Delirium et Mysterium - En kunnskapsbasert fagprosedyre om ikke-farmakologisk forebygging av delirium hos intensivpasienten

Master's thesis in Nursing scienceSammendrag Introduksjon: Delirium er et stort folkehelseproblem der intensivpasienten er spesielt utsatt. Studier har vist at 60-89% av respiratorpasienter og 40-60% av intensivpasienter uten respiratorbehandling utvikler delirium. Utvikling av denne tilstanden er forbundet med forlenget respirator- og liggetid, økte kostnader og kognitiv funksjonssvekkelse etter intensivoppholdet. Vi har lang erfaring fra intensivavdeling og opplever at delirium er en kompleks problemstilling hvor man i klinikken ikke har deliriumforebyggende kunnskapsbaserte retningslinjer. Formål: Kartlegge hvilken rolle intensivsykepleiere har i forebygging og identifisering av delirium hos intensivpasienten og hvilke kunnskapsbaserte ikke-farmakologiske tiltak de kan iverksette. Metode: Vi har utarbeidet en fagprosedyre som omhandler forebygging av delirium hos intensivpasienten. Et omfattende systematisk litteratursøk er gjennomført i samarbeid med spesialbibliotekar. Søket resulterte i 5 retningslinjer, 1 oppslagsverk og 6 systematiske oversikter som representerer de 4 øverste nivåene i S-pyramiden. Fagprosedyren er utarbeidet etter metode og minstekrav for utarbeidelse av kunnskapsbaserte fagprosedyrer. Anbefalinger, tiltak og beskrivelser presenteres i en konkret og oversiktlig multi-komponent tiltakspakke med referanser til evidensgrunnlaget. Tiltak som er utarbeidet på grunnlag av konsensus i tverrfaglig prosjektgruppe tydeliggjøres. Resultat: Anbefalinger til en kunnskapsbasert fagprosedyre som omhandler ikke- farmakologisk forebygging av delirium er utarbeidet på bakgrunn av mastergradsoppgaven. De ulike tiltakene er integrert i en tiltakspakke med evidensbaserte anbefalinger for anvendelse i praksisfeltet på intensivavdelingen. Konklusjon: En kunnskapsbasert fagprosedyre bidrar til kvalitetssikring av yrkesutøvelsen for intensivsykepleier og intensivpersonell. En ikke- farmakologisk deliriumforebyggende tiltakspakke er konkret, brukervennlig, nyttig for intensivpersonell og helsefremmende for intensivpasienten. Det er intensivsykepleiere som best kan forebygge tilstanden, da de er hos intensivpasienten hele døgnet. Abstract Introduction: Delirium is a widespread public health concern where the intensive care patient is especially at risk. Delirium is reported in 40% to 60% of non-mechanically ventilated, and 60% to 89% of mechanically ventilated patients in the Intensive Care Unit (ICU). The development of the condition is associated with prolonged duration of mechanical ventilation, ICU and hospital stay, increased cost and long-term cognitive impairment. Because of extensive experience from the ICU, we have witnessed delirium as a complex issue where in clinical practice delirium preventive evidence-based guidelines are absent. Aim: Determine the role of critical care nurses in prevention and identification of delirium in the ICU patient and which evidence-based non-pharmacological interventions they can initiate Method: We have developed a clinical procedure that contributes to the prevention of delirium in the ICU patient. An extensive systematic literature search was completed in coordination with a research librarian. Search resulted in 5 evidence-based clinical guidelines, 1 evidence-based summary and 6 systematic reviews representing the four top levels of the six S-model. The clinical procedure was developed according to the method and minimum requirements for the execution of evidence-based clinical procedures. Recommendations, interventions and descriptions are presented in a straight forward multi-component bundle with references to the base of evidence. The interventions developed based on a consensus in the interdisciplinary project group is clearly marked. Result: Recommendations for an evidence-based clinical procedure concerning non- pharmacological prevention of delirium is developed on the basis of master thesis. The different interventions are integrated in a bundle with evidence-based recommendations for implementation of clinical practice in the ICU. Conclusion: An evidence-based clinical procedure contributes to the ensured quality of professionalism as a critical care nurse and critical care personnel. A non-pharmacological delirium prevention bundle is straight forward, user friendly and beneficial for critical care personnel and health promoting for the intensive care patient. It is the critical care nurses who can best prevent the condition as they are with the ICU patient around the clock

Ancient origin and maternal inheritance of blue cuckoo eggs

Maternal inheritance via the female-specific W chromosome was long ago proposed as a potential solution to the evolutionary enigma of co-existing host-specific races (or 'gentes') in avian brood parasites. Here we report the first unambiguous evidence for maternal inheritance of egg colouration in the brood-parasitic common cuckoo Cuculus canorus. Females laying blue eggs belong to an ancient (∼2.6 Myr) maternal lineage, as evidenced by both mitochondrial and W-linked DNA, but are indistinguishable at nuclear DNA from other common cuckoos. Hence, cuckoo host races with blue eggs are distinguished only by maternally inherited components of the genome, which maintain host-specific adaptation despite interbreeding among males and females reared by different hosts. A mitochondrial phylogeny suggests that blue eggs originated in Asia and then expanded westwards as female cuckoos laying blue eggs interbred with the existing European population, introducing an adaptive trait that expanded the range of potential hosts

Nondisturbing extremum seeking control for multi-agent industrial systems

Industrial applications of extremum seeking control (ESC) can be a hit and miss affair. Although a gain in performance can be achieved, the dither applied to excite the system causes unwanted fluctuations in the performance of the system. The fluctuations in systems with a single extremum seeking loop are generally small. However, for systems with many extremum seeking loops, the fluctuations in each loop may add up to an intolerable amount of fluctuation in the total performance. In this article, we propose a method to cancel the dither-induced fluctuations in the overall system performance to a large extent by smartly constructing the dither signals in each extremum seeking loop using a centralized coordinator. The novelty of our method lies in the direct calculation of the dither signals that avoids the heavy computations required by other methods. Moreover, we provide a solvability analysis for the problem of cancelling dither-induced fluctuations in the total performance of the system. Furthermore, a complete stability analysis of the overall ESC scheme with dither coordination is given.publishedVersio

Host species determines egg size in Oriental cuckoo

© 2018 The Zoological Society of London.The Oriental cuckoo Cuculus optatus is an obligate brood parasite associated with species of the genus Phylloscopus. Four distinct phenotypes of Oriental cuckoo eggs, matching eggshell colour patterns of Arctic warbler Phylloscopus borealis, common chiffchaff (Siberian) P. collybita tristis, yellow-browed warbler P. inornatus and Pallas's leaf warbler P. proregulus, have been identified in the Russian part of its breeding area. We compared egg length, breadth and volume of Oriental cuckoo egg phenotypes with eggs of the corresponding hosts from three geographical regions in Russia: the Urals, Siberia and the Far East. We found significant oometric differences between Oriental cuckoo egg phenotypes. Egg breadth of each cuckoo group matched the egg breadth of the host species, while the length of cuckoo eggs did not match egg length in host species. Our results can be explained in terms of clutch geometry. An egg sticking out above the clutch is likely to be rejected by the host and so breadth should match the host's egg. This constrains cuckoos in maintaining large egg volumes, which are essential for providing a cuckoo chick with the energy required to eject the host eggs and chicks. An increased egg length might compensate for breadth constraints. We suggest that the size of cuckoo eggs might also be affected by parental care - when only one parent is involved in feeding, eggs need to be larger. This might explain why the longest cuckoo eggs belonged to the phenotype parasitizing the smallest host, Pallas's leaf warbler, where only one parent feeds the chicks. In our view, differences in egg sizes of Oriental cuckoo phenotypes provide evidence of their adaptations to brood parasitism on small leaf warbler species.Peer reviewe

A gap analysis for automated cargo handling operations with geared vessels frequenting small sized ports

With the Yara Birkeland, the world’s first autonomous cargo ship developed for commercial use, nearing regular unmanned operation, it is crucial to assess the availability and readiness of unmanned cargo handling solutions. While there are already fully automated container terminals at large international ports, the purpose of this study is to consider solutions to support autonomous ships for small sized ports with little infrastructure, typical of coastal harbors in Norway. The analysis centers on geared cargo vessels that can navigate such ports with minimal or no crew onboard, and the primary method used involved workshops and interviews with personnel from relevant industries. An important finding is the lack of skilled crane operators that are willing to follow the ship. The study concludes that it is important to address the following 3 key technological gaps: (1) the autonomous connection and release of break-bulk, (2) automatic securing and lashing of onboard cargo, and (3) shipboard cranes that can operate without an onsite crane operator.publishedVersio

Grindagutar på sjukeheim: Tilsette sin erfaring med kulturprosjekt

Grindagutar at nursing home: Employees experience with cultural project.Background: Culture activity contributes to holistic care for nursing home residents, and the employees are key personnel for success.Aim: Explore the employees’ experience putting culture projects into life in a nursing home.Methods: The material, based on four focus group interviews with employees in the nursing home, is categorized and analyzed through text condensation.Results: The culture projects created activity and were sources for thriving. However, not participating directly in the activity, the employees let the artists in, were available for them, and watched the patients during the performances. Their function as “door-openers/-keepers” resulted in hosting responsibility, leading to a position of confusion regarding the role as protectors for the patients. Main challenges were how to give feedback regarding whether the patients liked/disliked the performance, and the feeling of being trapped in a position as bystander rather than making the culture activity a common happening for the patients and the employees

E134 Oslofjordforbindelsen - Forundersøkelser i resipienter 2022

Etter oppdrag fra Statens vegvesen har NIBIO utført forundersøkelser i bekker, tjern og marine områder som vil kunne berøres av anleggsaktivitet under bygging av E134 Oslofjordforbindelsen. Forundersøkelsene har omfattet vannkjemi, bunndyr- og fiskeundersøkelser samt prøvetaking og analyse av eDNA. Samlet omfattet forundersøkelsene 21 stasjoner fordelt på bekker og elver, tjern og marine områder.E134 Oslofjordforbindelsen - Forundersøkelser i resipienter 2022publishedVersio

Designing a surveillance program for early detection of alien plants and insects in Norway

Naturalized species of alien plants and animals comprise < 3% of biodiversity recorded in Norway but have had major impacts on natural ecosystems through displacement of native species. Encroachment of alien species has been especially problematic for coastal sites close to transport facilities and urban areas with high density housing. The goal of our field project was to design and test a surveillance program for early detection of alien species of vascular plants and terrestrial insects at the first phase of establishment in natural areas. In our 3-year project (2018–2020), we sampled 60 study plots in three counties in the Oslofjord region of southern Norway. Study plots (6.25 ha) were selected by two criteria: manual selection based on expert opinion (27 plots) or by random selection based on weights from a hotspot analysis of occurrence of alien species (33 plots). Vascular plants were surveyed by two experienced botanists who found a total of 239 alien species of vascular plants in 95 rounds of surveys. Insects and other invertebrates were captured with a single Malaise trap per site, with 3–4 rounds of repeated sampling. We used DNA-metabarcoding to identify invertebrates based on DNA extractions from crushed insects or from the preservative media. Over 3500 invertebrate taxa were detected in 255 rounds of sampling. We recorded 20 alien species of known risk, and 115 species that were new to Norway, including several ‘doorknocker’ species identified by previous risk assessments. We modeled the probabilities of occupancy (ψ) and detection (p) with occupancy models with repeated visits by multiple observers (vascular plants) or multiple rounds of sampling (insects). The two probabilities covaried with risk category for alien organisms and both were low for species categorized as no known or low risk (range = 0.052–0.326) but were higher for species categorized as severe risk (range = 0.318–0.651)... Arthropods · DNA-metabarcoding · Early detection · Invasive · Invertebrates · Occupancy models · Rapid response · Study design · Vascular plantsDesigning a surveillance program for early detection of alien plants and insects in NorwaypublishedVersio

Sex Allocation in Relation to Host Races in the Brood-Parasitic Common Cuckoo (Cuculus canorus)

Sex allocation theory and empirical evidence both suggest that natural selection should favour maternal control of offspring sex ratio in relation to their ability to invest in the offspring. Generalist parasites constitute a particularly interesting group to test this theory as different females commonly utilize different host species showing large variation in provisioning ability. The common cuckoo (Cuculus canorus) is a generalist brood parasite that lays its eggs in the nest of many different passerine birds, but each female tends to specialize on one particular host species giving rise to highly specialized host races. The different host species show large variation in their ability to invest in the parasitic offspring, presenting an opportunity for female cuckoos to bias offspring sex ratio in relation to host species quality. Here, we investigate host-race specific sex allocation controlling for maternal identity in the common cuckoo. We found no evidence of any significant relationship between host race and sex ratio in one sympatric population harbouring three different host races, or in a total of five geographically separated populations. There was also no significant association between host quality, as determined by species-specific female host body mass, and cuckoo sex ratio. Finally, we found no significant relationship between individual cuckoo maternal quality, as determined by her egg volume, and sex ratio within each host race. We conclude that the generalist brood-parasitic common cuckoo show no significant sex-ratio bias in relation to host race and discuss this finding in light of gene flow and host adaptations

«Eit givande, men krevjande lagspel for å betre tenestene». Brukarerfaringar frå samarbeidsforsking

“A precious, but challenging teamwork for improved healthcare”.  Service users´ experiences from participatory researchIn spite of identifying the importance of service user (SU) involvement in healthcare research, few studies define specific activities.  Although an effective infrastructure is acknowledged as key to enable SU’s equal contribution, we, in Norway, recognize a lack of their involvement in studies on Chronic Obstructive Pulmonary Disease (COPD). Consequently, a preliminary project was designed to implement a research-training programme for co-researchers and seek their collaboration in a participatory research study on COPD. This paper reports the co-researchers’ experiences using a focus group interview. Through content analysis, we describe coresearchers’ experiences, which recognize the importance and challenges of participatory research.These experiences demonstrate how acknowledgement, a fruitful climate for collaboration, new insight and practical arrangements promote involvement, whilst too extensive training and vague expectations may hinder involvement. Empowering equality of relationships and involvement, particularly for co-researchers with failing health and no former research training, demands thorough planning and organizing.  Samarbeidspartnarar: brukarar Nina Maria Dolmen, Aud Jenny Jensen, Sissel Stavøstrand og Steinar Valvik, spesialsjukepleiar Grete Berg Grimelid, Helse Førde, ergoterapeut Evy Aarsheim, Flora kommune, og sosionom og PhD stipendiat Tone Larsen, Helse Førde