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

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'If you had only listened carefully...':the discursive construction of emerging leadership in a UK all-women management team

Increasingly, feminist linguistic research has adopted a discursive perspective to learn how women and men 'do' leadership in gendered ways. 'Women' as a social category is made relevant to this study by virtue of the lack of female senior leaders in UK businesses (Sealy and Vinnicombe, 2013). Much previous research has analysed leadership discourse in mixed gender groups, relying on theories that imply comparisons between men and women. Using an Interactional Sociolinguistic approach, this study aims to learn more about how women perform leadership in the absence of men by analysing the spoken interactions of a women-only team who were engaged in a competitive leadership task. The analysis reveals that the women accomplish leadership in multiple and complex ways that defy binary gendered classifications. Nonetheless, there is a distinctive gendered dynamic to the team's interactions which, it is argued, might be disadvantageous to women aspiring to senior positions

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

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

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

Literary ethnography of evidence-based healthcare : accessing the emotions of rational-technical discourse

In this article I revisit the idea of literary ethnography (proposed by Van de Poel-Knottnerus and Knottnerus, 1994) as a method for investigating social phenomena constituted principally through literature. I report the use of this method to investigate the topic of evidence-based healthcare, EBHC. EBHC is a field of discourse much built upon a dichotomy between rationality and emotionality. In this context literary ethnography, a particular type of discourse analysis, is valuable for allowing researchers to bring the emotional currents of technical-rational discourse into conscious awareness. In such discourses, emotions are not written out by name. The researcher must discern emotional phenomena by experiencing the discourse, and (try to) bring them into intelligible expression. As I clarify this process I develop Van de Poel-Knottnerus and Knottnerus’ method theoretically, look to destabilise the rationalityemotionality dichotomy foundational to discourse around EBHC, and so transgress its conventional lines of thought.PostprintPeer reviewe

Effect of a reduction in glomerular filtration rate after nephrectomy on arterial stiffness and central hemodynamics: rationale and design of the EARNEST study

Background: There is strong evidence of an association between chronic kidney disease (CKD) and cardiovascular disease. To date, however, proof that a reduction in glomerular filtration rate (GFR) is a causative factor in cardiovascular disease is lacking. Kidney donors comprise a highly screened population without risk factors such as diabetes and inflammation, which invariably confound the association between CKD and cardiovascular disease. There is strong evidence that increased arterial stiffness and left ventricular hypertrophy and fibrosis, rather than atherosclerotic disease, mediate the adverse cardiovascular effects of CKD. The expanding practice of live kidney donation provides a unique opportunity to study the cardiovascular effects of an isolated reduction in GFR in a prospective fashion. At the same time, the proposed study will address ongoing safety concerns that persist because most longitudinal outcome studies have been undertaken at single centers and compared donor cohorts with an inappropriately selected control group.<p></p> Hypotheses: The reduction in GFR accompanying uninephrectomy causes (1) a pressure-independent increase in aortic stiffness (aortic pulse wave velocity) and (2) an increase in peripheral and central blood pressure.<p></p> Methods: This is a prospective, multicenter, longitudinal, parallel group study of 440 living kidney donors and 440 healthy controls. All controls will be eligible for living kidney donation using current UK transplant criteria. Investigations will be performed at baseline and repeated at 12 months in the first instance. These include measurement of arterial stiffness using applanation tonometry to determine pulse wave velocity and pulse wave analysis, office blood pressure, 24-hour ambulatory blood pressure monitoring, and a series of biomarkers for cardiovascular and bone mineral disease.<p></p> Conclusions: These data will prove valuable by characterizing the direction of causality between cardiovascular and renal disease. This should help inform whether targeting reduced GFR alongside more traditional cardiovascular risk factors is warranted. In addition, this study will contribute important safety data on living kidney donors by providing a longitudinal assessment of well-validated surrogate markers of cardiovascular disease, namely, blood pressure and arterial stiffness. If any adverse effects are detected, these may be potentially reversed with the early introduction of targeted therapy. This should ensure that kidney donors do not come to long-term harm and thereby preserve the ongoing expansion of the living donor transplant program.<p></p&gt

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

Open-label, multicentre, dose-escalating phase II clinical trial on the safety and efficacy of tadekinig alfa (IL-18BP) in adult-onset Still's disease.

Adult-onset Still's disease (AOSD) is a rare systemic autoinflammatory disease; its management is largely empirical. This is the first clinical study to determine if interleukin (IL)-18 inhibition, using the recombinant human IL-18 binding protein, tadekinig alfa, is a therapeutic option in AOSD. In this phase II, open-label study, patients were ≥18 years with active AOSD plus fever or C reactive protein (CRP) levels ≥10 mg/L despite treatment with prednisone and/or conventional synthetic disease-modifying antirheumatic drugs (DMARDs). Previous biological DMARD treatment was permitted. Patients received tadekinig alfa 80 mg or 160 mg subcutaneously three times per week for 12 weeks; those receiving 80 mg not achieving early predicted response criteria (reduction of ≥50% CRP values from baseline and fever resolution) were up-titrated to 160 mg for a further 12 weeks. The primary endpoint was the occurrence of adverse events (AEs) throughout the study. Ten patients were assigned to receive 80 mg tadekinig alfa and 13 patients to the 160 mg dose. One hundred and fifty-five treatment-emerging AEs were recorded, and 47 were considered related to the study drug. Most AEs were mild and resolved after drug discontinuation. Three serious AEs occurred, one possibly related to treatment (toxic optic neuropathy). At week 3, 5 of 10 patients receiving 80 mg and 6 of 12 patients receiving 160 mg achieved the predefined response criteria. Our results indicate that tadekinig alfa appears to have a favourable safety profile and is associated with early signs of efficacy in patients with AOSD. NCT02398435