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Diabetic kidney disease (DKD) is now the principal cause of chronic kidney disease leading to end-stage kidney disease worldwide. As a primary contributor to the excess risk of all-cause and cardiovascular death in diabetes, DKD is a major contributor to the progressively expanding global burden of diabetes-associated morbidity and mortality. Sodium–glucose cotransporter 2 (SGLT2) inhibitors are a newer class of antihyperglycemic agents that exert glucose-lowering effects via glycosuric actions. Preclinical studies and clinical trials of SGLT2 inhibitors have consistently demonstrated reduction of albuminuria and preservation of kidney function. In particular, SGLT2 inhibitors lower risk of congestive heart failure, a major cardiovascular complication in DKD. This Perspective summarizes proposed mechanisms of action for SGLT2 inhibitors, integrates these data with results of recent cardiovascular outcomes trials, and discusses clinical applications for patients with DKD. The American Diabetes Association/European Association for the Study of Diabetes Consensus Report published online in October 2018 recommends SGLT inhibitors as preferred add-on therapy for patients with type 2 diabetes and established cardiovascular disease or chronic kidney disease, if kidney function is adequate. Results of the ongoing and just completed clinical trials conducted in patients with established DKD will facilitate further refinement of current guidelines.

This Forum provides a range of voices on the Language Gap, as our aim is to shed light on the need for more critical dialogue to accompany the proliferation of political initiatives, policymaking, educational programs, and media coverage. We highlight some relevant background on the Language Gap and describe some of the research used to support the concept. The diverse slate of Forum contributions that we have assembled approach the Language Gap topic from a range of linguistic anthropological perspectives-theoretical, empirical, political, ethnographic, personal, and experiential. Based on an acknowledgment of the need to improve educational access for economically and culturally diverse students, the subsequent discussions provide a range of perspectives designed to move away from denouncing and altering home language skills as a panacea for academic woes and social inequity. Linguistic anthropology's focus on language learning ecologies, and the sophistication therein, provides a novel perspective on the Language Gap. The contributions included below problematize existing ideologies, demonstrate the wealth of resources within various communities, and propose new directions for school practices and policymaking in an effort to bridge the "language gap" toward a more inclusive and discerning view of linguistic practices across diverse groups. [Language Gap, poverty, education, language socialization] bs_bs_banner

Individuals with a prior history of (susceptible to high altitude pulmonary edema (HAPE-S) have high resting pulmonary arterial pressures, but little data are available on their vascular response to exercise. We studied the pulmonary vascular response to exercise in seven HAPE-S and nine control subjects at sea level and at 3,810 m altitude. At each location, both normoxic (inspired PO2 = 148 Torr) and hypoxic (inspired PO2 = 91 Torr) studies were conducted. Pulmonary hemodynamic measurements included pulmonary arterial and pulmonary arterial occlusion pressures. A multiple regression analysis demonstrated that the pulmonary arterial pressure reactivity to exercise was significantly greater in the HAPE-S group. This reactivity was not influenced by altitude or oxygenation, implying that the response was intrinsic to the pulmonary circulation. Pulmonary arterial occlusion pressure reactivity to exercise was also greater in the HAPE-S group, increasing with altitude but independent of oxygenation. These findings suggest an augmented flow-dependent pulmonary vasoconstriction and/or a reduced vascular cross-sectional area in HAPE-S subjects.

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The perception of risks (e.g., diseases, accidents, and natural hazards) is investigated using a multitask, multimodel approach. We studied the proximities among 18 risks induced by three tasks: judgment of similarity, conditional prediction, and dimensional evaluation. The comparative judgments (similarity and prediction) were reasonably close, but the dimensional evaluation did not correlate highly with either similarity or prediction. Similarity judgments and conditional predictions appear to be represented best by tree models, which are based on discrete features, whereas the dimensional evaluations are better explained by spatial models, such as multidimensional scaling and factor analysis. We discuss the implications of these results for the study of mental representations and for the analysis of risk perception.Much work in cognitive psychology is aimed at constructing formal representations of specific domains of knowledge or behavior. These representations are commonly constructed on the basis of observed data using some appropriate statistical, geometric, or computer model. Formal representations of psychological structures are generally incomplete because the data usually reflect only limited aspects of the process under study and because the assumptions that underlie the representations are approximate at best. The use of reaction time, error rate, or verbal protocols, for example, provides only a limited view of human reasoning. Analogously, the use of hierarchical clustering or multidimensional scaling to represent some semantic domain may exclude significant aspects of the data or impose extraneous features that are not present in the data. Although there are no general methods for avoiding errors of omission or commission caused by the selection of tasks and models, these errors may sometimes be reduced by the use of a multitask, multimodel

Ventilation-perfusion (VA/Q) mismatch has been shown to increase during exercise, especially in hypoxia. A possible explanation is subclinical interstitial edema due to high pulmonary capillary pressures. We hypothesized that this may be pathogenetically similar to high-altitude pulmonary edema (HAPE) so that HAPE-susceptible people with higher vascular pressures would develop more exercise-induced VA/Q mismatch. To examine this, seven healthy people with a history of HAPE and nine with similar altitude exposure but no HAPE history (control) were studied at rest and during exercise at 35, 65, and 85% of maximum 1) at sea level and then 2) after 2 days at altitude (3,810 m) breathing both normoxic (inspired Po2 = 148 Torr) and hypoxic (inspired Po2 = 91 Torr) gas at both locations. We measured cardiac output and respiratory and inert gas exchange. In both groups, VA/Q mismatch (assessed by log standard deviation of the perfusion distribution) increased with exercise. At sea level, log standard deviation of the perfusion distribution was slightly higher in the HAPE-susceptible group than in the control group during heavy exercise. At altitude, these differences disappeared. Because a history of HAPE was associated with greater exercise-induced VA/Q mismatch and higher pulmonary capillary pressures, our findings are consistent with the hypothesis that exercise-induced mismatch is due to a temporary extravascular fluid accumulation.

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