Machine-learning based reconstructions of primary and secondary climate variables from North American and European fossil pollen data.

We test several quantitative algorithms as palaeoclimate reconstruction tools for North American and European fossil pollen data, using both classical methods and newer machine-learning approaches based on regression tree ensembles and artificial neural networks. We focus on the reconstruction of secondary climate variables (here, January temperature and annual water balance), as their comparatively small ecological influence compared to the primary variable (July temperature) presents special challenges to palaeo-reconstructions. We test the pollen-climate models using a novel and comprehensive cross-validation approach, running a series of h-block cross-validations using h values of 100-1500 km. Our study illustrates major benefits of this variable h-block cross-validation scheme, as the effect of spatial autocorrelation is minimized, while the cross-validations with increasing h values can reveal instabilities in the calibration model and approximate challenges faced in palaeo-reconstructions with poor modern analogues. We achieve well-performing calibration models for both primary and secondary climate variables, with boosted regression trees providing the overall most robust performance, while the palaeoclimate reconstructions from fossil datasets show major independent features for the primary and secondary variables. Our results suggest that with careful variable selection and consideration of ecological processes, robust reconstruction of both primary and secondary climate variables is possible.

Abrupt high-latitude climate events and decoupled seasonal trends during the Eemian.

The Eemian (the Last Interglacial; ca. 129-116 thousand years ago) presents a testbed for assessing environmental responses and climate feedbacks under warmer-than-present boundary conditions. However, climate syntheses for the Eemian remain hampered by lack of data from the high-latitude land areas, masking the climate response and feedbacks in the Arctic. Here we present a high-resolution (sub-centennial) record of Eemian palaeoclimate from northern Finland, with multi-model reconstructions for July and January air temperature. In contrast with the mid-latitudes of Europe, our data show decoupled seasonal trends with falling July and rising January temperatures over the Eemian, due to orbital and oceanic forcings. This leads to an oceanic Late-Eemian climate, consistent with an earlier hypothesis of glacial inception in Europe. The interglacial is further intersected by two strong cooling and drying events. These abrupt events parallel shifts in marine proxy data, linked to disturbances in the North Atlantic oceanic circulation regime.

Development spots in communication during the management of the intrapartum period: An interpretive multiple case study in a developing context.

BACKGROUND: Health care activities are influenced by information communication between women during pregnancy, birth and motherhood and skilled birth attendants (SBAs) and further, between the health care workers during the continuum of care. Therefore, effective information communication processes (ICP) within and between health care facilities are a requirement for appropriate management of patients or clients. The management of the intrapartum period requires swift responses while managing critical information required for further referral and management processes. The involvement of multiple actors at different times with the same client carries the risk of communication breakdown at different points and at different levels of care. The information communicated during the intrapartum period is critical and should be accurate, timely and more importantly appropriate to enable better maternal and neonatal outcomes. PURPOSE: The purpose of this article is to discuss the complexities around ICP identified within a developing context that influence the management of the intrapartum period. METHODS: Multi-method, multiple case study approach was used to analyse two case studies. Only the challenges from one case study (A) are discussed in this article. In-depth interviews were conducted with the SBAs. The role of observer-as-participant was utilised during the observation; field notes and document review methods were used to gather the data. Thematic analysis and activity analysis were applied to analyse the data. RESULTS: The findings identified challenges with information and communication that influenced the management of the intrapartum period. CONCLUSION: This study exhibited the challenges identified as development points that can influence the management of the intrapartum period. These challenges were also identified as desirable changes from the present state depending on the perspective of the actor.

Reliability of temperature signal in various climate indicators from northern Europe.

We collected relevant observational and measured annual-resolution time series dealing with climate in northern Europe, focusing in Finland. We analysed these series for the reliability of their temperature signal at annual and seasonal resolutions. Importantly, we analysed all of the indicators within the same statistical framework, which allows for their meaningful comparison. In this framework, we employed a cross-validation procedure designed to reduce the adverse effects of estimation bias that may inflate the reliability of various temperature indicators, especially when several indicators are used in a multiple regression model. In our data sets, timing of phenological observations and ice break-up were connected with spring, tree ring characteristics (width, density, carbon isotopic composition) with summer and ice formation with autumn temperatures. Baltic Sea ice extent and the duration of ice cover in different watercourses were good indicators of winter temperatures. Using combinations of various temperature indicator series resulted in reliable temperature signals for each of the four seasons, as well as a reliable annual temperature signal. The results hence demonstrated that we can obtain reliable temperature information over different seasons, using a careful selection of indicators, combining the results with regression analysis, and by determining the reliability of the obtained indicator.

Newtonian boreal forest ecology: The Scots pine ecosystem as an example.

Isaac Newton's approach to developing theories in his book Principia Mathematica proceeds in four steps. First, he defines various concepts, second, he formulates axioms utilising the concepts, third, he mathematically analyses the behaviour of the system defined by the concepts and axioms obtaining predictions and fourth, he tests the predictions with measurements. In this study, we formulated our theory of boreal forest ecosystems, called NewtonForest, following the four steps introduced by Newton. The forest ecosystem is a complicated entity and hence we needed altogether 27 concepts to describe the material and energy flows in the metabolism of trees, ground vegetation and microbes in the soil, and to describe the regularities in tree structure. Thirtyfour axioms described the most important features in the behaviour of the forest ecosystem. We utilised numerical simulations in the analysis of the behaviour of the system resulting in clear predictions that could be tested with field data. We collected retrospective time series of diameters and heights for test material from 6 stands in southern Finland and five stands in Estonia. The numerical simulations succeeded to predict the measured diameters and heights, providing clear corroboration with our theory.

The expected and actual communication of health care workers during the management of intrapartum: An interpretive multiple case study.

BACKGROUND: Daily activities within a health care organisation are mediated by information communication processes (ICP) involving multiple health care professionals at different levels of care. Effective perinatal management requires critical information to be accurately communicated. If there is a breakdown in this communication patient safety is at risk for various reasons such as: inadequate critical information, misconception of information and uninformed decisions being made. The purpose of this study was to interpret the complexities around ICP in order to contribute to the effective management of the intrapartum period. METHODS: Multi method, multiple case study approach was used to understand the ICP during the management of the intrapartum period. During the study, the expected ICP, the actual ICP, the challenges involved and the desired ICP were analysed. Twenty-four in-depth interviews with skilled birth attendants (SBAs) employing observer-as-participant roles, field notes, and document review methods were utilised to gather the data. Thematic analysis was utilised to analyse the data using Atlas TI software. RESULTS: The study revealed three subthemes which emerged from the expected ICP, whilst three others that emerged formed the theme actual ICP. The subthemes from the expected ICP included: accessibility of obstetric services, expected referral, recommended tools, expected communication and expected documentation. The theme actual ICP held three emerging subthemes: the handover processes, collaborative information seeking, information communicated and referral processes. CONCLUSION: This study showed that what was expected was not what was actually happening. The requirements of the policies and protocols need to be effectively implemented to improve practice building these into current biomedical guidelines.

User participation in healthcare IT development: a developers' viewpoint in Finland.

BACKGROUND AND PURPOSE: Recent research showed that physicians in Finland were highly critical of their information technology (IT) systems. They were also critical of the methods of collaboration with the developers of the health IT systems (HITS) in use at the time of the questionnaire. This study turned the set-up around and asked systems developers the same questions about collaboration. What is developers' view on end user participation in HITS development at the moment? How would developers wish end users to participate in systems development? Do the developers' views differ from the physicians' (end users') views of the current state of collaboration in developing IT systems? METHODS: A web-based questionnaire study was conducted in one of the major HITS provider companies in Finland among all developers, including software developers and customer support and sales personnel. Both quantitative and free-text questions of a previous study were adapted for the purpose. The responses were analyzed with qualitative and basic quantitative methods. RESULTS: The response rate of the questionnaire was 37% and 136 responses were received. The developers who responded were experienced workers; 81% of the respondents had 6 years or more of work experience in IT systems development and 35% of them had 6 years or more of work experience in the healthcare domain. Almost three-quarters (72%) of the respondents agreed with the statement 'I work with users'. Almost all the developers (90%) thought that they are interested in user feedback and also 81% thought that they take the end users' opinions and experiences into account when developing software. A majority of the developers (57%) considered that corrections and modifications are currently not implemented quickly enough. The most popular means of user participation were that 'users would present their work and needs related to it in their workplace' (76%), followed by user groups (75%). The developers suggested many traditional user-centered and usability design methods, too. The developers' views were compared to the views of the physicians who primarily used the case company's products. The views were in direct opposition on whether developers are interested in end users' views (90% of the developers agreed, vs. 60% of the physicians disagreed) and take them into account (81% of the developers agreed, vs. 63% of the physicians disagreed), as well as on user groups (favored by 75% of the developers vs. 14% of the physicians). The majority of the respondents, both developers (57%) and physicians (74%), were dissatisfied with the pace of implementation of corrections and modifications. CONCLUSIONS: Both physicians and developers seem to be "willing but not able" to collaborate with each other. Possible reasons for the differences in views include the fact that there is no return channel of communication on what happened to the end users' feedback, and that developers collaborate with customer representatives who are not end users. It is obvious that there are one or more spots along the route between the "end developers" and end users where there is a breakdown of the information flow.

How to co-develop services, work, and information systems in healthcare: the daisy approach.

Information systems in healthcare need to be designed and developed in a collaborative way. However, existing collaborative methodologies for the parallel development of healthcare work and information systems are vague and fragmented. Furthermore, they neither address people-centred healthcare nor limited-resource contexts. In this paper we introduce an emerging holistic approach, based on a unifying theoretical basis, for co-developing the services, work and information systems in healthcare. The approach intends to (a) be collaborative in nature; (b) address the domains of both healthcare professionals and ordinary people / communities; (c) span the main analysis and design tasks of socio-technical information systems development from needs assessment through requirements setting to functional-architectural solutions; (d) be contextually sensitive; and (e) be practicable in "real life" beyond research settings.

Guidelines to encourage the adoption and meaningful use of health information technologies in the South African healthcare landscape.

There are various benefits associated with the adoption and meaningful use of health information technologies (HITs) in the healthcare sector. Despite these benefits, the South African healthcare sector has been slow to adopt HITs such as electronic record systems. The purpose of this research project was to formulate guidelines to encourage the adoption and meaningful use of HITs in the South African healthcare landscape. A three-round Delphi study was conducted to identify factors that should be addressed to encourage the adoption and meaningful use of HITs in the South African healthcare landscape. The Delphi panel included 21 participants that were considered to be suitably knowledgeable regarding the area under consideration. Consensus was reached on 42 factors that were rated as having a direct to significant impact on the adoption and meaningful use of HITs in the South African context. These factors were further analysed to formulate 20 guidelines that indicate that there are a wide range of factors that would have to be addressed involving a multitude of stakeholders.

Physicians' experiences of participation in healthcare IT development in Finland: willing but not able.

OBJECTIVE: To learn (1) about the kind of experiences that physicians have with participation in healthcare IT development; (2) whether physicians are interested in participating in IT development activities, and if so, how; and (3) the visions that physicians have regarding future IT systems. METHODS: A web-based questionnaire which was answered by about one-third of the working-age physicians in Finland, which is exceptionally broad and sizeable a sample. This research deals with only a small part of the entire questionnaire. The questions used for this study were both quantitative and qualitative. Statistical methods were applied to the former and content analysis to the latter. RESULTS: The responding physicians were highly critical of their IT systems, and their experiences with the current methods of participation, or rather the lack of it, were quite negative. However, a very significant proportion of the respondents were willing to contribute to IT systems development, contrary to a common assumption that clinicians are disinterested. Visioning of future systems was quite cautious, dealing mainly with usability improvements to the current systems. CONCLUSIONS: Major improvements are needed both in the usability of the systems currently in use in Finland and in the collaboration between end-users and developers. Improved methods of participation need to be developed and applied, particularly for the procurement, deployment and on-going development of commercial-off-the-shelf applications.

Assessing the role of a site visit in adopting activity driven methods.

Healthcare activities rely heavily on socio-technical information systems. Such systems should be developed according to a socio-technical approach. The Activity Driven (AD) approach has been developed to contribute to the early phases of information system development in healthcare. Multi-professional and multi-disciplinary education in teams has been used to introduce the approach to prospective analysts, including "lay" healthcare professionals. 'Almost real life cases' have been emphasized as promoters of learning. This paper reports on a study on site visits as a crucial element for adopting socio-technical methods of analysis in healthcare. The paper presents feedback collected from an intensive course on health information systems development held in Mozambique. The results indicate the high importance of site visits - not only as a starting point of system analysis but also as a crucial promoter to learning socio-technical methods. Based on the results, needs for improvements are identified to the usability of AD tools and to the practical arrangements of site visits.

Information needs in home based healthcare in South Africa.

Home based health care (HBHC) is advocated by the WHO "to ensure better accessibility to effective and efficient health care in community and home-settings to improve health and well-being, and contribute to morbidity and mortality reduction". In South Africa the government and many other role players see an increasingly important role for HBHC. Many researchers believe that the evolution of HBHC will follow the socio-technical network evolution. There can be no doubt that the focus is on using information and communication technologies (ICT) to implement HBHC solutions. The objective of this paper is to provide a rich picture of the current situation and needs for improvement in HBHC in South Africa today through descriptive research in one specific case. The longer-term purpose is to identify pain-points that require socio-technical solutions, including but not exclusively ICT-supported solutions.

Participatory interaction design in user requirements specification in healthcare.

Healthcare information systems are accused of poor usability even in the popular media in Finland. Doctors especially have been very critical and actively expressed their opinions in public. User involvement and user-centered design methods are seen as the key solution to usability problems. In this paper we describe a research case where participatory methods were experimented within healthcare information systems development in medicinal care in a hospital. The study was part of a larger research project on Activity-driven Information Systems Development in healthcare. The study started by finding out about and modeling the present state of medicinal care in the hospital. After that it was important to define and model the goal state. The goal state, facilitated by the would-be software package, was modeled with the help of user interface drawings as one way of prototyping. Traditional usability methods were extended during the study. According to the health professionals' feedback, the use of participatory and user-centered interaction design methods, particularly user interface drawings enabled them to describe their requirements and create common understanding with the system developers.

A socio-technical approach to continuity of care and electronic records in the South African context.

Paper-based techniques of record keeping are contributing greatly to the discontinuity of patient care among healthcare providers. To achieve continuity, access to the information contained in medical records collected by various healthcare providers is necessary. To improve the sharing of information contained in these medical records the use of electronic methods of record keeping as opposed to paper-based records becomes very important. Even though the benefits of using electronic methods of record keeping are widely documented, the majority of South African healthcare practitioners still use paper-based methods. This paper describes an explorative study to determine barriers to the adoption of electronic records in the private primary care sector of South Africa. An interpretive approach using a socio-technical systems theory perspective was used to conduct the study. Based on the analysis of the socio-technical subsystems in the South African context it was revealed that there is not sufficient information available on the barriers to adoption of electronic records and further research will be necessary to identify the barriers to the adoption of electronic records.

Gene expression profiles in asbestos-exposed epithelial and mesothelial lung cell lines.

BACKGROUND: Asbestos has been shown to cause chromosomal damage and DNA aberrations. Exposure to asbestos causes many lung diseases e.g. asbestosis, malignant mesothelioma, and lung cancer, but the disease-related processes are still largely unknown. We exposed the human cell lines A549, Beas-2B and Met5A to crocidolite asbestos and determined time-dependent gene expression profiles by using Affymetrix arrays. The hybridization data was analyzed by using an algorithm specifically designed for clustering of short time series expression data. A canonical correlation analysis was applied to identify correlations between the cell lines, and a Gene Ontology analysis method for the identification of enriched, differentially expressed biological processes. RESULTS: We recognized a large number of previously known as well as new potential asbestos-associated genes and biological processes, and identified chromosomal regions enriched with genes potentially contributing to common responses to asbestos in these cell lines. These include genes such as the thioredoxin domain containing gene (TXNDC) and the potential tumor suppressor, BCL2/adenovirus E1B 19kD-interacting protein gene (BNIP3L), GO-terms such as "positive regulation of I-kappaB kinase/NF-kappaB cascade" and "positive regulation of transcription, DNA-dependent", and chromosomal regions such as 2p22, 9p13, and 14q21. We present the complete data sets as Additional files. CONCLUSION: This study identifies several interesting targets for further investigation in relation to asbestos-associated diseases.

A participatory assessment of IS integration needs in maternity clinics using activity theory.

The design and development of information systems should focus on a wider context than merely one user group or organization. This is particularly the case with systems integration. A tentative description of the activity network, information needs, and user requirements should be acquired before any major changes are planned. Relatively rapid yet participatory methods are needed at this preliminary stage. In this article, we claim that activity theory offers a suitable framework for this. Subsequently, we present a qualitative study in which this approach was used, with focus on the practices of the information management within a maternity care activity network. The first aim was to elicit the most important integration needs in the existing information systems of Finnish maternity clinics. Secondly, we wanted to introduce a participatory approach to be utilized by the service-providing organizations themselves, rather than software companies or quality consultants. Data were collected in multi-professional group interviews. The results include information needs and communication problems as well as outlines for solutions in the systems integration of maternity clinics. Various tools of information management do not meet the concrete needs of health care work. Integration is needed on many levels, and it has to be adapted to the needs of numerous stakeholders. The applied activity-theoretical framework proved useful in describing such a multi-faceted system of information and its users. More research is needed on its wider applicability, particularly in situations where researchers are not active participants.

Integration models in health information systems: experiences from the PlugIT project.

Different approaches are available for the integration of existing health information systems (HIS) in integration projects. Within the PlugIT project in Finland, we have found it necessary to design and implement integration in a collaborative, multidisciplinary and open way. In this paper, we use some generic integration models and relate them to the methods, solutions and experiences of the project. We summarize the results from nine integration teams, methods development and supporting surveys and studies, and discuss these experiences to provide some guidelines for the HIS integration projects in general.

Gathering, structuring and describing information needs in home care: a method for requirements exploration in a "gray area".

The aim of our research is to develop a method for "requirements exploration"--gathering, structuring and describing requirements for information systems in previously weakly understood areas. In health care, information systems are usually developed for a single organization, or for information flow from one organization to another. In our case domain, multi-professional and multi-organizational home care, this approach is not very helpful. Moreover, home care takes place in "no-man's-land"; outside the organizations' infrastructure, in the customer's home, and technology is used scarcely. In this paper, we describe how information requirements were explored in this scantly understood domain by using an activity-theoretical approach. We also explain how this approach served our purposes. The method proved useful in grasping the network of activities and the information needs. The holistic nature of the method was particularly important, since technology is not the only solution to the needs we discovered.

Specification levels and collaborative definition for the integration of health information systems.

In this paper, we extend our previous work for defining interoperability for health information systems into proposed documentation levels for specifying integration, and a model for defining various interoperability aspects in collaboration between integrators, health service providers and system providers. We are using these models in defining solutions for a set of different integration needs in PlugIT project in Finland. We propose collaborative definition and clear levels of integration specifications to promote adequacy, consistency and efficiency of integration solutions and software component specifications in health information systems.

A process for specifying integration for multi-tier applications in healthcare.

Integration of the heterogeneous application systems in healthcare is needed to support the clinical and administrative work, patient-centric care, regional interoperability and utilisation of both valuable legacy systems and new technologies. The integration activity is complicated, and must be supported by flexible processes and methods. The integration methods should support the evaluation and specification of different integration approaches, standards and technologies on many interoperability levels. We introduce a process for specifying many integration decisions for a given integration situation. The process is part of an integration method, which is validated in PlugIT project in Finland.