The rationale and design of the antihypertensives and vascular, endothelial, and cognitive function (AVEC) trial in elderly hypertensives with early cognitive impairment: Role of the renin angiotensin system inhibition

<p>Abstract</p> <p>Background</p> <p>Prior evidence suggests that the renin angiotensin system and antihypertensives that inhibit this system play a role in cognitive, central vascular, and endothelial function. Our objective is to conduct a double-blind randomized controlled clinical trial, the antihypertensives and vascular, endothelial, and cognitive function (AVEC), to compare 1 year treatment of 3 antihypertensives (lisinopril, candesartan, or hydrochlorothiazide) in their effect on memory and executive function, cerebral blood flow, and central endothelial function of seniors with hypertension and early objective evidence of executive or memory impairments.</p> <p>Methods/Design</p> <p>The overall experimental design of the AVEC trial is a 3-arm double blind randomized controlled clinical trial. A total of 100 community eligible individuals (60 years or older) with hypertension and early cognitive impairment are being recruited from the greater Boston area and randomized to lisinopril, candesartan, or hydrochlorothiazide ("active control") for 12 months. The goal of the intervention is to achieve blood pressure control defined as SBP < 140 mm Hg and DBP < 90 mm Hg. Additional antihypertensives are added to achieve this goal if needed. Eligible participants are those with hypertension, defined as a blood pressure 140/90 mm Hg or greater, early cognitive impairment without dementia defined (10 or less out of 15 on the executive clock draw test or 1 standard deviation below the mean on the immediate memory subtest of the repeatable battery for the assessment of neuropsychological status and Mini-Mental-Status-exam >20 and without clinical diagnosis of dementia or Alzheimer's disease). Individuals who are currently receiving antihypertensives are eligible to participate if the participants and the primary care providers are willing to taper their antihypertensives. Participants undergo cognitive assessment, measurements of cerebral blood flow using Transcranial Doppler, and central endothelial function by measuring changes in cerebral blood flow in response to changes in end tidal carbon dioxide at baseline (off antihypertensives), 6, and 12 months. Our outcomes are change in cognitive function score (executive and memory), cerebral blood flow, and carbon dioxide cerebral vasoreactivity.</p> <p>Discussion</p> <p>The AVEC trial is the first study to explore impact of antihypertensives in those who are showing early evidence of cognitive difficulties that did not reach the threshold of dementia. Success of this trial will offer new therapeutic application of antihypertensives that inhibit the renin angiotensin system and new insights in the role of this system in aging.</p> <p>Trial Registration</p> <p>Clinicaltrials.gov NCT00605072</p

Biomaterials for Building Skins

Bio-based materials are considered a promising resource for buildings in the twenty-first century due to their sustainability and versatility. They can be produced locally, with minimum transportation costs and in an ecological manner. This chapter describes the potential of biomaterials for use in façades. It presents several examples of natural resources, including innovative alternative materials that are suitable for implementation as a building skin. Novel products resulting from material modifications and functionalization are presented, including a brief discussion on their environmental impacts. Alternative strategies for optimal biomaterials' recycling, reuse, and other end-of-life strategies are presented and supported with case study examples

Learning from history: Changes and path dependency in the social housing sector in Austria, France and the Netherlands (1889-2008), Chapter 3

European social housing history can be interpreted through the combination of two complementary notions: path dependency and change. Socio-political experiences and practices at the national, regional or municipal level are potentially powerful determinants of historical developments—an idea known as path dependency. However, they do not stop unexpected and sometimes rapid change. Change is produced by the combination of inherited experiences and mutations in specific demographic, political, social and economic circumstances. Different institutional contexts in different countries, and the varying interplay of actors in each, means that the history of social housing reflects a complex patchwork of disparate legislative, financial and architectural realities rather than a linear evolution. Our paper will therefore not offer a chronology of social housing but a descriptive and analytical view of the main historical sequences in which the fundamental ideas of social housing were implemented and the most significant configurations of actors and institutions that emerged. The article’s general thesis is backed up by a specific examination of three countries where the social housing sector has traditionally been large, and where it still accounts for a significant percentage of the whole housing supply: Austria, France, and the Netherlands. All three countries share a strong tradition of municipal power in their biggest cities, where social housing makes up a huge percentage of the total housing stock. The development of social housing is deeply rooted in the political history of each country and its development of the modern welfare state. The comparative approach thus offers an opportunity to observe the different administrative and geographical layers of social housing policies, and the changing structure of social propriety produced by the actors’ interplay.OTB Research Institut