Ari Voutilainen

Rapid and highly variable warming of lake surface waters around the globe

In this first worldwide synthesis of in situ and satellite-derived lake data, we find that lake summer surface water temperatures rose rapidly (global mean = 0.34°C decade−1) between 1985 and 2009. Our analyses show that surface water warming rates are dependent on combinations of climate and local characteristics, rather than just lake location, leading to the counterintuitive result that regional consistency in lake warming is the exception, rather than the rule. The most rapidly warming lakes are widely geographically distributed, and their warming is associated with interactions among different climatic factors—from seasonally ice-covered lakes in areas where temperature and solar radiation are increasing while cloud cover is diminishing (0.72°C decade−1) to ice-free lakes experiencing increases in air temperature and solar radiation (0.53°C decade−1). The pervasive and rapid warming observed here signals the urgent need to incorporate climate impacts into vulnerability assessments and adaptation efforts for lakes.

A global database of lake surface temperatures collected by in situ and satellite methods from 1985–2009

Global environmental change has influenced lake surface temperatures, a key driver of ecosystem structure and function. Recent studies have suggested significant warming of water temperatures in individual lakes across many different regions around the world. However, the spatial and temporal coherence associated with the magnitude of these trends remains unclear. Thus, a global data set of water temperature is required to understand and synthesize global, long-term trends in surface water temperatures of inland bodies of water. We assembled a database of summer lake surface temperatures for 291 lakes collected in situ and/or by satellites for the period 1985–2009. In addition, corresponding climatic drivers (air temperatures, solar radiation, and cloud cover) and geomorphometric characteristics (latitude, longitude, elevation, lake surface area, maximum depth, mean depth, and volume) that influence lake surface temperatures were compiled for each lake. This unique dataset offers an invaluable baseline perspective on global-scale lake thermal conditions as environmental change continues.

How to ask about patient satisfaction? The visual analogue scale is less vulnerable to confounding factors and ceiling effect than a symmetric Likert scale

AIMS To study the effects of scale type (visual analogue scale vs. Likert), item order (systematic vs. random), item non-response and patient-related characteristics (age, gender, subjective health, need for assistance with filling out the questionnaire and length of stay) on the results of patient satisfaction surveys. BACKGROUND Although patient satisfaction is one of the most intensely studied issues in the health sciences, research information about the effects of possible instrument-related confounding factors on patient satisfaction surveys is scant. DESIGN A quasi-experimental design was employed. A non-randomized sample of 150 surgical patients was gathered to minimize possible alterations in care quality. METHODS Data were collected in May-September 2014 from one tertiary hospital in Finland using the Revised Humane Caring Scale instrument. New versions of the instrument were created for the present purposes. In these versions, items were either in a visual analogue format or Likert-scaled, in systematic or random order. The data were analysed using an analysis of covariance and a paired samples t-test. RESULTS The visual analogue scale items were less vulnerable to bias from confounding factors than were the Likert-scaled items. The visual analogue scale also avoided the ceiling effect better than Likert and the time needed to complete the visual analogue scale questionnaire was 28% shorter than that needed to complete the Likert-scaled questionnaire. CONCLUSION The present results supported the use of visual analogue scale rather than Likert scaling in patient satisfaction surveys and stressed the need to account for as many potential confounding factors as possible.

The relationship between patients' perceptions of care quality and three factors: nursing staff job satisfaction, organizational characteristics and patient age.

BackgroundThe relationship between nurses’ job satisfaction and their perceptions of quality of care has been examined in previous studies. There is little evidence, however, about relationships between the job satisfaction of nursing staff and quality of care perceived by the patients. The aim of this study was to analyze, how the job satisfaction of nursing staff, organizational characteristics (hospital and unit type), and patients’ age relate to patients’ perceptions of the quality of care.MethodsThe study was cross-sectional and descriptive, based on a secondary analysis of survey data acquired during the At Safe study in Finland. The study included 98 units at four acute care hospitals between autumn 2008 and spring 2009. The participants were 1909 patients and 929 nursing staff. Patients’ perceptions of quality of care were measured using the 42-item RHCS questionnaire. Job satisfaction of nursing staff was measured with the 37-item KUHJSS scale. Statistical analyses included descriptive statistics, principal component analysis, t-tests, analysis of variance, linear regression, and multivariate analysis of variance.ResultsPatients’ perceptions of overall quality of care were positively related to general job satisfaction of nursing staff. Adequate numbers of staff appeared to be the clearest aspect affecting quality of care. Older patients were more satisfied with staff number than younger patients. Patients cared for in outpatient departments felt more respected than patients in wards, whereas patients in wards reported better care of basic needs (e.g., hygiene, food) than outpatients.ConclusionsThe evaluation of resources by nursing staff is related to patients’ perceptions of the adequacy of nursing staff levels in the unit. The results emphasize the importance of considering patients’ perceptions of the quality of care and assessments by nurses of their job satisfaction at the hospital unit level when evaluating quality of care.

A new look at patient satisfaction: learning from self-organizing maps.

BackgroundTo some extent, results always depend on the methods used, and the complete picture of the phenomenon of interest can be drawn only by combining results of different data processing techniques. This emphasizes the use of a wide arsenal of methods for processing and analyzing patient satisfaction surveys. ObjectiveThe purpose of this study was to introduce the self-organizing map (SOM) to nursing science and to illustrate the use of the SOM with patient satisfaction data. The SOM is a widely used artificial neural network suitable for clustering and exploring all kind of data sets. MethodsThe study was partly a secondary analysis of data collected for the Attractive and Safe Hospital Study from four Finnish hospitals in 2008 and 2010 using the Revised Humane Caring Scale. The sample consisted of 5,283 adult patients. The SOM was used to cluster the data set according to (a) respondents and (b) questionnaire items. The SOM was also used as a preprocessor for multinomial logistic regression. An analysis of missing data was carried out to improve the data interpretation. ResultsCombining results of the two SOMs and the logistic regression revealed associations between the level of satisfaction, different components of satisfaction, and item nonresponse. The common conception that the relationship between patient satisfaction and age is positive may partly be due to positive association between the tendency of item nonresponse and age. DiscussionThe SOM proved to be a useful method for clustering a questionnaire data set even when the data set was low dimensional per se. Inclusion of empty responses in analyses may help to detect possible misleading noncausative relationships.

Conventional vs. e-learning in nursing education: A systematic review and meta-analysis

BACKGROUND By and large, in health professions training, the direction of the effect of e-learning, positive or negative, strongly depends on the learning outcome in question as well as on learning methods which e-learning is compared to. In nursing education, meta-analytically generated knowledge regarding the comparisons between conventional and e-learning is scarce. OBJECTIVES The aim of this review is to discover the size of the effect of e-learning on learning outcomes in nursing education and to assess the quality of studies in which e-learning has been compared to conventional learning. METHODS A systematic search of six electronic databases, PubMed, Ovid MEDLINE®, CINAHL (EBSCOhost), Cochrane Library, PsycINFO, and ERIC, was conducted in order to identify relevant peer-reviewed English language articles published between 2011 and 2015. The quality of the studies included as well as the risk of bias in each study was assessed. A random-effects meta-analysis was performed to generate a pooled mean difference in the learning outcome. RESULTS Altogether, 10 studies were eligible for the quality assessment and meta-analysis. Nine studies were evaluated as good quality studies, but not without a risk of bias. Performance bias caused a high risk in nearly all the studies. In the meta-analysis, an e-learning method resulted in test scores that were, on average, five points higher than a conventional method on a 0-100 scale. Heterogeneity between the studies was very large. CONCLUSIONS The size and direction of the effect of a learning method on learning outcomes appeared to be strongly situational. We suggest that meta-regressions should be performed instead of basic meta-analyses in order to reveal factors that cause variation in the learning outcomes of nursing education. It might be necessary to perform separate meta-analyses between e-learning interventions aimed at improving nursing knowledge and those aimed at improving nursing skills.

Penetration and Migration Success of Diplostomum spp. Cercariae in Arctic Charr

Abstract We exposed 2 groups of young-of-the-year Arctic charr (Salvelinus alpinus) singly to 54 ± 2 (mean ± SE) Diplostomum spp. cercariae that had emerged from 4 randomly sampled snail hosts (Lymnaea stagnalis). The rearing tanks of the fish received Diplostomum spp. cercariae via the incoming water; therefore, 18 of the 36 fish had parasites in their eyes before the experimental exposure. Of the Diplostomum spp. cercariae presented to the fish, 19% penetrated and 46% of those that had penetrated the fish migrated successfully to the lens of the fish eye. The migration success of Diplostomum spp. from the site of penetration to the fish eye lens was lower in the previously parasitized (37.0 ± 8.7% [mean ± SE] adjusted with the number of penetrated cercariae) than in the unparasitized fish (55.3 ± 8.8%) and differed between the individual snail host from which the cercariae had emerged. In addition, the migration success of Diplostomum spp. decreased with an increase in the number of the cercariae that penetrated the fish. At the individual snail host level, there seemed to be a trade-off between penetration and migration ability of the cercariae. The results indicate that success of Diplostomum spp. in penetration and especially in migration to the fish eye is affected by both the molluscan first intermediate host and the piscine second intermediate host.

Meta-analysis: methodological confounders in measuring patient satisfaction:

The study aimed to identify methodological confounding factors affecting patient satisfaction survey results. The data gathered from CINAHL and PubMed databases consisted of 355 surveys published from 2006 to 2012. Linear regression and Bayesian models, with seven potential survey-related confounders together with patient age and gender as explanatory variables, were constructed. According to the linear model, up to 12% of the original variation in patient satisfaction was explained by confounding variables, not by the actual variation in satisfaction. The presence of an interviewer resulted in lower satisfaction levels, and the satisfaction results correlated negatively with the number of items in the questionnaire. According to the Bayesian model, if patients were over 60 years old and the questionnaire consisted mainly of positively phrased items, the probability of rating their experiences as very satisfied was 75%. The Bayesian and linear models endorsed each other and revealed specifically that the surveys reporting high patient satisfaction could be predicted on the basis of confounding variables. The following recommendations are given for constructing a patient satisfaction survey: use neutral rather than negatively or positively phrased items, and use enough items to increase the likelihood that the least satisfactory care components are also included in order to better enable comparisons across sporadic surveys.

From spatial ecology to spatial epidemiology: modeling spatial distributions of different cancer types with principal coordinates of neighbor matrices

BackgroundEpidemiology and ecology share many fundamental research questions. Here we describe how principal coordinates of neighbor matrices (PCNM), a method from spatial ecology, can be applied to spatial epidemiology. PCNM is based on geographical distances among sites and can be applied to any set of sites providing a good coverage of a study area. In the present study, PCNM eigenvectors corresponding to positive autocorrelation were used as explanatory variables in linear regressions to model incidences of eight most common cancer types in Finnish municipalities (n = 320). The dataset was provided by the Finnish Cancer Registry and it included altogether 615,839 cases between 1953 and 2010.ResultsPCNM resulted in 165 vectors with a positive eigenvalue. The first PCNM vector corresponded to the wavelength of hundreds of kilometers as it contrasted two main subareas so that municipalities located in southwestern Finland had the highest positive site scores and those located in midwestern Finland had the highest negative scores in that vector. Correspondingly, the 165th PCNM vector indicated variation mainly between the two small municipalities located in South Finland. The vectors explained 13 - 58% of the spatial variation in cancer incidences. The number of outliers having standardized residual > |3| was very low, one to six per model, and even lower, zero to two per model, according to Chauvenet’s criterion. The spatial variation of prostate cancer was best captured (adjusted r2 = 0.579).ConclusionsPCNM can act as a complementary method to causal modeling to achieve a better understanding of the spatial structure of both the response and explanatory variables, and to assess the spatial importance of unmeasured explanatory factors. PCNM vectors can be used as proxies for demographics and causative agents to deal with autocorrelation, multicollinearity, and confounding variables. PCNM may help to extend spatial epidemiology to areas with limited availability of registers, improve cost-effectiveness, and aid in identifying unknown causative agents, and predict future trends in disease distributions and incidences. A large advantage of using PCNM is that it can create statistically valid reflectors of real predictors for disease incidence models with only little resources and background information.

A methodological approach to measuring the oxygen consumption profile of six freshwater fish species: implications for determination of the standard metabolic rate

Procedures for the determination of standard metabolic rate (SMR) are variable and subjective in respirometry. We examined the oxygen consumption profile of six fish species (three salmonids and three cyprinids) in respirometry, and analysed the implications for the determination of SMR. In addition, we used data on Arctic charr (Salvelinus alpinus) and bleak (Alburnus alburnus) to define, how the length of a measuring period affects the determination of SMR and to investigate the temporal consistency of SMR. Fish activity in the respirometer differed between the species and there was a family-specific response to change in illumination. In salmonids, switching off the lights resulted in an increased oxygen consumption rate for hours, whereas in cyprinids the response was shorter or totally absent. In Arctic charr and bleak, individual oxygen consumption profiles remained unchanged between the consecutive trials. The results emphasize the importance of taking species-specific responses into account when determining SMR.