Opioid-Induced Constipation in Advanced Illness: Safety and Efficacy of Methylnaltrexone Bromide

Constipation, one of the major side effects of opiates used in palliative care, can impair patients’ quality of life to a point where it prevents sufficient pain control. Methylnaltrexone is a novel μ-receptor antagonist, which does not pass the blood brain barrier. It is licensed to treat opiate induced constipation for patients with advanced diseases. This review article presents an overview of pharmacology and safety of its application, evidence of its efficacy and economic aspects of its use in clinical practice. Available data are limited but strongly suggest that methylnaltrexone causes laxation in less than 24 hours for at least half of those patients over the first two weeks of usage without impairing pain control or causing serious adverse effects. To avoid danger of gastrointestinal perforation it is contraindicated for patients at risk for that complication. More research is needed to evaluate its long-term efficacy and economic impact

Study of fuel cells using storable rocket propellants Final report, 18 Aug. 1965 - 23 Jun. 1969

Operating fuel cells on gaseous nitrogen tetroxide and aerozine 5

Phosphodiesterase 5 inhibitors lower both portal and pulmonary pressure in portopulmonary hypertension: a case report

<p>Abstract</p> <p>Background</p> <p>Portopulmonary hypertension (PPHTN) is a severe complication in liver cirrhosis. PDE5 inhibitors lower pulmonary arterial pressure (PAP) in PPHTN. However, their effect on portal hypertension has not yet been investigated.</p> <p>Case presentation</p> <p>A 55 year old male patient presented with PPHTN and alcoholic liver cirrhosis. 10 mg of Tadalafil, a PDE5 inhibitor with a long half-life, was administered orally under continuous monitoring of pulmonary and portal hemodynamics. For maintenance therapy the patient received Sildenafil 20 mg bid.</p> <p>Tadalafil lowered mean PAP from 45 to 39 mmHg within 60 minutes. Cardiac output (CO) increased from 6.8 to 7.9 l/min. Central venous pressure (CVP) remained stable at 3 mmHg. Systolic and diastolic blood pressure was lowered from 167/89 to 159/86 mmHg. Pulse rate increased from 75 to 87 per min. Wedged hepatic vein pressure (WHVP) decreased from 21 to 18 mm Hg, hepatovenous pressure gradient (HVPG) decreased from 10 to 7 mmHg. Hemodynamic monitoring after 6 months of Sildenafil therapy revealed a sustained lowering of mean PAP. HVPG remained constant at 10 mmHg. Cardiac and pulmonary performance had further improved.</p> <p>Conclusion</p> <p>This case report shows for the first time, that phosphodiesterase 5 inhibitors lower both portal and pulmonary pressure in portopulmonary hypertension.</p

The environmental security debate and its significance for climate change

Policymakers, military strategists and academics all increasingly hail climate change as a security issue. This article revisits the (comparatively) long-standing “environmental security debate” and asks what lessons that earlier debate holds for the push towards making climate change a security issue. Two important claims are made. First, the emerging climate security debate is in many ways a re-run of the earlier dispute. It features many of the same proponents and many of the same disagreements. These disagreements concern, amongst other things, the nature of the threat, the referent object of security and the appropriate policy responses. Second, given its many different interpretations, from an environmentalist perspective, securitisation of the climate is not necessarily a positive development

Natural resource rent and stakeholder politics in Africa: towards a new conceptualisation

YesThis paper critically revisits the debate on natural resource rent, curse and conflict, interrogating some of the key assumptions that have become received knowledge in extant discourses. The paper demonstrates how orthodox theories’ preoccupation with issues of resource rent and resource curse tend to be marred by slants of ahistoricity and state-centricity. Adopting a stakeholder approach to the issues of resource rent and conflict in Africa, the author argues that natural resource rents produce and attract a multiplicity of competitive stakeholders, both domestic and external, in the resource-rich states. The competition and jostling of stakeholders for access to, and appropriation of, rentier resources is too often an antagonistic process in many emerging economies that has consequences and implications for violent conflict. The paper attempts a new conceptual explanation of how natural resource rents dialectically generate stakes, stakeholders and political conflict. The paper concludes by proposing the need for the more conflict-prone African rentier states to transition to a more functional state model, the transformative state

Effect of a weight loss intervention on anthropometric measures and metabolic risk factors in pre- versus postmenopausal women

<p>Abstract</p> <p>Background</p> <p>The present study examines changes in body weight, fat mass, metabolic and hormonal parameters in overweight and obese pre- and postmenopausal women who participated in a weight loss intervention.</p> <p>Methods</p> <p>Seventy-two subjects were included in the analysis of this single arm study (premenopausal: 22 women, age 43.7 ± 6.4 years, BMI 31.0 ± 2.4 kg/m²; postmenopausal: 50 women, age 58.2 ± 5.1 years, BMI 32.9 ± 3.7 kg/m²). Weight reduction was achieved by the use of a meal replacement and fat-reduced diet. In addition, from week 6 to 24 participants attended a guided exercise program. Body composition was analyzed with the Bod Pod^®. Blood pressures were taken at every visit and blood was collected at baseline and closeout of the study to evaluate lipids, insulin, cortisol and leptin levels.</p> <p>Results</p> <p>BMI, fat mass, waist circumference, systolic blood pressure, triglycerides, glucose, leptin and cortisol were higher in the postmenopausal women at baseline.</p> <p>Both groups achieved a substantial and comparable weight loss (pre- vs. postmenopausal: 6.7 ± 4.9 vs 6.7 ± 4.4 kg; n.s.). However, in contrast to premenopausal women, weight loss in postmenopausal women was exclusively due to a reduction of fat mass (-5.3 ± 5.1 vs -6.6 ± 4.1 kg; p < 0.01). In premenopausal women 21% of weight loss was attributed to a reduction in lean body mass.</p> <p>Blood pressure, triglycerides, HDL-cholesterol, and glucose improved significantly only in postmenopausal women whereas total cholesterol and LDL-cholesterol were lowered significantly in both groups.</p> <p>Conclusion</p> <p>Both groups showed comparable weight loss and in postmenopausal women weight loss was associated with a pronounced improvement in metabolic risk factors thereby reducing the prevalence of metabolic syndrome.</p

Natural resource rent and stakeholder politics in Africa: towards a new conceptualisation

YesThis paper critically revisits the debate on natural resource rent, curse and conflict, interrogating some of the key assumptions that have become received knowledge in extant discourses. The paper demonstrates how orthodox theories’ preoccupation with issues of resource rent and resource curse tend to be marred by slants of ahistoricity and state-centricity. Adopting a stakeholder approach to the issues of resource rent and conflict in Africa, the author argues that natural resource rents produce and attract a multiplicity of competitive stakeholders, both domestic and external, in the resource-rich states. The competition and jostling of stakeholders for access to, and appropriation of, rentier resources is too often an antagonistic process in many emerging economies that has consequences and implications for violent conflict. The paper attempts a new conceptual explanation of how natural resource rents dialectically generate stakes, stakeholders and political conflict. The paper concludes by proposing the need for the more conflict-prone African rentier states to transition to a more functional state model, the transformative state

Phosphodiesterase-5 inhibitors have distinct effects on the hemodynamics of the liver

<p>Abstract</p> <p>Background</p> <p>The NO - cGMP system plays a key role in the regulation of sinusoidal tonus and liver blood flow with phosphodiesterase-5 (PDE-5) terminating the dilatory action of cGMP. We, therefore, investigated the effects of PDE-5 inhibitors on hepatic and systemic hemodynamics in rats.</p> <p>Methods</p> <p>Hemodynamic parameters were monitored for 60 min. after intravenous injection of sildenafil and vardenafil [1, 10 and 100 μg/kg (sil1, sil10, sil100, var1, var10, var100)] in anesthetized rats.</p> <p>Results</p> <p>Cardiac output and heart rate remained constant. After a short dip, mean arterial blood pressure again increased. Systemic vascular resistance transiently decreased slightly. Changes in hepatic hemodynamic parameters started after few minutes and continued for at least 60 min. Portal (var10 -31%, sil10 -34%) and hepatic arterial resistance (var10 -30%, sil10 -32%) decreased significantly (p < 0.05). At the same time portal venous (var10 +29%, sil10 +24%), hepatic arterial (var10 +34%, sil10 +48%), and hepatic parenchymal blood flow (var10 +15%, sil10 +15%) increased significantly (p < 0.05). The fractional liver blood flow (total liver flow/cardiac output) increased significantly (var10 26%, sil10 23%). Portal pressure remained constant or tended to decrease. 10 μg/kg was the most effective dose for both PDE-5 inhibitors.</p> <p>Conclusion</p> <p>Low doses of phosphodiesterase-5 inhibitors have distinct effects on hepatic hemodynamic parameters. Their therapeutic use in portal hypertension should therefore be evaluated.</p

Homogeneous search for helium in the atmosphere of 11 gas giant exoplanets with SPIRou

The metastable helium triplet in the near-infrared (10833{\AA}) is among the most important probes of exoplanet atmospheres. It can trace their extended outer layers and constrain mass-loss. We use the near-infrared high-resolution spectropolarimeter SPIRou on the CFHT to search for the spectrally resolved helium triplet in the atmospheres of eleven exoplanets, ranging from warm mini-Neptunes to hot Jupiters and orbiting G, K, and M dwarfs. Observations were obtained as part of the SPIRou Legacy Survey and complementary open-time programs. We apply a homogeneous data reduction to all datasets and set constraints on the presence of metastable helium, despite the presence of systematics in the data. We confirm published detections for HAT-P-11b, HD189733b, and WASP-69b and set upper limits for the other planets. We apply the p-winds open source code to set upper limits on the mass-loss rate for the non-detections and to constrain the thermosphere temperature, mass-loss rate, line-of-sight velocity, and the altitude of the thermosphere for the detections. We confirm that the presence of metastable helium correlates with the stellar mass and the XUV flux received by the planets. We investigated the correlation between the mass-loss rate and the presence of metastable helium, but it remains difficult to draw definitive conclusions. Finally, some of our results are in contradiction with previous results in the literature, therefore we stress the importance of repeatable, homogeneous, and larger-scale analyses of the helium triplet to obtain robust statistics, study temporal variability, and better understand how the helium triplet can be used to explore the evolution of exoplanets.Comment: 28 pages, 13 figures, Accepted in A&A for publicatio

‘Hacking multitude’ and Big Data: Some insights from the Turkish ‘digital coup’

The paper presents my first findings and reflections on how ordinary people may opportunistically and unpredictably respond to Internet censorship and tracking. I try to capture this process with the concept of ‘hacking multitude'. Working on a case study of the Turkish government's block of the social media platform Twitter (March 2014), I argue that during systemic data choke-points, a multitude of users might acquire a certain degree of reflexivity over ubiquitous software of advanced techno-capitalism. Resisting naïve parallels between urban streets and virtual global streets, the article draws on Fuller's ‘media ecologies' to make sense of complex and dynamic interactions between processes and materialities, strategies of communication and mundane practices. Such a dense space is mostly invisible to network and traffic analysis, although it comes alive under the magnifying lens of digital ethnography. As the Turkish government tried to stop protesters on both the urban and the Twitter spheres, alternative material configurations and new hybrid formations and practices emerged. I try to bring this process alive following the traces – that is, a combination of digital data and materialities – of a social space between the protest for Twitter access, the ‘digital coup' and the interactions that this situation determined. In the final section, I briefly explore two research trajectories which can further develop my initial formulation of a ‘hacking multitude'. I argue that a generalisation of hacking/multitude is problematic for the political, cultural or economic processes more directly associated with Big Data