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Priority Setting in Norwegian Hospitals – An Overview of Available Research
No full textBackground: Even in wealthy Norway, there is a mismatch between medical need and the resources at hand given an aging population and technological advancements: priorities need to be made. Priority setting decisions occur at many levels of the healthcare system, and many resource allocation decisions are made by hospital leaders. The meso-level refers to healthcare service management at referral institutions, distinct from macro-level policymaking and micro-level clinical decisions. Aim: The process of setting priorities in the hospital setting remains unclear and insufficiently investigated. This review aims at making an overview of available research on priority setting at the meso-level. Method: We conducted a scoping review to gather data from research on priority setting and decision making in Norwegian hospitals. Our methodology followed PRISMA-scoping review principles, including a systematic literature search of the databases PubMed, Idunn, WoS, and CINAHL, and a manual search of reference lists. We included 11 empirical studies, covering various research objectives and domains, such as nursing ethics and costing analysis tool evaluation. Results: Using the Walt and Gilson policy analysis framework, we identified key elements of priority setting: content, context, process, and actors. Our analysis revealed a lack of empirical findings on the process domain. Conclusion: Scientific knowledge about priority setting remains centred around the content of policies, particularly criteria and guidelines. The focus on content overshadows procedural aspects within the policy analysis triangle. Understanding the processes of priority setting is crucial for the legitimacy of the public sector in a democratic welfare state.publishedVersio
Modular soundness checking of feature model evolution plans
No full textFeature model evolution plans (FMEPs) describe how feature models for software product lines (SPLs) evolve over time. While different feature models can exist for different points in time over the lifetime of the product line, an FMEP describes how to compute a feature model for a given time point. SPLs capitalise on the variability and reusability of the software through combining optional and mandatory features. As business requirements change over time, FMEPs should support intermediate update. A plan hence contains updates to an initial model by adding, deleting, moving or changing elements at different points in time, in line with the evolving business requirements on the SPL, potentially affecting feature models that should be derived in the future from the plan.
A recurring challenge in maintaining FMEPs is that updates may lead to inconsistent intermediate feature models, most notably so-called paradoxes. A paradox may not materialise at the first point in time an update on the plan is performed to obtain a particular feature model, but may only in combination with a later modification prescribed by the plan create a structurally invalid model. Correspondingly, a single modification to a plan may require multiple checks over the liftetime of the affected elements to rule out paradoxes.
Current approaches require the analysis from the point in time an update is applied to an FMEP throughout the entire lifetime of the plan. In this paper, we define a so-called interval-based feature model (IBFM) to represent FMEPs, with a precise definition of spatial and temporal scopes that narrow the time interval and the sub-models that an update can affect. We propose a rule system for updating IBFMs, and also prove the soundness of the proposed rules and show their modularity, i.e., that each rule operates strictly within its temporal and spatial scopes. We have conducted a detailed evaluation on our modular approach and present the experimental results, which show that we outperform an existing linear approach.publishedVersio
Succession of soil-living Nematoda and Diptera larvae (Chironomidae, Sciaridae, and Brachycera) near a melting glacier in Southern Norway
No full textDiptera larvae and Nematoda were extracted from soil samples collected in the foreland of the receding Hardangerjøkulen glacier near Finse, central south Norway. Samples were standardized by being taken in snowbed habitats with Salix herbacea L. vegetation. Diptera larvae were sampled in twenty plots from 32 to 227 years age, complemented by five plots with about 10,000-year-old soil. Nematodes were studied in soils of 4, 37, 39, 62, 78, 119, and 204 years age. There was a rapid colonization in young soils of both Diptera larvae and nematodes. Brachycera larvae were sparsely represented, and Sciaridae and Chironomidae larvae were most numerous in soils younger than 50 years. Genera of Chironomidae larvae were Bryophaenocladius, Pseudosmittia, Parasmittia, and Smittia. The number of nematode taxa increased from six in the youngest soil to fourteen in the oldest. Bacterial feeders were dominated by the genus Rhabditis sensu lato and fungal feeders by Tylenchus sensu lato. The plant-parasitic Paratylenchus sp. was present at 4 years, with highest abundance at 39 years. The abundance of omnivores (subfamily Dorylaiminae) did not vary between soil ages, but predators (fam. Mononchidae and genus Tripyla) were more abundant at 78 and 119 years.publishedVersio
Utilization of antenatal care among immigrant women in Norway: a nationwide register-based cohort study
No full textBackground: International research suggests that immigrants face poorer access to antenatal care, but comprehensive nationwide studies identifying variations across immigrant groups are lacking. Using national registries like the Medical Birth Registry, we compared antenatal care utilization among immigrant women by country/region of origin to Norwegian women.
Methods: We included 348,547 singleton births between 2012–2018 by women aged ≥ 16 years registered with ≥ 1 antenatal consultation in primary care, including 79,671 (22.9%) births by immigrant women. We calculated odds ratios (OR) and 95% confidence intervals (CI) using both crude and adjusted logistic regression models, assessing the likelihood of immigrant women having fewer consultations than recommended by national guidelines compared to Norwegian women per trimester. Estimates were adjusted for relevant sociodemographic variables.
Results: Large country-specific differences in estimates were noted across all trimesters. In the crude models, Eritrean (OR 3.01 [95%CI: 2.76–3.28]), Somali (OR 2.63 [95%CI: 2.48–2.79]) and Ethiopian (OR 1.90 [95%CI: 1.67–2.16]) women, and women from other Sub-Saharan countries (OR 1.92 [95%CI: 1.77–2.08]), had the highest odds of initiating antenatal care later than the first trimester. In later trimesters, care utilization by immigrants and Norwegian women were more similar, except for lower utilization among Somali women. Sociodemographic variables explained much of the observed differences.
Conclusion: Late initiation and substandard utilization of antenatal care among certain immigrant groups exists in Norway. Timely access to antenatal care is important for maternal and child health. Efforts should be initiated to facilitate earlier initiation of antenatal care, particularly among Eritrean, Somali, Ethiopian and other Sub-Saharan women.publishedVersio
Dosimetric comparison of intensity-modulated proton therapy and proton arc therapy for pediatric ependymoma
No full textBackground and purpose: Proton Arc Therapy (PAT) is an emerging proton therapy treatment modality with the potential to reduce radiation exposure to healthy tissues compared to conventional Intensity-Modulated Proton Therapy (IMPT) with fewer beams. This is an attractive option for treating pediatric patients, who are vulnerable to radiation-induced side effects. There is, however, a need to investigate the redistribution of dose to the target volume and organs at risk. In this study, we therefore explored the potential of PAT in proton therapy of pediatric ependymoma.
Methods and materials: Three-field IMPT and PAT treatment plans for 10 pediatric ependymoma patients were optimized using the Eclipse treatment planning system. The PAT plans consisted of 8 fields, spanning 170 degrees. Both modalities were robustly optimized with a ± 2 mm isocenter shift and a ± 3% range uncertainty.
Results: PAT showed improved CTV coverage compared to three-field IMPT, with a distinct increase in D98%. A clear dose reduction was found for the cochleae, with median values of 9.32 Gy(Relative Biological Effectiveness [RBE]) [0.76 – 30.40 Gy(RBE)] and 18.30 Gy(RBE) [1.24 – 29.75 Gy(RBE)] for PAT and IMPT, respectively, for the right cochlea. For the left cochlea, the respective doses were 12.34 Gy(RBE) [2.81 – 30.94 Gy(RBE)] and 18.49 Gy(RBE) [4.27 – 31.97 Gy(RBE)]. No significant difference for the brain integral dose was found between the two modalities.
Interpretation: PAT can improve the dosimetric outcome of proton therapy in pediatric ependymoma patients. Organs at risk dose varied on a patient-to-patient basis; thus, individual treatment plan comparisons are recommended.publishedVersio
Experiences of change following a blended intervention for adults with ADHD and emotion dysregulation: a qualitative interview study
No full textBackground: Emotion dysregulation commonly co-occurs with attention-deficit hyperactivity disorder (ADHD), leading to a range of negative outcomes. While psychological interventions have shown promise in bringing about positive changes in emotional and cognitive domains, there is still limited knowledge on the subjective experiences of change among the participants in these interventions.
Aim: The present study explores the experiences of adults with ADHD who had participated in a blended digital and face-to-face intervention aimed at improving emotion dysregulation. The study focuses on understanding their experiences of change and identifying contributors to change.
Methods: A total of 9 adults with ADHD participated in individual semi-structured, in-depth interviews following their participation in the intervention. The interviews were analyzed using thematic analysis.
Results: The thematic analysis resulted in three core themes. The first theme, ‘perceiving change’, represents changes that the participants experienced, with four subthemes: 1a) being in control, 1b) feeling aware, 1c) accepting oneself and one’s emotions and 1d) gaining insight and knowledge. The second theme, ‘supporting change’, captures factors that supported the participants’ changes, with five subthemes: 2a) acquiring skills, 2b) being in it together, 2c) therapist guidance, 2d) finding motivation 2e) putting it into practice. Lastly, the third theme, ‘sustaining change’, includes aspects important to maintain change, with two subthemes: 3a) working consistently and 3b) giving it time.
Conclusions: The findings show that the participants experienced various changes related to the management of their emotions following their participation in the intervention. Change was perceived as a multifaceted process, supported by internal factors such as motivation and engagement, along with external factors such as support from the other group members and the therapists. Taken together, the findings from the study could be important to the development of psychological interventions for adults with ADHD and may provide valuable knowledge to clinicians and policymakers.publishedVersio
Samfunnet er mitt lokale: Musikkterapeuters erfaringer med oppsøkende psykisk helse- og rusarbeid
No full textI denne intervjustudien undersøker forfatterne erfaringer til fem musikkterapeuter som arbeider oppsøkende innen psykisk helsefeltet. Med samfunnsmusikkterapi og medborgerskap som teoretisk rammeverk drøftes muligheter og utfordringer ved å bruke samfunnet som lokale. Forfatterne påpeker at tilgang til egnede lokaler kan være en utfordring, og at musikkterapeutene ofte benytter møterom, bibliotek, kafeer og parker som alternative arenaer. Til tross for logistiske utfordringer, redusert tilgang til musikkutstyr og begrensende bruksområder for musikk, fremheves hjemmebesøk som ukas høydepunkt for mange pasienter. Samtidig introduserer musikkterapi i hjemmet nye risikoområder knyttet til uregulerte miljøer, noe som understreker behovet for risikovurdering og sikkerhetshåndtering for å ivareta musikkterapeuter i deres arbeid.publishedVersio
Exiting with(out) a Voice: Political Mobilisation among the Post-Soviet Émigré Activists
No full textThis paper is guided by the research question of how activists abroad engage with their home countries and what shapes their level of and propensity to political mobilisation. The empirical basis of the study is provided by the cases of the Russian and Belarusian diasporas, researched through interviews, supplemented by document analysis and observation in Bergen. The theoretical argument of the study draws on the literature on diaspora politics, migrant networks, democratic remittances and Russian and Belarusian opposition both at home and abroad.
The comparison of Russian and Belarusian cases allows this research to demonstrate that the level of diaspora’s unification caused by the quotidian disruptions might vary from diaspora to diaspora. The differing levels of unification might be explained by the different levels of migrant networks’ development, shaped, in turn, by the differences in collective migration experience, as well as differences related to leadership and identity and culture. The differing levels of diaspora’s unification also affect how migrant communities approach short-term and long-term projects and strategies.
The study also covers the influence of the host countries, the changing nature of activism at home and abroad and the relations between diasporas and the civil societies in the home countries. Additionally, it touches upon diaspora mobilisation in the context of military conflict in Ukraine as an indirect channel of engagement with the home countries. The broad theoretical contribution of the paper is an emphasis on the transnational nature of both authoritarian regimes and their challengers.Master's Thesis in Politics and Governance of Global ChallengesGOV380MASV-GLGO
SIEC-testen, en rettsdogmatisk analyse av inngrepsvilkåret i fusjonskontrollen i gap-sakene
No full textMasteroppgave (70 sp) forskerlinjeJUS397MAJU
Copy Number Variation Analyses in Autoimmune Addison’s Disease and Diabetes
No full textBakgrunn: Autoimmun Addisons sykdom (AAD) og diabetes er endokrine lidelser som påvirker henholdsvis binyrene og bukspyttkjertelen. Hos unge, slanke individer med diabetes er type 1-diabetes (T1D) og Maturity Onset Diabetes of the Young (MODY) de vanligste undergruppene. Rollen til DNA-kopitallsvariasjoner (CNV) i T1D, MODY og AAD er uklar. Genomvid SNP-genotyping kan oppdage CNV og vurdere deres innvirkning på sykdomsrelaterte gener, men dette krever komplekse pipelines, omfattende data og nøye tolkning.
Formål: Dette arbeidet hadde som mål å undersøke rollen og bidraget til CNV-er i etiologien til to endokrine lidelser: AAD og diabetes. I tillegg utviklet vi en fleksibel og omfattende pipeline for å undersøke sjeldne CNV-er i genetiske studier.
Materialer/Metoder: I studier I og III gjennomførte vi CNV-analyse ved bruk av de svenske og norske Addison-registrene, samt de norske landsdekkende MODY (NMR) og barndiabetes (NCDR) registrene. I studie II utviklet vi en generell pipeline for å identifisere sjeldne CNV-er i case–control-studier ved bruk av SNP-arraydata.
Resultater: Studie I fant ingen signifikante forskjeller i sjeldne CNV-byrder mellom AAD-tilfeller og friske kontroller. Imidlertid var større delesjoner mer vanlig hos AAD-pasienter, spesielt i LRBA- og BCL2L11 gen-områdene. Studie III fant at 0,63 % av diabetes-tilfellene i NMR og 0,09 % i NCDR skyldtes patogene store delesjoner, med seks uoppdaget av standardbehandling i Norge. I tillegg hadde 0,25 % av individene fra NCDR trisomi 21. Studie II introduserte en regelbasert strukturert pipeline for CNV-bestemmelse, kvalitetskontroll og analyse.
Konklusjoner: Sjeldne store CNV-er er usannsynlig å være en hovedårsak til AAD, men ultra-sjeldne delesjoner i LRBA- og BCL2L11-genene kan ha en innvirkning. Tilsvarende bidrar sjeldne CNV-er, med unntak av delesjoner ved HNF1B- og HNF1A-genene, ikke vesentlig til MODY og T1D i Norge. Identifikasjonen av seks patogene MODY-delesjoner (HNF1B, HNF1A, GATA4) som ikke ble oppdaget ved rutinemessig screening, antyder utvidet MODY-screening for barn med atypisk diabetespresentasjon. Vår omfattende pipeline gir et effektivt rammeverk for array-basert CNV-analyse med bredt potensial.Background: Autoimmune Addison’s disease (AAD) and diabetes are endocrine disorders that affect the adrenal glands and pancreas, respectively. In young, lean individuals with diabetes, Type 1 diabetes (T1D) and Maturity Onset Diabetes of the Young (MODY) are the most common subtypes. The role of DNA Copy number variations (CNVs) in T1D, MODY, and AAD remains unclear. High-throughput SNP genotyping can detect CNVs and assess their impact on disease-associated genes, but this requires complex pipelines, extensive data, and careful interpretation.
Objective: This body of work aimed to investigate the role and contribution of CNVs in two endocrine disorders aetiology: AAD and diabetes. Also, we developed a flexible-comprehensive pipeline to investigate rare CNVs in genetic studies.
Materials/Methods: In Studies I and III, we conducted CNV analysis using the Swedish and Norwegian Addison Registries, and the Norwegian nationwide MODY (NMR) and childhood diabetes (NCDR) registries. In Study II, we developed a generic pipeline for identifying rare CNVs in case–control studies using SNP array data.
Results: Study I found no gross differences in rare-CNV-burden between AAD cases and healthy controls, but larger deletions were more common in AAD patients, particularly at the LRBA and BCL2L11 loci. Study III found that 0.63% of diabetes cases in the NMR and 0.09% in the NCDR were due to pathogenic large deletions, with six undetected by standard care in Norway. Also, 0.25% of individuals from NCDR had trisomy 21. Study II introduced a rule-based structured pipeline for CNV calling, quality control, analysis.
Conclusions: Rare large CNVs are unlikely to be a major cause of AAD, but ultra-rare deletions in LRBA and BCL2L11 genes may have an impact. Similarly, rare CNVs, beyond deletions at the HNF1B and HNF1A genes, do not significantly contribute to MODY and T1D in Norway. Six pathogenic MODY deletions (HNF1B, HNF1A, GATA4) undetected by routine screening suggest extended MODY screening for children with atypical diabetes presentation. Our comprehensive pipeline provides an efficient framework for array-based CNV analysis with broad potential.Doktorgradsavhandlin