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Environmentally persistent free radicals (EPFRs) play an important role in aerosol effects on air quality and public health, but their atmospheric abundance and sources are poorly understood. We measured EPFRs contained in PM2.5 collected in Fairbanks, Alaska, in winter 2022. We find that EPFR concentrations were enhanced during surface-based inversion and correlate strongly with incomplete combustion markers, including carbon monoxide and elemental carbon (R2 > 0.75). EPFRs exhibit moderately good correlations with PAHs, biomass burning organic aerosols, and potassium (R2 > 0.4). We also observe strong correlations of EPFRs with hydrocarbon-like organic aerosols, Fe and Ti (R2 > 0.6), and single-particle mass spectrometry measurements reveal internal mixing of PAHs, with potassium and iron. These results suggest that residential wood burning and vehicle tailpipes are major sources of EPFRs and nontailpipe emissions, such as brake wear and road dust, may contribute to the stabilization of EPFRs. Exposure to the observed EPFR concentrations (18 ± 12 pmol m-3) would be equivalent to smoking ∼0.4-1 cigarette daily. Very strong correlations (R2 > 0.8) of EPFR with hydroxyl radical formation in surrogate lung fluid indicate that exposure to EPFRs may induce oxidative stress in the human respiratory tract.

The Alaskan Layered Pollution And Chemical Analysis (ALPACA) field experiment was a collaborative study designed to improve understanding of pollution sources and chemical processes during winter (cold climate and low-photochemical activity), to investigate indoor pollution, and to study dispersion of pollution as affected by frequent temperature inversions. A number of the research goals were motivated by questions raised by residents of Fairbanks, Alaska, where the study was held. This paper describes the measurement strategies and the conditions encountered during the January and February 2022 field experiment, and reports early examples of how the measurements addressed research goals, particularly those of interest to the residents. Outdoor air measurements showed high concentrations of particulate matter and pollutant gases including volatile organic carbon species. During pollution events, low winds and extremely stable atmospheric conditions trapped pollution below 73 m, an extremely shallow vertical scale. Tethered-balloon-based measurements intercepted plumes aloft, which were associated with power plant point sources through transport modeling. Because cold climate residents spend much of their time indoors, the study included an indoor air quality component, where measurements were made inside and outside a house to study infiltration and indoor sources. In the absence of indoor activities such as cooking and/or heating with a pellet stove, indoor particulate matter concentrations were lower than outdoors; however, cooking and pellet stove burns often caused higher indoor particulate matter concentrations than outdoors. The mass-normalized particulate matter oxidative potential, a health-relevant property measured here by the reactivity with dithiothreiol, of indoor particles varied by source, with cooking particles having less oxidative potential per mass than pellet stove particles.

Low vitamin D (vitD) levels have been consistently reported in schizophrenia (SCZ) suggesting a role in the etiopathology. However, little is known about the role of underlying shared genetic mechanisms. We applied a conditional/conjunctional false discovery rate approach (FDR) on large, nonoverlapping genome-wide association studies for SCZ (N cases = 53 386, N controls = 77 258) and vitD serum concentration (N = 417 580) to evaluate shared common genetic variants. The identified genomic loci were characterized using functional analyses and biological repositories. We observed cross-trait SNP enrichment in SCZ conditioned on vitD and vice versa, demonstrating shared genetic architecture. Applying the conjunctional FDR approach, we identified 72 loci jointly associated with SCZ and vitD at conjunctional FDR

Enhanced Academic Support (EAS) is an intervention designed to improve academic achievement among children who receive support from the child welfare services (CWSs) in the home. We investigated the effects of EAS in a randomized controlled trial in Norway. In total, 82 families who received support from the CWS were included in the study (37 in the intervention group, 45 in the comparison group). Both groups were invited to a pretest, posttest, and follow-up measure of the children's math and reading skills, their teachers' evaluation of their academic competence, and of parental involvement in children's education. CWS workers, parents, and children reported the dosage of academic support received. In the intervention group, 48% of families received the threshold dosage of EAS needed for the intervention to be considered as delivered. There were no statistically significant differences between the intervention and comparison group on the children's math and reading skills, or their teachers' evaluation of the children's academic competence. Given the variation in intervention delivery and the limited statistical power, limited conclusions about the effect of EAS can be made. Important lessons from implementation in CWS and on conducting a pragmatic randomized trial are discussed.

Abstract Background Quality in healthcare is a subject in need of continuous attention. Quality improvement (QI) programmes with the purpose of increasing service quality are therefore of priority for healthcare leaders and governments. This study explores the implementation process of two different QI programmes, one externally driven implementation and one internally driven, in Norwegian nursing homes and home care services. The aim for the study was to identify enablers and barriers for externally and internally driven implementation processes in nursing homes and homecare services, and furthermore to explore if identified enablers and barriers are different or similar across the different implementation processes. Methods This study is based on an exploratory qualitative methodology. The empirical data was collected through the ‘Improving Quality and Safety in Primary Care – Implementing a Leadership Intervention in Nursing Homes and Homecare’ (SAFE-LEAD) project. The SAFE-LEAD project is a multiple case study of two different QI programmes in primary care in Norway. A large externally driven implementation process was supplemented with a tracer project involving an internally driven implementation process to identify differences and similarities. The empirical data was inductively analysed in accordance with grounded theory. Results Enablers for both external and internal implementation processes were found to be technology and tools, dedication, and ownership. Other more implementation process specific enablers entailed continuous learning, simulation training, knowledge sharing, perceived relevance, dedication, ownership, technology and tools, a systematic approach and coordination. Only workload was identified as coincident barriers across both externally and internally implementation processes. Implementation process specific barriers included turnover, coping with given responsibilities, staff variety, challenges in coordination, technology and tools, standardizations not aligned with work, extensive documentation, lack of knowledge sharing. Conclusion This study provides understanding that some enablers and barriers are present in both externally and internally driven implementation processes, while other are more implementation process specific. Dedication, engagement, technology and tools are coinciding enablers which can be drawn upon in different implementation processes, while workload acted as the main barrier in both externally and internally driven implementation processes. This means that some enablers and barriers can be expected in implementation of QI programmes in nursing homes and home care services, while others require contextual understanding of their setting and work.

AbstractObjective To investigate if wearing surgical face mask by doctors and nurses during suturing of traumatic wounds has any impact on postoperative infection rate.Design Randomized controlled study with masked or unmasked health personnel groups.Setting A Norwegian Minor Injury Department.Subjects Adult patients with traumatic wounds sutured at the clinic between 7 October 2019 and 28 May 2020.Main outcome measures Postoperative infections of sutured wounds.Results One hundred and sixty-five patients with 176 wounds were included in the study. Nine out of 88 wounds (10.2%) in the masked group and 11 out of 88 wounds in the unmasked group (12.5%) had a wound infection.Conclusions Despite a higher percentage of postoperative infections in the unmasked than in the masked group (12.5% versus 10.2%), the difference was not statistically significant (p = .6). This might imply that the use of facemasks during suture of traumatic wounds in an outpatient setting does not significantly reduce the number of infections. However, due to the covid pandemic, the study had to be prematurely stopped before the planned number of participants had been recruited (n = 594). This increases the risk of type II error.

Pandemics are regularly occurring events, and there are foundational principles of pandemic preparation upon which communities, regions, states, and nations may draw upon for elevated preparedness against an inevitable future infectious disease threat. Many disciplines within the social sciences can provide crucial insight and transdisciplinary thinking for the development of preparedness measures. In 2023, the National Science Foundation funded a conference of circumpolar researchers and Indigenous partners to reflect on COVID-19-related research. In this article, we synthesise our diverse social science perspectives to: (1) identify potential areas of future pandemic-related research in Alaska, and (2) pose new research questions that elevate the needs of Alaska and its people, pursuant of a specific body of pandemic knowledge that takes into account the ecological and sociocultural contexts of the region. In doing so, we highlight important domains of research in the social sciences from transdisciplinary perspectives, including the centering of Indigenous knowledges and needs, the contexts of risk perception and resilience, food and housing security, and more. We highlight the contributions of social sciences to pandemic knowledge and provide a foundation for future pandemic-related research in Alaska.

Atlantic salmon (Salmo salar) possesses a genome containing 10 genes encoding chitinases, yet their functional roles remain poorly understood. In other fish species, chitinases have been primarily linked to digestion, but also to other functions, as chitinase‐encoding genes are transcribed in a variety of non‐digestive organs. In this study, we investigated the properties of two chitinases belonging to the family 18 glycoside hydrolase group, namely Chia.3 and Chia.4, both isolated from the stomach mucosa. Chia.3 and Chia.4, exhibiting 95% sequence identity, proved inseparable using conventional chromatographic methods, necessitating their purification as a chitinase pair. Biochemical analysis revealed sustained chitinolytic activity against β‐chitin for up to 24 h, spanning a pH range of 2 to 6. Moreover, subsequent in vitro investigations established that this chitinase pair efficiently degrades diverse chitin‐containing substrates into chitobiose, highlighting the potential of Atlantic salmon to utilize novel chitin‐containing feed sources. Analysis of the gastric matrix proteome demonstrates that the chitinases are secreted and rank among the most abundant proteins in the gastric matrix. This finding correlates well with the previously observed high transcription of the corresponding chitinase genes in Atlantic salmon stomach tissue. By shedding light on the secreted chitinases in the Atlantic salmon's stomach mucosa and elucidating their functional characteristics, this study enhances our understanding of chitinase biology in this species. Moreover, the observed capacity to effectively degrade chitin‐containing materials implies the potential utilization of alternative feed sources rich in chitin, offering promising prospects for sustainable aquaculture practices.

Internalizing problems may be associated with poor academic performance and school absenteeism among youth. This study investigated the impact of the EMOTION: "Coping Kids" Managing Anxiety and Depression Program on academic achievement and school adaptation in children. Data were collected in a national cluster-randomized controlled trial at three time points in Norway. Children (N = 688, 8-12 years), who had elevated levels of anxiety or depressive symptoms from 36 schools participated. There were no significant differences between the intervention and control groups post-intervention or at 12-month follow-up regarding academic achievement and school adaptation. Likewise, no significant intervention effects were identified for school-related variables in the anxiety-only, depression-only, or combined (anxiety and depression) groups. The intervention did not have an impact on school functioning. Thus, focusing on school-related challenges and enhanced collaboration with teachers, possibly through a tailored version of the EMOTION program, could be an interesting adaptation of the intervention.

Abstract Background Norwegian school health services received a national best-practice guideline in 2017. To promote healthy life skills and identify adolescents needing support, the guideline includes strong recommendations for individual consultations with all 8th graders and increased collaboration with schools. To help implement the recommendations, a blended implementation strategy (SchoolHealth) was co-created with school nurses, students, and stakeholders. SchoolHealth consists of three implementation elements: Digital dialog and administration tool (audit and feedback +), Dialog support (external consultation), and Collaboration materials (targeted dissemination). This hybrid study will test the main and combined effects of the elements on guideline fidelity and effectiveness. Methods The GuideMe study is a factorial cluster randomized controlled trial examining SchoolHealth's effectiveness on guideline fidelity and guideline effectiveness goals. Forty Norwegian secondary schools will be randomized to eight different combinations of the elements in SchoolHealth. Participants will include school nurses and school personnel from these schools, and 8th grade students (n = 1200). Primary outcomes are school nurses' fidelity to the guidelines and student's ability to cope with their life (i.e., health literacy, positive health behaviors and self-efficacy). Quantitative methods will be used to test effects and mechanisms, while mixed- and qualitative methods will be used to explore mechanisms, experiences, and other phenomena in depth. Participants will complete digital questionnaires at the start and end of the schoolyear, and after the consultation during the schoolyear. The study will run in two waves, each lasting for one school year. The multifactorial design allows testing of interactions and main effects due to equal distribution of all factors within each main effect. Sustainment and scale-up of optimized SchoolHealth elements using national infrastructure are simultaneously prepared. Discussion The study will investigate possible effects of the implementation elements in isolation and in combination, and hypothesized implementation mechanisms. In-depth study of user experiences will inform improvements to elements in SchoolHealth. The results will yield causal knowledge about implementation strategies and the mechanisms through which they assert effects. Mixed-methods will provide insights into how and when the elements work. Optimizing guideline implementation elements can support adolescents in a crucial life phase. Trail registration ISRCTN24173836. Registration date 8 August 2022.

Rural communities is Alaska—predominantly Alaska Native Tribes—are at the forefront of climate change impacts and climate justice concerns in the United States. According to the 2019 Alaska statewide threat assessment report, 29 communities are currently experiencing significant climate change-related erosion. Further, 38 communities faces significant flooding, and 35 have major problems with thawing permafrost. Some Alaska Native communities have explored community relocation to adapt to these impacts. Because federal law does not recognize gradual environmental impacts like thawing permafrost and coastal erosion as disasters, these communities are ineligible for disaster funding and struggling with how to adapt to the very urgent—albeit less immediate—issues that they face.This article analyzes the chalenges of Alaska Native Tribes attempting to access federal assistance for community relocation. While some posit that the federal trust responsibility for Tribal Nations might help leverage federal help with community relocation, the status of Alaska Native Claims Settlement Act (ANCSA) extinguished almost all claims of aboriginal title and reservations in Alaska. General access to federal disaster funding and programs may be another avenue for assistance; however, the limited definition of "disaster" and overly burdensome requirements for federal programs mean that many Alaska Native communities are left to struggle on their own.In response to these challenges, this article explores possible solutions to help these communities with their relocation efforts. It examines the newly adopted Building Resilient Communities and Infrastructure Program as a potential funding opportunity for community relocation efforts, along with programs focused on climate justice. Finally, the article concludes by proposing the expansion of a state role in helping coordinate federal grant programs on behalf of Alaska Native Tribes and the funding of resilience officers by the federal government at regional Alaska Native organizations to navigate requirements for community relocation grant programs.

Abstract Background Irritable bowel syndrome (IBS) often co-occurs with psychiatric and gastrointestinal disorders. A recent genome-wide association study (GWAS) identified several genetic risk variants for IBS. However, most of the heritability remains unidentified, and the genetic overlap with psychiatric and somatic disorders is not quantified beyond genome-wide genetic correlations. Here, we characterize the genetic architecture of IBS, further, investigate its genetic overlap with psychiatric and gastrointestinal phenotypes, and identify novel genomic risk loci. Methods Using GWAS summary statistics of IBS (53,400 cases and 433,201 controls), and psychiatric and gastrointestinal phenotypes, we performed bivariate casual mixture model analysis to characterize the genetic architecture and genetic overlap between these phenotypes. We leveraged identified genetic overlap to boost the discovery of genomic loci associated with IBS, and to identify specific shared loci associated with both IBS and psychiatric and gastrointestinal phenotypes, using the conditional/conjunctional false discovery rate (condFDR/conjFDR) framework. We used functional mapping and gene annotation (FUMA) for functional analyses. Results IBS was highly polygenic with 12k trait-influencing variants. We found extensive polygenic overlap between IBS and psychiatric disorders and to a lesser extent with gastrointestinal diseases. We identified 132 independent IBS-associated loci (condFDR

The COVID-19 pandemic actualized teaching in digital learning environments and brought a steep learning curve for teachers in higher education. Several studies focusing on students’ experiences of this period have gradually emerged, but there has been less on how teachers experience digital learning environments. Hence, the purpose of this empirical study was to gain knowledge about how teachers experienced online teaching of large groups during the pandemic. Two group interviews were conducted with experienced teachers. The main finding was that teaching in digital environments leads to a type of digital apathy. The teachers experienced black screens and a lack of response from students, having a negative effect on them. They become tired, demotivated, and drained of energy. They experienced losing their qualities as lecturers, becoming boring, and being less free in what they could say. Breakout groups were easy to manage, but many students would leave when these were introduced. Teaching in digital learning environments seemed to lead to a comfortable distance, which posed a risk for both students and teachers to become resigned. Therefore, this teaching format may be more demanding than teaching in physical environments. The interviews were conducted at a time when teaching in digital learning environments was novel, and the informants’ expectations may have been characterized by traditional teaching. Their experiences may be different in the long run.

Background and purpose: We aimed to establish the incidence of late-detected developmental dysplasia of the hip (DDH) with a selective ultrasound (US) examination over 17 years using the femoral head coverage (FHC) as a US measurement. The secondary aim was to establish the everyday function using patient-reported outcome measures (PROMs). Patients and methods: The incidence of late-detected DDH was based on 60,844 children. Patients diagnosed for the first time after 3 months and before the age of 8 years were included. In the second part of the study, consent to participate was mandatory. PROMIS-25 Pediatric, PROMIS-25 Parent, and EQ-5D-5L were used according to the patient’s age to assess everyday function. Results: The incidence of late-detected DDH was 0.48/1,000. The median age at diagnosis was 8 months (range 4–41 months), with a tendency to require repeated treatment with open surgery if DDH was diagnosed later. Most children reported no or minor health problems with a mean of 18 years’ follow-up. Conclusion: We found that selective US examination of the hips by measuring the FHC is a reliable method to examine newborns for DDH resulting in a low incidence of late-detected DDH amounting to 0.48/1,000 newborn children.

The Teamwork Indicator (TWI) inventory for students monitors group development and can serve as a feedback tool in project work, active learning, and teams to improve the educational outcome. TWI consists of 20 items, it is simple and easy to use, and the inventory gauges changes over time in four central group dimensions: management, social collaboration, work commitment and attitudes toward evaluations. Based on a large sample (N=6595), the inventory has good psychometric properties. The item structure showed temporal and contextual stability for sex, cultural diversity, language, and training format. In active learning, students are left more to themselves, and in peer assessment, the inventory can partly substitute for feedback from a facilitator. The TWI is suitable for groups of a certain duration and with two-fold goals: content learning and social development of interactive, communication and collaborative skills. The use of TWI can initiate reflections about self, team and group functioning in general, which in the short and long-term is likely to translate into the outcome of new groups, probably also into the students' future careers.

Abstract Background In this study, we wanted to investigate the relationship between background variables, communication skills, and the bio-psychosocial content of a medical consultation in a general practice setting with a standardized patient. Methods Final-year medical school students (N = 111) carried out a consultation with an actor playing the role of a patient with a specific somatic complaint, psychosocial stressors, and concerns about cancer. Based on videotapes, communication skills and consultation content were scored separately. Results The mean level of overall communication skills had a significant impact upon the counts of psychosocial issues, the patient's concerns about cancer, and the information and planning parts of the consultation content being addressed. Gender and age had no influence upon the relationship between communication skills and consultation content. Conclusion Communication skills seem to be important for final-year students' competence in addressing sensitive psychosocial issues and patients' concerns as well as informing and planning with patients being representative for a fairly complex case in general practice. This result should be considered in the design and incorporation of communication skills training as part of the curriculum of medical schools.

Abstract Background Communication training builds on the assumption that understanding of the concepts related to professional communication facilitates the training. We know little about whether students' knowledge of clinical communication skills is affected by their attendance of communication training courses, or to what degree other elements of the clinical training or curriculum design also play a role. The aim of this study was to determine which elements of the curriculum influence acquisition of knowledge regarding clinical communication skills by medical students. Methods The study design was a cross-sectional survey performed in the four Norwegian medical schools with different curricula, spring 2003. A self-administered questionnaire regarding knowledge of communication skills (an abridged version of van Dalen's paper-and-pencil test) was sent to all students attending the four medical schools. A total of 1801 (59%) students responded with complete questionnaires. Results At the end of the 1st year of study, the score on the knowledge test was higher in students at the two schools running communication courses and providing early patient contact (mean 81%) than in the other two medical schools (mean 69–75%, P ≤ 0.001), with students studying a traditional curriculum scoring the lowest. Their scores increased sharply towards the end of the 3rd year, during which they had been subjected to extensive patient contact and had participated in an intensive communication course (77% vs. 72% the previous year, P ≤ 0.01). All students scored generally lower in academic years in which there was no communication training. However, at the end of the final year the difference between the schools was only 5% (81% vs. 86%, P ≤ 0.001). Conclusion The acquisition of knowledge regarding communication skills by medical students may be optimised when the training is given together with extensive supervised patient contact, especially if this teaching takes place in the initial years of the curriculum.

Abstract Background The Communication Skills Attitudes Scale (CSAS) created by Rees, Sheard and Davies and published in 2002 has been a widely used instrument for measuring medical students' attitudes towards learning communication skills. Earlier studies have shown that the CSAS mainly tests two dimensions of attitudes towards communication; positive attitudes (PAS) and negative attitudes (NAS). The objectives of our study are to explore the attitudes of Norwegian medical students towards learning communication skills, and to compare our findings with reports from other countries. Methods The CSAS questionnaire was mailed simultaneously to all students (n = 3055) of the four medical schools in Norway in the spring of 2003. Response from 1833 students (60.0%) were analysed by use of SPSS ver.12. Results A Principal component analysis yielded findings that differ in many respects from those of earlier papers. We found the CSAS to measure three factors. The first factor describes students' feelings about the way communication skills are taught, whereas the second factor describes more fundamental attitudes and values connected to the importance of having communication skills for doctors. The third factor explores whether students feel that good communication skills may help them respecting patients and colleagues. Conclusion Our findings indicate that in this sample the CSAS measures broader aspects of attitudes towards learning communication skills than the formerly described two-factor model with PAS and NAS. This may turn out to be helpful for monitoring the effect of different teaching strategies on students' attitudes during medical school.

Students learn best when they are active and engaged. Even when we combine asynchronous and synchronous communication, it is challenging to get the optimal levels of engagement and communication. A number of different ways of creating communication and interactivity have been tested out including mandatory on-campus seminars, small size groups of students, video conferencing with chat and teaching in real time. This paper presents a holistic approach to increase communication and engagement in online teaching by using the blended learning concept. The paper presents three different types of network models that combine synchronous and asynchronous communication. The methodological approach is mainly qualitative. The empirical data is mainly interviews and observations. The respondents are lectures who are teaching online. The theory this research rests on is theory on communication and relevant theory about online teaching. Findings and results are from Lervik's PhD work. The results show that the following conditions promote communication, dialogue and engagement in online teaching: compulsory campus meetings before starting online teaching, having small groups of students online, communicating through video conferencing with chat and teaching in true time. Blended learning will in this case be a combination of synchronous and asynchronous communication. The main findings of this research are that these lecturers conduct online education through three different network models. These three web network models vary with the aim of facilitating the flexibility of online students that combine work and study. A critical factor is to conduct on-campus seminars at the start of the education as this enables the teacher and students to get to know each other and develop the trust required to have the required involvement, engagement and communication. A high level of involvement and engagement will increase the learning outcome from the subsequent online teaching. The blend of learning opportunities provides the students with different approaches that can support different learning styles.