Unilabs (Norway)

BackgroundComputed tomography (CT) scans account for 60% of the total radiation dose in medical imaging. Literature has shown that patient dose varies across CT scanners, diagnostic protocols, and technical parameters at each site, suggesting an opportunity for starting an optimization process through establishing diagnostic reference levels (DRLs).PurposeTo establish local DRLs (LDRLs) for six Norwegian private diagnostic institutes for frequently performed CT protocols.Material and MethodsDose data from 900 patients were collected from six diagnostic facilities. Data were recorded from non-contrast CT scans of the head and contrast-enhanced scans of the thorax and abdomen and pelvis from average-sized adult patients. An ANOVA test was performed to determine the variation in dose between scanners. LDRLs were determined by the 75th percentile of median values from dose indicators of CT scanners.ResultsThe difference between the means of the dose distribution from each scanner was statistically significant (P < 0,05) for all examinations. The LDRLs determined were lower, for both national and international DRLs.ConclusionObserved dose variations from the scanners indicate a need for protocol optimization for some institutes, while the LDRLs demonstrate a potential for establishing newer national diagnostic reference levels (NDRLs) in Norway.

Introduction:The pandemic outbreak of coronavirus disease 2019 (COVID-19) greatly restricted routine healthcare services across Europe, including cancer diagnosis and treatment.Amongst skin cancers, malignant melanoma (MM) is responsible for most deaths.Objective: This study aimed to compare the number and characteristics of diagnosed MM cases before and during the pandemic in a Portuguese secondary hospital.Methods: This was an observational, retrospective study comparing a prepandemic (diagnosis from March 2019 to February 2020) and a pandemic group of patients with MM diagnosis (diagnosis between March 2020 and February 2021).Results: A total of 59 patients were included, 44 in the pre-pandemic group and 15 in the pandemic period.In the first year of the pandemic, there was a significantly lower number of MM diagnoses compared to the precedent year (15 vs 44, p < 0.01), without significant differences in tumor characteristics.The time from referral to first consultation was slightly shorter in the pandemic group (median of 36 vs 76 days, p = 0.056).Conclusions: This study provides evidence of a reduction in MM diagnosis during the first year of the COVID pandemic, despite no significant differences in prognostic factors.As the pandemic persists, one must emphasize the importance of early MM diagnosis and treatment.

ABSTRACTObjectivesTo assess risk factors for SARS-CoV-2 infection by first comparing positive cases with negative controls as determined by polymerase chain reaction (PCR) testing and then comparing these two groups with an additional population control group.Design and settingTest-negative design (TND), multicentre case-control study with additional population controls in South Eastern Norway.ParticipantsAdults who underwent SARS-CoV-2 PCR testing between February and December 2020. PCR-positive cases, PCR-negative controls, and additional age-matched population controls.Primary outcome measuresThe associations between various risk factors based on self-reported questionnaire and SARS-CoV-2 infection comparing PCR positive cases and PCR-negative controls. Using subgroup analysis, the risk factors were then compared with a population control group. Univariate and multivariate regression analyses were performed.ResultsIn total, 400 SARS-CoV-2 PCR-positive cases, 719 PCR-negative controls, and 14,509 population controls were included. Male sex was associated with the risk of SARS-CoV-2 infection when PCR-positive cases were compared with PCR-negative controls (OR 1.9, 95% CI 1.4 to 2.6). Age, education level, comorbidities (asthma, diabetes, hypertension), an exercise were not associated with the risk of SARS-CoV-2 infection when PCR-positive cases were compared with PCR-negative controls. In the subgroup analysis comparing PCR-positive cases with age-matched population controls, asthma was associated with the risk of SARS-CoV-2 infection (OR 1.6, 95% CI 1.1 to 2.1). Daily or occasional smoking was negatively associated with the risk of SARS-CoV-2 infection in both analyses (OR 0.5, 95% CI 0.3 to 0.8 and OR 0.55, 95% CI 0.35, to 0.82, respectively).ConclusionsMale sex was a possible risk factor, whereas smoking was negatively associated with the risk of SARS-CoV-2 infection, when comparing PCR-positive cases and PCR-negative controls. Asthma was associated with the risk of SARS-CoV-2 infection when PCR-positive cases were compared with population controls.ARTICLE SUMMARYStrengths and limitations of this studyThe test-negative design (TND) was an important strength of this study. The design can reduce confounding from healthcare-seeking bias because PCR-controls are likely to have similar healthcare-seeking attitudes as PCR+ cases.This study mostly included non-hospitalised patients, which can improve the generalisability of the findings to the general public.The use of an additional control group from the general public for comparison with the findings from the test-negative controls provides further information on the similarities and differences in risk factors for COVID-19 and other respiratory tract infections.In the subgroup analyses, PCR+ cases and PCR- controls were compared with the population controls to assess the risk factors for those aged 18–55 years. Hence, the results may not be generalisable to patients older than 55 years.PCR test results, rather than symptoms, were used to categorise the participants into cases or controls, and therefore risk factors for SARS-CoV-2 infection and not COVID-19 disease were assessed.

Operations for lumbar spinal stenosis is the most often performed surgical procedure in the adult lumbar spine. This study reports the clinical outcome of the 3 most commonly used minimally invasive posterior decompression techniques. To compare the effectiveness of 3 minimally invasive posterior decompression techniques for lumbar spinal stenosis. This randomized clinical trial used a parallel group design and included patients with symptomatic and radiologically verified lumbar spinal stenosis without degenerative spondylolisthesis. Patients were enrolled between February 2014 and October 2018 at the orthopedic and neurosurgical departments of 16 Norwegian public hospitals. Statistical analysis was performed in the period from May to June 2021. Patients were randomized to undergo 1 of the 3 minimally invasive posterior decompression techniques: unilateral laminotomy with crossover, bilateral laminotomy, and spinous process osteotomy. Primary outcome was change in disability measured with Oswestry Disability Index (ODI; range 0-100), presented as mean change from baseline to 2-year follow-up and proportions of patients classified as success (>30% reduction in ODI). Secondary outcomes were mean change in quality of life, disease-specific symptom severity measured with Zurich Claudication Questionnaire (ZCQ), back pain and leg pain on a 10-point numeric rating score (NRS), patient perceived benefit of the surgical procedure, duration of the surgical procedure, blood loss, perioperative complications, number of reoperations, and length of hospital stay. In total, 437 patients were included with a median (IQR) age of 68 (62-73) years and 230 men (53%). Of the included patients, 146 were randomized to unilateral laminotomy with crossover, 142 to bilateral laminotomy, and 149 to spinous process osteotomy. The unilateral laminotomy with crossover group had a mean change of -17.9 ODI points (95% CI, -20.8 to -14.9), the bilateral laminotomy group had a mean change of -19.7 ODI points (95% CI, -22.7 to -16.8), and the spinous process osteotomy group had a mean change of -19.9 ODI points (95% CI, -22.8 to -17.0). There were no significant differences in primary or secondary outcomes among the 3 surgical procedures, except a longer duration of the surgical procedure in the bilateral laminotomy group. No differences in clinical outcomes or complication rates were found among the 3 minimally invasive posterior decompression techniques used to treat patients with lumbar spinal stenosis. ClinicalTrials.gov Identifier: NCT02007083.

The potential of SARS-CoV-2 to spread is limited by herd immunity, which provides an indirect protection to susceptible subjects.[1][1] Although the seroprevalence against SARS-CoV-2 in the general population has been widely investigated,[1][1] no data are available on individuals before starting

The present text has the purpose of problematizing the absence of the curricular guidelines for the modality of Education of Youths and Adults, starting from the educational debates and the discussions about the BNCC for the social and political formation of the subjects of the EJA. Based on the different legal frameworks for the modality, we present a discussion about the educational policies for Basic Education (especially Elementary and Middle School) and the implementation of the guiding principle of curricular proposals among the various educational networks and school institutions in times im) probable and (in) certain of advances coated with setbacks in the education of the country.

Tungsten-promoted titania solid acid catalysts were synthesized by a hydrothermal method and used in the hydrolysis of waste bottle polyethylene terephthalate (PET) in supercritical CO2.

Water and fertilizer among the production factors are the elements that most restrict the production of cashew. The precise amount of these factors is essential to the success of the crop yield. This research aimed to determine the best factor-product ratio and analyze technical and economic indicators, of productivity of the cashew clone BRS 189 (Anacardium occidentale) to production factors water and potassium. The experiment was conducted from May 2009 to December 2009 in an experimental area of 56.0 m x 112.0 m in the irrigated Curu - Pentecoste, located in the municipality of Pentecoste, Ceará, Brazil. Production factors water (W) and potassium (K) were the independent variables and productivity (Y), the dependent variable. Ten statistical models that have proven satisfactory for obtaining production function were tested. The marginal rate of substitution was obtained through the ratio of the potassium marginal physical product and the water marginal physical product. The most suited model to the conditions of the experiment was the quadratic polynomial without intercept and interaction. Considering that the price of the water was 0.10 R$ mm -1, the price of the potassium 2.19 R$ kg -1 and the price of the cashew 0.60 R$ kg-1, the amounts of water and K2O to obtain the maximum net income were 6,349.1 L plant-1 of water and 128.7 g plant -1year, -1 respectively. Substituting the values obtained in the production function, the maximum net income was achieved with a yield of 7,496.8 kg ha-1 of cashew.