Diabetes knowledge in nursing homes and home-based care services: a validation study of the Michigan Diabetes Knowledge Test adapted for use among nursing personnel

Background: Providing high-quality diabetes care in nursing homes and home-based care facilities requires suitable instruments to evaluate the level of diabetes knowledge among the health-care providers. Thus, the aim of this study was to examine the psychometric properties of the Michigan Diabetes Knowledge Test adapted for use among nursing personnel. Methods: The study included 127 nursing personnel (32 registered nurses, 69 nursing aides and 26 nursing assistants) at three nursing homes and one home-based care facility in Norway. We examined the reliability and content and construct validity of the Michigan Diabetes Knowledge Test. Results: The items in both the general diabetes subscale and the insulin-use subscale were considered relevant and appropriate. The instrument showed satisfactory properties for distinguishing between groups. Item response theory-based measurements and item information curves indicate maximum information at average or lower knowledge scores. Internal consistency and the item-total correlations were quite weak, indicating that the Michigan Diabetes Knowledge Test measures a set of items related to various relevant knowledge topics but not necessarily related to each other. Conclusions: The Michigan Diabetes Knowledge Test measures a broad range of topics relevant to diabetes care. It is an appropriate instrument for identifying individual and distinct needs for diabetes education among nursing personnel. The knowledge gaps identified by the Michigan Diabetes Knowledge Test could also provide useful input for the content of educational activities. However, some revision of the test should be considered.publishedVersio

Transportation and predation control structures the distribution of a key calanoid in the Nordic Seas

The largest Calanus species in the Nordic Seas is also the copepod for which we have the poorest knowledge. Recent studies have shown that C. hyperboreus is more likely of sub-Arctic rather than Arctic origins, and the Nordic Seas are part of its core distribution areas worldwide. Large size and high fat content makes C. hyperboreus important prey for planktivores, and the Nordic Seas serve as main feeding grounds for a considerable biomass of planktivorous fish. We develop an individual-based model (IBM) based on existing knowledge of growth and life history of C. hyperboreus, and couple the IBM to an ecosystem model system encompassing physics, a nutrients–phytoplankton–zooplankton–detritus (NPZD) model and an IBM of the Atlantic congener C. finmarchicus. Given the main circulation routes in the region, a key question we address in this study is why C. hyperboreus is measured in low abundances in the (presumably) more favourable Norwegian Sea environment. We show that a core population of C. hyperboreus in the Greenland Sea supplies individuals to both the Iceland and Norwegian Seas, and that most copepods will visit more than one of the three regions during their life time. Advective pathways through environmental gradients creates intraspecific variation in development rates as reported by in situ observational studies. Furthermore, our results suggest that low abundances in the Norwegian Sea are more likely controlled by top-down processes (predation) rather than environmental limitations on growth or resource competition with C. finmarchicus.publishedVersio

New insights into the Barents Sea Calanus glacialis population dynamics and distribution

Arctic copepods are major grazers and vital food for planktivores in polar ecosystems but challenging to observe due to remoteness and seasonal sea ice coverage. Models offer higher spatio-temporal resolution, and individual-based models (IBMs) are useful since they incorporate individual variability which characterizes most copepod populations. Here, we present an IBM of the Arctic copepod Calanus glacialis, a key secondary producer in polar regions of the Barents Sea. The model is coupled to a three-dimensional physical-biological model, and an IBM for the Atlantic congener C. finmarchicus. We use the model to fill seasonal “gaps” between discontinuous spatio-temporal sampling for studying the spatial and seasonal population dynamics. Our simulations suggest that, across the Atlantic and Arctic domains of this ecosystem, total population egg production peaks in July, and copepodid 3 is the main overwintering stage descending to deeper overwintering depths between July and September. Total population biomass peaks at 5 times higher carbon mass than the seasonal minimums and is driven by the seasonal build-up of biomass in stages C4, C5 and adults. Ocean currents spreads the population over a large area, though with a clear spatial separation between C. glacialis and C. finmarchicus in the northern and southern Barents Sea, respectively. There is a mixture between 1- and 2-years life cycles in the model population, and those who require two diapause phases to reach maturity have spent a larger part of their life north of 77°N, where temperatures are colder and the growth season shorter than further south. A remaining question is where the source population of C. glacialis in this ecosystem resides, and whether the population relies on local survival and reproduction or continuous supply from a source population outside the Barents Sea

New insights into the Barents Sea Calanus glacialis population dynamics and distribution

Arctic copepods are major grazers and vital food for planktivores in polar ecosystems but challenging to observe due to remoteness and seasonal sea ice coverage. Models offer higher spatio-temporal resolution, and individual-based models (IBMs) are useful since they incorporate individual variability which characterizes most copepod populations. Here, we present an IBM of the Arctic copepod Calanus glacialis, a key secondary producer in polar regions of the Barents Sea. The model is coupled to a three-dimensional physical-biological model, and an IBM for the Atlantic congener C. finmarchicus. We use the model to fill seasonal “gaps” between discontinuous spatio-temporal sampling for studying the spatial and seasonal population dynamics. Our simulations suggest that, across the Atlantic and Arctic domains of this ecosystem, total population egg production peaks in July, and copepodid 3 is the main overwintering stage descending to deeper overwintering depths between July and September. Total population biomass peaks at 5 times higher carbon mass than the seasonal minimums and is driven by the seasonal build-up of biomass in stages C4, C5 and adults. Ocean currents spreads the population over a large area, though with a clear spatial separation between C. glacialis and C. finmarchicus in the northern and southern Barents Sea, respectively. There is a mixture between 1- and 2-years life cycles in the model population, and those who require two diapause phases to reach maturity have spent a larger part of their life north of 77°N, where temperatures are colder and the growth season shorter than further south. A remaining question is where the source population of C. glacialis in this ecosystem resides, and whether the population relies on local survival and reproduction or continuous supply from a source population outside the Barents Sea.publishedVersio

Sequential Monte Carlo Methods for Bayesian Filtering

29th May 2008This thesis is written in LATEX 2ε with the ‘uib-mi-master ’ document class, developed by Karl Ove Hufthammer. It was compiled using pdfeTeX-1.21a on 29th May 2008. The body text is 11 point URW Palladio with small caps. The maths font is URW Palladio and Pazo Math, the heading font is HV Math, and the computer code font is Bera Mono. Acknowledgements I would first like to thank my supervisor Hans Arnfinn Karlsen for good guidance on my thesis and for many advices and insightful discussions about statistics in general over the last two years. I would also like to thank the following persons: Geir Storvik for mail correspondence. My fellow students for many hours of theoretical discussions and social activities: Andrea

A standard protocol for describing the evaluation of ecological models

Numerical models of ecological systems are increasingly used to address complex environmental and resource management questions. One challenge for scientists, managers, and stakeholders is to appraise how well suited these models are to answer questions of scientific or societal relevance, that is, to perform, communicate, or access transparent evaluations of ecological models. While there have been substantial developments to support standardised descriptions of ecological models, less has been done to standardise and to report model evaluation practices. We present here a general protocol designed to guide the reporting of model evaluation. The protocol is organised in three major parts: the objective(s) of the modelling application, the ecological patterns of relevance and the evaluation methodology proper, and is termed the OPE (objectives, patterns, evaluation) protocol. We present the 25 questions of the OPE protocol which address the many aspects of the evaluation process and then apply them to six case studies based on a diversity of ecological models. In addition to standardising and increasing the transparency of the model evaluation process, we find that going through the OPE protocol helps modellers to think more deeply about the evaluation of their models. From this last point, we suggest that it would be highly beneficial for modellers to consider the OPE early in the modelling process, in addition to using it as a reporting tool and as a reviewing tool.publishedVersio

Assessing fear of hypoglycemia in a population-based study among parents of children with type 1 diabetes – psychometric properties of the hypoglycemia fear survey – parent version

Background: In the treatment of childhood type 1 diabetes, being aware of the parents’ fear of hypoglycemia is important, since the parents’ fear may influence the management of treatment and the children’s blood glucose regulation. The availability of proper instruments to assess the parents’ fear of hypoglycemia is essential. Thus, the aim of this study was to examine the psychometric properties of the Hypoglycemia Fear Survey – Parent version (HFS-P). Methods: In a Norwegian population-based sample, 176 parents representing 102 children with type 1 diabetes (6–15 years old) completed the HFS-P, comprising a 15-item worry subscale and a 10-item behavior subscale. We performed exploratory and confirmatory factor analysis and further analysis of the scales’ construct validity, content validity and reliability. Results: The Norwegian version of the HFS-P had an acceptable factor structure and internal consistency for the worry subscale, whereas the structure and internal consistency of the behavior subscale was more questionable. The HFS-P subscales were significantly correlated (from moderately to weakly) with symptoms of emotional distress, as measured by the Hopkins Symptom Checklist – 25 items. The mothers scored higher than fathers on both HFS-P subscales, but the difference was not statistically significant for the worry subscale. Conclusions: The HFS-P worry subscale seems to be a valid scale for measuring anxiety-provoking aspects of hypoglycemia, and the validity of the HFS-P behavior subscale needs to be investigated further

Reliable classification of children’s fractures according to the comprehensive classification of long bone fractures by Müller

Background and purpose: Guidelines for fracture treatment and evaluation require a valid classification. Classifications especially designed for children are available, but they might lead to reduced accuracy, considering the relative infrequency of childhood fractures in a general orthopedic department. We tested the reliability and accuracy of the Müller classification when used for long bone fractures in children. Methods: We included all long bone fractures in children aged < 16 years who were treated in 2008 at the surgical ward of Stavanger University Hospital. 20 surgeons recorded 232 fractures. Datasets were generated for intra- and inter-rater analysis, as well as a reference dataset for accuracy calculations. We present proportion of agreement (PA) and kappa (K) statistics. Results For intra-rater analysis, overall agreement (Κ) was 0.75 (95% CI: 0.68–0.81) and PA was 79%. For inter-rater assessment, K was 0.71 (95% CI: 0.61–0.80) and PA was 77%. Accuracy was estimated: Κ = 0.72 (95% CI: 0.64–0.79) and PA = 76%. Interpretation: The Müller classification (slightly adjusted for pediatric fractures) showed substantial to excellent accuracy among general orthopedic surgeons when applied to long bone fractures in children. However, separate knowledge about the child-specific fracture pattern, the maturity of the bone, and the degree of displacement must be considered when the treatment and the prognosis of the fractures are evaluated

Transportation and predation control structures the distribution of a key calanoid in the Nordic Seas

The largest Calanus species in the Nordic Seas is also the copepod for which we have the poorest knowledge. Recent studies have shown that C. hyperboreus is more likely of sub-Arctic rather than Arctic origins, and the Nordic Seas are part of its core distribution areas worldwide. Large size and high fat content makes C. hyperboreus important prey for planktivores, and the Nordic Seas serve as main feeding grounds for a considerable biomass of planktivorous fish. We develop an individual-based model (IBM) based on existing knowledge of growth and life history of C. hyperboreus, and couple the IBM to an ecosystem model system encompassing physics, a nutrients–phytoplankton–zooplankton–detritus (NPZD) model and an IBM of the Atlantic congener C. finmarchicus. Given the main circulation routes in the region, a key question we address in this study is why C. hyperboreus is measured in low abundances in the (presumably) more favourable Norwegian Sea environment. We show that a core population of C. hyperboreus in the Greenland Sea supplies individuals to both the Iceland and Norwegian Seas, and that most copepods will visit more than one of the three regions during their life time. Advective pathways through environmental gradients creates intraspecific variation in development rates as reported by in situ observational studies. Furthermore, our results suggest that low abundances in the Norwegian Sea are more likely controlled by top-down processes (predation) rather than environmental limitations on growth or resource competition with C. finmarchicus