Among hospitalized patients with first acute myocardial infarction, Type 2 diabetes mellitus is consistently associated with increased mortality and increased hospital admission for heart failure. The estimated 4-year survival rate is only 50%. Our results indicate that younger subjects with Type 2 diabetes and acute myocardial infarction are a high-risk group deserving of special study, and support the argument for aggressive targeting of coronary risk factors among patients with Type 2 diabetes.

Evaluation informed a number of important and unforeseen improvements to the prototype and helped refine the implementation plan. Engagement in the process of evaluation has led to high levels of stakeholder ownership and widespread implementation.

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Access to generations of scientific literature has never been more widespread. The advent of electronic publishing has improved the spread and speed of access while at the same time reducing unit costs. The current ‘open access’ debate raises interesting questions about the future of publishing and archiving. The declining growth of author‐pays titles, however, suggests that innovations that are sustainable long term and do not threaten the quality and integrity of scholarship are likely to be within the framework of the established model.

THE SERIALS PRICING DILEMMAThis series of articles, published over the past eight months by College & Research Libraries, paints an exasperating picture of a serials pricing crisis that has been and will continue to affect research libraries for some time. Issues that are at the heart of the problem are not about to dissipate. For example, recent actions demonstrate that commercial publishers are continuing to combine and, through combination, secure even more leverage in the scholarly communication process. We need only witness the recent purchase of Pergamon Press PLC by Elsevier, or read of Elsevier's continuing expectations for profit increases of 15 to 20 percent annually-achievable through acquisition and by expanding its list of scholarly scientific publications, 1 or receive the "good news" from Elsevier that this year's serial price increases are being absorbed by a stronger exchange rate/ to know that there is no good news to report.For librarians, serials price increases represent a problem without precedent, for this is not a crisis of our own making. Yet if we receive no help from our partners in the scholarly communication process, the crisis can lead to our unmaking. Traditional library crises involve space, money to build new collections, automation initiatives, and the like. When library space is the issue, a new building resolves the problem and brings to campus an impressive structure that can be pointed to with pride by students, faculty, and administrators as a visible commitment by the college or university to the learning process.Many a library director has made the case, with strong faculty support, for growing collection budgets. Growth represents tangible evidence of an institution's research strength as collection size and acquisitions budgets are nationally touted.