Progressing from initial non-shockable rhythms to a shockable rhythm is associated with improved outcome after out-of-hospital cardiac arrest

Background: Cardiac arrest patients with initial non-shockable rhythm progressing to shockable rhythm have been reported to have inferior outcome to those remaining non-shockable.Wewanted to confirm this observation in our prospectively collected database, and assess whether differences in cardiopulmonary resuscitation (CPR) quality could help to explain any such difference in outcome. Materials and methods: All out-of-hospital cardiac arrest (OHCA) cases in the Oslo EMS between May 2003 and April 2008 were retrospectively studied, and cases with initial asystole or pulseless electrical activity (PEA) were selected. Pre-hospital and hospital records, Utstein forms, and continuous ECGs were reviewed. Quality of CPR and outcome were compared for patients who progressed to a shockable rhythm and patients who remained in non-shockable rhythms. Results: Of 753 cases with initial non-shockable rhythms 517 (69%) had asystole and 236 (31%) PEA. Ninetyeight (13%) patients progressed to a shockable rhythm, while 653 (87%) remained non-shockable during the entire resuscitation effort (two unknown). Hands-off ratio was higher in the shockable than the nonshockable group, 0.21±0.12 vs. 0.16±0.10 (p = 0.000) with no significant difference in compression and ventilation rates. Overall survival to hospital discharge was 3%; 7% in the shockable and 2% in the nonshockable group (p = 0.014). Based on a multivariate logistic analysis young age, initial PEA, and progressing to a shockable rhythm were associated with better outcome. Conclusion: Progressing from initial non-shockable rhythms to a shockable rhythm was associated with improved outcome after OHCA. This occurred despite more pauses in chest compressions in the shockable group, probably related to defibrillation attempts

Managing risk with freight futures from IMAREX : testing hedging effectiveness and the unbiasedness hypothesis

This thesis investigates the hedging effectiveness and unbiasedness hypothesis of the IMAREX PM4TC freight futures contract. First, we present theory of dry bulk shipping and risk management. Then, we study hedging effectiveness of the futures contract. This is performed by using regression models and a VAR model to calculate constant hedge ratios and a VAR-GARCH model to calculate time-varying hedge ratios. We find the hedging effectiveness to range from 29,50% to 31,78%, when hedging one of the four T/C routes underlying the futures contract. Hedging with time-varying hedge ratios is in most cases shown to be superior to hedging with a constant hedge ratio. Finally, the unbiasedness hypothesis is studied. We find that one month to maturity futures contracts give an unbiased prediction of the spot price at maturity. This implies that a hedger can trade in one month to maturity futures contracts without paying a risk premium. A rolling hedge can thus be executed efficiently. In addition, the futures price can be used to guide in decision making. Unbiasedness is also indicated for two and three months to maturity contracts, but, due to a small data sample and residual diagnostics problems, we have not drawn any conclusions. Acknowledgements We would like to thank our advisors, Associate Professor Jonas Andersson and Professor Siri Pettersen Strandenes, for their contributions and helpful comments. At Jebsens, Jermyn Chua, Magnar Ekerhovd, Frode Høyland and Michael Tysoe have been very helpful with their support and clarifying observations. Our thanks also go to Mikal Bøe and Lene Marie Refvik at IMAREX, who have been cooperative by answering questions and supplying us with freight futures data. In addition, we would like to express our appreciation to John Michalis and Janet Sykes at The Baltic Exchange, who have given us access to spot price data. Finally, we thank Kjetil Tversland for designing the front page and printing the thesis

En kvalitativ studie om forholdet mellom unge muslimers tro og fremstillingen som gis i religion- og etikkfagets lærebøker i den videregående skolen

Denne oppgaven har hatt som tema å undersøke hvordan forholdet er mellom unge muslimers tro og lærebøkenes framstilling av islam, og hva muslimske ungdommer mener om det som står skrevet om deres tro i lærebøkene i den videregående skolen. Hensikten med oppgaven er å bidra til økt kunnskap om hvordan muslimske ungdommer selv forstår og uttrykker sin tro. Mitt prosjekt har fokusert på islam og hva som skjer når lærebøkene møter troen til shia-muslimske ungdommer. Jeg har arbeidet med utgangspunkt i følgende problemstilling: Hvordan er forholdet mellom lærebøkenes og unge muslimers framstilling av tro, og hva mener unge muslimer om det som står skrevet om deres tro i religion- og etikkfagets lærebøker i den videregående skole? Det bærende teoriperspektivet i oppgaven er den fortolkende religionspedagogikken som er utviklet av Robert Jackson ved the University of Warwick hvor refleksjon over religion knyttes til individnivå så vel som gruppenivå og tradisjonsnivå. For å finne svar på problemstillingen valgte jeg å benytte meg av kvalitativ metode, nærmere bestemt lærebokanalyse og fokusgruppeintervju med unge muslimer. Studiens hovedfunn er knyttet til at ungdommene følte at det ikke gis en balansert framstilling, men at sunni-islam gis mer oppmerksomhet i lærebøkene. Ungdommene problematiserte også billedbruk og oppslag som kan virke stigmatiserende fordi det blir fokusert på praksiser som ungdommene ikke opplever som representative. Et annet interessant funn var at informantene beskrev hvordan de kunne bruke ulike innganger til samtalen om islam, og at den endres ut i fra hvilken kontekst og agenda som ligger til grunn for samtalen. I følge noen av mine informanter var det en forskjell i det å snakke med ikke-muslimer og muslimer om tro. Hvis man snakket med ikke-muslimer var det på et mer generelt nivå. Kvinneaspektet i religionen var også noe de viste engasjement for, og flere av informantene mente at kvinnesynet med fordel kunne fått en noe mer nyansert framstilling i lærebøkene.

Changes from 1986 to 2006 in reasons for liking leisure-time physical activity among adolescents

Reasons for participating in physical activity (PA) may have changed in accordance with the general modernization of society. The aim is to examine changes in self-reported reasons for liking leisure-time physical activity (LTPA) and their association with self-reported LTPA over a 20-year period. Data were collected among nationally representative samples of 13-year-olds in Finland, Norway, and Wales in 1986 and 2006 (N = 9252) as part of the WHO cross-national Health Behaviour in School-aged Children (HBSC) study. Univariate ANOVAs to establish differences according to gender, year, and country were conducted. In all countries, 13-year-olds in 2006 tended to report higher importance in terms of achievement and social reasons than their counterparts in 1986, while changes in health reasons were minor. These reasons were associated with LTPA in a similar way at both time points. Health reasons for liking LTPA were considered most important, and were the strongest predictor of LTPA. The findings seem robust as they were consistent across countries and genders. Health education constitutes the most viable strategy for promoting adolescents' motivation for PA, and interventions and educational efforts could be improved by an increased focus on LTPA and sport as a social activity

A school based study of time trends in food habits and their relation to socio-economic status among Norwegian adolescents, 2001–2009

Background: In recent years, adolescents’ food habits have become a major source of concern, and substantial policy and intervention efforts have been made to influence adolescents to consume more fruit and vegetables and less sweets and soft drink. Particular attention has been devoted to the social gradient in food habits, aiming to reduce dietary inequality. However, few internationally published studies have evaluated trends in teenagers’ food habits, or investigated how dietary inequalities develop. Methods: We used Norwegian cross-sectional data from the international Health Behaviour in School-Aged Children (HBSC) study, collected via three nationally representative and comparable questionnaire surveys in 2001, 2005 and 2009. Food habits were identified by students’ consumption of fruit, vegetables, sweets and sugar rich soft drink. Socio-economic status (SES) was measured with the Family Affluence Scale (FAS). Multilevel logistic regression was used to analyze the data. Results: The analyses indicated an overall positive trend in food habits among adolescents in Norway. Students were more likely to consume fruit (OR 1.76, CI 1.61-1.92) and vegetables (OR 1.51, CI 1.37-1.66) daily in 2005 as compared to 2001, and were less likely to consume sweets (OR 0.58, CI 0.51-0.66 resp. OR 0.77, CI 0.67-0.90) and soft drink (OR 0.55, CI 0.49-0.62 resp. OR 0.84, CI 0.73-0.96) daily when comparing, respectively, 2005 with 2001 and 2009 with 2005. Across all survey years, students with higher SES were more likely to eat fruit (OR 1.47, CI 1.32-1.65) and vegetables (OR 1.40, CI 1.24-1.58) daily than did students with lower SES. Our analyses indicated that the socio-economic differences were stable in the period 2002 - 2010, with uniform improvement in fruit and vegetable consumption across all SES levels. No significant associations between SES and intake of sweets and sugar-added soft drink were found. Conclusion: The study identifies an overall improvement in diet among adolescents over a period characterized by onset of as well as ongoing initiatives targeting young people’s food habits. However, the observed socio-economic gradient in fruit and vegetable consumption remained unchanged

What Does It Take To Invest In Protective Actions Against Flooding?

Floods are one of the most destructive natural hazards in Europe and are predicted to be more severe than before in Norway. Lack of effective communication is pointed out to be one of the barriers to protective behavior against flooding, and the need for improvement is existent. Psychological distance and risk perception affect how one makes decisions, which is the foundation of behavior. Therefore, it is essential to investigate the relationship and how it predicts willingness to invest in protective actions. Further, it is of interest to explore how being a parent moderate the association, as it is assumed that parents are more willing to invest in protection for their children. A total of 293 respondents participated in the survey, including 183 parents and 110 non-parents. The hypothesized model was analyzed using SPSS. The results indicated that psychological distance negatively correlated with willingness to invest and risk perception, and there was a positive correlation between risk perception and willingness to invest. Risk perception significantly mediated the association between psychological distance and willingness to invest. The most exciting finding was that the mediation depended on the conditions of the moderator values and that parents were significant, whereas non-parents were not. Thus, all four hypotheses were supported by statistically significant results. The findings improve flood risk communication strategies through important indications on activating flood mitigation behavior. Further, the current study presents empirical results that add to previous parental theories and environmental psychology research

Effect of DHA on growth of two human colon cancer cell lines - the role of ER stress and unfolded protein response

Docosahexaenoic acid (DHA; 22:6n-3) is an essential omega-3 polyunsaturated fatty acid important to human health. DHA has been shown to have anticancer properties by reducing cancer cell proliferation, inducing apoptosis and differentiation, and inhibiting tumor cell invasion, angiogenesis and metastasis. Several mechanisms have been proposed to explain the effect of DHA in cancer. In colon cancer DHA may cause oxidative stress, changes in membrane composition or function, alterations in eicosanoid synthesis, signal transduction and regulation of gene expression. We have previously shown that DHA induces ER stress and growth arrest in some human cancer cell lines. The aim of this study was to investigate the molecular mechanisms involved in DHA anticancer properties, especially the role of endoplasmic reticulum (ER) stress, in human colon cancer cell lines with different DHA sensitivity. Two colon cancer cell lines, grown in the same culture medium, were selected based on their differences in sensitivity towards DHA. Cell growth response after DHA treatment was measured by cell counting and MTT viability assay, showing that DLD-1 cells were sensitive to DHA (70 μM) with about 50 % growth inhibition after 48 h, while LS411N cells were considered insensitive with almost no growth inhibition at the same conditions. RT-PCR and western blotting were used to measure transcript and protein levels of ER stress and unfolded protein response (UPR) mediators, like activating transcription factor 4 (ATF4), which was found to be induced. Confocal imaging was done to investigate the localization of proteins of interest, like ATF4 that had an increased signal in the nucleus after DHA (70 and 105 μM) treatment. The role of ATF4 in DHA-mediated growth inhibition in DLD-1 cells was investigated using siRNA. DLD-1 cells transfected with siRNA against ATF4 showed a clear reduction in both ATF4 protein level and cell growth compared to cells transfected with non targeting siRNA. However, the ATF4 knockdown did not affect the DHA-mediated growth inhibition, suggesting that ATF4 alone is not responsible for the DHA-mediated effect. Preliminary results also indicated a possible increase in autophagic flux in DLD-1 cells after treatment with DHA (70 μM). In the LS411N cells, the UPR was slightly induced at later timepoints, while there was no change in autophagic flux. The role of lipid peroxidation was also studied by co-incubating both cell lines with vitamin E and DHA. Vitamin E did not conteract DHA-mediated growth inhibition in DLD-1 cells, indicating that lipid peroxidation is not the main cause of DHA-mediated cytotoxicity

A far away world about which we know nothing : teaching the European Union in Norwegian schools

In this thesis, I explore how Norwegian Social Science textbooks present the EU, and how teachers teach about the EU in the Norwegian equivalent to the British Sixth Form (“videregående school”). I also study the pupils’ opinion about the teaching. The analysis is based on a textbook analysis of seven of the books in use right now in Norwegian videregående school, in addition to in-depth interviews with nine teachers and group interviews with 15 pupils. The most specific finding regarding the textbook analysis is that the books do not have enough text to cover the EU sufficiently. Actually, six of the seven books do not fulfil the learning objective regarding the EU satisfactory. In addition, the analysis shows that several of the textbooks present a sceptical view of the EU. The most consistent finding regarding the interviews is how little the pupils actually know and remember about the EU. It is likely to assume that the pupils know and remember so little, because there is so little teaching about the EU. Regardless of how the teachers teach, it seems that the amount of teaching is the problem. If the Government wishes the population to acquire greater knowledge about the EU, this research suggests the need for expanding the hours taught about the EU in school

Behaviour change interventions in primary health care

As part of a public health promotion strategy, and in order to prevent noncommunicable diseases (NCDs), the Directorate of Health recommends that Norwegian municipalities establish Healthy Life Centres (HLCs). This thesis builds on two studies that aim to: 1) find evidence of effect from interventions similar to the HLCs’ interventions and explore if intervention characteristics could explain differences in effect between studies, and 2) evaluate the effects of HLC interventions. In Study 1, we performed a systematic review of 48 randomised controlled trials (RCTs) of diet and physical activity interventions. We performed meta-analyses of 50 short-term (ES 0.37) and 32 long-term results (ES 0.24). Meta-regression analyses revealed that using several behaviour change techniques (BCTs), and especially the BCTs goal setting of behaviour or self-monitoring of behaviour, were associated with positive results at both short and long-term. Several other BCTs were associated with a long-term effect. There was evidence that a patient-centred and autonomous supportive approach in counselling seemed important to maintain change over time. In sum, interventions similar to the HLCs’ interventions were modestly effective in changing behaviour in the short-term, with reduced effect long-term. These results may support the design and implementation of HLC interventions and help to identify the competence needed in counselling for maintenance of change. In Study 2, we evaluated the effect of HLCs’ interventions on physical activity, selfreported health and quality of life, quality of diet and diet behaviour, use of tobacco, sleep pattern, and body image. We designed a six-month randomised controlled trial (RCT) with a longitudinal follow-up 24 months after baseline. We recruited 118 participants (35% of those invited). The participants were predominantly middleaged, obese, physically active, females motivated for change. Reasons for attendance were: being overweight, wanting to increase physical activity, to have a healthier diet, and to address musculoskeletal and mental health challenges. At the start of the trial, 70% of participants did 150 minutes of moderate to vigorous physical activity (MVPA) per week. The HLC interventions had no effect on the amount of time spent in MVPA or in sedentary behaviour after six months. However, those less physically active in the intervention group significantly increased their activity levels, as compared with the less active in the control group. The drop-out rate was 30%, and participants with mental health issues, musculoskeletal challenges or chronic somatic disease were more likely to leave the study. The HLCs recruited participants with lower education and income as intended. It is unlikely that interventions that encompass people who are already physically active will improve population health or mitigate social differences in health. The differences we identified in physical activity between educational groups seemed to widen during follow-up, and the interventions did not mitigate these differences