Violence against women is a human rights violation with grave health consequences and crippling effects on women’s abilities to contribute to societal development. Furthermore, violence against women is a global phenomenon, but women in low-income countries suffer a disproportionate burden. Factors such as economic crisis, political instability and civil unrest amplifies the burden. This is the case in Nepal, where the second phase of the ADVANCE project (Addressing Domestic Violence in Pregnancy 2) is based. 

The ADVANCE project addresses one of the most common types of violence against women, domestic violence, which poses significant health risks to women and their unborn infants in pregnancy. Antenatal care presents an opportunity for women to access adequate assistance that may prevent pregnancy-related complications caused by violence and that can have long-standing effects on maternal and child health.

Antenatal care (ANC) presents a ‘window of opportunity’ to reduce the harmful health consequences of domestic violence as most women use ANC services in their lifetimes (Photo: iStock)

However, to date, evidence of the effectiveness of  interventions to address domestic violence in antenatal care contexts is limited and mainly obtained from studies conducted in high-income countries. Considerable knowledge gaps exist to inform antenatal care providers in identifying and assisting pregnant women living with domestic violence in low-income country settings.

The original phase of the ADVANCE project (Addressing Domestic Violence in Antenatal Care Environments) was funded by the Research Council of Norway from 2013-2018 to fill some of these gaps, in Nepal and Sri Lanka. The ADVANCE project team has now been awarded 11 million Norwegian kroner from the FRIPRO research programme of The Research Council of Norway for a second phase of the project (2020-2025) focused on research activities in Nepal. ADVANCE 2 builds on findings from the first ADVANCE studies, now with the aim of ensuring sustainable and evidence-based changes can be made to antenatal care in Nepal.

How can knowledge from high-income countries be contextually adapted to be relevant and useful in other settings? How can effective low-cost interventions be set in place? How will such interventions reach women in the most remote areas where all types of health services are limited? In contexts where few women living with domestic violence are able to leave the relationship, how can health providers assist in mitigating potential harms to women’s health during pregnancy? These are some of the research questions we will answer in the continuation of the ADVANCE project.

To date, the ADVANCE team has completed a pioneering assessment of the burden of domestic violence in pregnancy in Nepal. We found a substantial proportion (21%) of pregnant women reported the experience of domestic violence, as published in the Scandinavian Journal of Public Health in August 2017. Young age and low socioeconomic status were particular risk factors for experiencing domestic violence. Women who reported having their own income and the autonomy to use it were at significantly lower risk of domestic violence compared to women with no income. The study also found that few women had ever disclosed their experience of domestic violence to a health care provider or been asked about domestic violence by a health provider. This underlines the importance of integrating culturally-sensitive and systematic assessment of domestic violence into antenatal care in the future in Nepal.

Project leaders, Research Fellow Jennifer Infanti and Professor Berit Schei

With ADVANCE 2, our team is planning to improve the assessment instrument we developed for the prevalence study, and formally validate it. The assessment instrument is an adapted version of the Abuse Assessment Screen (AAS), a widely-used five-item instrument originally developed in the USA to detect violence against pregnant women. We have translated the instrument to Nepali language and developed an electronic method of data capture for it called a Colour-Coded Audio Computer-Assisted Self-Interview (C-ACASI). Women wear headphones connected to a tablet computer, listen to the questions read to them by a recorded voice through the headphones, and respond to the answers by pressing colour-coded options (for example, in our study, red = yes and green = no). This technology allows women to answer sensitive questions about domestic violence in privacy in otherwise busy antenatal care settings. Importantly, it also allows for the inclusion of participants with limited or no literacy. In Nepal, the female literacy rate is approximately 67%.

We have also carried out an extensive qualitative study with 41 men and 76 women in 12 focus group discussions in community settings to explore perceptions of domestic violence in pregnancy. This was published in Global Health Action in 2016. In this work, we learned that other events than those covered in the AAS could be classified as domestic violence in Nepal and have the potential for harmful effects on a woman’s pregnancy. The community members identified culturally-specific forms of DV such as mothers-in-law restricting or denying food to pregnant women; being forced to perform long days of heavy manual labour into late pregnancy; bullying, belittling, threats and psychological stress related to dowries; and psychological stress related to cultural preference, familial pressure and taunting to give birth to a son.

Again, ADVANCE 2 builds on this prior knowledge. In the new study, we will modify the AAS to ensure it captures culturally-relevant examples of domestic violence, particularly types of emotional abuse. Our aim is therefore to create the Nepalese Abuse Assessment Screen (N-AAS), which will then be formally validated in our two partner hospitals (Dhulikhel Hospital and Kathmandu Medical College).

Example of illustrations made by a Nepalese artist to explain possible safety measures to practice during pregnancy.

It is critical not only to identify pregnant women living with domestic violence but also to provide them with assistance. In our prior work, we assessed the impact of a safety-promoting intervention delivered on an antenatal care ward at Kathmandu Medical College, in a cohort study. Pregnant women between 12-28 weeks gestation were recruited to the study at their regular antenatal care appointments at the hospital. They were educated about safety measures by a nurse or researcher using a pictorial flipchart that we developed in a teaching session lasting for a maximum of 30 minutes. The flipchart was based on a standardised safety behaviour checklist, originally created in a high-income country setting. We adapted the checklist to ensure the relevance of the safety behaviours for women in Nepal. The figure above is an example of the safety behaviours.

The findings of our study were promising, as published in the International Journal of Environmental Research and Public Health in 2020. We observed that the range of safety measures used by women increased from baseline to follow-up. However, the main weakness was the follow-up cohort study design as we were unable to compare the use of safety measures with other types of intervention. Therefore, in ADVANCE 2, we plan to test the intervention in a randomised controlled trial compared to standard care in both of our partner hospitals. This will expand the evidence-base on health sector interventions to address domestic violence in low-income country settings. The long-term goal is to integrate safety planning into standard antenatal care in Nepal.

The ADVANCE 2 study is led by Research Fellow Jennifer Infanti and Professor Berit Schei (Principal Investigator) at Department of Public Health and Nursing, NTNU. Our former PhD candidates from the original ADVANCE study, now NTNU graduates, will continue in key roles in the project’s second phase. Poonam Rishal is postdoctoral researcher for ADVANCE 2, based at Kathmandu Medical College and Teaching Hospital (KMC). Kunta Devi Pun is co-local Principal Investigator for ADVANCE 2, based at Dhulikhel Hospital-Kathmandu University School of Medical Sciences (KUSMS). Our other local Principal Investigators in Nepal are Sunil Kumar Joshi (KMC) and Rajendra Koju (DH-KUSMS). In Scandinavia, our partner institutions and/or supervisors for the ADVANCE 2 project include Katarina Swahnberg at Linnaeus University (Sweden), Mirjam Lukasse at University of South-Eastern Norway, and Lena Henriksen at Oslo Metropolitan University. Jacquelyn C. Campbell at Johns Hopkins School of Nursing (USA) is international advisor to the project team.

By Marlene Iversen Halvorsrød, PhD Candidate at CIUS

Treatment of ischemic heart disease has improved considerably the last decades. Not only the treatment itself, but also timing of treatment has been of great importance for this success. Nevertheless, ischemic heart disease is still the leading cause of death in the world.

The heart muscle, as every other muscle in the body, needs oxygen to maintain proper function. The coronary arteries supply the heart muscle with oxygenated blood. Ischemic heart disease is caused by stenosis or totally occlusion of this arteries and thereby reduced amount of available oxygen. This lack of oxygen can lead to permanent heart muscle damage. The longer the muscle have no available oxygen, the worse the damage will be. Treatment of ischemic heart disease is based on opening stenotic or occluded arteries to improve the accessibility of oxygen. Either by invasive blocking or medical (fibrinolytic) treatment. Time from debut of symptoms to treatment is a crucial determinant for success. The shorter ischemic time, the less heart muscle damage. After 6 hours without oxygen, the majority of heart muscle cells are likely to suffer from irreversible damage.

Classical symptoms of ischemic heart disease as heart attack are chest pain with radiation to neck and shoulder, shortness of breath and sweating. The symptoms are often related to physical activity. But this stenotic or occluded artery manifest with a great variability of symptoms that makes the diagnostic process hard and sometimes time consuming.

In addition to a patient’s symptoms, the most important quick diagnostic tool is the electrocardiogram (ECG). ECG was first used in late 1800 and is still a cornerstone in diagnosing ischemic heart diseases. ECG records the electrical signals through the heart. We classify heart attacks by the look of the ECG. A patient with chest pain and a certain pattern in ECG called ST-elevation, usually has an occluded artery and will be treated immediately. In some cases, patients lack this typical pattern in ECG, but have the same occluded artery. This group of patients does not have the same algorithm for immediate treatment and the treatment can be delayed. The consequence is more damaged heart muscles than necessary.

A lot of effort is put down to solve this diagnostic puzzle. In our research group at CIUS (Centre of Innovative Ultrasound Solutions), NTNU (Norwegian University of Science and Technology) we try to take advantage of new advanced ultrasound technology to come closer to a solution. Ultrasound is routinely used in diagnosing ischemic heart disease today by looking at regional differences in how the heart muscle contract. To see this regional impairment, you need a trained eye and good image quality. This method is also highly subjective. We want to improve this diagnostic step by using new technology developed at NTNU with high frame rate imaging that gives better time resolution, tissue doppler that can measure the speed of the heart muscle in different regions, and 3D ultrasound.

We know that it is crucial that patients with blocked coronary artery get treatment immediately. We want to improve the way we select these patients. Medical technical solutions can take time to develop, but in time we hope to brake some barriers in this important issue concerning the world’s deadliest disease.

Av Malgorzata Isabela Magelssen, PhD Candidate at CIUS, NTNU

Cardiac diseases are a major health concern and many of the patients in a general practitioner’s (GPs) office have heart conditions. Hand-held ultrasound device (HUD) can improve the GP’s diagnostic possibilities. We want to evaluate if a training program with focus on practical ultrasound skills can help the GP’s to correctly diagnose certain heart conditions by using HUD. If successful, unnecessary referrals could be avoided and patients in need of specialist care would avoid delay in diagnosis and treatment.

Diagnostic ultrasound represents a potential tool to improve the accuracy of the diagnostics. Diagnosis in often inaccurate when based on medical history and clinical examination alone. Studies have shown that fellows in internal medicine and family practice have a poor identification rate for important and commonly encountered cardiac events. On the other hand, several clinical conditions are difficult to recognize with physical examination alone, but easy to recognize by ultrasound; examples are pericardial effusion, heart failure and even early LV dysfunction. Traditionally GPs refer patients to a specialist for cardiac ultrasound. Many of the referred patients are not in need of specialized care and could potentially be diagnosed and treated out of hospital. Due to long waiting lists, the time to diagnosis can be prolonged and further lead to delayed treatment. Quick and accurate diagnoses is essential in order to preserve the health and quality of life of the patients.

HUDs have in many hospitals become a routine part of the initial evaluation of patients with suspected heart disease. The low cost and easy accessibility have also made them available outside the more conventional settings. Previous studies have shown that when used by experts, residents or dedicated nurses, HUDs can improve the diagnostic accuracy. The accuracy is lower when used by non-experts, and thus, proper education and training is important.

Our research group at CIUS (Centre for Innovative Ultrasound Solutions), NTNU (Norwegian University of Science and Technology) is currently conducting a study where GPs utilize HUDs for evaluation of patients with suspected heart failure. The study is conducted in the outpatient clinic at Nord-Trøndelag Health Trust, Levanger Hospital. Before we started the inclusion of patients, 5 randomly selected GPs underwent both theoretical and practical training. One of our main question is what amount and which type of training is adequate for GPs to accurately evaluate patients with potential heart disease?

In our study, each GP was individually trained with focus on practical skills. First, they all received a theoretical review of the basics of cardiac ultrasound including the most common pitfalls. We focused at the most important projections in cardiac ultrasound; parasternal long-axis and apical 4-chamber. Automatic applications to measure cardiac function were demonstrated. Further, they all received 5-6 individual days of “hands-on” training at Levanger Hospital. They spent the days examining patients and there was always a “teacher” present to aid in the examinations. At the end of the day, we went through the images and discussed future improvements. We also encouraged det GPs to use the HUDs at their own clinical practice as part of the training.

After the training period, we started the inclusion of patients in the study (150 in total). The patients were examined by a GP, a dedicated nurse and a Cardiologist. The purpose of the study is to evaluate if GPs can accurately diagnose heart failure when HUD is added as a supplement to the clinical examination. A focused cardiac ultrasound with the support of telemedicine and automatic measurements of heart function will hopefully help the GPs in this evaluation. A cardiac ultrasound performed by a specialist in cardiology works as a reference.
We hope to show that our approach for training GPs improves the accuracy of their everyday diagnostics to the best for the patients, and we hypothesize that by the dedicated training and the use of supportive tools the goal is achievable!

Yucel Karabiyik

Physical examination at the doctor’s office often involves palpation where the physician tries to feel the location, size, shape and stiffness of masses or organs in the body by touching. Sometimes, even the patients themselves can notice lumps or abnormalities in their body and refer to a physician. Examples include palpation for masses or abnormalities in breast, spleen, liver and thyroid. However, this process has its limitations. It is subjective, meaning that the diagnosis is highly dependent on the skills of the physician and it is not sensitive to small and deep tumors. Therefore, nowadays it is usually used for preliminary screening before referring the patient for further investigation.

Elastography is an imaging modality that can overcome these limitations. It is a quantitative method (as opposed to palpation) and the estimated tissue stiffness can sometimes be directly related to certain diseases or even stages of a disease. For instance, it has been found that the stiffness of liver estimated with elastography can be used for staging of liver fibrosis.

Figure 1

The method is based on generating very small amplitude displacements in the tissue and estimating how fast these displacements propagate in the form of waves. The stiffer the tissue, the faster the displacements propagate. The displacements are generated with actuators, which can be a loud speaker, an electrodynamic shaker or another kind depending on the application. The first step after creating the displacements is to image and estimate the displacement amplitudes. Diagnostic imaging techniques, magnetic resonance imaging (MRI) and medical ultrasound imaging are used for recording these displacements. Both techniques have their advantages and limitations. MRI can detect displacements in 3-D with good signal-to-noise ratio. However, it is costly and the scanning time is long compared to medical ultrasound. Ultrasound on the other hand, is portable, cheaper and faster but the displacement estimations have lower signal-to-noise ratio. Figure(1) shows an image from an ultrasound thyroid scanning. A 3-D printed neck holder is placed on the actuator and displacements are imaged using a linear ultrasound probe.

Figure 2

Figure (2) shows an example from a phantom recording. The shaker was driven with a 400 Hz sinusoidal signal. The phantom consists of inclusions with different stiffness values embedded in a tissue mimicking material. Figure (2).a shows an inclusion that is softer than the background material located between 25 – 45 mm depth. Wave images can be generated as shown in Figure (2).b after displacement estimation. One can see that in the upper part of the image, i.e., above 25 mm, the waves have constant wavelength. This wavelength is dependent on the stiffness of the material. Waves in the inclusion have shorter wavelengths which tells us that the material here is softer and the wave propagates with a lower velocity. Figure(2).c shows the final velocity estimations. As can be seen from the image, the part of the image where the inclusion is located has lower wave propagation velocity than the background. Using this velocity information, we can estimate the stiffness of the material.

Figure 3

Figure (3) shows the result of a recording from a stiff inclusion in the phantom. A 3-D ultrasound probe used for the recording and the stiff inclusion could be reconstructed in 3-D. Our main goal is to apply this technique in cardiac imaging and estimate the stiffness of the myocardium in 3-D using ultrasound imaging. Estimation of myocardial stiffness may potentially help in understanding and diagnosing of relaxation and contraction abnormalities in the heart.

Characteristics of doctors working in nursing homes and similar institutions in Norway in 2011, 2014 and 2017.

(Illustration: Colorbox)

This article describes some findings from the report Kartlegging av medisinskfaglig tilbud i sykehjem og heldøgns omsorgsboliger (Survey of professional medical services in nursing homes and residential care homes). Specifically, it presents descriptive characteristics of doctors employed in nursing homes or similar institutions in Norway in 2011, 2014 and 2017. Data are from KS’ (The Norwegian Association of Local and Regional Authorities) PAI register.

A total of 151 different municipalities were represented in the analyses: 103 municipalities in 2011, 108 in 2014 and 124 in 2017; and there were a total of 799 doctors working in nursing homes across these years. Specifically, there were 321, 383 and 448 doctors working in nursing homes in 2011, 2014 and 2017 respectively.

Turnover: As shown in Table 1, over two-thirds of the doctors worked in nursing homes in only one of the three years (2011, 2014 and 2017); and only approx. 10% of doctors worked in nursing homes at all three periods. These figures suggest high turnover. Even so, there was some improvement whereby, while approx. 7% of all doctors were only employed in 2011 and 2014, the proportion only employed in 2014 and 2017 rose to 15.1%.

Table 1: Continuity: Proportion of doctors employed in nursing homes in the period 2011-2017

Age: The doctors were between 25 and 80 years old during the study period, with an average age of 47 years in 2011, which then declined to 45 years in 2017.

Gender: The distribution of male and female doctors was fairly similar across the years. There was, however, a clear tendency towards more female doctors in nursing homes (from 42% in 2011 to 54% in 2017).

Figure 1: Gender distribution among the doctors. Source: PAI register data.

Part-time positions: Only 11% of doctors had a full-time position in 2011, and although this figure rose to 14% in 2014 and 24% in 2017, part-time employment is still the norm. Figure 2 also shows that women worked more hours (full time equivalents/FTEs) in nursing homes in 2011, 2014 and 2017 compared to men.

Table 2: Workload (% full-time equivalent) among the doctors.

Figure 2: Workload (% full-time equivalent/FTE) and gender among the doctors. Source: PAI register data. Workload (% full-time equivalent/FTE) is «the percent FTE on which the employee’s base salary is calculated” (1.00 = 100% = 37.5 hours per week).

The statistics here should be viewed with caution. Even though there are routines for assuring the quality of PAI register data, errors and omissions in the data can occur due to differences between municipalities in data reporting, and in how the variables in the register are defined and understood. Any such errors can lead to inaccuracies in the statistics reported here, which should therefore be approached with caution.

Reference:

Research report: Kartlegging av medisinskfaglig tilbud i sykehjem og heldøgns omsorgsboliger.
Authors: Melby, Line; Ågotnes, Gudmund; Ambugo, Eliva Atieno; Førland, Oddvar.

Ellen Sagaas Røed. Foto: Karl Jørgen Marthinsen/NTNU

Ultrasound technology can be used to so much more than just medical images. At the Center for Innovation in Ultrasound (CIUS), we’re working together to find out how ultrasound can solve problems.

One of our researchers is Ellen Katrine Sagaas Røed, PhD candidate at the University of South Eastern Norway (USN). She has been working as an acoustical transducer designer for Kongsberg Maritime Subsea since 2002.

— We design and manufacture transducers for underwater applications, such as fishery, sea bed mapping, positioning and communication, says Røed. Her job is to design the sound generating part of the transducer, using piezoelectric material that expands and contracts when subjected to an electric field.

Transducer performance

— Transducer performance is essential to image quality. The transducer frequency and sensitivity decide what kind of fish that can be detected or what kind of sea bed that can be mapped, and at what range. The frequency bandwidth is important for spatial resolution and communication. The size of the transducer is also an important factor, as the transducers are more and more often mounted on small vehicles like gliders and autonomous underwater vehicles (AUVs).

Alternative to single crystals

— Today we mostly use the piezoelectric ceramic PZT as the active material. PZT is a polycrystalline material, Røed explains. Lately, single crystal materials have become popular in high end medical transducers. Single crystals have a very large electromechanical coupling coefficient compared to PZT and may thus significantly increase bandwidth. Use of single crystals may also reduce transducer size. — However, the material has a very high-volume cost, she points out. — Underwater transducers typically operate in the kHz range. Thickness and diameter of the active part of a transducer scale with resonance frequency, so the active part of a 100 kHz underwater transducer will have approximately 1000 times the volume of a 1 MHz medical transducer. A new type of material called textured ceramics is now being developed. This material is expected to possess some of the benefits of single crystals, but at a lower volume cost.

Academic collaborations

One of the large research centers in this field is the Applied Research Laboratory at Pennsylvania State University. Their head of textured ceramics research, professor Richard Meyer, is co-supervisor on her project, and her main supervisor is Lars Hoff, professor at USN and leader of WP1 in CIUS. — We at Kongsberg Maritime Subsea find it very exciting to be able to explore high coupling piezoelectric materials in cooperation with these very competent academic groups with lots of transducer experience. CIUS has really been a catalyst for increased cooperation between Kongsberg and USN, and it was also the establishment of CIUS that made me think of the possibility for in depth studies of my design tasks through a PhD project.

Ellen in the lab at Kongsberg Maritime Subsea. Foto: Andreas Henriksen

Multidisciplinary field

Transducer design is a multidisciplinary field and the in-house manufacturing at Kongsberg Maritime Subsea makes Røed´s job even more diverse. — I really enjoy working with experts on different fields, from soldering and dicing to mechanical engineering, signal processing and testing. It makes me want to provide the best answers to their acoustic design related questions, and there are never lack of exciting and challenging design tasks. In this regard, the national ultrasound expertise available in CIUS is very valuable.

Informed exploitation of the ocean

— I hope that my PhD project will contribute to underwater transducers being used in even more applications and providing even better information, Røed says and adds: — Informed exploitation of the oceans is increasingly important and high coupling materials in transducers may contribute to more efficient monitoring.

Lung cancer has been the most common cancer type for several decades with a low survival rate worldwide. In Norway, the median survival time was 8.2 and 12.3 months for men and women respectively in 2013. Smoking is the most important risk factor for lung cancer, which accounts for 80-90 % of all lung cancer cases. Due to the declining trend in smoking, other lifestyle factors may become important for the incidence of lung cancer.

How dangerous is sitting still? (Illustration: iStock)

Sedentary lifestyle describes a series of human behaviors requiring low energy expenditure in a sitting or reclining posture when awake. Due to the development of technology, people perform more sedentary work, drives more cars and spend more times watching TV or playing video games. According to the World Health Organization (WHO), 60 to 85 % of the population worldwide live a sedentary life.

Prolonged sitting as a major sedentary behavior potentially contributes to illness, but its relation with lung cancer has been unclear. Moreover, people who are prolonged sitting can be either physically active or inactive during their leisure time.

Does sedentary lifestyle increase risk of lung cancer? The answer is that the risk may be increased if you are both prolonged seated and physically inactive during your leisure time.

In our study we followed 45,810 cancer-free adults who participated in the second survey of HUNT Study (HUNT2) in Norway (1995-97) to the end of 2014 to see if total sitting time daily or its combination with leisure physical activity level had any connection to developing lung cancer during the two decades. Total sitting time daily and physical activity were self-reported at the beginning of the study. We went to the Cancer Registry of Norway to find the participants who got lung cancer in this period. In total, 549 participants developed lung cancer for an approximate 18 years follow-up.

In our findings, we saw that total sitting time daily by itself was not associated with the incidence of lung cancer. However, participants who were both extendedly seated and physically inactive had a 44 % higher risk of lung cancer.

Our study is the first prospective cohort study to investigate lung cancer risk among people who were both extendedly seated and physically inactive during the leisure time. The findings suggest that both increasing physical activity and decreasing sitting time are important for lung cancer prevention.

This study was financed by the Extrastiftelsen through the Norwegian Cancer Society and top-up funding from the collaboration partner between the Liaison Committee for Education, Research and Innovation in Central Norway and Central Norway Regional Health Authority. None of the funding sources was involved in any aspect of the study design, conduct, analysis, interpretation of data, or writing the report.

References

• The Norwegian Directorate of Health. Nasjonalt handlingsprogram med retningslinjer for diagnostikk, behandling or oppfølgning av lungekreft, mesoteliom og thymom [National guidelines for diagnosis, treatment and monitoring of lung cancer, mesothelioma and thymoma]. Oslo: The Norwegian Directorate of Health, 2015.
• Thorp AA, Owen N, Neuhaus M, Dunstan DW. Sedentary behaviors and subsequent health outcomes in adults: a systematic review of longitudinal studies, 1996–2011. American journal of preventive medicine. 2011;41(2):207-15.
• Shen D, Mao W, Liu T, Lin Q, Lu X, Wang Q, et al. Sedentary Behavior and Incident Cancer: A Meta-Analysis of Prospective Studies. PloS one. 2014;9(8):e105709.

I am very excited and proud to introduce to you our brand new 2-year international Master’s programme in Physical Activity and Health. Please share this with any of your friends, colleagues and students who might be interested.

In August 2019, NTNU launches a new international MSc in Physical Activity and Health. We will offer the following three specializations: Exercise Physiology, Movement Science and Occupational Science.  (Photo: Kim L’Orange Sørenssen/NTNU)

Populations are ageing all over the world and inactivity-related diseases are on the rise. Why are most people inactive, and what are possible solutions for individuals and societies?

These hard questions are dealt with by the MSc in Physical Activity and Health. Here’s a few more:

What is the most time-efficient way for an individual to improve health and fitness? How can technology be used to improve health and performance? How can Olympic athletes become even better – and why are their training regimes also relevant for frail elderly and patients?

The MSc in Physical Activity and Health will provide students with knowledge concerning the relationship between physical activity, health, disease, participation, function and performance. There will be special emphasis on interventions to improve health and physical activity levels and reduce disability in different populations.

The MSc in Physical Activity and Health includes some courses that are compulsory for students of all specializations. For example, the course with the same name as the masters programme – Physical Activity and Health –  coordinated by me  (Marius Steiro Fimland), and the course Writing and communication coordinated by Ulrik Wisløff. Writing and communication is a new course emphasizing skills to communicate scientific results effectively both in and outside academic contexts – in writing, orally and visually. The MSc is research-based and the second year is fully devoted to the MSc-project.

Here is a brief description of the three specializations:

• Exercise Physiology emphasizes a comprehensive understanding of the mechanisms for supply and demand of oxygen transport, as well as the neuromuscular basis for muscle strength. A main goal is to identify exercise-training responses, prescribe and supervise effective strength and endurance training programs, and to study their effect on health and performance. Eivind Wang will be the coordinator.
• Movement Science emphasizes the understanding of, and skills to evaluate and improve movement. This includes physical performance, function and activity in daily life, in health and disease as well as in competitive sports. Karin Roeleveld is the coordinator. GeMS (Geriatrics, Movement and Stroke) and the Centre for Elite Sports Research are closely linked to this specialization.
• Occupational Science emphasizes the understanding of the complex interplay of individual, physical, group and societal environmental factors that affect human activity and everyday life. Occupational science translates this knowledge into evidence-based approaches for treating, rehabilitating and preventing diseases and unhealthy lifestyles, as well as promoting health and active living. Skender Redzovic will be the coordinator.

The new MSc in Physical Activity and Health replaces the three following master`s programmes:

• Exercise physiology
• Bevegelsesvitenskap
• Aktivitet og Bevegelse

You can find more information about the MSc in Physical Activity and Health, including application deadlines, on the programme’s webpages.

Do you want to know more? We are here for you!

PS Did you know that Universities in Norway have no tuition fee?

How do you check that a petroleum well is leak-proof, so that it cannot endanger the environment or the platform staff? To do so, you’d have to investigate a narrow hole with a diameter of maybe 30 cm, kilometers below the ground, where the temperatures can reach well above 100°C and the pressure is crushing. This may sound difficult, and it is! Even so, the petroleum industry has been doing things like these for almost a century, and over the past four decades they have increasingly been using ultrasonic techniques.

My colleague Andreas Talberg previously wrote a blog post about cement evaluation using the pitch-catch ultrasonic technique. In this blog post, I will explain how petroleum companies use well log measurements to evaluate the health of their wells, and touch upon some of the ways that we at the Centre for Innovative Ultrasound Solutions (CIUS) want to help them along.

What is a petroleum well?

A petroleum well is basically a deep hole in the ground, from the surface down to a petroleum reservoir. The well contains steel pipes, to keep the hole from caving in and to carry the petroleum from the reservoir to the surface. In some parts of the hole, there is cement between the pipes and the rock walls of the hole. The cement keeps the pipes in place and forms a tight seal. This seal ensures that the petroleum has only one way to flow up, namely through the pipes where the flow can be controlled.

That is what a healthy well looks like, and petroleum companies have to ensure that their wells are built healthy and stay that way. If, say, the cement does not seal the well completely or the pipes become extremely corroded, petroleum may leak from the reservoir. This represents both an environmental hazard and a safety hazard for the platform staff, and must naturally be avoided. Therefore, petroleum companies have to measure the state of their wells, which tells them whether the wells are healthy and helps them figure out what to do if they are not.

What is a well log?

There are a number of different types of measurements that can be done in a well: Ultrasonic, sonic, radiometric, mechanical, electromagnetic, and so forth. You can do any number of such measurements by sending the appropriate tools down into the well. The measurements are transmitted back up, where they are processed. The results can then be shown as a well log, like the one below.

A segment of an interpreted well log from well F-9 at the Volve field, courtesy of Equinor.

A well log looks quite confusing at first, and it may come as no surprise that learning to read one takes a lot of training. In short, however, each of the “columns” represents one or more types of information, drawn from the measurements that were done in the well.

Based on this information, experienced log interpreters can get a very good idea of the health of a well. For example, for a well with a steel pipe with cement on the outside, they can tell whether the pipe is corroded or otherwise slightly deformed, and whether there are any fluid channels between the cement and the pipe through which oil or gas could feasibly leak.

In this particular log, everything except for some of the curves in the leftmost and second rightmost column has been determined by the Ultrasonic Imager tool (USIT), an ultrasonic tool by Schlumberger. This tool uses a pulse-echo technique, which means that it shoots ultrasonic pulses straight at the pipe wall and records the echo that comes back. (This is somewhat different to the pitch-catch technique that Andreas wrote about.) As the tool is pulled through the well, it spins around, taking measurements in every direction. By processing these measurements, which typically look similar to those shown below, we can get a good idea of the shape and thickness of the pipe, and what material lies behind it.

Example USIT measurements for the cases of cement (left) and gas (right) behind the pipe.

How CIUS can help

As part of the CIUS collaboration, Equinor has released a large well log data set to CIUS, in addition to the Volve data set that they have released to the general public. These data sets include both raw measurement data and previously processed data based on these measurements. With these data sets and our expertise in ultrasonics and machine learning, we want to help give log interpreters an even better basis for making their evaluations.

There are several directions we want to go with this, and I will give a few examples. First, we believe that there is more information to be found in the measurements than what is drawn from them today. By developing better data processing techniques, we would provide log interpreters more information so that they can make evaluations with even more certainty.

Second, we want to help log interpreters with the easy parts of their task so that they can concentrate on the more difficult ones. By giving them extra decision support, for example through automatic suggestions for well log interpretations, we let them change the focus of their work towards the more challenging situations that require a skilled human to evaluate.

We are still in the early stages of this work, but when the results start coming in, we will let you know!

All images and data shown here are taken from the Volve Data Village data set that Equinor has released freely to the public, and are used with explicit permission.

If you’re from Trøndelag county you probably know someone who has participated in the Nord-Trøndelag Health study (HUNT). Maybe you even participated! But did you know that researchers at the K.G. Jebsen Center for Genetic Epidemiology collaborate with international scientists to study the genetics of diseases like heart disease and diabetes using HUNT?

Genotyping allows researchers to read the DNA nucleotide (e.g. A, T, C, or G) at millions of places in the human genome, and from 2014-2015, DNA from a subset of blood samples donated by HUNT participants was genotyped in an international effort between NTNU’s Dr. Kristian Hveem and Dr. Cristen Willer of the University of Michigan.

Variation in the human genome

The human genome is 3.1 billion nucleotides in size, and these nucleotides ultimately create the proteins that run the human body. Variation in the human genome is normal — I may have a T in a place that you have a C. But sometimes that variation puts a person at increased risk for developing a given disease. Usually this is because a person has inherited a unique combination of risk increasing alleles that in aggregate contribute to disease predisposition.

Genome Wide Association Study (GWAS)

To identify the genetic variants which increase disease risk, scientists use a statistical method called Genome Wide Association Study (GWAS) to identify which nucleotides at which genomic locations are associated with a given disease. Ultimately, identifying and understanding these associations may lead to treatments and pharmaceutical therapies. It also helps clinicians identify people with a high genetic risk score, which means they have a greater genetic burden of risk increasing variants than the average person. It is a current topic of research if people with higher genetic risk scores might benefit from lifestyle interventions and preventative care.

Phenome Wide Association Study (PheWAS)

Scientists from NTNU and the University of Michigan’s Center for Statistical Genetics use HUNT to develop statistical methods and discover novel disease-causing genetic variants. One example of their work is performing GWAS on hundreds of diseases, or phenotypes, in a phenome wide association study (PheWAS). A phenotype is the expressed characteristic in an organism that results from the genotype and the environment. When we consider many or all the phenotypes of an organism, we call this the phenome. PheWAS can identify genomic locations where a nucleotide leads to increased risk for multiple diseases.

PheWAS was performed on hundreds of diseases like coronary artery disease and laboratory measurements like blood lipid levels across multiple instances of HUNT enrollment. The LPA variant on chromosome 6, rs10455872, is associated with many of these phenotypes—coronary artery disease (CAD), myocardial infarction or heart attack (MI), coronary artery bypass graft which is a type of heart surgery (CABG.PCA), angina or chest pain (AnginaPecICD), and increased blood levels of serum cholesterol (SeChol.NT2BLM, SeChol.NT23BLM, SeChol.NT3BLM), and total cholesterol (TC, TC.NT2, TC.NT3).

For example, a variant in the LPA gene, which codes for the Lp(a) lipoprotein responsible for transporting fats in the body, is known to be associated with heart disease. By performing PheWAS for this LPA variant in HUNT (Figure 1), researchers find the G nucleotide is associated with an increased risk of coronary artery disease, myocardial infarction or heart attack, coronary artery bypass graft which is a type of heart surgery, angina or chest pain, and increased blood levels of serum cholesterol and total cholesterol.

HUNT Data can help us understand diseases

While these associations have been previously noted by clinicians and researchers, PheWAS enables many cross-phenotype comparisons in HUNT. This is important information for understanding disease mechanism and creating potential therapies. PheWAS may also identify a nucleotide that is protective for one disease but increases the risk for another. Because of Norway’s national registries and HUNT’s detailed questionnaires which span decades, HUNT is a valuable resource for international researchers who work to understand how variation in the human genome affects the entire phenome.