Secondary prevention in the clinical management of patients with cardiovascular diseases. Core components, standards and outcome measures for referral and delivery.

Despite major improvements in diagnostics and interventional therapies, cardiovascular diseases remain a major health care and socio-economic burden both in western and developing countries, in which this burden is increasing in close correlation to economic growth. Health authorities and the general population have started to recognize that the fight against these diseases can only be won if their burden is faced by increasing our investment on interventions in lifestyle changes and prevention. There is an overwhelming evidence of the efficacy of secondary prevention initiatives including cardiac rehabilitation in terms of reduction in morbidity and mortality. However, secondary prevention is still too poorly implemented in clinical practice, often only on selected populations and over a limited period of time. The development of systematic and full comprehensive preventive programmes is warranted, integrated in the organization of national health systems. Furthermore, systematic monitoring of the process of delivery and outcomes is a necessity. Cardiology and secondary prevention, including cardiac rehabilitation, have evolved almost independently of each other and although each makes a unique contribution it is now time to join forces under the banner of preventive cardiology and create a comprehensive model that optimizes long term outcomes for patients and reduces the future burden on health care services. These are the aims that the Cardiac Rehabilitation Section of the European Association for Cardiovascular Prevention & Rehabilitation has foreseen to promote secondary preventive cardiology in clinical practice.

Getting to the bottom of arsenic standards and guidelines

Public health policy for arsenic needs to better reflect the ability to detect the risk(s).

Assessing Lifetime Homes Standards and Part M Building Regulations for Housing Design in the UK

The aims of this article are to examine Lifetime Home Standards (LTHS) and Part M of the UK Building Regulations and to discuss how relevant and successful they are. The UK government expects all new homes to be built to LTHS by 2013. This is increasingly important with an ageing population. The home environment can enable independence and provide a therapeutic place for everyone. As Part M of the building regulations are compulsory in all housing and LTHS are mandatory for public sector housing, a review of research articles was undertaken on these standards. The paper begins with a brief background on accessibility regulations, followed by a critical review of the standards that takes the body of literature that has been written around them into account. This review suggests that the standards should be improved and that designers and architects face challenges to creatively incorporate them into housing design.

University Competition, Grading Standards, and Grade Inflation

We develop a model of strategic grade determination by universities distinguished by their distributions of student academic abilities. Universities choose grading standards to maximize the total wages of graduates, taking into account how the grading standards affect firms' productivity assessment and job placement. We identify conditions under which better universities set lower grading standards, exploiting the fact that firms cannot distinguish between good and badA''s. In contrast, a social planner sets stricter standards at better universities. We show how increases in skilled jobs drive grade inflation, and determine when grading standards fall faster at better schools. (JEL I21)

Is it time for standards and a common data exchange format for digital image analysis?

Digital image analysis is at a crossroads. While the technology has made great strides over the past few decades, there is an urgent need for image analysis to inform the next wave of large scale tissue biomarker discovery studies in cancer. Drawing parallels from the growth of next generation sequencing, this presentation will consider the case for a common language or standard format for storing and communicating digital image analysis data. In this context, image analysis data comprises more than simply an image with markups and attached key-value pair metrics. The desire to objectively benchmark competing platforms or a push for data to be deposited to public repositories much like genomics data may drive the need for a standard that also encompasses granular, cell-by-cell data.

Civil defence pedagogies and narratives of democracy: disaster education in Germany

‘Disaster education’ is a fledgling area of study in lifelong education. Many countries educate their populations for disasters, to mitigate potential damage and loss of life, as well as contribute to national security. In this paper, which draws on interview data from the German Federal Office for Civil Defence and Disaster Assistance and the Federal Agency for Technical Relief, archival research, analysis of websites and promotional materials as well as relevant academic literature, I examine disaster education and preparedness for national emergencies in Germany. I argue that it is not generally extended to the general public, rather confined to trained experts, decentralised, localised and exclusive. Theorising disaster education as a ‘civil defence pedagogy’ (Preston, 2008), a type of public pedagogy, which contributes to shaping narratives of national identity, I argue that it is unlikely that Germany will develop a more inclusive, universal, formalised, nor high-profile campaign in disaster education in the foreseeable future. This, I suggest, is due to narratives of the German democratic nation state as secure, federal, peaceful and unified, which originated at the founding of West Germany in 1949, and continue to shape contemporary political narratives.

Reform, Standards and Teacher Identity: Challenges of Sustaining Commitment

Teacher commitment has been found to be a critical predictor of teachers’ work performance, absenteeism, retention, burnout and turnover, as well as having an important influence on students’ motivation, achievement, attitudes towards learning and being at school (Firestone (1996). Educational Administration Quarterly, 32(2), 209–235; Graham (1996). Journal of Physical Education, Recreation and Dance, 67(1), 45–47; Louis (1998). School Effectiveness and School Improvement, 9(1), 1–27; Tsui & Cheng (1999). Educational Research and Evaluation, 5(3), 249–268). It is also a necessary ingredient to the successful implementation, adaptation or resistance reform agendas. Surprisingly, however, the relationship between teachers’ motivation, efficacy, job satisfaction and commitment, and between commitment and the quality of their work has not been the subject of extensive research. Some literature presents commitment as a feature of being and behaving as a professional (Helsby, Knight, McCulloch, Saunders, & Warburton (1997). A report to participants on the professional cultures of Teachers Research Project, Lancaster University, January). Others suggest that it fluctuates according to personal, institutional and policy contexts (Louis (1998). School Effectiveness and School Improvement, 9(1), 1–27) and identify different dimensions of commitment which interact and fluctuate (Tyree (1996). Journal of Educational Research, 89(5), 295–304). Others claim that teachers’ commitment tends to decrease progressively over the course of the teaching career (Fraser, Draper, & Taylor (1998). Evaluation and Research in Education, 12 (2), 61–71; Huberman (1993). The lives of teachers. London: Cassell). In this research, experienced teachers in England and Australia were interviewed about their understandings of commitment. The data suggest that commitment may be better understood as a nested phenomena at the centre of which is a set of core, relatively permanent values based upon personal beliefs, images of self, role and identity which are subject to challenge by change which is socio-politically constructed.

Current standards and progress in understanding and treatment of GIST.

Gastrointestinal stromal tumours (GIST), despite being rare, pose a relevant medical problem from the viewpoint of diagnosis and management. GIST are fragile, liable to metastasize and often located in delicate structures. Surgical options, therefore, are limited. In the last decade an improved understanding of the molecular mechanisms of the disease has resulted in novel modes of treatment. The introduction of systemic tyrosine kinase inhibitor therapy with imatinib has significantly improved the outcome of the disease and prolonged the survival of GIST patients. For many patients the acute threat of a deadly cancer has been transformed into a manageable chronic condition. Drug safety, tolerability and compliance, subjects of concern in all long-term therapies, have proven to be acceptable for the tyrosine kinase inhibitor imatinib. The present paper provides a compact overview of the epidemiology, pathophysiology and morphology of GIST, with special reference to the underlying molecular biology. Relevant aspects of diagnosis, therapy and monitoring of the disease are reviewed with particular emphasis on the available clinical evidence and recent guidelines.

Synthesis of isotope-labelled methoxypyrazine compounds as internal standards and quantitative determination of aroma methoxypyrazines in water and wines by solid-phase extraction with isotope dilution-GC-MS /

An efficient way of synthesizing the deuterium labelled analogues of three methoxypyrazine compounds: 2-d3-methoxy-3-isopropylpyrazine, 2-d3-methoxy-3- isobutylpyrazine, and 2-d3-methoxy-3-secbutylpyrazine, has been developed. To confirm that the deuterium labels had been incorporated into the expected positions in the molecules synthesized, the relevant characterization by NMR, HRMS and GC/MS analysis was conducted. Another part of this work involved quantitative determination of methoxypyrazines in water and wines. Solid-phase extraction (SPE) proved to be a suitable means for the sample separation and concentration prior to GC/MS analysis.Such factors as the presence of ethanol, salt, and acid have been investigated which can influence the recovery by SPE for the pyrazines from the water matrix. Significantly, in this work comparatively simple fractional distillation was attempted to replace the conventional steam distillation for pre-concentrating a sample with a relatively large volume prior to SPE. Finally, a real wine sample spiked with the relevant isotope-labelled methoxypyrazines was quantitatively analyzed, revealing that the wine with 10 beetles per litre contained 138 ppt of 2-methoxy-3-isopropylpyrazine. Interestingly, we have also found that 2-methoxy-3-secbutylpyrazine exhibits an extremely low detection limit in GC/MS analysis compared with the detection limit of the other two methoxypyrazines: 2- methoxy-3-isopropylpyrazine and 2-methoxy-3-isobutylpyrazine.

Report of the Committee appointed to inquire into the Present condition and distribution of the flags, standards and colors, which have been taken by the forces of the United States from their enemies, and whether it would be expedient to make any provision in relation to them.--

Adam Seybet, Chairman.

A case study of the Ottawa Valley whitewater rafting industry : standards and risks

This qualitative case study identifies and discusses the standards and risk management practices of the Ottawa Valley whitewater rafting industry and the impacts of the government enforced Special-purpose Vessels Regulations are discussed. Data collection occurred using a single case study design, which included interviews and document analysis. This study found that internal, industry, and actual standards are influenced through a variety of sources. These standards were found to affect the risk management practices of commercial whitewater rafting providers. In general, these standards promoted a high level of risk management within the Ottawa Valley rafting industry. The Special-purpose Vessels Regulations were found to be non-influential in raising the risk management standards of the Ottawa Valley whitewater rafting industry.

The Flags, Standards and Colors Taken by the Forces of the United States

Full Title: Report of the Committee appointed to inquire into the Present condition and distribution of the flags, standards and colors, which have been taken by the forces of the United States from their enemies, and whether it would be expedient to make any provision in relation to them Adam Seybet, Chairman. Exhibit folded at end of text. February 4, 1814. Read, and committed to a committee of the whole House on Monday next. Printed by A and G Way