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using their talents to the best effect, and constantly pushing them to new heights, levels of accomplishment that they might not have dreamed of on their own He was about putting all these motivating/inspiring factors together in one compelling, comprehensible package: himself The package wasn t always pretty He was tough and abusive and at times he was downright nasty, Bart Starr once commented publicly But Starr was a perceptive player who understood the package The shoutings, encouragements, inspirational messages, and vindictive assault on mistakes transcended the walls of our dressing rooms, he once wrote in a letter to my father, but in the privacy of those same rooms to have known the bigger man kneeling in tearful prayer with his players, after both triumph and defeat was a strengthening experience that only your squads can ever fully appreciate A strengthening experience : Isn t that what inspirational, motivational leadership and great organizations are all about

You should also consider what peripherals your users require or will make their jobs easier For example, it will be much faster and easier to obtain accurate data by using bar coding and a barcode scanner within the mobile device than requiring the user to input a code If your application is ideal for bar coding, you should consider a device with a built-in scanner Some applications also require connection to a printer This could be a small, wearable printer or a device that resides in a vehicle Connecting to printers and other peripherals will be much easier using Bluetooth technology (if and when the chipset becomes low cost), which allows devices in close proximity to communicate wirelessly, acting as a cable replacement If peripherals are a requirement, you may want to consider choosing a hardware vendor that is planning near-term support for Bluetooth and understands the timing and cost of their offering

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It is extremely important for the kidneys to keep the GFR at a level appropriate for the body because, as we have emphasized, the excretion of salt and water is strongly influenced by the GFR We have also emphasized that the GFR is strongly influenced by renal arterial pressure A rise in blood pressure causes an increased excretion of salt and water, a process called pressure natriuresis (see 7), whereas a fall in blood pressure diminishes excretion These changes in excretion are mediated partly via changes in GFR The effect is so strong that urinary excretion would tend to vary widely with the ordinary daily excursions of arterial pressure Also, vascular pressure in the thin-walled glomerular capillaries is higher than in capillaries elsewhere in the body and hypertensive damage ensues if this pressure is too high Therefore, both to protect the glomerular capillaries from hypertensive damage and to preserve a healthy GFR, changes in GFR and RBF are severely blunted by mechanisms that we collectively call autoregulation Consider first a situation in which mean arterial pressure rises 20% Such a modest rise occurs many times throughout the day in association with changes in excitement level and activity Pretend, for the moment, that all renal vascular resistances remain constant By the basic flow equation (Q 5 P/R), RBF would rise 20% also (actually slightly more if pressure in the renal vein is unaffected) What would this do to GFR It would rise much more than 20%, in fact almost 50% This is because net filtration pressure would rise almost 50% In effect, fractional changes in upstream pressure (in the renal artery) are magnified in terms of net filtration pressure Why is this At the beginning of the glomerulus, capillary hydrostatic pressure is about 60 mm Hg and the pressures opposing filtration sum to 36 mm Hg, yielding a net filtration pressure of about 24 mm Hg (Table 2 1) With an increase in arterial pressure to 120 mm Hg, capillary pressure would rise to about 71 mm Hg, but there would be no increase in the pressures that oppose filtration plasma oncotic pressure and Bowman s capsule pressure Therefore, net filtration pressure would rise to 71 36 5 35 mm Hg (an increase of almost 50%) The higher net filtration pressure would cause a parallel increase in GFR (In turn, this would raise plasma oncotic pressure at the distal end of the glomerulus, tending to reduce filtration somewhat, but the total effect is still a major rise in GFR) This emphasizes the crucial role of glomerular capillary pressure in glomerular filtration Now, what actually happens in the face of changes in mean arterial pressure As is the case in many organs, blood flow does not change in proportion to changes in arterial pressure The changes are blunted A rise in driving pressure is counteracted by a rise in vascular resistance that almost offsets the rise in pressure The word almost is crucial here Higher driving pressures do indeed lead to higher flow but not proportionally Consider Figure 2 4 Within the range of mean arterial pressures commonly found in the human body (between the dashed.

W H AT I T TA K E S T O B E # 1

Renal Blood Flow and GlomeRulaR FiltRation / 35

Finally, it is critical that you consider price, warranty, and technical support during the decision-making process When choosing a vendor, inquire about upgrade policies, future product pipeline, backward compatibility, support plans and possible leasing options

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