Trust and the Governance of Higher Education: The Introduction of Chancellor System in Hungarian Higher Education

Trust plays a vital role in the cooperation of social actors. While researching trust becomes important in public management, the impact of trust on higher education policy and management has drawn less attention. This chapter analyses the introduction of the chancellor system in Hungarian higher education from the perspective of trust. In this new governance model, chancellors, who are appointed by the government, became responsible for the administration and budgets of higher institutions (HEIs), while rectors kept their prerogatives only on academic issues. The success of an institution now depends on the cooperation of its two interdependent leaders. Trust plays an especially critical role in such leadership constellation. The study is based on empirical data collected through two surveys conducted in 2015 and 2016 among academic leaders of Hungarian higher education institutions and uses Hurley’s decision-to-trust-model (Hurley 2012) as an analytic framework

Agonistic democracy and passionate professional development in teacher-leaders

Politicians and policy-makers in education routinely proclaim the centrality of schools and teachers in sustaining and consolidating democracy and democratic society. This article offers an account of teachers engaged in research in their schools and classrooms, with peers and students, so as to highlight the democratic potential of this engagement. In order to do so, it draws on an agonistic account of democracy that is distinct from more familiar liberal or procedural versions. Such an account is characterised by an emphasis on the values of constitutive pluralism, robust contestation and enduring tragedy, where the latter entails recognition of the ineliminable nature of (political) conflict and the inevitability of loss in human life. The teachers involved in this research demonstrated capacities which, it is argued, reflect an agonistic democratic ethos, including: developing the confidence to assume intellectual leadership by asking questions and eliciting and engaging plural perspectives in relation to these questions; engagement in the cut and thrust of research without the expectation of finding any final or perfect solutions; and an acceptance of difference and disagreement as constitutive and constructive elements in rethinking areas of policy and practice. Developing and encouraging these capacities, it is argued, is important in an increasingly authoritarian policy context that threatens the vital links between democracy and education highlighted by Dewey a century ago

Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial

Aims  The third Universal Definition of Myocardial Infarction (MI) Task Force classified MIs into five types: Type 1, spontaneous; Type 2, related to oxygen supply/demand imbalance; Type 3, fatal without ascertainment of cardiac biomarkers; Type 4, related to percutaneous coronary intervention; and Type 5, related to coronary artery bypass surgery. Low-density lipoprotein cholesterol (LDL-C) reduction with statins and proprotein convertase subtilisin–kexin Type 9 (PCSK9) inhibitors reduces risk of MI, but less is known about effects on types of MI. ODYSSEY OUTCOMES compared the PCSK9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome (ACS) and elevated LDL-C (≥1.8 mmol/L) despite intensive statin therapy. In a pre-specified analysis, we assessed the effects of alirocumab on types of MI. Methods and results  Median follow-up was 2.8 years. Myocardial infarction types were prospectively adjudicated and classified. Of 1860 total MIs, 1223 (65.8%) were adjudicated as Type 1, 386 (20.8%) as Type 2, and 244 (13.1%) as Type 4. Few events were Type 3 (n = 2) or Type 5 (n = 5). Alirocumab reduced first MIs [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77–0.95; P = 0.003], with reductions in both Type 1 (HR 0.87, 95% CI 0.77–0.99; P = 0.032) and Type 2 (0.77, 0.61–0.97; P = 0.025), but not Type 4 MI. Conclusion  After ACS, alirocumab added to intensive statin therapy favourably impacted on Type 1 and 2 MIs. The data indicate for the first time that a lipid-lowering therapy can attenuate the risk of Type 2 MI. Low-density lipoprotein cholesterol reduction below levels achievable with statins is an effective preventive strategy for both MI types.For complete list of authors see http://dx.doi.org/10.1093/eurheartj/ehz299</p

Effect of alirocumab on mortality after acute coronary syndromes. An analysis of the ODYSSEY OUTCOMES randomized clinical trial

Background: Previous trials of PCSK9 (proprotein convertase subtilisin-kexin type 9) inhibitors demonstrated reductions in major adverse cardiovascular events, but not death. We assessed the effects of alirocumab on death after index acute coronary syndrome. Methods: ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) was a double-blind, randomized comparison of alirocumab or placebo in 18 924 patients who had an ACS 1 to 12 months previously and elevated atherogenic lipoproteins despite intensive statin therapy. Alirocumab dose was blindly titrated to target achieved low-density lipoprotein cholesterol (LDL-C) between 25 and 50 mg/dL. We examined the effects of treatment on all-cause death and its components, cardiovascular and noncardiovascular death, with log-rank testing. Joint semiparametric models tested associations between nonfatal cardiovascular events and cardiovascular or noncardiovascular death. Results: Median follow-up was 2.8 years. Death occurred in 334 (3.5%) and 392 (4.1%) patients, respectively, in the alirocumab and placebo groups (hazard ratio [HR], 0.85; 95% CI, 0.73 to 0.98; P=0.03, nominal P value). This resulted from nonsignificantly fewer cardiovascular (240 [2.5%] vs 271 [2.9%]; HR, 0.88; 95% CI, 0.74 to 1.05; P=0.15) and noncardiovascular (94 [1.0%] vs 121 [1.3%]; HR, 0.77; 95% CI, 0.59 to 1.01; P=0.06) deaths with alirocumab. In a prespecified analysis of 8242 patients eligible for ≥3 years follow-up, alirocumab reduced death (HR, 0.78; 95% CI, 0.65 to 0.94; P=0.01). Patients with nonfatal cardiovascular events were at increased risk for cardiovascular and noncardiovascular deaths (P<0.0001 for the associations). Alirocumab reduced total nonfatal cardiovascular events (P<0.001) and thereby may have attenuated the number of cardiovascular and noncardiovascular deaths. A post hoc analysis found that, compared to patients with lower LDL-C, patients with baseline LDL-C ≥100 mg/dL (2.59 mmol/L) had a greater absolute risk of death and a larger mortality benefit from alirocumab (HR, 0.71; 95% CI, 0.56 to 0.90; Pinteraction=0.007). In the alirocumab group, all-cause death declined wit h achieved LDL-C at 4 months of treatment, to a level of approximately 30 mg/dL (adjusted P=0.017 for linear trend). Conclusions: Alirocumab added to intensive statin therapy has the potential to reduce death after acute coronary syndrome, particularly if treatment is maintained for ≥3 years, if baseline LDL-C is ≥100 mg/dL, or if achieved LDL-C is low. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01663402

Psychological correlates of decision-making during prenatal diagnosis: a prospective study

Decision-making during prenatal diagnosis has not been extensively studied. We aimed to determine psychological correlates and level of decisional conflict following prenatal diagnosi

Abordagem do ciclo de políticas: uma contribuição para a análise de políticas educacionais Policy cycle approach: a contribution to the analysis of educational policies

Este artigo discute as contribuições da "policy cycle approach" (abordagem do ciclo de políticas) para a análise de políticas educacionais. Essa abordagem foi formulada por Stephen Ball e Richard Bowe e tem sido utilizada em diferentes contextos como referencial teórico-analítico para o estudo de políticas educacionais. O texto apresenta as idéias centrais da referida abordagem, o debate em torno desta e suas contribuições para a análise de políticas educacionais. O texto apresenta também um conjunto de questões norteadoras para a análise da trajetória de políticas ou programas educacionais com base nos cinco contextos do ciclo de políticas: contexto de influência, contexto da produção de texto, contexto da prática, contexto dos resultados/efeitos e contexto de estratégia política. O artigo argumenta que essa abordagem se constitui num referencial analítico útil e que permite uma análise crítica e contextualizada de programas e políticas educacionais desde sua formulação até a sua implementação no contexto da prática, bem como os seus resultados/efeitos.<br>This paper discusses the contributions of the 'policy cycle approach' to analyze educational policies. Formulated by Stephen Ball and Richard Bowe, such approach has been applied in different contexts as a theoretical and analytical framework to examine educational policies. This paper presents the main ideas of this approach, the debate surrounding it, and its contribution to the analysis of educational policies. Based on the five contexts of the policy cycle, namely: influence, text production, practice, outcomes and the political strategy; this paper also presents a set of questions to the trajectory analysis of educational policies or programs. It argues that this approach is a useful analytical framework that allows a critical and contextualized analysis of programs and educational policies from their formulation to their implementation in the context of practice as well as the policy effects