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Context: Music-based interventions are widely acknowledged to promote the wellbeing of care home residents, particularly those whose communication is impaired, such as through stroke or dementia. Yet in such settings the use of music is limited for reasons that are not entirely clear. Objectives: The Music Interventions for Depression and Dementia in ELderly care (MIDDEL) trial in 16 English care homes was used as a case study to highlight key issues which appear to affect the successful implementation and evaluation of music-based interventions. Methods: The fidelity data from the MIDDEL trial was used to develop inferences in consultation with interventionists and researchers. Based on the literature about implementing psychosocial interventions in care homes and data from this study, a checklist was developed to enhance implementation and research pertaining to music-based interventions in care homes. Findings: New insights were found on the adherence of interventionists to the fidelity criteria. Pragmatic issues relevant to conducting a trial immediately after a pandemic are highlighted, including: the difficulties of maintaining engagement with care home personnel and the practicalities of delivering an intensive intervention to a population who have depression and dementia. We derive recommendations for improving future interventional studies in care homes. Limitations: The participating care homes may not be representative of the industry. The Covid pandemic complicated the study in numerous ways documented here. Implications: The lessons learned offer guidance for future implementation and research on music-based interventions in residential care settings.

Background An evaluation report for a pilot project on the use of video in medical emergency calls between the caller and medical operator indicates that video is only used in 4% of phone calls to the emergency medical communication centre (EMCC). Furthermore, the report found that in half of these cases, the use of video did not alter the assessment made by the medical operator at the EMCC.We aimed to describe the reasons for when and why medical operators choose to use or not use video in emergency calls.Method The study was conducted in a Norwegian EMCC, employing a thematic analysis of notes from medical operators responding to emergency calls regarding the use of video.Result Informants reported 19 cases where video was used and 46 cases where it was not used. When video was used, three main themes appeared: ‘unclear situation or patient condition’, ‘visible problem’ and ‘children’. When video was not used the following themes emerged: ‘cannot be executed/technical problems’, ‘does not follow instructions’, ‘perceived as unnecessary’. Video was mostly used in cases where the medical operators were uncertain about the situation or the patients’ conditions.Conclusion The results indicate that medical operators were selective in choosing when to use video. In cases where operators employed video, it provided a better understanding of the situation, potentially enhancing the basis for decision-making.

Abstract Background In Scandinavia, various public reforms are initiated to enhance trust in the healthcare services and the public sector in general. This study explores experiences from a two-step service innovation project in municipal home care in Norway, coined as the Trust Model (TM), aiming at developing an alternative to the purchaser-provider split (PPS) and enhancing employee motivation, user satisfaction, and citizen trust. The PPS has been the prevalent model in Norway since the 1990s. There is little empirical research on trust-based alternatives to the PPS in healthcare. The overall objectives of this study were to explore facilitators and barriers to trust-based service innovation of municipal homecare and to develop a framework for how to support the implementation of the TM. Methods The TM elements were developed through a comprehensive participatory process, resulting in the decision to organize the home care service in small, self-managed and multidisciplinary teams, and trusting the teams with full responsibility for care decisions and delivery within a limited area. Through a longitudinal mixed methods case study design a) patients’ expressed values and b) factors facilitating or preventing the service innovation process were explored through two iterations. The first included three city districts, three teams and 80 patients. The second included four districts, eight teams and 160 patients. Results The patient survey showed patients valued and trusted the service. The team member survey showed increased motivation for work aligned with TM principles. Both quantitative and qualitative methods revealed a series of facilitators and barriers to the innovation process on different organizational levels (teams, team leaders, system). The key message arising from the two iterations is to keep patients’ values in the centre and recognize the multilevelled organizational complexity of successful trust-based innovation in homecare. Synthesizing the results, a framework for how to support trust-based service innovation was constructed. Conclusions Trust-based innovation of municipal homecare is feasible. The proposed framework may serve as a tool when planning trust-based innovation, and as a checklist for implementation and improvement strategies. Further research is needed to explore the validity of the framework and its replicability in other areas of healthcare.

An increasing number of special-use and high-rise buildings have presented challenges for efficient evacuations, particularly in fire emergencies. At the same time, however, the use of autonomous vehicles within indoor environments has received only limited attention for emergency scenarios. To address these issues, we developed a method that classifies emergency symbols and determines their location on emergency floor plans. The method incorporates color filtering, clustering and object detection techniques to extract walls, which were used in combination to generate clean, digitized plans. By integrating the geometric and semantic data digitized with our method, existing building information modeling (BIM) based evacuation tools can be enhanced, improving their capabilities for path planning and decision making. We collected a dataset of 403 German emergency floor plans and created a synthetic dataset comprising 5000 plans. Both datasets were used to train two distinct faster region-based convolutional neural networks (Faster R-CNNs). The models were evaluated and compared using 83 floor plan images. The results show that the synthetic model outperformed the standard model for rare symbols, correctly identifying symbol classes that were not detected by the standard model. The presented framework offers a valuable tool for digitizing emergency floor plans and enhancing digital evacuation applications.

Warm Atlantic-origin waters are modified in the Lofoten Basin in the Nordic Seas on their way toward the Arctic. An energetic eddy field redistributes these waters in the basin. Retained for extended periods, the warm waters result in large surface heat losses to the atmosphere and have an impact on fisheries and regional climate. Here, we describe the eddy field in the Lofoten Basin by analyzing Lagrangian simulations forced by a high-resolution numerical model. We obtain trajectories of particles seeded at three levels – near the surface, at 200 m and at 500 m depth – using 2D and 3D velocity fields. About 200 000 particle trajectories are analyzed from each level and each simulation. Using multivariate wavelet ridge analysis, we identify coherent cyclonic and anticyclonic vortices in the trajectories and describe their characteristics. We then compare the evolution of water properties inside cyclones and anticyclones as well as in the ambient flow outside vortices. As measured from Lagrangian particles, anticyclones have longer lifetimes than cyclones (16–24 d compared to 13–19 d), a larger radius (20–22 km compared to 17–19 km) and a more circular shape (ellipse linearity of 0.45–0.50 compared to 0.51–0.57). The angular frequencies for cyclones and anticyclones have similar magnitudes (absolute values of about 0.05f). The anticyclones are characterized by warm temperature anomalies, whereas cyclones are colder than the background state. Along their path, water parcels in anticyclones cool at a rate of 0.02–0.04 ∘Cd-1, while those in cyclones warm at a rate of 0.01–0.02 ∘Cd-1. Water parcels experience a net downward motion in anticyclones and upward motion in cyclones, often found to be related to changes in temperature and density. The along-path changes in temperature, density and depth are smaller for particles in the ambient flow. An analysis of the net temperature and vorticity fluxes into the Lofoten Basin shows that while vortices contribute significantly to the heat and vorticity budgets, they only cover a small fraction of the domain area (about 6 %). The ambient flow, including filaments and other non-coherent variability undetected by the ridge analysis, hence plays a major role in closing the budgets of the basin.

We investigate the impact of model trace gas transport schemes on the representation of transport processes in the upper troposphere and lower stratosphere. Towards this end, the Chemical Lagrangian Model of the Stratosphere (CLaMS) was coupled to the ECHAM/MESSy Atmospheric Chemistry (EMAC) model and results from the two transport schemes (Lagrangian critical Lyapunov scheme and flux-form semi-Lagrangian, respectively) were compared. Advection in CLaMS was driven by the EMAC simulation winds, and thereby the only differences in transport between the two sets of results were caused by differences in the transport schemes. To analyze the timescales of large-scale transport, multiple tropical-surface-emitted tracer pulses were performed to calculate age of air spectra, while smaller-scale transport was analyzed via idealized, radioactively decaying tracers emitted in smaller regions (nine grid cells) within the stratosphere. The results show that stratospheric transport barriers are significantly stronger for Lagrangian EMAC-CLaMS transport due to reduced numerical diffusion. In particular, stronger tracer gradients emerge around the polar vortex, at the subtropical jets, and at the edge of the tropical pipe. Inside the polar vortex, the more diffusive EMAC flux-form semi-Lagrangian transport scheme results in a substantially higher amount of air with ages from 0 to 2 years (up to a factor of 5 higher). In the lowermost stratosphere, mean age of air is much smaller in EMAC, owing to stronger diffusive cross-tropopause transport. Conversely, EMAC-CLaMS shows a summertime lowermost stratosphere age inversion – a layer of older air residing below younger air (an “eave”). This pattern is caused by strong poleward transport above the subtropical jet and is entirely blurred by diffusive cross-tropopause transport in EMAC. Potential consequences from the choice of the transport scheme on chemistry–climate and geoengineering simulations are discussed.

The main objective of this study is to assess the economic value of the Brazilian Amazon's ecosystem services accruing to Brazilians based on a meta-analysis of the Brazilian valuation literature. Insight in these local values provides an important benchmark to demonstrate the importance of preserving the Brazilian Amazon forest. The review covers almost 30 years of Brazilian valuation research on the Amazon, published predominantly in Portuguese, highlighting a high degree of study and data heterogeneity. The estimated mean value of the provision of habitat for species, carbon sequestration, water regulation, recreation and ecotourism to local populations is about 410 USD/ha/year. The standard deviation is however high, reflecting a wide dispersion in the distribution of values. Between 50 and 70 percent of the variation in these values can be explained with the help of the estimated meta-regression models, resulting in considerable prediction errors when applying a within-sample resampling procedure. These findings demonstrate the need for a more robust, common ecosystem services accounting and valuation framework before these values can be scaled up and aggregated across the entire Brazilian Amazon.

Observations from moored instruments are analyzed to describe the Norwegian Atlantic Slope Current at the Lofoten Escarpment (13∘ E, 69∘ N). The data set covers a 14-month period from June 2016 to September 2017 and resolves the core of the current from 200 to 650 m depth between the 650 and 1500 m isobaths. The along-isobath current, vertically averaged between 200 and 600 m depth, has an annual cycle amplitude of 0.1 m s−1, with the strongest currents in winter, and a temporal average of 0.15 m s−1. Higher-frequency variability is characterized by fluctuations that reach 0.8 m s−1, lasting for 1 to 2 weeks, and extend as deep as 600 m. In contrast to observations in Svinøy (2∘ E, 63∘ N), the slope current is not barotropic and varies strongly with depth (a shear of 0.05 to 0.1 m s−1 per 100 m in all seasons). Within the limitations of the data, the average volume transport of Atlantic Water is estimated at 2.0±0.8 Sv (1 Sv =106 m3 s−1), with summer and winter averages of 1.6 and 2.9 Sv, respectively. The largest transport is associated with the high temperature classes (>7 ∘C) in all seasons, with the largest values of both transport and temperature in winter. Calculations of the barotropic and baroclinic conversion rates using the moorings are supplemented by results from a high-resolution numerical model. While the conversion from mean to eddy kinetic energy (e.g., barotropic instability) is likely negligible over the Lofoten Escarpment, the baroclinic conversion from mean potential energy into eddy kinetic energy (e.g., baroclinic instability) can be substantial, with volume-averaged values of (1–2)×10-4 W m−3.

Abstract Background Traditional nurse call systems used in residential care facilities rely on patients to summon assistance for routine or emergency needs. Wireless nurse call systems (WNCS) offer new affordances for persons unable to actively or consciously engage with the system, allowing detection of hazardous situations, prevention and timely treatment, as well as enhanced nurse workflows. This study aimed to explore facilitators and barriers of implementation of WNCSs in residential care facilities. Methods The study had a cross-sectional descriptive design. We collected data from care providers (n = 98) based on the Measurement Instrument for Determinants of Innovation (MIDI) framework in five Norwegian residential care facilities during the first year of WNCS implementation. The self-reporting MIDI questionnaire was adapted to the contexts. Descriptive statistics were used to explore participant characteristics and MIDI item and determinant scores. MIDI items to which ≥20% of participants disagreed/totally disagreed were regarded as barriers and items to which ≥80% of participants agreed/totally agreed were regarded as facilitators for implementation. Results More facilitators (n = 22) than barriers (n = 6) were identified. The greatest facilitators, reported by 98% of the care providers, were the expected outcomes: the importance and probability of achieving prompt call responses and increased safety, and the normative belief of unit managers. During the implementation process, 87% became familiar with the systems, and 86 and 90%, respectively regarded themselves and their colleagues as competent users of the WNCS. The most salient barriers, reported by 37%, were their lack of prior knowledge and that they found the WNCS difficult to learn. No features of the technology were identified as barriers. Conclusions Overall, the care providers gave a positive evaluation of the WNCS implementation. The barriers to implementation were addressed by training and practicing technological skills, facilitated by the influence and support by the manager and the colleagues within the residential care unit. WNCSs offer a range of advanced applications and services, and further research is needed as more WNCS functionalities are implemented into residential care services.

Abstract Background Implementation of digital monitoring technology systems is considered beneficial for increasing the safety and quality of care for residents in nursing homes and simultaneously improving care providers’ workflow. Co-creation is a suitable approach for developing and implementing digital technologies and transforming the service accordingly. This study aimed to identify the facilitators and barriers for implementation of digital monitoring technology in residential care for persons with dementia and wandering behaviour, and explore co-creation as an implementation strategy and practice. Methods In this longitudinal case study, we observed and elicited the experiences of care providers and healthcare managers in eight nursing homes, in addition to those of the information technology (IT) support services and technology vendors, during a four-year implementation process. We were guided by theories on innovation, implementation and learning, as well as co-creation and design. The data were analysed deductively using a determinants of innovation framework, followed by an inductive content analysis of interview and observation data. Results The implementation represented radical innovation and required far more resources than the incremental changes anticipated by the participants. Five categories of facilitators and barriers were identified, including several subcategories for each category: 1) Pre-implementation preparations; 2) Implementation strategy; 3) Technology stability and usability; 4) Building competence and organisational learning; and 5) Service transformation and quality management. The combination of IT infrastructure instability and the reluctance of the IT support service to contribute in co-creating value with the healthcare services was the most persistent barrier. Overall, the co-creation methodology was the most prominent facilitator, resulting in a safer night monitoring service. Conclusion Successful implementation of novel digital monitoring technologies in the care service is a complex and time-consuming process and even more so when the technology allows care providers to radically transform clinical practices at the point of care, which offers new affordances in the co-creation of value with their residents. From a long-term perspective, the digital transformation of municipal healthcare services requires more advanced IT competence to be integrated directly into the management and provision of healthcare and value co-creation with service users and their relatives.

BackgroundInternet-delivered psychological treatments (IDPTs) are built on evidence-based psychological treatment models, such as cognitive behavioral therapy, and are adjusted for internet use. The use of internet technologies has the potential to increase access to evidence-based mental health services for a larger proportion of the population with the use of fewer resources. However, despite extensive evidence that internet interventions can be effective in the treatment of mental health disorders, user adherence to such internet intervention is suboptimal. ObjectiveThis review aimed to (1) inspect and identify the adaptive elements of IDPT for mental health disorders, (2) examine how system adaptation influences the efficacy of IDPT on mental health treatments, (3) identify the information architecture, adaptive dimensions, and strategies for implementing these interventions for mental illness, and (4) use the findings to create a conceptual framework that provides better user adherence and adaptiveness in IDPT for mental health issues. MethodsThe review followed the guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The research databases Medline (PubMed), ACM Digital Library, PsycINFO, CINAHL, and Cochrane were searched for studies dating from January 2000 to January 2020. Based on predetermined selection criteria, data from eligible studies were analyzed. ResultsA total of 3341 studies were initially identified based on the inclusion criteria. Following a review of the title, abstract, and full text, 31 studies that fulfilled the inclusion criteria were selected, most of which described attempts to tailor interventions for mental health disorders. The most common adaptive elements were feedback messages to patients from therapists and intervention content. However, how these elements contribute to the efficacy of IDPT in mental health were not reported. The most common information architecture used by studies was tunnel-based, although a number of studies did not report the choice of information architecture used. Rule-based strategies were the most common adaptive strategies used by these studies. All of the studies were broadly grouped into two adaptive dimensions based on user preferences or using performance measures, such as psychometric tests. Conclusions Several studies suggest that adaptive IDPT has the potential to enhance intervention outcomes and increase user adherence. There is a lack of studies reporting design elements, adaptive elements, and adaptive strategies in IDPT systems. Hence, focused research on adaptive IDPT systems and clinical trials to assess their effectiveness are needed.

BackgroundMany mobile health (mHealth) apps for mental health have been made available in recent years. Although there is reason to be optimistic about their effect on improving health and increasing access to care, there is a call for more knowledge concerning how mHealth apps are used in practice. ObjectiveThis study aimed to review the literature on how usability is being addressed and measured in mHealth interventions for mental health problems. MethodsWe conducted a systematic literature review through a search for peer-reviewed studies published between 2001 and 2018 in the following electronic databases: EMBASE, CINAHL, PsycINFO, PubMed, and Web of Science. Two reviewers independently assessed all abstracts against the inclusion and exclusion criteria, following the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. ResultsA total of 299 studies were initially identified based on the inclusion keywords. Following a review of the title, abstract, and full text, 42 studies were found that fulfilled the criteria, most of which evaluated usability with patients (n=29) and health care providers (n=11) as opposed to healthy users (n=8) and were directed at a wide variety of mental health problems (n=24). Half of the studies set out to evaluate usability (n=21), and the remainder focused on feasibility (n=10) or acceptability (n=10). Regarding the maturity of the evaluated systems, most were either prototypes or previously tested versions of the technology, and the studies included few accounts of sketching and participatory design processes. The most common reason referred to for developing mobile mental health apps was the availability of mobile devices to users, their popularity, and how people in general became accustomed to using them for various purposes. ConclusionsThis study provides a detailed account of how evidence of usability of mHealth apps is gathered in the form of usability evaluations from the perspective of computer science and human-computer interaction, including how users feature in the evaluation, how the study objectives and outcomes are stated, which research methods and techniques are used, and what the notion of mobility features is for mHealth apps. Most studies described their methods as trials, gathered data from a small sample size, and carried out a summative evaluation using a single questionnaire, which indicates that usability evaluation was not the main focus. As many studies described using an adapted version of a standard usability questionnaire, there may be a need for developing a standardized mHealth usability questionnaire.