Family caregivers provide critical care for children with medical complexity (CMC) at home, yet homes are still a poorly understood healthcare setting. Home environments include diverse physical environments, technologies, tools, tasks, and people, and are therefore complex work systems. Research suggests that home environments can contribute positively and negatively to both individuals’ well-being and the quality of care that families can provide. Our objective for this study was to determine how the physical environment of the home interacts within a work system to affect outcomes related to in-home care of CMC. We used contextual inquiry to interview 30 caregivers in their homes and analyzed our data using the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model. We focused on identifying physical environments’ interactions with other work system components and the resulting CMC outcomes. We identified six categories of outcomes that are influenced by work system interactions within the physical environment: 1) Safe or Unsafe delivery of care; 2) Prepared for or Inability to Respond to Care Crisis; 3) Home Mobility or Inaccessibility; 4) Efficient and Inefficient Care; 5) Inclusion and Isolation from Family; and 6) Socioemotional Comfort and Stress. The physical environment influences a range of outcomes from patient safety to families’ emotional well-being. Our results point to the need for adaptation of SEIPS 2.0 to the home environment by incorporating consideration for family and home-based outcomes into the model.
Background: People living with Alzheimer's Disease or related dementias (ADRD) and their care partners (e.g. family, friends) experience legal and financial planning challenges. Technology-based interventions have the potential to mitigate these challenges. However, care partners have reported discontinuing use of currently available technology-based interventions because they did not align with their needs, were not relevant, or were not available when needed. This persistent need for solutions personalized to care partner needs can be met through participatory design (PD), which engages end users in collaborative design exercises. Our objectives were to conduct PD with ADRD care partners to design a web-based financial and legal planning prototype that meets care partner needs. Method:We enrolled two groups of designers (n = 5/group). Participants were recruited nationally through community partners. We used phone screenings to confirm that participants were self-identified current or former care partners of someone living with ADRD, had internet access, were 18 or older, and spoke English. Design teams will complete 5 co-design sessions across 6 months, with at least 4 weeks between each design session. Sessions 1-3 have focused on problem identification, generating solutions, and solution convergence. Sessions 4 and 5 will focus on prototyping and evaluating the final prototype. Team members individually reviewed design session recordings to extract key design requirements. Discrepancies were resolved through consensus discussion.Result: Participants (n = 10) cared for a spouse (80%) and were from Wisconsin, Texas, and California. Sessions 1-3 generated 8 key design requirements. Participants wanted a tool that would help them 1) Learn, including learning new information; 2) Organize, including organizing existing information; 3) Act, including executing to-do lists; and 4) Connect, including gaining access to existing resources. Participants wanted a tool characterized by 5) Privacy, including keeping their information safe; 6) Flexibility,
Background and Objectives Care partners of people living with Alzheimer’s Disease and Related Dementias (ADRD) are faced with substantial legal and financial planning related to their care partner role. However, many care partners lack the legal and financial support needed to manage this role. The purpose of this study was to engage ADRD care partners in a remote participatory design process to create a technology-based financial and legal planning tool that meets care partner needs. Research Design and Methods We formed two researcher-facilitated co-design teams comprised of n=5 ADRD care partners each. We conducted a series of five parallel co-design sessions aimed to engage co-designers in interactive discussions and design activities to create the financial and legal planning tool. We used inductive thematic analysis of design session recordings to identify design requirements. Results Co-designers were 70% female with a mean age of 67.3 years (SD 9.07) and cared for a spouse (80%) or a parent (20%). Between sessions 3 and 5, the average system usability scale (SUS) score of the prototype increased from 89.5 to a 93.6, indicating high usability. Analyses yielded seven overarching design requirements for a legal and financial planning tool: support for action now (e.g., prioritized to-do lists); support for action later (e.g., reminders for keeping legal documents up-to-date); knowledge when I need it (e.g., tailored learning modules); connection to resources I need (e.g., state-specific financial support opportunities); everything where I can see it (e.g., comprehensive care budgeting tool); sense of privacy and security (e.g., password protection); and accessibility for all (e.g., tailoring for low-income care partners). Discussion and Implications The design requirements identified by co-designers provide a foundation from which we can build technology-based solutions to support ADRD care partners in financial and legal planning.
In this paper, we present the first-ever commercially available embedded Microcontrollers built on 90nm-node with silicon nanocrystal memories that has intrinsic capability of exceeding 500K program/erase cycles. We also show that the cycling performance across temperature (-40C to 125C) is very well behaved even while maintaining high performance that meets or exceeds the requirements of consumer, industrial, and automotive markets. In specific EEPROM implementation, such high endurance is capable of delivering in excess of 200M data updates. In addition, we also demonstrate that the nanocrystal flash memory is highly scalable to the next generation nodes and the scaling can be accomplished without degradation of program/erase speed, endurance and reliability. ( IntroductionRecently we announced the launch and qualification of high performance, low-power embedded 32-bit microcontrollers based on either ARM® Cortex™ -M4 core or ColdFire™ cores that are built using NC-based embedded flash (referred to as TFS for Thin Film Storage). The mixed-signal low-power microcontroller families have memories for with flash memory sizes ranging from 256Kb to 8Mb [1,2]. In addition, the unique capability of TFS has enabled inclusion of fully configurable embedded EEPROM functionality called 'FlexMemory.' With appropriate trade-off between endurance and memory density, the FlexMemory is capable of delivering as many as 10M data update operations when the intrinsic flash endurance is 10K. However, there has been an increasing demand for eFlash that can cover from low-end to high-end products, but capable of high flash endurance (≥ 100K) and reliability for markets, such as, automotive and smartcard applications. Evaluation of Kinetis Microcontrollers demonstrate that nanocrystal flash is intrinsically capable of achieving 500K+ cycling performance, and we also show reliable performance with extended endurance capability (≥ 100K) across temperature (-40C to 125C). With such substantially enhanced endurance capability of nanocrystal memories, FlexMemory can deliver an excess of 200M updates when appropriately configured.
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