ObjectiveCo-morbid insomnia and sleep apnea is a common and debilitating condition that is more difficult to treat compared to insomnia or sleep apnea-alone. Emerging evidence suggests that cognitive behavioral therapy for insomnia is effective in patients with COMISA, however, those with more severe sleep apnea and evidence of greater objective sleep disturbance may be less responsive to CBTi. Polysomnographic sleep study data has been used to predict treatment response to CBTi in patients with insomnia-alone, but not in patients with COMISA. (...) We used randomized controlled trial data to investigate polysomnographic predictors of insomnia improvement following CBTi, versus control in participants with COMISA.MethodsOne hundred and forty five participants with insomnia and sleep apnea [apnea-hypopnea index ≥ 15] were randomized to CBTi or no-treatment control. Mixed models were used to investigate the effect of pre-treatment AHI, sleep duration, and other traditional, and novel [quantitative electroencephalography ] polysomnographic predictors of between-group changes in Insomnia Severity Index scores from pre-treatment to post-treatment.ResultsCompared to control, CBTi was associated with greater ISI improvement among participants with; higher AHI, less wake after sleep onset, and less N3 sleep. No quantitative electroencephalographic, or other traditional polysomnographic variables predicted between-group ISI change.DiscussionAmong participants with COMISA, higher OSA severity predicted a greater treatment-response to CBTi, versus control. People with COMISA should be treated with CBTi, which is effective even in the presence of severe OSA and objective sleep disturbance. (shrink)

This volume gives an overview on the currently debated ethical issues regarding advance directives from an international perspective. It focuses on a wider understanding of the known and widely accepted concept of patient self-determination for future situations. Although advance directives have been widely discussed since the 1980s, the ethical bases of advance directives still remain a matter of heated debates. The book aims to contribute to these controversial debates by integrating fundamental ethical issues on advance directives with practical matters of (...) their implementation. Cultural, national and professional differences in how advance directives are understood by health care professions and by patients, as well as in laws and regulations, are pinpointed. (shrink)

The work of the French literary review, intellectual grouping and publishing team Tel Quel had a profound impact on the formation of literary and cultural debate in the 1960s and 70s. Its legacy has had enormous influence on the parameters of such debate today. From its beginning in 1960 to its closure in 1982, it published some of the earliest work of Jacques Derrida, Julia Kristeva, Michel Foucault and Roland Barthes. It was also associated with some of the key ideas (...) of the French avant-garde, publishing key articles by Georges Bataille and Antonin Artaud. The Tel Quel Reader presents for the first time in English the key essays written by the Tel Quel group. Essays by Julia Kristeva, one of the review's editor's Michel Foucault, and a fascinating interview with Roland Barthes are here made available for the first time in English. It provides a unique insight into the post-structuralist movement and presents some of the pioneering essays on literature and culture, film, semiotics and psychoanalysis. Assembling key essays from over a twenty-year period, The Tel Quel Reader is an indispensible resource for students of literature, cultural and visual studies, philosophy and French studies. (shrink)

Originally published in 1957. This book is concerned with the conflict between "Darwinism" as the Victorians called it, and Christianity, a conflict here re-stated in modern terms because it so vitally affects our understanding of human nature and human values today. The opening chapter describes the historical background. There is a short account of evolution and the argument over Genesis. The importance of natural selection is stressed, and rival theories as to the means of animal evolution are criticised. Discussions follow (...) on whether the course of evolution has been random or determined, on the argument from design, death in nature, the biologist’s methods and the difficulties in evolutionary ethics. (shrink)

Lack begins with a discussion of Max Weber's analysis of the disenchantment of the world and proceeds to develop Heidegger's philosophy in a way that suggests a "re-enchantment" of the world that faces the modern condition squarely, without nostalgia.