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Endothelial dysfunction: The contribution of diabetes mellitus to the risk factor burden in a high risk population  [PDF]
Muluemebet Ketete, Rabia Cherqaoui, Abid R. Maqbool, John Kwagyan, Shichen Xu, Otelio S. Randall
Journal of Biomedical Science and Engineering (JBiSE) , 2013, DOI: 10.4236/jbise.2013.66075

Background: Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality in Western societies and are rapidly becoming a worldwide health problem. African-Americans have increased morbidity and mortality rates from CVD. Our study aimed to assess the effects of the CVD risk factors burden alone versus with diabetes mellitus in a high riskCVDpopulation. Methods: The two study groups consisted of thirty seven diabetics and thirty seven non-diabetic African-Americans aged ≥55 years without clinical atherosclerosis having similar cardiovascular risk factors (age, hypertension, hypercholesterolemia, smoking, and body mass index) except for diabetes mellitus. Brachial artery flow-mediated dilation (FMD), Nitroglycerin-mediated dilatation (NMD) and carotid intima-media thickness (IMT) were recorded in all subjects. Results: Endothelial function as assessed by the brachial artery FMD was significantly impaired in the diabetic group compared to the non-diabetic group (7.8 ± 5 vs 3.3 ± 4; p = 0.0001). There were no differences in neither Nitroglycerin-mediated dilatation (NMD) nor carotid intima-media thickness (IMT) in the diabetic and non-diabetic groups. Conclusion: The contribution of diabetes to the development of endothelial dysfunction in subjects with clustering of CVD risk factors may be early as indicated by significant functional changes preceeding structural vascular changes..

Effect of Intensive Blood Pressure Control on Cardiovascular Remodeling in Hypertensive Patients with Nephrosclerosis
Otelio Randall,John Kwagyan,Tamrat Retta,Kenneth Jamerson,Velvie Pogue,Keith Norris,Muluemebet Ketete,Shichen Xu,Tom Greene,Xuelei Wang,Lawrence Agodoa
International Journal of Nephrology , 2013, DOI: 10.1155/2013/120167
Abstract: Pulse pressure (PP), a marker of arterial system properties, has been linked to cardiovascular (CV) complications. We examined (a) association between unit changes of PP and (i) composite CV outcomes and (ii) development of left-ventricular hypertrophy (LVH) and (b) effect of mean arterial pressure (MAP) control on rate of change in PP. We studied 1094 nondiabetics with nephrosclerosis in the African American Study of Kidney Disease and Hypertension. Subjects were randomly assigned to usual MAP goal (102–107?mmHg) or a lower MAP goal (≤92?mmHg) and randomized to beta-blocker, angiotensin converting enzyme inhibitor, or calcium channel blocker. After covariate adjustment, a higher PP was associated with increased risk of CV outcome (RR = 1.28, CI = 1.11–1.47, ) and new LVH (RR = 1.26, CI = 1.04–1.54, ). PP increased at a greater rate in the usual than in lower MAP groups (slope ± SE: 1.08 ± 0.15 versus 0.42 ± 0.15 mmHg/year, ), but not by the antihypertensive treatment assignment. Observations indicate that control to a lower MAP slows the progression of PP, a correlate of cardiovascular remodeling and complications, and may be beneficial to CV health. 1. Introduction Population and hospital-based studies [1, 2] have demonstrated that persistently elevated blood pressure (BP) levels increase the risk of cardiovascular (CV) events and subsequent CV mortality. Though the precise mechanisms of this association are still being investigated, several studies have detected a direct link between increased BP variability and target-organ damage [3–7]. The major target organs for the complications of elevated BP are the kidneys, heart, brain, and the arterial system. Study of the character of vascular alterations and the time course of such alterations is important to better understand the mechanism of hypertensive process. Retta and Randall [8] have suggested that target-organ damage is the result of an integrated effect of BP level as a function of time, whether it is continuously elevated or intermittent increases of pressure. Arterial stiffness is linked with changes in BP profile, characterized by isolated increase in systolic pressure and/or increase in pulse pressure (PP). Increased PP can result from an increase in systolic pressure and/or a decrease in diastolic pressure, which is typical for advanced arteriosclerosis and is responsible for the diastolic pressure stabilization or decline observed in aging [9]. Investigations in hypertension have generally focused on the steady components of blood pressure, such as mean arterial pressure (MAP), which is
Validation of Heart Failure Events in the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) Participants Assigned to Doxazosin and Chlorthalidone
Linda B Piller, Barry R Davis, Jeffrey A Cutler, William C Cushman, Jackson T Wright, Jeff D Williamson, Frans HH Leenen, Paula T Einhorn, Otelio S Randall, John S Golden, L Julian Haywood, the ALLHAT Collaborative Research Group
Trials , 2002, DOI: 10.1186/1468-6708-3-10
Abstract: Baseline characteristics (age, race, sex, blood pressure) did not differ significantly between treatment groups (P < .05) for participants with heart failure events. Post-event pharmacologic management was similar in both groups and generally conformed to accepted heart failure therapy. Central review of a small sample of cases showed high adherence to ALLHAT heart failure criteria. Of 105 participants with quantitative ejection fraction measurements provided, (67% by echocardiogram, 31% by catheterization), 29/46 (63%) from the chlorthalidone group and 41/59 (70%) from the doxazosin group were at or below 40%. Two-year heart failure case-fatalities (22% and 19% in the doxazosin and chlorthalidone groups, respectively) were as expected and did not differ significantly (RR 0.96; 95% CI, 0.67–1.38; P = 0.83).Results of the validation process supported findings of increased heart failure in the ALLHAT doxazosin treatment arm compared to the chlorthalidone treatment arm.The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) is a randomized, two-component clinical trial sponsored by the National Heart, Lung, and Blood Institute (NHLBI). A double-blind, active-controlled hypertension component is designed to compare the rate of fatal coronary heart disease (CHD) or nonfatal myocardial infarction (MI) (the primary endpoint) in high-risk hypertensive participants, aged 55 years or older, between those randomized to treatment initiated with a diuretic (chlorthalidone) and treatment initiated with each of three alternative antihypertensive drugs: a calcium-channel blocker (amlodipine), an angiotensin-converting enzyme (ACE)-inhibitor (lisinopril), or an alpha-adrenergic blocker (doxazosin). An open-label lipid-lowering component is designed to determine if lowering LDL cholesterol with pravastatin compared to "usual care" reduces all-cause mortality in a subset of moderately hypercholesterolemic patients. Randomization to the hypertension com
Nietzsche’s Best Life: The Ten Greatest Attributes of the Ubermensch, & a Comparison to Aristotle’s Virtuous Person  [PDF]
Randall Firestone
Open Journal of Philosophy (OJPP) , 2017, DOI: 10.4236/ojpp.2017.73020
Abstract: The paper first outlines the 10 primary attributes of the Ubermensch, Nie-tzsche’s ideal person, with numerous quotations. Those attributes are self-determination, creativity, becoming, overcoming, discontent, flexibility, self-mastery, self-confidence, cheerfulness, and courage. The paper then compares Nietzsche’s Ubermensch with Aristotle’s virtuous person. Nietzsche describes more of an attitude towards life and a process of living which are similar to a means as compared to Aristotle’s objective character traits which are goals or ends in themselves. The paper concludes that Nietzsche does a better job of describing the best human life—one that is dynamic, passionate, and unique; consisting of self-growth and creativity; and filled with new experiences, insights, and adventures.
The Epistemological Double Standard Inherent in Christian Metaphysical Beliefs  [PDF]
Randall S. Firestone
Open Journal of Philosophy (OJPP) , 2014, DOI: 10.4236/ojpp.2014.43033
Abstract: This paper uses comparative religion to critique Christian claims of possessing exclusively true metaphysical beliefs. In so doing, this paper takes a different approach than most other challenges to Christian metaphysical beliefs. Instead of directly responding to Christian arguments supporting their views, this paper challenges the Christian by pointing out that their grounds for rejecting the metaphysics of other religions will necessarily undermine the grounds of their own beliefs. Specifically, the paper takes the metaphysical beliefs of Hinduism, which has a metaphysics that appears both significantly different from and contrary to Christian dogma, and demonstrates that the same types of epistemological arguments that a Christian would almost certainly have to use against a Hindu can just as fruitfully be used to demonstrate the weaknesses, inconsistencies, and lack of evidential foundation that are prevalent in Christian metaphysical beliefs.
Naturalistic vs Supernatural Explanations: “Charting” a Course away from a Belief in God by Utilizing Inference to the Best Explanation  [PDF]
Randall S. Firestone
Open Journal of Philosophy (OJPP) , 2014, DOI: 10.4236/ojpp.2014.43034
Abstract: The article critiques the seven major arguments supporting a belief in God. The arguments are presented as Inferences to the Best Explanation with the use of charts. The charts graphically demonstrate that naturalistic explanations are being ignored by the theist, who favors inherently unverifiable supernatural explanations over naturalistic ones. The paper also discusses why metaphysical beliefs should not be trusted, and how such beliefs differ from scientific beliefs. The paper concludes that the arguments for the existence of God fail because the naturalistic explanations are the best explanations and should be accepted over the supernatural explanation of God. To the extent that the charting of all seven arguments is new, it should be a helpful explanatory tool, especially for students.
Why the Bible Cannot and Should Not Be Taken Literally  [PDF]
Randall S. Firestone
Open Journal of Philosophy (OJPP) , 2014, DOI: 10.4236/ojpp.2014.43035

This paper argues that there are at least five reasons why the claim that the Bible is to be taken literally defies logic or otherwise makes no sense, and why literalists are in no position to claim that they have the only correct view of biblical teachings. First, many words are imprecise and therefore require interpretation, especially to fill in gaps between general words and their application to specific situations. Second, if you are reading an English version of the Bible you are already dealing with the interpretations of the translator since the earliest Bibles were written in other languages. Third, biblical rules have exceptions, and those exceptions are often not explicitly set forth. Fourth, many of the Bible’s stories defy logic and our experiences of the world. Fifth, there are sometimes two contrary versions of the same event, so if we take one literally then we cannot take the second one literally. In each of these five cases, there is no literal reading to be found. Furthermore, this paper sets forth three additional reasons why such a literalist claim probably should not be made even if it did not defy logic to make such a claim. These include The Scientific Argument: the Bible contradicts modern science; The Historical Argument: the Bible is historically inaccurate; and The Moral Argument: the Bible violates contemporary moral standards.

Aliens, Humans, Animals, & Luck: Animal Treatment & Human Morality  [PDF]
Randall S. Firestone
Open Journal of Philosophy (OJPP) , 2016, DOI: 10.4236/ojpp.2016.63026
Abstract: This paper proposes two thought experiments to demonstrate that our current treatment of animals is immoral. The first thought experiment involves aliens coming to earth and doing to us what we do to animals—eating us, confining us in farms and zoos, doing experiments on us, etc. Drawing on the latest scientific research on the abilities of animals, this thought experiment seeks to show that there are more relevant similarities between human beings and animals than most people realize, and that the differences between us and many other animals are not morally relevant. Moreover, this thought experiment attempts to appeal primarily to our sense of justice by tapping into our emotions for ourselves rather than to the usual approach which appeals to our emotions for animals. The second thought experiment is similar to the first, but more centrally emphasizes the idea of luck. It will, in part, take an approach recommended by Donald VanDeVeer to employ Rawl’s veil of ignorance to mask not only our natural and social starting places, but also our species—whether we are human or of another species. However, one serious objection made to VanDeVeer’s approach will be circumvented, namely, that it is difficult to imagine ourselves as an animal. Rather, we will imagine that evolution has made it so we are not the smartest and most powerful species on earth. This thought experiment invites us to ask ourselves that if there were only two species to consider and we were the less advanced of the two, would we still not expect to be treated with dignity and respect? Both analogies ultimately challenge us to ask the following question: What principles of justice would we choose to govern the interactions between species if we were not the most intelligent and powerful species on earth?
An Argument for Libertarian Free Will: Hard Choices Based on either Incomparable or Equally Persuasive Reasons  [PDF]
Randall S. Firestone
Open Journal of Philosophy (OJPP) , 2017, DOI: 10.4236/ojpp.2017.71005
This articles proposes that the best explanation for hard choices, which are choices made when there are either incomparable options or equally appealing options, is the presence of libertarian free will; and that the two main alternatives, determinism and random choice, do not provide us with very compelling explanations. In the case of determinism, this is because the reasons supporting each option do not dictate or necessitate that we choose that option, and therefore any decision is necessarily underdetermined by the reasons for each option. Random choice fares no better since any choice made when the options are incomparable or equally appealing is supported by reasons and therefore is not random at all. As such, we should believe in free will. The article further reviews some of the current neuroscientific studies and explains how they do not show the absence of free will. The paper further argues that science likely could never prove that we do not have free will since showing that any decision is reflected or caused by our brain neurons firing does not show that the ultimate decision was not arrived at after a free will consideration of the issues. Lastly, the article suggests that the best way to view free will is as an attribute and ability that is always present, and as such there is no such thing as partial free will. Accordingly, we are fully responsible for the decisions we make and the actions we take. However, external and internal influences, especially those that lurk in our subconscious and of which we are not consciously aware, do mitigate our blameworthiness and praiseworthiness for those decisions.
The Character Development Defense to the Argument from Evil Is Logically Inconsistent  [PDF]
Randall S. Firestone
Open Journal of Philosophy (OJPP) , 2018, DOI: 10.4236/ojpp.2018.85031
Abstract: The Argument from Evil is usually considered the strongest argument against the belief in the Judeo-Christian conception of a perfect God. It states that a perfectly good, omniscient, and omnipotent God would not allow the degree of evil which exists in the world. This paper describes why the theist’s strongest response to this argument, widely known as the Soul-Making Theodicy and which this paper calls the Character Development Defense, rests on a logical contradiction. The argument proffered here reformulates an earlier argument made by B.C. Johnson which has been largely ignored in the philosophical literature. Specifically, the Character Development Defense asks humans to develop their character and thereby to take moral actions which benefit others, including mankind as a whole, but at the same time states that we need all the suffering in the world in order to give us ample opportunities for character development. If we follow the logic of this defense to its conclusion, then we should both help others to improve the world, but also not help them because that takes away the opportunities people need to develop their characters. This paper also reviews the literature in this area so it can be seen how the current argument takes a quite different approach. Lastly, the paper addresses five possible objections, and then replies to each objection.
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