Medicalisation, pharmaceuticalisation or both? Exploring the medical management of sleeplessness as insomnia

In this paper we examine the medical management of sleeplessness as ‘insomnia’, through the eyes of general practitioners (GPs) and sleep experts in Britain. Three key themes were evident in the data. These related to (i) institutional issues around advocacy and training in sleep medicine (ii) conceptual issues in the diagnosis of insomnia (iii) and how these played out in terms of treatment issues. As a result, the bulk of medical management occurred at the primary rather than secondary care level. These issues are then reflected on in terms of the light they shed on relations between the medicalisation and the pharmaceuticalisation of sleeplessness as insomnia. Sleeplessness, we suggest, is only partially and problematically medicalised as insomnia to date at the conceptual, institutional and interactional levels owing to the foregoing factors. Much of this moreover, on closer inspection, is arguably better captured through recourse to pharmaceuticalisation, including countervailing moves and downward regulatory pressures which suggest a possible degree of depharmaceuticalisation in future, at least as far prescription hypnotics are concerned. Pharmaceuticalisation therefore, we conclude, has distinct analytical value in directing our attention, in this particular case, to important dynamics occurring within if not beyond the medicalisation of sleeplessness as insomnia

TOWARDS REGIONAL DIFFERENTIATION OF RURAL DEVELOPMENT POLICY IN THE EU

In this study a comparative analysis of the Rural Development Plans (RDPs) in four intermediate rural regions (Northern Netherlands, Lower Saxony, Wales and Emilia Romagna) and four most urban regions (Southern Netherlands, North Rhine-Westphalia, Flanders and Lombardia) is made. Such plans are designed in the scope of the second pillar of the Common Agricultural Policy (CAP). In particular, the focus was on the question whether the menu approach of the second pillar enables EU member states and regions to design Rural Development Plans with a tailor-made set of measures which address their specific rural development needs. The findings of this study suggest that the current menu of rural development measures is sufficient to suit the wide range of socio-economic, ecological and physical circumstances in the EU regions. The analysis also revealed that there is some overlap between the three rural development priorities of the second pillar. Therefore, an outline of future rural development priorities and measures in the EU is designed, in which it is attempted to avoid overlap between the various rural development priorities and in which each measure contributes to the achievement of one development priority only. In addition, it is proposed that regions would select only those measures in their Rural Development Plan which really address the rural development needs in their region, even if this results in a Rural Development Plan with only one or two rural development measures. Such an approach of selecting rural development measures according to regional needs will result in a large variation in rural development measures implemented and may be considered regional differentiation of EU rural development policy.Agricultural and Food Policy,

Singlet Higgs Phenomenology and the Electroweak Phase Transition

We study the phenomenology of gauge singlet extensions of the Standard Model scalar sector and their implications for the electroweak phase transition. We determine the conditions on the scalar potential parameters that lead to a strong first order phase transition as needed to produce the observed baryon asymmetry of the universe. We analyze the constraints on the potential parameters derived from Higgs boson searches at LEP and electroweak precision observables. For models that satisfy these constraints and that produce a strong first order phase transition, we discuss the prospective signatures in future Higgs studies at the Large Hadron Collider and a Linear Collider. We argue that such studies will provide powerful probes of phase transition dynamics in models with an extended scalar sector.Comment: 36 pages, 13 figures, matches published version; Version with higher resolution figures available at http://www.its.caltech.edu/~profumo/higgs/EWPT.pd

Worcester Community Clean Energy Project: A Preliminary Assessment of Project Aims and Potential

E4TheFuture is orchestrating two pilot Community Clean Energy Projects (CCEP) in the state of Massachusetts. This paper is a preliminary analysis of the Worcester CCEP and is commissioned by E4TheFuture. The CCEP incorporates multiple types of renewable energies and a cooperative energy approach to provide clean energy access to any community member regardless of income level or homeowner status. The paper examines the CCEP’s mission statement and project estimates, using data provided by E4TheFuture and academic literature. The analysis seeks to determine the feasibility of the Worcester CCEP, its potential impact on underserved communities, and the potential for project replication

Network Variability Limits Stimulus-Evoked Spike Timing Precision in Retinal Ganglion Cells

SummaryVisual, auditory, somatosensory, and olfactory stimuli generate temporally precise patterns of action potentials (spikes). It is unclear, however, how the precision of spike generation relates to the pattern and variability of synaptic input elicited by physiological stimuli. We determined how synaptic conductances evoked by light stimuli that activate the rod bipolar pathway control spike generation in three identified types of mouse retinal ganglion cells (RGCs). The relative amplitude, timing, and impact of excitatory and inhibitory input differed dramatically between On and Off RGCs. Spikes evoked by repeated somatic injection of identical light-evoked synaptic conductances were more temporally precise than those evoked by light. However, the precision of spikes evoked by conductances that varied from trial to trial was similar to that of light-evoked spikes. Thus, the rod bipolar pathway modulates different RGCs via unique combinations of synaptic input, and RGC temporal variability reflects variability in the input this circuit provides

Have We Observed the Higgs (Imposter)?

We interpret the new particle at the Large Hadron Collider as a CP-even scalar and investigate its electroweak quantum number. Assuming an unbroken custodial invariance as suggested by precision electroweak measurements, only four possibilities are allowed if the scalar decays to pairs of gauge bosons, as exemplified by a dilaton/radion, a non-dilatonic electroweak singlet scalar, an electroweak doublet scalar, and electroweak triplet scalars. We show that current LHC data already strongly disfavor both the dilatonic and non-dilatonic singlet imposters. On the other hand, a generic Higgs doublet give excellent fits to the measured event rates of the newly observed scalar resonance, while the Standard Model Higgs boson gives a slightly worse overall fit due to the lack signal in the tau tau channel. The triplet imposter exhibits some tension with the data. The global fit indicates the enhancement in the diphoton channel could be attributed to an enhanced partial decay width, while the production rates are consistent with the Standard Model expectations. We emphasize that more precise measurements of the ratio of event rates in the WW over ZZ channels, as well as the event rates in b bbar and tau tau channels, are needed to further distinguish the Higgs doublet from the triplet imposter.Comment: 20 pages, 4 figures; v2: updated with most recent public data as of August 7. A generic Higgs doublet now gives the best fit to data, while the triplet imposter exhibits some tensio

Dorsal-CA1 hippocampal neuronal ensembles encode nicotine-reward contextual associations

Natural and drug rewards increase the motivational valence of stimuli in the environment that, through Pavlovian learning mechanisms, become conditioned stimuli that directly motivate behavior in the absence of the original unconditioned stimulus. While the hippocampus has received extensive attention for its role in learning and memory processes, less is known regarding its role in drug-reward associations. We used in vivo Ca2+ imaging in freely moving mice during the formation of nicotine preference behavior to examine the role of the dorsal-CA1 region of the hippocampus in encoding contextual reward-seeking behavior. We show the development of specific neuronal ensembles whose activity encodes nicotine-reward contextual memories and that are necessary for the expression of place preference. Our findings increase our understanding of CA1 hippocampal function in general and as it relates to reward processing by identifying a critical role for CA1 neuronal ensembles in nicotine place preference

Factor analysis of treatment outcomes from a UK specialist addiction service:relationship between the Leeds Dependence Questionnaire, Social Satisfaction Questionnaire and 10-item Clinical Outcomes in Routine Evaluation

INTRODUCTION AND AIMS: To examine the relationship between three outcome measures used by a specialist addiction service (UK): the Leeds Dependence Questionnaire (LDQ), the Social Satisfaction Questionnaire (SSQ) and the 10-item Clinical Outcomes in Routine Evaluation (CORE-10). DESIGN AND METHOD: A clinical sample of 715 service user records was extracted from a specialist addiction service (2011) database. The LDQ (dependence), SSQ (social satisfaction) and CORE-10 (psychological distress) were routinely administered at the start of treatment and again between 3 and 12 months post-treatment. A mixed pre/post-treatment dataset of 526 service users was subjected to exploratory factor analysis. Parallel Analysis and the Hull method were used to suggest the most parsimonious factor solution. RESULTS: Exploratory factor analysis with three factors accounted for 66.2% of the total variance but Parallel Analysis supported two factors as sufficient to account for observed correlations among items. In the two-factor solution, LDQ items and nine of the 10 CORE-10 items loaded on the first factor >0.41, and the SSQ items on factor 2 with loadings >0.63. A two dimensional summary appears sufficient and clinically meaningful. DISCUSSION AND CONCLUSIONS: Among specialist addiction service users, social satisfaction appears to be a unique construct of addiction and is not the same as variation due to psychological distress or dependence. Our interpretation of the findings is that dependence is best thought of as a specific psychological condition subsumed under the construct psychological distress. [Fairhurst C, Böhnke JR, Gabe R, Croudace TJ, Tober G, Raistrick D. Factor analysis of treatment outcomes from a UK specialist addiction service: Relationship between the Leeds Dependence Questionnaire, Social Satisfaction Questionnaire and 10-item Clinical Outcomes in Routine Evaluation. Drug Alcohol Rev 2014;33:643–650

Stress-induced reinstatement of nicotine preference requires dynorphin/kappa opioid activity in the basolateral amygdala

UNLABELLED: The dynorphin (DYN)/kappa-opioid receptor (KOR) system plays a conserved role in stress-induced reinstatement of drug seeking for prototypical substances of abuse. Due to nicotine\u27s high propensity for stress-induced relapse, we hypothesized that stress would induce reinstatement of nicotine seeking-like behavior in a KOR-dependent manner. Using a conditioned place preference (CPP) reinstatement procedure in mice, we show that both foot-shock stress and the pharmacological stressor yohimbine (2 mg/kg, i.p.) induce reinstatement of nicotine CPP in a norbinaltorphimine (norBNI, a KOR antagonist)-sensitive manner, indicating that KOR activity is necessary for stress-induced nicotine CPP reinstatement. After reinstatement testing, we visualized robust c-fos expression in the basolateral amygdala (BLA), which was reduced in mice pretreated with norBNI. We then used several distinct but complementary approaches of locally disrupting BLA KOR activity to assess the role of KORs and KOR-coupled intracellular signaling cascades on reinstatement of nicotine CPP. norBNI injected locally into the BLA prevented yohimbine-induced nicotine CPP reinstatement without affecting CPP acquisition. Similarly, selective deletion of BLA KORs in KOR conditional knock-out mice prevented foot-shock-induced CPP reinstatement. Together, these findings strongly implicate BLA KORs in stress-induced nicotine seeking-like behavior. In addition, we found that chemogenetic activation of Gαi signaling within CaMKIIα BLA neurons was sufficient to induce nicotine CPP reinstatement, identifying an anatomically specific intracellular mechanism by which stress leads to reinstatement. Considered together, our findings suggest that activation of the DYN/KOR system and Gαi signaling within the BLA is both necessary and sufficient to produce reinstatement of nicotine preference. SIGNIFICANCE STATEMENT: Considering the major impact of nicotine use on human health, understanding the mechanisms by which stress triggers reinstatement of drug-seeking behaviors is particularly pertinent to nicotine. The dynorphin (DYN)/kappa-opioid receptor (KOR) system has been implicated in stress-induced reinstatement of drug seeking for other commonly abused drugs. However, the specific role, brain region, and mechanisms that this system plays in reinstatement of nicotine seeking has not been characterized. Here, we report region-specific engagement of the DYN/KOR system and subsequent activation of inhibitory (Gi-linked) intracellular signaling pathways within the basolateral amygdala during stress-induced reinstatement of nicotine preference. We show that the DYN/KOR system is necessary to produce this behavioral state. This work may provide novel insight for the development of therapeutic approaches to prevent stress-related nicotine relapse