Aspirin and Ticlopidine for Prevention of Recurrent Stroke in Black Patients

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Blacks are disproportionately affected by stroke, yet they have been underrepresented in clinical trials. Recommendations for stroke prevention in this population have been based largely on trials that have included few black participants. This may not be an optimal practice because blacks are among those with a higher prevalence of major cardiovascular risk factors, a different distribution of atherosclerotic occlusive cerebral vascular lesions, vascular biological differences such as low renin hypertension, and a different pattern of use of medical procedures and access to care that could influence outcome.

A subgroup analysis of the Ticlopidine Aspirin Stroke Study (TASS)suggested a more favorable risk-benefit profile for nonwhites than whites. Specifically, among the 45 black and 108 nonwhite and nonblack study participants, there was a 4.1% relative risk reduction (RRR) for stroke and death at years favoring ticlopidine (500 mg/d) over aspirin (100 mg/d), and 10% fewer serious adverse events (SAEs). Overall in TASS, there was a 1% RRR for nonfatal stroke or death from any cause (P = .05) favoring ticlopidine at years.

The current study was designed in 1, with the belief that a targeted recurrent stroke prevention study for blacks was justified given their disproportionate stroke burden, promising data for ticlopidine as a recurrent stroke preventive treatment in nonwhites, and the lack of previous substantial representation of blacks in stroke clinical trials. The primary outcome of the African American Antiplatelet Stroke Prevention Study (AAASPS) was the composite end point of recurrent stroke, myocardial infarction, or vascular death.

A description of the design and methods of AAASPS has been reported previously in accordance with criteria proposed by the Consolidated Standards of Reporting Trials. That article16 included a discussion of barriers to black participation in clinical trials and how they were overcome, the rationale for study drug selection, relationships established with primary care physicians, management of cardiovascular risk factors, and other major aspects of the study. The diagnosis of stroke and stroke subtype was determined after review of source documents and case report forms and by application of criteria from the Trial of ORG 1017 in Acute Stroke Treatment (TOAST)1 by local principal investigators for the entry stroke and by the AAASPS adjudication committee for all outcome events. Entry and outcome stroke cases received computed tomography or magnetic resonance imaging of the head.

At the time our study design was developed in the early to mid-10s, we believed that there was uncertainty about the preferred aspirin dose for recurrent stroke prevention. Given this uncertainty, we opted for an aspirin dose of 650 mg/d in accordance with the recommendations by Barnett et al.

Eligibility criteria included black (African American) race; -85 years of age inclusive; noncardioembolic ischemic stroke with onset at least 7 days but not more than 0 days; cranial computed tomographic scan or magnetic resonance image of the brain consistent with occurrence of the entry cerebral infarct; measurable neurological deficit that correlates at onset with entry cerebral infarct; informed consent; and availablity of patient to be followed up in an outpatient treatment program.

Exclusion criteria included transient ischemic attack, subarachnoid hemorrhage, cardiac source embolism, iatrogenic stroke, nonatherosclerotic stroke, postoperative stroke occurring within 0 days of operation, or carotid endarterectomy as primary treatment measure for entry cerebral infarct; mean arterial blood pressure higher than 10 mm Hg on consecutive days; modified Barthel index of less than 10; history of dementia or neurodegenerative disease; severe comorbid condition (eg, cancer) judged to limit survival during -year follow-up; enrollment in another clinical trial; allergy or sensitivity to study drugs; woman of childbearing potential; gastrointestinal tract bleeding, bleeding diathesis, or platelet or other hematologic abnormality (judged to be a contraindication for administration of study drugs) currently active or clinically active in the past year; hematuria or positive stool guaiac test related to major bleeding source; and prolonged prothrombin time or partial thromboplastin time, blood urea nitrogen level higher than 40 mg/dL, serum creatinine level higher than .0 mg/dL (176.8 µmol/L), thrombocytopenia or neutropenia defined by the lower limit of normal for the platelet count or white blood cell count (unless absolute neutrophil count of at least 1800/mm), or liver function tests or more times the upper limit of normal. All sites had to receive formal approval from their institutional review board before the study could commence at a local site.

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THE CURTURAL AND POLITICAL IMPACT OF TELEVISION

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Team D 1

THE CULTURAL AND POLITICAL IMPACT MADE BY TELEVISION

Culture

The invention of the television and its emergency into American society in 15 has radically revolutionized the American way of life. The original foundations of the television resort back to Ireland in 17, where a telegraph operator, John May, discovered the photoelectric effect. He found that variations in light intensity on selenium bars show resistance which can be transmitted into electrical signals. In other words, they can be transmitted. The earliest broadcasts were in Berlin for the Olympic Games in 16 and 15 in Paris. The first American broadcast was in 1 from New York. It is hard to pinpoint who actually invented the television, because many men made significant contributions.

Two defining moments in the realm of television technology was the invention of color and digital television. A study conducted in 18 indicated that 8% of U.S. households owned at least one television. Television connects Americans to current events, such as the landing on the moon, the O.J. Simpson trial and the beating of Rodney King during the L.A. riots. Before television people living in different parts of the country or the world would not have been able to share cultural experiences.

Team D

Even statistics of the most commonly watched programs in America indicate a great deal about our culture. Shows such as NYPD Blue receive top ratings, can we assume that Americans are fairly passive to such violence. Do people literally assume that everything they see on the television is right and there is no other truth, or have people learned to distinguish real life from simulated television incidences? This is a subject that causes great debates over the moral implications that television has had on our American culture. Television broadcasters study trends in American interests - the Super Bowl is a perfect example. Broad-casters allocate air time to market their programs to the most television viewers.

Programs are also chosen with current interests and morals of the American people in mind. The trial of O.J. Simpson was in the top ten programs every viewed by the American people. As a result of

technical advancements we were able to watch coverage of the war in Iraq as it was occurring.

Political - Legal Impact

Legislators have recently made increasing efforts to regulate the level of violence viewed each day by children. The Telecommunications Act of 16, passed under the President Clinton administration, to

Team D

promote parental constraints on the subject matter viewed by children. As a direct result of the Tele-communications Act, a V-chip is required in all newly manufactured television sets. The V-clip allows parents to block any program from being viewed by their children. The primary goal of the Tele-communications Act is to encourage parents to take an active role in what their children are viewing. Provisions have been made that require a uniform rating system be used by all broadcasting networks.

In 16 the White House, the National Association of Broadcasting and the four major networks (ABC, CBS, NBC and FOX) agreed to support a new proposal to require broadcasters to air at least three hours of quality educational programming each week.

There is also a nation-wide movement sponsored by the TV-Free America Group. Each year this group sponsors the National TV-Turnoff Week, which is intended to promote less television watching, in hopes of encouraging ones children to read, talk, play and create things. Parents are also encouraged, if the child is mature enough, to discuss political and social issues with children.

Bibliography

1) http//www.loyola.edu/dept/philosophy/techne/backes.html

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Why should we empathize with the creature?

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In Mary Shelly's Frankenstein, the monster is a victim of society's superficiality. The author places the monster in a world where he is different from everyone else, and is shunned for it. We need to empathize with the monster, as it was a living being with feelings, and was turned away from his creator at the times he needed to be loved.

Although the monster is physically grotesque, he represents the love and feeling that Victor lacks. The monster is essentially more human than Victor. He wants to understand life and become a part of the human sphere. He wants to establish relationships with humans and he reaches out and shows his kindness to people. The monster shows his compassion when he aids the DeLacy family

"I found another means through which I was enabled to assist their labors. I found that the youth spent a great part of each day in collecting wood for the family fire, and during the night I often took his tools, the use of which I quickly discovered, and brought home firing sufficient for the consumption of several days."

The monster's sense of understanding exposes his human traits. This is contrasted with Victors lack of humanity. Victor cannot see beyond the outer shell of the monster and judges it solely on its manifestation. He thinks that the monster is evil because of its gargantuan size and ghastly appearance. Victor is too stubborn and brainwashed by his environment to look further and realize that the monster is a sensitive being loved, helped, and touched.

Touched by the dilemma of the child, a creature brought into the world and instantly forsaken, which because of its hideousness could not expect a substitute. Telling the story of its progress to Frankenstein, the Creature recounts its first encounter with civilization.

"I had hardly placed my foot within the door, before the children shrieked, and one of the women fainted. The whole village was roused; some fled, some attacked me, until, grievously bruised by stones and many other kinds of missile weapons, I escaped to the open country, and fearfully took refuge in a low hovel, quite bare, and making a wretched appearance after the palaces I had beheld in the village."

However, the monster has its endearing qualities. It, like all living beings, is mesmerized and reveres the universe. As the moon moves across the night sky it stares in wonder. The monster appreciates the love and closeness of the DeLacey family and is enthused by enlightened culture as it evolves. Sorrowfully, the monster is even shunned by the family that it thought was the epitome of love. The genuineness of their closeness and love seems to ridicule his loneliness.

"But where were my friends and relations? No father had watched my infant days, no mother had blessed me with smiles and caresses; or if they had, all my past life was now a blot, a blind vacancy in which I distinguished nothing. From my earliest remembrance I had been as I then was in height and proportion. I had never yet seen a being resembling me, or who claimed any intercourse with me. What was I? The question again recurred, to be answered only with groans."

After the monster reads the journal of victor, it finally blames the one person whom he should have blamed for all of his misery and suffering.

"I sickened as I read. "Hateful day when I received life! I exclaimed in agony. Cursed creator! Why did you form a monster so hideous that even you turned from me in digsust? God, in pity, made man beautiful and alluring, after his own image; but my form is a filthy type of yours, more horrid even from the very resemblance. Satan had his companions, fellow-devils, to admire and encourage him; but I am solitary and abhorred.

So tortured and haunted by the hatred toward him by society and Frankenstein is the monster that he decides to abandon all hope of ever being accepted for what it was. Just to please Victor, he casts himself from the ship onto the ice raft and sets himself aflame, his last words rehashing the pain and suffering he endured throughout his existence. We have no other choice but to side and sympathize with the monster; he was a good soul corrupted by the evils of mankind

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Management vs. Leadership

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"Love and marriage, go together like a horse and carriage," as the Frank Sinatra classic continues, "you can't have one without the other." Can the same be said for management and leadership? For most businesses, sound management practices, like a marriage, are the glue that keeps the business together. Leadership is the inspiration, or the love, that keeps the business growing and evolving to meet the demands of the marketplace. Much like a marriage, when good management is combined with effective leadershipthe end result is far greater than what could be accomplished by management or leadership alone.

In order to understand the synergy of management and leadership, it is important to understand what "manage" and "lead" mean. Merriam-Webster's Online Dictionary defines manage as "the act or art of managing; the conducting or supervising of something (as a business); judicious use of means to accomplish an end." It defines lead as "to guide on a way especially by going in advance; to direct on a course or in a direction" The two processes can, and often do, work together. Laurie Ford, of Critical Path Consultants, explains, "Leadership opens new opportunities for people to both see and participate in a new future they see something that ‘could be'…Management is the art and science of making the new future actually happen…. Management takes the possibilities that leaders create and makes them real."

Management is not reserved for those in titled positions. The act of managing occurs at every level of an organization. A mailroom clerk manages the distribution of hundreds of incoming packages and letters for his company.

A billing supervisor manages assigning adjustments and corrections to a staff of clerks. Good managers live in the here and now, evaluating what needs done, determining what resources are available, and combining the two. "Management is memos, mission statements, data and analysis, charts, goals, objectives, measurements, systems or processes". (Clemmer, 1)

While management tackles the daily operations, leadership provides the vision and inspiration for conducting the daily operations. Dwight D. Eisenhower described leadership as "the art of getting someone to do what you want done because they want to do it." (Boyens, 1) Leadership, too, can occur at any level of an organization. An Information Technology worker leads by developing new software that anticipates the needs of the customer. A corporate trainer leads by creating innovative programs for workers to reduce stress. All workers can lead by participating on committees or mentoring younger employees. (Boyens, .)

While it is possible to have management without leadership and leadership without management, having both is ideal for business success. Laurie Ford described the dynamic of management combined with leadership when she stated, "Leadership without management is wishful thinking. Management without leadership is aimless." As many happily married couples can attest, being in love enhances their partnership. Similarly, having leadership coupled with management gives an organization leverage and strength in a highly competitive marketplace.

References

Boyens, John (00). Truly effective leadership involves more than just being boss [Electronic Version]. Nashville Business Journal retrieved September, 00 from http//nashville.bizjournals.com/nashville/stories/00/0/08/smallb6.html

Cahn, Sammy and Van Huesen, James. Originally recorded by Frank Sinatra (156). On This Is Sinatra! Hollywood Capitol Records.

Calmer, Jim (001). Inspiring and Energizing with Strong Verbal Communication. Retrieved September, 00 from www.managerwise.com.

Ford, Laurie. Great Managing Tip 1 The Difference Between Management and Leadership (00) Retrieved September, 00 from http//www.laurieford.com/Leadership%0And%0Management%0Tips/GMT1_Difference_Between_Managment-and-Leadership.htm

Merriam-Webster Online (00) by Merriam-Webster, Incorporated Retrieved September, 00 from www.Merriam-Webster.com.

Smith, Gregory P. (001) Leading Your Employees in Times of Crisis. Retrieved September, 00 from www.managerwise.com.

Ward, Brian (00) How to Become a Great Leader. Retrieved September, 00 from www.managerwise.com.

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Broken Reality

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Symbolism is used extensively in Arthur Miller's play Death of a Salesman. The symbolism related to things that are broken and falling apart is apparent throughout this play. Also, this symbolism is the basis of the ultimate conclusion of the play. As one views from the eyes of the audience Willy Loman's car, house, and refrigerator fall apart, he also experiences Willy's broken dreams that Death of a Salesman represents.

Willy Loman worked hard all of his life. He was a salesman and strived to be the best, but he was not. Willy was searching for the "American Dream." To him, this included owning a house, the land on which the house was built, having a family, owning a car, and having spending money for his family. Willy used his car heavily for his job. His car was his transportation for his job; his job was his livelihood. As the car falls apart, Willy's job goes through the cracks. One can watch the simultaneous disintegration of Willy's car and job as if they were directly related. Mr. Loman's car is an apparent symbol of his job. Finally, Willy loses his job, and in the end of the play, the car is ruined as well. To end his life after losing his job, Willy used his car, the thing he used most for his job.

The Loman family home is what Willy has worked for all of his life. In Death of a Salesman, the house symbolized Willy's life. As the house that he has worked for the entirety of his life is falling apart, his life is falling apart as well. "‘Once in my life I would like to own something outright before it's broken.'" (7). Willy complains about many things in his life that, while he is working hard, cannot seem to get paid for before they break. Linda reminds him that the money she said they need will include the last payment on their house, "‘All told, about two hundred dollars would carry us, dear. But that includes the last payment on the mortgage. After this payment, Willy, the house belongs to us.'" (7). Later he points out all the work he has put into the house maintaining it "‘All the cement, the lumber, the reconstruction I put in this house!'" (74). However, he did not put that amount of work into his life outside searching for the "American Dream."

The refrigerator symbolizes all that Willy works for but cannot have. Mr. Loman is a failure. The refrigerator serves as a constant reminder of the failures, as it is a failure of an appliance. He worked for and attempted to pay for the refrigerator, but he always had to fix something that was broken with it, even before it was paid for. Many of the things Willy wanted for his family was out of his financial means. Had he been able to buy the well-known brand of refrigerator, maybe it would not have broken so frequently. "‘I told you we should've bought the well-advertised machine.'" (7). However, he could not afford the better brand because of his finances.

Linda was faithful and devoted to Willy, but Willy was not faithful to Linda. As Linda mends her silk stockings, Willy gives new silk stockings to a woman with whom he is having an affair. The stockings that Linda is mending symbolize the happiness in their life that has been broken. Linda is trying to repair the relationship between Willy and her. When Willy finds Linda mending the stockings, he is enraged, because he is forced to witness that their relationship is faltering and that it is falling apart because of him. "‘I won't have you mending stockings in this house! Now throw them out!'" ().

All of these examples, the car and the house and the refrigerator and the stockings, and all that is symbolized by them illustrate Willy's life that he has worked so hard for tumbling down at his feet, and there is nothing he can do about it. Willy wanted success, but he was a failure. As he realized this, he could not deal with his life. His dreams fell apart in front of him. Willy Loman was a failure as a salesman, and that broke him.

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Marvel's To his coy mistress

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In To His Coy Mistress, Andrew Marvell presents a speaker who appeals to his love through persuasion using an appeal to reason as his main tool. By using different methods of appeal, the speaker hopes to win his mistress love. From the title, one can see that the speaker is a man addressing a female. The use of the word coy shows the reader that this woman is shy but in an enticing way, she is almost intentionally leading him on.

The overall scheme of this poem follows an appeal to reason, as proven by the first lines of each of the three stanzas. The poem begins with, Had we but world enough and time, which sets up an argument in which the speaker says what he would do if time permitted. It continues in the second stanza with the first word, But, which indicates a problem with the speakers initial thoughts. The But begins a stanza in which the speaker introduces the idea that one does not live forever. There isn't enough time to court because death is near and then passion will have been wasted. However, by starting the final stanza with, Now therefore, the speaker gives a solution to the problem he raised in the previous stanza. The method by which one introduces an idea, finds a flaw in it, and then finds a solution to the problem follows a chain of logic and appeals to a persons reason.

In the first stanza, the speaker adopts a tone of praise and affection. He professes his love for his mistress by saying he would love her from times beginning to times end (7-10). The speakers love should grow vaster than empires (11-1) and he would adore her for thousands of years (1-18). He compliments his mistress beauty and soul by saying that she deserves thousands of years of praise for her body and heart (1-0). He professes his adoration by telling her that his love spans from the beginning of time, before the Flood (8), to the end of time, Till the conversion of the Jews (10). His praise is not altogether sincere because although he pretends to want her for who she is, he just wants her body. His flattery is, in my opinion, an exaggeration.

In the second stanza, the speaker's tone is darker and less flattering and he uses images associated with death like marble vault, worms, dust, ashes, and graves. These words serve to emphasize the point that one will inevitably die and serve to perhaps frighten the mistress. He tries to make the point that only through death, which gets closer every second "Time's winged chariot hurrying near", will his love disappear and that only the worms will enjoy his mistress (7) company when she dies.

In the third stanza he offers a plan by which the two should live, knowing that one does not live forever. The speaker wants to live with his mistress while they are still youthful (-4) and passionate like amorous birds of prey (8). He wants the two of them to make the most of their lives together (4-46) and refusal of his love does not make sense because their passion will mean nothing in death, a logical reason. In the final stanza, the speakers tone changes again. This time the man speaks with a rushed tone, as though attempting to get in a final argument before time runs out, or death catches him. The main indication of this rushed tone lies in the punctuation, which is very scarce. Also, the third stanza contains words associated with action and motion, like transpires, fires, sport, devour, power, strength, and run. This echoes the fact that he feels they must take action with their romance.

In conclusion, Marvells poem incorporates the three appeals by creating a situation where a man attempts to persuade his mistress into spending her life with him. Overall, the speaker appeals to reason by loving each other, they may not stop time and live forever as lovers, but they can make it seem that way by filling their lives with love and happiness.

Please note that this sample paper on Marvel's To his coy mistress is for your review only. In order to eliminate any of the plagiarism issues, it is highly recommended that you do not use it for you own writing purposes. In case you experience difficulties with writing a well structured and accurately composed paper on Marvel's To his coy mistress, we are here to assist you. Your paper on Marvel's To his coy mistress will be written from scratch, so you do not have to worry about its originality. Order your authentic assignment and you will be amazed at how easy it is to complete a quality custom paper within the shortest time possible!

Hello

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The Way To Happiness Essay and Poster Competition is a highly successful activity, which inspires children with positive messages and instills strong moral values in them. Run annually in the United States by The Way to Happiness Foundation International, the contest educates children about the harmful effects of drugs and crime, and helps protect them from negative influences. By studying, discussing and writing essays or drawing posters on various themes from The Way to Happiness book, kids of all ages and from a wide range of groups not only learn the basic values of life but they help make a safer America in the process.

The Way to Happiness Essay and Poster Competition is a highly successful activity which inspires children with positive messages and instills strong moral values in them. Run annually in the United States by The Way to Happiness Foundation International, the contest educates children about the harmful effects of drugs and crime, and helps protect them from negative influences. By studying, discussing and writing essays on various themes from The Way to Happiness book, kids of all ages and from a wide range of groups not only learn the basic values of life but they help make a safer America in the process. The contest is open to all kids, and not only are there more than 100 winners chosen nationally, but every entrant receives a small prize. Individuals, business leaders and corporations sponsor and support local activities in specific geographical areas across the country. The contest involves many local groups and schools and many thousands of youngsters are reached. The Making America Safe Youth Essay Contest started in the fall of 14. Close to 600 schools and youth groups participated in the first contest.

Teaching the Difference Between Right and Wrong

Have Right and Wrong Lost Their Meaning?

The Way to Happiness Essay and Poster Competition helps children and youth obtain a basic understanding of right and wrong. In todays society nothing could be more important. Its not easy educating children today. Not in the face of a society where right and wrong seem to have lost their meaning.

Drugs and crime endanger the survival potential of youth and parents as well as educators. They endanger our childrens future and threaten the very fabric of society. Drugs inevitably lead to ruined lives. Harmful actions and criminal behavior bring unhappiness, and not just for the victim but the perpetrator as well.

Do You Have a Desire to Help Kids?

In todays world, teaching youth the difference between right and wrong is not just a good idea it is a vital action that directly relates to the survival potential and happiness of our children and our society. As an educator and one who truly cares about the well-being and future of our children you have an opportunity here to really help young people steer away and stay away from lives of drugs and crime.

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All data submitted becomes the property of findfreeessays.com and you give up all legal rights to it! We only accept original papers, do not submit copyrighted material!

We require that you submit one of your own papers.

This helps findfreeessays.com grow and add new papers!

All data submitted becomes the property of findfreeessays.com and you give up all legal rights to it! We only accept original papers, do not submit copyrighted material!

We require that you submit one of your own papers.

This helps findfreeessays.com grow and add new papers!

All data submitted becomes the property of findfreeessays.com and you give up all legal rights to it! We only accept original papers, do not submit copyrighted material!

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