Katastrofeøvelse som lærings-arena for sykepleierstudenter?

Rapporten omhandler en studie om studenterfaringer med katastrofeøvelse som læringsarena for sykepleierstudenter på andre studieår, der sykepleie til akutt og kritisk syke pasienter er tema. Hensikten med studien var å undersøke hvilke opplevelser og erfaringer studentene fikk ved å delta som helsepersonell i katastrofeøvelsen, og om dette er en aktuell læringsarena for andre års sykepleierstudenter. For å videreutvikle kvalitet fra katastrofeøvelsen som læringsarena, trengs kunnskap basert på studenters erfaringer. Metode: Studien er beskrivende, med tematisk analyse av studentenes logger og hva de reflekterte over etter øvelsen. Logger ble skrevet i slutten av øvelsesdagen. Debriefingen ble gjort etter at loggene var skrevet. Utvalget bestod av 29 studenter på andre studieår i sykepleie og som hadde deltatt på katastrofeøvelsen. Det ble anvendt tematisk analyse av logger som svar på åpne spørsmål, om sykepleierstudentenes forventninger, forberedthet som læreforutsetning, umiddelbare opplevelser av læringsarenaen og læringsutbytter. Tematisk analyse skal gi kunnskap om hva som er tema og hva som karakteriserer tema som tas opp i datamateriale (Graneheim og Lundman, 2004). Resultater: Overbyggende tema var katastrofeøvelse som læringsarena. Analysen førte til fem deltema: 1. Forberedelser, 2. Kunnskap, 3. Forventninger, 4. Trygghet, 5. Læringsutbytter. Konklusjon: Katastrofeøvelsen i sin helhet var en positiv opplevelse for studentene. Deres tilbakemeldinger er entydige og viser at de ønsker å delta på katastrofeøvelser som ledd i utdanningsprosessen

The N-Terminally Truncated µ3 and µ3-Like Opioid Receptors Are Transcribed from a Novel Promoter Upstream of Exon 2 in the Human OPRM1 Gene

The human µ opioid receptor gene, OPRM1, produces a multitude of alternatively spliced transcripts encoding full-length or truncated receptor variants with distinct pharmacological properties. The majority of these transcripts are transcribed from the main promoter upstream of exon 1, or from alternate promoters associated with exons 11 and 13. Two distinct transcripts encoding six transmembrane domain (6TM) hMOR receptors, µ3 and µ3-like, have been reported, both starting with the first nucleotide in exon 2. However, no mechanism explaining their initiation at exon 2 has been presented. Here we have used RT-PCR with RNA from human brain tissues to demonstrate that the µ3 and µ3-like transcripts contain nucleotide sequences from the intron 1-exon 2 boundary and are transcribed from a novel promoter located upstream of exon 2. Reporter gene assays confirmed the ability of the novel promoter to drive transcription in human cells, albeit at low levels. We also report the identification of a “full-length” seven transmembrane domain (7TM) version of µ3, hMOR-1A2, which also contains exon 1, and a novel transcript, hMOR-1Y2, with the potential to encode the previously reported hMOR-1Y receptor, but with exon Y spliced to exon 4 instead of exon 5 as in hMOR-1Y. Heterologous expression of GFP-tagged hMOR variants in HEK 293 cells showed that both 6TM receptors were retained in the intracellular compartment and were unresponsive to exogenous opioid exposure as assessed by their ability to redistribute or affect cellular cAMP production, or to promote intracellular Ca2+ release. Co-staining with an antibody specific for endoplasmic reticulum (ER) indicated that the µ3-like receptor was retained at the ER after synthesis. 7TM receptors hMOR-1A2 and hMOR-1Y2 resided in the plasma membrane, and were responsive to opioids. Notably, hMOR-1A2 exhibits novel functional properties in that it did not internalize in response to the opioid peptide [D-Ala2, N-Me-Phe4, Gly-ol5]enkephalin (DAMGO).© 2013 Andersen et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Industry 4.0: New Technologies and Potential for Increased Value Creation

How to increase value creation from industrial production? This is an enduring question for business leaders, researchers and politicymakers alike. This explorative study examines the concept industry 4.0, which opportunities and challenges this concept presents to SMEs and which factors that affect their ability to take advantage of these new opportunities. First, a theoretical overview of the concepts industry 4.0, innovation, technology, competitiveness and internationalisation is provided. Based on this, a framework for understanding the interlinkages of these concepts is developed. Through a case study of six firms, insight is gathered which are analysed in a discussion based on the framework and theoretical foundation. Finally, some implications for future research, managers and policymakers are presented. Industry 4.0 presents firms with new opportunities to modernise industrial production and increase value creation. This provided they are capable of exploiting the associated uncertainty, have the capabilities necessary and don´t remain too constricted or limited by their existing resource base. While customised products are perceived by the interviewees to hinder automation of production, theory suggests that customisation may in fact be a driving force behind industry 4.0. Furthermore, it may present new opportunities to succeed with combination strategies. Core rigidities, especially along the values dimension may hamper the ability firms have to innovate and adapt to industry 4.0. It is suggested that the importance of dynamic capabilities, absorptive capacity and exploration is likely to increase in the shift to a new regime for industrial production. For managers, this study directs attention to some challenges and opportunities that should be addressed facing the fourth industrial revolution. Several propositions are developed that could be basis for future research, and implications that will be important topics for policy development under industry 4.0 are suggested

Phase specific CoD in elite level team sports

Masteroppgave - Norges idrettshøgskole, 2021Change of direction (CoD) is a fundamental skill in a variety of court- and field-based ball sports. Based on the force momentum relationship CoD performance is based on the ability to generate horizontal force. However, tests of physical performance tend to focus on the ability generate vertical force. Furthermore, CoD is made up of two phases (initial acceleration to deceleration and re-acceleration) that represents different qualities and not captured with the current outcome measurements of overall time. The aim of this study is to determine how different tests of physical performance (horizontal and vertical) relate to overall and phase specific change of direction outcome measurement. 15 male elite handball-players (age 21±1.6 years, height 192±6.5 cm, body weight 96 ± 10.8 kg) completed a battery of tests consisting of two linear unloaded sprints (20m) and the modified 505 test with two left and right foot turns from a two-point start prior to five left and right unilateral lateral jumps. Both CoD and lateral jumps were performed with a 3kg external load provided by a motorized resistance. Overall time was used as outcome measurement for both sprint and the m505 test with the additional phase specific times (phase 1a initial acceleration to deceleration and phase 1b re-acceleration) for the m505 test. Then, both leg press (LP) (pneumatic resistance) and 5 countermovement jump (CMJ) (force platform) was tested. From the leg press average concentric power (LPavg_power) was calculated, while both concentric peak (CMJcon_peak_power) and average power (CMJcon_avg_power) as well as peak eccentric peak power (CMJecc_peak_power) was calculated from the CMJ data. Relationships between test outcome measurements were determined using correlational analysis (Pearson r) with a significance level of p0.05). Neither leg press nor CMJ outcome variables were significantly correlated with neither sprint nor phase 1b time. However, LPavg_power (r=0.73), CMJcon_avg_power (r=0.59) and CMJcon_peak_power (r=0.54) significantly correlated m505 overall time, and LPavg_power (r=0.72), CMJcon_avg_power (r=0.61) and CMJcon_peak_power (r=0.58) significantly correlated phase 1a. Based on the lack of significant correlations between the different performance tests (sprint and CoD), especially for phase 1a, and that there is no significant correlations between phase 1a and 1b, it appears that CoD tests with phase specific analysis provide unique information that might be of important for ball sport athletes. Both leg press and CMJ outcome measurements were correlated with phase 1a and overall m505 time but not with phase 1b and linear sprint performance. Based on current findings it appears that phase specific assessment of m505 tests provide unique information not quantified with CMJ, leg press, lateral jump or linear sprint tests which can be important to performance in ball sport athletes.Institutt for fysisk prestasjonsevne / Department of Physical Performanc

Insomnia and risk for cardiovascular disease

Insomni og risiko for hjerte- og karsykdom Forskning som har blitt utført det siste tiåret har gitt resultater som taler for at dårlig søvn og søvnlidelser bidrar til utvikling av hjerte- og karsykdom. Insomni er definert som en subjektiv opplevelse av å ha problemer med innsoving, for tidlig oppvåkning om morgenen og/eller dårlig søvnkvalitet, og insomni ansees for å være den vanligste søvnforstyrrelsen. Forekomsten av minst ett av symptomene kan være så høy som 33% i den generelle befolkningen. Foreløpig er det få studier på sammenhengen mellom insomni og risiko for framtidig hjerte- og karsykdom. Insomni henger sammen med en ugunstig livsstil og utvikling av metabolsk syndrom, som betyr at personer med insomni ofte har høyere blodtrykk, kolesterol og høyere kroppsmasseindeks enn personer uten slike søvnplager. En annen mulighet for sammenhengen er at søvnproblemene bidrar til økt utskillelse av inflammatoriske stoffer i blodet som kan øke risikoen for hjerte- og karsykdom. Om det er en klar sammenheng mellom metabolsk syndrom og inflammasjon, er heller ikke kjent, og spesielt er dette uavklart i yngre aldersgrupper. Studiene i avhandlingen tok utgangspunkt i den andre Helseundersøkelsen i Nord-Trøndelag (HUNT-2) som foregikk i perioden 1995-97. Alle personer over 20 år i fylket ble invitert, og deltakerne fylte ut spørreskjema, gjennomgikk en klinisk undersøkelse, og det ble tatt blodprøver. I spørreskjemaet ble det blant annet spurt om søvnplager. Fra undersøkelsen startet til og med 2008 ble det fortløpende registrert førstegangs hjerteinfarkt eller hjertesvikt, hvor opplysningene enten ble hentet fra sykehusjournaler i Helse-Nord Trøndelag eller fra Dødsårsaksregisteret. I en undergruppe bestående av 10 000 deltakere ble det målt høy-sensitivt C-reaktivt protein (hsCRP) i blod, som er et mål på graden av inflammasjon i kroppen. Resultatene viste at personer med symptomer på insomni hadde en moderat økt risiko for førstegangs hjerteinfarkt og økt risiko for hjertesvikt sammenliknet med personer uten søvnproblemer. Vi fant også at sjansen for å få hjerteinfarkt eller hjertesvikt var høyere jo flere symptomer på insomni som var tilstede samtidig. Vi tok høyde for betydningen av andre faktorer som kunne påvirke resultatene, og i de statistiske analysene justerte vi for forskjeller i alder, kjønn, ekteskapsstatus, utdanningsnivå, skiftarbeid, blodtrykk, kolesterol, diabetes, vekt, fysisk aktivitet, alkohol og røyking. I tillegg justerte vi for symptomer på depresjon og angst, som begge kan medføre søvnplager. De justerte analysene viste at disse mulig konfunderende faktorene ikke påvirket resultatene i nevneverdig grad, noe som styrker sannsynligheten for at våre funn har en underliggende biologisk årsak. I en annen studie fant vi at den positive sammenhengen mellom metabolsk syndrom og hsCRP var like tydelig i alle aldersgrupper. Til tross for at personer med insomni oftere har metabolsk syndrom, fant vi ingen holdepunkter for at personer med insomni har økt utskillelse av hsCRP. Disse funnene taler imot at inflammasjon, indikert av høy hsCRP, kan forklare sammenhengen mellom insomni og framtidig hjerte- og karsykdom. Til tross for at insomni er forbundet med en moderat risikoøkning for hjerte- og karsykdom, er insomni så vanlig i befolkningen at søvnplager kan spille en viktig rolle for hjertehelse. I tillegg er insomni en lett gjenkjennbar og potensielt håndterbar tilstand. I forebygging av hjerte- og karsykdom bør derfor søvnplager tas med i vurderingen. Det kreves mer forskning på området, slik at man får en bedre forståelse av de underliggende mekanismene.PhD i helsevitenskapPhD in Health Scienc

Management of a life-threatening intercostal artery bleeding, difficult to visualize in open surgery: a case report

Life-threatening bleeding from an intercostal artery is a rare and challenging event. A 74-year-old patient with a right-sided pleural effusion was treated by a pigtail pleural drain. He developed a large haemothorax, initially addressed by a large bore chest tube. As he became haemodynamically unstable, he required an emergency anterolateral right thoracotomy. It was difficult to visualize and reach the bleeding vessel during open surgery. A 30° laparoscopy camera was introduced and the bleeding site was identified. An incision was made directly over the bleeding site and the two ends of the lacerated intercostal artery were ligated by two externally placed figure-of-eight sutures. The patient survived and recovered fully. As most general surgeons, even at smaller hospitals, are familiar with laparoscopy, the technique described here may be useful for other surgeons to employ if a life-threatening intercostal artery injury occurs.publishedVersionThis article is available under the Creative Commons CC-BY-NC license and permits non-commercial use, distribution and reproduction in any medium, provided the original work is properly cited

Laxatives or methylnaltrexone for the management of constipation in palliative care patients

Background: Constipation is common in palliative care; it can generate considerable suffering due to the unpleasant physical symptoms. In the first Cochrane Review on effectiveness of laxatives for the management of constipation in palliative care patients, published in 2006, no conclusions could be drawn because of the limited number of evaluations. This article describes the first update of this review. / Objectives: To determine the effectiveness of laxatives or methylnaltrexone for the management of constipation in palliative care patients. / Search methods: We searched databases including MEDLINE and CENTRAL (The Cochrane Library) in 2005 and in the update to August 2010. / Selection criteria: Randomised controlled trials (RCTs) evaluating laxatives for constipation in palliative care patients. In the update we also included RCTs on subcutaneous methylnaltrexone; an opioid-receptor antagonist that is now licensed for the treatment of opioid-induced constipation in palliative care when response to usual laxative therapy is insufficient. / Data collection and analysis: Two authors assessed trial quality and extracted data. The appropriateness of combining data from the studies depended upon clinical and outcome measure homogeneity. / Main results: We included seven studies involving 616 participants; all under-reported methodological features. In four studies the laxatives lactulose, senna, co-danthramer, misrakasneham, and magnesium hydroxide with liquid paraffin were evaluated. In three methylnaltrexone. In studies comparing the different laxatives evidence was inconclusive. Evidence on subcutaneous methylnaltrexone was clearer; in combined analysis (287 participants) methylnaltrexone, in comparison with a placebo, significantly induced laxation at 4 hours (odds ratio 6.95; 95% confidence interval 3.83 to 12.61). In combined analyses there was no difference in the proportion experiencing side effects, although participants on methylnaltrexone suffered more flatulence and dizziness. No evidence of opioid withdrawal was found. In one study severe adverse events, commonly abdominal pain, were reported that were possibly related to methylnaltrexone. A serious adverse event considered to be related to the methylnaltrexone also occurred; this involved a participant having severe diarrhoea, subsequent dehydration and cardiovascular collapse. / Authors' conclusions: The 2010 update found evidence on laxatives for management of constipation remains limited due to insufficient RCTs. However, the conclusions of this update have changed since the original review publication in that it now includes evidence on methylnaltrexone. Here it found that subcutaneous methylnaltrexone is effective in inducing laxation in palliative care patients with opioid-induced constipation and where conventional laxatives have failed. However, the safety of this product is not fully evaluated. Large, rigorous, independent trials are needed

Self-Reported Sleep Duration, Napping, and Incident Heart Failure: Prospective Associations in the British Regional Heart Study.

OBJECTIVES: To examine the associations between self-reported nighttime sleep duration and daytime sleep and incident heart failure (HF) in men with and without preexisting cardiovascular disease (CVD). DESIGN: Population-based prospective study. SETTING: General practices in 24 British towns. PARTICIPANTS: Men aged 60-79 without prevalent HF followed for 9 years (N = 3,723). MEASUREMENTS: Information on incident HF cases was obtained from primary care records. Assessment of sleep was based on self-reported sleep duration at night and daytime napping. RESULTS: Self-reported short nighttime sleep duration and daytime sleep of longer than 1 hour were associated with preexisting CVD, breathlessness, depression, poor health, physical inactivity, and manual social class. In all men, self-reported daytime sleep of longer than 1 hour duration was associated with significantly greater risk of HF after adjustment for potential confounders (adjusted hazard ratio (aHR) = 1.69, 95% CI = 1.06-2.71) than in those who reported no daytime napping. Self-reported nighttime sleep duration was not associated with HF risk except in men with preexisting CVD (<6 hours: aHR = 2.91, 95% CI = 1.31-6.45; 6 hours: aHR = 1.89, 95% CI = 0.89-4.03; 8 hours: aHR = 1.29, 95% CI = 0.61-2.71; ≥9 hours: aHR = 1.80, 905% CI = 0.71-4.61 vs nighttime sleep of 7 hours). Snoring was not associated with HF risk. CONCLUSION: Self-reported daytime napping of longer than 1 hour is associated with greater risk of HF in older men. Self-reported short sleep (<6 hours) in men with CVD is associated with particularly high risk of developing HF

Endothelial cells-directed angiogenesis in colorectal cancer : Interleukin as the mediator and pharmacological target

Author's accepted version (postprint).This is an Accepted Manuscript of an article published by Elsevier in International Immunopharmacology on 9 Dec 2022.Available online: https://www.sciencedirect.com/science/article/pii/S1567576922010104?via%3DihubacceptedVersio

Self-reported sleep duration and napping, cardiac risk factors and markers of subclinical vascular disease: cross-sectional study in older men.

STUDYOBJECTIVES: Daytime sleep has been associated with increased risk of cardiovascular disease and heart failure (HF), but the mechanisms remain unclear. We have investigated the association between daytime and night-time sleep patterns and cardiovascular risk markers in older adults including cardiac markers and subclinical markers of atherosclerosis (arterial stiffness and carotid intima-media thickness (CIMT)). METHODS: Cross-sectional study of 1722 surviving men aged 71-92 examined in 2010-2012 across 24 British towns from a prospective study initiated in 1978-1980. Participants completed a questionnaire and were invited for a physical examination. Men with a history of heart attack or HF (n=251) were excluded from the analysis. RESULTS: Self-reported daytime sleep duration was associated with higher fasting glucose and insulin levels (p=0.02 and p=0.01, respectively) even after adjustment for age, body mass index, physical activity and social class. Compared with those with no daytime sleep, men with daytime sleep >1 hour, defined as excessive daytime sleepiness (EDS), had a higher risk of raised N-terminal pro-brain natriuretic peptide of ≥400 pg/mL, the diagnostic threshold for HF (OR (95% CI)=1.88 (1.15 to 3.1)), higher mean troponin, reduced lung function (forced expiratory volume in 1 s) and elevated von Willebrand factor, a marker of endothelial dysfunction. However, EDS was unrelated to CIMT and arterial stiffness. By contrast, night-time sleep was only associated with HbA1c (short or long sleep) and arterial stiffness (short sleep). CONCLUSIONS: Daytime sleep duration of >1 hour may be an early indicator of HF