Mortality associated with diabetes mellitus in comparison with history of cardiovascular disease in older women.

BACKGROUND: Women with diabetes mellitus have an increased risk of cardiovascular disease (CVD) mortality and current treatment guidelines consider diabetes to be equivalent to existing CVD, but few data exist about the relative importance of these risk factors for total and cause-specific mortality in older women. METHODS: We studied 9704 women aged ≥65 years enrolled in a prospective cohort study (Study of Osteoporotic Fractures) during a mean follow-up of 13 years and compared all-cause, CVD and coronary heart disease (CHD) mortality among non-diabetic women without and with a prior history of CVD at baseline and diabetic women without and with a prior history of CVD. Diabetes mellitus and prior CVD (history of angina, myocardial infarction or stroke) were defined as self-report of physician diagnoses. Cause of death was adjudicated from death certificates and medical records when available (>95% deaths confirmed). Ascertainment of vital status was 99% complete. Log-rank tests for the rates of death and multivariate Cox hazard models adjusted for age, smoking, physical activity, systolic blood pressure, waist girth and education were used to compare mortality among the four groups with non-diabetic women without CVD as the referent group. Results are reported as adjusted hazard ratios (HR) with 95% confidence intervals (CI). RESULTS: At baseline mean age was 71.7±5.3 years, 7.0% reported diabetes mellitus and 14.5% reported prior CVD. 4257 women died during follow-up, 36.6% were attributed to CVD. The incidence of CVD death per 1000 person-years was 9.9 and 21.6 among non-diabetic women without and with CVD, respectively, and 23.8 and 33.3 among diabetic women without and with CVD, respectively. Compared to nondiabetic women without prior CVD, the risk of CVD mortality was elevated among both non-diabetic women with CVD (HR=1.82, CI: 1.60-2.07, P<0.001) and diabetic women without prior CVD (HR=2.24, CI: 1.87-2.69, P<0.001). CVD mortality was highest among diabetic women with CVD (HR=3.41, CI: 2.61-4.45, P<0.001). Compared to non-diabetic women with CVD, diabetic women without prior CVD had a significantly higher adjusted HR for total and CVD mortality (P<0.001 and P<0.05 respectively). CHD mortality did not differ significantly between non-diabetic women with CVD and diabetic women without prior CVD. CONCLUSION: Older diabetic women without prior CVD have a higher risk of all-cause and CVD mortality and a similar risk of CHD mortality compared to non-diabetic women with pre-existing CVD. For older women, these data support the equivalence of prior CVD and diabetes mellitus in current guidelines for the prevention of CVD.

Family history of cancer and the risk of laryngeal cancer: a case-control study from Italy and Switzerland.

Only limited data is available on the relationship between family history of laryngeal and other neoplasms and laryngeal cancer risk. We investigated the issue using data from a multicentre case-control study conducted in Italy and Switzerland between 1992 and 2009 including 852 cases with histologically confirmed laryngeal cancer and 1970 controls admitted to hospital for acute, non neoplastic conditions. Unconditional logistic regression models adjusted for age, sex, study center, education, tobacco smoking, alcohol drinking and number of siblings were used to estimate the odds ratios (ORs) of laryngeal cancer. The multivariate OR was 2.8 (95% confidence interval [CI], 1.5-5.3) in subjects reporting a first-degree relative with laryngeal cancer, as compared to subjects with no family history. The OR was higher when the relative was diagnosed before 60 years of age (OR = 3.5, 95% CI 1.4-8.8). As compared to subjects without family history, non-smokers, and moderate drinkers, the OR was 37.1 (95% CI 9.9-139.4) for current smokers, heavy drinkers, with family history of laryngeal cancer. Family history of colorectal (OR = 1.5, 95% CI 1.0-2.3) and kidney (OR = 3.8, 95% CI 1.2-12.1) cancer were also associated to an increased risk of laryngeal cancer, while no significant increase in risk was found for family history of cancer at all sites, excluding the larynx (OR = 1.1).

Two Cultures of Arts Education, Finland and Canada? An integrated View

Taidekasvatuksen kaksi kulttuuria, Suomi ja Kanada? Integroitu näkemys Tutkimuksessa kuvataan kanadalaisen Learning Through The Arts –pedagogiikan mukainen suomalainen kokeiluhanke, jonka aikana taiteilija–opettaja-parit opettivat yhdessä eri oppiaineita koululuokille: esim. matematiikkaa tanssien, biologiaa maalaten tai yhdistäen eri taiteenlajeja projektimuotoiseen oppimiseen. Hanketta arvioitaessa nousee esille, ei niinkään yksittäisten taiteilijoiden ja opettajien toiminta, vaan pikemminkin Kanadan ja Suomen rakenteelliset sekä kulttuuriset eroavuudet. Tutkimus sivuaa myös Suomessa käytävää keskustelua taiteen hyödyllisyydestä ja pohtii samalla taito- ja taideaineiden asemaa koulussa. Työn teoreettisessa osassa integroidaan opetussuunnitelmateoriaa, kasvatuksen historiaa ja filosofiaa, tähdentäen taidekasvatuksen merkitystä osana koko ihmisen kasvatusta. Opetussuunnitelmateorian osalta tarkastellaan romanttista ja klassista opetussuunnitelmaa, jotka eroavat toisistaan menetelmiensä, sisältöjensä, tavoitteidensa sekä arvioinnin osalta. Ns. kovat ja pehmeät aineet tai matemaattis-luonnontieteelliset aineet vastakohtanaan humanismi, voidaan ymmärtää sekä historiallisia että epistemologisia taustojaan vasten. Pepperin maailmanhypoteesien mukaisesti on kasvatuksen ongelmien ratkaisemiseksi hahmotettavissa neljä selvästi toisistaan eroavaa lähestymistapaa: formismi; organisismi; mekanisismi; sekä kontekstualismi. Kantin filosofiaan viitaten tutkimus puolustaa käsitystä taiteesta rationaalisena ja propositionaalisena kokonaisuutena, joka ei ole vain kommunikaation väline, vaan yksi todellisuuden kohtaamisen lajeista, tiedon ja etiikan rinnalla. Näin ajateltuna taito- ja taidekasvatuksen tulisi olla luonteeltaan aina myös kulttuurikasvatusta. Tutkimuksen tulosten perusteella voidaan väittää, että moniammatillinen yhteistyö monipuolistaa koulun opetusta. Mikäli huolehditaan siitä, että taiteilijat saavat riittävästi koulutusta opettamiseen liittyvissä asioissa, on mahdollista käyttää taiteilijoita opettajien rinnalla koulutyössä.

A Cartoon History of Iowa, 1968

This book is for students to learn about the history of Iowa through cartoons and drawings with questions to answer at the end of each of the 75 chapters. The author and artist is Herb V. Hake.

A new perspective on the evolutionary history of western European Sorex araneus group revealed by paternal and maternal molecular markers.

The species of the common shrew (Sorex araneus) group are morphologically very similar, but have undergone a spectacular chromosomal evolution. We investigate here the evolutionary history of the Sorex araneus group distributed in western Europe. In particular, we clarify the position of a difficult species, S. granarius, using sex-specific (mtDNA and Y-chromosome) markers. The karyotype of S. granarius is generally considered similar to the common ancestor of the restricted group considered here. The mtDNA data (1.4 kb) confirms the close relationship between S. granarius and S. araneus sensu stricto (hereafter S. araneus s.s.), but the Y-chromosome (3.4 kb) produces a quite different picture: S. granarius is closely related to another species, S. coronatus. Comparison of mtDNA and Y-chromosome phylogenies suggests that the genetic and chromosomal evolution in this group are disconnected processes. The evolutionary history of the south-western European populations of the S. araneus group can only be understood considering secondary contacts between taxa after their divergence, implying genetic exchanges by means of hybridization and/or introgression.

Impact of Duration of Primary Education on School Enrollment, Graduation and Drop-outs: A Cross- Country Analysis

Using a panel data for non-OECD countries covering the period 1970-2012, this chapter analyzes the impact of the duration of primary education on school enrollment, drop-out and completion rates. The empirical results show that for children in elementary school one ad- ditional grade of primary education have a negative impact on the enrollment rate, while the e ect on drop-outs is positive. Analogously, it is obtained that an additional grade in primary education reduces the enrollment rate in secondary education. These results are in line with the fertility model approach, that is, in developing and underdeveloped countries parents do not have incentive to send children to school given the high perceived economic value of children.

Syndrome hypothénarien du marteau: étiologie peu connue de phénomène de Raynaud secondaire [Hypothenar hammer syndrome: little-known etiology of secondary Raynaud's phenomenon]

Hypothenar hammer syndrome is an uncommonly encountered cause of Raynaud's phenomenon associated with professional or recreational activities. We report 6 consecutive cases seen in our angiology unit between 1988 and 1990. Clinical findings include a history of repeated microtraumatisms of the dominant hand, male sex, unilaterality, sudden onset, and severe Raynaud's phenomenon of the last three fingers. Investigations reveal an aneurysm or thrombosis of the distal cubital artery or of the superficial palmar branch, associated with occlusion of digital arteries. Avoidance of the aggravating conditions or resection and/or plasty of the affected vascular segment usually leads to disappearance of the symptoms.

Efficacy of in-hospital multidimensional interventions of secondary prevention after acute coronary syndrome: a systematic review and meta-analysis

BACKGROUND: Secondary prevention programs for patients experiencing an acute coronary syndrome have been shown to be effective in the outpatient setting. The efficacy of in-hospital prevention interventions administered soon after acute cardiac events is unclear. We performed a systematic review and meta-analysis to determine whether in-hospital, patient-level interventions targeting multiple cardiovascular risk factors reduce all-cause mortality after an acute coronary syndrome. METHODS AND RESULTS: Using a prespecified search strategy, we included controlled clinical trials and before-after studies of secondary prevention interventions with at least a patient-level component (ie, education, counseling, or patient-specific order sets) initiated in hospital with outcomes of mortality, readmission, or reinfarction rates in acute coronary syndrome patients. We classified the interventions as patient-level interventions with or without associated healthcare provider-level interventions and/or system-level interventions. Twenty-six studies met our inclusion criteria. The summary estimate of 14 studies revealed a relative risk of all-cause mortality of 0.79 (95% CI, 0.69 to 0.92; n=37,585) at 1 year. However, the apparent benefit depended on study design and level of intervention. The before-after studies suggested reduced mortality (relative risk [RR], 0.77; 95% CI, 0.66 to 0.90; n=3680 deaths), whereas the RR was 0.96 (95% CI, 0.64 to 1.44; n=99 deaths) among the controlled clinical trials. Only interventions including a provider- or system-level intervention suggested reduced mortality compared with patient-level-only interventions. CONCLUSIONS: The evidence for in-hospital, patient-level interventions for secondary prevention is promising but not definitive because only before-after studies suggest a significant reduction in mortality. Future research should formally test which components of interventions provide the greatest benefit.

Rationale and design of a randomized, double-blind, parallel-group study of terutroban 30 mg/day versus aspirin 100 mg/day in stroke patients: the prevention of cerebrovascular and cardiovascular events of ischemic origin with terutroban in patients with a history of ischemic stroke or transient ischemic attack (PERFORM) study.

BACKGROUND: Ischemic stroke is the leading cause of mortality worldwide and a major contributor to neurological disability and dementia. Terutroban is a specific TP receptor antagonist with antithrombotic, antivasoconstrictive, and antiatherosclerotic properties, which may be of interest for the secondary prevention of ischemic stroke. This article describes the rationale and design of the Prevention of cerebrovascular and cardiovascular Events of ischemic origin with teRutroban in patients with a history oF ischemic strOke or tRansient ischeMic Attack (PERFORM) Study, which aims to demonstrate the superiority of the efficacy of terutroban versus aspirin in secondary prevention of cerebrovascular and cardiovascular events. METHODS AND RESULTS: The PERFORM Study is a multicenter, randomized, double-blind, parallel-group study being carried out in 802 centers in 46 countries. The study population includes patients aged > or =55 years, having suffered an ischemic stroke (< or =3 months) or a transient ischemic attack (< or =8 days). Participants are randomly allocated to terutroban (30 mg/day) or aspirin (100 mg/day). The primary efficacy endpoint is a composite of ischemic stroke (fatal or nonfatal), myocardial infarction (fatal or nonfatal), or other vascular death (excluding hemorrhagic death of any origin). Safety is being evaluated by assessing hemorrhagic events. Follow-up is expected to last for 2-4 years. Assuming a relative risk reduction of 13%, the expected number of primary events is 2,340. To obtain statistical power of 90%, this requires inclusion of at least 18,000 patients in this event-driven trial. The first patient was randomized in February 2006. CONCLUSIONS: The PERFORM Study will explore the benefits and safety of terutroban in secondary cardiovascular prevention after a cerebral ischemic event.

Mortality associated with diabetes mellitus in comparison with history of cardiovascular disease in older women.

Current treatment guidelines consider diabetes to be equivalent to existing cardiovascular disease (CVD), but few data exist about the relative importance of these risk factors for total and CVD mortality in older women.We studied 9704 women aged >= 65 years enrolled in a prospective cohort study (Study of Osteoporotic Fracture) during a mean follow-up of 13 years and compared all-cause and CVD mortality among non-diabetic women without and with history of CVD at baseline and diabetic women without and with history of CVD. Diabetes mellitus and CVD were defined as self-report of physician diagnoses. Cause of death was adjudicated from death certificates and medical records when available. Ascertainment of vital status was 99% complete. Multivariate Cox hazard models adjusted for age, smoking, physical activity, systolic blood pressure, waist girth and education were used to compare mortality among the four groups with non-diabetic women without CVD as the referent group. At baseline mean age was 71.7 } 5.3 years, 7.0% reported diabetes mellitus and 14.5% reported prior CVD. 4257 women died during follow-up, 36.6% were attributed to CVD. Compared to non-diabetic women without prior CVD, the risk of CVD mortality was elevated among both non-diabetic women with CVD (HR = 1.82, 95% CI: 1.60-2.07, P <0.001) and diabetic women without prior CVD (HR = 2.24, CI: 1.87-2.69, P <0.001). CVD mortality was highest among diabetic women with CVD (HR = 3.41, CI: 2.61-4.45, P <0.001). Compared to non-diabetic women with CVD, diabetic women without prior CVD had a significantly higher adjusted HR for total and CVD mortality (P < 0.001 and P <0.05 respectively). Older diabetic women without prior CVD have a higher risk of all-cause and CVD mortality compared to nondiabetic women with pre-existing CVD. For older women, these data support the equivalence of prior CVD and diabetes mellitus in current guidelines for the prevention of CVD in primary care.

Improving Information Problem Solving skills in Secondary Education through embedded instruction

This empirical study consists in an investigation of the effects, on the development of Information Problem Solving (IPS) skills, of a long-term embedded, structured and supported instruction in Secondary Education. Forty secondary students of 7th and 8th grades (13–15 years old) participated in the 2-year IPS instruction designed in this study. Twenty of them participated in the IPS instruction, and the remaining twenty were the control group. All the students were pre- and post-tested in their regular classrooms, and their IPS process and performance were logged by means of screen capture software, to warrant their ecological validity. The IPS constituent skills, the web search sub-skills and the answers given by each participant were analyzed. The main findings of our study suggested that experimental students showed a more expert pattern than the control students regarding the constituent skill ‘defining the problem’ and the following two web search sub-skills: ‘search terms’ typed in a search engine, and ‘selected results’ from a SERP. In addition, scores of task performance were statistically better in experimental students than in control group students. The paper contributes to the discussion of how well-designed and well-embedded scaffolds could be designed in instructional programs in order to guarantee the development and efficiency of the students’ IPS skills by using net information better and participating fully in the global knowledge society.

Transatlantic Influence in the Shaping of Business Education: The Origins of IMD, 1946-1990

The history of the International Institute for Management Development (IMD), one of the most prestigious business schools in the world, highlights the role of multinationals in establishing business education in Europe and the problem of legitimacy. The creation of IMD's predecessors CEI and IMEDE by Alcan and Nestlé also illuminates the role of Harvard Business School in their development and the reciprocal influences of American and European management education after World War II.

El proyecto 'Ciutat, territori, paisatge': un recurso innovador para la educación en el paisaje en la enseñanza secundaria = The project 'City, territory, countryside', an innovative resource for educating about the countryside in secondary education

The far-reaching, fast-moving changes –diffuse urbanisation, building infrastructure, moving away from agricultural space, etc.– suffered by the countryside in most European countries makes it important to have education about the countryside in place to help secondary students interpret their environment and assess the importance of managing the territory to achieve a medium ordered at human scale. The project «City, territory, countryside» is a set of materials for secondary level that aim for reflection on the countryside, work on basic competences and educating about civic-minded attitudes in students

De los contenidos a las competencias numéricas en la enseñanza obligatoria = From contents to numerical competence in Compulsory Secondary Education

Mathematics has formed part of all our daily lives since the most remote origins of our civilization, although on too many occasions schools have done little for this functional view of mathematics reclaiming the formal role of this discipline in detriment of its more practical and applied element. From this perspective the curriculum organized by competence arises due to the need to fill this vacuum and allow our students to function better in the constant elements of real situations which they are going to have to resolve throughout their lives. The specifying of this general view of mathematic competence in the numeric competence should allow all our students to progressively acquire numeric sense, that is, that they have the capacity to apply good quantitative ideas in real situations

Entrepreneurship Education in Basic and Upper Secondary Education – Measurement and Empirical Evidence

The starting point of this study is to direct more attention to the teacher and those entrepreneurship education practices taking place in formal school to find out solutions for more effective promotion of entrepreneurship education. For this objective, the strategy-level aims of entrepreneurship education need to be operationalised into measurable and understandable teacher-level practices. Furthermore, to enable the effective development of entrepreneurship education in basic and upper secondary level education, more knowledge is needed of the state of affairs of entrepreneurship education in teaching. The purpose of the study is to increase the level of understanding of teachers’ entrepreneurship education practices, and through this to develop entrepreneurship education. This study builds on the literature on entrepreneurship education and especially those elements referring to the aims, resources, benefits, methods, and practises of entrepreneurship education. The study comprises five articles highlighting teachers’ role in entrepreneurship education. In the first article the concept of entrepreneurship and the teachers role in reflection upon his/hers approaches to entrepreneurship education are considered. The second article provides a detailed analysis of the process of developing a measurement tool to depict the teachers’ activities in entrepreneurship education. The next three articles highlight the teachers’ role in directing the entrepreneurship education in basic and upper secondary level education. Furthermore, they analyse the relationship between the entrepreneurship education practises and the teachers’ background characteristics. The results of the study suggest a wide range of conclusions and implications. First, in spite of many outspoken aims connected to entrepreneurship education, teachers have not set any aims for themselves. Additionally, aims and results seem to mix. However, it is possible to develop teachers’ target orientation by supporting their reflection skills, and through measurement and evaluation increase their understanding of their own practices. Second, applying a participatory action process it is possible to operationalise teachers’entrepreneurship education practices. It is central to include the practitioners’ perspective in the development of measures to make sure that the concepts and aims of entrepreneurship education are understood. Third, teachers’ demographic or tenure-related background characteristics do not affect their entrepreneurship education practices, but their training related to entrepreneurship education, participation in different school-level or regional planning, and their own capabilities support entrepreneurship education. Fourth, a large number of methods are applied to entrepreneurship education, and the most often used methods were different kinds of discussions, which seem to be an easy, low-threshold way for teachers to include entrepreneurship education regularly in their teaching. Field trips to business enterprises or inviting entrepreneurs to present their work in schools are used fairly seldom. Interestingly, visits outside the school are more common than visitors invited to the school. In line, most of the entrepreneurship education practices take place in a classroom. Therefore it seems to be useful to create and encourage teachers towards more in-depth cooperation with companies (e.g. via joint projects) and to network systematically. Finally, there are plenty of resources available for entrepreneurship education, such as ready-made materials, external stakeholders, support organisations, and learning games, but teachers have utilized them only marginally.