The Iowa Homemaker vol.33, no.2

Tomorrow?, Salli Hearst, page 7 Where Will You Live, Jacquie Edwards and Mary Kay Pitzer, page 8 From Campus to Career Clothes, Jane Hammerly, page 10 Your Paycheck… It’s All Yours, Prof. Edna Douglas, page 11 Your Career Days, Nancy Butler, page 12 From Bathroom to Ballroom – Terry Cloth, Ruth Anderson, page 13 Alums in the News, Margaret Cole and Kay Scholten, page 14 Career Antics, Mary Jean Stoddard, page 16 Live While You Work, Beth Bailey McLean, page 18 Today – Freezer Magic, Pat Stiff, page 20 Tomorrow – 70-Second Dinners, Mary Ann Thorsen, page 20 Seniors Decide, Ruth Anderson, page 22 Be On Your Toes About Hose, Karla Baur, page 23 What’s New, Ann Lindemeyer and Dee Mingus, page 24 Scholarships Abroad, Doris Jirsa, page 26 Marriage or Career… Here’s Your Future, Dorothy Thompson, page 28 Information Please, Rachel Bernau and Margaret Mattison, page 29 Trends, Gwen Olson, page 3

Citizen Journalism at the Margins

Amidst burgeoning literature on citizen journalism, we still know relatively little about how and why genuinely marginalised groups seek to use this form of reporting to challenge their exclusion. In this article, we aim to address this gap by analysing two UK citizen journalism initiatives emanating from The Big Issue Foundation, a national homeless organisation, and Access Dorset, a regional charity for disabled and elderly people. These case studies are united by the authors’ involvement in both instances, primarily through designing and delivering bespoke citizen journalism education and mentoring. Based on over 40 hours of interviews with participants of the workshops and 36 hours of participant observation, we analyse the challenges participants faced in their journey to become citizen journalists. This included: low self-esteem, physical health and mental wellbeing, the need for accessible and adaptable technology, and overcoming fear associated with assuming a public voice. We also analyse marginalised groups’ attitudes to professional journalism and education, and its role in shaping journalistic identity and self-empowerment. Whilst demonstrably empowering and esteem building,our participants were acutely aware of societal power relations that were seemingly still beyond their ability to influence. Those who are marginalised are, nevertheless, in the best position to use citizen journalism as a conduit for social change, we argue - though challenges remain even at the grassroots level to foster and sustain participatory practices

The Iowa Homemaker vol.33, no.2

Tomorrow?, Salli Hearst, page 7 Where Will You Live, Jacquie Edwards and Mary Kay Pitzer, page 8 From Campus to Career Clothes, Jane Hammerly, page 10 Your Paycheck… It’s All Yours, Prof. Edna Douglas, page 11 Your Career Days, Nancy Butler, page 12 From Bathroom to Ballroom – Terry Cloth, Ruth Anderson, page 13 Alums in the News, Margaret Cole and Kay Scholten, page 14 Career Antics, Mary Jean Stoddard, page 16 Live While You Work, Beth Bailey McLean, page 18 Today – Freezer Magic, Pat Stiff, page 20 Tomorrow – 70-Second Dinners, Mary Ann Thorsen, page 20 Seniors Decide, Ruth Anderson, page 22 Be On Your Toes About Hose, Karla Baur, page 23 What’s New, Ann Lindemeyer and Dee Mingus, page 24 Scholarships Abroad, Doris Jirsa, page 26 Marriage or Career… Here’s Your Future, Dorothy Thompson, page 28 Information Please, Rachel Bernau and Margaret Mattison, page 29 Trends, Gwen Olson, page 30</p

Tranexamic acid therapy for heavy menstrual bleeding

Introduction: Heavy menstrual bleeding (HMB, also known as menorrhagia) is an important health problem that interferes with women's quality of life. It is one of the most common reasons why women are seen by their family doctors in primary care and is a condition frequently treated by surgery. &lt;p/&gt;Areas covered: This review covers the pharmacology of tranexamic acid in brief and concentrates on its use in the treatment of HMB. Papers published in the English language between January 1985 and November 2010 were reviewed using Medline, Embase, Cinahl and the Cochrane Database of Systematic Reviews. Search terms were ‘heavy menstrual bleeding’, ‘tranexamic acid’ and ‘menorrhagia’. &lt;p/&gt;Expert opinion: Tranexamic acid, a competitive inhibitor of plasminogen activation, has been used to treat HMB for well over four decades. Although several treatment options are available for HMB, tranexamic acid is particularly useful in women who either desire immediate pregnancy or for whom hormonal treatment is inappropriate. Tranexamic acid is a well-tolerated, cost-effective drug that reduces menstrual blood loss in the range of 34 – 59%. It improves the health-related quality of life in women in HMB

Artropolis 90 : Lineages & Linkages

Varney documents the processes of organizing and mounting an exhibition of over 200 contemporary British Columbia artists. Includes artist's statements

Management of coronary disease in patients with advanced kidney disease

BACKGROUND Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. RESULTS At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P=0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P=0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P=0.03). CONCLUSIONS Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction

Health status after invasive or conservative care in coronary and advanced kidney disease

BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of &lt;30 ml per minute per 1.73 m2 or receipt of dialysis). A secondary objective of the trial was to assess angina-related health status. METHODS We assessed health status with the Seattle Angina Questionnaire (SAQ) before randomization and at 1.5, 3, and 6 months and every 6 months thereafter. The primary outcome of this analysis was the SAQ Summary score (ranging from 0 to 100, with higher scores indicating less frequent angina and better function and quality of life). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate the treatment effect with the invasive strategy. RESULTS Health status was assessed in 705 of 777 participants. Nearly half the participants (49%) had had no angina during the month before randomization. At 3 months, the estimated mean difference between the invasive-strategy group and the conservative-strategy group in the SAQ Summary score was 2.1 points (95% credible interval, 120.4 to 4.6), a result that favored the invasive strategy. The mean difference in score at 3 months was largest among participants with daily or weekly angina at baseline (10.1 points; 95% credible interval, 0.0 to 19.9), smaller among those with monthly angina at baseline (2.2 points; 95% credible interval, 122.0 to 6.2), and nearly absent among those without angina at baseline (0.6 points; 95% credible interval, 121.9 to 3.3). By 6 months, the between-group difference in the overall trial population was attenuated (0.5 points; 95% credible interval, 122.2 to 3.4). CONCLUSIONS Participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease did not have substantial or sustained benefits with regard to angina-related health status with an initially invasive strategy as compared with a conservative strategy

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used

Analysis of Outcomes in Ischemic vs Nonischemic Cardiomyopathy in Patients With Atrial Fibrillation A Report From the GARFIELD-AF Registry

IMPORTANCE Congestive heart failure (CHF) is commonly associated with nonvalvular atrial fibrillation (AF), and their combination may affect treatment strategies and outcomes