Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial

Objective: The HOME BP (Home and Online Management and Evaluation of Blood Pressure) trial aimed to test a digital intervention for hypertension management in primary care by combining self-monitoring of blood pressure with guided self-management. Design: Unmasked randomised controlled trial with automated ascertainment of primary endpoint. Setting: 76 general practices in the United Kingdom. Participants: 622 people with treated but poorly controlled hypertension (>140/90 mm Hg) and access to the internet. Interventions: Participants were randomised by using a minimisation algorithm to self-monitoring of blood pressure with a digital intervention (305 participants) or usual care (routine hypertension care, with appointments and drug changes made at the discretion of the general practitioner; 317 participants). The digital intervention provided feedback of blood pressure results to patients and professionals with optional lifestyle advice and motivational support. Target blood pressure for hypertension, diabetes, and people aged 80 or older followed UK national guidelines. Main outcome measures: The primary outcome was the difference in systolic blood pressure (mean of second and third readings) after one year, adjusted for baseline blood pressure, blood pressure target, age, and practice, with multiple imputation for missing values. Results: After one year, data were available from 552 participants (88.6%) with imputation for the remaining 70 participants (11.4%). Mean blood pressure dropped from 151.7/86.4 to 138.4/80.2 mm Hg in the intervention group and from 151.6/85.3 to 141.8/79.8 mm Hg in the usual care group, giving a mean difference in systolic blood pressure of −3.4 mm Hg (95% confidence interval −6.1 to −0.8 mm Hg) and a mean difference in diastolic blood pressure of −0.5 mm Hg (−1.9 to 0.9 mm Hg). Results were comparable in the complete case analysis and adverse effects were similar between groups. Within trial costs showed an incremental cost effectiveness ratio of £11 ($15, €12; 95% confidence interval £6 to £29) per mm Hg reduction. Conclusions: The HOME BP digital intervention for the management of hypertension by using self-monitored blood pressure led to better control of systolic blood pressure after one year than usual care, with low incremental costs. Implementation in primary care will require integration into clinical workflows and consideration of people who are digitally excluded. Trial registration: ISRCTN13790648

Developing global citizenship: co-creating employability attributes in an international community of practice

This book chapter discusses how creative industries graduates' employability skills and attributes are fostered through international collaboration. The creative industries have come to represent not only ‘soft’ cultural power but also a substantial contribution to national economies in the 21st century (DMCS, 2015). In the post-industrial knowledge economy universities are reframing what a career in the creative industries is or could be. The University of the Arts London is the largest art and design institution in Europe and its alumni practice their diverse crafts internationally and across disciplines ranging from fine arts to management. The Fashion Business School is one of three discipline-related schools at the London College of Fashion and its graduates join an industry which requires facility with working internationally and across disciplines with colleagues in design, operations, finance and promotions. Many of the established working practices of creative industries have been adopted more widely in a drive for innovation in the wake of the digital revolution which has seen a move towards less formal organizational structures and value placed on ‘diversity and divergence of opinion’ (Mathe, 2015: 135). Added value is sought through restructuring businesses to take advantage of the benefits of ‘Co-ordination, collaboration, outsourcing and open-source software’ afforded by hyper-connected living (Mathe, 2015: 135). Increasing pressure to meet the expectations of multiple stakeholders has driven the employability agenda and made it a priority in the 21st century for all higher education providers (HEA, 2016). Universities recognize the power of social media to engage alumni and boost employability prospects by building a network of graduates with a shared affinity for the institution (Lavrusik, 2009). At a less reductive level, the change that social media promised for pedagogy is one that sees students as ‘active co-producers’ of knowledge and also one where the learning process is a ‘participatory, social process supporting personal life goals and needs’(McLoughlin & Lee, 2007:664). A notion developed further as one of the ability to create ‘Personalised Learning Environments’ for students which reflect their lived experiences and create multiple online learner communities (McLoughlin & Lee, 2010: 29). Thus, social media interaction is promoted not only to enhance digital literacies necessary for 21st century job market but also to enhance self-efficacy through fostering Communities of Practice (Junco, 2012). With an increasing need to prepare our students for the globalised workplace and their future professional life, notably in the creative and communication industries, the role of education as a boundary spanner between cultures is critical (Byram & Fleming, 1998). Yet, it is important to recognise that inter-cultural empathy amongst students is not engendered by merely ‘connecting up’ with culturally different others. Rather, the inter-cultural interaction should be based on active engagement – necessitating reflection, analysis and action and these extended and ‘deep’ encounters should be facilitated by the educator (Byram, 2008). The chapter will discuss an example of a global classroom project which simulates some of the complexities of working in the modern fashion industry. Students from London College of Fashion work collaboratively with peers studying in Asia at three partner institutions: City University Hong Kong, LASALLE College of the Arts and RMIT Vietnam adopting multiple roles as researcher, advisor and expert reviewer and co-create learning outcomes which support the development of attributes and capabilities required by the future creative industries. A detailed case study will describe and evaluate this flexible informal collaboration which adopts a blended learning approach and has established a Community of Practice with over 450 students internationally. The successes enjoyed with regard to each institution’s employability and pedagogic aims as well as the cultural and practical difficulties faced will be explored. To further support the discussion the University of the Arts London employability initiative the Creative Attributes Framework will be introduced

Searches for Technosignatures: The State of the Profession

The small size of the SETI workforce is a major problem for NASA and the search for life elsewhere in the universe. The Astro2020 Decadal should address this issue by making nurturing the field an explicit priority for the next decade

New insights into the genetic etiology of Alzheimer’s disease and related dementias

Characterization of the genetic landscape of Alzheimer’s disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/‘proxy’ AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele

New insights into the genetic etiology of Alzheimer’s disease and related dementias

Characterization of the genetic landscape of Alzheimer’s disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/‘proxy’ AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele