Associations between unit workloads and outcomes of first extubation attempts in extremely premature infants below a gestational age of 26 weeks

Objective: The objective was to explore whether high workloads in neonatal intensive care units were associated with short-term respiratory outcomes of extremely premature (EP) infants born <26 weeks of gestational age. Methods: This was a population-based study using data from the Norwegian Neonatal Network supplemented by data extracted from the medical records of EP infants <26 weeks GA born from 2013 to 2018. To describe the unit workloads, measurements of daily patient volume and unit acuity at each NICU were used. The effect of weekend and summer holiday was also explored. Results: We analyzed 316 first planned extubation attempts. There were no associations between unit workloads and the duration of mechanical ventilation until each infant’s first extubation or the outcomes of these attempts. Additionally, there were no weekend or summer holiday effects on the outcomes explored. Workloads did not affect the causes of reintubation for infants who failed their first extubation attempt. Conclusion: Our finding that there was no association between the organizational factors explored and short-term respiratory outcomes can be interpreted as indicating resilience in Norwegian neonatal intensive care units.publishedVersio

Betydningen av kjønn i arbeidslivet for mennesker med fedme

Tittel: Betydningen av kjønn i arbeidslivet for mennesker med fedme. Hensikt: Hensikten med denne litteraturstudien var å undersøke betydningen av kjønn for deltakelse i arbeidslivet blant mennesker med fedme. Innledning: Kvinner har ikke like muligheter i arbeidslivet sammenlignet med menn. For mennesker. med fedme oppleves det mer diskriminering i arbeidslivet sammenlignet med normalvektige. Vi valgte å benytte deler av Modell for menneskelig aktivitet (MoHO) som teorigrunnlag for å forankre funnene i ergoterapeutisk teori. Metode: Metoden som ble benyttet var Scoping review. Litteraturstudien baserte seg på forskning, selvvalgt pensumlitteratur og annen aktuell litteratur. Litteratursøket ble utført systematisk og i databaser som var helsefaglige. Oppgaven inkluderte syv kvantitative forskningsartikler. Resultat: Vi kom frem til tre hovedfunn delt opp i følgende kategorier: Mulighet for deltakelse i arbeidslivet, vektdiskriminering og fravær. Et hovedfunn var at fedme var forbundet med mindre sannsynlighet for ansettelse og deltakelse i arbeidslivet, mest tydelig for kvinner. Et annet hovedfunn var at flere kvinner med fedme enn menn med fedme opplevde diskriminering på arbeidsplassen. Siste hovedfunn var at både kvinner og menn med fedme hadde økt sannsynlighet for fravær i arbeidslivet. Konklusjon: Studiene viste at kjønn har betydning for deltakelse i arbeidslivet blant mennesker med fedme, og at kvinner hadde dårligere forutsetninger i arbeidslivet sammenlignet med menn

Nettanalyse i forbindelse med transformatorhavari i spolejordet nett

Beskyttelse av sentrale komponenter i kraftsystemet er viktig for anleggseiere for å ivareta person- og forsyningssikkerhet, i tillegg til økonomiske hensyn. Når en transformator havarerer er det nyttig å undersøke bakenforliggende årsaker for å kunne forebygge lignende feil. Hovedfokuset i denne bacheloroppgaven har vært å undersøke mulige årsaker til transformatorhavari i spolejordet nett. Transformatoren som har blitt analysert var tilkoblet et 132 kV-nett og havarerte under et uvær i 2017. Problemstillingen har blitt besvart ved hjelp av litteraturstudie, caseanalyse og simulering. Dokumenter som feilrapporter fra berørte aktører, hendelsesliste, samt strøm- og spenningsmålinger har blitt gjennomgått. For å simulere feil og overspenninger har programmet ATPDraw blitt benyttet. Analysering av ovennevnte dokumenter viste at det oppsto fire etterfølgende jordfeil forskjellige steder i nettet. Første jordfeil skapte overspenninger og ubalanse, og førte trolig til flere jordfeil. Den fjerde jordfeilen oppsto inne i selve transformatoren. På dette tidspunktet var det allerede en stående jordfeil i nettet, noe som resulterte i en dobbel jordfeil. Transformatoren havarerte, og ble koblet fra nettet. Dette til tross for at alle spenningsmålinger viste lavere spenninger enn hva transformatoren skulle tåle av overspenninger. Simulering av feil i nettet med ATPDraw underbygger funnene i analysen. Året før havariet i 2017 ble det utført en oppløst gass analyse, DGA, av transformatoroljen. Analyse av disse resultatene viste at papirisolasjonen allerede på dette tidspunktet var svekket, da forholdstallet mellom karbondioksid og karbonmonoksid indikerte sterk nedbrytning av papir. DGA utført etter havariet viste også sterk nedbrytning av papirisolasjon, samt dannelse av den oppløste gassen acetylen. Under inspeksjon av transformatoren ble det oppdaget synlige skader etter utladning og lysbue. Dannelse av acetylen underbygger at det hadde oppstått lysbue. Det ble også oppdaget sotdannelse og flytende isolasjonspapir i oljen. Trolig var ikke svekkelsen av papirisolasjon eller overspenningene i transformatoren alene nok til å forårsake havariet. Transformatoren var dimensjonert for å tåle overspenningene som oppsto i forkant av havariet. Svekket isolasjon i transformatoren kan dermed anses som rotårsaken, og overspenningene var den utløsende årsaken til transformatorhavariet

Investigation of an outbreak caused by antibiotic susceptible Klebsiella oxytoca in a neonatal intensive care unit in Norway

Abstract Aim Klebsiella spp. have been stated to be the most frequent cause of neonatal intensive care unit (NICU) outbreaks. We report an outbreak of Klebsiella oxytoca in a NICU at a tertiary care hospital in Norway between April 2016 and April 2017. This study describes the outbreak, infection control measures undertaken and the molecular methods developed. Methods The outbreak prompted detailed epidemiological and microbial investigations, where whole genome sequencing (WGS) was particularly useful for both genotyping and development of two new K. oxytoca specific real‐time PCR assays. Routine screening of patients, as well as sampling from numerous environmental sites, was performed during the outbreak. A bundle of infection control measures was instigated to control the outbreak, among them strict cohort isolation. Results Five neonates had symptomatic infection and 17 were found to be asymptomatically colonized. Infections varied in severity from conjunctivitis to a fatal case of pneumonia. A source of the outbreak could not be determined. Conclusion This report describes K. oxytoca as a significant pathogen in a NICU outbreak setting and highlighs the importance of developing appropriate microbiological screening methods and implementing strict infection control measures to control the outbreak in a setting where the source could not be identified

Altered DNA base excision repair profile in brain tissue and blood in Alzheimer’s disease

Background Alzheimer’s disease (AD) is a progressive, multifactorial neurodegenerative disorder that is the main cause of dementia globally. AD is associated with increased oxidative stress, resulting from imbalance in production and clearance of reactive oxygen species (ROS). ROS can damage DNA and other macromolecules, leading to genome instability and disrupted cellular functions. Base excision repair (BER) plays a major role in repairing oxidative DNA lesions. Here, we compared the expression of BER components APE1, OGG1, PARP1 and Polβ in blood and postmortem brain tissue from patients with AD, mild cognitive impairment (MCI) and healthy controls (HC). Results BER mRNA levels were correlated to clinical signs and cerebrospinal fluid biomarkers for AD. Notably, the expression of BER genes was higher in brain tissue than in blood samples. Polβ mRNA and protein levels were significantly higher in the cerebellum than in the other brain regions, more so in AD patients than in HC. Blood mRNA levels of OGG1 was low and PARP1 high in MCI and AD. Conclusions These findings reflect the oxidative stress-generating energy-consumption in the brain and the importance of BER in repairing these damage events. The data suggest that alteration in BER gene expression is an event preceding AD. The results link DNA repair in brain and blood to the etiology of AD at the molecular level and can potentially serve in establishing novel biomarkers, particularly in the AD prodromal phase

Spatial Transcriptomics Reveals Genes Associated with Dysregulated Mitochondrial Functions and Stress Signaling in Alzheimer Disease

Alzheimer disease (AD) is a devastating neurological disease associated with progressive loss of mental skills and cognitive and physical functions whose etiology is not completely understood. Here, our goal was to simultaneously uncover novel and known molecular targets in the structured layers of the hippocampus and olfactory bulbs that may contribute to early hippocampal synaptic deficits and olfactory dysfunction in AD mice. Spatially resolved transcriptomics was used to identify high-confidence genes that were differentially regulated in AD mice relative to controls. A diverse set of genes that modulate stress responses and transcription were predominant in both hippocampi and olfactory bulbs. Notably, we identify Bok, implicated in mitochondrial physiology and cell death, as a spatially downregulated gene in the hippocampus of mouse and human AD brains. In summary, we provide a rich resource of spatially differentially expressed genes, which may contribute to understanding AD pathology

Predictors of extubation success: a population-based study of neonates below a gestational age of 26 weeks

Objective The aim of the study was to investigate first extubation attempts among extremely premature (EP) infants and to explore factors that may increase the quality of clinical judgement of extubation readiness. Design and method A population-based study was conducted to explore first extubation attempts for EP infants born before a gestational age (GA) of 26 weeks in Norway between 1 January 2013 and 31 December 2018. Eligible infants were identified via the Norwegian Neonatal Network database. The primary outcome was successful extubation, defined as no reintubation within 72 hours after extubation. Results Among 482 eligible infants, 316 first extubation attempts were identified. Overall, 173 (55%) infants were successfully extubated, whereas the first attempt failed in 143 (45%) infants. A total of 261 (83%) infants were extubated from conventional ventilation (CV), and 55 (17%) infants were extubated from high-frequency oscillatory ventilation (HFOV). In extubation from CV, pre-extubation fraction of inspired oxygen (FiO2) ≤0.35, higher Apgar score, higher GA, female sex and higher postnatal age were important predictors of successful extubation. In extubation from HFOV, a pre-extubation FiO2 level ≤0.35 was a relevant predictor of successful extubation. Conclusions The correct timing of extubation in EP infants is important. In this national cohort, 55% of the first extubation attempts were successful. Our results suggest that additional emphasis on oxygen requirement, sex and general condition at birth may further increase extubation success when clinicians are about to extubate EP infants for the first time