john-norris.net

As you wander a lonely virtual landscape, is anyone watching you?  Probably, if the land collect stats.  Should you be told?

As some may know, I maintain the Path of Support on Healthinfo Island in Second Life.* It features almost 100 posters of different support groups. The path includes groups  dealing with mental health conditions, chronic issues, and terminal illnesses.

I am acutely aware that some people, as well as avatars, do not want to be publicly associated with some of these ailments.  This may even be the reason why some join Second Life.  A person can be relatively anonymous behind their avatar.

However, some people’s SL lives are unique enough that close friends or associates may be able to figure out who the real life person is ‘behind’ the avatar.  Further, people may want the avatar itself to have some privacy.  I know some people who do not want to list certain groups their avatar belongs to because others’ may see it in their profile and think less of the avatar (as well as the person.)

It was with this in mind that I designed certain aspects of the Path of Support.  For example, I have a list of the groups in the notecard at the beginning, so that avatars need not be seen near group posters they are not comfortable being by.

To properly understand the utilization of Path of Support, I collect statistics on visitors.  There are a number of outfits and objects/scripts that will do so, and some report the name of the avatar including in real time (ttSLVC, 1902 Essential.)  However, given the nature of the material on the path, I decided to not collect avatar names. I do record that a visitor came by, that they took a note card, and in the case of some posters I am making, where the poster is located.

I now include a privacy statement about my reporting on the notecard at the entrances to the Path of Support.  I wonder if, like websites, more areas will also begin to post similar statements.  Can the HON code be far behind?

*If you have a Second Life client, you can visit the path here.

So, after Lively, I’ve decided to take a look at other virtual worlds besides Second Life.

Abstract: IMVU is an avatar based instant messaging environment. It allows for participation of anyone from 13 years of age and older. There are well over 100 healthcare support groups in IMUV. Many are more informal than those within Second Life, SL, or listed in the American Self-Help Group Clearinghouse, AS-HC. The number of groups and their membership can be broken down into categories, with similar amounts to SL and AS-HC. However, there are some differences, higher Mental Health, lower Disabilities groups and membership, that may be due to to younger demographics of IMVU. There is a long tail effect with a few groups having large memberships, but the majority having only a few members. Group growth rates can also me determined with many starting around the same time, but growing at differing rates.

Quick Overview of IMVU:

IMVU is an Instant Messaging Service (1) with a heavy graphical user interface. It is a 2.5d type space which is room based, one does not really walk around much.  Indeed, the focus on developing IMVU has been on avatars and not land.(2)  IMVU offers free accounts as well as paid. Users can be 13, with parent permission, or over. Users can generate content, and goods can be bought and sold. They currently have 20 million registered users and have been around since 2004.(3) Average User age is younger, perhaps 12-17 (4)

What’s an IMVU health group?

The groups area is well thought out and includes an online discussion forum as well as the possibility to meet up inworld. Groups are assigned to categories. I looked at the “Real Life/Health” groups for my research.(5) Of the 331 groups IMVU listed in that Health subcategory, I identified 142 as being about health. (Some of the group’s details suggested that at one time IMVU credits were given to people if they started a group. If true, and I saw it in several groups’ details, it would skew some of this data.)

I found a large number of seemingly simple ‘chat’ type groups within this health category. Many had no firm theme and only a modest amount of members. I am unsure as to what sort of health issues these should be understood to be dealing with. For 142 health groups I identified, 13, or roughly 10% were such chat groups. I left them out of my beginning analysis.

I attempted to categorized the rest under the American Self-Help Group Clearinghouse’s categories.(6) Some additional groups did not seem to fit, 31, so I left those out at this juncture. I did not see any groups that classified as Bereavement, but several of the chat oriented groups might qualify as they include ‘loss’, and other difficulties. However, I did not include them in the analysis below:

Number of Groups by Category Compared:

For 92 groups, here’s the number of groups, the category, and their percentage:

(Second Life, American Self-Help Clearinghouse)

3 Abuse 3% (SL >1%, AS-HC 3%))

4 Addiction 4% (SL 5%, AS-HC 7%))

11 Disability 8% (SL 21%, AS-HC 7%))

2 Family 2% (SL >1%, AS-HC?))

42 Health 46% (SL 49%, AS-HC 60%))

27 Mental Health 30% (SL, 15%, AS-HC 5%)

? Bereavement ?% (SL 4%, AS-HC ?%)

I took the IMVU groups and placed them into the categories used by American Self-Help Clearinghouse. I then looked at the categories as a percentage on the whole. I had done this with Second Life and American Self-Help Clearinghouse earlier.

Generally, the same percentages hold across all support group communities. However, IMVU was much higher in the Mental Health category. I am not sure why Mental Health would be so high in IMVU, but have some thoughts on the matter.

Mental Health’s high percentage testifies to the sheer number of Mental Health groups and a variety, of sorts, to their approaches. From looking at the groups, they do not seem to be addressing specific, clinical, mental health issues, say agoraphobia, or depression. The groups seem to be more informally oriented towards addressing people who are not happy, or need someone to talk to. This may be due to the younger demographics than in Second Life. Perhaps the younger community is more interested in talking, or framing their conversations, more informally. It may be that these younger members have these types of issues more than the presumably older Second Life or AS-HC community. It may be that a smaller learning curve draws in more people, diluting the number of people with less formal mental health needs. Also, those that need more formal help may be more willing to learn the complex tools of Second Life, or attend AS-HC meetings, to better have their needs met.

Interestingly, IMVU disability is about the same as AS-HC, and not as high as in Second Life. I will take more of a look at this, below.

Number of Members per Category Compared:

For all health groups I identified, including those not categorized, there are 3288 members. The groups I categorized have a total of 2227 members. I then looked at the percentage of memberships in each category over all 2227 members. In IMVU an avatar can be a member of more than one group. I did not see any limit to the number of groups one could be a member of. Second Life currently limits an avatar to 25 groups.

Here’s the categories and the percentage of membership. (Second Life):

Abuse 4% (SL <1%)

Addiction 1% (SL 2%)

Disability 7% (SL 24%)

Family 4% (SL <1%)

Health 32% (SL 38%)

Mental Health 53% (SL 31%)

Bereavement ?% (SL <1%)

Percentage of total by membership (not 100%)

Again we see the large interest in mental health. I think the prior analysis holds here as well. Not only are their a lot of mental health groups in IMVU, there are a lot of members involved in that area. This graph may also be explained by the younger demographic and easier tools of IMVU.

Conversely, the Disability membership is much higher for Second Life. My guess is that the advance communication and mobility features of Second Life are of such high value to the disabled population, they are less willing to inhabit IMVU.

Membership in Groups Compared

As in Second Life, IMVU memberships demonstrate the long tail effect. There are a few large groups, some in each category, but groups with smaller memberships predominate.

(Note: Not all groups are named in the graph)

Top 10 groups by membership are:

Suicide, Depression, and Relationships, 639 members.

<Be Yourself>, 254 members.

Suicide Awareness, 217 members.

Fibromyalgia, 152 members.

Soul ~ Heart ~ Body & Holistic Health, 111 members.

Tickle Me Pink, 91 members.

Pregnant Teens, 83 members.

Straight Edge, 83 members.

Mental Health Survivors, 76 members.

*Helping and Sharing Medical Advises (sic), 74 members.

Groups that have been around longer tend to have more members. However, there are plenty of groups outside of this general rule.
Comparing IMVU Group Growth Rates

IMVU group information also lists when the group was first created. The first group was in August of 2007. We can look at how many groups were created in each week for each category

(Note: Possible promotions could effect this result.)

We already noted the differences in the quantity of each category. With this data and graph we have the opportunity to see the growth of the categories as in a timeline.

Four out of the six categories had groups started within the first two weeks. However, their rates were quite different. Health began quickly and was well sustained for a little more than half the period before it slowed. Disability steadily increased its rate during the first third of the period, and then did not do much for the remainder. Mental Health also increased its rate at the beginning, then plateaued, before once again, increasing at the end. Addiction started late and slowly increased the number of its groups. Abuse started at the beginning and added only a few groups during the period. Family came in nearly one third of the way into the period, and did not add anything else.

It would be insightful to see how this corresponded with the general increase of the IMVU population, however, i do not have that information available.

I wonder how the bunching of rate increases are due to IMVU promotions, or just people in the same communities sharing/having the idea to create a group at the same time.

The rates also seem to show that the Health and Mental Health groups found that IMVU is suited their purposes and so continued, whereas the other groups started, but soon found that IMVU  was not their environment.

I am not able to get this sort of information from Second Life at this time. But I would be very curious to see if it is similar. One of the values of such a chart would be to help predict and prepare for support groups moving on their own into new worlds or media.

Discussion

I would like to continue visiting virtual worlds and doing similar research. With the demise of Lively, I want to be sure that we can learn what we can from these places while we have the chance.

IMVU had the added benefit of reporting the group’s start date.  Being able to see, over time, a virtual world being populated by healthcare support groups drew me to this particular project.
EndNotes:

(1) “Instant Messaging Goes Graphical” Daniel Terdiman. Wired 09.16.04 http://www.wired.com/science/discoveries/news/2004/09/64969

(2)”Q&A: IMVU’s Cary Rosenzweig On “Building From The Avatar Up” worldsinmotion.biz 07.28.08 http://www.worldsinmotion.biz/2008/06/qa_imvus_cary_rosenzweig_on_bu.php

(3) “A Message from Cary Rosenweig, Cheif Executive Officer of IMUV” Cary Rosenweig 07.20.08 http://www.imvu.com/about/letter_from_caryjay.php

(4) Couldn’t quickly find demographics for IMVU so used Quantcast estimate. Age that visits the IMVU website. http://www.quantcast.com/imvu.com

(5) I collected group data on Nov. 23, 24 2008. I used the IMVU website’s groups area, going through the 331 groups listed in the subheading “Health”.

(6) “The Self-Help Group Sourcebook Seventh Edition” B White, E Madara 2002 Saint Clares Health Services. (http://www.selfhelpgroups.org/)

Folks are lamenting the demise of Google’s virtual world, Lively.  There are discussions on how it might have been better integrated with other Google offerings.  I’ll put in my two cents…which I had actually sent to Google as a Lively feature request.

Personal Health Records could be used to drive online healthcare support communities.  The PHR could offer the client to connect them to others with the same issues, or professional help, via online support groups.  The groups could include anything from a listserve, online forum, IRC, or virtual world.

Since the PHR could include diagnosises from a licensed medical practitioner, it could help assure that the client actually has the issue and is not simply pretending.  Along with demographic information, this may help direct the client to the proper groups.  It may also increase the trust of the others in the group.  (Others whos issue is not verified could still be included in the group as well.)

Participation in the groups would need to include the ability to choose anonymous user names, or avatars.

Some meeting spaces could include information specific to the issue being addressed.  This could be “sticky notes” in the case of an online forum, or a complete virtual environment for a virtual world.  Educational as well as social aspects can be tailored for the client(s).

User generated content should be included for a variety of reasons if not only for the possibility of unique and highly specific issues addressed.  With good UGC tools, is it entirely possible that a mostly blank, area automatically created from the diagnosis, may become populated with quality UGC.

It might also be helpful to have the option to include some medical information in one’s profile.  That would allow people to find eachother.  If the system was locked down, healthcare professionals could have their licenses in their profile.  (This is already happening in online forums, just not driven by a PHR as far as I know.)

So this was the idea I proposed to Google, connecting Google Health to Google Lively.  However, the idea is valid for any group willing to go there.

If anyone needs help on that, just let me know.

Google is pulling the plug on their virtual world, Lively.  I jumped in early, was not impressed, and spent my time in Second Life instead.  However, lately I’ve been back and have been working on a room.  I’ve come to understand and appreciate a place Lively may have in the diverse mix of virtual worlds.  Before it shuts down, here are some lessons learned.

My room is Healthcare Support Groups (available till 2009) and is meant to educate and assist people inworld about choosing the proper group.  (Much like my work with Path of Support in Second Life. (SLULR))

1) You need a good way to communicate to those who are interested in your work. Since you can’ t be there all the time, the user needs to create something to get the message across.  Lively allows one to link to unfortunately low resolution graphics which I used to create posters…with a link to a website with the corresponding info.

2) The ability to easily put in multiple pieces of streaming media was an eye opener…very powerful content could be shared with one’s visitors.  Since everyone in the room heard the sound, the written word was a better way to go than a voice over.  You can check out the rough video here.

3) Different worlds for different folks-  The simplicity of Lively taught me that one could still do good work, that would help folks out, even with modest tools.  I can also understand how people put off with the complexities of some virtual worlds may be more comfortable in other environments.

4) Healthcare themes were early pioneers in Lively.  I was not invovled in the beginning of Second Life and there is no way that I know of to track when the groups started there.  With Lively I can see when rooms were created and take a snapshot of how it looks 4 months after it began:

4a.  Today I identified 21 rooms in Lively that deal with healthcare.  I think one could see them as similar to Second Life groups.  With few data points and rooms vaguely defined, it is hard to draw conclusions.  However,  health information / libraries and mental health had the most rooms.  General health and fitness also had a strong showing.

4b. Half of the room were created within the first week, or so, of when Lively began.  While, I recognize several names from Second Life who deal in libraries and larger health sims, the rest may be folks (peers?) may be actually looking for particular help and relationships.

4c.  Most (75%?) of the rooms had only 3 visitors since their inception.  However, the most popular rooms had many more visitors.  They dealt with Mutliple Sclerosis (36 visitors) and addictions (96 visitors).  I count myself lucky to have had 6 visitors in the 8 days I’ve been up.  Pehaps this is similar to the long tail of memberships in Second Life healthcare groups?

5.  Linking between virtual worlds is an intriguing concept.  I  like the idea of being able to go to those areas that have unique features you may want to take advantage of.  In Lively I had a clickable poster with a slurl to the Path of Support in Second Life.

6.  I need to get out more.  I enjoyed my time in Lively, once I decided to do something there.  I was surprised about how many healthcare folks were already there.  I’ll be making more of an effort to look into the various healthcare aspects of other virtual worlds.

Earlier this October I had the priviledge of being a panelist for the Stepping into Virtual Worlds Conference - Health.  It was a great time, especially having to summerize big parts of Second Life experience on the fly!  While I do reflect upon my time in virtual worlds, it is a good exercise to have to take another’s perspective.

Many thanks to the folks putting on the conference and inviting me.  And a big thanks to those who took the time to attend the panel discussion, I hope it was educational.  I learned quite a bit and met some neat folks.

I informally gathered some data about Second Life and thought I’d share some findings.  I am in no way a statistician, and my data is not complete, so take this all with a grain of salt.

Towards the end of September I took the File Cabinet list from SLHealthy and collected all the health care support groups.  In case I missed anything, I used the SL search client inworld to look up all groups with the keyword “support”.  There was about 2000 returned items.   After the first 100 pages, about 1000 groups, I was not able to view any results as they were private.  Of those I did see, I was able to garner an additional 20 or so healthcare groups that were not on the SLHealthy list.  (Yup, I added them to SLHealthy).  So I now have a list of about 150 groups. (A note of caution, some groups do not fit into nice categories. For instance, I counted Wheelies as a support group, but it could be considered more of a night club.)

How Many Healthcare Support Groups in SL?

The first 1000 “support” groups listed got me 150 actual groups. My first speculation is that the other 1000 “support” groups I was not able to view include other healthcare groups.  Of the viewable “support” groups the public healthcare support groups were about 15%.  Since healthcare is a private matter, I suspect that there is an even higher percentage of healthcare support groups in the remaining 1000 private “support” groups.  I’d feel comfortable saying there are about 200 to 300 healthcare support groups within Second Life.  (However, I am a bit leary in that the SL Search showed ‘private’ after exactly 100 pages.  It might merely be a bug in the software.)

The Long Tail…many groups many perspectives.

I also noted the number of members in each group.  When compared to each other, this gave a classic Long Tail as written about by Chris Anderson.  The picture at the top of the post is a bar graph of groups by membership and shows this long tail.  Of the 150 groups only about 25 of them have one hundred members or more.  Towards the thin, but long part of the tail, there are over 50 groups with less than a dozen members.  As Chris explained, the Internet allows folks to publish things cheaply, thus niches that only appeal to a few people and would never be able to make it in old (expensive) media, flourish on-line.  For a healthcare support group this is a boon in that it allows those with rare disease to interact with each other.  But in a bigger sense, it allows folks with unique approaches to their issues to interact with each other.  Thus, we find 19 groups concerning Cancer and 17 groups for Autism/Spectrum disorder.  People are making or finding groups that they feel comfortable in.

How many people are involved?

The groups I collected had a total of about 10,000 members.  However, since each avatar can join up to 25 groups and a person can have multiple avatars I wouldn’t say I have a great handle on how many people are actually involved in these groups.

Who’s issues are represented?

I then took the groups and tried to categorize them.  I decided to use the taxonomy of the American Self-Help Group Clearinghouse. They have been around since the 1980’s, have a database of over 900 support groups, and have their own classification system.

If you look at the number of groups per category as a percentage of the whole you get:

• Abuse:  > 1%  (Shown in the graphic to the right in yellow)
• Addictions 5%   (green)
• Bereavement 4%   (light blue)
• Disabilities 21%   (dark blue)
• Health 49%   (light purple)
• Mental Health 15%   (dark purple)
• Miscellaneous 5%   (red)

If you look at particular issues, the ones with the most groups are Cancer (19 groups),  Autism/Spectrum  disorder (17), Addiction and “Mobility” (7 each), HIV (6), and Bereavement (5).

Who’s in the groups?

If we take a look at the number of members in each of the categories as a percentage of the total number of members for all groups, we see a bit of a different breakdown:

• Abuse:  > 1%
• Addictions 2%
• Bereavement 1%
• Disabilities 24%
• Health 38%
• Mental Health 31%
• Miscellaneous 2%

While Bereavement counted for 4% or the groups, it only has 1% of the total members.  Perhaps this shows that such an issue brings out more varieties of approaches.

Mental Health counted for 15% of the groups but 31% of the total members.  This would seem to indicate the opposite of Bereavement.  Perhaps in Mental Health more people feel comfortable in fewer groups, unique approaches are not brought out.  However, I know that the group with the most members, Support for Healing, has several sub groups within it, that use different approaches, but whose membership is counted in total.

What’s it all mean?

Beyond this discussion, I don’t think my data is clean enough to make any certain pronouncements.  However, in general I think it shows that Second Life (Lyndon Lab’s grid) is full of folks helping each other out, that there is a long tail phenomena, and some issues are more represented than others with different groups trying different approaches.

This was all done in a fairly rushed fashion, and as I said, I am not a statistician.  I plan on taking a much closer and accurate look at the support groups.  Feel free to email me for an Open Office doc of the data.

* These graphs are currently in Second Life at Path Of Support (slurl)

If you run a healthcare support group online (be that a message board, forum, IRC,  etc…)  and are wondering about jumping into virtual worlds, I hope the following paper is helpful.

If you are running a face to face healthcare support group and wonder about doing so in a virtual world, this paper may also be helpful.  However, there are some general things about online support I do not address.

If you are looking for an introduction to the basics of Second Life, this is really not the paper for you.  But if you want to know how groups function without going into Second Life, this paper may be a good start.

Healthcare Support Groups in Online Virtual Worlds (v.2, 13 page pdf)

If you have suggestions for this paper, please drop me a line, or add your comment below.  I’ve released this under a Creative Commons Attribution-Share Alike 3.0 license and only want it to make it as useful as possible.

**Update Oct 1-

Thanks for all the suggestions. I’ve included some at this time, including a list of the 16 most popular healthcare support groups.

A podcast in your back pocket?

Here it is.

But really… this is demonstrating the ability for paper to carry a digital file.  The free PaperBack application (sorry, Windows only) allows one to translate digital data into an image and visa-versa.

“Straight from the Hip” is an 35 kg audio file (about 10 words) that has been compressed, turned into an image, and placed into one of my hipster templates.  Since it is a voice recording, I used the Speex codec to make the voice file as small as possible.

How to Listen:

1. Print out the hPDA page.  I printed it at 600 dpi.  Be sure not to have the printer do anything extra to the image- for example, no “sharpening”.
2. Use PaperBack to scan and retrieve the audio file.  Within PaperBack, I set the scan to 600 dpi.
3. Use a speex enabled audio program to listen to the podcast.  I used the free application SpeexDrop to translate the .spx file into .wav.

Make your own hPDA Podcast:

1. Record audio.  I used Audacity.  Save as a .wav.
2. Encode into Speex.  I used SpeexDrop.
3. Create image with PaperBack.  Within PaperBack, I set it to 200 dpi.
4. Add image to hipster.  Be careful to preserve the dpi.
5. Print the Hipster page.  I printed it at 600 dpi.  Be sure not to have the printer do anything extra to the image- for example, no sharpening.

While this seems to be stretching the Hipster idea, that’s what I’m here for, it may prove to more than just entertaining.  One could store other types of files, such as medical records, to-do lists, calendars, etc… things that would be easier to import into a computer from the a digital format.

Stay Tuned!

I’ve finished up my course work at Oregon Health and Sciences University and now am an official Biomedical Informaticist!

It is quite a program.  While I had researched BMI by myself for about a year prior to applying to OHSU, the quantity and quality of content in the courses was almost overwhelming.  I would highly recommend OHSU’s program to those who want to get up to speed fast, or go in-depth.

Some of the best parts, and a bit of a surprise to me, are my fellow students.  There are a lot of clinicians, many of them MDs, even some CMIO’s.   These folks had already been dealing with BMI issues at work, and were a fountain of real world examples and questions.

The certificate was all graduate level courses, and I can apply them to a Masters as well as a Doctorate.  It would be great to continue, but I’m would really like to use my experience and start helping folks out directly.

(Analyzing Healthcare as a Complex Adaptive System (CAS)
One of my fellow students at OHSU turned me on to CAS, and I’ve been researching it in my spare time. It really strikes a cord with me, and I am curious to develop a pragmatic understanding of it. I plan to summarize this in a paper.  I would be very curious to hear from others in this area.

So here’s my summer reading list:

A quick note of explanation:

There have been numerous attempts to change healthcare. Examples include the difficulty implementing an EMR at a small clinic or at the national level. Why do these attempts routinely fail?  CAS posits that a healthcare system  encompasses multi-relational agents that change and learn.  This is unlike the more typical analysis of the system as a machine, with standard parts and processes.  Merely bolting on new parts, or replacing old ones will not do.  One needs a broader view of the system, and a way to work within its deeply dynamic culture(s).  CAS tries to provide this.

I’ve currently read the following.  They are available on the Internet: (Forgive the improper citation formatting.)

What is a COMPLEX ADAPTIVE SYSTEM?
http://www.indydiscoverynetwork.com/cas.html

Quick read and definition of CAS.

Healthcare Organizations as adaptive systems
j Begun, B Zimmerman, K Dooley
Advances in Health Care Organization Theory 2003, pp 253-288
http://www.change-ability.ca/Complex_Adaptive.pdf

Nice introduction to CAS, its history, and Healthcare.

A Complex Adaptive Systems (CAS) Approach to Public Policy Decision Making
Society for Chaos Theory in Psychology in the Life Sciences
August, 1998
Glenda H. Eoyang
http://www.winternet.com/~eoyang/gstuff/SCTPLSPolicy.pdf

Although not strictly about healthcare, more in-depth about CAS style management and how it is supposed to work.

Health Care as a Complex Adaptive System: Implications for Design and Management
William B. Rouse
Volume 38, Number 1 - Spring 2008

http://www.nae.edu/nae/bridgecom.nsf/weblinks/MKEZ-7CLKRV?OpenDocument

Use CAS to help give value.  Management with incentives. Suggested matrices.  Good article and a quick read.

Healthcare Organizations as Complex Adaptive Systems
Sean Park, MA Candidate
University of Toronto
Jagger Smith, MHA Candidate
University of Ottawa

http://www.healthcareleadershipconference.nexx.com/assets/PDFs/Presentation%20PDFs/June%2011/Dockside%201/Health%20Care%20Organizations%20as%20Complex%20Adaptive%20Systems.pdf

Nice explanations, especially Complicated Vs Complex.  Some management tips.

Complex Adaptive System Behavior and Healthcare Expenditures: Evidence and Implications.
Rupper R; AcademyHealth. Meeting (2004 : San Diego, Calif.).
Abstr AcademyHealth Meet. 2004; 21: abstract no. 1517.
http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=103624551.html

Attempts to prove that Healthcare has at least one attribute of CAS.

Clinical Quality Needs Complex Adaptive Systems and Machine Learning
Stephen Marslanda and Iain Buchana,
http://www-ist.massey.ac.nz/smarsland/PUBS/MedInfo04.pdf

Only 5 pages and mostly about machine learning.  Some info on healthcare.

Finally, I’m in almost done reading the book, “Edgeware: insights from complexity science for health care leaders” by Brenda Zimmerman, CreateSpace 1998.  You’ll have to purchase this one, or get it though your library.  It’s quite good. Lots of examples on how to use CAS.

I’ll be digging up more Internet available information as well.