Bridge over troubled water – om broreparasjoner med retrograd fremstilte rotstifter

I denne kasuistikken beskrives en metode for å løse et klinisk problem som ofte oppstår blant eldre, munntørre pasienter med protetiske konstruksjoner. Bruk av retrograd fremstilt rotstift kan hos enkelte være en effektiv og kostnadsbesparende behandling.publishedVersio

Drivers of airport scheduled traffic in European winter tourism areas:Infrastructure, accessibility, competition and catchment area

Ski resorts in Europe are major tourism destinations that can generate traffic for their local airports. These small mountain airports can offer the airlines unparalleled accessibility to the resorts, but their catchment areas are typically not well populated. Local authorities are keen to develop scheduled flights but have failed many times in the past. In this context, there is no previous study that analyses the drivers of scheduled airport traffic in winter tourism regions. To that end, we compiled a large dataset of European airports and ski resorts and carry out a Poisson regression. Results show that catchment area, competition, and infrastructure outweigh accessibility to ski resorts as the main drivers of scheduled traffic at small mountain airports. This is linked to the dominance of low-cost carriers that prefer to operate out of major airports with larger aircraft. Small airports are recommended to focus on premium markets with smaller aircraft

"The effect of 48-weeks azithromycin therapy on levels of soluble biomarkers associated with HIV-associated chronic lung disease".

OBJECTIVES: HIV-associated immune activation contributes to chronic lung disease (CLD) in children and adolescents living with HIV. Azithromycin has immunomodulatory and anti-microbial properties that may be useful for treating HIV-associated CLD (HCLD). This study describes the effect of azithromycin on expression of plasma soluble biomarkers in children and adolescents with HCLD. METHODS: This study was nested within a multi-site double-blind, placebo controlled, randomised controlled trial (RCT) of azithromycin in individuals aged 6-19 years with HCLD (defined as FEV1 z-score < -1) in Malawi and Zimbabwe (BREATHE (NCT02426112)). Participants were randomized 1:1 to once-weekly oral azithromycin with weight-based dosing, for 48 weeks, or placebo. Twenty-six plasma soluble biomarkers were measured on a MagPix Luminex instrument at enrolment, after 48-weeks of treatment and 24-weeks after treatment cessation. Mixed effects models were constructed to compare biomarker expression across treatment and placebo groups. RESULTS: Weekly azithromycin was associated with reduced levels of C-Reactive Protein (CRP), E-Selectin, Matrix metalloproteinase 10 (MMP-10). Treatment effects for all soluble biomarkers were not sustained 24-weeks after treatment cessation with biomarker expression returning to pre-treatment levels. CONCLUSIONS: We observed real-world effects of azithromycin on acute inflammation, neutrophil accumulation, and extracellular matrix degradation, that were not sustained after treatment cessation. These results are pertinent when using azithromycin for its immunomodulatory properties, or targeting pathways represented by the soluble biomarkers in this study

Tilsynspolitikk og omstilling : en studie av Arbeidstilsynet

Oppgaven studerer omstillingen i Arbeidstilsynet i lys av de mål og ideal for statlige tilsyn som regjeringen Bondevik II formulerte i sin tilsynsmelding (St.meld. nr. 17 (2002-2003)). Fra et statsvitenskapelig perspektiv er det interessant å studere hvilken betydning politiske tiltaksplaner faktisk har for en organisasjons struktur, rolle og oppgaver. Arbeidstilsynet er i denne sammenheng et interessant case av flere grunner. For det første er etaten tillagt en viktig rolle i oppfølgingen av samfunnets mål for arbeidsmiljøet og det systematiske HMS-arbeidet. For det andre har etaten en utfordrende oppgave i forhold til valg av tilsynsstrategi siden antallet virksomheter som er underlagt arbeidsmiljølovgivningen er såpass omfattende. I sammenheng med tilsynsmeldingens konkrete endringsforslag, gjennomfører Arbeidstilsynet frem til utgangen av 2006 en større omstillingsprosess som det redegjøres for i oppgaven. I tillegg til en revisjon av selve tilsynsrollen i forhold til en økt bevisstgjøring omkring valg av tilsynsstrategi, gjennomfører etaten også en større omorganiseringsprosess. Dette innebærer blant annet en omlokalisering av Direktoratet for arbeidstilsynet fra Oslo til Trondheim sammen med en reduksjon i antall distriktskontor, som omgjøres til større regioner. Med bakgrunn i denne prosessen studeres implementeringen av tilsynsmeldingens mål i Arbeidstilsynet og de konkrete endringene dette medfører for organisasjonsstruktur, rolleoppfatning og tilsynsstrategi. Tilsynsmeldingen presenterte fire ideal for tilsynsvirksomhet: rolleklarhet, formålsklarhet, faglig uavhengighet og en styrket fagkompetanse. Problemstillingen tar således utgangspunkt i hvordan disse idealene konkret påvirkes av utvalgte organisasjonsteoretiske faktorer, som igjen vil kunne påvirke tilsynsrollen. Slik kan man få et bilde av den virkning omstillingen i Arbeidstilsynet gir ved en tilnærming til regjeringens mål, sett fra ulike perspektiv. Endringene som følger av omstillingen studeres her fra et instrumentelt, et institusjonelt og et omgivelsesperspektiv. Oppgaven er slik en endringsanalyse med et organisasjonsteoretisk utgangspunkt. Funnene i oppgaven viser at omstillingsprosessen i Arbeidstilsynet har bidratt til å akselerere tilnærmingen til de målene tilsynsmeldingen presenterte. Flere av idealene har således blitt styrket og bidratt til å skape endring i etaten. Dette har gitt seg utslag i form av en ny organisasjonsstruktur, nye oppgaveprioriteringer og en mer bevisst tilsynsstrategi. I tillegg har etaten målbevisst utviklet et tettere samarbeid med viktige omgivelser i form av et mer koordinert tilsyn fra flere HMS-etater. Samlet vil disse endringene påvirke etatens tilsynsrolle. Likevel kan ikke alle endringene tilskrives tilsynsmeldingen alene, siden Arbeidstilsynet over flere år har gjennomgått omstillinger for å tilpasse seg tidens krav i offentlig forvaltning

Free fatty acids in automatic milking systems (AMS)

Stadig flere norske bønder velger å investere i AMS, da AMS har vist seg og være fordelaktig i norsk melkeproduksjon. Det er ikke lenger bare melkebruk med stor kvote og et høyt antall melkekyr (60-70 kyr) eller samdrifter som legger om driften til AMS. Det har også blitt mer vanlig at melkebruk med mindre kvoter og et lavere antall melkekyr (<30 kyr) kjøper AMS. Overgangen fra ikke-AMS til AMS kan være grunnet et ønske om å øke melkeproduksjonen i fremtiden eller rett å slett for å bli mindre bundet til melketider. Etter omlegging av driften fra ikke-AMS til AMS opplever mange at melkekvaliteten blir noe dårligere. Da spesielt at fire fettsyrer (FFS) i melk stiger. Denne oppgaven tar for seg forskjell på melkekvalitet med vekt på FFS i AMS og ikke-AMS, forskjell mellom store og små AMS besetninger i forhold til FFS tall og om det er forskjell på type AMS eller melketeknikk. Det ble brukt datamateriell fra tankmelkprøver og individprøver lånt fra TINE’s melkeprodusenter. Resultatene viser at det er en signifikant forskjell (P<0,0001) på FFS mellom AMS og ikke-AMS besetninger. FuturLineSAC viste en signifikant forbedring (P<0,05) i FFS nivå fra oppstart med AMS i perioden <6 måneder og senere. Mens MloneGEA hadde en påviselig høyere FFS verdi i perioden <6 måneder og senere. DeLaval og Lely viste ingen signifikant forskjell mellom periodene. Samspillseffekten mellom kvotestørrelse og AMS og dens effekt på FFS var signifikant (P<0,001), største effekten mellom AMS systemene DeLaval og Lely i LK-gruppen Der Lely hadde et påviselig høyere nivå av FFS i enn DeLaval. Det ble også påvist en positiv moderat korrelasjon mellom individ og tankmelkprøver. Denne oppgave viser at AMS har et høyere FFS innhold enn ikke-AMS og at størrelse på besetning og type AMS har innvirkning på FFS. An increasing number of Norwegian farmers choose to invest in the automatic milking systems (AMS), as this system has proved itself to be beneficial following the Norwegian farming system. The last few years more and more farms with smaller milking quotas and a smaller herd size (<30 cows) have converted to AMS systems as well as the larger farms (60-70 cows). Another trend has been cooperation between different farms to create larger farms going from conventional milking to AMS. The wish to increase milk production or to become less tied to the farm and the milking can be amongdriving factors for investment of AMS. After the reorganization of operations from conventional dairy operation to AMS, many feel the milk quality becomes poorer. Especially that the free fatty acids (FFA) increases. This thesis examines the difference in milk quality with emphasis on FFA in AMS and non-AMS, the difference between large and small AMS herds compared to FFA level and if there is a difference in the type of AMS or milking technique. The data was materials from bulk milk samples and individual samples borrowed from TINE’s dairy farms. The results show that there is a significant difference (P<0.0001) of FFA in AMS and non-AMS. FuturLineSAC showed a significant improvement (P <0.05) in the FFA level from the introduction period of AMS to the period <6 months later. While MloneGEA had a detectable higher FFA value in the period <6 months later. DeLaval and Lely showed no significant difference between the periods. Interaction effect between quota size and AMS and its effect on FFS was significant (P <0.001), the largest effect of the AMS systems were found in the LK group where Lely demonstrated a higher level of FFA than in DeLaval. It was also seen a positive moderate correlation between individual and bulk milk samples. This thesis shows that AMS has a higher FFA content than non-AMS and that the size of the herd and type of AMS-system affects FFA.M-H

A Study on Oral Palliative Care : An exploratory study

Objective: Xerostomia is a substantial problem for a majority of patients in palliative care. Guidelines that exist for palliative care are mainly based on tradition and longtime experience. Scientific evidence is sparse. Consequently, one of the agents used for lubrication, glycerol, is recommended in some countries, while not recommended in others. Presently, little is known about the effects of different procedures for oral palliative care. Aim: The overall aim was to study procedures and oral care products with the aspiration of contributing in some measure to the body of knowledge within the field of oral palliative care and its future guidelines. Material and methods: A questionnaire study was conducted to explore circumstances surrounding procedures and knowledge regarding oral palliative care in Norwegian healthcare institutions. An in vitro study on reconstructed human oral mucosa was used to explore biological, dose-dependent effects of glycerol. Finally, the effectiveness of three different oral moisturizers were compared in a randomized controlled trial (RCT) in palliative care patients suffering from xerostomia. Results: The questionnaire study revealed that a plethora of different procedures for oral palliative care exist and that 25 % do not have oral palliative care procedures at all. The laboratory study showed that glycerol in concentrations of 42.5% and over led to an increase in cell proliferation and apoptosis, but had no effect on tissue integrity. In the RCT, 17% glycerol had the best effect directly after application, but no effect after two hours. The two other products had long-lasting effect, but were not preferred by the patients. Conclusions: There is an obvious need for awareness about a standardisation of oral palliative care. Glycerol does not seem to harm the mucosa in low concentrations, but lacks long-term effect. Other products may be more effective, but taste and consistency must be modified to suit the patient group

A Narrative of Oral Care in Palliative Patients

Painful oral conditions represent a significant problem for most patients with a serious disease and palliative care needs. The main causes of such conditions may be associated with the underlying disease and its treatment, but primarily with adverse side effects of drugs. Oral conditions can lead to worsening of the illness and reduced quality of life. The objective of this narrative is to present an overview of oral care problems of this group, including present clinical practice. The evidence base for procedures and efficient products is weak. There is therefore an obvious need for research within this field.publishedVersio

A Narrative of Oral Care in Palliative Patients

Painful oral conditions represent a significant problem for most patients with a serious disease and palliative care needs. The main causes of such conditions may be associated with the underlying disease and its treatment, but primarily with adverse side effects of drugs. Oral conditions can lead to worsening of the illness and reduced quality of life. The objective of this narrative is to present an overview of oral care problems of this group, including present clinical practice. The evidence base for procedures and efficient products is weak. There is therefore an obvious need for research within this field