ZEELAND — Zeeland's longtime plan to improve Hoogland Park will soon accept bids Hoogland Park is located near the cemetery at the corner of Rich Street and Peck Street The plan includes the use of adjacent property at 370 E Councilmembers approved a bid to demolish a home on the property in 2020 The city was unsuccessful in securing a Passport Grant through the Michigan Department of Natural Resources but a portion of funds was allocated in June to cover the cost of revamping Hoogland Park During a meeting of Zeeland City Council on Monday, Nov. 4, $109,526 was approved for a construction administration contract with MCSA Group, which will convert the schematic design into construction documents to be put up for bid The city plans to select a bid by March and complete construction by next fall “The plan looks great,” said Mayor Kevin Klynstra “It will be nice to get the property at 370 E staff will continue to work with the Zeeland Cemetery and Parks Commission to nail down details — Cassidey Kavathas is the politics and court reporter at The Holland Sentinel Contact her at ckavathas@hollandsentinel.com Prepare to be in stitches as Dual Piano returns to the Hoogland Center for the Arts August 8th-10th The Hoogland Center for the Arts is excited to welcome Dual Piano back for another great summer concert Damien and Mark will work their magic on the music as only they can do a couple of grand pianos and a couple of hours of delight - that's Dual Piano Comedy runs amuck throughout their programs and no one knows what is going to happen next – including Mark and Damien The ghosts of such past entertainers as Victor Borge Liberace and Ferrante & Teicher can be felt rampaging through the hall when Mark and Damien are at the keyboards gain access to exclusive promotions and contests and discover even more reasons to #EnjoyIllinois The Official Website of the Illinois Office of Tourism Randy Eccles: This is Community Voices on 91.9 UIS I'm really looking forward to the concert in Springfield Randy Eccles: You've been here in Springfield before it was “The Lincolns of Springfield.” This wonderful show that Terry Cranert and his wife produced and wrote about the life of our illustrious president The people of Springfield are so warm and loving and embraced us Randy Eccles: I'm hopeful that anybody who saw that understands that you're going to be here again and have a chance to see you Michal Connor Dawson: I'm going to be singing music I've spent the bulk of my life arranging these songs You'd get the melody because they were all done a cappella Because the workers were out in the fields but I've woven in different hymn tunes or popular songs of the time or musical things that make your ears prick up and say Randy Eccles: This performance is called Echoes of the Spirit These songs were definitely born of the spirit and the heart It was a difficult time in the life of our country Straight from the mouth of someone who'd actually been there but she was sowing these seeds in my brain and in my heart so that one day when I was a much older man I could sing these songs to a wider audience These are in their crude way because my ancestors were illiterate Because it was illegal to teach a Black person at the time to read or write imprisoned if you taught a Black person to read or write and ultimately leaving behind these beautiful songs that I'm proud to sing now as you were saying with your great grandmother there was so much lost because people weren't able to write it down If it hadn't been for enterprising white people in the end of the 1700s they would go along and collect these songs and preserve them Lucy McKim Garrison." It's a wonderful book This is hailed as one of the very first original collections of African American spirituals No other race has a group of songs called spirituals Randy Eccles: Earlier you were saying an emancipated slave or an emancipated person might write back to their plantation Why would they write back to somebody who had enslaved them Michal Connor Dawson: Do you mind if I share one of these letters with you Michal Connor Dawson: Talk about catharsis They would write because they were all family together even though they were mistreated and abused This letter is from Hannah Grover to her son Cato I pray you to come and see your dear old mother or send me $20 and I will come and see you in Philadelphia And if you can't come to see your old mother My master will free me if anybody will pay enough for me "If you'd only treated me like a human being All I asked for was a little bit of kindness." It's really heart breaking to hear but there were the majority who didn't get free Randy Eccles: The tragedy of family separation is well illustrated by that letter and I'm sure by so many others The thing that brings me back time and time again thinking about these people who have my blood is they were able to make lemonade out of lemons in the best way possible that's what draws me to them — their timelessness Randy Eccles: What would the public recognize from any of these spirituals but they know their neighbor will hit them Randy Eccles: Is that something they'll be able to hear at the Hoogland I'm thrilled to be in this town that I love I sense the place is thick with beautiful spirits wandering the streets The place has not been changed in a long time and there's these old buildings it's called Bind Up the Nation's Wounds in The Lincolns of Springfield I told my friends this and they laughed at me so they could hear what one of their own was doing It's a song about opening our hearts and binding up the wounds that have plagued this nation from the beginning The divisions of racial separation and hatred and it's just thrilling for me to have these songs inculcated in my soul Randy Eccles: If somebody would like to hear your music before the event Michal Connor Dawson: it's on Spotify. It's on Apple music. It's on my website, which is MichalDawsonConnor. com. And I have a fair number of pieces on there One of my favorite songs is Nobody Knows the Trouble I've Seen (sings acapella) "Nobody knows the trouble I've seen Randy Eccles: It's impressive to hear you sing it Michal Connor Dawson: I know you didn't ask me to sing Randy Eccles: Anybody else who has the opportunity to hear you and get to see you in person on Friday Michal Connor Dawson: One of the greatest spirituals that exists is He's Got the Whole World in his Hands and I will ask the audience to sing it with me Please come out and support this incredible theater complex Gus Gordon has done a remarkable job bringing live theater and music to the world Randy Eccles: A little bit more on your background it looks like you spent some time everywhere and I just got through a very difficult event Michal Connor Dawson: They singed the back part of my house but there's great guilt with my house surviving when so many didn't and I did some solo concerts all over small towns in Germany I've had four trips there with the Roger Wagner Chorale Randy Eccles: You've performed on Broadway several times too That's one of the songs that's near and dear to my heart Randy Eccles: We look forward to seeing you back in Springfield Thanks for spending some time with us today on Community Voices We'll look forward to seeing you on Friday We have the address for the funeral home & the family on file If you're not happy with your card we'll send a replacement or refund your money Hoogland created this Life Tributes page to make it easy to share your memories © 2025 Langeland-Sterenberg Yntema Funeral Homes Made with love by funeralOne Please select what you would like included for printing: Copy the text below and then paste that into your favorite email application at Royale Meadows Care Center in Sioux Center the daughter of Richard and Sarah (DeVries) Hulstein She graduated from Plato #5 country school 1946 she married Alfred at her family’s farm in Carmel She had been a resident of Royale Meadows Care Center of Sioux Center Ethel and Alfred were looking forward to their 70th wedding anniversary in June She was involved in Trash for Cash and Ladies Bible Study with the church  Survivors include: her husband of nearly 70 years IA,Grandchildren;Leonard's Children: Tanya (Matt) Eaton of N             Kayla (Matt) Blessinger and their children Mitchell and Lila of CO Roger's Children: Jason (Shelly) Luckel and their children Alexis             Bradley (Stephanie) Hoogland and their daughter Paisley of CO Stan's Children: Darren (Deb) Hoogland of IA             KayLynn (Elmer) Rolfes and their son Carson of IA             Morgan Hoogland of Iowa.She was also survived by many nieces and nephews She was preceded by: her parents; one brother two grandchildren; Shelly and Nathan Hoogland In lieu of flowers the Hoogland family requests to direct memorial donations to Hospers First Christian Reformed Church or Royale Meadows Care Center This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply Service map data © OpenStreetMap contributors and support for a vital cause is coming to downtown Springfield The Children’s Advocacy Center of Illinois (CACI) is proud to present “That’s What She Said” a live storytelling event happening at the Hoogland Center for the Arts known for spotlighting the voices of local women through powerful will take the stage with a lineup of inspiring speakers from the community But this event is about more than just stories — it’s about purpose and advocacy for children who have experienced abuse throughout the state guests are helping ensure that young survivors across Illinois continue to receive the compassionate care they deserve “This event gives women a platform to share their truth — and allows the audience to connect in a really human often emotional way,” said Liz Brown-Reeves and it supports a mission that touches so many lives.” “That’s What She Said” is part of a growing national movement that amplifies real women's voices in local communities and deeply personal — from humor to heartbreak and everything in between The event will be held at the Hoogland Center for the Arts in Springfield bringing together community members for a night that is as meaningful as it is memorable visit www.childrensadvocacycentersofillinois.com or www.hcfta.org HOLLAND — Zeeland’s longest serving mayor He was a councilman for eight years prior to being elected mayor Mayor Kevin Klynstra said what stood out most about Hoogland was his passion for the city “He loved this city more than anyone I’ve ever met,” Klynstra said “He dedicated his life to serving our community.” Hoogland led growth and development with policy changes and local incentives that aided in the recruitment and retention of some of Zeeland’s largest industrial businesses He also worked toward the preservation of downtown and helped launch the campaign "Feel the Zeel" in 2007 said he was ready to continue his service to the city I enjoy the job and I think I work well with (City Manager) Tim (Klunder),” Hoogland said “There are some things yet I’d still like to complete More: After nearly eight decades, Zeeland mayor not slowing down Hoogland was known for his fundraising expertise which resulted in the creation of the Howard Miller Library and Community Center He helped raise funds for the Zeeland Historical Society Netherlands American Foundation and Zeeland Community Hospital Subscribe: Get all your breaking news and unlimited access to our local coverage Klynstra has ordered city flags be flown at half-staff from Monday Hoogland will be laid to rest with military honors at the Zeeland Cemetery on Lincoln Avenue on Aug The city’s police and fire departments will honor Hoogland with a casket watch and will lead the procession from the memorial service to the cemetery For more information, visit langelandsterenberg.com/obituaries — Contact reporter Austin Metz at ametz@hollandsentinel.com Enter your phone number above to have directions sent via text ZEELAND — A sizable reconstruction at Hoogland Park is slated to begin in May after Zeeland City Council approved a bid of $1.185 million during a meeting Monday “It will be nice to see that when it’s done,” said Councilmember Jim Broersma The completed project will include a new restroom building According to a rendering previously shared with council a bocce ball court and a natural playscape The bid was significantly lower than the estimated project cost of $1.7 million The project budget is $1.413 million in total More: Hoogland Park will see long-awaited $1.7M facelift in 2025 Similarly, the city has been working on refreshing Heritage Square for renaming, with a proposed title of Hoogland Plaza in memory of Former Mayor Les Hoogland, who died in 2024 estimated around $20,000 for landscaping and plaque placement Harrie Lavreysen and Jeffrey Hoogland cross the finish line and set the new world record during the men’s team sprint event Harrie Lavreysen of Netherlands celebrates after setting the new world record in the men’s team sprint event Conor Leahy and Kelland O’Brien compete on their way to set the world record Oliver Wood of Britain prepares to compete in the men’s team pursuit event Thomas Denis of France and Valentin Tabellion of France compete during the men’s team pursuit event Chloe Moran and Maeve Plouffe compete during the women’s team pursuit event Charlie Tanfield and Ethan Vernon compete during the men’s team pursuit event congratulate each other after competing in the men’s team pursuit event Tsuyaka Uchino of Japan adjusts her helmet before competing in the women’s team pursuit event Matthew Glaetzer of Australia competes during the men’s team sprint event Chloe Dygert and Kristen Faulkner compete during the women’s team pursuit event Anna Morris and Jessica Roberts compete during the women’s team pursuit event Qi Liu of China competes during the men’s team sprint event Lisa Klein and Mieke Kroeger start the women’s team pursuit event France (AP) — Harrie Lavreysen figured that on a searing fast track in the velodrome outside of Paris and going against the erstwhile sprinting kings from Britain that his trio from the Netherlands would have to set a world record to defend their Olympic gold medal “Of course we were going for the gold medal The Dutch had a big lead in the three-lap race when Van den Berg swung off the front after Lap 1 Hoogland was left to sprint to the finish with no pressure at all The time of 40.949 seconds beat Britain by nearly a full second and the mark of 41.191 they set in their heat against Canada “and then going under 41 seconds is amazing.” The Netherlands knocked off its own Olympic record in qualifying Monday night then lowered the world mark it set during its triumph at the Tokyo Olympics in the heats Lavreysen and Hoogland into the finals against their longtime nemesis Britain pitting the two nations that have combined to win the last five gold medals It was never much of a contest for the gold medal this time The Dutch have dominated the team sprint since winning their first world title in 2018 and the latest Olympic gold sets up what could be a memorable Paris Games Lavreysen and Hoogland also are among the favorites in the sprint and the keirin They are three great individuals,” Carlin said which trailed the French team through two laps of their head-to-head race before anchor Matthew Glaetzer pulled back more than a tenth of a second on rival Rayan Helal to land on the podium “I think we should be proud,” Glaetzer said “To bring it home and win the bronze final is special.” The Australians covered 4,000 meters in 3:40.730 more than a second faster than Italy’s winning time at the Tokyo Games but I don’t think we realized we were going that quick out there,” Welsford said “I think we just really gelled really well who had their streak of three straight Olympic pursuit titles snapped three years ago subbed Charlie Tanfield into the lineup along with Ethan Hayter Oliver Wood and Ethan Vernon to face Denmark The quartet trailed by more than a second at one point before rallying to win in 4:42.151 and advance to the gold-medal race Wednesday night New Zealand nearly broke the world record with a stunning time of 4:04.679 in qualifying which was fifth-fastest in qualifying and can do no better than bronze when the heat races and medal rounds take place Wednesday night “One thing I learned from the Olympics last time I was here (in Tokyo) is you never know what to expect,” New Zealand’s Bryony Botha said “We are trying to be realistic and just follow our own process « Back Jeffrey Hoogland roared to a new kilometre time trial world record Tom Davidson spoke to the Dutchman and his team to find out what it took It might come as a surprise, but Jeffrey Hoogland needed to be persuaded to have a punt at the kilometre time trial world record “He took a lot more convincing than I thought,” his coach ‘Do you fancy a trip to Mexico where it can be all about you and the upshot is that you become the world record holder I want to be world champion first.’ And that kind of threw me ‘I’m pretty certain you’re going to be world champion on your worst day.’” and this February became the first person to go under 58 seconds at sea level was that plans were already in place,” the coach reveals without him really knowing too much.” shaving 0.87 seconds off a benchmark that lasted for almost a decade “Every time I think about it I get this amazing feeling,” Hoogland says speaking to Cycling Weekly from a beach resort on the Caribbean Sea “I didn’t just want to set a new world record I wanted to set it so it’s pretty hard to ever beat again.” Hoogland’s team came across a road block in planning They had originally hoped to run the sprinter’s kilo effort as a race with a rider on the opposite side of the track offering a drag advantage the UCI has suspended the Mexican Federation meaning Hoogland would have to stage an official world record event Kordi, however, had a trick up his sleeve. To generate airflow, he planned to send a motorcyclist onto the boards in the minutes before the effort. “He was whizzing around at 70km/h, and as soon as we gave the signal, he was off in five seconds,” the former British Cycling sprint coach says They practiced the motorbike’s track exit in the days before the effort was the sudden drop in atmospheric conditions “[Hoogland] did the effort on the worst day he could have done it on,” says Kordi The velodrome in Aguascalientes relies on warm air pumped in from outside to heat up Hoogland did very little training on the track “I was there 10 years ago and I expected it to maybe have gotten worse over time but it was exactly how I remembered it,” Hoogland says they turn rapidly and you get smashed in pretty hard.” his peak torque coming in the standing start It had been tested in a wind tunnel using a mannequin of Wout van Aert the most comparable one to Hoogland that they had lying around The suit contained fabrics used in speed skating so when the sprinter neared 80km/h on his second lap “The biggest mistake was the last turn when I went into the red but at that point I couldn’t focus or see anymore Hoogland twisted his face in pain as he lay beside the track showed him gasping into a humidifier face mask wearing the grimace of a man immobilised by the lactic acid in his legs considering the circumstances at high altitude Everything was more intense than ever before.” It would end up taking Hoogland more than half an hour to compose himself after his effort pulling on a pair with the number 55 - his new time benchmark - and cartoon images of the Hulk the comic book character who lends the sprinter his nickname Lap times (seconds): 1 (standing start) - 17.52 - 12.03 - 12.44 - 13.3 Average speed: 64.943km/hTop speed: 79km/hMax power (estimated): 3,000w Hoogland's double leg press PB: 760kg (equivalent to a 1990s Mini Cooper) the cost of the project was estimated to be in the region of €65,000 (£56,500) financial consultant AP Support and Japanese giant Yamaha but it ended up costing “significantly more” the Dutchman is beginning to think more and more about his legacy in the sport “I’m a bit of an older athlete at the moment and I don’t know how long my career will go on,” the 30-year-old says frankly your legacy starts to become more important actually everything I’ve wanted in my life already with track cycling.” Hoogland holds three out of the four men’s sprint world records: the kilometre time trial the team sprint (set at the 2020 World Championships) and the flying 500m which he achieved in the middle two laps of his kilo Hoogland returned to the track to try to complete the set with the flying 200m “I was actually surprised by how close I came,” he says The sprinter landed three hundredths of a second short of the 9.1 second record where he shared “some beers” and “some laughs” with his team “Maybe I’ll go for the 200m next time “Everything I add now is even better and more fun I love that people will remember me as one of the greatest in track cycling and I worked really hard for that I will hopefully not be forgotten in track cycling When it comes to designing a kilo-record-setting bike “stiffness is more or less the main goal,” says Tim de Boer “Especially with a rider like Jeffrey we mainly look for stiffness and aerodynamics Weight is a little bit less important.” Hoogland’s Koga track bike weighed 7.7kg and is worth around €21,000 in its constituent parts The sprinter used a 70-tooth carbon Digirit chainring - the biggest he has ever ridden - with a 15-tooth rear cog “I think the kilo is maybe the hardest event regarding gearing because everything is in it,” the mechanic says We felt that the gear was pretty perfect.” running a Mavic Comete front disc and a rear Campagnolo Ghibli disc His Dugast tubular tyres - 20mm in width at the front “Most teams do it like that,” De Boer says explaining that higher pressures offer less rolling resistance and greater control in the corners Although Hoogland’s Speedbar TT extensions were brand new his PRO Missile base bar was over a decade old reliable model for fear that he might snap a different one were developed specially to withstand Hoogland’s power Thank you for reading 20 articles this month* Join now for unlimited access Enjoy your first month for just £1 / $1 / €1 *Read 5 free articles per month without a subscription Try first month for just £1 / $1 / €1 An enthusiastic cyclist himself, Tom likes it most when the road goes uphill, and actively seeks out double-figure gradients on his rides. His best result is 28th in a hill-climb competition, albeit out of 40 entrants. Strengthening Rehabilitation in Health Systems Volume 5 - 2024 | https://doi.org/10.3389/fresc.2024.1371553 Objectives: The purpose of this systematic review is to provide an overview of published follow-up care programs of primary and secondary health conditions (SHCs) in spinal cord injury/disorder (SCI/D) and spina bifida and describe recommendations on content setting of follow-up care programs for persons with SCI/D and spina bifida Methods: According to the sequence of procedures of the AWMF (Association of the Scientific Medical Societies in Germany) a systematic literature search was performed (in PubMed Cochrane Library and nine additional databases for guidelines) between 5 September 2019 and 22 September 2019 2018) and guidelines (up to 2018) published in English or German and describing an evidence-based follow-up care program for persons with SCI/D or spina bifida were included Results: The systematic literature search found 1973 publications in PubMed and Cochrane Library resulting in 19 papers for SCI/D and 6 for Spina bifida we included 34 guidelines developed by reputable committees or medical associations were rated and classified according to the guidance of AWMF level of evidence of follow-up care programs was mostly based on informal procedures and expert opinion or formally consent based expert opinion or publications described an evidence based comprehensive clinical practice guideline (CPG) for follow-up care for people with SCI/D or spina bifida Conclusion: Based on the comprehensive and extensive literature research conducted regular (annual) follow-up care appointments at specialized SCI clinics are recommended There is a notable absence of a comprehensive CPG covering all relevant health conditions for long-term follow-up in SCI/D or spina bifida In order to provide persons with SCI/D with up-to-date and best possible medical and rehabilitative care a CPG for follow-up care is urgently needed the German-speaking Medical Society of Paraplegia (DMGP) has commissioned its members to establish a guideline for follow-up care for individuals with SCI/D The current review serves as an evidence-based framework for the development of this guideline Urinary tract infections can be particularly troublesome due to the disruption of normal bladder function and impaired immune responses making individuals with SCI/D more susceptible to these infections Pressure injuries result from prolonged immobility and the loss of sensation in affected areas leading to tissue breakdown and the formation of open wounds Respiratory infections often arise due to weakened respiratory muscles and compromised cough reflexes making individuals with SCI/D vulnerable to pneumonia and other respiratory ailments This statistic emphasizes the critical role that specialized SCI clinics play in not only managing SHCs but also in preserving the overall health and life expectancy of individuals with SCI However, despite the clear benefits of regular check-ups up to now, limited evidence regarding content and frequency of follow-up care programs for persons with SCI/D exist (13) de Witte & Post performed a literature study regarding follow-up care in SCI and described the effects of different follow-up care programs regarding secondary impairments hardly any evidence existed regarding content and frequency of follow-up care in persons with SCI/D the content of these descriptions was often focusing on one secondary health condition The researchers pointed out the urgent need for the development and publication of comprehensive follow-up care programs tailored specifically for individuals with SCI/D The current systematic review was undertaken to explore and describe current evidence on long-term follow-up care of SHCs in SCI/D or spina bifida and to serve as a basis for the development of a clinical practice guideline (CPG) for follow-up care as commissioned by the German-speaking medical SCI Society (DMGP) Although we are aware that follow-up care in SCI and spina bifida is much broader than follow-up of HCs the current review was limited to this topic The objective of this systematic review therefore is to provide an overview of current evidence and recommendation regarding follow-up care for SHCs in SCI/D and spina bifida with following specific aim: To describe current existing recommendations on content setting of follow-up care programs focusing on SHCs for persons with SCI/D and spina bifida We conducted a systematic review of clinical practice guidelines (CPGs) and publications using the JBI Manual for Evidence Synthesis (14) The search was conducted in all databases between 5 September 2019 and 22 September 2019 and included publications from January 2008 until December 2018 This leads to underrepresentation of relevant aspects for this population we added a separate search for spina bifida in our search strategy to ensure that aspects relevant for persons with spina bifida are also covered in the review Inclusion criteria according to PICO format Medical content of guidelines and publications Eligibility criteria for publications and guidelines were defined according to the extended PICO-(patient, intervention, comparison, outcome, study design) format (Table 1) We included an article if it described recommendations for medical follow-up care for persons with SCI/D or spina bifida (living in the community) If an article focused solely on recommendations for acute phase we excluded publications considering mainly pediatric aspects an experienced SCI/D physician & LM a health scientist) assessed the retrieved records by title and abstract against the inclusion criteria After an initial selection of the literature the full articles were read and evaluated independently by the two reviewers (IEH & LM) they decided whether the study met the established criteria discrepancies were solved through discussion or involving a member (all senior physicians) of the core group of the development of the clinical practice guideline for long term follow-up care n SCI as a third reviewer (XJ Two trained authors (IEH and LM) participated in the data extraction and methodological assessment process using a standardized data extraction form in MS Excel We retrieved the following information (1) title For guidelines we extracted additional information about recommendations including assessment recommendations Of all included manuscripts we extracted aim Opinion papers and qualitative studies were not specifically rated but we described their content using the above-mentioned categories The synthesis includes all medical aspects covered in the papers and guidelines (Supplementary Table S1). As a reference framework the ICF-Core Set for long-term care (56) was used to identify and quantify the underlying medical conditions. Following the standardized ICF linking rules (57) two authors (IE and LM) linked the ICF categories of the ICF-Core Set for long-term care to the inherent health condition The search for publications related to follow-up care for people with SCI/D was carried out on 5th September 2019 and resulted in 1973 articles and for people with spina bifida in 19 articles. The decision tree for the selection of manuscripts is presented in Figure 1 We finally included 19 articles on SCI/D and 6 articles on spina bifida The search results are available on request The search results for guidelines is explained in chapter 3.5 PRISMA flowchart for search strategy and results (a) PubMed search with no specific filters for publication methods (b) PubMed search with limitation on Guidelines () publications for people with spinal cord injury/disorder ()* publications specifically for people with spina bifida Most articles were excluded due to missing and no clear conclusion on follow-up care (7) along with some articles focused only on therapeutic and nursing (2) aspects Others described solely the patient perspective (with focus on quality of life) (3) focusing on consumer needs and highlighted issues of communication we excluded articles discussing education and vocational rehabilitation (2) as well as one publication focusing on rehabilitation access (1) These articles provide insights into the effectiveness of telephone or video-based follow-up or care planning in various medical contexts The authors recommend that regular visits to an outpatient clinic should occur every 18–24 months A total of 34 guidelines were found including the topic of follow-up care for SCI/D (see Figure 1) In total 31 guidelines are focusing on people with SCI/D three guidelines solely on people with spina bifida and another three guidelines address both people with spina bifida and SCI/D The Guideline for Care of People with spina bifida from the American Spina Bifida Association is very comprehensive, covering a wide range of topics related to health problems and self-management (44) The sources provide information on the causes The guideline is informed by current self-management research for people with spina bifida and offers recommendations to promote self-management and independence across the lifespan The guideline covers 25 areas of physical health and general well-being for people with spina bifida Most of the included guidelines were developed and published in the United States of America (14) while others were published in the United Kingdom (5) or Canada (2) The remaining guidelines were developed within global or European committees (3) A total of 34 guidelines were included in the study. All guidelines were methodologically assessed by the DELBI tool (54) and the results are summarized in Supplementary Table S5 Most guidelines perform very well in terms of formulating clear objectives regarding scope and purpose most guidelines demonstrate editorial independence guidelines tend to perform poorly in terms of integrating and involving interest groups as well as in methodological accuracy during the development process guidelines tend to receive a poor rating in terms of applicability in the German healthcare system This remark refers specifically to the German healthcare system and cannot be generalized globally Three systematic reviews (59, 69, 75) were identified in the search results and their quality were assessed with the R-AMSTAR tool (53). The overall quality of the studies was assessed as low quality. Not fully addressed were especially quality items related to the methodological reporting. The results of the quality assessment of all included systematic reviews are summarized in Supplementary Table S6 Total quality scores ranged from 9 (73) to 19 points (62). None of the 13 observational studies full field all quality standards set by STROBE (52). In particular, the quality criteria were not met in the methods and results sections (e.g., no effort to address potential sources of bias). The results of the quality assessment of all included observational studies are summarized in Supplementary Table S7 The current retrieved publications cover though a broad range of different health conditions, including urological problems, pain, pressure injuries and osteoporosis (48, 58–62) Although clinical opinion is to perform comprehensive follow-up care in SCI/D and spina bifida we found hardly any publications or guidelines describing this comprehensive approach and covering all relevant health conditions for persons with SCI/D or spina bifida with the ICF generic core set and the ICF Core set for spinal cord injury in the long-term context an ideal framework for the development of an evidence based comprehensive clinical practice guideline for follow-up care would exist and the current findings of this review could serve as an evidence-based basis for a comprehensive clinical practice guideline as commissioned by the DMGP Innovative approaches such as telemedicine and local visits by nurses might help to ensure specialized care in those vulnerable population This approach could also help to reduce healthcare costs by preventing unnecessary referrals to specialists The search results for persons with spina bifida highlight the importance of understanding their health needs particularly as they transition into adulthood The articles provide valuable insights into the management of spina bifida The findings can inform the development of evidence-based practices in healthcare to improve outcomes for individuals with spina bifida Considering the methodological quality of included publications we can conclude that high quality recommendations for follow-up care for people with SCI/D and spina bifida are largely missing With the application of the STROBE tool for observational studies the AMSTAR checklist for systematic reviews and the JBI-tool for randomized Trials we provide a valuable baseline to inform the development of an evidence-based practice guideline in follow-up car for people with SCI/D As there were also publications with methodological limitations included there might be a risk of bias considering the reliability of specific recommendations for follow-up care for individuals with SCI/D and spina bifida The results of this systematic review may be limited by the following factors: The search was performed in 2019 as a first step of the development of the guideline on follow-up care of secondary health conditions in spinal cord injury and spina bifida” and thus included literature from January 2008 until December 2018 relevant articles and guidelines might have been published which we have not included in the current review A revision of the guideline for follow-up care including an update of the review is planned and due on 1.1.2027 and will include all new literature and guidelines published We conducted our systematic search in PubMed Cochrane library and in several Guideline databases nevertheless there is a residual probability that a publication on this topic has not been included where only German and English were considered 12 out of the 19 publications (in PubMed) were conducted in Canada Three were conducted in Switzerland and two in Germany The other publications were from Bangladesh The high number of English-speaking countries might be due to the lack of translation of publications in other languages Most publications come from the USA which can partly be explained due to the reasonably shorter initial rehabilitation period for people with SCI and therefore There is an underrepresentation of evidence on long-term follow-up care in low and middle income countries The idea of a LHS assumes that a health system can learn when it can rely on cyclic processes where data for the health system serve as a basis for the generation of new evidence establishment of an LHS is helpful to ensure evidence to be integrated in clinical practice and experience from clinical practice to be integrated in new research follow-up care of persons with SCI encompasses much more as prevention and early treatment of SHCs Besides the assessment and evaluation of body structures and body functions regular evaluation and assessment of activities and quality of life should be performed during each follow-up visit The ICF and its core sets build a framework for the evaluation of all relevant aspects of functioning with SCI it was beyond the scope of the current guideline to describe all aspects of follow-up care in persons with SCI we recommend regular (annual) follow-up care appointments at specialized SCI clinics While several specific health concerns (SHCs) were addressed in follow-up care programs there is a notable absence of a comprehensive clinical practice guideline (CPG) covering all health conditions relevant for the long-term follow-up of individuals with SCI/D or spina bifida the DMGP has commissioned its members to establish a guideline for follow-up care for individuals with SCI/D The original contributions presented in the study are included in the article/Supplementary Material further inquiries can be directed to the corresponding author XJ: Writing – review & editing MB: Writing – review & editing BH: Writing – review & editing FM: Writing – review & editing The author(s) declare that no financial support was received for the research Martin Schubert (delegate of University clinic Balgrist Hildegard Oswald (librarian Swiss Paraplegic Centre) Austrian and Swiss SCI Patient association: Daniel Joggi Hannes Wiesinger and Marcel Studer delegate of the Swiss Spina Bifida and hydrocephalus (SBH) patient association as well as delegates of the interest groups: Dr Karl Kothbauer (†) (Neurosurgery Cantonal Hospital Lucerne Raoul Heilbronner (Neurosurgery Swiss Paraplegic Centre) MsC (Neuro-urology Swiss Paraplegic Centre) The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fresc.2024.1371553/full#supplementary-material Arbeitsgemeinschaft wissenschaftlicher medizinischer Fachgesellschaften/Association of the Scientific Medical Societies in Germany; CPG Deutsches Leitlinienbewertungsinstrument/German instrument for deutschsprachige medizinische Gesellschaft für Paraplegiologie; ICF International Classification of functioning National Institute for Health and Care Excellence; PICO Preferred Reporting Items for Systematic Reviews and Meta-analyses; R-AMSTAR Revised—A MeaSurement Tool to Assess Systematic Reviews; SCI/D Strengthening The Reporting 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This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) distribution or reproduction in other forums is permitted provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited in accordance with accepted academic practice distribution or reproduction is permitted which does not comply with these terms *Correspondence: Inge Eriks-Hoogland, aW5nZS5lcmlrc0BwYXJhcGxlZ2llLmNo Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher 94% of researchers rate our articles as excellent or goodLearn more about the work of our research integrity team to safeguard the quality of each article we publish Chad Pregracke is the founder and president of Living Lands and Waters a nonprofit organization dedicated to cleaning up America's rivers He is set to speak at an Earth Day celebration at the Hoogland Center for the Arts on April 18 He spoke to Community Voices about growing up on the Mississippi River and how he became a leader in environmental cleanup He also explained how he and his team have mobilized volunteers to remove more than 14 million pounds of garbage from 25 rivers across the U.S The free April 18 event at the Hoogland Center for the Arts will feature a social hour from 5:30 - 7 p.m cash bar and art exhibit by Sangamon Watercolor Society and a presentation by Chad Pregracke from 7 - 8:30 p.m. For more information visit: https://www.facebook.com/share/1GLjDGSDhZ/ Ashley Brown originated the role of Mary Poppins on Broadway 14 as the headliner for the Hoogland Center for the Arts Gala Brown spoke to the Beyond the Mouse podcast about her upcoming performance Jeffrey Hoogland misses bronze medal after judges reject team's protest in men's sprint final but he did so to a mix of cheers from the Union Jack-waving British fans and boos from the orange-clad Dutch supporters of his rival in the final Carlin had faced a warning in his quarterfinal match when he defeated Japan's Ota Kaiya in the third head-to-head and the memory of the incident was fresh in the mind of the Dutch coach when Carlin faced Hoogland for the bronze medal Carlin slid up-track and ran into Hoogland very nearly crashing the both of them in the process.  and Kordi said he thought that meant the officials would relegate Carlin and the bronze medal would belong to Hoogland But the jury decided instead to issue another warning to Carlin but Kordi said Carlin came out of the sprinters' lane which is against the rules if the rider has taken the lane He came out of sprinters lane," Kordi said the crash and the collision that did influence the race in my opinion Kordi said the officials made it clear on the morning of the final round that they would be more stringent "The jury made it clear to me this morning with all the incidents that had happened with Carlin included with all the fighting - basically rugby on wheels - that if you come out the sprinter's lane when it's engaged "It was two pedal strokes not just that his front wheel flicked in and out There's two pedal strokes in that corner there [turn 3] It was a close race and it affected the outcome because it was in the corner and he goes uphill and kills the speed So I was confused because they said it didn't influence the race "I was saying he altered the course by going out of it - [Hoogland] could have had a sharper corner and probably come over him and the other guy [Carlin] would have probably lost the speed as well But they didn't seem to think that affected the race because I thought we were saying that if you come in the sprint is lane Although Kordi said he wasn't angry with Carlin for how he raced he added he didn't think the jury would be so forgiving if it was another sprinter "I think what it's encouraging is people pushing boundaries There's a saying in sports that you swallow your whistle in the highest sort of pressurized moments meaning they're not going to give the call because it's such a grand occasion but I still am confused with all the warnings and head butting and coming out the line he was doing yesterday and today that it didn't actually come of anything." The boos and the protests didn't hurt Carlin as much as the entire sprint tournament where he had to defeat riders like Nicholas Paul (Trinidad & Tobago) and Ota all while just getting over a fractured ankle that he suffered in April "I won't lie when I say the last two days have probably been the most mentally challenging in my career," Carlin said you just saunter in if you're one of the top qualifiers and then you walk away and you recompose yourself for the harder races The jeers of the Dutch fans were just another day in the life of a match sprinter "Tokyo was the same - that's part of the Olympics and you put yourself in the light to be challenged on that she coordinates coverage for North American events and global news As former elite-level road racer who dabbled in cyclo-cross and track Laura has a passion for all three disciplines When not working she likes to go camping and explore lesser traveled roads UCI governance and performing data analysis More than half of the respondents to a State Journal-Register poll said the best place for a New Year's Eve date in Springfield is at First Night at the Hoogland Center for the Arts That outdistanced "staying at home/on the couch" in the SJ-R poll the family-friendly celebration of the arts put on by the Springfield Area Arts Council More: Here's why two UIS Performing Arts Center venues will temporarily close in 2025 Among the performers at the Hoogland Center area the Lincoln Ring of Magicians Lotus Fire Belly Dancers and Capital City Improv with the Illinois Capitol Building as the backdrop Tickets are $25 (youth 15 and under attend free) and available at the SAAC website or the Hoogland box office. Contact Steven Spearie: 217-622-1788; sspearie@sj-r.com; X, twitter.com/@StevenSpearie. Volume 5 - 2024 | https://doi.org/10.3389/fresc.2024.1371556 Introduction: While it is well-established that follow-up care programs play a crucial role in preventing and early detecting secondary health conditions (SHCs) in persons with spinal cord injury [SCI the availability of evidence-based follow-up care programs remains limited Under the leadership of the German-speaking Medical Society for Paraplegiology (DMGP) we have developed an evidence based clinical practice guideline for follow-up care of SHCs in persons with SCI and identify research gaps Methods: This guideline was developed in accordance with the regulations of the Association of the Scientific Medical Societies in Germany (AWMF e.V.) we utilized the International Classification of Functioning Disability and Health (ICF) generic core set and ICF Core Set for individuals with SCI in long-term context as our foundational framework We conducted a comprehensive literature review to identify existing recommendations for follow-up care and graded the level of evidence according to relevant instruments we formulated recommendations and achieved consensus through a structured nominal group process involving defined steps and neutral moderation while adhering to the criteria outlined in the German guideline development instrument (DELBI) Results: Although there is a fair number of literatures describing prevalence and severity of SHCs after SCI the amount of literature including recommendations was low (19 for SCI and 6 for SB) Based on the current evidence on prevalence and severity of SHCs and available recommendations a clinical practice guideline on follow-up care of most relevant SHCs was defined The recommendations for follow-up care are described in the following chapters: (1) Nervous system; (2) (Neuropathic) pain; (3) Cardiovascular diseases; (4) Respiratory System; (5) Immunological system vaccination and allergies; (6) Gastrointestinal tract and function; (7) Endocrinological system and nutrition; (8) Urogenital system; (9) Contraception birth and postpartum care; (10) Musculoskeletal system; (11) Pressure injuries; (12) Psychological health; (13) Medication and polypharmacy Conclusion: We could successfully establish an evidence based clinical practice guideline for follow-up care of SHCs in individuals with SCI There is however a notable lack of high-quality recommendations for SCI follow-up care The management of SCI therefore goes beyond the initial injury and acute care phase necessitating a comprehensive approach to long-term follow-up care A critical aspect of follow-up care involves the prevention or early diagnosis of new health conditions (HCs) Despite the established benefits of follow-up care programs throughout the lifespan, including improved health, prevention of SHCs, current follow-up care programs are scarce, limited in availability, predominantly rely on expert opinions, and exhibit considerable variation in terms of content, frequency, and setting (23) To provide individuals with SCI with up-to-date and optimal medical and rehabilitative care as well as to establish a first step building an evidence-based framework for a (learning) health system (LHS) in SCI the development of an evidence-based clinical practice guideline for follow-up care in persons with SCI is imperative The German-speaking Medical Society for Paraplegiology (DMGP) has tasked its members with the development of a clinical practice guideline for the follow-up care of SHCs in individuals with SCI This guideline aims to provide the most comprehensive and current recommendations for the long-term care of persons with SCI Its purpose is to serve as a foundation for a dynamic LHS ensuring continuous enhancement through structured data assessment along the continuum of care and so building a framework for research and adaptation The guideline addresses critical clinical questions Content of follow-up care programs: What should be the core components of follow-up care programs focusing on prevention and early adaptation of SHCs including clinical and additional evaluations Assessments tailored to specific SCI groups: Are there specific assessments that should be uniquely tailored to distinct SCI groups Frequency of follow-up care appointments: How often should individuals undergo follow-up care appointments Setting for follow-up care appointments: In what clinical settings should these follow-up care appointments take place By addressing these clinically relevant key questions the guideline seeks to provide a structured and evidence-based approach to optimize the long-term care of individuals with SCI ultimately aiming to enhance their overall well-being and quality of life The development of the present guideline was spearheaded by the DMGP e.V The core working group comprised six medical doctors/physicians (IEH XJ) all with over 15 years of experience in the field of SCI The extended working group existed of medical doctors/physicians hailing from diverse backgrounds including physical medicine and rehabilitation RB) as well as members from patient associations for individuals living with SCI or SB The development process also engaged representatives (mandates holders) of professional societies within the Association of the Scientific Medical Societies (AWMF) for external reviews all DMGP members were provided the opportunity to review the guideline The content of the clinical practice guideline was structured using the International Classification of Functioning and Health (ICF) Generic Core Set and ICF Core Sets for individuals with spinal cord injury in the long-term context as frameworks (Table 1) (26, 27). Additional ICF categories were incorporated by expert opinion recommendation of the core group (see Supplementary Material) Grey literature sources were also examined from the Spinal cord injury research evidence (SCIRE) project and existing guidelines Comparison and Outcomes (PICO) tool was used to identify all relevant literature Included were all studies which included persons with SCI and SB (P) frequency and setting of follow-up care of SHC in SCI (I) and describing outcome measures (O) A reviewer (IEH) evaluated the identified “titles and abstracts” according to the inclusion criteria (IEH) After an initial selection of literature from PubMed (spinal cord injury n = 1,973/SB n = 19) the full texts from the databases were then retrieved (n = 34/n = 6) and evaluated by two reviewers (IEH & LM) the reviewers then decided again whether the study met the established criteria two additional members of the guideline group were consulted to reach a decision 19/6 articles were ultimately assessed as suitable for addressing the key questions and thus serve as the basis of evidence The information from the relevant literature was extracted by one person (IEH) and documented in a specially developed template which was later used for processing in the consensus process The information includes title and authors of the study Since all identified texts were written in English the summary of the information was also conducted in English Additional findings from guidelines and textbooks were consecutively included in the template The approach to evidence assessment is based on the process of a systematic literature review. Critical Appraisal Tools are used to evaluate the quality of the relevant literature. Since various types of literature and studies were identified through the literature search, different tools were also utilized to represent the quality. Level of evidence was classified according to the AWMF Regulations in four Grade categories: high, moderate, low and very low (30) In a next step the Grade of recommendation A (must/must not), B (should/should not) and 0 (could/could not) was then defined, based on the level of evidence and according to the regulations of the AWMF (30) The analysis of this literature search served as the foundation for this guideline grading of evidence and grade of recommendation Based on the ICF Generic Core Set (27) and ICF Core Sets for individuals with spinal cord injury in the long-term context (26) and expert opinion of the working groups a content of the guideline was defined (see Supplementary Table S1) The included ICF categories were clustered in 13 chapters: (1) Nervous system sleep and autonomic function; (2) Pain; (3) Cardiovascular diseases including cardiometabolic syndrome and thrombosis; (4) Respiratory System infections and sleep-associated breathing disorders; (5) Immunological system including vaccination and allergies; (6) Gastrointestinal tract and function including obstipation and incontinence screening recommendations for colon carcinoma and dysphagia; (7) Endocrinological system and nutrition including osteoporosis and malnutrition; (8) Urogenital system renal function and urinary tract infections preventive medicine and screening for women and pregnancy in women with spinal bifida; (9) Pregnancy birth and postpartum care; (10) Musculoskeletal system including upper extremities and scoliosis; (11) Pressure injuries; (12) Psychological health; (13) Medication and polypharmacy guidelines and textbooks was allocated to the referring chapters and authors summarized the relevance and recommendations for follow-up care The AWMF-guideline “Follow-up care in persons with SCI” (32) recommends following: The primary objectives of these appointments are to prevent the onset of SHCs and optimize the person's rehabilitation status 1. Content of follow-up care: Follow-up care appointments should encompass a broad range of health aspects, as defined by the current guideline (see Supplementary Table S1) and not be limited to SCI-specific issues They should also evaluate typical aging-related concerns such as degenerative changes and cardiovascular health 2. Assessment: Ideally, follow-up care appointments should adopt an interdisciplinary and/or interprofessional approach, involving healthcare professionals from various backgrounds. This collaborative approach ensures comprehensive assessment and management of the person's health. In Supplementary Table S1 specific recommendations on assessments Frequency of follow-up care appointments: Regular monitoring for all individuals with SCI: It is strongly recommended that every person with SCI undergoes regular follow-up care appointments It is advisable to schedule follow-up appointments at specific intervals persons should attend follow-up appointments at 3 annual appointments at specialized SCI clinics are recommended Setting of follow-up appointments: Follow-up care appointments ideally are scheduled at a specific SCI clinic to ensure a holistic health evaluation Specific health issues might need inclusion of other medical specialists an important role in healthcare management of persons with SCI is reserved for the general practitioner of the person 5. Assessments tailored to specific SCI groups: Specific recommendations for different age groups, persons with tetraplegia, those with complete lesions, persons able to walk, women, and persons with spina bifida are made where applicable and included in Supplementary Table S1 The supplement provides a detailed overview of recommendation of all above mentioned 13 chapters, but now clustered in five key-components (neurological status, general internal status, neuro-urological & urogenital status, musculoskeletal status and rehabilitation status). For each chapter a short description of the problem (frequency/severity) is given, followed by the recommendations including level of evidence and grade of recommendation. In Supplementary Table S1 we provide a “quick-read” overview of the content of follow-up care appointments as well as clinical examination and additional examinations It also includes an overview of assessments that are recommended The key components of follow-up care appointments are listed below They mirror the comprehensive approach which is needed to ensure that all relevant aspects of health and functioning are covered in follow-up appointments 1. SCI specific neurological assessment: Each follow-up care appointment should include a thorough assessment of SCI-specific neurological aspects (33) This evaluation should encompass the individual's neurological status as well as any changes or developments in their SCI special attention should be given to cognitive status and shunt function Any neurological concerns or developments should be identified and addressed Assessment of internal medicine status: The follow-up care process should involve a comprehensive assessment of the individual's internal medicine status This includes evaluating their overall health (including for example cardiac preventive care and screening status and medication management Any changes or issues related to internal medicine should be addressed and managed as appropriate (Neuro-) musculoskeletal assessment: An integral part of follow-up care is the assessment of (neuro-) musculoskeletal health This evaluation examines the individual's musculoskeletal system Any musculoskeletal concerns or developments should be identified and addressed Neuro-urological and urogenital assessment: Follow-up care appointments should incorporate a neuro-urological and urogenital assessment This includes evaluating urinary and genital function identifying any issues related to bladder or sexual health Rehabilitation status: The individual's rehabilitation status should be continuously monitored and assessed during follow-up care appointments and the need for adjustments or modifications to the rehabilitation plan individuals with SCI can receive comprehensive and proactive care that aims to optimize their overall well-being and address potential health issues associated with aging This approach ensures that follow-up care is tailored to the unique needs of each person with SCI promoting a higher quality of life and long-term health The current clinical practice guideline for follow-up care in individuals with SCI represents a significant milestone as it stands as the first comprehensive evidence-based guideline for follow-up care across the lifespan for individuals with SCI and SB This guideline emerged through a collaborative effort of experts including healthcare specialists and individuals with lived experience The incorporation of the ICF generic core set and the ICF core set for SCI underscores the guideline's robust evidence-based foundation With the implementation of the current follow-up care guideline a framework for assessment of SHCs in persons with SCI has now been established making outcomes of follow-up carte appointments measurable and therefore comparable It also sets the standard for follow-up care recommending on content frequency of follow-up care appointments and specific considerations for subgroups The idea of a LHS assumes that a health system can learn when it can rely on cyclic processes where reliable and regular assessed data for the health system serve as a basis for the generation of new evidence The evidence is transferred into practice for implementation and structured data generated from practice as well as experience from implementation are fed back into the cycle By including structured assessments and outcomes a comparison over time and between health care settings is possible In recognition of the dynamic nature of SCI and the ever-evolving healthcare landscape the guideline adopts a learning health system approach This approach serves as a bridge between research evidence and practical application allowing real-world data to generate new research questions and inform ongoing improvements in care delivery the guideline remains adaptable and aligned with the dynamic nature of SCI and healthcare It is imperative to emphasize that guidelines are most effective when integrated into everyday clinical practice. The implementation of the guidelines in our health care setting is a step-wise approach based on recommendations of Beachemin et al. (34) using a repeating-process model While the guideline provides a valuable framework for follow-up clinical care it is essential to underscore that individualized care should always consider the unique circumstances of each health care setting and each person Guidelines are not legally binding documents and should be applied judiciously in light of individual needs and the regional/national health care system The guideline is anticipated to undergo periodic updates in accordance with AWMF guidelines These updates will prioritize the enhancement of guideline development methodology including the evaluation of systematic reviews and meta-analyses in line with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement and the application of the GRADE approach to assess the quality of available evidence and the strength of recommendations The guideline recommends specialist in SCI care (ideally a PMR specialist) to be the coordinator of follow-up care in close collaboration with all included health care specialist The guideline therefore is not only a tool for SCI specialists but also informs general practitioners and persons with SCI on the recommendations for follow-up care The DMGP successfully established a clinical practice guideline for follow-up care of SHCs in individuals with SCI Although we found a fair number of literatures describing prevalence and severity of SHCs after SCI for some health conditions this was completely missing (for example breast and cervical cancer prevalence in women with SCI and the amount of literature specifying recommendations for follow-up care appointments was low (19 for SCI and 6 for SB) and mostly of low-moderate quality CB: Writing – review & editing HE: Writing – review & editing MV-A: Writing – review & editing RB: Writing – review & editing KF: Writing – review & editing RT: Writing – review & editing Switzerland) which participated in the start of the guideline development We also like to thank Hildegard Oswald (librarian at Swiss Paraplegic Centre) for her help with the literature searches and moderating the process Further thanks we are obliged the persons with “lived experience” Austrian and Swiss SCI Patient associations: Daniel Joggi delegate of the Swiss Spina Bifida and hydrocephalus (SBH) patient association we thank the delegates of all involved interest groups: German society of neurorehabilitation (DGNR) Austrian society of neurorehabilitation (ÖGNR) German society for gynecology and birth (DGGG) We also like to express our thanks to the guideline committee of the German speaking association of paraplegiology (DMGP) and its members for providing us with valuable feedback The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fresc.2024.1371556/full#supplementary-material Deutsches Leitlinienbewertungsinstrument/German instrument for methodological guideline appraisal; DMGP Deutschsprachige Medizinische Gesellschaft für Paraplegiologie (German Medical Association for Paraplegia); e.V eingetragener Verein (registered association); GRADE international classification of functioning physical medicine and rehabilitation; PRISMA preferred reporting items for systematic reviews and meta-analyses; SB Recent trends in mortality and causes of death among persons with spinal cord injury Survival after non-traumatic spinal cord injury: evidence from a population-based rehabilitation cohort in Switzerland All-cause and cause-specific mortality following non-traumatic spinal cord injury: evidence from a population-based cohort study in Switzerland Differential survival after traumatic spinal cord injury: evidence from a multi-center longitudinal cohort study in Switzerland Mortality and longevity after a spinal cord injury: systematic review and meta-analysis Google Scholar secondary health conditions and quality of life in people with spinal cord injury Lifetime prevalence of chronic health conditions among persons with spinal cord injury Survival and cause of death after traumatic spinal cord injury A long-term epidemiological survey from Denmark Long-term survival in spinal cord injury: a fifty year investigation Long-term morbidity and mortality after spinal cord injury: 50 years of follow-up A prospective assessment of mortality in chronic spinal cord injury and psychosocial outcomes of persons spinal cord injured more than 20 years ago Expectations of life and health among spinal cord injured adults and economic risk factors for mortality after spinal cord injury severity of injury and period of latency: a descriptive study on 135 patients with spinal cord injury and bladder cancer Factors affecting mortality and morbidity in adult spina bifida PubMed Abstract | Crossref Full Text | Google Scholar Spina bifida outcome: a 25-year prospective International spinal cord injury data sets Developing core sets for persons with spinal cord injuries based on the international classification of functioning disability and health as a way to specify functioning ICF core sets for individuals with spinal cord injury in the long-term context Towards a minimal generic set of domains of functioning and health MD: Wolters Kluwer Health/Lippincott Williams & Wilkins (2011) Google Scholar ISCOS—textbook on comprehensive management of spinal cord injuries Crossref Full Text | Google Scholar Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften Google Scholar S2k-Leitlinie Lebenslange Nachsorge für Menschen mit Querschnittlähmung Google Scholar International standards for neurological classification of spinal cord injury (revised 2011) Implementation of clinical practice guidelines in the health care setting: a concept analysis Health care utilization in persons with spinal cord injury: part 2-determinants geographic variation and comparison with the general population Thietje R and Jordan X (2024) Evidence based clinical practice guideline for follow-up care in persons with spinal cord injury Received: 16 January 2024; Accepted: 9 August 2024;Published: 9 September 2024 Copyright: © 2024 Eriks-Hoogland, Müller, Baumberger, Huber, Michel, Belfrage, Elmerghini, Veseli-Abazi, Böthig, Fiebag, Thietje and Jordan. 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Volume 8 - 2023 | https://doi.org/10.3389/feduc.2023.1293754 This article is part of the Research TopicBest Practices in Numeracy Education for the 21st CenturyView all 5 articles A correction has been applied to this article in: Corrigendum: The changing nature of basic skills in numeracy Conducting large calculations manually with pen and paper following prescribed procedures or algorithms has been diminishing in significance for some time individuals employ digital instruments for such computational tasks and the application of digital instruments for computation that numeracy education for adults prioritizes these competencies to achieve efficacy This lack impedes their autonomous and effective participation in our technologically advanced leading to potential occupational exclusions and daily life challenges While adult numeracy educational practices should mirror these broad multifaceted competencies for effectiveness a significant portion of such practices remains anchored in manual calculations with abstract numbers Although there's a discernible shift toward materials and strategies that align with the aforementioned broad competencies the traditional computational approach remains deeply entrenched Subsequent sections will elucidate the primary cause for this enduring incongruence with a deeper exploration of the evolution of basic numeracy skills Figure 1. Common European Numeracy Framework: aspects of the quality of numerate behavior. Adapted from (Hoogland et al., 2021) To grasp the evolving essence of numeracy as a basic skill it's crucial to differentiate between two distinct yet related phenomena shaped by our interactions with a world abundant in numerical concepts and artifacts The depth and breadth of this toolkit can vary among individuals Regular engagement in diverse numeracy situations can enhance and solidify this toolkit and math anxiety can influence its effective utilization The second phenomenon is the capacity to finds answers to more complex and larger calculations using written down procedures and algorithms These complex mathematical operations go beyond the direct scope of the mental toolkit Examples include more complex calculations starting from 123 × 939 cultures developed specific written algorithms or even clay tablets were employed to break down these calculations into smaller manageable steps that could be tackled using the mental toolkit The mental toolkit was used in these procedures over and over again in a specific—detached from reality—way The distinction between the mathematical mental toolkit and procedural calculations offers a lens to comprehend the evolution of basic numeracy skills The first phenomenon is rather universal and encompasses also the higher-order skills necessary to cope with a plethora of numeracy situations the second one is time-bound and started loosing its relevance at the end of last century after being prominent for centuries We will discuss in broad strokes three periods in recent times and how the phenomena described above played a role We distinguish between roughly three periods brought about significant changes in the way society perceived and imparted basic skills As industries grew and urbanized areas expanded the need for a more universally applicable set of skills became evident It became clear that this system of apprenticeships was insufficient to meet the demands of a rapidly changing workforce The mid-19th century, particularly the Victorian era, saw an emphasis on the so-called 3 R's of Reading, 'Riting, and 'Ritmetic. These skills were deemed essential for individuals to navigate the complexities of an industrialized society (Thomas, 1987) there was a global push toward mass education Schools became the primary institutions for imparting a standardized set of skills Subjects like language and mathematics were at the forefront considered indispensable for personal and professional growth there was a noticeable shift in pedagogical approaches While the emphasis on mastering basic facts remained the procedural content became more abstract and decontextualized The practical application of these skills in daily life was often overlooked in favor of rote learning and procedural mastery This abstract approach to mathematics trickled down to adult education as well There was a prevailing belief that mastering abstract mathematical procedures was a prerequisite to harnessing one's mental toolkit in real-life situations with adults learning skills that they found little to no application for in their daily lives witnessed a seismic shift in the substantiation of basic skills revolutionizing the landscape of arithmetic were capable of executing a vast array of calculations from basic arithmetic to advanced scientific computations This technological leap posed a challenge to the traditional goals in education as the necessity to manually perform calculations diminished This meant also that the “natural” environment to keep using and exercising the mental toolkit in carrying out procedures came under pressure because the need to master it to solve calculational problems dwindled rapidly A discernible gap emerged between real-world practice and school curricula While calculators and digital computation tools became ubiquitous in daily life their use was often restricted in educational settings In primary and most secondary education this discrepancy was kept at arms length by simply not allowing calculators or other digital calculation software in the mathematics lessons For adult numeracy education the need to tackle this discrepancy is urgent It simply doesn't make sense to teach adults again procedures that are not used anymore while an abundance of challenging numeracy problems comes across in their daily life a stark contrast is evident when we turn our gaze to the prevalent practices in adult numeracy education The current pedagogical landscape is dominated by traditional often emphasizing decontextualized number crunching and rigid procedural algorithms while rooted in historical educational paradigms seems misaligned with the dynamic demands of the contemporary world Labeling the prevailing calculational approach as “catastrophic teaching of skills” is not an overstatement It epitomizes an educational scenario where a skill is incessantly drilled into learners without any tangible demonstration of its applicability outside the classroom Such an approach not only diminishes the perceived value of the skill but also causes a disconnect between learning and real-world relevance To foster a versatile mathematical mindset in adults a paradigm shift in educational practices in adult numeracy education is imperative The focus should pivot from rote calculations to the cultivation of higher-order skills that resonate with the complexities of a mathematized society By anchoring lesson tasks in real-world scenarios and emphasizing ánd exercising higher order skills that hold tangible relevance we can bridge the chasm between adult classrooms and practical use ensuring that adults are well-equipped to navigate the intricacies of the modern world The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest Google Scholar Google Scholar Google Scholar Google Scholar Google Scholar Google Scholar Google Scholar Google Scholar Google Scholar Google Scholar Google Scholar CrossRef Full Text | Google Scholar CrossRef Full Text | Google Scholar CrossRef Full Text | Google Scholar Google Scholar Google Scholar Citation: Hoogland K (2023) The changing nature of basic skills in numeracy Received: 13 September 2023; Accepted: 02 October 2023; Published: 20 October 2023 Copyright © 2023 Hoogland. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) *Correspondence: Kees Hoogland, a2Vlcy5ob29nbGFuZEBodS5ubA== Brad has spent over 20 years in marketing and strategy helping the CEOs of the world’s largest global companies to improve their business performance and impact He joined BCG’s Atlanta office in 2001 and left in 2004 to help start (r)evolution partners a growth and innovation strategy firm that was acquired by Prophet in 2012 Brad returned to BCG in 2016 to servee as the Chief Operating Officer of BCG BrightHouse to help grow and scale the firm globally Brad moved to Berlin to start and build the BCG BrightHouse business in Europe and the Middle East He served as President and Managing Director of Europe and Middle East for BCG BrightHouse until 2021.His worked principally focused on helping BCG’s global clients to improve their business performance and impact He has deep experience in industrial goods Brad currently serves as the Chief Strategy & Financial Officer at Decisely a private-equity backed insurtech company that is reinventing the ecosystem of small business employee healthcare benefits Brad was born and raised outside Washington He earned an MBA from the Booth School of Business at the University of Chicago and a BS in Chemical Engineering from Case Western Reserve University Brad has served on the executive committee of the Product Development and Management Association board and has been awarded the American Marketing Association’s Marketer of the Year Brad and his wife are the proud parents of three daughters who attend the University of Wisconsin "13" the musical opens at the Hoogland this weekend. For tickets, go to hcfta.orgg Silver medallist Jeffrey Hoogland (left) and gold medallist Harrie Lavreysen celebrate Dutch 1-2 after the men's Sprint race Denmark's Julie Leth reacts after winning the women's Point race Denmark's Tobias Aagaard Hansen on his way to gold in the men's Elimination race Tim Torn Teutenberg and Roger Kluge of Germany win men's Madison Tobias Aagaard Hansen wins third medal of week in rowdy men's Elimination race Mina Sato makes it a Keirin sweep for Japan On the fifth and final day of the 2024 UCI Track World Championships five world titles were decided at Ballerup Super Arena outside Copenhagen were the top two countries at Track Worlds Great Britain added four to their talley on the final day in the women’s Points and Keirin races as well as the men’s Elimination and Madison races Host nation Denmark took two gold medals on the fifth and final day of competition at the Ballerup Super Arena outside Copenhagen to match Great Britain and the Netherlands with four gold medals Denmark also had two silver and a bronze to give them seven total Belgium and Italy each earned four total medals Harrie Lavreysen outdueled Jeffrey Hoogland in a Dutch showdown for the men's Sprint title at the 2024 UCI Track World Championships It was Lavreysen's third gold medal of the week at the Ballerup Super Arena and a sixth consecutive Sprint world championship For the second time he went up against his compatriot Hoogland who won the gold in the men's Team Sprint.  The 27-year-old Lavreysen swept both races against Hoogland adding a 16th career gold to his world championships domination as well as holding five Olympic gold medals And I knew that record [of 14 world titles] could be broken one day The Track World Championships have been held for over 100 years and have many great records and rankings That I can top one of those lists is very special," Lavreysen told Nos.nl after the race "I knew I had to go for the kilometre time trial at some point Kaiya Ota (Japan) defeated last year's silver medallist Nicholas Paul (Trinidad & Tobago) and earned the bronze medal third in the Sprint at the Tokyo Olympic Games also was part of Japan's bronze medal finish this week in the men's Team Sprint.  Lavreysen defeated Ota in back-to-back races while Hoogland needed a decider to move to the gold medal round ahead of Paul It was the second round that Hoogland needed a decider round to continue as he split races on Saturday's quarterfinals against Mikhail Yakovlev (Israel) and moved on with the decider victory by a slim 0:00:0.018 margin.  Sprint for goldPos.Rider (Country)1Harrie Lavreysen (Netherlands)2Jeffrey Hoogland (Netherlands)Swipe to scroll horizontallySprint for bronzePos.Rider name (Country)3Kaiya Ota (Japan)4Nicholas Paul (Trinidad & Tobago) Women's Points Race Julie Leth (Denmark) won the gold medal in the women's Points race going three points better than defending champion Lotte Kopecky (Belgium) and finished just ahead of New Zealand's Ally Wollaston Kopecky experienced a mechanical issue with her chain before the final sprint which kept her from winning a third world title in the Points race (having previously won in 2021 and 2023) The Belgian all-rounder also won the silver in the Elimination race this week "This silver is a bit harder to accept than the one from the elimination it is still a World Championship and it is still a medal It was not meant to be," Kopecky said to Sporza "It was still difficult to get 4 points back on Leth Without the chain problem I would probably have been stranded on one point so that would not have changed the final result." Jennifer Valente (United States of America) Mizuki Ikeda (Japan) and Alexandra Manly (Australia) took a lap and 20 points early in the race Then Leth launched a lethal attack and moved into the lead with lap bonus.  Kopecky pushed the pace and could only be followed by Leth Marit Raaijmakers (Netherlands) and Neah Evans (Great Britain) Evans was one of the riders brought down in a crash in the final bend while Kopecky could not counter the final sprint of Leth The 32-year-old Leth celebrated her second gold of the week and had a special celebration with the crowd as she heads to retirement.  Denmark's Tobias Aagaard Hansen took the rainbow jersey as he outpaced two-time world champion Elia Viviani (Italy) in the men's Elimination race on Sunday But it was far from a straightforward event as the race saw a number of crashes as well as relegations of three riders for causing disruptions in the frenzied competition Jules Hesters (Belgium) was removed and posted a result of 18th for "dangerous riding" in a close pass with Edibaldo Maldonado Rayas (Mexico) Three laps later Blake Agnoletto (Australia) was relegated for causing a crash The loudest controversy struck when Jan-Willem van Schip (Netherlands) was relegated from the final four riders and then disqualified for "improper conduct" After Diogo Narciso (Portugal) was dismissed by Van Schip to fifth place On the next pass with Bibic the trailing rider in fourth the race jury ruled Van Schip as the dropped rider for "dangerous riding" when he interfered with Narciso on the previous lap demonstrating his displeasure by cursing and directing an obscene gesture toward the UCI officials in front of the spectators improper conduct directed at any other person" While Van Schip's behaviour could have spoiled the event the Danish crowd went on to celebrate Hansen's success having been part of the gold medal Team Pursuit effort alongside Carl-Frederik Bevort and Frederik Rodenberg Madsen and taking a silver in the Scratch race (Image credit: Tissot Timing for UCI)Mina Sato ensured that Japan could lay claim to both Keirin world titles at this year’s Track Worlds following Kento Yamasaki’s victory in the men’s race earlier this week Sato took the gold when she came out from the wheel of sprint champion Emma Finucane the British rider leading the way into the final lap of the race Sato sped around the outside as she launched her bid for glory She edged around the outside of the final corner to nip into the lead with perfect timing to take home the rainbow jersey by a bike length Hetty van de Wouw (Netherlands) also managed to make her way past Finucane just getting past metres ahead of the finish line for the silver.  Katy Marchant (Great Britain) was another late mover also nudging past Finucane in a photo finish to claim bronze Sato’s win is her first at the Track Worlds following silver medals in 2021 and 2022 This year she has won the UCI Nations Cup and Japan Track Cup meaning the world title rounds out an incredibly successful season The wins from Yamasaki and Sato mark the first Keirin world titles for Japan since 1987 when Harumi Honda won the men’s title in Vienna Germany scored victory in the men’s Madison as Tim Torn Teutenberg and Roger Kluge took home rainbow jerseys ahead of Belgium and Denmark in the final event of the Track World Championships on Sunday The Germans finished with 76 points to Belgium’s 60 Denmark narrowly missed out on the silver medal with 59 points while Portugal finished in fourth on 53 points and 22-year-old Teutenberg were among the early leaders in the event along with Portuguese brothers Ivo and Rui Oliveira Belgian pair Lindsay De Vylder and Fabio Van den Bossche and the Danish duo Niklas Larsen and Michael Mørkøv were forced into catch-up mode winning sprints along the way in order to try and close the points gap The podium squads were up front in the hunt for points at the midway stage with Dutch pairing Yoeri Havik and Vincent Hoppezak and Portugal also in the mix extending their lead and avoiding pressure from other teams to ensure they enjoyed a good lead heading into the final phase The battle that remained was over silver and bronze and it came down to the death as Belgium surged ahead at the last sprint picking up four points to Denmark’s two and nabbing second place I always dreamed of becoming world champion and now it’s real,” Teutenberg said after the race before Kluge spoke about their age difference and bouncing back from the disappointment of coming fifth at the Paris Olympics age doesn’t matter,” Kluge said “He’s young but he’s been a working professional for years already We had two days of preparation at home to get clear about our tactics even if I didn’t have the signs on Friday that it could go this well “Madison is a special race and I’m happy I could show off that I still have the legs to go for it In Paris we were very unlucky and I’m happy that we could finish off the season here.”  a sports marketing and public relations agency which managed projects for Tour de Georgia a Georgia non-profit to promote safe cycling She is proud to have worked in professional baseball for six years - from selling advertising to pulling the tarp for several minor league teams She has climbed l'Alpe d'Huez three times (not fast) Her favorite road and gravel rides are around horse farms in north Georgia (USA) and around lavender fields in Provence (France) Get ready for a scorching Summer of Sport as TNT Sports brings fans well over 3,000 hours of live action this May June and July from across the nation’s favourite sporting events tournaments and championships to fans across the UK and Ireland marked Earth Month by spotlighting some of the key initiatives that form part of its 2025 Corporate Social Responsibility (CSR) strategy Discovery Sports Europe will oversee promotion and distribution for the Golden Trail World Series circuit as part of a multi-year partnership A record-breaking 41 permanent teams are set for action when the 2025 FIM Endurance World Championship fires up in France next week The French equipment brand signs five-year deal as the Official Bicycle Shoe Supplier and also becomes the official partner for its home UCI World Cup round of Les Gets Iconic Japanese bicycle components manufacturer signs four-year deal as the Official Drivetrain & Electric Drive Unit Components partner New AI technology platform transforms storytelling capabilities for WHOOP UCI Mountain Bike World Series coverage enhancing the viewer experience through data-driven insights Discovery (WBD) Sports Europe agrees new partnership with the International Federation of Sport Climbing (IFSC) to broadcast all IFSC World Cup and World Championship events until 2028 outdoor and lifestyle brands make their collective TV and multi-platform sponsorship debut  The Union Cycliste Internationale (UCI) and its partner Warner Bros Discovery (WBD) Sports confirm that the UCI Track Champions League was held for the last time in 2024 the UCI Track Nations Cup will be revitalised from 2026 UK - Tom Daley: 1.6 Seconds tells the incredible life story of five-time Olympic medallist Tom Daley OBE in a new collaboration between Warner Bros Set to premiere on discovery+ in the UK and Ireland early June broadcast on Really and TNT Sports later that month the feature documentary film explores the remarkable journey of one of Great Britain’s most iconic athletes  | Privacy Notice  | Cookies & Tracking Technologies Notice via the web service Clipsource ("Service") a tool for visitors and registered users ("User") to use the videos texts and other information ("Materials") from the Service for publication or personal consumption This agreement regulates the conditions around the User's use of the Service and Materials from the Service The Service includes search and monitoring and playback embedding and downloading of Materials from businesses organizations and others ("Sources") via 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The data can also be used to alert the user of new Material. For further information please see our Privacy Policy These Terms shall be construed in accordance with Swedish law becoming the first team to ride 750m in less than 41 seconds it's close to the Netherlands,” said Hoogland and then going under 41 seconds is amazing." Van den Berg got off to a flying start over the first 250m nearly leaving his team-mates outside his draft setting up an ideal second lap for the Dutch trio gradually increasing his speed and building a larger gap for Hoogland to utilise in the final lap Hoogland took over from Lavreysen at the 500m mark speeding away to a world record and Olympic gold medal "When I crossed the line after two laps He added: “I was already smiling on my bike before he finished Team GB couldn’t match the sheer speed of the Netherlands riding to the finish line in a time of 41.814 to claim the silver medal they were more than pleased to finish with the silver medal We had that in the tank if we executed well," said Carlin "It's not easy to come to your first Olympic Games Australia won a tight battle against hosts France in the bronze-medal match to claim the final spot on the podium with a time of 41.597 "It was a really hard one, and a challenging one," said Richardson. "I could not even be prouder of the team that I am riding with and it shows the heart that we put into that final ride, switching it up last minute without any preparations." The crowd saluted the effort of the French riders, who raced to fourth in a time of 41.993 seconds. 🥇","event":null,"destination_url":"","entry_point_tag":"base","entry_point_type":"instory_campaign"}" data-tracking="click" href="https://www.olympics.com/en/sign-in?entry_point_type=instory_campaign&entry_point_tag=base&template=base&origin=https%3A%2F%2Folympics.com%2Fen%2Folympic-channel" target="_blank" rel="noopener noreferrer">Olympic Membership - Free Live Stream Sports & Original Series - join now Say a little prayer for audiences at “Late Nite Catechism” at the Hoogland Center for the Arts this Sunday afternoon This long-running comedy play and participatory theater takes audience members back The Sister teaches a catechism class to a roomful of students The show was written in 1993 and popular Chicago actress Mary Zentmyer has played the role for 26 years This will be the third time HCFTA has brought Zentmyer as Sister to the arts center “We presented ‘Late Nite Catechism’ in 2016 and the sequel Both productions were huge hits for the Hoogland The shows have toured around the country with different performers but Mary really struck a nerve with our local audiences She is so quick-witted and funny as Sister “There is a large Catholic community in central Illinois,” Gordon continued “and this show reminds them all of their days in Catholic school The nuns and priests we've had in the audience frequently laugh the loudest But that doesn't mean this is a show that only Catholics will find funny People of all denominations find this show hilarious.” Sister goes from being a compassionate instructor rewarding the “students” for correct answers with items like glow-in-the-dark rosaries and laminated saint cards to an authoritative instructor These abrupt swings may strike a resonant chord among those who survived the ups and downs of going to school with an all-knowing authoritarian at the head of the class appealed to her with the comic approach to religion and the show was funny but not disrespectful “Having been raised Catholic with a great aunt who was a Sister of Providence and a great uncle who was a Passionist Father I grew up with an Irish-Catholic mother and am the baby of six children so this acting role fulfilled that dream with no lesson plans to do classes as an elementary school kid and being taught by the school sisters of St Francis at Alvernia High School on the Northwest Side of Chicago have all prepared me for this role.”  Zentmyer appreciates the Sister’s no-nonsense approach to everything but strict and tough — all qualities necessary when you have more than 50 students to teach in one classroom There were no teacher's assistants — just one nun.”  You do not have to be Catholic to "get it," Zentmyer said You will find it even funnier if you attended Catholic School and remember the good Sisters.” In this scripted yet somewhat improvisational play the audience becomes part of the cast called upon to answer pop quiz questions and share stories if they wish and you will hear other stories of your fellow 'classmates’ nun memories or ruler-whacking stories Some of the funniest moments are the true stories that the audience members share “There's a reason why people keep coming back to Sister's Class,” Zentmyer added and listen to stories about these hard-working and throw a few bucks into the basket after class and it will go directly to real retired nuns who took a Vow of Poverty and kept you in line all those years ago.” More information: Visit www.hcfta.org or call 217-523-2787 You don't have permission to access the page you requested. What is this page?The website you are visiting is protected.For security reasons this page cannot be displayed. Method: Regional and cellular dystrophin distribution was evaluated in both human and rat hippocampi and in rat cerebellar tissue by immunofluorescent colocalization with neuronal (NeuN and calbindin) and glial (GFAP) markers. In addition, hippocampal dystrophin levels were estimated by Western blot analysis in biopsies from TLE patients, post-mortem controls, amygdala kindled (AK)-, and control rats. Conclusion: Dystrophin is ubiquitously expressed by astrocytes in the human and rat hippocampus and in the rat cerebellum. Hippocampal full-length dystrophin (Dp427) levels are upregulated in human TLE, but not in AK rats, possibly indicating a compensatory mechanism in the chronic epileptic human brain. Volume 10 - 2016 | https://doi.org/10.3389/fncel.2016.00174 Objective: Dystrophin is part of a protein complex that connects the cytoskeleton to the extracellular matrix it functions as an anchoring protein within the central nervous system such as in hippocampus and cerebellum Its presence in the latter regions is illustrated by the cognitive problems seen in Duchenne Muscular Dystrophy (DMD) Since epilepsy is also supposed to constitute a comorbidity of DMD it is hypothesized that dystrophin plays a role in neuronal excitability we aimed to study brain dystrophin distribution and expression in both human and experimental temporal lobe epilepsy (TLE) Method: Regional and cellular dystrophin distribution was evaluated in both human and rat hippocampi and in rat cerebellar tissue by immunofluorescent colocalization with neuronal (NeuN and calbindin) and glial (GFAP) markers hippocampal dystrophin levels were estimated by Western blot analysis in biopsies from TLE patients Results: Dystrophin was expressed in all hippocampal pyramidal subfields and in the molecular- suggesting expression in astrocytes such as Bergmann glia (BG) and velate protoplasmic astrocytes In rat hippocampus and cerebellum there were neither differences in dystrophin positive cell types nor in the regional dystrophin distribution between AK and control animals hippocampal full-length dystrophin (Dp427) levels were about 60% higher in human TLE patients than in post-mortem controls (p < 0.05) whereas the level of the shorter Dp71 isoform did not differ AK animals showed similar dystrophin levels as controls Conclusion: Dystrophin is ubiquitously expressed by astrocytes in the human and rat hippocampus and in the rat cerebellum Hippocampal full-length dystrophin (Dp427) levels are upregulated in human TLE possibly indicating a compensatory mechanism in the chronic epileptic human brain its potential theoretical relation with epileptogenesis is hard to speculate upon and hence this isoform will not be further discussed in this paper to evaluate regional and cellular dystrophin distribution in the aforementioned two anatomical brain regions by means of immunofluorescence and to assess whether there were quantitative differences in dystrophin expression between epileptic and control individuals by means of Western blot analysis All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards Written informed consent was obtained from all individual participants included in the study and/or institutional guidelines for the care and use of animals were followed All procedures performed in studies involving animals were in accordance with the ethical standards of the institution or practice at which the studies were conducted Netherlands) were kept under controlled conditions (21 ± 2°C ambient temperature background noise provided by radio and food and water available ad libitum) The animals were habituated 1 week to the experimenter and the housing before the start of the experiment All experimental procedures were approved by the local animal ethics committee of Maastricht University and complied with national and international governmental legislation Also one stainless screw was implanted over the nasal sinus The connector was fixed on the skull using dental acrylic cement Amygdala kindling started 10 days after the electrode implantation and was performed as described previously (Aalbers et al., 2009, 2014; Rijkers et al., 2010) stimulation was performed twice daily (first stimulus between 8 and 10 AM second stimulus between 2 and 4 PM; an interstimulus-interval > 6 h) with the following parameters: 2 s A stimulus intensity of 400 μA was chosen to assure that the intensity was above the after discharge threshold for all rats Stimuli were delivered through a WPI Accupulser A310 connected to a WPI Stimulus Isolation Unit A360 (World Precision Instruments All rats were videotaped (Olympus FE-330) during delivery of the kindling stimulus and for as long as the behavioral seizure lasted. Seizure severity was evaluated offline from video-recordings by two blinded observers and classified according to the Racine scale (Racine et al., 1972) defined as five consecutive stage five seizures rats received one AK-stimulation per day for two more weeks Sham rats (N = 8) received an amygdala electrode that was not stimulated are further described in the respective sections Clinical characteristics of subjects used for Western blotting analysis Immediately after surgical resection, the hippocampi were cooled for 1 min at 4°C 0.9% saline and then dissected into two parts perpendicular to the longitudinal axis. One part was fixed in 4% paraformaldehyde overnight at 4°C, embedded in paraffin, and used for routine histopathological evaluation. The other part was immediately frozen on dry ice and stored at -80°C until further analysis (Aalbers et al., 2014) rats were sacrificed and processed for immunofluorescence as described previously Rats received an overdose of pentobarbital (Nembutal 0.1 mg/kg body weight) and were then trans-cardially perfused with 0.5 M ice cold phosphate buffered saline (PBS) followed by 4% paraformaldehyde in 0.5 M PBS Brains were dissected and post-fixed in 4% paraformaldehyde/0.5 M PBS for 90 min brains were cryoprotected by immersion in 20% sucrose/0.5 M PBS for 24 h the brains were frozen by immersion in -40°C isopentane for 3 min and stored at -80°C until further analysis by immunofluorescence 50 μm sagital sections of the right cerebellum (50 μm free floating) and coronal sections of the left hippocampus (30 μm free floating) were serially cut using a cryostat Free-floating sections were successively incubated at room temperature for 30 min in 1 M tris-buffered saline (TBS) and 10% normal donkey serum (NDS) for 60 min sections were incubated overnight at 4°C in TBS containing 0.5% Triton X-100 and 10% NDS - for NeuN (neuronal nuclei) in hippocampus - or PBS - for GFAP (glial fibrillary acidic protein) and calbindin in cerebellum and GFAP in hippocampus - and rabbit polyclonal anti-dystrophin (Abcam followed by donkey anti-rabbit secondary antibody conjugated to Alexa 488 (Invitrogen sections were incubated overnight with monoclonal mouse anti-calbindin D-28k (SWANT diluted 1:25,000) as a marker for PC or with monoclonal mouse anti-GFAP (Sigma-Aldrich Hippocampal tissue was also stained with monoclonal mouse anti-GFAP (Sigma-Aldrich diluted 1:500) and additionally with monoclonal mouse NeuN (Millipore diluted 1:50) as a marker for neuronal nuclei Primary antibodies were detected by donkey anti-mouse secondary antibody conjugated with Alexa 594 (Invitrogen USA) staining (1:500) was performed at room temperature and after washing the sections were coverslipped with 80% glycerol Negative controls were incubated with non-immune serum Rat biceps femoris muscle sections were used as a positive control for dystrophin immunofluorescence Additionally we performed triple staining - due to the unclear subcellular localisation of the dystrophin protein in the cerebellar sections - with the following primary anti-bodies: rabbit anti-dystrophin (Abcam monoclonal mouse anti-calbindin D-28k (SWANT diluted 1:2,500) and polyclonal goat anti- GFAP (Santa Cruz Biotechnology All primary antibodies were diluted in 1% NDS in 0.5% PBS-T and simultaneously incubated at 4°C for 16 h after blocking for 1 h with 10% NDS Secondary antibodies used were: Donkey anti-mouse secondary antibody conjugated to Alexa 647 (Abcam donkey anti-rabbit secondary antibody conjugated to Alexa 488 (Abcam donkey anti-goat secondary antibody conjugated to Alexa 594 (Invitrogen All secondary antibodies were diluted in 1% NDS in 0.5% PBS-T and simultaneously incubated at room temperature for 2 h Paraffin-embedded human hippocampal sections of 4 μm were cut in a coronal plane and directly mounted on glass followed by antigen-retrieval (0.01 M citric acid in a water bath of 95°C for 20 min Sections were immunohistochemically stained as described above using the following antibody concentrations: rabbit anti-dystrophin (1:100) Photomicrographic images were made using a BX51-microscope (Olympus Japan) connected to an Olympus XC10 camera (Olympus Images were taken with different exposure times for the different fluorophores Exposure times were kept constant among all sections thereby only being filter-specific (DAPI/Hoechst 1 ms confocal 1 μm space stacks were made of neuronal and glial cells in hippocampal sections (600 times magnification) PC in cerebellar sections (1000 times magnification not shown) and the cerebellar triple staining (400 times magnification) by means of a confocal disk spinning unit microscope (Olympus Japan) financed by The Netherlands Organisation for Scientific Research (grant number 911-06-003) all pictures were taken from the GCL of the DG right-side hippocampi were isolated by dissection and frozen at -80°C until further analysis The right side was chosen since this is contralateral to the stimulation site hence preventing potential confounding by the effects of direct electrical stimulation rat and human) was separately homogenized in lysis buffer (1 g tissue per 9 ml lysis buffer) containing 0.01 M PBS 1 mM EGTA (ethylene glycol tetraacetic acid) 1 mM EDTA (ethylenediaminetetraacetic acid) and protease inhibitor (Roche Custom Biotech For the limited amount of rat cerebellar tissue available (sham control and AK acute group; both N = 4) proteins were extracted from paraformaldehyde fixed sections using an extraction buffer kit according to the manufacturer’s instructions (Qiagen Optical density values were normalized to glyceraldehyde-3-phosphate dehydrogenase (GAPDH) detected by mouse monoclonal anti-GAPDH primary (Fitzgerald Industries International diluted 1:2,000,000) and donkey anti-mouse IRDye 680RD (LI-COR Quantified blot intensities were averaged of at least two independent experiments (and thus two or more samples per animal) within groups and were expressed as the mean + SEM These values were then used to calculate group averages In order to evaluate the effect of kindling on dystrophin expression we compared levels of sham and kindled animals by a Mann-Whitney U test To compare the acute effect with the long-lasting effect of a seizure on dystrophin expression in the hippocampus we compared rats that were sacrificed 2 and 24 h after a seizure by we corrected the alpha of 0.05 by Bonferroni to 0.025 we compared dystrophin levels in epileptic and non-epileptic tissue In order to assess the influence of neuronal cell loss and gliosis we also evaluated the difference in dystrophin expression between epileptic patients with and without HS Dystrophin distribution was studied in rat hippocampus and rat cerebellum. A general overview of these examined anatomical regions is depicted in Figure 1 by means of low-power images Immunofluorescent overview staining of rat hippocampus (A) and rat cerebellum (B) in order to evaluate dystrophin expression in an animal model for TLE consisting of the GCL is stained purple due to colocalization between NeuN (red) and Hoechst (blue) and is surrounded by dystrophin (green) positive astrocytes and blood vessels through all different hippocampal layers (B) The three cerebellar layers can be clearly distinguished: from right to left note the completely red MCL as a consequence of densely packed PC processes the PCL as visualized by the calbindin (red) antibody and finally the GCL which mainly consists of dystrophin (green) positive cells and blood vessels The regional and cellular distribution of dystrophin did not differ between sham control and AK rats H&E-staining of (dorsal) hippocampus of a sham rat (A) and AK rat (B) granular cell dispersion or pyramidal cell loss) could be noted Immunofluorescent staining of dystrophin distribution in rat hippocampus Double staining for dystrophin (green) and GFAP (red) (magnification 400 times) reveals colocalization (yellow signal) of GFAP and dystrophin in rat hippocampal sections of a control rat (A) and a similar colocalization pattern of GFAP and dystrophin is present in the hippocampus of AK rats (acute condition) (B) No colocalization is present in the double-labeled immunofluorescent staining for dystrophin (green) and NeuN (red) (magnification 200 times) in and around the pyramidal cell layer of the CA3 region in sham rat tissue (C) nor in AK (acute) rat (D) There is also no colocalization between dystrophin (green) and NeuN (red) (magnification 400 times) in the hilus between the DG and CA3 in control rat hippocampus (E) or AK (acute) rat hippocampus (F) (G,H) (sub)cellular distribution of dystrophin in rat hippocampus (DG) as visualized by confocal microscopy (magnification 600 times) (G) One micrometer spacing stack through the hippocampus of a sham rat stained for dystrophin (green) and GFAP (red) white arrowheads indicate dystrophin positive (H) One micrometer spacing stack through the hippocampus of a sham rat stained for dystrophin (green) and NeuN (red) black arrowheads indicate dystrophin positive (perivascular) astrocyte-like cells Asterisks indicate dystrophin positive blood vessels AK = Amygdala Kindled rat (here: acute AK rat; i.e. Dystrophin distribution in rat cerebellum (sagital sections) (A) Sham rat section stained for dystrophin (green) and GFAP (red) (B) AK (acute) rat section stained for dystrophin and GFAP Note the colocalization between GFAP and dystrophin (in both A,B) which are extending from the molecular layer and surround the PC There is also co-expression in the GCL between GFAP and dystrophin thereby possibly reflecting dystrophin positive velate protoplasmic astrocytes (white arrowheads) (C) Dystrophin (green) and calbindin (red) expression in sham rat cerebellum (D) Dystrophin and calbindin expression in the cerebellum of an (acute) AK rat There is no clear co-expression of dystrophin with calbindin positive PC in (C,D) (E) Triple staining in sham/control rat tissue with dystrophin (red) and calbindin (gray) visualized by means of confocal microscopy solely performed in order to assess which cell types here express dystrophin Dystrophin is visible in blood vessels and in BG (indicated by white arrowheads) both around the PC - where the soma of the BG is located - but also in the processes within the MCL Calbindin is depicted in gray and stains the PC as such Note the presence of multiple blood vessels in all three layers of all images AK = Amygdala Kindled animal (here: acute AK rat; i.e. It should be noted that the dystrophin distribution pattern was similar for sclerotic and non-sclerotic patients therefore no visual distinction could be made and hence only the images of an epileptic Immunofluorescence of dystrophin distribution in human hippocampus of a post-mortem control patient (A,C,E) and a TLE patient without sclerosis (B,D,F) (A) NeuN (red) in the GCL of the DG without dystrophin (green) positive astroglial-like cells in post mortem control tissue none of these NeuN positive cells are stained yellow and are therefore dystrophin negative (B) NeuN staining revealing NeuN (red) in the GCL of the DG and many dystrophin (green) positive astroglial-like cells in the hippocampus (DG) of a TLE patient (C) GFAP (red) but not dystrophin (green) positive astrocytes (indicated by means of black arrowheads) around the DG in the hippocampus of a post-mortem control patient (D) Dystrophin positive astrocytes around the DG of an epileptic hippocampus double stained for dystrophin (green) and GFAP (red) (E) 400 times magnified close-up of the DG of a post-mortem control patient The white arrowhead indicates a glial cell that reveals some colocalization between GFAP (red) and dystrophin (green) whilst the black arrowheads indicate none colocalizing astrocytes (F) 400 times magnified close-up of an area within the DG of a TLE patient glial cells that show (yellow) colocalization between GFAP (red) and dystrophin (green) Western blotting demonstrated that the full-length isoform (Dp427), Dp140, and Dp71 are expressed in the hippocampus and cerebellum of AK rats (see Figures 6C,F and 7C for a typical example) Mean values of relative dystrophin expression in hippocampus and cerebellum of sham and AK rats (SEM’s are indicated with whiskers) (A) Dp427 expression in sham rats (N = 8) versus acute AK (N = 7) and chronic AK rats (N = 8) (B) Dp71 expression in again sham rats (N = 8) versus acute AK (N = 8) and chronic AK (N = 8) rats (C) An example of the performed Western blot technique for dystrophin (in green) in rat hippocampus The different isoform bands as well as the GAPDH bands (red) are indicated (D) Dp427 expression in the cerebellum of sham rats (N = 4) versus (acute) AK rats (N = 4) (E) Dp71 expression in again sham rats (N = 4) and (acute) AK rats (N = 4) (F) Typical example of Western blot performed in cerebellum A = acute AK rat (sacrificed 2 h after last seizure) C = chronic AK rat (sacrificed 24 h after last seizure) Mean values of relative dystrophin expression in the hippocampus of patients operated for therapy-resistant TLE by means of neurosurgical removal of the hippocampus compared to post-mortem controls (SEM’s are indicated with whiskers) (A) Dp427 expression in post-mortem controls (N = 8) versus epilepsy patients both with severe sclerosis and without sclerosis (total N = 15) ∗Significant at alpha < 0.025 (B) Dp71 expression in again hippocampus from post-mortem control patients (N = 9) and in hippocampus from all patients included with TLE (i.e. with and without severe sclerosis; N = 15) (C) Example of Western blot performed in human hippocampus tissue; it is interesting to note the aspecific dystrophin (green) bands Abbreviations in panel C: W = without/no sclerosis p = 0.343 for Dp427 and p = 0.686 for Dp71) the post-mortem delay time was minimized (average time ± SEM = 1112 ± 175 min) dystrophin expression intensity did not correlate with post-mortem delay (Pearson’s R = 0.28 p = 0.47); hence the post-mortem delay did not influence the analysis Dp427 expression was on average 59.8% higher (SEM post-mortem control group: 10.7%; SEM pooled epilepsy group: 26.9%) in TLE patients (N = 15; p = 0.023), whereas Dp71 expression was not significantly increased in epileptic patients (+8.4%; p = 0.682; Figure 7) there was no statistically significant difference in dystrophin expression between severely sclerotic and non-sclerotic hippocampi from TLE patients (data not shown p-values of 0.689 and 0.955 for Dp427 and Dp71 we evaluated the hippocampal and cerebellar distribution of dystrophin in TLE patients and in an animal model of TLE (I) qualitatively by means of immunofluorescence in order to assess both the regional and cellular distribution pattern and (II) quantitatively by means of Western blot analysis We have shown that dystrophin is expressed in different types of glial cells in multiple layers of both the hippocampus and the cerebellum no expression of dystrophin in neuronal cells – like granular cells in the hippocampus or PC in the cerebellum – was found the dystrophin distribution pattern did not seem to differ between sham control and AK conditions the amount of dystrophin expression was not different between control and kindled animals In human hippocampi from TLE patients there was a significant increase in the amount of Dp427 when pooling all TLE samples we checked for auto-fluorescence by microscopic evaluation of unstained sections The contradicting effect of up- and downregulation within the same structure might have led to a net difference of approximately zero which may explain the results in our study in which a homogenate of the full hippocampus was evaluated we could not detect any major regional differences by visual inspection of the immunofluorescent stained rat hippocampus sections The dystrophin increase (here: only Dp427) in epileptic hippocampi could theoretically be explained as a compensatory upregulatory mechanism. Dp427 and Dp71 have powerful effects on excitation by clustering of postsynaptic GABAA-receptors (Brünig et al., 2002) and astrocytic AQP-4 and Kir4.1 channels (Connors et al., 2004; Perronnet and Vaillend, 2010), respectively, (Hendriksen et al., 2015) thereby illustrating another relation with (hyper) excitation and consequently TLE mutation dependent; a more distal mutation affects more brain isoforms and would thus give rise to multiple deficient counteracting mechanisms (i.e. hence increasing the probability of hyperexcitable brain (networks) and thereby epilepsy The discrepancy between human and experimental TLE data regarding dystrophin expression is interesting. Possibly, this can be explained by the presence of neuronal cell loss and gliosis in human TLE, which is absent in AK since this model is not characterized by neurodegeneration (Brandt et al., 2004). Indeed, Heuser et al. (2012) demonstrated a difference in dystrophin immunoreactivity in epilepsy patients with and without hippocampal sclerosis in this study we did not find such a difference in dystrophin expression between these two groups Another possible explanation is that in humans the tissue from which the seizure originated was evaluated while in rats the contralateral hippocampus was used in order to exclude the influence of direct electrical stimulation all human patients suffered from chronic and intractable epilepsy that has been tried to manage for years before epilepsy surgery was performed The compensatory mechanisms hypothesized above may only develop over years in-vivo and not after the relatively short period (i.e. the full-length isoform was based on immunofluorescence neither visualized in cerebellum nor in hippocampus for ethical reasons we were not able to include human cerebellar tissue in this study cerebellar rat tissue was treated differently in the Western blot procedure since it was paraformaldehyde fixed As the material from the experimental AK group has been treated in the same way this should not have affected the relative difference between the two groups the two groups included in the analysis of the cerebellum are small the average age of the post-mortem control patients was – logically – substantially higher than the average age of the epilepsy patients which could have influenced the quantitative expression of neuronal proteins Future research should focus on studying dystrophin expression in different brain areas in order to better understand the possible association between hyperexcitation and dystrophin alterations since this relation has only been marginally addressed in literature Conversely the role of dystrophin in (hyper)excitation should be further evaluated using animal models in which different dystrophin isoforms are absent ideally by making use of electrical kindling techniques such as in this study applied and which has not been studied before future studies should disentangle the possible contribution of the different dystrophin isoforms to epileptogenesis in order to assess possibilities for new anti-epileptic therapies Dystrophin is ubiquitously expressed in the hippocampus and cerebellum of AK rats and in human hippocampal tissue from epilepsy patients with and without HS as proven by Western blot and immunofluorescent analysis in this study which principal function in the brain it is to anchor GABAA receptors in the post-synaptic membrane is increased in human epileptic hippocampi possibly as a compensatory mechanism in order to restore the inhibitory balance in hyperexcitable brains This is the first study that reports on a (full-length) dystrophin upregulation in epilepsy which justifies more research in order to further investigate this newly emerging relationship between hyperexcitation and dystrophin Future studies should address how the different brain dystrophin isoforms are related to hyperexcitation in what direction this relationship may be established and whether dystrophin may represent a novel target for seizure treatment All authors agree to be accountable for the content of the work RH and MA performed the statistical analysis MA obtained the animal tissue used in this study OS and JD obtained the human tissue used in this study MA and GH supervised the laboratory experiments after which all authors substantially contributed to obtain the final version JV initiated this research project and furthermore supervised and guided the collective research process The authors would like to thank Dr. F. van Leeuwen for the calbindin antibodies, H. E. Steinbusch for the microscopy and staining assistance, E. Yeung for optimizing the double staining protocol and I. D. Reis for the assistance with the triple staining. Finally, the authors would like to refer to the following conference paper: Aalbers et al. 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This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) provided the original author(s) or licensor are credited and that the original publication in this journal is cited *Correspondence: Ruben G. F. Hendriksen, aGVuZHJpa3Nlbi5ydWJlbkBnbWFpbC5jb20= †These authors have contributed equally to this work. A two-phase research framework was adopted to address this inquiry. A comprehensive literature review was conducted to discern the prevalent challenges regarding numeracy awareness. Subsequently, two illustrative case studies were undertaken in Slovenia and Spain to contrast and deliberate upon the insights derived from the literature review. Qualitative research methods were employed to engage in a nuanced exploration of the gathered data. This empirical analysis deduced guidelines aimed at enhancing awareness and ameliorating some of these challenges. We conclude that making visible the awareness that adults already have about numeracy in aspects of their lives, such as finance, health, or the use and critical interpretation of data, can give policymakers and curriculum developers clues to design effective numeracy programs to address the multifaceted challenges confronting contemporary society, both in the immediate and foreseeable future. Volume 8 - 2023 | https://doi.org/10.3389/feduc.2023.1295781 Introduction: The contemporary scientific literature indicates that numeracy is a multifaceted concept The ongoing societal and technological transformations underscore the imperative to re-evaluate the attributes characterizing a numerate individual and the strategic initiatives that policymakers should devise and implement to ensure that individuals are not marginalized from participation in public and private domains due to their lack of numeracy proficiency Numerous empirical investigations on numeracy consistently affirm its pivotal role in enabling individuals to engage autonomously across diverse contexts within their daily lives numeracy’s fundamental role has often been neglected in our societies The present study scrutinizes the overarching challenges associated with numeracy particularly emphasizing the challenges regarding healthcare and the critical utilization and interpretation of data awareness Methods: A two-phase research framework was adopted to address this inquiry A comprehensive literature review was conducted to discern the prevalent challenges regarding numeracy awareness two illustrative case studies were undertaken in Slovenia and Spain to contrast and deliberate upon the insights derived from the literature review Qualitative research methods were employed to engage in a nuanced exploration of the gathered data Results: This empirical analysis deduced guidelines aimed at enhancing awareness and ameliorating some of these challenges Discussion and Conclusion: We conclude that making visible the awareness that adults already have about numeracy in aspects of their lives or the use and critical interpretation of data can give policymakers and curriculum developers clues to design effective numeracy programs to address the multifaceted challenges confronting contemporary society both in the immediate and foreseeable future where numeracy was only identified with knowing how to perform a series of arithmetic operations using the existing algorithms correctly and appropriately numeracy has been integrated with cultural we argue that it has become a multifaceted concept This article is the product of two case studies that have been carried out in Spain and Slovenia two of the countries that participate in the Erasmus+ project Numeracy in Practice (NiP) which is currently running for the period 2022–2024 we indicate the research work that we present here and the methods that have been used to collect evidence and discuss it organized according to the main areas that have been used in the NiP project concerning numeracy awareness: general health and critical use and interpretation of media current challenges regarding numeracy awareness are identified We finalize this paper with a reflection on the impact of this sort of work on future lines of action Several authors have endeavored to offer a concrete definition of numeracy. After more than 70 years of discussion, a widespread agreement is that numeracy is not just mathematics, it is more (Arney, 2002; O’Donoghue, 2003; Barwell, 2004; Callingham and Beswick, 2015). In Table 1 some relevant quotes are included endorsing this idea: for example proposed the following definition of numeracy: To be numerate means to be competent, confident, and comfortable with one’s judgments on whether to use mathematics in a particular situation and if so, what mathematics to use, how to do it, what degree of accuracy would be appropriate, and what the answer means in relation to the context (Coben, 2000b, p. 35; emphasis in the original; Coben et al., 2003 The article published by Coben (1992) (What do we need to know Issues in numeracy research) was a turning point that laid the foundations for establishing a new field of research: the learning of mathematics by adults The international forum Adults Learning Mathematics (ALM) was then created and an effort to investigate the relationship between adults and mathematics from education was begun in a more rigorous and systematized manner The OECD endorsed this effort by establishing a research agenda: the international surveys (the first one was the International Adult Literacy Survey—IALS—in 1996) which are still carried out today through the Program for the International Assessment of Adult Competencies Despite the difficulties in defining its limits (even because there are languages with no comparable word to translate it) numeracy continues to be the international term used when referring to how adults use mathematics in their lives In recent years, the international scientific community has reached a certain consensus around the idea that numeracy must be understood as a social practice rather than a set of quantitative contents (numbers, symbols, etc.) or procedures (addition /subtraction structures, multiplication/division structures, proportional reasoning, etc.). Now, “numeracy” focuses on the social use given to these contents and processes (Figure 1) Figure 1. Numeracy conceptual development (Hoogland et al., 2019) the Erasmus+ Project Numeracy in Practice that frames the study being presented in this article the concept of numeracy is defined as a multifaceted concept which cannot be understood only as a competence as a set of knowledge or as a social practice alone It is considered to be all these different aspects together The concept of numeracy and numerate behavior encompasses more than just substantive mathematical knowledge and skills It is about managing all kinds of situations that require mathematical insight as described in the PIAAC definition—competencies which enable individuals to take adequate actions in situations which need further elaboration and the situation in which mathematical activities occur play an essential role The use of mathematical knowledge and skills (content) in daily life is always situation-specific (in context) The quality of the mathematical action depends on how the person relates himself to his or her mathematical knowledge and skills (dispositions) and the extent to which he/she can oversee and control a situation (higher-order skills) On the other hand, being numerically competent involves using a series of higher-order skills. Many of those that appear in Figure 2 have already been mentioned in various frameworks on numeracy [Organisation for Economic Co-operation and Development (OECD), 2021] There is also an overlap with the so-called 21st Century Skills Every individual—whatever his/her cognitive abilities and experiences—uses higher-order skills These skills include managing and analyzing situations but also critical thinking and problem-solving and obviously they can also be improved by many individuals Figure 2. Common European Numeracy Framework (CENF; Hoogland et al., 2021a) Content knowledge and skills matter to improve numerate behavior The first four subcategories—quantity and number and chance—can be found in most frameworks regarding mathematics or numeracy outside the formal school system They can be considered the contemporary replacements of the Algebra-and-Geometry division which dominated the 19th and 20th centuries The use of (digital) tools and applications is another set of subcategories relevant today to cope with situations in our digitalized society Finally, another facet of the framework that we use here is dispositions (Hoogland and Díez-Palomar, 2022) Adult numeracy dispositions develop throughout life starting from childhood and compulsory school They depend on people’s capabilities beliefs and feelings concerning mathematics they are also influenced by external positive and negative experiences: how and what mathematics was learned in schools and experiences in lived-in situations Students who perform better in school mathematics may have good math and numeracy provisions: feeling confident with numbers and recognizing the usefulness of mathematics students with negative experiences may develop negative feelings for numbers The disappointment when receiving low marks for mathematics may have an enormous influence on the numeracy capacities of the future adult our main objective is to make numeracy visible Why is it important to run campaigns to draw attention to numeracy and contexts in our daily lives is numeracy present and what challenges does this entail from the point of view of making it visible What opportunities for future action can we find by making numeracy visible to everyone most of the existing scientific literature on numeracy has always been dedicated either to defining the concept or to developing tools (frameworks) to be able to measure it in quantitative or qualitative studies we do something that has only been partially done in the field of adult education or studies of a socio-cultural nature (studies of the “mathematics” present in the cultural practices of human groups): we want to identify the numeracy that appears in the different contexts of daily life and make it visible and critical use and interpretation of media The objective is to make numeracy visible in these four areas The research questions of the study reported here are: what are the challenges regarding numeracy awareness today And what prospects for future initiatives can be discerned by rendering numeracy apparent to all The study we report here was organized in two phases to answer this question A systematic review of scientific literature was carried out in the first phase. The objective of this phase was to find the recent contributions made so far on numeracy when trying to make it visible. To do this, we first review what numeracy means since this concept has been defined differently over time (Hoogland et al., 2019, 2021a) The study reported in this paper focuses on numeracy as a multifaceted construct defined within the Common European Numeracy Framework (CENF) and Numeracy in Practice (NiP) projects To guide the systematic review of the scientific literature we used the four thematic axes of numeracy defined in the NiP project: general Drawing on identifying the principal contributions within the current body of research on numeracy across the aforementioned four domains we proceeded to the second phase of our study contrasting the findings extracted from our systematic literature review with the perspectives and insights of adults given that these two countries are members of the consortium of partners involved in the Numeracy in Practice (NiP) project which serves as the overarching framework for our investigation We used a “focus group” as a research instrument in both case studies which is grounded in the ontological principle positing that a comprehensive understanding of reality is constructed by engaging all the actors involved Details about the data collection tools and the subsequent analytical procedures are elaborated upon in the following sections First, we conducted a systematic literature review. Following Egger et al. (2008), we defined the following inclusion and exclusion criteria (see Table 2) We decided not to use the PRISMA method (Moher et al., 2010) to perform the literature review The reason for our decision is that PRISMA is based on a targeted search with standard words and combinations of words (keywords) in databases without considering prior knowledge on the subject so this method has the serious flaw of including irrelevant or little-known studies in the literature review it omits other studies that all of us who work in numeracy studies know are essential references but that the algorithm does not recognize (due to the use of everyday expressions or non-normative ones in the title of the paper or because the word “numeracy” does not appear in it and therefore are excluded from the search results this search has been complemented with the use of search engines such as Google Scholar and the EU Cordis research projects search engine to complement the literature review as we are aware that in addition to expert knowledge on the subject the use of these other sources is relevant to find identify and include other less known studies that also respond to the objective of our study Secondly, we carried out two focus groups (one in Spain and the other in Slovenia). Focus groups are commonly used in educational research (Denzin and Ryan, 2007) Focus groups stand apart from other forms of group interviews by the researcher’s use of a predetermined set of directed inquiries tailored to evoke group perspectives on a particular subject Participants in the focus groups (both in Spain and Slovenia) included: adult learners (with basic academic skills up to ISCED level 2) and teachers in adult education The objective of these two focus groups conducted in Spain and Slovenia was to collect the voices of the participants (mathematics teachers in adult education and other stakeholders) to validate the contributions identified through the review of scientific literature It is essential to say that a representative sample has yet to be made and that the results presented below cannot be generalized The intention has been to identify relevant topics that future research would need to contrast with surveys carried out with representative samples Our objective here has only been to identify items that could raise awareness and make numeracy visible in the four areas defined above: general The systematic literature review was employed to methodically consolidate the principal contributions of the international scientific community on our subject of inquiry This review served the two-fold purpose of refining the scope of our investigation and identifying the key insights substantiated by prior research we formulated an instrument tailored to probe the extent of these contributions within two distinct groups—adult learners and teachers of adult learners—drawn from Spain and Slovenia These countries are members of the NiP project consortium and our selection criterion focused on individuals engaged in adult education with participants falling into the categories of adult education students (lacking higher education) and adult education teachers Our choice of employing focus groups was deliberate given that the conversational dynamics among participants engender spontaneous discussions that often yield unanticipated This conversational spontaneity enriches the original question script of the instrument an instrument featuring a predefined set of questions to steer focus group conversations ensures reproducibility across diverse contexts facilitates the combination of data for comparative analysis as detailed in the limitations section toward the conclusion of this paper the focus group methodology is inherently circumscribed in its capacity for generalization extending only to the participants within the two case studies While focus groups permit in-depth exploration of the subject of study by affording interviewers the flexibility to pursue unscripted inquiries these findings must subsequently be corroborated through studies employing representative samples thereby allowing for broader applicability to the entire study population we present the results that have been obtained both stemming from the revision of the scientific literature as from the contributions drawn from the two focus groups conducted in the two countries participating in this study The findings are organized into topics to facilitate their presentation The first challenge we have encountered is the difficulty in identifying numeracy aspects, contents, or behaviors from daily life that are currently considered components of numerate behavior (Hoogland et al., 2021b; Tout et al., 2021) In the framework from where we depart as a reference in this study (the Common European Numeracy Framework) numeracy is a multifaceted concept that refers to mathematical knowledge and skills (including quantity and number that are used in different contexts (everyday life and that puts in place a series of higher order skills measured also by the dispositions of the person which broadly coincide with what we have found two decades later both in the case of the participants in the focus group in Slovenia and in the one we carried out in Spain When asked about examples to identify numeracy the most common one is usually either “doing the shopping,” “adapting a recipe for four people to a larger number of diners,” or “doing chores.” The following quote illustrates the type of comments made by people who participated in this study: it was just what I had in my purse (Adult learner According to Coben (2000b) mathematics is associated with common sense when it is invisible She illustrates it with the following quote: You measure, put up shelves, distance, sire, and the brackets, where they go – that all involve general maths. To me, though, that’s just common sense. […] You do not think of [it] as being math (Coben, 2000b Our data aligns with Coben’s assertion concerning the invisibility nature of numeracy Although we use numeracy quite a lot on a daily basis This person acknowledges the ubiquity of numeracy within everyday life scenarios it is noteworthy that people need to maintain a conscious awareness of this omnipresence While numeracy practices are not visible, they are part of a numerical behavior, a way of acting and resolving the different situations that we encounter in daily life, in the workplace, when we exercise our citizenship, or in any of the other situations that Hoogland et al. (2021b) highlight as “contexts.” However, when one asks about instances of employing numerical concepts in any of the contexts emphasized by Hoogland et al. (2021b) the notion of “common sense” appears to yield to a recognition that the activities in question are intricately connected to the domain of mathematics How much does each thing you have in the trolley cost To know more or less what you are going to pay (Adult learner As these mathematical aspects cease to remain concealed they undergo a transformation into explicit mathematics within the discourse of the individuals involved in the two focus groups The subsequent quotation from the Slovenian case study exemplifies this assertion: Numeracy is associated closely to mathematics so people think they are the same thing (Adult learner It is of paramount importance to underscore that the participants in this study consciously avoid the use of the term “numeracy” in their discourse primarily because neither the Spanish nor Slovenian languages possess a direct equivalent for this concept When explicitly discussing their engagement with numerical concepts they employ the term “mathematics.” another critical aspect to highlight in the discourse of the people who participated in this study is that they seem to establish a distinction between “daily life mathematics” and “school mathematics.” The teachers who work in adult education centers who participated in the Spanish focus group say that the difficulties occur in the second case when we are talking about “school mathematics.” In the fact that they do not know how to do subtraction or that they do know how to subtract in their life but they do not know how to do it in their notebook They do not know how to do it in the notebook because and if you have to “carry,” they no longer know… the concept of… how do I explain it to them: units And here I find that I do not know how to do it Think that sometimes it’s because some people do not even know how to hold a pencil and have never been to school (Teacher The review of the scientific literature is consistent with this distinction (Civil, 2002). Díez-Palomar (2020) states that women who go to adult schools to study the basic level of education usually use different mental strategies to count and solve problems sometimes totally different from “pencil and paper” school strategies the case of subtraction by inverse addition is a widespread mental strategy when shopping and differs entirely from subtraction “by positional value.” An older woman was trying to understand the meaning of “borrowing one” to apply the subtraction algorithm when the minuend unit is smaller than the subtrahend unit and it is necessary to “borrow a unit from the tens” (for example when you want to subtract 25 minus 19; to subtract nine from five you have to ask a 10 from 20 to have 15 and then be able to subtract the 9) Nobody does that kind of subtraction when they go shopping Thanks to the egalitarian dialog established in that case that lady could overcome a negative disposition toward the place value algorithm of subtraction (since she had developed a negative self-confidence saying that she was incapable of subtracting) Talking with the facilitator made it evident to her that she knew how to subtract because she “added” from 19 to 25 to obtain the result (the difference) consistent with the comments that came out in the focus groups of our study shows another key finding: that there is a tension between “invisible” numerical behavior (those strategies that we use as if it were common sense and visible mathematics in school through algorithms organizing and communicate the schedules to take medicines While some studies talk about the competencies that people have in this type of practice the focus is on the effects of changing the numerical representation (for example going from using a graph to a table of values) In the case of the people who have participated in the case studies of this study a clear example is that which refers to diets and the calculation of the number of calories and the amount of food to eat Diet is a topic that is of interest to some of the people who participated in the study and they use its numeracy to calculate the calorie content of foods and make decisions about what to eat and what not to eat based on the results of those calculations one of the key issues that arises here is the estimation and precision of the calculations the decision is based on an estimate (which implies assuming tolerance margins rather than considering the precise calculation) Another recurring example is calculating dosages; in this case the task consists of taking half of a pill (which shape is a cercle) How exactly to cut a pill which is a cercle This situation is common and involves geometric thinking the person ends up using a “visual” approach to break the pill “more or less” by what looks like “half.” They call you from the hospital and tell you: look I’m from the hospital and we’ll change your appointment Sometimes you do not even know how to take the date they tell you… But you have made me think about medication: look the other day we did this in the classroom: the teacher told us: imagine that you must take a pill You must take half of the pill; But how much is “half” How do you make sure you cut “half” exactly a teacher working with adult people in Slovenia stated that: Interpreting data like dosage and frequency of medicine intake can be challenging for low-educated individuals I come across examples of needing help understanding these things when taking medicine (Teacher or the possession of limited numeracy skills exerts a profound and far-reaching influence on individuals’ health status and their capacity to oversee their own well-being or the well-being of those reliant upon them Being able to interpret numerical data can mean a difference between positive and negative health outcomes (Teacher According to the EU, only 45% of the European population understand simple and compound interest, and 20% understand the link between interest rates and bond prices; 35% need to understand what inflation is, and 34% do not understand that an investment with a higher return is likely to be riskier (Eurobarometer, 2023) people remember the case of the futures market when the global financial crisis occurred due to the real estate market bubble many people were recruited by banks to invest in the futures market buying shares in products that did not exist with the confidence that they would later become produce and investors were going to earn large amounts of money through interest Something similar has happened (or is happening) with cryptocurrencies Financial literacy (financial numeracy) is a crucial aspect the mathematical algorithms embedded in finance are so complicated that not even the experts themselves can know for sure what is in those stock packages The results of previous research are also consistent with what people participating in case studies say Regarding the mathematical knowledge and skills facet of the CENF framework people tend to have more difficulties with calculations involving percentages (quantity and number) or the calculation of probabilities (data and chance) The literature highlights the world of finance as the one that usually presents the most significant difficulties because it involves very complex and non-transparent algorithms which are difficult to understand even for people with expert financial literacy But the literature also mentions other contexts such as domestic finances (calculating bills Among the people who participated in this study the examples that are repeated the most are understanding the receipt of electricity Another example is understanding the purchase receipt: … and we see the purchase receipt of Mercadona [grocery store] to see where the decimals are placed … (Adult learner There is also a person who talks about the retirement pension These are examples that illustrate different contexts in which one (or several) of the mathematical knowledge and skills defined in the CENF framework appear the problems: addition problems… I bought a fish that cost me 3,50 there are things that are difficult to understand and she did not know how to add or subtract or anything when she charged for a coffee when she charged…because mentally [she knew how to calculate] … but later when it came to… [in school] … well those are the elements they must live with (Adult learner Possessing a high level of financial literacy exerts a significant influence on individuals’ prospects. Additionally, numeracy also provides a “critical sense” that bears substantial consequence in the lives of individuals, enabling them to make enlightened and responsible choices. This “critical disposition” holds the capacity to shield individuals from potential risks and uncertainties, as expounded by Beck (1992) The subsequent quotation from the Slovenian case study serves as an illustrative embodiment of this revelation: Financial literacy does not only give the individuals the ability to understand amounts It also provides the basis for improvements in attitude toward finances and a more reasonable and responsible use of resources that benefits not only the individual but also the people and the environment around them (Adult learner such as reading about voting trends or electoral results Any electoral debate between candidates is another relevant example of the biased use of statistical data Evans and his colleagues report several sources to this effect For people who took part in the focus groups the fact that media use mathematics content is obvious: they are very aware that mathematics appears in the media The main challenges that are derived thereof include checking the source of the data if the form of representation is correct (i.e. the intervals in which the data are grouped are equal) if the measures of central tendency or dispersion are used correctly and it is part of the do’s and don’ts of the critical reader of information in the media The following quote from one of the adult learners in the Spanish case illustrates this “critical spirit” in the reading of information provided by the media: … the evolution of the mortgages in the last years graphs can provide us with biased information but they represent it in a tendentious way so that the interpretation that we can do is not correct (Adult learner Diminished numeracy skills can likewise constrain individuals’ aptitude for interpreting data and comprehending the information disseminated by the media consequently impeding their capacity to respond effectively and initiate appropriate actions The subsequent quotation from the Slovenian case study serves as an exemplification of this phenomenon: People need to pay more attention to numerical skills for critical interpretation of important information 1-degree rise in global temperature may seem like a small thing People can underestimate the importance of such change because they do not know what it means in the context of climate and not act to counter global warming decisively enough because of lack of critical interpretation skills they can vote for policies that make global warming even worse (Adult learner one of the things that follows from the study that we report here is that although the people who have participated in the focus groups know that the media use numerical information and that they share the need to read the information of the media critically it is also true that this way of acting implies an active attitude playing agency in reading the information offered by the media is related to people’s disposition Carrying out a passive reading of the media without paying attention to what is read can have the effect of being exposed to biased information whether involuntarily or in a tendentious way But neither in the review of the literature nor in the data from the focus groups have we managed to find more information on this topic The fact that numeracy is often presented to us in an invisible way (implicit embedded) represents a challenge for adult teachers who design the lessons study programs and evaluation and assessment instruments (and for the authorities who design adult education standards) It is also a challenge for adults themselves since the “invisibility” of mathematics in certain situations is related to action dispositions such as “using intuition,” “beliefs,” and “emotional decisions” instead of using mathematical reasoning to solve problems and/or make decisions (like when I buy a lottery ticket because it coincides with my date of birth without thinking that any ticket has the same probability of winning) The objects that appear in the “mathematics knowledge and skills” facet in the CENF framework can be visible or invisible (embedded in the human practices of our societies). But in all cases, they are equally mathematical. Just because some practices are “common sense” does not mean they are any less mathematical. Bernstein's (2000) concept of horizontal discourse has sometimes been used to refer to numeracy both regulated by rules of discourse that are structured in restricted and elaborate codes what he is saying is that people who do not know how to use the elaborate code of the vertical discourse (academic mathematics) have a lower level than those who use the restricted code of the horizontal discourse The evidence that we have collected in the fieldwork shows that the numeracy that adult learners use in their daily lives also presents elements of the “mathematics knowledge and skills” facet as well as what we call “academic mathematics” (or “pencil and paper”) Another general challenge that emerges from our work is that we must break with the idea that familiarity is associated with “common sense,” and when situations are unfamiliar then the contents are perceived as “mathematics” (in the academic sense of the term) consider the case of someone thinking that if twice as many people come to dinner what they will have to do is calculate twice as much food so that everyone can have dinner is “common sense”; and then consider this other case of someone thinking that if the prospect of medicine gives the indications for the case of an 80 kg adult he have to administer that medicine to his son and he has to apply a conversion rule that is not linear (but considering the volumetric difference) This is considered “doing math.” The challenge is to consider that we are talking about numerical awareness in both cases Gramsci (1971) already gave us elements in his philosophical reflections to dismantle this obstacle: for him, “common sense” is immediate knowledge, which serves to solve problems, and which is the result of a deep knowledge of all the variables present in the situation or problem to be solved. In our field of mathematics teaching, the Gramscian concept of common sense is very close to the concept of intuition of Poincaré (1908) Mathematical intuition cannot appear without a deep base of knowledge It is a spontaneous form of knowledge but deeply rooted It is also part of the task to make numeracy more visible we have organized the analysis in four areas (general and critical use and interpretation of media) it is relevant to indicate that numeracy is a social practice in all areas and contexts of our lives Many of the challenges already discussed above are common to all four areas the mathematical knowledge and skills facet is also related to dispositions In cases such as financial mathematics (bank products mathematics is evident (often in a very complex way) But as the testimonies of the people who participated in this study show finances do not only appear in the professional context; We also see them in everyday life (at home when calculating the tip at the restaurant it happens that sometimes we prefer to make a decision based on a belief (disposition) not as a result of a rational calculation of different options (for example I invest in shares of a company because everyone invests and I think I will be able to benefit; but if suddenly confidence is lost as happened during the Crash of ‘29 The fact that we rely on a series of beliefs without numerical basis to act (and that this leaves us in a situation of profound vulnerability) is also another of the challenges that we have been able to detect considering that several of the arguments we have used so far also apply to the field of critical use and interpretation of media one of those that most clearly emerges is the case of agency Many previous studies have drawn attention to the deceptions arising from using mathematics (statistics we do not pay attention (we see the data provided to us with a passive attitude) one of the main challenges regarding numeracy awareness in this area is to find a way for everyone to have an active attitude (agency) to read the information about the world around us critically this applies not only to cases in which media misinforms but also when media use numbers to report truth thus people also need to be numerate to interpret correctly As one of the participants in this study stated in the focus group: Critical thinking can be improved and supported by strong numeracy skills as it often Relies on estimates and predictions of trends that can be expressed through numbers and other mathematical ways (Adult learner the identification of prevailing numeracy awareness challenges may constitute a means to enhance individuals’ capacity for critical thinking and their preparedness to confront the exigencies of our contemporary society we wanted to identify some of the challenges regarding numeracy awareness in the four areas defined in the Erasmus+ project Numeracy in Practice We do not intend to generalize these challenges They have emerged from the 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This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) *Correspondence: Javier Díez-Palomar, amRpZXpwYWxvbWFyQHViLmVkdQ== Please note that this is an automated translation and it will not be perfect All articles have been written in English and if anything appears to not make sense “In the era of science-ing the sh%t out of it -Mehdi Kordi on Hoogland's wear-and-tear of gear A $5 million commitment from alumni Susan and Keith Hoogland names the university’s new trans-institutional minor for business study the Hoogland Undergraduate Business Program The gift continues a tradition of Vanderbilt philanthropy for the Hooglands both 1982 graduates of the College of Arts and Science couple has supported the Managerial Studies program and also served as Reunion chairs for their 25th Reunion in 2007 and as class fundraising chairs for their 30th Reunion in 2012 three of their six children are Vanderbilt graduates “This generous gift from the Hooglands—one of the first at Vanderbilt to name an academic program—provides all of our undergraduates the opportunity to pursue business education,” Provost and Vice Chancellor for Academic Affairs Susan R. Wente said “[rquote]Adding an undergraduate business minor to our curriculum signals the thirst for business education from our students—and the appetite for innovation and leadership on campus.[/rquote] We look forward to introducing this uniquely Vanderbilt program that is open to any of our undergraduates.” Wente added that the new minor complements the strong liberal arts foundation at the heart of Vanderbilt undergraduate programs. She also noted that the minor meshes with key themes in the Academic Strategic Plan through its unique teaching model that draws on the trans-institutional strength of faculty and provides immersive experiences for students The new cross-campus undergraduate business program consists of a business core—undergraduate-only classes taught by faculty members from the Owen Graduate School of Management—that introduces students to five fundamental business disciplines: financial reporting Students may choose electives from the four undergraduate schools to build “business pathways” according to their specific areas of interest The courses are designed to actively engage students in solving business problems—whether those occur at a start-up business Those hands-on opportunities are important to Keith Hoogland, who joined his father’s business after college. He is now president of Highland Ventures and Family Video I felt behind because I hadn’t taken classes like accounting or business,” he said “This new minor will make Vanderbilt’s liberal arts students even better prepared when they graduate.” Hoogland who majored in economics and psychology at Vanderbilt says the new minor will make Vanderbilt’s undergraduate education more complete and its graduates more competitive in the job market Susan Hoogland said that her wake-up moment was when she learned a friend’s son wasn’t even considering Vanderbilt because the university does not offer a bachelor’s in business “Vanderbilt was missing out on these incredibly talented students,” she said students can get what they need to be successful entrepreneurs without subtracting from the wonderful liberal arts education I credit Vanderbilt for being willing to think out of the box with this program.” She seconds her husband’s belief in the value of a liberal arts education there won’t be as many opportunities to take history and art classes,” she said “Those classes are just as important as the business courses.” the couple’s ties to Vanderbilt remain strong and both still enjoy a circle of close friends from their college days “We both had such a great time at Vanderbilt,” Keith Hoogland says “[lquote]Vanderbilt has had a huge impact on both of our lives We’re excited to be a part of this great new program.”[/lquote] A wide selection of courses and experiential opportunities in the new minor will enable students to design a flexible program specific to their academic and professional interests while increased faculty and administrative resources will offer comprehensive support for students navigating the program This program’s goal is to enrich the undergraduate educational experience helping to prepare graduates who can lead in business and beyond “Integrating the study of business with liberal arts will provide our students with a rich foundation for long-term career success,” said Katharine Brooks, the Evans Family Executive Director of the Career Center “The program will encourage experiential learning helping students combine their liberal arts and business knowledge to creatively solve real-world problems.” more than 200 sophomores and juniors are enrolled in classes for the minor Seniors who have declared one of the existing business-related minors (Human and Organizational Development and/or Financial Economics) will complete those programs Nashville, Tennessee 37240 615-322-7311 • Contact Us Vanderbilt University’s Online Privacy Notice Esther Mae Hoogland passed away at age 94. Esther was born March 23, 1925 in Vriesland, MI to William and Elizabeth Meengs. She married John Hoogland (who preceded her in death in 2017) in 1948 and after 71 years together (married for 69 years)... View Obituary & Service Information The family of Esther Mae Hoogland created this Life Tributes page to make it easy to share your memories      Clara Hoogland age 94 of Sioux Center at Crown Point Estates Care Center in Sioux Center      A funeral service will be 10:30 AM Wednesday, October 19, 2022, at the Bethel Christian Reformed Church in Sioux Center.  The funeral service will be live-streamed on the Bethel Christian Reformed Church youtube: Clara Hoogland Service      Burial will follow at Memory Gardens Cemetery in Sioux Center      Public visitation with family present will be Tuesday October 18th from 5:00 to 7:00 PM at the Bethel Christian Reformed Church Memorials may be directed to the Bethel Christian Reformed Church Christian Education Fund      Clara Hoogland was born on November 23 the daughter of John and Helen (Kooiker) Kroese She grew up on a farm near Hull and attended Country school and Hull Christian through the eighth grade they farmed southwest of Sioux Center and in 1962 they moved to a farm east of Sioux Center      Clara was a member of the Bethel Christian Reformed Church      Left to cherish her memory are her five children and one great-great-grandchild; three siblings      She was preceded in death by her parents and Helen Kroese; husband Alfred of 39 years; one sister