Quality in care homes: How wearable devices and social network analysis might help.

Social network analysis can support quality improvement in care homes but traditional approaches to social network analysis are not always feasible in care homes. Recalling contacts and movements in a home is difficult for residents and staff and documentary and other sources of individual contacts can be unreliable. Bluetooth enabled wearable devices are a potential means of generating reliable, trustworthy, social network data in care home communities. In this paper, we explore the empirical, theoretical and real-world potential and difficulties in using Bluetooth enabled wearables with residents and staff in care homes for quality improvement. We demonstrate, for the first time, that a relatively simple system built around the Internet of Things, Bluetooth enabled wearables for residents and staff and passive location devices (the CONTACT intervention) can capture social networks and data in homes, enabling social network analysis, measures, statistics and visualisations. Unexpected variations in social network measures and patterns are surfaced, alongside "uncomfortable" information concerning staff time spent with residents. We show how technology might also help identify those most in need of social contact in a home. The possibilities of technology-enabled social network analysis must be balanced against the implementation-related challenges associated with introducing innovations in complex social systems such as care homes. Behavioural challenges notwithstanding, we argue that armed with social network information, care home staff could better tailor, plan and evaluate the effects of quality improvement with the sub-communities that make up a care home community.

'Smart' BLE wearables for digital contact tracing in care homes during the COVID-19 pandemic-a process evaluation of the CONTACT feasibility study.

BACKGROUND: Rapid and mass transmission of the SARS-CoV-2 virus amongst vulnerable people led to devastating effects from COVID-19 in care homes. The CONTACT intervention introduced Bluetooth Low Energy 'smart' wearable devices (BLE wearables) as a basis for automated contact tracing in, and feedback on infection risks and patterns to, care homes to try and improve infection prevention and control (IPC). We planned a cluster randomised controlled trial (RCT) of CONTACT. To be feasible, homes had to adopt CONTACT's technology and new ways of working. This paper reports on the process evaluation conducted alongside CONTACT's feasibility study and explains why it lacked the feasibility and acceptability for a definitive RCT. METHODS: This mixed method process evaluation used Normalisation Process Theory (NPT) qualitative (interviews, field notes, study case report forms and documents, and observation) and quantitative (survey instruments, counts of activity) data to plan, implement, and analyse the mechanisms, effects, and contextual factors that shaped the feasibility and acceptability of the CONTACT intervention. RESULTS: Thirteen themes within four core NPT constructs explained CONTACT's lack of feasibility. Coherence: the home's varied in the scale and extent of commitment and understanding of the technology and study procedures. Leadership credibility was important but compromised by competing priorities. Management and direct care staff saw CONTACT differently. Work to promote (cognitive participation) and enact (collective action) CONTACT was burdensome and failed to be prioritised over competing COVID-19-related demands on time and scarce human and cognitive resources. Ultimately, staff appraisal of the value of CONTACT-generated information and study procedures (reflexivity) was that any utility for IPC was insufficient to outweigh the perceived burden and complexity involved. CONCLUSIONS: Despite implementation failure, dismissing BLE wearables' potential for contact tracing is premature. In non-pandemic conditions, with more time, better co-design and integration of theory-driven implementation strategies tailored to care homes' unique contexts, researchers could enhance normalisation in readiness for future pandemic challenges. TRIAL REGISTRATION: ISRCTN registration: 11,204,126 registered 17/02/2021.

Evaluating the performance of wearable devices for contact tracing in care home environments.

COVID-19 has had a devastating impact worldwide, including in care homes where there have been substantial numbers of cases among a very vulnerable population. A key mechanism for managing exposure to the virus and targeting interventions is contact tracing. Unfortunately, environments such as care homes that were most catastrophically impacted by COVID-19 are also those least amenable to traditional contact tracing. A promising alternative to recall and smartphone-based contact tracing approaches is the use of discrete wearable devices that exploit Bluetooth Low Energy (BLE) and Long-Range Wide Area Network (LoRaWAN) technologies. However, the real-world performance of these devices in the context of contact tracing is uncertain. A series of experiments were conducted to evaluate the performance of a wearables system that is based on BLE and LoRaWAN technologies. In each experiment, the number of successful contacts was recorded and the physical distance between two contacts was compared to a calculated distance using the Received Signal Strength Indication (RSSI) to determine the precision, error rate, and duration of proximity. The overall average system contact detection success rate was measured as 75.5%; when wearables were used as per the manufacturer's guidelines the contact detection success rate increased to 81.5%, but when obstructed by everyday objects such as clothing or inside a bag the contact detection success rate was only 64.2%. The calculated distance using RSSI was close to the physical distance in the absence of obstacles. However, in the presence of typical obstacles found in care home settings, the reliability of detection decreased, and the calculated distance usually appeared far from the actual contact point. The results suggest that under real-world conditions there may be a large proportion of contacts that are underestimated or undetected.

An Emergency Response System: Construction, Validation, and Experiments for Disaster Management in a Vehicular Environment.

Natural disasters and catastrophes not only cost the loss of human lives, but adversely affect the progress toward sustainable development of the country. As soon as disaster strikes, the first and foremost challenge for the concerned authorities is to make an expeditious response. Consequently, they need to be highly-organized, properly-trained, and sufficiently-equipped to effectively respond and limit the destructive effects of a disaster. In such circumstances, communication plays a vital role, whereby the consequences of tasks assigned to the workers for rescue and relief services may be streamlined by relaying necessary information among themselves. Moreover, most of the infrastructure is either severely damaged or completely destroyed in post-disaster scenarios; therefore, a Vehicular Ad Hoc Network (VANET) is used to carry out the rescue operation, as it does not require any pre-existing infrastructure. In this context, the current work proposes and validates an effective way to relay the crucial information through the development of an application and the deployment of an experimental TestBed in a vehicular environment. The TestBed may able to provide a way to design and validate the algorithms. It provides a number of vehicles with onboard units embedded with a credit-card-size microcomputer called Raspberry Pi and a Global Positioning System (GPS) module. Additionally, it dispatches one of the pre-defined codes of emergency messages based on the level of urgency through multiple hops to a central control room. Depending on the message code received from a client, the server takes appropriate action. Furthermore, the solution also provides a graphical interface that is easy to interpret and to understand at the control room to visualize the rescue operation on the fly.