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Build trust with remote users to get qualitative feedback



Over the past decade, software developers and growth marketers have automated most qualitative user feedback and testing. And yet, what about testing with communities like patients or senior citizens who may be more challenging to reach?

It was 2:00 a.m. at the Marriott Hotel in Singapore and I just wanted to get to bed after a 16-hour flight. As co-founder of a digital health company, I was in the process of building a community of test patients. Because of security and privacy concerns, I had to approach this process unconventionally; manually recruiting prospective testers online through administered groups and forums.

One of our test users had placed two urgent calls to me. I immediately called her back.

“One of our group members needs a new doctor. She is not doing well and needs a better specialist. I know you have a doctor on staff and I know it’s not his job but…umm, but…”

I interjected immediately.

“Don’t worry. You don’t need to say anything. We’ll do everything we can.”

Immediately, I dropped everything and called our company’s Chief Medical Officer to start a referral process. For the next few days, we fired off introductions to new doctors and assisted even though these tasks were not at all related to our company’s product. We were engaging with a non-conventional community which sometimes required going above and beyond the call of duty.

In recent years, product managers have fundamentally altered and automated usability testing for new products. Employing distributed labor marketplaces like Rainforest QA, Usabilia and Juicy Studio, growth-minded product managers have accelerated UI, UX, and backend product testing to ship faster and faster.

One of the most important subsets of usability testing, qualitative user feedback, has also faced an onslaught of automation.

And yet, there are numerous organizations who operate in spaces like healthcare, politics, or even eldercare where obtaining qualitative feedback is not that easily automated. Often, these are fields where security, privacy, and other restrictions necessitate a manual recruiting strategy focused on partnership and community development. A good example of this is a digital health company looking to test the first iteration of its product with patients where protected health information may be shared. Yet another example is an application focused on First Amendment violations targeting journalists or other at-risk groups where identity disclosure may be prohibitive. One needs to look no further than recent news of Google’s Nightingale project with Ascension Health to underscore the importance of the right policies and controls in these spaces.

I’ve learned the lessons in this space first-hand. Over the past two years, I have built a user community of patients who suffer from cardiovascular disease. For no monetary compensation, they are testing our company’s digital health application because they believe in its potential to make a difference in their lives and those of others. The most remarkable and fulfilling experience of my professional career, I have learned that to test your product with non-conventional users, you have to approach the process non-conventionally as well. In the words of Y Combinator Founder Paul Graham, you are going to have to “do things that don’t scale” and not be afraid of digging right in.

Specifically, you have to look for and recruit users in unexpected places; some of which resist automated growth marketing efforts. Second, you need to understand the value of partnership as these groups tend to resist more transactional relationships. And finally, you need to ask for permission and be honest and forthright with your intentions as to the testing process and the eventual product that you hope will hit the market.

Recruit in unexpected places

If recruiting test users in a challenging space like healthcare, law and order, or even eldercare, you need to seek them out in non-traditional and unexpected places. While you may think that online discussion forums like that are centered around user testing is the first place to go, there are other channels in which you can find more engaged and eager communities.

In medicine, community platforms including Patients Like Me and Care Opinion provide a key outlet to reach potential participants in a constructive and open way. In the political space, sites like Democratic Gain and Hill Zoo act similarly. Uniquely, these platforms have built-in security and approval features that protect users’ identities and allow them to only enter into conversations with their express and full consent. This is a key consideration for sensitive groups.

Facebook Groups allows for even more long tail recruiting but with the obvious and attendant risks that recruiting on an open platform like Facebook carries. Due to the closed nature of the Groups product as well as many built-in security features, Facebook Groups has escaped many of the information integrity issues and as a result, is one of the healthy components of the platform. Start by searching for a group in your space. Proceed by asking the group’s administrator for permission to engage with members by explaining your purpose and focus honestly. Often, in areas like medicine or politics, group members are eager to participate in testing new products where they can offer feedback in real-time and make an impact.

Even more fascinating is Quora . Quora’s platform emphasizes long tail discussions on a range of topics that even Facebook Groups cannot be narrow enough to encapsulate or cover. So, if you are looking for users with an extremely narrow focus, say those who are interested in testing a mobile app for tourism in the historic center of Hvar, Croatia, Quora may be your best opportunity to connect with like-minded individuals. Quora’s discussions can go quite deep, drive substantial value, and be generative of new product features.

It’s a partnership, not a transaction

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Former Amazon Mexico CEO suspected in wife’s murder




The ubiquitous Amazon logo. The onetime CEO of Amazon Mexico is embroiled in a murder case, according to the New York Post. 

The former CEO of Amazon Mexico is suspected of arranging his wife’s murder while engaged in a gritty divorce battle, according to the New York Post.

Juan Carlos García is wanted by the authorities for questioning after his estranged spouse Abril Pérez Sagaón was shot to death by a motorcyclist in front of the couple’s two teenage children in Mexico City.


According to a report by El Pais, she was shot in the head and neck.

Perez, a mother of three, was in Mexico City for a court hearing regarding custody of their children and was headed to the airport before being ambushed in her car.

According to the BBC, Garcia was taken into custody this January after Perez, who had a restraining order against her husband, accused Garcia of attempted murder, saying he attacked her while she was asleep with a baseball bat.

Garcia was released last month after 10 months in pretrial detention and the judge downgraded the charge to domestic violence.


Garcia, who left Amazon Mexico three years ago, is the main suspect although no charges have been filed.

Perez’s family believes her husband arranged the assassination.

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Lib Dems consider hung Parliament options




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Media captionLib Dems want to stop Boris Johnson winning a majority, says Davey

The Lib Dems’ deputy leader says the party can stop Boris Johnson from winning the general election “and through that we can stop Brexit”.

Sir Ed Davey told the BBC the most likely outcome on 12 December was a “minority Tory government”.

He suggested the Lib Dems would support them, along with other parties, if they agreed to another EU referendum.

The party launched its election manifesto earlier with a pledge to stop Brexit which they say would save £50bn.

If the party wins the general election outright, it says it would revoke Article 50, halting Brexit and keeping the UK in the European Union.

If it does not win, it will continue campaigning for another EU referendum, or “People’s Vote”.

Sir Ed told the BBC’s Andrew Neil Show the party wants to stop the Conservatives getting a majority at the election and then use whatever leverage they have to push for another referendum.

“The most likely result I think, looking at the figures, is probably a minority Tory government,” said Sir Ed.

“If it’s a minority Tory government, Boris Johnson says he wants to deliver Brexit… The only way he could do that is with a People’s Vote and so we will challenge him and we will work with others to say ‘if you want to do what you said, Mr Johnson… if you want to do what you said, work for a People’s Vote.”

He added: “We can stop Boris Johnson getting a majority and through that we can stop Brexit.”

Sources inside the party concede now that after the withdrawal of the Brexit Party in Conservative seats, what might have been a wildly unpredictable four-way race, has moved to a scrappy national two-way – with the SNP separately dominant in Scotland, and the third smaller UK-wide party eagerly trying to nibble at the margins to get in.

With Labour yet to make any big breakthrough in the campaign, the Lib Dems claim they are the ones who can nab seats from the Conservatives.

So Lib Dem votes in marginal seats are the ones that could prevent Johnson from a clear run at five years in office.

The party’s private hopes a few weeks ago of a massive increase in the number of seats has slipped a lot.

Read Laura’s full blog

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Media captionLib Dem leader Jo Swinson is pressed on whether she’d block a Tory or Labour government

Lib Dem leader Jo Swinson has repeatedly insisted that she is aiming to be the prime minister of a Liberal Democrat government after 12 December’s election – but she admitted in a BBC interview that it would be a “big step”, given the current opinion polls.

‘Government of national unity’

She told the BBC’s political editor Laura Kuenssberg her MPs would not actively support a Labour or Tory programme of government as she believes neither Jeremy Corbyn nor Boris Johnson are fit to be prime minister.

But she did not rule out allowing either of them to take office – by abstaining in a vote on their first Queen’s Speech – if they agreed to hold another EU referendum.

She also suggested there could be a “government of national unity” – made up of senior figures from different parties – if there was no overall winner at the polls.

“It’s certainly something which I put forward and suggested a few months ago, it wasn’t something which there was a majority for, ultimately, in the previous Parliament, but we don’t know what the arithmetic of the next Parliament will look like.

“And I just don’t think that we should be sort of trapped by convention into thinking our politics has to go down the tramlines that we’ve assumed it would in the past because this is a time of change in politics.”

She said people needed to be “more imaginative about what happens” after an election, suggesting that there were MPs in other parties that the Lib Dems could work with.

‘Remain bonus’

At her party’s manifesto launch, Ms Swinson said the economic boost the UK would get from staying in the EU was at the heart of her plan to build a “brighter future for people”.

The so-called £50bn “Remain bonus” would pay for 20,000 new teachers, extra cash for schools and support for the low-paid.

She said the UK “deserved better” than Boris Johnson or Jeremy Corbyn in Number 10.

The largest single spending commitment in the Lib Dems’ 96-page manifesto, launched at an event in north London, is a major expansion of free childcare, to be paid for by an increase in corporation tax and changes to capital gains allowances on the sale of assets.

There are also eye-catching pledges to freeze the cost of many rail fares for five years, to legalise and tax cannabis sales to over-18s and to charge those taking frequent international flights more.

The Lib Dems are hoping to significantly boost their presence in Parliament on the back of their opposition to Brexit, as they target pro-Remain seats in the south of England and London held by the Conservatives and Labour.

Speaking at her manifesto launch, she accused Boris Johnson of “lying” when he said a Tory victory on 12 December would “get Brexit done”.

What lay ahead instead, she said, were “years and years of endless trade negotiations” with the EU and “more time and energy wasted in getting something we know will not be as good as what we have now”.

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Websites ‘must block illicit nitrous oxide sales’




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Media captionExplained: What is nitrous oxide – or ‘nos’?

A trading standards expert has warned online stores need to “take responsibility” to prevent the illicit sale of nitrous oxide.

The gas – dubbed “laughing gas” or “nos” – is being sold with equipment needed to take it as a high on sites like Amazon and eBay.

It is the second most commonly used recreational drug in England and Wales after cannabis.

Sales are tricky to police as it has legal uses in catering and pain relief.

Nitrous oxide is sold on Amazon and eBay alongside the “crackers” and balloons used to take it.

On social media sellers were happy to deliver around the clock.

Samantha – not her real name – used nos when she was younger after a housemate bought it on Amazon.

The 22-year-old from Cardiff said: “When you’re that age and everyone around you is doing it, and you’re not really seeing any bad, negative impacts from it, you think, ‘Oh it’s fine, it’s something that young people do’.”

But she experienced fizzing in her nose, nausea and a tight chest after taking a substance friends bought online.

Image caption It was discovered being sold on eBay and Amazon

They thought it was nos. It was CO2.

Carbon dioxide is not used recreationally but inhaling it carries similar risks.

“The next day I felt really, really terrible, and I think it was a lot of anxiety about what I’d done the night before,” Samantha said.

“It was something that turned me off doing anything like that because it was so scary.”

Nitrous oxide – the highs and lows

  • Effects include euphoria, calmness, dizziness, difficulty thinking straight, giggling and hallucinations
  • Inhaling nitrous oxide from the canister or in an enclosed space – like with a bag over your head – is very dangerous
  • By inhaling nitrous oxide the user risks falling unconscious or suffocating from lack of oxygen. People have died this way
  • If someone collapses after using nos, turn them on to their side, call 999 and stay with them until an ambulance arrives

Source: Frank

Nitrous oxide has been linked to 17 deaths in the last three years, according to official statistics. Among 16 to 24-year-olds about one in 11 used it last year.

Legislation introduced in 2016 made it illegal to sell as a high.

Prosecutors say the law is not working because its legal uses make enforcement tricky.

BBC Wales found boxes of nos canisters being sold on Amazon in a special deal including the balloons used to take it.

On eBay, some “crackers” were sold alongside balloons. There were money-saving deals on bulk purchases and nos canisters advertised in the “similar sponsored items” section.

When BBC Wales searched for nitrous oxide canisters on both sites, crackers and balloons also came up in searches and were suggested by the sites’ algorithms as products that could be bought with nos.

Image caption The gas is often inhaled using balloons

Amazon has since removed the product being sold as a package of nos canisters and balloons.

The company said sellers must follow their guidelines.

A spokesman said: “Those who do not will be subject to action including potential removal of their account.”

An eBay spokesman said: “Listings encouraging illegal activity are banned from eBay’s platform.

“We have removed the items and are taking enforcement action against the sellers.”

‘Huge concern’

Nitrous oxide is also sold through social media accounts.

Many carry warnings against recreational use, but when a BBC Wales investigator called five sellers in Wales and south-west England, all were happy to deliver nos that night – despite the reporter saying it was for recreational use.

Some offered discount deals for multiple boxes.

Caerphilly council’s Tim Keohane secured one of Wales’ first prosecutions of a shop for illegally selling it in August.

Caerphilly and Gwent Police prosecuted Khehra Store Ltd after it was found to have sold nos at the 7-11 shop in Bedwas Road, Caerphilly, in 2018.

The firm and its boss were hit with fines and charges of about £2,000.

Anyone found guilty of selling or giving away nitrous oxide for illegal purposes can face up to seven years in prison, an unlimited fine, or both.

Image copyright Wellcome Collection
Image caption Nitrous oxide has been used recreationally since the early 1800s

Mr Keohane said the offence was harder to prove with online vendors. They can flout the law by selling items separately or posting disclaimers against misuse.

He said the drug’s widespread use among the young and online sales were a “huge concern”.

But its legitimate uses – such as for producing whipped cream – made legislating against web distribution difficult.

Mr Keohane said: “Companies like Amazon and eBay need to take responsibility because it is so difficult to police the internet and sellers.”

The Royal College of Nursing (RCN) has said many are unaware of the risks.

They include breathing difficulties, increased heart rate, burns and death.

Mental health nurse Jeremy Davis, of RCN Wales, said: “For every young person who has a balloon at a party and has five minutes that are the best of their evening, there is another one who wakes up in A&E.

“There are four or five more [each year] who don’t wake up.”

In May, several 4ft cylinders were stolen from Prince Charles Hospital, Merthyr Tydfil.

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