Physical activity and exercise capacity in survivors of preterm birth : A population-based cohort study of long-term consequences of prematurity

Background: Physical activity (PA) is an important mediator of health. Extremely preterm (EP) (<28 weeks’ gestation) and extremely low birth weight (ELBW) (<1000 g) subjects are at increased risk of long-term sequelae that may influence their participation in physical activity (PA) and their exercise capacity. Aims: To compare PA and exercise capacity, by measuring peak oxygen consumption (VO2), as well as body composition between EP/ELBW-born subjects and term-born (TB) controls. Another aim was to identify factors associated with poorer outcomes related to participation and performance in PA and exercise capacity in the EP/ELBW-born group. Cardiopulmonary exercise testing (CPET) both with and without continuous laryngoscopy were used for assessing peak VO2. A method comparison study was therefore conducted to investigate the reliability of peak VO2 obtained by CPET performed with continuous laryngoscopy (CLE test), compared to standard CPET. Methods: A Norwegian national cohort of EP/ELBW children born during 1999-2000 and a regional sub-sample of that cohort and their TB controls were studied. At age 5 years, EP/ELBW-born children were assessed to identify motor- and behavioural problems, as well as deficits in intellectual functioning. At age 11 years, body composition was determined by dual-energy X-ray absorptiometry, and information on PA participation and performance was obtained from a parental questionnaire. A sub-group of particular interest comprising EP/ELBW-born adults who underwent neonatal patent ductus arteriosus (PDA) surgery were examined for left vocal cord paralysis (LVCP). In this PDA surgery group, peak VO2 measurements were obtained and laryngeal obstruction during exercise was assessed for by using the CLE test. The results on peak VO2 were compared to EP/ELBW-born controls with no history of PDA surgery, as well as to TB controls who underwent ordinary CPET. The reliability of gas exchange parameters obtained by the CLE test was determined by comparing gas exchange variables in healthy subjects performing CPET both with and without added CLE setup. Results: EP/ELBW-born children and young adults were less often physically active than TB controls. Parental reported data showed that EP/ELBW-born children had reduced endurance and poorer proficiency in sports and play and were less vigorous during PA than TB controls. EP/ELBW-born children with neurodevelopmental disability (NDD) had even poorer PA outcomes. Young EP/ELBW-born adults had reduced peak VO2 compared to TB controls with a mean difference (95% confidence interval (CI)) of 4.9 (1.8–8.0) ml/kg/min. In otherwise healthy EP/ELBW-born children, preschool motor coordination problems, behavioural problems, and borderline intellectual functioning predicted lower endurance and less vigorous PA at school age. Additionally, motor coordination problems and behavioural problems predicted poor proficiency in sports activities, and borderline intellectual functioning predicted fine motor clumsiness (odds ratios 2–5). Compared to TB controls, EP/ELBW-born children had lower values (mean difference, 95% CI) for total bone mineral density z-score (0.30, 0.13–0.52), muscle mass (0.9, 0.3–1.5 kg), and fat mass ratio (0.14, 0.06–0.21). The differences were reduced when adjusting for PA frequency. The positive association between PA frequency and bone mineral density and muscle mass was weaker in EP/ELBW-born children compared to TB controls. The prevalence of LVCP in 30 EP/ELBW-born adults who underwent PDA surgery was 53%. LVCP and observed laryngeal obstruction during exercise in the PDA surgery group were not associated with reduced peak VO2. Agreement (±95% limits of agreement) for peak VO2 when obtained by the CLE test and standard CPET was 0.2 (±3.7) ml/kg/min. Conclusions and future perspectives: This thesis found that EP/ELBW-born children and young adults were less physically active and that they had lower peak VO2 as adults, compared to TB controls. Children born EP/ELBW with NDD, motor coordination problems, behavioural problems, or borderline intellectual functioning had poorer outcomes related to later PA performance. These findings highlight the need for focused intervention in these groups to improve PA outcomes. The body composition profile in EP/ELBW-born children implies an increased risk of cardiometabolic disease and osteoporosis later in life. High prevalence of LVCP after neonatal PDA surgery has implications in terms of follow-up, although LVCP was not associated with reduced peak VO2. Peak VO2 obtained by the CLE test can be used interchangeably with peak VO2 obtained from standard CPET. Future studies should aim to determine factors that enhance PA participation in EP/ELBW-born individuals and to investigate short- and long-term health benefits of PA in the EP/ELBW-born population.Doktorgradsavhandlin

Exploring reality through new lenses. The informal essay as an academic genre

Can the essay genre used in education and reserarch provide new options for describing reality? This genre has already obtained a strong position in philosophy, in which it has proven to be appraopriate when dealing with "the far too big and the far too small questions". But what about the essay as a supplement to - or even a replacement for - traditonal descriptions within social science in higher education

Vascular endothelial function assessed by flow-mediated vasodilatation in young adults born very preterm or with extremely low birthweight: A regional cohort study

Background: Preterm birth and low birthweight have been associated with increased risk of cardiovascular disease in young adults. Endothelial dysfunction is established as an early marker for development of atherosclerotic cardiovascular disease. Previous studies of endothelial function in young adults born very preterm or with extremely low birthweight have, however, shown diverging results. Objective: We aimed to evaluate the risk of cardiovascular disease as measured by vascular endothelial function in young adults born very preterm (<29 weeks of gestation) or with extremely low birthweight (<1,000 g), compared with term-born controls. Methods: This study included 50 young adults born very preterm or with extremely low birthweight and 49 term-born controls born in Norway in the periods 1982–1985, 1991–1992, and 1999–2000 at mean age 28 (±6) years. The endothelial function was assessed by ultrasound measured flow-mediated dilatation (FMD) of the right brachial artery. The arterial diameter was measured at baseline, after release of 5 min of occlusion, and after sublingual administration of nitroglycerine. FMD was reported as absolute and percentage diameter change from baseline and relative to nitroglycerine-induced dilatation. Results: The participants were mainly normal weight non-smokers, without hypertension, diabetes, or established cardiovascular disease. The cases and controls had mean blood pressure 112/71 (SD 12/9) and 112/69 (SD 11/8) mmHg, body mass index 24.0 (SD 4.2) and 24.4 (SD 4.5) kg/m2, and HbA1c 32.7 (SD 2.5) and 33.0 (SD 2.6) mmol/mol, respectively. For both groups, 4 (8%) were smokers. Mean FMD for the adults born very preterm or with extremely low birthweight was 0.17 mm (95% CI 0.14, 0.21) vs. 0.24 mm (95% CI 0.20, 0.28) for the controls (p = 0.01), corresponding to a percentage increase of 5.4% (95% CI 4.2, 6.6) and 7.6% (95% CI 6.2, 8.9), respectively (p = 0.02). The FMD relative to maximal nitroglycerine-induced dilatation was 20% and 31%, respectively (p = 0.001). Conclusions: Young adults born very preterm or with extremely low birthweight have significantly lower FMD compared with the term-born controls suggesting an increased risk of cardiovascular disease.publishedVersio

The adoption of Digital Twins: Drivers, enablers, barriers, challenges, and benefits

The Fourth Industrial Revolution provides a wave of smart innovative technologies, where the Digital Twin is one of them. A Digital Twin is seen as a digital replica of a physical asset, process, or system, allowing real-time monitoring, simulations, and analysis for better decision-making. Despite its benefits, few have implemented Digital Twins and begun utilizing its value. Thus, this thesis investigates how organizations can get started with a Digital Twin by looking at the different elements of the implementation process. A systematic literature review was conducted to obtain a background foundation of Digital Twin adoption. The review aimed to identify what existing research had found as drivers and enablers, barriers, challenges during implementation, and benefits provided by a Digital Twin. To provide new research on the field, we followed a qualitative research method. Through 19 semi-structured interviews of Digital Twin experts, findings indicate that factors driving and enabling Digital Twin adoption include data access, staying competitive, improved asset management, and management support. The study also shows that costs, competence, and lack of incentives are the most significant challenges related to the implementation. Furthermore, it is important to be aware of your own needs and what you want the Digital Twin to solve, in order to measure a successful implementation. Interviewing experts with Digital Twin experience identified benefits such as proactive maintenance, improved decision-making, simulations, and increased efficiency. This study contributes to valuable perspectives on Digital Twin knowledge and its implications. Practitioners can use these findings to achieve awareness and knowledge related to implementation challenges, and further use this theory to see how the benefits of a Digital Twin can be realized

The adoption of Digital Twins: Drivers, enablers, barriers, challenges, and benefits

The Fourth Industrial Revolution provides a wave of smart innovative technologies, where the Digital Twin is one of them. A Digital Twin is seen as a digital replica of a physical asset, process, or system, allowing real-time monitoring, simulations, and analysis for better decision-making. Despite its benefits, few have implemented Digital Twins and begun utilizing its value. Thus, this thesis investigates how organizations can get started with a Digital Twin by looking at the different elements of the implementation process. A systematic literature review was conducted to obtain a background foundation of Digital Twin adoption. The review aimed to identify what existing research had found as drivers and enablers, barriers, challenges during implementation, and benefits provided by a Digital Twin. To provide new research on the field, we followed a qualitative research method. Through 19 semi-structured interviews of Digital Twin experts, findings indicate that factors driving and enabling Digital Twin adoption include data access, staying competitive, improved asset management, and management support. The study also shows that costs, competence, and lack of incentives are the most significant challenges related to the implementation. Furthermore, it is important to be aware of your own needs and what you want the Digital Twin to solve, in order to measure a successful implementation. Interviewing experts with Digital Twin experience identified benefits such as proactive maintenance, improved decision-making, simulations, and increased efficiency. This study contributes to valuable perspectives on Digital Twin knowledge and its implications. Practitioners can use these findings to achieve awareness and knowledge related to implementation challenges, and further use this theory to see how the benefits of a Digital Twin can be realized

What does your profile picture say about you? The accuracy of thin-slice personality judgments from social networking sites made at zero-acquaintance

The myocardium exhibits heterogeneous nature due to scarring after Myocardial Infarction (MI). In Cardiac Magnetic Resonance (CMR) imaging, Late Gadolinium (LG) contrast agent enhances the intensity of scarred area in the myocardium. In this paper, we propose a probability mapping technique using Texture and Intensity features to describe heterogeneous nature of the scarred myocardium in Cardiac Magnetic Resonance (CMR) images after Myocardial Infarction (MI). Scarred tissue and non-scarred tissue are represented with high and low probabilities, respectively. Intermediate values possibly indicate areas where the scarred and healthy tissues are interwoven. The probability map of scarred myocardium is calculated by using a probability function based on Bayes rule. Any set of features can be used in the probability function. In the present study, we demonstrate the use of two different types of features. One is based on the mean intensity of pixel and the other on underlying texture information of the scarred and non-scarred myocardium. Examples of probability maps computed using the mean intensity of pixel and the underlying texture information are presented. We hypothesize that the probability mapping of myocardium offers alternate visualization, possibly showing the details with physiological significance difficult to detect visually in the original CMR image. The probability mapping obtained from the two features provides a way to define different cardiac segments which offer a way to identify areas in the myocardium of diagnostic importance (like core and border areas in scarred myocardiu

Balancing Privacy and Progress in Artificial Intelligence: Anonymization in Histopathology for Biomedical Research and Education

The advancement of biomedical research heavily relies on access to large amounts of medical data. In the case of histopathology, Whole Slide Images (WSI) and clinicopathological information are valuable for developing Artificial Intelligence (AI) algorithms for Digital Pathology (DP). Transferring medical data "as open as possible" enhances the usability of the data for secondary purposes but poses a risk to patient privacy. At the same time, existing regulations push towards keeping medical data "as closed as necessary" to avoid re-identification risks. Generally, these legal regulations require the removal of sensitive data but do not consider the possibility of data linkage attacks due to modern image-matching algorithms. In addition, the lack of standardization in DP makes it harder to establish a single solution for all formats of WSIs. These challenges raise problems for bio-informatics researchers in balancing privacy and progress while developing AI algorithms. This paper explores the legal regulations and terminologies for medical data-sharing. We review existing approaches and highlight challenges from the histopathological perspective. We also present a data-sharing guideline for histological data to foster multidisciplinary research and education.Comment: Accepted to FAIEMA 202

Hestemøkk som gjødselkilde – god håndtering for tilbakeføring til dyrkingsjord

Horse manure managemen

Cardiac Function and Early Risk Markers for Cardiovascular Disease in Children and Young Adults Surviving Severe Childhood Disease

Sammendrag på norsk Bakgrunn Prosessene som ligger bak utvikling av hjerte-kar sykdom starter tidlig i livet og er avhengig av antall risikofaktorer og debuttidspunkt av disse. Noen grupper er mer utsatt for hjerte-kar sykdom allerede i ung alder på grunn av tidligere medisinsk behandling og sykdom, som for eksempel prematurt fødte og barnekreftoverlevere. For å få mer kunnskap om deres hjerte- og kar helse er det nødvendig med flere kliniske studier. Metoder Forskningsprosjektet «Prosjekt Ekstrem Prematuritet» (PEP) har inkludert tre norske kohorter av unge voksne som ble født før svangerskapsuke 29 eller med ekstremt lav fødselsvekt (<1000 gram) (PB/ELBW), samt kjønns- og alderslike terminfødte kontroller. Endotelfunksjon, vurdert ved ultralydmålt stressmediert dilatasjon (FMD) av arteria brachialis, ble målt hos 50 PB/ELBW med gjennomsnittsalder 28 år (± 6) og 49 kontroller, og myokardfunksjon, vurdert ved ekkokardiografi, ble analysert hos 63 PB/ELBW med gjennomsnittsalder 27 år (± 6) og 64 kontroller fra denne studiepopulasjonen. Studien "Fysisk aktivitet og fysisk form hos barnekreftoverlevere" (PACCS) har inkludert unge barnekreftoverlevere som har vært behandlet for kreft i Norge, samt kjønns- og alderslike kontrollpersoner. Myokardfunksjon, vurdert ved ekkokardiografi, ble analysert hos 128 barnekreftoverlevere med gjennomsnittsalder 14 år (± 3) og 23 kontroller fra denne studiepopulasjonen. I tillegg ble korrelasjonen mellom barnekreftoverlevernes myokardfunksjon og maksimale oksygenopptak (VO2) oppnådd ved tredemølletest undersøkt. Resultat FMD og systolisk myokardfunksjon var lavere hos PB/ELBW sammenlignet med kontrollene. FMD var 5.4% (95% konfidensintervall (CI) 4.2, 6.6) hos PB/ELBW versus 7.5% (95% CI 6.2, 8.9) hos kontrollene, p-verdi 0.02. Venstre ventrikkel global longitudinell strain (LV-GLS) var -19.4% (95 % CI -20.0, -18.9) hos PB/ELBW versus -20.6% (95 % CI -21.1, -20.1) hos kontrollene, p-verdi 0.003. Diastolisk hjertefunksjon, inkludert analyser av venstre atrie strain, samt ikke-invasivt målte estimater for myokardarbeid var likt hos PB/ELBW og kontrollene. Venstre ventrikkels systoliske funksjon var redusert hos barnekreftoverleverne sammenlignet med kontrollene. LV-GLS var -19.7% (95% CI -2.1, -19.3) hos barnekreftoverleverne versus -21.3% (95% CI -22.2, -20.3) hos kontrollene, p-verdi 0.004. Barnekreftoverlevere behandlet med lav dose antracykliner (<100 mg/m 2) hadde også lavere z-skår for venstre ventrikkel strain sammenlignet med kontrollgruppen (henholdsvis -0.1 (95% CI -0.4, 0.5) og 0,9 (95% CI 0.2, 1.5), p-verdi= 0.02). Hos barnekreftoverleverne var redusert venstre ventrikkelfunksjon assosiert med lavere maksimalt VO2 (PCC -0.3 for LV-GLS). Høyere antracyklindoser, og lengre tidsintervall siden siste kreftbehandling var assosiert med avtagende myokardfunksjon (PCC henholdsvis 0.5 og 0.3 for LV-GLS). Konklusjoner og fremtidsperspektiver PB/ELBW hadde lavere endotelfunksjon og venstre ventrikkel funksjon sammenlignet med terminfødte kontroller. Disse funnene kan indikere at unge voksne født veldig prematurt eller med ekstremt lav fødselsvekt har økt risiko for å utvikle aterosklerotisk hjerte-karsykdom og hjertesvikt. Vi fant redusert venstre ventrikkel systolisk funksjon hos unge barnekreftoverlevere sammenlignet med friske kontroller, og lavere venstre ventrikkelfunksjon var assosiert med lavere maksimalt VO2. Disse funnene indikerer økt risiko for utvikling av hjertesvikt. Lengre tidsintervall siden siste kreftbehandling og høyere behandlingsdoser med antracykliner var assosiert med mer redusert hjertefunksjon, men hjertefunksjonen hos de behandlet med lave antracyklindoser var også redusert sammenlignet med kontrollgruppen. På bakgrunn av tidligere kunnskap og våre funn anbefaler vi oppfølging av prematurt fødte voksne og unge barnekreftoverlevere, spesielt med tanke på å redusere forekomst av modifiserbare kardiovaskulære risikofaktorer. Regelmessig kontroll av myokardfunksjon hos alle barnekreftoverlever allerede fra ung alder, også hos de behandlet med lave anthracyklindoser, synes også indisert.Abstract Background The underlying processes of cardiovascular disease begin early in life and depend on the number and intensity of risk factors. Some populations are prone to increased cardiovascular risk already at young age due to severe disease and intensive treatment during development and growth, such as survivors of preterm birth and childhood cancer. Clinical studies of their cardiovascular function are of importance to increase knowledge of their cardiovascular risk. Methods The “Project Extreme Prematurity” (PEP) has included three Norwegian cohorts of young adults born very preterm at gestational age <29 weeks or with extremely low birthweight <1000 grams (PB/ELBW), and sex- and age matched term-born controls. Endothelial function, assessed by ultrasound measured flow-mediated dilatation (FMD) of the brachial artery, was investigated in 50 PB/ELBW with mean age 28 years (± 6) and 49 controls, and myocardial function, assessed by echocardiography, was investigated in 63 PB/ELBW with mean age 27 years (± 6) and 64 controls of this study population. The “Physical Activity and fitness in Childhood Cancer Survivors” (PACCS) study has included paediatric childhood cancer survivors (CCSs) previously treated for cancer in Norway, and sex- and age matched controls. Echocardiographic measured myocardial function was investigated in 128 CCSs with mean age 14 years (± 3) and 23 controls of this study population. Additionally, the correlation between myocardial function and peak oxygen consumption (VO2) achieved on treadmill was analysed in the CCSs. Results The PB/ELBW had reduced endothelial function and systolic myocardial function compared to controls. FMD was 5.4% (95% confidence interval (CI) 4.2, 6.6) for PB/ELBW versus 7.5% (95% CI 6.2, 8.9) for controls, p= 0.02. Left ventricular global longitudinal strain (LV-GLS) was -19.4% (95% CI -20.0, -18.9) for PB/ELBW versus -20.6% (95% CI -21.1, -20.1) for controls, p= 0.003. Measures of diastolic function, including left atrial (LA) reservoir strain, and measures of myocardial work were similar in PB/ELBW and controls. The CCSs had reduced LV-GLS compared to controls (-19.7% (95% CI -20.1, -19.3) versus -21.3% (95% CI -22.2, -20.3), respectively, p= 0.004). This also applied for the CCS subgroup treated with low doses of anthracyclines (<100 mg/m2) which had lower LV longitudinal strain z-score compared to the controls (-0.1 (95% CI -0.4, 0.5) versus 0.9 (95% CI 0.2, 1.5), respectively, p= 0.02). Among the CCSs, lower left ventricular myocardial function was associated with lower peak VO2 (PCC= -0.3 for LV-GLS), and higher doses of anthracyclines and increasing time after treatment were associated with lower myocardial function (PCC= 0.5 and 0.3, respectively, for LV-GLS). Conclusions and future perspectives The PB/ELB had lower endothelial function and myocardial function measured by LV-GLS compared to controls. These findings could indicate an elevated risk in preterm born young adults of developing atherosclerotic cardiovascular disease and heart failure. The paediatric CCSs, including the subgroup treated with low doses of anthracyclines, had reduced LV systolic myocardial function compared to controls, and lower LV function was associated with poorer peak VO2. Increasing time after treatment and higher treatment doses of anthracyclines were associated with lower myocardial function. These findings could indicate an increased risk of developing heart failure and poorer prognosis with higher treatment doses of anthracyclines, although no safe dose of anthracyclines seems to exist. Based on these findings, follow-up programs for preterm born adults and survivors of childhood cancer, with special attention to reduce modifiable cardiovascular risk factors, should be recommended, and regularly monitoring of myocardial function might be indicated for all CCSs, regardless of anthracycline treatment doses.Doktorgradsavhandlin