Public-private partnerships in fostering outer space innovations.

As public and private institutions recognize the role of space exploration as a catalyst for economic growth, various areas of innovation are expected to emerge as drivers of the space economy. These include space transportation, in-space manufacturing, bioproduction, in-space agriculture, nuclear launch, and propulsion systems, as well as satellite services and their maintenance. However, the current nature of space as an open-access resource and global commons presents a systemic risk for exuberant competition for space goods and services, which may result in a "tragedy of the commons" dilemma. In the race among countries to capture the value of space exploration, NASA, American research universities, and private companies can avoid any coordination failures by collaborating in a public-private research and development partnership (PPRDP) structure. We present such a structure founded upon the principles of polycentric autonomous governance, which incorporate a decentralized autonomous organization framework and specialized research clusters. By advancing an alignment of incentives among the specified participatory members, PPRDPs can play a pivotal role in stimulating open-source research by creating positive knowledge spillover effects and agglomeration externalities as well as embracing the nonlinear decomposition paradigm that may blur the distinction between basic and applied research.

Reduction of Time on the Ground Related to Real-Time Video Detection of Falls in Memory Care Facilities: Observational Study.

BACKGROUND: Lying on the floor for a long period of time has been described as a critical determinant of prognosis following a fall. In addition to fall-related injuries due to the trauma itself, prolonged immobilization on the floor results in a wide range of comorbidities and may double the risk of death in elderly. Thus, reducing the length of Time On the Ground (TOG) in fallers seems crucial in vulnerable individuals with cognitive disorders who cannot get up independently. OBJECTIVE: This study aimed to examine the effect of a new technology called SafelyYou Guardian (SYG) on early post-fall care including reduction of Time Until staff Assistance (TUA) and TOG. METHODS: SYG uses continuous video monitoring, artificial intelligence, secure networks, and customized computer applications to detect and notify caregivers about falls in real time while providing immediate access to video footage of falls. The present observational study was conducted in 6 California memory care facilities where SYG was installed in bedrooms of consenting residents and families. Fall events were video recorded over 10 months. During the baseline installation period (November 2017 to December 2017), SYG video captures of falls were not provided on a regular basis to facility staff review. During a second period (January 2018 to April 2018), video captures were delivered to facility staff on a regular weekly basis. During the third period (May 2018 to August 2018), real-time notification (RTN) of any fall was provided to facility staff. Two digital markers (TUA, TOG) were automatically measured and compared between the baseline period (first 2 months) and the RTN period (last 4 months). The total number of falls including those happening outside of the bedroom (such as common areas and bathrooms) was separately reported by facility staff. RESULTS: A total of 436 falls were recorded in 66 participants suffering from Alzheimer disease or related dementias (mean age 87 years; minimum 65, maximum 104 years). Over 80% of the falls happened in bedrooms, with two-thirds occurring overnight (8 PM to 8 AM). While only 8.1% (22/272) of falls were scored as moderate or severe, fallers were not able to stand up alone in 97.6% (247/253) of the cases. Reductions of 28.3 (CI 19.6-37.1) minutes in TUA and 29.6 (CI 20.3-38.9) minutes in TOG were observed between the baseline and RTN periods. The proportion of fallers with TOG >1 hour fell from 31% (8/26; baseline) to zero events (RTN period). During the RTN period, 76.6% (108/141) of fallers received human staff assistance in less than 10 minutes, and 55.3% (78/141) of them spent less than 10 minutes on the ground. CONCLUSIONS: SYG technology is capable of reducing TOG and TUA while efficiently covering the area (bedroom) and time zone (nighttime) that are at highest risk. After 6 months of SYG monitoring, TOG was reduced by a factor of 3. The drastic reduction of TOG is likely to decrease secondary comorbid complications, improve post-fall prognosis, and reduce health care costs.

Long-term digital device-enabled monitoring of functional status: Implications for management of persons with Alzheimer's disease.

INTRODUCTION: Informal caregiving is an essential element of health-care delivery. Little data describes how caregivers structure care recipients' lives and impact their functional status. METHODS: We performed observational studies of community dwelling persons with dementia (PWD) to measure functional status by simultaneous assessment of physical activity (PA) and lifespace (LS). We present data from two caregiver/care-recipient dyads representing higher and average degrees of caregiver involvement. RESULTS: We acquired >42,800 (subject 1); >41,300 (subject 2) PA data points and >154,500 (subject 1); >119,700 (subject 2) LS data points over 15 months of near continuous observation. PA and LS patterns provided insights into the caregiver's role in structuring the PWD's day-to-day function and change in function over time. DISCUSSION: We show that device-enabled functional monitoring (FM) can successfully gather and display data at resolutions required for dementia care studies. Objective quantification of individual caregiver/care-recipient dyads provides opportunities to implement patient-centered care.

Real-time video detection of falls in dementia care facility and reduced emergency care.

An artificial intelligence-enabled video fall detection system using visual science reduced emergency department visits by 80% in 6 communities over 3 months.

Building-in-Briefcase: A Rapidly-Deployable Environmental Sensor Suite for the Smart Building.

A building’s environment has profound influence on occupant comfort and health. Continuous monitoring of building occupancy and environment is essential to fault detection, intelligent control, and building commissioning. Though many solutions for environmental measuring based on wireless sensor networks exist, they are not easily accessible to households and building owners who may lack time or technical expertise needed to set up a system and get quick and detailed overview of environmental conditions. Building-in-Briefcase (BiB) is a portable sensor network platform that is trivially easy to deploy in any building environment. Once the sensors are distributed, the environmental data is collected and communicated to the BiB router via the Transmission Control Protocol/Internet Protocol (TCP/IP) and WiFi technology, which then forwards the data to the central database securely over the internet through a 3G radio. The user, with minimal effort, can access the aggregated data and visualize the trends in real time on the BiB web portal. Paramount to the adoption and continued operation of an indoor sensing platform is battery lifetime. This design has achieved a multi-year lifespan by careful selection of components, an efficient binary communications protocol and data compression. Our BiB sensor is capable of collecting a rich set of environmental parameters, and is expandable to measure others, such as CO 2 . This paper describes the power characteristics of BiB sensors and their occupancy estimation and activity recognition functionality. We have demonstrated large-scale deployment of BiB throughout Singapore. Our vision is that, by monitoring thousands of buildings through BiB, it would provide ample research opportunities and opportunities to identify ways to improve the building environment and energy efficiency.

Extended, continuous measures of functional status in community dwelling persons with Alzheimer's and related dementia: Infrastructure, performance, tradeoffs, preliminary data, and promise.

BACKGROUND: The past decades have seen phenomenal growth in the availability of inexpensive and powerful personal computing devices. Efforts to leverage these devices to improve health care outcomes promise to remake many aspects of healthcare delivery, but remain in their infancy. NEW METHOD: We describe the development of a mobile health platform designed for daily measures of functional status in ambulatory, community dwelling subjects, including those who have Alzheimer's disease or related neurodegenerative disorders. Using Smartwatches and Smartphones we measure subject overall activity and outdoor location (to derive their lifespace). These clinically-relevant measures allow us to track a subject's functional status in their natural environment over prolonged periods of time without repeated visits to healthcare providers. Functional status metrics are integrated with medical information and caregiver reports, which are used by a caregiving team to guide referrals for physician/APRN/NP care. COMPARISON: with Existing Methods We describe the design tradeoffs involved in all aspects of our current system architecture, focusing on decisions with significant impact on system cost, performance, scalability, and user-adherence. RESULTS: We provide real-world data from current subject enrollees demonstrating system accuracy and reliability. CONCLUSIONS: We document real-world feasibility in a group of men and women with dementia that Smartwatches/Smartphones can provide long-term, relevant clinical data regarding individual functional status. We describe the underlying considerations of this system so that interested organizations can adapt and scale our approach to their needs. Finally, we provide a potential agenda to guide development of future systems.

Reduction in Fall Rate in Dementia Managed Care Through Video Incident Review: Pilot Study.

BACKGROUND: Falls of individuals with dementia are frequent, dangerous, and costly. Early detection and access to the history of a fall is crucial for efficient care and secondary prevention in cognitively impaired individuals. However, most falls remain unwitnessed events. Furthermore, understanding why and how a fall occurred is a challenge. Video capture and secure transmission of real-world falls thus stands as a promising assistive tool. OBJECTIVE: The objective of this study was to analyze how continuous video monitoring and review of falls of individuals with dementia can support better quality of care. METHODS: A pilot observational study (July-September 2016) was carried out in a Californian memory care facility. Falls were video-captured (24×7), thanks to 43 wall-mounted cameras (deployed in all common areas and in 10 out of 40 private bedrooms of consenting residents and families). Video review was provided to facility staff, thanks to a customized mobile device app. The outcome measures were the count of residents' falls happening in the video-covered areas, the acceptability of video recording, the analysis of video review, and video replay possibilities for care practice. RESULTS: Over 3 months, 16 falls were video-captured. A drop in fall rate was observed in the last month of the study. Acceptability was good. Video review enabled screening for the severity of falls and fall-related injuries. Video replay enabled identifying cognitive-behavioral deficiencies and environmental circumstances contributing to the fall. This allowed for secondary prevention in high-risk multi-faller individuals and for updated facility care policies regarding a safer living environment for all residents. CONCLUSIONS: Video monitoring offers high potential to support conventional care in memory care facilities.

Understanding road usage patterns in urban areas.

In this paper, we combine the most complete record of daily mobility, based on large-scale mobile phone data, with detailed Geographic Information System (GIS) data, uncovering previously hidden patterns in urban road usage. We find that the major usage of each road segment can be traced to its own--surprisingly few--driver sources. Based on this finding we propose a network of road usage by defining a bipartite network framework, demonstrating that in contrast to traditional approaches, which define road importance solely by topological measures, the role of a road segment depends on both: its betweeness and its degree in the road usage network. Moreover, our ability to pinpoint the few driver sources contributing to the major traffic flow allows us to create a strategy that achieves a significant reduction of the travel time across the entire road system, compared to a benchmark approach.