154 research outputs found
Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial
Background: Intensive antiplatelet therapy with three agents might be more effective than guideline treatment for preventing recurrent events in patients with acute cerebral ischaemia. We aimed to compare the safety and efficacy of intensive antiplatelet therapy (combined aspirin, clopidogrel, and dipyridamole) with that of guideline-based antiplatelet therapy.
Methods: We did an international, prospective, randomised, open-label, blinded-endpoint trial in adult participants with ischaemic stroke or transient ischaemic attack (TIA) within 48 h of onset. Participants were assigned in a 1:1 ratio using computer randomisation to receive loading doses and then 30 days of intensive antiplatelet therapy (combined aspirin 75 mg, clopidogrel 75 mg, and dipyridamole 200 mg twice daily) or guideline-based therapy (comprising either clopidogrel alone or combined aspirin and dipyridamole). Randomisation was stratified by country and index event, and minimised with prognostic baseline factors, medication use, time to randomisation, stroke-related factors, and thrombolysis. The ordinal primary outcome was the combined incidence and severity of any recurrent stroke (ischaemic or haemorrhagic; assessed using the modified Rankin Scale) or TIA within 90 days, as assessed by central telephone follow-up with masking to treatment assignment, and analysed by intention to treat. This trial is registered with the ISRCTN registry, number ISRCTN47823388.
Findings: 3096 participants (1556 in the intensive antiplatelet therapy group, 1540 in the guideline antiplatelet therapy group) were recruited from 106 hospitals in four countries between April 7, 2009, and March 18, 2016. The trial was stopped early on the recommendation of the data monitoring committee. The incidence and severity of recurrent stroke or TIA did not differ between intensive and guideline therapy (93 [6%] participants vs 105 [7%]; adjusted common odds ratio [cOR] 0·90, 95% CI 0·67â1·20, p=0·47). By contrast, intensive antiplatelet therapy was associated with more, and more severe, bleeding (adjusted cOR 2·54, 95% CI 2·05â3·16, p<0·0001).
Interpretation: Among patients with recent cerebral ischaemia, intensive antiplatelet therapy did not reduce the incidence and severity of recurrent stroke or TIA, but did significantly increase the risk of major bleeding. Triple antiplatelet therapy should not be used in routine clinical practice
Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial
Background: Intensive antiplatelet therapy with three agents might be more effective than guideline treatment for preventing recurrent events in patients with acute cerebral ischaemia. We aimed to compare the safety and efficacy of intensive antiplatelet therapy (combined aspirin, clopidogrel, and dipyridamole) with that of guideline-based antiplatelet therapy.Methods: We did an international, prospective, randomised, open-label, blinded-endpoint trial in adult participants with ischaemic stroke or transient ischaemic attack (TIA) within 48 h of onset. Participants were assigned in a 1:1 ratio using computer randomisation to receive loading doses and then 30 days of intensive antiplatelet therapy (combined aspirin 75 mg, clopidogrel 75 mg, and dipyridamole 200 mg twice daily) or guideline-based therapy (comprising either clopidogrel alone or combined aspirin and dipyridamole). Randomisation was stratified by country and index event, and minimised with prognostic baseline factors, medication use, time to randomisation, stroke-related factors, and thrombolysis. The ordinal primary outcome was the combined incidence and severity of any recurrent stroke (ischaemic or haemorrhagic; assessed using the modified Rankin Scale) or TIA within 90 days, as assessed by central telephone follow-up with masking to treatment assignment, and analysed by intention to treat. This trial is registered with the ISRCTN registry, number ISRCTN47823388.Findings: 3096 participants (1556 in the intensive antiplatelet therapy group, 1540 in the guideline antiplatelet therapy group) were recruited from 106 hospitals in four countries between April 7, 2009, and March 18, 2016. The trial was stopped early on the recommendation of the data monitoring committee. The incidence and severity of recurrent stroke or TIA did not differ between intensive and guideline therapy (93 [6%] participants vs 105 [7%]; adjusted common odds ratio [cOR] 0·90, 95% CI 0·67â1·20, p=0·47). By contrast, intensive antiplatelet therapy was associated with more, and more severe, bleeding (adjusted cOR 2·54, 95% CI 2·05â3·16,
A New Theory of Social Control
A Review of Norms, Deviance, and Social Control: Conceptual Matters by Jack P. Gibb
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MORALITY, SELFâCONTROL, AND CRIME
This paper offers evidence to specify further SelfâControl Theory by investigating its predictive strength relative to morality and its interconnections with morality in accounting for criminal probability. Using random sample household survey data from Lviv, Ukraine, we confirm that selfâcontrol is an important predictor of criminal probabilities in an unusual cultural context. However, morality is also shown to be a strong independent predictor with strength that seems to exceed substantially that of selfâcontrol. In addition, taking morality into account significantly reduces the coefficients for selfâcontrol, sometimes eliminating them entirely, and morality shows little interaction with selfâcontrol in its predictions of the measures of criminal probability. The results suggest that the recently formulated Situational Action Theory, which features (weak) morality as the prime cause of criminal behavior and questions the relative importance of selfâcontrol, should be taken seriously. Overall, the results confirm the importance of selfâcontrol as a factor in misbehavior; yet, they also provide a mandate for greater attention to morality as a potent variable in understanding misconduct
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A CROSS-NATIONAL TEST OF BONGER'S THEORY OF CRIMINALITY AND ECONOMIC CONDITIONS
Social Learning, Reinforcement and Crime: Evidence from Three European Cities
This study reports a cross-cultural test of Social Learning Theory using direct measures of social learning constructs and focusing on the causal structure implied by the theory. Overall, the results strongly confirm the main thrust of the theory. Prior criminal reinforcement and current crime-favorable definitions are highly related in all three contexts and both strongly predict self-projections of criminal behavior. In addition, effects of prior reinforcement on projected misconduct appear to be both direct and indirect (through crime-favorable definitions). Yet, the findings also indicate that the processes underlying direct effects of reinforcement on criminal probabilities may need to be explicated further. Moreover, some types of definitions may be more influential than other types. Finally, parts of the reinforcement process may be affected by socio-cultural contexts
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The Costs of Coercive Control: Assessing Behavioral and Mental Health Correlates of Erratic and Oppressive Coercion
Some theorists argue that coercion's consequences depend upon the consistency with which it is experienced. This study measures the consistency of coercive experiences across social domains and lifespan stages then tests hypotheses linking coercion's consistency to crime, prosocial behaviors, and depressive symptoms using data from randomly selected respondents in Ukraine and Bangladesh. Descriptive analyses test theoretical claims that erratic coercion generates crime while oppressive coercion deters crime, but at the cost of suppressing prosocial behaviors and exacerbating depressive symptoms. Findings show positive associations between projected criminal behavior and coercion's magnitude, and between relative erratic but not absolute erratic coercion and projected criminal behavior. Oppressive coercion is linked to more depressive symptoms and, contradicting theoretical expectations, higher levels of criminal intent. Overall, this study's findings challenge widespread reliance on coercive controls to influence social outcomes by documenting higher levels of projected criminal behavior and mental health problems among more coerced respondents
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