Statins for extension of disability-free survival and primary prevention of cardiovascular events among older people: protocol for a randomised controlled trial in primary care (STAREE trial)

Introduction: The world is undergoing a demographic transition to an older population. Preventive healthcare has reduced the burden of chronic illness at younger ages but there is limited evidence that these advances can improve health at older ages. Statins are one class of drug with the potential to prevent or delay the onset of several causes of incapacity in older age, particularly major cardiovascular disease (CVD). This paper presents the protocol for the STAtins in Reducing Events in the Elderly (STAREE) trial, a randomised double-blind placebo-controlled trial examining the effects of statins in community dwelling older people without CVD, diabetes or dementia. Methods and analysis: We will conduct a double-blind, randomised placebo-controlled trial among people aged 70 years and over, recruited through Australian general practice and with no history of clinical CVD, diabetes or dementia. Participants will be randomly assigned to oral atorvastatin (40 mg daily) or matching placebo (1:1 ratio). The co-primary endpoints are disability-free survival defined as survival-free of dementia and persistent physical disability, and major cardiovascular events (cardiovascular death or non-fatal myocardial infarction or stroke). Secondary endpoints are all-cause death, dementia and other cognitive decline, persistent physical disability, fatal and non-fatal myocardial infarction, fatal and non-fatal stroke, heart failure, atrial fibrillation, fatal and non-fatal cancer, all-cause hospitalisation, need for permanent residential care and quality of life. Comparisons between assigned treatment arms will be on an intention-to-treat basis with each of the co-primary endpoints analysed separately in time-to-first-event analyses using Cox proportional hazards regression models. Ethics and dissemination: STAREE will address uncertainties about the preventive effects of statins on a range of clinical outcomes important to older people. Institutional ethics approval has been obtained. All research outputs will be disseminated to general practitioner co-investigators and participants, published in peer-reviewed journals and presented at national and international conferences. Trial registration number: NCT02099123.Sophia Zoungas, Andrea Curtis, Simone Spark, Rory Wolfe, John J McNeil, Lawrence Beilin, Trevor T-J Chong, Geoffrey Cloud, Ingrid Hopper, Alissia Kost, Mark Nelson, Stephen J Nicholls, Christopher M Reid, Joanne Ryan, Andrew Tonkin, Stephanie A Ward, Anthony Wierzbicki, On behalf of STAREE investigator grou

Orwellian Language and the Politics of Tribal Termination (1953-1960)

From 1953 to 1960, the federal government terminated sovereign recognition for 109 American Indian nations. Termination was a haphazard policy of assimilation that had disastrous consequences for Indian land and culture. Nonetheless, termination cloaked latent motivations for Indian land within individual rights rhetoric that was at odds with Indian sovereignty. Termination highlights the rhetorical features of social control under capitalism portrayed in George Orwell’s Nineteen Eighty-Four (1949), in which opposing principles are fused and inverted. This essay critiques termination’s Orwellian language to show how ideographs of social liberation are refashioned by the state to subvert Indian sovereignty and popular dissent

The Trickster Shift : Humour and Irony in Contemporary Native Art

This richly illustrated book highlights the humour and irony in the work of contemporary Native artists from Canada. Ryan’s introduction outlines the genesis of his research on the Trickster figure in traditional First Nations culture. The non-linear structure of the text is conceived as “trickster discourse,” and reflects the intertextual nature of its subject matter. The four texts by Ryan use irony and parody to address the following topics: contemporary interpretations of the Trickster figure; the re-creation of identity in the work of Native artists; the subversion of traditional Aboriginal forms of representation; and the deconstruction of political power/government oppression. The texts are interspersed with artist’s statements, excerpts from conversations with artists and curators, reviews and descriptions of various exhibitions. Includes a six-page index. Brief biographical notes on the author and artists interviewed. Circa 400 bibl. ref

Agreement between fiber optic and optoelectronic systems for quantifying sagittal plane spinal curvature in sitting

Photograph of the Bristow Frisco Depot

Potato Ingestion as an Effective Race Fuel Alternative to Improve Cycling Performance in Trained Cyclists

Carbohydrate (CHO) ingestion is an established strategy to improve endurance performance. Race fuels should not only sustain performance, but also be readily digested and absorbed and replenish electrolytes. Potatoes are a cost-effective option that fulfills these criteria; however, their impact on endurance performance remains unexamined. PURPOSE: Compare the effects of potato purée (POT) ingestion during endurance cycling on subsequent performance versus commercial CHO gel (GEL) or a control (water, CTL). METHODS: Twelve trained cyclists (31±9y; 71±8kg; VO2max: 61±9mL/kg/min) consumed a standardized breakfast then performed a 2h cycling challenge (60-85%VO2max) followed by a time trial (6kJ/kg body mass) while consuming POT, GEL, or CTL in a randomized-crossover design. POT, GEL and CTL were administered with U-[13C6]glucose for an indirect estimate of gastric emptying rate. Repeated blood samples were collected. RESULTS: Time trial performance significantly improved (P=0.03) with POT (33.0±4.5min) and GEL (33.0±4.2min) versus CTL condition (39.5±7.9min); while POT and GEL conditions (P=1.00) had no difference. Post-challenge, blood glucose concentrations were lower (P0.05). CONCLUSION: Potatoes served as a viable alternative to commercial gels by sustaining performance and blood glucose concentrations during endurance cycling events in trained cyclists