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The aim of the article is to discuss how university mathematics courses can become more relevant for pre-service teachers (PSTs). We therefore introduce a concept we call mathematical orientation and develop an analytical framework based on Felix Klein's pervasive approach to elementary mathematics from a higher standpoint and the work of the practical philosopher Stegmaier on orientation. This framework is used to analyze the mathematical orientation of PSTs on two mathematics courses in Norway and Switzerland. In a qualitative empirical approach, we analyzed 85 reflections written by PSTs on the topic of decimal expansions and reconstructed aspects of their individual mathematical orientation. Our results show that mathematical orientation varies across PSTs to a certain extent. In particular, different points of reference, perspectives, standpoints, and types of links between the mathematical content and teaching situations could be identified. We therefore propose that mathematical orientation can be considered a key variable in addressing the mathematical needs of PSTs in university courses.

Hojjat Daniali,1 Mollie A Ruben,2 Per M Aslaksen,3 Charlotte Fiskum,1 Ted J Kaptchuk,4 Magne A Flaten1 1Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; 2Department of Psychology, University of Rhode Island, Kingston, RI, USA; 3Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway; 4Program in Placebo Studies, Beth Israel Deaconess Medical Center/ Harvard Medical School, Boston, MA, USACorrespondence: Hojjat Daniali, Department of Psychology, Norwegian University of Science and Technology, Trondheim, NO-7491, Norway, Email hojjat.daniali@ntnu.noIntroduction: Studies suggest facial expressions of caregivers may be important in placebo effects; however, this has not been systematically tested. This experiment investigated the effects of caregivers’ singular positive nonverbal behaviours (NBs) on pain reports.Methods: Fifty-one males and 53 females (total of 104) participants were randomized to four groups that were displayed positive facial expressions, tone of voice, body movement, or neutral NBs of videotaped experimenters. Subjective reports of pain, stress, arousal, and cardiac activity were obtained in a pre-test, a conditioning phase, and at a post-test. Four minutes of heat pain was induced in each test, and a placebo cream was administered before the conditioning and post-test in all groups.Results: There were no differences between the NB groups in the reduced pain. Males had larger reduction in pain in the post-test, and females had lower arousal than the opposite sex. During the conditioning, females had larger reduction in pain ie, unconditioned pain response (UPR). In females, the UPR predicted the reinforced expectation ie, increase in expectations from conditioning to post-test, and fear of minor pain negatively predicted both the UPR and reinforced expectation.Discussion: Singular NBs of caregiver were weak to enhance placebo effects. Females had lower pain during conditioning, and the UPR amplitude in females was associated with positive expectations. Moreover, for females, fear of minor pain weakened the UPR and expectations of cream.Conclusion: No NB of caregivers is more effective in reducing pain. Caregivers’ NBs are less effective when displayed individually. Males and females may be different in underlying mechanisms of placebo effects.Keywords: placebo effects, subtle factors, nonverbal behaviours, heat pain, experimenter effects, pain report

Abstract Background Intermittent theta burst stimulation (iTBS) when applied over the left dorsolateral prefrontal cortex (DLPFC) has been shown to be equally effective and safe to treat depression compared to traditional repetitive transcranial magnetic stimulation (rTMS) paradigms. This protocol describes a funded single-centre, double-blind, randomized placebo-controlled, clinical trial to investigate the antidepressive effects of iTBS and factors associated with an antidepressive response. Methods In this trial, outpatients (N = 96, aged 22–65 years) meeting the diagnostic criteria for at least moderate depression (Montgomery and Aasberg Depression Rating Scale score ≥ 20) will be enrolled prospectively and receive ten, once-a-day sessions of either active iTBS or sham iTBS to the left DLPFC, localized via a neuronavigation system. Participants may have any degree of treatment resistance. Prior to stimulation, participants will undergo a thorough safety screening and a brief diagnostic assessment, genetic analysis of brain-derived neurotropic factor, 5-HTTLPR and 5-HT1A, and cerebral MRI assessments. A selection of neuropsychological tests and questionnaires will be administered prior to stimulation and after ten stimulations. An additional follow-up will be conducted 4 weeks after the last stimulation. The first participant was enrolled on June 4, 2022. Study completion will be in December 2027. The project is approved by the Regional Ethical Committee of Medicine and Health Sciences, Northern Norway, project number 228765. The trial will be conducted according to Good Clinical Practice and published safety guidelines on rTMS treatment. Discussion The aims of the present trial are to investigate the antidepressive effect of a 10-session iTBS protocol on moderately depressed outpatients and to explore the factors that can explain the reduction in depressive symptoms after iTBS but also a poorer response to the treatment. In separate, but related work packages, the trial will assess how clinical, cognitive, brain imaging and genetic measures at baseline relate to the variability in the antidepressive effects of iTBS. Trial registration ClinicalTrials.gov NCT05516095. Retrospectively registered on August 25, 2022.

Abstract Background Changes that improve the quality of health care should be sustained. Falling back to old, unsatisfactory ways of working is a waste of resources and can in the worst case increase resistance to later initiatives to improve care. Quality improvement relies on changing the clinical system yet factors that influence the sustainability of quality improvements are poorly understood. Theoretical frameworks can guide further research on the sustainability of quality improvements. Theories of organizational learning have contributed to a better understanding of organizational change in other contexts. To identify factors contributing to sustainability of improvements, we use learning theory to explore a case that had displayed sustained improvement. Methods Førde Hospital redesigned the pathway for elective surgery and achieved sustained reduction of cancellation rates. We used a qualitative case study design informed by theory to explore factors that contributed to sustain the improvements at Førde Hospital. The model Evidence in the Learning Organization describes how organizational learning contributes to change in healthcare institutions. This model constituted the framework for data collection and analysis. We interviewed a strategic sample of 20 employees. The in-depth interviews covered themes identified through our theoretical framework. Through a process of coding and condensing, we identified common themes that were interpreted in relation to our theoretical framework. Results Clinicians and leaders shared information about their everyday work and related this knowledge to how the entire clinical pathway could be improved. In this way they developed a revised and deeper understanding of their clinical system and its interdependencies. They became increasingly aware of how different elements needed to interact to enhance the performance and how their own efforts could contribute. Conclusions The improved understanding of the clinical system represented a change in mental models of employees that influenced how the organization changed its performance. By applying the framework of organizational learning, we learned that changes originating from a new mental model represent double-loop learning. In double-loop learning, deeper system properties are changed, and consequently changes are more likely to be sustained.

Abstract Background The cancellation of planned surgeries causes prolonged wait times, harm to patients, and is a waste of scarce resources. To reduce high cancellation rates in a Norwegian general hospital, the pathway for elective surgery was redesigned. The changes included earlier clinical assessment of patients, better planning and documentation systems, and increased involvement of patients in the scheduling of surgeries. This study evaluated the outcomes of this new pathway for elective surgery and explored which factors affected the outcomes. Methods We collected the number of planned operations, performed operations, and cancellations per month from the hospital’s patient administrative system. We then used Student's t-test to analyze differences in cancellation rates (CRs) before and after interventions and a u-chart to analyze whether the improvements were sustained. We also conducted semi-structured interviews with employees of the hospital to explore the changes in the surgical pathway and the factors that facilitated these changes. Results The mean CR was reduced from 8.5% to 4.9% (95% CI for mean reduction 2.6-4.5, p p = 0.04). A clear improvement strategy, involvement of frontline clinicians, introduction of an electronic scheduling system, and engagement of middle managers were important factors for the success of the interventions. Conclusion The redesign of the old clinical pathway contributed to a sustained reduction in cancellations and an increased number of performed operations.

Abstract Background Referral letters are the main communication means between Primary and Specialised Mental Health Care. However, studies of referral letters reveal that they lack important information, and how this lack of information affects the care for patients is unknown. This study aims to explore if and to what degree the quality of referral letters within Mental Health Care for adults can be improved and the potential improvement's impact on defined patient, professional and organisational related outcomes. Methods and design A controlled study with pre and post test will be prepared and accomplished to explore the correlation between the content of referral letters and outcomes of the care for the referred patients. The study is performed in accordance with the guideline of the Medical Research Council on development and evaluation of complex interventions. Using a mixed method design, a stepwise model will be conducted: Firstly, process and outcome measures will be developed and tested. Secondly, by these measures, the results from an intervention group of General Practitioners (GPs) who receive a complex quality improvement intervention will be compared with results from a control group who perform "care as usual". Compliance to the introduced guideline will be measured as a mediator. Discussion The Western Norway Mental Health Interface Study is among the first trials to evaluate the impact of the quality of referral letters on the organization of care. This study will provide information that will be usable for healthcare managers and clinicians in both Primary and Specialised Care settings. Trial Registration ClinicalTrials.gov: NCT01374035

A well-known hypothesis in education and amongst the general public is that matching instructional method with an individual's modality-specific learning style improves learning and cognitive performance. Several critical reviews in the past decade, however, have shown that the hypothesis has not been properly evaluated with appropriate methodology. Furthermore, the association between learning style and other cognitive abilities such as working memory has not been examined. Thus, the aim of the current study was to examine the association between modality-specific learning style, immediate recall, and working memory performance. University students with visual or auditory learning styles were randomly assigned to one of two instructional methods and then given a multiple-choice recall test. In addition, the participants completed working memory tasks with visual or auditory presentation. The results failed to support the matching hypothesis or any association between modality-specific learning style and working memory.

Stargardt disease (STGD1), associated with biallelic variants in the ABCA4 gene, is the most common heritable macular dystrophy and is currently untreatable. To identify potential treatment targets, we characterized surviving STGD1 photoreceptors. We used clinical data to identify macular regions with surviving STGD1 photoreceptors. We compared the hyperreflective bands in the optical coherence tomographic (OCT) images that correspond to structures in the STGD1 photoreceptor inner segments to those in controls. We used adaptive optics scanning light ophthalmoscopy (AO-SLO) to study the distribution of cones and AO-OCT to evaluate the interface of photoreceptors and retinal pigment epithelium (RPE). We found that the profile of the hyperreflective bands differed dramatically between patients with STGD1 and controls. AO-SLOs showed patches in which cone densities were similar to those in healthy retinas and others in which the cone population was sparse. In regions replete with cones, there was no debris at the photoreceptor-RPE interface. In regions with sparse cones, there was abundant debris. Our results raise the possibility that pharmaceutical means may protect surviving photoreceptors and so mitigate vision loss in patients with STGD1.

Objectives: Concurrent type 1 diabetes (T1D) and celiac disease (CeD) pose challenges in insulin dosage adjustments and gluten-free dietary adherence. Urine testing for gluten immunogenic peptides (GIP) is a new method to detect gluten exposure within the last 3–12 h. Our aims were to compare gluten-free dietary adherence between T1D + CeD and CeD individuals and evaluate urinary GIP testing in an outpatient setting. Materials and methods: This observational cross-sectional study included three adult groups: (1) T1D and CeD, (2) CeD only, and (3) T1D only. T1D participants were recruited from outpatient clinics, the CeD group via social media. One urine sample (12 pm–7 pm) was analyzed using a qualitative immunographic GIP test. CeD participants completed 'Celiac Dietary Adherence Test' (CDAT) and 'Celiac Symptom Index' (CSI) questionnaires. IgA anti-transglutaminase 2 (IgA-TG2) and IgG anti-deamidated gliadin (IgG-DGP) serology were also analyzed. Results: 197 participants, mean (SD) age 43 (15) years, were included. Female percentages were: CeD: 90%, T1D + CeD: 64%, and T1D: 47%. Positive urinary GIP was found in 15% (14/96) of T1D + CeD and 0% (0/50) of CeD (p = 0.002). As expected, most T1D only participants had positive urinary GIP (86%, 44/51). CDAT and CSI scores did not differ between T1D + CeD and CeD groups. Positive IgA-TG2 and/or IgG-DGP levels were found in 12% of T1D + CeD and 6% of CeD participants (p = 0.38). Conclusions: A single GIP urine test revealed higher gluten exposure in T1D + CeD versus CeD only, questioning dietary adherence in this population. Urinary GIP tests can be useful for clinical follow-up. Created with [ABSTRACT FROM AUTHOR]

The National Oceanic and Atmospheric Administration (NOAA) has been responsible for enabling The United States rapid responders during the hurricane season. Over decades of experience in enabling Rapid Response nationwide resulted in NOAA identifying the detailed engineering requirements for designing the next generation geospatially enabled airborne rapid response systems for aerial survey image capture, georeferencing, and high precision mapping. This paper is focused on presenting the state of the art, new trends, and the performance analysis of NOAA’s DSS version 6 for Rapid Response which development and testing took place in 2020/2021.

Artikkelen gir en genetisk og litteraturhistoriografisk analyse av Camilla Colletts selvbiografi I de lange netter (Idln). Den belyser tilblivelsen, mottakelsen og den litteraturfaglige forståelsen av Idln fra den første utgaven i 1863 og frem til i dag. Med støtte i bokhistorisk teori samt brev, anmeldelser og andre paratekster gjøres en empirisk-genetisk analyse av de tre utgave av Idln som utkom i Colletts levetid. Tidligere ukjent historisk materiale kaster nytt lys over Idlns tilblivelse og komposisjonshistorie, og viser at forholdet mellom begreper som «verk», «forfatter» og «forfatterskap» i Idln må tenkes på nytt. Med en bokhistorisk og empirisk tilnærming til forfatterbegrepet utfordrer artikkelen innarbeidede fortolkninger av de norske utgavene så vel som forskningens fremstillinger av Colletts forfatterpraksis.