The Importance of Social Skills Instruction for Students With a High Number of Adverse Childhood Experiences (ACEs)

Abstract The purpose of this action research study was to discover the importance of using small group instruction in the area of social skills with students who have multiple adverse childhood experiences (ACEs). Classroom teachers filled out a questionnaire about students to the best of their knowledge that relates to ACEs. The classroom teacher then used an IBRST (individualized behavior rating scale)to determine the student’s ability to follow CHAMPS (Conversation, Help, Activity, Movement, Participation, and Success) expectations in the classroom. I compared IBRST scores of students with little to no ACE exposure to those of students with high ACE exposure. The classroom teacher then provided small group instruction in the area of social skills to those students with high ACE scores and were able to track whether or not this is beneficial to those students. We could see that students with high ACE scores raised their IBRST scores and that there is a correlation between these scores and the importance of classroom teachers completing the questionnaire on students each year and instructing in the area of social skills

Treatment of displaced proximal humeral fractures in elderly patients

The optimal treatment for patients with displaced fractures of the proximal humerus, especially elderly patients with osteoporosis, is still controversial. For the 2- and 3-part fractures according to the Neer classification, there is a trend towards more frequent surgical interventions with modern locking plates. For the more comminuted 4-part fracture with a higher risk for avascular necrosis, a primary hemiarthroplasty (HA) has been the accepted treatment. The alternative treatment for these fractures is non-operative with a short immobilization period and early physiotherapy. The latest Cochrane review regarding this topic concludes that there is insufficient evidence from randomized controlled trials (RCTs) to determine which interventions are the most appropriate for the management of different types of fractures. It is also stated that future trials should use validated outcome measures, including patient-assessed functional outcomes such as health-related quality of life (HRQoL). However, due to their design, quality-of-life instruments may be less sensitive for detecting small but yet important changes, i.e. they may have a limited responsiveness. In a prospective cohort study with a 2-year follow-up, 50 elderly patients with a displaced 2-part fracture of the proximal humerus were treated with open reduction and internal fixation with a locking plate. The result showed that locking plates appear to be a good treatment alternative with an acceptable complication rate and an acceptable functional outcome. In an RCT with a 2-year follow-up, 60 elderly patients with a displaced 3-part fracture of the proximal humerus were allocated to treatment with open reduction and internal fixation with a locking plate or non-operative treatment. The results of the study indicated an advantage in functional outcome and HRQoL in favor of the locking plate as compared to non-operative treatment, but at a cost of additional surgery in 30% of the patients. The main advantage of the locking plate appeared to be an improved range of motion (ROM). In an RCT with a 2-year follow-up, 55 patients with a displaced 4-part fracture of the proximal humerus were allocated to treatment with a primary HA or non-operative treatment. The results of the study demonstrated a significant advantage in quality of life in favor of HA as compared to non-operative treatment. The main advantage of HA appeared to be less pain, while there were no differences in ROM. 145 patients with a displaced proximal humeral fracture were included in a study with the aim to evaluate the responsiveness of the EQ-5D instrument. The EQ-5D displayed good internal and external responsiveness and can be recommended for use as a quality-of-life measure in patients with this particular injury. An additional conclusion of the studies was that, regardless of primary treatment, a displaced fracture of the proximal humerus results in a substantial negative effect upon the patients‟ HRQoL

Evaluation of battery energy storage systems in the Norwegian power grid to cope with increased vehicle electrification

Regjeringen har satt salgsmål for å øke elektrifiseringen av kjøretøy i Norge. Målene inkluderer at nye personbiler skal være nullutslippskjøretøy innen 2025. I tillegg skal alle lette varebiler, tunge varebiler, 75% av langdistansebussene og 50% av lastebilene være nullutslippskjøretøy innen 2030. Dette resulterer i en økende etterspørsel etter ladeinfrastruktur, både oppdateringer av eksisterende ladestasjoner, for å øke effektuttak og etablering av nye stasjoner. Nye utfordringer oppstår med økt elektrifisering. Utbyggere av ladestasjoner opplever begrenset nettkapasitet, noe som fører til høye kostnader for å forsterke nettet. Med økende ladeeffekt øker også investeringene i å etablere ladestasjoner. Nettselskap erkjenner behovet for å forsterke det eksisterende nettet når ladestasjonsoperatører ber om høy effekttilkobling til nettet. Derfor bør blant annet aspekter som avvikende spenninger, overbelastning av strømnettet, forventet redusert fleksibilitet og økte overharmoniske spenninger vurderes for å sikre en sikker nettdrift. I denne avhandlingen har et batterilagringssystem (BESS) blitt undersøkt. Systemet ble presentert som en mulig løsning for å fortsette utviklingen av ladestasjoner som var ulønnsomme eller tidkrevende prosjekter. Avhandlingen bruker tre metoder: et litteratursøk, kvalitative informantintervjuer og en GAP-analyse. I litteraturgjennomgangen ble ni artikler inkludert for å undersøke den optimale måten å utnytte et batterilagringssystem på i kombinasjon med en hurtigladestasjon. Det ble gjennomført elleve informantintervjuer med aktører fra fem ulike grupper. Ladeoperatører, nettselskaper, leverandører av batterilagringssystemer, støtteordingsinformanten og store kjøretøybrukere ga en bred, informativ og tilstrekkelig forklaring av deres opplevelse av den nåværende situasjonen for ladeinfrastruktur i Norge. I tillegg bidro de til å belyse fremtidige krav og forventinger. Litteratursøket viste en generell interesse for å bruke batteri av ulike grunner. Noen av grunnene var å redusere nettleie, bidra til å avlaste distribusjonsnettet og øke lønnsomheten til ladestasjonen. Flere tjenester ble presentert, for eksempel nettstøtte, frekvenskontrolltjenester, lastflytting og energiarbitrasje. Ifølge informantene som ble intervjuet, er det en stor etterspørsel etter ladeinfrastruktur med høyere effekt. Ladeoperatørene bemerket avgifter ved nettilknytning på steder med lav kapasitet og høy nettleie, noe som førte til mindre lønnsomme prosjekter. Dette kan også føre til færre installasjoner av ladestasjoner og manglende evne til å møte etterspørselen i årene som kommer. Som en løsning på dette ble det innført batterier for å øke hurtigladestasjonenes fortjeneste. Ifølge aktørene i denne avhandlingen er høyere effekttopper på ladestasjoner, finansiering for tunge kjøretøy og større ladeeffekt noe de forventer mer av i fremtiden. I GAP-analysen ble det presentert kortsiktige og langsiktige løsninger med batterilagringssystemer for å takle den økte etterspørselen etter ladeinfrastruktur. I en kortsiktig periode kan nettselskap kjøpe batteritjenester for å støtte nettet og for å knytte kunder raskere til nettet. Nettselskapene kan også integrere et batteri på en hurtigladestasjon for å redusere nettavgiftene og anleggsbidragene. Til slutt, for den kortsiktige løsning, var støtteordninger en sentral del for å utvide ladeinfrastrukturen for tunge kjøretøy. Den langsiktige løsningen inkluderte ladeoperatører som kunne øke fortjenester ved å selge tjenester i de norske reservemarkedene, i tillegg til energiarbitrasje og utvidelse av ladestasjonstilbudet. I tillegg ble det presentert at batterioperatører kunne selge tjenester til ladeoperatører og nettselskap for økt effektuttak og nettstøtte. Det ble også gitt et forslag om finansiering av batteri i distribusjonsnettet hvor verdistabling ble prioritert. Å øke batterioperatørens lønnsomhet, i tillegg til å anerkjenne betydningen av en mulig fleksibilitetsressurs, ble sett på som en løsning på den økende etterspørselen etter ladeinfrastruktur når elbilandelen i Norge øker.The Norwegian Government has set sales targets to increase the electrification of vehicles in Norway. The targets include new passenger cars to be zero-emissions vehicles by 2025. In addition, all light vans, heavy vans, 75% of the long-distance buses and 50 % of the lorries should be zero-emission vehicles by 2030. This results in an increasing demand for charging infrastructure, both updating existing stations with higher power outputs and establishing new charging stations. New challenges arise with increased electrification. Charging station developers experience limited grid capacity, leading to high costs of reinforcing the grid. With growing charger powers, the investment in establishing stations also grows. Distribution system operators acknowledge the need of reinforcing the existing grid when charging station operators request high power grid-tie. Therefore, aspects of deviating voltages, power grid congestion, expected reduced flexibility and increased harmonic distortions, amongst others should be considered to ensure a safe grid operation. In this thesis, the use of a battery energy storage system (BESS) has been investigated. The system was presented as one possible solution to proceed with the development of charging stations for unprofitable and time-consuming establishments. The thesis includes three methodologies: a literature review, qualitative informant interviews, and a GAP analysis. In the literature review, nine articles were included to examine the optimal way of utilising a battery energy storage system in combination with a fast charging station. Eleven informant interviews, with stakeholders from five different groups, were conducted. Charge point operators, distribution system operators, battery energy storage system providers, a funding informant, and heavy vehicle users presented a wide, informative, and adequate explanation of their experiences with the current charging infrastructure in Norway. Additionally, they noted future demands and prospects. The literature review showed an overall interest in utilising BESS for various reasons; Reducing grid fees, helping alleviate the distribution grid, and increasing the profitability of the charging station were repeated. Several services were presented, such as grid support, frequency control services, load shifting, and energy arbitrage. According to the informants interviewed, there is a rapid demand for charging infrastructure with higher power output. However, charging operators noted fees when grid-tying at locations with low capacity and high power grid fees, leading to less profitable projects. This could result in fewer charging station installations and a failure to meet demand in the coming years. As a solution to this, implementing batteries to increase a fast charging station's profits was introduced. According to the stakeholders of this thesis, future prospects are higher power peaks at charging stations, funding for heavy vehicles, and greater power charging output. In the GAP analysis, short- and long-term solutions with battery energy storage systems to cope with the increased demand in charging infrastructure were presented. For a short-term period, The DSO may rent BESS services for grid support and to grid-tie customers faster. CPOs may also integrate a BESS at a FCS to lower the grid fees and investment contributions. Lastly, for the short-term solution, funding was a central part to expand the heavy vehicle charging infrastructure. The long-term solution included CPOs possible increase revenue by selling services in the Norwegian reserve markets, in addition to energy arbitrage and expanding their charging station offer. Additionally, BESS operators selling services to CPOs and DSOs for increased power outputs and grid support were presented. Lastly, a proposal on funding BESSs in the distribution grid and favouring value stacking was given. Increasing the BESS operator's profitability in addition to recognising the importance of a possible flexibility resource was seen as a reasonable solution to the growing demand for charging infrastructure in Norway

Convergences and divergences of geographies from an East-Central European perspective

STUDY DESIGN:  Prospective cohort study. OBJECTIVE:  This study investigates the results of long posterior instrumentation with regard to complications and survival. SUMMARY OF BACKGROUND DATA:  Fractures of the cervical spine and the cervicothoracic junction related to ankylosing spinal disease (ASD) endanger both sagittal profile and spinal cord. Both anterior and posterior stabilization methods are well established, and clear treatment guidelines are missing. METHODS:  Forty-one consecutive patients with fractures of the cervicothoracic junction related to ASD were treated by posterior instrumentation. All patients were followed prospectively for 2 years using a standardized protocol. RESULTS:  Five patients experienced postoperative infections, 3 patients experienced postoperative pneumonia, 2 patients required postoperative tracheostomy, and 1 patient had postoperative cerebrospinal fluid leakage due to accidental durotomy. No patient required reoperation due to implant failure or nonunion. Mean survival was 52 months (95% confidence interval: 42-62 mo). Survival was affected by patient age, sex, smoking, and spinal cord injury. CONCLUSION:  Patients with ASD experiencing a fracture of the cervicothoracic region are at high risk of developing complications. The posterior instrumentation of cervical spinal fractures related to ASD is recommended due to biomechanical superiority. Level of Evidence: 4

Insertion torque is not a good predictor of pedicle screw loosening after spinal instrumentation: a prospective study in 8 patients

<p>Abstract</p> <p>Background</p> <p>Pedicle screw loosening is a major safety concern in instrumented spinal surgery due to loosening with potential pseudarthrosis and possible loss of correction requiring revision surgery. Several cadaver studies have compared insertion torque of pedicle screws with resistance to pullout or cyclic loading. In most of these studies, a correlation has been found between these variables. Clinical studies have been made, comparing insertion torque to bone mineral density or radiological signs of screw loosening. There are no clinical studies comparing insertion torque to extraction torque or other biomechanical parameters in vivo. This study was designed to investigate whether the insertion torque of pedicle screws can be used to predict the purchase of the screws.</p> <p>Methods</p> <p>The insertion torque of stainless steel pedicle screws was recorded in eight patients undergoing lumbar fusion surgery with four-screw constructs. Torque gauge manometers were used for the recordings. The implants were removed after one year, and the extraction torque of the screws was recorded.</p> <p>Results</p> <p>The mean insertion torque was 76 ± 41 Ncm and the mean extraction torque 29 ± 36 Ncm. The r value was 0.591, suggesting that there was a correlation between the insertion and extraction torque. However, the scattergram revealed that the screws could be divided into two groups, six screws with a high correlation between insertion and extraction torque, and 26 screws where no correlation could be demonstrated.</p> <p>Conclusions</p> <p>In this unique human in-vivo study, the insertion torque could not be used to predict the purchase of lumbar pedicle screws one year after implantation. It could be demonstrated that in vivo insertion torque alone is of minor value to estimate pullout strength, and should be combined with or replaced by more accurate measures.</p

Hvordan tar barn i bruk de mulighetene uterommet kan gi i relasjonsleken? : en observasjonsstudie av hvordan noen barn leker sammen i barnehagens uterom

In my master thesis I wanted to focus on the outdoor environment of the norweigian kindergarten, and how this room or place can afford play between children. My main research question is: ”How does children make use of the possibilities that the outdoor room/place can afford in relational play?” To find an answer to this, I have used a fenomenological approach when it comes to theory and method. I am influenced among others by the French philosopher Maurice Merleau-Ponty. The term lifeworld and the body as a subject together with theories on play, relations and place make out the main part of my theory. In addition, hermeneutics and grounded theory are important factors of my method. I base this on theories developed by Heidegger and Gadamer amongst others. To collect data for my work, I spent two days a week for five weeks in a traditional kindergarten during their outdoor playtime. I was interacting with the children both as a participant in their play and as an observer from the outside. To document my data I used a notebook where I wrote down play observations and thoughts on what I saw in the everyday life of their playtime. After I had finished my field work, I decided to use five of the observations I had written down. These observations have made the platform of what I build my master thesis on. My results are based on the observations I have done and the analyses that came of this. I found a few things that stood out and seemed to be important in the children’s outdoor relational play. In short, what I found out was this; the importance of acknowledging each other, testing their own and others’ boundaries, the choice of a place out of interest, to create meaning through play and through the use of a place, and to create places not available to everyone. These were all factors that seemed important to the children I observed. They used the outdoor environment as a room to do all this. The way they did it varied from child to child, but it was clear to me that the outdoor environment afforded play, and the children used this room in a way that suitet them. The way I see it, the outdoor environment is a place that children use to their benefit, so that children of different age and base can share the same experience and share a common ground and be joined in relational play.Master i barnehagepedagogik

Reassessing the gender ideology of the supra-regional corded ware culture

The Corded Ware culture (c. 2900-2200 BC; hereafter ‘CWC’ for the phenomenon itself or ‘CW’ as the adjective) is a widespread prehistoric phenomenon encountered throughout Europe and was characterised by standardised burial practices and material culture. Recent studies incorporating scientific methods have revived the traditional hypothesis, that the sudden appearance of the CWC was caused by mass migrations from the Pontic Caspian steppe. Among other things, this new archaeological culture is typically associated with the introduction of a binary gender system and the establishment of a patriarchal society.However, such a narrative is largely rooted in andro- and ethnocentric, Western assumptions: biological sex is equated with gender, grave goods are taken as a direct representation of identity, and weapons (i.e. the CW ‘battle-axe’) are associated with masculinity. Moreover, burials under barrows are overrepresented in the ‘grand narrative’ of the CWC, while other funerary and depositional contexts are underrepresented.This paper aims to investigate CW gender, while taking the abovementioned problems into account. The emphasis is placed on the expression of gender through material culture and its selective deposition (i.e. specific objects deposited in specific contexts). Two regions have been selected as a case study: Southern Jutland (102 burials, 13 depositions (i.e. buried objects without a body), 29 single finds) and Bavaria (90 burials, three depositions, 32 single finds). The co-occurrences of various object categories in different depositional contexts are studied in each region. The results are contextualised in comparison to the extensive network analysis by Q. Bourgeois and E. Kroon (2017), which consisted of 1161 CW burials and resulted in the recognition of striking burial norms, but only takes the funerary context into account.The present comparative and multi-contextual study adds nuance to the binary reading of CW gender and suggests that CW gender may have been constructed through an interplay of normative supra-regional versus idiosyncratic local identities. The supra-regional and local burial styles do not necessarily convey a ‘male’ and ‘female’ gender identity but emphasise the larger CW community and local values respectively. Thus, this study argues that the core value displayed in burials is the CW community, rather than gender and particularly ‘male-dominant’, martial values as suggested in the grand narrative of this period.European Prehistor

Thrombospondin in Early Human Wound Tissue

We examined partial thickness incised human wounds of 2, 3, 5, 7, and 14 days of age for the presence of thrombospondin by immunostaining and light microscopy. At 2, 3, 5, and 7 days after wounding, thrombospondin is present primarily at the cut edges of the lateral and deep margins of the wound. It appears to be cleared from these extracellular matrix sites, and is no longer detectable in those sites in most 14-day-old wounds. Thrombospondin staining is present, however, in increased amounts around the vascular channels within and adjacent to the 7- and 14- day wounds in increased amounts relative to vascular channels distant from the wound. Our observations are consistent with known in vitro data regarding the binding of thrombospondin to fibrin and components of the extracellular matrix, as well as with data showing that proliferating endothelial cells secrete more thrombospondin than quiescent endothelial cells. These data support the hypothesis that thrombospondin plays a role in the early organization of the extracellular matrix of wounds

Kyphoplasty in osteoporotic vertebral compression fractures - Guidelines and technical considerations

Osteoporotic vertebral compression fractures are a menace to the elderly generation causing diminished quality of life due to pain and deformity. At first, conservative treatment still is the method of choice. In case of resulting deformity, sintering and persistent pain vertebral cement augmentation techniques today are widely used. Open correction of resulting deformity by different types of osteotomies addresses sagittal balance, but has comparably high morbidity

Pharmacological strategies to reduce pruritus during postoperative epidural analgesia after lumbar fusion surgery - a prospective randomized trial in 150 patients

BACKGROUND: Epidural analgesia with bupivacain, epinephrine and fentanyl provides excellent pain control after lumbar fusion surgery, but pruritus and motor block are frequent side effects. Theoretically epidural ropivacain combined with oral oxycodone could decrease the incidence of these side effects. The two regimens were compared in a prospective randomized trial. PATIENTS AND METHODS: 150 patients (87 women) treated with posterior instrumented lumbar fusion were included. The mean age was 51 +/- 11 years. 76 were randomized to bupivacain, epinephrine and fentanyl (group B) and 74 to ropivacain and oxycodone (group R). Pruritus, motor block and pain were measured 6 hours after surgery, thereafter 6 times per day for 5 days. Any pain breakthrough episode was registered whenever it occurred. RESULTS: The epidural treatment could be performed in 143 patients (72 in group B and 71 in group R). Disturbing pruritus occurred in 53 patients in group B compared to 12 in group R (p &lt; 0.0001). Motor blockade was most frequent on day 1, occurring in 45% of the patients with no difference between the groups. Both regimes gave good pain control with average VAS under 40, but the pain relief was statistically better in group B. The number of pain breakthrough episodes did not differ between the groups. CONCLUSIONS: Pruritus could be reduced with a combination of epidural ropivacain and oral oxycodone, at the price of a slightly higher pain level. Ropivacaine was not found to be superior to bupivacaine with regard to motor blocks