How well did Norwegian general practice prepare to address the COVID-19 pandemic?

Objectives We aimed to describe the quality improvement measures made by Norwegian general practice (GP) during the COVID-19 pandemic, evaluate the differences in quality improvements based on region and assess the combinations of actions taken. Design Descriptive study. Setting Participants were included after taking part in an online quality improvement COVID-19 course for Norwegian GPs in April 2020. The participants reported whether internal and external measures were in place: COVID-19 sign on entrance, updated home page, access to video consultations and/or electronic written consultations, home office solutions, separate working teams, preparedness for home visits, isolation rooms, knowledge on decontamination, access to sufficient supplies of personal protective equipment (PPE) and COVID-19 clinics. Participants One hundred GP offices were included. The mean number of general practitioners per office was 5.63. Results More than 80% of practices had the following preparedness measures: COVID-19 sign on entrance, updated home page, COVID-19 clinic in the municipality, video and written electronic consultations, knowledge on how to use PPE, and home office solutions for general practitioners. Less than 50% had both PPE and knowledge of decontamination. Lack of PPE was reported by 37%, and 34% reported neither sufficient PPE nor a dedicated COVID-19 clinic. 15% reported that they had an isolation room, but not enough PPE. There were no geographical differences. Conclusions Norwegian GPs in this study implemented many quality improvements to adapt to the COVID-19 pandemic. Overall, the largest potentials for improvement seem to be securing sufficient supply of PPE and establishing an isolation room at their practices.publishedVersio

Preanalytical stability of plasma biomarkers for Alzheimer's disease pathology

INTRODUCTION: Plasma tests have demonstrated high diagnostic accuracy for identifying Alzheimer's disease pathology. To facilitate the transition to clinical utility, we assessed whether plasma storage duration and temperature affect the biomarker concentrations. METHODS: Plasma samples from 13 participants were stored at +4°C and +18°C. Concentrations of six biomarkers were measured after 2, 4, 6, 8, 10, and 24 h by single molecule array assays. RESULTS: Phosphorylated tau 181 (p-tau181), phosphorylated tau 231 (p-tau231), neurofilament light (NfL), and glial fibrillary acidic protein (GFAP) concentrations were unchanged both when stored at +4°C and +18°C. Amyloid-β 40 (Aβ40) and amyloid-β 42 (Aβ42) concentrations were stable for 24 h at +4°C but declined when stored at +18°C for longer than 6 h. This decline did not affect the Aβ42/Aβ40 ratio. DISCUSSION: Plasma samples can be stored for 24 h at +4°C or +18°C and result in valid assay results for p-tau181, p-tau231, Aβ42/Aβ40 ratio, GFAP, and NfL. HIGHLIGHTS: Plasma samples were stored for 24 h at +4°C and +18°C, mimicking clinical practice.Concentrations for Alzheimer's disease biomarkers were measured at six time-points.p-tau181, p-tau231, NfL, and GFAP concentrations were unchanged during the experiment.Storage at +18°C affected Aβ40 and Aβ42 concentrations while storage at +4°C did not. The Aβ42/Aβ40 ratio was unaffected.These plasma tests seem suitable for use in general practice

Preanalytical stability of plasma biomarkers for Alzheimer's disease pathology

Introduction Plasma tests have demonstrated high diagnostic accuracy for identifying Alzheimer's disease pathology. To facilitate the transition to clinical utility, we assessed whether plasma storage duration and temperature affect the biomarker concentrations. Methods Plasma samples from 13 participants were stored at +4°C and +18°C. Concentrations of six biomarkers were measured after 2, 4, 6, 8, 10, and 24 h by single molecule array assays. Results Phosphorylated tau 181 (p-tau181), phosphorylated tau 231 (p-tau231), neurofilament light (NfL), and glial fibrillary acidic protein (GFAP) concentrations were unchanged both when stored at +4°C and +18°C. Amyloid-β 40 (Aβ40) and amyloid-β 42 (Aβ42) concentrations were stable for 24 h at +4°C but declined when stored at +18°C for longer than 6 h. This decline did not affect the Aβ42/Aβ40 ratio. Discussion Plasma samples can be stored for 24 h at +4°C or +18°C and result in valid assay results for p-tau181, p-tau231, Aβ42/Aβ40 ratio, GFAP, and NfL.publishedVersio

Hypertension in Pregnancy and Offspring Cardiovascular Risk in Young Adulthood:Prospective and Sibling Studies in the HUNT Study (Nord-Trøndelag Health Study) in Norway

Women with hypertensive disorders in pregnancy are at increased lifetime risk for cardiovascular disease. We examined the offspring’s cardiovascular risk profile in young adulthood and their siblings’ cardiovascular risk profile. From the HUNT study (Nord-Trøndelag Health Study) in Norway, 15 778 participants (mean age: 29 years), including 210 sibling groups, were linked to information from the Medical Birth Registry of Norway. Blood pressure, anthropometry, serum lipids, and C-reactive protein were assessed. Seven hundred and six participants were born after exposure to maternal hypertension in pregnancy: 336 mothers had gestational hypertension, 343 had term preeclampsia, and 27 had preterm preeclampsia. Offspring whose mothers had hypertension in pregnancy had 2.7 (95% confidence interval, 1.8–3.5) mm Hg higher systolic blood pressure, 1.5 (0.9–2.1) mm Hg higher diastolic blood pressure, 0.66 (0.31–1.01) kg/m2 higher body mass index, and 1.49 (0.65–2.33) cm wider waist circumference, compared with offspring of normotensive pregnancies. Similar differences were observed for gestational hypertension and term preeclampsia. Term preeclampsia was also associated with higher concentrations of non–high-density lipoprotein cholesterol (0.14 mmol/L, 0.03–0.25) and triglycerides (0.13 mmol/L, 0.06–0.21). Siblings born after a normotensive pregnancy had nearly identical risk factor levels as siblings born after maternal hypertension. Offspring born after maternal hypertension in pregnancy have a more adverse cardiovascular risk profile in young adulthood than offspring of normotensive pregnancies. Their siblings, born after a normotensive pregnancy, have a similar risk profile, suggesting that shared genes or lifestyle may account for the association, rather than an intrauterine effect. All children of mothers who have experienced hypertension in pregnancy may be at increased lifetime risk of cardiovascular disease

Experimental testing of the new wind tunnel at the University of Stavanger

This thesis aims to gain experience in using the newly installed CTO S.A open circuit wind tunnel at the University of Stavanger. Extensive research has been done on the topics of wind tunnel use, general aerodynamics, blockage-correction methods, and other methods necessary to obtain accurate data. This thesis also presents the configuration and details of the specific wind tunnel used. Wind tunnel tests have been performed on several geometries, these are circular flat disks, cylinder and step cylinder. Designing of geometries and modifications to the tunnel was done prior to the testing. Blockage- correction methods and other methods has been applied to the results for comparison. Our results on the circular disk and cylinder is also compared to previous results from tests on the same geometries to ultimately gain insight and usability of all the methods. The drag characteristics of the step cylinder is compared to the drag characteristics of uniform cylinders. The corrected drag coefficients for the 200mm circular disks corresponds well to previous results. However, the corrected drag coefficients for the 50, 100, and 150mm disks deviates to a varying degree, due to unknown fault in the image method. Comparing the corrected drag coefficients of the cylinder at different Reynolds numbers with previous results from "two-dimensional flow" experiments reveals clear similarities. However, the magnitude of the corrected drag coefficients appears to correspond better to the previous results obtained for cylinders with an aspect ratio of 5. When comparing flow separation angles on the cylinder using different techniques, inherent differences are observed, both for laminar and turbulent boundary layer. The step cylinder drag coefficient is overall lower compared to drag coefficient of uniform cylinders, showing that calculating drag forces and drag coefficient can not be done accurately by only combining data on forces and coefficients from "two dimensional flow". The drag coefficient for a step cylinder will most likely be lower overall, where the extent of the difference depends on the diameter ratios. Conclude on the most accurate blockage- correction method can not be done with our limited results where all seem effective. However it can be assumed that the Maskell III method is more accurate than Maskell’s method since it also considers the wake distortion

Experimental testing of the new wind tunnel at the University of Stavanger

This thesis aims to gain experience in using the newly installed CTO S.A open circuit wind tunnel at the University of Stavanger. Extensive research has been done on the topics of wind tunnel use, general aerodynamics, blockage-correction methods, and other methods necessary to obtain accurate data. This thesis also presents the configuration and details of the specific wind tunnel used. Wind tunnel tests have been performed on several geometries, these are circular flat disks, cylinder and step cylinder. Designing of geometries and modifications to the tunnel was done prior to the testing. Blockage- correction methods and other methods has been applied to the results for compar- ison. Our results on the circular disk and cylinder is also compared to previous results from tests on the same geometries to ultimately gain insight and usability of all the methods. The drag characteristics of the step cylinder is compared to the drag characteristics of uniform cylinders. The corrected drag coefficients for the 200mm circular disks corresponds well to previous results. However, the corrected drag coefficients for the 50, 100, and 150mm disks deviates to a varying degree, due to unknown fault in the image method. Comparing the corrected drag coefficients of the cylinder at different Reynolds numbers with previous results from "two-dimensional flow" experiments reveals clear similarities. However, the magnitude of the corrected drag coefficients appears to correspond better to the previous results obtained for cylinders with an aspect ratio of 5. When comparing flow separation angles on the cylinder using different techniques, inherent differences are observed, both for laminar and turbulent boundary layer. The step cylinder drag coefficient is overall lower compared to drag coefficient of uniform cylinders, showing that calculating drag forces and drag coefficient can not be done accu- rately by only combining data on forces and coefficients from "two dimensional flow". The drag coefficient for a step cylinder will most likely be lower overall, where the extent of the difference depends on the diameter ratios. Conclude on the most accurate blockage- correction method can not be done with our limited results where all seem effective. However it can be assumed that the Maskell III method is more accurate than Maskell’s method since it also considers the wake distortion

How well did Norwegian general practice prepare to address the COVID-19 pandemic?

Objectives We aimed to describe the quality improvement measures made by Norwegian general practice (GP) during the COVID-19 pandemic, evaluate the differences in quality improvements based on region and assess the combinations of actions taken. Design Descriptive study. Setting Participants were included after taking part in an online quality improvement COVID-19 course for Norwegian GPs in April 2020. The participants reported whether internal and external measures were in place: COVID-19 sign on entrance, updated home page, access to video consultations and/or electronic written consultations, home office solutions, separate working teams, preparedness for home visits, isolation rooms, knowledge on decontamination, access to sufficient supplies of personal protective equipment (PPE) and COVID-19 clinics. Participants One hundred GP offices were included. The mean number of general practitioners per office was 5.63. Results More than 80% of practices had the following preparedness measures: COVID-19 sign on entrance, updated home page, COVID-19 clinic in the municipality, video and written electronic consultations, knowledge on how to use PPE, and home office solutions for general practitioners. Less than 50% had both PPE and knowledge of decontamination. Lack of PPE was reported by 37%, and 34% reported neither sufficient PPE nor a dedicated COVID-19 clinic. 15% reported that they had an isolation room, but not enough PPE. There were no geographical differences. Conclusions Norwegian GPs in this study implemented many quality improvements to adapt to the COVID-19 pandemic. Overall, the largest potentials for improvement seem to be securing sufficient supply of PPE and establishing an isolation room at their practices

Assessing short-term risk of ischemic stroke in relation to all prescribed medications

We examined the short-term risk of stroke associated with drugs prescribed in Norway or Sweden in a comprehensive, hypothesis-free manner using comprehensive nation-wide data. We identified 27,680 and 92,561 cases with a first ischemic stroke via the patient- and the cause-of-death registers in Norway (2004–2014) and Sweden (2005–2014), respectively, and linked these data to prescription databases. A case-crossover design was used that compares the drugs dispensed within 1 to 14 days before the date of ischemic stroke occurrence with those dispensed 29 to 42 days before the index event. A Bolasso approach, a version of the Lasso regression algorithm, was used to select drugs that acutely either increase or decrease the apparent risk of ischemic stroke. Application of the Bolasso regression algorithm selected 19 drugs which were associated with increased risk for ischemic stroke and 11 drugs with decreased risk in both countries. Morphine in combination with antispasmodics was associated with a particularly high risk of stroke (odds ratio 7.09, 95% confidence intervals 4.81–10.47). Several potentially intriguing associations, both within and across pharmacological classes, merit further investigation in focused, follow-up studies.publishedVersio