Role of anti-hypertension class drugs in the pathogenesis of diabetes mellitus complications

The diabetic patient is subject to many complications in the event of poor control of blood glucose or blood pressure. Diabetic nephropathy is the leading cause of kidney dialysis in the developed world. Diabetic retinopathy is one of the leading causes of blindness in the United States. Cardiovascular diseases are the leading cause of morbidity in the United States. There are many different factors that predispose people to developing these conditions. Among these factors in a diabetic patient, hypertension has been shown to be strongly correlated with progression of micro and macrovascular complications. There are several antihypertensive treatment options for lowering blood pressure including angiotensin receptor blockers, angiotensin converting enzyme inhibitors, calcium channel blockers, beta adrenergic receptor blockers, and diuretics among others. By lowering blood pressure in diabetic patients comorbid with hypertension, complications arising from either condition have been shown to be reduced to a greater extent than can be explained with either normal blood pressure or blood glucose levels. However, there is mounting evidence that certain beta-adrenergic receptor blockers cause insulin desensitization, adverse lipid metabolism, and poor carbohydrate metabolism. Furthermore, hypertension is a complex disease process especially when considered from the perspective of the patient with diabetes. There are many possible underlying mechanisms for the hypertension and resulting complications, so it may be important for the prescribing physician to employ a combination of different classes of antihypertensive pharmaceuticals when treating their patients. Although some antihypertensive agents may cause some adverse effects in patients, they are usually very well tolerated, and attempts should be made to incorporate them into a treatment plan for preventing the onset of diabetic complications

A direct method for the evaluation of lower and upper bound ratchet limits

The calculation of the ratchet limit is often vital for the assessment of the design and integrity of components which are subject to cyclic loading. This work describes the addition of a lower bound calculation to the existing Linear Matching Method upper bound ratchet analysis method. This lower bound calculation is based on Melan's theorem, and makes use of the residual and elastic stress fields calculated by the upper bound technique to calculate the lower bound ratchet limit multiplier. By doing this, the method combines the stable convergence of the upper bound method but retains the conservatism offered by the lower bound. These advantages are complemented by the ability of the Linear Matching Method to consider real 3D geometries subject to complex load histories including the effect of temperature dependent yield stress. The convergence properties of this lower bound ratchet limit are investigated through a benchmark problem of a plate with a central hole subject to cyclic thermal and mechanical loads. To demonstrate the effectiveness of the method, the ratchet limit of a thick walled pipe intersection, also subject to cyclic thermal and mechanical loads, is considered. Validation of these results is provided by full elastic-plastic FEA in Abaqus

Corporate social responsibility in the New Zealand hotel industry: An explorative study

This explorative study examines the extent to which New Zealand 4 and 5 star hotel managers have adopted CSR practices and their commitment through CSR participation. Additionally, this study investigated the influence that New Zealand Government CSR sponsored incentives (“Qualmark” and “Enviro Awards”) have on the adoption of social and environmental practices into the hotel industry and the effect this has on hotel employees' CSR participation. Importantly, previous studies have indicated that employee involvement in CSR has been shown to result a more committed and loyal workforce. This study has indicated that through a greater CSR participation, hotel managers can influence attraction and retention of employees, therefore lowering employee turnover. A pragmatic interruptive methodological approach was adopted in designing the research method for this study. By employing a mixed method research approach the findings of this study reveal that Chain hotel is more likely to incorporate a CSR approach in daily operations. However, evidence from this study has indicated that a hotel's involvement in social and environmental activities have no significant affect upon employee decision to seek employment with that hotel. This study also provides evidence that the initial cost of CSR implementation affected the type and range of CSR involvement. Although employee involvement in CSR activities was viewed as important, there was a lack of related rewards and incentives for CSR participation in line with organisational and employee goals and perception offered in this study. Evidence from this study also implies that an employee's social and environmentally responsibility, although beneficial, was not looked upon as essential in employee selection criteria. However, some hotels had incorporated social and environmental questions when selecting employees, indicating a gradual change in adopting a more knowledgeable and socially involved employee. These findings will contribute to evaluating the impacts of a hotel manager's CSR decisions influencing employee turnover and CSR participation

Observations on cardiogenic shock

The circulatory, arterial blood gas tension and metabolic changes following acute myocardial infarction have been studied serially in patients with and without cardiogenic shock. The effects of oxygen administration on these changes has been investigated. Follow-up studies have been undertaken following recovery from shock and at various stages of convalescence in most patients. Cardiogenic shock has been shown to be associated with a severe impairment of left ventricular function with a reduced cardiac output and markedly reduced stroke volume* an elevated central venous pressure and an inadequate compensatory increase in systemic vascular resistance. These circulatory changes were accompanied by a very considerable degree of arterial blood hypoxaemia, as well as a metabolic acidosis, lactic acidaemia and hyperglycaemia. In uncomplicated acute myocardial infarction the circulatory changes were found to be highly variable. The cardiac output and stroke volume varied from normal to very low values. The systemic vascular resistance varied between high and low values, resulting in the maintenance of the blood pressure at moderate to normal levels. Uncomplicated acute myocardial infarction was accompanied by only a mild degree of arterial blood hypoxaemia and a complete lack of metabolic disturbance. The patients without shock showed a normal rise in arterial blood oxygen tension when breathing oxygen. In contrast, those with shock showed a relatively small increase of arterial blood oxygen tension following oxygen therapy. This impaired response has been shown to be due to the shunting of about 25% of the cardiac output through vessels inaccessible to pulmonary gas exchange. These patients are therefore in urgent need of oxygen and this must be given in as high a concentration as possible. The circulatory effects of oxygen therapy in patients with uncomplicated myocardial infarction are similar to those found in normal subjects - that is, a fall in heart rate and cardiac output with a slight increase in systemic vascular resistance and arterial blood pressure. It is possible that the poor and variable response of arterial blood oxygenation in cases of cardiogenic shock accounts for the less marked and equally variable circulatory response to such therapy. Recovery from cardiogenic shock was found to be associated with a reduction in tachycardia and central venous pressure with an increase in blood pressure* stroke volume and cardiac output and only small variable changes in systemic vascular resistance. The arterial hypoxacmia, metaoolic acidosis and lactic acicaemia progressively declined with recovery. Progressive recovery from uncomplicated acute myocardial infarction was associated with a reduction in central venous pressure and an increase in strrke volume. There was a progressive increase in the arterial blood oxygen tension levels towards normal with increasing recovery. The pathophysiological and therapeutic implications of these findings are discussed

Suggestive course of study in English for first year junior high school pupils

Thesis (M.A.)--Boston University, 1931. This item was digitized by the Internet Archive

Suggestive course of study in English for first year junior high school pupils

Thesis (M.A.)--Boston University, 1931. This item was digitized by the Internet Archive

Doctor of Philosophy

dissertationAcculturating to the United States confers risk for cardiovascular disease, possibly through cardiovascular reactivity (CVR) when communicating in a non-native language and interacting with individuals from a different ethnic background. Sixty-four women who immigrated to the United States from Mexico participated in the study. Cardiovascular responses were examined while participants communicated in both English and Spanish with a non-Hispanic White or Mexican American partner. Perceived discrimination, acculturation, task-related emotional responses, and perceptions of the interaction partner were also assessed. Speaking in English evoked greater increases in blood pressure and heart rate than communicating in Spanish and larger increases in negative affect. English - speaking interaction partners were also viewed as less friendly and more dominant. Perceived discrimination and levels of acculturation did not predict CVR. These findings suggest that health effects of acculturation for Mexican Americans may involve the cardiovascular stress responses associated with communicating in a non-native language

Shakedown and limit analysis of 90° pipe bends under internal pressure, cyclic in-plane bending and cyclic thermal loading

The Linear Matching Method is used to create the shakedown limit and limit load interaction curves of 90 degree pipe bends for a range of bend factors. Two load cases are considered i) internal pressure and inplane bending (which includes opening, closing and reversed bending) and ii) internal pressure and a cyclic through wall temperature difference giving rise to thermal stresses. The effects of the ratios of bend radius to pipe mean radius (R/r) and mean radius to wall thickness (r/t) on the limit load and shakedown behaviour are presented