Norwegian University of Science and Technology

Existing scales mainly focus on danger-based threats of death and bodily harm to assess exposure to traumatic events in war zone. However, major provocations and transgression of deeply held values and moral beliefs, as well as witnessing the suffering of others can be as traumatic as fear-inducing danger-based events. This raises the need for scales that assess both danger and nondanger-based events among soldiers operating in modern war zones. Norwegian military personnel deployed to Afghanistan between late 2001 and end of 2020 were invited to participate in a cross-sectional survey with a final sample size of 6,205 (males: n = 5,693; 91.7%; mean age = 41.93 years). We applied data reduction techniques (e.g., exploratory factor analysis, EFA, and exploratory graph analysis, EGA, through a community detection algorithm) to develop a 12-item, three-factor model (personal threat, traumatic witnessing, and moral injury) of the Warzone Stressor Exposure Index (WarZEI). Confirmatory factor analysis showed support for the factor model, with evidence of concurrent, discriminant, and incremental validity. These results indicate the WarZEI is a reliable and valid measure for assessing exposure to warzone stressors that allows for heterogeneity and the multidimensional nature of exposure to warzone stressors.

Waiting time is a rationing mechanism that is used in publicly funded healthcare systems as a mean to ensure equal access for equal need. However, several studies suggest that individuals with higher socioeconomic status wait less. These studies typically measure patients' socioeconomic status as an aggregate measure from patients' residential area and the results are hence vulnerable for aggregation biases. We shed light on the magnitude of the aggregation bias by analyzing socioeconomic gradients in waiting times when education and income are measured on three different levels: the individual level, the population cell level, and the municipal level. Our individual level socioeconomic gradient is modest compared with the literature. When socioeconomic status is measured on an aggregate level, we observe stronger associations with socioeconomic variables and less accurate estimates. A researcher who only has access to the aggregate data runs the risk of overstating the magnitude of the socioeconomic gradients.

Hunting gestures, i.e., gestures used to avoid scaring away prey or raising the attention of predators, are a central part of the hunter-gatherer lifestyle of many foragers. These gestures have been documented for several groups in Southern Africa. This article is dedicated to such gestures, specifically those used by the speakers of a moribund East Kalahari Khoe language – Tjwao. It documents the hunting gestures collected in the villages of Sanqinyana and Sifulasengwe in Western Zimbabwe and analyzes them by adopting a formal descriptive approach. The focus is on the phonology and semantics of the gestures. Regarding phonology, handshape, palm orientation, location of the gesture, movement, handedness, and any participation of other parts of the body in the production of a gesture are discussed. Concerning semantics, we examine the referents of the hunting gestures and the type and extent of iconic relationship each gesture entertains with its real-world referent. In light of the analysis, we conclude that the hunting gesture code used by Tjwao speakers largely complies with the profile exhibited by the other hunting gesture codes found across the area, although certain dissimilarities can also be observed. This provides further evidence supporting the existence of the Kalahari Basin Area Sprachbund .

The amyloidogenic homotetrameric plasma protein transthyretin (TTR) has an affinity for bicyclic small molecule ligands in its two thyroxine (T4) binding sites. We have shown that native tetrameric TTR binds to amyloid ligands based on the trans‐stilbene scaffold. The fluorescent Congo‐red analogue, X34, is a symmetric bi‐trans‐stilbene that contains two salicylic acid motifs. We used fluorescence spectroscopy methods to interrogate X34 binding to the TTR tetramer and fibril. We discovered two binding sites in both TTR forms by tryptophan FRET, ligand self‐quenching, Stern‐Volmer plots and binding curves, for the latter including the competitive ligand diflunisal. X34 binds with the similar affinity as diflunisal in the first binding site (Kd1=150 nM), and negative cooperativity renders the binding to the second site with lower affinity very similar compared to diflunisal (Kd2= 1.1 μM). This behavior is coherent with the salicylic acid moiety of diflunisal binding into the binding pocket of TTR (reverse mode). Interestingly X34 binding to TTR fibrils was also well fitted to two binding sites, however with overall lower affinity (Kd1=1.2 μM; Kd2=2.1 μM) compared to binding to the native tetramer. X34 fluorescence when bound to TTR‐fibrils was significantly blue shifted compared to binding to the TTR‐tetramer.

Background Norwegian Municipal Inpatient Acute Care (MIPAC) services were established as part of the 2012 Coordination Reform. The intention was to prevent unnecessary hospital admissions by redirecting and maintaining less urgent patients at the primary care level, which provides inpatient acute healthcare services closer to patients’ home. However, the role MIPAC plays in the patient trajectory and how trajectories vary across different units and settings is less clear. Objective Therefore, this study aimed to (1) describe the general patient transfer trajectories for MIPAC patients and (2) examine facility and regional variations in MIPAC patients’ sources of admission and discharge destinations. Design A cross-sectional study using aggregated register data. Methods The study involved 36 662 admissions across 185 MIPAC units in 2019. Descriptive statistics were used to describe patient transfer trajectories, and a random-effects multinomial logistic model was applied to assess the association between facility and regional factors and patients’ admission sources and discharge destinations. Results The findings revealed distinct admission and discharge patterns based on facility and regional factors. Notably, intermunicipal units with 5 and more municipalities collaborating had higher relative risk ratios (RRR) for discharging to hospital (RRR = 1.50, 95%CI: 1.30-1.72) compared with independent MIPAC units. Large MIPAC units with more than 5 beds had increased relative risk ratios of patients admitted from the hospital than from home (RRR = 4.29, 95%CI: 1.56-11.78). Additionally, regional disparities existed, with units in the Central (RRR = 2.29, 95%CI: 1.56-3.38) and Western Norway health authorities (RRR:1.58, 95%CI: 1.22-2.06) displaying higher nursing home discharge rates than units in the South-Eastern Norway health authority. Conclusions and implications This study confirms the Norwegian MIPAC services’ adherence to admission avoidance policies and identifies significant variations in service delivery across regions and facilities. The Norwegian MIPAC model also has potential to inspire other countries in developing admission avoidance services in the primary care setting.

Background In diagnosing chronic orthopedic implant infections culture of sonicate represents a supplement to tissue cultures. However, the extent to which biofilm forms on implant surfaces and the degree of dislodgement of bacteria by sonication remains unclear. In this in vivo study using a low bacterial inoculum, we aimed to determine whether a variable effect of sonication could be observed in a standardized in vivo model. Materials and Methods Seven Wistar rats underwent surgery with intramuscular implantation of two bone xenograft implants, each containing two steel plates. The grafts were inoculated with approximately 500 colony forming units (CFU) of Staphylococcus epidermidis ATCC 35984. After 20 days the rats were sacrificed, and the steel plates were removed from the bone grafts. Epifluorescence microscopy and scanning electron microscopy (SEM) were used to visualize biofilm formation and dislodgement on the plate surfaces. In addition to cultures of sonicate, a quantitative S. epidermidis specific PCR was developed for enumeration of bacteria. Results A chronic, low-grade implant infection was successfully established, with all animals remaining in good health. All infected bone graft implants yielded abundant growth of S. epidermidis, with a median of 3.25 (1.6–4.6) × 10⁷ CFU per/graft. We were unable to distinguish infected plates from negative controls using epifluorescence microscopy. On infected plates small colonies of staphylococci were identified by SEM. The number of bacteria detected in the sonicate was low with 500 (100–2400) CFU/plate and 475 (140–1821) copies/plate by qPCR. The difference in area covered by fluorescent material before and after sonication was 10.1 (5.7–12.3) %, p = 0.018. Conclusion Despite the pronounced infection in the surrounding tissue, only few bacteria were detected on the surface of the steel implants. This is evident from the minimal findings by SEM before sonication, as well as the very low CFU counts and DNA copies in the sonicate. Sonication did not show variable effectiveness, indicating it is a valuable addition to, but not a replacement for biopsy cultures in cases of implant-associated infections with low-virulence microorganisms.

Chemical recycling of plastic waste could reduce its environmental impact and create a more sustainable society. Hydrogenolysis is a viable method for polyolefin valorization but typically requires high hydrogen pressures to minimize methane production. Here, we circumvent this stringent requirement using dilute RuPt alloy to suppress the undesired terminal C–C scission under hydrogen-lean conditions. Spectroscopic studies reveal that PE adsorption takes place on both Ru and Pt sites, yet the C–C bond cleavage proceeds faster on Ru site, which helps avoid successive terminal scission of the in situ-generated reactive intermediates due to the lack of a neighboring Ru site. Different from previous research, this method of suppressing methane generation is independent of H2 pressure, and PE can be converted to fuels and waxes/lubricant base oils with only <3.2% methane even under ambient H2 pressure. This advantage would allow the integration of distributed, low-pressure hydrogen sources into the upstream of PE hydrogenolysis and provide a feasible solution to decentralized plastic upcycling.

Objective The efficacy of TNF inhibitors for treating chronic low back pain with Modic changes is uncertain. This study investigated the superiority of infliximab over placebo in patients with Modic changes type 1. Methods In this multicenter, randomized, triple‐blind, placebo‐controlled trial, patients aged 18‐65 with moderate to severe chronic low back pain and Modic changes type 1 were enrolled from five Norwegian public hospitals between January 2019 and October 2022. Participants were randomly assigned to four intravenous infusions of 5 mg/kg infliximab or placebo. The primary outcome was difference in change in the Oswestry Disability Index (ODI) score from baseline to 5 months. Secondary outcomes included changes in low back pain intensity, disability, and health‐related quality of life. A linear mixed model was used for efficacy analyses. Results 128 patients (mean age 43 years, 65.6% women) participated (64 in each group). All patients who received at least one dose of the allocated infusion were included in the primary analyses. The average ODI score change was ‐7.0 (9.7) in the infliximab group and ‐6.4 (10.4) in the placebo group. The difference in the ODI change between the two groups was 1.3 ODI points (95% CI, ‐2.1 to 4.6; p= 0.45). Analyses showed no effect of infliximab compared to placebo on secondary outcomes. Adverse event rates were similar between groups. Conclusions Infliximab did not demonstrate superiority over placebo in reducing pain‐related disability in patients with moderate to severe chronic low back pain with Modic changes type 1 at 5 months. image

This chapter focuses on issues of justice in sustainability transitions. Although there is an increasing focus in academia, policymaking and practice on the importance making sustainability transitions not only environmentally and economically sustainable, but also just and fair so that costs and benefits are shared equally, this chapter illustrates that social inequities can often be exacerbated rather than alleviated in the context of sustainability transitions. Indeed, people who are vulnerable and marginalised do not often benefit from sustainability transitions: they may have limited opportunities to actively participate as citizens and suffer from negative consequences of climate and energy policies and projects. Such injustices are often the reason for contestations of developments, projects, policies and initiatives that are part of sustainability transitions. This underlines the importance of considering questions of distributional, recognition, procedural, restorative, cosmopolitan, spatial, postcolonial, intergenerational and multispecies justice when designing, developing, and implementing sustainability transition policies and projects across all socio-technical systems.

To explore the characteristics of cracking induced by frost wedging in hard rock, freezing tests of granite specimens that contained prefabricated slots filled with water were conducted in the laboratory. The freezing-driven crack initiation and propagation were numerically simulated by the extended finite element method (XFEM). The effects of tensile strength, slot depth, slot width and model size on the crack initiation and propagation were investigated in the numerical study. It was found that for a given freezing condition, a higher rock tensile strength and a larger model resulted in shorter crack lengths, while wider and deeper slots led to longer crack lengths. The crack growth rate increased with increasing in the slot depth and width, but decreased with increasing in rock tensile strength and model size. Furthermore, it was observed in the two-slot model that the crack growth was affected by the distance of the slot to the free side boundary of the model. Quantitative relationships between the crack growth length and the influencing factors were established for granite. The findings of this study provide insights into the mechanism of frost cracking in hard rock.

To effectively preserve thermal targets in infrared (IR) images and texture information in visible (VIS) images, this paper proposes a saliency detection-based and multi-scale oriented features image fusion method. Firstly, an edge guidance network is used to extract salient targets from IR images in order to generate salient target masks, which provide direction for fusing various types of information and increase the network’s generalization capability. Secondly, a particular loss function in each region is developed in conjunction with the salient target masks to direct the network to perform feature extraction. It can extract salient target characteristics and background texture information selectively while maintaining the integrity of the salient target and background regions efficiently. Finally, an oriented fusion approach based on feature hierarchy is proposed, which minimizes information dropout by integrating deep features on distinct scales with direction. Extensive experiments are carried out in this research using available datasets such as TNO and RoadScene. The method outperforms 10 state-of-the-art methods in the most of the evaluation metrics. This demonstrates that proposed fusion method not only preserves the salient target information of IR images, but also retains more VIS image features.

Background As a response to the political decision by the Norwegian Ministry of Health and Care Services to establish some kind of “medication free treatment” for patients with severe mental illness throughout the country, a 6-bed ward unit dedicated to offer such treatment was in 2017 established in Tromsø, Norway by the North Norway Health Care Region. The aim of the present study was to explore the experiences of patients admitted to this ward unit. Method Semi-structured interviews were conducted with 19 persons who had received treatment from the ward during the period January 2017 to October 2021. Analysis was done in line with Systematic Text Condensation and interviews were recorded, transcribed and analyzed using software NVivo. Results The importance of engaging in a dialogue about the possibilities of living a life without medication was unanimously validated, along with a focus on empowerment, motivation, activity and flexibility. Not everyone reported fulfillment of their own wishes or the ward’s goal of tapering down, and reflected upon emotions such as ambivalence or fear. Three core concepts were identified to describe the participants’ experiences: 1) Tapering off, 2) Relations, and 3) Frames and content. A fourth concept overarches the process formed by these concepts; 4) Processes across categories. Conclusion The study contributes to a deeper understanding of what "medication free" truly means, going beyond simply taking or not taking medications. It adds nuance to the debate surrounding medication free treatment. The ability to taper off medications is linked to intrapersonal factors, such as readiness and personal commitment, as well as the therapeutic environment, including the frames and values present on the ward. "Medication free" is more complex than it may initially appear, as many participants continue to use some form of psychotropic drugs. The sense of being part of something new and "exclusive" can be understood in light of what participants felt was lacking in previous treatment. It appears to be a need of rediscovering the significance of empowerment and empathic relationships in treatment of severe mental illness, in order to foster a sense of coherence and meaning.

Background This study explores sick leave changes 1-year pre- and post-treatment start for common mental health issues and their associations with self-reported symptoms, functioning, and health changes. Methods Ninety-five employed patients, without previous disability benefits, underwent treatment at a public mental health outpatient clinic. Sick leave data was obtained from the Norwegian Labour and Welfare Administration. Symptoms, work/social functioning, and health quality were self-reported at treatment onset and completion. Results Twelve months before starting treatment, only 6.3% were on sick leave, contrasting with 69.5% at treatment start. At post-treatment, 25% received work assessment allowance (WAA), 63% were off sick leave, and 12% were on sick leave. Sick leave days exhibited an inverted U-shape for non-WAA recipients. Those on sick leave post-treatment reported less improvement in symptoms and health, while the WAA group showed diminished work functioning enhancement. Discussion Evaluating the effect mental health treatment has on sick leave is clearly affected by the timing of assessments. Treatment seems associated with improved sick leave outcomes compared with status at treatment start, but less so when compared with status one year before starting treatment. Also, a large group of patients went on to receive WAA, constituting a group in need of further longitudinal evaluations and interventions.

Reciprocal structure–function relationships underlie both healthy and pathological behaviours in complex neural networks. Thus, understanding neuropathology and network dysfunction requires a thorough investigation of the complex interactions between structural and functional network reconfigurations in response to perturbation. Such adaptations are often difficult to study in vivo. For example, subtle, evolving changes in synaptic connectivity, transmission and the electrophysiological shift from healthy to pathological states, for example alterations that may be associated with evolving neurodegenerative disease, such as Alzheimer's, are difficult to study in the brain. Engineered in vitro neural networks are powerful models that enable selective targeting, manipulation and monitoring of dynamic neural network behaviour at the micro‐ and mesoscale in physiological and pathological conditions. In this study, we engineered feedforward cortical neural networks using two‐nodal microfluidic devices with controllable connectivity interfaced with microelectrode arrays (mMEAs). We induced P301L mutated tau protein to the presynaptic node of these networks and monitored network dynamics over three weeks. Induced perturbation resulted in altered structural organization and extensive axonal retraction starting in the perturbed node. Perturbed networks also exhibited functional changes in intranodal activity, which manifested as an overall decline in both firing rate and bursting activity, with a progressive increase in synchrony over time and a decrease in internodal signal propagation between pre‐ and post‐synaptic nodes. These results provide insights into dynamic structural and functional reconfigurations at the micro‐ and mesoscale as a result of evolving pathology and illustrate the utility of engineered networks as models of network function and dysfunction.