Neurometabolite Levels in Alcohol Use Disorder Patients During Baclofen Treatment and Prediction of Relapse to Heavy Drinking

Background and Aims: Baclofen, a GABAB agonist, is used as a treatment for alcohol dependence. We aimed to examine brain metabolites following administration of baclofen or placebo in alcohol dependent individuals enrolled in a randomized placebo-controlled trial.Methods: Participants included 31 alcohol dependent individuals (recent drinking: N = 16; and abstinent: N = 15) who had received daily baclofen (BAC 30–75 mg = 20) or placebo (PL = 11) for at least 2 weeks (average 17 days). Using in vivo proton magnetic resonance spectroscopy (1H-MRS), spectra from the right parietal lobe were analyzed to obtain measures of GABA, Glutamate (Glu), Glutathione (GSH) and N-Acetyl Apartate (NAA) 120 min following administration of PL or BAC.Results: When weighting alcohol dependent participants according to recent alcohol consumption (within 24 h), there were significant differences between BAC and PL on parietal concentrations of GSH (p < 0.01) and NAA (p < 0.05). Multiple linear regression revealed a significant predictive effect of GSH on heavy drinking days at 12 weeks follow-up (Model: F = 14.28, R2 = 0.85; GSH: B = −1.22, p = 0.01) and also percentage days abstinent at 12 weeks follow-up (Model: F = 6.50, R2 = 0.72; GSH: B = 0.99, p = 0.06).Conclusion: Our data provide preliminary evidence that the effect of baclofen may be mediated by increased parietal concentrations of the antioxidant GSH and NAA in recently drinking alcohol dependent patients. GSH/Cr levels were also predictive of improved drinking outcomes in the trial and suggests a role for neural oxidative stress in alcohol use disorder

The Lancaster Care Charter

In the fall of 1991 the Munich Design Charter was published in Design Issues. This charter was written as a design-led “call to arms” on the future nations and boundaries of Europe. The signatories of the Munich Design Charter saw the problem of Europe, at that time, as fundamentally a problem of form that should draw on the creativity and expertise of design. Likewise, the Does Design Care…? workshop held at Imagination, Lancaster University in the autumn of 2017 brought together a multidisciplinary group of people from 16 nations across 5 continents, who, at a critical moment in design discourse saw a problem with the future of Care. The Lancaster Care Charter has been written in response to the vital question “Does Design Care…?” and via a series of conversations, stimulated by a range of presentations that explored a range of provocations, insights, and more questions, provides answers for the contemporary context of Care. With nation and boundary now erased by the flow of Capital the Charter aims to address the complex and urgent challenges for Care as both the future possible and the responsibility of design. The Lancaster Care Charter presents a collective vision and sets out new pragmatic encounters for the design of Care and the care of Design

New Australian guidelines for the treatment of alcohol problems: an overview of recommendations

Summary of recommendations and levels of evidence Chapter 2: Screening and assessment for unhealthy alcohol use Screening Screening for unhealthy alcohol use and appropriate interventions should be implemented in general practice (Level A), hospitals (Level B), emergency departments and community health and welfare settings (Level C). Quantity–frequency measures can detect consumption that exceeds levels in the current Australian guidelines (Level B). The Alcohol Use Disorders Identification Test (AUDIT) is the most effective screening tool and is recommended for use in primary care and hospital settings. For screening in the general community, the AUDIT-C is a suitable alternative (Level A). Indirect biological markers should be used as an adjunct to screening (Level A), and direct measures of alcohol in breath and/or blood can be useful markers of recent use (Level B). Assessment Assessment should include evaluation of alcohol use and its effects, physical examination, clinical investigations and collateral history taking (Level C). Assessment for alcohol-related physical problems, mental health problems and social support should be undertaken routinely (GPP). Where there are concerns regarding the safety of the patient or others, specialist consultation is recommended (Level C). Assessment should lead to a clear, mutually acceptable treatment plan which specifies interventions to meet the patient’s needs (Level D). Sustained abstinence is the optimal outcome for most patients with alcohol dependence (Level C). Chapter 3: Caring for and managing patients with alcohol problems: interventions, treatments, relapse prevention, aftercare, and long term follow-up Brief interventions Brief motivational interviewing interventions are more effective than no treatment for people who consume alcohol at risky levels (Level A). Their effectiveness compared with standard care or alternative psychosocial interventions varies by treatment setting. They are most effective in primary care settings (Level A). Psychosocial interventions Cognitive behaviour therapy should be a first-line psychosocial intervention for alcohol dependence. Its clinical benefit is enhanced when it is combined with pharmacotherapy for alcohol dependence or an additional psychosocial intervention (eg, motivational interviewing) (Level A). Motivational interviewing is effective in the short term and in patients with less severe alcohol dependence (Level A). Residential rehabilitation may be of benefit to patients who have moderate-to-severe alcohol dependence and require a structured residential treatment setting (Level D). Alcohol withdrawal management Most cases of withdrawal can be managed in an ambulatory setting with appropriate support (Level B). Tapering diazepam regimens (Level A) with daily staged supply from a pharmacy or clinic are recommended (GPP). Pharmacotherapies for alcohol dependence Acamprosate is recommended to help maintain abstinence from alcohol (Level A). Naltrexone is recommended for prevention of relapse to heavy drinking (Level A). Disulfiram is only recommended in close supervision settings where patients are motivated for abstinence (Level A). Some evidence for off-label therapies baclofen and topiramate exists, but their side effect profiles are complex and neither should be a first-line medication (Level B). Peer support programs Peer-led support programs such as Alcoholics Anonymous and SMART Recovery are effective at maintaining abstinence or reductions in drinking (Level A). Relapse prevention, aftercare and long-term follow-up Return to problematic drinking is common and aftercare should focus on addressing factors that contribute to relapse (GPP). A harm-minimisation approach should be considered for patients who are unable to reduce their drinking (GPP). Chapter 4: Providing appropriate treatment and care to people with alcohol problems: a summary for key specific populations Gender-specific issues Screen women and men for domestic abuse (Level C). Consider child protection assessments for caregivers with alcohol use disorder (GPP). Explore contraceptive options with women of reproductive age who regularly consume alcohol (Level B). Pregnant and breastfeeding women Advise pregnant and breastfeeding women that there is no safe level of alcohol consumption (Level B). Pregnant women who are alcohol dependent should be admitted to hospital for treatment in an appropriate maternity unit that has an addiction specialist (GPP). Young people Perform a comprehensive HEEADSSS assessment for young people with alcohol problems (Level B). Treatment should focus on tangible benefits of reducing drinking through psychotherapy and engagement of family and peer networks (Level B). Aboriginal and Torres Strait Islander peoples Collaborate with Aboriginal or Torres Strait Islander health workers, organisations and communities, and seek guidance on patient engagement approaches (GPP). Use validated screening tools and consider integrated mainstream and Aboriginal or Torres Strait Islander-specific approaches to care (Level B). Culturally and linguistically diverse groups Use an appropriate method, such as the “teach-back” technique, to assess the need for language and health literacy support (Level C). Engage with culture-specific agencies as this can improve treatment access and success (Level C). Sexually diverse and gender diverse populations Be mindful that sexually diverse and gender diverse populations experience lower levels of satisfaction, connection and treatment completion (Level C). Seek to incorporate LGBTQ-specific treatment and agencies (Level C). Older people All new patients aged over 50 years should be screened for harmful alcohol use (Level D). Consider alcohol as a possible cause for older patients presenting with unexplained physical or psychological symptoms (Level D). Consider shorter acting benzodiazepines for withdrawal management (Level D). Cognitive impairment Cognitive impairment may impair engagement with treatment (Level A). Perform cognitive screening for patients who have alcohol problems and refer them for neuropsychological assessment if significant impairment is suspected (Level A). Summary of key recommendations and levels of evidence Chapter 5: Understanding and managing comorbidities for people with alcohol problems: polydrug use and dependence, co-occurring mental disorders, and physical comorbidities Polydrug use and dependence Active alcohol use disorder, including dependence, significantly increases the risk of overdose associated with the administration of opioid drugs. Specialist advice is recommended before treatment of people dependent on both alcohol and opioid drugs (GPP). Older patients requiring management of alcohol withdrawal should have their use of pharmaceutical medications reviewed, given the prevalence of polypharmacy in this age group (GPP). Smoking cessation can be undertaken in patients with alcohol dependence and/or polydrug use problems; some evidence suggests varenicline may help support reduction of both tobacco and alcohol consumption (Level C). Co-occurring mental disorders More intensive interventions are needed for people with comorbid conditions, as this population tends to have more severe problems and carries a worse prognosis than those with single pathology (GPP). The Kessler Psychological Distress Scale (K10 or K6) is recommended for screening for comorbid mental disorders in people presenting for alcohol use disorders (Level A). People with alcohol use disorder and comorbid mental disorders should be offered treatment for both disorders; care should be taken to coordinate intervention (Level C). Physical comorbidities Patients should be advised that alcohol use has no beneficial health effects. There is no clear risk-free threshold for alcohol intake. The safe dose for alcohol intake is dependent on many factors such as underlying liver disease, comorbidities, age and sex (Level A). In patients with alcohol use disorder, early recognition of the risk for liver cirrhosis is critical. Patients with cirrhosis should abstain from alcohol and should be offered referral to a hepatologist for liver disease management and to an addiction physician for management of alcohol use disorder (Level A). Alcohol abstinence reduces the risk of cancer and improves outcomes after a diagnosis of cancer (Level A)

To transmit gender : A rhetorical study of gender constructions in the Swedish Employment Service's recruitment material regarding male- and female dominated professions

This rhetorical study aims to investigate how gender constructions are produced and reproduced through linguistic and symbolic expressions. Thus, there has been interest in analyzing recruitment films from the state authority – The Swedish Employment Service – primarily regarding male- and female dominated professions to gain knowledge of how they work to maintain or challenge perceptions of gender and gender equality in the labor market. In order to examine this, I have used Kenneth Burke's theory of identification, Judith Butler's theory of gender and performativity together with Mats Landqvist's terms, social categorizations and intersectional perspective. I found that gender is constructed differently depending on whether it is male- or female constructed. In addition, the analysis shows that women are associated with values ​​such as health, care and looks while men are represented with attributes as tough, muscular and elderly. The comparison between the artifacts showed that all recruitment films create identification bases that appeal to young people and usually to both genders regardless of occupation. The overall purpose of the essay and what I hope to convey is knowledge of how gender-dominated professions differ and work to change the view of gender

Emulation of c applications for an embedded system in Linux

I det här arbetet har en emulator till DeLavals inbyggda system IOM 200 utvecklats i en Linuxmiljö. Konceptet har varit att implementera en emulator i DeLavals testprocess för mjukvaran i ett inbyggt system. Syftet med emulatorimplementationen var att underlätta utvecklingen av mjukvaran genom att ta bort beroendet av hårdvaran. Baserat på studier av olika metoder, tillgängliga verktyg och tidigare arbeten skapades en emulatormodell för IOM 200 och ett koncept för hur den ska implementeras. Arbetet har även skapat en fungerande prototyp som kan exekvera ett mindre kodsegment från IOM 200 och därigenom validerar emulatormodellen. Emulatormodellen utformades på den redan befintliga FreeRTOS-simulatorn som finns tillgänglig i Linux. Anledningen är att FreeRTOS används i IOM 200, den är gratis att använda och den möter emulatorns abstraktionskrav. Utöver FreeRTOS-simulatorn implementerades stubbar och wrapper-funktioner som tillhandahöll gränssnitt som gjorde IOM 200 applikationen exekverbar i emulatorn. In this work an emulator for DeLaval’s embedded system IOM 200 has been developed in a Linux environment. The concept was to implement the emulator in DeLaval’s software test process for embedded systems. The purpose of creating an emulator was to ease the development of the embedded software by removing the dependency on embedded hardware. An emulator model and a concept for its implementation was created through the studies of various methods, available tools, and existing works in the emulator field. Based on the model the work created a working prototype that can execute a smaller code segment from the IOM 200 application. The emulator model was designed on the already existing FreeRTOS simulator that is available forLinux. The motive being that FreeRTOS is the operating system running on IOM 200, it is open source, free to use and it has the perfect level of abstraction for the emulator. Stubs and wrappers were implemented to the emulator in addition to the FreeRTOS simulator. These stubs and wrappers provided the interfaces needed for the IOM 200 application to be executable in the emulator

P120 – MEMS-gyroscope in cleaning robot

Detta projekt syftar till att undersöka om det går att kurskorrigera en av Weda AB:s poolrengöringsrobotar med hjälp av ett MEMS-gyroskop. Den valda rengöringsroboten styrs idag av en PLC, och konceptet är att komplettera styrenheten med ett MEMS gyroskop som kan detektera kursavvikelser. Undersökandet av möjligheterna för implementeringen börjar med att samla information om MEMS gyroskopens funktion och i vilka tekniker de används idag. Vidare utförs beräkningar mot Wedas definition av rak kurs, det resulterade i för höga krav på känsligheten i gyroskopet. Trots det otillfredsställande resultatet beslutar Weda att projektet ska fortsätta undersöka gyroskopets möjligheter. En marknadsundersöknings med 9 tillverkningsföretag genomförs i syfte att se vad marknaden erbjuder för MEMS gyroskop idag. Sedan konsulteras distribueringsföretaget Avnet som bidrar med sina kunskaper, erfarenheter och rekommendationer för konceptet. Ett av de framstående gyroskopen i undersökningen användes för att genomföra två tester. Syftet av dem var att simulera olika situationer som rengöringsroboten kan utsättas för. Resultatet visar att repetitionsnoggrannheten är god men att gyroskopet inte är tillförlitligt i låga hastigheter, vilket är en dålig egenskap för rengöringsroboten W2000 som körs med en hastighet 0,2 m/s. Testresultatet diskuterades med Bosch och dem tror att gyroskopets automatiska kalibrering är orsaken till att det inte ger tillförlitliga mätdata vid låga hastigheter.During this project the possibilities to monitor and adjust the direction of a pool cleaning robot with a MEMS gyroscope are evaluated. The robot chosen for the evaluation is manufactured by Weda AB. The concept is to add a MEMS gyroscope to the robot, which will give the control unit (PLC) feedback regarding the direction of the robot. The evaluation includes general information about MEMS gyroscopes, where they are used, common built in errors etc. To be able to select a suitable MEMS gyroscope the needed sensitivity is calculated. The needed sensitivity is based on requirements from Weda AB. The evaluation also includes a market survey which shows that the needed sensitivity cannot be fulfilled by products available on the market. The market survey is based on nine manufacturing companies and a recommendation from a distribution company called Avnet. One of the prominent MEMS gyroscopes was used to carry out two tests. The tests were designed to mimic motions of the pool cleaning robot. The test result shows that the gyroscope has good repetition accuracy, but it is not trustworthy when the rotation speed is low. The test result was discussed with the manufacturer and they think that the non positive result is caused by the automatic calibration

Multiple perspectives on self-regulation in alcohol use disorder: executive functioning, neuroimaging and psychophysiology

Empirical thesis.Bibliography: pages 213-260.Chapter One. General introduction -- Chapter Two. Executive functioning and dysregulated drinking history are associated with regulation of alcohol cue responses in non-treatment-seeking drinkers -- Chapter Three. Regulation of alcohol cue-elicited responses in alcoholic liver disease and alcohol dependent drinkers during a cue reactivity task -- Chapter Four. Impaired decision-making and reduced somatic responses indicating expectation of risky choices during the Iowa Gambling Task in severe alcohol use disorderD -- Chapter Five. Neural correlates of alcohol cue-induced brain activation and neuropsychological executive functioning measures in individuals with alcohol dependence -- Chapter Six. General discussion -- References -- Appendices.Reduced ability to regulate deleterious behaviours can lead to negative social, health, and financial outcomes. Individuals with alcohol use disorder that continue to drink despite adverse consequences from their drinking demonstrate dysregulated drinking behaviour, potentially due to difficulty in appropriate self-regulation. Identifying the factors that may be integral in appropriate regulation of responses to alcohol cues may help us better understand the underlying mechanisms involved in self-regulation in these dysregulated individuals. Elucidating the factors involved in the regulation of impulsive, motivational drives inherent in alcohol use disorder is important to inform and augment current frameworks, which do not yet adequately explain dysregulated behaviour within this complex and multifaceted disorder.Thus, the aim of thesis was to empirically examine the regulation of responses to alcohol cues and influencing factors in alcohol use disorder. A diverse methodology of neuropsychological, psychophysiological and neuroimaging techniques was applied to comprehensively evaluate regulation across various time periods surrounding cue presentation, to assess the influence of components, such as executive functioning, in appropriate regulation, and to identify overlapping evidence of underlying regulatory processes and influencing factors in a range of dysregulated alcohol use disorder samples.Four separate studies were conducted. The first applied an influential theoretical framework of executive functioning to demonstrate discrete executive functioning domains were uniquely associated with the regulation of alcohol cue-elicited responses as indicated by physiological indices in non-treatment-seeking drinkers. The second further investigated these associations using the same methodology in more severely dysregulated alcohol use disorder samples—individuals with alcoholic liver disease and alcohol dependence—and showed overall difficulties in regulation of responses in these samples that were not related to executive functioning ability. The third used the same dysregulated samples to examine whether reduced capacity for incorporating previous negative feedback leads to impaired decision-making processes regarding drinking, and found reduced physiological responses to risky choices with negative outcomes and decision-making deficits in these samples. The final study used functional neuroimaging techniques to find converging reduced neural activation in prefrontal regions related to regulation of alcohol cue responses, and worse executive functioning and dysregulated drinking measures in an alcohol dependent sample.Taken together, this thesis advances our understanding of the integral components that may underlie the progression and maintenance of alcohol use disorder. This body of work contributes to the literature involved in elucidating the role of self-regulation and influencing factors in alcohol use disorder, through a convergence of neurocircuitry and underlying neurocognitive mechanisms that is essential to advance our understanding of key processes of regulation in alcohol use disorder and better inform treatment approaches.Mode of access: World wide web1 online resource (ix, 276 pages) graphs, table

Automatic calibration of milk meters

Detta examensarbete har utförts på uppdrag av DeLaval, ett företag inom mjölkningsindustrin. Projektets huvudmålsättning var att automatisera kalibreringen av DeLavals mjölkningsrobot VMS v300. Kalibreringen av mjölkmätarna, som mäter mängden mjölk under mjölkning, måste ske manuellt. Dagens kalibreringsprocess är ICAR-godkänd vilket innebär att ICAR sätter upp riktlinjer för hur noggrann mätningen ska vara för att vara godkänd. Arbetet har utförts på distans vilket innebär att det endast finns teoretiska beräkningar, enklare skisser, och teoretiska modeller i rapporten.  Arbetet inleds med en faktagenomgång, där processen kring hur kalibreringen utförs förtydligas. Vidare förklaras även hur mycket mjölk som fås av en ko under en mjölkning, vilken mjölkmätare som används, kalibreringsparametrar, lösningsförslag, och hur den automatiserade kalibreringen av en AMR (Automatic Milking Rotary) fungerar. Med hjälp av matematiska beräkningar och simuleringar utvärderas lösningsförslagen. Slutsatsen är att nivåmätaren, som nu finns placerad och kan användas i VMS:en, inte når de krav som ställs på kalibreringen. Istället kan en ultraljudssensor ersätta den nuvarande nivåmätaren och erhålla en godkänd kalibreringsprocess. Detta innebär att kalibreringsprocessen kan automatiseras.This report is a thesis commissioned by the dairy industry company DeLaval. The main objective of theproject was to automate DeLaval's calibration of its milking robot VMS v300. At present, DeLavalneeds to manually calibrate the milk meters, that measure the amount of milk during milking, to getan accurately measured amount of milk. Today's calibration process is ICAR-approved, which meansthat ICAR sets guidelines for how accurate the measurement must be for approval. The work has been carried out remotely, which means that there are only theoretical calculations,simpler sketches, and theoretical models in the report. The work begins with a factual review, which clarifies the process of how the calibration is performed.Furthermore, it is also explained how much milk is obtained by a cow during milking, which milkmeter is used, calibration parameters, solution suggestions, and how the automated calibration of anAutomatic Milking Rotary (AMR) works. By means of mathematical calculations and simulations, a model is set up to evaluate the solutionproposals, which resulted in a feasible model. The conclusion for the work is that the level meter,which is now located and can be used in the VMS, does not meet the requirements set for thecalibration. Instead, an ultrasonic sensor can replace the current level meter and obtain an approvedcalibration process. This means that the calibration process can be automated