Background: Unexpected systemic shocks such as pandemics or natural disasters challenge the absorptive capacity of health and care systems to maintain adequate service levels.[1] Strategies have focused on better coordination between services, with multi-disciplinary care pathways being one instrument to achieve coordinated responses.[2] But the co-design process for this type of pathways tends to be too long and involved for fast response required by crises. Targeted community and stakeholder engagement: Health and care service planners and providers, service payers, public health and civil protection agencies as well as regional and municipal governments are affected by this problem. They need methods and tools to support ad-hoc design and instantiation of cross-sectoral pathways to address different types of crises. The DYNAMO initiative has brought together an initial group of stakeholders from five countries to start a multi-staged co-design programme that will also include further stakeholders. Explanation of the initiative: DYNAMO will develop an innovative software tool enabling stakeholders to jointly adapt existing service delivery processes to systemic shocks and structural changes. This includes sharing and integrating cross-sectoral data to accurately forecast possible outcomes and impacts of alternative pathway configurations. By means of a public tendering process, the participating care providers are developing the software package together with commercial technology providers. Up to now, local pathway modelling groups have been set up at each site. These have identified several ""high pressure"" service scenarios (e.g. future pandemics widespread internet/power outages, recurrent heat waves). For each scenario, alternative pressure points were identified that could have a notable impact on the performance of current health and care systems (e.g. resource or staff shortages). In the next project phase, several technology providers will be selected to co-develop prototype solutions that meet the requirements of the "high-pressure" service scenarios. Achieved and expected impacts: The definition of the high pressure scenarios and associated pressure points are a first outcome and showed that priorities for disaster readiness vary considerably between regions. With the software tools and methodologies to be developed, DYNAMO expects to significantly improve the response time and quality of health care ecosystems to a wide variety of systemic threats. Learnings for an international audience: DYNAMO is in its early stages and there are as yet no formalized learnings. Experiences and observations shared between projects participants however highlighted two key issues: 1) Responses to universal threats still happen in a haphazard and uncoordinated manner and awareness of the precise issue of multi-disciplinary pathways to respond to such threats is still too low. 2) While DYNAMO focusses on the development of a software tool, there is agreement among participating regions that this needs to be embedded into a regional cooperation culture and structure (a kind of “readiness community”) in order to achieve its intended impacts. [1] Adger WN, Brown K, Fairbrass J. et al. Governance for sustainability: towards a ‘thick’ analysis of environmental decision making. Environ Plan A. 2003;35(6):1095–1110. doi: 10.1068/A35289. [2] Lewis, L. and N. Ehrenberg (2020). Realising the true value of integrated care: Beyond COVID-19. https://integratedcarefoundation.org/publications/realising-the-true-value-of-integrated-care-beyond-covid-19-2#report

Gegenstand dieses Buches sind Phänomene an der Syntax-Pragmatik-Schnittstelle, z.B. die Vorfeldbesetzung, Versetzungsstrukturen an den Satzrändern, die Verbstellung, zentrale vs. periphere Nebensätze. Das Ziel ist es, anhand der betrachteten Strukturen aufzuzeigen, inwiefern bestimmte (syntaktisch auffällige) Strukturen mit bestimmten Diskursfunktionen/informationsstrukturellen Status einhergehen. Das Buch ist keine reine Einführung in die Pragmatik/Informationsstruktur oder Syntax, sondern zeigt auf, an welchen Stellen die ansonsten meist in Isolation behandelten Konzepte interagieren. Aufgaben zu den verschiedenen Kapiteln erleichtern das Verständnis.

The quest for more integrated care is not in itself new, but recent technology developments have nourished hopes that application of advanced digital solutions can make a major contribution to better joined-up care delivery, in particular to those suffering from chronic conditions. However, in contrast, with an enormous breadth of research activities, few instances of routine application of integrated eCare have yet emerged. This raises the question whether the concept of digitally-supported care delivery is indeed a present-day reality transforming traditionally separated care systems or just a hyped-up vision of what could be. Based on a review of recent evidence, including lessons learned from pilot implementations in different countries, the authors argue that the inherent properties of digital technologies do not by themselves lead to better-integrated care delivery. Rather, a reasonable implementation strategy needs to take account of the fact that desired end user support is not delivered by such technologies alone, but by socio-technical systems. An implementation approach that pays simultaneous attention to the stakeholders involved, to the particular working models of the different care actors, and to the technologies to be employed is shown to considerably increase the likelihood of achieving positive impacts on different levels, even if risks and uncertainty cannot be completely avoided.

Telehealthcare is an increasingly popular option for health and social care organisations providing care to people in their own homes, principally providing the means to improve both the quality and efficiency of care services. However, the evidence-base for the impacts of telehealthcare in terms of general quality of life , well-being and satisfaction for older people and informal carers remains patchy. We argue that the impacts of telehealthcare lie in certain specific areas not sufficiently covered by existing measures. As a consequence, important knowledge about client impacts of telehealthcare is missing, with negative consequences for related decision processes. We present work conducted within the CommonWell and INDEPENDENT projects on developing an instrument that addresses these shortcomings and allows for a better assessment of the impacts of telehealthcare systems on end users and family carers. The proposed eCare Client Impact Survey (eCCIS) instrument covers ten domains: self-assessed impacts (positive and negative); impacts on the carer (burden, anxiety, ability to care, reassurance, time and resources spent caring); usefulness of the system; management of health status and care; usability of the system; fit with everyday life; satisfaction with telehealthcare staff; service valuation, willingness-to-pay; and overall satisfaction. The instrument was first tested in the evaluation of the CommonWell and INDEPENDENT pilots with about 1200 respondents. We present some of the results obtained by applying this instrument, and describe the future work that should be done to refine and validate it.

Being both EU-IST integrated projects in the field of AAL. PERSONA and SOPRANO organized a conjoint workshop on the occasion of the AmI-07 conference in order for the researchers of the projects to exchange insights of the approaches to the key field challenges, the achievements so far in each of the projects, and possible synergies in the future. Here, we summarize the exchanged info and the workshop results. The paper gives a good overview of the two projects and their status by the end of October 2007.

The example chosen to best demonstrate how the character and detail of user ideas changed in the different stages of the R&D process is the development of an exercise support system applying an avatar showing the exercises on the TV in the home of an older person.

The call for better joined-up service delivery, particularly to those suffering from chronic conditions, traces back as far as into the 1950s. However, a disjointed care provision split into multiple service silos prevails. In the present chapter, the authors present lessons from practice, particularly from two recent pilot projects, INDEPENDENT and SmartCare, to show what can be achieved through the use of ICT-supported, integrated care and to show how it can be achieved under given framework conditions. The guiding question is which roads will actually lead to Rome and which will not. By simply adding ICT to current care practices one will most likely not end up with better care. Rather, the authors argue that a multi-pronged innovation approach needs to be pursued, one that simultaneously pays attention to the stakeholders involved, to the particular working models of the different care actors, and to the technologies to be employed. Using such an approach is shown to considerably increase the likelihood of achieving positive impacts on different levels, even if risks and uncertainty cannot be completely avoided.