Emergency Care Handover (ECHO study) across care boundaries : the need for joint decision making and consideration of psychosocial history

Background: Inadequate handover in emergency care is a threat to patient safety. Handover across care boundaries poses particular problems due to different professional, organisational and cultural backgrounds. While there have been many suggestions for standardisation of handover content, relatively little is known about the verbal behaviours that shape handover conversations. This paper explores both what is communicated (content) and how this is communicated (verbal behaviours) during different types of handover conversations across care boundaries in emergency care. Methods: Three types of interorganisational (ambulance service to emergency department (ED) in ‘resuscitation’ and ‘majors’ areas) and interdepartmental handover conversations (referrals to acute medicine) were audio recorded in three National Health Service EDs. Handover conversations were segmented into utterances. Frequency counts for content and language forms were derived for each type of handover using Discourse Analysis. Verbal behaviours were identified using Conversation Analysis. Results: 203 handover conversations were analysed. Handover conversations involving ambulance services were predominantly descriptive (60%–65% of utterances), unidirectional and focused on patient presentation (75%–80%). Referrals entailed more collaborative talk focused on the decision to admit and immediate care needs. Across all types of handover, only 1.5%–5% of handover conversation content related to the patient's social and psychological needs. Conclusions: Handover may entail both descriptive talk aimed at information transfer and collaborative talk aimed at joint decision-making. Standardisation of handover needs to accommodate collaborative aspects and should incorporate communication of information relevant to the patient's social and psychological needs to establish appropriate care arrangements at the earliest opportunity

Remote Antenna Unit Selection Assisted Seamless Handover for High-Speed Railway Communications with Distributed Antennas

To attain seamless handover and reduce the han- dover failure probability for high-speed railway (HSR) com- munication systems, this paper proposes a remote antenna unit (RAU) selection assisted handover scheme where two antennas are installed on high speed train (HST) and distributed antenna system (DAS) cell architecture on ground is adopted. The RAU selection is used to provide high quality received signals for trains moving in DAS cells and the two HST antennas are employed on trains to realize seamless handover. Moreover, to efficiently evaluate the system performance, a new met- ric termed as handover occurrence probability is defined for describing the relation between handover occurrence position and handover failure probability. We then analyze the received signal strength, the handover trigger probability, the handover occurrence probability, the handover failure probability and the communication interruption probability. Numerical results are provided to compare our proposed scheme with the current existing ones. It is shown that our proposed scheme achieves better performances in terms of handover failure probability and communication interruption probability.Comment: 7 figures, accepted by IEEE VTC-Spring, 201

On the Minimization of Handover Decision Instability in Wireless Local Area Networks

This paper addresses handover decision instability which impacts negatively on both user perception and network performances. To this aim, a new technique called The HandOver Decision STAbility Technique (HODSTAT) is proposed for horizontal handover in Wireless Local Area Networks (WLAN) based on IEEE 802.11standard. HODSTAT is based on a hysteresis margin analysis that, combined with a utilitybased function, evaluates the need for the handover and determines if the handover is needed or avoided. Indeed, if a Mobile Terminal (MT) only transiently hands over to a better network, the gain from using this new network may be diminished by the handover overhead and short usage duration. The approach that we adopt throughout this article aims at reducing the minimum handover occurrence that leads to the interruption of network connectivity (this is due to the nature of handover in WLAN which is a break before make which causes additional delay and packet loss). To this end, MT rather performs a handover only if the connectivity of the current network is threatened or if the performance of a neighboring network is really better comparing the current one with a hysteresis margin. This hysteresis should make a tradeoff between handover occurrence and the necessity to change the current network of attachment. Our extensive simulation results show that our proposed algorithm outperforms other decision stability approaches for handover decision algorithm.Comment: 13 Pages, IJWM

Learning Dynamic Robot-to-Human Object Handover from Human Feedback

Object handover is a basic, but essential capability for robots interacting with humans in many applications, e.g., caring for the elderly and assisting workers in manufacturing workshops. It appears deceptively simple, as humans perform object handover almost flawlessly. The success of humans, however, belies the complexity of object handover as collaborative physical interaction between two agents with limited communication. This paper presents a learning algorithm for dynamic object handover, for example, when a robot hands over water bottles to marathon runners passing by the water station. We formulate the problem as contextual policy search, in which the robot learns object handover by interacting with the human. A key challenge here is to learn the latent reward of the handover task under noisy human feedback. Preliminary experiments show that the robot learns to hand over a water bottle naturally and that it adapts to the dynamics of human motion. One challenge for the future is to combine the model-free learning algorithm with a model-based planning approach and enable the robot to adapt over human preferences and object characteristics, such as shape, weight, and surface texture.Comment: Appears in the Proceedings of the International Symposium on Robotics Research (ISRR) 201

Incorporating Digital Repeaters into the Soft Handover Standard in Digital Video Broadcasting Handheld

Digital Video Broadcasting for Handhelds (DVB-H) is a standard for broadcasting IP data services to portable devices. Handover in unidirectional broadcast networks is a novel issue introduced by this technology. This paper proposes and analyses the Repeater Aided Soft Handover (RA_handover) algorithm for a DVB-H receiver with MIMO antennas and presents the benefits of implementing RA_handover compared with a handover process without repeaters. For network planning and optimisation purposes simulation models are developed to analyse the RA_handover approach. It is shown that RA_handover could greatly improve the quality of service and consume much less front-end battery power than a handover method without repeaters. In addition, the cost introduced by the algorithm is briefly estimated. In conclusion, curves are given that show the relationship between quality of service and consumed battery power, which provide further support for including RA_handover in the DVB-H soft handover standard. The paper provides valuable outcomes for service providers and standard policy makers

Context-Aware Handover Policies in HetNets

Next generation cellular systems are expected to entail a wide variety of wireless coverage zones, with cells of different sizes and capacities that can overlap in space and share the transmission resources. In this scenario, which is referred to as Heterogeneous Networks (HetNets), a fundamental challenge is the management of the handover process between macro, femto and pico cells. To limit the number of handovers and the signaling between the cells, it will hence be crucial to manage the user's mobility considering the context parameters, such as cells size, traffic loads, and user velocity. In this paper, we propose a theoretical model to characterize the performance of a mobile user in a HetNet scenario as a function of the user's mobility, the power profile of the neighboring cells, the handover parameters, and the traffic load of the different cells. We propose a Markov-based framework to model the handover process for the mobile user, and derive an optimal context-dependent handover criterion. The mathematical model is validated by means of simulations, comparing the performance of our strategy with conventional handover optimization techniques in different scenarios. Finally, we show the impact of the handover regulation on the users performance and how it is possible to improve the users capacity exploiting context information