Norwegian Centre Research Articles

Identifying low-risk chest pain in out-of-hours primary care: the diagnostic performance of preHEAR and preHEART scores based on two European cohorts

Abstract Background Distinguishing cardiac from non-cardiac acute chest pain presents a diagnostic challenge. Risk stratification tools, such as the HEART score, have been developed for decision support for hospital-based settings. For prehospital settings, the preHEART score was developed as an alternative to the HEART score, with refinements made to meet prehospital conditions, as illustrated in Figure 1. While promising for use by emergency medical services, the diagnostic performance in primary care is unknown. Purpose In this study, we aim to evaluate the preHEART score (with and without high-sensitivity cardiac troponin (hs-cTn)) as a risk stratification tool to rule out acute myocardial infarction (MI) in patients evaluated in out-of-hours primary care. Methods We relied on retrospective data from two cohorts, namely, the OUT-ACS study involving 1,711 consecutive patients (47.7% female, median age: 56 (25th-75th percentiles: 45-68)) evaluated at a Norwegian primary care emergency centre from 2016-2018; and the TRACE study involving 664 consecutive patients (56.9% female, median age: 48 (25th-75th percentiles: 32-67) from a Dutch primary care emergency centre in 2017. We evaluated the preHEAR (OUT-ACS & TRACE without hs-cTn) and preHEART scores (OUT-ACS). The threshold of ≤3 points was considered low-risk and previously determined as optimal for rule-out purposes. The primary outcome was the diagnostic performance for ruling out MI at the index episode, and the secondary outcome was the composite of 90-day all-cause death or MI. Results In the OUT-ACS cohort, 61 (3.6%) patients were diagnosed with an MI; for the TRACE study, MI was diagnosed in 20 (3.0%) patients. The percentage of patients deemed at low risk by preHEAR was 49.3% (n=843) and 82.7% (n=549) for OUT-ACS and TRACE, respectively. For preHEART, only 33.6% (n=575) of OUT-ACS patients were deemed low-risk. As shown in Figure 2, the corresponding sensitivity/specificity indices for index MI were 63.9%/49.8% (OUT-ACS) and 65.0%/84.2% (TRACE) for preHEAR and 93.4%/34.6% for preHEART. Positive predictive values were low (preHEAR 5.0-11.3%, preHEART 5.0%), whereas negative predictive values were high (preHEAR 97.4-98.7%, preHEART 99.3%). For the secondary outcome, similar diagnostic performance metrics were found. All missed MI cases (n=4) in the low-risk preHEART group were female. Conclusion The preHEAR and preHEART scores did not result in adequate rule-out safety for an emergency primary care setting despite a low a priori MI risk. Moreover, the score appears to underestimate the risk for MI in females.preHEAR(T) risk scoresPerformance of the risk scores

Teachers' perception of their students' dietary habits in Addis Ababa, Ethiopia: a qualitative study.

Poor dietary choices and consumption of unhealthy foods are major determinants of malnutrition among adolescents in Ethiopia. The school food environment is a valuable setting for exploring adolescents' eating habits. Teachers have an important role in understanding factors that impact students' dietary choices. The aim of this study is to explore secondary school teachers' perceptions towards adolescents' dietary habits in Ethiopia. The study employed a qualitative research design. Four focus group discussions, involving a total of 13 teachers, were conducted at governmental and private schools in Addis Ababa, Ethiopia. Additionally, observations of the food environment in these four schools. The transcripts from the focus group discussions and photographs from observations were analyzed using thematic analysis. Triangulation of data sources and persistent observation of the data were employed to enhance the study's trustworthiness. The study was approved by the Norwegian Center for Research Data and the Addis Ababa Health Bureau, and all participants provided informed consent. Teachers perceived adolescents' dietary habits as unhealthy, characterized by the consumption of unsafe foods, limited variety, and reliance on processed foods. Factors negatively influencing adolescents' dietary habits include a lack of awareness about a healthy diet among both students and parents. Low familial income levels were also identified as a barrier to eating a healthy diet. The unavailability of healthy foods and the advertising of unhealthy and processed foods as well as peer influence were hindrances to a healthy diet both at school and home. This study provides additional evidence of the nutrition transition which is linked to the double burden of malnutrition among adolescents in low-income countries. Factors affecting adolescent diets at school are multileveled. Incorporating nutrition education into the school curriculum will likely improve dietary awareness mitigating peer influence. Regulating the school food environment and enforcing advertisement laws targeting adolescents can promote healthier school food environments. Providing short term nutrition trainings for biology or science teachers and strengthen their role in delivering nutrition education to children and their families, along with implementing measures to address food insecurity and restricting availability of unhealthy food at school need to be regarded as priorities.

Oral healthcare beliefs among home care services personnel; a cross-sectional study in south-eastern Norway

BackgroundThere is little knowledge about home care services personnel competencies and beliefs concerning oral healthcare for home-dwelling, dependent older adults. This study aims to map oral healthcare beliefs among home care services personnel, and have the following question: How do the education level, years of work experience and training in oral health have impact on home care services personnel oral healthcare beliefs?MethodsA cross-sectional study among home care services personnel working with older people receiving home care services was conducted across four municipalities in south-eastern Norway. The questionnaire consisted of background information (gender, education level, years of work experience, training in oral healthcare, employment status) and the nursing Dental Coping Beliefs scale. Ethics approval for this study was obtained from the Norwegian Centre for Research Data.ResultsTwo hundred and sixty-two homecare services personnel responded to the questionnaire, 16.5% males and 83.5% females; 40.5% had had training in oral healthcare. Home care services personnel believed that gum diseases and cavities can be prevented by dental flossing (61.4%) and toothbrushing (98.4%). 59% disagreed that preventing sickness and medicines from destroying teeth is impossible. However, the majority of the home care services personnel were uncertain about how oral mucosal disorders can be treated. Having more than three years of higher education was positively associated with being in higher quartiles of oral healthcare beliefs, and external locus of control, and having training in oral healthcare was positively associated with being in the lower quartiles of internal locus of control and self-efficacy dimensions. Males were more likely to be in the lower quartile of oral healthcare beliefs, which wasn’t positive.ConclusionIn the population studied, the home care services personnel beliefs about oral healthcare improved with an increasing level of education and having had training in oral healthcare. This suggests that home care services personnel need more education and training in oral healthcare.

Feasibility, acceptability and preliminary evaluation of a user co-facilitated psychoeducational programme: a feasibility proof-of-concept randomised control trial

BackgroundMental health settings are increasingly using co-facilitation of educational group interventions in collaboration with patient partners and service users. However, despite promising results, limited information is available regarding the feasibility and satisfaction levels of these programmes among adults newly diagnosed with attention-deficit hyperactivity/impulsivity disorder (ADHD). Hence, this study aimed to determine the feasibility, acceptability, and preliminary effects of a user co-facilitated psychoeducational group programme for adults diagnosed with ADHD.MethodsThis feasibility proof-of-concept randomised controlled trial recruited outpatients from a Norwegian community mental health centre. Outpatients randomised to the intervention group (IG) received a psychoeducational programme supplementing Treatment As Usual (TAU), while the control group received TAU. Feasibility was determined by the acceptance rate, adherence rate, and dropout rate. Acceptability was measured with the Client Satisfaction Questionnaire and a 3-item scale measuring satisfaction with the received information. To test the preliminary effects, self-efficacy, symptom severity, and quality of life were measured at baseline and pre- and post-intervention.ResultsFeasibility was demonstrated; most of the patients were willing to enrol, participants attended 82% of the psychoeducational programme, and only 13% dropped out of the study. The between-group analyses revealed that the IG reported significantly greater mean satisfaction than the CG. Moreover, the intervention group was more satisfied with the information they received during the psychoeducational programme. Concerning the preliminary effects, the linear mixed model showed improvement in quality of life (the subscale relationship); however, other patient-reported outcomes did not show improvements.ConclusionsThis proof-of-concept randomised controlled trial supports the feasibility and acceptability of the user co-facilitated psychoeducational programme for patients newly diagnosed with ADHD in an outpatient setting. While preliminary findings indicate promise in enhancing patient-reported outcomes, a larger study is warranted to assess the intervention’s effectiveness rigorously.Trial registrationNCT03425, 09/11/2017.

Enabling and exploiting student expertise: the case of a Norwegian centre for excellence in education

ABSTRACT Student involvement has been advocated for and studied by educational scholars in recent years. Simultaneously, measures to increase student involvement have surfaced, such as the Norwegian Centres for Excellence in Education (CEE) initiative. This study explores how students, staff and leaders have experienced student involvement through a CEE in the Norwegian context by turning to sociological institutional theory, in which governance structures and change processes are interlinked. The Centre for Excellence in Music Performance Education (CEMPE) was run from 2014 to 2023, situated at a music academy characterised by privatised teaching culture and a master/apprentice teaching model. In this instrumental case study, primary data were collected from 18 semi-structured interviews with students and staff who had occupied management roles at CEMPE/the Academy. Interview transcripts were triangulated with secondary data in the form of strategic documents such as annual reports, action plans, minutes from steering group meetings, applications and publication lists. The data were coded with thematic narrative analysis, and four distinct narratives on student involvement were identified: (1) students as participants; (2) students as creators; (3) students as facilitators; and (4) students as consultants. The findings indicate that the involved students were both empowered and burdened through their work in the centre. The paid student positions, in particular, enabled students to develop qualifications that staff members and the Academy benefitted from and where students took the roles as facilitators and consultants. However, student expertise can be exploited if not properly supported and fostered, which makes co-creation practices crucial in higher education.

Addressing a Critical Voice in Clinical Practice: Experiences of Nursing Students, Teachers, and Supervisors-A Qualitative Study.

Our goal was to explore how power asymmetry manifests within the relationships between students, teachers, and supervisors, and how it influences students' ability for critical reflection. This study has an explorative qualitative design. Thirty in-depth interviews with nursing students (15), teachers (9), and supervisors (6) were conducted in addition to 16 observations of mid-term assessments during clinical practice. The analysis was conducted using Braun and Clarke's thematic analysis. The students described being a student as a balancing act between humility, conforming to the supervisor's expectations, and speaking their minds. The view expressed by the teachers and supervisors is that training for the nursing profession is closely linked to the students' ability to act independently. Due to the supervisors' hierarchical position, however, students are hesitant to voice any criticism regarding insufficient supervision or unsatisfactory performance of clinical tasks while at the same time being evaluated on their ability to critically reflect on their own and others' clinical performance. This study was prospectively registered with the Norwegian Centre for Research Data on the 15th of August 2017 with the registration number 54821.

Does the use of surgical face masks reduce postoperative infections in traumatic wounds sutured outside hospital? A randomized study at a Norwegian casualty center

Objective To investigate if wearing surgical face mask by doctors and nurses during suturing of traumatic wounds has any impact on postoperative infection rate. Design Randomized controlled study with masked or unmasked health personnel groups. Setting A Norwegian Minor Injury Department. Subjects Adult patients with traumatic wounds sutured at the clinic between 7 October 2019 and 28 May 2020. Main outcome measures Postoperative infections of sutured wounds. Results One hundred and sixty-five patients with 176 wounds were included in the study. Nine out of 88 wounds (10.2%) in the masked group and 11 out of 88 wounds in the unmasked group (12.5%) had a wound infection. Conclusions Despite a higher percentage of postoperative infections in the unmasked than in the masked group (12.5% versus 10.2%), the difference was not statistically significant (p = .6). This might imply that the use of facemasks during suture of traumatic wounds in an outpatient setting does not significantly reduce the number of infections. However, due to the covid pandemic, the study had to be prematurely stopped before the planned number of participants had been recruited (n = 594). This increases the risk of type II error.

Transcranial direct current stimulation for chronic headaches, a randomized, controlled trial.

Chronic headaches are a frequent cause of pain and disability. The purpose of this randomized trial was to examine whether transcranial direct current stimulation (tDCS) applied to the primary motor cortex, reduces pain and increases daily function in individuals suffering from primary chronic headache. A prospective, randomized, controlled trial, where participants and assessors were blinded, investigated the effect of active tDCS vs. sham tDCS in chronic headache sufferers. Forty subjects between 18 and 70 years of age, with a diagnosis of primary chronic headache were randomized to either active tDCS or sham tDCS treatment groups. All patients received eight treatments over four consecutive weeks. Anodal stimulation (2 mA) directed at the primary motor cortex (M1), was applied for 30 min in the active tDCS group. Participants in the sham tDCS group received 30 s of M1 stimulation at the start and end of the 30-minute procedure; for the remaining 29 min, they did not receive any stimulation. Outcome measures based on data collected at baseline, after eight treatments and three months later included changes in daily function, pain levels, and medication. Significant improvements in both daily function and pain levels were observed in participants treated with active tDCS, compared to sham tDCS. Effects lasted up to 12 weeks post-treatment. Medication use remained unchanged in both groups throughout the trial with no serious adverse effects reported. These results suggest that tDCS has the potential to improve daily function and reduce pain in patients suffering from chronic headaches. Larger randomized, controlled trials are needed to confirm these findings. The study was approved by the local ethics committee (2018/2514) and by the Norwegian Centre for Research Data (54483).

Enhancing climate resilience in buildings using Collective Intelligence: A pilot study on a Norwegian elderly care center

The combined challenge of climate change and population aging requires novel solutions that enhance the resilience of building energy systems and secure indoor comfort for vulnerable occupants in extreme weather conditions. This research investigates the performance of a newly developed Energy Management (EM) system based on Collective Intelligence (CI) and Reinforcement Learning (RL), called CIRLEM, managing the energy performance of an urban complex in Ålesund, Norway, including an elderly care center with decentralized PV generation, EV charging and storage, while connected to a main electricity grid. CIRLEM controls multiple flexibility assets including independent thermal zones (the demand-side agents) and Electric Vehicle (EV) charging stations (the local storage). In a novel approach, CIRLEM coordinates the distributed storage and generation together with the demand side to control energy systems and react collaboratively to environmental variations. Under extreme weather conditions, without applying CIRLEM, the demand can be more than double that of typical weather conditions. The implementation of the double-layer CIRLEM can reduce the total demand by 35 % over a month. Furthermore, the inclusion of photovoltaic (PV) systems allows the system to be independent from the grid for almost 40 % of its operational hours, while adding EV storage can increase it to around 70 %. Finally, the application of CIRLEM reduced overheating hours from 17 h ∙°C to 2 h ∙°C under extreme conditions, while maintaining comfortable conditions even during temperature ramps.

Public health nurses' experiences with mental health promotion for adolescent immigrants in schools: Aqualitative study.

This study aimed to explore public health nurses' experiences with mental health promotion for adolescent immigrants in lower secondary and high school, aiming to enhance knowledge and insights for effective mental health promotion. A qualitative design employing a hermeneutic approach was chosen. Thirteen public health nurses were selected using purposive criterion sampling and snowballing. Thematic analysis was applied, adhering to COREQ guidelines for transparency. The research was approved by the Norwegian Centre for Research Data. The guidelines of the National Committee for Research Ethics in the Social Sciences and the Humanities were followed. Data were collected through three focus-group interviews (n = 13), using semi-structured interview guides to explore the experiences of public health nurses in promoting mental health among adolescent immigrants. This study identified three key themes: (i) Striving to understand adolescent immigrants' mental health aspects, including both positive and negative aspects; (ii) Different strategies for promoting mental health, viewing adolescents as both recipients and contributors to their well-being; and (iii) Barriers to public health nurses' promotion of mental health, including language, cultural, and knowledge-related obstacles and trust issues. Public health nurses noted that language barriers and trust issues often delayed adolescent immigrants from seeking help for mental health concerns. Cultural competence and empathy were deemed crucial. To meet these needs, public health nurses must build rapport with parents, collaborate with professionals, implement follow-up programmes, and advocate for policy changes. Limitations of this qualitative study include potential bias from the authors' background and non-generalizability of results to other contexts. In conclusion, public health nurses' experiences reveal the need for enhanced cultural competence, language proficiency, and trust-building to better serve adolescent immigrants. Collaborative efforts, follow-up programmes, and policy advocacy are essential to improve mental health promotion in school settings.

The effects of lockdown of work and activities for adults with multiple, complex needs including sensory impairments during the pandemic in 2020.

Sheltered work and leisure activities were locked down in at the Signo centre in March 2020 because of the COVID-19 pandemic. The Signo centre is a Norwegian national centre for adults with multiple, complex needs, including severe sensory loss/impairments. Tension and uncertainty rapidly spread among relatives and workers. To explore the impacts of the pandemic on residents, 24 adults living in Signo Vivo answered a semi-structured interview together with their primary worker. Additionally, reports on staff injuries and PRN medication between April and Aug of 2020 were compared to the period before the lockdown. The reports from the interviews included fewer stressful events for the participants, more rest and sleep, more time spent in their own apartments, and more time with smaller groups of workers. The reports on staff injuries and PRN medication showed decreased occurrence.

Short-term ship roll motion prediction using the encoder–decoder Bi-LSTM with teacher forcing

The safety of maritime operations has become a paramount concern with the advancement of intelligent ships. Ship stability and safety are directly impacted by roll motion, making the prediction of short-term ship roll motion pivotal for assisting navigators in making timely adjustments and averting hazardous roll conditions. However, predicting ship roll motion poses challenges due to nonlinear dynamics. This study aims to predict short-term ship roll motion by leveraging the encoder–decoder structure of Bidirectional Long Short-Term Memory Networks (Bi-LSTM) with teacher forcing. The model is accomplished by employing an encoder–decoder structure to map input sequences to output sequences of varying lengths, and employing teacher forcing to enhance the network’s ability to extract information. To refine and analyze the prediction model, aspects such as the quantity of training data to guarantee model generalization, establishing apposite length relationships between input and output sequences, and assessing the model performance in various sea states are investigated. Additionally, comparative experiments assessing roll motion prediction for intervals of 10s, 30 s, 60 s, and 120 s are conducted to substantiate the necessity and effectiveness of the proposed network. The dataset originates from a commercial professional simulator developed by the Norwegian company Offshore Simulator Center AS (OSC).

The arts of attention and Oslo Architecture Triennale

This paper starts from a two-fold observation: firstly, that attention rests at the core of our environmental challenges; and secondly, that by becoming (more) attentive to the modified, transformed, and controlled urban environments in which we dwell, we may be better equipped to attend to these challenges. The paper therefore develops and introduces “an urban attention ecology” that seeks to expand our ability to attend to urban form in ways that open possibilities to critically address and creatively negotiate the ways in which cities are built and inhabited. The potentials and challenges of the urban attention ecology are thought through in a practice-based account of a broad range of critical spatial practices centring around the theme of degrowth. These practices took the form of performances, installations, and other artistic projects that the author gathered, developed and presented as curator of the Oslo Architecture Triennale 2019. Cover photo: The Factory of the Future at the Norwegian Centre for Design and Architecture. OAT / Istvan Virag.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) as adjunct treatment in life threatening postpartum hemorrhage: Fourteen years' experience from a single Norwegian center.

Postpartum hemorrhage (PPH) remains a global health problem. The introduction of resuscitative endovascular balloon occlusion of the aorta (REBOA) in 2008 sought to enhance the management of hemorrhagic shock during PPH. In this study, we present a single Norwegian center's experience with REBOA as a supportive treatment in combating life threatening PPH. This is a historical cohort study from St Olav's University Hospital, with data from period 2008-2021. It includes all patients who underwent REBOA as an adjunct treatment due to life threatening PPH, analyzing the outcomes and trends over a 14-year period. A total of 37 patients received REBOA as an adjunct treatment. All procedures were technically successful, achieving hemodynamic stability with an immediate average increase in systolic blood pressure of 36 ± 22 mmHg upon initial balloon inflation. Additionally, a downward trend was noted in the frequency of hysterectomies and the volume of blood transfusions required over time. No thromboembolic complications were observed. Our 14 years of experience at St Olav's Hospital suggests that REBOA serves as a safe and effective adjunct interventional technique for managing life-threatening PPH. Furthermore, the findings indicate that incorporating a multidisciplinary approach to enable rapid aortic occlusion can potentially reduce the necessity for blood transfusions and hysterectomies.

Photographs in burn patient diaries: A qualitative study of patients’ and nurses’ experiences

ObjectiveTo explore burn patients’ and burn intensive care nurses’ experiences of the photos in patient diaries. DesignA qualitative inductive study using thematic analysis was performed. We conducted individual interviews with six former burn patients (age range 20–77 years; four women), and two focus groups with 11 burn intensive care nurses (age range 38–61 years; all women). Data from patients and nurses were analysed together, and the findings reported according to the consolidated criteria for reporting qualitative research (COREQ). SettingA Norwegian burn centre where the writing of diaries including text and photos has been practiced for approximately two decades. FindingsThree main themes were derived from the combined analysis of the two data sets: hesitating when facing photos; visualising others care; and visualising the trajectory from burn trauma to recovery. Although the patients worried beforehand about what they would see in the photos and the nurses feared to select frightening photos, the photos were welcome, and several patients said they would have liked even more. The photos filled in gaps of memory, told more than words, and did not lie. Photos of family, friends or staff demonstrated shared actions that supported memories and recovery. ConclusionBoth the burn patients and the burn intensive care nurses considered photos to be an essential part of the diary that gave context and provided a factual presentation of the patients’ pathway of treatment, care and recovery. Implication for clinical practiceTailored information about photo content should be offered to patients before a diary is handed over to them. Nurses should attempt to include photos covering the patients’ entire stay at the burn centre, as well as photos of family, friends and staff. Individual nurses should be supported in their practical selection of photos for the diary.

Exploring public health nurses' acceptability of clinical assessment tools in a Norwegian child health centre.

Infants' symptoms of mental struggle are often diffuse and undifferentiated, and health services do not identify many infants at risk of poor development. However, primary health care is advantageous for early identification, given there are frequent consultations during the infant's first two years. Health policy encourages using evidence-based screening but use varies in primary health care. The Alarm Distress Baby Scale (ADBB) is an assessment tool targeting social withdrawal in infants 2-24 months of age. To explore contextual factors related to public health nurses' (PHNs) acceptability of clinical assessment tools in a Norwegian child health centre. Prior to an upcoming ADBB training, we used focus group discussions with PHNs to explore their views on their professional role and practice and how this concurs with using assessment tools. Thematic analysis resulted in the following themes: (1) A Role requiring Supporting the Parents and Safeguarding the Infant; (2) The Challenge of Interpreting Infant Expressions; and (3) Organisational Preconditions for Accepting New Methods. Our findings show that PHNs regard assessment tools as an aid to detect infants at risk, but that systematic use of such tools can hinder their ability to be flexible, egalitarian, and resource-focused. We also find that acceptability of assessment tools requires a system for continuous training and a well-established referral routine.

The Norwegian Center for Interdisciplinary Education (INTED)

The Norwegian Center for Interdisciplinary Education (INTED)

Giving birth on the way to the clinic: undocumented migrant women’s perceptions and experiences of maternal healthcare accessibility along the Thailand–Myanmar border

BackgroundMillions of women give birth annually without the support of a trained birth attendant. Generally and globally, countries provide maternal health services for their citizens but there is a coverage gap for undocumented migrant women who often can’t access the same care due to their legal status. The objective of this investigation is to explore undocumented migrants’ experiences and perceptions of maternal healthcare accessibility.MethodsWe held focus groups discussions with 64 pregnant women at 3 migrant health clinics on the Thailand–Myanmar border and asked how they learned about the clinic, their health care options, travel and past experiences with birth services. In this context undocumented women could sign up for migrant health insurance at the clinic that would allow them to be referred for tertiary care at government hospitals if needed.ResultsWomen learned about care options through a network approach often relying on information from community members and trusted care providers. For many, choice of alternate care was limited by lack of antenatal care services close to their homes, limited knowledge of other services and inability to pay fees associated with hospital care. Women travelled up to 4 h to get to the clinic by foot, bicycle, tractor, motorcycle or car, sometimes using multiple modes of transport. Journeys from the Myanmar side of the border were sometimes complicated by nighttime border crossing closures, limited transport and heavy rain.ConclusionsUndocumented migrant women in our study experienced a type of conditional or variable accessibility where time of day, transport and weather needed to align with the onset of labour to ensure that they could get to the migrant clinic on time to give birth. We anticipate that undocumented migrants in other countries may also experience conditional accessibility to birth care, especially where travel is necessary due to limited local services. Care providers may improve opportunities for undocumented pregnant women to access maternal care by disseminating information on available services through informal networks and addressing travel barriers through mobile services and other travel supports.Trial registration The research project was approved by Research Ethics Committee at the Faculty of Medicine, Chiang Mai University (FAM-2560-05204), and the Department of Community Medicine and Global Health at the University of Oslo—Norwegian Centre for Research Data (58542).

A holistic sustainability assessment of a zero-emission development in Norway

The decarbonisation of the construction sector is critical to meet national and international climate goals. Literature gives many examples of measures for the reduction of greenhouse gas (GHG) emissions from buildings. However, few studies investigate the trade-offs between potentially conflicting GHG emission reduction measures or the affordability of these measures. Ydalir is a Zero Emission Neighbourhood (ZEN) pilot area in the Norwegian research centre for Zero Emission Neighbourhoods in smart cities. One of the major challenges Ydalir faces is how to reduce GHG emissions from the neighbourhood towards a net zero emission building (nZEB). Additional challenges include retaining social, environmental, and economical sustainability for both the project developer and building owners and avoid suboptimal solutions. This paper investigates the trade-offs between energy efficiency and material use for two scenarios. The scenarios are a Norwegian building code scenario and a passive house scenario. The analysis ascertains total energy demand, whole life cycle GHG emissions, and cost assessment for two housing units within Ydalir Torg. The results show lower total GHG emissions and lower GHG emissions from operational energy use in the passive house scenario, and an increase in GHG emissions from the production phase due to thicker levels of insulation. The cost assessment shows increased investment costs for the project developer in the passive house scenario, despite lower operational costs for the building owner. Total GHG emission payback times for the passive house scenario are at 18 - 19 years. Cost payback time varies between 10 - 37 years. This paper is useful for practitioners that wish to balance GHG emission reduction requirements between operational energy use, material use and affordability.

Impact of climate change on carbon emissions in future road design: frost protection of roads in temperate climates

The aim of this case study was to estimate the impact of future adaptation to climate change with respect to frost on emissions from road construction. Based on the Representative Concentration Pathways (RCPs) published by the Intergovernmental Panel for Climate Change, the Norwegian Centre for Climate Services has predicted statistical frost quantities for the years 2071–2100 in Norway. Carbon emissions in production, loading, transportation, and construction related to the frost protection of roads were estimated based on the predictions and compared with frost protection based on frost quantities for the years 1981–2010. The case study covered two recently constructed four-lane highways in Norway that represent areas with minor and major frost quantities. Three alternative power sources for machinery and transportation were studied: fossil fuel, biofuel, and electricity. These alternatives were combined with two scenarios for climate change (RCPs): one intermediate (RCP4.5) and one business-as-usual scenario (RCP8.5). Based on the combined alternatives and RCPs, the estimated reduction in CO2-equivalents ranged from 22% to 90%.