Change in Blood Pressure Variability Among Treated Elderly Hypertensive Patients and Its Association With Mortality

Background: Information is scarce regarding effects of antihypertensive medication on blood pressure variability (BPV) and associated clinical outcomes. We examined whether antihypertensive treatment changes BPV over time and whether such change (decline or increase) has any association with long-term mortality in an elderly hypertensive population. Methods and Results: We used data from a subset of participants in the Second Australian National Blood Pressure study (n=496) aged ≥65 years who had 24-hour ambulatory blood pressure recordings at study entry (baseline) and then after a median of 2 years while on treatment (follow-up). Weighted day-night systolic BPV was calculated for both baseline and follow-up as a weighted mean of daytime and nighttime blood pressure standard deviations. The annual rate of change in BPV over time was calculated from these BPV estimates. Furthermore, we classified both BPV estimates as high and low based on the baseline median BPV value and then classified BPV changes into stable: low BPV, stable: high BPV, decline: high to low, and increase: low to high. We observed an annual decline (mean±SD: −0.37±1.95; 95% CI, −0.54 to −0.19; P<0.001) in weighted day-night systolic BPV between baseline and follow-up. Having constant stable: high BPV was associated with an increase in all-cause mortality (hazard ratio: 3.03; 95% CI, 1.67–5.52) and cardiovascular mortality (hazard ratio: 3.70; 95% CI, 1.62–8.47) in relation to the stable: low BPV group over a median 8.6 years after the follow-up ambulatory blood pressure monitoring. Similarly, higher risk was observed in the decline: high to low group. Conclusions: Our results demonstrate that in elderly hypertensive patients, average BPV declined over 2 years of follow-up after initiation of antihypertensive therapy, and having higher BPV (regardless of any change) was associated with increased long-term mortality

Ecosystem impacts of Alpine water intakes for hydropower: the challenge of sediment management

The natural flow hydrological characteristics (such as the magnitude, frequency, duration, timing, and rate of change of discharge) of Alpine streams, dominated by snowmelt and glacier melt, have been established for many years. More recently, the ecosystems that they sustain have been described and explained. However, natural Alpine flow regimes may be strongly modified by hydroelectric power production, which impacts upon both river discharge and sediment transfer, and hence on downstream flora and fauna. The impacts of barrages or dams have been well studied. However, there is a second type of flow regulation, associated with flow abstraction at intakes where the water is transferred laterally, either to another valley for storage, or at altitude within the same valley for eventual release downstream. Like barrages, such intakes also trap sediment, but because they are much smaller, they fill more frequently and so need to be flushed regularly. Downstream, while the flow regime is substantially modified, the delivery of sediment (notably coarser fractions) remains. The ecosystem impacts of such systems have been rarely considered. Through reviewing the state of our knowledge of Alpine ecosystems, we outline the key research questions that will need to be addressed in order to modify intake management so as to reduce downstream ecological impacts. Simply redesigning river flows to address sediment management will be ineffective because such redesign cannot restore a natural sediment regime and other approaches are likely to be required if stream ecology in such systems is to be improved

A Micro-SME Case Study of Social Media Adoption

The file attached to this record is the author's final peer reviewed versionEquipped by the advancement in technology, social media has altered the delivery, structure and availability of information, putting the once capital-intensive role of broadcasting (Simmons et al., 2011) within the reach of individuals. Blackshaw & Nazaro (2006, cited in Xiang and Gretzel 2010) define Social Media as Internet-based applications that carry consumer-generated content. Importantly, Hansen et al. (2011) adds a focus on the tools and potential business benefits. ‘Social media tools cultivate the internal discussions that improve quality, lower costs, and enable the creation of customer and partner communities that offer new opportunities for coordination, marketing, advertising, and customer support. These networks contain information that has significant business value by exposing participants in the business network who play critical and unique roles’ (Hansen et al. 2011: 4). Social media provides immense power to consumers and transforms individuals from passive recipients of information and products into active creators of content (information and ideas) who are able to actively and immediately communicate with one another. One of the emerging challenges facing Small and Medium-sized Enterprises (SMEs) is how they appropriately incorporate and harness the mass collaboration that social media facilitates. Durkin et al. (2013: 720) state, ‘Where attention has been applied to the SME context the focus (current literature) has mainly been on primarily tactical marketing issues.’ In addition literature documents the impact of on-line engagement for off-line social relationships (Fisher and Reuber, 2011) and mobile marketing (Jayawardhena et al., 2009).’ However, Durkin et al. (2013) identify, a paucity of social media research relating to strategic considerations, innovation and entrepreneurship. Entrepreneurship enables enterprises to successfully identify business opportunities, develop: products; markets; the supply chain and thus increase their competitiveness and innovative capacity (Birkinshaw, 2000). The researchers suggest, social media can significantly help in this regard. However, the ONS (2014) data, states only 54.0% of all businesses use social media. A closer examination of the ONS (2014) data and outlined academic research (Durkin et. al, 2013 and Simmons et al, 2011) highlight a number of problems: Problem 1: Micro businesses are significantly less likely than small businesses to use the technology for customer and innovative purposes. The ONS (2014) data states only 5.8% of micro businesses use social media to innovate compared to over 30% using social media for customer relationship activities. It is also noted that under 30% of micro businesses use social media compared to over 50% of small businesses. Suggesting they are less likely to benefit entrepreneurially from social media. Problem 2: There is a paucity of theoretical understanding and literature relating to relationship between social media and entrepreneurial activity. Current frameworks fail to provide an understanding of the concept, structures and relationships. AIMS & OBJECTIVES The paper aims to begin to address these problems by way of two key objectives: Objective 1: To identify and examine why and how a micro SME has adopted and used social media operationally and strategically. Objective 2: To understand the decision-making for social media use. What can be learned from the case studies experience and decisions? METHODOLOGY In response to the objectives and the focus on social media use and activities the primary strategy for data collection is in depth/detailed interviews and observation. For the paper a single case study will provide the data for analysis. Observations of the case studies social media use will be undertaken to observe and record their online actions and behavior (Collis and Hussey, 2014: 148). The non-participant observation will be undertaken via social media technologies used by the case studies. Some of the activities and meta-data will be analysed using a variety of online tools (example: simplymeasured.com). Durkin et al.’s (2013: 724) theoretical model of social media adoption and use provides the framework of observation and interview questions. CONTRIBUTION The paper adds to the current understanding of SMEs and social media us by adding to the limited understanding of social media use amongst micro businesses. Through empirical data collection and analysis the paper provides a detailed and in depth understanding of social media use by a micro SME. Key to the paper’s contribution is going beyond the understanding of use. Therefore, the contribution is to: understand micro SME social media adoption and activity; and to take the first steps in developing guidance and support for micro SMEs wanting to use social media for entrepreneurial purposes

Understanding Social Media Entrepreneurship to promote innovation within SMEs

TOPIC Social media has transformed the delivery, structure and availability of information, putting the once capital-intensive role of broadcasting (Simmons et al., 2011) within the reach of individuals. New interactions are generated by social media technologies (Hanse et al., 2010); connectivity is enhanced by human networks (Hwang and Kim, 2015). Blackshaw & Nazaro (2006, cited in Xiang and Gretzel 2010) define Social Media as Internet-based applications that carry consumer-generated content. Importantly, Hansen et al. (2011) adds a focus on the tools and potential business benefits to improve quality and create customer and partner communities (Hansen et al., 2014). Furthermore, the information shared through the networks has significant business value that plays an essential role within the business (Hansen et al., 2011) AIM Social media provides immense power to consumers and transforms individuals from passive recipients of information and products into active creators of content (information and ideas) who are able to actively and immediately communicate with one another. Digital technologies produce positive social impact in various fields from healthcare to financial sectors (DCMS, 2017). Interactions and collaborative technologies are included by social media (Farshid et al., 2011). Researchers have highlights the benefits for businesses to engage with social media to improve their communication and brand management viewpoints (Barwise and Meehan, 201; Gaines-Ross, 2010; EFMA, 2013), while others pointed out the positive impact of on-line engagement for off-line social relationships (Fisher and Reuber, 2011) and mobile marketing (Jayawardhena et al., 2009). Finally, Durkin et al. (2013) identify, a paucity of social media research relating to strategic considerations, innovation and entrepreneurship. However, one of the emerging challenges facing Small and Medium-sized Enterprises (SMEs) is how they appropriately incorporate and harness the mass collaboration that social media facilitates. METHODOLOGY The paper is based on a qualitative study; it used observation to explore certain kinds of structured data (Mintzber, 1973). The data were collected by observing two SMEs based in Leicester. Observation allowed us to inductively develop patterns of social media use and activities. For the paper two case studies will provide the data for analysis. Observations of the case studies social media use will also be undertaken to observe and record their online actions and behaviours (Collis and Hussey, 2014: 148). The non-participant observation will be undertaken via social media technologies used by the case studies. Some of the activities and meta-data will be aniseed using a variety of online tools (example: simplymeasured.com). Durkin et al.’s (2013: 724) theoretical model of social media adoption and use provides the framework of observation. CONTRIBUTION The paper adds to the current understanding of SMEs and social media us by adding to the context of innovation amongst micro businesses. Through observation the paper provides a number of good practice case studies. Key to the paper’s contribution is going beyond the understanding of use