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Objective: This study proposes an updated method for the film thickness of 21 resin composites used as cements., Materials and Methods: A load of 30 N was subjected to two glass plates stacked on a heated base to simulate clinically relevant pressure and temperature during the seating of inlays/onlays/veneers. The axial position of the actuator was recorded before and after placing 22.15 mm 3 of resin composite between the glass slides. The difference between the two measurements was calculated for each specimen. A total of 18 condensable restoratives, 1 injectable restorative, and 2 resin cements were tested, 5 specimens each (n = 5, N = 105). One-way ANOVA was performed for both variables and Games-Howell post hoc test was used for pairwise comparisons., Results: The film thickness range was 6-200 μm, with the lowest values for restorative composites (AP-X, Z250, and Herculite XRV Incisal LT with 6-8 μm), followed by Gradia Direct (25 μm) and flowable/injectable composite resins, including designated cements (15-27 μm). Inspiro, Ultradent Transcend Universal, and ENA Hri dentin stood below 50 μm (range 28-49 μm). The other materials (range 81-200 μm) cannot be recommended for thermo-modified cementation., Conclusions: The initial viscosity of restorative composites is not an indication of the film thickness when used for thermo-modified cementation. There is a wide choice of appropriate materials available on the market., Clinical Significance: Some restorative composites are able to generate very thin films and can be used as cement with numerous advantages when compared to designated flowable or dual-cure cements., (© 2024 Wiley Periodicals LLC.)

Background and Aims: Fatigue is commonly observed in Crohn's disease (CD) and ulcerative colitis (UC), but its association to achieving remission is not clearly established. In this study we describe the odds for fatigue in patients with CD/UC one year after diagnosis based on different definitions of remission and identified factors associated with chronic fatigue (CF) among patients in endoscopic/radiological remission., Methods: Patients ≥18 years with CD/UC were recruited from the IBSEN III cohort. Using the Fatigue Questionnaire, and dichotomizing the score, CF was defined as the presence of substantial fatigue (SF) for ≥6 months. Remission was divided into symptomatic (CD: HBI score<5/UC: SCCAI score<3), biochemical (faecal calprotectin ≤250µg/g), endoscopic/radiological (CD: normal intestinal MRI/CT combined with normal endoscopy/UC: Mayo endoscopic score 0) and histological (normal mucosal biopsies). Both the likelihood of SF/CF, depending on the definition of remission, and associations between CF and selected factors for CD/UC in endoscopic/radiological remission, were evaluated using binary logistic regression analysis., Results: In total, 711/1416 patients were included. For both CD and UC, symptomatic remission significantly reduced the odds for SF and CF. Additionally, the odds for SF were significantly reduced for UC in biochemical remission. Among those in endoscopic/radiological remission (n=181), CF was independently associated with sleep disturbances (OR=10.40, 95%CI [3.28;32.99], p<0.001) and current treatment with infliximab (OR=4.31, 95%CI [1.15;16.17], p=0.03)., Conclusions: Stricter definitions of disease remission were not associated with a decreased likelihood of fatigue. For patients in endoscopic/radiological remission, CF was independently associated with sleep disturbances and current treatment with infliximab., (© The Author(s) 2024. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation.)

Divergent patterns of phenotypic selection on floral traits can arise in response to interactions with functionally distinct pollinators. However, there are a limited number of studies that relate patterns of phenotypic selection on floral traits to variation in local pollinator assemblages in pollination-generalized plant species. We studied phenotypic selection on floral traits of Viscaria vulgaris, a plant that interacts with a broad range of diurnal and nocturnal pollinators, and related divergence in phenotypic selection on floral traits to the expected level of divergence in local pollinator assemblages. We detected phenotypic selection on floral traits involved in the attraction of pollinators and the mechanics of pollen removal and deposition, and demonstrated that floral traits are subject to spatiotemporal variation in the strength and direction of phenotypic selection. We revealed that diurnal and nocturnal pollinators, when considered in isolation, mediated divergent patterns of phenotypic selection on floral traits. Consistent with the Grant-Stebbins model, we observed that divergence in phenotypic selection on floral traits increased with the expected level of divergence in local pollinator assemblages. Thus, generalized plant-pollinator interactions can mediate phenotypic selection on floral traits, and distinct local pollinator assemblages can generate a geographic mosaic of divergent patterns of phenotypic selection. We underscore that these outcomes are not exclusive to specialized plant-pollinator interactions and can emerge at a local geographic scale., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Evolutionary Biology.)

Purpose: To measure oxygen demand, uptake, and deficits in competitive cross-country skiers during outdoor roller skiing at different competition durations, ranging from the endurance domain to the sprint domain., Methods: Ten competitive cross-country skiers (6 males; V ˙ O 2max 78 ± 3 and 4 females; V ˙ O 2max 62 ± 3 mL∙kg -1 ∙min -1 ) raced time trials consisting of 1, 2, and 4 laps in a 1.6 km racecourse in a randomized order with 35 min recovery in-between. Oxygen uptake was measured using a wearable metabolic system while oxygen demand was estimated from kinematic data (GPS and IMU) and an athlete-specific model of skiing economy. Skiing economy and V ˙ O 2max was established on a separate test day using six submaximal constant-load trials at different speeds and inclines, and one maximal-effort trial on a roller-skiing treadmill., Results: Average oxygen demand was 112 ± 8%, 103 ± 7% and 98 ± 7% of V ˙ O 2max during the 1 (3:37 ± 0:20 m:ss), 2 (7:36 ± 0:38 m:ss) and 4 (15:43 ± 1:26 m:ss) lap time trials, respectively, and appeared to follow an inverse relationship with time-trial duration. Average oxygen uptake was unaffected by race length (86 ± 5%, 86 ± 5%, and 86 ± 7% of V ˙ O 2max , respectively). Accumulated oxygen deficit at the end of each time trial was 85 ± 13, 106 ± 32 and 158 ± 62 mL∙kg -1 , while oxygen deficits per work bout was 23 ± 3, 18 ± 3 and 16 ± 3 mL∙kg -1 for the 1, 2, and 4-lap time trials, respectively., Conclusion: Elite cross-country skiers adjust their pacing strategies from attaining relatively small oxygen deficits per work bout in the endurance domain, to larger deficits in the sprint domain. This indicates a shift in strategy from prioritizing stable work-economy and rate-of-recovery in the endurance domain, to maximizing power output in the sprint domain., (© 2024. The Author(s).)

Purpose: Excessive paper dust during paper production may harm the workers' respiratory health. We wanted to assess the inhalable paper dust levels and its determinants among paper industry workers., Methods: A study was conducted in Ethiopia to assess the level of personal inhalable paper dust exposure among four paper mills. A total of 150 samples were collected using the IOM sampler attached to Side Kick Casella pumps at a flow rate of 2 L/min. The samples were analyzed in Nemko Norlab, Norway. Linear mixed-effect models were applied to identify determinants of inhalable paper dust., Results: The geometric mean of personal inhalable paper dust was 3.3 mg/m 3 with 80% of the measurements exceeding the Swedish occupational exposure limit (OEL) of 2 mg/m 3 . The linear mixed-effects model showed that the level of dust was 28% higher when using high-speed than when using low-speed rewinding machines, while paper mills with an average of more than four machines per job group had 22% higher exposure than paper mills with a lower number of machines. Furthermore, working in packing and preparation was associated with higher dust exposure than in other areas., Conclusions: The dust exposure levels were above the Swedish OEL for 80% of the samples. This indicates that preventive measures should be established in the industry. The exposure model identified high-speed rewinding machines, a high number of machines, and work in preparation and packing as associated with high levels of paper dust exposure., Competing Interests: Declarations Ethical approval Ethical clearance was obtained from the Institutional Review Board of the College of Health Science Addis Ababa University number 079/22/SPH and from the Regional Committee for Research Ethics South East Norway, number 2022/521268. After the purpose and the importance of their participation were explained informed consent was taken from each study participant. Privacy and confidentiality of information given by each participant were kept properly and personal identifiers were removed. Conflict of interest The authors declare that they have no competing interests., (© 2024. The Author(s).)

Chronic respiratory symptoms are a health concern in the paper industry. This study evaluates the association between personal inhalable paper dust exposure and chronic respiratory symptoms among workers in this industry. In total, 270 workers from the paper industry and 267 from a water bottling factory participated. Chronic respiratory symptoms were assessed using a standardized questionnaire, modified from the American Thoracic Society. A job exposure matrix, based on cross-sectional personal measurements of inhalable paper dust, was used to estimate the exposure-response relationship between cumulative dust exposure and chronic respiratory symptoms. There was a higher prevalence of chronic coughs (27.4% vs. 7.5%), breathlessness (25.6% vs. 11%), coughs with sputum (21.1% vs. 1.1%), and wheezing (25.6% vs. 5%) among paper workers compared to those in the water bottling industry. A Poisson regression analysis revealed that the prevalence ratios for chronic coughs (APR = 3.3 and 95% CI: 2.0-5.4), breathlessness (APR = 2.2 and 95% CI: 1.4-3.4), and wheezing (APR = 4.3 and 95% CI: 2.3-7.7) were significantly higher in paper workers than in water bottling workers. Among paper workers, a significant exposure-response relationship was observed between cumulative dust exposure and chronic coughs after adjusting for age, sex, history of respiratory illnesses, work in other dusty industries, and use of biofuels. As there were only four ever-smokers, smoking was not included in the regression analysis. The results show a significant association between dust exposure and coughing, highlighting the need for control measures to prevent the development of respiratory symptoms among workers.

Level of Evidence: II., Competing Interests: Declaration of conflicting interestsThe authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Diversification of plant chemical phenotypes is typically associated with spatially and temporally variable plant-insect interactions. Floral scent is often assumed to be the target of pollinator-mediated selection, whereas foliar compounds are considered targets of antagonist-mediated selection. However, floral and vegetative phytochemicals can be biosynthetically linked and may thus evolve as integrated phenotypes. Utilizing a common garden of 28 populations of the perennial herb Arabis alpina (Brassicaceae), we investigated integration within and among floral scent compounds and foliar defense compounds (both volatile compounds and tissue-bound glucosinolates). Within floral scent volatiles, foliar volatile compounds, and glucosinolates, phytochemicals were often positively correlated, and correlations were stronger within these groups than between them. Thus, we found no evidence of integration between compound groups indicating that these are free to evolve independently. Relative to self-compatible populations, self-incompatible populations experienced stronger correlations between floral scent compounds, and a trend toward lower integration between floral scent and foliar volatiles. Our study serves as a rare test of integration of multiple, physiologically related plant traits that each are potential targets of insect-mediated selection. Our results suggest that independent evolutionary forces are likely to diversify different axes of plant chemistry without major constraints., (© 2024 The Author(s). New Phytologist © 2024 New Phytologist Foundation.)

Background: Intensive care unit (ICU) patients experience several symptoms, yet patterns of symptoms and their relationship with demographic and clinical characteristics have not previously been investigated., Objectives: To identify and compare subgroups (i.e. latent symptom classes) of intensive ICU patients based on prevalence of co-occurring symptoms over seven days., Research Methodology: Prospective cohort study of adult ICU patients' self-reports of five symptoms during seven days in ICU. Latent class analysis was applied to identify subgroups of ICU patients., Setting: Multicenter study with patients from six mixed ICUs in Norway., Main Outcome Measures: Patient Symptom Survey was used to assess five symptoms (i.e., thirst, pain, anxiousness, tiredness, shortness of breath)., Results: Among 353 included patients, median age was 63 years and 60.3 % were male. Subgroups of patients were identified in a Low class (n = 126, 35.7 %), Middle Class (n = 177, 50.1 %) and High Class (n = 50, 14.2 %) based on reporting of the prevalence of five symptoms. Patients in the Low class had a low prevalence of all symptoms. Middle Class patients had a high prevalence of thirst and tiredness and a low prevalence of pain, anxiousness and shortness of breath. The High class patients had a high prevalence of all symptoms. Symptom prevalence remained stable in the Low and Middle class over time and increased over time in the High class. There were significant differences among symptom classes in use of mechanical ventilation (p = 0.012), analgesics (p < 0.001), alpha-2 agonists (p = 0.004) and fluid restriction (p = 0.006). Patients in the High class received more of these ICU-treatments., Conclusions: Findings suggest that subgroups of ICU patients with distinct symptom experiences can be identified. The High prevalence class patients had consistently high levels of all symptoms across seven ICU days and received more ICU-related interventions., Implication for Clinical Practice: Some ICU patients experience a consistently high prevalence of co-occurring symptoms. Clinicians should be aware of treatment factors that could be linked to a high burden of symptoms., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Individuals with non-celiac gluten/wheat sensitivity (NCGWS) experience improvement in gastrointestinal symptoms following a gluten-free diet. Although previous results have indicated that fructo-oligosaccharides (FOS), a type of short-chain fructans, were more likely to induce symptoms than gluten in self-reported NCGWS patients, the underlying mechanisms are unresolved., Methods: Our main objective was therefore to investigate whether FOS-fructans and gluten affect the composition and diversity of the faecal microbiota (16S rRNA gene sequencing), faecal metabolites of microbial fermentation (short-chain fatty acids [SCFA]; gas chromatography with flame ionization detector), and a faecal biomarker of gut inflammation (neutrophil gelatinase-associated lipocalin, also known as lipocalin 2, NGAL/LCN2; ELISA). In the randomised double-blind placebo-controlled crossover study, 59 participants with self-reported NCGWS underwent three different 7-day diet challenges with gluten (5.7 g/day), FOS-fructans (2.1 g/day), and placebo separately (three periods, six challenge sequences)., Results: The relative abundances of certain bacterial taxa were affected differently by the diet challenges. After the FOS-fructan challenge, Fusicatenibacter increased, while Eubacterium (E.) coprostanoligenes group, Anaerotruncus, and unknown Ruminococcaceae genera decreased. The gluten challenge was primarily characterized by increased abundance of Eubacterium xylanophilum group. However, no differences were found for bacterial diversity (α-diversity), overall bacterial community structure (β-diversity), faecal metabolites (SCFA), or NGAL/LCN2. Furthermore, gastrointestinal symptoms in response to FOS-fructans were generally not linked to substantial shifts in the gut bacterial community. However, the reduction in E. coprostanoligenes group following the FOS-fructan challenge was associated with increased gastrointestinal pain. Finally, correlation analysis revealed that changes in gastrointestinal symptoms following the FOS-fructan and gluten challenges were linked to varying bacterial abundances at baseline., Conclusions: In conclusion, while FOS-fructans induced more gastrointestinal symptoms than gluten in the NCGWS patients, we did not find that substantial shifts in the composition nor function of the faecal microbiota could explain these differences in the current study. However, our results indicate that individual variations in baseline bacterial composition/function may influence the gastrointestinal symptom response to both FOS-fructans and gluten. Additionally, the change in E. coprostanoligenes group, which was associated with increased symptoms, implies that attention should be given to these bacteria in future trials investigating the impact of dietary treatments on gastrointestinal symptoms., Trial Registration: Clinicaltrials.gov as NCT02464150., (© 2024. The Author(s).)

The vast majority of people with cystic fibrosis (pwCF) have untreated secondary chronic rhinosinusitis (CRS). Whereas the introduction of the cystic fibrosis transmembrane conductance regulator modulator (CFTRm) treatment regime has improved the lung function of pwCF, few studies have been published examining the effect on sinonasal symptoms in children. Our aim was to explore the effect of double CFTRm treatment on CRS and olfaction in children with CF. pwCF were included in this non-randomized cross-sectional study, where an otolaryngologist performed a complete ENT examination before initiating treatment with elaxacaftor/tezacaftor/ivacaftor (ETI). Twenty-three pwCF aged 6-12 years were included. Eighteen of 23 patients were on a double CFTRm treatment, and 5 patients were CFTRm naive, respectively. Altogether, 19 had normal olfaction, 20 had none or mild CRS symptoms according to SNOT-22, and 14 had a normal endoscopy. None of the patients had symptoms of chronic rhinosinusitis lasting for more than 12 weeks, thus none of the patients fulfilled the criteria for CRS. Children with CF treated with double CFTRm have few to no symptoms of CRS and normal olfaction, which is an improvement compared with children following treatment modalities prior to CFTRm., (© 2024 The Authors. APMIS published by John Wiley & Sons Ltd on behalf of Scandinavian Societies for Pathology, Medical Microbiology and Immunology.)

Purpose: To investigate the association between five dietary trajectories over 21 years and frailty in Norwegian older adults., Methods: This study used data from three surveys of the Tromsø Study. Diet was measured using food frequency questionnaires at baseline (Tromsø4, 1994-95), after 7 years (Tromsø5, 2001) and at the end of follow-up (Tromsø7, 2015-16). Survey-specific diet scores were constructed based on the Nordic Nutrition Recommendations 2023 and group-based trajectory modelling was used to derive dietary trajectories. At follow-up, frailty was assessed with a 41-item frailty index. Linear regression analysis was performed to assess the associations between dietary trajectories and frailty, adjusted for baseline variables., Results: Among the 715 participants, 55% were women, with an average age of 54 years at baseline and 74 years at follow-up. The dietary trajectories 'moderately healthy' and 'healthy increase' were associated with a lower frailty index score at follow-up (β = -0.02, 95% confidence interval (CI) = -0.04, -0.002, β = -0.03, 95% CI = -0.06, -0.007), compared with the 'unhealthy' trajectory., Conclusion: Our findings suggest that maintaining a moderately healthy to very healthy diet from mid-life into older age is associated with a lower risk of frailty and supports the promotion of a healthy diet from adulthood to facilitate healthy ageing., (© 2024. The Author(s).)

Objectives: Pleural mesothelioma is a rare respiratory cancer, mainly caused by inhalation of asbestos fibres. Other inorganic fibres are also suggested risk factors. We aimed to investigate the association between exposure to asbestos or refractory ceramic fibres (RCFs) and pleural mesothelioma among male Norwegian offshore petroleum workers., Methods: Among 25 347 men in the Norwegian Offshore Petroleum Workers (NOPW) cohort (1965-1998), 43 pleural mesothelioma cases were identified through the Cancer Registry of Norway (1999-2022). A case-cohort study was conducted with 2095 randomly drawn non-cases from the cohort. Asbestos and RCF exposures were assessed with expert-made job-exposure matrices (JEMs). Weighted Cox regression was used to estimate HRs and 95% CIs, adjusted for age at baseline and pre-offshore employment with likely asbestos exposure., Results: An increased risk of pleural mesothelioma was indicated for the highest versus lowest tertile of average intensity of asbestos (HR=1.21, 95% CI: 0.57 to 2.54). Pre-offshore asbestos exposure (vs no such exposure) was associated with increased risk of pleural mesothelioma (HR=2.06, 95% CI: 1.11 to 3.81). For offshore workers with no pre-offshore asbestos exposure, an increased risk of pleural mesothelioma was found for the highest tertile of average intensity of asbestos (HR=4.13, 95% CI: 0.93 to 18), versus the lowest tertile. No associations were found between RCF and pleural mesothelioma., Conclusions: Associations between JEM-based offshore asbestos exposure and pleural mesothelioma were confirmed in the NOPW cohort. Pleural mesothelioma risk was also associated with asbestos exposure before work in the offshore petroleum industry., Competing Interests: Competing interests: The authors declare that they have no financial or other relationships that might lead to a conflict of interest. However, coauthors TKG and JSS have received funding from the Research Council of Norway (governmental agency) in the form of an industry-collaborative grant to the Cancer Registry of Norway (governmental agency) in 2019, to establish an enlarged cohort of offshore petroleum workers. A condition pertaining to such industry-collaborative grants is that 20% (US$175 000) of the grant was provided by the petroleum industry and 80% (US$700 000) from State funding by the Research Council itself with the intention of joining forces for the common interest of occupational health among petroleum workers. The application process was governed by the Research Council alone without any involvement from the petroleum industry. The grant does not cover the salary of the PIs or any of the employees at collaborating institutions., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

During the COVID-19 pandemic in Norway, the testing criteria and capacity changed numerous times. In this study, we aim to assess consequences of changes in testing criteria for infectious disease surveillance. We plotted the proportion of positive PCR tests and the total number of PCR tests for different periods of the pandemic in Norway. We fitted regression models for the total number of PCR tests and the probability of positive PCR tests, with time and weekday as explanatory variables. The regression analysis focuses on the time period until 2021, i.e. before Norway started vaccination. There were clear changes in testing criteria and capacity over time. In particular, there was a marked difference in the testing regime before and after the introduction of self-testing, with a drastic increase in the proportion of positive PCR tests after the introduction of self-tests. The probability of a PCR test being positive was higher for weekends and public holidays than for Mondays-Fridays. The probability for a positive PCR test was lowest on Mondays. This implies that there were different testing criteria and/or different test-seeking behaviour on different weekdays. Though the probability of testing positive clearly changed over time, we cannot in general conclude that this occurred as a direct consequence of changes in testing policies. It is natural for the testing criteria to change during a pandemic. Though smaller changes in testing criteria do not seem to have large, abrupt consequences for the disease surveillance, larger changes like the introduction and massive use of self-tests makes the test data less useful for surveillance., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Engebretsen, Aldrin. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The introduction of biologic therapies and the 'treat-to-target' treatment strategy may have changed the disease course of ulcerative colitis (UC)., Aims: To describe the early disease course and disease outcome at 1-year follow-up in a population-based inception cohort of adult patients with newly diagnosed UC., Methods: The Inflammatory Bowel Disease in South-Eastern Norway (IBSEN) III study is a population-based inception cohort study with prospective follow-up. Patients newly diagnosed with inflammatory bowel disease during 2017-2019 were included. Patients ≥18 years at diagnosis of UC who attended the 1-year follow-up were investigated. We registered clinical, endoscopic and demographic data at diagnosis and 1-year follow-up., Results: We included 877 patients with UC (median age 36 years (range: 18-84), 45.8% female). At diagnosis, 39.2% presented with proctitis, 24.7% left-sided colitis and 36.0% extensive colitis. At the 1-year follow-up, 13.9% experienced disease progression, and 14.5% had received one or more biologic therapies. The colectomy rate was 0.9%. Steroid-free clinical remission was observed in 76.6%, and steroid-free endoscopic remission in 68.7%. Anaemia and initiation of systemic steroid treatment at diagnosis were associated with biologic therapy within the first year after diagnosis., Conclusion: In this population-based inception cohort, colectomy rate in the first year after diagnosis was low, and a high proportion of patients were in remission at 1-year follow-up. The use of biologic therapy increases, consistent with findings from previous studies., (© 2024 The Author(s). Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.)

Purpose: The gold standard for skin cancer diagnosis is surgical excisional biopsy and histopathological examination. Several non-invasive diagnostic techniques exist, although they have not yet translated into clinical use. This is a proof-of-concept study to assess the possibility of imaging an angiosarcoma in the periocular area., Methods: We use laser speckle, hyperspectral, and photoacoustic imaging to monitor blood perfusion and oxygen saturation, as well as the molecular composition of the tissue. The information obtained from each imaging modality was combined in order to yield a more comprehensive picture of the function, as well as molecular composition of a rapidly growing cutaneous angiosarcoma in the periocular area., Results: We found an increase in perfusion coupled with a reduction in oxygen saturation in the angiosarcoma. We could also extract the molecular composition of the angiosarcoma at a depth, depicting both the oxygen saturation and highlighting the presence of connective tissue via collagen., Conclusions: We demonstrate the different physiological parameters that can be obtained with the different techniques and how these can be combined to provide detailed 3D maps of the functional and molecular properties of tumors useful in preoperative assessment.

Objective: Both exposure to occupational chemicals and to unusual working hours have well documented effects on health. Determination of occupational exposure limits is, however, usually based on chemical-only exposure and assumes an 8-h workday, 5 days/week and a 40-h work week. A significant proportion of the workforce is exposed to chemicals while working in other work schedules. This review thus aimed to synthesize and evaluate the scientific support for a combined effect of unusual working hours and chemical exposure and, if possible, give recommendations for OEL adjustments to account for unusual working hours., Methods: The search for articles was made as part of the preparation of a report for the Nordic Expert Group for Criteria Documentation of Health Risks from Chemicals. In this report, unusual working hours were categorized as shift work or extended (>8 h) working hours. Inclusion criteria were observational studies in the English language published up to November 2021 in peer-reviewed journals, with explicit metrics of exposure (chemicals and unusual working hours) and of health outcome, and which explicitly tested the association between exposure and outcome. Search engines of seven databases were used., Results: Of the initially 15 400 identified papers, 9 studies published between 1985 and 2021 met the inclusion criteria, 7 of which showed significant associations. Results from a few of the studies, i.e. regarding effects of dust and endotoxin on lung function, effects of acetone on sleep quality and tiredness, effects of carbon disulphide on coronary artery disease and effects of chemicals on spontaneous abortion, suggested more pronounced effects during night shifts compared to during day shifts., Discussion: The reviewed data is considered insufficient to conclude on recommendations for OEL adjustment for shift work. Suggested areas of future studies are mentioned., Conclusion: Further studies about the effects of the combined exposure to unusual working hours and chemical exposure are essential for risk assessment, and for recommendation of potential OEL adjustments. What is important about this paper? Effects of chemical agents at the workplace may depend not only on exposure level and duration but also on the time of exposure in relation to the circadian rhythm. This study reviewed the scientific support for a combined effect of unusual working hours and chemical exposure and revealed an obvious need for additional studies regarding the complex interplay of the two different exposures with respect to adverse health effects., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.)

Objectives: Previous reports indicate bone deficits in patients with Fontan circulation. However, the consequences of these deficits on bone strength and when these changes occur are unclear., Aim: To compare the tibial bone strength-strain index between young patients (6-19 years) with Fontan circulation and age- and sex-matched controls, and to determine strength-strain-index in subgroups of children (6-12 years) and adolescents (13-19 years) versus controls., Method: The tibia was examined with peripheral quantitative CT. Based on the assessed data, bone strength-strain index was calculated in the lateral and anterior-posterior directions., Results: Twenty patients with Fontan and twenty controls (mean age 13.0 ± 4.4 years; 50% females) were examined. Patients had a lower strength-strain index in the lateral direction compared to controls (808.4 ± 416.8mm 3 versus 1162.5 ± 552.1mm 3 , p = 0.043). Subgroup analyses showed no differences regarding strength-strain index in children (6-12 years) with Fontan circulation compared to controls. However, the adolescents (13-19 years) with Fontan circulation had lower strength-strain indexes in both the lateral and anterior-posterior directions compared to controls (1041.4 ± 299.8mm 3 versus 1596.4 ± 239.6mm 3 , p < 0.001, and 771.7 ± 192.4mm 3 versus 1084.9 ± 215.0mm 3 , p = 0.004). When adjusted for height, there were differences between patients (6-19 years) and controls in strength-strain indexes in both the lateral and anterior-posterior directions. In subgroup analyses, the results remained robust., Conclusion: Young patients (6-19 years) with Fontan circulation have a lower strength-strain index in the tibia compared to controls. Subgroup analyses show that this deficit is mainly driven by the differences in adolescents (13-19 years), which might suggest that bone strength decreases with age.

Background: In animals, dietary sulfur amino acid restriction (SAAR) improves metabolic health, possibly mediated by altering sulfur amino acid metabolism and enhanced anti-obesogenic processes in adipose tissue., Aim: To assess the effects of SAAR over time on the plasma and urine SAA-related metabolites (sulfurome) in humans with overweight and obesity, and explore whether such changes were associated with body weight, body fat and adipose tissue gene expression., Methods: Fifty-nine subjects were randomly allocated to SAAR (∼2 g SAA, n = 31) or a control diet (∼5.6 g SAA, n = 28) consisting of plant-based whole-foods and supplemented with capsules to titrate contents of SAA. Sulfurome metabolites in plasma and urine at baseline, 4 and 8 weeks were measured using HPLC and LC-MS/MS. mRNA-sequencing of subcutaneous white adipose tissue (scWAT) was performed to assess changes in gene expression. Data were analyzed with mixed model regression. Principal component analyses (PCA) were performed on the sulfurome data to identify potential signatures characterizing the response to SAAR., Results: SAAR led to marked decrease of the main urinary excretion product sulfate (p < 0.001) and plasma and/or 24-h urine concentrations of cystathionine, sulfite, thiosulfate, H 2 S, hypotaurine and taurine. PCA revealed a distinct metabolic signature related to decreased transsulfuration and H 2 S catabolism that predicted greater weight loss and android fat mass loss in SAAR vs. controls (all p interaction < 0.05). This signature correlated positively with scWAT expression of genes in the tricarboxylic acid cycle, electron transport and β-oxidation (FDR = 0.02)., Conclusion: SAAR leads to distinct alterations of the plasma and urine sulfurome in humans, and predicted increased loss of weight and android fat mass, and adipose tissue lipolytic gene expression in scWAT. Our data suggest that SAA are linked to obesogenic processes and that SAAR may be useful for obesity and related disorders. TRIAL IDENTIFIER: https://clinicaltrials.gov/study/NCT04701346., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: The matched case-control design, up until recently mostly pertinent to epidemiological studies, is becoming customary in biomedical applications as well. For instance, in omics studies, it is quite common to compare cancer and healthy tissue from the same patient. Furthermore, researchers today routinely collect data from various and variable sources that they wish to relate to the case-control status. This highlights the need to develop and implement statistical methods that can take these tendencies into account., Results: We present an R package penalizedclr, that provides an implementation of the penalized conditional logistic regression model for analyzing matched case-control studies. It allows for different penalties for different blocks of covariates, and it is therefore particularly useful in the presence of multi-source omics data. Both L1 and L2 penalties are implemented. Additionally, the package implements stability selection for variable selection in the considered regression model., Conclusions: The proposed method fills a gap in the available software for fitting high-dimensional conditional logistic regression models accounting for the matched design and block structure of predictors/features. The output consists of a set of selected variables that are significantly associated with case-control status. These variables can then be investigated in terms of functional interpretation or validation in further, more targeted studies., (© 2024. The Author(s).)

Background and Aim: Many children with an FH mutation also exhibit elevated lipoprotein(a) levels, which is an independent risk factor for atherosclerotic cardiovascular disease. Studies have reported higher levels of lipoprotein(a) in adult and middle-aged women than men. There is limited knowledge on the concentration and change of lipoprotein(a) levels in children with genetic FH, and therefore we investigated sex-differences in lipoprotein(a) level and change in lipoprotein(a) in girls and boys with genetically confirmed FH., Methods: Medical records were reviewed retrospectively in 438 subjects with heterozygous FH that started follow-up below the age of 19 years at the Lipid Clinic, Oslo University Hospital in Norway, and of these we included 386 subjects with at least one Lp(a) measurement., Results: Mean (SD) age at baseline was 13.8 (7.3) years and the age was similar between sexes. Girls had a higher lipoprotein(a) level than boys at baseline: median (25-75 percentile) 223 (108-487) vs. 154 (78-360) mg/L, respectively ( p  < 0.01). From baseline to follow-up measurement (mean [SD] 8.9 [6.1] years apart), the mean (95 % CI) absolute and percentage change in Lp(a) level in girls was 151.4 (54.9-247.8) mg/L and 44.8 (16.4-73.1) %, respectively, and in boys it was 66.8 (22.9-110.8) mg/L and 50.5 (8.8-92.3) %, respectively (both p > 0.05)., Conclusions: We found an increase in Lp(a) levels in children with genetic FH with age, and higher levels in girls than boys, which could impact risk assessment and future ASCVD. Further research is needed to elucidate whether subjects with FH could benefit from lipoprotein( a )-lowering therapies that are under current investigations., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Dr. Bogsrud has received research grants and/or personal fees from 10.13039/100002429Amgen and 10.13039/100004339Sanofi, none of which are related to the content of this manuscript. Dr. Retterstøl has received research grants and/or personal fees from Akcea, 10.13039/100002429Amgen, 10.13039/100004336Novartis, and 10.13039/100004339Sanofi, none of which are related to the content of this manuscript. 10.13039/501100007212GL reports personal fees from 10.13039/100002429Amgen, 10.13039/100004339Sanofi and Boehringer Ingelheim, none of which are related to the content of this manuscript. Dr. Holven has received research grants and/or personal fees from 10.13039/100004339Sanofi, none of which are related to the content of this manuscript. Msc. Johansen, Dr. Christensen and Dr. Narverud have nothing to disclose., (© 2024 The Authors.)

Vulvar leiomyoma is rare and is often misdiagnosed as a cyst or abscess in the Bartholin's glands. Other causes of benign tumours of the vulva are Gartner's duct cysts, fibromas, fibroadenomas, lipomas and hamartomas. Adenoma was the tentative diagnosis is this case history, but the histology showed a benign leiomyoma.

Background: Wrist arthroplasty is increasingly offered to patients with symptomatic wrist arthritis as an alternative to wrist arthrodesis. The purpose of this study was to present our outcomes with the ReMotion™ wrist arthroplasty in a consecutive series of patients with wrist arthritis from non-inflammatory conditions. Methods: Thirteen (eight women, nine dominant wrists) patients, 68 (44-85) years of age with advanced radiocarpal arthritis due to SLAC/SNAC (11) and Kienbock disease (2) had a ReMotion™ (Stryker, Michigan, USA) wrist arthroplasty implanted, and were prospectively followed for 7 (4-9) years. The outcome measures included patient-rated wrist and hand evaluation (PRWHE) score, disabilities of the arm, shoulder and hand questionnaire (QuickDASH) score, visual analogue pain score (0-10) on the radial and ulnar aspect of the wrist at rest (VASrR/VASuR) and activity (VASrA/VASuA), active wrist range of motion (AROM) including flexion, extension, ulnar and radial deviation, pronation and supination and grip and key-pinch strength measured preoperatively and at yearly follow-ups by independent hand therapists. Results: Six patients had ten re-operations during the follow-up including four revisions to a new arthroplasty. Four were considered loose at follow-up. A significant reduction in PRWHE (63 to 12), radial pain at activity (6 to 1) and increased pronation (85° v 90°) was observed. Conclusions: We found a high complication and reoperation rate, two out of 13 had no complications or reoperations. The ReMotion™ arthroplasty should be used with caution in non-inflammatory wrist patients and the patients followed closely. A high reoperation and revision rate can be expected, and surgeons familiar with revision arthroplasty procedures should perform the surgery. Level of Evidence: Level II (Therapeutic).

3D cell culture models exposed at the air-liquid interface (ALI) represent a potential alternative to animal experiments for hazard and risk assessment of inhaled compounds. This study compares cocultures composed of either Calu-3, A549 or HBEC3-KT lung epithelial cells, cultured together with THP-1-derived macrophages and EA.hy926 endothelial cells, in terms of barrier capacity and responses to a standard reference sample of fine particulate matter (SRM 2786). High-content imaging analysis revealed a similar cellular composition between the different cell models. The 3D cell cultures with Calu-3 cells showed the greatest barrier capacity, as measured by transepithelial electrical resistance and permeability to Na-fluorescein. Mucus production was detected in 3D cell cultures based on Calu-3 and A549 cells. Exposure to SRM 2786 at ALI increased cytokine release and expression of genes associated with inflammation and xenobiotic metabolism. Moreover, the presence of THP-1-derived macrophages was central to the cytokine responses in all cell models. While the different 3D cell culture models produced qualitatively similar responses, more pronounced pro-inflammatory responses were observed in the basolateral compartment of the A549 and HBEC3-KT models compared to the Calu-3 model, likely due to their reduced barrier capacity and lower retention of secreted mediators in the apical compartment., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest. The following are the supplementary data related to this article. Supplementary data to this article can be found online at https://doi.org/10.1016/j.tiv.2024.105841., (Copyright © 2024. Published by Elsevier Ltd.)

The article focuses on social educators' reflections on their own professional practice in encounters with people with intellectual disability receiving services. Drawing on Interpersonal Process Recall, a video-assisted method, together with a focus group interview, the study explores the experiences from in-situ encounters of five social educators employed in a Norwegian municipality. The key findings are that they view relationship-building as integral to their work, they grant primacy to the ideal of autonomy and they strive towards realizing this in their daily work. The study however displays how these emphases might lead to dilemmas, especially between the wish to support the service users' self-determination and the urge to protect them from harm. Of special note was how the service users' increasing use of social media was perceived as a particular challenge for social educators, who were left with an experience of being unable to protect., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Environmental change is disrupting mutualisms between organisms worldwide. Reported declines in insect populations and changes in pollinator community compositions in response to land use and other environmental drivers have put the spotlight on the need to conserve pollinators. While this is often motivated by their role in supporting crop yields, the role of pollinators for reproduction and resulting taxonomic and functional assembly in wild plant communities has received less attention. Recent findings suggest that observed and experimental gradients in pollinator availability can affect plant community composition, but we know little about when such shifts are to be expected, or the impact they have on ecosystem functioning. Correlations between plant traits related to pollination and plant traits related to other important ecosystem functions, such as productivity, nitrogen uptake or palatability to herbivores, lead us to expect non-random shifts in ecosystem functioning in response to changes in pollinator communities. At the same time, ecological and evolutionary processes may counteract these effects of pollinator declines, limiting changes in plant community composition, and in ecosystem functioning. Despite calls to investigate community- and ecosystem-level impacts of reduced pollination, the study of pollinator effects on plants has largely been confined to impacts on plant individuals or single-species populations. With this review we aim to break new ground by bringing together aspects of landscape ecology, ecological and evolutionary plant-insect interactions, and biodiversity-ecosystem functioning research, to generate new ideas and hypotheses about the ecosystem-level consequences of pollinator declines in response to land-use change, using grasslands as a focal system. Based on an integrated set of seven hypotheses, we call for more research investigating the putative pollinator-mediated links between landscape-scale land use and ecosystem functioning. In particular, future research should use combinations of experimental and observational approaches to assess the effects of changes in pollinator communities over multiple years and across species on plant communities and on trait distributions both within and among species., (© 2023 The Authors. Biological Reviews published by John Wiley & Sons Ltd on behalf of Cambridge Philosophical Society.)

Introduction: Pre-frailty provides an ideal opportunity to prevent physical frailty and promote healthy ageing. Excess adiposity has been associated with an increased risk of pre-frailty, but limited studies have explored whether the association between adiposity measures and pre-frailty varies by social position., Methods: We used data from the seventh survey of the Tromsø Study (Tromsø7) conducted in 2015-2016. Our primary sample consisted of 2,945 women and 2,794 men aged ≥ 65 years. Pre-frailty was defined as the presence of one or two of the five frailty components: low grip strength, slow walking speed, exhaustion, unintentional weight loss and low physical activity. Adiposity was defined by body mass index (BMI), waist circumference (WC), fat mass index (FMI) and visceral adipose tissue (VAT) mass. Education and subjective social position were used as measures of social position. Poisson regression with robust variance was used to assess the association between adiposity measures and pre-frailty, and the interaction term between adiposity measures and social position measures were utilised to explore whether the association varied by social position., Results: In our sample, 28.7% of women and 25.5% of men were pre-frail. We found sub-multiplicative interaction of BMI-defined obesity with education in women and subjective social position in men with respect to development of pre-frailty. No other adiposity measures showed significant variation by education or subjective social position. Regardless of the levels of education or subjective social position, participants with excess adiposity (high BMI, high WC, high FMI and high VAT mass) had a higher risk of pre-frailty compared to those with low adiposity., Conclusion: We consistently observed that women and men with excess adiposity had a greater risk of pre-frailty than those with low adiposity, with only slight variation by social position. These results emphasize the importance of preventing excess adiposity to promote healthy ageing and prevent frailty among all older adults across social strata., (© 2024. The Author(s).)

This article addresses the limitations of existing statistical models in analyzing and interpreting highly skewed miRNA-seq raw read count data that can range from zero to millions. A heavy-tailed model using discrete stable distributions is proposed as a novel approach to better capture the heterogeneity and extreme values commonly observed in miRNA-seq data. Additionally, the parameters of the discrete stable distribution are proposed as an alternative target for differential expression analysis. An R package for computing and estimating the discrete stable distribution is provided. The proposed model is applied to miRNA-seq raw counts from the Norwegian Women and Cancer Study (NOWAC) and the Cancer Genome Atlas (TCGA) databases. The goodness-of-fit is compared with the popular Poisson and negative binomial distributions, and the discrete stable distributions are found to give a better fit for both datasets. In conclusion, the use of discrete stable distributions is shown to potentially lead to more accurate modeling of the underlying biological processes., (© 2024 the author(s), published by De Gruyter, Berlin/Boston.)

Technologically advanced running shoes (TARS) improve performance compared to classical running shoes (CRS). Improved race performance has been attributed to metabolic savings in male runners, but it remains unclear if these same benefits are experienced among females and in recreational runners. The mechanisms behind these benefits are still not fully understood despite the need for optimisation, and their influence on injury mechanisms has not been explored. Here we combined biomechanical, physiological, and modelling approaches to analyse joint mechanics, oxygen uptake, and tibial load in nineteen male and female recreational runners running with CRS and TARS at their individual lactate threshold speed (12.4 ± 1.9 km/h). Oxygen uptake was 3.0 ± 1.5% lower in TARS than in CRS. Ankle dorsiflexion, joint moment and joint power were reduced in TARS compared to CRS at various phases of stance including midstance, while knee joint mechanics were mostly similar throughout. There were no significant differences for tibial bending moment during the stance phase but cumulative tibial damage per kilometre was 12 ± 9% lower in TARS compared to CRS. Our results suggest that running with TARS reduces oxygen cost in recreational female and male runners, which may partly be explained by differences in lower limb joint mechanics. The lower cumulative tibial bone load with TARS may allow runners to run longer distances in this type of shoe compared to CRS., (© 2024. The Author(s).)

A set of 25 strains belonging to clade V of Mannheimia mainly isolated from cattle was investigated and is proposed to represent Mannheimia indoligenes sp. nov. The species can be separated from the other validly published species of the genus by pheno- and genotype. Only indole separates M. indoligenes and Mannheimia varigena while two to seven characters separate M. indoligenes from other species of Mannheimia . Thirteen strains belonging to biogroups 6, 7, 8C, 9, 10, 12 and UG5 formed a monophyletic group based on 16S rRNA gene sequence comparisons with 98-100 % similarity. Eight of these strains were further included in the whole genome comparison. Digital DNA-DNA hybridization showed that the similarities between the suggested type strain M14.4 T and the other strains of M. indoligenes were 62.9 % or higher. The average nucleotide identity was 95.5 % or higher between M14.4 T and the other strains of the species. The rpoB gene sequence similarity was 95-100 % within M. indoligenes . MALDI-TOF allowed a clear separation from other Mannheimia species further supporting classification as a novel species and making it the diagnostic identification tool of choice for M. indoligenes . The type strain is M14.4 T (=CCUG 77347 T =DSM 116804 T ) isolated from a cattle tongue in Scotland.

Herbivorous rodents in boreal, alpine and arctic ecosystems are renowned for their multi-annual population cycles. Researchers have hypothesised that these cycles may result from herbivore-plant interactions in various ways. For instance, if the biomass of preferred food plants is reduced after a peak phase of a cycle, rodent diets can be expected to become dominated by less preferred food plants, leading the population to a crash. It could also be expected that the taxonomic diversity of rodent diets increases from the peak to the crash phase of a cycle. The present study is the first to use DNA metabarcoding to quantify the diets of two functionally important boreal rodent species (bank vole and tundra vole) to assess whether their diet changed systematically in the expected cyclic phase-dependent manner. We found the taxonomic diet spectrum broad in both vole species but with little interspecific overlap. There was no evidence of systematic shifts in diet diversity metrics between the phases of the population cycle in either species. While both species' diet composition changed moderately between cycle phases and seasons, these changes were small compared to other sources of diet variation-especially differences between individuals. Thus, the variation in diet that could be attributed to cyclic phases is marginal relative to the overall diet flexibility. Based on general consumer-resource theory, we suggest that the broad diets with little interspecific overlap render it unlikely that herbivore-plant interactions generate their synchronous population cycles. We propose that determining dietary niche width should be the first step in scientific inquiries about the role of herbivore-plant interactions in cyclic vole populations., Competing Interests: The authors declare that they have no conflict of interest., (© 2024 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)

Background: Fee-for-service is a common payment model for remunerating general practitioners (GPs) in OECD countries. In Norway, GPs earn two-thirds of their income through fee-for-service, which is determined by the number of consultations and procedures they register as fees. In general, fee-for-service incentivises many and short consultations and is associated with high service provision. GPs act as gatekeepers for various treatments and interventions, such as addictive drugs, antibiotics, referrals, and sickness certification. This study aims to explore GPs' reflections on and perceptions of the fee-for-service system, with a specific focus on its potential impact on gatekeeping decisions., Methods: We conducted six focus group interviews with 33 GPs in 2022 in Norway. We analysed the data using thematic analysis., Results: We identified three main themes related to GPs' reflections and perceptions of the fee-for-service system. First, the participants were aware of the profitability of different fees and described potential strategies to increase their income, such as having shorter consultations or performing routine procedures on all patients. Second, the participants acknowledged that the fees might influence GP behaviour. Two perspectives on the fees were present in the discussions: fees as incentives and fees as compensation. The participants reported that financial incentives were not directly decisive in gatekeeping decisions, but that rejecting requests required substantially more time compared to granting them. Consequently, time constraints may contribute to GPs' decisions to grant patient requests even when the requests are deemed unreasonable. Last, the participants reported challenges with remembering and interpreting fees, especially complex fees., Conclusions: GPs are aware of the profitability within the fee-for-service system, believe that fee-for-service may influence their decision-making, and face challenges with remembering and interpreting certain fees. Furthermore, the fee-for-service system can potentially affect GPs' gatekeeping decisions by incentivising shorter consultations, which may result in increased consultations with inadequate time to reject unnecessary treatments., (© 2024. The Author(s).)

In the dawning era of artificial intelligence (AI), health care stands to undergo a significant transformation with the increasing digitalization of patient data. Digital imaging, in particular, will serve as an important platform for AI to aid decision making and diagnostics. A growing number of studies demonstrate the potential of automatic pre-surgical skin tumor delineation, which could have tremendous impact on clinical practice. However, current methods rely on having ground truth images in which tumor borders are already identified, which is not clinically possible. We report a novel approach where hyperspectral images provide spectra from small regions representing healthy tissue and tumor, which are used to generate prediction maps using artificial neural networks (ANNs), after which a segmentation algorithm automatically identifies the tumor borders. This circumvents the need for ground truth images, since an ANN model is trained with data from each individual patient, representing a more clinically relevant approach., Competing Interests: The authors declare no competing interests., (© 2024 The Authors.)

Agricultural intensification at field and landscape scales, including increased use of agrochemicals and loss of semi-natural habitats, is a major driver of insect declines and other community changes. Efforts to understand and mitigate these effects have traditionally focused on ecological responses. At the same time, adaptations to pesticide use and habitat fragmentation in both insects and flowering plants show the potential for rapid evolution. Yet we lack an understanding of how such evolutionary responses may propagate within and between trophic levels with ensuing consequences for conservation of species and ecological functions in agroecosystems. Here, we review the literature on the consequences of agricultural intensification on plant and animal evolutionary responses and interactions. We present a novel conceptualization of evolutionary change induced by agricultural intensification at field and landscape scales and emphasize direct and indirect effects of rapid evolution on ecosystem services. We exemplify by focusing on economically and ecologically important interactions between plants and pollinators. We showcase available eco-evolutionary theory and plant-pollinator modelling that can improve predictions of how agricultural intensification affects interaction networks, and highlight available genetic and trait-focused methodological approaches. Specifically, we focus on how spatial genetic structure affects the probability of propagated responses, and how the structure of interaction networks modulates effects of evolutionary change in individual species. Thereby, we highlight how combined trait-based eco-evolutionary modelling, functionally explicit quantitative genetics, and genomic analyses may shed light on conditions where evolutionary responses impact important ecosystem services., (© 2023 The Authors. Biological Reviews published by John Wiley & Sons Ltd on behalf of Cambridge Philosophical Society.)

We present an ultrasonic method of detecting cracks in pipelines based on using normally incident transducers in a pitch-catch setup, which can only excite Lamb modes of higher order than the fundamental modes A 0 and S 0 commonly used in crack detection applications. By excitation and measurements of the Lamb modes S 1 , S 2 , and A 3 , in a steel plate immersed in fluid with and without a notch (to emulate a crack), the performance of the modes towards crack detection is quantified by assessing whether it returns a high leaky component and whether the notch has a large impact on the leaky component. In order to narrow the scope of measurements necessary to investigate notch sensitivity for different system parameters, and to potentially optimize the system setup, we present a computationally efficient theoretical model based on angular spectrum method (ASM) and the theoretical sensitivity kernel formulation from the field of seismology that accounts for a scatterer in the wave path between the transmitter and receiver. The model is compared against measurements, which show that the frequency components of the S 2 mode has both the largest leaky frequency component in the given setup and the largest sensitivity at a frequency close to the maximum leaky frequency such that a difference caused by the notch is easily measured. By using the measurements and the validation calculation as baseline reference, we calculate the expected S 2 mode sensitivity and leaky components for larger plate thicknesses and larger standoffs, which exemplifies how the model can be applied in measurement system design and optimization., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

The effective control of ectoparasitic salmon lice, Lepeophtheirus salmonis, in fish farms is challenged by the salmon lice having developed resistance towards several antiparasitic drugs and by the effectiveness of non-medicinal treatments being limited by considerations of fish welfare. When new antiparasitics are introduced to the market, these should be used sparingly to slow resistance development. Using a population model for salmon lice parameterised for salmonid fish farms in Norway, we quantified how reduced treatment effectiveness influences treatment frequency and lice abundance. Furthermore, we investigated when in the production cycle a highly effective lice treatment leads to the largest reduction in the total number of treatments, mean lice abundance and lice larvae production. Results showed that reductions in treatment effectiveness to lower than 50% led to the steepest increases in treatment frequency and mean lice abundance, as well as to increased risk that lice abundance increased beyond control. The timing of the most effective treatment had only moderate effects on the total treatment need and the mean number of adult female lice through the production cycle, but large effect on the production of lice larvae in spring. These findings imply that farmers can optimise the timing of the most effective treatment to reduce the release of lice larvae in the period of year when wild salmonids are in coastal waters, without compromising total treatment need or mean lice levels., Competing Interests: Declaration of Competing Interest We have no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: General practitioners (GPs) have an important gatekeeping role in the Norwegian sickness insurance system. This role includes limiting access to paid sick leave when this is not justified according to sick leave criteria. 85% of GPs in Norway operate within a fee-for-service system that incentivises short consultations and high service provision. In this qualitative study, we explore how GPs practise the gatekeeping role in sickness absence certification., Methods: Qualitative data was collected through six focus group interviews with 33 GPs, working in practices with a minimum of four practising GPs, in different geographical regions across Norway, including both urban and rural areas. Data was analysed using Braune and Clarke's thematic analysis approach., Results: Our results indicate that GPs' sick-listing decisions are largely driven by patient demand and preferences for sick leave. GPs reported that they rarely overrule patient requests for sickness absence, including in cases where such requests conflict with the GPs' opinion of whether sick leave is justified or benefits the patient. The degree of effort made to limit unjustified or non-beneficial sick leave seems to depend on the GPs' available time and perceived risk of conflict with the patient. GPs generally expressed dissatisfaction with their role as certifiers of sickness absence., Conclusion: Our study suggests that GPs' decisions about sickness certification is largely driven by patient preferences. The GPs' gatekeeping function is limited to negotiations about grade and duration of absence spells., (© 2024. The Author(s).)

Small rodent population cycles characterise northern ecosystems, and the cause of these cycles has been a long-lasting central topic in ecology, with trophic interactions currently considered the most plausible cause. While some researchers have rejected plant-herbivore interactions as a cause of rodent cycles, others have continued to research their potential roles. Here, we present an overview of whether plants can cause rodent population cycles, dividing this idea into four different hypotheses with different pathways of plant impacts and related assumptions. Our systematic review of the existing literature identified 238 studies from 150 publications. This evidence base covered studies from the temperate biome to the tundra, but the studies were scattered across study systems and only a few specific topics were addressed in a replicated manner. Quantitative effects of rodents on vegetation was the best studied topic, and our evidence base suggests such that such effects may be most pronounced in winter. However, the regrowth of vegetation appears to take place too rapidly to maintain low rodent population densities over several years. The lack of studies prevented assessment of time lags in the qualitative responses of vegetation to rodent herbivory. We conclude that the literature is currently insufficient to discard with confidence any of the four potential hypotheses for plant-rodent cycles discussed herein. While new methods allow analyses of plant quality across more herbivore-relevant spatial scales than previously possible, we argue that the best way forward to rejecting any of the rodent-plant hypotheses is testing specific predictions of dietary variation. Indeed, all identified hypotheses make explicit assumptions on how rodent diet taxonomic composition and quality will change across the cycle. Passing this bottleneck could help pinpoint where, when, and how plant-herbivore interactions have - or do not have - plausible effects on rodent population dynamics., (© 2023 The Authors. Biological Reviews published by John Wiley & Sons Ltd on behalf of Cambridge Philosophical Society.)

Aim: The aim of the present retrospective study was to evaluate the long-term results, including technical and biologic outcomes, of maxillary extended porcelain veneers with an incisal edge thickness above 2 mm., Materials and Methods: Patients treated with extended porcelain veneers performed by a single clinician at University of Geneva between 1990 and 2003 were identified and invited to an examination. Of the 37 identified patients, 10 patients with 50 veneers agreed to be examined and were included. A clinical examination was performed to assess survival rates as well as technical and biologic outcomes (modified United States Public Health Services criteria). Patient records were also reviewed to retrieve patient and reconstruction data and every complication event. Patient-reported outcome measures (PROMs) were evaluated using a visual analog scale to measure esthetic satisfaction, functional and phonetic comfort, masticatory improvement, tooth sensitivity, and acceptance of restoration replacement in case of failure. Data were descriptively analyzed, and Kaplan-Meier survival estimators were computed for survival rates and complication events., Results: The survival rate of the veneers was 96% after a mean follow-up of 20.7 ± 3.7 years in function. The technical complication rate amounted to 30%, including two failures, nine repairable fractures, three cracks, and one displacement due to trauma. No cavitated caries lesions or endodontic complications were registered. PROMs were very high for esthetic satisfaction and phonetic comfort., Conclusions: Within the limitations of the present retrospective study, extended porcelain veneers appear to be a successful long-term treatment option in terms of clinical outcomes and patient satisfaction.

Background: Dietary sulfur amino acid restriction (SAAR) improves metabolic health in animals. In this study, we investigated the effect of dietary SAAR on body weight, body composition, resting metabolic rate, gene expression profiles in white adipose tissue (WAT), and an extensive blood biomarker profile in humans with overweight or obesity., Methods: N = 59 participants with overweight or obesity (73% women) were randomized stratified by sex to an 8-week plant-based dietary intervention low (~ 2 g/day, SAAR) or high (~ 5.6 g/day, control group) in sulfur amino acids. The diets were provided in full to the participants, and both investigators and participants were blinded to the intervention. Outcome analyses were performed using linear mixed model regression adjusted for baseline values of the outcome and sex., Results: SAAR led to a ~ 20% greater weight loss compared to controls (β 95% CI - 1.14 (- 2.04, - 0.25) kg, p = 0.013). Despite greater weight loss, resting metabolic rate remained similar between groups. Furthermore, SAAR decreased serum leptin, and increased ketone bodies compared to controls. In WAT, 20 genes were upregulated whereas 24 genes were downregulated (FDR < 5%) in the SAAR group compared to controls. Generally applicable gene set enrichment analyses revealed that processes associated with ribosomes were upregulated, whereas processes related to structural components were downregulated., Conclusion: Our study shows that SAAR leads to greater weight loss, decreased leptin and increased ketone bodies compared to controls. Further research on SAAR is needed to investigate the therapeutic potential for metabolic conditions in humans., Trial Registration: ClinicalTrials.gov identifier: NCT04701346, registered Jan 8th 2021, https://www., Clinicaltrials: gov/study/NCT04701346., (© 2024. The Author(s).)

Background: Veterinarians are an occupational group with an increased suicide risk. Euthanasing animals may influence both veterinarians' views on assisted dying in humans and their suicide risk. We investigated (I) attitudes towards assisted dying, (II) whether the field of work and the frequency of euthanasing animals were associated with positive attitudes towards human euthanasia, and (III) whether frequently euthanasing animals was associated with serious suicidal thoughts., Methods: We conducted a nationwide cross-sectional study among veterinarians in Norway (response rate: 75%). Logistic regression models were used to calculate the odds ratios for both positive attitudes towards human euthanasia and serious suicidal thoughts. The analyses were adjusted for socio-demographic and work-related factors., Results: Fifty-five percent of the veterinarians agreed that euthanasia should be permitted for humans with a fatal disease and short life expectancy. Working with companion animals was independently associated with positive attitudes towards human euthanasia (OR = 1.66 (95% CI: 1.23-2.23)), while veterinarians' frequency of euthanasing animals was not. Frequency of euthanasing animals was independently associated with serious suicidal thoughts, OR = 2.56 (95% CI: 1.35-4.87)., Conclusions: Veterinarians' attitudes towards assisted dying in humans did not differ from those of the general population. Veterinarians' frequency of euthanasing animals was not associated with positive attitudes towards euthanasia in humans. However, veterinarians working in companion animal practices were more likely to have positive attitudes towards euthanasia in humans. Moreover, euthanising animals five times or more a week was associated with serious suicidal thoughts. We need more research to infer about causality in these findings., (© 2023. The Author(s).)

The naming of prokaryotes is governed by the International Code of Nomenclature of Prokaryotes (ICNP) and partially by the International Code of Nomenclature for Algae, Fungi and Plants (ICN). Such codes must be able to determine names of taxa in a universal and unambiguous manner, thus serving as a common language across different fields and activities. This unity is undermined when a new code of nomenclature emerges that overlaps in scope with an established, time-tested code and uses the same format of names but assigns different nomenclatural status values to the names. The resulting nomenclatural confusion is not beneficial to the wider scientific community. Such ambiguity is expected to result from the establishment of the 'Code of Nomenclature of Prokaryotes Described from DNA Sequence Data' ('SeqCode'), which is in general and specific conflict with the ICNP and the ICN. Shortcomings in the interpretation of the ICNP may have exacerbated the incompatibility between the codes. It is reiterated as to why proposals to accept sequences as nomenclatural types of species and subspecies with validly published names, now implemented in the SeqCode, have not been implemented by the International Committee on Systematics of Prokaryotes (ICSP), which oversees the ICNP. The absence of certain regulations from the ICNP for the naming of as yet uncultivated prokaryotes is an acceptable scientific argument, although it does not justify the establishment of a separate code. Moreover, the proposals rejected by the ICSP are unnecessary to adequately regulate the naming of uncultivated prokaryotes. To provide a better service to the wider scientific community, an alternative proposal to emend the ICNP is presented, which would result in Candidatus names being regulated analogously to validly published names. This proposal is fully consistent with previous ICSP decisions, preserves the essential unity of nomenclature and avoids the expected nomenclatural confusion.

Objective: The objective of our study was to examine whether occupational exposure to benzene is associated with lung cancer among males in the Norwegian Offshore Petroleum Workers cohort., Methods: Among 25 347 male offshore workers employed during 1965-1998, we conducted a case-cohort study with 399 lung cancer cases diagnosed between 1999 and 2021, and 2035 non-cases sampled randomly by 5-year birth cohorts. Individual work histories were coupled to study-specific job-exposure matrices for benzene and other known lung carcinogens. Weighted Cox regression was used to estimate HRs and 95% CIs for the associations between benzene exposure and lung cancer, by major histological subtypes, adjusted for age, smoking and occupational exposure to welding fumes, asbestos and crystalline silica. Missing data were imputed., Results: For lung cancer (all subtypes combined), HRs (95% CIs) for the highest quartiles of benzene exposure versus unexposed were 1.15 (0.61 to 2.35) for cumulative exposure, 1.43 (0.76 to 2.69) for duration, and 1.22 (0.68 to 2.18) for average intensity (0.280≤P-trend≤0.741). For 152 adenocarcinoma cases, a positive trend was observed for exposure duration (P-trend=0.044)., Conclusions: In this cohort of offshore petroleum workers generally exposed to low average levels of benzene, we did not find an overall clear support for an association with lung cancer (all subtypes combined), although an association was suggested for duration of benzene exposure and adenocarcinoma. The limited evidence might be due to restricted statistical power., Competing Interests: Competing interests: None declared. However, coauthors JSS (PI) and TKG (co-PI), were awarded an industry-collaborative grant by the Research Council of Norway (RCN, a governmental agency) in 2019 to establish an updated cohort of offshore petroleum workers. The petroleum industry and RCN provided 20% (US$175 000) and 80% (US$700 000), respectively. The RCN governed the application process independently. The grant covers the PhD position for coauthor RB., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Introduction and Objective: Endotoxins from gram-negative bacteria might be released when the coffee cherries are processed and may cause respiratory health problems among workers in the coffee industry. The relationship between bacterial contamination and occupational exposure to endotoxin levels has not been thoroughly explored previously in primary coffee processing factories in Ethiopia, or elsewhere. The aim of this study was to characterize the level of personal endotoxin exposure and its relations with bacterial contamination of coffee cherries in such factories in Ethiopia., Material and Methods: A cross-sectional study was conducted from March 2020 - February 2021 in 9 primary coffee processing factories in 3 regions in Ethiopia. A total of 180 personal air samples were collected to analyze workers' exposure to inhalable dust and endotoxin. Correlation tests were performed to assess the relationship between total bacteria and endotoxin levels and between inhalable dust and endotoxin levels., Results: The geometric mean (GM) of personal inhalable dust exposure among machine room workers and hand pickers were 9.58 mg/m 3 and 2.56 mg/m 3 , respectively. The overall GM of endotoxin exposure among machine room workers and hand pickers were 10,198 EU/m 3 and 780 EU/m 3 , respectively. Gram-negative bacteria were found in all 54 coffee samples. The correlation between inhalable dust and endotoxin exposure was significant (r=0.80; P <0.01)., Conclusions: About 92% of the samples from hand pickers and all samples from machine room workers exceeded the occupational exposure limit of 90 EU/m 3 recommended by the Dutch Expert Committee on Occupational Standards. Prevention and control of bacterial contamination of the coffee in primary coffee processing are suggested to reduce endotoxin exposure that might cause respiratory health problems among coffee workers.

Purpose: To compare performance, physiological and biomechanical responses between double poling (DP) and diagonal stride (DIA) during treadmill roller skiing in elite male cross-country skiers., Method: Twelve skiers (VO 2peak DIA up ; 74.7 ± 3.7 ml kg -1 min -1 ) performed two DP conditions at 1° (DP flat ) and 8° (DP up ) incline, and one DIA condition, 8° (DIA up ). Submaximal gross efficiency (GE) and maximal 3.5 min time-trial (TT) performance, including measurements of VO 2peak and maximal accumulated O 2 -deficit (MAOD), were determined. Temporal patterns and kinematics were assessed using 2D video, while pole kinetics were obtained from pole force., Results: DIA up induced (mean, [95% confidence interval]) 13% [4, 22] better 3.5-min TT performance, 7%, [5, 10]) higher VO 2peak and 3% points [1, 5] higher GE compared to DP up (all P < 0.05). DP up induced 120% higher MAOD compared to DP flat , while no significant differences were observed for VO 2peak or GE between DP flat and DP up . There was a large correlation between performance and GE in DP and a large correlation between performance and VO 2peak for DIA up (all r = 0.7-0.8, P < 0.05). No correlations were found between performance and VO 2peak for any of the DP conditions, nor between performance and GE for DIA up (r = 0.0-0.2, P > 0.1)., Conclusion: At 8º uphill roller skiing, DIA up induce higher VO 2peak , GE, and superior time-trial performance than DP up in elite male skiers. There was no difference between VO 2peak or GE between DP flat and DP up . A large correlation was observed between DIA up performance and DIA up VO 2peak , while DP performance was best correlated to submaximal GE., (© 2023. The Author(s).)

Background and Aims: Although fatigue is common in inflammatory bowel disease [IBD], its pathogenesis remains unclear. This study aimed to determine the prevalence of fatigue and its associated factors in a cohort of patients newly diagnosed with IBD., Methods: Patients ≥18 years old were recruited from the Inflammatory Bowel Disease South-Eastern Norway [IBSEN III] study, a population-based, observational inception cohort. Fatigue was assessed using the Fatigue Questionnaire and compared with data from a Norwegian general population. Univariate and multivariate linear and logistic regression analyses were performed to evaluate the associations of total fatigue [TF; continuous score] and substantial fatigue [SF; dichotomized score ≥4] with sociodemographic, clinical, endoscopic, laboratory, and other relevant patient data., Results: In total, 983/1509 [65.1%] patients with complete fatigue data were included (ulcerative colitis [UC], 68.2%; Crohn's disease [CD], 31.8%). The prevalence of SF was higher in CD [69.6%] compared with UC [60.2%] [p < 0.01], and in both diagnoses when compared to the general population [p < 0.001]. In multivariate analyses, depressive symptoms, pain intensity, and sleep disturbances were associated with increased TF for both diagnoses. In addition, increased clinical disease activity and Mayo endoscopic score were significantly associated with TF in UC, whereas all disease-related variables were insignificant in CD. Similar findings were observed for SF, except regarding the Mayo endoscopic score., Conclusions: SF affects approximately two-thirds of patients newly diagnosed with IBD. Fatigue was associated with depressive symptoms, sleep disturbances, and increased pain intensity in both diagnoses, while clinical and endoscopic activity were associated factors only in UC., (© The Author(s) 2023. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation.)

Background and Objectives: The incidence rate of Parkinson disease (PD) has been increasing rapidly during the past years. Yet, no treatments exist to prevent or slow the progression of the disease. Moreover, we are unable to detect early disease stages during which intervention with disease-modifying therapies is most likely to succeed. The objective of this study was to perform an agnostic drug-wide association study estimating the association between the use of any of the drugs prescribed in Norway and the subsequent risk of PD., Methods: This registry-based cohort study use data from the entire Norwegian population between 2004 and 2019 linked to the Norwegian Prescription Registry, with more than 600 million individual prescriptions. Drug classes were screened according to Anatomical Therapeutic Chemical codes at level 2, corresponding to therapeutic subgroups. We used Cox regression models to estimate hazard ratios (HRs) and 95% CIs for the associations between drug classes and PD risk. All p values were corrected for multiple testing using the false discovery rate. In addition, we conducted sensitivity analyses of exposure definition as well as time-lag and dose-response analyses., Results: The study population comprised 3,223,672 individuals, 15,849 of whom developed PD during the follow-up. We identified 31 drug classes that were statistically significantly associated with PD risk in Norway during the follow-up. Drugs acting on the renin-angiotensin system (HR 0.92, 95% CI 0.89-0.95), corticosteroids for systemic use (0.88, 95% CI 0.84-0.93), and vaccines (0.89, 95% CI 0.82-0.96) were associated with a decreased risk of PD even up to 10 years before PD onset. Drug classes used to treat symptoms related to prodromal signs of PD, such as constipation, urological issues, and depression, were associated with an increased risk of subsequent diagnosis of PD with HRs of 1.6 (95% CI 1.49-1.73), 1.48 (1.42-1.53), and 1.94 (1.87-2.01), respectively., Discussion: This drug-wide study identified 31 drug classes that were associated with the PD risk change. It reveals the links of renin-angiotensin system medications, vaccines, and corticosteroids with PD risk and suggests that monitoring drug usage using pharmacoepidemiology may allow identifying individuals with prodromal PD., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.)

Background: Optical spectroscopy is commonly used clinically to monitor oxygen saturation in tissue. The most commonly employed technique is pulse oximetry, which provides a point measurement of the arterial oxygen saturation and is commonly used for monitoring systemic hemodynamics, e.g. during anesthesia. Hyperspectral imaging (HSI) is an emerging technology that enables spatially resolved mapping of oxygen saturation in tissue (sO 2 ), but needs to be further developed before implemented in clinical practice. The aim of this study is to demonstrate the applicability of HSI for mapping the sO 2 in reconstructive surgery and demonstrate how spectral analysis can be used to obtain clinically relevant sO 2 values., Methods: Spatial scanning HSI was performed on cutaneous forehead flaps, raised as part of a direct brow lift, in eight patients. Pixel-by-pixel spectral analysis, accounting for the absorption from multiple chromophores, was performed and compared to previous analysis techniques to assess sO 2 ., Results: Spectral unmixing using a broad spectral range, and accounting for the absorption of melanin, fat, collagen, and water, provided a more clinically relevant estimate of sO 2 than conventional techniques, where typically only spectral features associated with absorption of oxygenated (HbO 2 ) and deoxygenated (HbR) hemoglobin are considered. We demonstrate its clinical applicability by generating sO 2 maps of partially excised forehead flaps showed a gradual decrease in sO 2 along the length of the flap from 95 % at the flap base to 85 % at the flap tip. After being fully excised, sO 2 in the entire flap decreased to 50 % within a few minutes., Conclusions: The results demonstrate the capability of sO 2 mapping in reconstructive surgery in patients using HSI. Spectral unmixing, accounting for multiple chromophores, provides sO 2 values that are in accordance with physiological expectations in patients with normal functioning microvascularization. Our results suggest that HSI methods that yield reliable spectra are to be preferred, so that the analysis can produce results that are of clinical relevance., Competing Interests: Declaration of competing interest The authors declare they have no competing interests., (Copyright © 2023. Published by Elsevier Inc.)