Addition of aliskiren to an ACE inhibitor (or angiotensin receptor blocker) and beta-blocker had favorable neurohumoral effects in heart failure and appeared to be well tolerated.

Outlining probably represents the most common strategy recommended to help novice writers improve their writing. However, although good evidence exists that it has beneficial effects, much less is known about how it achieves these effects. In this paper, we examine how ideas are developed during outlining and how this is related to the quality of the text that is subsequently produced. We focus particularly on how the different processes are coordinated in working memory and on the differences between more and less experienced writers, and consider the implications for educational practice. Two groups of writers, differing in educational level, were asked to write argumentative essays about a discussion topic. In order to investigate the contribution of different components of working memory to outlining, secondary tasks designed to load on the central executive and visual-spatial sketchpad components of working memory were imposed during outlining. Effects of educational level and secondary tasks on the ways novice writers generated and organized their ideas during outlining, and on the resulting quality of the text, were measured. The results suggest that the beneficial effects of planning on text content depend on the extent to which new ideas are introduced during the organizational phase of planning and on the extent to which rhetorical goals are incorporated in planning. However, less experienced writers showed much less evidence of this kind of knowledge-transforming activity during outlining, and we suggest that this aspect of outlining should be the target of educational interventions. Secondary-task effects suggested that the central executive and the spatial component of the visuo-spatial sketchpad play significant, but different roles in the transformation of knowledge, with the spatial component having a specific effect on the generation of new ideas during the organizational phase of planning. We suggest that teaching interventions with novice writers should therefore include attention to the spatial properties of outlines. Finally, some evidence indicates that, although outlining has a beneficial effect on content for all writers, it may reduce the quality of verbal expression for less experienced writers. We suggest that this aspect of their writing needs to be closely monitored. Furthermore, more research into the detailed nature of the processes involved in turning plans into text needs to be conducted.

Background:The implantable cardioverter defibrillator (ICD) reduces mortality in patients at risk for life-threatening arrhythmias via high energy shock. The Florida Shock Anxiety Scale (FSAS) was developed to measure ICD patient shock-related anxiety. Initial psychometric evaluation revealed good reliability and validity. The purpose of this study was to examine the psychometrics of the FSAS in a large US sample of ICD patients.Methods: Participants were recruited via e-mail and the survey was completed online. Ultimately, 443 ICD patients (359 male and 421 White) completed the 10-item FSAS.Results: Means for FSAS were comparable to previously published data (M = 15.18, SD = 6.5). Interitem reliability was good (Cronbach's α = 0.89). The FSAS was negatively correlated with single-item measures of emotional well-being (r = -0.378, P < 0.01), sense of security (r = -0.365, P < 0.01), perceived general health (r = -0.185, P < 0.01), and quality of life (r = -0.216, P < .01), demonstrating discriminant validity. Convergent validity was supported through significant correlations with number of shocks (r = 0.464, P < 0.01) and reported disruptiveness of shock (r = 0.484, P < 0.01). Confirmatory factor analysis revealed that a single (second-order) factor model (χ 2 [34] = 75.34, P < 0.05, comparative fit index = 0.98, root mean-square error of approximation = 0.05) had the best fit.Conclusions: Shock anxiety as a construct can be measured in a reliable and valid method by the FSAS. These nationally representative data suggest that a single score for shock anxiety is an easy to use and appropriate method of assessment. (PACE 2012; 35:1146-1153 implantable cardioverter defibrillator, anxiety, psychometrics, assessment, psychosocial

I In nt tr ro od du uc ct ti io on n. . Aliskiren is the first in a new class of direct renin inhibitors to be approved for the treatment of hypertension. P Pa at ti ie en nt ts s a an nd d m me et th ho od ds s. . In this double-blind, multicentre trial, 694 patients with hypertension (mean sitting diastolic blood pressure [BP] ≥ 95 and < 110 mmHg) were randomised to once-daily aliskiren 150 mg (n=231), atenolol 50 mg (n=231) or the combination (150/50 mg; n=232) for six weeks, followed by a further six weeks on double the initial doses of aliskiren and atenolol. Efficacy (reduction from baseline in mean sitting systolic and diastolic BP) and tolerability of study treatments were assessed; plasma renin activity (PRA) was measured in a subset of patients. R Re es su ul lt ts s. . At Week 12 endpoint, aliskiren, atenolol and aliskiren/atenolol lowered systolic and diastolic BP from baseline by 14.3/11.3, 14.3/13.7 and 17.3/14.1 mmHg, respectively. Systolic BP reductions with aliskiren/atenolol were significantly greater than those with aliskiren (p=0.039) or atenolol (p=0.034) alone, and diastolic BP reductions were greater than with aliskiren alone (p<0.001). Diastolic BP changes were larger with atenolol than with aliskiren (p=0.003, correlating with the large reductions in pulse rate (> 10 bpm) observed with atenolol. Aliskiren, atenolol and aliskiren/atenolol reduced geometric mean PRA from baseline by 65%, 52% and 61%, respectively. In patients with moderate or high baseline PRA (≥ 0.65 ng/ml/hour), PRA was reduced to low levels (< 0.65 ng/ml/hour) at Week 12 endpoint in a greater proportion of patients receiving aliskiren (11/15 patients, 73.3%) or aliskiren/atenolol (18/23, 78.3%) than with atenolol (10/21, 47.6%). Aliskiren treatment was associated with numerically lower rates of adverse events and discontinuations due to adverse events compared with atenolol or combination treatment, and unlike atenolol was not associated with bradycardia. C Co on nc cl lu us si io on ns s. . Direct renin inhibition with aliskiren may be an appropriate substitute for beta-blocker treatment in patients with uncomplicated hypertension. Aliskiren also represents an attractive option for dual therapy with atenolol to improve systolic BP/pulse pressure reductions and BP control with maintained tolerability compared with atenolol alone.