A Comprehensive User Modeling Framework and a Recommender System for Personalizing Well-Being Related Behavior Change Interventions: Development and Evaluation

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VALO Work tilallisena ratkaisuna : Fyysiset, kognitiiviset, sosiaaliset ja mentaaliset tekijät aivotyön näkökulmasta

Toimistotyötiloissa tarvitaan hyvät olosuhteet niin keskittymistä vaativiin työtehtäviin kuin yhdessä työskentelyn tilanteisiin, joissa keskustellaan ja vaihdetaan ajatuksia. Tässä tutkimuksessa tarkasteltiin toimistotilaympäristöä tilamittausten, kyselyiden, haastatteluiden ja asiantuntija-arviointien avulla aivotyön sujuvuuden ja kuormituksen näkökulmasta. Tutkimuksen kohteena oli VALO Work monitilaympäristö, joka sisältää erilaisia tilatyyppejä sekä erillisiä työhuoneita. Tutkimuksen toteuttivat Työterveyslaitos ja VTT. Sisäilmastomittauksilla tutkittiin lämpötilaa, suhteellista kosteutta, hiilidioksidipitoisuutta, liikettä ja äänitasoa. Kyselyillä selvitettiin tilan käyttäjien työtä sekä käyttäjien arvioita eri tiloista ja niissä työskentelystä. Asiantuntija-arvioinnissa tiloja tarkasteltiin sujuvan aivotyön ja kognitiivisen ergonomian näkökulmasta havainnoimalla ja haastatteluilla. Tulokset toivat esiin, että sisäilmaston osalta mittaukset kaikkien mitattujen suureiden osalta pysyivät erinomaisesti tavoitearvojen puitteissa, yli 90% todellisesta mitatusta tilojen käyttöajasta. Hälyn taso ja liikkeen määrä olivat eri tilojen eri käyttötarkoitusten mukaiset. Myös tilojen käyttäjien kokemukset vastasivat tilamittauksia. Kyselytulosten perusteella työ sujuu VALOn tiloissa keskimäärin hieman paremmin kuin sen ulkopuolella. Kaiken kaikkiaan tulokset osoittavat, että VALO Work on toimistoympäristö, jossa on erinomaiset olosuhteet monenlaisille vaativille aivotyön tehtäville. Tilakokonaisuudessa on hyvät puitteet myös hyvinvointia ja työkykyä ylläpitäville tauoille, vapaa-ajalle ja yöpymiseen. Jatkossa olisi hyödyllistä kiinnittää huomiota myös keinoihin, joilla käyttäjiä ohjataan tilojen monipuoliseen ja tarkoituksenmukaiseen käyttöön, jotta työskentely on sujuvaa, tuloksellista ja terveellistä

Cardiopulmonary Resuscitation in Adults Over 80 : Outcome and the Perception of Appropriateness by Clinicians

OBJECTIVES To determine the prevalence of clinician perception of inappropriate cardiopulmonary resuscitation (CPR) regarding the last out-of-hospital cardiac arrest (OHCA) encountered in an adult 80 years or older and its relationship to patient outcome. DESIGN Subanalysis of an international multicenter cross-sectional survey (REAPPROPRIATE). SETTING Out-of-hospital CPR attempts registered in Europe, Israel, Japan, and the United States in adults 80 years or older. PARTICIPANTS A total of 611 clinicians of whom 176 (28.8%) were doctors, 123 (20.1%) were nurses, and 312 (51.1%) were emergency medical technicians/paramedics. RESULTS AND MEASUREMENTS The last CPR attempt among patients 80 years or older was perceived as appropriate by 320 (52.4%) of the clinicians; 178 (29.1%) were uncertain about the appropriateness, and 113 (18.5%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the "appropriate" subgroup was 8 of 265 (3.0%), 1 of 164 (.6%) in the "uncertain" subgroup, and 2 of 107 (1.9%) in the "inappropriate" subgroup (P = .23); 503 of 564 (89.2%) CPR attempts involved non-shockable rhythms. CPR attempts in nursing homes accounted for 124 of 590 (21.0%) of the patients and were perceived as appropriate by 44 (35.5%) of the clinicians; 45 (36.3%) were uncertain about the appropriateness; and 35 (28.2%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the nursing home patients was 0 of 107 (0%); 104 of 111 (93.7%) CPR attempts involved non-shockable rhythms. Overall, 36 of 543 (6.6%) CPR attempts were undertaken despite a known written do not attempt resuscitation decision; 14 of 36 (38.9%) clinicians considered this appropriate, 9 of 36 (25.0%) were uncertain about its appropriateness, and 13 of 36 (36.1%) considered this inappropriate. CONCLUSION Our findings show that despite generally poor outcomes for older patients undergoing CPR, many emergency clinicians do not consider these attempts at resuscitation to be inappropriate. A professional and societal debate is urgently needed to ensure that first we do not harm older patients by futile CPR attempts.Peer reviewe

Soluble urokinase plasminogen activator receptor and lactate as prognostic biomarkers in patients presenting with non-specific chief complaints in the pre-hospital setting - the PRIUS-study

Background: Emergency Medical Services (EMS) are faced daily with patients presenting with non-specific chief complaints (NSC). Patients presenting with NSCs often have normal vital signs. It has previously been established that NSCs may have a serious underlying condition that has yet to be identified. The aim of the current study was to determine if soluble urokinase plasminogen activator receptor (suPAR) and lactate could be used to identify serious conditions among patients presenting with NSCs to the EMS. The secondary aim was to describe the prognostic value for mortality in the group. Method: A blinded prospective observational cohort study was conducted of patients brought to the ED by ambulance after calling the national emergency number 112 and who were assessed as having NSC by the EMS. Biomarkers were measured during index EMS assessment before transportation to the ED. Patients were followed via EMS and hospital electronic health records. Descriptive and logistic regression analyses were used. Results: A total of 414 patients were included, with a median age of 82 years. A serious condition was present in 15.2% of the patients. Elevated suPAR above 3 ng/ml had a positive likelihood ratio (LR+) of 1.17 and a positive predictive value (PPV) of 17.3% as being predictive of a prevalent serious condition. Elevated suPAR above 9 ng/ml had LR+ 4.67 and a PPV of 16.7% as being predictive of 30-day mortality. Lactate was not significantly predictive. Conclusion: Pre-hospital suPAR and lactate cannot differentiate serious conditions in need of urgent treatment and assessment in the ED among patients presenting with non-specific chief complaints. suPAR has shown to be predictive of 30-day mortality, which could add some value to the clinical assessment.Peer reviewe

Kotona asumista tukevat teknologiat ikäihmisille: KATI-viitearkkitehtuuri

Ikääntyneiden henkilöiden kotona asumista, toimintakyvyn ylläpitoa ja heille kotiin tuotavia palveluja voidaan tukea ja mahdollistaa teknologian avulla eri tavoin. Kotona asumisen teknologiat ikäihmisille (KATI) -viitearkkitehtuuri on tarkoitettu hyvinvointialueille ja muille toimijoille, jotka kehittävät toimintamalleja ja palveluja iäkkäiden henkilöiden kotona asumisen ja hyvinvoinnin tueksi sekä parantamaan palvelujen saatavuutta ja yhdenvertaisuutta. Tavoitteena on, että palveluissa teknologia ja toimintamallit integroidaan saumattomaksi palvelukokonaisuudeksi tuottamaan käyttäjilleen hyötyä ja hyvinvointia. Viitearkkitehtuuri taustoittaa teknologian hyödyntämisen mahdollisuuksia, kuvaa kansallisia strategioita ja linjauksia sekä luonnostelee vision, miten teknologia voi olla luonteva osa iäkkään henkilön itsenäistä kotona asumista ja palvelujen tarjoamista kotiin. Teknologian käyttöönotossa huomioitava lainsäädäntökehys kuvataan odotettuine muutostarpeineen. Samoin kuvataan keskeiset kotona asumisen teknologiaratkaisuja kehittävät ja hyödyntävät toimijat, päätietoryhmät ja tietovarannot sekä tietojärjestelmäkokonaisuus. Lopuksi ehdotetaan jatkotoimenpiteitä viitearkkitehtuurin hyödyntämiseksi ja teknologian käyttöönottamiseksi ikääntyvän väestön tukena. Viitearkkitehtuuri ja kansallinen KATI-toimintamalli täydentävät toisiaan

Investigation of municipal solid waste (MSW) and industrial landfills as a potential source of secondary raw materials

Many of the secondary raw materials (SRM) in landfills constitute valuable and scarce natural resources. It has already been recognised that the recovery of these elements is critical for the sustainability of a number of industries and SRM recov¬ery from anthropogenic waste deposits represents a significant opportunity. In this study, the characterisation of the different waste fractions and the amount of SRM that can potentially be recovered from two landfill sites in Finland is presented. The first site was a municipal solid waste (MSW) landfill site and it was specifically in¬vestigated for its metals, SRM, plastics, wood, paper, and cardboard content as well as its fine fraction (<20 mm). The second site was an industrial landfill site contain¬ing residual wastes from industrial processes including 1) aluminium salt slag from refining process of aluminium scrap and 2) shredding residues from automobiles, household appliances and other metals containing waste. This site was investigated for its metals and SRM recovery potential as well as its fine fraction. Results suggest that the fine fraction offers opportunities for metal (Cr, Cu, Ni, Pb, and Zn) and SRM extraction and recovery from both landfill site types while the chemical composition of the industrial waste landfill offered greater opporutinity as it was comparable to typical aluminium salt slags. Nevertheless, the concentrations of rare earth metals (REE) and other valuable elements were low even in comparison with the concentra¬tions found in the Earth’s crust. Therefore mining landfill sites only for their metals or SRM content is not expected to be financially viable. However, other opportunities, such as waste-derived fuels from excavated materials especially at MSW landfill sites, still exists and fosters the application and feasibility of landfill mining

Improving distribution models of riparian vegetation with mobile laser scanning and hydraulic modelling

This study aimed at illustrating how direct measurements, mobile laser scanning and hydraulic modelling can be combined to quantify environmental drivers, improve vegetation models and increase our understanding of vegetation patterns in a sub-arctic river valley. Our results indicate that the resultant vegetation models successfully predict riparian vegetation patterns (Rho = 0.8 for total species richness, AUC = 0.97 for distribution) and highlight differences between eight functional species groups (Rho 0.46–0.84; AUC 0.79–0.93; functional group-specific effects). In our study setting, replacing the laser scanning-based and hydraulic modelling-based variables with a proxy variable elevation did not significantly weaken the models. However, using directly measured and modelled variables allows relating species patterns to e.g. stream power or the length of the flood-free period. Substituting these biologically relevant variables with proxies mask important processes and may reduce the transferability of the results into other sites. At the local scale, the amount of litter is a highly important driver of total species richness, distribution and abundance patterns (relative influences 49, 72 and 83%, respectively) and across all functional groups (13–57%; excluding lichen species richness) in the sub-arctic river valley. Moreover, soil organic matter and soil water content shape vegetation patterns (on average 16 and 7%, respectively). Fluvial disturbance is a key limiting factor only for lichen, bryophyte and dwarf shrub species in this environment (on average 37, 6 and 10%, respectively). Fluvial disturbance intensity is the most important component of disturbance for most functional groups while the length of the disturbance-free period is more relevant for lichens. We conclude that striving for as accurate quantifications of environmental drivers as possible may reveal important processes and functional group differences and help anticipate future changes in vegetation. Mobile laser scanning, high-resolution digital elevation models and hydraulic modelling offer useful methodology for improving correlative vegetation models.</p

Effect of small-scale snow surface roughness on snow albedo and reflectance

The primary goal of this paper is to present a model of snow surface albedo accounting for small-scale surface roughness effects. The model is based on photon recollision probability, and it can be combined with existing bulk volume albedo models, such as Two-streAm Radiative Trans-fEr in Snow (TARTES). The model is fed with in situ measurements of surface roughness from plate profile and laser scanner data, and it is evaluated by comparing the computed albedos with observations. It provides closer results to empirical values than volume-scattering-based albedo simulations alone. The impact of surface roughness on albedo increases with the progress of the melting season and is larger for larger solar zenith angles. In absolute terms, small-scale surface roughness can decrease the total albedo by up to about 0.1. As regards the bidirectional reflectance factor (BRF), it is found that surface roughness increases backward scattering especially for large solar zenith angle values