MOBILITY BOOST: A QUALITY IMPROVEMENT PROJECT TO BRIDGE A GAP IN CARE FOR HOSPITALIZED ADULTS

Early mobility quality improvement (QI) projects are leading the charge to shift the prevailing culture in acute care from a culture of immobility to a culture of mobility. Low mobility and hospital acquired functional decline is a persistent problem, especially for older adults, often leading to increased post acute care costs, increased risk of hospital readmission and increased mortality. Transition of care programs designed to improve care transitions and prevent hospital readmission exist but fail to include rehabilitation professionals or to adequately consider patient functional status during hospitalization. The goal of this research was to implement and evaluate an early mobility quality improvement (QI) project that added a physical therapist and mobility technician to an existing transition of care program (Project BOOST) to increase adult patients mobility and level of physical activity during hospitalization, using both quantitative and qualitative methods. The project was implemented from August 2, 2016 to February 4, 2017. A physical therapist rounded with one of two Project BOOST teams to promote increased patient mobility performed with a mobility technician daily. The physical therapist also recommended rehabilitation consultations (physical and occupational therapy) for appropriate patients. The AM-PAC “6 Clicks” Basic Mobility Short Form was used to set mobility tier levels for intervention group patients. Quantitative evaluation used observed hospital length of stay, 30 day same hospital all-cause readmission, and change in AM-PAC score from admission to discharge as outcome measures. Results showed that observed hospital length of stay decreased 0.9 days in the intervention group and 30 day same hospital all-cause readmission decreased 4.8%. Bivariate analysis of patient observed hospital length of stay was statistically significant for intervention group patients (p=0.07) but failed to reach statistical significance for same hospital readmission in intervention group patients (p=0.18). Qualitative evaluation used a phenomenological lens to explore the context of the early mobility quality improvement project and shared experience of patients and staff members exposed to more mobility and higher levels of activity during hospitalization. Twelve participants were interviewed during implementation of the project including four patients and eight staff members (physicians, nurses and a mobility technician). One overarching theme and four supporting themes were found from the data. The essential meaning was that mobility bridged a gap in care. Staff understood the benefits of early mobility for patients. Patients expressed how important mobility was for their discharge and quality of life. Patients with greater functional independence and higher mobility level reduced nursing burden of care. When patients were consistently presented with opportunities to be mobile and active during acute illness, they expected mobility to be a part of their daily care plan. This comprehensive evaluation of an early mobility quality improvement project found the intervention bridged a gap in care for patients. Adding a physical therapist to the Project BOOST team and promoting patient mobility during hospitalization resulted in improved patient outcomes. Early mobility quality improvement projects have the potential to transform clinical practice and improve quality of care

Strategic Design through Brand Contextualization

Providing meaningful customer experience is at the core of any successful business activity. Brands can function as vehicles to bundle the ingredients of experience together and give them structure by which consumers are able to understand and interpret products and services. To complement the technical and functional reality and experience, brands create particular narratives around products and services, within the realm of their use experience. This paper aims to contribute to understanding of strategic design and brand contextualization by looking thoroughly into a research-driven student project. The product-service design assignment given to seven teams of four to five post-graduate students was to design a new bike-sharing system, serving the sustainable urban mobility needs of the city of Gothenburg in Sweden. The task was accompanied by a request to create a fictive brand case and specific brand narrative, based on a thorough analysis of pre-selected existing brands. The paper discusses how the teams crafted their brand narratives and how different design and service elements were used to create specific and meaningful brand experiences. In addition to the contribution of the paper to design research and practice, we present a process that might be more widely useful for the education of strategic design and brand management

Robotic Wireless Sensor Networks

In this chapter, we present a literature survey of an emerging, cutting-edge, and multi-disciplinary field of research at the intersection of Robotics and Wireless Sensor Networks (WSN) which we refer to as Robotic Wireless Sensor Networks (RWSN). We define a RWSN as an autonomous networked multi-robot system that aims to achieve certain sensing goals while meeting and maintaining certain communication performance requirements, through cooperative control, learning and adaptation. While both of the component areas, i.e., Robotics and WSN, are very well-known and well-explored, there exist a whole set of new opportunities and research directions at the intersection of these two fields which are relatively or even completely unexplored. One such example would be the use of a set of robotic routers to set up a temporary communication path between a sender and a receiver that uses the controlled mobility to the advantage of packet routing. We find that there exist only a limited number of articles to be directly categorized as RWSN related works whereas there exist a range of articles in the robotics and the WSN literature that are also relevant to this new field of research. To connect the dots, we first identify the core problems and research trends related to RWSN such as connectivity, localization, routing, and robust flow of information. Next, we classify the existing research on RWSN as well as the relevant state-of-the-arts from robotics and WSN community according to the problems and trends identified in the first step. Lastly, we analyze what is missing in the existing literature, and identify topics that require more research attention in the future

The Nature of Context-Sensitive Solutions, Stakeholder Involvement and Critical Issues in the Urban Context

Over the last several decades many transportation and planning agencies have experienced conflicting demands emerging from the need to develop projects in an expeditious manner while at the same time involving stakeholders in the decision-making process, which sometimes is perceived as slowing project delivery and/or increasing costs. Given this tension between apparently conflicting demands, it is important to understand how the stakeholder involvement is being carried out and what best practices may be recommended. This study examines the issue in the context of a relatively new policy framework – Context Sensitive Solutions (CSS) – which supports the early integration of stakeholders into the planning process. The report pays particular attention to stakeholders’ involvement in projects within urban centers, where there is likely to be more complexity, both in terms of the number of stakeholders and end users affected. CSS is a relatively new process and not consistently interpreted or applied across states and/or agencies. The literature suggests that an underlying assumption when applying CSS principles to community involvement processes is that stakeholders are empowered through clear policies and procedures directed towards their participation. In our research, we found that the extent to which public agencies apply the CSS framework and involve and respond to stakeholders depends on each agency\u27s interest to engage the public in the deliberation process to find the best-fit project for a community. It is likely that the increased integration of stakeholders into the planning and project development process will not become a state of practice until the benefits flowing from community involvement are clearly understood by the agency staff. The CSS literature describes many benefits associated with comprehensive stakeholder engagement, including gaining constituents\u27 buy-in and support for project financing. A movement toward standardizing CSS policies and directives across the country will facilitate a public discussion about the benefits of engaging communities into the project design phase and away from solely expert-based designs. In addition, there are a number of stakeholder involvement practices that, if adopted, could expedite the integration of communities\u27 views and values in the decision-making process, while at the same time minimizing the chances of protracted consultation processes, time delays and additional costs

MOSAIC vision and scenarios for mobile collaborative work related to health and wellbeing

The main objective of the MOSAIC project is to accelerate innovation in Mobile Worker Support Environments by shaping future research and innovation activities in Europe. The modus operandi of MOSAIC is to develop visions and illustrative scenarios for future collaborative workspaces involving mobile and location-aware working. Analysis of the scenarios is input to the process of road mapping with the purpose of developing strategies for R&D leading to deployment of innovative mobile work technologies and applications across different domains. This paper relates to one specific domain, that of Health and Wellbeing. The focus is therefore is on mobile working environments which enable mobile collaborative working related to the domain of healthcare and wellbeing services for citizens. This paper reports the work of MOSAIC T2.2 on the vision and scenarios for mobile collaborative work related to this domain. This work was also an input to the activity of developing the MOSAIC roadmap for future research and development targeted at realization of the future Health and Wellbeing vision. The MOSAIC validation process for the Health and Wellbeing scenarios is described and one scenario – the Major Incident Scenario - is presented in detail

Upgrading of Symbolic and Synthetic Knowledge Bases: Analysis of the Architecture, Engineering and Construction industry and the Automotive Industry in China

The degree and the way of upgrading differ widely per industry. This article tries to give some new insights in these differences by linking the concept of upgrading to that of the knowledge base. Moreover, we try to identify barriers to upgrading as well as the appropriate spatial scale on which upgrading takes place, again for different knowledge bases. We support our argument by analysing the process of upgrading in two industries in China: the AEC industry (in Beijing and Shanghai) and the automotive industry (in Shanghai). Within these industries we focus on upgrading on two levels: within firms and within projects. Our findings for both industries suggest that the principal ways of upgrading of the symbolic knowledge base are joint brainstorming in internal and external project teams and labour mobility. Major factors that hinder the upgrading of symbolic knowledge include the development stage of China, the Chinese educational system and tensions about duplication of western designs. Upgrading of the synthetic knowledge base takes mainly place via inter-company training programmes of foreign firms, technology transfer and labour mobility on the long run. A possible barrier for upgrading of synthetic knowledge, especially in the automotive industry, is that foreign firms tend to keep certain engineering activities in their home base because of the risk of knowledge leakage. However, this is changing quickly as many foreign carmakers and their suppliers invest in engineering centres in China due to an increasing demand for cars, to governmental regulations and to intensifying competition.Urban development, upgrading, automotive industry, AEC industry, knowledge economy, China.

Out there and in here: design for blended scientific inquiry learning

One of the benefits of mobile technologies is to combine ‘the digital’ (e.g., data, information, photos) with ‘field’ experiences in novel ways that are contextualized by people’s current located activities. However, often cost, mobility disabilities and time exclude students from engaging in such peripatetic experiences. The Out There and In Here project, is exploring a combination of mobile and tabletop technologies in support for collaborative learning. A system is being developed for synchronous collaboration between geology students in the field and peers at an indoor location. The overarching goal of this research is to develop technologies that support people working together in a suitable manner for their locations. There are two OTIH project research threads. The first deals with disabled learner access issues: these complex issues are being reviewed in subsequent evaluations and publications. This paper will deal with issues of technology supported learning design for remote and co-located science learners. Several stakeholder evaluations and two field trials have reviewed two research questions: 1. What will enhance the learning experience for those in the field and laboratory? 2. How can learning trajectories and appropriate technologies be designed to support equitable co-located and remote learning collaboration? This paper focuses on describing the iterative linked development of technologies and scientific inquiry pedagogy. Two stages within the research project are presented. The 1st stage details several pilot studies over 3 years with 21 student participants in synchronous collaborations with traditional technology and pedagogical models. Findings revealed that this was an engaging and useful experience although issues of equity in collaboration needed further research. The 2nd stage, in this project, has been to evaluate data from over 25 stakeholders (academics, learning and technology designers) to develop pervasive ambient technological solutions supporting orchestration of mixed levels of pedagogy (i.e. abstract synthesis to specific investigation). Middleware between tabletop ‘surface’ technologies and mobile devices are being designed with Microsoft and OOKL (a mobile software company) to support these developments. Initial findings reveal issues around equity, ownership and professional identity