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This article explores general practitioners' (GPs) persuasive efforts in cases where biomedical evidence is absent but expected. Health insurance in Western countries is based on the biomedical ideal that legitimate complaints should have objective causes detectable by medical examination. For GPs responsible for assessing sickness and incapacity for work, the demand for objective evidence can be problematic: what if they as experts deem that a patient is in fact sick and eligible for benefits, but are unable to provide objective evidence to that fact? How can they convince bureaucrats in the insurance system to accept their judgment? Taking ‘medically unexplained symptoms’ as my case, I draw on focus group and follow-up interviews with GPs in Norway to explore how GPs attempt to persuade bureaucrats to accept their professional judgment. Proposing the concept of ‘rhetorical work’, I reconstruct a typology of such work that doctors engage in to influence bureaucratic decision-making and provide long-term health benefits for patients. I then discuss the potential societal implications of GPs' rhetorical practices and the applications of the concept of rhetorical work in future research.

Masteroppgave JUS399 MAJUR MAJUR-2

Depleted oil reservoirs are considered a viable solution to the global challenge of CO2 storage. A key concern is whether the wells can be suitably sealed with cement to hinder the escape of CO2. Under reservoir conditions, CO2 is in its supercritical state, and the high pressures and temperatures involved make real-time microscopic observations of cement degradation experimentally challenging. Here, we present an in situ 3D dynamic X-ray micro computed tomography (μ-CT) study of well cement carbonation at realistic reservoir stress, pore-pressure, and temperature conditions. The high-resolution time-lapse 3D images allow monitoring the progress of reaction fronts in Portland cement, including density changes, sample deformation, and mineral precipitation and dissolution. By switching between flow and nonflow conditions of CO2-saturated water through cement, we were able to delineate regimes dominated by calcium carbonate precipitation and dissolution. For the first time, we demonstrate experimentally the impact of the flow history on CO2 leakage risk for cement plugging. In-situ μ-CT experiments combined with geochemical modeling provide unique insight into the interactions between CO2 and cement, potentially helping in assessing the risks of CO2 storage in geological reservoirs.

Hva skjer med den nordiske modellen når store deler av arbeidsoperasjonene utføres av arbeidsinnvandrere som er midlertidig ansatte? I artikkelen anvendes organisasjonsteoretiske og institusjonelle perspektiver for å utforske hvordan den nordiske modellens premisser på virksomhetsnivå påvirkes av et høyt innslag av arbeidsinnvandrere. Analysen viser at arbeidsmigrantene møter institusjonelle logikker som bryter med arbeidserfaringer de har fra eget hjemland. Dette kan bety at økt arbeidsmigrasjon bidrar til å utfordre den nordiske arbeidslivsmodellen

It has been hypothesized that a condensed nervous system with a medial ventral nerve cord is an ancestral character of Bilateria. The presence of similar dorsoventral molecular patterns along the nerve cords of vertebrates, flies, and an annelid has been interpreted as support for this scenario. Whether these similarities are generally found across the diversity of bilaterian neuroanatomies is unclear, and thus the evolutionary history of the nervous system is still contentious. Here we study representatives of Xenacoelomorpha, Rotifera, Nemertea, Brachiopoda, and Annelida to assess the conservation of the dorsoventral nerve cord patterning. None of the studied species show a conserved dorsoventral molecular regionalization of their nerve cords, not even the annelid Owenia fusiformis, whose trunk neuroanatomy parallels that of vertebrates and flies. Our findings restrict the use of molecular patterns to explain nervous system evolution, and suggest that the similarities in dorsoventral patterning and trunk neuroanatomies evolved independently in Bilateria.

Production of inoculum of Colletotrichum acutatum from both previously infected and overwintered tissue, as well as newly developed plant tissue of sour cherry (Prunus cerasus), was studied in southern Norway. Plant parts were sampled from commercial, private, or research orchards, and incubated for 2 to 14 days (time depended on tissue type) in saturated air at 20°C. In early spring, abundant sporulation was found on scales of overwintered buds and shoots. A mean of 35% infected buds in four cultivars was observed, with a maximum of 72% of the buds infected in one of the samples. Over 3 years, the seasonal production of overwintered fruit and peduncles of cv. Fanal infected the previous year was investigated. In all three years, the infected plant material was placed in the trees throughout the winter and the following growing season; in two of the years, fruit and peduncles were also placed on the ground in the autumn or the following spring. Old fruit and peduncles formed conidia throughout the season, with a peak in May and June. Spore numbers declined over the season, but the decline was more rapid for plant material on the ground than in the trees. On average over 2 years, 68.7, 24.0, or 7.3% of the inoculum came from fruit placed in the trees, placed on the ground in spring, or placed on the ground the preceding autumn, respectively. The number of fruit and peduncles attached to the trees in a planting of cv. Hardangerkirsebær was followed from February to July one year, and although there was a decline over time, fruit and/or their peduncles were still attached in substantial numbers in July, thus illustrating their potential as sources of inoculum. In observations over 2 years in a heavily infected orchard of cv. Stevnsbær, 75 and 47% of flowers and newly emerged fruit, respectively, were infected. Artificially inoculated flowers and fruit produced conidia until harvest, with a peak in mid-July. It may be concluded that previously infected and overwintered, as well as newly emerged tissue of sour cherry, may serve as sources of inoculum of C. acutatum throughout the growing season.

Focusing on the case of medically unexplained symptoms (MUS), this article explores diagnostic classification in the absence of biomedical evidence or other strong medical warrants for diagnosis. The data are from three focus group interviews with Norwegian general practitioners (GPs) conducted in 2015, that centred on the issue of what diagnoses to use (or not) for MUS. The qualitative analysis reconstructs the logic underlying GPs' diagnostic accounts, which centred on the meaning of diagnostic categories and on anticipating how 'generalised others' would respond to those meanings (called 'diagnosing by anticipation'). The analysis suggests that GPs confer diagnoses by balancing unwarranted medical accuracy and anticipated harmful diagnostic consequences; the goal of diagnosis was finding categories in the International Classification of Primary Care that would yield acceptable results, without making a liar of the GP in the process. Drawing on the distinction between diagnosis as colligation and classification, the findings and their relevance for medical sociology are discussed. Counter to frequent descriptions as 'illness that cannot be diagnosed', the analysis shows how GPs can diagnose MUS in the bureaucratic sense of diagnosis as classification - a sense that has been missing from sociological view.

In this paper, we present a comparative analysis of three survey studies of disease prestige in medical culture. The studies were conducted in 1990, 2002 and 2014 using the same research design. In each of the three rounds, a sample of Norwegian physicians was asked to rate a set of 38 diseases on a scale from 1 to 9 according to the prestige they believed health personnel in general would award them. The results show a remarkable stability in the prestige rank order over 25 years. The top three diseases in all three surveys were leukaemia, brain tumour and myocardial infarction. The four lowest ranked were fibromyalgia, depressive neurosis, anxiety neurosis and hepatocirrhosis. The most notable change concerns apoplexy (brain stroke), which moved from a rank of 33 to 29 and then to 23 over the three rounds. We argue that the stable pattern, as well as this change, substantiate the interpretation of previous research, i.e. that the prestige of a disease is affected by the localization of the affected organ or body part, the effect and style of its typical treatment, and the social attributes of the typical patient. Analysing physicians’ shared evaluations of different diseases, the paper contributes to the cultural understanding of disease conceptions in medicine. Understanding these conceptions is important because disease prestige may influence decision-making in the healthcare sector.

Depleted oil reservoirs are considered a viable solution to the global challenge of CO2 storage. A key concern is whether the wells can be suitably sealed with cement to hinder the escape of CO2. Under reservoir conditions, CO2 is in its supercritical state, and the high pressures and temperatures involved make real-time microscopic observations of cement degradation experimentally challenging. Here, we present an in situ 3D dynamic X-ray micro computed tomography (μ-CT) study of well cement carbonation at realistic reservoir stress, pore-pressure, and temperature conditions. The high-resolution time-lapse 3D images allow monitoring the progress of reaction fronts in Portland cement, including density changes, sample deformation, and mineral precipitation and dissolution. By switching between flow and nonflow conditions of CO2-saturated water through cement, we were able to delineate regimes dominated by calcium carbonate precipitation and dissolution. For the first time, we demonstrate experimentally the impact of the flow history on CO2 leakage risk for cement plugging. In-situ μ-CT experiments combined with geochemical modeling provide unique insight into the interactions between CO2 and cement, potentially helping in assessing the risks of CO2 storage in geological reservoirs. This is an open access article published under a Creative Commons Attribution (CC-BY) License, which permits unrestricted use, distribution and reproduction in any medium, provided the author and source are cited.

To see whether nurses rate diseases according to prestige and, if so, how their ratings compare to the disease prestige hierarchy previously uncovered among physicians.Cross-sectional survey.In 2014, 122 nurses in a continuing education programme for healthcare personnel in Norway rated a sample of 38 diseases according to how prestigious they see these as being among healthcare workers in general.The nurses were found to rank myocardial infarction, leukaemia, and brain stroke at the top of the prestige hierarchy and depressive neurosis, anxiety neurosis, and fibromyalgia at the bottom. Their rankings overlap significantly with those previously documented for physicians and suggest that nurses assess the diseases through a 'cure' rather than a 'care' perspective on health care.The nurses ordered diseases in a prestige hierarchy and their rankings are strikingly like those of physicians. The findings are of significant relevance to nursing practice and set a new course for future research into prestige and nursing culture.The findings should encourage nurses - individually and collectively - to reflect on whether and how notions of disease prestige influence their decision-making. By showing that nurses as well as physicians are able to rate diseases according to prestige, the study suggests new avenues for future disease prestige research.目的: 观察护士对于疾病的评价会否根据该疾病的声望。如果会的话,如何将他们的评价与之前医生中发现的疾病声望等级进行比较。 设计: 横断式调查。 方法: 2014年,在挪威一项针对医护人员的进修项目中,122名护士根据他们认为这些疾病在普通医务工作者中的声望对38种疾病样本做出评价。 结果: 护士将心肌梗死、白血病和脑卒中排在声望等级的最高层,而将抑郁神经症、焦虑神经症和纤维肌痛排在最底层。他们的排名与之前为医生记录的声望排名存在明显的重叠,表明护士是从“治疗”的角度对疾病做出评估的,而非通过“护理”的角度。 结论: 护士按名望等级排序疾病的顺序,但其排名顺序与内科医师的顺序存在明显的相似度。研究结果对护理实务有重要的参考价值,并为未来的声誉与护理文化研究提供新的课程。 影响: 研究结果应该鼓励护士个人和群体思考疾病声望是否会影响其决策,以及如何影响其决策。这项研究表明,护士和医生都能够根据声望对疾病进行评价,从而为未来的疾病声望研究提供了新的切入途径。.

This article explores the making and management of anomaly in scientific work, taking ‘medically unexplained symptoms’ (MUS) as its case. MUS is a category used to characterize health conditions that are widely held to be ambiguous, in terms of their nature, causes and treatment. It has been suggested that MUS is a ‘wastebasket diagnosis’. However, although a powerful metaphor, it does neither the category nor the profession justice: Unlike waste in a wastebasket, unexplained symptoms are not discarded but contained, not ejected but managed. Rather than a ‘wastebasket’, I propose that we instead think about it as a ‘junk drawer’. A junk drawer is an ordering device whose function is the containment of things we want to keep but have nowhere else to put. Based on a critical document analysis of the research literature on MUS (107 research articles from 10 medical journals, published 2001–2016), the article explores how the MUS category is constituted and managed as a junk drawer in medical science.

NAKSIN (Nye aktsomhetskart for snøskred i Norge) er et verktøy under utvikling/uttesting for å identifisere potensielt skredfarlige områder med hensyn på snøskred. Verktøyet har som mål å skulle erstatte det eksisterende aktsomhetskartet for snøskred. Sammenlignet med sin forgjenger er NAKSIN en langt mer sammensatt modell hvor det søkes å ta hensyn til flere av de viktige komponentene som spiller inn ved snøskred. Der det nåværende aktsomhetskartet beregnes ut fra et forenkle topografisk kriterium med påfølgende bruk av en empirisk utløpsmodell, tas det i NAKSIN høyde for blant annet småskala topografi, mer raffinert utvelgelse av utløsningsområder, klima, skog samt at det benyttes en dynamisk skredmodell. I denne oppgaven har det blitt sett på to faktorer knyttet til klimadataene som benyttes i NAKSIN. Den ene faktoren er høydeinterpoleringen av klimadataene for årlig maksimal snødybde HSmax og 3-døgns nedbør. Som et alternativ til den nåværende interpoleringsmetoden, hvor interpoleringen utføres på distribusjonsparameterne til ekstremverdifordelingene, har det blitt studert hvordan utfallet blir dersom man interpolerer på fordelingenes returverdier i stedet. Denne nye metoden viser seg å kunne være et godt alternativ til nåværende løsning. De aktuelle klimadataene går igjennom mange prosesser før de benyttes i NAKSIN, og ved å interpolere på returverdier har man i større grad kontroll og oversikt over utfallet av høydeinterpoleringen, spesielt med hensyn til hvordan returverdiene for høye returperioder utvikler seg med høyden. Den andre faktoren som har blitt studert er en ny type ekstremverdifordeling for årlig maksimal snødybde. Der det tidligere har blitt benyttet en generalisert paretofordeling, har det nå blitt testet ut hvordan verdiene ser ut med en gumbelfordeling. Gumbelfordelingen viser seg å gi markant større verdier og bredere haler enn for årlig maksimal snødybde. I tillegg viser fordelingen også tydeligere høydekorrelasjon og mer konsistent bredde på halene. Det har til nå vært en utfordring i NAKSIN at skredsannsynligheter og bruddybder blir for lave. Benyttelse av gumbeldistribuert årlig maksimal snødybde kan trolig bidra til å øke disse. NAKSIN (New methodology for avalanche hazard indication maps in Norway) is a tool in development / testing to identify areas potentially endangered by avalanches. This new tool will hopefully replace the existing avalanche hazard indication map. Compared to its predecessor, NAKSIN is a far more complex model in which it seeks to include more of the components that play an important role in avalanche hazard. The current map is calculated from a relatively simplified topographic criterion with subsequent use of an empirical run-out model. NAKSIN, on the other hand, takes into account small-scale topography, a more refined selection of release areas, climate, forest effects and a dynamic run-out model. In this paper, two factors related to the climate data used in NAKSIN have been studied. The first factor is the height interpolation of the climate data for annual maximum snow depth and 3-day rainfall. As an alternative to the current interpolation method, where the interpolation is performed on the distribution parameters of the extreme value distributions, it has been studied how the outcome will be if one interpolates on the return values rather than the distribution parameters. This new method proves to be a good alternative to the current solution. The current climate data goes through many processes before being used in NAKSIN, and by interpolating on return values have greater control and overview of the outcome of the height interpolation, especially regarding how the return values for high return periods develop with height. The second factor that has been studied is a new type of extreme value distribution for annual maximum snow depth. Where a generalized pareto distribution has previously been used, it has now been tested what the values look like with a Gumbel distribution. The Gumbel distribution is found to give significantly greater values and wider tails than the generalized pareto distribution for annual maximum snow depth. In addition, the distribution also shows clearer height correlation and more consistent width of the tails. So far, a challenge in NAKSIN has been that the estimated values of avalanche probabilities and fracture depths are too low. The use of Gumbel distributed annual maximum snow depth can probably contribute to increase these.

Master's thesis in Mechatronics (MAS500) This thesis investigates the opportunity of generating complementary technology devices forexisting remotely operated vehicles (ROVs) so that abandoned material can be collected andretrieved, particularly from the bottom of the ocean.According to World Wide Fund for Nature (WWF), over eight million tons of plastic end upin the sea each year [13]. Furthermore, they claim that based on a survey of Northern fulmarsin the North Sea, as many as 9 out of 10 birds have plastic in their stomachs. However, plasticis not the only issue regarding marine litter. A survey from the Institute of Marine Researchshows that accessories findings reported by divers in the bottom of the ocean contain a sig-nificant number of derelict pots in addition to many other objects, which is a result of ghostfishing [37]. This issue is given a high priority in this report.The steps of this report were first to investigate existing solutions for deep-sea robotic ma-nipulation. This paper will aim its focus on the development of an underwater robot arm,which is to be mounted on a ROV. The center of interest will be only on the arm and notthe ROV. The robot arm’s main task is to attach a custom-made end-effector (containing acarabiner and a balloon inside) unto derelict pots and then activate the balloon such that thederelict pots are lifted up to the sea surface. This prototype was intended to be actuated by seawater.

Objectives: To provide overview of research on training interventions for healthcare providers aimed at promoting competencies in delivering group-based patient education. Methods: A systematic literature search identified relevant studies. Data was extracted on training details, study design, outcomes and experiences. Results were summarized and qualitative data analyzed using content analysis. Results: Twenty-seven studies exploring various training interventions were included. Ten studies used qualitative methods, eight quantitative and nine mixed methods. Use of a comparison group, validated instruments and follow-up measures was rare. Healthcare providers' reactions to training were mostly positive. Several studies indicated positive short-term effects on self-efficacy and knowledge. Results on observed skills and patient outcomes were inconclusive. Results on healthcare providers' experience of delivery of group-based patient education following training were categorized into 1) Benefits of training interventions, 2) Barriers to implementation and 3) Delivery support. Conclusions: Further evaluation of training for healthcare providers delivering group-based patient education is needed before conclusions on training efficacy can be drawn. The results indicate an expanding research field still in maturation. Practice implications: Efficacy studies evaluating theoretically grounded training with clear attention on group facilitation and follow-up support are needed. Inclusion of validated instruments and long-term outcomes is encouraged. (c) 2020 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

SK152

Bachelor i sjukepleie, Fakultet for helse- og sosialvitskap, Institutt for helse- og omsorgsvitskap, Campus Haugesund SYKHB3001

Preharvest cuticular fractures in sweet cherry fruit have been suggested to facilitate pathogen invasion, and a method to classify the mount of cuticular fracturing into five categories (from 1 = no visible fractures to 5 = severe fracturing) has previously been proposed. Sweet cherry fruit of the four cultivars Early Burlat, Lapins, Van, and Vista were sorted into these five categories of cuticular fracturing and inoculated with conidial suspensions of either Botrytis cinerea or Monilinia laxa. After incubating the fruit at 20°C and 100% relative humidity for 4 to 7 days, they were assessed for visible fungal growth. Due to quiescent infections of M. laxa, fruit treated with B. cinerea developed more brown rot than gray mold. However, a significant linear relation (P < 0.05) between the amount of cuticular fracturing and fungal infections was obtained in five of seven trials with B. cinerea and in two of four trials with M. laxa, indicating that fungal infections in sweet cherry fruit may be facilitated by cuticular fractures. Independent of cultivar and year, a significant linear relation was found between the category of cuticular fracturing and percentage of infected fruit after inoculation with both B. cinerea and M. laxa, and in control fruit (P = 0.0001, 0.0183, and 0.0182, respectively). This is the first report quantifying an increase in fungal infection with increasing amount of cuticular fracturing. The mean difference in fruit rot (%) ± standard deviation among fruit in fracturing categories 1 and 5, expressed as the linear contrast of amount of fruit rot in category 5 minus amount of fruit rot in category 1, was 37.2 ± 7.4 (P = 0.0001), 35.4 ± 11.0 (P = 0.0022), 17.0 ± 6.7 (P = 0.0135), and 29.8 ± 4.7 (P = 0.0001), after treatments with B. cinerea, M. laxa, water control, and for all data pooled, respectively.

Access to accurate reference data is a prerequisite in order to translate chemical shifts to an absolute scale for inner-shell ionization energies. Calibration standards for oxygen 1s (O 1s) ionization energies are less well established than, for instance, for carbon 1s. To improve upon this situation, adiabatic and vertical O 1s ionization energies for gaseous carbon dioxide (CO2) are critically reviewed and used to establish the most accurate values currently available: 541.085(17) and 541.253(17) eV, respectively. Combining these with new precise measurements of shifts in O 1s ionization energies for H2O, CO, and O2 allows us to establish equally accurate absolute ionization energies for these molecules as for CO2. The resulting adiabatic and vertical energies are 539.728(17) and 539.827(17) eV for H2O, 542.439(17) and 542.495(17) eV for CO, 543.285(17) and 543.294(17) eV for O2 (4Σ final state), and 544.338(17) and 544.423(17) eV for O2 (2Σ final state). It is proposed that O 1s in CO2 be adopted as a standard of higher precedence, and that H2O, CO, and O2 be used also. The O 1s ionization energies in these molecules occur in the range 540–543 eV. These proposed standards should provide optimal internal calibration for a wide range of oxygen-containing compounds. publishedVersion

Effects of controlled atmosphere (CA) conditions on physiological disorders and fungal fruit decay on apple ‘Aroma’ were investigated. Fruit from three growing seasons were stored at 1% or 2% O2 (both at 2% CO2) at either 1°C or 3°C in small research units; controls were kept in the same ventilated rooms at the two temperatures (ambient air). The fruit were removed from storage after four or six months and assessed for fruit decay immediately afterwards and after two weeks at 20°C. Fruit quality parameters were recorded at the end of storage. On a three-year average, fruit stored in CA was less ripe at the end of storage. After both four and six months storage, CA reduced total decay (physiological disorders and fungal decay) by on average 70% and 45%, respectively, compared to storage in ambient air. Senescent breakdown was lower after CA storage for four months, but not after six months and not after simulated shelf life. Soft scald was lower when stored in CA both after cold storage at 1°C and ...