Sustained Pressure Research Articles

Resin-Cement Blend Enhances Wellbore Integrity

_ This article, written by JPT Technology Editor Chris Carpenter, contains highlights of paper SPE 213763, “Use of Innovative Resin-Cement Blend To Enhance Wellbore Integrity,” by Wajid Ali, Faisal A. Al-Turki, and Athman Abbas, SPE, TAQA Well Services, et al. The paper has not been peer reviewed. _ A major challenge occasionally faced during a well’s life cycle is the buildup of sustained casing pressure (SCP). Compromised cement-sheath integrity is one of the primary reasons for such a pressure buildup. Meeting this challenge requires development of an isolation material that can enhance the mechanical properties of cement. This paper presents the laboratory testing and application of a resin-cement system in a scenario where potential high-pressure influx was expected across a water-bearing formation. The resin-cement system was designed to be placed as a tail slurry to provide enhanced mechanical properties compared with a conventional slurry. Introduction The objectives of this study were to investigate the use of new systems at different densities with epoxy resin as an additive and to demonstrate value added in terms of improved mechanical properties and bonding. The resin used in this study is diglycidylether of bisphenol-F, a linear epoxy resin formed by reacting bisphenol-F with a suitable amount of epichlorohydrin and hydroxide. Amines are used as curing agents for epoxy resins. The curing mechanism is a step-growth polymerization. The curing is observed initially by an increase in viscosity and then by hardening. The final product’sproperties, in terms of compressive strength and viscosity, also are affected by the type and concentration of the amine. Aliphatic amines produce more-flexible types of epoxy resins compared with aromatic amine curing agents. Aromatic amines will produce a stronger, harder epoxy resin. Experimental Study Cement Slurry Preparation and Testing. The cement slurry was formulated and mixed with a maximum speed of 12,000 rev/min for 15 seconds and then at 4,000 rev/min for 35 seconds. To condition the cement slurry, an atmospheric consistometer was used. A viscometer was used to measure rheological properties. Thickening time tests also were conducted. Fluid-loss measurements (dynamic and static) were performed on the prepared cement slurry. Dynamic fluid loss can affect rheology and thickening time of cement slurries. Static fluid loss can result in reduction in cement slurry and allow formation fluids to enter the cement slurry. Separation of water is observed when a cement slurry is allowed to stand for a period before it sets. To determine the extent of water separation, a free water test was performed to determine the extent of water separation. The test was conducted by allowing cement slurry to stand in a 250-mL graduated cylinder for 2 hours. The cement slurry was poured into a cylindrical cell and lowered into a curing chamber. While maintaining pressures and temperatures, the cement slurry was cured up to 30 days. At the end of the curing period, the pressure and temperature were reduced to ambient conditions and the test specimens were removed from the curing chamber to be tested for mechanical properties.

Heat transport process associated with the 2021 eruption of Aso volcano revealed by thermal and gas monitoring

The thermal activity of a magmatic–hydrothermal system commonly changes at various stages of volcanic activity. Few studies have provided an entire picture of the thermal activity of such a system over an eruptive cycle, which is essential for understanding the subsurface heat transport process that culminates in an eruption. This study quantitatively evaluated a sequence of thermal activity associated with two phreatic eruptions in 2021 at Aso volcano. We estimated plume-laden heat discharge rates and corresponding H2O flux during 2020–2022 by using two simple methods. We then validated the estimated H2O flux by comparison with volcanic gas monitoring results. Our results showed that the heat discharge rate varied substantially throughout the eruptive cycle. During the pre-eruptive quiescent period (June 2020–May 2021), anomalously large heat discharge (300–800 MW) were observed that were likely due to enhanced magma convection degassing. During the run-up period (June–October 2021), there was no evident change in heat discharge (300–500 MW), but this was accompanied by simultaneous pressurization and heating of an underlying hydrothermal system. These signals imply progress of partial sealing of the hydrothermal system. In the co-eruptive period, the subsequent heat supply from a magmatic region resulted in additional pressurization, which led to the first eruption (October 14, 2021). The heat discharge rates peaked (2000–4000 MW) the day before the second eruption (October 19, 2021), which was accompanied by sustained pressurization of the magma chamber that eventually resulted in a more explosive eruption. In the post-eruptive period, enhanced heat discharge (~ 1000 MW) continued for four months, and finally returned to the background level of the quiescent period (< 300 MW) in early March 2022. Despite using simple models, we quantitatively tracked transient thermal activity and revealed the underlying heat transport processes throughout the Aso 2021 eruptive activity.Graphical abstract

Healthcare System Sustainability Challenges in Nepal and Opportunities Offered by Alternative Healthcare Delivery Arrangements.

The burden of chronic diseases in Nepal is increasing due to demographic and epidemiological transitions; alongside the persistent impact of communicable, maternal, newborn, and child health diseases, this critical situation acts as the precursor to rising healthcare costs. Nepal struggles to sustain its healthcare system amidst political instability, pandemics, natural disasters, and slow economic growth, particularly when healthcare funding is mainly dependent on out-of-pocket payments. Nepal requires lower-cost alternative healthcare delivery arrangements to provide high-value care while relieving economic sustainability pressures. Alternative healthcare delivery arrangements have a broad potential scope; they can involve strategic changes in how care is delivered and by whom, or they can also involve the application of information and communication technologies, e.g., telemedicine. This paper highlights the specific challenges to healthcare system sustainability in Nepal and the potential for high-value, lower-cost alternative healthcare delivery models to improve system performance in the longer term.

A Multi-Faceted Digital Health Solution for Monitoring and Managing Diabetic Foot Ulcer Risk: A Case Series.

Diabetic foot ulcers (DFU) are a devastating complication of diabetes. There are numerous challenges with preventing diabetic foot complications and barriers to achieving the care processes suggested in established foot care guidelines. Multi-faceted digital health solutions, which combine multimodal sensing, patient-facing biofeedback, and remote patient monitoring (RPM), show promise in improving our ability to understand, prevent, and manage DFUs. Patients with a history of diabetic plantar foot ulcers were enrolled in a prospective cohort study and equipped with custom sensory insoles to track plantar pressure, plantar temperature, step count, and adherence data. Sensory insole data enabled patient-facing biofeedback to cue active plantar offloading in response to sustained high plantar pressures, and RPM assessments in response to data trends of concern in plantar pressure, plantar temperature, or sensory insole adherence. Three non-consecutive case participants that ultimately presented with pre-ulcerative lesions (a callus and/or erythematous area on the plantar surface of the foot) during the study were selected for this case series. Across three illustrative patients, continuous plantar pressure monitoring demonstrated promise for empowering both the patient and provider with information for data-driven management of pressure offloading treatments. Multi-faceted digital health solutions can naturally enable and reinforce the integrative foot care guidelines. Multi-modal sensing across multiple physiologic domains supports the monitoring of foot health at various stages along the DFU pathogenesis pathway. Furthermore, digital health solutions equipped with remote patient monitoring unlock new opportunities for personalizing treatments, providing periodic self-care reinforcement, and encouraging patient engagement-key tools for improving patient adherence to their diabetic foot care plan.

Application of Multi-Criteria Decision-Making (MCDM) to Select the Most Sustainable Power-Generating Technology

In response to the growing importance of sustainability and regulatory pressures, companies are increasingly engaging in sustainable projects to mitigate environmental and social harm. Therefore, it is crucial to incorporate sustainability considerations during selecting construction projects in the feasibility phase. This study aims to identify a comprehensive set of sustainability criteria and sub-criteria to help the owners of power-generating plants to select the most sustainable technology for their new projects. Sixteen criteria are identified and categorized under the pillars of sustainability: economic, social, and environmental, plus the technical category. To illustrate practical application, a case study demonstrates the use of these essential sustainability criteria through a hybrid multi-criteria decision-making (MCDM) model for power-generating technology ranking. The results suggest that when stakeholders’ perspectives are weighted approximately equally, considering all sustainability pillars, natural gas with carbon capture is favored for sustainability. A three-scenario sensitivity analysis was performed involving expert opinions from one of the largest power-generating companies in Canada. This integrated generic model can be utilized by industry experts to apply multi-dimensional rational decision-making techniques to solve the complex problem of selecting the most sustainable alternative in construction projects.

Driver-response relationships in a large shallow lake since the Anthropocene: Short-term abrupt perturbations versus long-term sustainable.

Lakes, as integral social-ecological systems, are hotspots for exploring climatic and anthropogenic impacts, with crucial pathways revealed by continuous sediment records. However, the response of multi-proxies in large shallow lakes to typical abrupt events and sustained drivers since the Anthropocene remains unclear. Here, we explored the driver-identification relationships between multi-proxy peaks and natural and anthropogenic events as well as the attribution of short-term perturbations and long-term pressures. To this end, sediment core records, socio-ecological data, and documented events from official records were integrated into a large shallow lake (Dongting Lake, China). Significant causal cascades and path effects (goodness-of-fit: 0.488; total effect: -1.10; p < .001) were observed among catchment environmental proxies, lake biogenic proxies, and mixed-source proxies. The peak-event identification rate (PEIR) and event-peak driving rate were proposed, and values of 28.57%-46.43% and 50%-81.25% were obtained, respectively. The incomplete accuracy of depicting event perturbations using sediment proxies was caused by various information filters both inside and outside the lake. PEIRs for compound events were 1.41 (±0.72) and 1.09 (±0.46) times greater than those for anthropogenic-dominated and natural-dominated events, respectively. Furthermore, socio-economic activity, hydrologic dynamics, land-use changes, and agriculture exerted significant and persistent pressures, cumulatively contributing 55.3%-80.9% to alterations in sediment proxies. Relatively synergistic or antagonistic trends in temporal contributions of these forces were observed after 2000, which were primarily attributed to the "Grain for Green" project and the Three Gorges Dam. This study represents one of the few investigations to distinguish the driver-response relationship of multiple proxies in large shallow lakes under typical event perturbations and long-term sustained pressures since the Anthropocene. The findings will help policymakers and managers address ecological perturbations triggered by climate change and human activities over long-term periods.

Evaluation of the inter-arm blood pressure difference in subjects with hypertension in Nnewi North Local Government Area, Anambra state

Hypertension is defined as a sustained elevated blood pressure with a systolic blood pressure (SBP) of 140mmHg or more and a diastolic blood pressure of 90mmHg or more. The evaluation of the inter-arm blood pressure difference in subjects with hypertension in Nnewi North Local Government Area, Anambra state was done via sampling techniques. The study population was obtained using convenience sampling method and comprised of male and female hypertensive patients aged 25 to 90 years, from the cardiology unit NAUTH Nnewi. Normotensive subjects of the same age range and gender were used as control. The sample size was determined to be 70 subjects using this formula: n= (z2pq)/d2). The result of the finding showed that there was a significant increase in the mean age when the control was compared to the hypertensive group, and no significant difference in their weight, height and BMI. Furthermore, the findings of this research also supported a significant increase in the left arterial systolic and diastolic blood pressure in the control compared to the hypertensive groups. Also, the mean right systolic and diastolic blood pressure showed a significant increase when the control was compared to the hypertensive group. The inter-arm systolic and diastolic blood pressure had no significant difference when control was compared to the hypertensive group.

A Study on Effect of Punica Granatum Rind Extract on Bed Linen for Preventing Bed Sore

The study was conducted to develop the herbal finish bed linen for bedsore cure. Bedsore, also known as pressure ulcers or pressure sores, are injuries to the skin and underlying tissue resulting from prolonged pressure on the skin. They typically develop in areas where bones are close to the skin surface, such as the heels, ankles, hips, and tailbone, due to sustained pressure from lying in one position for too long. The risk factors for bedsores include immobility, poor nutrition, moisture, and friction. If left untreated, bedsores can lead to serious complications, including infections that can extend into deeper tissues. Therefore, to prevent the risking factors of the bedsore this study is done. In this study, the bed linen is made with the blending of cotton and bamboo fibre to create a sustainable and eco-friendly environment. The bed linen is made from bamboo in the weft and cotton in the warp treated with Punica Granatum rind (pomegranate peel) extract solution. The solution is extracted by saxholet extraction method. The pomegranate peel powder is used for its antibacterial and anti-inflammatory properties. This herbal finish will promote the wound healing process of the bedsore at the early stage.

How Can Small and Medium-Sized Manufacturing Enterprises Improve Green Innovation Performance through Innovation Ecosystems?

Under the fierce business competition and sustainable development pressure, the pattern of enterprise innovation has gradually changed from independent innovation to cooperative innovation. As a collection of multi-type innovation actors, the innovation ecosystem provides opportunities and platforms for cooperative innovation among government–industry–university–research institutions. While the present studies on innovation ecosystems are mostly from the perspective of the system level, few studies pay attention to the innovation mechanism of small and medium-sized manufacturing enterprises (SMMEs) in the innovation ecosystem. Therefore, this study takes SMMEs embedded in innovation ecosystems as research objects and explores the factors affecting green innovation. We constructed a theoretical model to explain the effect of innovation eco-embeddedness on green innovation performance based on ecosystem theory and network embeddedness theory; we then collected 363 samples of SMMEs in China through surveys and further tested the data empirically. The results show that the innovation eco-embeddedness (IEE) of SMMEs has a positive effect on their green innovation performance (GIP), and their green value co-creation practices (GVCCPs) partially mediate the relationship between IEE and GIP. Moreover, ecological norms (ENs) in the innovation ecosystem not only positively moderate the impact of IEE on GVCCPs but also positively moderate the mediating role of GVCCPs. This study enriches the relevant research on innovation ecosystems from the perspective of non-core enterprises and provides a theoretical basis and practical reference for SMMEs to implement green innovation practices and realize growth through innovation ecosystems.

A creep/recovery model of dry fiber fabric during compaction considering temperature and in‐plane tension

AbstractIn the manufacturing of fiber‐reinforced composite materials, the preforming stage of dry fiber fabric entails compaction operations carried out under constant pressure, a specific preforming temperature, and in‐plane tension. Throughout this process, permanent deformation and creep/recovery behavior are observed in the fabric, correlating with factors such as time, sustained pressure, temperature, and in‐plane tension. Effective control of fiber volume fraction and material composition necessitates a thorough comprehension of these phenomena as well as the capacity to predict them with accuracy. To solve this, a viscoelastic‐plastic model was put forth, which provides an account of the viscous effects on the fabric during its stages of compression and recovery. The proposed model incorporates changed Burgers units to manage time‐dependent deformations and plastic units to address permanent deformations. Through the application of a single set of parameters, the model precisely and comprehensively characterizes through‐thickness creep/recovery behavior of preformed dry fiber fabrics under varying conditions, including creep stress, temperature, and in‐plane tension. To enhance the practical utility of the model, an application has been developed and validated against experimental data conducted under diverse test conditions. The results demonstrate consistency between experimental curves and model‐predicted curves across various compression scenarios.Highlights A viscoelastic‐plastic model was proposed with a single parameter set. Stress, temperature, and in‐plane tension all exacerbated creep/recovery. Model captures temp. and time‐related creep/recovery with in‐plane tension. The model has been transformed into a practical application tool.

Hierarchically structured porous natural dielectric layer for sustainable pressure sensing, gesture monitoring, and detecting spatial pressure distribution

Flexible pressure sensors are essential in intelligent skins, healthcare monitoring systems, and soft robotics to bridge mechanical movements and electrical signals. Conventional pressure sensors, however, have a variety of challenges, including a complex fabrication method, increased cost, and biocompatibility issues. This work presents a novel bio-friendly, hierarchically structured porous natural dielectric material based capacitive pressure sensor featuring a maximum sensitivity of 0.0572 kPa−1. The proposed pressure sensor uses a biofilm with a typically arranged honeycomb structure as a dielectric layer sandwiched between the Aluminum (Al) electrodes and incorporates polydimethylsiloxane (PDMS) encapsulation. With a 1.44 cm2 sensing area, the device exhibits a response time (Tres) of 250 ms and a recovery time (Trec) of 156 ms, functioning within a capacitive pressure sensing range of 0–110 kPa. This device monitors various human activities and stimuli and accurately detects pressure distribution and gesture recognition.

The short-term effect of Blood Pressure Reduction after Biofeedback in Malignant Hypertension: A case report

Objectives: The purpose of this study was to report the short-term blood pressure-lowering effects observed in a patient with malignant hypertension through slow breathing maneuver with heart rate variability(HRV) biofeedback.Methods: Biofeedback sessions, totaling 13, each lasting 10 minutes, were administered. Blood pressure was measured pre and post-treatment, as well as thrice daily at 10 am, 4 pm, and 8 pm. Systolic blood pressure(SBP), diastolic blood pressure(DBP), and pulse rate were recorded for comparative analysis.Results: Before biofeedback, the average SBP, DBP, and pulse rate were 227.2±18.3, 135.2±11.0, and 104.4±5.3, respectively. Immediately post-biofeedback, these values changed to 213.7±15.2, 126.9±8.5, and 99.2±3.6. However, sustained long-term blood pressure reduction was not observed.Conclusions: The findings suggest that biofeedback therapy induces a short-term reduction in blood pressure in cases of malignant hypertension, potentially associated with autonomic nervous system regulation. Integrating biofeedback with other Korean medicine treatments, such as acupuncture or moxibustion, may offer a comprehensive approach for managing malignant hypertension.

Making Tourism Sustainable? Environment and Resort Tourism in Negril, Jamaica, 1970s–2002

Based on newspaper accounts, official documents and reports by international donors, this article sets out the growing awareness about the environmental impact of resort tourism in Jamaica and action proposed and undertaken to put tourism on a more sustainable path, from the 1970s till the adoption of a Masterplan for Sustainable Tourism Development in 2002. Through a case study of the resort town of Negril, it will argue that the Master Plan was the culmination of action and lobbying by industry stakeholders and environmental groups, a global and regional shift towards sustainable tourism and pressure from international donors. It will also make the case that, throughout the period, the Jamaican government struggled to balance the economic and environmental sustainability of tourism because of the centrality of tourism to the national economy and its limited fiscal space.

Long-Term Protective Effects and Mechanisms of Gastric Bypass Surgery on the Kidneys in Hypertensive Obese Rat.

Investigate the long-term protective effects of gastric bypass surgery on the kidneys of hypertensive obese rats to better understand the role of gastric bypass surgery in preventing renal injury in humans with hypertension and obesity. Compare 6-week-old spontaneously hypertensive rats, including 30 Roux-en-Y gastric bypass (RYGB) and 30 sham operations. Body weight and blood pressure were monitored before and up to 12 months after the operation. Blood lipids, blood creatinine, and blood urea nitrogen were measured. Kidney pathology was assessed using HE staining, while renal fibrosis was observed via Masson staining. Inflammatory indicators were examined by ELISA. The expression of the NLRP3 gene in the kidney was measured using immunofluorescence and western blot, and the changes in key pathways including ASC/IL-1β protein were verified. RYGB reduced the body weight of hypertensive obese rats and had a protective effect on blood pressure. Additionally, the bypass effectively mitigated renal inflammation and fibrosis. Moreover, RYGB modulated the expression of NLRP3 and prevented kidney damage via the ASC/IL-1 pathway. This study validates that RYGB effectively attains sustained blood pressure control in hypertensive obese rats and has a potential kidney-protective mechanism via the NLRP3-ASC/IL-1β pathway.

Enhancing blood pressure management protocol implementation in patients with acute intracerebral haemorrhage through a nursing-led approach: A retrospective cohort study.

To evaluate the impact of nurse care changes in implementing a blood pressure management protocol on achieving rapid, intensive and sustained blood pressure reduction in acute intracerebral haemorrhage patients. Retrospective cohort study of prospectively collected data over 6 years. Intracerebral haemorrhage patients within 6 h and systolic blood pressure ≥ 150 mmHg followed a rapid (starting treatment at computed tomography suite with a target achievement goal of ≤60 min), intensive (target systolic blood pressure < 140 mmHg) and sustained (maintaining target stability for 24 h) blood pressure management plan. We differentiated six periods: P1, stroke nurse at computed tomography suite (baseline period); P2, antihypertensive titration by stroke nurse; P3, retraining by neurologists; P4, integration of a stroke advanced practice nurse; P5, after COVID-19 impact; and P6, retraining by stroke advanced practice nurse. Outcomes included first-hour target achievement (primary outcome), tomography-to-treatment and treatment-to-target times, first-hour maximum dose of antihypertensive treatment and 6-h and 24-h systolic blood pressure variability. Compared to P1, antihypertensive titration by stroke nurses (P2) reduced treatment-to-target time and increased the rate of first-hour target achievement, retraining of stroke nurses by neurologists (P3) maintained a higher rate of first-hour target achievement and the integration of a stroke advanced practice nurse (P4) reduced both 6-h and 24-h systolic blood pressure variability. However, 6-h systolic blood pressure variability increased from P4 to P5 following the impact of the COVID-19 pandemic. Finally, compared to P1, retraining of stroke nurses by stroke advanced practice nurse (P6) reduced tomography-to-treatment time and increased the first-hour maximum dose of antihypertensive treatment. Changes in nursing care and continuous education can significantly enhance the time metrics and blood pressure outcomes in acute intracerebral haemorrhage patients. STROBE guidelines. No Patient or Public Contribution.

Role of macrophages in regression of myocardial fibrosis following alleviation of left ventricular pressure overload.

Sustained hemodynamic pressure overload (PO) produced by murine transverse aortic constriction (TAC) causes myocardial fibrosis; removal of TAC (unTAC) returns left ventricle (LV) hemodynamic load to normal and results in significant, but incomplete regression of myocardial fibrosis. However, the cellular mechanisms that result in these outcomes have not been defined. The objective was to determine temporal changes in myocardial macrophage phenotype in TAC and unTAC and determine whether macrophage depletion alters collagen degradation after unTAC. Myocardial macrophage abundance and phenotype were assessed by immunohistochemistry, flow cytometry, and gene expression by RT-PCR in control (non-TAC), 2 wk, 4 wk TAC, and 2 wk, 4 wk, and 6 wk unTAC. Myocardial cytokine profiles and collagen-degrading enzymes were determined by immunoassay and immunoblots. Initial collagen degradation was detected with collagen-hybridizing peptide (CHP). At unTAC, macrophages were depleted with clodronate liposomes, and endpoints were measured at 2 wk unTAC. Macrophage number had a defined temporal pattern: increased in 2 wk and 4 wk TAC, followed by increases at 2 wk unTAC (over 4 wk TAC) that then decreased at 4 wk and 6 wk unTAC. At 2 wk unTAC, macrophage area was significantly increased and was regionally associated with CHP reactivity. Cytokine profiles in unTAC reflected a proinflammatory milieu versus the TAC-induced profibrotic milieu. Single-cell sequencing analysis of 2 wk TAC versus 2 and 6 wk unTAC revealed distinct macrophage gene expression profiles at each time point demonstrating unique macrophage populations in unTAC versus TAC myocardium. Clodronate liposome depletion at unTAC reduced CHP reactivity and decreased cathepsin K and proMMP2. We conclude that temporal changes in number and phenotype of macrophages play a critical role in both TAC-induced development and unTAC-mediated partial, but incomplete, regression of myocardial fibrosis.NEW & NOTEWORTHY Our novel findings highlight the dynamic changes in myocardial macrophage populations that occur in response to PO and after alleviation of PO. Our data demonstrated, for the first time, a potential benefit of macrophages in contributing to collagen degradation and the partial regression of interstitial fibrosis following normalization of hemodynamic load.

Sustainability reporting, institutional pressures and universities: evidence from the Spanish setting

Purpose Relying on institutional theory and Oliver’s (1991) strategic responses framework, the purpose of this paper is to investigate the different strategies adopted by Spanish public universities to respond to institutional pressures for sustainability reporting. Design/methodology/approach Data were collected from a variety of sources, such as a series of email-structured interviews with key personnel from universities, a qualitative analysis of sustainability reports and a consultation of the website of each Spanish public university. Findings The findings reveal that Spanish public universities have responded to institutional pressures for sustainability reporting by adopting acquiescence, compromise, avoidance and defiance strategies. The variety of strategic responses adopted by Spanish public universities suggests that these organizations have not fully adhered to institutional pressures. Practical implications The results of this paper would be useful for practitioners since it tries to demonstrate whether universities, which are facing increasing institutional pressures and demands from stakeholders, have been developing sustainability reporting practices. Social implications Universities have a remarkable social impact that could be used to promote sustainability practices. This paper investigates how these organizations can contribute to sustainability reporting as they should reproduce social norms. Originality/value The sustainability reporting context is in a phase of change. This paper tries to contribute to the accounting research by analyzing the extent to which universities are engaged in sustainability reporting. Relying on these premises, Oliver’s (1991) framework might be an insightful theoretical perspective to examine the responses provided by universities to institutional pressures.

A systematic review of literature examining the application of a social model of health and wellbeing.

Following years of sustained pressure on the UK health service, there is recognition amongst health professionals and stakeholders that current models of healthcare are likely to be inadequate going forward. Therefore, a fundamental review of existing social models of healthcare is needed to ascertain current thinking in this area, and whether there is a need to change perspective on current thinking. Through a systematic research review, this paper seeks to address how previous literature has conceptualized a social model of healthcare and, how implementation of the models has been evaluated. Analysis and data were extracted from 222 publications and explored the country of origin, methodological approach, and the health and social care contexts which they were set. The publications predominantly drawn from the USA, UK, Australia, Canada and Europe identified five themes namely: the lack of a clear and unified definition of a social model of health and wellbeing; the need to understand context; the need for cultural change; improved integration and collaboration towards a holistic and person-centred approach; measuring and evaluating the performance of a social model of health. The review identified a need for a clear definition of a social model of health and wellbeing. Furthermore, consideration is needed on how a model integrates with current models and whether it will act as a descriptive framework or, will be developed into an operational model. The review highlights the importance of engagement with users and partner organizations in the co-creation of a model of healthcare.

Concurrent exercise training potentiates the effects of angiotensin-converting enzyme inhibitor on regulatory systems of blood pressure control in ovariectomized hypertensive rats.

Enalapril has shown satisfactory potential in controlling increased and sustained blood pressure (BP). However, multiple dysregulated mechanisms that interact with each other and are involved in the pathophysiology of arterial hypertension may not be affected, contributing to the remaining cardiovascular risk. Using an exercise training protocol, we investigated whether adding both approaches to arterial hypertension management could promote higher modulation of regulatory mechanisms of BP in postmenopausal rats. Spontaneously hypertensive rats were allocated into sedentary (S) and ovariectomized groups: sedentary (OS), sedentary treated with enalapril maleate (OSE) and trained treated with enalapril maleate (OTE). Both the pharmacological and exercise training protocols lasted for 8 weeks. The BP was directly recorded. Inflammation and oxidative stress were evaluated in the cardiac tissue. Although BP reduction was similar between OSE and OTE, trained group showed lower vasopressor systems outflow after sympathetic ganglion blocking by hexamethonium (mean BP) (OTE: -53.7 ± 9.86 vs. OS: -75.7 ± 19.2 mmHg). Bradycardic and tachycardic response were increased in OTE group (-1.4 ± 0.4 and -2.6 ± 0.4 vs. OS: -0.6 ± 0.3 and -1.3 ± 0.4 bpm/mmHg, respectively), as well as BP variability. In addition, the combination of approaches induced an increase in interleukin 10, antioxidant defense (catalase and glutathione peroxidase) and nitrite levels compared with the OS group. Despite similar BP, the inclusion of exercise training in antihypertensive drug treatment exacerbates the positive adaptations induced by enalapril alone on autonomic, inflammatory and oxidative stress profiles, probably affecting end-organ damage and remaining risk.

Strategic communication in contexts of high sustainability pressure: balancing purposefulness, transparency and participation in pursuit of organizational legitimacy

PurposeThe purpose of this paper is to: (1) identify strategies to (re)establish organizational legitimacy which dominates the literature; (2) propose and empirically illustrate an analytical framework that establishes the linkages between the dimensions of purposefulness, transparency and participation identified in this literature review as important resources in the creation of organizational legitimacy.Design/methodology/approachBased on a review of the academic literature, we propose a three-dimensional conceptual framework for understanding and studying strategic communication in contexts of high sustainability pressure. The empirical material we use for illustration is the letters from the chief executive officer (CEO) and the chairman published in the integrated annual report of a Danish company that is well known for its focus on sustainability.FindingsThe analysis shows that all three dimensions, i.e. purposefulness, transparency and participation, are present in this data, which the authors find supportive of the theoretical argument that strategic communication needs to encompass all three concepts in order to appear legitimate in contexts of high sustainability pressure.Originality/valueIn recent years, there has been an increased focus on strategic communication of sustainability. However, there is still a lack of general consensus of what is understood by strategic communication in contexts of high sustainability pressure. Overlapping concepts and dimensions make operationalization difficult. This, for example, is a problem for corporations who are increasingly asked by their stakeholders to account for their sustainability activities and engage in conversations of strategic significance to their sustainability goals.