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Does Migration Widen Mortality Inequalities Between Rural and Urban Areas? Long-Term Mortality Risk Among Rural Stayers, Rural Migrants, Urban Migrants, and Returners in Norway
Get PDFIn many countries, the main internal migration trend has been from rural to urban areas. However, there is little knowledge of whether internal migration from rural to urban areas contributes to widening geographical inequalities in health and survival. In the present study, we investigated differences in long-term mortality risk among stayers (individuals who did not move from their rural municipality), rural migrants (individuals who moved to other rural municipalities), urban migrants (individuals who moved to urban municipalities), and returners (individuals who first moved to urban municipalities and then returned to rural municipalities). Data from a population-based survey carried out among adults in Finnmark aged 30–62 years in 1987/88 was linked to the National Population Register and the Norwegian Cause of Death Registry to identify migration and deaths from recruitment to the health survey up to December 2017. Flexible parametric survival models were used to examine the age-varying associations between different migration careers and mortality. For both men and women, the estimated mortality risk was lower for all internal migrant groups when compared to stayers. However, for men, the findings only applied to ages under 85 years for rural migrants, 81 years for urban migrants, and 71 years for returners, while for women, the findings applied to ages under 75 years for rural migrants, 78 years for urban migrants, and the age range 46–86 years for returners. The lower mortality risk observed among migrants contributes to widening health inequalities between rural depopulation areas and areas with increasing populations. Migrants to rural areas may limit this effect
The future Barents Sea—A synthesis of physical, biogeochemical, and ecological changes toward 2050 and 2100
Get PDFThe Barents Sea is a hotspot for ongoing Arctic climate change, manifested in a rapid warming of the ocean
and the atmosphere and a strong decline of the winter sea-ice cover. These changes in the physical
environment have large consequences for marine ecosystems, including commercial fish populations. In
a warmer future climate, both physical and ecological changes are expected to intensify. Here, we provide
a first comprehensive overview of future climate change projections for the Barents Sea, and the associated
physical, biogeochemical, and ecological consequences based on climate models and end-to-end ecosystem
models. We also discuss potential future changes in human activities and their impacts, including changes in
shipping activity and contaminants. We analyze results for two time horizons—the near-future (2040–2050)
and the far-future (2090–2100)—and for two different emission scenarios: one with moderate future
greenhouse gas emissions (SSP2-4.5) and one high-emission scenario (SSP5-8.5). The projections show that
the future Barents Sea will be warmer, less ice-covered, more acidic, and more productive, with fish
populations and spawning sites moving northward. There are small differences in multi-model mean physical
and biogeochemical projections between the two emission scenarios by 2050, while large scenario differences
emerge toward the end of the century. The implications of these results are far-reaching, including
identifying the sensitivity of ecosystem change to future emissions, informing regional management
strategies, and potentially identifying needs for adaptation to changes already likely to occur
Why is it so difficult to understand why we don’t understand human systemic lupus erythematosus? Contemplating facts, conflicts, and impact of “the causality cascade paradigm”
Get PDFn attempts to understand systemic lupus erythematosus (SLE), we find ourselves in the intellectual cross-point between nosology, pathogenicity-oriented science, philosophy, empiricism, and qualified conjectures. A vital consequence in science theory is that scientific hypotheses that are not critically investigated are in danger of being transformed into scientific dogmas. This statement has consequences for this study. Two central problematic aspects are discussed. For the first, we have to consider new selection principles for classification criteria—implying integration of the causality principle. Second, central historical data must be implemented if we aim to understand SLE. These data comprise famous descriptions of distinct, dynamically changing DNA structures linked to the genetic machinery. These unique structures have since their discoveries decades ago mostly been ignored in SLE research. Likewise, inconclusive dogmatic data indicate that different glomerular ligands are recognized by nephritogenic anti-dsDNA antibodies—exposed chromatin fragments or inherent membrane ligands. These incongruent models have not been comparatively and systematically investigated. Three research areas will be critically discussed: (i) selection and role of SLE classification criteria, a process that must imply the causality principle; (ii) definition and impact of anti-dsDNA structure-specific antibodies; (iii) incongruent pathogenic models that account for lupus nephritis. A precise and critically important question is if SLE itself is a response to a dominant unified cause that initiates a cascade of downstream effects (criteria) or if SLE represents combined responses to a random interplay of multiple cause-effect events. These principally different explanations are formally not excluded or accepted today. Currently, SLE may be regarded as a disease with phenotypic diversity, independently segregated manifestations with unresolved etiologies that are not unique to a single SLE phenotype. The focus for the present discussion is basically how we, by critical hypotheses, can re-consider science-based selection of SLE classification criteria in order to delimitate and rationalize SLE. Classification criteria, autoimmunity, DNA structures, and anti-dsDNA antibodies are integrated aspects in this discussion
Ready for Shared decision making: Development of a meta-curriculum for training healthcare professionals in shared decision making
Get PDFBackground and aim: Healthcare professionals (HCPs) can facilitate informed values-based choices by involving patients in health decisions through a process known as shared decision-making (SDM). However, HCPs have insufficient communication competencies in SDM and training programs are lacking. The research project aimed to develop a meta-curriculum for training HCPs in SDM, "Ready for SDM," addressing various HCP types and competence levels through a modularised approach. This dissertation comprises four studies that evaluate three modules of the meta-curriculum.
Methods: The Knowledge-to-Action framework (KTA), supplemented with other theoretical frameworks, was operationalised to shape the development as implementation research throughout the project. A series of studies were conducted to evaluate the training modules using multiple study designs, including a mixed-methods study, a cluster randomized controlled trial, a descriptive study and a descriptive observational study. Quantitative and qualitative research methods were applied either independently or in combination. Kirkpatrick's model for evaluating training programs structured the endpoints according to the first three of four evaluation levels: reactions, learning, behaviour and results.
Results: The results are structured according to the KTA framework, distinguishing between knowledge creation and use to achieve sustainable, evidence-informed and theory-driven SDM training for HCPs. Three "Ready for SDM" modules for HCP and students, including nurses, physicians, interprofessional groups and SDM ambassadors were evaluated. These modules were found to be comprehensible, acceptable and relevant for HCPs, enhancing SDM-related competencies and contributed to substantial training activity in Norwegian specialist healthcare services. However, evaluations also identified key areas for improvement, implying a need for revisions to enhance feasibility. The meta-curriculum represents a novel approach, addressing barriers to SDM training implementation through its multi-modular, adaptive design, using a generic pedagogical and interprofessional approach and a continuous feedback-driven learning system.
Conclusion: Through four studies, "Ready for SDM" has shown promising results on a broad range of endpoints and implementation in specialist healthcare is ongoing. However, it has not yet been evaluated in its entirety and in the context of other necessary measures to successfully implement shared decision-making.Bakgrunn og mål: Helsepersonell kan legge til rette for informerte valg ved å involvere pasienter i beslutninger om egen helse gjennom en prosess kalt samvalg. Nåværende kommunikasjonskompetanse i samvalg er imidlertid utilstrekkelig, og spesifikke opplæringsprogrammer mangler. Prosjektets mål var å utvikle et rammeverk for kompetanseheving i samvalg, kalt "Klar for samvalg", som retter seg mot ulike typer helsepersonell og kompetansenivåer gjennom en modulbasert tilnærming. Gjennom fire studier evaluerer dette PhD-prosjektet tre moduler i rammeverket.
Metoder: Knowledge-to-Action-rammeverket (KTA), supplert med andre teoretiske rammeverk, ble operasjonalisert for å forme utviklingen som implementeringsforskning. Studiene, som benyttet ulike forskningsdesign, inkluderte en deskriptiv studie med kombinerte metoder, et klynge-randomisert kontrollert forsøk, en studie med deskriptivt fler-metodisk design, og en deskriptiv observasjonsstudie. Kvantitative og kvalitative forskningsmetoder ble anvendt uavhengig av eller i kombinasjon med hverandre. Kirkpatricks modell for evaluering av treningsprogrammer ble benyttet til å strukturere endepunktene i henhold til de tre første av fire evalueringsnivåer: reaksjoner, læring, atferd og resultater.
Resultater: Resultatene er organisert i henhold til KTA-rammeverket og skiller forholdet mellom kunnskapsutvikling og -bruk, for å oppnå bærekraftig, evidensbasert og teoridrevet opplæring av helsepersonell. I avhandlingen ble tre moduler av "Klar for samvalg" evaluert. Disse modulene rettet seg mot helsepersonell og studenter, inkludert sykepleiere, leger, tverrfaglige grupper og samvalgsambassadører. Modulene viste seg å være forståelige, akseptable og relevante, og forbedret samvalgsrelatert kompetanse samt bidro til betydelig opplæringsaktivitet i norsk spesialisthelsetjeneste. Evalueringene identifiserte også viktige områder for forbedring av modulene, noe som førte til revisjoner for å forbedre gjennomførbarheten. Rammeverket representerer en innovativ tilnærming til kompetanseheving i samvalg. Det adresserer barrierer for implementering gjennom et multimodulært, adaptivt design, ved å bruke en generisk pedagogisk og tverrfaglig tilnærming, og ved å benytte et kontinuerlig tilbakemeldingsdrevet læringssystem.
Konklusjon: "Klar for samvalg" har gjennom de fire studiene vist lovende resultater på et bredt spekter av endepunkter, og implementeringen i spesialisthelsetjenesten er i gang. Det gjenstår en fullstendig evaluering av rammeverket i sin helhet og satt i sammenheng med andre nødvendige tiltak får å lykkes med innføringen av samvalg
Adaptive responses in foodborne pathogens to environmental and antibiotic stress
Get PDFFoodborne illnesses cause significant mortality, particularly in underdeveloped nations. The gastric acid barrier in the stomach serves as a vital defense against pathogens, but bacteria with acid tolerance mechanisms can bypass it, often requiring antibiotics for treatment. The growing threat of antibiotic resistance underscores the need to better understand how resistant bacteria emerge. Vibrio cholerae, a foodborne pathogen responsible for severe outbreaks globally, highlights the importance of studying bacterial adaptability and resistance. This doctoral research focused on bacterial adaptability, acid tolerance, and antibiotic resistance, with emphasis on V. cholerae in two of three studies. In the first study, we examined the genomic adaptability of V. cholerae strains under environmental and evolutionary pressures. Using a hybrid de novo assembly of the strain C6706, we identified unique mutations in genes related to quorum sensing, stress response, motility, and acid tolerance. Phenotypic tests revealed significant differences in biofilm formation, motility, and mutation rates between C6706 and the reference strain N16961, critical for V. cholerae’s adaptive evolution. The second study investigated adaptive acid tolerance in V. cholerae, using a high-density transposon library and transposon-insertion sequencing to uncover novel acid tolerance genes. Many of these genes were related to cell membrane changes, suggesting multiple ATR systems, beyond the known amino acid decarboxylase pathways, play crucial roles in acid tolerance. In the third study, we developed a model to explore how antibiotic mechanisms influence resistance. Our findings challenge the idea that bactericidal antibiotics are less likely to drive resistance compared to bacteriostatic ones. We introduced the concept of the secondary mutant selection window, emphasizing the role of secondary mutations in resistance development. These studies highlight the need to integrate genomic, phenotypic, and pharmacodynamic data to better understand foodborne illness pathogenesis and improve therapeutic strategies.Matbårne sykdommer forårsaker en betydelig mengde dødelighet, spesielt i land med underutviklet infrastruktur og renovasjonsordninger. Magesyren er en viktig barriere mot matbårne patogener, men noen bakterier kan utvikle syretoleranse og omgå denne barrieren. Infeksjonen som så kan utvikle seg vil kunne kreve antibiotikabehandling. På grunn av, og for å unngå den videre utviklingen av, antibiotikaresistente bakterier er det viktig å forstå hvordan resistente bakterier fungerer. Vibrio cholerae er en slik matbåren bakterie. Cholera utbrudd som følge av naturkatastrofer understreker viktigheten av å forstå denne bakterien med tanke på tilpasningsevne og resistens utvikling. Denne doktorgradsforskningen fokuserte på bakteriell tilpasningsevne, syretoleranse og antibiotikaresistens, med hovedvekt på V. cholerae i to av tre studier. I den første studien undersøkte vi den genomiske tilpasningsevnen til V. cholerae-stamme under miljømessige og evolusjonære påkjenninger. Ved å bruke en hybrid de novo-sammenstilling av stammen C6706 identifiserte vi unike mutasjoner i gener relatert til quorum sensing, stressrespons, motilitet og syretoleranse. Fenotypiske tester avslørte betydelige forskjeller i biofilmdannelse, motilitet og mutasjonsrater mellom C6706 og referansestammen N16961, som er avgjørende for V. choleraes adaptive evolusjon. Den andre studien undersøkte adaptiv syretoleranse hos V. cholerae ved bruk av et høy-tetthets transposonbibliotek og transposon-innsettingssekvensering for å avdekke nye gener for syretoleranse. Mange av disse genene var knyttet til endringer i cellemembranen, noe som tyder på at flere syretoleransesystemer, utover de kjente aminosyredekarboksylaseveiene, spiller viktige roller i syretoleranse. I den tredje studien utviklet vi en modell for å utforske hvordan antibiotikamekanismer påvirker resistens. Våre funn utfordrer ideen om at bakteriedrepende antibiotika er mindre tilbøyelige til å fremme resistens enn bakteriostatiske antibiotika. Vi introduserte konseptet «det sekundære mutante seleksjonsvinduet», som fremhever betydningen av sekundære mutasjoner i resistensutvikling. Disse studiene understreker behovet for å integrere genomiske, fenotypiske og farmakodynamiske data for å bedre forstå patogenesen av matbårne sykdommer og forbedre terapeutiske strategier
The changing face of the Arctic: four decades of greening and implications for tundra ecosystems
Get PDFArctic landscapes occupy a nexus of environmental change processes, globally significant soil carbon stores, wildlife populations, and subsistence-based human societies. In response to rapid climate warming, tundra ecosystems are experiencing widespread changes to vegetation and underlying permafrost, coupled with an array of ecological disturbances that are expected to intensify in the future. Declines in the extent of the cryosphere on land (permafrost and seasonal snow) and offshore (sea-ice) raise the question of whether and for how long warmer portions of the Low Arctic will fit established concepts of “what is Arctic,” given the influence the cryosphere has historically had on tundra ecosystem structure and function. The era of spaceborne observation of circumpolar tundra greenness, in the form of the Normalized Difference Vegetation Index (NDVI), has entered its fifth decade and provides foundational information concerning ecosystem conditions and responses to climatic trends, variability, ecological disturbance, and successional processes. Here we review the evolving story of Arctic greening, and synthesize long-term spaceborne records of NDVI, climatic data, field observations, and the knowledge base of Arctic residents to place the last four decades of Arctic environmental change in context, and establish expectations and research priorities for the coming decade. Greenness dynamics display high spatio-temporal variability, reflecting complex interactions of climatic warming and variability, landscape history, ecological disturbance, and other factors. Nonetheless, long-term increases in NDVI—commonly known as “the greening of the Arctic”—remain prominent across large areas in all available long-term spaceborne datasets and align with long-term shifts in vegetation structure documented in disparate Arctic regions. Common shifts reported from the Low Arctic, such as shrubification, generally portend declines in floristic diversity, and shifts in fauna that favor boreal forest species. Despite lingering uncertainties regarding trend attribution and sources of interannual variability, the sequence of record-high circumpolar tundra greenness values observed since 2020 provides strong evidence that Arctic tundra ecosystems have entered a state without historic precedent on timescales approaching a millennium
Data-driven Approach for Passenger Assignment in Urban Rail Transit Networks: Insights from Passenger Route Choices and Itinerary Choices
Get PDFCongestion in urban rail transit (URT) systems often results in passengers being left behind on platforms due to trains’ reaching capacity. Distinguishing between the travel choice behaviors of passengers who board the first arriving train (Type I passengers) and those who are left behind (Type II passengers) in passenger assignment is essential for effective URT passenger management. This paper proposes a data-driven passenger-to-train assignment model (DPTAM) that leverages automated fare collection (AFC) data and automated vehicle location (AVL) data to differentiate between the travel choice behaviors of the two types of passengers. The model comprises two modules based on passenger travel choice behavior: the passenger route choice model (PRCM) and the passenger itinerary choice model (PICM). The PRCM employs a granular ball–based density peaks clustering (GB-DP) algorithm to estimate passengers’ route choices based on historical data, enhancing precision and efficiency in passenger classification and
route matching. The PICM incorporates tailored itinerary selection strategies that consider train capacity constraints and schedules, enabling accurate inference of passenger itineraries and localization of their spatiotemporal states. The model also estimates train loads and left-behind probabilities to identify congested periods and sections. The effectiveness of DPTAM is validated through synthetic data, demonstrating superior assignment accuracy compared to benchmarks. Additionally, real-world data from Chengdu Metro reveal the impact of congestion on travel behavior and effectively identify congested periods and
high-demand stations and sections, highlighting its potential to enhance URT system efficiency and passenger management
A constellation of mud volcanoes originated from a buried Arctic mega-slide, Southwestern Barents Sea
Get PDFGlobal estimates on the number of submarine mud volcanoes are highly uncertain, as well as their role in the deep-sea biosphere and methane budgets. Here, we report the discovery of ten Arctic mud volcanoes in the Barents Sea (440–480 m depth), where only two had been previously known. The new mud volcanoes form flat-topped mounds on the seafloor and are connected to seismic chimneys rooted within the infilling of a buried Pleistocene mega-slide scar. We suggest informally naming the area the Polaris Mud Volcano Complex. These structures have been active at least since the Late Weichselian deglaciation (< 20 ka), displaying evidence of ongoing methane-rich mud expulsion, i.e. mud pools and flows and chemosynthetic fauna. Finally, we propose a conceptual model for their formation which can be exported to other similar settings. Given the widespread occurrence of mega-slides and associated deposits along (paleo)glaciated continental margins, our findings call for a re-evaluation of mud volcanism potential in such regions