Fauna analyses of a possible electrical cable corridor in the Hardanger fjord

In relation to a possible cable pathway on the sea floor through the inner half of the Hardanger fjord, the Institute for Marine Research has carried out ROV inspections of the benthic faunal communities along 17 selected bottom transects. The surveyed area was restricted to the inner half of the Hardanger fjord – from Sima to Norheimsund in the period 9–29 November 2010. The deep horizontal seabed along the midline of the investigated part of the fjord was dominated by the crustacean Munida sp and its borrow, the sea cucumbers Bathyplotes sp and Stichopous sp, sea-pens, and the echiuran Bonellia sp. The steep walls along the sides of the investigated fjord were populated with less abundant but still relatively frequently-occurring taxa such the sea star Brisingia sp, the large bivalve Acesta sp, and several species of sponges. Though any local recovery time is unknown, we do not consider these populations to be threatened by the possible cable-laying activities. These are not listed in the Norwegian redlist and are not considered as threatened by the OSPAR Convention. However, in the outer part of the investigated area (transects named Kvamsøy cliff wall and Øystese), the vulnerable corals Lophelia pertusa and Anthomastus grandiflorus (redlisted) and Primnoa sp were observed. To avoid threatening impacts to these groups of corals, we therefore recommend using video monitoring during any cable-laying activities

Fauna analyses of a possible electrical cable corridor in the Hardanger fjord

In relation to a possible cable pathway on the sea floor through the inner half of the Hardanger fjord, the Institute for Marine Research has carried out ROV inspections of the benthic faunal communities along 17 selected bottom transects. The surveyed area was restricted to the inner half of the Hardanger fjord – from Sima to Norheimsund in the period 9–29 November 2010. The deep horizontal seabed along the midline of the investigated part of the fjord was dominated by the crustacean Munida sp and its borrow, the sea cucumbers Bathyplotes sp and Stichopous sp, sea-pens, and the echiuran Bonellia sp. The steep walls along the sides of the investigated fjord were populated with less abundant but still relatively frequently-occurring taxa such the sea star Brisingia sp, the large bivalve Acesta sp, and several species of sponges. Though any local recovery time is unknown, we do not consider these populations to be threatened by the possible cable-laying activities. These are not listed in the Norwegian redlist and are not considered as threatened by the OSPAR Convention. However, in the outer part of the investigated area (transects named Kvamsøy cliff wall and Øystese), the vulnerable corals Lophelia pertusa and Anthomastus grandiflorus (redlisted) and Primnoa sp were observed. To avoid threatening impacts to these groups of corals, we therefore recommend using video monitoring during any cable-laying activities

Patient characteristics and healthcare use for high-cost patients with musculoskeletal disorders in Norway: a cohort study

Background: A high proportion of healthcare costs can be attributed to musculoskeletal disorders (MSDs). A small proportion of patients account for most of the costs, and there is increasing focus on addressing service overuse and high costs. We aimed to estimate healthcare use contributing to high costs over a five-year period at the individual level and to examine if healthcare use for high-cost patients is in accordance with guidelines and recommendations. These findings contribute to the understanding of healthcare use for high-cost patients and help in planning future MSD-care. Methods: This study combined Norwegian registries on healthcare use, diagnoses, demographic, and socioeconomic factors. Patients (≥ 18 years) were included by their first MSD-contact in 2013–2015. We analysed healthcare use during the subsequent five years. Descriptive statistics were used to compare high-cost (≥ 95th percentile) and non-high-cost patients. Total healthcare contacts and costs for high-cost patients were examined stratified by number of hospitalisations and surgical treatments. Healthcare use of General Practitioners (GPs), physiotherapy, chiropractor and Physical Medicine and Rehabilitation physicians prior to the first hospitalisation or surgical treatment for a non-traumatic MSD was registered. Results: High-cost patients were responsible for 61% of all costs. Ninety-four percent of their costs were related to hospital treatment. Ninety-nine percent of high-cost patients had at least one hospitalisation or surgical procedure. Out of the high-cost patients, 44% had one registered hospitalisation or surgical procedure, 52% had two to four and 4% had five or more. Approximately 30–50% of patients had seen any healthcare personnel delivering conservative treatment other than GPs the year prior to their first hospitalisation/surgical treatment for a non-traumatic MSD. Conclusion: Most healthcare costs were concentrated among a small proportion of patients. In contrast to guidelines and recommendations, less than half had been to a healthcare service focused on conservative management prior to their first hospitalisation or surgical treatment for a non-traumatic MSD. This could indicate that there is room for improvement in management of patients before hospitalisation and surgical treatment, and that ensuring sufficient capacity for conservative care and rehabilitation can be beneficial for reducing overall costs.publishedVersio

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background: End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods: This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results: In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion: Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone.publishedVersio

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Kartlegging og analyser av faunaen i Hardangerfjorden før mulig legging av elektrisk kabel i korridor

In relation to a possible cable pathway on the sea floor through the inner half of the Hardanger fjord, the Institute for Marine Research has carried out ROV inspections of the benthic faunal communities along 17 selected bottom transects. The surveyed area was restricted to the inner half of the Hardanger fjord – from Sima to Norheimsund in the period 9–29 November 2010. The deep horizontal seabed along the midline of the investigated part of the fjord was dominated by the crustacean Munida sp and its borrow, the sea cucumbers Bathyplotes sp and Stichopous sp, sea-pens, and the echiuran Bonellia sp. The steep walls along the sides of the investigated fjord were populated with less abundant but still relatively frequently-occurring taxa such the sea star Brisingia sp, the large bivalve Acesta sp, and several species of sponges. Though any local recovery time is unknown, we do not consider these populations to be threatened by the possible cable-laying activities. These are not listed in the Norwegian redlist and are not considered as threatened by the OSPAR Convention. However, in the outer part of the investigated area (transects named Kvamsøy cliff wall and Øystese), the vulnerable corals Lophelia pertusa and Anthomastus grandiflorus (redlisted) and Primnoa sp were observed. To avoid threatening impacts to these groups of corals, we therefore recommend using video monitoring during any cable-laying activities

Fauna analyses of a possible electrical cable corridor in the Hardanger fjord

In relation to a possible cable pathway on the sea floor through the inner half of the Hardanger fjord, the Institute for Marine Research has carried out ROV inspections of the benthic faunal communities along 17 selected bottom transects. The surveyed area was restricted to the inner half of the Hardanger fjord – from Sima to Norheimsund in the period 9–29 November 2010. The deep horizontal seabed along the midline of the investigated part of the fjord was dominated by the crustacean Munida sp and its borrow, the sea cucumbers Bathyplotes sp and Stichopous sp, sea-pens, and the echiuran Bonellia sp. The steep walls along the sides of the investigated fjord were populated with less abundant but still relatively frequently-occurring taxa such the sea star Brisingia sp, the large bivalve Acesta sp, and several species of sponges. Though any local recovery time is unknown, we do not consider these populations to be threatened by the possible cable-laying activities. These are not listed in the Norwegian redlist and are not considered as threatened by the OSPAR Convention. However, in the outer part of the investigated area (transects named Kvamsøy cliff wall and Øystese), the vulnerable corals Lophelia pertusa and Anthomastus grandiflorus (redlisted) and Primnoa sp were observed. To avoid threatening impacts to these groups of corals, we therefore recommend using video monitoring during any cable-laying activities

Fauna analyses of a possible electrical cable corridor in the Hardanger fjord

In relation to a possible cable pathway on the sea floor through the inner half of the Hardanger fjord, the Institute for Marine Research has carried out ROV inspections of the benthic faunal communities along 17 selected bottom transects. The surveyed area was restricted to the inner half of the Hardanger fjord – from Sima to Norheimsund in the period 9–29 November 2010. The deep horizontal seabed along the midline of the investigated part of the fjord was dominated by the crustacean Munida sp and its borrow, the sea cucumbers Bathyplotes sp and Stichopous sp, sea-pens, and the echiuran Bonellia sp. The steep walls along the sides of the investigated fjord were populated with less abundant but still relatively frequently-occurring taxa such the sea star Brisingia sp, the large bivalve Acesta sp, and several species of sponges. Though any local recovery time is unknown, we do not consider these populations to be threatened by the possible cable-laying activities. These are not listed in the Norwegian redlist and are not considered as threatened by the OSPAR Convention. However, in the outer part of the investigated area (transects named Kvamsøy cliff wall and Øystese), the vulnerable corals Lophelia pertusa and Anthomastus grandiflorus (redlisted) and Primnoa sp were observed. To avoid threatening impacts to these groups of corals, we therefore recommend using video monitoring during any cable-laying activities

Shiga Toxin Regulates Its Entry in a Syk-dependent Manner

Shiga toxin (Stx) is composed of an A-moiety that inhibits protein synthesis after translocation into the cytosol, and a B-moiety that binds to Gb3 at the cell surface and mediates endocytosis of the toxin. After endocytosis, Stx is transported retrogradely to the endoplasmic reticulum, and then the A-fragment enters the cytosol. In this study, we have investigated whether toxin-induced signaling is involved in its entry. Stx was found to activate Syk and induce rapid tyrosine phosphorylation of several proteins, one protein being clathrin heavy chain. Toxin-induced clathrin phosphorylation required Syk activity, and in cells overexpressing Syk, a complex containing clathrin and Syk could be demonstrated. Depletion of Syk by small interfering RNA, expression of a dominant negative Syk mutant (Syk KD), or treatment with the Syk inhibitor piceatannol inhibited not only Stx-induced clathrin phosphorylation but also endocytosis of the toxin. Also, Golgi transport of Stx was inhibited under all these conditions. In conclusion, our data suggest that Stx regulates its entry into target cells

Combination of health care service use and the relation to demographic and socioeconomic factors for patients with musculoskeletal disorders: a descriptive cohort study

Abstract Background Patients with musculoskeletal disorders (MSDs) access health care in different ways. Despite the high prevalence and significant costs, we know little about the different ways patients use health care. We aim to fill this gap by identifying which combinations of health care services patients use for new MSDs, and its relation to clinical characteristics, demographic and socioeconomic factors, long-term use and costs, and discuss what the implications of this variation are. Methods The study combines Norwegian registers on health care use, diagnoses, comorbidities, demographic and socioeconomic factors. Patients (≥ 18 years) are included by their first health consultation for MSD in 2013–2015. Latent class analysis (LCA) with count data of first year consultations for General Practitioners (GPs), hospital consultants, physiotherapists and chiropractors are used to identify combinations of health care use. Long-term high-cost patients are defined as total cost year 1–5 above 95th percentile (≥ 3 744€). Results We identified seven latent classes: 1: GP, low use; 2: GP, high use; 3: GP and hospital; 4: GP and physiotherapy, low use; 5: GP, hospital and physiotherapy, high use; 6: Chiropractor, low use; 7: GP and chiropractor, high use. Median first year health care contacts varied between classes from 1–30 and costs from 20€-838€. Eighty-seven percent belonged to class 1, 4 or 6, characterised by few consultations and treatment in primary care. Classes with high first year use were characterised by higher age, lower education and more comorbidities and were overrepresented among the long-term high-cost users. Conclusion There was a large variation in first year health care service use, and we identified seven latent classes based on frequency of consultations. A small proportion of patients accounted for a high proportion of total resource use. This can indicate the potential for more efficient resource use. However, the effect of demographic and socioeconomic variables for determining combinations of service use can be interpreted as the health care system transforming unobserved patient needs into variations in use. These findings contribute to the understanding of clinical pathways and can help in the planning of future care, reduction in disparities and improvement in health outcomes for patients with MSDs