Design and implementation of a virtual world training simulation of ICU first hour handover processes

Nursing training for an Intensive Care Unit (ICU) is a resource intensive process. High demands are made on staff, students and physical resources. Interactive, 3D computer simulations, known as virtual worlds, are increasingly being used to supplement training regimes in the health sciences; especially in areas such as complex hospital ward processes. Such worlds have been found to be very useful in maximising the utilisation of training resources. Our aim is to design and develop a novel virtual world application for teaching and training Intensive Care nurses in the approach and method for shift handover, to provide an independent, but rigorous approach to teaching these important skills. In this paper we present a virtual world simulator for students to practice key steps in handing over the 24/7 care requirements of intensive care patients during the commencing first hour of a shift. We describe the modelling process to provide a convincing interactive simulation of the handover steps involved. The virtual world provides a practice tool for students to test their analytical skills with scenarios previously provided by simple physical simulations, and live on the job training. Additional educational benefits include facilitation of remote learning, high flexibility in study hours and the automatic recording of a reviewable log from the session. To the best of our knowledge, we believe this is a novel and original application of virtual worlds to an ICU handover process. The major outcome of the work was a virtual world environment for training nurses in the shift handover process, designed and developed for use by postgraduate nurses in training.

Handover : the collective narrative of nursing practice

This paper examines the practice of handover in a large metropolitan hospital. It shows that the handover is a significant site at which to examine how tensions and imperatives derived from the traditional institutional position and role of the nurse are played out in contradiction with emergent professionalism. It identifies handover dimensions and focuses discussion on how the collective narrative of the handover serves to construct patient identities as well as ensure solidarity and cohesion among nurses.

SSCRC Austin ICU Handover

Video presented as part of Melbourne Smart Services CRC Participants conferences. Video showing the results of our collaboration with the Smart Services CRC and Austin Health. We created an environment for nurses to learn ICU Handover processes. Handover processes in an ICU involve, briefing meetings with ward nurses, and then a bedside handover of patient care information to the nurse starting the next shift. This simulation will allow students to remotely practice their handover skills, thus freeing up expensive resources at teaching hospitals, and enabling them to be at a higher skill level when they commence live training. More information available at: www.bpmve.org.

Enhanced fast handover triggering mechanism for fast proxy mobile IPv6

Handover performance is critical to support real-time traffic applications in wireless network communications. The longer the handover delay is, the longer an Mobile Node (MN) is prevented from sending and receiving any data packet. In real-time network communication applications, such as VoIP and video-conference, a long handover delay is often unacceptable. In order to achieve better handover performance, Fast Proxy Mobile IPv6 (FPMIPv6) has been standardised as an improvement to the original Proxy Mobile IPv6 (PMIPv6) in the Internet Engineering Task Force (IETF). The FPMIPv6 adopts a link layer triggering mechanism to perform two modes of operation: predictive and reactive modes. Using the link layer triggering, the handover performance of the FPMIPv6 can be improved in the predictive mode. However, an unsuccessful predictive handover operation will lead to activation of a reactive handover. In the reactive mode, MNs still experience long handover delays and a large amount of packet loss, which significantly degrade the handover performance of the FPMIPv6. Addressing this problem, this thesis presents an Enhanced Triggering Mechanism (ETM) in the FPMIPv6 to form an enhanced FPMIPv6 (eFPMIPv6). The ETM reduces the most time consuming processes in the reactive handover: the failed Handover Initiate (HO-Initiate) delay and bidirectional tunnel establishment delay. Consequently, the overall handover performance of the FPMIPv6 is enhanced in the eFPMIPv6. To show the advantages of the proposed eFPMIPv6, a theoretical analysis is carried out to mathematically model the performance of PMIPv6, FPMIPv6 and eFPMIPv6. Extensive case studies are conducted to validate the effectiveness of the presented eFPMIPv6 mechanism. They are carried out under various scenarios with changes in network link delay, traffic load, number of hops and MN moving velocity. The case studies show that the proposed mechanism ETM reduces the reactive handover delay, and the presented eFPMIPv6 outperforms the PMIPv6 and FPMIPv6 in terms of the overall handover performance.

Towards an understanding of the information dynamics of the handover process in aged care settings: A prerequisite for the safe and effective use of ICT

Background Poor clinical handover has been associated with inaccurate clinical assessment and diagnosis, delays in diagnosis and test ordering, medication errors and decreased patient satisfaction in the acute care setting. Research on the handover process in the residential aged care sector is very limited. Purpose The aims of this study were to: (i) Develop an in-depth understanding of the handover process in aged care by mapping all the key activities and their information dynamics, (ii) Identify gaps in information exchange in the handover process and analyze implications for resident safety, (iii) Develop practical recommendations on how information communication technology (ICT) can improve the process and resident safety. Methods The study was undertaken at a large metropolitan facility in NSW with more than 300 residents and a staff including 55 registered nurses (RNs) and 146 assistants in nursing (AINs). A total of 3 focus groups, 12 interviews and 3 observation sessions were conducted over a period from July to October 2010. Process mapping was undertaken by translating the qualitative data via a five-category code book that was developed prior to the analysis. Results Three major sub-processes were identified and mapped. The three major stages are Handover process (HOP) I “Information gathering by RN”, HOP II “Preparation of preliminary handover sheet” and HOP III “Execution of handover meeting”. Inefficient processes were identified in relation to the handover including duplication of information, utilization of multiple communication modes and information sources, and lack of standardization. Conclusion By providing a robust process model of handover this study has made two critical contributions to research in aged care: (i) a means to identify important, possibly suboptimal practices; and (ii) valuable evidence to plan and improve ICT implementation in residential aged care. The mapping of this process enabled analysis of gaps in information flow and potential impacts on resident safety. In addition it offers the basis for further studies into a process that, despite its importance for securing resident safety and continuity of care, lacks research.

The cross layer RMPA handover: a reliable mobility pattern aware handover strategy for broadband wireless communication in a high-speed railway domain

Enhancing the handover process in broadband wireless communication deployment has traditionally motivated many research initiatives. In a high-speed railway domain, the challenge is even greater. Owing to the long distances covered, the mobile node gets involved in a compulsory sequence of handover processes. Consequently, poor performance during the execution of these handover processes significantly degrades the global end-to-end performance. This article proposes a new handover strategy for the railway domain: the RMPA handover, a Reliable Mobility Pattern Aware IEEE 802.16 handover strategy "customized" for a high-speed mobility scenario. The stringent high mobility feature is balanced with three other positive features in a high-speed context: mobility pattern awareness, different sources for location discovery techniques, and a previously known traffic data profile. To the best of the authors' knowledge, there is no IEEE 802.16 handover scheme that simultaneously covers the optimization of the handover process itself and the efficient timing of the handover process. Our strategy covers both areas of research while providing a cost-effective and standards-based solution. To schedule the handover process efficiently, the RMPA strategy makes use of a context aware handover policy; that is, a handover policy based on the mobile node mobility pattern, the time required to perform the handover, the neighboring network conditions, the data traffic profile, the received power signal, and current location and speed information of the train. Our proposal merges all these variables in a cross layer interaction in the handover policy engine. It also enhances the handover process itself by establishing the values for the set of handover configuration parameters and mechanisms of the handover process. RMPA is a cost-effective strategy because compatibility with standards-based equipment is guaranteed. The major contributions of the RMPA handover are in areas that have been left open to the handover designer's discretion. Our simulation analysis validates the RMPA handover decision rules and design choices. Our results supporting a high-demand video application in the uplink stream show a significant improvement in the end-to-end quality of service parameters, including end-to-end delay (22%) and jitter (80%), when compared with a policy based on signal-to-noise-ratio information.

Handover en LTE basado en distancia en plataforma de simulación

[ES]Mejorar el proceso de handover en el despliegue de comunicaciones inalámbricas de banda ancha tradicionalmente ha motivado muchas iniciativas de investigación. En el dominio de los ferrocarriles de alta velocidad, el reto es incluso mayor. Debido a las largas distancias que se cubren, el nodo móvil se ve envuelto en una secuencia obligatoria de procesos de handover. Consecuentemente, un rendimiento pobre en la ejecución de esos procesos de handover degrada significativamente el rendimiento global extremo a extremo. Este documento propone una nueva estrategia de handover para el dominio de los ferrocarriles: un algoritmo de decisión para LTE basado en distancia en lugar de en potencia. La decisión de realizar el handover se realiza cuando un eNB candidato se encuentra más cerca del UE que el eNB fuente. Adicionalmente, cabe la posibilidad de retrasar esa decisión mediante un umbral. Asimismo, se añade una nueva función al modelo de LTE de la plataforma de simulación empleada en la verificación de este modelo. Este mecanismo de decisión introduce un retardo menor en los procesos de handover y, en consecuencia, la calidad extremo-a-extremo aumenta.

From projects into operations: lessons for data handover

Data from civil engineering projects can inform the operation of built infrastructure. This paper captures lessons for such data handover, from projects into operations, through interviews with leading clients and their supply chain. Clients are found to value receiving accurate and complete data. They recognise opportunities to use high quality information in decision-making about capital and operational expenditure; as well as in ensuring compliance with regulatory requirements. Providing this value to clients is a motivation for information management in projects. However, data handover is difficult as key people leave before project completion; and different data formats and structures are used in project delivery and operations. Lessons learnt from leading practice include defining data requirements at the outset, getting operations teams involved early, shaping the evolution of interoperable systems and standards, developing handover processes to check data rather than documentation, and fostering skills to use and update project data in operations

Análise de Handover inter e intra-célula em um sistema de telefonia celular através de método de medição simplificado

This dissertation has the purpose to present a portable device named PlugData MG100G, equipped with a cellular module, to analyze the radiofrequency coverage in a GSM network situated in João Pessoa city, state of Paraíba, at four distinct regions. The equipment, originally, was developed to be used in fixed environments, so it was adapted so that it could be used in conditions of mobility. From the Mobile Measurement Reports (MMRs) RF coverage and the handover process are analyzed. The MMRs enable the identification of the serving cell and the list of the closest neighboring cells monitored by the mobile. This work analyses only data referent to the serving cell and the two closest neighboring cells. Inter-cell and intra-cell handovers are identified. The frequency planning and quality of service offered by the network related to the regions are discussed as well

Análise de handover a partir do uso de femtocells em redes LTE: abordagem baseada em simulação discreta

O volume de tráfego de dados em redes celulares está crescendo exponencialmente. A explosão do uso de dispositivos e aplicações móveis nos últimos anos, tem levado a uma sobrecarga da infraestrutura da rede responsável pelo escoamento desse tráfego, afetando tanto o desempenho da rede quanto a experiência do usuário. Um dos elementos-chave nas redes LTE (Long Term Evolution) é a possibilidade de implantação de múltiplas femtocells para a melhoria de cobertura e taxa de dados. No entanto, as sobreposições arbitrárias na cobertura dessas células tornam a gestão do mecanismo de handover complexo e desafiador. Nesse sentido, esta dissertação propõe uma metodologia para o estudo do impacto do handover em redes LTE com femtocells. A partir de uma abordagem de simulação discreta, os efeitos da implantação de femtocells foram avaliados. Objetivou-se com isso, mensurar os impactos e a correlação do uso de femtocell nos parâmetros de QoS (Quality of Service) e indicadores de desempenho de handover.

IEEE 802.21: Media Independent Handover

In questo lavoro, dopo un'introduzione sul panorama contemporaneo, si è analizzato lo standard IEEE 802.21, illustrandone i motivi che hanno portato al suo sviluppo, la timeline del processo di standardizzazione, gli obbiettivi del working group, l'architettura del sistema specificato e le sue funzionalità, con particolare riguardo all'utilità in applicazioni reali, al fine di darne un giudizio completo sulla sua effettiva efficacia. Dopo aver citato qualche esempio di possibile applicazione dello standard e descritto lo stato attuale dell'arte, si è studiata una sua implementazione cross-platform chiamata ODTONE, descrivendone i vari componenti e le loro funzionalità, ma anche sottolineando le attuali mancanze per arrivare ad una implementazione completa sotto tutti i punti di vista. Successivamente si è studiata ed implementata un'applicazione, MIH-proxy, che potesse sfruttare in modo costruttivo i servizi specificati dallo standard per creare un proxy che potesse scegliere su quale interfaccia instradare i pacchetti a seconda dello stato attuale di tutti i collegamenti, realizzato in versione unidirezionale e bidirezionale. In particolare questa applicazione è in grado di restare in ascolto di cambiamenti di stato delle interfacce di rete, e.g. quando viene stabilita una connessione oppure cade, e, di conseguenza, stabilire di volta in volta quali collegamenti utilizzare per inviare dati. Nella versione bidirezionale è anche possibile far comunicare tra loro applicazioni che normalmente utilizzerebbero il protocollo di trasporto TCP attraverso un ulteriore componente, phoxy, che si preoccupa di convertire, in modo trasparente, un flusso TCP in datagrammi UDP eventualmente cifrati. Sarà quindi possibile creare un collegamento criptato ad alta affidabilità tra le applicazioni che possa sfruttare tutte le interfacce disponibili, sia per inviare, sia per ricevere.

Studio ed implementazione di un algoritmo per la gestione dell'handover in ambiente Android

In questo elaborato di tesi, viene progettata ed implementata una soluzione per gestire il processo di handover in ambiente Android. Tale proposta, è costituita da un algoritmo in grado di gestire automaticamente le interfacce di connessione dei dispostivi, in relazione alle preferenze e agli spostamenti effettuati dall'utente. Le prove sperimentali effettuate, confermano che tale proposta è una buona base per risolvere il problema dell'handover e si presta bene a cooperare con altri protocolli quali ABPS (Always Best Packet Switching). Inoltre l'applicazione si presta bene ad un semplice utilizzo e può essere impiegata anche come servizio eseguito in background, non richiedendo frequenti interazioni da parte dell'utente. Oltre all'algoritmo citato in precedenza, sono stati proposti altri dettagli implementativi, non presenti in letteratura. In particolare, vengono modificate alcune impostazioni di sistema, accedendo agli opportuni file, in modo tale che Android gestisca correttamente le scansioni delle interfacce e la loro attivazione/disattivazione.

Efecto del tamaño de la ventana de promediado y la histéresis variable en algoritmos de handover horizontal en redes convergentes

En las redes convergentes inalámbricas, el traspaso horizontal entre distintos puntos de acceso de la red WLAN es una gran fuente de degradación de la calidad de la VoIP y otros servicios conversacionales en tiempo real. Esto es debido a que este tipo de redes no fueron concebidas originalmente para soportar este tipo de servicios, y los traspasos siguen un protocolo ¿cortar antes de realizar¿, produciéndose interrupciones en la comunicación motivadas por el tiempo que necesitan los terminales en volver a asociarse a la red. En este artículo se estudia el efecto que tienen el tamaño de la ventana de promediado de la señal, la histéresis variable y el retardo del handover por parecido entre potencia de puntos de acceso de destino sobre el número de traspasos y las caídas de la potencia de señal por debajo del valor de sensibilidad del terminal, causantes principales de las interrupciones en la comunicación, y, con ello, de la degradación de la calidad de las comunicaciones.