Obstructive sleep apnoea and sexual function in men

Obstructive sleep apnoea (OSA) is associated with sexual dysfunction. Untreated OSA and erectile dysfunction (ED) have both been identified as being indicative of a high risk of developing cardiovascular disease. Treatments for ED, such as testosterone supplementation or PDE-5 inhibitors, and for OSA, such as Continuous Positive Airways Pressure (CPAP) are both readily available. The effects of these treatments on the other associated conditions have not been fully assessed. The efficacy of testosterone supplementation, in untreated OSA, on sexual function and quality of life has not been investigated. PDE-5 inhibitors are an established treatment for erectile dysfunction, however, there is a paucity of information regarding their efficacy in OSA, and there is a theoretical risk of worsening of OSA with their use. CPAP, in some observational and non-treatment or alternative treatment controlled studies, has been shown to improve erection function in men with OSA, however the majority of these studies have been in men with OSA, with and without ED. Two randomised controlled trials investigating the effects of testosterone in untreated OSA (n=67), and the effects of CPAP and a PDE-5 inhibitor in men with OSA and ED using a factorial design (n=61) were performed. Sleep, sexual function and quality of life was assessed. CPAP increased the quantity of nocturnal erections and a PDE-5 inhibitor improved their quality. However, neither CPAP use, exogenous testosterone nor a PDE-5 inhibitor improved subjective erectile function in men with OSA. Post-hoc analysis showed that adherent CPAP use (>4hours per night) increased subjective erectile function and sexual desire, as well as several parameters of quality of life in men with OSA and ED. Testosterone also increased sexual desire in men with OSA

Barrett's esophagus and its association with hiatal hernia, cigarette smoking and colonic tumors

Introduction and Aims Barrett's esophagus (BE) is a premalignant condition to esophageal adenocarcinoma involving metaplasia of the esophageal epithelium. Since BE was first identified and described, it has been closely associated with hiatal hernia. The strength of the relationship has never been quantified, nor has the association, adjusted for confounders such as obesity and reflux, been examined. Male gender, obesity and reflux are well recognized risk factors for BE, however it is less certain what role environmental factors such as cigarette smoking play in the development of the condition. The association of BE with colonic tumors has also been speculated on but not clearly established. The aim of this thesis was to further explore the epidemiology of BE, specifically the relationship between BE and hiatal hernia, cigarette smoking and colonic tumors, through meta-analyses. Methods Three meta-analyses and systematic reviews were conducted, quantifying the relationship between BE and hiatal hernia, cigarette smoking and colonic tumors, respectively. Four electronic databases (Medline, PubMed, Embase, and Current Contents Connect) were searched for observational studies of BE patients. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random effects model for the association BE with hiatal hernia, cigarette smoking and colonic tumors. Results A positive relationship was observed between BE and hiatal hernia, which remained even after adjusting for reflux. Cigarette smoking was associated with an increased risk of BE. This was reflected in subgroup analyses of ever-, current- and former-smokers. BE was also associated with colonic tumors. The relationship was observed with both benign adenomatous tumors as well as with colorectal cancer, though it was stronger for colorectal cancer. Conclusions The association between BE and hiatal hernia is stronger for long segment BE when compared with short segment BE, and it appears to be independent of reflux. BE patients are also more likely to have ever smoked cigarettes. BE is associated with colonic tumors, with the association being stronger with colorectal cancer than with benign lesions

An Agrarian Imaginary in Urban Life: Cultivating Virtues and Vices Through a Conflicted History.

This paper explores the influence and use of agrarian thought on collective understandings of food practices as sources of ethical and communal value in urban contexts. A primary proponent of agrarian thought that this paper engages is Paul Thompson and his exceptional book, The Agrarian Vision. Thompson aims to use agrarian ideals of agriculture and communal life to rethink current issues of sustainability and environmental ethics. However, Thompson perceives the current cultural mood as hostile to agrarian virtue. There are two related claims of this paper. The first argues that contrary to Thompson’s perception of hostility, agrarian thought is popularly and commercially mobilized among urban populations. To establish this claim I extend Charles Taylor’s notion of a social imaginary and suggest that urban agriculture can be theorized as an agrarian imaginary. Entwined with the first claim is the second, that proponents selectively use agrarian history to overemphasis a narrative of virtue while ignoring or marginalizing historical practices of agrarian violence, exclusion and dispossession. I do not discount or deny the significance of agrarian virtue. By situating agrarian thought within a clearer virtue ethics framework and acknowledging potential manifestation of agrarian vice, I suggest that the idea of agrarian virtue is strengthened. Keywords: Agrarian, Social imaginary, Urban agriculture, Virtue, Vice, Charles Taylo

Citizenship Status and Pressure Group Action

This thesis investigates the intersection between citizenship status and pressure group action. It asks a two-pronged question. First, does variation in citizenship status (to be citizen or noncitizen) produce variation in pressure group action? Second, where there is variation, how is it that citizenship status matters; where there is no variation, how is it that citizenship status (a decidedly political status) does not matter? In response to this two-part question, a two-part theoretical framework has been developed. To answer the question of whether citizenship status matters, an interactive model of action has been developed. This provides a common measure through which similarities and differences in action-paths between citizen and non-citizen pressure groups can be uncovered. It is found that citizenship status does have an effect on pressure group action, notably in a pressure group’s interaction with a) their constituency; b) potential allies; c) other-state political institutions; and d) other-state media. To answer the question of how citizenship matters and does not matter, the idea of the capability mechanism has been developed. This asserts that variation in citizenship status - understood through either a rights or identity framework - produces, reduces, or removes capabilities. This, in turn, shapes action. This model is also used to explain similarities. Both the empirical findings and the theoretical frameworks developed within this thesis are useful for further analysis of the significance of citizen or non-citizen status on one’s relationship to political systems

Bibliography

Regular use of beta2-agonists might result in increased bronchial hyper-responsiveness (BHR) and decreased forced expiratory volume in 1 sec (FEV1). It has been suggested that these possible detrimental effects are not a real deterioration of the disease, but that it might be only a transient (rebound) effect shortly after discontinuing this regular use. Moreover, these effects are thought to occur especially during short-acting and not during long-acting beta2-agonists use. The aim of this study was to invest gate whether a rebound effect (a pharmacological deterioration effect diminishing after several hours) in FEV1 and PC20 (concentration of histamine causing a 20% fall in FEV1 with regard to baseline) occurred after cessation of regular use of beta2-agonists, and whether this occurred both after short-acting and long-acting beta2-agonists. Allergic asthmatic patients (n = 134) were randomly allocated to the use of a short-acting (salbutamol), a long-acting beta2-agonist (formoterol) or placebo for 12 weeks (double-blind, double-dummy). No other asthma medication was allowed, including inhaled corticosteroids. At the start and every 4 weeks later FEV and PC20 were measured, each time at least 12 h after the last doses of study medication, which is in the possible rebound period. To investigate whether a (transient) rebound effect occurred, parameters were additionally measured at least 72 h later after discontinuation of the study medication. After 12 weeks of short-acting beta2-agonist use, a drop was seen in FEV1 from 85.6 (+/- 2.21)% predicted to 78.8 (+/- 2.9)% predicted, measured 15 h (median) after the last doses of medication. This was significantly different compared to placebo. When measured 168 h (median) later FEV1 recovered to 85.5 (+/- 2.4)% predicted, comparable to baseline. PC20 decreased with -1.17 (+/- 0.44) doubling dose after 12 weeks of short-acting beta2-agonist use, measured 15 h after the last doses of medication, which was significantly different compared to placebo. However, 168 h later PC20 recovered slightly with +0.55 (+/- 0.34) doubling dose, but this value was still lower compared to placebo. In contrast, during long-acting beta2-agonist and placebo use no significant changes were seen. In conclusion, the use of short-acting beta2-agonists resulted in a transient (rebound) effect in FEV while the effects on PC20 may point to a real deterioration of the disease. Long-acting beta2-agonist and placebo use showed no changes.We conclude that a mono-therapy of short-acting and not of long-acting beta2-agonists might have deleterious effects in asthma

Combining intensive practice nurse counselling or brief general practitioner advice with varenicline for smoking cessation in primary care: study protocol of a pragmatic randomized controlled trial

Introduction: Combining behavioural support and pharmacotherapy is most effective for smoking cessation and recommended in clinical guidelines. Despite that smoking cessation assistance from the general practitioner can be effective, dissemination of clinical practice guidelines and efforts on upskilling has not lead to the routine provision of smoking cessation advice among general practitioners. Intensive counselling from the practice nurse could contribute to better smoking cessation rates in primary care. However, the effectiveness of intensive counselling from a practice nurse versus usual care from a general practitioner in combination with varenicline is still unknown. Materials and methods: A pragmatic randomized controlled trial was conducted comparing: (a) intensive individual counselling delivered by a practice nurse and (b) brief advice delivered by a general practitioner; both groups received 12-weeks of open-label varenicline. A minimum of 272 adult daily smoking participants were recruited and treated in their routine primary care setting. The primary outcome was defined as prolonged abstinence from weeks 9 to 26, biochemically validated by exhaled carbon monoxide. Data was analysed blinded according to the intention-to-treat principle and participants with missing data on their smoking status at follow-up were counted as smokers. Secondary outcomes included: one-year prolonged abstinence, short-term incremental cost-effectiveness, medication adherence, and baseline predictors of successful smoking cessation. Discussion: This trial is the first to provide scientific evidence on the effectiveness, cost-effectiveness, and potential mechanisms of action of intensive practice nurse counselling combined with varenicline under real-life conditions. This paper explains the methodology of the trial and discusses the pragmatic and/or explanatory design aspects

The Implementation of the Feedback Principle in Science and Technics

In this study positive and negative influence of the feedback have been examined. A feedback principle in the alternating current amplifier and in the speed regulator of the turbine rotation was described. The main conclusion of the positive and negative effect was obtained. Negative feedback worsens the properties of an object, reducing a strengthening factor, delaying regulatory action. Positive feedback considerably raises device work stability. This research will enable to identify the importance and effectiveness of the feedback principle in science and technics

Identity and Interests: Understanding the Meltdown in Israeli-Turkish Relations 2002-2012

The recent deterioration of the strong bilateral alliance between Israel and Turkey has significant affects on the balance of power within the Middle East. As such, it is important that scholars determine why this meltdown has occurred. This thesis sought to explain the deterioration of relations between Israel and Turkey and overcome gaps in the existing literature concerned with this meltdown of bilateral relations by taking a fresh look into the role of identity and the interests it creates. Hence, the framework of Wendtian constructivism was applied in order to examine the social origins and impacts of identity and interests on alliance formation and deterioration. In this thesis, I suggested that Israel’s identity has changed slowly over the past decade and as such, should be perceived as ‘relatively’ stable. Conversely, however, Turkey’s national identity changed sharply, drifting away from the Ataturk agenda of Westernisation and secularism towards an Islamic heritage. In order to strengthen my argument that this shift in Turkish identity has primarily accounted for the deterioration of its relations with Israel, I analysed Turkish attitudes towards foreign policies other than its bilateral relationship with Israel, as well as its newly defined interests. Thus, whereas Israel’s relatively stable national identity and domestic policies were matched by its relatively stable foreign interests over the past decade, deep changes to Turkey’s national identity redirected its domestic policies under Recep Tayyip Erdoğan’s government. Consequently, Turkey has employed a number of political tensions and events as pretexts in order to unilaterally disengage from its relations with Israel so that it can further new foreign policies and interests. Identity matters, and for better or worse, identity changes precede foreign policy change, a lesson we must not forget

Animation in relational information visualization

In order to be able to navigate in the world without memorizing each detail, the human brain builds a mental map of its environment. The mental map is a distorted and abstracted representation of the real environment. Unimportant areas tend to be collapsed to a single entity while important landmarks are overemphasized. When working with visualizations of data we build a mental map of the data which is closely linked to the particular visualization. If the visualization changes significantly due to changes in the data or the way it is presented we loose the mental map and have to rebuild it from scratch. The purpose of the research underlying this thesis was to investigate and devise methods to create smooth transformations between visualizations of relational data which help users in maintaining or quickly updating their mental map