Impact of EMG Changes in Continuous Vagal Nerve Monitoring in High-Risk Endocrine Neck Surgery

Background: Continuous vagal intraoperative neuromonitoring (CIONM) of the recurrent laryngeal nerve (RLN) may reduce the risk of RLN lesions during high-risk endocrine neck surgery such as operation for large goiter potentially requiring transsternal surgery, advanced thyroid cancer, and recurrence. Methods: Fifty-five consecutive patients (41 female, median age 61 years, 87 nerves at risk) underwent high-risk endocrine neck surgery. CIONM was performed using the commercially available NIM-Response 3.0 nerve monitoring system with automatic periodic stimulation (APS) and matching endotracheal tube electrodes (Medtronic Inc.). All CIONM events (decreased amplitude/increased latency) were recorded. Results: APS malfunction occurred on three sides (3 %). A total of 138 CIONM events were registered on 61 sides. Of 138, 47 (34 %) events were assessed as imminent (13 events) or potentially imminent (34 events) lesions, whereas 91 (66 %) were classified as artifacts. Loss of signal was observed in seven patients. Actions to restore the CIONM baseline were undertaken in 58/138 (42 %) events with a median 60 s required per action. Four RLN palsies (3 transient, 1 permanent) occurred: one in case of CIONM malfunction, two sudden without any significant previous CIONM event, and one without any CIONM event. The APS vagus electrode led to temporary damage to the vagus nerve in two patients. Conclusions: CIONM may prevent RLN palsies by timely recognition of imminent nerve lesions. In high-risk endocrine neck surgery, CIONM may, however, be limited in its utility by system malfunction, direct harm to the vagus nerve, and particularly, inability to indicate RLN lesions ahead in time.publishedVersio

Political parties' framing of farm animal welfare: A fragmented picture

In this article, we draw from qualitative interviews with political parties' representatives and a content analysis of party programs to identify how political parties frame animal welfare policies in Norway. In analyzing the framing of animal welfare and its significance for understanding agricultural post-exceptionalism, we found that though they frame animal welfare issues in conflicting ways, most see Norwegian animal welfare as reasonably good but perceive potential for improvement. They also generally understand societal claims as lacking or having an unclear factual basis, which has legitimized their nonaction as political parties. Even so, because of active new actors such as animal welfare organizations and retailers, the parties do not believe that public pressure will wane. Although introducing new farm animal welfare policies can represent a move towards post-exceptionalism in Europe's agri-food sector, the discourse on animal welfare policies amongst political parties implies that such is not the case in Norway.Political parties' framing of farm animal welfare: A fragmented picturepublishedVersio

Kronisk syk maktbalanse: En kvalitativ studie av brukermedvirkning og makt i NAVs tilretteleggingsprosesser

Denne masteroppgaven undersøker hvordan personer med kronisk sykdom opplever maktbalansen i relasjonen til NAV-veiledere i tilretteleggingsprosessen. Studien er forankret i en forståelse av møtet mellom individ og velferdssystem som et asymmetrisk relasjonelt rom, hvor både strukturelle, institusjonelle og profesjonelle maktformer er virksomme. Med et fokus på makt, brukermedvirkning, autonomi og profesjonsutøvelse, søker oppgaven å synliggjøre hvordan personer med langvarige helseplager erfarer sin posisjon som brukere innenfor et system som både skal tilby hjelp og ivareta kontroll. Studien bygger på seks kvalitative, semistrukturerte intervjuer med personer som lever med kronisk sykdom og har vært i kontakt med NAV over lengre tid. Analysen av intervjuene er gjennomført som en tematisk analyse basert på Braun og Clarke (2006, 2013), med støtte i kvalitativ metodeforståelse fra Malterud (2017) og Kvale & Brinkmann (2015). Det er lagt vekt på å ivareta informantenes stemmer og erfaringer, samtidig som analysen er teoretisk informert og kontekstuelt forankret. Det teoretiske rammeverket kombinerer ulike maktteorier og velferdssosiologiske perspektiver. Foucaults(1978, 2004, 2012) begreper om disiplinerende og produktiv makt belyser hvordan normer og institusjonelle praksiser former subjektposisjoner og selvforståelser. Lukes’ tredimensjonale maktbegrep (2005) anvendes for å analysere både synlig beslutningsmakt og mer subtile former for maktutøvelse, som påvirkning på ønsker og oppfatninger. Lipskys(1980) teori om bakkebyråkrati og profesjonelt skjønn bidrar til å forstå hvordan veilederne i NAV utøver skjønn innenfor rammene av et system preget av kontroll og målstyring. Perspektiver på kronisk sykdom(Bury, 1982), New Public Management (Evetts, 2009, Øverbye, 2010) og arbeidslinjas normative føringer danner en viktig kontekst for forståelsen av NAVs organisering og praksis. Funnene viser at informantene ofte opplever NAV som en utilgjengelig og byråkratisk instans med sterk definisjonsmakt. Opplevelsen av avhengighet og avmakt går igjen i alle intervjuene, og flere informanter beskriver at de må “kjempe” for å bli trodd, forstått og få tiltak som er tilpasset deres situasjon. Reell brukermedvirkning fremstår som begrenset og betinget, der brukernes stemme ofte underordnes systemets logikk og standardiserte prosesser. Samtidig viser analysen at det finnes variasjoner i veilederpraksis: enkelte veiledere utøver sitt skjønn på en måte som åpner for dialog, fleksibilitet og respekt, mens andre følger regelverket mekanisk og uten rom for individuelle hensyn. Oppgaven drøfter hvordan NAVs systemlogikk – preget av effektivitet, rapportering og kontroll – risikerer å marginalisere brukere med sammensatte og lite “målbare” behov. Dette kommer særlig til uttrykk i møte med personer med kronisk sykdom, som ofte ikke passer inn i arbeidslinjas idealer om aktivitet og selvforsørgelse. Oppgaven peker på spenningen mellom velferdsstatens normative idealer om inkludering og støtte, og de styringsmekanismer som ipraksis produserer distanse, mistillit og standardisering. Avslutningsvis argumenterer oppgaven for at det eksisterer en betydelig maktasymmetri i relasjonen mellom bruker og system, og at denne maktubalansen svekker muligheten for reell brukermedvirkning. Ved å rette søkelyset mot brukernes erfaringer med NAV, belyses viktige utfordringer knyttet til profesjonell maktutøvelse, systemets innretning og velferdsstatens legitimitet. Oppgaven bidrar dermed til en kritisk forståelse av hvordan velferdsforvaltningen opererer i praksis – og hvordan den oppleves av dem som er mest avhengige av den

How does a selection of male elite players in handball use basic techniques in mental training?

Faglærer i kroppsøving og idrettsfag Fakultet for lærerutdanning, kultur og idrettKRO35

Patient-tailored levothyroxine dosage with pharmacokinetic/pharmacodynamic modeling: A novel approach after total thyroidectomy

Background: After seven decades of levothyroxine (LT4) replacement therapy, dosage adjustment still takes several months. We have developed a decision aid tool (DAT) that models LT4 pharmacometrics and enables patient-tailored dosage. The aim of this was to speed up dosage adjustments for patients after total thyroidectomy. Methods: The DAT computer program was developed with a group of 46 patients post-thyroidectomy, and it was then applied in a prospective randomized multicenter validation trial in 145 unselected patients admitted for total thyroidectomy for goiter, differentiated thyroid cancer, or thyrotoxicosis. The LT4 dosage was adjusted after only two weeks, with or without application of the DAT, which calculated individual free thyroxine (fT4) targets based on four repeated measurements of fT4 and thyrotropin (TSH) levels. The individual TSH target was either <0.1, 0.1–0.5, or 0.5–2.0 mIU/L, depending on the diagnosis. Initial postoperative LT4 dosage was determined according to clinical routine without using algorithms. A simplified DAT with a population-based fT4 target was used for thyrotoxic patients who often went into surgery after prolonged TSH suppression. Subsequent LT4 adjustments were carried out every six weeks until target TSH was achieved. Results: When clinicians were guided by the DAT, 40% of patients with goiter and 59% of patients with cancer satisfied the narrow TSH targets eight weeks after surgery, as compared with only 0% and 19% of the controls, respectively. The TSH was within the normal range in 80% of DAT/goiter patients eight weeks after surgery as compared with 19% of controls. The DAT shortened the average dosage adjustment period by 58 days in the goiter group and 40 days in the cancer group. For thyrotoxic patients, application of the simplified DAT did not improve the dosage adjustment. Conclusions: Application of the DAT in combination with early postoperative TSH and fT4 monitoring offers a fast approach to LT4 dosage after total thyroidectomy for patients with goiter or differentiated thyroid cancer. Estimation of individual TSH-fT4 dynamics was crucial for the model to work, as removal of this feature in the applied model for thyrotoxic patients also removed the benefit of the DAT

Smart teknologi for et bærekraftig landbruk

publishedVersio

Smart teknologi for et bærekraftig landbruk

Denne rapporten oppsummerer hovedresultater og anbefalinger fra det tre-årige prosjektet Smart teknologi for et bærekraftig landbruk (SmaT, 2018-2021). Prosjektet har vært et samarbeid mellom Felleskjøpet Agri, Norsk landbrukssamvirke og Mære landbruksskole og forskere fra Ruralis og NTNU, og har også involvert teknologiorienterte bønder og andre fagfolk. Arbeidet er finansiert av Forskningsmidlene for jordbruk og matindustri, samt med egeninnsats fra brukerpartnerne i prosjektet.publishedVersio

Political parties' framing of farm animal welfare: A fragmented picture

In this article, we draw from qualitative interviews with political parties' representatives and a content analysis of party programs to identify how political parties frame animal welfare policies in Norway. In analyzing the framing of animal welfare and its significance for understanding agricultural post-exceptionalism, we found that though they frame animal welfare issues in conflicting ways, most see Norwegian animal welfare as reasonably good but perceive potential for improvement. They also generally understand societal claims as lacking or having an unclear factual basis, which has legitimized their nonaction as political parties. Even so, because of active new actors such as animal welfare organizations and retailers, the parties do not believe that public pressure will wane. Although introducing new farm animal welfare policies can represent a move towards post-exceptionalism in Europe's agri-food sector, the discourse on animal welfare policies amongst political parties implies that such is not the case in Norway

Political parties' framing of farm animal welfare: A fragmented picture

In this article, we draw from qualitative interviews with political parties' representatives and a content analysis of party programs to identify how political parties frame animal welfare policies in Norway. In analyzing the framing of animal welfare and its significance for understanding agricultural post-exceptionalism, we found that though they frame animal welfare issues in conflicting ways, most see Norwegian animal welfare as reasonably good but perceive potential for improvement. They also generally understand societal claims as lacking or having an unclear factual basis, which has legitimized their nonaction as political parties. Even so, because of active new actors such as animal welfare organizations and retailers, the parties do not believe that public pressure will wane. Although introducing new farm animal welfare policies can represent a move towards post-exceptionalism in Europe's agri-food sector, the discourse on animal welfare policies amongst political parties implies that such is not the case in Norway