Implementation of new guidelines in the prehospital services: a nationwide survey of Norway

Background A debate regarding the potential harmful effects of rigid neck collar and backboard usage among prehospital and hospital care providers in Norway provoked the development of an evidence-based guideline. “The Norwegian guideline for the prehospital management of adult trauma patients with potential spinal injury” was developed with rigorous scientific methods and published in 2016. An e-learning course was developed in parallel. The aim of this study is to explore whether emergency medical services personnel in Norway have implemented the guideline, and to what extent the e-learning course was applied during the implementation process. Method An electronic survey was distributed individually to registered prehospital personnel in Norway 18 months after publication of the guideline. Results In all, 938 of 5500 (17%) EMS personnel responded to the survey. More than one-half confirmed knowledge of the guideline; among these, 56% claimed that the guideline was implemented in the service they work. Not having responded to trauma cases in real life was the main reason for not having executed the guideline. The e-learning course had been completed by 18% of respondents. Conclusion Although the guideline has not been authorized or made compulsory by national authorities, one-half of respondents with knowledge of the guideline reported it as implemented. E-learning did not seem to have affected the implementation. The guideline was developed based on perceived needs among care providers, and this probably facilitated implementation of the guideline.publishedVersio

Principal component-based image segmentation: a new approach to outline in vitro cell colonies

publishedVersio

Sharp dose profiles for high precision proton therapy using focused proton beams

Proton beam therapy has been developed to irradiate the tumor with higher precision and dose conformity compared to conventional X-ray irradiation. The dose conformity of this treatment modality may be further improved if narrower proton beams are used. Still, this is limited by multiple Coulomb scattering of protons through tissue. The primary aim of this work was to develop techniques to produce narrow proton beams and investigate the resulting dose profiles. We introduced and assessed three different proton beam shaping techniques: 1) metal collimators (100/150~MeV), 2) focusing of conventional- (100/150~MeV), and 3) focusing of high-energy (350~MeV, shoot-through) proton beams. Focusing was governed by the initial value of the Twiss parameter $\alpha$~($\alpha_0$), and can be implemented with magnetic particle accelerator optics. The dose distributions in water were calculated by Monte Carlo simulations using Geant4, and evaluated by target to surface dose ratio (TSDR) in addition to the transverse beam size~($\sigma_T$) at the target. The target was defined as the location of the Bragg peak or the focal point. The different techniques showed greatly differing dose profiles, where focusing gave pronouncedly higher relative target dose and efficient use of primary protons. Metal collimators with radii ~3.6~mm). In contrast, a focused beam of conventional (150~MeV) energy produced a very high TSDR (>~80) with similar $\sigma_T$ as a collimated beam. High-energy focused beams were able to produce TSDRs > 100 and $\sigma_T$ around 1.5~mm. From this study, it appears very attractive to implement magnetically focused proton beams in radiotherapy of small lesions or tumors in close vicinity to healthy organs at risk. This can also lead to a paradigm change in spatially fractionated radiotherapy.Comment: Submitted to Scientific Report

Levekårsutfordringer i fylket og landsdelen

Dette er en studie av levekårsproblemer i Vest-Agder, der utgangspunktet ligger i de problemene som over en lang årrekke har blitt avdekket gjennom SSBs levekårsindeks. Kommunene i Vest-Agder skårer middels eller forholdsvis svakt på mange felter, men den høye andelen på uføretrygd og på attføring er det som særlig gir grunn til bekymring. Det er viktig å merke seg at denne levekårsindeksen ikke kan svare på spørsmål av typen ”hvor i landet er det best å bo?” Flere av indikatorene peker ut relativt beskjedne populasjoner av mennesker med problemer som indikerer økonomisk marginalisering. Man skal imidlertid ikke bagatellisere problemene: I mange av Agderkommunene er andelen uførepensjonerte så høy at vi ikke lenger kan snakke om smågrupper. Videre kan fenomenet fortelle oss mye om den generelle levekårsituasjonen i fylket. Trekker man inn likestillingsperspektivet, blir andelen berørte svært høy

Structural changes during water-mediated amorphization of semiconducting two-dimensional thiostannates

Owing to their combined open-framework structures and semiconducting properties, two-dimensional thio­stannates show great potential for catalytic and sensing applications. One such class of crystalline materials consists of porous polymeric [Sn$_3$S$_7$$^{2−}$]n sheets with molecular cations embedded in-between. The compounds are denoted R-SnS-1, where R is the cation. Dependent on the cation, some R-SnS-1 thio­stannates transition into amorphous phases upon dispersion in water. Knowledge about the fundamental chemical properties of the thio­stannates, including their water stability and the nature of the amorphous products, has not yet been established. This paper presents a time-resolved study of the transition from the crystalline to the amorphous phase of two violet-light absorbing thio­stannates, i.e. AEPz-SnS-1 [AEPz = 1-(2-amino­ethyl)­piperazine] and trenH-SnS-1 [tren = tris­(2-amino­ethyl)­amine]. X-ray total scattering data and pair distribution function analysis reveal no change in the local intralayer coordination during the amorphization. However, a rapid decrease in the crystalline domain sizes upon suspension in water is demonstrated. Although scanning electron microscopy shows no significant decrease of the micrometre-sized particles, transmission electron microscopy reveals the formation of small particles (∼200–400 nm) in addition to the larger particles. The amorphization is associated with disorder of the thio­stannate nanosheet stacking. For example, an average decrease in the interlayer distance (from 19.0 to 15.6 Å) is connected to the substantial loss of the organic components as shown by elemental analysis and X-ray photoelectron spectroscopy. Despite the structural changes, the light absorption properties of the amorphisized R-SnS-1 compounds remain intact, which is encouraging for future water-based applications of such materials

Bacille Calmette-Guérin (BCG) vaccination at birth and antibody responses to childhood vaccines. A randomised clinical trial

Contains fulltext : 169904.pdf (publisher's version ) (Open Access)INTRODUCTION: BCG vaccination has been associated with beneficial non-specific effects on child health. Some immunological studies have reported heterologous effects of vaccines on antibody responses to heterologous vaccines. Within a randomised clinical trial of Bacille Calmette-Guerin (BCG) vaccination at birth, The Danish Calmette Study, we investigated the effect of BCG at birth on the antibody response to the three routine vaccines against DiTeKiPol/Act-Hib and Prevenar 13 in a subgroup of participants. METHODS: Within 7days after birth, children were randomised 1:1 to BCG vaccination or to the control group (no intervention). After three routine vaccinations given at age 3, 5 and 12months, antibodies against DiTeKiPol/Act-Hib and Prevenar 13 (Streptococcus pneumoniae serotype type 4, 6B, 9V, 14, 18C, 19F and 23F) were measured 4weeks after the third vaccine dose. RESULTS: Among the 300 included children (178 BCG; 122 controls), almost all children (>96%) had antibody responses above the protective levels. Overall BCG vaccination at birth did not affect the antibody level. When stratifying by 'age at randomisation' we found a possible inducing effect of BCG on antibodies against B. pertussis and all pneumococcal serotypes, when BCG was given after the first day of life. Girls had significantly higher antibody levels for Haemophilus influenza type b and pneumococcus than boys. CONCLUSIONS AND RELEVANCE: Three routine vaccinations with DiTeKiPol/Act-Hib and Prevenar 13 induced sero-protective levels in almost all children. No overall effect of neonatal BCG vaccination was observed

Adverse reactions to the Bacillus Calmette-Guérin (BCG) vaccine in new-born infants:an evaluation of the Danish strain 1331 SSI in a randomized clinical trial

AbstractObjectiveTo evaluate adverse reactions of the Bacillus Calmette–Guérin (BCG) Statens Serum Institut (SSI) (Danish strain 1331) used as intervention in a randomized clinical trial.DesignA randomized clinical multicenter trial, The Danish Calmette Study, randomizing newborns to BCG or no intervention. Follow-up until 13 months of age.SettingPediatric and maternity wards at three Danish university hospitals.ParticipantsAll women planning to give birth at the three study sites (n=16,521) during the recruitment period were invited to participate in the study. Four thousand one hundred and eighty four families consented to participate and 4262 children, gestational age 32 weeks and above, were randomized: 2129 to BCG vaccine and 2133 to no vaccine. None of the participants withdrew because of adverse reactions.Main outcome and measureTrial-registered adverse reactions after BCG vaccination at birth. Follow-up at 3 and 13 months by telephone interviews and clinical examinations.ResultsAmong the 2118 BCG-vaccinated children we registered no cases of severe unexpected adverse reaction related to BCG vaccination and no cases of disseminated BCG disease. Two cases of regional lymphadenitis were hospitalized and thus classified as serious adverse reactions related to BCG. The most severe adverse reactions were 10 cases of suppurative lymphadenitis. This was nearly a fivefold increase compared to what was expected based on the summary of product characteristics of the vaccine. All cases were treated conservatively and recovered. Six of 10 (60%) families of children experiencing suppurative lymphadenitis compared to 117/2071 (6%) of those with no lymphadenitis indicated that the vaccine had more adverse effects than expected (p-value <0.001).Conclusions and relevanceBCG vaccination was associated with only mild morbidity and no mortality. A higher incidence of suppurative lymphadenitis than expected was observed. All children were treated conservatively without sequelae or complications.Trial registrationTrial registration number NCT01694108 at www.clinicaltrials.go