The Iceland Greenland Seas Project

A coordinated atmosphere-ocean research project, centered on a rare wintertime field campaign to the Iceland and Greenland Seas, seeks to determine the location and causes of dense water formation by cold-air outbreaks. The Iceland Greenland Seas Project (IGP) is a coordinated atmosphere-ocean research program investigating climate processes in the source region of the densest waters of the Atlantic Meridional Overturning Circulation. During February and March 2018, a field campaign was executed over the Iceland and southern Greenland Seas that utilized a range of observing platforms to investigate critical processes in the region – including a research vessel, a research aircraft, moorings, sea gliders, floats and a meteorological buoy. A remarkable feature of the field campaign was the highly-coordinated deployment of the observing platforms, whereby the research vessel and aircraft tracks were planned in concert to allow simultaneous sampling of the atmosphere, the ocean and their interactions. This joint planning was supported by tailor-made convection-permitting weather forecasts and novel diagnostics from an ensemble prediction system. The scientific aims of the IGP are to characterize the atmospheric forcing and the ocean response of coupled processes; in particular, cold-air outbreaks in the vicinity of the marginal-ice zone and their triggering of oceanic heat loss, and the role of freshwater in the generation of dense water masses. The campaign observed the lifecycle of a long-lasting cold-air outbreak over the Iceland Sea and the development of a cold-air outbreak over the Greenland Sea. Repeated profiling revealed the immediate impact on the ocean, while a comprehensive hydrographic survey provided a rare picture of these subpolar seas in winter. A joint atmosphere-ocean approach is also being used in the analysis phase, with coupled observational analysis and coordinated numerical modelling activities underway

Developing a proxy version of the Adult Social Care Outcome Toolkit (ASCOT)

Background: Social care-related quality of life is a key outcome indicator used in the evaluation of social care interventions and policy. It is not, however, always possible to collect quality of life data by self-report even with adaptations for people with cognitive or communication impairments. A new proxy-report version of the Adult Social Care Outcomes Toolkit (ASCOT) measure of social care-related quality of life was developed to address the issues of wider inclusion of people with cognitive or communication difficulties who may otherwise be systematically excluded. The development of the proxy-report ASCOT questionnaire was informed by literature review and earlier work that identified the key issues and challenges associated with proxy-reported outcomes. Methods: To evaluate the acceptability and content validity of the ASCOT-Proxy, qualitative cognitive interviews were conducted with unpaid carers or care workers of people with cognitive or communication impairments. The proxy respondents were invited to ‘think aloud’ while completing the questionnaire. Follow-up probes were asked to elicit further detail of the respondent’s comprehension of the format, layout and content of each item and also how they weighed up the options to formulate a response. Results: A total of 25 unpaid carers and care workers participated in three iterative rounds of cognitive interviews. The findings indicate that the items were well-understood and the concepts were consistent with the item definitions for the standard self-completion version of ASCOT with minor modifications to the draft ASCOT-Proxy. The ASCOT-Proxy allows respondents to rate the proxy-proxy and proxy-patient perspectives, which improved the acceptability of proxy report. Conclusions: A new proxy-report version of ASCOT was developed with evidence of its qualitative content validity and acceptability. The ASCOT-Proxy is ready for empirical testing of its suitability for data collection as a self-completion and/or interview questionnaire, and also evaluation of its psychometric properties

Developing a proxy version of the Adult Social Care Outcome Toolkit (ASCOT)

Background: Social care-related quality of life is a key outcome indicator used in the evaluation of social care interventions and policy. It is not, however, always possible to collect quality of life data by self-report even with adaptations for people with cognitive or communication impairments. A new proxy-report version of the Adult Social Care Outcomes Toolkit (ASCOT) measure of social care-related quality of life was developed to address the issues of wider inclusion of people with cognitive or communication difficulties who may otherwise be systematically excluded. The development of the proxy-report ASCOT questionnaire was informed by literature review and earlier work that identified the key issues and challenges associated with proxy-reported outcomes. Methods: To evaluate the acceptability and content validity of the ASCOT-Proxy, qualitative cognitive interviews were conducted with unpaid carers or care workers of people with cognitive or communication impairments. The proxy respondents were invited to ‘think aloud’ while completing the questionnaire. Follow-up probes were asked to elicit further detail of the respondent’s comprehension of the format, layout and content of each item and also how they weighed up the options to formulate a response. Results: A total of 25 unpaid carers and care workers participated in three iterative rounds of cognitive interviews. The findings indicate that the items were well-understood and the concepts were consistent with the item definitions for the standard self-completion version of ASCOT with minor modifications to the draft ASCOT-Proxy. The ASCOT-Proxy allows respondents to rate the proxy-proxy and proxy-patient perspectives, which improved the acceptability of proxy report. Conclusions: A new proxy-report version of ASCOT was developed with evidence of its qualitative content validity and acceptability. The ASCOT-Proxy is ready for empirical testing of its suitability for data collection as a self-completion and/or interview questionnaire, and also evaluation of its psychometric properties

Exploring the views of being a proxy from the perspective of unpaid carers and paid carers: developing a proxy version of the Adult Social Care Outcomes Toolkit (ASCOT)

Background: Outcomes-based policy and administration of public services present a compelling argument for the value of outcomes data. However, there are a number of challenges inherent in collecting these data from people who are unable to complete a paper-based survey or interview due to cognitive or communication impairments. In this paper, we explore the views of being a proxy from the perspective of unpaid carers and paid carers who may be asked to act as a proxy on behalf of the person(s) they care for. We consider the key issues that need to be addressed when adapting an instrument designed to measure social care outcomes, the Adult Social Care Outcomes Tool (ASCOT), into a proxy-report tool. Methods: Participants took part in either a focus group (35 paid carers in eight focus groups), or a one-to-one interview (eight unpaid carers). All participants were recruited via carer organisations and care providers. Transcripts, field notes and audio data collected during focus groups and interviews were analysed using a thematic framework approach. Results: Participants agreed that any person acting as a proxy would need to be very familiar with the care recipient, as well as their needs and care provision. A number of provisions for proxy respondents were proposed to improve face validity and acceptability of completing a questionnaire by proxy, and to ensure that any potential bias is reduced in the design of the questionnaire. These included: providing two sets of response options for each proxy perspective (the proxy themselves and the proxy view of how they think the care recipient would respond); a comments box to help people explain why they have selected a given response option (especially where these indicate unmet need); and providing clear guidance for the proxy respondent on how they should complete the questionnaire. Conclusions: This study has shown some of the challenges involved in assessing outcomes by proxy and explored some potential ways these can be mitigated. The findings highlight the benefits of developing and testing proxy measures in a robust way to widen participation in social care research

From hospitals to nursing homes – the consequences of the Care Coordination Reform

Background: The coordination reform was introduced in January 2012 to ensure sustainability of health and care services. The transfer of responsibility for treatment from the specialist to the primary health service formed a central pillar of the reform. This study compares the situation before and after the introduction of the coordination reform for frail elderly patients being transferred from hospitals to nursing homes, related to: 1) deaths, and 2) age, sex, days of hospitalization and discharge destination. Objective: Investigate possible differences in the population of patients transferred from hospitals to nursing homes before and after the introduction of the Care Coordination Reform. Method: The data were retrieved from a 35-bed short-term ward at one nursing home, where the procedures and staffing were unchanged in the period before and after the reform. Information on the patients' age, sex, days in the nursing home, discharge destination and death in the nursing home was retrospectively collected for 186 patients aged ? 70 years for the period before the introduction of the coordination reform, and for 177 patients after the introduction of the coordination reform. Results: We found that the number of patients who died in the nursing home after hospitalization doubled (27% versus 13%, p##less_than###0.002) following the introduction of the coordination reform. Compared with the situation before the reform, patients admitted after the reform were older (median 88 years (range 73-103) versus 85 years (range 70-99), p###less_than###0.001). Fewer patients were transferred to a different nursing home (21% versus 45%, p ###less_than### 0.001), and more were discharged to their own home (47% versus 36%, p = 0.04). Conclusion: Our results show that patients transferred from hospitals to nursing homes after the introduction of the coordination reform were older. Moreover, more patients died during short-term stays in nursing homes after being transferred from hospitals. There is reason to assume that these results have consequences for the needs for competence and staffing in nursing homes

Patient’s and health care provider’s perspectives on music therapy in palliative care – an integrative review

Abstract Background The use of music as therapy in multidisciplinary end-of-life care dates back to the 1970s and nowadays music therapy (MT) is one of the most frequently used complementary therapy in in-patient palliative care in the US. However existing research investigated music therapy’s potential impact mainly from one perspective, referring to either a quantitative or qualitative paradigm. The aim of this review is to provide an overview of the users’ and providers’ perspectives on music therapy in palliative care within one research article. Methods A systematic literature search was conducted using several databases supplemented with a hand-search of journals between November 1978 and December 2016. Inclusion criteria were: Music therapy with adults in palliative care conducted by a certified music therapist. Both quantitative and qualitative studies in English, German or a Scandinavian language published in peer reviewed journals were included. We aimed to identify and discuss the perspectives of both patients and health care providers on music therapy’s impact in palliative care to forward a comprehensive understanding of it’s effectiveness, benefits and limitations. We investigated themes mentioned by patients within qualitative studies, as well as commonly chosen outcome measures in quantitative research. A qualitative approach utilizing inductive content analysis was carried out to analyze and categorize the data. Results Twelve articles, reporting on nine quantitative and three qualitative research studies were included. Seven out of the nine quantitative studies investigated pain as an outcome. All of the included quantitative studies reported positive effects of the music therapy. Patients themselves associated MT with the expression of positive as well as challenging emotions and increased well-being. An overarching theme in both types of research is a psycho-physiological change through music therapy. Conclusions Both quantitative as well as qualitative research showed positive changes in psycho-physiological well-being. The integration of the users´ and providers´ perspectives within future research applicable for example in mixed-methods designs is recommended

Palkanmaksuohjelma Hilant Oy:lle

Opinnäytetyön tarkoituksena oli määritellä, suunnitella ja toteuttaa tietokantapohjainen internetselaimella toimiva ohjelma Hilant Oy:n palkanlaskijalle. Ohjelman tarkoitus on saada tulostettua työntekijälle palkkalaskelma. Järjestelmään syötetään tarvittavat työntekijäntiedot sekä palkkajaksoon kuuluvat tulot ja vähennykset. Lopuksi ohjelma laskee palkansaajalle tarvittavat laskut sekä tulostaa valmiin palkkalaskelman työntekijälle. Web-selaimella toimiva käyttöliittymä toteutettiin käyttämälle seuraavia ohjelmointikieliä: HTML, CSS, JavaScript ja PHP. Tietokanta luotiin HeidiSQL-ohjelmalla. Toteutuksessa tarvittiin osaamista Web-ohjelmoinnista, sekä tietokantakyselyistä. Opinnäytetyön tuloksena syntyi määrittelyjen mukainen ohjelma.This thesis purpose of define, design and implement a database internet browser program for Hilant Ltd’s. Programs purpose is get payslip for employee. At first you enter the necessary employee data and what need the payslip. Then programs calculate and print payslip for employee. Web-browser interface was imlemented using the following programlanguages HTML, CSS, JavaScript and PHP. The database was created HeidiSQL program. Projects needed expertise in web programming and database queries. Ready program was within specifications