Clinical Pathway for Coronary Atherosclerosis in Patients Without Conventional Modifiable Risk Factors JACC State-of-the-Art Review

Reducing the incidence and prevalence of standard modifiable cardiovascular risk factors (SMuRFs) is critical to tackling the global burden of coronary artery disease (CAD). However, a substantial number of individuals develop coronary atherosclerosis despite no SMuRFs. SMuRFless patients presenting with myocardial infarction have been observed to have an unexpected higher early mortality compared to their counterparts with at least 1 SMuRF. Evidence for optimal management of these patients is lacking. We assembled an international, multidisciplinary team to develop an evidence-based clinical pathway for SMuRFless CAD patients. A modified Delphi method was applied. The resulting pathway confirms underlying atherosclerosis and true SMuRFless status, ensures evidence-based secondary prevention, and considers additional tests and interventions for less typical contributors. This dedicated pathway for a previously overlooked CAD population, with an accompanying registry, aims to improve outcomes through enhanced adherence to evidence-based secondary prevention and additional diagnosis of modifiable risk factors observed

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

"In the past, many believed that runes appeared magically" : A study about language history in lower secondary school textbooks

Den här studien syftar till att undersöka läroböckers språkhistoriska innehåll utifrån språklighistoriemedvetenhet, hur innehållet kopplas till kursplanen i svenska, samt vilka materiallärare använder sig av i undervisning av språkhistoria i högstadiet. För att besvara dessa frågor har en läromedelsanalys och enkätstudie utförts. Läromedelsanalysen utgår från kategorierna: epoker, språkliga släktband, språkliga nivåer samt språkets milstolpar. Resultatet visar att läroböckerna till viss del drar kopplingar mellan dåtid och nutid, men om avsikten är att skapa en större samtidsförståelse med hjälp av det är oklart. De tre läroböckerna har olika omfattande språkhistoriskt innehåll, där både styrkor och brister har hittats i analysen. Läroböckernas språkhistoriska innehåll förhåller sig till kursplanens syfte och centrala innehåll, och beskriver i olika utsträckning språkets utveckling. Enkätstudien visade att lärare använder en blandning läromedel i sin undervisning av språkhistoria. De kombinerar olika läromedel för att skapa en helhet i undervisningen. Resultatet visade också att läroboken fortfarande har en plats i undervisningen av språkhistoria. Slutsatser av denna studie visar att läroböckerna på olika sätt saknar innehåll som kan främja språkligt historiemedvetande i ämnet, samt att läroboken fortfarande används i undervisning av språkhistoria, men ofta i kombination med andra former av läromedel för att komplettera ämnesinnehållet

Muntligt baserade uppgifter inom andraspråksinlärning i läroböcker i högstadiet (7-9)

This research paper analyzes how different L2 textbooks in lower secondary school relateto speaking proficiency, in reference to the curriculum. It also investigates how thetextbooks approach speaking proficiency activities differently. The aim of my study istherefore to investigate if and how contemporary textbooks for learning English in lowersecondary school stimulate the development of speaking proficiency. To answer thesequestions, I compare four textbooks, through a content analysis based on the knowledgerequirements for speaking proficiency in English, in year 9. The results show that therecently published books have more activities that help develop speaking proficiency,namely Focus and Sparks. These books also have more activities in groups, which is adifferent approach than the textbook Primetime, which only provides activities in pairs.All books have activities connected to the requirements. However, Focus and Sparks havesignificantly more activities where all requirements are combined. This suggests that thetextbooks recently published prioritize speaking proficiency activities using discussions.The findings of this study are that the textbooks researched relate to the requirementsdifferently. More recent books follow the requirements to a greater extent, helpingstudents develop their speaking proficiency more efficiently

Muntligt baserade uppgifter inom andraspråksinlärning i läroböcker i högstadiet (7-9)

This research paper analyzes how different L2 textbooks in lower secondary school relateto speaking proficiency, in reference to the curriculum. It also investigates how thetextbooks approach speaking proficiency activities differently. The aim of my study istherefore to investigate if and how contemporary textbooks for learning English in lowersecondary school stimulate the development of speaking proficiency. To answer thesequestions, I compare four textbooks, through a content analysis based on the knowledgerequirements for speaking proficiency in English, in year 9. The results show that therecently published books have more activities that help develop speaking proficiency,namely Focus and Sparks. These books also have more activities in groups, which is adifferent approach than the textbook Primetime, which only provides activities in pairs.All books have activities connected to the requirements. However, Focus and Sparks havesignificantly more activities where all requirements are combined. This suggests that thetextbooks recently published prioritize speaking proficiency activities using discussions.The findings of this study are that the textbooks researched relate to the requirementsdifferently. More recent books follow the requirements to a greater extent, helpingstudents develop their speaking proficiency more efficiently

En trend att bryta

En trend att bryta Innehållsförteckning – Inledaren: Våga trotsa trender av Håkan Eklund – En trend att bryta av John Wrede – Kasnäs – en företagarby av Clara Henriksdotter – Dröminflyttare, på riktigt av Pia Prost – Kvarkens skärgård av Carita Nyström – En aktiv deltidsboendeförening av Ralf Nyman – Allt går när motivationen är hög av Håkan Eklund – En färjtur mindre släcker inget ljus av Sylvia Sundström – Nagu Marina av Kristin Mattsson – Transporterna den största utmaningen av Clara Henriksdotter – Lustresor i skärgården av Bertil Nygård – Inflyttade kvinnor i Kumlinge tar för sig av Satu Numminen – Från Årets by i Österbotten av Iris Sjöberg – Åboländsk ygdesjöfart av Charlotte von Haartman – När byråkratin motarbetar inflyttning av Håkan Eklund – När det fryser till av Lars Sundström – Bokhörnan av Håkan Eklund – Nordiska skärgårdssamarbetet av Ester Miiros – Kolumnen ”Från Ninnus horisont” av Nina Söderlund – Sista bilden av Håkan Eklun

Mortality and Cardiovascular Outcomes in Patients Presenting With Non–ST Elevation Myocardial Infarction Despite No Standard Modifiable Risk Factors: Results From the SWEDEHEART Registry

Background A significant proportion of patients with ST‐segment–elevation myocardial infarction (MI) have no standard modifiable cardiovascular risk factors (SMuRFs) and have unexpected worse 30‐day outcomes compared with those with SMuRFs. The aim of this article is to examine outcomes of patients with non–ST‐segment–elevation MI in the absence of SMuRFs. Methods and Results Presenting features, management, and outcomes of patients with non–ST‐segment–elevation MI without SmuRFs (hypertension, diabetes, hypercholesterolemia, smoking) were compared with those with SmuRFs in the Swedish MI registry SWEDEHEART (Swedish Web‐System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies; 2005–2018). Cox proportional hazard models were used. Out of 99 718 patients with non–ST‐segment–elevation MI, 11 131 (11.2%) had no SMuRFs. Patients without SMuRFs had higher all‐cause and cardiovascular mortality at 30 days (hazard ratio [HR], 1.20 [95% CI, 1.10–1.30], P<0.0001; and HR, 1.25 [95% CI, 1.13–1.38]), a difference that remained after adjustment for age and sex. SMuRF‐less patients were less likely to receive secondary prevention statins (76% versus 82%); angiotensin‐converting enzyme inhibitors/angiotensin receptor blockade (54% versus 72%); or β‐blockers (81% versus 87%, P for all <0.0001), with lowest rates observed in women without SMuRFs. In patients who survived to 30 days, rates of all‐cause and cardiovascular death were lower in patients without SMuRFs compared with those with risk factors, over 12 years. Conclusions One in 10 patients presenting with non–ST‐segment–elevation MI present without traditional risk factors. The excess 30‐day mortality rate in this group emphasizes the need for both improved population‐based strategies for prevention of MI, as well as the need for equitable evidence‐based treatment at the time of an MI

Clonal evolution and resistance to EGFR blockade in the blood of colorectal cancer patients

Colorectal cancers (CRCs) evolve by a reiterative process of genetic diversification and clonal evolution. The molecular profile of CRC is routinely assessed in surgical or bioptic samples. Genotyping of CRC tissue has inherent limitations; a tissue sample represents a single snapshot in time, and it is subjected to spatial selection bias owing to tumor heterogeneity. Repeated tissue samples are difficult to obtain and cannot be used for dynamic monitoring of disease progression and response to therapy. We exploited circulating tumor DNA (ctDNA) to genotype colorectal tumors and track clonal evolution during treatment with the epidermal growth factor receptor (EGFR)-specific antibodies cetuximab or panitumumab. We identified alterations in ctDNA of patients with primary or acquired resistance to EGFR blockade in the following genes: KRAS, NRAS, MET, ERBB2, FLT3, EGFR and MAP2K1. Mutated KRAS clones, which emerge in blood during EGFR blockade, decline upon withdrawal of EGFR-specific antibodies, indicating that clonal evolution continues beyond clinical progression. Pharmacogenomic analysis of CRC cells that had acquired resistance to cetuximab reveals that upon antibody withdrawal KRAS clones decay, whereas the population regains drug sensitivity. ctDNA profiles of individuals who benefit from multiple challenges with anti-EGFR antibodies exhibit pulsatile levels of mutant KRAS. These results indicate that the CRC genome adapts dynamically to intermittent drug schedules and provide a molecular explanation for the efficacy of rechallenge therapies based on EGFR blockade