Research protocol of the Laval-ROSA Transilab: a living lab on transitions for people living with dementia

BACKGROUND

The Laval-ROSA Transilab is a living lab that aims to support the Laval Integrated Health and Social Services Centres (Quebec, Canada) in consolidating the Quebec Alzheimer Plan. It aims to improve care transitions between different settings (Family Medicine Groups, home care, and community services) and as such improve the care of people living with dementia and their care partners. Four transition-oriented innovations are targeted. Two are already underway and will be co-evaluated: A) training of primary care professionals on dementia and interprofessional collaboration; B) early referral process to community services. Two will be co-developed and co-evaluated: C) developing a structured communication strategy around the dementia diagnosis disclosure; D) designation of a care navigator from the time of dementia diagnosis. The objectives are to: 1) co-develop a dashboard for monitoring transitions; 2) co-develop and 3) co-evaluate the four targeted innovations on transitions. In addition, we will 4) co-evaluate the impact and implementation process of the entire Laval-ROSA Transilab transformation, 5) support its sustainability, and 6) transfer it to other health organizations.

METHODS

Multi-methods living lab approach based on the principles of a learning health system. Living labs are open innovation systems that integrate research co-creation and knowledge exchange in real-life settings. Learning health systems centers care improvement on developing the organization's capacity to learn from their practices. We will conduct two learning cycles (data to knowledge, knowledge to practice, and practice to data) and involve various partners. We will use multiple data sources, including health administrative databases, electronic health records data, surveys, semi-structured interviews, focus groups, and observations.

DISCUSSION

Through its structuring actions, the Laval-ROSA Transilab will benefit people living with dementia, their care partners, and healthcare professionals. Its strategies will support sustainability and will thus allow for improvements throughout the care continuum so that people can receive the right services, at the right time, in the right place, and from the right staff.

Demand response in the workplace: A field experiment

To increase the share of intermittent renewable energy in our production mix, occupants of buildings can be called upon to lower, anticipate or postpone their consumption according to the network balance. This article presents a small-scale field experiment aimed at introducing demand response in the workplace. We test the impact of load-shedding signals assorted with incentives on the energy consumption of workers in the tertiary sector. Two incentive schemes are tested, namely, an honorary contest and a monetary tournament. The results show a reduction in workers power demand during the load-shedding periods when the incentives are based on the honorary contest. In contrast, the monetary tournament where workers can win money according to their behavior seems to have no impact. The results also suggest that few workers can be responsible for a large part of energy consumption while the building is partially automatically controlled.

How to deal with the consent of adults with cognitive impairment involved in European geriatric living labs?

BACKGROUND

Living labs are realistic environments designed to create links between technology developers and end-users (i.e. mostly older adults). Research in LLH (Living labs in health) covers a wide range of studies from non-interventional studies to CT (clinical trials) and should involve patients with neurocognitive disorders. However, the ethical issues raised by the design, development, and implementation of research and development projects in LLH have been the subject of only little interest thus far.

OBJECTIVE

Our aim was to determine a pragmatic, ethical and regulatory correct approach to seek the informed consent of patients with neurocognitive disorders according to the different types of studies carried out in European LLH, with a focus on the French context.

METHODS

A narrative review of regulatory texts and clinical articles was conducted, and a pragmatic procedure to determine the decision-making capacity of older adults in LLH was proposed.

RESULTS

Individuals must be adequately informed and freely agree to participate in CT. The capacity to consent should be assessed in CT including cognitively impaired older adults. We propose the following steps: first to assess for delirium using the 4 'A's Test (4AT) or the 3-min Diagnostic interview for Confusion Assessment Method (3D-CAM), second to search for medical history of major neurocognitive disorder, and third to assess the decision capacity using the University of California, San Diego Brief Assessment of Capacity to Consent (UBACC).

CONCLUSIONS

Including individuals with neurocognitive disorders in research implies using an efficient and pragmatic strategy to inform participants and obtain their consent. The tool we offer here may be useful in the routine operation of LLH but can also be extended to all CT with this population.

Empowerment Through Participation in a Cancer Prevention Exhibit: Evidence from the Hygée Lab Intervention

While many countries have launched cancer prevention initiatives to improve the public's understanding of risk and protective factors, few are systematically evaluated. Hygée Lab, a living lab in a socioeconomically deprived area of France, is designed to interactively communicate evidence-based information about cancer prevention and treatment with the goal to improve visitors' understanding of cancer risk and prevention factors, reduce fatalism in regard to cancer, and increase feelings of empowerment. Pre- and post-visit data were collected during the first 18 months of the exhibit's opening from two segments of the population: adolescents from local schools (N = 134) and the general public (N = 112). Adolescents from the same schools who did not participate in the visit comprised the control group (N = 94). A further 232 general public visitors completed post-surveys only. Pre-post-visit comparisons reveal significant changes in both adolescent and general public visitors: cancer understanding improves, fatalism in regard to cancer is reduced, and feelings of empowerment increase. This systematic evaluation of Hygée Lab offers promise for how interactive exhibits may be used for cancer prevention amongst low health literacy populations.

The development of gerontechnology for hospitalized frail elderly people: The ALLEGRO hospital-based geriatric living lab

Our objective was to bridge the gap between gerontechnology developers and hospitalized frail elderly people, in order to promote open gerontechnology innovation in hospitals. We designed a hospital-based living lab that provides reflexive "idea incubator workshops" that gather both the users and the developers of technology, supplemented with an "experimental hospital room" for the testing of devices by older inpatients. The ALLEGRO living lab was delivered in 2018 at the Geriatric Department of Angers University Hospital, France. The workshops and experimental hospital room should help frail older inpatients to participate in the co-design and co-development of new technologies to improve hospital care and promote successful aging.

Adaptive and technology-independent architecture for fault-tolerant distributed AAL solutions

Today's architectures for Ambient Assisted Living (AAL) must cope with a variety of challenges like flawless sensor integration and time synchronization (e.g. for sensor data fusion) while abstracting from the underlying technologies at the same time. Furthermore, an architecture for AAL must be capable to manage distributed application scenarios in order to support elderly people in all situations of their everyday life. This encompasses not just life at home but in particular the mobility of elderly people (e.g. when going for a walk or having sports) as well. Within this paper we will introduce a novel architecture for distributed AAL solutions whose design follows a modern Microservices approach by providing small core services instead of a monolithic application framework. The architecture comprises core services for sensor integration, and service discovery while supporting several communication models (periodic, sporadic, streaming). We extend the state-of-the-art by introducing a fault-tolerance model for our architecture on the basis of a fault-hypothesis describing the fault-containment regions (FCRs) with their respective failure modes and failure rates in order to support safety-critical AAL applications.