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Background
Modification of the home environment, together with rehabilitative interventions, is important for maximizing the level of functioning after an individual with disability undergoes rehabilitation in the hospital.
Objectives
We developed a simple screening scale – the home environment checklist (HEC) – to identify any mismatch between an individual's abilities and their home environment to help clinicians monitor the appropriateness of the home environment to which individuals with disability will be discharged. We also examined the psychometric properties of the HEC.
Methods
The HEC was developed by a multidisciplinary panel of rehabilitation experts using information routinely collected in rehabilitation clinics before discharge. The reliability of the checklist was assessed in 60 individuals undergoing rehabilitation. The inter-rater agreement and internal consistency of the scale were assessed by weighted kappa statistics and Cronbach's alpha, respectively. Rasch analysis was performed with 244 rehabilitation individuals to evaluate the internal construct validity, and the known-groups validity was confirmed by a comparison of the daily activity levels of 30 individuals with disabilities under rehabilitation to the HEC score.
Results
The HEC was developed as a simple, 10-item checklist. The weighted kappa statistics ranged from 0.73 to 0.93, indicating excellent inter-rater reliability. Cronbach's alpha was 0.92, indicating high internal consistency. Rasch analysis with a testlet approach on 3 subscales demonstrated a good fit with the Rasch model (χ2 = 13.2, P = 0.153), and the demonstrated unidimensionality and absence of differential item functioning supported the internal construct validity of the HEC. HEC scores were significantly different (P < .01) among individuals with disability and 3 levels of restrictions in their activities (no limitation, home-bound, and bed-bound), which demonstrates the known-groups validity of the HEC.
Conclusions
The HEC has good reliability and validity, which supports its utility in rehabilitation clinics.
This paper describes using a mobile robot, equipped with some sonar sensors and an odometer, to test navigation through the use of a cognitive map. The robot explores an office environment, computes a cognitive map, which is a network of ASRs [36, 35], and attempts to find its way home.
Ten trials were conducted and the robot found its way home each time. From four random positions in two trials, the robot estimated the home position relative to its current position reasonably accurately.
Our robot does not solve the simultaneous localization and mapping problem and the map computed is fuzzy and inaccurate with much of the details missing.
In each homeward journey, it computes a new cognitive map of the same part of the environment, as seen from the perspective of the homeward journey. We show how the robot uses distance information from both maps to find its way home.
We propose a reinforcement learning approach to heating control in home automation, that can acquire a set of rules enabling an agent to heat a room to the desired temperature at a defined time while conserving as much energy as possible. Experimental results are presented that show the feasibility of our method.
This paper shows how a mobile robot equipped with sonar sensors and an odometer is used to test ideas about cognitive mapping. The robot first explores an office environment and computes a "cognitive map" which is a network of ASRs [1]. The robot generates two networks, one for the outward journey and the other for the journey home.
It is shown that both networks are different. The two networks, however, are not merged to form a single network. Instead, the robot attempts to use distance information implicit in the shape of each ASR to find its way home. At random positions in the homeward journey, the robot calculates its orientation towards home. The robot's performances for both problems are evaluated and found to be surprisingly accurate.
Background
Joint contractures in nursing home residents limit the capacity to perform daily activities and restrict social participation. The purpose of this study was to develop a complex intervention to improve participation in nursing home residents with joint contractures.
Methods
The development followed the UK Medical Research Council framework using a mixed-methods design with re-analysis of existing interview data using a graphic modelling approach, group discussions with nursing home residents, systematic review of intervention studies, structured 2-day workshop with experts in geriatric, nursing, and rehabilitation, and group discussion with professionals in nursing homes.
Results
Graphic modelling identified restrictions in the use of transportation, walking within buildings, memory functions, and using the hands and arms as the central target points for the intervention. Seven group discussions with 33 residents revealed various aspects related to functioning and disability according the International Classification of Functioning, Disability and Health domains body functions, body structures, activities and participation, environmental factors, and personal factors. The systematic review included 17 studies with 992 participants: 16 randomised controlled trials and one controlled trial. The findings could not demonstrate any evidence in favour of an intervention. The structured 2-day expert workshop resulted in a variety of potential intervention components and implementation strategies. The group discussion with the professionals in nursing homes verified the feasibility of the components and the overall concept. The resulting intervention, Participation Enabling CAre in Nursing (PECAN), will be implemented during a 1-day workshop for nurses, a mentoring approach, and supportive material. The intervention addresses nurses and other staff, residents, their informal caregivers, therapists, and general practitioners.
Conclusions
In view of the absence of any robust evidence, the decision to use mixed methods and to closely involve both health professionals and residents proved to be an appropriate means to develop a complex intervention to improve participation of and quality of life in nursing home residents. We will now evaluate the PECAN intervention for its impact and feasibility in a pilot study in preparation for an evaluation of its effectiveness in a definitive trial.
Trial registration
German clinical trials register, reference number DRKS00010037 (12 February 2016).
Background
Joint contractures in frail older people are associated with serious restrictions in participation. We developed the Participation Enabling CAre in Nursing (PECAN) intervention, a complex intervention to enable nurses to promote participation in nursing home residents with joint contractures. The aim of this study was to examine the feasibility of the implementation strategy and to identify enablers and barriers for a successful implementation.
Methods
The implementation of PECAN was investigated in a 6-month pilot cluster-randomised controlled trial (c-RCT). As a key component of the implementation strategy, nominated nurses were trained as facilitators in a one-day workshop and supported by peer-mentoring (visit, telephone counselling). A mixed-methods approach was conducted in conjunction with the pilot trial and guided by a framework for process evaluations of c-RCTs. Data were collected using standardised questionnaires (nursing staff), documentation forms, problem-centred qualitative interviews (facilitators, therapists, social workers, relatives, peer-mentors), and a group discussion (facilitators). A set of predefined criteria on the nursing home level was examined. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using directed content analysis.
Results
Seven nursing homes (n = 4 intervention groups, n = 3 control groups) in two regions of Germany took part in the study. Facilitators responded well to the qualification measures (workshop participation: 14/14; workshop rating: “good”; peer-mentor visit participation: 10/14). The usage of peer-mentoring via telephone varied (one to seven contacts per nursing home). Our implementation strategy was not successful in connection with supplying the intervention to all the nurses. The clear commitment of the entire nursing home and the respect for the expertise of different healthcare professionals were emphasised as enablers, whereas a lack of impact on organisational conditions and routines and a lack of time and staff competence were mentioned as barriers.
Conclusion
The PECAN intervention was delivered as planned to the facilitators but was unable to produce comprehensive changes in the nursing homes and subsequently for the residents. Strategies to systematically include the management and the nursing team from the beginning are needed to support the facilitators during implementation in the main trial.
Trial registration
German clinical trials register, DRKS00010037. Registered 12 February 2016.
When animals (including humans) first explore a new environment, what they remember is fragmentary knowledge about the places visited. Yet, they have to use such fragmentary knowledge to find their way home. Humans naturally use more powerful heuristics while lower animals have shown to developa varietyof methodsthat tend to utilize two key pieces of information,namely distance and orientation information.
Their methods differ depending on how they sense their environment.
Could a mobile robot be used to investigate the nature of such a process, commonly referred to in the psychological literature as cognitive mapping? What might be computed in the initial explorations and how is the resulting “cognitive map” be used to return home?
In this paper, we presented a novel approach using a mobile robot to do cognitive mapping. Our robot computes a “cognitive map” and uses distance and orientation information to find its way home.
The process developed provides interesting insights into the nature of cognitive mapping and encourages us to use a mobile robot to do cognitive mapping in the future, as opposed to its popular use in robot mapping.
Background
The admission to a nursing home is a critical life-event for affected persons as well as their families. Admission related processes are lacking adequate participation of older people and their families. To improve transitions to nursing homes, context- and country-specific knowledge about the current practice is needed. Hence, our aim was to summarize available evidence on challenges and care strategies associated with the admission to nursing homes in Germany.
Methods
We conducted a scoping review and searched eight major international and German-specific electronic databases for journal articles and grey literature published in German or English language since 1995. Further inclusion criteria were focus on challenges or care strategies in the context of nursing home admissions of older persons and comprehensive and replicable information on methods and results. Posters, only-abstract publications and articles dealing with mixed populations including younger adults were excluded. Challenges and care strategies were identified and analysed by structured content analysis using the TRANSCIT model.
Results
Twelve studies of 1,384 records were finally included. Among those, seven were qualitative studies, three quantitative observational studies and two mixed methods studies. As major challenges neglected participation of older people, psychosocial burden among family caregivers, inadequate professional cooperation and a lack of shared decision-making and evidence-based practice were identified. Identified care strategies included strengthening shared decision-making and evidence-based practice, improvement in professional cooperation, introduction of specialized transitional care staff and enabling participation for older people.
Conclusion
Although the process of nursing home admission is considered challenging and tends to neglect the needs of older people, little research is available for the German health care system. The perspective of the older people seems to be underrepresented, as most of the studies focused on caregivers and health professionals. Reported care strategies addressed important challenges, however, these were not developed and evaluated in a comprehensive and systematic way. Future research is needed to examine perspectives of all the involved groups to gain a comprehensive picture of the needs and challenges. Interventions based on existing care strategies should be systematically developed and evaluated to provide the basis of adequate support for older persons and their informal caregivers.
Generating a more detailed understanding of domestic electricity demand is a major topic for energy suppliers and householders in times of climate change.
Over the years there have been many studies on consumption feedback systems to inform householders, disaggregation algorithms for Non-Intrusive-Load-Monitoring (NILM), Real-Time-Pricing (RTP) to promote supply aware behavior through monetary incentives and appliance usage prediction algorithms. While these studies are vital steps towards energy awareness, one of the most fundamental challenges has not yet been tackled: Automated detection of start and stop of usage cycles of household appliances. We argue that most research efforts in this area will benefit from a reliable segmentation method to provide accurate usage information.
We propose a SVM-based segmentation method for home appliances such as dishwashers and washing machines. The method is evaluated using manually annotated electricity measurements of five different appliances recorded over two years in multiple households.
The IT architecture for meter reading and utility services is at the core of new business models and has a decisive role as an enabler for resource efficiency measures. The communication architecture used by those services has significant impact on cost, flexibility and speed of new service rollout. This article describes how the dominant system model for meter reading came about, what alternative models exist, and what trade-offs those models have for rollout of new services by different stakeholders. Control of a self learning home automation system by dynamic tariff information (Real-Time-Pricing) is given as an application example.
Real-world domestic electricity demand datasets are the key enabler for developing and evaluating machine learning algorithms that facilitate the analysis of demand attribution and usage behavior. Breaking down the electricity demand of domestic households is seen as the key technology for intelligent smart-grid management systems that seek an equilibrium of electricity supply and demand. For the purpose of comparable research, we publish DEDDIAG, a domestic electricity demand dataset of individual appliances in Germany. The dataset contains recordings of 15 homes over a period of up to 3.5 years, wherein total 50 appliances have been recorded at a frequency of 1 Hz. Recorded appliances are of significance for load-shifting purposes such as dishwashers, washing machines and refrigerators. One home also includes three-phase mains readings that can be used for disaggregation tasks. Additionally, DEDDIAG contains manual ground truth event annotations for 14 appliances, that provide precise start and stop timestamps. Such annotations have not been published for any long-term electricity dataset we are aware of.
Shifting energy peak load is a subject that plays a huge role in the currently changing energy market, where renewable energy sources no longer produce the exact amount of energy demanded.
Matching demand to supply requires behavior Changes on the customerside, which can be achieved by incentives suchas Real-Time-Pricing (RTP).
Various studies show that such incentives cannot be utilized without a complexity reduction, e.g., by smart home automation systems that inform the customer about possible savings or automatically schedule appliances to off-peak load phases.
We propose a probabilistic appliance usage prediction based on historical energy data that can be used to identify the times of day where an appliance will be used and therefore make load shift recommendations that suite the customer’s usage profile. A huge issue is how to provide a valid performance evaluation for this particular problem.
We will argue why the commonly used accuracy metric is not suitable, and suggest to use other metrics like the area under the Receiver Operating Characteristic (ROC) curve, Matthews Correlation Coefficient (MCC) or F1-Score instead.
Purpose
The purpose of this paper is to investigate how professional football clubs from the English Premier League, German Bundesliga and Spanish Primera División use digital media to expand their international reach in emerging football markets (EFM) outside of Europe. Based on the EPRG framework and Rugman’s home-region hypothesis, the aim is to broaden the perspective where “sports go global” for a further understanding of actors’ international orientation in the digital sphere.
Design/methodology/approach
The study is based on data from desk research and a qualitative survey, comprising information on international digital media activities of 58 European clubs. Cluster analysis is used to identify different international orientations with regard to digital media activities.
Findings
The data provide evidence that clubs differ strongly in their orientations towards EFM. While some global players that provide digital media content in several EFM languages and attract a large share of Facebook followers from EFM exist, other clubs focus on their home region. League-specific differences become apparent.
Originality/value
This study determines the international online orientations of European football clubs by combining two previously separated research streams in football management studies: internationalisation and digital media activities. Most clubs with a strong EFM fan base choose polycentric, multi-language digital media strategies, followed by geocentric, standardised approaches. By offering a novel angle on internationalisation in professional football, this study contributes towards optimising clubs’ international online strategies for EFM, which are markets that promise high growth rates.
Background: Acquired joint contractures have a significant impact on functioning and quality of life in nursing home residents. There is very limited evidence on measures for prevention and treatment of disability due to joint contractures. We have developed the PECAN intervention (Participation Enabling CAre in Nursing) to improve social participation in nursing home residents. A cluster-randomised pilot trial was conducted to assess the feasibility of study procedures in preparation for a main trial according to the UK Medical Research Council (MRC) framework.
Methods: Nursing homes in two regions of Germany were randomly allocated either to the intervention or optimised standard care (control group). All residents with joint contractures aged > 65 years were eligible for the study. The residents’ data were collected through structured face-to-face interviews by blinded assessors at baseline, after 3 and 6 months. The primary outcome was social participation, measured by a subscale of the PaArticular Scales. Secondary outcomes included activities and instrumental activities of daily living, health-related quality of life, falls and fall-related consequences. Data on the trial feasibility were collected via documentation forms.
Results: Seven out of 12 nursing homes agreed to participate and remained in the trial. Of 265 residents who fulfilled the inclusion criteria, 129 were randomised either to the intervention (n = 64) or control group (n = 65) and analysed. A total of 109 (85%) completed the trial after 6 months. The mean age was 85.7 years (SD 7.0), 80% were women. The severity of the residents’ disability differed across the clusters. The completion rate was high (> 95%), apart from the Instrumental Activities of Daily Living Scale. Some items of the PaArticular Scales were not easily understood by residents. The frequency of falls did not differ between study groups.
Conclusion: Our data confirmed the feasibility of the overall study design. We also revealed the need to improve the procedures for the recruitment of residents and for data collection before implementation into a main trial. The next step will be an adequately powered main trial to assess the effectiveness and cost-effectiveness of the intervention.
Background: Nursing home residents are frequently affected by joint contractures, which impacts their participation and daily activities. A complex intervention, the Participation Enabling Care in Nursing (PECAN), was previously developed and pilot tested to address their needs. Its effectiveness and safety will be evaluated in the present study.
Methods/design: This multicentre cluster-randomised controlled trial will be conducted in 32 nursing homes spread over two regions of Germany. A total of 578 residents over 65 years old with joint contractures will be included. To compare the effect of the PECAN intervention with optimised standard care (usual care and an information session), randomisation will take place at a cluster level.
The individually tailored intervention was designed using the biopsychosocial model in the International Classification of Functioning, Disability and Health (ICF) to reduce activity limitations and participation restrictions resulting from existing joint contractures by addressing barriers and by strengthening supportive factors on an individual level and an organisational level.
The implementation strategy comprises a facilitators’ workshop, a peer mentoring approach including a peer mentor visit and telephone peer counselling, an in-house information event, an information session for the nursing team and a training session on collegial consultation for the facilitators. The in-house information event will also take place in the nursing homes of the control group. The primary outcome is the residents’ participation and activities after 12 months of follow-up as assessed using the PaArticular Scales. The secondary outcome is the residents’ quality of life. A cost-effectiveness analysis (costs per additional resident who experienced a decrease of ten points in the participation or activities subscale of the PaArticular Scales) and a cost–utility analysis (costs per additional quality adjusted life year) will be conducted. We will investigate barriers and facilitators in a comprehensive process evaluation.
Discussion: We expect a clinically relevant improvement of participation and activities in residents with joint contractures. Our findings will provide important insights regarding participation in the situation of the affected individuals.
We present an approach for indoor mapping and localisation using sparse range data, acquired by a mobile robot equipped with sonar sensors.
The chapter consists of two main parts. First, a split and merge based method for dividing a given metric map into distinct regions is presented, thus creating a topological map in a metric framework. Spatial information extracted from this map is then used for self-localisation on the return home journey.
The robot computes local confidence maps for two simple localisation strategies based on distance and relative orientation of regions. These local maps are then fused to produce overall confidence maps.
Background Free movement of the limbs is a prerequisite of mobility and autonomy in old age. Joint contractures, i.e. restrictions in full range of motion of any joint due to deformity, disuse or pain, are common problems of frail older people, particularly in nursing home residents.
Contractures are among the most unexplored and underreported syndromes in clinical and homecare settings. Epidemiological studies indicate a wide range of prevalence of joint contractures in older individuals between 20% and 80%. This variation is due to different definitions of contracture and varying diagnostic criteria or data collection methods, different research settings, sample size and study participants? characteristics.
The aetiology of joint contractures is multifaceted. In older people contractures may be caused by a variety of health conditions and situations, but immobility due to an acute injury or disease seems to be the major risk factor. Upper limb joint contractures may result in loss of ability to dress or eat independently while lower limb contractures may lead to instability and inability to walk independently and higher risk of bed confinement.
Joint contractures further increase the risk of other adverse patient outcomes like pain, pressure ulcers and risk of falls. Thus, joint contractures are a major cause for excess disability in older people with a significant impact on overall quality of life and functioning. Preventive and rehabilitation interventions targeting joint contractures may decrease morbidity, increase functioning and quality of life, and, ultimately, prevent long-term disability. In the United States of America, presence of joint contractures is an established indicator of quality of care in nursing facilities.
In Germany, joint contracture risk assessment and prevention have recently been defined as a quality indicator of nursing home care that should be regularly monitored by experts from the statutory health insurance system. Nursing homes are obliged to report whether they regularly assess the risk of joint contracture and administer relevant preventive measures. In clinical settings, joint contractures are assessed by measuring the range of motion.
However, from a patient- and nursing-oriented perspective the relevance of a systematic registration of contractures in care-dependent older people is unclear unless their impact on functioning is understood. Contracture assessment is only an intermediate step in the evaluation of patient-relevant outcomes such as quality of life, functioning, and the ability to participate in everyday life and social participation. Arguably, a clinical definition of joint contracture is difficult because the contracture?s severity is determined by the consequences on activities of daily living, quality of life and social participation. In addition, there is no consensus on aspects most relevant to the affected individuals.
A variety of functional measures is currently used for the assessment and evaluation of geriatric patients. To date, there is no consensus on common concepts for the choice of outcome measures specifically for evaluating the impact of interventions targeted on joint
When animals (including humans) first explore a new environment, what they remember is fragmentary knowledge about the places visited. Yet, they have to use such fragmentary knowledge to find their way home.
Humans naturally use more powerful heuristics while lower animals have shown to develop a variety of methods that tend to utilize two key pieces of information, namely distance and orientation information.
Their methods differ depending on how they sense their environment. Could a mobile robot be used to investigate the nature of such a process, commonly referred to in the psychological literature as cognitive mapping? What might be computed in the initial explorations and how is the resulting “cognitive map” be used for localization?
In this paper, we present an approach using a mobile robot to generate a “cognitive map”, the main focus being on experiments conducted in large spaces that the robot cannot apprehend at once due to the very limited range of its sensors. The robot computes a “cognitive map” and uses distance and orientation information for localization.