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Abstract This study investigated the crucial role of formulating and applying standard operating procedures (SOPs) in the context of emergency planning and response. The effective application of SOPs during operations is essential in order to address challenges that surpass individual organizational capacities. A specific focus on fostering efficient information sharing and executing specified actions maximizes the prospect of success. To explore the collective functionality of SOPs across organizations, we conducted a comprehensive tabletop exercise involving 10 organizations spanning tactical, operational, and strategic levels. Our analysis identified six key challenges, primarily related to the structures for information sharing, communication pathways, and the complex integration and application of common SOPs within these diverse organizational contexts. This research contributes insights into the use of SOPs in large-scale, cross-organizational scenarios.

Bilingual subject instruction, designed to facilitate the acquisition of the Norwegian language, is a support class aimed at immigrant students in primary and lower secondary Norwegian schools. This study delves into the beliefs of two Polish-Norwegian bilingual teachers regarding multilingualism in this instructional context and the factors influencing their decisions on incorporating students' prior linguistic knowledge. Utilizing a narrative approach, the analysis of interviews reveals that both teachers perceive multilingualism as valuable for learning support and students' social engagement. Individual variations emerge in how these teachers employ multilingual resources, reflecting a connection between their beliefs, experiences, and reported pedagogical decisions.

Abstract Background Cerebellar degeneration-related (CDR) proteins are associated with paraneoplastic cerebellar degeneration (PCD) – a rare, neurodegenerative disease caused by tumour-induced autoimmunity against neural antigens resulting in degeneration of Purkinje neurons in the cerebellum. The pathogenesis of PCD is unknown, in large part due to our limited understanding of the functions of CDR proteins. To this end, we performed an extensive, multi-omics analysis of CDR-knockout cells focusing on the CDR2L protein, to gain a deeper understanding of the properties of the CDR proteins in ovarian cancer. Methods Ovarian cancer cell lines lacking either CDR1, CDR2, or CDR2L were analysed using RNA sequencing and mass spectrometry-based proteomics to assess changes to the transcriptome, proteome and secretome in the absence of these proteins. Results For each knockout cell line, we identified sets of differentially expressed genes and proteins. CDR2L-knockout cells displayed a distinct expression profile compared to CDR1- and CDR2-knockout cells. Knockout of CDR2L caused dysregulation of genes involved in ribosome biogenesis, protein translation, and cell cycle progression, ultimately causing impaired cell proliferation in vitro. Several of these genes showed a concurrent upregulation at the transcript level and downregulation at the protein level. Conclusions Our study provides the first integrative multi-omics analysis of the impact of knockout of the CDR genes, providing both new insights into the biological properties of the CDR proteins in ovarian cancer, and a valuable resource for future investigations into the CDR proteins.

Abstract Atmospheric methane oxidizing bacteria (atmMOB) constitute the sole biological sink for atmospheric methane. Still, the physiological basis allowing atmMOB to grow on air is not well understood. Here we assess the ability and strategies of seven methanotrophic species to grow with air as sole energy, carbon, and nitrogen source. Four species, including three outside the canonical atmMOB group USCα, enduringly oxidized atmospheric methane, carbon monoxide, and hydrogen during 12 months of growth on air. These four species exhibited distinct substrate preferences implying the existence of multiple metabolic strategies to grow on air. The estimated energy yields of the atmMOB were substantially lower than previously assumed necessary for cellular maintenance in atmMOB and other aerobic microorganisms. Moreover, the atmMOB also covered their nitrogen requirements from air. During growth on air, the atmMOB decreased investments in biosynthesis while increasing investments in trace gas oxidation. Furthermore, we confirm that a high apparent specific affinity for methane is a key characteristic of atmMOB. Our work shows that atmMOB grow on the trace concentrations of methane, carbon monoxide, and hydrogen present in air and outlines the metabolic strategies that enable atmMOB to mitigate greenhouse gases.

Background Individual variation in the need for healthcare constitutes knowledge gaps for young atrial fibrillation (AF) patients. We aimed to estimate the prevalence and primary care burden of early-onset AF in Norway, emphasising sex differences, in a nationwide healthcare database.Methods We used data from the Norwegian Control and Payment of Health Reimbursement database to identify all Norwegian residents ≥18 years of age registered with a primary care physician (PCP) in 2019, with onset of AF at ≤50 years of age (early-onset AF) in the period 2006–2019. From the accumulated number of early-onset AF cases among current residents, we calculated the prevalence in 2019. The group-level primary care burden was calculated as the total number of annual AF consultations divided by the annual number of AF patients (2014–2018), and individual burden as the mean number of consultations per AF patient per year within the study period. We analysed the distribution of AF consultations between PCP and primary care emergency room (ER) services in total and by sex.Results We identified 10 925 Norwegian residents with early-onset AF in 2019 (26.3% women, mean age 48.4 years). The prevalence of early-onset AF was 0.34% (women: 0.19%, men: 0.50%). The early-onset AF population had on average one annual primary care consultation for AF. The individual burden of annual AF consultations varied widely;

BackgroundIn robot-assisted laparoscopic prostatectomy surgery patients are tilted 30°–40° head-down. Knowledge of cerebral autoregulation and determinants of cerebral blood flow in this setting is limited, though postoperative cognitive impairment has been reported. This observational study describes the hemodynamic determinants of cerebral blood flow and dynamics of cerebral perfusion pressure during surgery in the Trendelenburg position and the correlations with postoperative cognition measures.Materials and methodsWe included patients scheduled for robot-assisted laparoscopic prostatectomy without known cerebrovascular disease. Cardiac index, mean arterial pressure, central venous pressure, optic nerve sheath diameter as a surrogate for intracranial pressure, ultrasound-measured internal carotid artery (ICA) blood flow and PaCO2 were recorded at six time points (awake, anesthetized, immediately after tilt, 1 h of tilt, just before end of tilt, and before emerging from anaesthesia). Comprehensive cognitive tests were performed before surgery and 10 and 180 days post-surgery. Data was evaluated using linear regression models.ResultsForty-four males with a mean age of 67 years were included. Duration of anesthesia was 226 min [IQR 201,266] with 165 min [134,199] in head-down tilt. ICA flow decreased after induction of anesthesia (483 vs. 344 ml/min) and remained lowered before increasing at return to horizontal position (331 vs. 407 ml/min). Cerebral perfusion pressure decreased after 1 h tilt (from 73 to 62 mmHg) and remained lowered (66 mmHg) also after return to horizontal position. Optic nerve sheath diameter increased from mean 5.8 mm to 6.4 mm during the course of surgery. ICA flow correlated positively with cardiac index (β 0.367. 1 L/min/m2 increase corresponding to 92 ml/min increased ICA flow). PaCO2 had a positive effect on ICA flow (β 0.145. 1 kPa increase corresponding to 49 ml/min increased ICA flow), while mean arterial pressure had a negative effect (β −0.203. 10 mmHg increase corresponding to a 29 ml/min decline in ICA flow). We found no evidence of postoperative cognitive dysfunction.ConclusionICA flow and cerebral perfusion pressure were significantly reduced during robot-assisted laparoscopic prostatectomy surgery. ICA flow positively correlated with cardiac index and PaCO2, but negatively with mean arterial pressure. Postoperative cognitive function was not impaired.

Background American and European guidelines define hypertension differently and are sex agnostic. Our aim was to assess the impact of different hypertension thresholds at the age of 40 on 30-year stroke risk and to examine sex differences.Methods We included 2608 stroke-free individuals from the Akershus Cardiac Examination 1950 Study, a Norwegian regional study conducted in 2012–2015 of the 1950 birth cohort, who had previously participated in the Age 40 Program, a nationwide health examination study conducted in 1990–1993. We categorised participants by systolic blood pressure (SBP) at age 40 (

The aim of this cross-sectional study was to analyse the educational background, educational desires and participation in education among three samples of female prisoners with Norwegian citizenship in Norwegian prisons over the period from 2009 to 2015. The female participants were n = 106 in 2009, n = 74 in 2012 and n = 79 in 2015, respectively, with a mean age of 38 years. Moreover, the study examined whether self-reported learning difficulties could predict participation in education activity while incarcerated. The results show that the female prisoners included in this study increased their educational level over the studied years. Similar education patterns were observed in the 2009 and 2012 samples regarding all educational levels for the female prisoners. A different pattern was observed in the 2015 data, with 44.3 % having mandatory education as their highest level compared to 57.6 in 2009 and 53.4 in 2012, respectively. However, these differences in percent between the samples at any education level were not significant. Significant differences were, however, found regarding the desire for upper secondary education between the samples in 2009 and 2012, and 2009 and 2015, respectively. In 2009, 20.2% reported upper secondary education as an educational desire, whereas 35.2% reported this as a desire in 2012, and 36.7% in 2015. Participation in educational activity during incarceration also changed during the time period of these studies. Many of the female prisoners participate in educational activity, but a significant difference was found between the samples in 2012 and 2015 as there was a decrease in activity. In 2012, 41.9% did not participate, whereas in 2015, almost 60% (58.2) of the female prisoners did not participate in any educational activity. Both the highest completed education level and self-reported learning difficulties predicted participation in education activity among the female prisoners in the 2015 sample.

BackgroundThe recommended treatment for cervical spinal cord injury (cSCI) is surgical decompression and stabilization within 24 h after injury. The aims of the study were to estimate our institutional compliance with this recommendation and identify potential factors associated with surgical delay.MethodsPopulation-based retrospective database study of patients operated for cSCI in 2015–2022 within the South-East Norway Health Region (3.1 million inhabitants). Data extracted were demographics, injury description, management timeline, place of primary triage [local hospital (LH) or neurotrauma center (NTC)]. Main outcome variables were: (1) time from injury to surgery at NTC, (2) time from injury to admission NTC, and (3) time from admission NTC to surgery.ResultsWe found 243 cSCI patients having acute neck surgery. Their median age was 63 years (IQR 47–74 years), 77% were male, 48% were ≥65 years old. Primary triage at an LH occurred in 150/243 (62%). The median time from injury to acute surgery was 27.8 h (IQR 15.4–61.9 h), and 47% had surgery within 24 h. The median time from injury to NTC admission was 5.6 h (IQR 1.9–19.4 h), and 67% of the patients were admitted to the NTC within 12 h. Significant factors associated with increased time from injury to NTC admission were transfer via LH, severe preinjury comorbidities, less severe cSCI, time of injury other than night, absence of multiple injuries. The median time from NTC admission to surgery was 16.7 h (IQR 9.5–31.0 h), and 70% had surgery within 24 h. Significant factors associated with increased time from NTC admission to surgery were increasing age and non-translational injury morphology.ConclusionLess than half of the patients with cSCI were operated on within the recommended 24 h time frame after injury. To increase the fraction of early surgery, we suggest the following: (1) patients with clinical suspicion of cSCI should be transported directly to the NTC from the scene of the accident, (2) MRI should be performed only at the NTC, (3) at the NTC, surgery should commence on the same calendar day as arrival or as the first operation the following day.

In this work we propose a generalization of the endurance function employed in the continuum approach to high-cycle fatigue modeling by Ottosen et al. (2008). The von Mises-type backstress-modified effective stress term of the original formulation is replaced by the non-quadratic Hershey-Hosford function, which introduces flexibility with respect to the predicted fatigue limit in pure shear. While the original model assumes a fixed ratio between the fatigue limits in fully reversed torsion and fully reversed bending of 0.5774 for all materials, the modification enables the ratio to take on values on the interval from 0.5 to 0.5852 by calibration to experimental data that is readily available in the literature. Like the original formulation simplifies to the invariant-based Mises-Sines fatigue limit criterion for proportional stress histories, the current proposal can be written as a Hershey-Hosford-Sines criterion. A systematic validation to experimental multiaxial infinite fatigue life data from eight different mild and semi-hard metals with fully reversed torsion and bending fatigue limit ratios lower than 0.6 demonstrates that the proposed modification increases the accuracy and reduces the number of non-conservative predictions.

Abstract Background During the COVID‐19 pandemic, nursing home leaders implemented infection control to protect residents and staff. Aim To understand the barriers and facilitators for leading nursing homes through the COVID‐19 pandemic. Methods We invited 34 nursing homes to participate, and 20 leaders (59%) attended focus group interviews. The COM‐B model and the theoretical domains framework were used in design and analysis of the study. Results The barriers for infection control were organisational unpreparedness, high volumes of information, lack of clinical skills, protective equipment, and testing capacity, the nursing home's architectural design, health authorities' low priority of nursing homes, staff's fear, and mental pressure on the leaders over time. The facilitators were having a customised corona plan, change of routines, certification of new skills, access to the municipal quality system, the ability for crisis leadership, loyalty to the nursing home, and support from the environment. The number of part‐time positions and the opportunity to outsource parts of the services were also important determinants for infection control. Conclusions The results identify several barriers and facilitators for nursing home leaders' behaviour for infection control. The results confirm the importance of supporting the leaders' resilience and crisis leadership while working in the pressurised environment of a pandemic. Relevance to Clinical Practice The study provides important insights into barriers and facilitators for leading nursing homes through the COVID‐19 pandemic, which could help to inform future strategies for infection control. Patient or Public Contribution No patient or public contribution.

Abstract Background Meeting the oral health needs of the increasing population of older adults presents a major challenge in dental care. Knowledge about the oral health status in the young-elderly age group is essential for the planning of future oral health education and prevention programs. The aims of the present study were therefore to investigate the caries experience among 65-year-olds in Oslo, Norway, and to explore associations between having decayed teeth and sociodemographic, behavioural, and biological factors. Methods A random sample of 65‑year‑olds in Oslo answered a questionnaire and underwent clinical and radiographic examinations (n = 457, 52% men and 48% women) at the Research Clinic, Faculty of Dentistry, University of Oslo, between February and December 2019. Primary- and secondary coronal and root caries lesions, root remnants, and missing and restored teeth were recorded. Decayed teeth (DT) were defined as teeth with coronal- and root caries lesions that had progressed into dentine and root remnants, and the DMFT/S scores were calculated. Results The mean number of teeth was 25 (SD: 4) and the mean DMFT was 19.4 (SD: 4.7). Thirty seven percent of the individuals had at least one decayed tooth (DT > 0), and the mean number of filled teeth (FT) was 16.1 (SD: 5.4). Multivariable logistic regression analysis showed that male gender (OR: 1.8, 95% CI: 1.2–2.8), basic level of education (OR: 1.9, 95% CI: 1.2–2.9), irregular dental attendance (OR: 2.2, 95% CI: 1.0-4.8), and hyposalivation (OR: 2.1, 95% CI: 1.0-4.4) were significant risk indicators for having decayed teeth (DT > 0) (p

Abstract Background Data mining of electronic health records (EHRs) has a huge potential for improving clinical decision support and to help healthcare deliver precision medicine. Unfortunately, the rule-based and machine learning-based approaches used for natural language processing (NLP) in healthcare today all struggle with various shortcomings related to performance, efficiency, or transparency. Methods In this paper, we address these issues by presenting a novel method for NLP that implements unsupervised learning of word embeddings, semi-supervised learning for simplified and accelerated clinical vocabulary and concept building, and deterministic rules for fine-grained control of information extraction. The clinical language is automatically learnt, and vocabulary, concepts, and rules supporting a variety of NLP downstream tasks can further be built with only minimal manual feature engineering and tagging required from clinical experts. Together, these steps create an open processing pipeline that gradually refines the data in a transparent way, which greatly improves the interpretable nature of our method. Data transformations are thus made transparent and predictions interpretable, which is imperative for healthcare. The combined method also has other advantages, like potentially being language independent, demanding few domain resources for maintenance, and able to cover misspellings, abbreviations, and acronyms. To test and evaluate the combined method, we have developed a clinical decision support system (CDSS) named Information System for Clinical Concept Searching (ICCS) that implements the method for clinical concept tagging, extraction, and classification. Results In empirical studies the method shows high performance (recall 92.6%, precision 88.8%, F-measure 90.7%), and has demonstrated its value to clinical practice. Here we employ a real-life EHR-derived dataset to evaluate the method’s performance on the task of classification (i.e., detecting patient allergies) against a range of common supervised learning algorithms. The combined method achieves state-of-the-art performance compared to the alternative methods we evaluate. We also perform a qualitative analysis of common word embedding methods on the task of word similarity to examine their potential for supporting automatic feature engineering for clinical NLP tasks. Conclusions Based on the promising results, we suggest more research should be aimed at exploiting the inherent synergies between unsupervised, supervised, and rule-based paradigms for clinical NLP.

Abstract Aims and objectives To explore students' experiences from a pilot project testing out a model for active, collaborative learning in first‐year placement at a nursing home. Background There is a need for innovative learning activities and projects to improve clinical education in nursing homes. Active, collaborative approaches in placement learning may enhance students learning outcome. Design The study had a qualitative and explorative design, in which the experiences of students participating in the pilot were investigated through paired interviews at the end of their placement. Methods Twenty‐two students participated in the study, and data from paired interviews were analysed using qualitative content analysis. COREQ reporting guidelines were used. Results Three themes emerged from the analysis: (1) The learning cell as facilitator for learning; (2) Discovering learning possibilities in nursing homes and (3) Applying tools and resources for learning. Conclusions The model could reduce tension and anxiety while helping the students focus on learning options and use their environment more actively for learning. Working with a learning partner seems to increase student learning through common planning, feedback and reflection. The study emphasises the importance of facilitating active learning through the scaffolding structures and configuration of the students' learning space. Relevance to clinical practice This study indicates the potential for introducing active and collaborative pedagogical models in clinical placement. The model can promote nursing homes as a conducive learning arena for nursing students and help prepare students for a future work role in a rapidly changing health care field. Patient or public contribution The result of the research is shared and discussed with stakeholders prior to finalising the article.

Abstract Aim This paper aims to explore professional caregivers' experiences of psychosocial care for older persons living in nursing homes following the professional caregivers' participation in the International Caregiver Development Programme (ICDP). Design A qualitative study. Methods About 15 focus group interviews and 25 participatory observations of five ICDP group courses were conducted with 31 employees in nursing homes, including registered nurses, enrolled nurses and nursing aids. The findings emerged through hermeneutic analysis. Results Main findings: (i) Adjusting the communication to the residents' psychosocial needs, (ii) Seeing the residents as individuals and (iii) Adjusting to individual interaction with the residents. The professional caregivers experienced that the residents participated more in communication, interaction and activities, in addition to be more satisfied, calm, happy and thankful in interaction with the caregivers. Furthermore, they described that the environment in the units became calmer and that they were considering psychosocial care before medication. Work‐related stress seems to impact ICDP participation and may be a barrier to implementation.

Science and chemistry teachers often feel that they have insufficient knowledge about the legal requirements concerning proper handling of chemicals. To help teachers and technicians, we have developed an online resource with information and tools for the various aspects of chemical safety, such as legislation, risk assessment, storage, labelling and waste handling, including a framework for routines and training for staff and students. Additionally, the resource introduces the concept of green chemistry, an emerging field within chemistry education, and provides examples on how teachers could work with green chemistry principles in the science and chemistry classroom. The aim is that this extensive online material, covering the most important aspects of health, safety and environmental work in school science education, can serve as a useful resource for school leaders, teachers, technicians and science teacher educators in their work with these issues. The resource was developed by partners from the Universities of Helsinki, Ljubljana, Oslo, and Stockholm and co-funded by the Erasmus+ program of the European Union. The content is published in five languages and is freely available at https://chesse.org.