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Therapeutic alliance is widely considered one of the factors most associated with treatment success in psychotherapy across a variety of outcomes. However, these effects may differ based on treatment approach or who is rating alliance (client, therapist, or third-party observer). Notably, research on this relationship among individuals with primary aggression problems is limited, with no study to date investigating therapeutic alliance in psychotherapy among individuals with intermittent explosive disorder (IED), the only psychiatric disorder for which affective aggression is pathognomonic. The current study sought to fill this gap by exploring the role of therapeutic alliance on a range of outcomes among 51 adults with IED who participated in a randomized clinical trial comparing cognitive-behavioral and supportive psychotherapy. Therapeutic alliance was assessed by clients, therapists, and an observer at week four of treatment, and outcomes included time in treatment, anger, aggression, emotion dysregulation, and IED remission status. Results showed that alliance was positively associated with reduced anger and aggression at post-treatment. Although alliance was more highly rated in the cognitive-behavioral condition, the alliance-outcome relationship did not differ based on treatment condition. There were no differences found between raters of alliance. These findings support the importance of developing and maintaining a strong relationship in psychotherapy with individuals diagnosed with IED. / Psychology

Cardiovascular disease (CVD) has become one of the commonest causes of comorbidity and mortality among People living with human immunodeficiency virus (HIV) (PLWH) on antiretroviral therapy (ART). Nearly 50% of PLWH are likely to have an increased risk of developing CVD, including coronary heart disease, cerebrovascular disease, peripheral artery disease and aortic atherosclerosis. Aside from the common risk factors, HIV infection itself and side effects of antiretroviral therapy contribute to the pathophysiology of this entity. Potential non-pharmacological therapies are currently being tested worldwide for this purpose, including eating patterns such as Intermittent fasting (IF). IF is a widespread practice gaining high level of interest in the scientific community due to its potential benefits such as improvement in serum lipids and lipoproteins, blood pressure (BP), platelet-derived growth factor AB, systemic inflammation, and carotid artery intima-media thickness among others cardiovascular benefits. This review will focus on exploring the potential role of intermittent fasting as a non-pharmacological and cost-effective strategy in decreasing the burden of cardiovascular diseases among HIV patients on ART due to its intrinsic properties improving the main cardiovascular risk factors and modulating inflammatory pathways related to endothelial dysfunction, lipid peroxidation and aging. Intermittent fasting regimens need to be tested in clinical trials as an important, cost-effective, and revolutionary coadjutant of ART in the fight against the increased prevalence of cardiovascular disease in PLWH. / Revisión por pares

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Sweden’s municipalities are leading the green energy transition, in this study, a techno-economic evaluation was done for a number of carbon neutral scenarios for Växjö municipality’s future energy system, situated within Sweden’s projected energy demand development in 2030 and 2050. The municipality’s partially decentralized energy system relies heavily on interconnected electricity supply from the national grid, and fuels imports from other parts of Sweden. It was a matter of question: in which ways will future demand changes induce supply changes, and whether a future carbon neutral energy system will be less costly in a sustained-electricity supply condition? To answer this, a balanced energy reference system for the municipality was created from an actual energy balance, using an hour-by-hour dynamic energy analysis tool EnergyPlan. Afterward, a future energy demand projection for Växjö was stemmed from the Swedish Energy Agency (SEA) sustainable future scenarios for Sweden, based on an average inhabitant energy demand. Modelling results for Växjö carbon neutral scenarios showed that Växjö energy system will be sufficient to supply future heat demand but not electricity demand, nor transport and industrial fuels. While in the short-term being carbon neutral is more economically attainable without changes in electricity supply technologies, a projected electricity price and consumption increase, change the outcomes for a carbon neutral scenario based on Intermittent Renewable Energy (IRE) to be less costly in the long term.

Objective: Establish and validate an experimental pain model that will create pain for at least 20-minutes and then use the model to determine if: 1) cryotherapy decreases experimentally induced pain, 2) experimentally induced pain contributes to arthrogenic muscle inhibition, and 3) cold application influences pain or arthrogenic muscle inhibition. To answer these questions we conducted two experiments, the results of which are presented in two manuscripts. Methods: Seventy (n = 30 for experiment I and n = 40 for experiment II), physically active healthy male subjects participated. Interventions: Independent variables used for experiment I were condition (5% hypertonic saline infusion/cryotherapy, no-saline infusion/cryotherapy, 5% hypertonic saline infusion/sham) and time (precondition, every minute during a condition, and 10 minutes following each condition). For experiment II, independent variables were treatment (saline infusion, saline infusion/cryotherapy, saline infusion/sham, and no-saline infusion) and time (pretreatment, posttreatment, and 30-minutes posttreatment). Dependent variables measured were pain perception, knee surface and ambient temperatures, and Hmax, and Mmax measures (experiment II only). Results: Saline caused more pain than no-saline at minutes 3, 4, and 5 during infusion. Pain caused by saline and sham application remained constant from 4 minutes during application through 1 minute following application. Cold application decreased pain for 16 minutes. Pain resulted in arthrogenic muscle inhibition following and 30 minutes following saline infusion. Cryotherapy removed inhibition following but not 30 minutes following application. Pain for the saline groups increased following infusion as measured with the pain rating index and visual analogue scale. According to pain rating index, cryotherapy did not decrease pain; however, cryotherapy decreased pain as measured with the visual analogue scales. No change in temperature occurred during the non-cooling conditions. Ambient temperatures fluctuated less than 1°C. Conclusion: Saline infusion caused anterior knee pain for over 20 minutes and resulted in arthrogenic muscle inhibition. Cryotherapy disinhibited the quadriceps motoneuron pool and reduced pain as measured with visual analogue scales. Cryotherapy did not decrease pain as measured with the McGill pain questionnaire.

The following master thesis is conducted on behalf of The Royal Institute of Technology and Manetos AB with the purpose of investigating potential business markets for the new innovation, the Digital Circuit Breaker (DCB). The DCB is a mean for digitalising the distribution board, which is the middleman between households’ electrical appliances and the electrical grid. Through this digitalisation, a two-way communication between households and the grid can emerge, creating possibilities for demand side flexibility and energy management. The technology also provides more transparency for homeowners and real estate owners into households’ and buildings’ energy consumption, through monitoring and disaggregation. The study found that the energy landscape is facing significant challenges for the future. The integration of more intermittent energy, unpredictable energy consumption, new power consuming technologies and an aging grid were examples of challenges which potentially could jeopardize the security of electric supply. Many of these challenges however were also found to be issues which the DCB could potentially solve. It was also found that power-based tariffs spoke in favour of the DCB. Based on the overall empirical results, the study found that there is a need amongst utilities for demand side flexibility solutions and that there is a need amongst homeowners for electricity transparency and monitoring tools. This gives rise to a situation where the possibility to commercialize the DCB exists. By making the DCB a demand flexibility solution for utilities and a transparency and monitoring tool for homeowners, the needs for both utilities and homeowners can be fulfilled. The recommendations towards Manetos were to focus on the business markets electric utilities, more specifically municipally owned grid companies, and homeowners. It was found that the municipally owned grid companies focused more on socioeconomics than profit based grid companies. Furthermore, the municipally owned grid companies that had powerbased tariffs in place today showed great interest in the DCB as a tool for better managing electrical load and avoiding power peaks. For homeowners it was found that the people who owned electric vehicles or had direct electric heating showed great interest in an electricity management tool such as the DCB. The study also found real estate companies to be a business market of interest, however, not enough interviews were conducted in order to draw conclusions for the markets viability. Therefore, further investigation of the real estate company market is recommended. / Följande examensarbete har utförts på uppdrag av Kungliga Tekniska Högskolan och Manetos AB med syftet att undersöka potentiella affärsmarknader för en ny innovation kallad den Digitala Brytaren (DCB – Digital Circuit Breaker). DCBn är ett verktyg för att digitalisera elskåpet, vilket fungerar som en mellanhand mellan hushåll och elnätet. Denna digitalisering möjliggör för tvåvägskommunikation mellan hushåll och elnät, vilket öppnar upp möjligheter för efterfrågeflexibilitet och bättre energihushållning. Teknologin ökar även transparensen gällande byggnaders energikonsumtion, både för hushåll och fastighetsägare, genom övervakning och dissaggregering. Studien fann att energilandskapet står inför betydande utmaningar inför framtiden. Integrationen av mer intermittent energi, oförutsägbar energikonsumtion, nya teknologier och ett åldrande elnät är några exempel på utmaningar vilka kan komma att äventyra leveranssäkerheten i systemet. Många av dessa utmaningar visade sig dock vara problem som DCBn skulle kunna lösa. Studien fann även att effektbaserade tariffer, vilka idag används som ett verktyg för att motverka höga effektuttag, fungerar som incitament för DCBn och för en mer hållbar energikonsumtion generellt. Baserat på de övergripande empiriska resultaten fann studien att det finns ett behov för efterfrågeflexibilitets lösningar bland elnätsägare, samt ett behov för transparens- och kontroll-verktyg för villaägare. Detta ger möjlighet för att kommersialisera DCBn. Behoven hos både elnätsägare och villaägare kan uppnås genom att paketera DCBn som ett efterfrågeflexibilitets-, transparens- och övervaknings-verktyg. Rekommendationen till Manetos var att fokusera på kundsegmenten elnätsägare, främst de kommunalt ägda, samt villaägare. Studien fann att kommunalägda elnätsägare fokuserade mer på samhällsekonomi är de vinstdrivande elnätsföretagen. Vidare så fann studien att de kommunala elnätsägarna vilka idag använder effekt tariffer, hade ett stort intresse för DCBn som ett verktyg för att minska effekttoppar och uppnå bättre övervakning. För villaägare kunde det ses att de personer som ägde elbilar eller hade direktverkande el i bostaden visade störst intresse för ett verktyg såsom DCBn. Även kundsegmentet fastighetsägare visade sig vara av intresse, dock genomfördes inte ett tillräckligt stort antal intervjuer inom segmentet för att kunna dra slutsatser om marknadens lönsamhet. Därför föreslås undersökning av detta segment för vidare framtida studier, såväl som att undersöka potentialen för DCBn internationellt samt att inkludera ett större antal villaägare i studien.

Ventilator-associated pneumonia (VAP) is the leading healthcare-acquired infection among ventilated patients in intensive care units (ICU). VAP is a serious patient complication that results in increased hospital length of stay, cost, morbidity, and mortality. The accumulation of subglottic secretions above the endotracheal tube (ETT) cuff increases the risk of VAP, as these secretions may leak around the cuff of the ETT resulting in aspiration and an increased risk for infection. An in depth literature review was done to determine the effectiveness of subglottic secretion aspiration (by means of specialized ETT tubes with intrinsic suction lumens) in decreasing the incidence rate of VAP. Evidenced-based data were gathered from the CINAHL Plus with Full Text, PubMed, and Cochrane Database of Systematic Reviews databases for this review. VAP guidelines recommend subglottic secretion aspiration as a means to prevent its occurrence. However, important variables such as suction pressure, frequency, secretion viscosity, and ETT cuff pressure and volume need to be considered. The interaction among these variables determines the effectiveness of subglottic secretion removal. The goal of this review was to highlight these interactions and provide evidenced-based information for critical care nurses to expand their understanding of the dynamics involved in subglottic secretion aspiration and how to efficiently use this practice to prevent VAP.

<p> An optimization study of an intermittent-flow multistage fluidized ion exchange column was performed using a stochastic approximation method. A new type of downcomer, a fluid diode, was designed and employed to alleviate liquid bypassing through the downcomer. The well known ion exchange system, H⁺/Na⁺ exchange on Dowex 50W resin, was used in this work. </p> <p> The volumetric efficiency of the system was optimized with regard to certain column and diode parameters. A maximum volumetric efficiency of 71.8 hr⁻¹ was obtained for the following conditions: </p> <p> average liquid flowrate = 3661 ml/min ; </p> <p> resin flowrate = 56.1 gm/min ; </p> <p> plate spacing 11.43 cm ; </p> <p> lateral diode displacement= 0.794 cm. </p> <p> Experiments have shown that a 78.2% increase in volumetric efficiency was achieved by use of the fluidic diode downcomers. </p> / Thesis / Master of Engineering (ME)

Groundwater and surface water contamination has been linked in the past to inadequate or failing on-site wastewater treatment and disposal systems. The on-site wastewater systems installed in coastal areas have more potential for inflicting this kind of environmental damage. This work studied the regulatory compliance and environmental protection of the four types of on-site wastewater disposal systems found on the Mississippi Gulf Coast; i.e., vegetative rock filter, subsurface drip irrigation, sand mound, and sprinkler systems, by statistical techniques. Compliance was also evaluated for groundwater samples collected from monitoring wells installed at four corners of a disposal field. This work eventually culminated in formulation of strategy for modifying the aerobic treatment prior to disposal to help reduce nitrogen loading on the discharging environment. Process modeling and simulations were performed to optimize conditions for biological nitrogen reduction in the treatment unit by efficient management of aeration. Two separate proposals were developed, such as either running the aerator unit in a low operating dissolved oxygen concentration or intermittent aeration mode.