Enhancing nitrogen removal through macrophyte harvest and installation of woodchips-based floating beds in surface-flow constructed wetlands.

Wetland management maintains nitrogen (N) removal capacity in mature and overgrown constructed wetlands (CWs). We evaluated whether CW management by macrophyte harvesting, and subsequent installation of woodchips-based floating beds (WFBs) planted with Glyceria maxima and Filipendula ulmaria improved N removal. In sixteen heavily overgrown experimental CWs, we applied four treatments: i) only macrophyte harvesting, ii) 5% of the harvested-CW surface covered with WFBs, iii) 20% WFBs cover, and iv) a control treatment (heavily overgrown). N removal was determined in all wetlands at nine occasions. Plant biomass accrual, N assimilation, and denitrification genes nirS, nirK, nosZI and nosZII on plant roots and woodchips from WFBs were estimated. Macrophyte harvesting improved N removal of heavily overgrown CWs, whereas subsequent WFB installation only sometimes improved N removal. Mean N removal efficiencies (± standard deviation) overall were 41 ± 15 %, 45 ± 20 %, 46 ± 16 % and 27 ± 8.3 % for treatments i to iv, respectively. Relative biomass production, root length and root surface area for G.maxima (mean ± standard deviation: 234 ± 114 %, 40 ± 6.5 cm, 6308 ± 1059 cm2g-1, respectively) were higher than those for F. ulmaria (63 ± 86 %, 28 ± 12 cm, 3131 ± 535 cm2g-1, respectively) whereas biomass N assimilation was higher for F. ulmaria (1.8 ± 0.9 gNm-2 of WFB) than for G. maxima (1.3 ± 0.5 gNm-2 of WFB). Denitrification gene abundance was higher on plant roots than on woodchips while G. maxima hosted higher root denitrification gene abundance than F. ulmaria. We conclude that macrophyte harvesting improves N removal in heavily overgrown CWs. WFBs installation has the potential to support plant growth and denitrification in surface-flow constructed wetlands. Further studies need to evaluate the long-term effects of macrophyte harvesting and WFB installation on N removal in CWs.

Small Cell Lung Cancer in Norway: Patterns of Care by Health Region and Survival Trends.

INTRODUCTION/BACKGROUND: There has been a marked survival improvement for patients with non-small-cell lung cancer. We describe the national trends in characteristics and survival, and geographical differences in diagnostic workup, treatment, and survival for patients with small-cell lung cancer (SCLC). MATERIALS AND METHODS: Patients registered with SCLC at the Cancer Registry of Norway in 2002 to 2022 were included. Trends in overall survival were estimated for all SCLC patients, patients with limited stage SCLC, patients undergoing surgery, and by health region. Adjusting for case-mix, a multivariable Cox regression was performed examining the association between health region and death. RESULTS: The study included 8374 patients. The stage distribution remained unchanged during the study period. The 5-year overall survival increased from 7.7% to 22.8% for patients with limited stage. The use of multidisciplinary team meetings varied from 62.5% to 85.7%, and the use of positron emission tomography-computer tomography varied from 70.4% to 86.2% between the health regions. Treatment patterns differed markedly between the health regions, with the proportion dying without any registered treatment ranging from 1.2% to 10.9%. For limited stage patients in 2018 to 2022, the median overall survival ranged from 16.5 to 25.5 months across health regions, and the 5-year overall survival ranged from 18.7% to 28.7% (P = .019). CONCLUSION: The survival for patients with SCLC remains poor. The use of diagnostic procedures, treatment modalities, and survival differed between regions, warranting investigations to further explore the reasons.

Multiplexed measurement of binding- and neutralizing antibodies to SARS-CoV-2 variants in 12.000 post-vaccine sera

Diagnostic assays currently used to monitor the efficacy of COVID-19 vaccines measure levels of antibodies to the receptor-binding domain of ancestral SARS-CoV-2 (RBDwt). However, the predictive value for protection against new variants of concern (VOCs) has not been firmly established. Here, we used bead-based arrays and flow cytometry to measure binding of antibodies to spike proteins and receptor-binding domains (RBDs) from VOCs in 12,000 sera. Effects of sera on RBD-ACE2 interactions were measured as a proxy for neutralizing antibodies. The samples were obtained from healthy individuals or patients on immunosuppressive therapy who had received two to four doses of COVID-19 vaccines and from COVID-19 convalescents. The results show that anti-RBDwt titers correlate with the levels of binding- and neutralizing antibodies against the Alpha, Beta, Gamma, Delta, Epsilon and Omicron variants. The benefit of multiplexed analysis lies in the ability to measure a wide range of anti-RBD titers using a single dilution of serum for each assay. The reactivity patterns also yield an internal reference for neutralizing activity and binding antibody units per milliliter (BAU/ml). Results obtained with sera from vaccinated healthy individuals and patients confirmed and extended results from previous studies on time-dependent waning of antibody levels and effects of immunosuppressive agents. We conclude that anti-RBDwt titers correlate with levels of neutralizing antibodies against VOCs and propose that our method may be implemented to enhance the precision and throughput of immunomonitoring.

Immunity in Omicron SARS-CoV-2 breakthrough COVID-19 in vaccinated adults

The new SARS-CoV-2 variant of concern (VOC) Omicron has more than 30 mutations in the receptor binding domain (RBD) of the Spike protein enabling viral escape from antibodies in vaccinated individuals and increased transmissibility1-6. It is unclear how vaccine immunity protects against Omicron infection. Here we show that vaccinated participants at a superspreader event had robust recall response of humoral and pre-existing cellular immunity induced by the vaccines, and an emergent de novo T cell response to non-Spike antigens. We compared cases from a Christmas party where 81 of 110 (74%) developed Omicron breakthrough COVID-197, with Delta breakthrough cases and vaccinated non-infected controls. Omicron cases had significantly increased activated SARS-CoV-2 wild type Spike-specific (vaccine) cytotoxic T cells, activated follicular helper (TFH) cells, functional T cell responses, boosted humoral responses, activated anti-Spike plasmablasts and anti-RBD memory B cells compared to controls. Omicron cases had significantly increased de novo memory T cell responses to non-Spike viral antigens compared to Delta breakthrough cases demonstrating development of broad immunity. The rapid release of Spike and RBD-specific IgG+ B cell plasmablasts and memory B cells into circulation suggested affinity maturation of antibodies and that concerted T and B cell immunity may provide durable broad immunity.

Dispersion of resonant modes in patch antenna lattices.

Spectroscopic polar angle resolved Mueller matrix ellipsometry at multiple azimuthal incidences, together with a full-field model, reveal new details in the interplay between localized gap surface plasmon resonances and propagating surface plasmon polaritons (SPPs) in a rectangular array of metal-insulator-metal patches. A plane-wave expansion of the field in the insulator shows that the fundamental localized resonances are composed of oppositely propagating modes. Sharp dispersive resonances observed in p-polarization, excited near the opening of diffracted orders, are shown to be grating coupled SPPs. The SPPs show strong coupling with localized modes of similar symmetry, while they appear suppressed by modes of dissimilar symmetry.

Thermoplastic Microfluidics.

Thermoplastic polymers are besides glass the material of choice for the industrialization of microfluidic and organ-on-chip applications. In most cases, however, such devices are developed on the basis standard lithographic clean room technologies and subsequent casting into PDMS. This results in comparably fast progress in the development of functional designs but important aspects with respect to later industrialization are thereby largely neglected. For that reason, it is advisable to switch at a rather early stage of development from PDMS to a thermoplastic polymer such as, for instance, cyclo-olefin (co)polymer (COC, COP). By making this step, additional challenges related to the anticipated manufacturing process can be identified, which is particularly important when aiming at industrialization. We present herein a standard process sequence for mastering of microfluidic devices by two-photon polymerization and final transfer into COC films by hot embossing. In addition, we describe the laser micromanufacturing of polymeric mold inserts and subsequent prototype injection molding of small series of COP samples.

Excess risk and clusters of symptoms after COVID-19 in a large Norwegian cohort

Physical, psychological and cognitive symptoms have been reported as post-acute sequelae for COVID-19 patients but are also common in the general, uninfected population. We aimed to calculate the excess risk and identify patterns of 22 symptoms up to 12 months after COVID-19 infection. We followed more than 70,000 participants in an ongoing cohort study, the Norwegian Mother, Father and Child Cohort Study (MoBa) during the COVID-19 pandemic. Infected and non-infected cohort participants registered presence of 22 different symptoms in March 2021. One year after the initial infection, 13 of 22 symptoms were associated with SARS-CoV-2 infection, based on relative risks between infected and uninfected subjects. For instance, 17.4% of SARS-CoV-2 infected cohort participants reported fatigue that persist 12 months after infection, compared to new occurrence of fatigue that had lasted less than 12 months in 3.8% of non-infected subjects (excess risk 13.6%). The adjusted relative risk for fatigue was 4.8 (95 % CI 3.5 to 6.7). Two main underlying factors explained 50% of the variance in the 13 symptoms. Brain fog, poor memory, dizziness, heart palpitations, and fatigue had high loadings on the first factor, while shortness-of breath and cough had high loadings on the second factor. Lack of taste and smell showed low to moderate correlation to other symptoms. Anxiety, depression and mood swings were not strongly related to COVID-19. Our results suggest that there are clusters of symptoms after COVID-19 due to different mechanisms and question whether it is meaningful to describe long COVID as one syndrome.

Implementing cancer patient pathways in Scandinavia how structuring might affect the acceptance of a politically imposed reform.

Through political decisions all three Scandinavian countries implemented national reforms in cancer care introducing cancer patient pathways. Though resistance from the professional community is common to top-down initiatives, we recognized positive receptions of this reform in all three countries and professionals immediately contributed in implementing the core measures. The implementation of a similar reform in three countries with a similar health care system created a unique opportunity to look for shared characteristics. Combining analytical framework of institutional theory and research on policy implementation, we identified common patterns of structuring of the initial implementation: The hierarchical processes were combined with supplementary structures located both within and outside the formal management hierarchy. Some had a permanent character while others were more project-like or even resembled social movements. These hybrid structures made it possible for actors from high up in the hierarchy to communicate directly to actors at the operational hospital level. Across the cases, we also identified structural components acting together with the traditional command-control; negotiation, consensus and counseling. However, variations in the presence of these did not seem to have significant impact on processes causing decisions and acceptance. These variations may, however, influence the long-term practice and outcome of cancer-care pathway-reform. Knowledge from our study should be considered when orchestrating future health care reforms and especially top-down politically initiated reforms.

Mind the Differences: How Diagnoses and Hospital Characteristics Influence Coordination in Cancer Patient Pathways.

Integrated care pathway (ICP) is a prevailing concept in health care management including cancer care. Though substantial research has been conducted on ICPs knowledge is still deficient explaining how characteristics of diagnose, applied procedures, patient group and organizational context influence specific practicing of ICPs. We studied how coordination takes place in three cancer pathways in four Norwegian hospitals. We identified how core contextual variables of cancer pathways affect complexity and predictability of the performance of each pathway. Thus, we also point at differences in core preconditions for accomplishing coordination of the cancer pathways. In addition, the findings show that three different types of coordination dynamics are present in all three pathways to a divergent degree: programmed chains, consultative hubs and problem-solving webs. Pathway coordination also depends on hierarchical interaction. Lack of corresponding roles in the medical-professional and the administrative-institutional logics presents a challenge for coordination, both within and between hospitals. We recommend that further improvement of specific ICPs by paying attention to what should be standardized and what should be kept flexible, aligning semi-formal and formal structures to pathway processes and identify the professional cancer related background and management style required by the key-roles in pathway management.

Exploring the triggering process of a cancer care reform in three Scandinavian countries.

Cancer incidence is increasing, and cancer is a leading cause of death in the Scandinavian countries, and at the same time more efficient but very expensive new treatment options are available. Based on the increasing demand, high expectations and limited resources, crises in public legitimacy of cancer care evolved in the three Scandinavian countries. Similar cancer care reforms were introduced in the period 2007-2015 to address the crisis. In this article we explore processes triggering these reforms in countries with similar and well-developed health care systems. The common objective was the need to reduce time from referral to start treatment, and the tool introduced to accomplish this was integrated care pathways for cancer diagnosis, that is Cancer Patient Pathways. This study investigates the process by drawing on interviews with key actors and public documents. We identified three main logics in play; the economic-administrative, the medical and the patient-related logic and explored how institutional entrepreneurs skillfully aligned these logics. The article contributes by describing the triggering processes on politically initiated similar reforms in the three countries studied and also contributes to a better understanding on the orchestrating of politically initiated health care reforms with the intention to change medical practice in hospitals.

The greenhouse gas emission effects of rewetting drained peatlands and growing wetland plants for biogas fuel production.

Efforts to mitigate greenhouse gas (GHG) emissions are receiving increased attention among governmental and commercial actors. In recent years, the interest in paludiculture, i.e. the use of rewetted peatlands, has grown because of its potential to reduce GHG emissions by stopping soil decomposition. Moreover, cultivating wetland plants on rewetted peatlands for bioenergy production that replaces fossil fuels in the transport sector, can contribute to additional GHG emission reductions. In this study, an analysis of literature data was conducted to obtain data on GHG emissions (CO2 and CH4) and biomass production from rewetted peatlands cultivated with two different wetland plant species: Phragmites australis (Pa) and Typha latifolia (Tl). In addition, a biogas experiment was carried out to investigate the biomethane yield of Pa and Tl biomass, and the reduction of global warming potential (GWP) by using biomethane as vehicle fuel. The results show that peatland rewetting can be an important measure to mitigate the GWP as it reduces GHG emissions from the soil, particularly on a 100-year timescale but also to some extent on a 20-year timescale. More specifically, rewetting of 1 km2 of peatland can result in a GWP reduction corresponding to the emissions from ±2600 average sized petrol cars annually. Growing Pa on rewetted peatlands reduces soil GHG emissions more than growing Tl, but Pa and Tl produced similar amounts of biomass and biomethane per land area. Our study concludes that Pa, because of a more pronounced GWP reduction, is the most suitable wetland plant to cultivate after peatland rewetting.

Practicing Integrated Care Pathways in Norwegian Hospitals: Coordination through Industrialized Standardization, Value Chains, and Quality Management or an Organizational Equivalent to Improvised Jazz Standards.

The goal of coordinating pathways for cancer patients through their diagnostic and treatment journey is often approached by borrowing strategies from traditional industries, including standardization, process redesign, and variation reduction. However, the usefulness of these strategies is sometimes limited in the face of the complexity and uncertainty that characterize these processes over time and the situation at both patient and institutional levels. We found this to be the case when we did an in-depth qualitative study of coordination processes in patient pathways for three diagnoses in four Norwegian hospitals. What allows these hospitals to accomplish coordination is supplementing standardization with improvisation. This improvisation is embedded in four types of emerging semi-formal structures: collegial communities, networks, boundary spanners, and physical proximity. The hierarchical higher administrative levels appear to have a limited ability to manage and support coordination of these emerging structures when needed. We claim that this can be explained by viewing line management as representative of an economic-administrative institutional logic while these emerging structures represent a medical-professional logic that privileges proximity to the variation and complexity in the situations. The challenge is then to find a way for emergent and formal structures to coexist.

Public adherence to governmental recommendations regarding quarantine and testing for COVID-19 in two Norwegian cohorts

BackgroundCombatting the COVID-19 pandemic relies at present on non-pharmacological interventions. Governments are using various approaches from general advice to full lockdown. There is a need to describe and understand adherence to public health actions. MethodsParticipants from two ongoing cohorts, the Norwegian Mother, Father and Child Cohort Study (MoBa) and The Norwegian Influenza Pregnancy Cohort (NorFlu), answered questionnaires every 14 days since March 2020. From the summer of 2020, testing for presence of SARS-CoV-2 became easily available. Recommendations were that respiratory symptoms should lead to testing, and that confirmed or suspected COVID-19 should be followed by quarantine. We estimated the adherence to these guidelines in responses from cohort participants in the period August to October 2020. ResultsLess than 40% of men who were ill and less than 45% of women who were ill, tested themselves for SARS-CoV-2 during the same 14-day periods. Among subjects tested for COVID-19, about 53% of men and 59% of women reported quarantine. For subjects with a confirmed or suspected COVID-19 diagnosis, the proportions quarantined were 65% for men and 72% for women. ConclusionsPublic adherence to governmental recommendations regarding testing and quarantine were lower than expected in a country with high trust in government. This leaves considerable room for improvement in adherence, possibly reducing the need for more restrictive interventions.

The association between work situation and life satisfaction during the COVID-19 pandemic: prospective cohort study in Norway

ObjectivesTo analyse the population effects on life quality of being laid off from work, having to work from home, or having been diagnosed with COVID-19. DesignNationwide population-based cohort study. SettingNorway. ParticipantsWe followed more than 80,000 participants in an ongoing cohort study, the Norwegian Mother, Father and Child Cohort Study (MoBa) during the COVID-19 pandemic. We analysed current life satisfaction in April and again in September/October 2020 for subjects whose work situation and infection status had changed. Main outcome measuresSelf-reported satisfaction with life, using a scale from 0 (worst) to 10 (best). ResultsTemporary and permanent layoffs, working from a home-based office, and getting a COVID-19 diagnosis were associated with modestly, but significantly lower concurrent life satisfaction, both on a population level and for subjects who changed status. The associations with change in work situation were stronger for men. For men with permanent job loss, the adjusted odds ratio for low life satisfaction (<6) was 3.2 (95% CI 2.4 to 4.2) in April and 4.9 (95% CI 3.5 to 6.9) in autumn. A suspected or confirmed COVID-19 diagnosis was associated with an adjusted odds ratio for low life satisfaction of 1.9 (95% CI 1.6 to 2.3) in spring. The strength of associations between work situation and life satisfaction did not vary much across socio-economic strata, but layoffs were more common among those with low education. ConclusionLayoffs, home office and infection status had clear impact on the quality of life as measured with a global life satisfaction scale. These findings suggest that social differentials in quality of life, are increasing during the pandemic. FundingThis work was funded by the Norwegian Research Councils Centres of Excellence Funding Scheme (no. 262700) and by the Norwegian Institute of Public Health (NIPH). SUMMARY BOXESO_ST_ABSWhat is already known on this topicC_ST_ABS- Being laid off from work or having to work from a home-based office is usually associated with reduced life quality. - The population effect has not been estimated during the present surge in cases of COVID-19 in Europe. What this study adds- This population-based study shows that life satisfaction in Norway has been stable from the first to the second wave of the pandemic, but that both layoffs and working from home is associated with reduced life satisfaction, especially among men. - The reduced life satisfaction in people working from a home-based office implies that large proportions of the population are affected.

Increase in curative treatment and survival of lung cancer in Norway 2001-2016.

We have studied the alterations in the use of curative treatment and the outcome for lung cancer patients in Norway 2001-2016. The Cancer Registry of Norway has a practically complete registration of all cancer diagnoses, treatments given and deaths. For the years 2001-2016, 43,137 patients were diagnosed with lung cancer. Stereotactic radiotherapy was established nationwide from 2008 and its use has increased, and in 2016, 8.8% were given this treatment. In addition 20.6% were operated and 8.5% were treated with conventional radiotherapy. Thus 37.9% of those diagnosed were treated with intention to cure, compared to 22.9% in 2001 (p < 0.0001). Further, the median survival for the whole group diagnosed with lung cancer increased from 6.0 (95% CI 5.6-6.7) months in 2001 to 11.8 (95% CI 10.9-12.7) in 2016. The 5 year survival increased from 9.4 (95% CI 8.1-10.8)% to 19.9 (95% CI 19.2-20.6)% in the same period. In 2016 the age adjusted incidence rate was 59.5 per 100,000 (Norwegian standard) and had increased significantly in both sexes. There had also been an increase in mean age at diagnosis and the proportion diagnosed in an early stage. The increase in curative treatment has been paralleled with a doubling in both the median and 5-year survival. The present results are used for surveillance and as a benchmark, and we are looking forward to reaching a proportion of 40% of patients given curative treatment.

Investigation of Product and Process Fingerprints for Fast Quality Assurance in Injection Molding of Micro-Structured Components.

Injection molding is increasingly gaining favor in the manufacturing of polymer components since it can ensure a cost-efficient production with short cycle times. To ensure the quality of the finished parts and the stability of the process, it is essential to perform frequent metrological inspections. In contrast to the short cycle time of injection molding itself, a metrological quality control can require a significant amount of time and the late detection of a problem may then result in increased wastage. This paper presents an alternative approach to process monitoring and the quality control of injection molded parts with the concept of "Product and Process Fingerprints" that use direct and indirect quality indicators extracted from part quality data in-mold and machine processed data. The proposed approach is based on the concept of product and process fingerprints in the form of calculated indices that are correlated to the quality of the molded parts. A statistically designed set of experiments was undertaken to map the experimental space and quantify the replication of micro-features depending on their position and on combinations of processing parameters with their main effects to discover to what extent the effects of process variation were dependent on feature shape, size, and position. The results show that a number of product and process fingerprints correlate well with the quality of the micro features of the manufactured part depending on their geometry and location and can be used as indirect indicators of part quality. The concept can, thus, support the creation of a rapid quality monitoring system that has the potential to decrease the use of off-line, time-consuming, and detailed metrology for part approval and can thus act as an early warning system during manufacturing.

Ventilation inhomogeneity in infants with recurrent wheezing.

BACKGROUND: The care of infants with recurrent wheezing relies largely on clinical assessment. The lung clearance index (LCI), a measure of ventilation inhomogeneity, is a sensitive marker of early airway disease in children with cystic fibrosis, but its utility has not been explored in infants with recurrent wheezing. OBJECTIVE: To assess ventilation inhomogeneity using LCI among infants with a history of recurrent wheezing compared with healthy controls. METHODS: This is a case-control study, including 37 infants with recurrent wheezing recruited from outpatient clinics, and 113 healthy infants from a longitudinal birth cohort, the Canadian Healthy Infant Longitudinal Development study. All infants, at a time of clinical stability, underwent functional assessment including multiple breath washout, forced expiratory flows and body plethysmography. RESULTS: LCI z-score values among infants with recurrent wheeze were 0.84 units (95% CI 0.41 to 1.26) higher than healthy infants (mean (95% CI): 0.26 (-0.11 to 0.63) vs -0.58 (-0.79 to 0.36), p<0.001)). Nineteen percent of recurrently wheezing infants had LCI values that were above the upper limit of normal (>1.64 z-scores). Elevated exhaled nitric oxide, but not symptoms, was associated with abnormal LCI values in infants with recurrent wheeze (p=0.05). CONCLUSIONS: Ventilation inhomogeneity is present in clinically stable infants with recurrent wheezing.