Exploring variation in timely reperfusion treatment in ST-segment elevation myocardial infarction in Norway: A national register-based cohort study

Objectives This study aimed to investigate determinants of reperfusion within recommended time limits (timely reperfusion) for ST-segment elevation myocardial infarction patients, exploring the impact of geography, patient characteristics and socio-economy. Design National register-based cohort study. Setting Multilevel logistic regression models were applied to examine the associations between timely reperfusion and residency in hospital referral areas and municipalities, patient characteristics, and socio-economy. Participants 7607 Norwegian ST-segment elevation myocardial infarction patients registered in the Norwegian Registry of Myocardial Infarction during 2015–2018. Main outcome measures The odds of timely reperfusion by primary percutaneous coronary intervention (PCI) or fibrinolysis. Results Among 7607 ST-segment elevation myocardial infarction patients in Norway, 56% received timely reperfusion. The Norwegian goal is 85%. While 81% of the patients living in the Oslo hospital referral area received timely reperfusion, only 13% of the patients living in Finnmark did so. Patients aged 75–84 years had lower odds of timely reperfusion than patients below 55 years of age (OR 0.73, 95%CI 0.61 to 0.87). Patients with moderate or high comorbidity had lower odds than patients without (OR 0.81, 95%CI 0.68 to 0.95 and OR 0.61, 95%CI 0.44 to 0.84). More than 2 hours from symptom onset to first medical contact gave lower odds than less than 30min (OR 0.63, 95%CI 0.54 to 0.72). 1–2 hours of travel time to a PCI centre (OR 0.39, 95%CI 0.31 to 0.49) and more than 2 hours (OR 0.22, 95%CI 0.16 to 0.30) gave substantially lower odds than less than 1 hour of travel time. Conclusions The varying proportion of patients receiving timely reperfusion across hospital referral areas implies inequity in fundamental healthcare services, not compatible with established Norwegian health policy. The importance of travel time to PCI centre points at the expanded use of prehospital pharmacoinvasive strategy to obtain the goals of timely reperfusion in Norway

Anti-immigrant backlash: the Democratic Dilemma for immigration policy

Anti-immigrant backlash has emerged in recent years as a considerable threat to democracy. In many countries illiberal and anti-democratic political forces driven in part by anti-immigrant sentiment have damaged or threaten to damage the proper functioning of democratic institutions. Should policymakers try to avert this threat by implementing more restrictive immigration policy? If they do so, they may expose immigrants to unjust exclusion. If they do not, they may risk democratic dysfunction, even democratic failure. I will call this the Democratic Dilemma for immigration policy. In this paper I argue that this is a hard ethical dilemma that does not lend itself to a straightforward resolution. I propose an analytic and evaluative framework for assessing possible policy responses to the Dilemma to aid policymakers’ as well as the public’s ethical judgement

DNA methylation fine-tunes pro-and anti-inflammatory signalling pathways in inactive ulcerative colitis tissue biopsies

DNA methylation has been implied to play a role in the immune dysfunction associated with inflammatory bowel disease (IBD) and the disease development of ulcerative colitis (UC). Changes of the DNA methylation and correlated gene expression in patient samples with inactive UC might reveal possible regulatory features important for further treatment options for UC. Targeted bisulfite sequencing and whole transcriptome sequencing were performed on mucosal biopsies from patients with active UC (UC, n= 14), inactive UC (RM, n= 20), and non-IBD patients which served as controls (NN, n= 11). The differentially methylated regions (DMRs) were identifed by DMRseq. Correlation analysis was performed between DMRs and their nearest differentially expressed genes (DEGs). Principal component analysis (PCA) was performed based on correlated DMR regulated genes. DMR regulated genes then were functional annotated. Cell-type deconvolutions were performed based on methylation levels. The comparisons revealed a total of 38 methylation-regulated genes in inactive UC that are potentially regulated by DMRs (correlation p value< 0.1). Several methylation-regulated genes could be identified in inactive UC participating in IL-10 and cytokine signalling pathways such as IL1B and STAT3. DNA methylation events in inactive UC seem to be fine-tuned by the balancing pro- and anti- inflammatory pathways to maintain a prevailed healing process to restore dynamic epithelium homeostasis

Exploring the variation in associations between socioeconomic indicators and non-communicable diseases in the Tromsø Study: an algorithmic approach

Aims: We contribute to the methodological literature on the assessment of health inequalities by applying an algorithmic approach to evaluate the capabilities of socioeconomic variables in predicting the prevalence of non-communicable diseases in a Norwegian health survey. Methods: We use data from the seventh survey of the population based Tromsø Study (2015–2016), including 11,074 women and 10,009 men aged 40 years and above. We apply the random forest algorithm to predict four non-communicable disease outcomes (heart attack, cancer, diabetes and stroke) based on information on a number of social root causes and health behaviours. We evaluate our results using the classification error, the mean decrease in accuracy, partial dependence statistics. Results: Results suggest that education, household income and occupation to a variable extent contribute to predicting non-communicable disease outcomes. Prediction misclassification ranges between 25.1% and 35.4% depending on the non-communicable diseases under study. Partial dependences reveal mostly expected health gradients, with some examples of complex functional relationships. Out-of-sample model validation shows that predictions translate to new data input. Conclusions: Algorithmic modelling can provide additional empirical detail and metrics for evaluating heterogeneous inequalities in morbidity. The extent to which education, income and occupation contribute to predicting binary non-communicable disease outcomes depends on both non-communicable diseases and socioeconomic indicator. Partial dependences reveal that social gradients in non-communicable disease outcomes vary in shape between combinations of non-communicable disease outcome and socioeconomic status indicator. Misclassification rates highlight the extent of variation within socioeconomic groups, suggesting that future studies may improve predictive accuracy by exploring further subpopulation heterogeneity

Environmental drivers of increased ecosystem respiration in a warming tundra

Arctic and alpine tundra ecosystems are large reservoirs of organic carbon1,2. Climate warming may stimulate ecosystem respiration and release carbon into the atmosphere3,4. The magnitude and persistency of this stimulation and the environmental mechanisms that drive its variation remain uncertain5,6,7. This hampers the accuracy of global land carbon–climate feedback projections7,8. Here we synthesize 136 datasets from 56 open-top chamber in situ warming experiments located at 28 arctic and alpine tundra sites which have been running for less than 1 year up to 25 years. We show that a mean rise of 1.4 °C [confidence interval (CI) 0.9–2.0 °C] in air and 0.4 °C [CI 0.2–0.7 °C] in soil temperature results in an increase in growing season ecosystem respiration by 30% [CI 22–38%] (n = 136). Our findings indicate that the stimulation of ecosystem respiration was due to increases in both plant-related and microbial respiration (n = 9) and continued for at least 25 years (n = 136). The magnitude of the warming effects on respiration was driven by variation in warming-induced changes in local soil conditions, that is, changes in total nitrogen concentration and pH and by context-dependent spatial variation in these conditions, in particular total nitrogen concentration and the carbon:nitrogen ratio. Tundra sites with stronger nitrogen limitations and sites in which warming had stimulated plant and microbial nutrient turnover seemed particularly sensitive in their respiration response to warming. The results highlight the importance of local soil conditions and warming-induced changes therein for future climatic impacts on respiration

Walking sideways? Management of the Norwegian snow crab fishery

The snow crab (Chionoecetes opilio) in the Barents Sea is an invasive species, first discovered in 1997. Since 2012, a commercial fishery has developed, and various management measures have been implemented. Despite fishing gear restrictions, limits for the catch season and the implementation of a TAC-regime in 2017 onwards, the fishery struggles with substantial sustainability challenges. Vessels allocated a licence demonstrate radical differences in catches, and the fleet suffers from an unprofitable overcapacity and lack of environmentally friendly harvesting operations. The management authorities and the fishermen’s organizations seem to agree that the regulated open access and the Olympic fisheries model are the main sources of the present problems. The Directorate of Fisheries (DoF) [1] has introduced a discussion paper outlining various options for closing the fishery. The article outlines these- and other options, and discusses the alternatives in terms of improved sustainability, i.e., environmental, economic as well as social. A key point is that closing the fishery (like many other management measures), are not only technical interventions. They are also political, and they contribute to modify both the regulating system and the system to be regulated

Å forebygge turnover i barnevernstjenesten. En kvalitativ studie om forebygging av turnover i barnevernstjenesten

Problemstilling: Hvordan kan ledere i kommunalt barnevern bidra til å forebygge turnover i barneverntjenesten? Teori: Studiens teoretiske utgangspunkt omfatter teori som belyser rammebetingelser i kommunalt barnevern, teori om turnover, helserisiko ved å jobbe i barnevernet, teorier innen Human resource og teorier innen barnevernledelse. Metode: Studien er kvalitativ. Det er gjennomført individuelle intervjuer med fire barnevernledere. Intervjuene er analysert med kvalitativ innholdsanalyse. Funn: Funnene viser at barnevernlederne gjør ulike tiltak som kan sees i sammenheng med å redusere turnover, blant annet systematiske veiledninger og ulike organiseringer for å redusere belastninger. Barnevernlederne er også opptatt å skape god kultur preget av anerkjennelse og ivaretakelse. Konklusjon: For å forebygge turnover, kreves det en balanse mellom administrative oppgaver og relasjonell ledelse, samt en bevissthet om de ulike faktorene som kan påvirke ansattes trivsel og arbeidsprestasjon. Ved å fremme en kultur for læring, støtte og fellesskap, kan turnover reduseres, og arbeidsmiljøet i barneverntjenesten styrkes

Folkeretten, Russland og NATO. Begrunnelser for bruken av væpnet makt

Denne oppgaven ser på hvordan Russland og NATO forholder seg til folkeretten ved begrunnelser for bruken av væpnet makt. Folkerettens rettsregler danner internasjonale normer som kan styre atferden til stater. Imidlertid så vil stater ofte velge å ignorere eller bryte med folkeretten når de ønsker det. Bruken av væpnet makt mot andre stater er et av de mest alvorlige bruddene under folkeretten, og skaper stor internasjonal oppmerksomhet. Russland sin bruk av væpnet makt mot Ukraina har satt Russland i søkelyset for det internasjonale samfunnet i dag. Russland på sin side mener at deres bruk av væpnet makt sammenfaller med folkeretten. Russland begrunner bruken av væpnet makt ut ifra beskyttelse av russiske statsborgere, statskupp og invitasjon fra den lovlige presidenten, selvforsvar, humanitær intervensjon og en løsrivelse fra separatistregioner. Vi skal dermed analysere om begrunnelsene brukt av Russland sammenfaller med folkeretten. Samtidig velger Russland ofte å peke på Vesten, og deres bruk av væpnet makt mot andre stater. Vi skal derfor sammenligne de russiske begrunnelsene med NATO sine begrunnelser for en konflikt, Kosovo-konflikten. NATO begrunnet sin bruk av væpnet makt for en humanitær intervensjon og regional stabilitet. Samtidig har løsrivelsen av Kosovo også vært sentral del av konflikten som vi skal også sammenligne. Konklusjonen viser hvordan verken Russland eller NATO sine begrunnelser er i tråd med folkeretten. Det var likheter og ulikheter ved begrunnelsene for bruken av væpnet makt. Likhetene viser skepsisen til begrunnelser for væpnet makt, og negative effekter på egenskaper til folkeretten. Forskjeller forteller hvorfor NATO sin bruk av væpnet makt ble generelt sett på som legitim av det internasjonale samfunnet, mens Russland ble sett på som illegitim. Vi vil se at Kosovo sin løsrivelse kan ikke bli sett på som en presedens for Krim sin løsrivelse. Til slutt ser vi at begge sider parodier folkeretten, og at Russland prøver å parodiere NATOs begrunnelser for å kunne hevde en vestlig dobbelstandard

«Det var den siste jobben eg skulle ha». Ein studie av statstilsette si oppleving av ein nedbemanningsprosess

Samandrag Denne masteroppgåva tek for seg to grupper ved Havforskingsinstituttet si oppleving av ein nedbemanningsprosess i 2022-2023. Vi undersøker om dei tilsette har opplevd prosessen som rettferdig, og om oppleving av jobbsikkerheit og forventingar til arbeidskvardagen, har endra seg som følgje av nedbemanningsprosessen. Studien byggjer i hovudsak på teoriar om organisasjonsrettferd og psykologiske kontraktar. Vi argumenterer for at kjensler spelar ei viktig rolle i opplevingar på arbeidsplassen, og undersøker om nedbemanningsprosessen kan kallast ei affektiv hending. Studien sine viktigaste funn er at dei tilsette ikkje har opplevd nedbemanningsprosessen som rettferdig, og at jobbsikkerheit og tankar om arbeidskvardagen har vorte endra for dei fleste respondentane. Gjennom den komparative tilnærminga finn vi at tilsette i den eine gruppa har sterkare negative opplevingar knytt til nedbemanningsprosessen, enn i den andre. Respondentar i dei to gruppene har opplevd brot på forventingar noko ulikt, men i begge grupper opplever respondentar arbeidsgivar som mindre rettferdig enn forventa. Nøkkelord: nedbemanning, stat, rettferd, psykologisk kontrakt, AETAbstract This master’s thesis examines the experiences of a downsizing process in two groups of employees at the Institute of Marine Research, in 2022-2023. We investigate whether the employees experienced the process as fair, and whether their sense of job security and workday expectations have changed as a result of the downsizing process. The research is mainly built on theories of organizational justice, and psychological contracts. We argue that emotions play an important role in workplace experiences, and investigate whether the downsizing process can be called an affective event. The most important findings of the study are that the employees did not experience the downsizing process as fair, and that the sense of job security and workday expectations have changed for most of the respondents. Through the comparative approach, we find that employees in one group have stronger negative experiences linked to the downsizing process than the other. Respondents in the two groups have experienced breach of expectations somewhat differently, but we find that in both groups there are respondents who experience their employer as less fair than anticipated. Keywords: downsizing, state, justice, psychological contract, AE

VAMPyR—A high-level Python library for mathematical operations in a multiwavelet representation

Wavelets and multiwavelets have lately been adopted in quantum chemistry to overcome challenges presented by the two main families of basis sets: Gaussian atomic orbitals and plane waves. In addition to their numerical advantages (high precision, locality, fast algorithms for operator application, linear scaling with respect to system size, to mention a few), they provide a framework that narrows the gap between the theoretical formalism of the fundamental equations and the practical implementation in a working code. This realization led us to the development of the Python library called VAMPyR (Very Accurate Multiresolution Python Routines). VAMPyR encodes the binding to a C++ library for multiwavelet calculations (algebra and integral and differential operator application) and exposes the required functionality to write a simple Python code to solve, among others, the Hartree–Fock equations, the generalized Poisson equation, the Dirac equation, and the time-dependent Schrödinger equation up to any predefined precision. In this study, we will outline the main features of multiresolution analysis using multiwavelets and we will describe the design of the code. A few illustrative examples will show the code capabilities and its interoperability with other software platforms