Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

Background: The EMPA KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. Methods: EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. Findings: Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5–2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62–0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16–1·59), representing a 50% (42–58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). Interpretation: In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. Funding: Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council

Development of a situational judgment test for global engineering competency

Background: As globalization continues to impact the engineering profession, many programs aim to prepare current and future engineers to work across national and cultural boundaries. Yet there remains a lack of quality tools for assessing global competency among engineers and other technical professionals, including their behavioral tendencies in global work situations. Purpose: We introduce development of a situational judgment test (SJT) covering three dimensions of global engineering competency (GEC) in Chinese national/cultural context. The main aim of this article is to describe how the SJT was developed through a systematic multistep process. Secondarily, we explore relationships between SJT performance and other theoretically relevant variables. Methods: After generating a large initial pool of SJT scenarios and behavioral response items, we used ratings from subject matter experts (SMEs) to select six SJT scenarios and create scoring keys for 26 response items. To further explore the instrument\u27s validity, we deployed the SJT items, other relevant measures, and a demographic survey to a sample of practicing engineers (n = 400). Results: SME ratings provide strong evidence for the content relevance of the GEC–SJT tool. Survey results also suggest positive relationships between SJT performance and Chinese cultural knowledge, age, and years of work experience. However, more validity and reliability evidence is needed before recommending wider use of the instrument. Conclusions: Our findings suggest the SJT format as a promising behavior-based approach to measuring global competency and other professional attributes in engineering. We also discuss directions for future research and training efforts related to assessing and developing global competency

Cultural and Intellectual Openness Differentially Relate to Social Judgments of Potential Work Partners

Objective: This study investigates the differential functioning of cultural and intellectual openness (the two aspects of Openness to Experience) in relation to social cognitive processes by examining how they influence people\u27s perceptions and interpretations of social information when deciding to initiate working relationships. Method: Using a policy-capturing design, 681 adult participants were asked to rate their similarity to and preference to work with potential work partners characterized by varying nationalities and levels of work-related competence. Multilevel moderated mediation was conducted to simultaneously evaluate whether the indirect effects of potential work partners’ characteristics (i.e., nationalities and levels of work-related competence) on work partner preference through perceived similarity were moderated by cultural and intellectual openness. Results: Perceived similarity mediated the relationships between work partner nationality and work-related competence and participants’ work partner preferences. Furthermore, the negative indirect effect of work partner nationality on work partner preference via perceived similarity was attenuated by cultural openness, and the positive indirect effect of work partner work-related competence on work partner preference via perceived similarity was strengthened by intellectual openness. Conclusions: Cultural and intellectual openness may have distinct functions that influence how people perceive, evaluate, and appreciate social information when making social judgments

Who’s that? - Social situation awareness for behaviour support agents: A feasibility study

Behaviour support agents need to be aware of the social environment of the user in order to be able to provide comprehensive support. However, this is a feature that is currently lacking in existing systems. To tackle it, first of all we explore literature from social sciences in order to find which elements of the social environment need to be represented. We structure this knowledge as a two-level ontology that models social situations. We formalize the elements that are needed to model social situations, which consist of different types of meetings between two people. We conduct an experiment to evaluate the lower level of the ontology using feedback from the subjects, and to test whether we can use the data to reason about the priority of different situations. Subjects found our proposed features of social relationships to be understandable and representative. Furthermore, we show these features can be combined in a decision tree to predict the priority of social situations.Interactive Intelligenc

Den motiverende endringen – livsstilsendringer for hjerteinfarktpasienter

Tittel: Den motiverende endringen – livsstilsendringer for hjerteinfarktpasienter Hensikt: Hensikten med oppgaven er å undersøke om sykepleiere kan bidra med å hjelpe pasienter som har gjennomgått et hjerteinfarkt, til å endre livsstil gjennom en metode som kalles motiverende intervju. Problemstilling: Hvordan kan sykepleier gjennom motiverende intervju bidra til livsstilsendringer hos pasienter som har gjennomgått sitt første hjerteinfarkt? Metode: Denne bacheloroppgaven er et litteraturstudium, hvor det er utført strukturerte og systematiske søk for å finne relevante forskningsartikler i ulike databaser for å belyse min problemstilling. Det er også foretatt en ressurssamtale med en fagperson relatert til motiverende intervju. Kunnskap er supplert med pensumbøker fra sykepleierstudiet og andre relevante fagbøker. Resultat: Motiverende intervju er en metode som kan benyttes til livsstilsendring for pasienter med behov for endring, og viser god effekt innen områder som fysisk aktivitet, røykeslutt og kolesterol. Behandlingshastighet for pasienter som har gjennomgått hjerteinfarkt, påvirker motivasjonen. Sosial støtte er også viktig i tiden etter et hjerteinfarkt. Konklusjon: Bruk av motiverende intervju må tilpasses pasientens endringsforberedthet i «Stages of Change». Mestringsforventning og indre motivasjon er viktig for endringen. Sykeleie fremheves som en god profesjon for å utøve MI angående livsstilsendringer, men likevel er det opp til pasienten om livsstilen vil bli endret eller ikke. Nøkkelord: Motiverende intervju, livsstilsendring, hjerteinfark

The Relation Between Attachment and Depression in Children and Adolescents: A Multilevel Meta-Analysis

Insecure attachment to primary caregivers is associated with the development of depression symptoms in children and youth. This association has been shown by individual studies testing the relation between attachment and depression and by meta-analyses focusing on broad internalizing problems instead of depression or adult samples only. We therefore meta-analytically examined the associations between attachment security and depression in children and adolescents, using a multilevel approach. In total, 643 effect sizes were extracted from 123 independent samples. A significant moderate overall effect size was found (r = .31), indicating that insecure attachment to primary caregivers is associated with depression. Multivariate analysis of the significant moderators that impacted on the strength of the association between attachment security and depression showed that country of the study, study design, gender, the type of attachment, and the type of instrument to assess attachment uniquely contributed to the explanation of variance. This study suggests that insecure attachment may be a predictor of the development of depression in children and adolescents. When treating depression in children, attachment should therefore be addressed