Prevalence of atherosclerosis and association with 5-year outcome: The Norwegian Stroke in the Young Study

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Virtual reality simulation training in stroke thrombectomy centers with limited patient volume—Simulator performance and patient outcome

Background Virtual reality simulation training may improve the technical skills of interventional radiologists when establishing endovascular thrombectomy at limited-volume stroke centers. The aim of this study was to investigate whether the technical thrombectomy performance of interventional radiologists improved after a defined virtual reality simulator training period. As part of the quality surveillance of clinical practice, we also assessed patient outcomes and thrombectomy quality indicators at the participating centers. Methods Interventional radiologists and radiology residents from three thrombectomy-capable stroke centers participated in a five months thrombectomy skill-training curriculum on a virtual reality simulator. The simulator automatically registered procedure time, the number of predefined steps that were correctly executed, handling errors, contrast volume, fluoroscopy time, and radiation dose exposure. The design was a before-after study. Two simulated thrombectomy cases were used as pretest and posttest cases, while seven other cases were used for training. Utilizing the Norwegian Stroke Register, we investigated clinical results in thrombectomy during the study period. Results Nineteen interventional radiologists and radiology residents participated in the study. The improvement between pretest and posttest cases was statistically significant for all outcome measures in both simulated cases, except for the contrast volume used in one case. Clinical patient outcomes in all three centers were well within the recommendations from multi-society consensus guidelines. Conclusion Performance on the virtual reality simulator improved after training. Virtual reality simulation may improve the learning curve for interventional radiologists in limited-volume thrombectomy centers. No correlation alleged, the clinical data indicates that the centers studied performed thrombectomy in accordance with guideline-recommended standards.publishedVersio

A protocol to develop shared socio-economic pathways for European agriculture

Moving towards a more sustainable future requires concerted actions, particularly in the context of global climate change. Integrated assessments of agricultural systems (IAAS) are considered valuable tools to provide sound information for policy and decision-making. IAAS use storylines to define socio-economic and environmental framework assumptions. While a set of qualitative global storylines, known as the Shared Socio-economic Pathways (SSPs), is available to inform integrated assessments at large scales, their spatial resolution and scope is insufficient for regional studies in agriculture. We present a protocol to operationalize the development of Shared Socio-economic Pathways for European agriculture – Eur-Agri-SSPs – to support IAAS. The proposed design of the storyline development process is based on six quality criteria: plausibility, vertical and horizontal consistency, salience, legitimacy, richness and creativity. Trade-offs between these criteria may occur. The process is science-driven and iterative to enhance plausibility and horizontal consistency. A nested approach is suggested to link storylines across scales while maintaining vertical consistency. Plausibility, legitimacy, salience, richness and creativity shall be stimulated in a participatory and interdisciplinary storyline development process. The quality criteria and process design requirements are combined in the protocol to increase conceptual and methodological transparency. The protocol specifies nine working steps. For each step, suitable methods are proposed and the intended level and format of stakeholder engagement are discussed. A key methodological challenge is to link global SSPs with regional perspectives provided by the stakeholders, while maintaining vertical consistency and stakeholder buy-in. We conclude that the protocol facilitates systematic development and evaluation of storylines, which can be transferred to other regions, sectors and scales and supports inter-comparisons of IAAS

Shared Socio-economic Pathways for European agriculture and food systems: the Eur-Agri-SSPs

Scenarios describe plausible and internally consistent views of the future. They can be used by scientists, policymakers and entrepreneurs to explore the challenges of global environmental change given an appropriate level of spatial and sectoral detail and systematic development. We followed a nine-step protocol to extend and enrich a set of global scenarios – the Shared Socio-economic Pathways (SSPs) – providing regional and sectoral detail for European agriculture and food systems using a one-to-one nesting participatory approach. The resulting five Eur-Agri-SSPs are titled (1) Agriculture on sustainable paths, (2) Agriculture on established paths, (3) Agriculture on separated paths, (4) Agriculture on unequal paths, and (5) Agriculture on high-tech paths. They describe alternative plausible qualitative evolutions of multiple drivers of particular importance and high uncertainty for European agriculture and food systems. The added value of the protocol-based storyline development process lies in the conceptual and methodological transparency and rigor; the stakeholder driven selection of the storyline elements; and consistency checks within and between the storylines. Compared to the global SSPs, the five Eur-Agri-SSPs provide rich thematic and regional details and are thus a solid basis for integrated assessments of agriculture and food systems and their response to future socio-economic and environmental change

Tiltaksanalyse Nitelva

Årsliste 2007Feil Lnr. inni rapporten (Lnr.5334-2007)Vannbruksplangruppa for Nitelv