CYP2C9 genotype and pharmacodynamic responses to losartan in patients with primary and secondary kidney diseases

Losartan is used for anti-proteinuric as well as blood pressure effects in chronic kidney disease (CKD). It is metabolized by cytochrome P450 2C9 to active E-3174. Single nucleotide polymorphisms in CYP2C9 that reduce catalytic activity could reduce clinical benefits. The study aims were to determine whether CYP2C9 variant alleles (*2 and *3) altered urinary protein excretion, glomerular filtration rate, and blood pressure in Caucasians prescribed losartan. Differences between baseline and six-month follow-up outcomes were compared by CYP2C9 genotypes in 59 patients using unpaired T-test or Mann Whitney U test. Primary renal disease patients had a trend toward less favorable antiproteinuric response (−31.7±156 vs −125±323%; p=0.123) when carrying variant alleles. Patients with secondary renal diseases had less favorable diastolic blood pressure (9.8±16.0 mm Hg vs −3.2±10.6 mm Hg; p=0.043) and systolic blood pressure (16.2±27.1 mm Hg vs −5.5±17.5 mm Hg; p=0.044) with CYP2C9 variants. Preliminary results suggest a possible influence of CYP2C9 genotype on proteinuria and blood pressure in Caucasian CKD patients treated with losartan

Effects of uridine diphosphate glucuronosyltransferase 2B7 and 1A7 pharmacogenomics and patient clinical parameters on steady-state mycophenolic acid pharmacokinetics in glomerulonephritis

The role of pharmacogenomics, clinical and demographic parameters in pharmacokinetic predictions was evaluated in patients receiving mycophenolic acid (MPA)

The Phenomenon of "Fit" in School Superintendent Selection: A Case Series Study

Background/Problem Statement: This qualitative case series study investigated the phenomenon of “fit” as it relates to the underrepresentation of female superintendents in the field of educational leadership. The study was conducted during the 2018-2019 school year. At the time of the study, women represented 23% of the overall population of superintendents in the state in which the study occurred. The conceptual framework guiding the study is based on feminist standpoint and gatekeeping theories. According to feminist standpoint theory, women and men “engage in distinct activities and the two groups are accorded different rights and opportunities” (Wallace, 2014, p.49). As explained by Lewin’s (1951) model on gatekeeping “there are people, events, or situations that control the gates and determine what may pass and/or what is blocked” (p.147). Not only may stereotypical societal influences heavily impact who epitomizes the superintendency, access to the role may also inhibited by biased processes of gatekeeping. This research focused on gender bias as a possible explanation for the division of labor that exists between male and female superintendents. Purpose/Research Questions: This study sought to understand the notion of “fit” by exploring the criteria, both written and unwritten, used by gatekeepers such as consultant firms and school boards charged with overseeing the superintendent selection process. In addition, the study examined whether gatekeepers have biases concerning their definition of leadership potential that is rooted in stereotypical images of the superintendency. In examining the notion of what constitutes a “fit” between a candidate and a job, the research explored the perceptions of all parties involved in the screening and selection process of the superintendent search to compare their experiences on how fit is determined, assessed and utilized in hiring decisions; and if those perceptions and experiences are different between men and women. The following research questions guided the work: RQ1: How is “best fit” defined and assessed in candidates for the superintendent position by those involved in the screening and selection process? RQ2: What differences, if any, exist between the perceptions of superintendents, search firm consultants and school board members regarding how “fit” is determined by gatekeepers during the selection and hiring process, and does it vary by gender? RQ3: What variation in perceptions, if any, exist between current men and women superintendents regarding the criteria gatekeepers use in the superintendent selection process related to the concept of “fit”? Methods: The study took place in the south-central region of the United States and included three different sample groups: Three female and two male superintendents; two female and two male search firm consultants; and two female and two male school board members. The primary data collection instrument consisted of thirteen in-depth, semi-structured, informal interviews. The interviews were recorded and transcribed by Trint software and edited by the researcher. The researcher used NVivo 12 software for coding via computer-assisted content analysis in order to organize, analyze and connect data and to search for disconfirming evidence that runs contrary to the research. The process involved three phases. In the pre-coding phase, data was reviewed for word frequency. In the coding stage, the themes were classified into nodes in order to examine relationships among data. Lastly, in the post-coding stage, the themes were used to present findings related to the research questions. In addition to examining interview data, discourse analysis was used to examine artifacts such as sample candidate profiles, superintendent interview questions, news articles, job postings and researcher field notes. In using discourse analysis (Altheide & Schneider, 2013) the researcher was able to focus on selected nuances of language to assess how vocabulary, word choice, and topics work together to impart meaning about the desired characteristics and expectations of a superintendent as set forth by a hiring entity during the selection process. Results/Findings: The theories that provided the framework for this research were supported in the findings in that the experiences and perceptions of male and female informants varied significantly with regard to access to consultants and therefore, access to the superintendency. This variation supports the feminist standpoint assertion that women do not have the same advantages as men in gaining access to the superintendency. Further, the findings uphold the premise of gatekeeping theory in that there was evidence that implicit biases, rooted in the stereotypical images of the superintendent held by consultants, hinder women from gaining access to the superintendency. The prevailing findings that emerged as having the greatest impact on determining “fit” during the superintendent hiring process are: 1. The consultant is the primary gatekeeper that determines access to the superintendency. 2. Assuming prerequisite skills are similar among finalists, likeability is the determining factor in getting the job. 3. There is gender bias in the process. Conclusion: Elements of the routine practices of gatekeepers, combined with the historical, stereotypical images of the school superintendent and dominant social and cultural values, often all work together to diminish the access of women to the role of superintendent. Based on the prevailing findings, the following recommendations are being made: 1. Each school board member should be required to attend implicit bias training prior to beginning the superintendent selection process. 2. Consultant firms should be required to publish their placement record on their website and provide that information to each board as part of the application process when seeking to represent a Board in the superintendent selection process. 3. College preparation programs and administrative leadership organizations must provide opportunities for women to learn how the superintendent selection process works and host networking events for women to meet individually with the actual headhunters that work with school boards.Educational Leadership and Policy Studies, Department o