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INTRODUCTION: In the 330-patient ADVOCATE trial of avacopan for the treatment of antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis, in which 81% of patients had renal involvement, estimated glomerular filtration rate (eGFR) increased on average 7.3 ml/min per 1.73 m(2) in the avacopan group and 4.1 ml/min per 1.73 m(2) in the prednisone group (P = 0.029) at week 52. This new analysis examines the results in the patient subgroup with severe renal insufficiency at enrollment into the trial, i.e., eGFR ≤20 ml/min per 1.73 m(2). METHODS: eGFR was determined at baseline and over the course of the trial. Changes in eGFR were compared between the 2 treatment groups. RESULTS: In ADVOCATE, 27 of 166 patients (16%) in the avacopan group and 23 of 164 patients (14%) in the prednisone group had a baseline eGFR ≤20 ml/min per 1.73 m(2). At week 52, eGFR increased on average 16.1 and 7.7 ml/min per 1.73 m(2) in the avacopan and prednisone groups, respectively (P = 0.003). The last eGFR value measured during the 52-week treatment period was ≥2-fold higher than baseline in 41% of patients in the avacopan group compared to 13% in the prednisone group (P = 0.030). More patients in the avacopan group versus prednisone group had increases in eGFR above 20, 30, and 45 ml/min per 1.73 m(2), respectively. Serious adverse events occurred in 13 of 27 patients (48%) in the avacopan group and 16 of 23 patients (70%) in the prednisone group. CONCLUSION: Among patients with baseline eGFR ≤20 ml/min per 1.73 m(2) in the ADVOCATE trial, eGFR improved more in the avacopan group than in the prednisone group.

Background: Incident atrial fibrillation (AF) occurs in 5–10% of patients after acute myocardial infarction (AMI) and is associated with adverse outcomes. Guidelines now recommend screening for AF in all elderly patients. However, the relevance of screen-detected AF and short episodes of irregular supraventricular ectopic beats (“micro-AF”) after AMI is unknown. Objectives: The objective of the study was to investigate the value of 2-week intermittent ECG screening to detect incident AF and “micro-AF” in elderly patients 12 months after an AMI and its association with risk of cardiovascular events. Methods: This was an investigator-initiated, multicenter sub-study of the OMega-3 fatty acids in Elderly patients with Myocardial Infarction (OMEMI) trial, in Norway. Women and men aged 70–82 years, with a recent AMI, were recruited during 2012–2018. All participants had a 12-lead ECG performed at 3, 12, and 24 months. Patients without AF 1 year after the index AMI underwent 2 weeks of intermittent 30-s “thumb ECG” screening. Incident AF and “micro-AF” (episodes of ≥3 consecutive irregular supraventricular ectopic beats) were registered, and the association with risk of major cardiovascular events (MACEs; nonfatal AMI, stroke, coronary revascularization, hospitalization for heart failure, or all-cause death) was analyzed with logistic regression. Results: Among 1014 patients (198 [28.7%] women), 255 (25.1%) had known AF or AF identified at baseline. New-onset AF was detected clinically or at study visits in 39 (3.8%) patients. By screening participants without AF (n = 567), unknown AF was identified in 4 (0.7%) and “micro-AF” in 27 (4.8%) patients. Among 43 patients with incident AF, 21 (48.8%) experienced a MACE, which was significantly higher than those without AF (n = 114, 15.9%; p < 0.001), driven by a higher risk of AMI or revascularization. Nine (33.3%) patients with “micro-AF” and 75 (13.9%) without “micro-AF” experienced a MACE (p = 0.002), explained mostly by a higher risk of heart failure hospitalization (p < 0.001). Using patients without AF and “micro-AF” as reference, “micro-AF” was associated with an intermediate risk of MACE (OR 2.8; 95% CI 1.2–6.4) and new-onset AF with a high risk of MACE (OR 5.3; 95% CI 2.8–10.0). Conclusions: Two-week intermittent ECG screening identified few cases of new-onset AF but a substantial number of patients with “micro-AF.” “Micro-AF” was associated with an increased risk of major cardiovascular events, albeit with an intermediate risk compared to those with new-onset AF.

Total bilirubin consists of an unconjugated form, solubilized by its binding to albumin, and a conjugated form representing a minor part of the circulating bilirubin. As total bilirubin in physiological concentrations is a powerful antioxidant, its concentration gradient may reflect the health status of an individual, and serve as a prognostic indicator of outcome in primary and secondary cardiovascular disease prevention. The aim of this study was to assess the association between total bilirubin and incident cardiovascular events following a myocardial infarction. Total bilirubin in serum was measured at baseline 2–8 weeks after hospitalization for an MI in 881 patients, aged 70 to 82 years, included in the OMEMI (Omega-3 Fatty acids in Elderly with Myocardial Infarction) study, where patients were followed-up for up to 2 years. The first major adverse clinical event (MACE) was the primary endpoint and consisted of nonfatal MI, unscheduled coronary revascularization, stroke, hospitalization for heart failure or all-cause death. As total bilirubin was non-normally distributed, log-transformed values and quartiles of bilirubin were analyzed using Cox regression models. The median (Q1, and Q3) baseline concentration of bilirubin was 11 (9, and 14) µmol/L, and higher log-transformed concentrations were associated with male sex, lower New York Heart Association (NYHA) class and non-smoking. MACE occurred in 177 (20.1%) patients during the follow-up. Higher concentrations of bilirubin were associated with a lower risk of MACE: HR 0.67 (95%CI 0.47–0.97) per log-unit increase, p = 0.032. Patients in the lowest quartile of bilirubin (

Dáruiduhttin lea leamaš stáda sámepolitihka prinsihpalaš vuođđun 1880-logu rájes, ja dáruiduhttin lei boađusin stáda doaimmain sámegiela ja kultuvrra ektui. Dat politihkka almmolaččat loahpahuvvui nuppi máilmmi soađi áiggi 1940–1945, ja Norgga stuoradiggi almmolaččat mearridii molsut sámepolitihkalaš prinsihpa dáruiduhttimis seailluhit sámegiela ja kultuvrra almmolaččat. Liikká leat olbmot ođđa sámepolitihka áiggi guođđán eatnigielaset ja sámi kultuvrralaš dovdomearkkaid nugo biktasiid, namaid jnv. Dát dáruiduvve go mánát dahje nuorraolbmot geavahišgohte dárogiela ja nugo dážabiktasiid dahje go váhnemat válljeje dárogiela vuosttašgiellan mánáidasaset. Orro leame dego dáruiduvvan livččii joatkán vaikko dáruiduhttin lei almmolaččat loahpahuvvon. Mun lean dutkan sámegiela saji ja hástalusaid Guovdageainnus, ja dán artihkkalis mun dutkandieđuid vuođul čilgen mot Guovdageainnu olbmot aktevran čáhkkegohte saji sámegillii almmolaš giellan. English title: Saami language: challenges, preservation and development in Guovdageaidnu English abstract: The principle of Norwegianization formed the basis of Norway’s official policy towards the Saami from the 1880s until the mid-1900s, a period in which the Norwegian authorities prevented and prohibited the use of as well as instruction in the Saami language. Norwegianization did not function uniformly in all Saami speaking areas and the Saami language survived better in some areas than in others. Becoming “Norwegianized” occurred when Saami speaking persons started using a non-native language instead of their own mother tongue, a process that just happened, without any discussion or explanation whatsoever. I have studied the status and condition of the Saami language in Guovdageaidnu/Kautokeino throughout the 1900s. The Saami language has survived in Guovdageaidnu/Kautokeino, though the language situation has varied from one period to the next. The 1980s were prosperous and in this period the municipality officially adopted Saami on an equal footing with Norwegian. Survival of a language, however, depends on its use, and for Saami schools, it is a goal to make pupils functionally bilingual. Since the 1990s, Saami has been an official language in central areas in Norway. However, there are internal variations in the language situation. In the Saami municipalities, Saami is used in people’s everyday lives both at home and at work. There is need for the development of the language., Dáruiduhttin lea leamaš stáda sámepolitihka prinsihpalaš vuođđun 1880-logu rájes, ja dáruiduhttin lei boađusin stáda doaimmain sámegiela ja kultuvrra ektui. Dat politihkka almmolaččat loahpahuvvui nuppi máilmmi soađi áiggi 1940–1945, ja Norgga stuoradiggi almmolaččat mearridii molsut sámepolitihkalaš prinsihpa dáruiduhttimis seailluhit sámegiela ja kultuvrra almmolaččat. Liikká leat olbmot ođđa sámepolitihka áiggi guođđán eatnigielaset ja sámi kultuvrralaš dovdomearkkaid nugo biktasiid, namaid jnv. Dát dáruiduvve go mánát dahje nuorraolbmot geavahišgohte dárogiela ja nugo dážabiktasiid dahje go váhnemat válljeje dárogiela vuosttašgiellan mánáidasaset. Orro leame dego dáruiduvvan livččii joatkán vaikko dáruiduhttin lei almmolaččat loahpahuvvon. Mun lean dutkan sámegiela saji ja hástalusaid Guovdageainnus, ja dán artihkkalis mun dutkandieđuid vuođul čilgen mot Guovdageainnu olbmot aktevran čáhkkegohte saji sámegillii almmolaš giellan.

BACKGROUND: The cardiovascular benefit from n-3 polyunsaturated fatty acids (PUFAs) after acute myocardial infarction (AMI) is controversial, and the importance of serum eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) concentrations for clinical events is unclear.OBJECTIVES: To assess changes in EPA and DHA serum concentrations during n-3 PUFA supplementation and their association with incident cardiovascular events.METHODS: In the OMEMI trial, elderly patients with a recent AMI were randomized to 1.8 g/day of EPA/DHA or control (corn oil) for 2 years. The primary outcome was a composite of AMI, coronary revascularization, stroke, heart failure hospitalization, or all-cause death (major adverse cardiovascular event [MACE]) and the secondary outcome was new-onset atrial fibrillation (AF).RESULTS: EPA and DHA measurements were available in 881 (92% of survivors) participants at randomization and study completion. EPA and DHA increased in the active treatment arm (n = 438) by a median of 87% and 16%, respectively. Greater on-treatment increases in EPA and DHA were associated with decreasing triglycerides, increasing high-density lipoprotein cholesterol, and lower baseline EPA and DHA concentrations. Greater on-treatment increases in EPA were associated with lower risk of MACE (adjusted hazard ratio 0.86 [95% confidence interval, CI, 0.75-0.99], p = 0.034), and higher risk of AF (adjusted hazard ratio (HR) 1.36 [95% CI 1.07-1.72], p = 0.011). Although there were similar tendencies for DHA changes and outcomes, these associations were not statistically significant (HR 0.84 [0.66-1.06] for MACE and 1.39 [0.90-2.13] for AF).CONCLUSION: Greater on-treatment increases in EPA were associated with lower risk of MACE and higher risk of new-onset AF. These data suggest that the cardiovascular effects of increasing n-3 PUFA levels through supplements are complex, involving both potential benefits and harm.

The use of chemical scale inhibitors in the oil and gas industry for subsea installations has been presented for a long time, but the ever-increasing exploration of HPHT (high pressure high temperature) wells put demands on knowledge of how the rheological properties such as viscosity of scale inhibitors behave under large pressures. This work reports new experimental data of high-pressure viscosity using a rotational rheometer, measured across a pressure range of 0.1 MPa to 15 MPa, at temperatures from 273 K to 298 K, and a broad range of shear rates, 100 $$s^{-1}$$ s - 1 to 1000 $$s^{-1}$$ s - 1 for a scale inhibitor. The experimental data are used to construct a power-law regression model with fitting parameters. Results indicate that the inhibitor shows a near Newtonian behavior.

Med utgangspunkt i problemstillingen Hvordan forstår barnehageledere begrepene i barnehageloven kap.8, og hvordan erfarer de implementeringsprosessen av endringene i barnehageloven? Har jeg forsøkt å få mer innsikt i og kunnskap om barnehageledernes begrepsforståelse og erfaringer knyttet til arbeidet med endringene i barnehageloven som ble innført den 1. januar 2021. Jeg har utført en kvalitativ studie hvor fokusgruppeintervju er grunnlaget for å tilnærme meg problemstillingen. Intervjuet gav meg et innholdsrikt datamateriale som synliggjør kompleksiteten i begrepsforståelse og erfaringer barnehagelederne har med implementeringen av endringene i barnehageloven. Jeg har i denne studien valgt å sette søkelyset på tre temaer når jeg drøftet datamaterialet mitt, «Begrepenes kompleksitet», «Betydningen av nærhet» og «Betydningen av samarbeid med foresatte». Gjennom dette fikk jeg som forsker ny innsikt i hvilke forståelser barnehageledere har for begrepene mobbing, krenkelse og nulltoleranse, samt deres erfaringer med implementeringsprosessen til en felles forståelse blant personalet i barnehagen. Funnene som ble gjort i denne studien indikerer nettopp det som Lund et al etterlyser i sin forskning: Hele barnet, hele løpet – mobbing i barnehagen (2015), der et behov for begrepsforståelse er nødvendig. I min studie kommer det fram at begrepsforståelse er komplekst, barnehagens rammebetingelser utfordrer barnehagelederne i nærledelse og tilgjengelighet. Barnehagelederne beskriver hvordan en organisasjonskultur kan bidra til en større lojalitet mellom ansatte enn til barna. Tillit blir et nøkkelord i samarbeidet med foresatte og det er et begrep som er vanskelig å konkretisere. Barnehagelederne opplever foresatte som er svært opptatt av hvordan barna har det i barnehagen. For å arbeide med et trygt og godt psykososialt barnehagemiljø kreves det blant annet klok og verdibevisst ledelse, kombinert med godt faglig skjønn. I tillegg må barnehagelederne sette fokus på det mellommenneskelige i ledelse og sørge for at personalet utvikler kompetanse i tråd med samfunnsmandatet.

Enhanced knowledge regarding modifiable risk factors for hip fractures are warranted. We aimed to study the associations between two indicators of physical fitness (resting heart rate and level of physical activity) in middle-aged individuals, and the risk of hip fractures during the subsequent three decades. Data on objectively measured resting heart rate and self-reported leisure time physical activity from a national health survey (1985–1999) was linked to a database including all hip fractures treated in Norwegian hospitals from 1994 through 2018. We calculated hazard ratios (HR) with 95 % confidence intervals (95 % CI) for hip fractures according to categories of resting heart rate (mean of two repeated measures), and leisure time physical activity level in adjusted Cox proportional hazard models. In total, 367,386 persons (52 % women) aged 40 to 45 years were included, of whom 5482 persons sustained a hip fracture during a mean follow-up of 24.8 years. Higher resting heart rate was associated with higher hip fracture risk. Men with a resting heart rate above 80 bpm, who also reported low levels of physical activity, had a HR of 1.82 (95 % CI 1.49–2.22) for hip fracture compared to men with a resting heart rate below 70 bpm who reported high levels of physical activity. The same measure of association fo women was 1.62 (95 % CI 1.28–2.06). Physical fitness measured by low resting heart rate in middle age, and a high physical activity level were associated with a lower long-term risk of hip fractures in both men and women. Resting heart rate, self-reported physical activity in middle age, and long-term risk of hip fracture. A NOREPOS cohort study of 367,386 men and women

Background Findings from recent clinical outcome trials have raised concerns regarding potential off target adverse effects from supplementation with n-3 polyunsaturated fatty acids (PUFA) on atrial fibrillation (AF) risk. Purpose We aimed to assess AF and “micro-AF” in elderly patients with myocardial infarction (MI), randomized to n-3 PUFA or placebo. Methods In the OMEMI trial, 70–82 years old patients with a recent MI were randomized to 1.8g/day of eicosapentaenoic/docosahexaenoic acid (EPA/DHA) or placebo (corn oil) for two years. New-onset AF was recorded by clinical detection and by screening, also for “micro-AF” (episodes of ≥3 consecutive irregular supraventricular ectopic beats), by two weeks Zenicor thumb ECG (adjudicated by investigators blinded to treatment allocation). Serum phospholipid content of EPA and DHA was determined by gas chromatography at baseline and study end. Results Of 1014 patients in the OMEMI trial, 759 (75%) had no history of AF at baseline. These patients were aged 75±4 years and 542 (71%) were male. During the two year follow-up 43 patients developed new-onset AF (39 clinically-detected and 4 by thumb-ECG screening). In addition, 27 patients had episodes of micro-AF, yielding a total of 70 patients with new-onset AF or micro-AF. In the n-3 PUFA group 46 (11.9%) had AF/micro-AF (28 AF and 18 micro-AF) while in the placebo group 24 (6.5%) had AF/micro-AF (15 AF and 9 micro-AF); HR 1.90 (95% CI 1.16–3.11, P=0.011; Figure 1, panel A). In both treatment arms combined, EPA increased with a mean of 60% in no-AF, 80% in micro-AF and 110% in AF (P=0.003 for linear trend; Figure 1, panel B). In patients randomized to n-3 PUFA, EPA increased with a mean of 120% in no-AF, 130% in micro-AF and 180% in clinical-AF (P=0.04 for linear trend). There were no significant associations between changes in DHA and new-onset AF. Conclusion Supplementation with 1.8 g of n-3 PUFA to post MI patients increased the risk of micro-AF and AF, and there seemed to be a graded association between increases in serum EPA and the risk of micro-AF and AF. Changes in serum DHA was not related to the risk of AF/micro-AF. Funding Acknowledgement Type of funding sources: None.

Introduction ADAMTS13 cleaves von Willebrand Factor (VWF) into less active fragments. TSP1 binds to VWFs cleavage-site, protecting it from degradation. Low ADAMTS13 and high VWF have been associated with cardiovascular disease (CVD) and atrial fibrillation (AF). We aimed to investigate the interplay between VWF, ADAMTS13 and TSP1, and assess any relation to endpoints. Materials and methods 1027 elderly with a recent myocardial infarction (MI) were followed for 2 years. ADAMTS13 antigen (ag) and activity (act), VWF ag and TSP1 were analyzed. The primary endpoint (MACE; n = 210) included MI, stroke, heart failure hospitalization, coronary revascularization and death. The secondary endpoint was new-onset AF (n = 43). Results ADAMTS13 ag and act were weakly correlated to VWF (r = 0.10, P = 0.002, both). TSP1 did not correlate to ADAMTS13 or VWF. Patients experiencing a MACE had higher VWF and lower ADAMTS13(ag) at baseline (P < 0.012, both), however not significant after adjusting for covariates. The association with MACE was mainly driven by death (n = 40), with an adjusted OR 2.4 (P = 0.008) for VWF Q4 vs. Q1-3 and OR 0.4 (P = 0.012) for ADAMTS13(ag) Q1 vs. Q2-4. VWF was lower (1.25 vs. 1.39 IU/mL, P = 0.008) and VWF/ADAMTS13(ag)-ratio was lower (1.81 vs. 2.05 x10−3, P = 0.009) in patients with new-onset AF, and these associations persisted in adjusted models. Conclusion In elderly patients with a recent MI, levels of VWF, ADAMTS13 and TSP1 did not correlate. ADAMTS13 and VWF associated weakly with MACE, mainly driven by death. Low VWF and VWF/ADAMTS13-ratio were associated with new-onset AF in our population and needs further research.

Study design This is a retrospective cohort study. Objective To evaluate the results of patients operated for chronic coccydynia, and determine any factors that could affect outcomes. Summary of background data Patients with coccydynia who do not respond to conservative treatment will often profit from coccygectomy. Studies of results and complications vary considerably and often report on a limited number of patients. Methods 184 patients were operated with coccygectomy in our department and followed-up with questionnaires after a minimum of one year post-operatively. Treatment results were compared to their pre-operative state, and any complications or re-operations were recorded and analysed. Results 171 patients (93%) responded to final follow-up. The overall success rate was 71%, defined by patients being either completely well or much better at final follow-up. Furthermore, 89% off all patients would have consented to the operation if they had known the outcome in advance. The rate of post-operative infections was reduced from 10% to 2% by increasing the duration of prophylactic postoperative antibiotics from 24 to 48 hours (p = 0.018). Conclusion Coccygectomy, for patients where conservative measures have failed, seems to give acceptable levels of success and high levels of patient satisfaction. The main complication after this procedure is infection, and the risk can be somewhat reduced by using antibiotic prophylaxis for 48 hours after surgery.Level of Evidence: 4.

Inherited and acquired mutations in hematopoietic stem cells can cause clonal expansion with increased risk of cardiovascular disease (CVD), a condition known for the clonal hematopoiesis of indeterminate potential (CHIP). Inherited genetic variants in two CHIP-associated genome loci, the telomerase gene telomerase enzyme reverse transcriptase (TERT) (rs7705526) and the epigenetic regulator ten–eleven translocation 2 (TET2) (rs2454206), were investigated in 1001 patients with stable coronary artery disease (CAD) (mean age 62 years, 22% women), with regards to cardiovascular outcome, comorbidities, and leukocyte telomere length. Over 2 years, mutated TERT increased the risk two-fold for major clinical events (MACEs) in all patients (p = 0.004), acute myocardial infarction (AMI) in male patients (p = 0.011), and stroke in female patients (p < 0.001). Mutated TET2 correlated with type 2 diabetes (p < 0.001), the metabolic syndrome (p = 0.002), as well as fasting glucose, HbA1c, and shorter telomeres (p = 0.032, p = 0.003, and p = 0.016, respectively). In conclusion, our results from stable CAD patients highlight TERTs’ role in CVD, and underline TET2s’ role in the epigenetic regulation of lifestyle-related diseases.

Aim Campaigns to prevent prone sleeping and other modifiable risk factors have greatly reduced the incidence of sudden infant death syndrome in Norway. Sleep-related infant deaths still occur sporadically and may be preventable. We studied infants' sleeping environments and whether parents followed safe sleep recommendations. Methods Parents with infants up to 12 months of age were invited to complete an online questionnaire from May to December 2018. It was publicised by health centres and on websites and social media. Results We received 4886 responses and 4150 met the age criteria and were included. Just under two-thirds (62.7%) reported routine bed-sharing, and this practice was associated with increased nocturnal breastfeeding, single parents and having more than one child. A small number of infants under six months were occasionally placed prone when they were laid down to sleep (2.1%) and 29.7% were placed on their side. Nearly three-quarters (72.6%) of the 2330 parents with infants under six months of age reported previous high-risk behaviour, such as sleeping together on a sofa or bed-sharing after smoking or drinking. Conclusion Norwegian parents rarely used prone sleeping positions for infants. However, bed-sharing was common, including high-risk scenarios such as smoking, alcohol use and sofas.

Background: High intake of marine n-3 polyunsaturated fatty acids (PUFA) has been associated with reduced risk of cardiovascular events; however, this has not been confirmed in patients with a recent acute myocardial infarction (AMI). Elderly patients are at particularly increased cardiovascular risk after myocardial infarction, but few trials address this group specifically. Omega-3 fatty acids hold the potential to reduce cardiovascular events with limited adverse effects in this vulnerable group. The hypothesis was that daily addition of 1.8g n-3 PUFA to standard of care secondary prophylaxis in elderly patients who have survived an AMI would reduce the risk of subsequent cardiovascular events during 2 years follow-up. Methods: The OMEMI trial (Omega-3 Fatty acids in Elderly with Myocardial Infarction) is an investigator-initiated, multicenter, randomized clinical trial adding 1.8 g n-3 PUFA (930 mg eicosapentaenoic acid and 660 mg docosohexaenoic acid) versus placebo (corn oil) daily to standard of care in patients aged 70 to 82 years with recent (2–8 weeks) AMI. The primary endpoint was a composite of nonfatal AMI, unscheduled revascularization, stroke, all-cause death, heart failure hospitalization after 2 years. The secondary outcome was new atrial fibrillation. The safety outcome was major bleeding. Serum fatty acids were measured as biomarkers of adherence. Results: In total, 1027 patients were randomized. Follow-up data were available for 1014 patients who were included in the intention-to-treat analysis. Mean±SD age was 75±3.6 years, 294 (29%) were female, and mean triglycerides were 111.4±61.9 mg/dL. The primary endpoint occurred in 108 (21.4%) patients on n-3 PUFA versus 102 (20.0%) on placebo (hazard ratio, 1.08 [95% CI, 0.82–1.41]; P =0.60). The secondary endpoint occurred in 28 (7.2%) patients on n-3 PUFA versus 15 (4.0%) on placebo (1.84 [0.98–3.45]; P =0.06). Median changes in eicosapentaenoic acid and docosahexaenoic acid were +87% and +16% for n-3 PUFA versus −13% and −8% for placebo. Major bleeding occurred in 54 (10.7%) and 56 (11.0%) in the n-3 PUFA and placebo groups, respectively ( P =0.87). Similar results were found in per-protocol analysis (n=893). Conclusions: We could not detect reduction in clinical events in our elderly patients with recent AMI who were treated with 1.8 g n-3 PUFAs daily for 2 years. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01841944.

Aims We aimed to establish the short- and long-term efficacy of corticosteroid injection for coccydynia, and to determine if betamethasone or triamcinolone has the best effect. Methods During 2009 to 2016, we treated 277 patients with chronic coccydynia with either one 6 mg betamethasone or one 20 mg triamcinolone cortisone injection. A susequent injection was given to 62 (26%) of the patients. All were reviewed three to four months after injection, and 241 replied to a questionnaire a mean of 36 months (12 to 88) after the last injection. No pain at the early review was considered early success. When the patient had not been subsequently operated on, and indicated on the questionnaire that they were either well or much better, it was considered a long-term success. Results At the three- to four-month review, 22 (9%) reported that they had no pain. The long-term success of one injection was 15% and rose to 29% after a second injection. Logistic regression tests showed that both early success (odds ratio (OR) 5.5, 95% confidence interval (CI) 2.1 to 14.4; p = 0.001) and late success (OR 3.7, 95% CI 1.7 to 8.3; p = 0.001) was greater with triamcinolone than with betamethasone. Late success was greater for patients with symptoms for less than 12 months (OR 3.0, 95% CI 1.4 to 6.7; p = 0.006). We saw no complications of the injections. Conclusion We conclude that the effect of corticosteroid injection for coccygodynia is moderate, possibly because we used modest doses of the drugs. Even so, they seem worthwhile as they are easily and quickly performed, and complications are rare. If the choice is between injections of betamethasone or triamcinolone, the latter should be selected. Cite this article: Bone Joint Open 2020;1-11:709–714.

Aims We aimed to establish the short- and long-term efficacy of corticosteroid injection for coccydynia, and to determine if betamethasone or triamcinolone has the best effect. Methods During 2009 to 2016, we treated 277 patients with chronic coccydynia with either one 6 mg betamethasone or one 20 mg triamcinolone cortisone injection. A susequent injection was given to 62 (26%) of the patients. All were reviewed three to four months after injection, and 241 replied to a questionnaire a mean of 36 months (12 to 88) after the last injection. No pain at the early review was considered early success. When the patient had not been subsequently operated on, and indicated on the questionnaire that they were either well or much better, it was considered a long-term success. Results At the three- to four-month review, 22 (9%) reported that they had no pain. The long-term success of one injection was 15% and rose to 29% after a second injection. Logistic regression tests showed that both early success (odds ratio (OR) 5.5, 95% confidence interval (CI) 2.1 to 14.4; p = 0.001) and late success (OR 3.7, 95% CI 1.7 to 8.3; p = 0.001) was greater with triamcinolone than with betamethasone. Late success was greater for patients with symptoms for less than 12 months (OR 3.0, 95% CI 1.4 to 6.7; p = 0.006). We saw no complications of the injections. Conclusion We conclude that the effect of corticosteroid injection for coccygodynia is moderate, possibly because we used modest doses of the drugs. Even so, they seem worthwhile as they are easily and quickly performed, and complications are rare. If the choice is between injections of betamethasone or triamcinolone, the latter should be selected. © 2020 Author(s) et al. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-N C-N D 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc-nd/4.0/.

Study design This is a retrospective cohort study. Objective To evaluate the long-term outcomes after surgery for refractory coccygodynia in patients with normal imaging studies compared with patients where imaging shows an anomaly. Summary of background data Patients with coccydynia who do not respond to conservative treatment will often profit from coccygectomy. Most surgeons employ plain radiographs or magnetic resonance imaging (MRI) in their preoperative work-up. These will often show anomalies, but in some cases they do not. We investigated whether these patients do less well than those with abnormal images. Methods We operated on 184 patients with coccydynia during a 7-year period and 171 (93%) responded to follow-up questionnaires after 37 (range: 12-85) months. Images of 33 patients were normal and 138 showed some coccygeal pathology. Surgery was considered to have been unsuccessful when respondents stated at review that they were somewhat better, unchanged, or worse. Results There were no clinically or statistically significant differences in outcome between the groups. Surgery was unsuccessful in 24% of patients with normal images and in 32% among those with abnormal images. The median pain scores (0-10) during the week before review were two (interquartile range [IQR]: 0-3) and one (IQR: 1-5) in the two groups respectively. Similar proportions in the two groups stated that they would not have consented to surgery if they had known the outcome in advance. Conclusion Patients with severe coccydynia who have not responded to conservative treatment should not be denied surgery only because their radiographs or MRI studies look normal. Level of evidence 4.

Aims To determine if the results of treatment of adolescents with coccydynia are similar to those found in adults. Adult patients with coccydynia may benefit from injection therapy or operative treatment. There is little data evaluating treatment results in adolescents. We have treated adolescent patients similarly to adults and compared the outcomes. Methods Overall, 32 adolescents with coccydynia were treated at our institution during a seven-year period; 28 responded to final follow-up questionnaires after a minimum of one year, 14 had been treated with only injection therapy, and 14 had been operated with coccygectomy. We collected data with regards to pain while sitting, leaning forward, rising from a sitting position, during defecation, while walking or jogging, and while travelling in trains, planes, or automobiles. Pain at follow-up was registered on a numeric pain scale. Each adolescent was then matched to adult patients, and results compared in a case control fashion. The treatment was considered successful if respondents were either completely well or much better at final follow-up after one to seven years. Results Out of the 28 treated adolescents, 14 were regarded as successfully treated. Seven were somewhat better, and the remaining seven were unchanged. In the adult control group the corresponding number was 15 successfully treated, eight patients were somewhat better, and five were unchanged. Six of the 14 successfully treated adolescents had been operated. There were no significant differences between the groups in the various registered domains, or on numeric pain scale. Conclusion Treatment results in adolescent patients seem similar to those in adults. The long-term success rate of injection therapy is low. In case of injection treatment failure, operation may be considered, also in adolescents.

The unexpected death of a child is one of the most challenging losses as it fractures survivors’ sense of parenthood and other layers of identity. Given that not all the bereaved parents who have need for support respond well to available treatments and that many have little access to further intervention or follow-up over time, online interventions featuring therapeutic writing and peer support have strong potential. In this article we explore how a group of bereaved mothers experienced the process of participating in an online course in therapeutic writing for the integration of grief. Our research questions were: How do parents who have lost a child experience being part of an online course in therapeutic writing? What are the perceived benefits and challenges of writing in processing their grief? We followed an existential phenomenological approach and analyzed fieldwork notes (n = 13), qualitative data from the application and assessment surveys (n = 35; n = 21), excerpts from the journals of some participants (n = 3), and email correspondence with some participants (n = 5). We categorized the results in three meaning units: (1) where does my story begin? The “both and” of their silent chaos; (2) standing on the middle line: a pregnancy that does not end; (3) closures and openings: “careful optimism” and the need for community support. Participants experienced writing as an opportunity for self-exploration regarding their identities and their emotional world, as well as a means to develop and strengthen a bond with their children. They also experienced a sense of belonging, validation, and acceptance in the online group in a way that helped them make sense of their suffering. Online writing courses could be of benefit for bereaved parents who are grieving the unexpected death of a child, but do not replace other interventions such as psychotherapy. In addition to trauma and attachment informed models of grief, identity informed models with a developmental focus might enhance the impact of both low-threshold community interventions and more intensive clinical ones. Further studies and theoretical development in the area are needed, addressing dialogical notions such as the multivoicedness of the self.

Norsk sammendrag Behandling av halebenslidelser Kroniske halebenssmerter, eller coccygodyni, er en lidelse hvor både diagnose og behandling gjennom årene har vært omstridt. Denne avhandlingen omhandler resultatene etter behandling av coccygodyni i fem publiserte artikler. Artiklene har tatt utgangspunkt i til sammen 481 pasienter som ble behandlet ved St Olavs Hospital i perioden 2009-2020, og omfatter både resultater etter lokale kortisoninjeksjoner og operativ behandling med fjerning av halebenet. Vi har undersøkt korttidsresultater, sluttresultater etter minimum ett år fra avsluttet behandling, og potensielle komplikasjoner ved kirurgi. Gjennom dette har vi tilegnet oss ny kunnskap omkring utredning og behandlingsresultater i denne pasientgruppen. Flere kirurger fraråder å operere dersom halebenet ser normalt ut på røntgen eller MR. Vi finner at normal preoperativ billeddiagnostikk ved denne lidelsen ikke predikerer et dårligere resultat etter operasjon, og således ikke bør benyttes til å ekskludere kirurgi som behandlingsalternativ. Videre finner vi at langtidsresultatene etter injeksjonsbehandling ikke er så gode som forventet sammenlignet med tidligere publikasjoner på emnet, med under en tredjedel suksessrate ved langtidsoppfølging. Injeksjonsbehandling er imidlertid lite invasivt og medfører svært liten risiko. Behandlingen bør således fortsatt vurderes før eventuell kirurgi. Hos pasienter som opereres er langtidsresultatene bedre. 71% av pasientene var enten helt smertefri eller mye bedre ved langtidsoppfølging. Halebenskirurgi har imidlertid høy infeksjonsrisiko, med inntil 10% dype infeksjoner. Etter at vi forlenget postoperativ peroral antibiotikaprofylakse fra 24 til 48 timer falt infeksjonsraten til 2%. Lite kunnskap har tidligere eksistert om behandlingen av barn med denne tilstanden. Ved St. Olav har vi tilbudt barn tilsvarende behandling som voksne, og fulgt opp 28 barn i alderen 11-17 år. Vi har sammenlignet resultatene med matchede voksne pasienter i en case-controllstudie. Våre funn tilsier at barn med halebenssmerter har sammenlignbare resultater med voksne, både med tanke på injeksjonsbehandling og kirurgi. Tradisjonelt sett har halebenskirurgi vært forbundet med flere dagers sykehusinnleggelse etter operasjonen. Vi har innført et dagkirurgisk behandlingsalternativ for pasienter med kort reisevei hjem, og sett på resultatene etter dette. Vi finner at dagkirurgisk halebensfjerning gir lignende resultater som ved sykehusinnleggelse, både med tanke på suksessrater og infeksjonsrater, og således bør anses som et trygt alternativ. Disse funnene vil kunne ha betydning for utredning, behandlingsstrategi, og metodevalg for pasienter med denne lidelsen i fremtiden.

Sammendrag Et viktig prinsipp i norsk skole, er å ha et inkluderende læringsmiljø. Dette innebærer blant annet å skape et trygt fellesskap der mangfold blir respektert og anerkjent som en ressurs, samt at alle elevene får medvirke, utveksle kunnskap og samspille i fellesskapet (Kunnskapsdepartementet, 2020). Haug (2003) presenterer at inkludering i skolen kan deles i fire kategorier: samvær, deltakelse, samarbeid og utbytte. Göransson og Nilholm (2014) deler opp forståelsen av inkluderende utdanning i fire nivåer: (A) plassering av elever med funksjonsnedsettelse i klasserom, (B) sosial og faglig inkludering av elever med funksjonsnedsettelse, (C) sosial og faglig inkludering av alle elever og (D) inkluderende samfunn. Et stort antall elever er fraværende fra skolen over lengre tid på grunn av langtidssykdom, og kan ikke delta i klasserommet på samme måte som de andre elevene. I den forbindelse har det blitt utviklet en robot (AV1) som kan stå i klasserommet som stedfortreder for eleven (No Isolation, u.å.a). Studiens problemstilling er følgende: «Hvilke erfaringer har lærere med hvordan AV1-robot blir brukt i inkluderingen av langtidssyke elever i grunnskolen?». Datamaterialet ble samlet inn gjennom fire semistrukturerte intervjuer av lærere i grunnskolen som hadde erfaring med bruk av AV1-robot i inkluderingen av en langtidssyk elev. Hovedfunn fra studiens undersøkelse ble delt inn i fire kategorier: (1) tilrettelegging, (2) deltakelse, (3) personvern og (4) kommunikasjon. Læreren måtte tilrettelegge for at den langtidssyke eleven skulle kunne delta klassens undervisning og fellesskap. På denne måten kunne eleven delta mer i både faglig og sosial aktivitet gjennom AV1-roboten enn før roboten ble tatt i bruk. Informantene erfarte at den langtidssyke eleven ikke kunne være inkludert i alle sammenhenger gjennom roboten på grunn av personvernhensyn. Kommunikasjonen gjennom roboten var bedre enn uten robot, men det kunne opplevdes utfordrende i flere sammenhenger. Funnene indikerer at lærer, medelever og personvern har betydning for inkluderingen av langtidssyke elever når AV1-roboten tas i bruk, noe som blir drøftet i diskusjonsdelen av oppgaven. Resultatet gir implikasjoner for hvordan roboten kan tas i bruk i praksis, og hvilke aspekter som bør forskes videre på. Abstract An inclusive learning environment is a core principle of the Norwegian education system. This means making a safe community where diversity is being respected and acknowledged as a resource, besides letting all student participate, exchange knowledge and interact (Kunnskapsdepartementet, 2020). Haug (2003) makes an argument that inclusion at school can be divided into four sections: belonging, participation, cooperation and benefit. Göransson and Nilholm (2014, p. 265) divides the understanding of inclusive education into four levels: “(a) inclusion as the placement of pupils with disabilities in mainstream classrooms, (b) inclusion as meeting the social/academic needs of pupils with disabilities, (c) inclusion as meeting the social/academic needs of all pupils and (d) inclusion as creation of communities”. Long-term absence from school because of illness affects many pupils making them not able to attend the classroom in the same way as other students. A robot (AV1) has been developed to be deployed in the classroom as a stand-in for the pupil (No Isolation, n.d.). The thesis question is: “What has teachers experienced regarding to the use of the AV1-robot to include long-term ill pupils in primary school?”. The data was collected through four semi-structured interviews with teachers in primary school that has experience using the robot to include long- term ill pupils. The main finding of this study can be divided into four categories: (1) facilitation, (2) participation, (3) privacy and (4) communication. The teacher needed to facilitate so that the long-term ill student could participate in the teaching and class community. The pupils were able to participate more in both academic and social activity through the robot, compared to before. The informants reported that the long-term ill pupils were not able to be included in every situation because of privacy issues. Communication using the robot was better than without, but it was challenging in several situations. The findings indicate that the teacher, fellow pupils and privacy concerns have significance for including long-term ill pupils using the AV1-robot, further discussed later in the thesis. The results give implications to how the robot can be deployed, and areas for further research.

Background In the OMEMI trial, elderly post-MI patients did not achieve reduction in cardiovascular events from supplementation of 1.8g n-3 polyunsaturated fatty acids (PUFA). In two recent trials of hypertriglyceridaemic patients the REDUCE-IT trial demonstrated an association between high levels of serum eicosapentaenoic acid (EPA) and reduced risk of CV events with 4 g/day icosapent ethyl supplements while in the STRENGTH trial no such association was present in patients treated with 4 g/day of EPA+ docosahexaenoic acid (DHA). Purpose To assess associations between changes in concentrations of EPA and DHA during two years supplementation with n-3 PUFA and incident cardiovascular events in the OMEMI trial. Methods In the randomized controlled OMEMI trial, 1014 elderly patients with a recent acute myocardial infarction (AMI) were treated with 1.8g/day of EPA and docosahexaenoic acid (DHA) or placebo for two years, and followed for the primary outcome of MACE (AMI, coronary revascularization, stroke or heart failure hospitalization) and secondary outcome of new-onset atrial fibrillation (AF). Serum concentrations of EPA and DHA were measured at inclusion and at study completion by gas chromatography, and reported as % weight of total FA (%wt) in serum phospholipids. Results Serial EPA and DHA measurements at study inclusion and completion were available in 881 patients (92% of survivors). At baseline EPA and DHA concentrations were (mean±SD) 2.84±1.41 and 5.71±1.35%wt, respectively. Higher baseline EPA and DHA concentrations were associated with previous n-3 PUFA supplementation, lower prevalence of current smoking and diabetes, lower levels of triglycerides and higher levels of HDL-cholesterol (all p Conclusion Patients treated with 1.8 g/day n-3 PUFA for two years experienced a doubling of serum EPA concentrations. Greater increases in EPA were associated with a lower risk of MACE, but also a higher risk of new-onset AF. Changes in DHA concentrations were not associated with outcomes, suggesting that EPA may be the more important n-3 PUFA with respect to risk of cardiovascular events. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Oslo University Hospital, Ullevål Figure 1

BackgroundTelomeres are non-coding sequences at the end of eukaryote chromosomes, which in complex with associated proteins serve to protect subtelomeric DNA. Telomeres shorten with each cell division, are regarded as a biomarker for aging and have also been suggested to play a role in atherosclerosis and cardiovascular disease (CVD). The aim of the present study was to explore the associations between leukocyte telomere length and serum polyunsaturated fatty acids, diet, cardiovascular risk factors and features of myocardial infarction (MI) in elderly patients.MethodsThe material is based upon the first 299 included patients in the OMEMI trial, where patients aged 70–82 years of age are randomized to receive omega-3 supplements or corn oil (placebo) after MI. Patients were included 2–8 weeks after the index MI. DNA was extracted from whole blood, and leukocyte telomere length (LTL) was analyzed by qPCR and reported as a number relative to a reference gene. Serum long chain polyunsaturated fatty acid (LCPUFA) content was analyzed by gas chromatography. Diet was evaluated with the validated SmartDiet food frequency questionnaire. Medical records, patient interviews and clinical examination provided previous medical history and anthropometric data. Non-parametric statistical tests were used.ResultsMedian (25, 75 percentile) LTL was 0.55 (0.42, 0.72). Patients had a median age of 75 years, 70.2% were male and 45.2% used omega-3 supplements. There was a weak, but significant correlation between LTL and linoleic acid (r = 0.139,p = 0.017), but not with other LCPUFAs. There was a trend towards longer telomeres with a healthier diet, but this did not reach statistical significance (p = 0.073). No associations were found between LTL and CVD risk factors or features of MI.ConclusionsIn our population of elderly with a recent myocardial infarction LTL was associated with linoleic acid concentrations, but not with other LCPUFAs. Patients with a healthy diet tended to have longer telomeres. The limited associations may be due to age and the narrow age-span in our population. Further studies, designed to detect longitudinal changes should be performed to explore the role of telomeres in cardiovascular aging.Trial registrationClinical trials no.NCT01841944, registration date April 29, 2013.

BACKGROUND AND OBJECTIVES: The 52-week, randomized, double-blind, noninferiority, government-funded NOR-SWITCH trial demonstrated that switching from infliximab originator to less expensive biosimilar CT-P13 was not inferior to continued treatment with infliximab originator. The NOR-SWITCH extension trial aimed to assess efficacy, safety and immunogenicity in patients on CT-P13 throughout the 78-week study period (maintenance group) versus patients switched to CT-P13 at week 52 (switch group). The primary outcome was disease worsening during follow-up based on disease-specific composite measures. METHODS: Patients were recruited from 24 Norwegian hospitals, 380 of 438 patients who completed the main study: 197 in the maintenance group and 183 in the switch group. In the full analysis set, 127 (33%) had Crohn's disease, 80 (21%) ulcerative colitis, 67 (18%) spondyloarthritis, 55 (15%) rheumatoid arthritis, 20 (5%) psoriatic arthritis and 31 (8%) chronic plaque psoriasis. RESULTS: Baseline characteristics were similar in the two groups at the time of switching (week 52). Disease worsening occurred in 32 (16.8%) patients in the maintenance group vs. 20 (11.6%) in the switch group (per-protocol set). Adjusted risk difference was 5.9% (95% CI -1.1 to 12.9). Frequency of adverse events, anti-drug antibodies, changes in generic disease variables and disease-specific composite measures were comparable between arms. The study was inadequately powered to detect noninferiority within individual diseases. CONCLUSION: The NOR-SWITCH extension showed no difference in safety and efficacy between patients who maintained CT-P13 and patients who switched from originator infliximab to CT-P13, supporting that switching from originator infliximab to CT-P13 is safe and efficacious. Ministry of Health and Care services, Norway

BACKGROUND: The C5a receptor inhibitor avacopan is being studied for the treatment of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis.METHODS: In this randomized, controlled trial, we assigned patients with ANCA-associated vasculitis in a 1:1 ratio to receive oral avacopan at a dose of 30 mg twice daily or oral prednisone on a tapering schedule. All the patients received either cyclophosphamide (followed by azathioprine) or rituximab. The first primary end point was remission, defined as a Birmingham Vasculitis Activity Score (BVAS) of 0 (on a scale from 0 to 63, with higher scores indicating greater disease activity) at week 26 and no glucocorticoid use in the previous 4 weeks. The second primary end point was sustained remission, defined as remission at both weeks 26 and 52. Both end points were tested for noninferiority (by a margin of 20 percentage points) and for superiority.RESULTS: A total of 331 patients underwent randomization; 166 were assigned to receive avacopan, and 165 were assigned to receive prednisone. The mean BVAS at baseline was 16 in both groups. Remission at week 26 (the first primary end point) was observed in 120 of 166 patients (72.3%) receiving avacopan and in 115 of 164 patients (70.1%) receiving prednisone (estimated common difference, 3.4 percentage points; 95% confidence interval [CI], -6.0 to 12.8; PCONCLUSIONS: In this trial involving patients with ANCA-associated vasculitis, avacopan was noninferior but not superior to prednisone taper with respect to remission at week 26 and was superior to prednisone taper with respect to sustained remission at week 52. All the patients received cyclophosphamide or rituximab. The safety and clinical effects of avacopan beyond 52 weeks were not addressed in the trial. (Funded by ChemoCentryx; ADVOCATE ClinicalTrials.gov number, NCT02994927.).

HO2-300

Master's thesis in Renewable energy (ENE500) Ammonia fuelled solid oxide fuel cell (SOFC) systems are regarded as a promising alternative for energy production due to high efficiency and low environmental impact. Ammonia is a carbon free compound with high energy density, low production cost and much simpler transport-and storage properties than hydrogen. The state-of-the-art SOFC contains a Ni/YSZ anode which has proven to be an effective catalyst to crack ammonia at intermediate temperatures (∼700°C). In this study an experimental work was conducted using an Open Flange SOFC test set-up with a planar anode-supported single cell consisting of a Ni/YSZ anode, YSZ electrolyte, and LSM cathode. The objective of the study is to investigate the feasibility of using vaporised ammonia solution as fuel in SOFC systems. For safety reasons the experimental supply of ammonia was from an aqueous solution of 32 wt %. The experiments were divided into two parts.In the first part three variations of ammonia concentration (32wt%, 15.2wt% and 5.9wt%) were supplied to the fuel cell to investigate the current –voltage behaviour obtained at 750 ⁰C. Maximum power densities at 45 mW/cm2, 37.5 mW/cm2, and 25 mW/cm2respectively were observed which were consistent with the reduction in partial pressure and mass flow of ammonia as the concentration of ammonia in the aqueous solution was decreased. The second part of the experiment was a comparison of 32wt% ammonia solution with pure hydrogen and a 3:1 hydrogen/nitrogen mixture. It was observed that the maximum power densities of the32%wt ammonia solution reached power densities comparable to the ones obtained with hydrogen as fuel at 850°C..

Objectives. Ageing is one of the strongest risk factors for atrial fibrillation (AF), and additional risk factors are also closely related to ageing. Remodeling is part of the pathophysiology of AF, and a possible common denominator of ageing and other AF risk factors. The aim of this study was to investigate any association between the presence of AF and the ageing biomarkers, leukocyte telomere length (LTL) and sirtuin-1 (SIRT-1), and the cardiac remodeling biomarkers Galectin-3 and sST2 in elderly myocardial infarction (MI) patients. Design. Patients were included after admission for MI. Diagnosis of AF was retrieved from medical records and classified as either history of AF before MI or new onset from admission to study inclusion. SIRT-1, sST2 and Galectin-3 were analyzed by ELISAs and LTL by qPCR. Results. In total, 299 patients were included, median age 75 years, 70.2% male. A history of AF was recorded in 38 patients and 30 patients experienced new onset AF. Higher levels of SIRT-1 were associated with lower risk of having a history of AF (OR = 0.46 (95% CI 0.26, 0.81), p = 0.007), whereas higher sST2 levels were associated with higher risk of AF (OR = 4.13 (95% CI 1.69, 10.13), p = 0.002). Results remained significant after adjustment for other AF risk factors. No significant associations with AF were found for Galectin-3 or LTL. None of the biomarkers associated with new onset AF. Conclusion. In elderly patients with MI, higher ST2 and lower SIRT-2 levels were associated with higher prevalence of AF, possibly reflecting both ageing and the remodeling phenomena in AF.

Dihomo-gamma-linolenic acid (DGLA) is an n-6 polyunsaturated fatty acid (PUFA) derived from linoleic acid (LA). The LA:DGLA ratio reflects conversion from LA to DGLA. Low levels of DGLA in serum have been related to poor outcome in myocardial infarction (MI) patients. Aims: To assess the association of DGLA and LA:DGLA with total death as a primary aim and incident cardiovascular events as a secondary objective. Methods: Baseline samples from 1002 patients, aged 70 to 82 years, included 2–8 weeks after an MI and followed for 2 years, were used. Major adverse clinical events (MACE) consisted of nonfatal MI, unscheduled coronary revascularization, stroke, hospitalization for heart failure or all-cause death. Cox regression analysis was used to relate serum n-6 PUFA phospholipid levels (%wt) to the risk of MACE, adjusting for the following: (1) age, sex and body mass index (BMI), (2) adding baseline cod liver oil supplementation, (3) adding prevalent hypertension, chronic kidney disease and diabetes mellitus. Results: Median DGLA level in serum phospholipids was 2.89 (Q1–Q3 2.43–3.38) %wt. DGLA was inversely related to LA and LA:DGLA ratio. There were 208 incident cases of MACE and 55 deaths. In the multivariable analysis, the hazard ratio (HR) for the total death in the three higher quartiles (Q2–4) of DGLA as compared to Q1 was 0.54 (0.31–0.95), with p = 0.03 (Model-1), 0.50 (0.28–0.91), with p = 0.02 (Model-2), and 0.47 (0.26–0.84), with p = 0.012 (Model-3), and non-significant for MACE. Risk of MACE (Model 3) approached borderline significance for LA:DGLA in Q2–4 vs. Q1 [HR 1.42 (1.00–2.04), p = 0.052]. Conclusions: Low levels of DGLA were related to a high LA:DGLA ratio and risk of total death in elderly patients with recent MI.

I dette prosjektet har vi forsket på to ulike maskinsyns-algoritmer for hastighetsestimering av en undervannsdrone. Løsningene er produsert for SINTEF Ocean AS, hvor de skal brukes på en undervannsdrone som beveger seg langs et nettet i en merd. Vi har eksperimentert med flere ulike algoritmer, men vi valgte å forske på feature matching og optical flow. Fokuset i dette prosjektet var å sammenligne nøyaktigheten til feature matching og optical flow for hastighetsestimering av en undervannsdrone i en merd. På grunnlag av dette kom vi fram til vår problemstilling: Hvor nøyaktig kan man estimere hastigheten til en undervannsdrone i en merd, ved bruk av feature matching sammenliknet med optical flow? Det eneste av input til algoritmene er video-data fra undervannsdronen. Video-ressursene vi har brukt til testing, besto av både simulerte nett og opptak fra en reell merd. En utfordring er at nettet er visuelt uniformt. Dette gjør det vanskelig å behandle video-data, og beregne bevegelsen til undervannsdronen. Resultatet etter testing og forskning viser at begge algoritmene er uegnet til praktisk bruk. Til tross for dette, er fortsatt feature matching mer nøyaktig enn optical flow ved høyere hastigheter i det simulerte miljøet. Optical flow er derimot mer nøyaktighet enn feature matching ved lavere hastigheter i simulert miljø. Feature matching er mer nøyaktig enn optical flow ved alle hastigheter for video-data fra en reell merd. Algoritmene gir forskjellige resultater, men generelt er ingen av de egnet til praktisk bruk. In this project we have researched machine-vision algorithms for velocity estimation of an underwater drone. The solutions are produced for SINTEF Ocean AS, where they will be used in an underwater drone that moves along a fish net. We have experimented using multiple different algorithms, but the focus in this report is on feature matching and optical flow. Furthermore we will focus on comparing the accuracy of feature detection and optical flow for velocity estimation of an underwater drone in a fish net. On the basis of this, we decided our thesis question: How accurately can one estimate the velocity of an underwater drone in a fish net, using feature matching compared to optical flow? The only input for the algorithms is video from the underwater drone. The video resources we have used for testing consisted of both a simulated and a real fish net. The fish net is visually uniform, which is a challenge which makes it difficult to work with the video data and estimate the velocity. The results show, after testing and research, that neither of the algorithms are suitable for use in practice. In the simulated environment, feature matching is more accurate than optical flow during higher velocities. Optical flow is more accurate during lower velocities. In the real video, feature matching has a higher accuracy during every velocity compared to optical flow. The algorithms gave different results, but generally neither are suitable for use in practice.

Pain while sitting is the most common complaint among patients with Coccydynia. In young patients this may seriously affect their schooling which usually involves long periods of sitting. We studied if this improved after either injection therapy or surgery. During a seven-year period 32 adolescents with a mean age of 15 (range: 11-17) years were treated in our department because of coccydynia. They were followed up with mailed questionnaires at a minimum of 12 months after treatment and 28 (88%) responded. Three were no longer attending school and were excluded. Of the remainder, 12 received only injection therapy while 13 were operated upon. Mean follow-up time was 36 (14-66) months. Eight reported absence from school during the month before treatment, but only one during the week before review (p

We wished to determine if coccygectomy as an outpatient procedure is a safe alternative to inpatient treatment. 68 patients were treated at our institution with coccygectomy as an outpatient procedure during a seven-year period. Out of these 61 (90%) responded to final follow-up questionnaires after a minimum of one year. We recorded satisfaction with the outpatient modality, and compared postoperative complications and long-term satisfaction with patients who had been operated as inpatients during the same period. Out of the 61 patients who responded to final follow up, 39 (64%) were satisfied with having the operation as an outpatient procedure. The patients who would have preferred overnight hospitalization generally felt that traveling home the same day was painful. There was significantly less pain on the journey home if the procedure had been performed under spinal anaesthesia. In terms of complications, there were 10% reoperations due to deep infection in the outpatient group, and 12% superficial wound infections treated with oral antibiotics. The corresponding numbers for the in-patient group were 8% and 14%. The long-term success rate was similar for both groups. 87% of outpatients and 89% of inpatients reported that they would have consented to the operation if they had known the result in advance. Coccygectomy as an outpatient procedure gives similar results to inpatient treatment and can be regarded as an acceptable alternative. Spinal anaesthesia reduces postoperative pain on the journey home. This work is licensed under a Creative Commons Attribution NonCommercial 4.0 License (CC BY-NC 4.0). ©Copyright: the Author(s), 2020 Licensee PAGEPress, Italy Orthopedic Reviews 2020;12:8813 doi:10.4081/or.2020.8813

The mesosphere is perhaps the least explored region in the atmosphere with very few methods of observing. This thesis will primarily be exploring a new technique for measuring the distribution of kinetic energy in the mesosphere across a wide range of spatial and temporal scales. The method being used relies on correlation functions between pairs of meteor measurements. These measurements are made using a network of specular meteor radars located in Northern Norway. This network produced 32 million meteor measurements over a 2 year period. The correlation function estimation method has been previously used on a smaller data set, but has so far not been used for a longer data set and at high latitudes. The main advantage of the new technique is that by studying the second order statistics of the wind field, we can obtain significantly better temporal and spatial resolution than before. Such a large data set allows for great resolution for both spatial and temporal correlation functions. By using temporal correlation functions and the kinetic energy spectrum, different atmospheric wave phenomena can be studied. These include diurnal and semi diurnal tides. The horizontal and vertical correlation functions will be used to verify that the kinetic energy follows a power law, as theoretically expected by the Kolmogorov theory for turbulence. This was done by using a second order structure function applied to correlation functions. The temporal and horizontal correlation functions were used to study the summer-winter variation in kinetic energy, some variation in the temporal domain is the impact from large scale waves as well as in the power spectra were there is a steeper power law slope during the winter. As for the horizontal domain there are differences in kinetic energy in the zonal and meridional direction for both large and small scale waves. The dataset in this thesis a lot more can be found out about the mesosphere, in this thesis only a few of the possibilities are explored. The results are in agreement with earlier work, confirming the results obtained by the earlier study.

ObjectiveTo investigate the predictive value of baseline depression/anxiety on the likelihood of achieving joint remission in rheumatoid arthritis (RA) and psoriatic arthritis (PsA) as well as the associations between baseline depression/anxiety and the components of the remission criteria at follow-up.MethodsWe included 1326 patients with RA and 728 patients with PsA from the prospective observational NOR-DMARD study starting first-time tumour necrosis factor inhibitors or methotrexate. The predictive value of depression/anxiety on remission was explored in prespecified logistic regression models and the associations between baseline depression/anxiety and the components of the remission criteria in prespecified multiple linear regression models.ResultsBaseline depression/anxiety according to EuroQoL-5D-3L, Short Form-36 (SF-36) Mental Health subscale ≤56 and SF-36 Mental Component Summary ≤38 negatively predicted 28-joint Disease Activity Score ConclusionDepression and anxiety may reduce likelihood of joint remission based on composite scores in RA and PsA and should be taken into account in individual patients when making a shared decision on a treatment target.

Summary Background TNF inhibitors have improved treatment of Crohn's disease, ulcerative colitis, spondyloarthritis, rheumatoid arthritis, psoriatic arthritis, and chronic plaque psoriasis, but are expensive therapies. The aim of NOR-SWITCH was to examine switching from originator infliximab to the less expensive biosimilar CT-P13 regarding efficacy, safety, and immunogenicity. Methods The study is a randomised, non-inferiority, double-blind, phase 4 trial with 52 weeks of follow-up. Adult patients on stable treatment with infliximab originator treated in a hospital setting for at least 6 months were eligible for participation. Patients with informed consent were randomised in a 1:1 ratio to either continued infliximab originator or to switch to CT-P13 treatment, with unchanged dosing regimen. Data were collected at infusion visits in 40 Norwegian study centres. Patients, assessors, and patient care providers were masked to treatment allocation. The primary endpoint was disease worsening during 52-week follow-up. 394 patients in the primary per-protocol set were needed to show a non-inferiority margin of 15%, assuming 30% disease worsening in each group. This trial is registered with ClinicalTrials.gov, number NCT02148640. Findings Between Oct 24, 2014, and July 8, 2015, 482 patients were enrolled and randomised (241 to infliximab originator, 241 to CT-P13 group; one patient was excluded from the full analysis and safety set for CT-P13) and 408 were included in the per-protocol set (202 in the infliximab originator group and 206 in the CT-P13 group). 155 (32%) patients in the full analysis set had Crohn's disease, 93 (19%) had ulcerative colitis, 91 (19%) had spondyloarthritis, 77 (16%) had rheumatoid arthritis, 30 (6%) had psoriatic arthritis, and 35 (7%) had chronic plaque psoriasis. Disease worsening occurred in 53 (26%) patients in the infliximab originator group and 61 (30%) patients in the CT-P13 group (per-protocol set; adjusted treatment difference −4·4%, 95% CI −12·7 to 3·9). The frequency of adverse events was similar between groups (for serious adverse events, 24 [10%] for infliximab originator vs 21 [9%] for CT-P13; for overall adverse events, 168 [70%] vs 164 [68%]; and for adverse events leading to discontinuation, nine [4%] vs eight [3%], respectively). Interpretation The NOR-SWITCH trial showed that switching from infliximab originator to CT-P13 was not inferior to continued treatment with infliximab originator according to a prespecified non-inferiority margin of 15%. The study was not powered to show non-inferiority in individual diseases. Funding Norwegian Ministry of Health and Care Services.

Additional file 1: Table S1. Primer sequences for the telomere and single copy gene analyses.

Additional file 2: Table S2. Coefficients of correlations (r) between LTL and serum phospholipid fatty acid levels, patients with previous regular intake of n-3 supplements excluded from analysis.

Telomere length (TL), growth differentiate factor (GDF)11, insulin growth factor (IGF)1, sirtuin (SIRT)1 and inflammatory processes have been related to ageing and age-related diseases, like coronary artery disease (CAD). We aimed to investigate the associations between leukocyte TLs (LTLs), chronological age, sex and comorbidities in CAD patients. Any covariations between LTL, GDF11, IGF1, SIRT-1 and pro-inflammatory cytokines were further assessed. Methods In 300 patients with stable CAD (age 36–81 years, 20% females), DNA and RNA were isolated from whole blood for PCR analysis and relative quantification of LTLs and gene-expression of GDF11, IGF1,SIRT1, IL-12, IL-18 and IFNƴ, respectively. Serum was prepared for the analyses of circulating IL-18, IL-12, IL-6 and TNFα. Results Patients with previous myocardial infarction (MI) presented with 20% shorter LTLs vs. patients without (p = 0.019) indicating LTLs to be of importance for CAD severity. The observation however, was only observed in men (p = 0.009, n = 115), in which the upper LTL quartile associated with 64% lower frequency of previous MI compared to quartile 1–3 (p = 0.005, adjusted). LTLs were not differently distributed according to sex or comorbidities such as hypertension, diabetes type 2 and metabolic syndrome. LTLs and GDF11 were inversely correlated to age (r = −0.17; p = 0.007 and r = −0.16; p = 0.010, respectively), however, separated in gender, LTL only in women (r = −0.37) and GDF11 only in men (r = −0.19) (p = 0.006, both). GDF11 and SIRT1 were strongly inter-correlated (r = 0.56, p ≤ 0.001), suggesting common upstream regulators. LTLs were moderately correlated to GDF11 and SIRT1 in overweight women (BMI ≥ 25 kg/m2) (r = 0.41; p = 0.027 and 0.43; p = 0.020, respectively), which may reflect common life-style influences on LTLs and these markers. In all women, we observed further that the highest LTL quartile associated with higher GDF11 and SIRT expression and lower circulating levels of IL-12, IL-18 and TNFα, as compared to quartile 1, which may indicate lifestyle influences on female LTLs. In men, the highest LTL quartile associated with lower IFNƴ expression and lower circulating TNFα. Overall, the results indicate an association between chronic low-grade inflammation and LTLs. Conclusions Shorter LTLs in CAD patients with previously suffered MI may indicate telomere attrition as part of its pathophysiology in men. The inverse association between LTLs and age exclusively in women underpins the previously reported decline in attrition rate in men with increasing age. As elevated GDF11 and SIRT1 along with attenuated pro-inflammatory cytokines seem to positively affect LTL in women, we hypothesize a potential sex-dimorphism in LTL regulation, which may implicate sex- adjusted health-preventive therapies.

Bachelor i Fornybar Energi Fakultet for ingeniør- og naturvitenskap, Institutt for miljø- og naturvitenskap, Fornybar energi. Norge har gode forutsetninger for vindkraft på land. Andelen av vindkraftproduksjon har økt de siste årene, og det er forventet at ytterligere 1337 MW settes i drift i 2019. Til tross for utviklingen som skjer nå, er energimarkedet usikkert. Denne oppgaven forsøker å gi innblikk i hvorvidt norsk vindkraft er lønnsomt under dagens situasjon og i hvilken grad forskjellige faktorer påvirker lønnsomheten. I tillegg vil den sammenligne nåverdien til en investering gjort i dag med en investering gjort om fem år. For å generalisere dagens situasjon laget vi et fiktivt vindkraftverk som forsøker å reflektere forholdene i dag. Deretter gjorde vi et anslag på strømpris og elsertifikatpris. Dette satt vi inn i en lønnsomhetsmodell som er basert på nåverdimetoden. Vi beregnet også LCOE for grunnscenariet og framtidsscenariet. Videre utførte vi en følsomhetsanalyse, som viser hvor følsom nåverdien er for endringer i forutsetningene. For å sammenligne en investering om fem år mot en investering i dag, brukte vi to metoder. Først fant vi konkrete verdier på hvordan forutsetningene kan se ut om fem år. Deretter laget vi matriser som viser hvordan lønnsomheten oppfører seg under forskjellige forutsetninger fremtiden kan gi. Vi fant at kraftverket vil være lønnsomt med en nåverdi på NOK 143 273 171,51. Det har en LCOE på 39,1 øre/kWh, og inntekter på 43,6 øre/kWh. Dermed har kraftverket et overskudd på 4,5 øre/kWh. I resultatet fremgår det at nåverdien er mest følsom overfor endringer i strømprisen. En endring på - 6,97 % vil gi en nåverdi lik 0. Etter strømpris følger henholdsvis kapasitetsfaktor, investeringsutgift, avkastningskrav, driftskostnader og elsertifikatpris. Vi fant også at det vil lønne seg å vente fem år med investeringen, sammenliknet med å investere i dag. Dette øker nåverdien med 32,48%. Med usikkerheter knyttet til teknologisk utvikling og strøm- og elsertifikatpriser er ikke våre beregninger en endelig fasit. Man må også i realiteten ta høyde for eksempelvis lokale forhold. Vi mener likevel at investering i vindkraft i stor grad er lønnsomt under dagens situasjon. Det vil etter våre vurderinger også være lønnsomt å vente med investeringen i fem år, på tross av tapte inntekter fra elsertifikater. I tillegg er strømprisen den variabelen som påvirker nåverdien mest, og det er umulig å si med sikkerhet hvordan den utvikler seg flere år frem i tid. Det vil derfor alltid være risiko knyttet til investering i vindkraft. FE403

The need to exchange more data in industry is growing. Automation requires more and more data to adapt technology to industrial needs correctly. This is visible in both industry (Factory 4.0) and in the Internet of Things (IoT). All these data are produced, transferred, processed and stored for further use. An affordable communication system that permits all of the necessary operations to be performed quickly and reliably is needed. One of the proposals is OPC UA. Unfortunately, there are many situations in which OPC UA is not efficient for various reasons. One of them is the lack of real-time communication in OPC UA. Another situation that is not suited for OPC UA is the setup of the server and incoming data.

This thesis investigates child second language acquisition without communication. This is a case study of a Norwegian four-year-old girl who has acquired English only by watching television. It is interesting to investigate language acquisition through television as language is argued to be a social phenomenon. It is predicted that the child, Lucy, will have no problems acquiring English structures that are similar in Norwegian and English. However, it is expected that she will struggle with structures that are not similar in Norwegian and English, such as do-support. This study indicate that there is a partial acquisition through television and that more input is required for do-support to be acquired.

Copyright 2019 Society of Photo‑Optical Instrumentation Engineers (SPIE). One print or electronic copy may be made for personal use only. Systematic reproduction and distribution, duplication of any material in this publication for a fee or for commercial purposes, and modification of the contents of the publication are prohibited. In this work we have explored the live-cell friendly nanoscopy method Multiple Signal Classification Algorithm (MUSICAL) for multi-colour imaging of various organelles and sub-cellular structures in the cardiomyoblast cell line H2c9. We have tested MUSICAL for fast (up to 230Hz), multi-colour time-lapse sequences of various sub-cellular structures (mitochondria, endoplasmic reticulum, microtubules, endosomes and nuclei) in living cells using low excitation-light dose. Challenges and opportunities with applying MUSICAL for studying rapid sub-cellular dynamics are discussed.

Additional file 3. Methods. Description regarding CV calculations.

BLUBACH 2018/19 Fakultet for lærerutdanning, kultur og idrett Institutt for pedagogikk, religion og samfunnsfag Barnehagelærerutdanning Dato: 30.05.2019 BLUBACH