Fauna analyses of a possible electrical cable corridor in the Hardanger fjord

In relation to a possible cable pathway on the sea floor through the inner half of the Hardanger fjord, the Institute for Marine Research has carried out ROV inspections of the benthic faunal communities along 17 selected bottom transects. The surveyed area was restricted to the inner half of the Hardanger fjord – from Sima to Norheimsund in the period 9–29 November 2010. The deep horizontal seabed along the midline of the investigated part of the fjord was dominated by the crustacean Munida sp and its borrow, the sea cucumbers Bathyplotes sp and Stichopous sp, sea-pens, and the echiuran Bonellia sp. The steep walls along the sides of the investigated fjord were populated with less abundant but still relatively frequently-occurring taxa such the sea star Brisingia sp, the large bivalve Acesta sp, and several species of sponges. Though any local recovery time is unknown, we do not consider these populations to be threatened by the possible cable-laying activities. These are not listed in the Norwegian redlist and are not considered as threatened by the OSPAR Convention. However, in the outer part of the investigated area (transects named Kvamsøy cliff wall and Øystese), the vulnerable corals Lophelia pertusa and Anthomastus grandiflorus (redlisted) and Primnoa sp were observed. To avoid threatening impacts to these groups of corals, we therefore recommend using video monitoring during any cable-laying activities

Fauna analyses of a possible electrical cable corridor in the Hardanger fjord

In relation to a possible cable pathway on the sea floor through the inner half of the Hardanger fjord, the Institute for Marine Research has carried out ROV inspections of the benthic faunal communities along 17 selected bottom transects. The surveyed area was restricted to the inner half of the Hardanger fjord – from Sima to Norheimsund in the period 9–29 November 2010. The deep horizontal seabed along the midline of the investigated part of the fjord was dominated by the crustacean Munida sp and its borrow, the sea cucumbers Bathyplotes sp and Stichopous sp, sea-pens, and the echiuran Bonellia sp. The steep walls along the sides of the investigated fjord were populated with less abundant but still relatively frequently-occurring taxa such the sea star Brisingia sp, the large bivalve Acesta sp, and several species of sponges. Though any local recovery time is unknown, we do not consider these populations to be threatened by the possible cable-laying activities. These are not listed in the Norwegian redlist and are not considered as threatened by the OSPAR Convention. However, in the outer part of the investigated area (transects named Kvamsøy cliff wall and Øystese), the vulnerable corals Lophelia pertusa and Anthomastus grandiflorus (redlisted) and Primnoa sp were observed. To avoid threatening impacts to these groups of corals, we therefore recommend using video monitoring during any cable-laying activities

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Kartlegging og analyser av faunaen i Hardangerfjorden før mulig legging av elektrisk kabel i korridor

In relation to a possible cable pathway on the sea floor through the inner half of the Hardanger fjord, the Institute for Marine Research has carried out ROV inspections of the benthic faunal communities along 17 selected bottom transects. The surveyed area was restricted to the inner half of the Hardanger fjord – from Sima to Norheimsund in the period 9–29 November 2010. The deep horizontal seabed along the midline of the investigated part of the fjord was dominated by the crustacean Munida sp and its borrow, the sea cucumbers Bathyplotes sp and Stichopous sp, sea-pens, and the echiuran Bonellia sp. The steep walls along the sides of the investigated fjord were populated with less abundant but still relatively frequently-occurring taxa such the sea star Brisingia sp, the large bivalve Acesta sp, and several species of sponges. Though any local recovery time is unknown, we do not consider these populations to be threatened by the possible cable-laying activities. These are not listed in the Norwegian redlist and are not considered as threatened by the OSPAR Convention. However, in the outer part of the investigated area (transects named Kvamsøy cliff wall and Øystese), the vulnerable corals Lophelia pertusa and Anthomastus grandiflorus (redlisted) and Primnoa sp were observed. To avoid threatening impacts to these groups of corals, we therefore recommend using video monitoring during any cable-laying activities

Fauna analyses of a possible electrical cable corridor in the Hardanger fjord

In relation to a possible cable pathway on the sea floor through the inner half of the Hardanger fjord, the Institute for Marine Research has carried out ROV inspections of the benthic faunal communities along 17 selected bottom transects. The surveyed area was restricted to the inner half of the Hardanger fjord – from Sima to Norheimsund in the period 9–29 November 2010. The deep horizontal seabed along the midline of the investigated part of the fjord was dominated by the crustacean Munida sp and its borrow, the sea cucumbers Bathyplotes sp and Stichopous sp, sea-pens, and the echiuran Bonellia sp. The steep walls along the sides of the investigated fjord were populated with less abundant but still relatively frequently-occurring taxa such the sea star Brisingia sp, the large bivalve Acesta sp, and several species of sponges. Though any local recovery time is unknown, we do not consider these populations to be threatened by the possible cable-laying activities. These are not listed in the Norwegian redlist and are not considered as threatened by the OSPAR Convention. However, in the outer part of the investigated area (transects named Kvamsøy cliff wall and Øystese), the vulnerable corals Lophelia pertusa and Anthomastus grandiflorus (redlisted) and Primnoa sp were observed. To avoid threatening impacts to these groups of corals, we therefore recommend using video monitoring during any cable-laying activities

Fauna analyses of a possible electrical cable corridor in the Hardanger fjord

In relation to a possible cable pathway on the sea floor through the inner half of the Hardanger fjord, the Institute for Marine Research has carried out ROV inspections of the benthic faunal communities along 17 selected bottom transects. The surveyed area was restricted to the inner half of the Hardanger fjord – from Sima to Norheimsund in the period 9–29 November 2010. The deep horizontal seabed along the midline of the investigated part of the fjord was dominated by the crustacean Munida sp and its borrow, the sea cucumbers Bathyplotes sp and Stichopous sp, sea-pens, and the echiuran Bonellia sp. The steep walls along the sides of the investigated fjord were populated with less abundant but still relatively frequently-occurring taxa such the sea star Brisingia sp, the large bivalve Acesta sp, and several species of sponges. Though any local recovery time is unknown, we do not consider these populations to be threatened by the possible cable-laying activities. These are not listed in the Norwegian redlist and are not considered as threatened by the OSPAR Convention. However, in the outer part of the investigated area (transects named Kvamsøy cliff wall and Øystese), the vulnerable corals Lophelia pertusa and Anthomastus grandiflorus (redlisted) and Primnoa sp were observed. To avoid threatening impacts to these groups of corals, we therefore recommend using video monitoring during any cable-laying activities

Shiga Toxin Regulates Its Entry in a Syk-dependent Manner

Shiga toxin (Stx) is composed of an A-moiety that inhibits protein synthesis after translocation into the cytosol, and a B-moiety that binds to Gb3 at the cell surface and mediates endocytosis of the toxin. After endocytosis, Stx is transported retrogradely to the endoplasmic reticulum, and then the A-fragment enters the cytosol. In this study, we have investigated whether toxin-induced signaling is involved in its entry. Stx was found to activate Syk and induce rapid tyrosine phosphorylation of several proteins, one protein being clathrin heavy chain. Toxin-induced clathrin phosphorylation required Syk activity, and in cells overexpressing Syk, a complex containing clathrin and Syk could be demonstrated. Depletion of Syk by small interfering RNA, expression of a dominant negative Syk mutant (Syk KD), or treatment with the Syk inhibitor piceatannol inhibited not only Stx-induced clathrin phosphorylation but also endocytosis of the toxin. Also, Golgi transport of Stx was inhibited under all these conditions. In conclusion, our data suggest that Stx regulates its entry into target cells

Combination of health care service use and the relation to demographic and socioeconomic factors for patients with musculoskeletal disorders: a descriptive cohort study

Abstract Background Patients with musculoskeletal disorders (MSDs) access health care in different ways. Despite the high prevalence and significant costs, we know little about the different ways patients use health care. We aim to fill this gap by identifying which combinations of health care services patients use for new MSDs, and its relation to clinical characteristics, demographic and socioeconomic factors, long-term use and costs, and discuss what the implications of this variation are. Methods The study combines Norwegian registers on health care use, diagnoses, comorbidities, demographic and socioeconomic factors. Patients (≥ 18 years) are included by their first health consultation for MSD in 2013–2015. Latent class analysis (LCA) with count data of first year consultations for General Practitioners (GPs), hospital consultants, physiotherapists and chiropractors are used to identify combinations of health care use. Long-term high-cost patients are defined as total cost year 1–5 above 95th percentile (≥ 3 744€). Results We identified seven latent classes: 1: GP, low use; 2: GP, high use; 3: GP and hospital; 4: GP and physiotherapy, low use; 5: GP, hospital and physiotherapy, high use; 6: Chiropractor, low use; 7: GP and chiropractor, high use. Median first year health care contacts varied between classes from 1–30 and costs from 20€-838€. Eighty-seven percent belonged to class 1, 4 or 6, characterised by few consultations and treatment in primary care. Classes with high first year use were characterised by higher age, lower education and more comorbidities and were overrepresented among the long-term high-cost users. Conclusion There was a large variation in first year health care service use, and we identified seven latent classes based on frequency of consultations. A small proportion of patients accounted for a high proportion of total resource use. This can indicate the potential for more efficient resource use. However, the effect of demographic and socioeconomic variables for determining combinations of service use can be interpreted as the health care system transforming unobserved patient needs into variations in use. These findings contribute to the understanding of clinical pathways and can help in the planning of future care, reduction in disparities and improvement in health outcomes for patients with MSDs

Associations between outpatient care and later hospital admissions for patients with chronic obstructive pulmonary disease - a registry study from Norway

Abstract Background Although chronic obstructive pulmonary disease (COPD) admissions put a substantial burden on hospitals, most of the patients’ contacts with health services are in outpatient care. Traditionally, outpatient care has been difficult to capture in population-based samples. In this study we describe outpatient service use in COPD patients and assess associations between outpatient care (contact frequency and specific factors) and next-year COPD hospital admissions or 90-day readmissions. Methods Patients over 40 years of age residing in Oslo or Trondheim at the time of contact in the period 2009–2018 were identified from the Norwegian Patient Registry (in- and outpatient hospital contacts, rehabilitation) and the KUHR registry (contacts with GPs, contract specialists and physiotherapists). These were linked to the Regular General Practitioner registry (characteristics of the GP practice), long-term care data (home and institutional care, need for assistance), socioeconomic and–demographic data from Statistics Norway and the Cause of Death registry. Negative binomial models were applied to study associations between combinations of outpatient care, specific care factors and next-year COPD hospital admissions and 90-day readmissions. The sample consisted of 24,074 individuals. Results A large variation in the frequency and combination of outpatient service use for respiratory diagnoses (GP, emergency room, physiotherapy, contract specialist and outpatient hospital contacts) was apparent. GP and outpatient hospital contact frequency were strongly associated to an increased number of next-year hospital admissions (1.2–3.2 times higher by increasing GP frequency when no outpatient hospital contacts, 2.4-5 times higher in combination with outpatient hospital contacts). Adjusted for healthcare use, comorbidities and sociodemographics, outpatient care factors associated with lower numbers of next-year hospitalisations were fees indicating interaction between providers (7% reduction), spirometry with GP or specialist (7%), continuity of care with GP (15%), and GP follow-up (8%) or rehabilitation (18%) within 30 days vs. later following any current year hospitalisations. For 90-day readmissions results were less evident, and most variables were non-significant. Conclusion As increased use of outpatient care was strongly associated with future hospitalisations, this further stresses the need for good communication between providers when coordinating care for COPD patients. The results indicated possible benefits of care continuity within and interaction between providers

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89·6 per cent) compared with that in countries with a middle (753 of 1242, 60·6 per cent; odds ratio (OR) 0·17, 95 per cent c.i. 0·14 to 0·21, P < 0·001) or low (363 of 860, 42·2 per cent; OR 0·08, 0·07 to 0·10, P < 0·001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high‐HDI countries (risk difference −9·4 (95 per cent c.i. −11·9 to −6·9) per cent; P < 0·001), but the relationship was reversed in low‐HDI countries (+12·1 (+7·0 to +17·3) per cent; P < 0·001). In multivariable models, checklist use was associated with a lower 30‐day perioperative mortality (OR 0·60, 0·50 to 0·73; P < 0·001). The greatest absolute benefit was seen for emergency surgery in low‐ and middle‐HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low‐HDI countries was half that in high‐HDI countries