The Reign of King John

Lacking the warlike bluntness of his predecessor, Richard the Lionheart, John came to the throne of England at a time when economic forces in the realm were threatening to undermine the very basis of feudal power. His attempts to adjust a political system to cope with this threat and at the same time to assert the hegemony of the monarchy over its chief rivals—the barons and the church—made his reign one of particular importance and significance in English history

The Twenty-Fifth Lunar and Planetary Science Conference. Part 1: A-G

Papers from the conference are presented, and the topics covered include the following: planetary geology, meteorites, planetary composition, meteoritic composition, planetary craters, lunar craters, meteorite craters, petrology, petrography, volcanology, planetary crusts, geochronology, geomorphism, mineralogy, lithology, planetary atmospheres, impact melts, volcanoes, planetary evolution, tectonics, planetary mapping, asteroids, comets, lunar soil, lunar rocks, lunar geology, metamorphism, chemical composition, meteorite craters, and planetary mantles

Appropriateness of antiplatelet therapy for primary and secondary cardio- and cerebrovascular prevention in acutely hospitalized older people

Aims: Antiplatelet therapy is recommended for the secondary prevention of cardio- and cerebrovascular disease, but for primary prevention it is advised only in patients at very high risk. With this background, this study aims to assess the appropriateness of antiplatelet therapy in acutely hospitalized older people according to their risk profile. Methods: Data were obtained from the REPOSI register held in Italian and Spanish internal medicine and geriatric wards in 2012 and 2014. Hospitalized patients aged 6565 assessable at discharge were selected. Appropriateness of the antiplatelet therapy was evaluated according to their primary or secondary cardiovascular prevention profiles. Results: Of 2535 enrolled patients, 2199 were assessable at discharge. Overall 959 (43.6%, 95% CI 41.5\u201345.7) were prescribed an antiplatelet drug, aspirin being the most frequently chosen. Among patients prescribed for primary prevention, just over half were inappropriately prescribed (52.1%), being mainly overprescribed (155/209 patients, 74.2%). On the other hand, there was also a high rate of inappropriate underprescription in the context of secondary prevention (222/726 patients, 30.6%, 95% CI 27.3\u201334.0%). Conclusions: This study carried out in acutely hospitalized older people shows a high degree of inappropriate prescription among patients prescribed with antiplatelets for primary prevention, mainly due to overprescription. Further, a large proportion of patients who had had overt cardio- or cerebrovascular disease were underprescribed, in spite of the established benefits of antiplatelet drugs in the context of secondary prevention