Breathing In Man Research Articles

Prevalence and Predictors of Sleep-Disordered Breathing in Men Participating in the Multicenter AIDS Cohort Study

Data on the prevalence of sleep-disordered breathing (SDB) in people with HIV are limited. Moreover, whether the associations between SDB and age or BMI differ by HIV status is unknown. Is SDB more prevalent in men with HIV than those without HIV, and do the predictors of SDB differ between the two groups? Home polysomnography was used in the Multicenter AIDS Cohort Study to assess SDB prevalence in men with (n= 466; 92%virologically suppressed) and without (n= 370) HIV. SDB was defined using the oxygen desaturation index (ODI) and the apnea-hypopnea index (AHI), using four definitions:≥ 5 events/h based on an ODI with a 3%(ODI3) or 4%(ODI4) oxygen desaturation, or an AHI with a 3%oxygen desaturation or EEG arousal (AHI3a) or with a 4%oxygen desaturation (AHI4). SDB prevalence was similar in men with and without HIV using the ODI3 and AHI3a definitions. However, SDB prevalence was higher in men with than without HIV using the ODI4 (55.9%vs47.8%; P= .04) and the AHI4 definitions (57.9%vs50.4%; P= .06). Mild and moderate SDB were more common in men with than without HIV. Associations between SDB prevalence and age, race, and BMI were similar in men with and without HIV. Among men with HIV, viral load, CD4 cell count, and use of antiretroviral medications were not associated with SDB prevalence. SDB prevalence was high overall but greater in men with than without HIV using the ODI4 threshold definition. Efforts to diagnose SDB are warranted in people with HIV, given that SDB is associated with daytime sleepiness and impaired quality of life.

Characteristics of external breathing in young men of the indigenous ethnic group of Yakutia with different body types

Characteristics of external breathing in young men of the indigenous ethnic group of Yakutia with different body types

417 Transgender Hormone Therapy and Sleep-Disordered Breathing

Abstract Introduction Sex hormones may affect human respiration during wakefulness and sleep. Testosterone has been associated with increased obstructive respiratory events contributing to sleep-disordered breathing (SDB) in men, whereas a protective effect against SDB has been attributed to estrogen in women. These associations, primarily observed in cisgender populations, have been rarely examined in transgender individuals on hormone replacement therapy (HRT). The present study investigated associations between HRT and SDB in transgender adults. Methods A chart review of medical records from transgender patients was conducted in a large academic sleep medicine center. Individuals were included if they were at least 18 years old, had one or more sleep complaints, and SDB testing results available. Participants were then stratified by affirmed gender (transmasculine and transfeminine) and by HRT status. We used descriptive statistics procedures to examine differences between gender and HRT groups. Associations between HRT and the apnea-hypopnea index (AHI) were estimated with age-adjusted linear regression models. Results Of the 194 individuals identified, 89 satisfied the inclusion criteria. Nearly half of participants were transmasculine (52%). The mean age was 38±13 years, and mean body mass index was 34.7±9.0 Kg/m2. Approximately 60% of participants were on HRT at the time of SDB evaluation. Transmasculine people who were prescribed testosterone had a significantly increased AHI and lower oxygen nadir in comparison to transmasculine individuals not on testosterone (AHI 36.8±37.8/hour vs.15.3±16.6/hour, p=0.01; oxygen nadir 83.4±8.3% vs. 89.1±2.4%, p=0.001). In contrast, differences between transfeminine people with and without feminizing HRT (androgen blocker + estrogen) were not statistically significant (AHI 21.4±27.7/hour vs. 27.7±26.0/hour, p=0.45; oxygen nadir 86.5±6.7% vs. 84.1±7.7%, p=0.29). Linear regression models adjusted for age found an association between HRT and AHI for transmasculine (β=16.7, 95% CI 2.7, 30.8), but not for transfeminine participants (β=-2.5, 95% CI -17.9, 12.9). Conclusion These findings suggest differential associations between HRT and AHI among transgender individuals, with transmasculine on testosterone having a significant increase in AHI. Prospective studies with large sample sizes are warranted to evaluate these associations. Support (if any) Dr. Gavidia’s work was supported by an NIH/NINDS T32-NS007222 grant

Minimizing airflow turbulence in women lowers the work of breathing to levels similar to men.

Smaller airways increase resistance and the propensity toward turbulent airflow, both of which are thought to be mechanisms behind greater resistive and total work of breathing (Wb) in females. Previous research examining the effect of airway size on the Wb between the sexes is limited by the inability to experimentally manipulate airway size. Heliox (21% oxygen, balance helium) is less dense than room air, which reduces turbulent airflow and airway resistance. The purpose of our study was to utilize heliox inspiration in women to provide a stimulus physiologically similar to increasing airway size. We hypothesized that when breathing heliox women would have a Wb similar to men breathing room air. Eighteen healthy young subjects (n = 9 women, 9 men) completed two maximal exercise tests on a cycle ergometer over 2 days. Subjects breathed room air for one test and heliox for the other. Wb was assessed with an esophageal balloon catheter. During the room air trial, when ventilations were >65 L/min, women had a significantly greater Wb compared with men (P < 0.05). The greater Wb in women was due to greater resistance to turbulent flow. For both sexes, breathing heliox resulted in increased expiratory flow (+132 ± 18% of room air), an elimination of expiratory flow limitation, and a reduction in Wb (69 ± 12% of room air) (all P < 0.05). When the women were breathing heliox, Wb was not different from that in the men breathing room air. Our findings support the idea that the smaller conducting airways in females are responsible for a greater total and resistive Wb.NEW & NOTEWORTHY When healthy young women breathe heliox gas during exercise, their work of breathing is not different from men breathing room air. Heliox inspiration reduces airway resistance and promotes laminar flow, which is a physiologically similar effect of increasing airway size. Our findings provide experimental evidence that smaller airways in women are responsible for the greater work of breathing during exercise.

Quantifying the mechanical work of breathing in men and women during rowing.

To quantify the mechanical work of breathing (Wb) during an indoor rowing test in men and women. Additionally, to compare sex-based differences in the Wb and its components through a rowing test. Fifteen collegiate rowers were recruited (8 women/7 men) and performed a 2000m rowing test on a rowing ergometer. Esophageal pressure was measured during exercise via balloon catheterization, after which pressure-volume curves were used to calculate total, inspiratory resistive and elastic, and total expiratory Wb. Men had significantly higher values of instantaneous and cumulative total Wb at and beyond 37.5% (430.4 ± 42.5 vs. 282.1 ± 45.1Jmin-1, P < 0.05) and 62.5% (1946.8 ± 150.9 vs. 1360.1 ± 197.2J, P < 0.05) total exercise time, respectively. However, when compared at the same minute ventilation, women had higher values of total (at and above ~ 140 Lmin-1), inspiratory resistive (at and above ~ 120 Lmin-1), and inspiratory elastic (at and above ~ 135 Lmin-1) Wb, whereas men presented higher total expiratory Wb compared to women at any ventilation. Although female rowers present higher relative values of inspiratory resistive and elastic Wb, their male counterparts develop greater ventilatory efforts during a 2000m rowing test, resulting in a larger total mechanical Wb. We interpret these findings to mean that the Wb reflects both anatomical (i.e., airways and lung sizes) and respiratory (i.e., minute ventilation) sex differences during rowing.

WAKE-up stroke is associated with sleep-disordered breathing in men

WAKE-up stroke is associated with sleep-disordered breathing in men

Correlation of the Epworth Sleepiness Scale and Sleep-Disordered Breathing in Men and Women.

To compare Epworth Sleepiness Scale (ESS) scores of men and women and determine if there is a correlation with sleep-disordered breathing (SDB) based on subsequent polysomnography (PSG). Consecutive adult patients were identified who completed ESS and PSG at Mayo Clinic in Rochester, Minnesota, between January 1, 2013, and January 31, 2015. Apnea-hypopnea index (AHI) ≥ 5 events/h was classified as presence of SDB, and increasing values represented greater severity. Among 6,593 patients with valid ESS scores and timely subsequent PSG, 42% were women. Mean (standard deviation [SD]) age of women was 56.2 (15.2) years; men, 58.5 (15.1) years. Mean (SD) ESS score was 9.5 (5.4) for women and 9.5 (5.3) for men. SDB was present in 83.6% of men and 68.3% of women. Mean (SD) AHI of men was 25.9 (26.7) events/h; women, 16.1 (22.4) events/h (P < .001). Each unit increase in ESS score of men was associated with a 0.51-unit increase in AHI (P < .001); women had a 0.16-unit associated increase (P = .04) (effect ratio, threefold greater for men). PSG demonstrated that women had greater sleep efficiency, less respiratory effort-related arousals, and less hypoxemia (all P < .001). Among women, ESS did not correlate with presence of SDB or mild to moderate SDB. There was a small association in women with severe SDB. ESS is not correlated with SDB at mild to moderate levels in women and has a smaller association than in men with severe SDB. Further work is necessary to understand sex-specific differences in patients with SDB.

Enhanced cerebral perfusion during brief exposures to cyclic intermittent hypoxemia.

Cerebral vasodilation and increased cerebral oxygen extraction help maintain cerebral oxygen uptake in the face of hypoxemia. This study examined cerebrovascular responses to intermittent hypoxemia in eight healthy men breathing 10% O2 for 5 cycles, each 6 min, interspersed with 4 min of room air breathing. Hypoxia exposures raised heart rate ( P < 0.01) without altering arterial pressure, and increased ventilation ( P < 0.01) by expanding tidal volume. Arterial oxygen saturation ([Formula: see text]) and cerebral tissue oxygenation ([Formula: see text]) fell ( P < 0.01) less appreciably in the first bout (from 97.0 ± 0.3% and 72.8 ± 1.6% to 75.5 ± 0.9% and 54.5 ± 0.9%, respectively) than the fifth bout (from 94.9 ± 0.4% and 70.8 ± 1.0% to 66.7 ± 2.3% and 49.2 ± 1.5%, respectively). Flow velocity in the middle cerebral artery ( VMCA) and cerebrovascular conductance increased in a sigmoid fashion with decreases in [Formula: see text] and [Formula: see text]. These stimulus-response curves shifted leftward and upward from the first to the fifth hypoxia bouts; thus, the centering points fell from 79.2 ± 1.4 to 74.6 ± 1.1% ( P = 0.01) and from 59.8 ± 1.0 to 56.6 ± 0.3% ( P = 0.002), and the minimum VMCA increased from 54.0 ± 0.5 to 57.2 ± 0.5 cm/s ( P = 0.0001) and from 53.9 ± 0.5 to 57.1 ± 0.3 cm/s ( P = 0.0001) for the [Formula: see text]- VMCA and [Formula: see text]- VMCA curves, respectively. Cerebral oxygen extraction increased from prehypoxia 0.22 ± 0.01 to 0.25 ± 0.02 in minute 6 of the first hypoxia bout, and remained elevated between 0.25 ± 0.01 and 0.27 ± 0.01 throughout the fifth hypoxia bout. These results demonstrate that cerebral vasodilation combined with enhanced cerebral oxygen extraction fully compensated for decreased oxygen content during acute, cyclic hypoxemia. NEW & NOTEWORTHY Five bouts of 6-min intermittent hypoxia (IH) exposures to 10% O2 progressively reduce arterial oxygen saturation ([Formula: see text]) to 67% without causing discomfort or distress. Cerebrovascular responses to hypoxemia are dynamically reset over the course of a single IH session, such that threshold and saturation for cerebral vasodilations occurred at lower [Formula: see text] and cerebral tissue oxygenation ([Formula: see text]) during the fifth vs. first hypoxia bouts. Cerebral oxygen extraction is augmented during acute hypoxemia, which compensates for decreased arterial O2 content.

Bubble and macroaggregate methods differ in detection of blood flow through intrapulmonary arteriovenous anastomoses in upright and supine hypoxia in humans

Blood flow through intrapulmonary arteriovenous anastomoses (Q̇IPAVA) increases in healthy humans breathing hypoxic gas and is potentially dependent on body position. Previous work in subjects breathing room air has shown an effect of body position when Q̇IPAVA is detected with transthoracic saline contrast echocardiography (TTSCE). However, the potential effect of body position on Q̇IPAVA has not been investigated when subjects are breathing hypoxic gas or with a technique capable of quantifying Q̇IPAVA. Thus the purpose of this study was to quantify the effect of body position on Q̇IPAVA when breathing normoxic and hypoxic gas at rest. We studied Q̇IPAVA with TTSCE and quantified Q̇IPAVA with filtered technetium-99m-labeled macroaggregates of albumin (99mTc-MAA) in seven healthy men breathing normoxic and hypoxic (12% O2) gas at rest while supine and upright. On the basis of previous work using TTSCE, we hypothesized that the quantified Q̇IPAVA would be greatest with hypoxia in the supine position. We found that Q̇IPAVA quantified with 99mTc-MAA significantly increased while subjects breathed hypoxic gas in both supine and upright body positions (ΔQ̇IPAVA = 0.7 ± 0.4 vs. 2.5 ± 1.1% of cardiac output, respectively). Q̇IPAVA detected with TTSCE increased from normoxia in supine hypoxia but not in upright hypoxia (median hypoxia bubble score of 2 vs. 0, respectively). Surprisingly, Q̇IPAVA magnitude was greatest in upright hypoxia, when Q̇IPAVA was undetectable with TTSCE. These findings suggest that the relationship between TTSCE and 99mTc-MAA is more complex than previously appreciated, perhaps because of the different physical properties of bubbles and MAA in solution. NEW & NOTEWORTHY Using saline contrast bubbles and radiolabeled macroaggregrates (MAA), we detected and quantified, respectively, hypoxia-induced blood flow through intrapulmonary arteriovenous anastomoses (Q̇IPAVA) in supine and upright body positions in healthy men. Upright hypoxia resulted in the largest magnitude of Q̇IPAVA quantified with MAA but the lowest Q̇IPAVA detected with saline contrast bubbles. These surprising results suggest that the differences in physical properties between saline contrast bubbles and MAA in blood may affect their behavior in vivo.

Gabapentin acutely increases the apnea-hypopnea index in older men: data from a randomized, double-blind, placebo-controlled study.

Although drugs with sedative properties may increase the risk of airway collapse during sleep, their acute effects on the apnea-hypopnea index in older adults are under-reported. We investigated the acute effects of gabapentin (GABA) on sleep breathing in older men without sleep apnea. A double-blind, randomized, placebo-controlled cross-over pilot study using a bedtime dose of gabapentin 300mg was conducted in eight non-obese older men. Polysomnography measured the effects of the intervention. The apnea-hypopnea index was higher in the gabapentin arm than in the placebo arm (22.4±6.1 versus 12.2±4.3, P≤0.05, d: 0.67), as was the oxygen desaturation index (20.6±5.8 versus 10.8±3.9, P≤0.05, d: 0.68). The number needed to harm was four. A subset analysis demonstrated that differences in sleep respiratory parameters were present only during non-rapid eye movement sleep, as well as only in the supine position. No adverse events were reported. Hence, gabapentin worsened sleep breathing acutely compared with placebo. Long-term clinical trials are warranted to elucidate the clinical relevance of these findings for the safety profile of GABAergic agents.

Effects of posture on chest-wall configuration and motion during tidal breathing in normal men.

[Purpose] The purpose of this study was to clarify the impact of postural changes during tidal breathing on the configuration and motion of chest-wall in order to further breathing motion evaluation. [Subjects and Methods] Chest-wall configuration and motion in the supine, right lateral, and sitting positions were measured using optoelectronic plethysmography in 15 healthy adult men. [Results] The anteroposterior diameters of the chest wall were significantly lower in the supine position for the pulmonary and abdominal rib cages, whereas the mediolateral diameters in the lateral position were lowest for the abdominal rib cage. Regarding chest-wall motion, both craniocaudal and anteroposterior motions of the anterior surface of the pulmonary and abdominal rib cages were significantly greater in the sitting position. Regarding motion of the left lateral abdominal rib cage, lateral motion was greatest in the lateral position. [Conclusion] Chest-wall configuration and motion changed according to posture in healthy men, particularly in the pulmonary and abdominal rib cages.

Inter-Observer Agreement in Measuring Respiratory Rate.

BackgroundRespiratory rate (RR) is an important vital sign which is strongly correlated with in-hospital mortality. At the same time, RR is the most likely vital sign to be omitted when assessing a patient. We believe that one reason for this could be the difficulty in measure the RR, since it is not read off a monitor, but counted manually. Also there is the possibility of assessment bias and the inter-observer reliability becomes important. We therefore set out to investigate how the nursing staff counting the actual number of respirations per minute would agree with the nursing staff using a predefined ordinal scale.MethodsFor this prospective study, we recorded five videos of a young healthy man breathing approximately 5, 10, 15, 30 and 60 times per minute. The videos were shown in a random order to a suitable sample of the nursing staff. The participants were randomized into two groups; one to count the exact number of breaths per minute, and one to use a predefined ordinal scale.ResultsComparing the exact number of breaths per minute, the Intra Class Coefficient (ICC) was 0.99 (95% CI: 0.97–1.00). Comparing the RR using the predefined scale, the overall Kappa Fleiss Coefficient was 0.75.ConclusionsThe inter-observer agreement was high when comparing the use of the actual number of breaths per minute and substantial when comparing the use of the predefined scale. This is the largest inter-observer study on RR to date. However, further studies on the use of scaled comparisons of RR are needed.

Activation of Retrotrapezoid Nucleus (RTN) Maintains Normal Breathing in Hyperoxia Despite the Loss of Carotid Body (CB) Input

Rationale and objectives: the CBs contribute greatly to resting ventilation in conscious mammals. For example, their excision produces large and long‐lasting breathing reductions. Yet sustained hyperoxia, which silences the CBs, produces minimal breathing reductions in conscious rats and mildly activates breathing in man. RTN is a major cluster of central respiratory chemoreceptors (CRCs). Here we tested whether, under hyperoxia, breathing might be maintained by a compensatory increase in RTN activity.Methods: RTN and nearby C1 neurons were bilaterally transduced with archaerhodopsin (PRSx8‐ArchT‐EYFP‐LVV). We first showed that RTN neurons were instantly silenced by green light in anesthetized rats. We then measured the effect of RTN inhibition (10s) on breathing (fR, VT) and BP in conscious rats exposed to normoxia (21% FiO2) or hyperoxia (65% FiO2). Arterial blood gases (PO2, PCO2), pHa and HCO3 were measured under both conditions.Results: hyperoxia produced a very mild respiratory acidosis. RTN inhibition elicited a much larger fR and VT reduction in rats exposed to hyperoxia than to normoxia. BP was unaffected under hypoxia or hyperoxia suggesting that the C1 neurons were minimally impacted by the light.Interpretation: in conscious rats hyperoxia activates RTN, which maintains ventilation at control level (normoxia) despite the presumed loss of CB activity. RTN activation by hyperoxia probably results from several mechanisms including mild respiratory acidosis, Haldane effect and CNS vasoconstriction, the latter causing reduced CO2 wash‐out and brain parenchymal acidification. Funding: HL074011 (PGG), 5T32HL007284‐38 (TMB).

Composing Breathtails (A Song Cycle in 21 Breaths)

#1: unleashed in the composer candy store My good fortune: a commission from Mutable Music for baritone Thomas Buckner, with some unusually open conditions: no restrictions on duration, instrumentation, or delivery time. There's more: an invitation to engage in a collaboration with a living poet. #2: breath--at the center I immediately envisioned a piece with a central role for the shakuhachi (Japanese bamboo flute), (1) simply because I adore the instrument and its earthy and ethereal colors. Sonic images of breath-driven sonorities emanating from the shakuhachi, combined with the human voice and its infinite variety of sounds, grew to include strings--the most vocal of Western instruments. My desire to explore the notion of in this composition led to a collaboration with poet Charles Bernstein, culminating in a series of fierce, witty poems. Essentially a secular treatment of ruminations on the breath, the poems embody references, often quirky, to yoga, Buddhism, and meditation. #3: why Breathtails (as opposed to Breathtales)? Charles Bernstein suggested this title. It immediately struck me as perfect for the piece. By his own admission, Charles is obsessively drawn to the wrong version of a homophone. In response to my query about the tail/ tale business, he clarifies: sense of tales of is there, irrevocably. For our work, it's a call to attentiveness, slight shifts of spelling creating other meanings. But also trails of that one leaves if you could make the breath, say of the singer, visually manifest itself like smoke rings from a cigarette. For some reason I also think of dragon tails in ancient Chinese paintings . . . or angel tails. (personal communication, July 9, 2013) For me, the title conjures yet another image, of wispy echoes of sound left in the wake of the shakuhachi music. #4: 21 poems I was fixated on a total of 21 poems due to my attraction, for numerological purposes, to the number 3. I wanted a compound number that could reduce to 3 when the digits were added. The number 12 seemed to be too small, and 30 too large--hence, 21, manifested in different ways throughout the piece. Indeed, the basis of Song 11 is that poem's 21-line structure. #5: counting breaths How many physical breaths were required to complete Breathtails? An investigation, using low-tech and esoteric math, led to some surprising results. Consideration: My first email inquiry to Charles Bernstein: Oct. 19, 2007 (2:32 PM) Final delivery of the musical score to Tom Buckner: Aug. 11, 2011 (2:06 AM) The 1392.5 days between those two events resulted in the inhaling and exhaling of approximately 36,093,600 breaths--a number sporting some intriguing properties. (2) How did I arrive at this figure, 36,093,600? 25.920 = approximate number of human breaths in a 24-hour period (each breath consisting of one inhale/exhale); 1392.5 = number of days between my first email to Charles Bernstein and the date of score delivery; 25.920 x 1392.5 = 36,093,600 breaths! #6: gift of time Why did it take all these millions of breaths, spanning nearly four years, to compose Breathtails? Inter-ruptures: illness prior creative commitments teaching Underscored by: no deadline #7: January 20, 2013 Today the sun-drenched wind whistles and whirls, a serendipitous quasi-sostenuto. Gliding to-and-fro on a swing my husband built overlooking the grand sweep of Green Valley, California, immersed in the rush of earth's in all her infinite nuance, I'm inspired to recollect the construction of Breathtails in reverse gear. #8: nourishment from the cosmos Which brings me to Rudolf Steiner. (3) What he wrote about breath: Man's breathing is a living expression of the course of the sun. …

Oxygen cost of exercise hyperpnoea is greater in women compared with men.

The oxygen cost of breathing represents a significant fraction of total oxygen uptake during intense exercise. At a given ventilation, women have a greater work of breathing compared with men, and because work is linearly related to oxygen uptake we hypothesized that their oxygen cost of breathing would also be greater. For a given ventilation, women had a greater absolute oxygen cost of breathing, and this represented a greater fraction of total oxygen uptake. Regardless of sex, those who developed expiratory flow limitation had a greater oxygen cost of breathing at maximal exercise. The greater oxygen cost of breathing in women indicates that a greater fraction of total oxygen uptake (and possibly cardiac output) is directed to the respiratory muscles, which may influence blood flow distribution during exercise. We compared the oxygen cost of breathing (V̇O2 RM ) in healthy men and women over a wide range of exercise ventilations (V̇E). Eighteen subjects (nine women) completed 4days of testing. First, a step-wise maximal cycle exercise test was completed for the assessment of spontaneous breathing patterns. Next, subjects were familiarized with the voluntary hyperpnoea protocol used to estimate V̇O2 RM . During the final two visits, subjects mimicked multiple times (four to six) the breathing patterns associated with five or six different exercise stages. Each trial lasted 5min, and on-line pressure-volume and flow-volume loops were superimposed on target loops obtained during exercise to replicate the work of breathing accurately. At ∼55 lmin(-1) V̇E, V̇O2 RM was significantly greater in women. At maximal ventilation, the absolute V̇O2 RM was not different (P>0.05) between the sexes, but represented a significantly greater fraction of whole-body V̇O2 in women (13.8±1.5vs. 9.4±1.1% V̇O2). During heavy exercise at 92 and 100% V̇O2max, the unit cost of V̇E was +0.7 and +1.1mlO2 l(-1) greater in women (P<0.05). At V̇O2max, men and women who developed expiratory flow limitation had a significantly greater V̇O2 RM than those who did not (435±44vs. 331±30mlO2 min(-1) ). In conclusion, women have a greater V̇O2 RM for a given V̇E, and this represents a greater fraction of whole-body V̇O2. The greater V̇O2 RM in women may have implications for the integrated physiological response to exercise.

Call and Response: Derek Walcott’s Collaboration with Homer in His THE ODYSSEY: A STAGE VERSION

Call and Response:Derek Walcott’s Collaboration with Homer in His THE ODYSSEY: A STAGE VERSION Rachel D. Friedman Towards the end of Omeros, Walcott’s poetic persona, after admitting to Omeros that he has never read his poems “all the way through,” proclaims to him that he was the “freshest” of all of his readers (1990.283): I have always heardyour voice in that sea, master, it was the same songof the desert shaman, and when I was a boy your name was as wide as a bay, as I walked alongthe curled brow of the surf; the word “Homer” meant joy,joy in battle, in work, in death, then the numbered peace of the surf’s benedictions, it rose in the cedars,in the laurier-cannelles, pages of rustling trees.Master, I was the freshest of all your readers. For me, coming to Walcott as a classicist who had spent years reading and studying the Homeric poems, the freshness of his readings was stunning and invigorating and has helped me to discover a Homer that I did not previously have access to.1 [End Page 59] Walcott has often insisted on the simultaneity of great art and of the damaging limitations imposed by readings based on chronology. He encourages us, instead, to listen to the conversations that emerge between him and the poets he has read. At a symposium at Duke University, for example, held in 1995, he spoke in a room filled with collages by Romare Bearden, the great African-American artist who grew up in the midst of the Harlem Renaissance. Walcott used the occasion to reflect on Bearden’s response to Homer in his Odyssey collages and analogized Bearden’s creative process to his own (1997.240–41): And yet I think it is this whole freshness of experience that made me feel that my references to Homer, and to all the other writers I was indebted to in the book, were perfectly valid. And I knew it would lead to a kind of academic acclaim that I’m not very happy about—“Oh, so much is owed to so-and-so”—I hate that. It is a patronizing way of saying about, for instance, Romare’s work: “Look at those black cutouts. They are like Greek vases.” Yes, they may be like Greek vases, but they are simultaneous concepts, not chronological concepts. The black cutout of a diving figure is no more historical than the silhouette of a Greek athlete on a vase. It’s not a question of where you stop, since you then have to go from the Greek silhouette back to the Egyptian profile, et cetera. If you think of art merely in terms of chronology, you are going to be patronizing to certain cultures. But if you think of art as a simultaneity that is inevitable in terms of certain people, then Joyce is a contemporary of Homer (which Joyce knew). Walcott’s appeal to the work of Bearden to explore the nature of the relationship between two artists across the ages can provide us with a fruitful starting point for considering the nature of Walcott’s own collaboration with Homer in his 1993 The Odyssey: A Stage Version (henceforth SVO), the focus of my attention here. [End Page 60] In the catalogue of a recent exhibit of the Bearden Odyssey collages at the DC Moore Gallery in New York, Robert G. O’Meally, a scholar of jazz, effectively compares this process of collaboration between Bearden and Homer to the kind of improvisation that happens between two jazz musicians playing together (2007.22–23): But Bearden was also an improviser in the “Harlem” sense that that title implies collaboration. For like Charlie Parker, working so closely with Dizzy Gillespie that on records you can feel the two men breathing together as they create their exciting musical lines, Bearden in this series of collages gets close enough to The Odyssey of Homer that the two artists play together like section-mates in a jazz band. Just as Homer the writer/singer/(and perhaps dancer) of poetic lines depended on his audiences to complete the creative process (jazz people...

Oxygen cost of exercise hyperpnea is greater in women compared to men (882.3)

We tested the hypothesis that the O2 cost of exercise hyperpnea is greater in women compared to men. Healthy subjects (8M, 7F) first performed a maximal step cycle exercise test with esophageal and gastric balloon instrumentation followed by a hyperpnea familiarization trial on a separate day. Cardiorespiratory parameters were measured and flow‐ and pressure‐volume loops were constructed from the same breaths (~n=10) for each exercise stage. Days 3 and 4 involved exercise hyperpnea mimicking over 5 ventilatory levels while in the cycling position. Mimicking trials were repeated (n=4) for each ventilatory level. End‐tidal CO2 was controlled to a level corresponding to each exercise stage. Respiratory muscle O2 uptake (VO2rm) was linearly related to work of breathing (WOB) in men (r=0.94, P&lt;0.001) and women (r=0.88, P&lt;0.001). The VO2rm to VE relationship was assessed by fitting a regression accounting for viscous and resistive work. There was no difference in viscous work (P=0.45); however, the resistive component was ~13x greater in women (P&lt;0.05). At maximal ventilation the absolute VO2rm was similar between sexes (0.39 vs. 0.42 l min‐1, P=0.52) despite men having a greater VE (108 vs. 169 l min‐1); but the VO2rm represented a greater fraction of whole‐body VO2 in women (14.6 vs. 9.8%, P&lt;0.05). In conclusion, the O2 cost of exercise hyperpnea is greater in women owing to a greater resistive WOB.Grant Funding Source: Natural Sciences and Engineering Research Council of Canada

Sleep Apnea and Cardiometabolic Risk in South Asians

Sleep Apnea and Cardiometabolic Risk in South Asians

Naturalia : the history of natural history and medicine in the seventeenth century

In 1712 the poet Elkanah Settle (1648–1724) published a funeral poem, Threnodia Apollinaris , dedicated to the memory of Dr Martin Lister.[1][1] Settle had a good deal of material to draw upon, because Lister had been Vice-President of the Royal Society, a physician to Queen Anne, and the first

Effects of testosterone therapy on sleep and breathing in obese men with severe obstructive sleep apnoea: a randomized placebo‐controlled trial

High doses of short-term testosterone have been shown to acutely worsen sleep-disordered breathing in men with obstructive sleep apnoea (OSA). The effects of lower, near-conventional doses of testosterone in obese men with OSA may differ over the longer term but have not been systematically studied. We assessed sleep and breathing effects of near-conventional testosterone treatment as an adjunct to weight loss in obese men with severe OSA. An 18-week randomized, double-blind, placebo-controlled, parallel group trial in 67 men. All subjects were placed on a hypocaloric diet and then received intramuscular injections of 1000 mg testosterone undecanoate or placebo at 0, 6 and 12 weeks. Sleep and breathing were measured by nocturnal polysomnography at 0, 7 and 18 weeks. Testosterone, compared to placebo, worsened the oxygen desaturation index (ODI) by 10·3 events/h (95%CI, 0·8-19·8 events/h; P = 0·03) and nocturnal hypoxaemia (sleep time with oxygen saturation <90%, SpO(2) T90%) by 6·1% (95%CI, 1·5-10·6; P = 0·01) at 7 weeks. Testosterone therapy did not alter ODI (4·5, -5·4 to 14·4 events/h; P = 0·36) or SpO(2) T90% at 18 weeks (2·9, -1·9-7·7%; P = 0·23) compared to placebo. The testosterone treatment effects on ODI and SpO(2) T90% were not influenced by baseline testosterone concentrations (testosterone by treatment interactions, all P > 0·35). Blood testosterone concentrations did not correlate with ODI or SpO(2) T90% (all P > 0·19). Testosterone therapy in obese men with severe OSA mildly worsens sleep-disordered breathing in a time-limited manner, irrespective of initial testosterone concentrations. This time-dependency was not related to testosterone concentrations. www.anzctr.org.au Identifier: ACTRN1260-6000404527.