An inspiratory load enhances the antihypertensive effects of home-based training with slow deep breathing: a randomised trial

QuestionCan adding an inspiratory load enhance the antihypertensive effects of slow breathing training performed at home?DesignRandomised trial with concealed allocation.ParticipantsThirty patients with essential hypertension Stage I or II.InterventionExperimental groups performed slow deep breathing at home, either unloaded or breathing against a load of 20 cmH2O using a threshold-loaded breathing device. Participants trained for 30 min, twice daily for 8 weeks. A control group continued with normal activities.Outcome measuresResting blood pressure and heart rate were measured at home and in the laboratory before and after the training period.ResultsCompared to the control group, systolic and diastolic blood pressure decreased significantly with unloaded breathing by means of 7.0 mmHg (95% CI 5.5 to 8.5) and 13.5 mmHg (95% CI 11.3 to 15.7), respectively (laboratory measures). With loaded breathing, the reductions were greater at 18.8 mmHg (95% CI 16.1 to 21.5) and 8.6 mmHg (95% CI 6.8 to 10.4), respectively. The improvement in systolic blood pressure was 5.3 mmHg (95% CI 1.0 to 9.6) greater than with unloaded breathing. Heart rate declined by 8 beats/min (95% CI 6.5 to 10.3) with unloaded breathing, and 9 beats/min (95% CI 5.6 to 12.2) with loaded breathing. Very similar measures of blood pressure and heart rate were obtained by the patients at home.ConclusionHome-based training with a simple device is well tolerated by patients and produces clinically valuable reductions in blood pressure. Adding an inspiratory load of 20 cmH2O enhanced the decrease in systolic blood pressure.Trial registrationNCT007919689

Validated Risk Score for Predicting 6-Month Mortality in Infective Endocarditis.

Background Host factors and complications have been associated with higher mortality in infective endocarditis (IE). We sought to develop and validate a model of clinical characteristics to predict 6-month mortality in IE. Methods and Results Using a large multinational prospective registry of definite IE (International Collaboration on Endocarditis [ICE]-Prospective Cohort Study [PCS], 2000-2006, n=4049), a model to predict 6-month survival was developed by Cox proportional hazards modeling with inverse probability weighting for surgery treatment and was internally validated by the bootstrapping method. This model was externally validated in an independent prospective registry (ICE-PLUS, 2008-2012, n=1197). The 6-month mortality was 971 of 4049 (24.0%) in the ICE-PCS cohort and 342 of 1197 (28.6%) in the ICE-PLUS cohort. Surgery during the index hospitalization was performed in 48.1% and 54.0% of the cohorts, respectively. In the derivation model, variables related to host factors (age, dialysis), IE characteristics (prosthetic or nosocomial IE, causative organism, left-sided valve vegetation), and IE complications (severe heart failure, stroke, paravalvular complication, and persistent bacteremia) were independently associated with 6-month mortality, and surgery was associated with a lower risk of mortality (Harrell's C statistic 0.715). In the validation model, these variables had similar hazard ratios (Harrell's C statistic 0.682), with a similar, independent benefit of surgery (hazard ratio 0.74, 95% CI 0.62-0.89). A simplified risk model was developed by weight adjustment of these variables. Conclusions Six-month mortality after IE is 25% and is predicted by host factors, IE characteristics, and IE complications. Surgery during the index hospitalization is associated with lower mortality but is performed less frequently in the highest risk patients. A simplified risk model may be used to identify specific risk subgroups in I

Sensitivity to situated positionings: Generating insight into organizational change

Within ethnographic forms of organisational research, sensitivity to context is generally acknowledged as a critical ingredient for analysing processes and practices. When conducting such research, however, researchers typically privilege one particular research context for generating knowledge: although some ethnographic scholars underscore the importance of adopting a diversity of both insider and outsider roles, ethnographic research is usually equated with gaining a deep familiarity with the field of study through immersion. First, we argue that, although immersion elicits valuable knowledge ‘from within’, its prioritisation inevitably blinds the researcher’s eye to equally interesting insights stemming from alternative – and often unintended – positionings. Testifying to the significance of researchers’ relational reflexivity for data interpretation, we show how a variety of researcher’ positionings vis-à-vis the researched generated a variety of insights. Critical sensitivity to fieldworker identities in an ethnographic study of planned organisational change within a police organisation allowed us, second, to criticise the change management literature for routinely building on a fixed dichotomy between ‘change agents’ and ‘change recipients’ and to empirically demonstrate a wider variety of police officers’ positionings in relation to change initiatives (i.e. countering, complying with and co-opting) and its initiators (i.e. engaging in other-depreciating, self-questioning or self-affirming identity work)

“This Disgusting Feast of Filth”: Meat Eating, Hospitality, and Violence in Sarah Kane’s Blasted

Sarah Kane’s Blasted (1995) scandalised its early audiences with its staging of sexual violence, war crimes, and cannibalism. One reviewer famously described it as a ‘disgusting feast of filth’, an appraisal which unwittingly captures the centrality of questions of appetite to the play’s ethical project. In this essay, I argue that attention to the consumption of meat is crucial to a fuller understanding of the play’s well-documented interest in sexual violence and militarism. I trace how Kane brings meat into an economy of exchange, hospitality, and gift-giving which, while ostensibly driven by care, is nonetheless thoroughly structured by violence

The affordance of compassion for animals: a filmic exploration of industrial linear rhythms

Compassion is an emotion that could be useful for improving the lives of animals within the intensive and factory farming system (IFFS). Rhythms that exist within this system play a role in making compassion difficult to realize, which formulates the research question: How do the rhythms of the IFFS shape the affordance of compassion for animals? Drawing on a cultural mode of analysis informed by Henri Lefebvre’s work on rhythms, this paper explored the rhythms of three films that focus on the treatment of animals in this system: Meat; Our Daily Bread and Never Let Me Go. Industrial linear rhythms seem to compromise the compassion offered to animals in the IFFS by manipulating the cyclical rhythms of animals and animalized bodies from birth, through life and at death. Compassion for animals and animalized bodies in the IFFS, this paper concludes, is often provided in a piecemeal and localized manner

Was Jack the Ripper a Slaughterman? Human-Animal Violence and the World’s Most Infamous Serial Killer

Hundreds of theories exist concerning the identity of “Jack the Ripper”. His propensity for anatomical dissection with a knife—and in particular the rapid location and removal of specific organs—led some to speculate that he must have been surgically trained. However, re-examination of a mortuary sketch of one of his victims has revealed several aspects of incisional technique highly inconsistent with professional surgical training. Related discrepancies are also apparent in the language used within the only letter from Jack considered to be probably authentic. The techniques he used to dispatch his victims and retrieve their organs were, however, highly consistent with techniques used within the slaughterhouses of the day. East London in the 1880s had a large number of small-scale slaughterhouses, within which conditions for both animals and workers were exceedingly harsh. Modern sociological research has highlighted the clear links between the infliction of violence on animals and that inflicted on humans, as well as increased risks of violent crimes in communities surrounding slaughterhouses. Conditions within modern slaughterhouses are more humane in some ways but more desensitising in others. The implications for modern animal slaughtering, and our social reliance on slaughterhouses, are explored

State of the field: What can political ethnography tell us about anti-politics and democratic disaffection?

This article adopts and reinvents the ethnographic approach to uncover what governing elites do, and how they respond to public disaffection. Although there is significant work on the citizens’ attitudes to the governing elite (the demand side) there is little work on how elites interpret and respond to public disaffection (the supply side). We argue that ethnography is the best available research method for collecting data on the supply side. In doing so, we tackle long-standing stereotypes in political science about the ethnographic method and what it is good for. We highlight how the innovative and varied practices of contemporary ethnography are ideally suited to shedding light into the ‘black box’ of elite politics. We demonstrate the potential pay-off with reference to important examples of elite ethnography from the margins of political science scholarship. The implications from these rich studies, we argue, suggest a reorientation of how we understand the drivers of public disaffection and the role that political elites play in exacerbating cynicism and disappointment. We conclude by pointing to the benefits to the discipline in embracing elite ethnography both to diversify the methodological toolkit in explaining the complex dynamics of disaffection,and to better enable engagement in renewed public debate about the political establishment

The tyranny of light

“I celebrate opacity, secretiveness, and obstruction!” pro-claimed no one, ever, in the social sciences. As with “love” and “democracy,” merely uttering the words transparency and openness generates a Pavlovian stream of linguistically induced serotonin. Who, really, would want to come out on record as a transparency-basher, an openness-hater? But as with love and democracy, it is the specific details of what is meant by transparency and openness, rather than their undeniable power and appeal as social science ideals, that most matter. This, to me, is the single most important point to be made about the DA-RT