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Betanodaviruses have been isolated and detected in both farmed and wild fish species worldwide. They are classified in five clusters, and all are connected to mortalities in farmed fish. The clusters do not represent specific geographical areas or host species, but one cluster, barfin flounder nervous necrosis virus (BFNNV), is mainly associated with cold water fish species. This study presents the first species-specific clade within the BFNNV cluster. This clade consists of six isolates from wild and farmed Atlantic cod in Norway and is genetically distinct from other betanodaviruses in the North Atlantic. Screening of farmed and wild cod in Norway shows that betanodaviruses are present in wild fish on the west coast of Norway, including migratory cod, but so far we have not detected any betanodavirus-positive wild cod in northern Norway. The presence of significant amounts of betanodaviruses in wild cod represents a serious challenge for the management of viral nervous necrosis in farmed cod in Norway. Betanodavirus-positive farmed cod were present both in western and northern Norway. Mortalities in three cod farms were suspected to be caused by betanodaviruses; however, in two of these, other pathogens may have been responsible for or strongly contributed to the mortalities. [ABSTRACT FROM AUTHOR]

In the summers of 1981 and 2000, 288 goosandersMergus merganserwere sampled in the estuary of the River Tana in northern Norway, which has the largest wild Atlantic salmonSalmo salarstock in the world. Based on 2308 otoliths found in their stomach contents, sandeelsAmmodytessp. were found to be the dominant prey, and only one pair of Atlantic salmon otoliths was found. This suggested that goosanders were not significant predators on Atlantic salmon smolts in the estuary, probably because of the high abundance of sandeels and other marine prey fishes, at least in these particular years. [ABSTRACT FROM AUTHOR]

Shorthorn sculpin (Myoxocephalus scorpius) and large cod (300–400 g body weight) are important predators on newly settled 0-group cod (Gadus morhua) and saithe (Pollachius virens) in Porsangerfjorden in northern Norway. The Atlantic wolffish (Anarhichas lupus) used to be abundant but is now very rare in the fjord. Video recorded experiments showed that interactions between shorthorn sculpins, wolffish and large cod affected predation rates on small 0-group cod and saithe in tanks with a gravel, cobble and seaweed (Fucus serratus) substrate. We found that sculpins were unable to catch 0-group specimens when they were the only predatory species in the experimental tank and the lights were left on 24 h a day (to simulate the midnight sun), and that they did not even attempt to catch them. The addition of a large cod to the tank increased sculpin attack rates and predation success significantly. The "cod effect" was due to 0-group specimens avoiding attacks by escaping into the cobbles or vegetation, were they could be more easily reached by the sculpins. When tanks were supplemented with a wolffish in addition to the cod, both sculpin and cod predation success was lowered by approximately 50% in the 24-h light regime. When the experimental setup was changed to a day/night light cycle, however, the wolffish presence had no effect. Also, sculpins in tanks without cod and wolffish went from consuming zero to 29% of the 0-group specimens in the tank when the light regime went from 24-h light to day/night. Sculpins and cod were most effective predators on 0-group cod and saithe at dusk/night/dawn, and the presence of a cruising predator like cod increased sculpin predation success and probably vice versa. The experimental data indicate that rebuilding wolffish stocks in the fjord system may make the bottom substrate more protective for 0-group specimens of cod and saithe, by limiting the foraging volume of an effective bottom-dwelling 0-group predator like the sculpin. Further field and lab studies must be conducted before the reported findings optionally can be turned into a management advice. • The widely distributed Shorthorn sculpin is abundant and an important predator on newly settled cod and saithe juveniles. • Sculpin´s predation success is greatly increased when a larger cruising cod predator is also present in the tank. • Continuous light favors juveniles escape success while a full light cycle is more advantageous for the predators. • Wolffish presence lower cod and sculpin predation in continuous light but not when the cycle includes dusk, night and dawn. [ABSTRACT FROM AUTHOR]

Abstract: The Barents Sea capelin stock is, potentially, the largest capelin stock in the world, with a maximum biomass in the range of 6–8 million tonne. The main spawning grounds for this capelin stock are along the coast of northern Norway. By modeling and fieldwork, this study addresses the interaction between mesoscale physical process and newly hatched capelin larvae. The study documents a close relationship between selected spawning location, advection, retention, mortality windows and dispersal patterns. [Copyright &y& Elsevier]

Introduction. Infections by carbapenemase-producing Pseudomonas aeruginosa (CP-Pa) are concerning due to limited treatment options. The emergence of multidrug-resistant (MDR) high-risk clones is an essential driver in the global rise of CP-Pa. Hypothesis/Gap Statement. Insights into the molecular epidemiology of CP-Pa are crucial to understanding its clinical and public health impact. Despite the low incidence of infections in Norway, global spread requires an understanding of regional dissemination patterns. Aim. This study aimed to investigate the phenotypic and genotypic characteristics of CP-Pa isolates in Norway and molecular epidemiology by utilizing available metadata. Methodology. The study collection comprised all verified CP-Pa isolated in Norway from 2006 to 2022 ( n =67) obtained from clinical (75%; n =50) or screening samples (22%; n =15) or had no available information (3%; n =2). Phenotypic analyses included antimicrobial susceptibility testing against clinically relevant antipseudomonal antibiotics and comparative testing for carbapenemase production using three different methods ( β -CARBA, IMI/IMD gradient test and Coris O.K.N.V.I RESIST-5). Whole-genome sequencing was performed to identify virulence factors, resistance determinants and genomic relatedness. Results. The isolates were categorized as MDR ( n =39) encoding Verona integron-encoded metallo- β -lactamase (VIM) ( n =28), New Delhi metallo- β -lactamase (NDM) ( n =6), imipenemase metallo- β -lactamase (IMP) ( n =4) or Guiana extended spectrum metallo- β -lactamase ( n =1) carbapenemases or extensively drug-resistant (XDR; n= 28) encoding VIM ( n =11), NDM ( n =9) or IMP ( n =8) carbapenemases. CP-Pa numbers ranged from 1 to 7 annually, peaking at 17 in 2022. Most isolates ( n =64) were associated with international travel or hospitalization abroad. Phylogenetic analyses identified nine clusters of closely related genomes, with one suspected case of domestic patient-to-patient transmission. Among 21 detected sequence types, several were global high-risk clones, including ST235 ( n =12), ST111 ( n =9), ST773 ( n =9), ST253 ( n =3), ST357 ( n =3), ST395 ( n =3), ST823 ( n =3), ST233 ( n =2), ST654 ( n =2), ST260 ( n =1) and ST308 ( n =1), covering 72% of the Norwegian isolates. ST1047 (IMP-1) and ST773 (NDM-1) were associated with Ukrainian war victims. Carbapenemase detection rates for phenotypic tests were 88% ( β -CARBA), 91% (IMI/IMD) and 94% (Coris) in our collection. Conclusion. The study highlights the low incidence yet high genomic diversity of CP-Pa in Norway and the dominance of high-risk clones linked to imports, contributing to the high proportion of XDR.

Infections with OXA-244-carbapenemase-producing Escherichia coli with sequence type (ST)38 have recently increased in Europe. Due to its low-level activity against carbapenems, OXA-244 can be difficult to detect. Previous assessments have not revealed a clear source and route of transmission for OXA-244-producing E. coli , but there are indications of non-healthcare related sources and community spread. Here we report a hospital-associated outbreak of OXA-244-producing E. coli ST38 involving three hospitals in Western Norway in 2020. The outbreak occurred over a 5-month period and included 12 cases identified through clinical (n = 6) and screening (n = 6) samples. The transmission chain was unclear; cases were identified in several wards and there was no clear overlap of patient stay. However, all patients had been admitted to the same tertiary hospital in the region, where screening revealed an outbreak in one ward (one clinical case and five screening cases). Outbreak control measures were instigated including contact tracing, isolation, and screening; no further cases were identified in 2021. This outbreak adds another dimension to the spread of OXA-244-producing E. coli ST38, illustrating this clone's ability to establish itself in the healthcare setting. Awareness of challenges concerning OXA-244-producing E. coli diagnostic is important to prevent further spread.

Objectives: To investigate how a standard ceiling mounted light-emitting diode (LED)-based bright light intervention affected alertness and neurobehavioural performance during three consecutive simulated night shifts, and timing of circadian rhythm after the shifts., Methods: Twenty seven participants (20 females, 21.4±2.1 years; mean±SD) worked three consecutive night shifts (23:00-07:00) under a full-spectrum (4000 K) bright light (900 lx) and a standard light (90 lx) condition in a counterbalanced crossover design (separated by 4 weeks). Subjective alertness (Karolinska Sleepiness Scale) and neurobehavioural performance (Psychomotor Vigilance Task and Digit Symbol Substitution Test) were assessed five times during each shift. Salivary dim-light melatonin onset (DLMO) was assessed before and after the shifts. The simulated night shifts were conducted in a laboratory while the participants slept at home., Results: Subjective alertness and neurobehavioural performance deteriorated during the night shifts in both light conditions. However, bright light significantly reduced alertness and performance decrements as compared with standard light. For a subset of the participants, DLMO was delayed by a mean of 3:17±0:23 (mean±SEM) hours after three night shifts in bright light and by 2:06±0:15 hours in standard light, indicating that bright light causes larger phase delay., Conclusion: Bright light improved performance and alertness during simulated night shifts and improved adaptation to night work. Bright light administered by ceiling mounted LED luminaires has the potential to improve adaptation to night work and reduce the risk of accidents and injuries among night workers., Trial Registration Number: NCT03203538., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Current guidelines on the use of β-blockers in post-acute myocardial infarction (MI) patients without reduced left ventricular ejection fraction (LVEF) are based on studies before the implementation of modern reperfusion and secondary prevention therapies. It remains unknown whether β-blockers will reduce mortality and recurrent MI in contemporary revascularized post-MI patients without reduced LVEF., Design: BETAMI is a prospective, randomized, open, blinded end point multicenter study in 10,000 MI patients designed to test the superiority of oral β-blocker therapy compared to no β-blocker therapy. Patients with LVEF ≥40% following treatment with percutaneous coronary intervention or thrombolysis and/or no clinical signs of heart failure are eligible to participate. The primary end point is a composite of all-cause mortality or recurrent MI obtained from national registries over a mean follow-up period of 3 years. Safety end points include rates of nonfatal MI, all-cause mortality, ventricular arrhythmias, and hospitalizations for heart failure obtained from hospital medical records 30 days after randomization, and from national registries after 6 and 18 months. Key secondary end points include recurrent MI, heart failure, cardiovascular and all-cause mortality, and clinical outcomes linked to β-blocker therapy including drug adherence, adverse effects, cardiovascular risk factors, psychosocial factors, and health economy. Statistical analyses will be conducted according to the intention-to-treat principle. A prespecified per-protocol analysis (patients truly on β-blockers or not) will also be conducted., Conclusions: The results from the BETAMI trial may have the potential of changing current clinical practice for treatment with β-blockers following MI in patients without reduced LVEF. EudraCT number 2018-000590-75., (Copyright © 2018 Elsevier Inc. All rights reserved.)

To explore if vitamin D modulates interferon-β1a treatment effects in relapsing-remitting multiple sclerosis, we examined relationships between serum vitamin D and magnetic resonance imaging (MRI) activity and ten systemic inflammation markers in 88 patients, before and during treatment. Odds ratios for all MRI parameters were negatively associated with vitamin D levels before therapy, but converged to equally low values irrespective of vitamin D status during treatment. During therapy, similar alterations of MRI activity and inflammation markers were found across patients categorized by mean vitamin D values. This suggests that vitamin D status has no major influence on interferon-β1a treatment effects., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Aims: To examine the impact of physical fitness (PF) on the association between fasting serum triglycerides (FTG) and diabetes risk and whether temporal changes in FTG predict diabetes risk in healthy middle-aged men., Methods: FTG and PF (bicycle exercise test) were measured in 1962 men aged 40-59 years in 1972-1975 (Survey 1) and repeated in 1387 still healthy men on average 7.3 years later (Survey 2). Diabetes was diagnosed according to WHO 1985-criteria., Results: During 35 years follow-up 202/1962 (10.3%) men developed diabetes. Compared with the lowest, the upper FTG tertile had a 2.58-fold (95% CI: 1.81-3.74) diabetes risk adjusted for age, fasting blood glucose and maternal diabetes, and a 2.29-fold (95%CI: 1.60-3.33) when also adjusting for PF. Compared with unchanged (±25%) FTG levels (n=664), FTG reduction of more than 25% (n=261) was associated with 56% lower (0.44; 95% CI: 0.24-0.75) diabetes risk, while FTG increase of more than 25% (n=462) was associated with similar risk. These associations were unchanged when adjusted for PF and PF change., Conclusions: High FTG-levels predicted long-term diabetes risk in healthy middle-aged men, and the association was only modestly weakened when adjusted for PF. A reduction in FTG was associated with decreased diabetes risk., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Gentamicin is important in synergistic bactericidal therapy with cell wall agents for severe enterococcal infections. During 2003-2008, a 10-fold increase in the prevalence of high-level gentamicin resistance (HLGR), to above 50%, in blood culture isolates of Enterococcus faecium, was reported by the Norwegian Surveillance System for Antimicrobial Resistance. A representative national collection of invasive E. faecium isolates (n = 99) from 2008 was examined by a multilevel approach. Genotyping revealed a polyclonal population dominated by major hospital-associated lineages (mainly ST203, ST17, ST18, ST202 and ST192). The presence of aac(6')-Ie-aph(2″)-Ia, encoding the bi-functional aminoglycoside-modifying enzyme, was found in 98% of HLGR isolates (56/57). Furthermore, a significantly higher prevalence of potential virulence genes, toxin-antitoxin loci as well as pRE25 and pRUM type replicons was demonstrated in isolates belonging to major hospital-associated lineages compared to other sequence types. Megaplasmids of pLG1 replicon type (200-330 kb) were present in 90% of the isolates. Co-hybridization analyses revealed genetic linkage of aac(6')-Ie-aph(2″)-Ia to this replicon type. Transfer of HLGR-encoding plasmids was restricted to E. faecium. In conclusion, the increased prevalence of HLGR in invasive E. faecium in Norway is associated with hospital-adapted genetic lineages carrying aac(6')-Ie-aph(2″)-Ia-encoding transferable megaplasmids of the pLG1 replicon type., (© 2012 Federation of European Microbiological Societies. Published by Blackwell Publishing Ltd. All rights reserved.)

Background: Traumatic brain injury (TBI) is a major cause of lost disability-adjusted life years, and a valid model allowing prediction of outcome would be welcome. For a clinical prediction model to be valid, generalization to other populations must be possible. The aim of this study was to externally validate a model for in-hospital mortality in patients with TBI, which was recently development at the University of Southern California (USC)., Methods: The validation cohort was derived from a hospital-based, prospectively collected trauma registry in Oslo, Norway. We included patients admitted with a head injury without hypotension, severe thoracic, or abdominal injury (n = 3,136). We calculated the probability of death according to the USC model. The performance of the model was evaluated using measures of calibration and discrimination in the total sample and subgroups according to initial Glasgow Coma Scale (GCS) score., Results: The USC model provided excellent discrimination (area under the receiver operating characteristic curve, AUC = 0.93), but unsatisfactory calibration (p < 0.001) for the total sample (GCS 3-15). In the GCS 4-8 subgroup we found good discrimination (AUC = 0.89) but poor calibration (Hosmer-Lemeshow test, p < 0.001)., Conclusion: The findings question the external validity of the USC model, suggesting that it should not be implemented as a tool for short-term mortality prediction in our TBI population.

When the working hours of junior doctors at a medical clinic were reduced from 44 to 40.7 hours per week a questionnaire was distributed to the doctors themselves and to the different categories of nurses to find out how this change had affected the schedule for investigation and treatment of the patient, care of the patient, discharge from hospital, and collaboration with other health professionals. In the opinion of doctors and nurses alike, the reduced working hours had led to delays in investigation of patients, poorer care, problems in connection with discharge from hospital, and poorer collaboration with other professional groups. It could well be difficult to achieve normal working hours for junior doctors in hospitals with patients under continuous treatment without this having av decided negative effect on continuity of treatment.

In this study, 1884 patients who were selected from 3647 consecutive patients who survived at least 6 days after an acute myocardial infarction were randomized to double-blind treatment with either placebo or timolol and followed for 12-33 months. One hundred fifty-two patients in the placebo group and 98 in the timolol group died. The life-table cumulative probability of total death was 21.9% in the placebo group and 13.3% in the timolol group, corresponding to a relative reduction of 39.4% (p = 0.0003). One hundred thirty-one nonfatal reinfarctions were confirmed in the placebo group and 90 were confirmed in the timolol group, including events among withdrawn patients. The life-table probability rate of reinfarction was 16.4% in the placebo and 11.8% in the timolol group (p = 0.001). We conclude that chronic treatment with timolol in survivors of acute myocardial infarction who can tolerate beta-adrenergic blockade is effective in reducing both total mortality and reinfarction over 33 months.

In 54 patients with suspected deep vein thrombosis in the lower extremity, B-scan ultrasonography was compared with contrast venography for diagnostic accuracy. In the area of the common femoral/popliteal vein ultrasonography was correct in 53 patients, giving an accuracy of 98% (53/54). There were no false-negative studies, which gives a sensitivity of 100% (21/21). There was one false-positive study for a specificity of 97% (32/33). The technique is inexpensive and produces no discomfort to the patient. It is quite obvious that even small hospitals have the equipment and the competent staff to carry out this examination. We claim that B-scan ultrasonography is a certain, non-invasive method of demonstrating deep vein thrombosis in the common femoral/popliteal vein area.

The original Norwegian Multicenter Study on Timolol after Myocardial Infarction was a double-blind, randomized study comparing the effect of timolol with that of placebo for up to 33 months after acute myocardial infarction. The initial results showed that the cumulated mortality rate was 39.4 per cent lower among 945 patients randomly assigned to timolol treatment than among 939 patients randomly assigned to placebo (P = 0.0003). After the end of the double-blind period the majority of participating patients in the timolol group continued to receive beta-adrenergic blockade, whereas the majority of placebo-treated patients continued without such blockade. During an extended follow-up of participating patients up to 72 months after randomization, the mortality curves of the two groups continued to rise in parallel. Cumulated mortality rates were 32.3 per cent in the placebo group and 26.4 per cent in the timolol group (P = 0.0028). We conclude that the previously observed early beneficial effect of beta-adrenergic blocking therapy is maintained for at least six years after infarction.