Is it time to reappraise blood pressure thresholds and targets? Statement from the international society of hypertension - a global perspective

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Management and efficacy of intensified insulin therapy starting in outpatients

Diabetic patients under multiple injection insulin therapy (i.e., intensified insulin therapy, IIT) usually start this treatment during hospitalization. We report here on the logistics, efficacy, and safety of IIT, started in outpatients. Over 8 months, 52 type I and type II diabetics were followed up whose insulin regimens consecutively had been changed from conventional therapy to IIT. Two different IIT strategies were compared: free mixtures of regular and intermediate (12 hrs)-acting insulin versus the basal and prandial insulin treatment with preprandial injections of regular insulin, and ultralente (24 hrs-acting) or intermediate insulin for the basal demand. After 8 months HbA1 levels had decreased from 10.6%±2.4% to 8.0%±1.3% (means±SD). There was no difference between the two regimens with respect to metabolic control; but type II patients maintained the lowered HbA1 levels better than type I patients. Only two patients were hospitalized during the follow-up time because of severe hypoglycemia. An increase of body weight due to the diet liberalization during IIT became a problem in one-third of the patients. Our results suggest that outpatient initiation of IIT is safe and efficacious with respect to near-normoglycemic control. Weight control may become a problem in IIT patients

Communicative competence and institutional affiliation: interactional processes of identity construction by immigrant students in Catalonia

The growing presence of children of immigrant families in the public school system in the bilingual region of Catalonia provides us with an opportunity to study how young multilingual and multicultural speakers construct their social competencies and their identity within the specific context of a gate-keeping social institution such as the school. The study reported in this paper approaches language learning as a process of socialisation that involves not only learning how to make sense of linguistic signs but also learning how to enact different social roles in particular institutions. The analysis focuses on the interactional profiles of two immigrant students in two types of communicative activities that are representative of the school context: responding to questions from an adult and cooperating with a peer in the resolution of a learning task. By shifting the focus of analysis from a decontextualised notion of communicative competence to the notion of 'institutionally affiliated communicative competence' and concentrating on issues such as the (1) the relationship between knowledge and participation, (2) language choice inside and outside school and (3) definitions of correctness in language use, the study reveals how the two students construct a highly 'affiliated' identit

Analytic frameworks for assessing dialogic argumentation in online learning environments

Over the last decade, researchers have developed sophisticated online learning environments to support students engaging in argumentation. This review first considers the range of functionalities incorporated within these online environments. The review then presents five categories of analytic frameworks focusing on (1) formal argumentation structure, (2) normative quality, (3) nature and function of contributions within the dialog, (4) epistemic nature of reasoning, and (5) patterns and trajectories of participant interaction. Example analytic frameworks from each category are presented in detail rich enough to illustrate their nature and structure. This rich detail is intended to facilitate researchers’ identification of possible frameworks to draw upon in developing or adopting analytic methods for their own work. Each framework is applied to a shared segment of student dialog to facilitate this illustration and comparison process. Synthetic discussions of each category consider the frameworks in light of the underlying theoretical perspectives on argumentation, pedagogical goals, and online environmental structures. Ultimately the review underscores the diversity of perspectives represented in this research, the importance of clearly specifying theoretical and environmental commitments throughout the process of developing or adopting an analytic framework, and the role of analytic frameworks in the future development of online learning environments for argumentation

A Qualitative Methodology for Studying Parent–Child Argumentation

This chapter provides a detailed exposé of the research methodology on which the investigation of parent–child argumentation during mealtime is based. In the first part, the conceptual tools adopted for the analysis of argumentative discussions between parents and children, i.e., the pragma-dialectical ideal model of a critical discussion and the Argumentum Model of Topics, are presented. Subsequently, the process of data gathering and the procedures for the transcription of oral data are discussed. Finally, in the last part of the chapter, ethical issues and practical problems in collecting parent–child mealtime conversations present throughout the study are considered

Impaired flow-induced arterial remodeling in DOCA-salt hypertensive rats

Arteries from young healthy animals respond to chronic changes in blood flow and blood pressure by structural remodeling. We tested whether the ability to respond to decreased (-90%) or increased (+100%) blood flow is impaired during the development of deoxycorticosterone acetate (DOCA)-salt hypertension in rats, a model for an upregulated endothelin-1 system. Mesenteric small arteries (MrA) were exposed to low blood flow (LF) or high blood flow (HF) for 4 or 7 weeks. The bioavailability of vasoactive peptides was modified by chronic treatment of the rats with the dual neutral endopeptidase (NEP)/endothelin-converting enzyme (ECE) inhibitor SOL1. After 3 or 6 weeks of hypertension, the MrA showed hypertrophic arterial remodeling (3 weeks: media cross-sectional area (mCSA): 10 +/- 1 x 10(3) to 17 +/- 2 x 10(3) mu m(2); 6 weeks: 13 +/- 2 x 10(3) to 24 +/- 3 x 10(3) mu m(2)). After 3, but not 6, weeks of hypertension, the arterial diameter was increased (empty set: 385 +/- 13 to 463 +/- 14 mu m). SOL1 reduced hypertrophy after 3 weeks of hypertension (mCSA: 6 x 10(3) +/- 1 x 10(3) mu m(2)). The diameter of the HF arteries of normotensive rats increased (empty set: 463 +/- 22 mu m) but no expansion occurred in the HF arteries of hypertensive rats (empty set: 471 +/- 16 mu m). MrA from SOL1-treated hypertensive rats did show a significant diameter increase (empty set: 419 +/- 13 to 475 +/- 16 mu m). Arteries exposed to LF showed inward remodeling in normotensive and hypertensive rats (mean empty set between 235 and 290 mu m), and infiltration of monocyte/ macrophages. SOL1 treatment did not affect the arterial diameter of LF arteries but reduced the infiltration of monocyte/ macrophages. We show for the first time that flow-induced remodeling is impaired during the development of DOCA-salt hypertension and that this can be prevented by chronic NEP/ECE inhibition. Hypertension Research (2012) 35, 1093-1101; doi:10.1038/hr.2012.94; published online 12 July 201

Transgenic Mice Over-Expressing ET-1 in the Endothelial Cells Develop Systemic Hypertension with Altered Vascular Reactivity

Endothelin-1 (ET-1) is a potent vasoconstrictor involved in the regulation of vascular tone and implicated in hypertension. However, the role of small blood vessels endothelial ET-1 in hypertension remains unclear. The present study investigated the effect of chronic over-expression of endothelial ET-1 on arterial blood pressure and vascular reactivity using transgenic mice approach. Transgenic mice (TET-1) with endothelial ET-1 over-expression showed increased in ET-1 level in the endothelial cells of small pulmonary blood vessels. Although TET-1 mice appeared normal, they developed mild hypertension which was normalized by the ETA receptor (BQ123) but not by ETB receptor (BQ788) antagonist. Tail-cuff measurements showed a significant elevation of systolic and mean blood pressure in conscious TET-1 mice. The mice also exhibited left ventricular hypertrophy and left axis deviation in electrocardiogram, suggesting an increased peripheral resistance. The ionic concentrations in the urine and serum were normal in 8-week old TET-1 mice, indicating that the systemic hypertension was independent of renal function, although, higher serum urea levels suggested the occurrence of kidney dysfunction. The vascular reactivity of the aorta and the mesenteric artery was altered in the TET-1 mice indicating that chronic endothelial ET-1 up-regulation leads to vascular tone imbalance in both conduit and resistance arteries. These findings provide evidence for the role of spatial expression of ET-1 in the endothelium contributing to mild hypertension was mediated by ETA receptors. The results also suggest that chronic endothelial ET-1 over-expression affects both cardiac and vascular functions, which, at least in part, causes blood pressure elevation

Complex systems and applied linguistics

This book introduces and develops the potential of complex systems as a metaphor or supra-theory for systems in applied linguistics. Change and heterogeneity are central to complex systems theory and to the resonances that we find between complex systems and applied linguistics systems. The book explores these resonances and what happens when complex systems theory is used to make sense of central areas of applied linguistic concerns: language, language learning, discourse and the language classroom. Principles of complex systems theory are explained, drawing on work that has been most developed in the biological sciences and that is being extended into the social sciences, developmental psychology and other applied disciplines. These principles importantly include descriptions of change over time (system dynamics) that work for all levels and scales: movement from temporary and relative stability through adaptive behaviours and self-organisation to the emergence of new patterns that are not amenable to reductive explanations. Seeing applied systems as complex, adaptive and dynamic opens up new conceptualisations of properties and activities, enables new questions about how people use, learn and teach languages, and demands new ways of investigating behaviour and development

An introduction to video methods in organizational research

Video has become a methodological tool of choice for many researchers in social science, but video methods are relatively new to the field of organization studies. This article is an introduction to video methods. First, we situate video methods relative to other kinds of research, suggesting that video recordings and analyses can be used to replace or supplement other approaches, not only observational studies but also retrospective methods such as interviews and surveys. Second, we describe and discuss various features of video data in relation to ontological assumptions that researchers may bring to their research design. Video involves both opportunities and pitfalls for researchers, who ought to use video methods in ways that are consistent with their assumptions about the world and human activity. Third, we take a critical look at video methods by reporting progress that has been made while acknowledging gaps and work that remains to be done. Our critical considerations point repeatedly at articles in this special issue, which represent recent and important advances in video method