Exile Vol. VII No. 1

EDITORIAL 4 Silent Strife (story) by Robert Kribbs 5-12 Six Haiku (poems) by Jean Ludwig 13 Carter (sketch) by Sara Curtis 14-16 FELT PEN DRAWING by Lucinda Piersol 17 A Summer Chapter (narrative) by Clark Blaise 18-24 One, Two, Button My (poem) Sara Curtis 25 To Recognize the Chair (poem) by Linda Chase 26 In Case of the Twelfth Pig by Linda Chase 27 Awarded the semi-annual EXILE-Denison Bookstore Writing Prize: A Summer Chapter by Clark Blaise 18-2

Regulation of food intake in monkeys: Response to caloric dilution

Ability to regulate level of energy intake was studied in adult rhesus monkeys (Macaca mulatta) using calorically diluted diets. Twenty-four hour access to a complete liquid diet was provided via leakproof gravity feeders. The addition of water provided 4 caloric concentrations over the range of 0.5 to 1.35 kcal/ml. Average caloric intake per kg body weight was 84 +/- 0.7 kcal/kg (mean +/- SE). Seven of the eight monkeys maintained a constant caloric intake by adjusting oral intake in response to randomly ordered but sustained changes in caloric density. One monkey ingested a significantly higher caloric load while receiving the highest density diet. Rates of compensation for dilution following each diet change varied widely, occurring over periods of 3 days to 2 weeks. It was concluded that individual monkeys vary significantly in the rat of adjustment to caloric dilution, and thus long term studies must be used in studying controls of feeding in monkeys.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24454/1/0000728.pd

A systematic review on the correlation between skeletal and jawbone mineral density in osteoporotic subjects

Objectives: The aim of this systematic review was to assess whether the systemic skeletal reduction of bone mineral density (BMD) that characterizes osteoporotic subjects is also associated with a reduction of BMD in the jawbones. Material and methods: Two reviewers searched independently and in duplicate three databases up to May 2014 and assessed the risk of bias using a tailored version of the Newcastle-Ottawa scale (NOS). Only papers reporting either Pearson's correlation coefficient or Spearman's rank correlation coefficient between skeletal and jawbone mineral density in more than five osteoporotic subjects were selected. Results: From 1763 citations, 64 full-text papers were screened and five papers that met the inclusion criteria were included in the final analysis. None of the included studies complied with all NOS criteria, and as only two studies were eligible for meta-analysis, this was not performed. Conclusions: Only limited conclusions can be drawn from this systematic review, due to the small number of studies included, their heterogeneity, and their high risk of bias. Future studies that take into consideration both upper and lower jaws, that use the same technique to measure skeletal and jaw BMD (ideally dual-energy X-ray absorptiometry, DXA), and that account for confounding variables (such as medications/diseases affecting bone metabolism and demographics) are needed to provide more robust conclusions

Symptoms of insomnia among patients with obstructive sleep apnea before and after two years of positive airway pressure treatment.

To assess the changes of insomnia symptoms among patients with obstructive sleep apnea (OSA) from starting treatment with positive airway pressure (PAP) to a 2-y follow-up.Longitudinal cohort study.Landspitali--The National University Hospital of Iceland.There were 705 adults with OSA who were assessed prior to and 2 y after starting PAP treatment.PAP treatment for OSA.All patients underwent a medical examination along with a type 3 sleep study and answered questionnaires on health and sleep before and 2 y after starting PAP treatment. The change in prevalence of insomnia symptoms by subtype was assessed by questionnaire and compared between individuals who were using or not using PAP at follow-up. Symptoms of middle insomnia were most common at baseline and improved significantly among patients using PAP (from 59.4% to 30.7%, P < 0.001). Symptoms of initial insomnia tended to persist regardless of PAP treatment, and symptoms of late insomnia were more likely to improve among patients not using PAP. Patients with symptoms of initial and late insomnia at baseline were less likely to adhere to PAP (odds ratio [OR] 0.56, P = 0.007, and OR 0.53, P < 0.001, respectively).Positive airway pressure treatment significantly reduced symptoms of middle insomnia. Symptoms of initial and late insomnia, however, tended to persist regardless of positive airway pressure treatment and had a negative effect on adherence. Targeted treatment for insomnia may be beneficial for patients with obstructive sleep apnea comorbid with insomnia and has the potential to positively affect adherence to positive airway pressure.NIH HL72067 HL94307 Eimskip Fund of the University of Iceland Landspitali University Hospital Research Fund Philips Respironic

Adaptação portuguesa do questionário de qualidade de vida (SAQLI) nos doentes com síndrome de apneia obstructiva do sono

Objetivo: A Síndrome da Apneia Obstrutiva do Sono é a patologia do sono mais prevalente e afeta os vários domínios de qualidade de vida destes doentes, sendo necessária a sua avaliac¸ão objetiva. O objetivo do presente estudo foi o de validar, para a populac¸ão portuguesa, uma medida específica de qualidade de vida relacionada com a apneia do sono - o SAQLI. Material e métodos: Uma amostra de 206 pacientes portugueses com apneia do sono completou a versão portuguesa do SAQLI para avaliac¸ão da sua compreensibilidade, validade de construto e confiabilidade, e repetiu as mesmas medidas após um e três meses de terapia com CPAP. A medida de ansiedade e depressão hospitalares (HADS) foi também utilizada para testar a validade de construto. Resultados: Os resultados de validade interna revelados pelo coeficiente de alfa de Cronbach foram acima do padrão (0,70) para todos os domínios. A análise fatorial mostrou que os itens de funcionamento diário, emocional e sintomas saturaram nos domínios originais da escala. Os dados longitudinais revelaram uma diferenc¸a significativa (p < 0,001) em cada domínio do SAQLI e entre o resultado total, antes e após o uso do CPAP. Em termos de validade externa, todos os domínios SAQLI se correlacionaram negativamente com as escalas de ansiedade e depressão. Conclusões: Os resultados do presente estudo demonstraram que a versão em português do SAQLI apresenta uma boa qualidade psicométrica e é válida para avaliar o impacto da apneia do sono e tratamento com CPAP em pacientes portugueses.Fundação para a Ciência e a Tecnologia (FCT

Compliance with Positive Airway Pressure Treatment for Obstructive Sleep Apnea

ObjectivesPositive airway pressure (PAP) is considered a standard treatment for moderate-to-severe obstructive sleep apnea (OSA) patients. However, compliance with PAP treatment is suboptimal because of several types of discomfort experienced by patients. This study investigated compliance with PAP therapy, and affecting factors for such compliance, in OSA patients.MethodsWe performed a survey on 69 patients who engaged in PAP therapy between December 2006 and November 2007. After diagnostic polysomnography and manual titration, patients trialed PAP using the ResMed instrument and explored autoadjusting PAP (APAP), continuous PAP (CPAP), and flexible PAP (using expiratory pressure relief [EPR]) at least once every week for 1 month. Compliance measures were mean daily use (hr), percentage of days on which PAP was used, and percentage of days on which PAP was used for >4 hr. Data were obtained at night using the software Autoscan version 5.7® of the ResMed Inc. We obtained data on anthropometric (age, BMI, neck circumflex, Epworth sleepiness scale, Pittsburgh Sleep Quality Index, hypertension, alcohol intake), polysomnographic data (severity of apnea-hypopnea index [AHI], proportion of nonsupine sleep time, position dependence of sleep), PAP mode and AHI during PAP use for affecting factors.ResultsAfter 1 month, 41 of the 69 patients (59.4%) were pleased with PAP therapy and purchased instruments. Twenty-four patients (34.7%) used PAP for more than 3 months. The percentage of days on which PAP was used was statistically higher in patients with hypertension than in normotensive patients (P=0.003). There were negative correlations 1) between nonsupine position sleep time and percentage of days on which PAP was used (r=-0.424, P=0.039), and 2) between the AHI during PAP use and the percentage of days on which PAP was used for >4 hr (r=-0.443, P=0.030). There were no statistical differences between AHI, BMI, PAP pressure, or other measured parameters, on the one hand, and compliance, on the other.ConclusionThe affecting factors for PAP use were hypertension history, sleep posture (shorter nonsupine sleep time), and lower AHI during PAP use

Influence of sex hormones on the periodontium

Objectives : Sex hormones have long been considered to play an influential role on periodontal tissues, bone turnover rate, wound healing and periodontal disease progression. The objectives of this review article are to (1) address the link between sex hormones and the periodontium, (2) analyse how these hormones influence the periodontium at different life times and (3) discuss the effects of hormone supplements/replacement on the periodontium. Materials and Methods : Two autonomous searches were performed in English language utilizing Medline, Premedline and Pubmed as the online databases. Publications up to 2002 were selected and further reviewed. In addition, a manual search was also performed including specific related journals and books. Results : It is certain that sexual hormones play a key role in periodontal disease progression and wound healing. More specifically, these effects seem to differentiate by gender as well as lifetime period. In addition, the influence of sex hormones can be minimized with good plaque control and with hormone replacement. Conclusion : Despite profound research linking periodontal condition with sex hormones kinetics, more definitive molecular mechanisms and therapy still remain to be determined.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75598/1/j.1600-051X.2003.00055.x.pd

Arousal frequency is associated with increased fatigue in obstructive sleep apnea

Fatigue is an important and often underemphasized symptom in patients with obstructive sleep apnea (OSA). Sleep fragmentation, i.e., arousals and disruptions in sleep architecture, is common in patients with OSA and may potentially contribute to their fatigue. We hypothesized that arousal frequency and changes in sleep architecture contribute to the fatigue experienced by patients with OSA. Seventy-three patients with diagnosed but untreated OSA (AHI ≥ 15) were enrolled in this study. A baseline polysomnogram was obtained, and fatigue was measured with the Multidimensional Fatigue Symptom Inventory-short form (MFSI-sf). We evaluated the association between fatigue and arousals and various polysomongraphic variables, including sleep stages and sleep efficiency. Significant correlations between MFSI-sf subscale scores and various arousal indices were noted. Emotional fatigue scores were associated with total arousal index (r = 0.416, p = .021), respiratory movement arousal index (r = 0.346, p = .025), and spontaneous movement arousal index (r = 0.378, p = .025). Physical fatigue scores were associated with total arousal index (r = 0.360, p = .033) and respiratory movement arousal index (r = 0.304, p = .040). Percent of stage 1 sleep and REM sleep were also associated with physical and emotional fatigue scores. Hierarchal linear regression analysis demonstrated that emotional fatigue scores were independently associated with spontaneous movement arousals after controlling for age, body mass index, depression, and sleep apnea severity. These findings suggest that arousals may contribute to the fatigue seen in patients with OSA