University Of Bergen Research Articles

Leveraging machine learning to identify subgroups of misclassified patients in the emergency department: a multi-center proof-of-concept study.

Hospitals use triage systems to prioritize the needs of patients within available resources. Misclassification of a patient can lead to either adverse outcomes in a patient who did not receive appropriate care in the case of undertriage or waste of hospital resources in the case of overtriage. Recent advances in machine learning algorithms allow for the quantification of variables important to under- and overtriage. The aim of this study was to identify clinical features most strongly associated with triage misclassification using a machine learning classification model to capture non-linear relationships. Multicenter retrospective cohort data from two big regional hospitals in Norway was extracted. The South African Triage system is used at Bergen University Hospital and the Rapid Emergency Triage and Treatment System is used at Trondheim University Hospital. Variables included triage score, age, gendersex, arrival time, subject area affiliation, reason for emergency department contact, discharge location, level of care, and time of death were retrieved. Random forest classification models were used to identify features with the strongest association with overtriage and undertriage in clinical practice in Bergen and Trondheim. We reported variable importance as SHAP-values (SHapley Additive exPlanations). We collected data on 205,488 patient records from Bergen University Hospital and 304,997 patient records from Trondheim University Hospital. Overall, overtriage was very uncommon at both hospitals (all <0.1%), with undertriage differing between both locationlocations with 0.8% at Bergen and 0.2% at Trondheim University Hospital. Demographics were similar for both hospitals, however the percentage given a high priority triage score (red or orange) was higher in Bergen (24%) compared to 9% in Trondheim. Clinical referral department was found to be the variable with the strongest association with undertriage (mean SHAP +0.62 and +0.37 for Bergen and Trondheim, respectively). We identified subgroups of patients consistently undertriaged using two common triage systems. While the importance of clinical characteristics to triage misclassification varies by triage system and location, but we found consistent evidence between the two locations that clinical referral department is the most important variable associated with triage misclassification. Replication of this approach at other centers could help to further improve triage scoring systems and improve patient care worldwide.

Study preferences and exam outcomes in medical education: insights from renal physiology

BackgroundEfficient learning strategies and resource utilization are critical in medical education, especially for complex subjects like renal physiology. This is increasingly important given the rise in chronic renal diseases and the decline in nephrology fellowships. However, the correlations between study time, perceived utility of learning resources, and academic performance are not well-explored, which led to this study.MethodsA cross-sectional survey was conducted with second-year medical students at the University of Bergen, Norway, to assess their preferred learning resources and study time dedicated to renal physiology. Responses were correlated with end-of-term exam scores.ResultsThe study revealed no significant correlation between time spent studying and overall academic performance, highlighting the importance of study quality over quantity. Preferences for active learning resources, such as Team-Based Learning, interactive lessons and formative assignments, were positively correlated with better academic performance. A notable correlation was found between students’ valuation of teachers’ professional competence and their total academic scores. Conversely, perceived difficulty across the curriculum and reliance on self-found online resources in renal physiology correlated negatively with academic performance. ‘The Renal Pod’, a locally produced renal physiology podcast, was popular across grades. Interestingly, students who listened to all episodes once achieved higher exam scores compared to those who listened to only some episodes, reflecting a strategic approach to podcast use. Textbooks, while less popular, did not correlate with higher exam scores. Despite the specific focus on renal physiology, learning preferences are systematically correlated with broader academic outcomes, reflecting the interconnected nature of medical education.ConclusionThe study suggests that the quality and strategic approaches to learning significantly impact academic performance. Successful learners tend to be proactive, engaged, and strategic, valuing expert instruction and active participation. These findings support the integration of student-activating teaching methods and assignments that reward deep learning.

An open door to the job market? Music therapy students’ reflections on practice placement in Norway

This study explores the transition between learning at university and learning in a work context through practice placement. It was conducted at the University of Bergen (UiB), which offers a five-year programme in music therapy. Practice placement is integrated at all levels of the programme, starting with observation of music therapy, to a placement where students work more autonomously. The aim of this study was to learn from the experiences of students participating in the programme, as their insights are crucial for informing the programme’s content. Our question was: How do students from the UiB five-year integrated music therapy programme reflect on their internship experiences, and how can we understand their reflections from a work-based learning perspective? To investigate this, we conducted two focus groups, each with five students. Following a thematic analysis of the data, three main themes and six sub-themes were developed: 1. Developing an identity as a music therapist (1.1. Gaining a professional identity, 1.2. Finding a voice in interdisciplinary meetings); 2. An open door to the job market (2.1. Learning from experience, 2.2. Developing new networks); and 3. Challenges with the music therapy practice placement (3.1. Feeling side-lined, 3.2. Lack of a broader teaching model). The themes, grounded in the empirical findings, are discussed from a sociocultural perspective, drawing on concepts such as apprenticeship learning, community of practice, and weak ties. This article concludes with implications for practice and suggestions for further research.

Primary Sjogren syndrome - A bibliometric analysis via CiteSpace.

This study employs CiteSpace software to analyze the research status, hotspots, and trends of primary Sjogren syndrome (pSS). Relevant publications from 1999 to 2023 were searched in the Web of Science Core Collection (WoSCC) set, followed by generating a network map using CiteSpace software to identify top authors, institutions, countries, keywords, journals, references, and research trends. A total of 3564 valid articles were included in this study. The People Republic of China had the highest number of articles (n = 524), while the University of Bergen emerged as the institution with the highest publication count (n = 94). Mariette X was identified as the author with the most publications (n = 67), whereas Vitali C received recognition as the most cited author (n = 1706). Annals of Rheumatic Diseases stood out as the journal with the highest citation count (n = 2530). Notably, an article published in the Annals of Rheumatic Diseases in 2017 garnered significant attention by being cited a remarkable 304 times. The bibliometric analysis reveals that key areas of research in pSS encompass investigating pathogenesis; advancing and applying targeted biological agents; and establishing treatment and diagnostic standards.

What makes mentors thrive? An exploratory study of their satisfaction in undergraduate medical education

BackgroundMentoring medical students with varied backgrounds and individual needs can be challenging. Mentors’ satisfaction is likely to be important for the quality and sustainability of mentorships, especially in programs where the mentor has responsibility for facilitating a group of mentees. However, little is known about what influences mentors’ satisfaction. The aim of this study was to measure mentors’ self-reported satisfaction with the mentoring experience and to explore associations between satisfaction and its putative factors.MethodsAn online survey was sent out to all physician mentors in each of the three mentorship programs (UiT The Arctic University of Norway, the University of Bergen, and McGill University, graduation years 2013–2020, n = 461). Data were analyzed by descriptive statistics, dimension reduction, and linear regression.ResultsOn a scale from 1 to 5, mean mentor satisfaction score at two Norwegian and one Canadian medical school was 4.55 (95% CI 4.47, 4.64). In a multilevel multivariate regression analysis, two predictors were significantly associated with mentors’ satisfaction: (1) the perception that students found the group meetings valuable (β = 0.186, 95% CI 0.021, 0.351, p = 0.027) and (2) mentors’ perceived rewards (β = 0.330, 95% CI 0.224, 0.437, p < 0.001). Perceived rewards included experiencing gratifying relationships with students, and mentors’ perception of self-development.ConclusionsIn this study, mentors appeared to be highly satisfied with their mentoring functions. Our findings suggest that mentors’ overall satisfaction is closely linked to their experiences of fulfilling mentor-student relationships and personal and professional development. Interestingly, and perhaps contrary to commonly held assumptions, we found no association between mentor satisfaction and financial compensation. Furthermore, satisfaction was not associated with the provision of pre-assigned topics for discussions for mentor group meetings. We propose that the mentors’ experienced psycho-social rewards, and their competence in establishing well-functioning group dynamics, should be areas of focus for faculty development.

Risk Factors for Early Dental Implant Failure.

To report the prevalence of early implant failure and evaluate factors that contribute to the early failure of dental implants placed at a teaching clinic. The study also aims to identify risk indicators for early implant loss to better predict and prevent early implant loss in the future. This retrospective study included all patients with a dental implant placed by the Section of Oral Surgery and Oral Medicine, Department of Clinical Dentistry, University of Bergen, between January 2011 and December 2018. All information was collected from operation logbooks and from patient records. A failed implant in this study was defined as an implant lost before functional loading. A total of 1,005 dental implants were placed in the studied time period, of which 54 failed early, giving an early failure rate (EFR) of 5.4%, with functional loading obtained for the remaining 94.6%. Analysis showed an increased hazard for early implant failure among smokers, men, and younger patients. With an age increase of 10 years, the risk of implant failure was reduced by 14% (hazard ratio [HRR] = 0.86, P = .037). A higher failure rate was found in anterior maxillary implants than in posterior maxillary implants (7.79% vs 3.29%, respectively; HRR = 0.47; P = .041). The probability for early failure in the posterior mandible was significantly increased compared to the posterior maxilla (HRR = 3.68, P = .005). If the first implant failed, it was more likely that the consecutive implant would also fail (HRR = 1.82). In the study, 53.4% of the placed implants were Straumann (EFR = 5.2%), 30.3% were Nobel Biocare (EFR = 7.2%), and 16.3% were Astra Tech (EFR = 2.5%). This study found that younger, male, and smoker patients were associated with an increase in early failure of dental implants. Significantly increased failure rates were also seen for implants placed in the mandible, and there were differences with respect to implant system. Although differences were found in early failure both for patient- and implant-related factors, the overall early failure rate (5.4%) in this study was low.

You know it, you like it – student appreciation of active learning methods

ABSTRACT Active learning methods increase student learning, despite potential ressentiment of students towards these methods, based on the lack of knowledge, experience, exposure, or cultural ressentiments regarding social interactions with people perceived as strangers, which hamper the success of these methods. We investigated the student appreciation of five active learning methods among students and PhD candidates at the University of Bergen, Norway. The results indicate that exposure may increase the appreciation for these methods and that Norwegian students show appreciation compared to Non-Norwegians. Group Work was the most experienced and appreciated method, whereas the Jigsaw Classroom was the only method less appreciated than the average. The appreciation differed based on the method and the faculty of the students and implies that students in discussion-based “soft” sciences have different methodological appreciation than students in fact-based “hard” sciences. We present recommendations for the choice of active learning methods at different faculties.

A History Matching Study for the FluidFlower Benchmark Project

In this study, we conduct a comprehensive history matching study for the FluidFlower benchmark model. This benchmark was prepared and organized by the University of Bergen, the University of Stuttgart, and Massachusetts Institute of Technology, for promoting understanding of the complex physics of geological carbon storage (GCS) through in-house experiments and numerical simulations. This paper synthesizes the experiences of history matching the benchmark data encountered by the Delft-DARTS and CSIRO participants. History matching is first performed based on a low-dimensional-zonated structured model using a simple Poisson-like solver. The permeability of six facies and two faults is inferred in this stage to match the digitized concentration data. The history matching is then further enhanced to richer spatial and physical models to capture the spatial variation of permeability and buoyancy effects, using an unstructured grid. Efficient adjoint methods are used to evaluate the gradient used in the optimization of data misfits or equivalent Bayesian log-likelihoods. With efficient optimization methods available for both maximum a posteriori model inference and Randomized Maximum Likelihood methods for model uncertainty, we perform history matching using both binary and continuous concentration observations. The results show that the tracer plumes in the enriched model match the experimental plumes more accurately compared with the results from the parsimonious-zonated model. The history matching results based on the concentration observations provide more similar plume shapes compared with the case based on the binary observations. The permeability difference between the model before and after history matching reveals that the tracer plume zone and the high permeable zone are the regions of high sensitivity in terms of data misfit between the model response and observations. Surprisingly, CO2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$_2$$\\end{document} concentration plume forecasts based on these history-matched models were not especially sensitive to the improvements observed in the enhanced model.

Design and first experience of the prototype pixel layers for the ALICE FoCal

The University of Bergen is involved in developing two calorimeters: the pixel section of the Electromagnetic Forward Calorimeter for the ALICE Upgrade to be installed during LS3 for data-taking in the period 2029–2032 and the Digital Tracking Calorimeter for the proton Computed Tomography prototype. Both designs utilize pixel sensors and require a reliable connection to the readout which is positioned approximately 5 meters away. Furthermore, the structural design of these calorimeters calls for a compact layer assembly. This paper provides the strategies deployed to meet these critical requirements, focusing on the implementation of the chip-on-flex assembly, and the ultrasonic welding techniques. It further describes other design considerations essential for maintaining good signal integrity. Finally, it gives insight into the experiences and challenges faced while working with the prototypes, both in the laboratory and test beam setups.

Improving diagnostic precision in primary ovarian insufficiency using comprehensive genetic and autoantibody testing.

Is it possible to find the cause of primary ovarian insufficiency (POI) in more women by extensive screening? Adding next generation sequencing techniques including a POI-associated gene panel, extended whole exome sequencing data, as well as specific autoantibody assays to the recommended diagnostic investigations increased the determination of a potential etiological diagnosis of POI from 11% to 41%. POI affects ∼1% of women. Clinical presentations and pathogenic mechanisms are heterogeneous and include genetic, autoimmune, and environmental factors, but the underlying etiology remains unknown in the majority of cases. Prospective cross-sectional study of 100 women with newly diagnosed POI of unknown cause consecutively referred to Haukeland University Hospital, Bergen, Norway, January 2019 to December 2021. In addition to standard recommended diagnostic investigations including screening for chromosomal anomalies and premutations in the fragile X mental retardation 1 gene (FMR1) we used whole exome sequencing, including targeted analysis of 103 ovarian-related genes, and assays of autoantibodies against steroid cell antigens. We identified chromosomal aberrations in 8%, FMR1 premutations in 3%, genetic variants related to POI in 16%, and autoimmune POI in 3%. Furthermore in 11% we identified POI associated genetic Variants of unknown signifcance (VUS). A homozygous pathogenic variant in the ZSWIM7 gene (NM_001042697.2) was found in two women, corroborating this as a novel cause of monogenic POI. No associations between phenotypes and genotypes were found. Use of candidate genetic and autoimmune markers limit the possibility to discover new markers. To further investigate the genetic variants, family studies would have been useful. We found a relatively high proportion of genetic variants in women from Africa and lack of genetic diversity in the genomic databases can impact diagnostic accuracy. Since no specific clinical or biochemical markers predicted the underlying cause of POI discussion of which tests should be part of diagnostic screening in clinical practice remains open. New technology has altered the availability and effectiveness of genetic testing, and cost-effectiveness analyses are required to aid sustainable diagnostics. The study was supported by grants and fellowships from Stiftelsen Kristian Gerhard Jebsen, the Novonordisk Foundation, the Norwegian Research Council, University of Bergen, and the Regional Health Authorities of Western Norway. The authors declare no conflict of interest. NCT04082169.

2.Q. Workshop: Difficult to reach – populations: How to recruit for qualitative and/or quantitative studies?

Abstract Background Migrants are often described as a difficult-to-reach group for research and become underrepresented or their representation is biased in most research projects. Researchers face challenges related to language barriers, intercultural communication, participant health literacy level, time, participant expectations, differences in education levels, cultural heritage, and values. Other challenges may be related to techniques (sending follow-up emails, phone calls, or face-to-face contact with participants). Improving the recruitment of a representative sample of participants is critical for conducting qualitative and quantitative research that includes the diverse populations we live in. Over the last five years, our research group conducted two large projects among Syrian refugees, including surveys, interviews, and interventions: the CHART project (Changing Health and health care needs Along the Syrian Refugees’ Trajectories to Norway) and the Integration for Health project. Both projects encountered challenges in recruitment but managed to recruit as intended. Based on our positive experiences conducting these studies, this workshop aims to share lessons learned to overcome recruitment challenges during the recruitment and data collection phases and to learn from other researchers with positive experiences. Aim To gain knowledge and improve skills in recruiting and addressing participants described as hard to reach in research and to reflect upon the best ways of accessing hard-to-reach populations. Timetable • Who are the hard-to-reach populations in public health and why? Esperanza Diaz - 10 min • Moderated conversation by Claire Collins. Presenters: Ayan Sheikh-Mohamed, Wegdan Hassan, and Khadra Yasien Ahmed, who present challenges from their studies- what we have done well and what not -20 minutes. • Work in groups: further sharing of experiences with participants and lessons to carry home - 20 minutes. Key messages • This workshop will increase awareness, knowledge, and skills in how to understand your target population. • Build trust and share various tools for recruiting hard-to-reach populations to increase the success of public health research. Speakers/Panelists Wegdan Hasha University of Bergen, Bergen, Norway Khadra Yasien Ahmed Department of Global Public Health and Primary Care, University of Bergen, Norway Ayan Bashir Sheikh-Mohamed Department of Global Public Health and Primary Care, University of Bergen, Norway Esperanza Diaz Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway

Complex Philosophical Oeuvre and Its Complex User Community: Reflections on the Past, Present, and Future Digitisation of Wittgenstein’s Philosophical Writings

&#x0D; &#x0D; &#x0D; This paper reports the results of a user survey conducted by the Wittgenstein Archives at the University of Bergen (WAB) concerning some of the digital research tools and resources it has developed over the past three decades. The authors’ analysis of the survey results is embedded within a broader discussion of the nature and history of the digitisation of Wittgenstein’s philosophical writings. It is argued that the special nature of both Wittgenstein’s philosophy—especially the later Wittgenstein’s conceptions of meaning, concepts, and philosophy itself—and its primary material sources (Wittgenstein’s “Nachlass”) inherently call for a variety of advanced digital tools and resources; for instance, a digital interactive edition of his works, such as WAB’s Wittgenstein IDP: The Nachlass in Interactive Dynamic Presentation, to complement static ones such as traditional print editions and other, non-interactive digital editions. For similar reasons, the authors argue, WAB’s ongoing and future development of digital tools and resources for the study of Wittgenstein’s philosophy must be closely coordinated with the evolving needs of WAB’s large and diverse user community.&#x0D; &#x0D; &#x0D;

Mit.OnOff: A Science Communication Project for Public Awareness about Mitochondrial Cytopathies.

Mitochondrial diseases are rare, heterogeneous, incurable and complex to diagnose. Probably due to their rareness, there is still a lack of literacy in this area, especially in society, but also in schools and in general, health care services. Accordingly, tools that may bring advancement in science and health literacy are needed. Mit.OnOff is a science communication project based on a bilateral partnership between the University of Coimbra (Portugal) and the University of Bergen (Norway). It aims to inform society about rare diseases related to mitochondrial cytopathies with an emphasis on LHON. The initiative focuses on the creation of an illustrated book explaining the diseases caused by the failure of energy production in simple and accessible language. The aim is to raise awareness (particularly in Portugal and Norway) and provide in-depth knowledge to people suffering from these diseases. This project involves expert scientists in the field of mitochondrial disease, science communicators and artists in alignment with the United Nations SDGs, Agenda 2030. Mit.OnOff is a bilateral partnership (Portugal and Norway) established to address the lack of knowledge and health literacy on the subject of mitochondrial disease. The book will be distributed in both countries, creating a sense of inclusion and visibility and influencing decisions regarding these diseases. It is a relevant educational medium (e.g., schools, health care provision). The distribution of the book is complemented with other communication materials. Oral communications are made, together with public involvement, in which special glasses will be distributed to simulate a mitochondrial disease that leads to blindness (LHON) for the public to experience what it is like living with a rare disease. It is hoped that the production of this book will give patients a sense of inclusion and representation in the media. This, in turn, will contribute to achieving the SDG targets (3,4,5,8,10,12), i.e., ensuring people live healthy lives, reducing child mortality, and increasing life expectancy, ensuring access to inclusive, equitable and quality education for all, ensuring gender equality, and contributing to a peaceful and prosperous world.

Reflections on 50 Years of Experience in Educational Technology

I came to the world of educational technology in the 1980s from a position as a computer science professor at a regional state university in Alabama where I had been practicing as an educational technologist without awareness that I was doing so. In the intervening years, I have come to realize the complexities and challenge of educational technology and instructional design, thanks to mentors such as Robert Gagné, David Merrill, Robert Tennyson, and many others too numerous to name. Those learning experiences were largely unplanned and happened more or less by coincidence as I left teaching computer science to become the senior scientist for instructional systems at the Air Force Human Recourses Laboratory (a.k.a. Armstrong Laboratory) in San Antonio, Texas. I have also had the pleasure of being a tenured professor at the University of Bergen, Syracuse University, Florida State University, the University of Georgia, and the University of North Texas, where I have tried to apply the lessons learned along the way. Regretfully, what I see now happening in the broad domain of educational technology is a return to the beliefs I had when I entered this field so many years ago. Those unaware of the complexities and challenges and untrained in educational technology and learning science but adept with one or more technologies believe they can apply their technology knowledge to solve any educational problem that arises. If these remarks have any benefit, it is to help those technophiles understand that the emphasis and focus in educational technology and learning science should be placed initially and primarily on the learner and not on a particular technology nor the content to be learned. Technologies come and go, and those with keep knowledge in a content domain have already indicated what can be learned in that domain. As a result of my focus on the individual learner in this paper, this will not be a typical academic research paper. Rather it will be a plea to consider what really matters – not one’s own prominence or advancement but helping others develop their own thoughts and understanding. Onward through the fog (a slogan borrowed from Oat Willie’s in Austin, Texas).

Interactive Dynamic Presentation (IDP) and Semantic Faceted Search and Browsing (SFB) of the Wittgenstein Nachlass

Abstract In 2000 the Wittgenstein Archives at the University of Bergen (WAB) published the CD-ROM edition of Wittgenstein’s Nachlass: The Bergen Electronic Edition (BEE). Moreover, since then WAB has worked towards complementing the static CD-ROM edition with an interactive web platform that additionally allows more user-specific and more user-tailored utilizations of WAB’s Nachlass resources. The paper describes two specific web service tools of this platform: Interactive Dynamic Presentation (IDP) of the Wittgenstein Nachlass and Semantic Faceted Search and Browsing (SFB) of Wittgenstein domain metadata. The paper argues that it is only when these two tools are fully implemented and functional that WAB can adequately serve the scholarly needs of the Wittgenstein Nachlass user community. The paper discusses some selected features and functionalities of the two tools in detail. An earlier version of this paper was published as „Complementing Static Scholarly Editions with Dynamic Research Platforms: Interactive Dynamic Presentation (IDP) and Semantic Faceted Search and Browsing (SFB) for the Wittgenstein Nachlass“ in Selected Papers from the CLARIN Annual Conference 2020, ed. by C. Navarretta &amp; M. Eskevich (Utrecht: CLARIN ERIC). In writing this paper I have benefitted from comments by K. De Smedt, N. Gangopadhyay, Ø. Gjesdal, J. Hendrickson, C. Huitfeldt, H. Al Ruweh, the Clarin 2020 conference reviewers and editors as well as Jasmin Trächtler.

Porous Worlds – the Liminal Spaces of Relief

Porous Worlds – the Liminal Spaces of Relief was carried out as an artistic research PhD project in affiliation with The Art Academy, Faculty of Fine Art, Music and Design at the University of Bergen. The project examines the relief, its connections to art, craft, architecture, and ornament, as well as its various dimensions as an artistic medium. It has been the relief´s in-between status and the lack of contemporary art discourse around it that has informed the questions like: what is at stake working with relief form today? What kind of artistic potential and possibilities does ceramic relief have to offer?

Post COVID-19 condition after delta infection and omicron reinfection in children and adolescents.

The burden of COVID-19 in children and adolescents has increased during the delta and omicron waves, necessitating studies of long-term symptoms such as fatigue, dyspnoea and cognitive problems. Furthermore, immune responses in relation to persisting symptoms in younger people have not been well characterised. In this cohort study, we investigated the role of antibodies, vaccination and omicron reinfection upon persisting and long-term symptoms up to 8 months post-delta infection. SARS-CoV-2 RT-PCR positive participants (n=276, aged 10-20 years) were prospectively recruited in August 2021. We recorded the major symptoms of post COVID-19 condition and collected serum samples 3- and 8-months post delta infection. Binding antibodies were measured by spike IgG ELISA, and surrogate neutralising antibodies against Wuhan and delta variants by the hemagglutination test (HAT). After delta infection, persisting symptoms at 3 months were significantly associated with higher delta antibody titres (OR 2.97, 95% CI 1.57-6.04, p=0.001). Asymptomatic acute infection compared to symptomatic infection lowered the risk of persisting (OR 0.13, 95% CI 0.02-0.55, p=0.013) and long-term (OR 0.28 95% CI 0.11-0.66, p=0.005) symptoms at 3 and 8 months, respectively. Adolescents (16-20 years) were more likely to have long-term symptoms compared to children (10-15 years) (OR 2.44, 95% CI 1.37-4.41, p=0.003). This clinical and serological study compares long-term symptoms after delta infection between children and adolescents. The association between high antibody titres and persisting symptoms suggest the involvement of an immune mechanism. Similarly to adults, the dominant long-term symptoms in children are fatigue, dyspnoea and cognitive problems. This work was funded by the Ministry of Health and Care Services, Norway, the University of Bergen, Norway and Helse Vest, Norway (F-12621).

From Tractatus to Later Writings and Back – New Implications from Wittgenstein’sNachlass

AbstractAs a celebration of theTractatus100th anniversary it might be worth revisiting its relation to the later writings. From the former to the latter, David Pears recalls that “everyone is aware of the holistic character of Wittgenstein’s later philosophy, but it is not so well known that it was already beginning to establish itself in theTractatus” (The False Prison, 1987). From the latter to the former, Stephen Hilmy’s (The Later Wittgenstein, 1987) extensive study of theNachlasshas helped removing classical misconceptions such as Hintikka’s claim that “Wittgenstein in thePhilosophical Investigationsalmost completely gave up the calculus analogy.” Hilmy points out that even in theInvestigationsone finds the use of the calculus/game paradigm to the understanding of language, such as “in operating with the word” (Part I, §559) and “it plays a different part in the calculus”. Hilmy also quotes from a late (1946) unpublished manuscript (MS 130) “this sentence has use in the calculus of language”, which seems to be compatible with “asking whether and how a proposition can be verified is only a particular way of asking ‘How do you mean?’” Central in this back and forth there is an aspect which seems to deserve attention in the discussion of a semantics for the language of mathematics which might be based on (normalisation of) proofs and/or Hintikka/Lorenzen game-dialogue: the explication of consequences. Such a discussion is substantially supported by the use of the open and searchableThe Wittgenstein Archives at the University of Bergen. These findings are framed within the discussion of the meaning of logical constants in the context of natural deduction style rules of inference.

Introducing Debate as a pedagogical tool in pharmacy education

Communication skills are crucial for pharmacists’ role in counselling and providing information to patients, other healthcare practitioners, and the community. This study explores the implementation of debate as a pedagogical tool into pharmacy education to improve students’ communication skills.This study is part of the design-based research (DBR) project FREMFARM that aims to design, test, and evaluate the expansion of active learning modalities in pharmacy education at the University of Bergen. The project embeds an explicit focus upon the Scholarship of Teaching and Learning. The sample in the current study consisted of 4th year pharmacy students. Qualitative methods were used to explore students’ perception of implementing the debate activity in the Clinical Pharmacy course. Data were collected using a short pre and post questionnaire, observation using an adapted version of the Teaching Dimension Observation Protocol and post activity focus groups. Analysis was inspired by the systematic text condensation methodology. Our main finding was that students showed a high level of enthusiasm and interest in the new learning activity. Most students agreed that the debate helped them structure their thinking and simplify their language when communicating complex concepts. Students also expressed that preparing for the debate helped them organize thoughts, spurred them to gather information from prior taught courses, and draw connections to additional fields to prepare arguments. Some students reported transformation in their learning and change of their position and perspective after the debate. Still, some students found the effort used to prepare for the debate activity too large in relation to the gains. We conclude that the debate as a teaching tool increases students’ engagement and that the students experience that the activity had positive impact on their communication and argumentation skills. Despite students experiencing the debate as an unknown and demanding methodology, they considered it important for their academic and professional development. It generated opportunities for critical thinking, argumentative capacity, use of communication skills and teamworking skills. We consider the first trial successful and will continue to implement and upscale the use of debate as a pedagogical tool for future evaluation.

Metabolic role of the hepatic valine/3-hydroxyisobutyrate (3-HIB) pathway in fatty liver disease

The valine (branched-chain amino acid) metabolite 3-hydroxyisobutyrate (3-HIB), produced by 3-Hydroxyisobutyryl-CoA Hydrolase (HIBCH), is associated with insulin resistance and type 2 diabetes, but implicated tissues and cellular mechanisms are poorly understood. We hypothesized that HIBCH and 3-HIB regulate hepatic lipid accumulation. HIBCH mRNA in human liver biopsies ("Liver cohort") and plasma 3-HIB ("CARBFUNC" cohort) were correlated with fatty liver and metabolic markers. Human Huh7 hepatocytes were supplemented with fatty acids (FAs) to induce lipid accumulation. Following HIBCH overexpression, siRNA knockdown, inhibition of PDK4 (a marker of FA β-oxidation) or 3-HIB supplementation, we performed RNA-seq, Western blotting, targeted metabolite analyses and functional assays. We identify a regulatory feedback loop between the valine/3-HIB pathway and PDK4 that shapes hepatic FA metabolism and metabolic health and responds to 3-HIB treatment of hepatocytes. HIBCH overexpression increased 3-HIB release and FA uptake, while knockdown increased cellular respiration and decreased reactive oxygen species (ROS) associated with metabolic shifts via PDK4 upregulation. Treatment with PDK4 inhibitor lowered 3-HIB release and increased FA uptake, while increasing HIBCH mRNA. Implicating this regulatory loop in fatty liver, human cohorts show positive correlations of liver fat with hepatic HIBCH and PDK4 expression (Liver cohort) and plasma 3-HIB (CARBFUNC cohort). Hepatocyte 3-HIB supplementation lowered HIBCH expression and FA uptake and increased cellular respiration and ROS. These data implicate the hepatic valine/3-HIB pathway in mechanisms of fatty liver, reflected in increased plasma 3-HIB concentrations, and present possible targets for therapeutic intervention. Funding was provided by the Research Council of Norway (263124/F20), the University of Bergen, the Western Norway Health Authorities, Novo Nordisk Scandinavia AS, the Trond Mohn Foundation and the Norwegian Diabetes Association.