STRUCTURAL AND FUNCTIONAL CORRELATES OF EXERCISE VENTILATORY INEFFICIENCY IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS WITH MILD-TO-MODERATE SPIROMETRIC ABNORMALITIES

Background: Individuals with chronic obstructive pulmonary disease (COPD) have higher than normal ventilatory equivalents for carbon dioxide (VE/VCO2) during exercise. There is growing evidence that emphysema on thoracic computed tomography (CT) scans is associated with poor exercise capacity in COPD patients with only mild-to-moderate airflow obstruction. We hypothesized that emphysema is an underlying cause of microvascular dysfunction and ventilatory inefficiency, which in turn contributes to reduced exercise capacity. We expected ventilatory inefficiency to be associated with a) the extent of emphysema; b) lower diffusing capacity for carbon monoxide; c) a reduced pulmonary blood flow response to exercise; and d) reduced exercise capacity. Methods: In a cross-sectional study, 19 subjects with mild-to-moderate COPD (mean ± SD FEV1= 82 ± 13% predicted, 12 GOLD grade 1) and 26 age-, sex-, and activity-matched controls underwent a ramp-incremental symptom-limited exercise test on a cycle ergometer. Ventilatory inefficiency was assessed by the minimum VE/VCO2 value (nadir). A subset of subjects also completed repeated constant work rate exercise bouts with non-invasive measurements of pulmonary blood flow. Emphysema was quantified as the percentage of attenuation areas below -950 Housefield Units on CT scans. An electronic scoresheet was used to keep track of emphysema sub-types. Results: COPD subjects typically had centrilobular emphysema (76.8 ± 10.1% of total emphysema) in the upper lobes (upper/lower lobe ratio= 0.82 ± 0.04). They had lower peak oxygen uptake (VO2), higher VE/VCO2 nadir and greater dyspnea scores than controls (p<0.05). Lower peak O2 and worse dyspnea were found in COPD subjects with VE/VCO2 nadirs ≥ 30. COPD subjects had blunted increases in pulmonary blood flow from rest to iso-VO2 exercise (p<0.05). Higher VE/VCO2 nadir in COPD subjects correlated with emphysema severity (r= 0.63), which in turn correlated with reduced lung diffusing capacity (r= -0.72) and blunted changes in pulmonary blood flow from rest to exercise (r= -0.69) (p<0.01). Conclusions: Ventilation “wasted” in emphysematous areas is associated with reduced exercise ventilatory efficiency in mild-to-moderate COPD. Exercise ventilatory inefficiency links structure (emphysema) and function (gas transfer) to a key clinical outcome (reduced exercise capacity) in COPD patients with modest spirometric abnormalities.

Facilitating Inclusion: Austrian Wisdom Councils as Democratic Innovation between Consensus and Diversity

Democratic innovations face the challenge of realizing deliberative democratic ideals in the context of structural inequality. Consensus decision making and expertise have been said to have exclusive effects on marginalized groups like women and ethnic and sexual minorities, which obstructs diversity. Wisdom Councils as practiced in Austria attempt to counter inequalities by including marginalized groups through the moderation technique dynamic facilitation. Exploratory participatory observations and interviews with a moderator and the participants of two Wisdom Councils in Austria provide a deeper understanding of the inclusive processes at work in Wisdom Councils facilitating a productive combination of consensus and diversity.

The State of the Nation Debate as part of the democratic parliamentary ritual: Rajoy and Rubalcaba discourse analysis, 2014

In this article we analyze the Debate on the State of the Nation 2014. The methodology consists in coding the speeches of the prime minister, Mariano Rajoy (PP) and the then opposition leader Alfredo Perez Rubalcaba (PSOE) through extracting word clouds, branched maps and word trees that have shown the most common concepts and premises. This preliminary analysis of two dimensions, quantitative and qualitative, makes it much easier and viable subsequent discourse analysis where we focus on the different types of arguments in the communicative act: claim/solution, circumstantial premises, goal premises, value premises, meansgoal premises, alternative options/addressing alternative options.

Democratic Stability through the Concept of Reasonableness in John Rawls

The paper addresses the question of the stability of a democratic state and shows the shortcomings of the political and institutional structure for this purpose. It argues for the need of an additional factor of reasonableness as defined by John Rawls. We reflect on its articulation with rationality, its role regarding laws and the areas where its presence is crucial to the health and maintenance of a democratic political society. The analysis concludes by justifying the instrumental need of such faculty in the political arena as well as vindicating it as a mandatory civic duty.

The Democratic Dynamics of Government Consultations. Speaking Freely and Listening Properly

There is a growing use of consultation and e-consultation procedures by governments. This chapter seeks to examine the role of consultation as part of a new technology of government. Consultation on policy development can reinvigorate democratic engage- ment but often it can silence views through a sort of participatory disempowerment; it can loosen the democratic anchorage of the public service within the state. The chapter develops a governmentality perspective interrogating what participation, democratic engagement and free speech mean in this context, and how ideas of publicness are constructed, managed and controlled. The focus is on the nature of consultation, its relationship to ideas of free speech and speaking freely, and its potential to empower subaltern counterpublics which can formulate oppositional interpretations and urge alternative conclusions. The aim is to develop an idea of the democratic adequacy of the consultation process and draw out a sense of how democratic engagement here can be structured – for good or ill.

Democratic Citizenship - A Conditioned Apprenticeship : A Call for Destabilisation of Democracy in Education

We live in times when the search for a citizenship education that can transcend national, ethnical and cultural borders is an important part of educational policy. In times of increased pressure by the European Union on its nation states to provide for nation-transcending democracy, this question becomes crucial for national policymaking in Europe. In this text, Swedish education policy will be taken as a case in point in order to shed light on how this question is being handled in this particular national policy setting. It is argued that the policy’s citizen fostering agenda tends to be counterproductive in the sense that it is still situated in national notions of the relationship between democracy and education, which tend to exclude certain individuals and groups of people on an age-related and (ethno) cultural basis. It is further argued that these excluding features can be related to educational ideas about socialisation. The aim of this text is underlined by suggesting a different way of framing democracy and democratic citizenship education: to increase the potential of education as regards the renewal of democracy and democratic citizenship.

Digitally Mediated Political Participation: Understanding the Democratic Impact of Internet Diffusion in the Asian Media Systems

Thesis (Ph.D.)--University of Washington, 2016-08

Rethinking What is Necessary in a Democratic Society: Militant Democracy and the Turkish State

Questions relating to contemporary understandings of democracy continue to preoccupy the academic landscape, from politics to law—how does one define democracy; is it necessary to recalibrate the concept of democracy to meet the exigencies of the current global security "crisis" and, following from this, how does one understand (and control) the democratic relationship of representation and accountability between citizen and state? Although those writing on the recalibration of democratic theory come from different points of departure, they often arrive at a similar conclusion; namely that this global era poses significant challenges to contemporary understandings of democracy. This article identifies and focuses on one challenge posed by the concept of “militant” democracy against the backdrop of the Turkish case.

Disentangling Discrimination: The Impact of Political and Societal Discrimination on Democratic (Dis)Engagement

Thesis (Ph.D.)--University of Washington, 2016-08

Integrity and public sector governance : a democratic deficit?

Towards participatory political theology: democratic consolidation in Southeastern Europe and the role of Eastern Christianity in the process

This thesis defends the position that the Eastern Orthodoxy has the potential to develop, on the basis of its core concepts and doctrines, a new political theology that is participatory, personalist and universalist. This participatory political theology, as I name it, endorses modern democracy and the values of civic engagement. It enhances the process of democracy-building and consolidation in the SEE countries through cultivating the ethos of participation and concern with the common good among and the recognition of the dignity and freedom of the person. This political-theological model is developed while analyzing critically the traditional models of church-state relations (the symphonia model corresponding to the medieval empire and the Christian nation model corresponding to the nation-state) as being instrumentalized to serve the political goals of non-democratic regimes. The participatory political-theological model is seen as corresponding to the conditions of the constitutional democratic state. The research is justified by the fact the Eastern Orthodoxy has been a dominant religiouscultural force in the European South East for centuries, thus playing a significant role in the process of creation of the medieval and modern statehood of the SEE countries. The analysis employs comparative constitutional perspectives on democratic transition and consolidation in the SEE region with the theoretical approaches of political theology and Eastern Orthodox theology. The conceptual basis for the political-theological synthesis is found in the concept and doctrines of the Eastern Orthodoxy (theosis and synergy, ecclesia and Eucharist, conciliarity and catholicity, economy and eschatology) which emphasize the participatory, personalist and communal dimensions of the Orthodox faith and practice. The paradigms of revealing the political-theological potential of these concepts are the Eucharistic ecclesiology and the concept of divine-human communion as defining the body of Orthodox theology. The thesis argues that with its ethos of openness and engagement the participatory political theology presupposes political systems that are democratic, inclusive, and participatory, respecting the rights and the dignity of the person. The political theology developed here calls for a transformation and change of democratic systems towards better realization of their personalist and participatory commitments. In the context of the SEE countries the participatory political theology addresses the challenges posed by alternative authoritarian political theologies practiced in neighboring regions.

Democratic Peace and Electoral Accountability

One of the few stylized facts in international relations is that democracies, unlike autoc- racies, very rarely fight each other. We examine the sustainability of international peace between democracies and autocracies, where the crucial difference between these two po- litical regimes is whether or not policymakers are subject to periodic elections. We show that the fear of losing office can deter democratic leaders from engaging in military con- flicts. Crucially, this discipline effect can only be at work if incumbent leaders can be re-elected, implying that democracies in which the executives are subject to term limits should be more conflict prone. To assess the validity of our predictions, we construct a large dataset on countries with executive term limits. Our analysis of inter-state conflicts for the 1816-2001 period suggests that electoral incentives are indeed behind the democratic peace phenomenon: while democratic dyads are in general less likely to be involved in conflicts than any other dyads, this result does not hold for democracies in which the executive faces binding term limits; moreover, the dispute patterns of democracies with term limits depend on whether the executive is in the last or penultimate mandate.

Prevalence of intestinal parasitic infections among school children in capital areas of the Democratic Republic of São Tomé and Príncipe, West Africa.

Background: Although the Democratic Republic of Sao Tome and Principe (DRSTP) has undertaken school children-based deworming programs against intestinal parasitic infections (IPIs) using a single dose of mebendazole annually since 2005, it remains unclear as to the outcome to date. The present study intends to investigate the recent IPIs status among school children living in capital areas of the DRSTP. Methods: A total of 252 school children (121 boys and 131 girls) of grades 4 and 5 from 4 primary schools located in the capital areas participated in the present study and their fresh fecal specimens were examined for the presence of any parasites using the merthiolate- iodine-formaldehyde concentration method as conducted. Results: The overall prevalence of IPIs was 64.7% (163/ 252). No significant gender difference in prevalence between boys (67.8%) and girls (61.8%) was found (p = 0.3). The majority of school children were infected with a single species of parasite (55.8%). Altogether, 12 different intestinal parasite species were identified in DRSTP school children, of which 9 species were pathogenic and the remaining 3 were non-pathogenic. Conclusion: Improving the detection method, sanitation facilities and personal hygiene as well as utilizing combined drugs are all important measures to greatly reduce IPIs in DRSTP school children.