Multicultural doula care from the perspectives of immigrant women in Norway: A qualitative study

Objectives The aim of the study was to illuminate immigrant women’s experiences of multicultural doula care as part of the ‘Vulnerable, pregnant and new in Norway – Safe during childbirth with a multicultural doula’ project. Methods The qualitative design was based on Braun & Clarke’s thematic analysis. Semi-structured interviews were held, assisted by an interpreter, with seven immigrant women from three different countries. Results The overarching theme illuminated a significant caring relationship between the immigrant women and their multicultural doula. The relationship was important for the women’s positive childbirth experience. Furthermore, four themes emerged as follows: feeling alone and scared; needing to be looked after; not knowing the language; and giving birth in a new and unfamiliar culture. The results revealed that the women felt safeguarded by the multicultural doula. They felt cared for and understood when the doulas acted as guides, knowing the culture and language, in collaboration with the midwife in maternal care. Conclusions Multicultural doulas can contribute to optimizing the quality of care provided to immigrant women during pregnancy and childbirth, with focus on an equal quality of care for all women. The findings can raise awareness of cultural competence in midwifery practice. More research is needed to develop new models that incorporate multicultural doulas into healthcare policies.publishedVersio

Potential value of waste heat energy from data center in Norway

The European Union (EU) has set ambitious climate goals through the European Green Deal, aiming for climate neutrality by 2050. As a result, utilization of waste heat has gained a momentum due to its potential value in society. Data centers are known for their significant power consumption and cooling needs and present an opportunity as a waste heat emitter. This thesis investigates the potential value of waste heat energy from a data center in Norway, with focus on the Green Edge Compute data center in Stavanger. The thesis assessment considers the context of infrastructure and energy grid distribution, aiming to identify sustainable integrated waste heat solutions. Technical feasibility for integrating waste heat from data centers with district heating systems is examined, considering the low output temperature from the data center and the seasonal variations in supply and demand. Key factors such as environmental impact, community development and economy are evaluated to determine the potential value of waste heat utilization. Due to the relatively new nature of waste heat from data centers through liquid medium, the limited availability of data and previous research in this specific field leads to broad and general findings. To assess the potential value of waste heat energy from data centers a comprehensive literature review was conducted, selecting a relevant case study from Norway as primary source. Collecting and analyzing data, evaluating value factors, identifying limitations, and proposing a solution for high value were the main steps to contribute to the understanding and implementation of waste heat utilization. Quantitative research was the main method applied. To enhance nuanced analysis because of lacking test data, a small-scale anonymous qualitative study was performed, discussing with industry experts to gather professional insights. This thesis explores the potential value of waste heat energy from a data center and highlights the significance in achieving energy efficiency, environmental sustainability, and economic benefits. By harnessing waste heat, data centers can reduce their reliance on conventional heating systems, resulting in energy conservation and operational efficiency. Implementing waste heat recovery systems offers advantages such as cost savings, economic growth, and employment possibilities. Integrating waste heat into energy grid systems and promoting collaborative initiatives enhances the value of utilizing waste heat from data centers

Sammenhengen mellom Campus Diskusjon og undersøkende tilnærming til matematikk

Samfunnet vårt er i stadig utvikling og det er utfordrende å forutsi hvilke kunnskaper som vil være nødvendige i fremtiden. Det vi derimot vet er at fremtidige arbeidsgivere fortsatt søker ansatte som er i stand til å løse ikke-rutinemessige problemer, analysere data, diskutere med kolleger, kommunisere resultater og arbeide selvstendig (PRIMAS, 2013). Campus Inkrement er et av de digitale læreverkene som brukes aktivt i flere skoler og som det er gjort lite forskning på ettersom det er et relativt “nytt fenomen". Vi har derfor valgt å rette oppmerksomhet på: Hvordan kan Campus Diskusjon og læreres kommunikasjon ses i sammenheng med undersøkende tilnærming til matematikk? I denne studien presenteres en kvalitativ casestudie som undersøker om det er en sammenheng mellom det digitale lærerverktøyet Campus Diskusjon og undersøkende tilnærming til matematikkundervisning. Vi har gjennomført en innholdsanalyse av diskusjonsoppgavene fra Campus Matte på 5. og 6. trinn som består av til sammen 404 diskusjonsoppgaver. Dette retter blikket mot vårt forskningsspørsmål “Hvordan kan det digitale læreverktøyet Campus Diskusjon ses i sammenheng med undersøkende matematikk". Vi har observert og intervjuet to lærerinformanter for å få bedre forståelse av “Hvordan kan læreres kommunikasjon og bruk av Campus Diskusjon ses i sammenheng med undersøkende matematikk?" Gjennom observasjoner og intervju har vi tilgang til hvordan diskusjonsverktøyet tas i bruk i klasserommet, og hvilke oppfatninger lærere har av verktøyet. Vi anvendte tematisk analyse for å analysere lærerens uttalelser og handlinger i henhold til Blomhøj (2016) sine tre faser for undersøkende matematikkundervisning. Funnene fra vår studie indikerer at diskusjonsoppgavene på Campus i svært liten grad tilrettelegger for at elever kan møte matematikkfaget gjennom en undersøkende tilnærming. Vi finner likevel at lærernes kommunikasjon og bruk av diskusjonsverktøyet har sammenhenger med en mer undersøkende tilnærming til matematikk gjennom at de oppmuntrer til aktiv elevdeltakelse, og fokuserer på løsningsprosess fremfor sluttsvar. Vi opplever imidlertid at læreverktøyet begrenser lærerne ettersom utformingen på oppgavene karakteriserer en mer tradisjonell tilnærming til faget

The iBLAD study: patient-reported outcomes in bladder cancer during oncological treatment: a multicenter national randomized controlled trial

Background: Patient-reported outcomes (PROs) are getting widely implemented, but little is known of the impact of applying PROs in specific cancer diagnoses. We report the results of a randomized controlled trial (RCT) of the active use of PROs in patients with locally advanced or metastatic bladder cancer (BC) undergoing medical oncological treatment (MOT) with focus on determining the clinical effects of using PROs during chemo- or immunotherapy compared to standard of care.Methods: We recruited patients from four departments of oncology from 2019 to 2021. Inclusion criteria were locally advanced or metastatic BC, initiating chemo- or immunotherapy. Patients were randomized 1:1 between answering selected PRO-CTCAE questions electronically once weekly with a built-in alert-algorithm instructing patients of how to handle reported symptoms as a supplement to standard of care for handling of side effects (intervention arm (IA)) vs standard procedure for handling of side effects (control arm (CA)). No real-time alerts were sent to the clinic when PROs exceeded threshold values. Clinicians were prompted to view the completed PROs in the IA at each clinical visit. The co-primary clinical endpoints were hospital admissions and treatment completion rate. Secondary endpoints were overall survival (OS), quality of life (EORTC's QLQ-C30 and QLQ-BLM30) and dose reductions.Results: 228 patients with BC were included, 76% were male. 141 (62%) of the patients had metastatic disease. 51% of patients in the IA completed treatment vs. 56% of patients in the CA, OR 0.83 (95% CI 0.47-1.44, p = 0.51). 41% of patients in the IA experienced hospitalization vs. 32% in the CA, OR 1.48 (95% CI 0.83-2.65, p = 0.17). OS was comparable between the two arms (IA: median 22.3mo (95% CI 17.0-NR) vs. CA: median 23.1mo (95% CI 17.7-NR). Patient and clinician compliance was high throughout the study period (80% vs 94%).Conclusions: This RCT did not show an effect of PRO on completion of treatment, hospitalizations or OS for BC patients during MOT despite a high level of patient and clinician compliance. The lack of real-time response to alerts remains the greatest limitation to this study

Target organ expression and biomarker characterization of chemokine CCL21 in systemic sclerosis associated pulmonary arterial hypertension

Introduction: Systemic sclerosis (SSc) is a heterogenous disorder that appears to result from interplay between vascular pathologies, tissue fibrosis and immune processes, with evidence for deregulation of chemokines, which normally control immune trafficking. We recently identified altered levels of chemokine CCL21 in SSc associated pulmonary arterial hypertension (PAH). Here, we aimed to define target organ expression and biomarker characteristics of CCL21. Materials and methods: To investigate target organ expression of CCL21, we performed immunohistochemistry (IHC) on explanted lung tissues from SSc-PAH patients. We assessed serum levels of CCL21 by ELISA and Luminex in two well-characterized SSc cohorts from Oslo (OUH, n=552) and Zurich (n=93) University hospitals and in 168 healthy controls. For detection of anti-CCl21 antibodies, we performed protein array analysis applying serum samples from SSc patients (n=300) and healthy controls. To characterize circulating CCL21 in SSc, we applied immunoprecipitation (IP) with antibodies detecting both full length and tailless and a custom-made antibody detecting only the C-terminal of CCL21. IP products were analyzed by SDS-PAGE/western blot and Mass spectrometry (MS). Results: By IHC, we found that CCL21 was mainly expressed in the airway epithelial cells of SSc patients with PAH. In the analysis of serum levels of CCL21 we found weak correlation between Luminex and ELISA (r=0.515, p<0.001). Serum levels of anti-CCL21 antibodies were higher in SSc patients than in healthy controls (p<0.001), but only 5% of the SSc population were positive for anti-CCL21 antibodies in SSc, and we found no correlation between anti-CCl21 and serum levels of CCL21. By MS, we only identified peptides located within amino acid (aa) 23-102 of CCL21, indicating that CCL21 in SSc circulate as a truncated protein without the C-terminal tail. Conclusion: This study demonstrates expression of CCL21 in epithelial lung tissue from SSc patients with PAH, and indicate that CCL21 in SSc circulates as a truncated protein. We extend previous observations indicating biomarker potential of CCL21, but find that Luminex is not suitable as platform for biomarker analyses. Finally, in vivo generated anti-CCL21 antibodies exist in SSc, but do not appear to modify serum CCL21 levels in patients with SSc-PAH

Effects of Hypothermia vs Normothermia on Societal Participation and Cognitive Function at 6 Months in Survivors After Out-of-Hospital Cardiac Arrest

ImportanceThe Targeted Hypothermia vs Targeted Normothermia After Out-of-Hospital Cardiac Arrest (TTM2) trial reported no difference in mortality or poor functional outcome at 6 months after out-of-hospital cardiac arrest (OHCA). This predefined exploratory analysis provides more detailed estimation of brain dysfunction for the comparison of the 2 intervention regimens.ObjectivesTo investigate the effects of targeted hypothermia vs targeted normothermia on functional outcome with focus on societal participation and cognitive function in survivors 6 months after OHCA.Design, Setting, and ParticipantsThis study is a predefined analysis of an international multicenter, randomized clinical trial that took place from November 2017 to January 2020 and included participants at 61 hospitals in 14 countries. A structured follow-up for survivors performed at 6 months was by masked outcome assessors. The last follow-up took place in October 2020. Participants included 1861 adult (older than 18 years) patients with OHCA who were comatose at hospital admission. At 6 months, 939 of 1861 were alive and invited to a follow-up, of which 103 of 939 declined or were missing.InterventionsRandomization 1:1 to temperature control with targeted hypothermia at 33 °C or targeted normothermia and early treatment of fever (37.8 °C or higher).Main outcomes and measuresFunctional outcome focusing on societal participation assessed by the Glasgow Outcome Scale Extended ([GOSE] 1 to 8) and cognitive function assessed by the Montreal Cognitive Assessment ([MoCA] 0 to 30) and the Symbol Digit Modalities Test ([SDMT] z scores). Higher scores represent better outcomes.ResultsAt 6 months, 836 of 939 survivors with a mean age of 60 (SD, 13) (range, 18 to 88) years (700 of 836 male [84%]) participated in the follow-up. There were no differences between the 2 intervention groups in functional outcome focusing on societal participation (GOSE score, odds ratio, 0.91; 95% CI, 0.71-1.17; P = .46) or in cognitive function by MoCA (mean difference, 0.36; 95% CI,−0.33 to 1.05; P = .37) and SDMT (mean difference, 0.06; 95% CI,−0.16 to 0.27; P = .62). Limitations in societal participation (GOSE score less than 7) were common regardless of intervention (hypothermia, 178 of 415 [43%]; normothermia, 168 of 419 [40%]). Cognitive impairment was identified in 353 of 599 survivors (59%).ConclusionsIn this predefined analysis of comatose patients after OHCA, hypothermia did not lead to better functional outcome assessed with a focus on societal participation and cognitive function than management with normothermia. At 6 months, many survivors had not regained their pre-arrest activities and roles, and mild cognitive dysfunction was common.Trial RegistrationClinicalTrials.gov Identifier: NCT0290830