The use of baclofen as a treatment for alcohol use disorder: a clinical practice perspective

Alcohol use disorder (AUD) is a brain disorder associated with high rates of mortality and morbidity worldwide. Baclofen, a selective gamma-aminobutyric acid-B (GABA-B) receptor agonist, has emerged as a promising drug for AUD. The use of this drug remains controversial, in part due to uncertainty regarding dosing and efficacy, alongside concerns about safety. To date there have been 15 randomized controlled trials (RCTs) investigating the use of baclofen in AUD; three using doses over 100 mg/day. Two additional RCTs have been completed but have not yet been published. Most trials used fixed dosing of 30-80 mg/day. The other approach involved titration until the desired clinical effect was achieved, or unwanted effects emerged. The maintenance dose varies widely from 30, to more than 300, mg/day. Baclofen may be particularly advantageous in those with liver disease, due to its limited hepatic metabolism and safe profile in this population. Patients should be informed that the use of baclofen for AUD is as an ‘off-label’ prescription, that no optimal fixed dose has been established, and that existing clinical evidence on efficacy is inconsistent. Baclofen therapy requires careful medical monitoring due to safety considerations, particularly at higher doses and in those with comorbid physical and/or psychiatric conditions. Baclofen is mostly used in some European countries and Australia, and in particular, for patients who have not benefitted from the currently used and approved medications for AUD

A randomised controlled trial of extended brief intervention for alcohol dependent patients in an acute hospital setting (ADPAC)

<p>Abstract</p> <p>Background</p> <p>Alcohol dependence affects approximately 3% of the English population, and accounts for significant medical and psychiatric morbidity. Only 5.6% of alcohol-dependent individuals ever access specialist treatment and only a small percentage ever seek treatment. As people who are alcohol dependent are more likely to have experienced health problems leading to frequent attendance at acute hospitals it would seem both sensible and practical to ensure that this setting is utilised as a major access point for treatment, and to test the effectiveness of these treatments.</p> <p>Methods/Design</p> <p>This is a randomised controlled trial with a primary hypothesis that extended brief interventions (EBI) delivered to alcohol-dependent patients in a hospital setting by an Alcohol Specialist Nurse (ASN) will be effective when compared to usual care in reducing overall alcohol consumption and improving on the standard measures of alcohol dependence. Consecutive patients will be screened for alcohol misuse in the Emergency Department (ED) of a district general hospital. On identification of an alcohol-related problem, following informed written consent, we aim to randomize 130 patients per group. The ASN will discharge to usual clinical care all control group patients, and plan a programme of EBI for treatment group patients. Follow-up interview will be undertaken by a researcher blinded to the intervention at 12 and 24 weeks. The primary outcome measure is level of alcohol dependence as determined by the Severity of Alcohol Dependence Questionnaire (SADQ) score. Secondary outcome measures include; Alcohol Use Disorders Identification Test (AUDIT) score, quantity and frequency of alcohol consumption, health-related quality of life measures, service utilisation, and patient experience. The trial will also allow an assessment of the cost-effectiveness of EBI in an acute hospital setting. In addition, patient experience will be assessed using qualitative methods.</p> <p>Discussion</p> <p>This paper presents a protocol for a RCT of EBI delivered to alcohol dependent patients by an ASN within an ED. Importantly; the trial will also seek to understand patients' perceptions and experiences of being part of a RCT and of receiving this form of intervention.</p> <p>Trial registration number</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN78062794">ISRCTN78062794</a></p

A Tale of Four “Carp”: Invasion Potential and Ecological Niche Modeling

. We assessed the geographic potential of four Eurasian cyprinid fishes (common carp, tench, grass carp, black carp) as invaders in North America via ecological niche modeling (ENM). These “carp” represent four stages of invasion of the continent (a long-established invader with a wide distribution, a long-established invader with a limited distribution, a spreading invader whose distribution is expanding, and a newly introduced potential invader that is not yet established), and as such illustrate the progressive reduction of distributional disequilibrium over the history of species' invasions.We used ENM to estimate the potential distributional area for each species in North America using models based on native range distribution data. Environmental data layers for native and introduced ranges were imported from state, national, and international climate and environmental databases. Models were evaluated using independent validation data on native and invaded areas. We calculated omission error for the independent validation data for each species: all native range tests were highly successful (all omission values <7%); invaded-range predictions were predictive for common and grass carp (omission values 8.8 and 19.8%, respectively). Model omission was high for introduced tench populations (54.7%), but the model correctly identified some areas where the species has been successful; distributional predictions for black carp show that large portions of eastern North America are at risk.ENMs predicted potential ranges of carp species accurately even in regions where the species have not been present until recently. ENM can forecast species' potential geographic ranges with reasonable precision and within the short screening time required by proposed U.S. invasive species legislation

Fish population responses to hydrological variation in a seasonal wetland in southeast México

ABSTRACT Hydrological variation differently affects fish species. In the present study, the response of local populations of 13 fish local species to hydrological variation in a tropical wetland was evaluated. The objectives were to analyze the abundance response of fish species with distinct life history strategies and to assess the role of hydrological variation on fish population patterns. We found that opportunistic strategists were favored by high hydrological variation in drought periods, the equilibrium strategists were related to stable habitats, and periodic strategists were regulated by floods and temperature. However, the life history strategies identified for some species in this study do not correspond to the classification reported in other studies. Our results highlight the importance to study the abundance responses of species at local and regional scales to identify variations in life-history strategies, which can reflect local adaptations of species to hydrological changes, this is useful in order to understand and predict the responses of fish populations to the local environment

Research on Teaching and Learning Probability

This book summarizes the vast amount of research related to teaching and learning probability that has been conducted for more than 50 years in a variety of disciplines. It begins with a synthesis of the most important probability interpretations throughout history: intuitive, classical, frequentist, subjective, logical propensity and axiomatic views. It discusses their possible applications, philosophical problems, as well as their potential and the level of interest they enjoy at different educational levels. Next, the book describes the main features of probabilistic thinking and reasoning, including the contrast to classical logic, probability language features, the role of intuitions, as well as paradoxes and the relevance of modeling. It presents an analysis of the differences between conditioning and causation, the variability expression in data as a sum of random and causal variations, as well as those of probabilistic versus statistical thinking. This is followed by an analysis of probability’s role and main presence in school curricula and an outline of the central expectations in recent curricular guidelines at the primary, secondary and high school level in several countries. This book classifies and discusses in detail the three different research periods on students’ and people’s intuitions and difficulties concerning probability: early research focused on cognitive development, a period of heuristics and biases programs, and the current period marked by a multitude of foci, approaches and theoretical frameworks

Professional Development in Mathematics for Teachers - Who, What, Why and How

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Professional development in mathematics for teachers: Who, what, why and how

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