Prerequisites for entry to advanced nurse practitioner studies- a qualitative study of Norwegian nurse anesthetist students' experiences.

BACKGROUND: Nurse anesthesia is acknowledged as advanced practice nursing, and requires independency in patient monitoring and clinical decision-making. In Norway, 2022, a prerequisite to nurse anesthesia education programs of at least two years of clinical nursing experience prior to entry, was removed. The consequences of removing the prerequisite of clinical nursing experience prior to entering the nurse anesthetist education program on academic progression or on students' qualifications after completion of the program remain unexplored. Hence, the purpose of the current study was to explore nurse anesthetist students' experiences of the impact their previous clinical nursing experience had on their academic progression. METHODS: A qualitative design with semi-structured individual interviews was used. The sample consisted of 12 nurse anesthetist students at the end of the education program. The data were analyzed using thematic analysis in-line with recommendations from Braun & Clarke. RESULTS: Two main themes with in total six subthemes were identified, namely 1) Experience develops non-technical skills, with subthemes (a) feeling secure in task management, (b) recognizing different situations, (c) understanding my role in teamwork, and 2) Integration of non-technical and technical skills, with subthemes (a) possessing procedural competence, (b) taking responsibility in medication administration, and (c) including a patient-centred approach. Previous clinical experience as a nurse prior to entry to a NA education program had provided a basis of non-technical and technical competencies, that supported further learning and development of advanced level competencies that are needed for NAs. CONCLUSION: Non-technical and technical nursing competence represented a solid base for achievement of anesthesia competence within the same areas, also ensuring patient-centred practice. Hence, the change in prerequisites to the NA education program must be followed by evaluations of consequences on students' academic progress and competence at the end of the program, as well as a possible increased need for supervision throughout.

The association between education and fear of recurrence among breast cancer patients in follow-up - and the mediating effect of self-efficacy.

BACKGROUND: Major restructuring of surveillance after breast cancer treatment with less follow-up consultations may result in insecurity and fear of recurrence (FCR) among the less resourceful breast cancer patients. We investigate the association between breast cancer patients' education and FCR and if self-efficacy mediates the associations between education and FCR. MATERIAL AND METHODS: A questionnaire survey was conducted from 2017 to 2019, among 1773 breast cancer patients shortly after having their follow-up switched from regular outpatient visits with an oncologist to either nurse-led or patient-initiated follow-up, with a subsequent questionnaire after 12 months. Data on disease and treatment characteristics were extracted from medical records and the Danish Breast Cancer Group Database. Logistic regression analyses were used to examine the association between education and FCR. Separate analyses were conducted for patients ≤ and >5 years since diagnosis and all models were adjusted for age and cohabitation status. To explore potential mediation by self-efficacy, we conducted regression analyses on education and FCR further adjusting for self-efficacy. RESULTS: The participation rate was 57%, and after the exclusion of patients due to missing data, 917 were included in analyses. Patients with long education had significantly less FCR compared to patients with short education (OR (95% CI) 0.71 (0.51;0,99)). When separated by time since diagnosis, there was no association among patients >5 years since diagnosis while the OR was 0.51 (95% CI, 0.30;0.85) for patients ≤5 years since diagnosis. Further adjusting for self-efficacy among patients <5 years since diagnosis resulted in an OR of 0.56 (95% CI, 0.33;0.95) among patients with long compared to short education. CONCLUSION: Up to 5 years after diagnosis, breast cancer patients with long education are less likely to experience FCR than patients with short education. Self-efficacy mediated only a very small part of this association, indicating that other factors play a role in socioeconomic differences in FCR among breast cancer patients.

Assessment and Comparison of Microplastic Contamination in Atlantic Navigation Routes with Known Uncertainty.

Microplastics (MP) have been found in various environments worldwide. However, not many studies focus on the open ocean due to logistical restraints. Between January and May 2020, the NRP Sagres sampled 123 linear paths of subsurface water of the Atlantic Ocean, passing by Cape Verde, the east coast of South America, and the west coast of Africa. The water was sampled through the ship's water system. The membranes were analyzed by the Hydrographic Institute of Portugal and the Norwegian Institute for Water Research by micro-FTIR. The contamination levels were reported with uncertainty, for 99% confidence level (CL), normalized for filtered water volume and the distance traveled during sampling. Uncertainties were calculated through a detailed ″bottom-up″ evaluation. MP were found in about a third of the stations (48 out of 123), and most of those stations (43 out of 48) presented concentrations below 1 m-3 km-1. The sites where higher concentrations were registered were the port of the island of Santiago (Cape Verde) ((5.9 ± 5.2) m-3 km-1), the Guanabara Bay in Rio de Janeiro (Brazil) ((41 ± 27) m-3 km-1), and close to South Africa ((4.9 ± 2.4) m-3 km-1). Most MP found were polyamide, polyester, polyethylene, ethylene vinyl acetate, and poly(methyl methacrylate). The estimated contamination levels cannot be directly compared with information obtained in other studies due to differences in how MP were determined and the unknown uncertainty of their measured values. This article presents a relevant and reliable contribution to understanding the MP distribution in the Atlantic Ocean.

Innovative reference materials for method validation in microplastic analysis including interlaboratory comparison exercises.

Reference materials (RMs) are vital tools in the validation of methods used to detect environmental pollutants. Microplastics, a relatively new environmental pollutant, require a variety of complex approaches to address their presence in environmental samples. Both interlaboratory comparison (ILC) studies and RMs are essential to support the validation of methods used in microplastic analysis. Presented here are results of quality assurance and quality control (QA/QC) performed on two types of candidate microplastic RMs: dissolvable gelatin capsules and soda tablets. These RMs have been used to support numerous international ILC studies in recent years (2019-2022). Dissolvable capsules containing polyethylene terephthalate (PET), polyvinyl chloride (PVC), polyethylene (PE), and polystyrene (PS), in different size fractions from 50 to 1000 µm, were produced for one ILC study, obtaining relative standard deviation (RSD) from 0 to 24%. The larger size fraction allowed for manual addition of particles to the capsules, yielding 0% error and 100% recovery during QA/QC. Dissolvable capsules were replaced by soda tablets in subsequent ILC studies and recovery test exercises because they were found to be a more reliable carrier for microplastic RMs. Batches of soda tablets were produced containing different single and multiple polymer mixtures, i.e., PE, PET, PS, PVC, polypropylene (PP), and polycarbonate (PC), with RSD ranging from 8 to 21%. Lastly, soda tablets consisting of a mixture of PE, PVC, and PS (125-355 µm) were produced and used for recovery testing during pretreatment of environmental samples. These had an RSD of 9%. Results showed that soda tablets and capsules containing microplastics >50 µm could be produced with sufficient precision for internal recovery tests and external ILC studies. Further work is required to optimize this method for smaller microplastics (< 50 µm) because variation was found to be too large during QA/QC. Nevertheless, this approach represents a valuable solution addressing many of the challenges associated with validating microplastic analytical methods.

An increase in the number of admitted patients with exercise-induced rhabdomyolysis. / Økning i antall pasienter med treningsindusert rabdomyolyse?

BACKGROUND: Rhabdomyolysis may lead to serious complications, and treatment is both time-consuming and costly. The condition can be caused by many factors, including intense exercise. The purpose of this study was to investigate whether the number of hospitalisations due to exercise-induced rhabdomyolysis has changed in recent years. We describe the disease course in hospitalised patients, and compare disease course in individuals with exercise-induced rhabdomyolysis and rhabdomyolysis due to other causes. MATERIAL AND METHOD: The study is a systematic review of medical records from Akershus University Hospital for the years 2008 and 2011 ­ 14. All hospitalised patients with diagnostic codes M62.8, M62.9 and T79.6 and creatine kinase levels > 5 000 IU/l were included. The cause of the rhabdomyolysis was recorded in addition to patient characteristics and the results of various laboratory tests. RESULTS: Of 161 patients who were hospitalised with rhabdomyolysis during the study period, 44 cases (27 %) were classified as exercise-induced. In 2008 there were no admissions due to exercise-induced rhabdomyolysis; in 2011 and 2012 there were six and four admissions respectively, while in 2014 there were 22. This gives an estimated incidence of 0.8/100 000 in 2012 and 4.6/100 000 in 2014. Strength-training was the cause of hospitalisation in 35 patients (80 % of the exercise-induced cases). Three patients (7 % of the exercise-induced cases) had transient stage 1 kidney injury, but there were no cases with stage 2 or stage 3 injury. By comparison, 52 % of patients with rhabdomyolysis due to another cause had kidney injury, of which 28 % was stage 2 or 3. INTERPRETATION: The number of persons hospitalised with exercise-induced rhabdomyolysis has increased four-fold from 2011 to 2014, possibly due to changes in exercise habits in the population. None of the patients with exercise-induced rhabdomyolysis had serological signs of kidney injury upon hospital discharge.

Young men's perceptions and attitudes towards two fertility awareness interventions and preferences for future initiatives.

This study explored young Danish men's perceptions and attitudes towards two fertility awareness (FA) interventions (a podcast episode and an informational poster) and their preferences for how fertility awareness and prevention efforts should be targeted and communicated to young men in the future. Focus groups were held with 13 young men who were between the ages of 25-35 and in a committed relationship over Zoom in January 2021. Data were analysed using qualitative content analysis. Young men preferred FA interventions to be factual as in the informational poster and to include personal stories that could serve as conversation starters as in the podcast. According to the young men, FA interventions should communicate using positive language and humour and not be negative or shaming. They preferred intervention formats like TV-programmes, podcasts, and social media. The participants also suggested fertility information should be included in sexual education in high school and vocational education. This research suggests that future FA campaigns should be developed in cooperation with the target group together with clinicians, and concurrent studies using different intervention formats should be performed. In all probability, a mix of different interventions is necessary to attain the desired effect to ensure long-lasting fertility awareness.

Large-scale monitoring and risk assessment of microplastics in the Amazon River.

Microplastics (MPs) are one of the most widespread contaminants worldwide, yet their risks for freshwater ecosystems have seldom been investigated. In this study, we performed a large monitoring campaign to assess the presence and risks of MPs in Amazonian freshwater ecosystems. We investigated MP pollution in 40 samples collected along 1500 km in the Brazilian Amazon, including the Amazon River, three major tributaries, and several streams next to the most important urban areas. MPs in the 55-5000 µm size range were characterized (size, shape, color) by microscopy and identified (polymer composition) by infrared spectroscopy. Ecotoxicological risks were assessed using chronic Species Sensitivity Distributions for effects triggered by food dilution and tissue translocation using data alignment methods that correct for polydispersity of environmental MPs and bioaccessibility. This study shows that MPs are ubiquitous contaminants in Amazonian freshwater ecosystems, with measured concentrations (55-5000 µm) ranging between 5 and 152 MPs/m3 in the Amazon River and its main tributaries, and between 23 and 74,550 MPs/m3 in urban streams. The calculated Hazardous Concentration for the 5% of species (HC5) derived from the SSDs for the entire MP range (1-5000 µm) were 1.6 × 107 MPs/m3 (95% CI: 1.2 × 106 - 4.0 × 108) for food dilution, and 1.8 × 107 MPs/m3 (95% CI: 1.5 × 106 - 4.3 × 108) for translocation. Rescaled exposure concentrations (1-5000 µm) in the Amazon River and tributaries ranged between 6.0 × 103 and 1.8 × 105 MPs/m3, and were significantly lower than the calculated HC5 values. Rescaled concentrations in urban streams ranged between 1.7 × 105 and 5.7 × 108 MPs/m3, and exceeded both calculated HC5 values in 20% of the locations. This study shows that ecological impacts by MP contamination are not likely to happen in the Amazon River and its major tributaries. However, risks for freshwater organisms may be expected in near densely populated areas, such as the cities of Manaus or Belem, which have limited wastewater treatment facilities.

Plastic recycling plant as a point source of microplastics to sediment and macroinvertebrates in a remote stream.

Microplastic is now ubiquitous in freshwater, sediment and biota, globally. This is as a consequence of inputs from, for example, waste mismanagement, effluents from wastewater treatment plants and surface runoff from agricultural areas. In this study, we investigated point source pollution of plastic to an upland stream, originating from a recycling plant that recycles polyethylene film in a remote area of Norway. Sediment (~2 kg) and macroinvertebrates (549 individuals in total) were sampled at one site upstream and two sites downstream of the recycling plant to study microplastic deposition and food web uptake. In total, 340 microplastic films were identified through a combination of visual and µFTIR analysis in the sediment samples. This corresponded to a concentration of 0.23 (± 0.057) items per g sediment upstream of the plastic recycling plant and 0.45 (± 0.017) and 0.58 (± 0.34) items per g downstream. The dominant plastic polymer was polyethylene, which increased significantly downstream of the plastic recycling plant. This indicates the role of the plastic recycling plant as a point source for microplastic in this catchment. Among the three sites investigated, a fairly constant concentration of polypropylene was found, indicating a diffuse source of polypropylene films across the catchment possibly relating to low-intensity agricultural land-use. Low levels of polyethylene were also observed upstream, which may be linked to either local or longer-distance atmospheric transport. Despite the considerable presence of microplastic in sediments, concentrations in macroinvertebrates were extremely low with only a single microplastic particle identified in the total of 549 macroinvertebrates-belonging to three different feeding groups-investigated. Our study suggests that: 1) microplastic pollution can be transferred to remote areas as unintended losses from recycling facilities, 2) remote areas with limited land-use pressure still have detectable levels of microplastic and 3) microplastic is only taken up by stream macroinvertebrates to a limited degree despite relatively high sediment concentrations, and thus there are no strong indications for ecological risks posed by microplastic to this ecological group at this location. Supplementary Information: The online version contains supplementary material available at 10.1186/s43591-022-00045-z.

Understanding the occurrence and fate of microplastics in coastal Arctic ecosystems: The case of surface waters, sediments and walrus (Odobenus rosmarus).

The Arctic ecosystem receives contaminants transported through complex environmental pathways - such as atmospheric, riverine and oceanographic transport, as well as local infrastructure. A holistic approach is required to assess the impact that plastic pollution may have on the Arctic, especially with regard to the unseen microplastics. This study presents data on microplastics in the Arctic fjords of western Svalbard, by addressing the ecological consequences of their presence in coastal surface waters and sediment, and through non-invasive approaches by sampling faeces from an apex predator, the benthic feeder walrus (Odobenus rosmarus). Sample locations were chosen to represent coastal areas with different degrees of anthropogenic pollution and geographical features (e.g., varying glacial coverage of catchment area, winter ice cover, traffic, visitors), while also relevant feeding grounds for walrus. Microplastics in surface water and sediments ranged between

[68Ga]Ga-NODAGA-E[(cRGDyK)]2 Angiogenesis PET/MR in a Porcine Model of Chronic Myocardial Infarction.

Angiogenesis is crucial in tissue repair and prevents scar tissue formation following an ischemic event such as myocardial infarction. The ischemia induces formation of new capillaries, which have high expression of integrin αvß3. [68Ga]Ga-NODAGA-E[(cRGDyK)]2 ([68Ga]Ga-RGD) is a promising PET-radiotracer reflecting angiogenesis by binding to integrin αvß3. A Göttingen mini-pig underwent transient catheter-induced left anterior descending artery (LAD) occlusion for 120 min, and after 8 weeks was imaged on a Siemens mMR 3T PET/MR system. A large antero-septal infarction was evident by late gadolinium enhancement (LGE) on the short axis and 2-4 chamber views. The infarcted area corresponded to the area with high [68Ga]Ga-RGD uptake on the fused PET/MR images, with no uptake in the healthy myocardium. To support the hypothesis that [68Ga]Ga-RGD uptake reflects angiogenesis, biopsies were sampled from the infarct border and healthy myocardium. Expression of αvß3 was evaluated using immunohistochemistry. The staining showed higher αvß3 expression in the capillaries of the infarct border compared to those in the healthy myocardium. These initial data confirm in vivo detection of angiogenesis using [68Ga]Ga-RGD PET in a translational model, which overall support the method applicability when evaluating novel cardio-protective therapies.

Impact of dust on airborne Staphylococcus aureus' viability, culturability, inflammogenicity, and biofilm forming capacity.

Staphylococcus aureus is an opportunistic pathogen associated with soft-tissue infections commonly encountered in indoor and farm environments as a component of airborne dust, which can potentially deposit in the respiratory tracts of workers and residents. However, knowledge regarding the survival and inflammatory potential of S. aureus in airborne dust has not been described. The objective of this study was to obtain knowledge on whether the presence of dust during aerosolisation affects the culturability (ability to grow on agar plates), their biofilm forming capacity, viability (using a viability qPCR), and inflammatory potential (using a human granulocyte based assay), and whether time from aerosolisation to subsequent analyses (the resting time) affects these. Aerosols containing S. aureus (DSM6148) in the presence of sterilised airborne dust from a pig farm were found to have higher culturability, viability, inflammatory potential, and ability to form biofilm compared with S. aureus aerosols generated without airborne dust. When aerosols of S. aureus were generated without dust, they showed a reduction in the culturability, as well as the biofilm forming capacity and an extended resting time was associated with a reduction in culturability, and biofilm forming capacity. In contrast, no differences in the viability were observed in samples with different resting times. The lack of a significant effect of different resting times on viability, and the significant effect on culturability, suggests that the stresses of aerosolisation may induce a viable, but not culturable (VBNC) state in S. aureus. A synergistic effect was found between S. aureus and dust concerning their ability to induce inflammation. In conclusion presence of airborne dust during aerosolisation of S. aureus affects the culturability, biofilm forming capacity, and inflammatory potential, but not the viability of S. aureus. This is of importance in relation to hygiene as well as how exposure to S. aureus is measured.

Urolithiasis and cystitis associated with Staphylococcus delphini group A and mortality in post-weaning mink kits (Neovison vison).

Mortality of mink kits represents a significant loss to production. However, causes of post-weaning mortality in mink kits in modern Danish mink production systems are still relatively poorly documented. We performed a cross-sectional mortality study on eight Danish mink farms including 1893 post mortem examinations of mink kits found dead or euthanized. We assessed the prevalence of cystitis and urolithiasis leading to mortality. Gross pathological findings as well as animal characteristics were recorded and associations with post mortem microbiology (using culture and MaldiTof-MS Vitek MS system) were investigated. Cystitis and/or urolithiasis were associated with death in 33 % (n = 476) and 37 % (n = 166) of the examined mink kits in 2015 and 2017. On farm level, the prevalence of cystitis and/or urolithiasis leading to mortality varied from 0.25 % to 1.27 % with a low overall mortality of 0.9-4.5 %. The bacterial agent most frequently isolated in post mortem bladder swabs from mink with a post mortem diagnosis of urolithiasis and cystitis was Staphylococcus delphini group A (51/283) with a significant (p < 0.0001, CI = [19.5;4745.7]) association to gross pathological findings in the urinary tract. Staphylococcus delphini group A was cultured from 70 % of the skin swabs obtained from apparently healthy mink euthanized at pelting (n = 222). In conclusion urinary tract disease (cystitis and urolithiasis) was the most prevalent post mortem diagnosis during the growth period and was associated with Staphylococcus delphini group A.

Measurement of respiratory rate by multiple raters in a clinical setting is unreliable: A cross-sectional simulation study.

OBJECTIVE: To evaluate the inter-observer reliability of nurses assessing respiratory rate. METHODS: We presented seven minimum 60-seconds long videos of thoraces of non-identifiable patients breathing to experienced nurses from several Danish emergency departments. Two videos were assessed by 50 raters while five were reviewed by eight. The videos were shown using an online system that also recorded the counted respiratory rate. RESULTS: A total of 140 nurses participated with a median of 15years' experience. The range of counted respiratory rate was minimum 10 on each video. For videos evaluated by eight nurses, average Inter Class Coefficient (ICC) was 0.662 (0.000-0.960) and individual ICC 0.197 (0.000-0.750). For the two case-videos analyzed by 50 nurses, average ICC was 0.0 (0.000-0.991) and individual ICC 0.0 (0.000-0.677). CONCLUSIONS: We found a wide variation in measurements of RR with both few and many observers assessing exactly the same patients.

Manganese, copper, and zinc in cerebrospinal fluid from patients with multiple sclerosis.

The concentrations of manganese, copper, and zinc in cerebrospinal fluid (CSF) from patients with multiple sclerosis (MS) and patients with no known neurological disease (control group) were measured. Manganese and copper levels were determined by two different analytical methods: atomic absorption spectrometry (AAS) and high-resolution inductively coupled plasma-mass spectrometry (HR-ICP-MS), whereas zinc levels were determined by HR-ICP-MS only. Manganese levels (mean+/-SEM) were significantly decreased in the CSF of MS patients (1.07+/-0.13 microg/L, ICP-MS; 1.08+/-0.11 microg/L, AAS) compared to the levels in the control group (1.78+/-0.26 microg/L, ICP-MS; 1.51+/-0.17 microg/L, AAS). Copper levels were significantly elevated in the CSF of MS patients (10.90+/-1.11 microg/L; ICP-MS, 11.53+/-0.83 microg/L, AAS) compared to the levels in the control group (8.67+/-0.49 microg/L, ICP-MS; 9.10+/-0.62 microg/L, AAS). There were no significant differences between the CSF zinc levels of MS and control patients. The physiological basis for the differences in manganese and copper concentrations between MS patients and controls is unknown, but could be related to alterations in the manganese- containing enzyme glutamine synthetase and the copper-containing enzyme cytochrome oxidase.