Voluntary and involuntary hospitalizations in acute psychiatric wards in Norway

ENGLISH ABSTRACT Background and aim The use of coercion in mental health care services has been widely debated, and it is agreed that the level of coercive hospitalizations should be as low as possible. In 2004-2005, SINTEF Health was commissioned by the Norwegian Directorate of Health and Social Affairs to build up, establish and lead an Evaluation Network for Acute Psychiatry. SINTEF Health invited all local health trusts in Norway to participate. The purpose was for the local health trusts in Norway to come together and establish new knowledge about acute psychiatry - an area that so far had too little focus with regard to quality assurance and research in Norway. Thus, the Multi-Center Study for Acute Psychiatry (MAP) was established. This dissertation takes a closer look at the use of involuntary hospitalizations and the factors that influence this process. Study One: - Predictors of involuntary hospitalizations to acute psychiatry Rates of involuntary hospitalized (IH) patients and involuntary psychiatric treatment of people with mental illness reflect characteristics of national mental health care and laws or other legal frameworks. International studies on the rates of IH in psychiatric hospitals show great variability in results. It is, however, very difficult to compare figures due to differences in methodology of studies and legislation between countries. The aims of Study One were to examine to (i) the rates of patients admitted to 20 acute psychiatric ward units in Norway for IH, (ii) compare voluntary hospitalized (VH) with IH patients’ and (iii) describe the predictors of IH. Study Two: - Voluntary and involuntary acute psychiatric hospitalization in Norway: A 24h follow up study The Norwegian Mental Health Care Act states that patients who are involuntarily admitted to a hospital must be reassessed by a psychiatrist or a specialist in clinical psychology within 24 hours to assess whether the patient fulfils the legal criteria of the psychiatric status and symptoms. International research on the process of reassessment of IH in psychiatry is scarce, and an investigation of Norway's routine re-evaluation of IH patients may increase knowledge and understanding of this aspect of psychiatric treatment. The aims of Study Two were to (i) investigate the rate of conversion from IH to a VH status; and (ii) identify the predictors of conversion from IH to VH. Study Three: - Patients’ attitudes to psychiatric hospitalization: A national multicentre study in Norway. Being IH raises a number of issues: attitudes from family and society, stigma of being hospitalized against patients own will, and the conflict of autonomy versus need for treatment. Law/policymakers, governments and the public want a reduction in IH. The aims of Study Three were to (i) investigate to what degree do patients referred for VH and IH state that they want admission or not; and (ii) what are the predicting factors for IH patients who stated they wanted admission. Methods The Multi-centre study of Acute Psychiatry (MAP) included all cases of acute consecutive psychiatric admissions in 20 acute psychiatric units in Norway, representing about 75% of the Norwegian acute psychiatric units during 2005–2006. Data included an Admission registration form describing admission variables and the rating scales of Global Assessment of Functioning and Health of the Nation Outcome Scales. Of the full sample of 3.326 referred patients for admission, 3.051 patients provided data on wanting admission or not. We studied demographics and characteristics of the two groups (VH and IH). We then did a logistic regression analysis by using generalized linear mixed modelling based on data from 1.231 IH patients to calculate predictors of IH who wanted admission. Results Study One: Fifty-six percent of the sample were VH and 44% were IH. Regression analysis identified contact with police, referred by physicians who did not know the patient, contact with health services within the last 48 hours, not living in own apartment or house, high scores for aggression, level of hallucinations and delusions, and contact with an out-of office hours / emergency primary health care clinic within the last 48 hours and low GAF symptom score as predictors for IH. IH patients were older, more often male, non-Norwegian, unmarried and had a lower level of education. They were more likely to have a disability pension or received social benefits, and were more often admitted during evenings and nights, found to have more frequent substance abuse, less often responsible for children and were less frequently motivated for admission. IH patients had less contact with psychiatric services before admission. Most patients were referred because of a deterioration of their psychiatric illness. Study Two: Out of 1468, admissions who were IH (44%), 1148 (78.2%) remained on IH status, while 320 patients (21.8%) were converted to VH. The predictors of conversion from IH to VH (IH → VH) after re evaluation of a specialist included patients wanting admission, better scores on Global Assessment of Symptom scale (GAF), fewer hallucinations and delusions and higher alcohol intake. Study Three: 69.5% of the patients stated they wanted admission. As expected, 96.5% of the VH stated they wanted admission. However, nearly one-third (29.7%) of IH patients also expressed a need for hospitalization. In a multivariate analysis, we found that being IH and wanting admission were predicted by not being transported by police, having less aggression and using less drugs. Conclusions IH seems to be guided by the severity of psychiatric symptoms and characteristics of the referred patient such as male gender, substance abuse, contact with GP or not, aggressive behaviour, low level of social functioning and lack of motivation. There was a need for assistance by the police in a significant number of cases. This complexity challenges the organization of primary health care and psychiatric health services and highlights a need to consider better pathways to care. The 24-hour re – assessment period for patients referred for IH, as stipulated by the Norwegian Mental Health Care Act, appeared to give adequate opportunity to reduce unnecessary IH, while safeguarding the patient's right to VH. It is important to explore the attitude of a patient who has been referred to involuntary hospitalization. This can form the basis for a future dialogue about alternative ways of dealing with the patient's serious mental condition, and as far as possible preserve the patient's autonomy and co-determination, and if possible reduce unnecessary involuntary hospitalizations.Some patients who expressed the need for admission are still being admitted to acute psychiatric units under IH rather than VH. Thus, it is imperative that more effort should be made in the process of referral and admission by communication with patients in order to achieve a VH. By allowing more time for the referral and admission process, the referring physician may gain more knowledge of the patient such that an IH would not be necessary. It is not within the study to establish causality concerning wrongful involuntary admission, but it is important to focus on the patient’s wishes in such complicated hospitalization processes. It is conceivable that coercion is used too much in some places. However, at the same time patients may need to receive treatment in a psychiatric hospital when this is necessary despite not being in agreement with the referral physician. Coercion should only be used based on Mental Health Care Act criteria and when it is strictly necessary for the treatment.NORWEGIAN ABSTRACT Bakgrunn og mål Bruken av tvang i psykisk helseverntjeneste er omdiskutert, og det er enighet om at nivået av tvangsinnleggelser skal være så lavt som mulig. I 2004 - 2005 fikk SINTEF Helse i oppdrag fra Sosial- og helsedirektoratet å bygge opp, etablere og lede et Evalueringsnettverk for akuttpsykiatri. SINTEF Helse inviterte alle helseforetak i landet til å delta. Hensikten var at helseforetakene kom sammen og etablerte ny kunnskap om akuttpsykiatri – et område som så langt hadde et for lite fokus med hensyn til kvalitetssikring og forskning i Norge. Dermed ble Multi - senter studiet for Akutt Psykiatri (MAP) etablert. Denne avhandlingen ser nærmere på bruken av tvangsinnleggelser og hvilke faktorer som påvirker dette

PAST - Profile-based Algorithm for Scheduling Tests, Intelligent Test Scheduling in the Cloud

Computer technology is an essential part of today's society with more and more critical infrastructure and important services being moved to the Internet every day. This widespread use of the Internet has increased the need for scalable hardware and software that can process a lot of traffic at the same time while not using excessive energy. This has contributed to the meteoric rise of cloud computing, and many companies are moving their applications and services to data centers. With computers and the Internet being such important parts of all areas of society, it is crucial that new software is tested before being shipped to the Internet. This is where software testing comes in, with most modern IT solutions having automated tests that often run in the cloud. These tests are triggered when changes to the code are uploaded to its repository, and are often running on the same cloud environment as the company's other applications and services. This project seeks to combine efficient power-saving strategies for cloud environments with software testing by developing an algorithm that schedules tests according to how resource demands change during their run-time. It does this by using workload profiles that are defined by how the resource usage of a given test changes over time, which differs from traditional workload profiles that often represent the resource demand as a static number. The goal is to use these profiles to make a schedule that allows compatible tests to be executed simultaneously on one server without exceeding limits on resource use.publishedVersio

Do interprofessional teams matter? : A survey-based study of patients and team members in hospitals and rehabilitation centres in secondary health care in Western Norway.

Background Health care today is becoming more complex, and patients must interact with an array of health care professionals working within and between various health care settings. Coordinated health services meeting the patients’ needs are certainly a major challenge for the modern society. Health care professionals working in interprofessional teams is a prioritised structure and are employed to ensure coordinated, collaborative care trajectories meeting the patients’ needs in hospitals and rehabilitation centres within secondary health care. Therefore, the overall aim of this thesis is to investigate specific team functions in interprofessional teams in hospitals and rehabilitation centres, as well as to examine how these team functions are associated with continuity of care, rehabilitation benefit, and changes in health and functioning, as reported by the patients. Materials and methods The first part of the thesis (Paper I) is based on data from a cross-sectional multi-centre study investigating the quality of communication and supportive relationships in teams working in various hospitals in secondary health care. In Paper I, these qualities in teams are explored by means of a Norwegian version of the Relational Coordination Survey (RCS) with data from 263 health care professionals working in 23 care processes. RCS data were collected in 2012 and 2013. The second part of this thesis (Papers II and III) utilises data from a longitudinal cohort study investigating associations between team functions in interprofessional rehabilitation teams and patient-reported outcomes in somatic rehabilitation centres. This section of the thesis also investigates associations between patient experienced interprofessional team functions, measured by Nijmegen Continuity Questionnaire-Norwegian version (NCQ-N), and changes in patient-reported health and functioning. RCS data were collected from 94 health care professionals working in 15 interprofessional teams in somatic rehabilitation centres in Western Norway in the first half of 2016 (Papers II and III). Patients were invited to participate when they were accepted for a rehabilitation stay at a somatic rehabilitation centre. Baseline data for the 701 included patients were collected during the first half of 2015, while follow-up data were collected one year after data collection at baseline. In the first section of this thesis, linear mixed-effect models and one-way analyses of variance were employed in the statistical analyses. In the second part of this thesis, linear models were utilised to assess associations between independent (RCS, Papers II and III and NCQ-N, Paper III) and dependent variables (the patient-reported outcomes). Results A main finding of this present study was that written clinical procedures describing the care process were associated with increased quality of communication in teams (Paper I). Another main finding was the positive association between interprofessional teams scoring high RCS supportive relationship scores and patient-reported team continuity (Paper II). Furthermore, high patients reported team, personal and cross-boundary continuity was associated with improved health for the patients (Paper III). The RCS subscale scores were significantly higher among health professionals holding similar occupational roles within the team, compared to communication and relationships between other members of the team (Paper I). However, the RCS quality of communication and supportive relationships in teams did not show significant associations with changes in patient-reported health and functioning (Paper III). Conclusions and implications Working in interprofessional teams with common strategies towards reaching the patients’ goals is the preferred way of delivering health care in hospitals and rehabilitation centres in secondary health care. This present study found that the quality of communication in interprofessional rehabilitation teams was associated with improved patient-reported team continuity, reflecting the current practice of interprofessional teamwork. In addition, this present study found that patients experiencing team continuity, personal and cross-boundary continuity in the rehabilitation process reported more improvement in their health state one year after rehabilitation. On the other hand, the quality of communication and relationships in teams as reported by professionals were not associated with improvements in patient-reported health and functioning. This finding could indicate that patient-reported measures of team continuity is a better predictor for the content of teamwork most important for positive rehabilitation outcomes compared to RCS subscales. Health care professionals having similar occupational roles had better communication and relationships with other professionals holding similar occupational roles. This finding could indicate that poor understanding of other team members’ roles that consequently hinders the quality of communication and relationships. Written clinical procedures were positively associated with increased quality of communication in teams. This finding indicates that written clinical procedures might increase the quality of health care delivery, improve continuity of care and be facilitated through the implementation of evidence-based clinical pathways

Mechanisms and Geochemical Models of Core Formation

The formation of the Earth's core is a consequence of planetary accretion and processes in the Earth's interior. The mechanical process of planetary differentiation is likely to occur in large, if not global, magma oceans created by the collisions of planetary embryos. Metal-silicate segregation in magma oceans occurs rapidly and efficiently unlike grain scale percolation according to laboratory experiments and calculations. Geochemical models of the core formation process as planetary accretion proceeds are becoming increasingly realistic. Single stage and continuous core formation models have evolved into multi-stage models that are couple to the output of dynamical models of the giant impact phase of planet formation. The models that are most successful in matching the chemical composition of the Earth's mantle, based on experimentally-derived element partition coefficients, show that the temperature and pressure of metal-silicate equilibration must increase as a function of time and mass accreted and so must the oxygen fugacity of the equilibrating material. The latter can occur if silicon partitions into the core and through the late delivery of oxidized material. Coupled dynamical accretion and multi-stage core formation models predict the evolving mantle and core compositions of all the terrestrial planets simultaneously and also place strong constraints on the bulk compositions and oxidation states of primitive bodies in the protoplanetary disk.Comment: Accepted in Fischer, R., Terasaki, H. (eds), Deep Earth: Physics and Chemistry of the Lower Mantle and Core, AGU Monograp

Do Bank Branch Closures Hurt the Local Economy?

Denne masteroppgaven undersøker hvordan nedleggelser av bankfilialer påvirker den lokale økonomien ved å analysere data fra norske kommuner i perioden 2007-2019. I løpet av perioden ble omtrent 30% av landets bankfilialer lagt ned. Tidligere forskning fra Sverige og USA tyder på at filialnedleggelser påvirker foretak negativt gjennom reduserte utlån (Amberg & Becker, 2024; Nguyen, 2019). Vi utvider dette til effekten på lokaløkonomien i norske kommuner. Sammenhengen mellom bankfilaler og lokaløkonomien går i begge retninger. En banks beslutning om å legge ned en filial kan påvirke den lokale økonomien gjennom redusert utlån til bedrifter. Samtidig kan de lokale forholdene påvirke bankens overskudd og forårsake at filialen legges ned, noe som gjør det vanskelig å skille mellom årsak og virkning. For å håndtere mulig endogenitet følger vi Amberg og Becker (2024), og bruker en shift-share-instrumentvariabelstrategi som utnytter nasjonale trender i filialnedleggelser, vektet med den lokale sammensetninger av banker. I tråd med anbefalinger fra Borusyak et al. (2025), endret for å passe paneldata, estimerer vi både statiske og dynamiske modeller basert på instrumenter konstruert fra nasjonale og regionale banker i Norge. Resultatene viser gjennomgående små og statistisk ikke-signifikante effekter av filialnedleggelser på sysselsetting, antall foretak og median husholdningsinntekt på kommunenivå. Dette null-resultatet passer dårlig med deler av den tidligere forskningen på temaet.We examine the impact of bank branch closures on the local economy by analysing data from Norwegian municipalities between 2007 and 2019. During this period approximately 30% of bank branches were closed nationwide Previous research in Sweden and the United States indicates that branch closure impairs business performance through reduced relationship lending (Amberg & Becker, 2024; Nguyen, 2019). We extend this research to the broader effects on the local economy in Norwegian municipalities. The relationship between a bank branch and the local economy goes in both directions. A bank`s decision to close a branch may influence the local economy through reduced lending to local firms. But also, local economic conditions may impact bank profits and motivate branch closure, making it difficult to distinguish cause from effect. Following Amberg and Becker (2024), we address this endogeneity problem by using a shift-share instrument variable strategy that uses national trends in bank downsizing, weighted by local bank compositions. Applying some methodological considerations due to Borusyak et al (2025) and adapting the methodology to a panel data setting, we estimate both static and dynamic models using instruments based on national and regional banks in Norway. The results generally show small and statistically insignificant effects of bank closures on employment, firm counts and median household income at the municipality level. This null result is in tension with what we would expect based on much of the previous literature

Tracking objects in 3D using Stereo Vision

This report describes a stereo vision system to be used on a mobile robot. The system is able to triangulate the positions of cylindrical and spherical objects in a 3D environment. Triangulation is done in real-time by matching regions in two images, and calculating the disparities between them

Effect of a prebiotic galactooligosaccharide mixture (B-GOS®) on gastrointestinal symptoms in adults selected from a general population who suffer with bloating, abdominal pain, or flatulence

Background Prebiotics exert beneficial effects upon gastrointestinal (GI) environment, but this is not always accompanied with a positive effect on GI symptoms. B‐GOS® is a prebiotic with high selectivity toward bifidobacteria and a variety of other beneficial effects in humans. Here, we investigated its effect on GI symptoms in adults who suffer with bloating, abdominal pain, and flatulence. Methods In a double‐blind, placebo‐controlled, crossover study, 83 subjects from the general population who presented with GI symptoms during screening period and had a predicted probability of functional bowel disorder of more than 75% were randomized to receive either a placebo or the B‐GOS® treatment (2.75 g/d). Subjects were screened for the presence of GI symptoms for 1 week, they consumed the treatments for 2 weeks, and then went through a 2‐week washout period, before switching to the other treatment for the final 2 weeks. GI symptoms, bowel movements, and stool consistency were assessed in daily and weekly questionnaires. Quality of life was assessed weekly and depression and anxiety at the end of each treatment period. Results B‐GOS® resulted in significantly (P < 0.001) lower scores for bloating, flatulence, and abdominal pain both from baseline and placebo at the end of first week. The effect was sustained at the end of second week. It had no effect on the number of bowel movements, consistency of stools, quality of life, or mood throughout the study. Conclusion Results suggest that B‐GOS® could possibly be used in the management of bloating, flatulence, or abdominal pain and warrant further investigation

Submarine gas seepage in a mixed contractional and shear deformation regime: Cases from the Hikurangi oblique-subduction margin

Gas seepage from marine sediments has implications for understanding feedbacks between the global carbon reservoir, seabed ecology and climate change. Although the relationship between hydrates, gas chimneys and seafloor seepage is well established, the nature of fluid sources and plumbing mechanisms controlling fluid escape into the hydrate zone and up to the seafloor remain one of the least understood components of fluid migration systems. In this study we present the analysis of new three-dimensional high-resolution seismic data acquired to investigate fluid migration systems sustaining active seafloor seepage at Omakere Ridge, on the Hikurangi subduction margin, New Zealand. The analysis reveals at high resolution, complex overprinting fault structures (i.e. protothrusts, normal faults from flexural extension, and shallow (<1 km) arrays of oblique shear structures) implicated in fluid migration within the gas hydrate stability zone in an area of 2x7 km. In addition to fluid migration systems sustaining seafloor seepage on both sides of a central thrust fault, the data show seismic evidence for sub-seafloor gas-rich fluid accumulation associated with proto-thrusts and extensional faults. In these latter systems fluid pressure dissipation through time has been favored, hindering the development of gas chimneys. We discuss the elements of the distinct fluid migration systems and the influence that a complex partitioning of stress may have on the evolution of fluid flow systems in active subduction margins

Sulfide melts and long-term low seismic wavespeeds in lithospheric and asthenospheric mantle

Some studies of lithospheric and asthenospheric seismic structure, report mantle velocities as low as ∼4% below the reference models used. While these low wavespeeds may be attributed to thermal effects in tectonically young or actively volcanic regions, in older, tectonically stable regions low velocity anomalies apparently persist even past the decay time of any thermal perturbation, rendering such a mechanism implausible. Low volume melts can also reduce wavespeeds, but their buoyancy should drain them upward away from source regions, preventing significant accumulation if they are able to segregate. Sulfide, ubiquitous as inclusions in lithospheric mantle xenoliths, forms dense, non-segregating melts at temperatures and volatile fugacities characteristic of even old lithospheric mantle. We show that 1–5 volume percent sulfide melts can act to permanently create reductions up to 5.5% in seismic wavespeeds in areas of the lithosphere and the asthenosphere disturbed by prior melting events that carry and concentrate sulfide