OBJECTIVETo investigate the efficacy, safety, and tolerability of empagliflozin in patients with type 2 diabetes and hypertension. RESEARCH DESIGN AND METHODSPatients (N = 825) with type 2 diabetes and hypertension (mean seated systolic blood pressure [SBP] 130-159 mmHg and diastolic blood pressure [DBP] 80-99 mmHg) were randomized (double blind) to 10 mg or 25 mg empagliflozin or placebo once daily for 12 weeks. RESULTSAt week 12, adjusted mean difference versus placebo in change from baseline in mean 24-h SBP (ambulatory blood pressure monitoring [ABPM]) was 23.44 mmHg (95% CI 24.78, 22.09) with 10 mg empagliflozin and 24.16 mmHg (25.50, 22.83) with 25 mg empagliflozin (both P < 0.001). At week 12, adjusted mean difference versus placebo in change from baseline in mean 24-h DBP (ABPM) was 21.36 mmHg (95% CI 22.15, 20.56) with 10 mg empagliflozin and 21.72 mmHg (95% CI 22.51, 20.93) with 25 mg empagliflozin (both P < 0.001). Changes in office BP were consistent with ABPM. Adjusted mean difference versus placebo in change from baseline in HbA 1c at week 12 was 20.62% (95% CI 20.72, 20.52) (26.8 mmol/mol [95% CI 27.9, 25.7]) with 10 mg empagliflozin and 20.65% (95% CI 20.75, 20.55) (27.1 mmol/mol [95% CI 28.2, 26.0]) with 25 mg empagliflozin (both P < 0.001). Empagliflozin was well tolerated. One patient on placebo and one patient on 10 mg empagliflozin reported events consistent with volume depletion. CONCLUSIONSEmpagliflozin was associated with significant and clinically meaningful reductions in BP and HbA 1c versus placebo and was well tolerated in patients with type 2 diabetes and hypertension.The lifetime risk of cardiovascular disease in patients with diabetes is 67-78% (1). Management of patients with type 2 diabetes should not only aim to control glycemia but also include the modification of cardiovascular risk factors (2,3). Hypertension affects approximately two-thirds of patients with diabetes (4,5) and is a significant contributing factor to cardiovascular complications (3,6). Lowering blood pressure (BP) has been shown to reduce cardiovascular events in patients with diabetes and to exert a renoprotective effect (3,7,8). The Joint National Committee (JNC) 2003 guidelines recommended targets of systolic BP (SBP) ,130 mmHg and diastolic BP (DBP) ,80 mmHg in patients with hypertension and diabetes (9). The guidelines

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In previous studies, the report of distress has been documented in parents after successfully completing cancer treatment of a child. It is typically assumed that this distress represents lasting reactions to experiences during active treatment, in the form of post-traumatic stress or less severe crisis reactions. However, some researchers have suggested that parents may also perceive current stressors related to a child's cancer even after successful completion of the cancer treatment. Using two family cases as a framework, we discuss strain and new conditions requiring adaptation in various aspects of the everyday life of parents after treatment completion. In addition, we argue that an examination of psychological exhaustion and fatigue in these parents may be appropriate. Further examination is needed on the nature of parental stress after a child's cancer treatment. The distinction is important, since the appropriate methods for professional support may differ with regard to parents struggling to cope with current stressors and those showing signs of persistent post-traumatic stress or fatigue.

Cattle mother-offspring contact calls encode individual-identity information; however, it is unknown whether cattle are able to maintain individuality when vocalising to familiar conspecifics over other positively and negatively valenced farming contexts. Accordingly, we recorded 333 high-frequency vocalisations from 13 Holstein-Friesian heifers during oestrus and anticipation of feed (putatively positive), as well as denied feed access and upon both physical and physical & visual isolation from conspecifics (putatively negative). We measured 21 source-related and nonlinear vocal parameters and stepwise discriminant function analyses (DFA) were performed. Calls were divided into positive (n = 170) and negative valence (n = 163) with each valence acting as a ‘training set’ to classify calls in the oppositely valenced ‘test set’. Furthermore, MANOVAs were conducted to determine which vocal parameters were implicated in individual distinctiveness. Within the putatively positive ‘training set’, the cross-validated DFA correctly classified 68.2% of the putatively positive calls and 52.1% of the putatively negative calls to the correct individual, respectively. Within the putatively negative ‘training set’, the cross-validated DFA correctly assigned 60.1% of putatively negative calls and 49.4% of putatively positive calls to the correct individual, respectively. All DFAs exceeded chance expectations indicating that vocal individuality of high-frequency calls is maintained across putatively positive and negative valence, with all vocal parameters except subharmonics responsible for this individual distinctiveness. This study shows that cattle vocal individuality of high-frequency calls is stable across different emotionally loaded farming contexts. Individual distinctiveness is likely to attract social support from conspecifics, and knowledge of these individuality cues could assist farmers in detecting individual cattle for welfare or production purposes.

Vocalisations are commonly expressed by gregarious animals, including cattle, as a form of short- and long-distance communication. They can provide conspecifics with meaningful information about the physiology, affective state and physical attributes of the caller. In cattle, calls are individually distinct meaning they assist animals to identify specific individuals in the herd. Consequently, there is potential for these vocalisations to be acoustically analysed to make inferences about how individual animals or herds are coping with their external surroundings, and then act on these signals to improve feed conversion efficiency, reproductive efficiency and welfare. In the case of dairy farming, where herd sizes are expanding and farmers are becoming more reliant on technologies to assist in the monitoring of cattle, the study of vocal behaviour could provide an objective, cost effective and non-invasive alternative to traditional measures of welfare. The vocalisations of cattle in response to calf separation, social isolation and painful husbandry procedures, alongside changes to feeding and oestrous activity are here reviewed. For future application of sound technology, research is first necessary to analyse the acoustic structure of cattle vocalisations and determine the specific information they encode. This review draws together the latest research in field of cattle bioacoustics highlighting how the source-filter theory and affective state dimensional approach can be adopted to decode this information and improve on-farm management.