O presente estudo objetivou determinar um protocolo para sedação de veados-mateiros (Mazama americana) que permitisse procedimentos comumente utilizados no manejo dessa espécie em cativeiro. Foram utilizados seis animais adultos, pesando 38,4 ± 5 Kg, pertencentes ao Núcleo de Pesquisa e Conservação de Cervídeos (UNESP - Jaboticabal). Os animais foram submetidos a dois tratamentos, com um intervalo mínimo de 30 dias entre eles, a saber: AX-0,5 - associação de 1 mg/kg de azaperone e 0,5 mg/kg de xilazina via intramuscular (IM) e AX-1,0 - associação de 1 mg/kg de azaperone e 1 mg/kg de xilazina (IM). A partir da administração do tratamento (0 minuto) foram avaliados os tempos para latência da sedação, para decúbito esternal, para a manipulação segura e para a manipulação sem segurança. Ainda, foram avaliados a qualidade da contenção química por meio da somatória de pontos obtida com a utilização de uma escala descritiva adaptada, a cada 10 minutos, por até 90 minutos, parâmetros fisiológicos (FC, fR, PAM e To) a cada 10 minutos, durante 60 minutos, perfil ácido-base e eletrolítico (pH, PaCO2, PaO2, HCO3-, EB, SaO2, Na+ e K+) aos 10, 30 e 60 minutos e lactato sérico aos 30 e 60 minutos pós-tratamentos. As diferenças foram consideradas significantes quando P < 0,05. O período de latência da sedação e período para os animais apresentarem decúbito esternal foram maiores em AX-0,5 (7 ± 6,6 e 12 ± 9,7 minutos, respectivamente) em relação a AX-1,0 (5 ± 2,0 e 6 ± 3,1 minutos respectivamente), porém não houve diferenças entre os grupos para os demais tempos avaliados. A qualidade da contenção química diferiu entre os grupos a partir de 60 minutos, observando-se possibilidade de manipulação sem segurança a partir de 60 minutos para AX-0,5 e de 90 minutos para AX-1,0. Não houve diferenças entre FC, fR, PAM e To e o lactato sérico entre os momentos nem entre os grupos. Em relação ao perfil ácido-base e eletrólitico, AX-0,5 apresentou diferenças em pH, HCO3-,, EB e K+, com valores aos 60 minutos superiores aos valores em 10 minutos, e AX-1,0 apresentou diferenças apenas para EB também com valores aos 60 minutos superiores aos 10 minutos. Diante dos resultados conclui-se que os dois protocolos promoveram sedação adequada e que a escolha entre eles deve ser pautada pela índole do animal. Embora não tenham ocorrido alterações fisiológicas consideráveis em nenhum dos grupos, sugere-se a suplementação de oxigênio nos primeiros 30 minutos de contenção química. / The aim of this study was to determine a sedation protocol for red brockets (Mazama Americana) that allows common handling procedures for captive individuals of this species. Six adult animals, weighing 38.4 ± 5 kg, from Núcleo de Pesquisa e Conservação de Cervídeos (UNESP - Jaboticabal) were used in the study. They underwent two treatments with a 30 days washout period: AX-0.5 with 1 mg/kg azaperone and 0.5 mg/kg xylazine, intramuscularly (IM), and AX-1.0 with 1 mg/kg azaperone and 1 mg/kg xylazine, IM. From the moment of drug administration (0 minute) latency periods for sedation, sternal recumbency, safe handling and unsafe handling were recorded. The quality of chemical restraint was quantified every 10 minutes, for up to 90 minutes, through a descriptive scale, and the physiological variables (FC, fR, PAM and To) every 10 minutes, up to 60 minutes. Acid base status and blood electrolytes (pH, PaCO2, PaO2, HCO3-, EB, SaO2, Na+ e K+) were assessed at 10, 30 and 60 minutes, while blood lactate was assessed at 30 and 60 minutes after treatment. Differences were considered significant when P < 0.05. Sedation latency periods and period for sternal recumbency were longer in AX-0.5 (7 ± 6,6 e 12 ± 9,7 minutes, respectively) in comparison to (AX-1.0 5 ± 2,0 e 6 ± 3,1 minutes respectively), however no other significant differences in periods between groups were observed. Quality of chemical restraint was significantly different between treatments after 60 minutes, when safe handling of the animals was no longer possible in AX-0.5, but only after 90 minutes in AX-1.0. No differences between FC, fR, PAM, To and blood lactate levels were observed between groups or between moments. Regarding the acid base status and blood electrolytes, animals from AX-0,5 showed significant differences in pH, HCO3-,, BE and K+ between 10 and 60 minutes, being values at 10 minutes higher. Same tendency was also observed in AX-1.0, however only for BE. In conclusion, both protocols led to adequate sedation and predilection between them should be based on the animal\'s behavior. Even though no alterations in physiological parameters were detected in any of the experimental groups, oxygen therapy is recommended for the first 30 minutes of chemical restraint in all animals.

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Bakgrund: Fastspänning är en intervention för att som sista utväg hantera hotfulla och våldsamma patienter i svensk psykiatrisk heldygnsvård. Dock är dess effekt bristande vetenskapligt utvärderad. Patientens perspektiv visar på en komplex upplevelse med risk för fysiska och psykiska skador. Sjuksköterskan prövas i sin yrkesroll gällande etik, beslutsfattande och sin egen säkerhet. Samtidigt är sjuksköterskans perspektiv på fastspänning relativt vetenskapligt outforskat. Syfte: Att belysa sjuksköterskors erfarenheter av fastspänning i psykiatrisk heldygnsvård. Metod: En empirisk, kvalitativ intervjustudie genomfördes med tio informanter och materialet analyserades med kvalitativ innehållsanalys inspirerad av Burnards metod för innehållsanalys. Resultat: Analysen resulterade i tre rubriker: fastspänning som del i omvårdnaden och dess svårigheter, sjuksköterskerollen i relation till fastspänning samt många faktorer påverkar utförandet. Slutsats: Fastspänning upplevdes som nödvändigt för att återskapa kontroll i hotfulla och våldsamma situationer samt skydda alla inblandade från skada. Patientens bästa prioriterades vilket kunde skapa etiska dilemman gällande eget beslutstagande och att följa beslut om fastspänning. Ledarskap, samarbete och förberedelse var nyckelfaktorer för att utföra fastspänning på ett bra sätt. / Background: Mechanical restraint is a common last resort intervention to handle threats and violence in Swedish psychiatric inpatient care. Its effect is lacking scientific evaluation. The patients’ perspective shows a complex experience with risk of physical and psychological injuries. Nurses are tested in their professional role regarding ethics, decision making and their own safety. At the same time the nurse’s perspective on mechanical restraint is relatively unexplored. Objective: To hightlight nurses’ experiences of mechanical restraint in psychiatric inpatient care. Method: An empirical, qualitative interview study with ten informants was conducted and the material was analysed with qualitative content analysis inspired by Burnard’s method of content analysis. Results: The analysis resulted in three headings: mechanical restraint as a part of nursing and its difficulties, the nurse’s professional role in relation to mechanical restraint, many factors affect the outcome. Conclusion: Mechanical restraint was perceived as necessary to regain control in threatening and violent situations in addition to protecting everyone involved from harm. The patient’s best interest was prioritized which could create ethical dilemmas regarding the nurse’s own decision or to follow other’s decision to perform mechanical restraint. Leadership, teamwork and preparation were key factors to performing mechanical restraint successfully.

The use of mechanical restraint is a common practice in psychiatric care, often defended by medical necessity but seldom questioned from a human rights perspective. The purpose of this thesis has been to investigate under which circumstances mechanical restraint by bed through belt fixation could amount to torture and other cruel, inhuman or degrading treatment or punishment. Persons with psychosocial disabilities are in a particularly vulnerable situation and as the International Convention on the Rights of Persons with Disabilities (CRPD) is the most comprehensive rights framework for this group, it has been discussed whether the CRPD sets out additional safeguards in relation to restraint.  A legal doctrinal approach is the basic methodology used in order to outline the current international and European legal framework on torture and other ill-treatment and disability rights. A survivor-controlled research methodology has been applied and to amplify other voices of persons with firsthand experience of being mechanically restrained, interviews have been conducted with persons from Sweden and Spain. Healthcare professionals have also been interviewed. A feminist perspective on the law is applied.  Different international conventions and bodies of the United Nations have diverse interpretations on what acts or omissions that amount to torture and other cruel, inhuman or degrading treatment or punishment, although there is an aim and will to streamline the conventions. It is clear that the use of mechanical restraint can create such intense mental or physical suffering required to reach the common criterion of seriousness. However, some people do not experience the required levels of suffering for it to be considered torture, meaning that it might not amount to torture but rather other ill-treatment. The threshold for being considered torture according to the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (UNCAT) seems to be somewhat higher than that of the International Covenant on Civil and Political Rights (ICCPR) and the European Convention of Human Rights (ECHR). In this thesis it was found that the most critical element for this is the requirement of intent. Intent can however be implied under certain circumstances if the practice is of discriminatory nature. If a person has a psychosocial disability, intent might be presumed if States do not provide appropriate health care. In the case of girls and women, intent might also be presumed since they seem to have a higher risk of getting restrained for unlawful reasons.  The main conclusion in this thesis is that mechanical restraint by bed through belt fixation could amount to torture or other cruel, inhuman or degrading treatment or punishment according to the UNCAT, ICCPR and ECHR.

The separation of solids from biological wastewater treatment is an important step in the treatment process, as it has a significant impact on effluent water quality. The moving bed biofilm reactor (MBBR) technology is a proven upgrade or replacement wastewater treatment system for carbon and nitrogen removal. However, a challenge of this technology is the characteristics of the effluent solids that results in their poor settlement; with settling being the common method of solids removal. The main objective of this research is to understand and expand the current knowledge on the settling characteristics of MBBR produced solids and the parameters that influence them. In particular, in this dissertation, the impacts are studied of carrier types, biofilm thickness restraint design of carriers, and varying carbonaceous loading rates on MBBR performance, biofilm morphology, biofilm thickness, biofilm mass, biofilm density, biofilm detachment rate, solids production, particle size distribution (PSD) and particle settling velocity distribution (PSVD). With this aim, three MBBR reactors housing three different carrier types were operated with varying loading rates. In order to investigate the effect of carrier geometrical properties on the MBBR system, the conventional, cylindrically-shaped, flat AnoxK™ K5 carrier with protected voids was compared to two newly-designed, saddle-shaped Z-carriers with the fully exposed surface area. Moreover, the AnoxK™ Z-200 carrier was compared to the AnoxK™ Z-400 carrier to evaluate the biofilm thickness restraint design of these carriers, where the Z-200 carrier is designed for greater biofilm thickness-restraint. The Z-200 carrier is designed to limit the biofilm thickness to the level of 200 µm as opposed to 400 µm for the Z-400 carrier. Finally, to investigate the effects of varying carbonaceous loading rates on system removal performance, biofilm characteristics and solids characteristics, further analyses were performed at three different loading rates of 1.5 to 2.5 and 6.0 g-sBOD/m2·d in steady-state conditions. The PSD and the PSVD analyses were combined to relate these two properties. A settling velocity distribution analytical method, the ViCAs, was applied in combination with microscopy imaging and micro-flow imaging to investigate the relation of PSD and settling behaviour of MBBR produced particles. The obtained results have indicated that the carrier type significantly impacted the MBBR performance, biofilm, and particle characteristics. As such, the K5 carrier MBBR system demonstrated a statistically significantly higher carbonaceous removal rate and efficiency (3.8 ± 0.3 g-sBOD/m2·d and 59.9 ± 3.0% sBOD removal), higher biofilm thickness (281.1 ± 8.7 μm), higher biofilm mass per carrier (43.9 ± 1.0 mg), lower biofilm density (65.0 ± 1.5 kg/m3), lower biofilm detachment rate (1.7 ± 0.7 g-TSS/ m2·d) and hence lower solids production (0.7 ± 0.3 g-TSS/d) compared to the two Z-carriers. The Z-carriers' different shape exposes the biofilm to additional shear stress, which could explain why the Z-carriers have thinner and denser biofilm, resulting in higher solids production and lower system performance in comparison with K5. Moreover, the carrier type was also observed to impact the particle characteristics significantly. PSD analysis demonstrated a higher percentage of small particles in the Z-carrier system effluent and hence a significantly lower solids settling efficiency. Therefore, the solids produced in the K5 reactor have shown enhanced settling behaviour, consisting of larger particles with faster settling velocities compared to Z-carriers. This dissertation also investigated the effects of restraint biofilm thickness on MBBR performance by comparing the Z-200 biofilm thickness-restraint carrier to the Z-400 carrier. No significant difference was observed in removal efficiency, biofilm morphology, biofilm density, biofilm detachment rate, and solids production between the Z-200 to the Z-400 carriers. The PSD and the PSVD analyses did not illustrate any significant difference in the particles’ settling behaviour for these two biofilm thickness restraint carriers, indicating that the biofilm thickness-restraint carrier design was not a controlling factor in the settling potential of MBBR produced solids. Finally, this research studied the effect of varying loading rates and demonstrated a positive, strong linear correlation between the measured sBOD loading rate and the removal rate, indicating first-order BOD removal kinetics. The biofilm thickness, biofilm density and biofilm mass decreased when the surface area loading rate (SALR) was increased from 2.5 to 6.0 g-sBOD/m2·d. The solids retention time (SRT) was also shown to decrease by increasing the SALR, where the lowest SRT (1.7 ± 0.1 days) was observed at the highest SALR, with the highest cell viability (81.8 ± 1.7%). Significantly higher biofilm detachment rate and yield were observed at SALR 2.5, with the thickest biofilm and a higher percentage of dead cells. Consequently, a higher fraction of larger and rapidly settling particles was observed at SALR of 2.5 g-sBOD/m2·d, which leads to a significantly better settling behaviour of the MBBR effluent solids. This study expands the current knowledge of MBBR-produced particle characteristics and settling behaviour. A comprehensive understanding of the MBBR system performance and the potential influencing factors on the MBBR produced solids, particle characteristics, and their settleability will lead to optimized MBBR design for future pilot- and full-scale applications of the MBBR.

The usage of linear 3D FEA is widespread within the bridge design community, and although this tool provides substantial benefits in the design process, there are certain practical issues related to the application of this analysis tool. A situation in which such an issue prevails is when linear 3D FEA is used to analyze restraint forces due to thermal shrinkage or expansion in concrete slab frame bridges. Effects related to restraint forces in concrete are difficult to model and predict as these forces differ significantly in nature from external loads, and dealing with them in practical design situations is complicated. In this thesis, cracking due to restraint forces in concrete slab frame bridges was investigated using 3D non-linear FE-analyses in the software package ATENA 3D. Using volumetric finite elements, attempts were made to realistically capture the load response and cracking behavior of concrete slab frame bridges subjected to restraint forces induced by temperature differences among members. The initial parts of this thesis aims to find appropriate modelling techniques and material models for the prediction of cracks due to restraint forces in base restrained walls using a previously reported experimental research project as reference. Comparative simulations were performed, using crack widths and crack patterns as comparate. Overall good correspondence was obtained with an exception of deviation in cracks formed at locations near the restrained corners where crack widths were overestimated in the simulations. The technique used to model the restrained boundary proved to be highly influential in the context of obtaining realistic results. Subsequent to the comparative study, a parametric study was performed where the correlation between crack widths and selected attributes was investigated. The parameter which exhibited the most distinct influential effect on the results was the length-to-height (L/H) ratio of the wall. The applicability of a crack control approach intended for crack width estimation in liquid retaining and containment structures made of concrete exposed to thermally induced restraint forces, given in EN 1992-3, was then evaluated for use in design of concrete frame bridges. This approach proved to return conservative results for walls with low L/H-ratios when compared to results produced in the numerical simulations. Finally, a NLFE (non-linear finite element) model of a concrete slab frame bridge designed by the consultancy company Tyréns AB was composed and tested. Different procedures of applying temperature differences between front wall and bridge deck were evaluated. This study indicated that the width of cracks induced by lateral restraint forces decreased when temperature was modelled applying a discrete thermal gradient to members in contact with back filling material compared to using a uniform temperature in these members when temperature differences between bridge deck and wall was simulated. The interacting effects of permanent external load effects and restraint forces were also investigated. Crack widths from NLFE simulations were then compared with corresponding results calculated using linear FEA results as input for design equations given in EN 1992-1-1. The latter resulted in estimated cracks more than 10 times wider than that obtained in the simulations, while crack widths predicted using the EN 1992-3 approach showed better correspondence to the NLFE results.

Bakgrund: I svenska barnsjukvården är barnkonventionen lag för att sjukvården ska bedrivas på barnets villkor. När barnsjukvården inte sker på barnets villkor påverkar det barnets välmående. För att kunna bemöta barnets behov behöver sjuksköterskan kunskap om barnets utveckling. Kommunikationen behöver ske individuellt och på barnets mognadsnivå för att främja barnets hälsa. Om detta inte sker kan det leda till situationer där barnet inte förstår. Detta kan ge uttryck i protester som kan leda till att metoder som fasthållning används. Det är viktigt att barnet förstår sin situation och känner sig trygg. Det är sjuksköterskans uppgift att involvera barnet och familjen i vården samt försäkra sig om att barnet förstår vad som ska ske.  Motiv: Fasthållning används fortfarande inom barnsjukvården trots att det strider mot lagen. Författarna vill undersöka varför detta sker och studera hur barnets delaktighet kan främjas i vården. Syfte: Sjuksköterskors erfarenheter av att göra barn 1–18 år delaktiga vid procedurer. Metod: Strukturerade enkäter besvarades av sjuksköterskor (n=9) från åtta barnkliniker i Sverige. Insamlad data analyserades med kvalitativ innehållsanalys. Resultat: Sjuksköterskornas erfarenheter av att göra barn delaktiga vid procedurer kunde upplevas som både svårt och enkelt. Det framkommer att sjuksköterskorna har bra erfarenheter av när vården sker på barnets villkor, men också dåliga erfarenheter där fasthållning sker mot barnets vilja. Resultatet har två huvudkategorier; När trygghet  främjas utifrån barnets villkor och När barnets delaktighet förminskas. Dessa kategorier fördes samman till ett tema; Kommunikation är vägen till delaktighet. Konklusion: Fasthållning kan undvikas när arbetsförhållandena, resurser, sjuksköterskans inställning och kunskap fungerar optimalt. / Background: In pediatric care in Sweden is the Convention on the Rights of the Child a law for the care to be done on child terms. When pediatric care isn't provided at the child's term it affects the child's well-being. To be able to meet the child's needs, the nurse´s knowledge of the child's development is needed. Communication needs to be done individually and at the child's maturity level in order to promote the child's health. If not, it can come to situations where the child doesn't understand. Which can lead to the child protesting and then decisions of restraining the child. It´s important that the child understands the situation and feel safe. It´s the nurse's role to involve the child and family and to make sure that the child understands what will happen. Motive: Restraining in pediatric healthcare is still performed even though it´s contrary to the law. The authors want to investigate why this occurs and how the child's participation can be promoted in their care. Aim: Nurse´s experiences of making the children aged 1-18 participate in procedures.  Methods: Structured questionnaires were answered by nurses (n = 9) from eight pediatric clinics in Sweden. Collected data were analyzed with qualitative content analysis.  Result: The nurses' experiences of making the children participate in procedures could be perceived as difficult and easy. It appears that the nurses have good experiences of when care is at the child's terms and bad experiences when restraining the child against their will. The result has two main categories; When safety is created on the child's terms and When the child's participation is reduced. These categories were brought together into a theme; Communication is the path to participation. Conclusion: Restraint can be avoided when working conditions, resources, the nurse's attitude and knowledge work optimally.

Agmatine is an endogenous amine derived from decarboxylation of arginine catalysed by arginine decarboxylase. Agmatine is considered a novel neuromodulator and possesses neuroprotective properties in the central nervous system. The present study examined whether agmatine has neuroprotective effects against repeated restraint stress-induced morphological changes in rat medial prefrontal cortex and hippocampus. Sprague-Dawley rats were subjected to 6 h of restraint stress daily for 21 days. Immunohistochemical staining with β-tubulin III showed that repeated restraint stress caused marked morphological alterations in the medial prefrontal cortex and hippocampus. Stress-induced alterations were prevented by simultaneous treatment with agmatine (50 mg/kg/day, i.p.). Interestingly, endogenous agmatine levels, as measured by high-performance liquid chromatography, in the prefrontal cortex and hippocampus as well as in the striatum and hypothalamus of repeated restraint rats were significantly reduced as compared with the controls. Reduced endogenous agmatine levels in repeated restraint animals were accompanied by a significant increase of arginine decarboxylase protein levels in the same regions. Moreover, administration of exogenous agmatine to restrained rats abolished increases of arginine decarboxylase protein levels. Taken together, these results demonstrate that exogenously administered agmatine has neuroprotective effects against repeated restraint-induced structural changes in the medial prefrontal cortex and hippocampus. These findings indicate that stress-induced reductions in endogenous agmatine levels in the rat brain may play a permissive role in neuronal pathology induced by repeated restraint stress.

Objective: Stress, either physical or psychological, can modulate immune function. However, the mechanisms associated with stress-induced immune suppression remain to be elucidated. β-Arrestin 2 serves as adaptor, scaffold, and/or signal transducer. The role of β-arrestin 2 in stress-induced immune suppression is not known yet. Methods/Results: Here, we demonstrate that β-arrestin 2 deficiency in mice increases the sensitivity to the chronic stress-induced reduction in the number of splenocytes. Interestingly, the stress-induced suppression of T helper-type (Th) 1 cytokines and the increased production of Th2 cytokines were greatly enhanced in β-arrestin 2-deficient mice compared with wild-type mice. Moreover, inhibition of PI3K in β-arrestin 2-deficient mice exerts an additive effect on the stress-induced reduction in the number of splenocytes. Conclusion: Our study demonstrates that a deficiency in β-arrestin 2 augments stress-induced immune suppression.

Restraint stress, either physical or psychological, can modulate immune function. However, the mechanisms associated with stress-induced lymphocyte reduction remains to be elucidated. We have previously shown that chronic stress induces Fas-mediated lymphocyte reduction. Here, we investigated the mechanisms by which restraint stress modulates lymphocyte reduction. Our data have shown that inhibition of p53 by the p53 inhibitor PFT-α attenuates stress-induced reduction in lymphocyte numbers. These results were verified using p53 knockout mice, suggesting a pivotal role of p53 in this process. In addition our data have indicated that PI3K/nuclear factor kappa B (NF-κB) signaling pathway plays an important role in the stress-induced lymphocyte reduction. Our study thus demonstrates that restraint stress promotes lymphocyte reduction through p53 and PI3K/NF-κB pathways.