Discourse-analytic approaches to text and talk

This chapter explores the different ways in which discourse-analytic approaches reveal the ‘meaningfulness’ of text and talk. It reviews four diverse approaches to discourse analysis of particular value for current research in linguistics: Conversation Analysis (CA), Discourse Analysis (DA), Critical Discourse Analysis (CDA) and Feminist Post-structuralist Discourse Analysis (FPDA). Each approach is examined in terms of its background, motivation, key features, and possible strengths and limitations in relation to the field of linguistics. A key way to schematize discourse-analytic methodology is in terms of its relationship between microanalytical approaches, which examine the finer detail of linguistic interactions in transcripts, and macroanalytical approaches, which consider how broader social processes work through language (Heller, 2001). This chapter assesses whether there is a strength in a discourse-analytic approach that aligns itself exclusively with either a micro- or macrostrategy, or whether, as Heller suggests, the field needs to fi nd a way of ‘undoing’ the micro–macro dichotomy in order to produce richer, more complex insights within linguistic research.

Alogliptin after acute coronary syndrome in patients with type 2 diabetes

Background - To assess potentially elevated cardiovascular risk related to new antihyperglycemic drugs in patients with type 2 diabetes, regulatory agencies require a comprehensive evaluation of the cardiovascular safety profile of new antidiabetic therapies. We assessed cardiovascular outcomes with alogliptin, a new inhibitor of dipeptidyl peptidase 4 (DPP-4), as compared with placebo in patients with type 2 diabetes who had had a recent acute coronary syndrome. Methods - We randomly assigned patients with type 2 diabetes and either an acute myocardial infarction or unstable angina requiring hospitalization within the previous 15 to 90 days to receive alogliptin or placebo in addition to existing antihyperglycemic and cardiovascular drug therapy. The study design was a double-blind, noninferiority trial with a prespecified noninferiority margin of 1.3 for the hazard ratio for the primary end point of a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. Results - A total of 5380 patients underwent randomization and were followed for up to 40 months (median, 18 months). A primary end-point event occurred in 305 patients assigned to alogliptin (11.3%) and in 316 patients assigned to placebo (11.8%) (hazard ratio, 0.96; upper boundary of the one-sided repeated confidence interval, 1.16; P<0.001 for noninferiority). Glycated hemoglobin levels were significantly lower with alogliptin than with placebo (mean difference, -0.36 percentage points; P<0.001). Incidences of hypoglycemia, cancer, pancreatitis, and initiation of dialysis were similar with alogliptin and placebo. Conclusions - Among patients with type 2 diabetes who had had a recent acute coronary syndrome, the rates of major adverse cardiovascular events were not increased with the DPP-4 inhibitor alogliptin as compared with placebo. (Funded by Takeda Development Center Americas; EXAMINE ClinicalTrials.gov number, NCT00968708.)