Determinants of institutional care at older ages in Finland

Väitöskirjassa selvitettiin ikäihmisten laitoshoitoon siirtymisen todennäköisyyttä ja sen taustoja kansainvälisesti ainutlaatuisen rekisteriaineiston avulla. Selvitettäviä asioita olivat eri sairauksien, sosioekonomisten tekijöiden, puolison olemassaolon ja leskeksi jäämisen yhteys laitoshoitoon siirtymiseen yli 65-vuotiailla suomalaisilla. Tutkimuksessa havaittiin, että dementia, Parkinsonin tauti, aivohalvaus, masennusoireet ja muut mielenterveysongelmat, lonkkamurtuma sekä diabetes lisäsivät ikäihmisten todennäköisyyttä siirtyä laitoshoitoon yli 50 prosentilla, kun muut sairaudet ja sosiodemografiset tekijät oli otettu huomioon. Korkeat tulot vähensivät laitoshoidon todennäköisyyttä, kun taas puutteellinen asuminen (ilman peseytymistiloja tai keskus- tai sähkölämmitystä) sekä erittäin puutteellinen asuminen (ilman lämmintä vettä, vesijohtoa, viemäriä tai vesivessaa) lisäsivät todennäkösyyttä, kun muut sosiodemografiset tekijät, sairaudet ja asuinalue oli huomioitu. Kerrostalon hissittömyys ei ollut yhteydessä laitoshoidon todennäköisyyteen. Todennäköisyys siirtyä laitoshoitoon oli jostain syystä korkeampaa niillä ikäihmisillä, jotka asuivat vuokralla ja matalampaa omakotitalossa asuvilla ja niillä, joilla oli auto. Puolison olemassaolo vähensi ja leskeksi jääminen lisäsi laitoshoidon todennäköisyyttä huomattavasti. Todennäköisyys oli erityisen suuri, yli kolminkertainen, kun puolison kuolemasta oli kulunut enintään kuukausi verrattuna niihin, joiden puoliso oli elossa. Todennäköisyys laski, kun puolison kuolemasta kului aikaa. Miesten ja naisten tulokset olivat samansuuntaisia. Korkeat tulot tai koulutus eivät suojanneet riskiltä joutua laitoshoitoon puolison kuoltua. Puolison kuolema näyttää lisäävän hoidon tarvetta, kun kotona ei ole enää puolisoa tukemassa ja huolehtimassa kodin askareista. Laitoshoidon tarve vähenee, jos ja kun lesket ajan kuluessa oppivat elämään yksin. Toisaalta tutkimustulokset saattavat viitata myös siihen, että kaikkein huonokuntoisimmat lesket, jotka eivät pärjää yksin asuessaan, siirtyvät laitoshoitoon hyvin nopeasti puolison kuoltua. Tutkimuksessa oli mukana yhteensä yli 280 000 yli 65-vuotiasta henkilöä, joiden pitkäaikaiseen laitoshoitoon siirtymistä seurattiin tammikuusta 1998 syyskuuhun 2003. Laitoshoidoksi määriteltiin terveyskeskuksissa, sairaaloissa ja vanhainkodeissa tai vastaavissa yksiköissä tapahtuva pitkäaikainen hoito, joka kesti yli 90 vuorokautta tai oli vahvistettu pitkäaikaishoidon päätöksellä. Tutkimuksessa käytetty aineisto koottiin väestörekistereistä, sosiaali- ja terveydenhuollon rekistereistä ja lääkerekistereistä.

Asiakassuunnitelma asiakaslähtöistä auttamista tavoitteellistamassa : Kohteen rakentumisen moniääninen menetelmä

The research focuses on client plan in the field of health care and social work on families with children. The purpose of the plan is to create objectives for helping the client and to assist in coordinating the ever-increasing multi-professional work. In general, the plan is understood in terms of assignments and as a contract specifying what to do in client cases. Taking this into consideration, the plan is outsourced into a written document. Instead of understanding the plan as a tool that stabilizes the objectives of action, documents it and facilitates evaluation, the client plan is conceptualized in this study as a practice. This kind of practice mediates client work as being itself also a process of action that focuses on an object whose gradual emergence and definition is the central question in multi-professional collaboration with a client. The plan is examined empirically in a non-stabilized state which leads to the research methodology being based on the dynamics between stabilization and emerging, non-stabilized entities the co-creation and formulation of practice and context. The theoretical approach of the research is the micro analytic approach of activity theory (Engeström R. 1999b). Grounding on this, the research develops a method of qualitative analysis which follows an emerging object with multiple voices. The research data is composed of the videotaped sessions from client meetings with three families, the interviews with the client and the workers as well as client documents that are used to follow up on client processes for at least one year. The research questions are as follows: 1) How is the client plan constructed between the client and different professional agents? 2) How are meanings constructed in a client-centred plan? 3) What are the elements of client-employee relationships that support the co-configuration necessitated by the changes in the client s everyday life? The study shows that the setting of objectives were limited by the palette of institutional services, which caused that the clients interpretations and acts of giving meaning to the kinds of help that was required were left out of the plan. Conceptually, the distinctions between client-centred and client-specific ways of working as well as an action-based working method are addressed. Central to this action-based approach is construing the everyday life of the client, recognizing different meanings and analyzing them together with the client as well as focusing attention on developing the prerequisites for social agency of the clients. The research portrays the elements for creating an action-based client plan. Key words: client plan, user perspective, multi-voiced meaning, multi-professional social work with children and families, agency

Trial of the Primary Care Practice Improvement Tool: Building organisational performance in Australian general practice and primary health care

Objective: To nationally trial the Primary Care Practice Improvement Tool (PC-PIT), an organisational performance improvement tool previously co-created with Australian primary care practices to increase their focus on relevant quality improvement (QI) activities. Design: The study was conducted from March to December 2015 with volunteer general practices from a range of Australian primary care settings. We used a mixed-methods approach in two parts. Part 1 involved staff in Australian primary care practices assessing how they perceived their practice met (or did not meet) each of the 13 PC-PIT elements of high-performing practices, using a 1–5 Likert scale. In Part 2, two external raters conducted an independent practice visit to independently and objectively assess the subjective practice assessment from Part 1 against objective indicators for the 13 elements, using the same 1–5 Likert scale. Concordance between the raters was determined by comparing their ratings. In-depth interviews conducted during the independent practice visits explored practice managers’ experiences and perceived support and resource needs to undertake organisational improvement in practice. Results: Data were available for 34 general practices participating in Part 1. For Part 2, independent practice visits and the inter-rater comparison were conducted for a purposeful sample of 19 of the 34 practices. Overall concordance between the two raters for each of the assessed elements was excellent. Three practice types across a continuum of higher- to lower-scoring practices were identified, with each using the PC-PIT in a unique way. During the in-depth interviews, practice managers identified benefits of having additional QI tools that relate to the PC-PIT elements. Conclusions: The PC-PIT is an organisational performance tool that is acceptable, valid and relevant to our range of partners and the end users (general practices). Work is continuing with our partners and end users to embed the PC-PIT in existing organisational improvement programs.

Perspectives on knowledge creating inquiry in higher education

Higher education is faced with the challenge of strengthening students competencies for the constantly evolving technology-mediated practices of knowledge work. The knowledge creation approach to learning (Paavola et al., 2004; Hakkarainen et al., 2004) provides a theoretical tool to address learning and teaching organized around complex problems and the development of shared knowledge objects, such as reports, products, and new practices. As in professional work practices, it appears necessary to design sufficient open-endedness and complexity for students teamwork in order to generate unpredictable and both practically and epistemologically challenging situations. The studies of the thesis examine what kinds of practices are observed when student teams engage in knowledge creating inquiry processes, how the students themselves perceive the process, and how to facilitate inquiry with technology-mediation, tutoring, and pedagogical models. Overall, 20 student teams collaboration processes and productions were investigated in detail. This collaboration took place in teams or small groups of 3-6 students from multiple domain backgrounds. Two pedagogical models were employed to provide heuristic guidance for the inquiry processes: the progressive inquiry model and the distributed project model. Design-based research methodology was employed in combination with case study as the research design. Database materials from the courses virtual learning environment constituted the main body of data, with additional data from students self-reflections and student and teacher interviews. Study I examined the role of technology mediation and tutoring in directing students knowledge production in a progressive inquiry process. The research investigated how the scale of scaffolding related to the nature of knowledge produced and the deepening of the question explanation process. In Study II, the metaskills of knowledge-creating inquiry were explored as a challenge for higher education: metaskills refers to the individual, collective, and object-centered aspects of monitoring collaborative inquiry. Study III examined the design of two courses and how the elaboration of shared objects unfolded based on the two pedagogical models. Study IV examined how the arranged concept-development project for external customers promoted practices of distributed, partially virtual, project work, and how the students coped with the knowledge creation challenge. Overall, important indicators of knowledge creating inquiry were the following: new versions of knowledge objects and artifacts demonstrated a deepening inquiry process; and the various productions were co-created through iterations of negotiations, drafting, and versioning by the team members. Students faced challenges of establishing a collective commitment, devising practices to co-author and advance their reports, dealing with confusion, and managing culturally diverse teams. The progressive inquiry model, together with tutoring and technology, facilitated asking questions, generating explanations, and refocusing lines of inquiry. The involvement of the customers was observed to provide a strong motivation for the teams. On the evidence, providing team-specific guidance, exposing students to models of scientific argumentation and expert work practices, and furnishing templates for the intended products appear to be fruitful ways to enhance inquiry processes. At the institutional level, educators do well to explore ways of developing collaboration with external customers, public organizations or companies, and between educational units in order to enhance educational practices of knowledge creating inquiry.

Interfacial microrheology as a tool to study viscoelastic transitions in nanoconfined soft matter

We present a method to perform in situ microrheological measurements on monolayers of soft materials undergoing viscoelastic transitions under compression. Using the combination of a Langmuir trough mounted on the inverted microscope stage of a laser scanning confocal microscope we track the motion of individual fluorescent quantum dots partly dispersed in monolayers spread at the air-water interface. From the calculated mean square displacement of the probe particles and extending a well established scheme of the generalized Stokes-Einstein relation in bulk to the interface we arrive at the viscoelastic modulus for the respective monolayers as a function of surface density. Measurements on monolayers of glassy as well as nonglassy polymers and a standard fatty acid clearly show sensitivity of our technique to subtle variations, in the viscoelastic properties of the highly confined materials under compression. Evidence for possible spatial variations of such viscoelastic properties at a given surface density for the fatty acid monolayer is also provided.

Tool wear monitoring using ant behaviour

In this paper we show the applicability of Ant Colony Optimisation (ACO) techniques for pattern classification problem that arises in tool wear monitoring. In an earlier study, artificial neural networks and genetic programming have been successfully applied to tool wear monitoring problem. ACO is a recent addition to evolutionary computation technique that has gained attention for its ability to extract the underlying data relationships and express them in form of simple rules. Rules are extracted for data classification using training set of data points. These rules are then applied to set of data in the testing/validation set to obtain the classification accuracy. A major attraction in ACO based classification is the possibility of obtaining an expert system like rules that can be directly applied subsequently by the user in his/her application. The classification accuracy obtained in ACO based approach is as good as obtained in other biologically inspired techniques.

Cascade PSI-BLAST web server: a remote homology search tool for relating protein domains

Owing to high evolutionary divergence, it is not always possible to identify distantly related protein domains by sequence search techniques. Intermediate sequences possess sequence features of more than one protein and facilitate detection of remotely related proteins. We have demonstrated recently the employment of Cascade PSI-BLAST where we perform PSI-BLAST for many 'generations', initiating searches from new homologues as well. Such a rigorous propagation through generations of PSI-BLAST employs effectively the role of intermediates in detecting distant similarities between proteins. This approach has been tested on a large number of folds and its performance in detecting superfamily level relationships is similar to 35% better than simple PSI-BLAST searches. We present a web server for this search method that permits users to perform Cascade PSI-BLAST searches against the Pfam, SCOP and SwissProt databases. The URL for this server is http://crick.mbu.iisc.ernet.in/similar to CASCADE/CascadeBlast.html.

Towards a Dynamic Communication Model: A Useful Tool in Relationship Communication

In order to bring insight into the emerging concept of relationship communication, concepts from two research traditions will be combined in this paper. Based on those concepts a new model, the dynamic relationship communication model, will be presented. Instead of a company perspective focusing on the integration of outgoing messages such as advertising, public relations and sales activities, it is suggested that the focus should be on factors integrated by the receiver. Such factors can be historical, future, external and internal factors. Thus, the model put a strong focus on the receiver in the communication process. The dynamic communication model is illustrated empirically using it as a tool on 78 short stories about communication. The empirical findings show that relationship communication occurs in some cases; in some cases it does not occur. The model is a useful tool in displaying relationship communication and how it differs from other communication. The importance of the time dimension, historical and future factors, in relationship communications is discussed. The possibility of reducing communications costs by the notion of relationship communication is discussed in managerial implications.

Interfacial microrheology as a tool to study viscoelastic transitions in nanoconfined soft matter

We present a method to perform in situ microrheological measurements on monolayers of soft materials undergoing viscoelastic transitions under compression. Using the combination of a Langmuir trough mounted on the inverted microscope stage of a laser scanning confocal microscope we track the motion of individual fluorescent quantum dots partly dispersed in monolayers spread at the air-water interface. From the calculated mean square displacement of the probe particles and extending a well established scheme of the generalized Stokes-Einstein relation in bulk to the interface we arrive at the viscoelastic modulus for the respective monolayers as a function of surface density. Measurements on monolayers of glassy as well as nonglassy polymers and a standard fatty acid clearly show sensitivity of our technique to subtle variations, in the viscoelastic properties of the highly confined materials under compression. Evidence for possible spatial variations of such viscoelastic properties at a given surface density for the fatty acid monolayer is also provided.

sRNAscanner: A Computational Tool for Intergenic Small RNA Detection in Bacterial Genomes

Background:Bacterial non-coding small RNAs (sRNAs) have attracted considerable attention due to their ubiquitous nature and contribution to numerous cellular processes including survival, adaptation and pathogenesis. Existing computational approaches for identifying bacterial sRNAs demonstrate varying levels of success and there remains considerable room for improvement. Methodology/Principal Findings: Here we have proposed a transcriptional signal-based computational method to identify intergenic sRNA transcriptional units (TUs) in completely sequenced bacterial genomes. Our sRNAscanner tool uses position weight matrices derived from experimentally defined E. coli K-12 MG1655 sRNA promoter and rho-independent terminator signals to identify intergenic sRNA TUs through sliding window based genome scans. Analysis of genomes representative of twelve species suggested that sRNAscanner demonstrated equivalent sensitivity to sRNAPredict2, the best performing bioinformatics tool available presently. However, each algorithm yielded substantial numbers of known and uncharacterized hits that were unique to one or the other tool only. sRNAscanner identified 118 novel putative intergenic sRNA genes in Salmonella enterica Typhimurium LT2, none of which were flagged by sRNAPredict2. Candidate sRNA locations were compared with available deep sequencing libraries derived from Hfq-co-immunoprecipitated RNA purified from a second Typhimurium strain (Sittka et al. (2008) PLoS Genetics 4: e1000163). Sixteen potential novel sRNAs computationally predicted and detected in deep sequencing libraries were selected for experimental validation by Northern analysis using total RNA isolated from bacteria grown under eleven different growth conditions. RNA bands of expected sizes were detected in Northern blots for six of the examined candidates. Furthermore, the 5'-ends of these six Northern-supported sRNA candidates were successfully mapped using 5'-RACE analysis. Conclusions/Significance: We have developed, computationally examined and experimentally validated the sRNAscanner algorithm. Data derived from this study has successfully identified six novel S. Typhimurium sRNA genes. In addition, the computational specificity analysis we have undertaken suggests that similar to 40% of sRNAscanner hits with high cumulative sum of scores represent genuine, undiscovered sRNA genes. Collectively, these data strongly support the utility of sRNAscanner and offer a glimpse of its potential to reveal large numbers of sRNA genes that have to date defied identification. sRNAscanner is available from: http://bicmku.in:8081/sRNAscanner or http://cluster.physics.iisc.ernet.in/sRNAscanner/.

Reasonability and the Linguistic - Division of Labor in Institutional Work

We examine institutional work from a discursive perspective and argue that reasonability, the existence of acceptable justifying reasons for beliefs and practices, is a key part of legitimation. Drawing on philosophy of language, we maintain that institutional work takes place in the context of ‘space of reasons’ determined by widely held assumptions about what is reasonable and what is not. We argue that reasonability provides the main contextual constraint of institutional work, its major outcome, and a key trigger for actors to engage in it. We draw on Hilary Putnam’s concept ‘division of linguistic labor’ to highlight the specialized distribution of knowledge and authority in defining valid ways of reasoning. In this view, individuals use institutionalized vocabularies to reason about their choices and understand their context with limited understanding of how and why these structures have become what they are. We highlight the need to understand how professions and other actors establish and maintain the criteria of reasoning in various areas of expertise through discursive institutional work.