Diabetes Mellitus and Erectile Dysfunctions

Diabetes Mellitus and Erectile Dysfunctions CHAPTER 1 INTRODUCTION 1.1 Diabetes Mellitus Diabetes Mellitus is a group of metabolic disorders which is characterized by chronic hyperglycemic condition with elevated blood glucose levels (Kohei., 2010). It may be either impaired insulin production or inability of cells to respond properly to the insulin synthesized from beta cells (Rudolf et al., 2012). There are majorly two types of diabetes- Type I or Insulin Dependent Diabetes Mellitus and Type II or Non-Insulin Dependent Diabetes Mellitus.The later condition is characterized by fasting hyperglycemia along with a risk of thrombolytic and atherosclerotic disorders that mainly affect the cerebral, peripheral and coronary arterial trees (Grant., 2007). Diabetes is associated with various complications including micro vascular and macro vascular complications such as retinopathy, nephropathy, atherosclerosis, endothelial dysfunction and erectile dysfunctions. 1.1.1 Type-I Diabetes (IDDM or Juvenile onset Diabetes Mellitus) Type I is a form of diabetes mellitus that results from the autoimmune destruction of the insulin-producing beta cells in thepancreas The ultimate lack of insulin leads to enhanced blood and urine glucose. The hallmark symptoms are polyuria (frequent urination), polydipsia (increased thirst), polyphagia (increased hunger), and weight loss. The reason of diabetes mellitus type 1 is unknown. Type 1 diabetes can be distinguished from type 2 by autoantibody testing. TheC-peptide assay can also be used to measure endogenous insulin production. Global the number of people with DM type 1 is unknown. It is estimated that about 80,000 children developed the disease a year. Numbers of people who currently have the disease in the United States are possibly as much as three million. Rates varies from a low of 1 per 100,000 in Japan and China to 8 to 17 per 100,000 in Northern Europe and the U.S., to a high of about 35 per 100,000 in Scandinavia Caused by immune destruction of beta cells of the pancreas. Antibodies to islet cells and insulin are observed at diagnosis. Insulin secretion gradually decreases. May present at any age but most common in childhood and adolescence. Insulin by sc injection is necessary for survival. Contributing factors:- Genetic predisposition, Environmental trigger (infection or stress) 1.1.2 Type- II Diabetes (NIDDM or Adult onset Diabetes Mellitus) Type II diabetes may be caused either by insulin resistance in the liver and skeletal muscle, or enhanced glucose production in liver, or excess production of free fatty acids by fat cells and insulin deficiency. Insulin secretion diminishes with gradual beta cell failure. Reductions in blood glucose levels can be achieved with changes in food intake and also physical activity patterns. Oral medication and/or insulin injections are finally required. Contributing factors: Obesity Age (onset of puberty is associated with increased insulin resistance) Lack of physical activity Genetic predisposition Racial/ethnic background (Native American, African American Hispanic and Pacific/Asian Islander) Conditions associated with insulin resistance as in polycystic ovary syndrome 1.2 Penile Anatomy The penis composed of three bodies of erectile tissue which run in parallel; the corpus spongiosum, surrounding urethra and terminating in glans penis and the two corpora cavernosa (CC) function as blood-filled capacitors which provide structure to the erect organ (Andersson et al., 1995). The penile CC is highly organised vascular structures which are morphologically acclimatised to their function of becoming engorged of sexual arousal. The trabecular smooth muscle comprises approximately 40-50% tissue cross-sectional area, as evaluated by histomorphometric analysis (Nehra et al., 1998). There are three main arteries in penis ie, cavernosal, dorsal and bulbourethral. These three arise from a shared branch of internal pudendal artery and provide an immense anastomotic network (Tiee et al., 2010). Nowadays, there is a tendency to Role of Arginase Inhibitor and Alpha-Tocopherol in Streptozotocin Induced Sexual Impairment in Male Rats 2013-14Â  perform experiments using pudendal artery in vitro instead of cavernosal tissue to check pathophysiological aspects of ED as this artery is the vital resistance of penile engogerment during sexual stimulation. Novel research suggests that pudendal artery contributes about 70% of total penile vascular resistence (Manabe et al., 2000). The blood supply in CC is mainly fed from the penile cavernosal artery (Andersson et al., 1995) which causes corporal engorgment during erection, whereas deep dorsal artery causes glans enlargement but venous drainage is not similar to the arterial supply; there has only one deep dorsal vein which runs alongside dorsal arteries and nerves in the Buck’s fascia above the tunica albuginea which is a multilayered organized structure where emissary veins pass. The penile venous system is generally stated as a single deep dorsal vein along with a pair of dorsal arteries located between tunica albuginea and Buck’s fascia for venous drainage (Moscovici et al., 1999). The corpus spongiosu m which is erectile tissue analogous to CC but with thinner tunica albuginea. The urethra lies inside the spongiosum. The innervations of penis is both autonomic ie, sympathetic and parasympathetic and somatic ie, sensory and motor. From the neurons present in the spinal cord peripheral ganglia, the sympathetic with parasympathetic nerves merge to form cavernous nerves, which enter in CC and corpus spongiosum for affecting the neurovascular events during detumescence and tumescence (Dean et al., 2005). 1.3 Physiology of Penile Erection Penile erection involves central and peripheral pathways. Tumescence initiated after central integration and processing of visual, tactile, olfactory and imaginative stimuli. At the initial of sexual stimulation, signals are generated to peripheral tissues involved. Hence final response is mediated by coordinating spinal activity through the autonomic pathways to penis, and also in somatic pathways to perineal striated muscles. Both of the central and peripheral regulation of the PE involves several neurotransmitters, of which details are still incompletely known. Spinally, there may be a network consisting of the primary afferents from the genitals along with spinal interneurons, sympathetic, parasympathetic and (somatic) nuclei, which is capable to integrate all information. Peripherally, a balance between substances which control the degree of contraction of cavernosal smooth muscle determining the functional state of the penis (Gratzke et al., 2010). The dynamic interplay between vasoconstrictors and vasodilators within the penis establish the state of erect or flaccid. PE is determined by the pressure changes in cavernosal arterioles and sinuses. The vasculature nature of the erectile mechanism differs from most of the vascular beds as it is comprised of arterioles and hollow blood-filled sinuses, both that are lined with endothelial cells and smooth muscle (Dean et al., 2005) as previously described. During flaccidity, this tissue is tonically contracted which allow only a small amount of arterial flow regarding nutritional purposes. Partial pressure of oxygen (PO2) in blood is around 35mmHg (Sattar et al., 1995). On the other hand, dilation of penile arteries is the primary event in the consequence of erection

Political Forces in the Glass Ceiling

Despite all of the political forces on the side of women who attempt to break through the glass ceiling, limited progress has been made. Numerous studies lament the virtual absence of women in the elite tier of corporate positions: chief executive officer, chairman, president, and executive vice president. Unfair employment practices strengthen the glass ceiling and hinder the advancement of women in the workplace. These practices include sexual harassment, sexual discrimination, and pregnancy discrimination. Although activists have succeeded in getting stronger laws passed, such as the Civil Rights Act of 1991, true progress eliminating the glass ceiling must be based on private sector initiatives. The Civil Rights Act of 1991 gives women considerable more clout in their defense against discrimination than did the Civil Rights Act of 1964. The Civil Rights Act of 1964 prohibited discrimination against women who successfully filed suit against their employers for unfair practices. The Act also states that these women can only receive back pay and reinstatement in their old jobs. However, the 1991 Civil Rights Act, incorporated previous laws while also easing the burden on employees suing to prove job discrimination. Within the new law, a successful litigant can collect monetary damages, as well as, request a jury trial, sue in conjunction with others who have received similar unfair treatment in the workplace, and request the courts to judge the case based on the reasonable woman standard as opposed to the reasonable man. The 1991 Act also places the burden of proof on the employer, rather than the employee. â€Å"Indeed, the Civil Rights Act of 1991 and other recent court decisions have given women new clout in the workplace† (Morris 61). An example of this clout is the intense publicity surrounding the Anita Hill v. Clarence Thomas hearing. Hill, a black law professor at the University of Oklahoma, electrified the nation when she charged that Clarence Thomas, then a Supreme Court nominee, had sexually harassed her when she worked for him in the early 1980s. Hill testified before the all-male Senate Judiciary Committee about her discomfort when Thomas insisted on describing pornographic movies and made sexual advances. An all-white and all-male Senate sought to discredit Hill, some of who accused her of lying or being delusional, but her testimony elicited nationwide support. The Senate confirmed Thomas† actions were inappropriate, but Hill†s testimony was almost entirely disregarded. The hearing angered women, especially those who had suffered similar experiences of sexual harassment in the workplace, and it also empowered many others to come forward with similar allegations. â€Å"The furor that ensued was just the fuel need to pass the Civil Rights Act of 1991† (Stith 187). In recent litigation, women have begun testing the extent of their employment rights beyond the rights guaranteed to them in the Civil Rights Acts. An example of this is a group of eight women employees of the Stroh Brewery Company in Detroit. These women charged that their employer had created a working environment that was hostile to women. As part of their allegation, they pointed to sexually offensive commercials that Stroh†s aired featuring the Swedish bikini team, scantily clad young women with large breasts. The Stroh plaintiffs contended that the ads were proof that the company sanctions sexism. â€Å"The company has defended its ads as simple entertainment protected by the First Amendment†s guarantee of free speech† (Vilanch 7). The plaintiffs in the Stroh case won their lawsuit and created a landmark decision for challenges of this type, particularly due to the fact the courts must now decide based on the reasonable woman. Although the presence of strong laws is powerful ammunition to fight to eliminate discrimination in the workplace, litigation is not the most effective solution to the problem. Women who experience workplace discrimination are often reluctant to file official complaints for a variety of reasons including; feelings of inadequacy, fear of reprisal, and fear of being labeled troublemakers. Some women also fear retaliation from their employers as well. In regard to the latter, other women simply do not have the money to carry out a lawsuit that may take years to settle or reach court. In sexual harassment lawsuits, the prospect of going to trial is enough to scare off many women, particularly once they realize how vulnerable their credibility is in legal matters concerning sexual activity. â€Å"Many labor experts believe women are held back from jobs because of subtle sexual harassment. Only the concerted efforts of enlightened companies, not litigation, can eradicate this form of injustice† (Morrison 15). One enlightened company, Du Pont, has made efforts to help women managers overcome the glass ceiling. Du Pont has established a staff position to focus on advancing the careers of promising women and minorities. â€Å"If a division is looking for the manager of affirmative action and upward mobility then Du Pont is the example to follow† (Gallagher 88). Such a staff position is needed to provide support, counseling, and advocacy for women who find their career advancement has stalled due to subtle discrimination. Despite the efforts of some companies, gender diversity is still sorely lacking in Corporate America. A recent study revealed that of America†s 500 largest companies, women held only 10 percent of the top executive positions. â€Å"For all the bravado of the past decade, women in most organizations are not much further along. The glass ceiling has not shattered† (Himelstein 64). Although some companies are diversifying their executive workforces, most companies prefer to initiate these diversity efforts on their own, rather than being forced into it by legislative quotas or affirmative action. For example, Coopers and Lybrand, whose all-male corporate management committee was confronted by its female employees last year, regarding the absence of women in management, preferred to resolve the situation themselves. At issue, was the fact that women only accounted for 8 percent of the firms† 1,300 partners and only 3 percent of the firm†s 70 regional managers. The confrontation which occurred during a management meeting where it was revealed that gender myths about women†s performance as managers still persisted. For instance, the male partners assumed that the women were reluctant to engage in business travel and informal business gatherings. As a result of the confrontation, Coopers and Lybrand initiated programs to address diversity issues. These programs included mentoring and formal training. â€Å"Coopers and Lybrand proclaimed that 30 percent of their new partners by the year 2000 would be women, up from 17 percent in 1999† (Glover 16). Eliminating the glass ceiling requires zealous planning efforts by corporations that are committed to diversity. The first step involves setting goals. â€Å"A few companies are achieving success in the battle to get women into the executive suit. They have backed sound strategies with effort, money, and long term commitment† (Weiss 191). Various companies base their goals on census data, desiring their workforce to reflect the gender demographics of the surround region, while other companies eschew quotas and internal goals, but seek the same results, increased diversity. Diversity goals can help but women into the pipeline through the hiring process. The presence of women in senior positions tends to attract women who hold similar aspirations. Once employed, women must receive the training that will allow them to move into the corporate ranks. For example, Colgate-Palmolive favors fast tracking its employees through cross training. Cross training exposes the employee to a variety of functions within the organization; the broad base of knowledge acquired is critical to success as a future manager. The efforts that corporations are putting into diversifying their workforces is bearing fruit. An example is J.C. Pennys, which initiated a drive in 1988 to fill 1,000 management positions (created by the relocation of company headquarters) with qualified women. After setting numerical goals and establishing formal networking and mentoring programs. â€Å"Pennys was able to increase its percentage of senior managers who are women from less than 12 percent in 1990 to more than 35 percent by 1997† (WIBC 103). The glass ceiling that prevents women from advancing to top positions will only be shattered by the combined efforts of political activists and the private sector. Strong legislation provides women with the power they need to litigate unfair employment practices. Private sector initiatives help create a climate that is supportive for women to develop their skills and make it to the top. Women have made key victories, both in the political arena and in Corporate America. Thousands of women managers are in the pipeline and on the right track to assume their rightful places in the ranks of corporate executives. If current efforts bear fruit, the glass ceiling will no longer be a limiting factor for women of the 21st century.

“A” for Alienation Essay

Alienation is a common theme in all writing; however, in The Scarlet Letter by Nathaniel Hawthorne, never has alienation been so vividly accounted. The Scarlet Letter is a story about Hester Prynne, a woman who commits adultery against her husband named Roger Chillingworth, with the local reverend named Arthur Dimmesdale; the result is a strange child named Pearl. The plot thickens as the mistress and the reverend strive to keep their sin a secret, and as Chillingworth appears back in town hiding his true identity; it climaxes on a scaffold where all secrets are revealed. Alienation is a heavy theme throughout the book, and it adds an incredible twist to see it’s affect on the characters. Alienation is portrayed through symbols, behavior, and drama with Hester, Pearl and Dimmesdale. Each character is associated with an important symbol that sets them apart from society. They also each deal with their alienation in different ways with different behaviors, and they are treated d ifferently by society causing drama. In the end, some can deal being outcasts from society, but some cannot. Hester, the main character of the book, is most evidently alienated from society for her sin. The most important symbol in the book, the embroidered â€Å"A† on her bosom, sewed on as punishment for adultery, is also a symbol for alienation. She is different from all of society because of that mark, and can never live a normal life because of it. â€Å"†¦Let her cover the mark as she will, the pang of it will be always in her heart,† (38), said a townsperson at first sight of the scarlet letter. As seen in this quote, society will always look at the scarlet letter as a wall between themselves and Hester. Hester’s behavior shows how greatly she is affected by her alienation. â€Å"Lonely as was Hester’s situation and without a friend on earth who dared to she herself, she, however, incurred no risk of want,† (57); in this quote one sees how being alienated from society can cause a person to become an introvert and become a lifeless body as Hester had become. There is a lot of drama surrounding Hester; all of society looks at Hester in shame. This complete shun from society drives Hester to live in an isolated cottage away from people. â€Å"In this little, lonesome dwelling†¦Hester established herself with her infant child,† (57). This particular dramatic  event alienated Hester geographically as well as socially. Hester’s alienation also causes others to become alienated like her daughter and the one she has an affair with; however, Hester is most sharply alienated from all. Hester’s daughter, Pearl, is also alienated from society. Her alienation has different circumstances, however, because she was born an alien, she did nothing wrong. Since she is the product of sin, many consider her a â€Å"demon child† with supernatural powers. For this reason, she herself is a symbol of her alienation; â€Å"It [Pearl] was the scarlet letter in another form; the scarlet letter endowed with life!† (70). She is compared to Hester’s symbol of alienation, but she is a breathing, living form of the same symbol. She alienated herself and her mother from society. She is not your normal child, she acts very different; â€Å"She [Hester] could recognize her [Pearl] wild, desperate, defiant, mood, the flightiness of her temper, and even some of the very cloud-shapes of gloom and despondency that had brooded in her heart,† (63). In this description of Pearl’s behavior, we see a child that does not fit in your normal Puritan mold; she is a child filled of energy, character, and mischief. She finds a way to live a happy life regardless of being an outcast from society. Because of Pearl’s behavior and her mother’s sin, lots of drama occurs around the possession of the child; â€Å"Women it is thy bandage of shame! †¦It is because of the stain which that letter indicates, that we would transfer thy child to other hands,† (76). Here, Governor Bellingham is trying to take Pearl from her mother to give her a â€Å"normal† life in attempt to raise the child into your average, molded Puritan. Pearl is a free willed little girl who circumstantially is outcasted by society. Arthur Dimmesdale, the local reverend, is Pearls father; however, this is a secret kept from society and is revealed in the final scene. Dimmesdale’s secret guilt alienates him internally from everyone around him. His hidden sin is eating him alive while he continues to put a mask on and preach to society as if nothing is wrong. This hidden secret is symbolized in the book as an unknown marking on his chest over his heart. â€Å"With a convulsive motion he tore away the ministerial band from before his breast. It was revealed!†Ã‚  (172); here, Dimmesdale reveals the markings on his chest to all of society and reveals his secret. This marking, weather it be a scarlet letter or not, is what symbolizes his alienation. It is an internal alienation from the outside world, and is not known by society until this moment. His behavior prior to this event should signs of a deep illness, not curable by any medicine. â€Å"His nerve seemed absolutely destroyed. His moral force was abused into more than childish weakness,† (109). Dimmesdale is weak in spirit and in health due to his extreme guilt alienating him from society. His behavior reflects his health which is in jeopardy due to his secret. This extreme pressure causes dramatic events to occur before the final climax. â€Å"Walking in the shadow of a dream, as it were, and perhaps actually under the influence of a species of somnambulism,† (101). The author here describes Dimmesdale’s journey to the scaffold one night; this night he can take the guilt no longer. It describes him to be in another world controlled by his guilt. He is alienated from all when he is in this frame of mind, and this can be seen through dramatic events such as this. Dimmesdale’s secret sin has caused his character to change considerably while ali enating him for the rest of the town. The three â€Å"aliens† in this story have different types of alienation, and are under different circumstance too; nevertheless, the simple fact remains, they are alienated from their surroundings. Each character deals with their alienation a different way, and this is evident at the end of the story. Dimmesdale cannot take his inner guilt any longer and dies, Pearl fights through her problems to live a normal life, and Hester lives forever in her sin on her own. Through symbols, each character’s behavior, and the drama occurring in their lives, alienation can be depicted with each character; however, the outcome of their alienation is governed only by the inner qualities of the character that the author has created. This reoccurring theme in literature has never taken a similar twist of outcomes, and it has brought interest, excitement, and meaning to the story.

Barracuda, By Christos Tsiolkas And Butterfly - 1995 Words

In the books Barracuda, written by Christos Tsiolkas and Butterfly, written by Sonya Hartnett, there is a strong theme of family and parent-child relationships present all throughout. Both stories feature protagonists caught in the throes of adolescence – a time in which a sense of identity begins to emerge in young people – and the way in which these stories explore these issues of growing up are tied very closely to the family. Through this, Barracuda and Butterfly are able to present to the audience an authentic take on growing up and what it means to truly be at home; what it means to belong. Set in the 1990s, Barracuda is a novel that follows the life of fourteen year old Danny Kelly as he journeys through adolescence and reaches adulthood. The story is told through non-linear narrative, jumping from first to second person; from Danny to Dan, from child to man. Danny is a gifted swimmer, accepted into a prestigious private school on a sports scholarship. He immediately feels out of place among his peers – at fourteen, Danny is competitive and angry and has a great desire to be the strongest, the fastest, the best. At first it seems Danny s sense of displacement stems from the bullying at his new school, but through observing the way in which Danny interacts with his family it is obvious that this is not the case. Thrust into a world where he does not belong, Danny feels a deep sense of shame that is tied closely to his family and cultural background. This is a