Patients with established cancer cachexia lack the motivation and self-efficacy to undertake regular structured exercise

Objectives Patients with advanced cancer frequently suffer a decline in activities associated with involuntary loss of weight and muscle mass (cachexia). This can profoundly affect function and quality of life. Although exercise participation can maintain physical and psychological function in patients with cancer, uptake is low in cachectic patients who are underrepresented in exercise studies. To understand how such patients’ experiences are associated with exercise participation we investigated exercise history, self-confidence and exercise motivations in patients with established cancer cachexia, and relationships between relevant variables. Methods Lung and gastrointestinal cancer outpatients with established cancer cachexia (n=196) completed a questionnaire exploring exercise history and key constructs of the Theory of Planned Behaviour relating to perceived control, psychological adjustment and motivational attitudes. Results Patients reported low physical activity levels and few undertook regular structured exercise. Exercise self-efficacy was very low with concerns it could worsen symptoms and cause harm. Patients showed poor perceived control and a strong need for approval but received little advice from healthcare professionals. Preferences were for low intensity activities, on their own, in the home setting. Regression analysis revealed no significant factors related to the independent variables. Conclusions Frequently employed higher intensity, group exercise models do not address the motivational and behavioural concerns of cachectic cancer patients in this study. Developing exercise interventions which match perceived abilities and skills are required to address challenges of self-efficacy and perceived control identified. Greater engagement of health professionals with this group is required to explore potential benefits of exercise

Algebras of Finite Representation Type

In this thesis we are considering finite dimensional algebras. We prove that any basic and indecomposable finite dimensional algebra A over an algebraically closed field k is isomorphic to a bound quiver algebra. Furthermore, if A is hereditary we prove that it is isomorphic to a path algebra. Finally, we prove that a path algebra is of finite representation type if and only if the underlying graph of the quiver is a Dynkin diagram. This is done using reflection functors

The Arnold Conjecture

Arnolds formodning sier at en Hamiltonsk symplektomorfi på en symplektisk mangfoldighet har minst like mange fikspunkter som en funksjon på mangfoldigheten har kritiske punkter. I denne oppgaven gir vi en introduskjon symplektisk topologi, og beviser at Arnolds formodning er tilfredsstilt for Hamiltonske symplektomorfier på en kompakt mangfoldighet som er tilstrekkelig nære identiten i en spesifik C^1 topologi, og for Hamiltonske symplektomorfier på den 2n-dimensjonelle torusen.The Arnold conjecture states that a Hamiltonian symplectomorphism of a symplectic manifold has at least as many fixed points as a function on the manifold has critical points. In this thesis, we give an introduction to symplectic topology, and we show that the Arnold conjecture is satisfied for Hamiltonian symplectomorphisms of a compact symplectic manifold that are sufficiently close to the identity in a particular C^1 topology, and for Hamiltonian symplectomorphisms of the standard 2n-dimensional torus

A longitudinal study of muscle strength and function in patients with cancer cachexia

Purpose Patients with cancer frequently experience an involuntary loss of weight (in particular loss of muscle mass), defined as cachexia, with profound implications for independence and quality of life. The rate at which such patients’ physical performance declines has not been well established. The aim of this study was to determine the change in muscle strength and function over 8 weeks in patients with already established cancer cachexia, to help inform the design and duration of physical activity interventions applicable to this patient group. Methods Patients with thoracic and gastrointestinal cancer, with unintentional weight loss of >5% in 6 months or BMI < 20 plus 2% weight loss were included. Physical and functional assessments (baseline, 4 weeks, 8 weeks) included: isometric quadriceps and hamstring strength, handgrip, standing balance, 10m walk time and timed up and go. Results Fifty patients (32 male), mean ±SD age 65 ±10 years and BMI 24.9 ±4.3kg/m2 were recruited. Thoracic cancer patients had lower muscle strength and function (p0.05). Baseline variables did not differentiate between completers and non-completers (p>0.05). Conclusions More than a third of patients with established cancer cachexia in our study were stable over 8 weeks, suggesting a subgroup who may benefit from targeted interventions of reasonable duration. Better understanding the physical performance parameters which characterize and differentiate these patients has important clinical implications for cancer multidisciplinary team practice

Prevalence of anemia and iron deficiency among women in rural Nepal - A cross-sectional cohort study

Abstrakt Mål: Det er lite kunnskap om prevalens av anemi blant kvinner i rurale Nepal, og denne studien ønsket å utvide kunnskapsgrunnlaget. Vi ville også undersøke forekomsten av jernmangel. Metode: Data ble samlet inn i 2019-2020 fra ikke-gravide, gifte kvinner i Bolde. Kvinnene bodde på 1800 meters høyde over havet. Som anbefalt av WHO, brukte vi grenseverdi på 12.7 g/dL for hemoglobin, i stedet for 12.0 g/dL for å definere anemi. For å finne jernstatus hos kvinnene brukte vi markørene ferritin, jern og TIBC, i tillegg til å kalkulere transferrinmetning. Resultater: Totalt bestod studien av 714 kvinner fra 21 til 82 år. Median hemoglobin var 14.4 g/dL (10.4-18.2 g/dL). Den vanligste etniske gruppen var Adhivasi/Janajati (82.8%), de fleste hadde månedlig inntekt under NPR 24 000 (65.7%) og manglet formell utdanning (84.9%). Prevalensen av anemi var 5.7%, og varierte fra 5.4% til 6.1% blant henholdsvis postmenopausale kvinner og kvinner i reproduktiv alder. Kvinner fra 21-30 år hadde en høyere prevalens med 13.2%, men forskjellen var ikke signifikant. Median jernverdi var 110 µg/dL (15-301 µg/dL) og median transferrinmetning var 27.1% (3.9-79.4%). Basert på ferritin ≤15 ng/mL og ≤30 ng/mL, hadde henholdsvis 4.1% og 18.3% jernmangel. Blant kvinnene med anemi var det 20% som hadde jernmangelanemi. Vi fant hemoglobinverdier over referanseområdet (>16 g/dL) blant 7.0% av kvinnene. Konklusjon: Vi fant en lavere forekomst av anemi sammenlignet med landsgjennomsnittet, men funnene våre var sammenlignbare med studier fra samme område. I tillegg fant vi en proporsjonalt lavere forekomst av jernmangelanemi sammenlignet med andre studier fra regionen.Abstract Objective: There are few data on the prevalence of anemia among women in rural Nepal, and the study aimed to expand the knowledge on the subject. We also wanted to examine the frequency of iron deficiency, as well as study the risk factors associated with anemia. Methods: Data were collected in 2019-2020 from non-pregnant, married women in Bolde. The women were residing at an altitude of about 1890 meters above sea level. To adjust for altitude, we used a cut-off of 12.7 g/dL for hemoglobin instead of 12.0 g/dL to define anemia, as recommended by WHO. Ferritin, iron and TIBC were analyzed, and transferrin saturation was calculated to assess iron status. Results: Altogether, 714 women aged 21-82 years were included. The median hemoglobin was 14.4 g/dL (10.4-18.2 g/dL). Most of the study population belong to the Adhivasi/Janajati ethnicity (82.8%), had a monthly income less than NPR 24 000 (65.7%) and did not have any formal education (84.9%). The prevalence of anemia was 5.7%, and the frequency varied from 5.4% to 6.1% among postmenopausal women and women of reproductive age respectively. Women aged 21-30 displayed the highest prevalence of anemia (13.2%), but the difference was not significant. Median iron level was 110 µg/dL (15-301 µg/dL), and the median transferrin saturation was 27.1% (3.9-79.4%). Based on ferritin levels of ≤15 ng/mL and ≤30 ng/mL, 4.1% and 18.3% had iron deficiency. Among those with anemia, 20% had iron deficiency anemia. We found that 7% of the population exhibited hemoglobin levels above the upper reference range (>16 g/dL). Conclusion: The prevalence of anemia among women in rural Nepal was low compared to the nationwide rate, however in line with previous studies from the same area. Furthermore, we found the frequency of iron deficiency anemia to be proportionally lower compared to other studies from the region

Prevalence of anemia and iron deficiency among women in rural Nepal A cross-sectional cohort study

Abstrakt Mål: Det er lite kunnskap om prevalens av anemi blant kvinner i rurale Nepal, og denne studien ønsket å utvide kunnskapsgrunnlaget. Vi ville også undersøke forekomsten av jernmangel. Metode: Data ble samlet inn i 2019-2020 fra ikke-gravide, gifte kvinner i Bolde. Kvinnene bodde på 1800 meters høyde over havet. Som anbefalt av WHO, brukte vi grenseverdi på 12.7 g/dL for hemoglobin, i stedet for 12.0 g/dL for å definere anemi. For å finne jernstatus hos kvinnene brukte vi markørene ferritin, jern og TIBC, i tillegg til å kalkulere transferrinmetning. Resultater: Totalt bestod studien av 714 kvinner fra 21 til 82 år. Median hemoglobin var 14.4 g/dL (10.4-18.2 g/dL). Den vanligste etniske gruppen var Adhivasi/Janajati (82.8%), de fleste hadde månedlig inntekt under NPR 24 000 (65.7%) og manglet formell utdanning (84.9%). Prevalensen av anemi var 5.7%, og varierte fra 5.4% til 6.1% blant henholdsvis postmenopausale kvinner og kvinner i reproduktiv alder. Kvinner fra 21-30 år hadde en høyere prevalens med 13.2%, men forskjellen var ikke signifikant. Median jernverdi var 110 µg/dL (15-301 µg/dL) og median transferrinmetning var 27.1% (3.9-79.4%). Basert på ferritin ≤15 ng/mL og ≤30 ng/mL, hadde henholdsvis 4.1% og 18.3% jernmangel. Blant kvinnene med anemi var det 20% som hadde jernmangelanemi. Vi fant hemoglobinverdier over referanseområdet (>16 g/dL) blant 7.0% av kvinnene. Konklusjon: Vi fant en lavere forekomst av anemi sammenlignet med landsgjennomsnittet, men funnene våre var sammenlignbare med studier fra samme område. I tillegg fant vi en proporsjonalt lavere forekomst av jernmangelanemi sammenlignet med andre studier fra regionen.Abstract Objective: There are few data on the prevalence of anemia among women in rural Nepal, and the study aimed to expand the knowledge on the subject. We also wanted to examine the frequency of iron deficiency, as well as study the risk factors associated with anemia. Methods: Data were collected in 2019-2020 from non-pregnant, married women in Bolde. The women were residing at an altitude of about 1890 meters above sea level. To adjust for altitude, we used a cut-off of 12.7 g/dL for hemoglobin instead of 12.0 g/dL to define anemia, as recommended by WHO. Ferritin, iron and TIBC were analyzed, and transferrin saturation was calculated to assess iron status. Results: Altogether, 714 women aged 21-82 years were included. The median hemoglobin was 14.4 g/dL (10.4-18.2 g/dL). Most of the study population belong to the Adhivasi/Janajati ethnicity (82.8%), had a monthly income less than NPR 24 000 (65.7%) and did not have any formal education (84.9%). The prevalence of anemia was 5.7%, and the frequency varied from 5.4% to 6.1% among postmenopausal women and women of reproductive age respectively. Women aged 21-30 displayed the highest prevalence of anemia (13.2%), but the difference was not significant. Median iron level was 110 µg/dL (15-301 µg/dL), and the median transferrin saturation was 27.1% (3.9-79.4%). Based on ferritin levels of ≤15 ng/mL and ≤30 ng/mL, 4.1% and 18.3% had iron deficiency. Among those with anemia, 20% had iron deficiency anemia. We found that 7% of the population exhibited hemoglobin levels above the upper reference range (>16 g/dL). Conclusion: The prevalence of anemia among women in rural Nepal was low compared to the nationwide rate, however in line with previous studies from the same area. Furthermore, we found the frequency of iron deficiency anemia to be proportionally lower compared to other studies from the region

Hearing Aid for Social Situations

Conventional hearing aids perform badly in environments with reverberation and noise. In this paper the use of microphone arrays as hearing aids to increase directivity and signal-to-noise ratio (SNR) in a noisy environment are evaluated. A portable microphone array prototype is constructed to test beamforming algorithms in a real environment. Delay and sum beamforming, sub-band beamforming and an experimental type of binaural beamforming is implemented in real-time using the digital signal processor ADSP-BF533. Results from testing showed that a four microphone array using sub-band beamforming outperforms delay and sum beamforming using the same number of microphones. The results also showed that it is possible to obtain binaural impression of the array output and source localization using the proposed binaural technique called beamspreading

‘A potentially ticking time bomb’ – barriers for prevention, diagnosis, and treatment of cardiovascular disease in people with intellectual disabilities

Background Research suggests that people with intellectual disabilities have a higher risk for cardiovascular disease than the general population. The aim of this study was to identify barriers for the prevention, diagnosis, and treatment of cardiovascular disease for people with intellectual disabilities. Method We conducted individual interviews with relatives and general practitioners and focus group interviews with staff working at an assisted home facility, a cardiac ward, an obesity clinic and two rehabilitation centres (n = 33) in Norway. Inductive approach and thematic analysis were used to analyse the data. Results We identified barriers on an individual and a structural level. The underlying reason for these barriers is that health problems, such as cardiovascular disease, are regularly overlooked as the condition of intellectual disability overshadows other possible diagnoses. Conclusion This focus on intellectual disability rather than other explanations leads to shortcomings in the prevention, diagnoses, and treatment of cardiovascular disease in this group.publishedVersio

Community-based Multidimensional Cancer Rehabilitation in Norway – a Feasibility Study

Under embargo until: 2023-07-28Background: Cancer survival is often accompanied by late effects that can be mitigated by tailored rehabilitation. In Norway this has traditionally been offered as residential programs, whereas community-based cancer rehabilitation programs are lacking. Objective: The aim was to assess feasibility and acceptability of a newly developed community-based multidimensional cancer rehabilitation program in Norway. Methods: A feasibility study with a mixed methods explanatory sequential design. The intervention was a 12-week group-based rehabilitation program comprising five components: goal setting, physical exercise, psychoeducation, individual follow-up consultations and peer support. Feasibility was assessed through recruitment, retention and intervention delivery. Acceptability was assessed through intervention adherence and participant evaluation. Qualitative data were generated from focus group interviews. Statistical analyses were descriptive and qualitative data were transcribed and analyzed using framework analyses. Results: Sixty participants started and 55 completed the 12-week rehabilitation program. The majority were female (80%) and mean age was 56 years. The largest diagnostic group was breast cancer (42%). Retention was high (92%), as was adherence rates for all intervention components. The exercise component was rated the most beneficial, followed by individual consultations and peer support. Qualitative findings contributed to explaining the high adherence and positive evaluation. Conclusions: High retention, strong adherence and positive evaluation imply that the community-based program was feasible and acceptable to cancer survivors. Implications for practice: The results will aid intervention refinement and contribute to a future randomized controlled trial to examine its effectiveness. If successful, the rehabilitation program could be implemented in the Norwegian Cancer Pathway “Home”.acceptedVersio