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Pragmatics refers to the ability to effectively use and interpret language in different contexts. Pragmatic abilities develop and refine through childhood, and they are essential for socialization, academic achievement and wellbeing. The scarcity of assessment tools in this field makes it challenging to provide a comprehensive assessment of pragmatic abilities. The Pragma test, originally developed for Finnish and also adapted into Italian, consists of a battery of tasks assessing children's pragmatic abilities. In this study, a first evaluation of the psychometric qualities of a Norwegian adaptation of this test is presented. In addition, we investigated pragmatic development between ages 5 and 7, and explored possible gender-based differences. Altogether 119 Norwegian-speaking children participated in the study. The children were tested with the Pragma test and parents completed the Children's Communication Checklist-2. The children were allocated into three groups: 5-year-olds, 6-year-olds and 7-year-olds. The psychometric qualities of this Norwegian adaptation supported its use as a tool for assessing pragmatics in children aged 5-7. Strong and significant growth in pragmatic competence was observed from age 5-6, subsequently flattening out between age 6 and 7, and gender differences in favour of girls were identified. These findings indicate that pragmatic ability, as measured by the Pragma test, shows similar age effects in a Norwegian setting as in Finnish and Italian contexts, paving the way for further cross-cultural and cross-linguistic studies.

The public spaces in Analco neighborhood in the historic center of Puebla show a lack of appropriation on the part of its users, are invaded by the informal commerce and the streets, gardens and pedestrian zones are in inadequate conditions, all of which contributes to their deterioration and insecurity. This article presents a proposal of a participatory management model that contributes to achieve the appropriation and humanization of public spaces and the historical, cultural and landscape heritage of the neighborhood. Understanding the logic of territorial problems implies an epistemological thought that, through a methodology based on action research, promotes the qualitative evaluation of the problem using successive approaches. By doing so, will be able to promote complex thinking and systemic approaches for the construction of knowledge and to understand the process of the neighborhood’s evolution where different interests and needs converge for the common well-being.

Abstract Parasites in fish muscle present a significant problem for the seafood industry in terms of both quality and health and safety, but the low contrast between parasites and fish tissue makes them exceedingly difficult to detect. The traditional method to identify nematodes requires removing fillets from the production line for manual inspection on candling tables. This technique is slow, labor intensive and typically only finds about half the parasites present. The seafood industry has struggled for decades to develop a method that can improve the detection rate while being performed in a rapid, non-invasive manner. In this study, a newly developed solution uses deep neural networks to simultaneously analyze the spatial and spectral information of hyperspectral imaging data. The resulting technology can be directly integrated into existing industrial processing lines to rapidly identify nematodes at detection rates (73%) better than conventional manual inspection (50%).

Abstract We investigate the use of various momentum methods in combination with an ensemble approximation of gradients, for accelerated optimization. Although momentum gradient descent methods are popular in machine learning, it is unclear how they perform when applied to time-consuming dynamic problems such as production optimization for petroleum reservoir management. Four different momentum methods are extensively tested on a reservoir test case in one deterministic and one robust setting. The numerical experiments show that momentum strategies yield, on average, a higher net present value with fewer simulations needed.

Abstract Background Primary healthcare, the first line of care in many countries, treats patients with diverse health problems. High workload, time pressure, poor job control and negative interpersonal experiences with supervisors have been documented in primary healthcare. The work environment in primary healthcare is also affected by several types of changes. Aim We aimed to explore the levels of job satisfaction, turnover intention, social support, leadership climate and change fatigue according to physicians in Swedish primary healthcare. We also aimed to identify and characterize physicians exhibiting both high turnover intention and low job satisfaction, i.e., “discontent with current job”. Methods A cross-sectional survey based on a random sample of physicians working in Swedish primary healthcare. Results Approximately one-quarter of the respondents were discontented with their current job. Discontent was negatively associated with poor general health and change fatigue among the respondents; social support from colleagues and a favorable leadership climate showed positive associations in terms of reducing the levels of discontent with current job. Conclusions The findings of this study highlight the association between low levels of job satisfaction and high levels of turnover intention (i.e., discontent with current job) among physicians in primary healthcare. Moreover, these variables exhibited a strong association with physicians’ general health; poor health significantly increased the likelihood of discontent with current job. Our findings also show that experiencing change fatigue is associated with discontent with current job among physicians in primary healthcare. This knowledge can help identify and improve shortcomings within the psychosocial work environment in Swedish primary healthcare.

Abstract Objective The Salzburg EEG criteria for nonconvulsive status epilepticus (NCSE) have been proposed as consensus criteria for NCSE. We aimed to perform an independent study of their diagnostic accuracy. Methods A prospective study was carried out at Oslo University Hospital, including all consecutive patients ≥15 years old who were referred for an EEG with an explicit or implicit question of NCSE from February 2020 to February 2022. Two independent EEG readers scored the included EEGs according to the Salzburg criteria and blinded to the clinical data. The reference standard was defined as the clinical diagnosis the patient received based on all available clinical and paraclinical data. Diagnostic accuracy in identifying “certain/possible NCSE” was assessed by calculating sensitivity, specificity, positive predictive value, and negative predictive value with their 95% confidence intervals. Results In total, 469 patients/EEGs were included in the study. The prevalence of NCSE according to the reference standard was 11% (n = 53). The criteria showed a sensitivity of 94% (95% CI: 92–96%), a specificity of 77% (95% CI: 73–81%), a positive predictive value of 34% (95% CI: 30–39%), and a negative predictive value of 99% (95% CI: 98–100%). False positives for “certain NCSE” (n = 16) included many serial seizures and stimulus‐induced rhythmic and periodic discharges (SIRPIDs), as well as a focal cortical dysplasia. False positives for “possible NCSE” (n = 79) were mainly represented by different encephalopathies and postictality. Interpretation The low specificity of the Salzburg criteria calls for refinement before implementation into daily clinical practice.

Abstract Background Evidence from low- and middle-income countries (LMIC) suggests that home environment is associated with early childhood development outcomes. However, studies from LMIC that have examined how the home environment during middle childhood is associated with intellectual abilities are scarce. The objective of the study was to explore the association between different aspects of the home environment at 7–8 years and fluid reasoning abilities in a rural, high-risk cohort in Pakistan. Methods We employed a cross-sectional research design to examine 1172 children between 7 and 8 years and their families, utilizing the Home Observation for Measurement of Environment for Middle Childhood (HOME-MC) to evaluate various aspects of the home environment and the Fluid Reasoning Index (FRI) of the Wechsler Intelligence for Children (WISC)-5th edition to assess the fluid reasoning abilities of the children. Multivariable regression analyses were used to examine the association between different components of HOME-MC (scored as indices) and FRI scores. Findings Learning materials and opportunities (β = 1.74, 95% CI = 1.15, 2.33) and Responsivity (β = 1.73, 95% CI = 1.07, 2.38) indices had the strongest association with FRI score followed by Family companionship index (β = 1.27, 95% CI = 0.63, 1.90). The eight different indices of the HOME-DC explained 22% of the total variation in FRI scores. Conclusion We conclude that concurrent learning opportunities, parental responsivity and family companionship at home are associated with fluid reasoning abilities during middle childhood which is comparable to what has been found in early childhood years.

Abstract Background Patients with migraine are vulnerable to insufficient sleep, but the impact of sleep restriction is largely unknown. In addition, the importance of sleep may be different in patients with migraine who mostly have attack onsets during sleep, so called sleep-related migraine, compared to patients with non-sleep-related migraine. In this study we investigate the effect of sleep restriction on endogenous pain modulation in patients with migraine and healthy controls. We also compared the effect of sleep restriction in sleep-related and in non-sleep-related migraine. Methods Measurements were conducted in 39 patients with migraine between attacks and 31 controls, once after habitual sleep and once after two consecutive nights of partial sleep restriction. There were 29 and 10 patients with non-sleep-related and sleep-related migraine respectively. Test stimulus was 2-min tonic noxious heat to the left volar forearm. Temporal summation was calculated as the regression coefficient for rated pain in the late part of this 2-min stimulation. Conditioning stimulus was right hand-immersion in 7 °C water. Conditioned pain modulation was defined as the difference in rated pain with and without the conditioning stimulus and was calculated for temporal summation and mean rated pain for the test stimulus. The effect of sleep restriction on temporal summation and conditioned pain modulation was compared in migraine subjects and controls using two-level models with recordings nested in subjects. Results Conditioned pain modulation for temporal summation of heat pain tended to be reduced after sleep restriction in patients with migraine compared to controls (p = 0.060) and, in an exploratory analysis, was reduced more after sleep restriction in sleep-related than in non-sleep-related migraine (p = 0.017). No other differences between groups after sleep restriction were found for temporal summation or conditioned pain modulation. Conclusion Patients with migraine may have a subtly altered endogenous pain modulation system. Sleep restriction may have an increased pronociceptive effect on this system, suggesting a mechanism for vulnerability to insufficient sleep in migraine. This effect seems to be larger in sleep-related migraine than in non-sleep-related migraine.

Objective Private health insurance is becoming more common in Norway. The aim of this study was to investigate GPs’ opinions on private health insurance, and their experiences from consultations where health insurance can affect decisions about referring.Design A web based cross-sectional survey.Setting Norwegian general practice.Subjects All GPs in Norway were in 2019 invited to participate in an online survey.Main outcome measures The GPs’ opinions and experiences regarding health insurance were reported as proportions. Multiple logistic regression was used to test associations between how frequently GPs refer patients without further considerations and variables concerning their characteristics, opinions, and experiences.Results Of 1,309 GPs (response rate 27%), 93% stated that private health insurance raises the risk of overtreatment and 90% considered such insurance to contribute to inequality in health. Frequently being pressured to refer in the absence of a medical indication was reported by 42%. Moreover, 28% often or always chose to refer patients without further consideration, and this was associated with perceptions of pressure with an adjusted odds ratio (AOR) of 3.80, 95% confidence interval (CI) 2.73–5.29, and unpleasant reactions from patients following refusals (AOR 1.63, 95% CI 1.14–2.33).Conclusion Although most participating GPs associated private health insurance with overtreatment and inequality in health, more than one in four choose to refer without further consideration. GPs’ experience of pressure to refer and negative reactions from patients when they consider referrals not to be medically indicated, raises the risk of medical overuse for patients holding private health insurance.

Infestations with the ectoparasite salmon louse Lepeophtheirus salmonis are considered one of the main stressors for wild salmonids in farm-intensive areas. In Norway, lice infestations on sea trout Salmo trutta are monitored annually at fixed stations distributed along the coast, providing management authorities with an empirical basis to evaluate the potential parasite transmission between farmed and wild salmonids and to evaluate the effect of different management strategies. However, the representativeness of these data is debated, as information on where and for how long the fish have been at sea before capture is rarely available. In this study, we used scale circulus counts to determine marine residency time for sea trout postsmolts caught in Hardangerfjord, a farm-intensive area in western Norway, and show how this information can be used for a better interpretation of lice infestations reported by surveillance programs. By analyzing scales from individuals of known marine residency time (n = 48), we established a periodicity of circulus deposition over the first summer at sea of approximately 8 d per circulus [95% CI: 7.6-8.4 d]. Next, we applied zero-altered (‘hurdle’) statistical models to show how marine residency time, inferred from scale circuli, significantly affected both the probability and intensity of infestation with salmon lice among wild sea trout postsmolts of unknown migration timing (n = 321). Importantly, incorporating circulus counts as a proxy for time at sea significantly improved model likelihood, highlighting the importance of incorporating supporting data on individual sea trout migration traits into salmon lice surveillance programs to improve our understanding of the observed distributions.

Abstract Background It is well known that individuals recently discharged from psychiatric inpatient care face a high risk of suicide. Severe physical health conditions have also been linked to suicide risk. The risk of suicide following discharge from somatic hospitals is not known for individuals admitted due to acute physical health conditions. Methods A Cohort study using data from the entire Norwegian population aged 12 years and older from 2008 to 2022 linked with information on health service use and cause of death. We used Cox regression with age as time axis to estimate sex-adjusted hazard ratios of suicide following discharge for ages 12 to 64 years and 65 years and older. We also performed analyses after excluding hospitalizations with indications of concurrent mental disorders, self-harm, or suicide attempts. To assess individual risk, we performed an adapted case-crossover analysis among discharged patients who died from suicide. Results A total of 4 632,980 individuals aged 12 to 64 years and 1,469,265 individuals aged 65 years and older were included. Compared to unexposed individuals at similar ages, we found an increased risk of suicide in the first 4 weeks after discharge, with a hazard ratio (HR) of 7.0 (95% confidence interval (CI) 5.9 to 8.3) among those aged 12 to 64 years and 6.8 (95% CI 5.4 to 8.6) among those 65 years and older. In the younger age group, the risk was attenuated, with a HR of 2.4 (95% CI 1.7 to 3.2) after excluding hospitalizations with indications of concurrent mental disorders, self-harm, or suicide attempts. The corresponding HR was 4.8 (95% CI 3.5 to 6.4) among those 65 years and older, declining to 1.9, (1.2 to 3.1) in weeks 5 to 8 and 1.2 (0.7 to 2.2) in weeks 21 to 24. The case-crossover analysis confirmed that individuals 65 years and older were particularly vulnerable. Conclusions The heightened risk of suicide following discharge from acute somatic hospitalization, even in the absence of concurrent mental disorders, self-harm, or prior suicide attempts, underscores the critical need for comprehensive mental health and existential support for patients post-discharge.

Abstract Background Family factors, sleep, and physical activity have previously been associated with risk of sick leave and disability benefits due to musculoskeletal disorders. However, how these factors act during adolescence and young adulthood is unclear. The aim of this study was to (i) examine if chronic pain, disability benefits and education in parents influence the risk of long-term sick leave due to musculoskeletal disorders in young adulthood, and (ii) to explore if offspring sleep problems and physical activity modify these effects. Methods A population-based prospective study of 18,552 adolescents and young adults (≤ 30 years) in the Norwegian HUNT Study. Survey data was linked to national registry data on sick leave, disability benefits, family relations and educational attainment. We used Cox regression to estimate hazard ratio (HR) with 95% confidence interval (CI) for long-term (≥ 31 days) sick leave due to a musculoskeletal disorder in offspring associated with parental factors and the joint effect of parental factors and offspring lifestyle factors. Results Parental chronic pain (HR 1.36, 95% CI 1.27–1.45), disability benefits (HR 1.41, 95% CI 1.33–1.48) and low educational attainment (HR 1.78, 95% CI 1.67–1.90) increased the risk of long-term sick leave due to musculoskeletal disorders among offspring. There was no strong evidence that sleep and physical activity modified these effects. Conclusion Chronic pain, disability benefit and low education in parents increased the risk of long-term sick leave due to musculoskeletal disorders among offspring, but these effects were not modified by offspring sleep problems or physical activity level. The findings suggest that efforts beyond individual lifestyle factors might be important as preventive measures.

Abstract Background The COVID-19 pandemic necessitated a swift transition to e-learning, significantly impacting nursing education due to its reliance on practical, hands-on experiences and the critical role nurses play in healthcare. Nursing students need to achieve high levels of clinical competence through experiences traditionally obtained in clinical settings, which e-learning had to replicate or supplement. Understanding the unique challenges faced by nursing students in e-learning environments is crucial for developing educational strategies that enhance learning outcomes and contribute to improved patient care. This study aimed to explore the experiences of nursing students and newly qualified nurses (as students) with e-learning during the COVID-19 lockdown, focusing on how it influenced their learning and professional development. Method This exploratory and descriptive study employed qualitative interviews with 31 participants, including full-time nursing students, part-time nursing students, and newly qualified nurses (as nursing students). Conducted online via Zoom during February and March 2022. Results The findings suggest that integrating small group interactions and employing strategic pedagogical support can enhance e-learning effectiveness. However, barriers such as technological difficulties, psychological challenges, and social isolation were also identified. Understanding these unique opportunities and challenges can help educational institutions optimize e-learning strategies, ensuring nursing students are well-prepared for their crucial roles in healthcare. Conclusion The rapid shift to e-learning due to the COVID-19 pandemic presented challenges such as technological, psychological and social aspects, but also opportunities to rethink and enhance nursing education delivery. Implementing appropriate pedagogical e-learning strategies, such as scaffolding and small group learning, can better prepare nursing students for their essential roles in healthcare. This study contributes to the body of knowledge on digital education and provides a foundation for future research aimed at optimizing e-learning in nursing education.

Abstract Background Individuals with non-celiac gluten/wheat sensitivity (NCGWS) experience improvement in gastrointestinal symptoms following a gluten-free diet. Although previous results have indicated that fructo-oligosaccharides (FOS), a type of short-chain fructans, were more likely to induce symptoms than gluten in self-reported NCGWS patients, the underlying mechanisms are unresolved. Methods Our main objective was therefore to investigate whether FOS-fructans and gluten affect the composition and diversity of the faecal microbiota (16S rRNA gene sequencing), faecal metabolites of microbial fermentation (short-chain fatty acids [SCFA]; gas chromatography with flame ionization detector), and a faecal biomarker of gut inflammation (neutrophil gelatinase-associated lipocalin, also known as lipocalin 2, NGAL/LCN2; ELISA). In the randomised double-blind placebo-controlled crossover study, 59 participants with self-reported NCGWS underwent three different 7-day diet challenges with gluten (5.7 g/day), FOS-fructans (2.1 g/day), and placebo separately (three periods, six challenge sequences). Results The relative abundances of certain bacterial taxa were affected differently by the diet challenges. After the FOS-fructan challenge, Fusicatenibacter increased, while Eubacterium (E.) coprostanoligenes group, Anaerotruncus, and unknown Ruminococcaceae genera decreased. The gluten challenge was primarily characterized by increased abundance of Eubacterium xylanophilum group. However, no differences were found for bacterial diversity (α-diversity), overall bacterial community structure (β-diversity), faecal metabolites (SCFA), or NGAL/LCN2. Furthermore, gastrointestinal symptoms in response to FOS-fructans were generally not linked to substantial shifts in the gut bacterial community. However, the reduction in E. coprostanoligenes group following the FOS-fructan challenge was associated with increased gastrointestinal pain. Finally, correlation analysis revealed that changes in gastrointestinal symptoms following the FOS-fructan and gluten challenges were linked to varying bacterial abundances at baseline. Conclusions In conclusion, while FOS-fructans induced more gastrointestinal symptoms than gluten in the NCGWS patients, we did not find that substantial shifts in the composition nor function of the faecal microbiota could explain these differences in the current study. However, our results indicate that individual variations in baseline bacterial composition/function may influence the gastrointestinal symptom response to both FOS-fructans and gluten. Additionally, the change in E. coprostanoligenes group, which was associated with increased symptoms, implies that attention should be given to these bacteria in future trials investigating the impact of dietary treatments on gastrointestinal symptoms. Trial registration Clinicaltrials.gov as NCT02464150.

In this study, we analyse a 9-year-old child's argumentative participation in a group discussion, from a microgenetic development angle. Specifically, we follow one child through the discussion and analyse the development process, defined as changed participation and as interactionally contingent upon the other participants and the teacher. The data consist of one video recording of the group discussion including two dilemmatic tasks for which the children are asked to come to a joint solution. A sequential analysis was performed from a sociocultural perspective on learning and communication. The findings show that the focus child's argumentative participation develops both quantitatively and qualitatively, and that this development reflects a switch between general agreement amongst the children in the first task and general disagreement in the second task. This disagreement angle is discussed both from an argumentation and an education perspective. Two of the focus child's argumentative resources (an imaginary space she creates and the use of the concept "data protection") are discussed in detail.

In the initial phase of the pandemic caused by the coronavirus (SARS-CoV-2), schools were closed, forcing most students to stay home on school days. In this chaotic and stressful situation, facing a potential life-threatening disease, parents needed to handle their family life, their own work, in addition to being teachers of their children. This situation may have been especially stressful for parents of children in need of special education. In this study, we examined possible determinants of parental satisfaction with the school during the lockdown using a sample of parents (N = 476) with children in need of special education. By applying a multivariate regression model, we found that the strongest predictor of parental satisfaction with the school during the lockdown was good communication between the parents and the school (r = 0.38), followed by how often the teachers were in contact with the children (r = 0.18) and how well the teachers guided the parents regarding home-schooling (r = 0.17). Notably, the degree of the children's difficulties, family climate or socioeconomic status was not related to parental satisfaction with the school during the lockdown.

Within the higher education sector, the principle of student-active and research-based education are established in strategy documents and action plans, but at the same time there is an ongoing debate about what is meant by research-based learning and how it can be applied in practical teaching contexts. The aim of this empirical study is to explore inclusion of research elements in higher education. The study introduces the concept of using systematic literature review (SLR) and digital collaboration as a learning method, and addresses how to succeed with digital collaborative systematic literature review as a research-like learning activity in higher education. An exploratory multiple case design is used, with participatory observation technique and thematic analysis. A practical contribution of this study is an example of how SLR is well-suited to do collective research-like learning activities. The main contribution is that the higher education teacher needs integrated knowledge, including research competence in addition to the traditional link between professional, didactic and technological competence. A model for research-like learning is proposed, which illustrates the need for research knowledge in relation to the technological pedagogical content knowledge.

Meta-analyses and international large-scale assessments (ILSA) are key sources for informing educational policy, research, and practice. While many critical research questions could be addressed by drawing evidence from both of these sources, meta-analysts seldom integrate ILSAs, and current integration practices lack methodological guidance. The aim of this methodological review is therefore to synthesize and illustrate the principles and practices of including ILSA data in meta-analyses. Specifically, we (a) review four ILSA data inclusion approaches (analytic steps, potential, challenges); (b) examine whether and how existing meta-analyses included ILSA data; and (c) provide a hands-on illustrative example of how to implement the four approaches. Seeing the need for meta-analyses on educational inequalities, we situated the review and illustration in the context of gender differences and socioeconomic gaps in student achievement. Ultimately, we outline the steps meta-analysts could take to utilize the potential and address the challenges of ILSA data for meta-analyses in education.

The study of agency has received increasing attention in recent years. The focus on change processes at the micro-level has brought new insights into the field of regional development. However, in debates about change and regional development, agents and leaders themselves have received far less attention than agency as a process. We provide an analytical model to show how political leaders and their leadership act as drivers of change through what we call actor properties (i.e., knowledge, networks and resources). We discuss how actor properties interact with the institutional context in which leaders operate and the various transitions from a political leader's legitimacy to the legacy of their political action. Empirical investigations of two peripheral regions in Italy and Norway illustrate how political leaders act as agents of change in geographical areas characterised by different socioeconomic and institutional contexts.