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Alive Today (alive + today)

Distribution by Scientific Domains

Medical Sciences	50%

Selected Abstracts

Regular or "Super-Aspirins"?

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2001
A Review of Thienopyridines or Aspirin to Prevent Stroke
PURPOSE: To review the evidence for the effectiveness and safety of the thienopyridines (ticlopidine and clopidogrel) compared with aspirin for the prevention of vascular events among patients at high risk of vascular disease. BACKGROUND: Atherosclerosis and resultant cardiovascular disease are important causes of morbidity and mortality in older people. In particular, atherosclerosis of the cerebral arteries can lead to transient ischemic attacks (TIAs) and stroke. Stroke ranks as the third-leading cause of death in the United States and in 1997 was responsible for over 150,000 fatalities.1 In addition to the mortality associated with this disease, stroke is also a leading source of long-term disability in survivors. Nearly 4.5 million stroke survivors are alive today,1 highlighting the fact that primary, but also secondary, prevention are extremely important for minimizing the complications of this illness. DATA SOURCES: Specialized trial registers of the Cochrane Stroke Group and the Antithrombotic Trialist's Collaboration, MEDLINE, and Embase were searched. Additional unpublished information and data were sought from Sanofi, the pharmaceutical company that developed and manufactures ticlopidine and clopidogrel, as well as the principal investigators of the Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events (CAPRIE) trial,7 the largest of the trials identified. STUDY SELECTION CRITERIA: All unconfounded randomized trials comparing either ticlopidine or clopidogrel with aspirin among patients at high risk of vascular disease (those with symptoms of ischemia of the cerebral, coronary, or peripheral circulations) who were followed for at least 1 month for the recurrence of vascular events were included. DATA EXTRACTION: Data were extracted from four completed randomized trials completed in the past 20 years, which included 22,656 patients.7,10 Two authors independently extracted the data from these trials for the following information: the types of patients enrolled; the entry and exclusion criteria; the randomization method; the number of patients originally allocated to the treatment and control groups; the method and duration of follow-up; the number of patients in each group lost to follow-up; information on compliance with the treatment allocated; the definitions of outcome events; the number of outcome events in each treatment group; and any method used for blinding patients, treating clinicians, and outcome assessors to treatment allocation. MAIN RESULTS: Four completed trials involving a total of 22,656 patients were identified. Aspirin was compared with ticlopidine in three trials (3,471 patients)8,10 and with clopidogrel in one trial (19,185 patients).7 A recent TIA or ischemic stroke was the qualifying event in 9,840 patients, a recent myocardial infarction in 6,302 patients, and symptomatic peripheral arterial disease in 6,514 patients. The average age of the patients was approximately 63, with approximately two-thirds of the patients being male and white. The duration of follow-up ranged from 12 to 40 months. CONCLUSIONS: This systematic review demonstrates that, compared with aspirin, thienopyridines are only modestly more effective in preventing serious vascular events in high-risk patients. For patients who are intolerant of, or allergic to aspirin, the available safety and efficacy data suggest that clopidogrel is an appropriate, but more-expensive, alternative antiplatelet drug. It appears safer than ticlopidine and as safe as aspirin but it should not replace aspirin as the first-choice antiplatelet agent for all patients. Further studies are necessary to determine which, if any, particular types of patients would benefit most and least from clopidogrel instead of aspirin. [source]

Unresolved issues relating to the Shaking Palsy on the celebration of James Parkinson's 250th birthday

MOVEMENT DISORDERS, Issue S17 2007
Andrew J. Lees MD
Abstract James Parkinson's Essay on the Shaking Palsy published in 1817 provided the first clear clinical description for the disorder now known throughout the world by his name. His primary reason for publishing his monograph shortly before his retirement from medical practice was to draw the medical profession's attention to a malady, which had not yet been defined as a nosological entity. He also hoped that the eminent anatomists of the day would be stimulated to elucidate the pathological lesion responsible for the clinical picture and that this in turn might lead to a rational cure. The concept of Parkinson's disease remains clinically based and successive generations of neurologists have refined and embellished Parkinson's seminal descriptions. Narrative accounts by affected individuals have also helped physicians understand what it is like to live with Parkinson's disease. For many years, the pathological hallmarks of Parkinson's disease were disputed and there were few clinico-pathological reports with adequate clinical description. However, most neurologists now link severe loss of nigral cells in the ventrolateral tier of the pars compacta of the substantia nigra with bradykinesia and the presence of Lewy bodies in a number of discrete brain stem and cortical regions with Parkinson's disease. There are many unanswered clinical questions relating to Parkinson's disease including the striking heterogeneity and frequent limb asymmetry. It also remains somewhat uncertain whether Parkinson's disease is ever truly unilateral by the time of clinical presentation and whether the hand rather than the foot is the most common site of onset. Hyposmia and visual hallucinations are helpful pointers in distinguishing Parkinson's disease from atypical Parkinsonism and should be specifically enquired about in the history. Simple reliable cultural-specific smell identification batteries are an urgent need and target of clinical research. It remains to be determined whether Alzheimer type dementia as opposed to a dysexecutive syndrome should be considered a part of Parkinson's disease and further detailed clinico-pathological correlative studies are needed. It is also unclear whether autosomal dominant monogenetic Parkinsonism due to synuclein or LRRK-2 mutations will prove to be identical clinically with Parkinson's disease and for the present it is wiser to regard Parkinson's disease as a sporadic disorder. Parkinson was an active political reformer and if alive today would certainly be campaigning to translate more effectively the rich seam of neuroscientific research of the last decade into therapeutic benefits for the rising number of people who are developing the shaking palsy as a result of increasing longevity in the developed world. © 2007 Movement Disorder Society [source]

Routes to Scholarly Success in Public Administration: Is There a Right Path?

PUBLIC ADMINISTRATION REVIEW, Issue 1 2004
Larry Schroeder
The Successful Scholars Project examined the determinants of successful public administration scholars. We surveyed the top 89 public administration scholars alive today (nominated by leaders of five national organizations) and asked them to rank a set of characteristics and behaviors that may have helped them achieve their success. We then analyzed the curricula vitae of 63 of the scholars. This article reports our study's findings and the recommendations of our successful scholars. Scholars heralded good methodological training and quality mentoring as significant. For research, choosing important, cutting-edge issues to write about, not following fads, being oneself, and publishing quality works were touted as important. Presenting research at national conferences also was highly recommended (while chairing committees and serving as discussants were not). Most scholars recommended steering away from administrative positions and university politics. We conclude with lessons for budding public administration scholars as well as lessons for designing public administration doctoral programs. [source]

On the invisibility of the emasculated (Respond to this article at http://www.therai.org.uk/at/debate)

ANTHROPOLOGY TODAY, Issue 1 2010
Richard Wassersug
Castrating a male by destroying his testicles is a practice that most people assume ended a century or so ago with the collapse of the Chinese and Ottoman Empires and the death of the last castrato in the Vatican choir. However, because advanced prostate cancer is treated by either chemical or surgical castration, there are probably more castrated men alive today than ever before in history. Castration is also used in the western world as either a step in the sexual reassignment of male to female (MtF) transsexuals or rarely to treat recidivist sexual predators. In addition, some men desire emasculation who are neither cancer patients, MtF transsexuals, nor sexual predators. In this essay I argue that the public association of castration with sexual predators and deviant behaviour is so great that men, who require it as a medical treatment for cancer or who seek it for other reasons typically hide from public view. One consequence of the shame associated with castration is that those, who desire emasculation but do not have a diagnosis of cancer, too often subject themselves to risky and illegal amateur surgeries outside the medical system. I argue that for whatever reason a male seeks castration, the overall invisibility of the emasculated in modern society is a disservice. It minimizes the public's understanding of the magnitude of the impact of castration on cancer patients and it inhibits those in need of medical treatment from getting it in an appropriate and timely fashion. [source]