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Aim Machine learning techniques have demonstrated success in predictive modeling across various clinical cases. However, few studies have considered predicting the use of multisectoral health and social services among older adults. This research aims to utilize machine learning models to detect high-risk groups of excessive health and social services utilization at early stage, facilitating the implementation of preventive interventions.Methods We used pseudonymized data covering a four-year period and including information on a total of 33,374 senior citizens from Southern Finland. The endpoint was defined based on the occurrence of unplanned healthcare visits and the total number of different services used. Input features included individual’s basic demographics, health status and past usage of healthcare resources. Logistic regression and eXtreme Gradient Boosting (XGBoost) methods were used for binary classification, with the dataset split into 70% training and 30% testing sets.Results Subgroup-based results mirrored trends observed in the full cohort, with age and certain health issues, e.g. mental health, emerging as positive predictors for high service utilization. Conversely, hospital stay and urban residence were associated with decreased risk. The models achieved a classification performance (AUC) of 0.61 for the full cohort and varying in the range of 0.55–0.62 for the subgroups.Conclusions Predictive models offer potential for predicting future high service utilization in the older adult population. Achieving high classification performance remains challenging due to diverse contributing factors. We anticipate that classification performance could be increased by including features based on additional data categories such as socio-economic data.

Abstract Background To compare the diagnostic value of 120-kV with conventional 96-kV Cone-Beam CT (CBCT) of the temporal bone after cochlear implant (CI) surgery. Methods This retrospective study included CBCT scans after CI surgery between 06/17 and 01/18. CBCT allowed examinations with 96-kV or 120-kV; other parameters were the same. Two radiologists independently evaluated following criteria on 5-point Likert scales: osseous spiral lamina, inner and outer cochlear wall, semi-circular canals, mastoid trabecular structure, overall image quality, metal and motion artefacts, depiction of intracochlear electrode position and visualisation of single electrode contacts. Effective radiation dose was assessed. Results Seventy-five patients (females, n = 39 [52.0%], mean age, 55.8 ± 16.5 years) were scanned with 96-kV (n = 32, 42.7%) and 120-kV (n = 43, 57.3%) protocols including CI models from three vendors (vendor A n = 7; vendor B n = 43; vendor C n = 25). Overall image quality, depiction of anatomical structures, and electrode position were rated significantly better in 120-kV images compared to 96-kV (all p

Abstract Background There is a need for better adoption of technology to meet the needs of home care professionals, older people, and informal caregivers. Methods Mixed methods were used to describe and analyse quantitative and qualitative data in a Finnish governmental programme called KATI. The study was three-fold: it 1) listed what kinds of technologies were piloted and deployed in a national study, 2) provided information from the perspectives of home care professionals about requirements to use technology by using focus-group interviews, and 3) assessed experiences of how the adoption of technology changes work and work processes over time by using repeated surveys. Informants in interviews (n = 25) and surveys (n = 90) were home care professionals, who also described the perspectives of older people and informal caregivers. The conceptual models framing the study were adapted from the Technology Acceptance Model and DirVA PROVE-IT. Results There were 80 technology pilots, in which variety of technologies were followed in home care. Familiarity with, commitment to and understanding of technology benefits were considered to be requirements for the technology to be used. The adoption of technology provided new skills and information about older people’s wellbeing, realisation of treatment and new possibilities in home care. It developed new procedures to focus on older people’s needs and motivated professionals by gained concrete aid. It enabled them to leave out some concrete procedures as unnecessary. On the other hand, there were also pessimistic and negative experiences when technology use provided nothing new or did not change anything. Conclusions The adoption of technology is dependent on the technology and its integration into the prevailing service practice. When they both work, it is possible to leave out unnecessary procedures in care, allocate resources and save time. It is possible to be aware of older people’s safety and how they cope at home, find new ways to get involved in older people’s lives, gain insight, and make changes at work. Continuous on-site training, modifications in service practices and communication throughout organisations is needed.

The search for better compositions in high entropy alloys is a formidable challenge in materials science. Here, we demonstrate a systematic Bayesian optimization method to enhance the mechanical properties of the paradigmatic five-element Cantor alloy in silico. This method utilizes an automated loop with an online database, a Bayesian optimization algorithm, thermodynamic modeling, and molecular dynamics simulations. Starting from the equiatomic Cantor composition, our approach optimizes the relative fractions of its constituent elements, searching for better compositions while maintaining the thermodynamic phase stability. With 24 steps, we find Fe21Cr20Mn5Co20Ni34 with a yield stress improvement of 58%, and with 72 steps, we find Fe6Cr22Mn5Co32Ni35 where the yield stress has improved by 74%. These optimized compositions correspond to Ni-rich medium entropy alloys with enhanced mechanical properties and superior face-centered-cubic phase stability compared to the traditional equiatomic Cantor alloy. The automatic approach devised here paves the way for designing high entropy alloys with tailored properties, opening avenues for numerous potential applications.

Abstract Background Today, digitalisation is strongly present in health and social care, and it increasingly affects the organisation of work, work requirements, tasks and tools. Due to the constant change in work, up-to-date knowledge is needed about these micro-level effects of digitalisation and how professionals experience the effects in their work. Furthermore, even though managers play a key role in implementing new digital services, their perceptions of the effects of digitalisation and whether they match the views of professionals remain unknown. This study examined how health and social care professionals and managers perceive the effects of digitalisation on the work of professionals. Methods We used a qualitative approach and conducted eight semi-structured focus group interviews with health and social care professionals (n = 30) and 21 individual interviews with managers in 2020 in four health centres in Finland. The qualitative content analysis included both an inductive and a deductive approach. Results Digitalisation was perceived to have changed professionals’ 1) workload and pace, 2) the field and nature of work, 3) work community communication and interaction, and 4) information flow and security. Both professionals and managers identified effects such as accelerated work, reduction in workload, constant learning of technical skills, complicated work due to vulnerable information systems, and reduction in face-to-face encounters. However, managers did not bring up all the effects that professionals considered important, such as the creation of new work tasks, increased and duplicated work, or insufficient time to get acquainted with the systems. Conclusions The findings suggest that some of the effects of digitalisation on professionals’ work and changes in the workplace may receive too little or no recognition from managers. This increases the risk that the potential negative effects may be overlooked and that managers will adopt systems that do not support the work of professionals. To reach a common understanding of the effects of digitalisation, continuous discussions between employees and different management levels are required. This contributes to professionals’ well-being and adaptation to changes, as well as the provision of quality health and social services.

Abstract Background Multi slice computed tomography (MSCT) is the most common used method in middle ear imaging. However, MSCT lacks the ability to distinguish the ossicular chain microstructures in detail resulting in poorer diagnostic outcomes. Novel cone beam computed tomography (CBCT) devices’ image resolution is, on the other hand, better than MSCT resolution. The aim of this study was to optimize imaging parameters of a novel full body CBCT device to obtain optimal contrast to noise ratio (CNR) with low effective dose, and to optimize its clinical usability. Methods Imaging of five anonymous excised human cadaver temporal bones, the acquisition of the effective doses and the CNR measurements were performed for images acquired on using Planmed XFI® full body CBCT device (Planmed Oy, Helsinki, Finland) with a voxel size of 75 µm. All images acquired from the specimens using 10 different imaging protocols varying from their tube current exposure time product (mAs) and tube voltage (kVp) were analyzed for eight anatomical landmarks and evaluated by three evaluators. Results With the exception of protocol with 90 kVp 100 mAs, all other protocols used are competent to image the finest structures. With a moderate effective dose (86.5 µSv), protocol with 90 kV 450 mAs was chosen the best protocol used in this study. A significant correlation between CNR and clinical image quality of the protocols was observed in linear regression model. Using the optimized imaging parameters, we were able to distinguish even the most delicate middle ear structures in 2D images and produce accurate 3D reconstructions. Conclusions In this ex vivo experiment, the new Planmed XFI® full body CBCT device produced excellent 2D resolution and easily created 3D reconstructions in middle ear imaging with moderate effective doses. This device would be suitable for middle ear diagnostics and for e.g., preoperative planning. Furthermore, the results of this study can be used to optimize the effective dose by selecting appropriate exposure parameters depending on the diagnostic task.

Abstract Mimicking natural structures allows the exploitation of proven design concepts for advanced material solutions. Here, our inspiration comes from the anisotropic closed cell structure of wood. The bubbles in our fiber reinforced foam are elongated using temperature dependent viscosity of methylcellulose and constricted drying. The oriented structures lead to high yield stress in the primary direction; 64 times larger than compared to the cross direction. The closed cells of the foam also result in excellent thermal insulation. The proposed novel foam manufacturing process is trivial to up-scale from the laboratory trial scale towards production volumes on industrial scales.

Introduction: This paper analyses and discusses the models and tools in the Finnish health and social care system to identify the individuals who might benefit from integrated multidisciplinary care. Description: The analysis and discussion of the paper is based on a study which mapped and studied the models and tools in practice or under development for identification in the Finnish health and social care organizations. The study used electric survey and structured interviews as research methods. Discussion: There are several different established models of identification in Finland and the experiences of using them are mainly positive. However, only every third of health and social care organizations in Finland have defined a common model or tool. The identification practices and criteria vary by region, municipality and/or organization. The identification is in general unsystematic and insufficient in practice that may inhibit the individuals to access the integrated care they might benefit from. Conclusions: Models and tools are needed for founding and identifying individuals who are outside the service system, those whose client-ship has just begun, and those who already access services. The identification of individuals for integrated multidisciplinary care and the assimilation and understanding of different identification models and tools requires the development of basic and further competence in the different fields of health and social care. Multidisciplinary collaboration requires shared concepts and positive attitudes on the development of integrated professional environments, identification models and services. It is therefore also a question of shared working culture.

Objectives To highlight the detail obtained on a Cone Beam Computed Tomography (CBCT) scan of the craniocervical junction and its usefulness to Chiropractors who specialize in the upper cervical spine. A review of the dose considerations to patients vs radiography in a chiropractic clinical setting and to review the effective radiation dose to the patient. Methods A review of studies discussing cervical biomechanics, neurovascular structures, and abnormal radiographic findings, was discussed in relation to chiropractic clinical relevance. Further studies were evaluated demonstrating radiation dose to the patient from radiographs compared to CBCT. Results Incidental and abnormal findings of the craniocervical junction were shown to have superior visualization with CBCT compared to radiography. The radiation dose to the patient for similar imaging protocols to the craniocervical junction and cervical spine was equal or less utilizing CBCT when compared to radiographs. Conclusions The use of CBCT for visualization of the craniocervical junction and cervical spine in the chiropractic clinical setting allows for adjunctive visualization of the osseous structures which is germane to clinical protocol. Further with CBCT the effective dose to the patient is equal or less than similar imaging protocols utilizing radiographs to evaluate the craniocervical junction.

BackgroundAlthough the COVID-19 pandemic has significantly boosted the implementation of digital services worldwide, it has become increasingly important to understand how these solutions are integrated into professionals’ routine work. Professionals who are using the services are key influencers in the success of implementations. To ensure successful implementations, it is important to understand the multiprofessional perspective, especially because implementations are likely to increase even more. ObjectiveThe aim of this study is to examine health and social care professionals’ experiences of digital service implementations and to identify factors that support successful implementations and should be considered in the future to ensure that the services are integrated into professionals’ routine work. MethodsA qualitative approach was used, in which 8 focus group interviews were conducted with 30 health and social care professionals from 4 different health centers in Finland. Data were analyzed using qualitative content analysis. The resulting categories were organized under the components of normalization process theory. ResultsOur results suggested 14 practices that should be considered when implementing new digital services into routine work. To get professionals to understand and make sense of the new service, (1) the communication related to the implementation should be comprehensive and continuous and (2) the implementation process should be consistent. (3) A justification for the service being implemented should also be given. The best way to engage the professionals with the service is (4) to give them opportunities to influence and (5) to make sure that they have a positive attitude toward the service. To enact the new service into professionals’ routine work, it is important that (6) the organization take a supportive approach by providing support from several easy and efficient sources. The professionals should also have (7) enough time to become familiar with the service, and they should have (8) enough know-how about the service. The training should be (9) targeted individually according to skills and work tasks, and (10) it should be diverse. The impact of the implementation on the professionals’ work should be evaluated. The service (11) should be easy to use, and (12) usage monitoring should happen. An opportunity (13) to give feedback on the service should also be offered. Moreover, (14) the service should support professionals’ work tasks. ConclusionsWe introduce 14 practices for organizations and service providers on how to ensure sustainable implementation of new digital services and the smooth integration into routine work. It is important to pay more attention to comprehensive and continuing communication. Organizations should conduct a competence assessment before training in order to ensure proper alignment. Follow-ups to the implementation process should be performed to guarantee sustainability of the service. Our findings from a forerunner country of digitalization can be useful for countries that are beginning their service digitalization or further developing their digital services.

In fatigue fracture the crack growth is slow and in many materials exhibits apparent self-similarity as expressed by the dependence of the growth velocity on a stress intensity factor that grows with the crack size. We study the intermittency of fatigue crack dynamics in aluminium alloys by optical tracking. A power-law distribution of crack tip jumps is found with an exponent close to two and a cutoff which increases with time or crack propagation. The cutoff is related to the crack velocity. We show how such a distribution evolves or coarse grains with the scale of observation or time window. The correlations of the crack propagation imply short-range memory effects in the underlying dynamics. Our results show universal features of fatigue cracks and how these lead to the crack growth and failure in material samples.

Hourglasses measure time because the discharge rate of dry sand is constant. Here Koivistoet al. show that when such a system contains water there is a surge in discharge because the fluid drains faster than the grains, which might help us understand the transport of grains in silos.

Introduction: This research in progress studies the enactment of integrated care in the system-wide social and health care reform suggested by the government of Finland. In the new model the responsibility for organising social and health care will be transferred from the municipalities to the eighteen new counties, while the service delivery will be the responsibility of public, private and third sector organisations. The counties will have the responsibility for defining the service packages and chains on the basis of the needs of different client groups. The challenge for integrated care is that there will be multiple service providers from whose services a client’s service package or chain can be composed of. The preparation of the implementation of the model has started in the preliminary county organisations, while the new counties are planned to start their activity in January 2021. Theory and Methods: This research studies the social and health care system as systemic practices that constitute and mold each other. A model is studied as a script that defines the elements of a practice and their relations. A model is locally translated and adapted into practice. This research is based on a multi-case study setting which studies the implementation process in five counties. This first part of the research analysed during 2018 the strategies and means for defining the service packages and chains within five county organizations..Official public documents were analysed and thematic dialogues with the temporary county organisations were carried out. Results and discussion: There was uncertainty among the counties concerning what the government means by the service packages and chains. Every county had chosen the life span model as a ground for defining the service packages and chains: children and families, adults of working age, and elderly. Within this model definition of different sub-segments was under consideration. The challenge concerned especially how to identify the clients who need several different services. The present public service providers were extensively involved in the definition practices in every county, while there were differences between the counties who, organiser or provider, was leading the definition practice. The different client groups were heard in different occasions and forums in the counties, but they were not participating in the actual definition practices. Conclusions and lessons learnt: The counties were preparing the service packages and chains in extreme uncertainty because the suggested laws were not accepted in the parliament yet. So far they were in the beginning of the definition work. Segmentation, defining the service packages and chains on the basis of the needs of client groups, multifaceted utilization of knowledge, and above all the role of the counties as an organizer of services were new things which required time and learning. Limitations and suggestions for future research: This research defines generic socio-technical elements to be taken into account when implementing new models of integrated care. Later it will analyse how the way the service packages and chains have been defined constitutes preconditions, possibilities and challenges for enacting person-centered integrated care by the service providers.

Introduction: Since the early 2000s, Government policies in Finland have supported administrative and operative integration of health and social care to create larger authorities for organising services and to strengthen coordination of primary and specialised care, and social services. Nationally, the policies have led to attempts to reform the service system to support integration. At the local level, municipal collaboration has been launched to create regional joint health and social care authorities to boost administrative integration and to facilitate the implementation of innovative forms of integrated care. Of these local initiatives, we address two county level joint authorities which have established comprehensive integrated care organisations merging primary and specialised health care and social services under one management. Our aim is to evaluate the success and transferability of these initiatives. Methods: We focus on two vanguard counties, South and North Karelia, which have established joint health and social care authorities in Finland. In South Karelia the authority has operated since 2010 and in North Karelia since 2017. For the multimethod study, we collected intensively data on the operation of the joint authorities and health and social services provided particularly for client groups benefiting from integration. We compiled county policy and evaluation documents on health and social care, run an online survey among employees, and carried out individual and group interviews of management and employees. Results: The two counties have several common features including the population of 130,000-169,000 inhabitants, regions of a larger town with a specialised hospital and several rural municipalities. While both counties have intensively supported to care integration, they display differences in their approaches. South Karelia has gradually developed integrated services for focused client groups, such as homebased rehabilitation services for the elderly, integrated services for children and young people, and integrated psychosocial services for adults. In North Karelia, reorganised recently, integration has focused on integrated health and welfare centres bringing earlier separate primary and mental health care, and social and substance abuse services on the same premises. In both counties, preliminary experiences on adopting integrated care models are positive. Efficiency has improved and waiting time and costs decreased without deteriorating patient satisfaction. The early experiences also underline the importance of strengthened shared management to address smooth work processes between different professional groups. Discussion and conclusions: The establishment of the joint health and social care authorities with a strong emphasis on integrated care seems to be successful. The early experiences suggest a positive impact in terms of efficiency. Transferability particularly to larger urban municipalities is challenging to assess. The national health and social system reform currently prepared in Finland may include features, such as increasing privatisation and market-based services, which request changes in the integrated care models. Limitations: The study was based only on two county-based health and social care authorities with relatively similar integrated care models. Suggestions for future research: Due to limitations in case-studies, long-term broader follow-up studies are needed for assessing and comparing the impact and outcomes of different integrated care models.

The yielding of dry foams is enabled by small elementary yield events on the bubble scale, “T1”s. We study the large-scale detection of these in an expanding two-dimensional (2D) flow geometry using artificial intelligence (AI) and nearest neighbor analysis. A good level of accuracy is reached by the AI approach using only a single frame, with the maximum score for vertex centered images highlighting the important role the vertices play in the local yielding of foams. We study the predictability of T1s ahead of time and show that this is possible on a timescale related to the waiting time statistics of T1s in local neighborhoods. The local T1 event predictability development is asymmetric in time, and measures the variation of the local property to yielding and similarly the existence of a relaxation timescale after local yielding.

This article critically discusses the intellectual and conceptual shifts that have occurred in information society theories (and also policies) in the previous four decades. We will examine the topic by focusing on the work of Daniel Bell and Manuel Castells, arguably two of the most important information society theorists. A key element in the academic shift from “post-industrial” (Bell) thinking to the discourse on “network society” (Castells) is that it has brought forward a different way of understanding the role of the state vis-a-vis the development of new information and communication technologies, as well as a new assessment of the role of the state in the economy and society at large. Against the Keynesian undertones of Bell’s ideas, Castells’ network society theory represents a neoliberally restructured version of “information society” that is associated with the rise of flexibility, individuality and a new culture of innovation. We argue that these changing discourses on the information society have served a definite hegemonic function for political elites, offering useful ideals and conceptions for forming politics and political compromises in different historical conjunctures. We conclude the article by looking at how the on-going global economic crisis and neoliberalism’s weakening hegemonic potential and turn to austerity and authoritarian solutions challenges existing information society theories.

Abstract Background The aim of this study was to assess and compare the effective doses (ICRP 103) in the ankle region of X‐ray imaging resulting from a multi slice computed tomography (MSCT) device, two cone beam CT (CBCT) devices and one conventional x‐ray device. Methods Organ dose measurements were performed using 20 metal oxide field effect transistor (MOSFET) dosimeters that were placed in a custom made anthropomorphic RANDO ankle phantom. The following scanners were assessed in this study: Siemens Sensation Open 24‐slice MSCT‐scanner (120 kVp, 54 mAs), NewTom 5G CBCT scanner (110 kVp, 2.3 ‐ 59 mAs), Planmed Verity CBCT‐scanner (90 kVp, 48 mAs), Shimadzu FH‐21 HR direct radiography equipment (AP + LAT), (57 kVp, 16 mAs). Results Measurements of the MSCT device resulted in 21.4 μSv effective dose. The effective doses of CBCTs were between 1.9 μSv and 14.3 μSv for NewTom 5G and 6.0 μSv for Planmed Verity. Effective doses for the Shimadzu FH‐21 HR conventional radiography were 1.0 μSv (LAT) and 0.5 μSv (AP), respectively. Conclusions Compared with a conventional 2D radiographic device, this study showed a 14‐fold effective dose for standard MSCT and 1.3 ‐10 fold effective dose for standard CBCT protocols. CBCT devices offers a 3D view of ankle imaging and exhibited lower effective doses compared with MSCT.

Medioitumisen käsite on noussut näkyvästi esille viestinnän ja median tutkimuksessa viime vuosina. Muutamat tutkijat ovat pyrkineet jopa nostamaan sen mediatutkimuksen keskeiseksi käsitteeksi ja tulkintahorisontiksi. Käsite on kuitenkin jäänyt useista määrittely-yrityksistä huolimatta suhteellisen ambivalentiksi ja monitulkintaiseksi. Tässä artikkelissa jäsennämme tätä hajanaista kenttää erottamalla kaksi teoreettista tulkintaa medioitumisesta: vahvan ja heikon version. Vahvan tulkinnan mukaan ”medialogiikka” määrittää yhä enemmän eri yhteiskunnan instituutioiden ja ryhmien toimintaa. Heikko versio puolestaan kyseenalaistaa yhden medialogiikan olemassaolon, vaikka korostaakin samalla median kasvavaa merkitystä yhteiskunnassa. Se näkee medioitumisen yhtenä keskeisenä yhteiskunnallisena ”metaprosessina”. Arvioimme kriittisesti sekä vahvan että heikon version lähtöoletuksia ja johtopäätöksiä median roolista yhteiskunnassa. Lisäksi pohdimme medioitumisteorian merkitystä mediatutkimuksen identiteetille, mikä on keskeistä pyrittäessä ymmärtämään medioitumista koskevan keskustelun viimeaikaista suosiota.

Musical competence may confer cognitive advantages that extend beyond processing of familiar musical sounds. Behavioural evidence indicates a general enhancement of both working memory and attention in musicians. It is possible that musicians, due to their training, are better able to maintain focus on task-relevant stimuli, a skill which is crucial to working memory. We measured the blood oxygenation-level dependent (BOLD) activation signal in musicians and non-musicians during working memory of musical sounds to determine the relation among performance, musical competence and generally enhanced cognition. All participants easily distinguished the stimuli. We tested the hypothesis that musicians nonetheless would perform better, and that differential brain activity would mainly be present in cortical areas involved in cognitive control such as the lateral prefrontal cortex. The musicians performed better as reflected in reaction times and error rates. Musicians also had larger BOLD responses than non-musicians in neuronal networks that sustain attention and cognitive control, including regions of the lateral prefrontal cortex, lateral parietal cortex, insula, and putamen in the right hemisphere, and bilaterally in the posterior dorsal prefrontal cortex and anterior cingulate gyrus. The relationship between the task performance and the magnitude of the BOLD response was more positive in musicians than in non-musicians, particularly during the most difficult working memory task. The results confirm previous findings that neural activity increases during enhanced working memory performance. The results also suggest that superior working memory task performance in musicians rely on an enhanced ability to exert sustained cognitive control. This cognitive benefit in musicians may be a consequence of focused musical training.