Modelling fire occurrences in heavy goods vehicles in road tunnels

The project reported in this paper has been organized to scrutinize current incident data on near fires and fully developed fires in Norwegian road tunnels longer than 500 m. This length is chosen because it is assumed that shorter tunnels are less critical in case of fires. The project included collecting data and transferring it into formats enabling mathematical modelling. The major issue of this work has been to resolve: What are the major contributing tunnel infrastructure factors leading to heavy goods vehicle (HGV) fires in Norwegian tunnels? By using Poisson regression modelling, several models are developed showing good fit with the observations. All models reveal that slope, length, annual average daily traffic of heavy goods vehicles, and whether a tunnel is subsea are significant factors. The most important is the subsea factor, and the effect of other risk factors is also more severe for subsea tunnels. The work also discusses weaknesses in the data material and the fact that there are several other interesting factors, for example related to the state of HGVs and driver behavior that are currently missing. The research potential for better modelling and understanding of HGV fires in tunnels is huge.publishedVersio

Long-Term Outcomes After Open Repair for Ruptured Abdominal Aortic Aneurysm

Background Early mortality in ruptured abdominal aneurysm (rAAA) is high, but data on long-term outcome are scarce. The aim of this study was to investigate the long-term outcome in survivors after open surgery for rAAA in well-defined population. Methods This is a population-based, observational long-term follow-up (beyond 30-day mortality) study of patients surgically treated for rAAA from 2000 through 2014. Long-term survival was analysed using Kaplan–Meier estimates and compared to the general population by analyses of relative survival. Results Out of 178 patients operated for rAAA, 95 patients (55%) either died in the perioperative period, were referred from other hospitals or were lost to follow-up (two patients). Altogether 83 patients were eligible for long-term outcomes: 72 men and 11 women. Estimated median crude survival time was 6.5 years [95% confidence interval (CI) 4.8–8.2]. Men had a median survival of 7.3 years (95% CI 5.1–9.4) versus 5.4 years in females (95% CI 3.5–7.3) (P = 0.082). Reinterventions during follow-up occurred in 31 (37%). Relative survival demonstrated a slightly higher risk of death in the rAAA population compared to the general age- and gender-matched population. Age, but not comorbidities, had a significant influence on long-term survival. Conclusion For survivors beyond 30 days after surgery for rAAA, long-term survival compares well to that of an age- and sex-matched population. A high frequency of cardiovascular comorbidities did not seem to affect long-term survival.publishedVersio

Long-Term Outcomes After Open Repair for Ruptured Abdominal Aortic Aneurysm

Background Early mortality in ruptured abdominal aneurysm (rAAA) is high, but data on long-term outcome are scarce. The aim of this study was to investigate the long-term outcome in survivors after open surgery for rAAA in well-defined population. Methods This is a population-based, observational long-term follow-up (beyond 30-day mortality) study of patients surgically treated for rAAA from 2000 through 2014. Long-term survival was analysed using Kaplan–Meier estimates and compared to the general population by analyses of relative survival. Results Out of 178 patients operated for rAAA, 95 patients (55%) either died in the perioperative period, were referred from other hospitals or were lost to follow-up (two patients). Altogether 83 patients were eligible for long-term outcomes: 72 men and 11 women. Estimated median crude survival time was 6.5 years [95% confidence interval (CI) 4.8–8.2]. Men had a median survival of 7.3 years (95% CI 5.1–9.4) versus 5.4 years in females (95% CI 3.5–7.3) (P = 0.082). Reinterventions during follow-up occurred in 31 (37%). Relative survival demonstrated a slightly higher risk of death in the rAAA population compared to the general age- and gender-matched population. Age, but not comorbidities, had a significant influence on long-term survival. Conclusion For survivors beyond 30 days after surgery for rAAA, long-term survival compares well to that of an age- and sex-matched population. A high frequency of cardiovascular comorbidities did not seem to affect long-term survival.publishedVersio

Heat-shock protein 90α in plasma reflects severity of fatigue in patients with Crohn’s disease

Heat-shock proteins (HSPs) are evolutionarily conserved proteins with important cellular homeostasis functions during harmful conditions, including inflammation. Some HSPs are secreted extracellularly and act on distant cells by downregulating inflammation and increasing cellular stress defence mechanisms. HSP90a has been postulated to signal fatigue in chronic inflammation. We investigated whether HSP90a is associated with fatigue in patients with Crohn’s disease. Fifty-three patients with newly diagnosed Crohn’s disease were included in a cross-sectional study. Data on demographics and disease distribution were obtained. Fatigue was measured by the fatigue visual analogue scale (fVAS). Disease activity was assessed by the Simple Endoscopic Score for Crohn’s disease and Harvey Bradshaw Index. C-reactive protein, faecal calprotectin and HSP90a were also measured. The median fVAS score was 52 mm, indicating significant fatigue. HSP90a scores correlated significantly with fVAS (r¼0.31, P¼0.03). In a multivariate regression model, HSP90a was the only significant contributor to fVAS scores (b¼0.31, P¼0.03). When patients were dichotomised into groups with high and low HSP90a concentrations, significantly higher fVAS scores were demonstrated in the group with high HSP90a (M¼62.4, confidence interval 53.0–71.8 vs. 43.3, 31.6–55.0; P¼0.01). Thus, HSP90a may contribute to fatigue generation and/or modulation in patients with Crohn’s disease.publishedVersio

Utilizing students' feedback to ensure quality in teaching and learning: A lesson from covid-19

In this article we investigate the impact of COVID-19 on teaching quality and student active teaching. The data used for the analysis is from more than 4,000 students at the University of Stavanger, collected for the Study Barometer, one of the most important metrics for assessing student satisfaction in higher education, in the period 2018-2020. Special attention is given to the teaching quality index and the active student participation in teaching index. Comparisons of the data from 2020 with the data given in the period 2018-2019 show few significant differences. For the Faculty of Health Sciences, however, there are strong significant differences for both the teaching quality index and the student active participation in teaching index. We reflect upon and discuss factors that may have contributed to these differences and show how a large-scale survey can identify drawbacks in teaching and learning in higher education.publishedVersio

Comparison of heart rate feedback from dry-electrode ecg, 3-lead ecg, and pulse oximetry during newborn resuscitation

Background: Assessment of heart rate (HR) is essential during newborn resuscitation, and comparison of dry-electrode ECG technology to standard monitoring by 3-lead ECG and Pulse Oximetry (PO) is lacking. Methods: NeoBeat, ECG, and PO were applied to newborns resuscitated at birth. Resuscitations were video recorded, and HR was registered every second. Results: Device placement time from birth was median (quartiles) 6 (4, 18) seconds for NeoBeat versus 138 (97, 181) seconds for ECG and 152 (103, 216) seconds for PO. Time to first HR presentation from birth was 22 (13, 45) seconds for NeoBeat versus 171 (129, 239) seconds for ECG and 270 (185, 357) seconds for PO. Proportion of time with HR feedback from NeoBeat during resuscitation from birth was 85 (69, 93)%, from arrival at the resuscitation table 98 (85, 100)%, and during positive pressure ventilation 100 (95, 100)%. For ECG, these proportions were, 25 (0, 43)%, 28 (0, 56)%, and 33 (0, 66)% and for PO, 0 (0, 16)%, 0 (0, 16)%, and 0 (0, 18)%. All p < 0.0001. Conclusions: NeoBeat was faster to place, presented HR more rapidly, and provided feedback on HR for a larger proportion of time during ongoing resuscitation compared to 3-lead ECG and PO.publishedVersio

Newborns requiring resuscitation: Two thirds have heart rate ≥100 beats/minute in the first minute after birth

Aim The aim was to study the prevalence of bradycardia at birth in newborns requiring positive pressure ventilation (PPV), distribution of first measured heart rate (HR), changes in HR before start of PPV and HR response to PPV. Methods A population-based study including newborns ≥30 weeks' gestation receiving PPV at birth. HR was captured immediately after birth and continuously throughout resuscitation using the dry-electrode ECG device NeoBeat. Time of birth was registered in the Liveborn app. Provision of PPV was captured by video. Results We included 98 newborns receiving PPV at birth. Among newborns with HR measured within 60 s after birth, median (quartiles) first HR was 112 (84, 149) bpm recorded 19 (14, 37) s after birth, of which 33% had first HR <100 and 10% had first HR <60 bpm respectively. First HR was widely distributed. Median HR at start PPV 69 s after birth was 129 bpm. In newborns with an initial low HR, HR typically remained low for 20 s of PPV before increasing rapidly over the next 20–30 s. Conclusions First measured HR was ≥100 bpm in two thirds of newborns receiving PPV. In bradycardic infants, HR did not increase until after 20 s of PPV.publishedVersio

Prevalence of bradycardia in 4876 newborns in the first minute after birth and association with positive pressure ventilation: A population-based cross-sectional study

Objective To determine the prevalence of bradycardia in the first minute after birth and association with positive pressure ventilation (PPV). Method A population-based cross-sectional study was conducted from June 2019 to December 2021 at Stavanger University Hospital, Norway. Parents consented to participation during pregnancy, and newborns ≥28 weeks’ gestation were included at birth. Heart rate (HR) was captured immediately after birth and continuously for the first minute(s). Time of birth was registered on a tablet. Provision of PPV was captured using video. Results Of 4876 included newborns, 164 (3.4%) did not breathe (two-thirds) or breathed ineffectively (one-third) and received PPV at birth. HR in the first minute had a wide distribution. The prevalence of first measured HR <100 and <60 beats/minute at median 16 s was 16.3% and 0.6%, respectively. HR increased in most cases. At 60 s, 3.7% had HR <100 beats/minute, of which 82% did not require PPV. In total, 25% of newborns had some registered HR <100 beats/minute during the first minute, of which 95% did not require PPV. Among newborns who received PPV, 76% and 62% had HR ≥100 beats/minute at 60 s and at start PPV, respectively. Conclusion Bradycardia with HR <100 bpm in the first minute of life was frequent, but mostly self-resolved. Among the 4% of newborns that remained bradycardic at 60 s, only 20% received PPV. Two-thirds of resuscitated newborns had HR ≥100 beats/minute at start PPV. None of the ventilated newborns were breathing adequately at start PPV.publishedVersio

High mobility group box 1 and a network of other biomolecules influence fatigue in patients with Crohn’s disease

Background Fatigue is common in patients with chronic inflammatory and autoimmune diseases, often with a severe impact on the patient’s daily life. From a biological point of view, fatigue can be regarded as an element of the sickness behavior response, a coordinated set of responses induced by pathogens to enhance survival during an infection and immunological danger. The mechanisms are not fully understood but involve activation of the innate immune system, with pro-inflammatory cytokines, in particular interleukin (IL)-1β, acting on cerebral neurons. These mechanisms are also active during chronic inflammatory conditions. High mobility group box 1 (HMGB1) protein has interleukin-1 like properties and is a strong inducer of innate immune responses. Its role in generation of fatigue is not clarified. Emerging evidence indicates that also other biomolecules may influence sickness behavior. We aimed to elucidate how HMGB1 influences fatigue in patients with Crohn’s disease, and how the protein interacts with other candidate biomarkers of fatigue. Methods In 56 patients with newly diagnosed Crohn’s disease, fatigue was evaluated using three different fatigue instruments: the fatigue visual analog scale (fVAS), Fatigue Severity Scale (FSS), and the vitality subscale of Medical Outcomes Study Short-Form Health Survey (SF-36vs). The biochemical markers IL-1 receptor antagonist (RA), soluble IL-1 receptor type 2 (sIL-RII), heat shock protein 90 alpha (HSP90α), HMGB1, anti-fully reduced (fr)HMGB1 antibodies (abs), hemopexin (HPX), and pigment epithelium-derived factor (PEDF) were measured in plasma. Multivariable regression and principal component analyses (PCA) were applied. Results Multivariable regression analyses revealed significant contributions to fatigue severity for HMGB1 in the FSS model, HSP90α in the fVAS model and IL-1RA in the SF-36vs model. Depression and pain scores contributed to all three models. In PCA, two components described 53.3% of the variation. The “inflammation and cellular stress dimension” was dominated by IL-1RA, sIL-1RII, HSP90α, HPX, and PEDF scores, where the “HMGB1 dimension” was dominated by HMGB1, anti-frHMGB1 abs, and fVAS scores. Conclusion This study supports the hypothesis that HMGB1 and a network of other biomolecules influence fatigue severity in chronic inflammatory conditions. The well-known association with depression and pain is also acknowledged.publishedVersio

State transition modeling of complex monitored health data

This article considers the analysis of complex monitored health data, where often one or several signals are reflecting the current health status that can be represented by a finite number of states, in addition to a set of covariates. In particular, we consider a novel application of a non-parametric state intensity regression method in order to study time-dependent effects of covariates on the state transition intensities. The method can handle baseline, time varying as well as dynamic covariates. Because of the non-parametric nature, the method can handle different data types and challenges under minimal assumptions. If the signal that is reflecting the current health status is of continuous nature, we propose the application of a weighted median and a hysteresis filter as data pre-processing steps in order to facilitate robust analysis. In intensity regression, covariates can be aggregated by a suitable functional form over a time history window. We propose to study the estimated cumulative regression parameters for different choices of the time history window in order to investigate short- and long-term effects of the given covariates. The proposed framework is discussed and applied to resuscitation data of newborns collected in Tanzania