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Abstract Purpose The European health data space promises an efficient environment for research and policy-making. However, this data space is dependent on high data quality. The implementation of electronic medical record systems has a positive impact on data quality, but improvements are not consistent across empirical studies. This study aims to analyze differences in the changes of data quality and to discuss these against distinct stages of the electronic medical record’s adoption process. Methods Paper-based and electronic medical records from three surgical departments were compared, assessing changes in data quality after the implementation of an electronic medical record system. Data quality was operationalized as completeness of documentation. Ten information that must be documented in both record types (e.g. vital signs) were coded as 1 if they were documented, otherwise as 0. Chi-Square-Tests were used to compare percentage completeness of these ten information and t-tests to compare mean completeness per record type. Results A total of N = 659 records were analyzed. Overall, the average completeness improved in the electronic medical record, with a change from 6.02 (SD = 1.88) to 7.2 (SD = 1.77). At the information level, eight information improved, one deteriorated and one remained unchanged. At the level of departments, changes in data quality show expected differences. Conclusion The study provides evidence that improvements in data quality could depend on the process how the electronic medical record is adopted in the affected department. Research is needed to further improve data quality through implementing new electronical medical record systems or updating existing ones.

This study investigates the levels of and associations among academic stress, perceived motivational climate and emotional problems in students at Norwegian upper secondary schools. A structural equation model with a sample of 1379 students (M[subscript age] 16.5 years old) tested the associations between perceived mastery and performance climates and emotional problems via associations with academic stress. Levels of academic stress and emotional problems were found to be higher among female participants than male participants. Performance climate was related to higher academic stress; it was also related to more emotional problems through its association with academic stress. Mastery climate was associated with lower academic stress, and both directly and indirectly (via academic stress) related to less emotional problems. There was a strong link between academic stress and emotional problems, and this was significantly stronger among female participants. Practical implications are suggested.

Medical specialists' lifelong learning is essential for improving patients' health. This study identifies affordances for learning general practitioners (GPs) engage in, and explores what influences engagement in those affordances. Eleven GPs were interviewed and the interview transcripts were analysed thematically. Stephen Billett's theoretical framework of workplace participatory practices was used as an analytical lens to explore the topic. Challenging patient cases were identified as the main trigger for engagement in learning. Local, national and international colleagues from the same and other specialties, were found to be an important affordance for learning, as was written material such as websites, journals and recommendations. Other inputs for learning were conferences and courses. Workplace aspects that were essential for GPs to engage in learning related to: place and time to talk, relevance to work, opportunity for different roles, organisation of work and workload, and working climate. Importantly, the study identifies a need for a holistic approach to lifelong learning, including spontaneous and structured opportunities for interaction over time with colleagues, establishment of incentives and arenas for exchange linked to peer learning, and acknowledgement of the workplace as an important place for learning and sufficient time with patients. This study contributes with a deepened understanding of how GPs navigate existing affordances for learning both within and outside their workplaces.

Primary Human Papillomavirus (HPV) screening on samples collected by women themselves has proven to be an effective strategy for cervical cancer screening (CCS) and may increase participation rates in women who do not partake (regularly) in screening. The aim of this study is to investigate reasons for non-participation and perceptions of CCS using self-sampling methods among under-screened women in Flanders. Individual interviews with 15 underscreened women aged 30–64 years were conducted. During the interviews, participants were given the opportunity to try out a urine and vaginal self-sampling kit. Thematic analysis was based on Ajzen’s model of the Theory of Planned Behavior. The results showed that 14 out of 15 participants were more likely to participate in CCS if they had the option to self-sample. One of the main findings was a lack of knowledge on different aspects of cervical cancer. Most women had a positive attitude toward cancer screening and primary prevention such as HPV vaccination. Subjective norms were influenced by healthcare professionals, peers, and organized government initiatives. Informational, organizational, contextual, and emotional factors were mentioned as barriers as well as facilitators for participation. Additionally, high self-efficacy was considered to make self-sampling more convenient. All women showed the intention to use at least one method of self-sampling. We can conclude that women who do not participate in CCS would be more motivated to participate using self-sampling methods. Adequate education and guidance should be provided.

Abstract Background Guideline-compliant provision of psycho-oncological (PO) care is still challenging in Germany. Hence, a new care programme, called integrated cross-sectoral psycho-oncology (isPO), was implemented to improve the integration of needs-oriented PO care. Quality of care (QoC) was externally evaluated from the patient’s perspective. We aim to gain insight into patients’ experiences with isPO and how their assessment affects relevant patient-reported outcomes (anxiety and depression, health status, and work ability). Methods An explanatory, sequential mixed-methods design was applied. Patients were surveyed twice during their 1-year care trajectory: after 3 (T1) and 12 (T2) months. Data sets were matched using pseudonyms. Care documentation data, including sociodemographic characteristics and the primary outcome variable (anxiety and depression), were matched. In the survey, patients rated their satisfaction with respective isPO service providers and the programme in general (QoC). Health status (EORTC-QLQ-C30) and work ability (WAS) were measured. Descriptive analyses and t-tests for dependent samples were conducted to assess changes in outcome variables over time. Linear regression analyses were conducted to assess whether care satisfaction predicted outcome variables. Patients who completed their isPO care trajectory were asked to participate in semi-structured telephone interviews to share their experiences. Purposeful sampling was applied. All 23 interviews were audiotaped, transcribed, and analysed via content-structuring method. Results Patients reported medium-to-high satisfaction with their isPO care. All patient-related outcomes significantly improved over time and QoC measures predicted those outcomes. Needs orientation (e.g., care intensity or mode of delivery) was perceived as essential for high QoC, and outpatient care with fixed contact persons as highly important for care continuity. Furthermore, patients identified programme optimisation needs, such as period of care or extension of care to relatives. Conclusions Patients assessed the isPO programme’s QoC positively. They identified facilitators for QoC and optimisation needs. Therefore, data on QoC can function as an indicator for a programme’s feasibility and maturity within care reality. As patients’ care satisfaction positively influences important patient-related outcomes, it may be routinely considered for quality management. Based on patients’ perspectives, isPO seems to be recommendable for routine psycho-oncological care in Germany, if ongoing programme optimisation within structured quality management is guaranteed. Trial registration The study was registered in the German Clinical Trials Register (No. DRKS00015326) on 30.10.2018.

Epstein–Barr virus (EBV) may cause a wide spectrum of symptomatology in humans ranging from asymptomatic upper respiratory tract infection to infectious mononucleosis and in more severe cases lymphoproliferative disorders or hemophagocytic lymphohistiocytosis. Its neoplastic potential is higher in immunocompromised individuals. We describe a case of EBV-positive mucocutaneous ulcer, a more indolent clinical entity on the spectrum of EBV-driven lymphoproliferative disorders, and are one of the first to put sulfasalazine, an immunomodulatory agent, forward as the possible culprit.

BackgroundElectronic medical records (EMR) are considered a key component of the health care system’s digital transformation. The implementation of an EMR promises various improvements, for example, in the availability of information, coordination of care, or patient safety, and is required for big data analytics. To ensure those possibilities, the included documentation must be of high quality. In this matter, the most frequently described dimension of data quality is the completeness of documentation. In this regard, little is known about how and why the completeness of documentation might change after the implementation of an EMR. ObjectiveThis study aims to compare the completeness of documentation in paper-based medical records and EMRs and to discuss the possible impact of an EMR on the completeness of documentation. MethodsA retrospective document analysis was conducted, comparing the completeness of paper-based medical records and EMRs. Data were collected before and after the implementation of an EMR on an orthopaedical ward in a German academic teaching hospital. The anonymized records represent all treated patients for a 3-week period each. Unpaired, 2-tailed t tests, chi-square tests, and relative risks were calculated to analyze and compare the mean completeness of the 2 record types in general and of 10 specific items in detail (blood pressure, body temperature, diagnosis, diet, excretions, height, pain, pulse, reanimation status, and weight). For this purpose, each of the 10 items received a dichotomous score of 1 if it was documented on the first day of patient care on the ward; otherwise, it was scored as 0. ResultsThe analysis consisted of 180 medical records. The average completeness was 6.25 (SD 2.15) out of 10 in the paper-based medical record, significantly rising to an average of 7.13 (SD 2.01) in the EMR (t178=–2.469; P=.01; d=–0.428). When looking at the significant changes of the 10 items in detail, the documentation of diet (P

Abstract Objective In addition to the common difficulties of ongoing trials, the COVID-19 pandemic posed several challenges to scientists worldwide and created an additional burden for vulnerable patient groups. In the nFC-isPO of individualised treatment for anxiety and depression in newly diagnosed patients with cancer caregivers (e.g. psycho-oncologists) reported elevated HADS scores in newly enrolled patients after the outbreak of the COVID-19 pandemic. Accordingly, the question arises whether the pandemic affected HADS scores. Therefore, stratified analyses by the time of enrolment (T1) were performed for patients with 12 months of care (T3). Methods Patients with 12 months of care (N = 1,140) were analysed. A comparison within the regression discontinuity design according to the time points at which patients completed the baseline (T1) HADS questionnaire was conducted to examine differences between patients recruited before Q2/2020 (pre-pandemic) and after the coronavirus outbreak. Furthermore, mean HADS scores at T1 and T3 for all quarters during the study were compared. Results Mean T1 and T3 HADS scores of patients with cancer during the pandemic are only slightly higher than those of the pre-pandemic group. No significant treatment effect was observed in either the pre-pandemic (p = 0.5495, Late = 1.7711) or the post-pandemic group (p = 0.9098, LATE=-0.2933). In contrast, the average local treatment effect in the post-pandemic group suggests a minimal decrease in HADS score in the predefined range and thus a positive treatment effect for isPO. Comparison of mean HADS scores at T1 and T3 did not show a large increase by pandemic-related timepoints, however, a decrease of approximately 2–3 points over each quarter at 12 months compared to baseline is observed. Conclusion The existing nFC-isPO care is resilient to crisis and may counteract external influences such as the Corona pandemic. Accordingly, the pandemic had little influence on the fears of patients with cancer in the nFC-isPO. This emphasises that psycho-oncology is vital for the reduction of stress, anxiety and depression in patients with cancer. Trial Registration The study was registered in the German Clinical Trials Registry on 30 October 2018 under the ID “DRKS00015326”.

Abstract Background Anaerobic fungi of the phylum Neocallimastigomycota have a high biotechnological potential due to their robust lignocellulose degrading capabilities and the production of several valuable metabolites like hydrogen, acetate, formate, lactate, and ethanol. The metabolism of these fungi, however, remains poorly understood due to limitations of the current cultivation strategies in still-standing bottles, thereby restricting the comprehensive evaluation of cultivation conditions. Results We describe the analysis of growth conditions and their influence on the metabolism of the previously isolated fungus Neocallimastix cameroonii G341. We established a bioreactor process in a stirred tank, enabling cultivation under defined conditions. The optimal growth temperature for the fungus was between 38.5 °C and 41.5 °C, while the optimal pH was 6.6–6.8. Like other dark fermentation systems, hydrogen production is dependent on the hydrogen partial pressure and pH. Shaking the bottles or stirring the fermenters led to an increase in hydrogen and a decrease in lactate and ethanol production. Regulation of the pH to 6.8 in the fermenter nearly doubled the amount of produced hydrogen. Conclusions Novel insights into the metabolism of Neocallimastix cameroonii were gained, with hydrogen being the preferred way of electron disposal over lactate and ethanol. In addition, our study highlights the potential application of the fungus for hydrogen production from un-pretreated biomass. Finally, we established the first cultivation of an anaerobic fungus in a stirred tank reactor system.

Even with inclusive general education classrooms, high school students with autism spectrum disorder (ASD) often have few social interactions with classmates. Peer support arrangements hold promise for increasing peer interactions and shared learning within general education classrooms. However, previous evaluations of this intervention have focused narrowly on adolescents with severe intellectual disability. In this pilot study, we examined the impact and social validity of peer support arrangements for four high school students with ASD. All four students increased their social interactions with peers, while academic engagement either increased or maintained for three students. Social validity data from peer partners and students indicated they considered the intervention acceptable. We discuss limitations and offer recommendations for future research and practice aimed at enhancing social connections within inclusive classrooms.

Dropout from upper secondary education is a persistent educational problem, particularly among first-generation immigrant youth. This study examined factors associated with intentions to dropout to gain further insight into the process of leaving upper secondary education. The analyses of 1299 Norwegian first-year upper secondary school students' (88% native Norwegians, 12% first-generation immigrants) self-reported intentions to quit school, loneliness, and peer victimization in school showed that first-generation immigrants experienced higher levels of loneliness than native Norwegians. In contrast, there were no differences in the levels of peer victimization and intentions to quit between native Norwegians and first-generation immigrants. However, loneliness showed a significantly stronger association with intentions to quit among first-generation immigrants. The results underscore the importance of tackling first-generation immigrants' loneliness in school to reduce their intentions to quit upper secondary education and thus potentially improve conditions for school completion.

Abstract Background Persistent post-concussion symptoms (PCS) are associated with prolonged disability, reduced health-related quality of life and reduced workability. At present, no strong evidence for treatments for people with persistent PCS exists. Our research group developed a novel intervention, “Get going After concussIoN (GAIN)”, that incorporates multiple evidence-based strategies including prescribed exercise, cognitive behavioural therapy, and gradual return to activity advice. In a previous randomised trial, GAIN provided in a hospital setting was effective in reducing symptoms in 15–30-year-olds with PCS 2–6 months post-injury. In the current study, we describe the protocol for a trial designed to test the effectiveness of GAIN in a larger municipality setting. Additionally, we test the intervention within a broader age group and evaluate a broader range of outcomes. The primary hypothesis is that participants allocated to enhanced usual care plus GAIN report a higher reduction in PCS 3 months post-intervention compared to participants allocated to enhanced usual care only. Methods The study is a stepped-wedge cluster-randomised trial with five clusters. The 8-week interdisciplinary GAIN program will be rolled out to clusters in 3-month intervals. Power calculation yield at least 180 participants to be enrolled. Primary outcome is mean change in PCS measured by the Rivermead Post-Concussion Symptoms Questionnaire from enrolment to 3 months after end of treatment. Secondary outcomes include participation in and satisfaction with everyday activities, labour market attachment and other behavioural measures. Self-reported outcomes are measured at baseline, by end of treatment and at 3, 6, and 18 months after end of treatment. Registry-based outcomes are measured up to 36 months after concussion. Discussion The trial will provide important information concerning the effectiveness of the GAIN intervention in a municipality setting. Furthermore, it will provide knowledge of possible barriers and facilitators that may be relevant for future implementation of GAIN in different settings. Trial registration The current GAIN trial is registered in ClinicalTrials.gov (study identifier: NCT04798885 ) on 20 October 2020.

The current longitudinal study examined students' intentions to quit school as a process that unfolds over time in a social context of upper secondary school. Based on self-report data collected from 1379 students at three time points over 13 months, the results from latent growth curve modelling revealed average increases in intentions to quit school and loneliness among peers at school, and no average change in perceived emotional support from teachers. In line with hypotheses, there was: (1) a negative association between change in perceived emotional support from teachers and change in intentions to quit school; and (2) a positive association between change in loneliness among peers and change in intentions to quit school, while controlling for gender, study track, and previous academic achievement. It is important that schools implement strategies to prioritise the quality of interpersonal relationships as an integral component of their educational mandate.

Teachers are crucial agents in adolescents' school life, and teachers' roles involve both academic and socio-emotional functions. This study examined how first-year students in upper secondary school in Norway (n = 1379) perceive aspects of teacher support (emotional support, feedback quality, and autonomy granting), and the associations with intentions to quit school. Based on priori considerations, direct associations of teacher support with intentions to quit and indirect associations via emotional engagement and boredom were tested through structural equation modeling. The model was adjusted for GPA, gender, immigrant background, and study track. Results indicated that perceived emotional support was the most central aspect of teacher support, as revealed by both indirect and direct associations with intentions to quit. Feedback quality and autonomy granting were weakly and indirectly associated with intentions to quit. Boredom was an important factor associated with intentions to quit.

IntroductionMacrophages are the preferential target of Mycobacterium avium subsp. paratuberculosis (MAP), the etiologic agent of ruminant paratuberculosis. Uptake of pathogens by intestinal macrophages results in their trafficking through endosomal compartments, ultimately leading to fusion with an acidic lysosome to destroy the pathogen. MAP possesses virulence factors which disrupt these endosomal pathways. Additionally, levels of serum vitamin D3 have proven relevant to host immunity. Dynamics of endosomal trafficking and vitamin D3 metabolism have been largely unexplored in bovine paratuberculosis.MethodsThis study aimed to characterize expression of early and late endosomal markers Rab5 and Rab7, respectively, within CD68+ macrophages in frozen mid-ileum sections harvested from cows at different stages of natural paratuberculosis infection. Additionally, factors of vitamin D3 signaling and metabolism were characterized through expression of vitamin D3 activating enzyme 1α-hydroxylase (CYP27B1), vitamin D3 inactivating enzyme 24-hydroxylase (CYP24A1), and vitamin D3 receptor (VDR) within CD68+ ileal macrophages.Results and discussionCows with clinical paratuberculosis had significantly greater macrophage and MAP burden overall, as well as intracellular MAP. Total expression of Rab5 within macrophages was reduced in clinical cows; however, Rab5 and MAP colocalization was significantly greater in this group. Intracellular Rab7 colocalization with MAP was not detected in subclinical or Johne's Disease negative (JD-) control cows but was present in clinical cows. Additionally, macrophage CYP27B1 expression was significantly reduced in clinical cows. Taken together, the results from this study show disparate patterns of expression for key mediators in intracellular MAP trafficking and vitamin D metabolism for cows at different stages of paratuberculosis.

This study explores the establishment experiences of physicians in the Swedish medical context who have been trained outside the European Union. The study used a qualitative approach with a quasi-longitudinal research design. The data were gathered via 63 semi-structured interviews with migrant physicians at three different periods. The data were analysed using qualitative thematic content analysis, adopting the theory on the context dependence of knowledge, which includes different forms of knowledge as sensitising concepts in the discussion. The MPs perceived themselves as having the medical knowledge (encoded knowledge) needed to work in Sweden. However, they perceived that they needed to develop knowledge of how to use the encoded knowledge in the Swedish medical context. The needed knowledge was thus foremost encultured, embedded, embodied, or embrained. The results are presented in the following themes: medical knowledge; knowledge of the healthcare system and its variations; knowledge of administrative routines; understanding the role as a physician, interaction and hierarchies between physicians and other healthcare staff; understanding the interaction and hierarchies between physicians and patients; and knowledge of the Swedish language. Knowledge, as described in the themes, function as gateways that needs to be unlocked for practising medicine in a new context. Embedded, embrained, embodied, and encultured knowledge interact and are interdependent, and the different forms of knowledge work as gateways to other forms of knowledge, and thus, they open for each other. However, to pass the gateways, managing the common language is important. We conclude that language is an enabler and a key to unlocking gateways to practise.

Abstract Aims Impairment of vascular function contributes to the progression of chronic heart failure (HF) by increasing the afterload. Treatment with selective sodium‐glucose cotransporter 2 (SGLT2) inhibitors improves the prognosis of HF, but the precise mechanisms remain unclear. The aim of this study was to analyse the effect of empagliflozin on vascular function in patients with HF. Methods and results In an investigator initiated, double‐blind, randomized, placebo‐controlled, parallel‐group, clinical study, patients with HF NYHA II‐III and an ejection fraction of 49% or less were randomized 2:1 to receive empagliflozin 10 mg once daily or placebo for 3 months. A total of 74 patients (15% female), aged 66 ± 9 years, with a mean ejection fraction of 39 ± 8% and a median NTproBNP of 558 pg/mL (IQR 219–1051 pg/mL), were included. Vascular parameters such as central systolic blood pressure (cSBP), central pulse pressure (cPP), forward (FPH), and reflected pressure pulse height (RPH) decreased under resting conditions after 1 and 3 months (1 month: cSBP −6.4 ± 8.3 mmHg, P

Macrophages are important host defense cells in ruminant paratuberculosis (Johne’s Disease; JD), a chronic enteritis caused by Mycobacterium avium subsp. paratuberculosis (MAP). Classical macrophage functions of pathogen trafficking, degradation, and antigen presentation are interrupted in mycobacterial infection. Immunologic stimulation by 25-hydroxyvitamin D3 (25(OH)D3) and 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) enhances bovine macrophage function. The present study aimed to investigate the role of vitamin D3 on macrophage phenotype and endosomal trafficking of MAP in monocyte-derived macrophages (MDMs) cultured from JD-, JD+ subclinical, and JD+ clinically infected cattle. MDMs were pre-treated 100 ng/ml 25(OH)D3 or 4 ng/ml 1,25(OH)2D3 and incubated 24 hrs with MAP at 10:1 multiplicity of infection (MOI). In vitro MAP infection upregulated pro-inflammatory (M1) CD80 and downregulated resolution/repair (M2) CD163. Vitamin D3 generally decreased CD80 and increased CD163 expression. Furthermore, early endosomal marker Rab5 was upregulated 140× across all stages of paratuberculosis infection following in vitro MAP infection; however, Rab5 was reduced in MAP-activated MDMs from JD+ subclinical and JD+ clinical cows compared to healthy controls. Rab7 expression decreased in control and clinical cows following MDM infection with MAP. Both forms of vitamin D3 reduced Rab5 expression in infected MDMs from JD- control cows, while 1,25(OH)2D3 decreased Rab7 expression in JD- and JD+ subclinical animals regardless of MAP infection in vitro. Vitamin D3 promoted phagocytosis in MDMs from JD- and JD+ clinical cows treated with either vitamin D3 analog. Results from this study show exogenous vitamin D3 influences macrophage M1/M2 polarization and Rab GTPase expression within MDM culture.

Chronic disease affects patients' disability and participation in activities of daily living. Longitudinal information on disability and physical activity is generally scarce in patients with chronic disease. The current study aimed to investigate if self-reported disability and physical activity changed in patients with chronic disease receiving physiotherapy. Furthermore, the aim was to assess if an improvement in self-reported disability was related to an increase in objectively measured physical activity and if an aggravation in self-reported disability was related to a decrease in physical activity. Seventy patients with either multiple sclerosis, Parkinson's disease, rheumatoid arthritis or stroke receiving free of charge physiotherapy were tested at baseline and 1 year later. Disability was measured with the self-reported modified Ranking Scale-9 Questionnaire and physical activity was objectively measured using tri-axial accelerometry. Neither self-reported disability nor physical activity changed among patients receiving 1 year of free of charge physiotherapy at group level. Furthermore, self-reported change of disability was not expressed with changes in objectively measured physical activity, indicating that the two measures represent two different constructs.

Mycobacterium avium subsp. paratuberculosis (MAP) is the etiological agent of Johne’s disease, a severe gastroenteritis of ruminants. This study developed a model cell culture system to rapidly screen MAP mutants with vaccine potential for apoptosis. Two wild-type strains, a transposon mutant, and two deletion mutant MAP strains (MOI of 10 with 1.2 × 106 CFU) were tested in murine RAW 264.7 macrophages to determine if they induce apoptosis and/or necrosis. Both deletion mutants were previously shown to be attenuated and immunogenic in primary bovine macrophages. All strains had similar growth rates, but cell morphology indicated that both deletion mutants were elongated with cell wall bulging. Cell death kinetics were followed by a real-time cellular assay to measure luminescence (apoptosis) and fluorescence (necrosis). A 6 h infection period was the appropriate time to assess apoptosis that was followed by secondary necrosis. Apoptosis was also quantified via DAPI-stained nuclear morphology and validated via flow cytometry. The combined analysis confirmed the hypothesis that candidate vaccine deletion mutants are pro-apoptotic in RAW 264.7 cells. In conclusion, the increased apoptosis seen in the deletion mutants correlates with the attenuated phenotype and immunogenicity observed in bovine macrophages, a property associated with good vaccine candidates.

UtForskerne: En ny tilnærming til religions- og livssynsundervisning i barneskolen

Med fagfornyelsen har KRLE-faget fått fem kjerneelement. Dette temanummeret undersøker det vi mener er den største nyheten blant dem: «Utforsking av religioner og livssyn med ulike metoder». Kjerneelementene uttrykker fagenes bærende ideer og fremmer arbeidet med dybdelæring. Slik Utdanningsdirektoratet definerer dybdelæring handler det både om innholdskunnskap og prosedyrekunnskap i fagene, metaperspektiv på egen læring og evne til å ta i bruk tilegnet kunnskap i nye sammenhenger (Udir 2019). I utviklingen av nye læreplaner ble læreplangruppene først engasjert i arbeid med å formulere kjerneelementene. Kjerneelementene som ble fastsatt for KRLE og RE er 1) Kjennskap til religioner og livssyn, 2) Utforsking av religioner og livssyn med ulike metoder, 3) Utforsking av eksistensielle spørsmål og svar, 4) Kunne ta andres perspektiv og 5) Etisk refleksjon. Beskrivelsen av innholdet i kjerneelement nr 2 lyder i sin helhet som følger: Elevene skal undersøke og utforske kristendom og andre religioner og livssyn som ­sammensatte fenomener gjennom bruk av varierte metoder. Deres forståelse av religioner og livssyn utdypes og utfordres gjennom analyse av og kritisk refleksjon over kilder, normer og definisjonsmakt. Kjennskap til ulike syn på og definisjoner av religioner og livssyn inngår i kjerneelementet og er vesentlig for å forstå og håndtere mangfold. I november (2021) ble konferansen «Utforsking av religioner og livssyn med ulike metoder i skolen» arrangert i Trondheim. Arrangør var prosjektet «Utforsking av religioner og livssyn med ulike metoder» i NTNU RE Research Group, i samarbeid med Prismet. Målet med konferansen var å bidra til forståelse av kjerneelementet og deling av ideer om hvordan det kan arbeides med kjerneelementet i lærerutdanning og grunnskole. Alle forskningsartiklene i nummeret springer ut fra denne konferansen, og kan knyttes til kjerneelementet i sin helhet, eller til ulike deler av det. Formålet med å vie et temanummer til dette ene kjerneelementet er å utforske det, slik det oppfordrer til utforsking av fagets emner: fra ulike perspektiv og med ulike metoder. Skribentene i dette nummeret er alle religionsdidaktikere med ulik faglig bakgrunn, og utgjør dermed «eit kritisk samvirke mellom ulike basisfaglege tradisjonar» (Brekke, dette nummeret, s. 51). Geir Skeie spør hva det innebærer for religions­didaktikken at elevene skal utforske i faget og diskuterer forholdet mellom elevenes utforsking og vitenskapsfagene sin forskning. Sentralt i hans diskusjon er hvorvidt utforskingen skal imitere eller være inspirert av forskning. Øyvind Soltun Andreassen og Camilla Stabel Jørgensen analyserer kjerneelementet, og finner et ressursperspektiv på uenighet. Dette innebærer at elever skal bruke ulike former for uenighet, kompleksitet og mangfold som ressurs for å utvikle kunnskap om og forståelse for religioner og livssyn. Øystein Brekke skriver om religions- og livssynsfaget som faglig konglomerat der ulike vitenskapsfaglige tradisjoner virker sammen, og ser kjerneelementet som en invitasjon til å arbeide med et bredt spekter av perspektiv og posisjoner i klasserommet. Han argumenterer videre for at en livssynsåpen fagontologi er en bedre ramme for slikt arbeid enn en sekulær fagontologi. Knut Aukland spør hvilken kunnskap vi vil at utforsking med ulike metoder skal lede til, og diskuterer forholdet mellom det å lære om religion og det å lære hvordan man kan lære om religion. Diskusjonen lander i en tabell over ulike kunnskapsformer i faget; en tabell han inviterer leseren til å være med å utvikle. Beate Børresen og Kåre Fuglseth beskriver og sammenligner filosofisk samtale og Tren tanken som utforskende arbeidsmåter, og diskuterer dem i lys av det danningspedagogiske paradokset. De argumenterer for at de to arbeidsmåtene til sammen gir ressurser til å takle paradokset, gjennom kombinasjonen av struktur og frihet for elevenes utforsking. Til slutt gjør Inge Andersland og Oddrun Marie Hovde Bråten rede for ulike forståelser av begrepene «religion» og «livssyn», og utforsker hvordan disse er synlige i læreplanens forskjellige deler. De argumenterer deretter for at spenningene og konfliktene som ligger i de ulike måtene å bruke begrepene på, kan brukes didaktisk for å tilrettelegge for elevers utforsking i faget. På ulike måter undersøker artiklene altså fagets metoder og normene som styrer metodevalg og metodebruk i kunnskapssøking – både i vitenskapelig forskning og i skolens undervisningspraksis. Vi tror derfor temanummeret kan gi en oversikt over sentrale diskusjoner og posisjoner i det fagdidaktiske forskningsfeltet. Siden fokus for temanummeret er kjerneelementet om utforsking med ulike metoder, er det rimelig at nettopp læreplanen undersøkes og analyseres i flere av bidragene. Prismet ønsker tilsvarende undersøkelser av flere av kjerneelementene velkommen, samtidig som vi inviterer til ytterligere analyser av og refleksjoner over et bredere utvalg av kilder som kan fortelle om religioner og livssyn som sammensatte fenomen. I tillegg til seks forskningsartikler, inneholder nummeret tre korte omtaler av den rykende ferske oversettelsen utForskerne: En ny tilnærming til religions- og livssynsundervisning i barneskolen oversatt fra The RE-searchers: A New Approach to Religious Education in primary schools. Omtalene er skrevet av 1) Bjarte Mongstad og Gunvor Wendel – to lærere som har brukt ressursen i sin tverrfaglige undervisning på ungdomstrinnet, 2) Camilla Stabel Jørgensen som har lest korrektur på den norske oversettelsen og 3) Rob Freathy – en av forfatterne av den engelske ressursen. Det er verdt å nevne at fem av de seks vitenskapelige artiklene i dette nummeret tematiserer nettopp the RE-searchers. Ny læreplan har ført til ny lærebok. I temanummerets siste bidrag anmelder Ragnhild Laird Iversen Innføring i KRLE-didaktikk. Undervisning i religion, livssyn og etikk i et flerkulturelt samfunn. God lesing! Ingunn Aadland, redaktør Camilla Stabel Jørgensen Øyvind Soltun Andreassen gjeste-medredaktører

I denne artikkelen analyserer vi kjerneelementet «Utforsking av religioner og livssyn med ulike metoder» for bedre å forstå hva som ligger i formuleringene det inneholder og hvilke nye utfordringer det stiller lærere overfor. Dataene som undersøkes, er muntlige utvekslinger om teksten i kjerneelementet mellom deltagere i et praksisfellesskap av KRLE-/RE-lærer­utdannere, så vel som teksten i kjerneelementet og teksten i den utgående læreplanen. For å identifisere hva som er nytt, sammenlignes teksten i kjerneelementet med teksten i utgående læreplan. De muntlige utvekslingene analyseres for å forstå hvordan de som utdanner KRLE-lærere (som skal bruke læreplanen) tolker formuleringene i dette kjerne­elementet. Vårt hoved­funn er at kjerneelementet introduserer et ressursperspektiv på uenighet. Vi diskuterer hvordan kjerneelementet beskriver kompleksitet, mangfold og uenighet, og hvordan kjerneelementet forventer at elever skal bruke kompleksitet, mangfold og uenighet som en ressurs i deres egen utvikling av kunnskap og forståelse i faget. Nøkkelord: Læreplananalyse, kjerneelement, utforsking, varierte metoder, epistemologisk bevissthet, ressursperspektiv på uenighet

Post-school outcomes for adolescents and young adults with autism spectrum disorder (ASD) are exceedingly poor. The convergence of adolescence as a development period, the expression of ASD during adolescence, and the complicated logistic nature of high schools create a perfect storm of complexity that may pose challenges and establish barriers to providing an effective secondary education program. Given this complexity, addressing learning needs for adolescents with ASD and improving post-school outcomes requires a comprehensive approach. In this article, the authors describe a set of implementation science principles and practices that could be employed in supporting the adoption and implementation of a comprehensive program for high school students with ASD. The program developed by the Center on Secondary Education for Students With Autism Spectrum Disorder(CSESA) serves as a case example of how such principles and practices may be employed in program planning and implementation. [This paper was published in "Remedial and Special Education," (EJ1021022).]

Abstract Background Mycobacterium avium subspecies paratuberculosis (MAP), the cause of Johne disease, is a slow growing mycobacterium. Viable MAP detection is difficult, inconstant and time-consuming. The purpose of this study was to compare a rapid phage/qPCR assay performed on peripheral blood mononuclear cells (PBMCs) with three standard methods of MAP detection: fecal MAP PCR; plasma antigen-specific IFN-γ & serum MAP ELISA hypothesizing that, if sensitive and specific, Johne animals would be positive and Control animals negative. We studied a well characterized herd of Holstein cattle that were naturally infected with MAP and their Controls. Results With phage/qPCR 72% (23/32) of Johne and 35% (6/17) of Controls were MAP positive. With fecal PCR 75% (24/32) of Johne and 0% (0/17) of Controls were MAP positive. With plasma antigen-specific IFN-γ 69% (22/32) of Johne and 12% (2/17) of Controls were MAP positive. With serum MAP ELISA, 31% (10/32) of Johne and 0% (0/17) of Controls were MAP positive. When phage / qPCR and fecal PCR results were combined, 100% (32/32) Johne and 35% (6/17) of Control animals were MAP positive. Younger Control animals (1–3 years) had significantly fewer plaques (25 ± 17 SEM) than older Controls (4–12 years) (309 ± 134 p = 0.04). The same trend was not observed in the Johne animals (p = 0.19). Conclusions In contrast to our hypothesis, using the phage/qPCR assay we find that viable circulating MAP can rapidly be detected from the blood of animals infected with, as well as those in the Control group evidently colonized by MAP. These data indicate that the presence of viable MAP in blood does not necessarily signify that an animal must of necessity be demonstrably ill or be MAP positive by standard diagnostic methods.

Abstract Cell-mediated immune responses to Mycobacterium avium subsp. paratuberculosis (MAP) are regulated by various types of T lymphocytes. The aim of this study was to quantitate T cell subsets in the mid-ileum of cows naturally infected with MAP to identify differences during different stages of infection, and to determine whether these subsets could be used as predictors of disease state. Immunofluorescent labeling of T cell subsets and macrophages was performed on frozen mid-ileal tissue sections archived from naturally infected dairy cows in either subclinical or clinical disease status, and noninfected control cows. Comprehensive IF staining for CD4, CD8α, TcR1-N24 (gamma delta), FoxP3, CXCR3 and CCR9 served to define T cell subsets and was correlated with macrophages present. Clinically affected cows demonstrated significantly higher numbers of CXCR3+ (Th1-type) and CCR9+ (total small intestinal lymphocytes) cells at the site of infection compared to the subclinical cows and noninfected controls. Further, predictive modeling indicated a significant interaction between CXCR3+ and AM3K+ (macrophages) cells, suggesting that progression to clinical disease state aligns with increased numbers of these cell types at the site of infection. The ability to predict disease state with this model was improved from previous modeling using immunofluorescent macrophage data. Predictive modelling indicated an interaction between CXCR3+ and AM3K+ cells, which could more sensitively detect subclinical cows compared to clinical cows. It may be possible to use this knowledge to improve and develop an assay to detect subclinically infected animals with more confidence during the early stages of the disease.

Field visits to churches, mosques, temples or other buildings used by religious groups, are often valued by students of religious education as an opportunity to engage with the 'reality' of the subject: religions as they exist in the world. The Council of Europe text "Signposts" specifies field visits as an important contributor to the religious dimension of intercultural education, but also identifies issues that need to be addressed by researchers and teachers. During an excursion, students interact with representatives who are likely to represent their tradition in one particular way. The aim of this paper is to investigate how the representation of religion and religiosity is constructed during excursions by representatives and visitors. We have developed an analytical tool based on the interpretive approach and the theory of speech genres. Based on our analysis of documentation related to four field visits with students to places of worship, we suggest how the different speech genres in play during an excursion can help in promoting awareness of different levels of religion: individual, group and the whole tradition.

Introduction: Holistic rehabilitation approaches addressing the numerous complex challenges in young persons with acquired brain injury are required. The purpose of this study was to describe and evaluate the holistic person-centered youth mentoring intervention program, which is based on occupational therapy. Methods: Prospectively collected data were extracted from a national clinical quality database (n = 59). Proportions of young persons receiving different aspects of support and proportions rating the intervention as meaningful were calculated. One-year changes in occupation, work ability, and social interactions were calculated. Results: The young persons most frequently received support for energy management (75%) and structuring of everyday life (61%). Seventy-three percent rated the intervention as meaningful. One year post-inclusion, occupation and work ability had increased by 35% and 58%, respectively, and it had declined by 10% and 26%, respectively. The 1-year increase and decrease in social interactions were less clear (15% and 25%, respectively). One-year changes did not differ between those who entered the program early or late after injury indicating the potential beneficial effect of the program. Conclusion: The findings could indicate that the program has a unique value in supporting young persons with acquired brain injury to create a meaningful everyday life through occupation, work ability, and social interaction. [ABSTRACT FROM AUTHOR]

Abstract Infection with Mycobacterium avium subspecies paratuberculosis (MAP) is complex, but little is known about the role that natural killer (NK) cells play. In the present study, four bovine NK-lysin peptides were synthesized to evaluate their bactericidal activity against MAP. The results demonstrated that bNK-lysin peptides were directly bactericidal against MAP, with bNK1 and bNK2A being more potent than bNK2B and bNK2C. Mechanistically, transmission electron microscopy revealed that the incubation of MAP with bNK2A resulted in extensive damage to cell membranes and cytosolic content leakage. Furthermore, the addition of bNK2A linked with a cell-penetrating peptide resulted in increased MAP killing in a macrophage model.

The role of vitamin D3 in modulating immune responses has been well-established for over two decades; however, its specific functions have not been extensively detailed in cattle, particularly cattle in different stages of infection with Mycobacterium avium subspecies paratuberculosis (MAP). Consistent with previous work in our lab, the present study showed that infected cattle in the clinical stage of disease have reduced serum 25-hydroxyvitamin D3 [25(OH)D3]. Additionally, effects of vitamin D3 on peripheral blood mononuclear cells (PBMCs) from naturally infected dairy cattle in subclinical (n = 8) or clinical (n = 8) stages of infection were compared to non-infected control cows (n = 8). Briefly, PBMCs were isolated and cultured in vitro with 4 ng/ml 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] or 100 ng/ml 25(OH)D3. Treatment with 1,25(OH)2D3 resulted in decreased secretion for some pro-inflammatory cytokines in clinical animals, including IL-1β, IL-6, and IFN-γ. Similar responses for IL-1β and IL-6 were noted with the addition of 25(OH)D3. Additionally, pro-inflammatory cytokine gene expression tended to be upregulated in PBMCs from clinical animals after treatment with 1,25(OH)2D3. In contrast, PBMCs from clinical animals treated with 25(OH)D3 showed downregulation of pro-inflammatory cytokine gene expression, although only significant for IL1B. Following 25(OH)D3 treatment, clinical animals showed significant reduction in CD4+CD25+ T cells. CYP27B1 gene expression was notably decreased in clinical and control animals following 25(OH)D3 treatment but increased in subclinical cows. 1,25(OH)2D3 treatment reduced CYP24A1 gene expression in all groups, while 25(OH)D3 treatment only significantly reduced expression for control cows. Lastly, serum 25(OH)D3 levels were significantly lower in clinical animals. Taken together, these data show vitamin D3 modulates cytokine signaling in cattle at different stages of MAP infection and, therefore, may have implications on disease progression.

Little is known about the role that B cells play in immune responses to infection with the intracellular pathogen, Mycobacterium avium subsp. paratuberculosis (MAP). Traditionally, the role of B cells has been constrained to their function as antibody-producing cells, however, antibodies are not thought to play a protective role in mycobacterial infections. The present study was designed to characterize B cell subpopulations as well as activation/maturation states in cattle with paratuberculosis. Peripheral blood mononuclear cells (PBMCs) were isolated from noninfected control cows (n = 8); as well cattle naturally infected with MAP in the subclinical (n = 8) and clinical (n = 7) stage of infection and stimulated with MAP antigen for 6 days. MAP infection resulted in greater numbers of total B cells for clinical cows compared to control noninfected cows. The major subpopulation in freshly isolated PBMCs in clinical cows was B-1a B cells, but this shifted to a composite of both B-1a and B-2 B cells upon stimulation of PBMCs with either MAP antigen or pokeweed mitogen, with higher numbers of B-2 B cells. Early B cells were observed to predominate the population of B cells in PBMCs, with lesser populations of germinal B cells, memory B cells and plasma cells. These subpopulations were elevated in clinical cows upon stimulation of PBMCs with MAP antigen, except for plasma cells which were lower compared to control noninfected cows. Increased numbers of B cells in clinical cows aligned with higher expression of B cell markers such as MAPK1/3, BTG1, Bcl2, CD79A and SWAP70, depending upon in vitro stimulation with either mitogen or antigen. This would indicate that the B cells were capable of activation but were anti-apoptotic in nature. The shift to B-2 B cells in the periphery of clinical cows seems to be indicative of an expansion of memory B cells, rather than plasma cells. This may be a last attempt by the host to control the rampant inflammatory state associated with advanced clinical disease.

Background and Aim. Cognitive impairment is a common consequence following stroke. Previous research shows differences in rehabilitation services supporting physical, cognitive, and psychosocial needs. The aim of the current study was to explore health professionals’ experiences with service provision for patients with mild and moderate cognitive impairment after stroke in a North Norwegian context. Methods. A focus group interview with clinicians, coordinators, and leaders involved in stroke survivors’ rehabilitation trajectories was conducted. The group consisted of a strategic selection of participants with diverse professional backgrounds from specialist and primary healthcare services. The transcribed material was analyzed thematically using systematic text condensation based on an inductive, interpretive approach. Results. We found that patients with mild and moderate cognitive impairment after stroke were characterized as a neglected group in rehabilitation services and that neglect was related to both structural and professional issues. First, neglect seemed partly related to the availability of existing healthcare services, which mainly followed up on physical challenges after stroke. Second, cognitive rehabilitation seemed to be less prioritized than other health services, and the established interdisciplinary municipality teams did not seem prepared to follow-up on cognitive issues. Finally, at a professional level, the study reveals the need for building competence in cognitive rehabilitation and having services available in the long run. Conclusion. The study demonstrates the need to increase knowledge concerning cognitive rehabilitation and how rehabilitation trajectories and services should be organized to fulfil stroke survivors’ and carers’ long-term needs.

Mycobacterium avium subspecies paratuberculosis (MAP), the causative agent of ruminant enteritis, targets intestinal macrophages. During infection, macrophages contribute to mucosal inflammation and development of granulomas in the small intestine which worsens as disease progression occurs. Vitamin D3 is an immunomodulatory steroid hormone with beneficial roles in host-pathogen interactions. Few studies have investigated immunologic roles of 25-hydroxyvitamin D3 (25(OH)D3) and 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) in cattle, particularly cattle infected with MAP. This study examined the effects of exogenous vitamin D3 on immune responses of monocyte derived macrophages (MDMs) isolated from dairy cattle naturally infected with MAP. MDMs were pre-treated with ± 100 ng/ml 25(OH)D3 or ± 4 ng/ml 1,25(OH)2D3, then incubated 24 hrs with live MAP in the presence of their respective pre-treatment concentrations. Following treatment with either vitamin D3 analog, phagocytosis of MAP by MDMs was significantly greater in clinically infected animals, with a greater amount of live and dead bacteria. Clinical cows had significantly less CD40 surface expression on MDMs compared to subclinical cows and noninfected controls. 1,25(OH)2D3 also significantly increased nitrite production in MAP infected cows. 1,25(OH)2D3 treatment played a key role in upregulating secretion of pro-inflammatory cytokines IL-1β and IL-12 while downregulating IL-10, IL-6, and IFN-γ. 1,25(OH)2D3 also negatively regulated transcripts of CYP24A1, CYP27B1, DEFB7, NOS2, and IL10. Results from this study demonstrate that vitamin D3 compounds, but mainly 1,25(OH)2D3, modulate both pro- and anti-inflammatory immune responses in dairy cattle infected with MAP, impacting the bacterial viability within the macrophage.

Mycobacterium avium subspecies paratuberculosis (MAP) is an environmentally hardy pathogen of ruminants that plagues the dairy industry. Hallmark clinical symptoms include granulomatous enteritis, watery diarrhea, and significant loss of body condition. Transition from subclinical to clinical infection is a dynamic process led by MAP which resides in host macrophages. Clinical stage disease is accompanied by dysfunctional immune responses and a reduction in circulating vitamin D3. The immunomodulatory role of vitamin D3 in infectious disease has been well established in humans, particularly in Mycobacterium tuberculosis infection. However, significant species differences exist between the immune system of humans and bovines, including effects induced by vitamin D3. This fact highlights the need for continued study of the relationship between vitamin D3 and bovine immunity, especially during different stages of paratuberculosis.

Degradation of lignocellulosic materials to release fermentable mono- and disaccharides is a decisive step toward a sustainable bio-based economy, thereby increasing the demand of robust and highly active lignocellulolytic enzymes. Anaerobic fungi of the phylum Neocallimastigomycota are potent biomass degraders harboring a huge variety of such enzymes. Compared to cellulose, hemicellulose degradation has received much less attention; therefore, the focus of this study has been the enzymatic xylan degradation of anaerobic fungi as these organisms produce some of the most effective known hydrolytic enzymes. We report the heterologous expression of a GH43 xylosidase, Xyl43Nc, and a GH11 endoxylanase, X11Nc, from the anaerobic fungus Neocallimastix californiae in Escherichia coli. The enzymes were identified by screening of the putative proteome. Xyl43Nc was highly active against 4-Nitrophenol-xylopyranosides with a Km of 0.72 mM, a kcat of 29.28 s−1, a temperature optimum of 32°C and a pH optimum of 6. When combined, Xyl43Nc and X11Nc released xylose from beechwood xylan and arabinoxylan from wheat. Phylogenetic analysis revealed that Xyl43Nc shares common ancestry with enzymes from Spirochaetes and groups separately from Ascomycete sequences in our phylogeny, highlighting the importance of horizontal gene transfer in the evolution of the anaerobic fungi.

The research deals with the theme of the interactions between society and nature, having as territorial delimitation the community of Nova Rússia, municipality of Blumenau, located in the buffer zone of the Serra do Itajaí National Park (PNSI). The objective is to describe the environmental history and the regional development of this community. The main activities that contributed to regional development between 1860-1940 were mining, forest exploration (wood and firewood), and subsistence farming activities. Between 1950-1990 there was an expansion of the occupation of space by exploratory activities already developed, and reduction of the native forest by pine and eucalyptus plantations. Beginning in the 1990s, there are initiatives for the commercial use of the region for leisure and recreation, as well as initiatives for the conservation of nature. These activities have been extended with the creation of the PNSI in 2004 and have become important elements of regional development with practices focused on sustainability.

Mycobacterium avium subsp. paratuberculosis (MAP) causes a chronic inflammatory intestinal disease, called Johne's disease (JD) in many ruminants. In the dairy industry, JD is responsible for significant economic losses due to decreased milk production and premature culling of infected animals. Test-and-cull strategy in conjunction with risk management is currently recommended for JD control in dairy herds. However, current diagnostic tests are labor-intensive, time-consuming, and/or too difficult to operate on site. In this study, we developed a new method for the detection of anti-M. paratuberculosis antibodies from sera of M. paratuberculosis-infected animals. M. paratuberculosis antigen-coated magnetic beads were sequentially reacted with bovine serum followed by a horseradish peroxidase (HRP)-labeled secondary antibody. The reaction of HRP with its substrate was then quantitatively measured electrochemically using a redox-active probe, ferrocyanide. After optimization of electrochemical conditions and concentration of the redox-active probe, we showed that the new electrochemical detection method could distinguish samples of M. paratuberculosis-infected cattle from those of uninfected cattle with greater separation between the two groups of samples when compared with a conventional colorimetric testing method. Since electrochemical detection can be conducted with an inexpensive, battery-operated portable device, this new method may form a basis for the development of an on-site diagnostic system for JD.

Over a decade ago Mycobacterium avium subspecies paratuberculosis (Map) specific genes were initially identified in a whole genome context by comparing draft genome sequences of Map strain K-10 with Mycobacterium avium subspecies hominissuis (Mah) strain 104. This resulted in identification of 32 Map specific genes, not including repetitive elements, based on the two-genome comparison. The goal of this study was to define a more complete catalog of M. avium subspecies-specific genes. This is important for obtaining additional diagnostic targets for Johne's disease detection and for understanding the unique biology, evolution and niche adaptation of these organisms. There are now over 28 complete genome sequences representing three M. avium subspecies, including avium (Maa), Mah, and Map. We have conducted a comprehensive comparison of these genomes using two independent pan genomic comparison tools, PanOCT and Roary. This has led to the identification of more than 250 subspecies defining genes common to both analyses. The majority of these genes are arranged in clusters called genomic islands. We further reduced the number of diagnostic targets by excluding sequences having high BLAST similarity to other mycobacterial species recently added to the National Center for Biotechnology Information database. Genes identified as diagnostic following these bioinformatic approaches were further tested by DNA amplification PCR on an additional 20 M. avium subspecies strains. This combined approach confirmed 86 genes as Map-specific, seven as Maa-specific and three as Mah-specific. A single-tube PCR reaction was conducted as a proof of concept method to quickly distinguish M. avium subspecies strains. With these novel data, researchers can classify isolates in their freezers, quickly characterize clinical samples, and functionally analyze these unique genes.