that's nearby and close here in moston and so that got me interested in the simulation healthcare simulation world and i stumbled upon the center for medical simulation here uh and thought this would be a great place to do my doctoral dissertation because uh medical error healthcare error is actually quite rare and i'd have to watch a lot of healthcare provision to find a few small mistakes but here at the center for medical simulation and a lot of other simulation centers we push people to work at the edge of their expertise so it's common that they zig when they wish they had zagged almost every single day and so i could study what was happening in that context yeah the i love you know you're using this like at the edge cases or or in the these error cases that we follow a procedure a lot we follow like an algorithm for a certain procedure in nuclear or in or in manufacturing or in even when we're doing a sport we're following certain algorithms and especially when you're a physician you're you know you're following algorithms and and so what happens when you get a curveball that's thrown at you when you have an edge case an error how can we know how to um which which line of trajectory do we transition to that has the highest rate of efficacy of you know making sure that the patient is safe and healthy and um and the procedure goes as as well as possible and um and i i really like envisioning it as as as a sport because you know that totally makes sense the connection between your sport profession as well as your medical simulation uh and then okay so then the implementation of it so then um you like um using you told me as this is like this goal better outcomes for our patients and helping clinicians feel mastery and there's an there's a massive exponential growth of this that's happening you said over the last 15 years it's just been hockey sticking up you have people from around the world even today yeah you know visiting so yeah so tell us about this goal and and how it's happening here so i think i'll talk about this alan in terms of how do you create simulations and how do you educate people to be really good simulation educators so let's imagine that i've got a resident who's in emergency medicine and he or she has a young kid who's come to the emergency department and they've been in an accident and they're in shock and they need more volume whether it's blood volume or uh more just more fluid in their body to maintain their their blood pressure one of the ways that that can get done when you need to get a lot of fluid in all at once or if there's if you're having difficulty getting it in via normal IVs is you put in something called an intraosseous line and that is something that you basically put in through the uh skin into the bone itself so it's a little bit of a scary procedure for people to learn for the first time and so what we think about is what are the different things you would have to be able to master to put in an i o line and one is actually putting in the line itself the procedure but the second is imagine an anxious mom or dad standing there seeing you with this giant thing that you're about to put into their kid's leg and they start freaking out so there's several things that you have to master as that resident one is the procedure one is managing the anxious parent one may be managing your internal self so when you made the analogy to sports one of the connections is this process of mastery learning or deliberate practice where you practice get feedback try it again try it again so we break that process up into different pieces for people so one might be practicing the procedure just getting your hands and feet in the right place and putting it in the right place in the patient the other might be the difficult conversation with the parent so mom you know bear with me here uh and how you would talk with the parent or you would assign someone to talk with the parent yeah yeah this is this is you're really hitting on it from a way you know we try our best to help on the show make it clear about the nuance and the complexity of our of our world and when you take a procedure and you start explaining that hey it's not just uh you know it's not just roses uh that it's all gonna just be completely smooth every single time there's so many variables at play so so not only do we have to get good at building the mastery at the actual procedure itself the physical um eradication of an issue or the amelioration of the health an augmentation of the health in in any way but also we have to deal with a potentially a parent that is concerned we also have to deal with something another variable that's happening in the procedure that like we had a hypotension issue uh earlier that we'll we'll get to so if something like that happens how does the team react to that so there's all these cool ways that you're that you're running simulations and just for for everyone to get an idea of of you know what this actually looks like uh you can see this video that we're you know embedding right now that you know there are these you have these you have the actual simulation rooms where there's an actual patient and a practicing table with all the instruments you know you see the heart rate and you see the blood pressure levels and then you also there's a there's a room outside of that which is kind of like the control center where you're viewing what's happening you can hear the physicians and nurses describing what's occurring in their procedures you're videotaping that so that they can then debrief on what happened in so yeah so teach us about this because that was so fascinating for us to learn sure so one way to think about this is practice uh if anybody who's watching this practice learned an instrument or uh worked on their free throw shots in basketball or hit tennis shots as we know you have to hit thousands of tennis balls to be able to hit a good top spin in a game the clinicians who come to our center practice hundreds of hours every year thousands of hours every year in their discipline but they rarely have the opportunity to practice step back observe and think about their thinking so we really break this down into three parts we think about what are the clinical results or psychosocial results so think about that example did the kid get the volume did the kid get the blood into them they needed did the mom get uh talked to in a compassionate way so the result would be the mom would be calm the kid would be stabilized uh uh hemodynamically the actions that the clinicians take that's the second thing we think about what are they doing or not doing saying or not saying so we can help them learn different steps of conversations or different clinical procedures or whatever the third piece though is what we really focus on so there's clinical results there's actions taken or not taken but then there's the thinking or the frames of the clinicians when they're doing things so most of us humans to do an expert procedure or whether it's play a musical instrument or take care of a patient we have a whole complex routine of thoughts and feelings and expertise that we're blending all together to produce those actions so what we do in simulation is you can practice the actions but then you get to press pause and either go into a debriefing and take some time and reflect on your thinking by talking about it with other colleagues or you can literally press pause in the middle of the simulation and sort of like a video game live die repeat you're just gonna that it's not actually a real patient it's a mannequin patient or an actor patient who's not going to be harmed or hurt by anything we're doing so you can pause think about what you're doing wind the situation back a few minutes and try it again so it's all about the deliberate practice of getting better at whatever you're doing yes yes yeah as as you're explaining that to I was I was thinking about as these simulations become so indistinguishable from reality that it'll also be powerful because then people could really not have that going on in their head that oh this is just a simulation so I may not have to treat this seriously as I should be so there's almost a very strange dynamic that will occur when it becomes so you know indistinguishable but I love may I may I build on what you said yeah please yeah so that will be wonderful and that may happen but part of the art of good healthcare simulation or any simulation is we try to create something called a fiction contract which is this idea that I've made it real enough physiologically emotionally and experientially and conceptually such that like if the blood pressure drops and you give a medication that should raise the blood pressure the blood pressure will come back up so the world is functioning the way you expect even if the mannequin is a plastic mannequin that looks sort of real not that real what we find is people are very able to buy in and participate with their heart and mind if we make it real enough and importantly we make it psychologically safe enough so your professional skills are on display like let's say we were doing a simulation of an interview and then we paused it we debriefed to do that you'd want to feel like hey you know people care about me here they're here to help me become a better interviewer or maybe I'm doing media training they're here to help me be a better interview week it can't be a kind of gotcha environment so we can get people to be act as if it's real with a surprisingly low level of fidelity or realism yeah yeah the the the trust that it has to be built into the environment that people can feel like you were like you describe that it's so crucial for them to feel like they can voice how they feel because it's almost as though we have to become more and more comfortable with the dynamically shifting patient care environment to say how we think the next part of the procedure should go and if we feel comfortable voicing it then in practice then we will in the in the actual environment and so building that sort of a culture between physicians and nurses when all these different things are shifting with with parents or family as well as the actual physical procedure and all the variables that are being tweaked along the way let's let's give let's give the actual example that that that we had okay we were watching an appendectomy so there was just about a little over an hour there was a simulation occurring where the physicians and nurses on the operating table were working on a patient the simulated patient with with with the the process was to remove the appendix and there was this is very interesting we you know I called it a curve ball and I'll we'll let you explain but the general idea is that you threw anaphylaxis at the team and the the anaphylaxis caused it caused a hypotension it caused a rash it caused a bunch of things that then they had to dynamically adjust to so this was very fascinating for me watching it and seeing a simulated environment of it because now they know what to do when this edge case happens in the real world and they can be prepared to to to save the patient and there was even the epinephrine drip that was occurring and how much of it you needed to give in order to kick the you know the body into action to fight the anaphylaxis so yes please explain this it was so cool watching it and then in the control room there was you know there were people you know we were listening to them watching them and it was so interesting yeah and well let me uh I'll do my best to explain it with the caveat that I'm an organizational behavior scholar not a clinician so I'm going to explain it somewhat conceptually but with a few clinical examples so what we would like to do in healthcare simulation is prepare people for things that they are going to face so if they if that was your mom on the table or your dad on the table you would like them to be very comfortable with anaphylaxis happening in the middle of an operation that one of your loved ones was having and be able to quickly know what were the medications they need to give and so on we try to help people in our simulation center there's lots of different kinds of simulations but here we tend to help people work at the edge of their expertise we have advanced practitioners who are already capable of managing fairly complex challenges so in this case an appendectomy is a pretty bread and butter surgery even a minimally invasive one which was what was happening and anaphylaxis is pretty bread and butter problem for many people in the textbook so it's possible for you to go through 10 years of practice and you know all about the signs and symptoms of anaphylaxis but you have never actually treated it yourself wow you and the other thing is the textbook presentation of anaphylaxis which is an allergic reaction could be hypotension which is a drop in blood pressure a rash wheezing a variety of other things but what my clinical colleagues in this course and others have told me is anaphylaxis doesn't always present in the textbook manner and so what we're trying to prepare people for is their own autonomic nervous system reaction their own stress which can kind of shut down how their brain actually thinks just like any other person so you've got to calm yourself down rethink what's going on assess the signs and symptoms and figure out how to manage the patient sometimes with additional complexities in the presentation of the patient themselves so it might be a bread and butter anaphylaxis it might be a bread and butter appendectomy but maybe there's something complex about the patient that makes it extra difficult and so we're looking for people to be able to apply the knowledge they have in a situation that's new for them yeah yeah there's a couple things there one of the things was the physicians and nurses we typically don't think need to be a good practitioners of meditation or mindfulness like one's ability to to see you know a stressful situation and not you know necessarily panic but maybe you know take a deep breath realize okay what do we need to do to best handle this right now and then take it from a very you know logical procedural perspective and then also the I love how you keep describing this state of of of flow it's almost as though yeah you're challenging people right at their expertise level it's not too easy but it's not yeah too hard and then they're they're right in that state of their optimal cognitive challenge and then by doing that that's how they keep becoming a master in what they're what they're working on may I build on that for a second yes so one of the things that's important is simulation is expensive it's expensive in time it's expensive in space it's expensive in equipment so anybody can study what are the signs and symptoms of anaphylaxis what are the first line treatments I could you could study that and I could give you a test of that tomorrow and you could probably answer a lot of questions correctly what we're trying to do is create this context where people where it's valuable to work at the edge of your expertise or sorry to to take the value of all this expensive input and help people at the edge of their expertise if we're just about the knowledge they don't need simulation if we're just about the experience which they get every single day they don't need simulation it's the unique combination of practice plus debriefing plus reflection that helps you get in that sort of deliberate practice improvement loop yeah that's very very well put and there's actually um you know like Achille interactive one of the really great um progress is that we've made in digital medicine kind of takes people to their optimal level of of of a cognitive challenge with with increasing certain areas of their of their cognitive processing maybe working memory or their just attention all these focus right so so it's as though you've created a similar you know closed loop feedback system with people being at their optimal level of cognitive challenge in an experiential environment versus a textbook environment like you're indicating earlier which just has um you know we're seeing today with the advent of like spatial computing in the 3d virtual reality augments reality spaces it's just when you envision an actual biological system in the 3d space and you can tweak it it's much greater level of of of remembering uh and uh and under learning then it is on a 2d page um so you have the experiential environment then you go into the debriefing side of things which then you're having discourse amongst your peers about what was what you could what you learned what you could do better and then um you go into another one it's just this is a very very beautiful um process that you've that you built here and okay so then it it's also interesting that um you have this process I want to talk about the the actual um debriefing and uh dash the assessment please teach us about that sure um so we were approached a number of years ago by a colleague who was involved with the american heart association adam chang who was really interested in how do we get novice educators to be better at the very very important task of helping people be better in managing cardiac arrest and he had some different ideas about how to do that and he came to me and my colleague robert simon and he said I'd like to be able to assess the quality of the debriefing after they practice doing a code resuscitation what is the impact of the debriefing on the learning can you give me can what's your assessment tool and we said um we don't have one but we thought hmm challenge so robert simon is a psychometrician I'm a organizational behavior psychologist with an interest in conversation and cognition and we got busy with our simulation colleague uh dan reymer and working with a variety of colleagues all over the world we created an instrument to assess the quality of debriefing so that doesn't sound all that interesting but what's really cool about it is it gives a common language a common set of standards a common parlance that we can all use then to create a community of people who knows how to have this technical conversation better better better so the dash has been translated into about six different languages it's about to come out in mandarin it's uh arabic translation is underway and what's neat about that is simulation programs in riyadh or in beijing or in santander spain get together work on giving each other feedback on their debriefing again who cares the reason I care and the reason I think it's really important is debriefing is a stylized way to practice having difficult conversations all of us humans hate the awkwardness of critiquing another person we would just rather do you know have a root canal practically instead of that but what the dash or debriefing getting better debriefing helps you do is learn how you can be curious and assume the best of the other person which solves this horrible dilemma of having to basically cover over my feelings and lie to you about the critique and just hope that you're going to guess why you did it wrong so what we focus on is I can be straight with you about the critique because you're intelligent capable trying to bet do your best and want to improve I'm thinking that about you which reduces my anxiety and social awkwardness and lets me tell you the truth in a kindly way yes and so the dash helps build communities that can do that better you you know this this behavior science side of things the perspective that you take there about building out the environments that make it people comfortable with having a growth mindset and a comfortable with critique feedback integration and then further practice is being translated into Mandarin and Arabic that's huge it's billions of people that's awesome and I love that you know the debriefing side is such a critical you know you guys will have a video here embedded as well where you can see the sitting around the table having discussion watching the video replay of what happened in the medical simulation with the patient and with everyone moving and you know being able to pause it being able to rewind it fast forward it jump to the different highlighted annotation points was really cool yeah yeah that part was very interesting as well like when the actual allergic reaction happened you can kind of like find that area and go to it exactly right yeah that's that's very cool and then you can rewatch how people yeah behave at that moment so what we've been talking about this individual skill development and and cognition improvement and self-management improvement you could think about that as the core of an onion of performance improvement but I'd like to just mention a couple other ways that that's spreading out in the simulation world especially related to some of the other technological developments you mentioned so for example with 3d printing our colleagues at the boston children's hospital peter weinstock and others have worked with their surgical colleagues to create a con a process whereby if there's a child coming in for neurosurgery they use the ct scan of that child's brain produce a 3d model of that child's brain and then the neurosurgeons can practice what's the route to get into for example a tumor before the child is even on the operating table greatly reducing the amount of time that the kid needs to be under anesthesia and in reducing some of the uncertainty of a very complex procedure so that is happening around the world we need to do that interview too yes let's make that one happen too that'll be fascinating yeah well so we can actually yeah we can model the actual patients biological systems and then go and practice on their exact biological systems like tumor whatever the ailment is and then practice on on removing that and and get mastery on it and then actually do it on the patient holy cow that's great yeah yeah so and then another application that's happening again using kind of simulation to look at the systems of care is a colleague in Australia named Victoria brazil and team at the gold coast university hospital have been using simulation to map out the patient journey but also build interprofessional knowledge and trust so let me tell you what all those terms mean so imagine that you want to get the patient from who's having a some kind of a heart attack a STEMI from the door of the emergency department to the cath lab for definitive treatment they have to come from the ambulance and the pre-hospital providers through the emergency department transported through the hospital up to the cath lab nobody really understands what each other's roles are there they're sometimes misunderstandings even conflict between this and we can set up a situation where people can wear go pros and see each other's part of the process and Victoria and team debrief 40 50 people all together who can see that entire process and so they learn about each other's roles and build trust among each other so it's very easy to focus on the technology but what simulation really is an excuse to do is understand each other's thinking better so going back to the very beginning of the interview what I'm passionate about is how do we build how do we come to each other from sort of a stance of curiosity and respect when we do these interprofessional simulations people get more curiosity and more respect about each other's roles yeah yeah similarly I just want to quickly build on that one too it was so cool all the way to the actual EMTs that are sitting in that ambulance yeah and having that GoPro so that you know the physicians and nurses and staff at hospital can see what they're experiencing with the patient while they're being transported all the way to like you said just all of the complexity that actually occurs at the hospital being able to get behind with the curious curiosity behind the eyes of every single one of those people along the way you're building that trust it's it is such an interdisciplinary field and to be able to to take care of the patient oh yeah give us more of these examples okay well there's another one that I think is really interesting and important which is testing out whether architectural designs actually work for patient safety and patient care so colleagues at the modern health services in Brisbane Australia that team at Boston Children's that I mentioned earlier the team at Texas Children's team at all Johns Hopkins all children's in Florida all of them have different ways of bringing simulation to a building basically bring a patient bring the people so for imagine that you're building a pediatric intensive care unit or let's say regular intensive care unit you build a room that has a bed and a sink and all these different things it looks great but what you hadn't thought about is if that kid all of a sudden crashes and needs to be on something called ECMO or you need to bring a defibrillator in there or you need to bring ECMO in there and the defibrillator was already in there and the 10 people that go with all that equipment and all the plugs and all the cords and all the noise and all whoa all of a sudden all those things don't actually fit in that room yeah and you can't take care of the child so simulation is being used to help plan to do mid-course testing on architectural designs and then to test after the design is done so huge cost savings but also important safety advances yeah so architecturally speaking can the room where the patient is being operated on fit the anomaly case equipment that needs to be brought into the room how noisy will it be can it be plugged in all this yeah all these how many more staff members are going to be in the room to do that part of it do they how will they know the patient's data you had this you know love that look this an image embedded here where you actually have a whiteboard in the in the operating room with the the the data on the patient there you know their date of birth there they're like they're if they have any allergies if they have the their actual health record number yeah itself but Alan let me just I hasten to say I think a lot of my colleagues would really love it if we could go back to having whiteboards everywhere many of my colleagues are now working with an electronic medical record or an integrated electronic medical record which is supposed to make life easier totally but if you imagine that now you have all these doctors nurses respiratory therapists other allied health who are supposed to be looking at the patient and each other are now also on top of that basically having to do data entry data entry on top and so the into the electronic medical record it adds a level of complexity that we're also trying to understand using simulation because it completely changes the relationships in the room not only with the patient but with each other yeah when we had Dr Robert Lustig on the show he made it very clear that he and a lot of the other physicians around the world have found it to be quite difficult to you know you're the doctor and I'm the patient and you're spending you know a part of the time looking at me and empathizing with me and then part of the time looking at a device and entering data into a device and then that whole process is it takes you longer and it's a and it's also very important that that electronic medical or health record can then also be read by the other that the data can very easily move around that I can retain some ownership of the data there's all these can that data then be used for further medical research do I have control that there's so many of these questions and it makes a lot of sense to to find the most frictionless process of being able to potentially capture what the physicians and nurses are saying by voice and then find the key phrases parse for the key phrases enter that in to the electronic record that'd be fantastic go hopefully the the algorithms that we're working on will be able to get us to that point there's I mean there's so many so much else that that we can talk about with the examples I think this is an interesting one since this was this was just happening we had we had one of the midwifery nurses visiting for physicians visiting from Belgium yeah so we had and this was just was again just happening a little over an hour ago you know people from around the world usually have about four or so like let's say anesthesiologists that come in and that they're training they're from mass gen mass use a general hospital and they're in their training on on how to become a better anesthesiologist with these simulations but then you can also have people from around the world like from Belgium coming to visit and so usually what the midwives doing is working with the mother that's about to birth a child and there can be complications that occur like you were explaining the shoulder could get you you know stuck in the canal and then they're and then what so how do you so then they quite these are the things is how do you prepare the midwife to be able to handle a situation like that through simulation there could be some nerve damage that occurs how do you talk to the the the family after that so this is very beautiful you were starting to teach me about this and then so maybe walk us through some more of these you know you have people visiting from around the world and they've they're in different fields and you have different simulations for them and then they take it back and teach their part of the world about it yeah so just to set this context here and then maybe pick an example that would illustrate it so we have simulation fellows that join us for three months to 12 months who come from whether it's Germany or Spain or Saudi Arabia or Belgium or wherever and they are working on improving their simulation programs whether they are skill based or system based or these different kinds of applications that we've discussed a lot of what we specialize in is interprofessional communication so how do people from different professions which often amounts to slightly different cultures because how professions are trained can be quite different in what your expectations are and your assumptions are work together so let's take the labor and delivery example that you gave so one of the things that we sometimes practice here is a mother who comes in let's say she's had a motor vehicle accident or some other kind of situation or condition where she's deteriorating maybe she's heading toward a heart attack maybe she has some kind of a cardiac arrhythmia at the same time the baby maybe is having some fetal distress so the problem is we've got to take care of the mom and we've got to take care of the baby and the people who are focused on stabilizing the mom often the anesthesiologist and the people are focused on caring for the baby often the OBGYNs or the midwives or the nurses have slightly competing objectives there are certain things that need to be done for the baby there are certain things that need to be done for the mom and they have to quickly negotiate that in maybe minutes or 90 seconds they have to clarify what each other's goals are and if they haven't been in that situation quickly grasp that and find a way to make a decision for example sometimes it's going to be in the interest of both mom and baby to do an emergency cesarean section and get the baby out but to do that requires certain preparations and certain kinds of things for the mom sometimes it might be better to do something for the mom first and wait before we deliver the baby imagine just trying to figure that all out as the blood pressure is going down and the heart rate is going up and fetal monitors looking non-reassuring these are things that we try to help people practice here and so returning to some of the themes we've discussed that involve self-management how do I calm myself down so my colleague Rebecca Meinhardt who's an anesthesiologist and an OB anesthesiologist has been doing a study in one of our courses on how do the clinicians perceive a crisis what is a crisis to them what is it externally what is it internally in terms of what they feel and she's trying to understand that so we can better build that into our courses and prepare that help people be prepared for self-management then there's organizing the team so for example that anesthesiologist might need to name the things that are happening help people claim roles and then aim the team with the intervention so we have a algorithm as you've called it before that's name claim aim that helps people organize the team so those are some of the different things that we might do in that interprofessional way and Jennifer Joris who's the midwife visiting us from Belgium that you met is really interested in that sort of interprofessional coordination and collaboration under stress and time pressure wow that example in 90 seconds let's say uh they have to logically talk about the protocol the next step um that's so crazy yeah and wow the blood pressure is dropping like what yeah and so these are you know let's get behind the eyes of of of more people you know everything from people that are still um using jerry can gallons to go and get water from wells all the way to um people that are uh working in the restaurants that we're eating and customers at all the way to the nurses and physicians that are working on on our loved ones and the more that we can do that and realize the complexity of what their work is and um and even potentially you know do the simulations that get people a more comfortable uh in those environments uh with more mastery in those environments well and one of the ways we can get the more comfortable is because it's a simulation and the patient is either a mannequin patient or an actor patient who's not going to be harmed or hurt by what's done or not done is we could literally and we do come in in the middle of that situation we literally press pause we're like pause patient's not going to get any better not going to get any worse let's just think this through what are the signs and symptoms you're concerned about what are the signs and symptoms you're concerned about yes how are you thinking about moving forward how are you thinking about moving forward so they can hear each other's plans they can calm down a little bit talk it out and then we literally rewind a minute or two start it back up so it's sort of like a live video game yes and they can reorganize themselves it's so cool yeah when you you know when you you know in many ways well this is this is a game civilization the human experiment earth is a game and so you know it would be fascinating to actually be able to pause our game earth and go how do we you know geopolitically handle artificial intelligence let's take a break yeah oh that would be so wonderful if you stop the world i want to get off i need to think about how can we slow down global warming here yeah yeah because the fact that the economy is just roaring at unprecedented speeds and um causing us in many ways to not be able to press the pause button it just keeps us going every single day and that's why we experience a lot of the miscommunications and issues that we do and we have no space for oops moments yeah with the scale of errors that could potentially be occurring yeah okay this has been this has been so fascinating and i want to ask you about where you see all of this going with the future of healthcare the future of medical simulations healthcare simulations where do you see this moving to in the in the future so i think there's kind of two or three big trends that i think are important and likely to get more important so one is AR augmented reality virtual reality and we're working with a group called e-real who is synthesizing work from a bunch of universities around Italy to bring AR and VR to healthcare and i can talk more about AR and VR one is integration of simulation so we've learned into the healthcare system and the third is using it more for just in time type training so we've already alluded to all three of those so the AR VR is an area where there's a number of companies that are already trying to help us visualize for example 3d models of things and be actually in them and we know a lot about the transfer from 3d to 2d that is already showing for example in mammography that we can have greater accuracy and better prevention of adverse outcomes with better visualization this is not my area of expertise but i believe it's something that's going to be important uh the second is this integration so i'm a simulationista as they say but what i'm really keen to do is how do we bring debriefing more and more into just real clinical spaces we don't need simulation we have hundreds of cases every day thousands of cases every day at at massachusetts general hospital or other could we have a mini micro debrief of that are there ways that we we're not going to practice on our patients but there's a lot of what we do that we could learn from if we could have some little moments of reflection but the other is to build it into the context such that we are testing our systems while building our skills so we're actually in situ there's a lot of in situ simulation happening and i believe that's going to expand in some ways in situ in situ so right in the situation yep in the city yeah so using that what's that latin word yeah so in the clinic in the home in the real clinic in the real home in the in the uh intensive care unit in the operating room itself so people are using their own equipment their own environment their own electronic medical record and those kinds of things allow us to learn a lot more about the intersection of our skills in our systems challenge there as it's very expensive to be in any real clinical space i can potentially take uh the my own um electronic health record and uh and run like my own biometrics and potentially run a simulation on what it would be like if i um if i took the antibiotic that i needed to combat something or that i need um if i maybe needed uh some sort of a a if i would desired a genetic engineering procedure of some sort and just see what it would do to meet potentially and that that's interesting then of course like uh um taking and you leveraging the power of of computation and all the permutations that um really powerful computing can do um in the actual operating room and be able to simulate out if we made this decision and you know in just 90 seconds i'll hear all the decisions the highest efficacy is this one and you know to be able to see which protocols best and then of course like you said debriefings around the world if i was thinking about it would be great if there were you know two teams tackling and that way the team that tackles the surgery can then go debrief for half an hour while the other team goes and does the next one so that it's not um having to go from one to the next to the next to the next there's no debriefing time in between that was interesting and then of course yeah we have some great um connections for you we'll love to connect you to infinite retina who we just had on the show on um the uh spatial computing and augmented reality uh and they already um work with so many um uh healthcare organizations that are using the technology to be able to um have that augmentation that three-dimensional augmentation of the patient experience to to make sure it's of greater levels of of efficacy um awesome conversation in just so mind-expanding i feel so much more enlightened i want to ask you just two questions that we typically ask our guests on the way out of the show first questions of course funny in the given the context we're in uh are we in a simulation uh well you and i did a little bit of a debriefing we thought a little bit about what we would want to do here and theoretically we could pause at any time and rewind redo in fact we should have done that that would have been kind of fun um i try to approach my life as a little bit of a deliberately developmental opportunity so or action inquiry and i give myself as much slack as i can to rewind and redo so even if we're not going to immediately redo this um you know if this had been a real life would we be doing this differently or is life a simulation i like to think about being able to practice and get better though as you say it's a game with real consequences so um i will say parts of life are a simulation yeah yeah it's a constant uh leveling up and um and knowing that it is uh building our own our own skill sets and helping contribute at the level of our family community world is just so critical brings us most meaning in life and uh and that's what i think drives so much of our existence is so i'd like to just ask you a question about simulation so i noticed that the podcast is called simulation and i was thinking wow ellen must be into rehearsal practice something why does he call it simulation so why is your show called simulation it's called simulation for so many reasons um you know it's so funny that you know we are here center for medical simulation and i think that um when you take uh simulations and healthcare simulations and engineering software to find the right fit for aerospace or for automotive or for whatever industry on an engineering software side of things or there's um there's simulations used for um for how to uh calculate the you know the trajectory of of the rockets that need to go to the international space station you know there's the there's simulations for for biology the central dogma of biology and how that actually works um when you uh when you drop in um you know the above like pharmaceuticals into the biological system how that affects it i mean it's endless where simulations are actually applied already in in real life and so you know that's you know one of the reasons of course another one of the reasons is because this the question of if we are in a simulation is very interesting and it also um speaks greatly to in the next couple of decades hopefully within 50 years we'll be running our own um simulations and we'll be able to do things like look back at um at how humans actually evolved from you know from the big bang to the development of the earth orbiting the star to the development of of of life uh all the way up to um civilization flourishing and we can actually finally look at all the artifacts the archaeology of the anthropology of the evolution and we can not have to play the guessing game we can actually watch how uh language was invented how fire was invented how the wheel was invented um and so anyway that's you know these are the these are the reasons why so you are really attracted to these abilities to kind of predict and and play out and that's why you named it simulation or yeah yeah that and I would also say that um it's just a lot of the show is about um also asking really thought-provoking questions the leaders at the edge of their fields and inspiring and engaging other people to get to the edge and work at the edge and build the future and so um you know the thought-provoking question you know are we in a simulation what is consciousness are we alone in the cosmos the last question we like to ask our guess is what is the most beautiful thing in the world empathy compassion attunement being together really those are those are really raw yeah yeah yeah and I I hope that um one of the things for millennials and for gen z is really hear what Jenny just said you know really the empathy the attunement the ability to get behind the other's eyes and to be there with the presence with the heart and the energy the spirit right here you know is uh so so crucial um so to say that we're you know with our friends when we're FaceTiming around the devices is you know much much different um so yeah yeah thank you so much this is such a great interview good to meet you great to spend some time together yes I love you and I love your work so much thank you thank you for all that you're doing for all that the Center for Medical Simulation is doing um please check out the links below all again the links are harvardmedsim.org also uh Jenny's link to her LinkedIn profile the med simulation on twitter as well as get curious now um Jenny's twitter check out those links below everyone let us know your thoughts about the episode as well so share the thoughts around medical simulation healthcare simulation with your friends your families online with your co-workers let's get more talking about this let's get behind the eyes of the physicians and the caretakers the nurses that are helping us live healthy um lives and all the complicated protocols that they go through and uh also support the artists and entrepreneurs and the organizations that you believe in around the world simulations links are below as well support us help us scale help us grow help us continue come to cool places like Boston to do interviews like this and go and build the future everyone manifest your dreams into the world we love you very much thank you for tuning in and we will see you soon peace