The Emancipation Proclamation In The Writings Of Selected Professional Negro Historians And Selected Professional Southern White Historians

Revolutionary changes is one of the most interesting phenomenon in the study of historiography, m no area has there been such a change in the area of historical writing in the era of the Civil War by black and white writers in recent years. The purpose of this paper is to examine the Emancipation Proclamation in the light of the contemporary Civil rights and Negro rights struggle as well as the struggle of the southern region to maintain some semblance of traditional cultural identity and distinctiveness. The writer chose this topic because the Emancipation Proclamation readily becomes the focal point of much emotional bias in historical interpretation. There are few incidences in American history with the capacity to evoke reactions strong enough to overcome the caution of the trained professional because the status of race was involved in the act. The writer feels that it is significant in the study to use professional Negro and Southern White writers in an area of public controversy instead of lay writers because of the way professional historians write and document their materials. What will be demonstrated here is not new information on the Emancipation Proclamation, but the fact that the facts of history are, under the best professional circumstances, the victim of overt bias of the writer, some of which even he himself would find it difficult to explain. STATEMENT OF THE PROBLEM The development of the scholarship on the problem of the Emancipation Proclamation among the seven selected Negro writers shows the follox^ing Pattern between World War II and the present. Three categories dominate this pattern of writing which appeared successively as international humanitarian, military, and war for human freedom. There are three Negroes who fall into the international humanitarian category. They are, W.E.B. DuBois, Charles Wesley, and John Hope Franklin. DuBois saw the Emancipation Proclamation come not simply to black folks in 1863; to white Americans came slowly a new vision and a new uplift, a sudden freeing of hateful mental shadows. Charles Wesley observed that the Emancipation Proclamation as far as foreign nations were concerned was to shift the war issue to slavery and to win anti-slavery sympathizers in Europe. John Hope Franklin felt that the Emancipation Proclamation had moral and humanitarian significance

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

BACKGROUND: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. METHODS: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). FINDINGS: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29-146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0- 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25-1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39-1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65-1·60]; p=0·92). INTERPRETATION: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention. FUNDING: British Heart Foundation

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Effect of immediate initiation of antiretroviral treatment in HIV-positive individuals aged 50 years or older

Submitted by Fábio Marques ([email protected]) on 2018-03-12T19:03:26Z No. of bitstreams: 1 Effect of immediate initiation of antiretroviral treatment in HIV-positive individuals aged 50 years or older.pdf: 2183723 bytes, checksum: ccb422bcccab25adadd98d7f47e99144 (MD5)Approved for entry into archive by Raquel Dinelis ([email protected]) on 2018-03-20T15:09:24Z (GMT) No. of bitstreams: 1 Effect of immediate initiation of antiretroviral treatment in HIV-positive individuals aged 50 years or older.pdf: 2183723 bytes, checksum: ccb422bcccab25adadd98d7f47e99144 (MD5)Made available in DSpace on 2018-03-20T15:09:24Z (GMT). No. of bitstreams: 1 Effect of immediate initiation of antiretroviral treatment in HIV-positive individuals aged 50 years or older.pdf: 2183723 bytes, checksum: ccb422bcccab25adadd98d7f47e99144 (MD5) Previous issue date: 2017Harvard T.H. Chan School of Public Health. Department of Epidemiology. Boston.Institut Pierre Louis d’épidémiologie et de Santé Publique. Sorbonne Universités, INSERM, UPMC Univ Paris 06. France.Institute of Global Health.University College London. London, United Kingdom.Instituto de Salud Carlos III. Centro Nacional de Epidemiologia. Madrid, Spain / Instituto de Salud Carlos III. CIBERESP. Madrid, Spain.Harvard T.H. Chan School of Public Health. Department of Epidemiology. Boston.Institut Pierre Louis d’épidémiologie et de Santé Publique. Sorbonne Universités, INSERM, UPMC Univ. Paris. Paris, France / Hôpital Antoine Béclère, Service de Médecine Interne. AP-HP, Clamart, France.Stichting HIV Monitoring. Amsterdam, the Netherlands / Academic Medical Centre, Department of Global Health and Division of Infectious Diseases, University of Amsterdam, Amsterdam, the Netherlands / Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands.Stichting HIV Monitoring. Amsterdam, the Netherlands.Institute of Global Health.University College London. London, United Kingdom.Hospital San Pedro—CIBIR, Logroño, Spain.Instituto de Salud Carlos III. Centro Nacional de Epidemiologia. Madrid, Spain / Instituto de Salud Carlos III. CIBERESP. Madrid, Spain.University of Basel. University Hospital Basel. Basel Institute for Clinical Epidemiology and Biostatistics, Basel, Switzerland.University of Zurich. University Hospital Zurich. Division of Infectious Diseases and Hospital Epidemiology. Zurich, Switzerland.Hospital Parc Tauli. Infectious Disease Department. Sabadell, Spain.Hospital Clinic-IDIBAPS. Barcelona, Spain.Patras University Hospital. Division of Infectious Diseases. Patras, Greece.National and Kapodistrian University of Athens. Faculty of Medicine. Department of Hygiene, Epidemiology and Medical Statistics. Athens, Greece.Université de Bordeaux, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, Bordeaux, France / Université de Bordeaux. Centre INSERM U1219- Centre Inserm Epidémiologie et Biostatistique, Bordeaux, France.Université de Bordeaux, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, Bordeaux, France. / Université de Bordeaux. Centre INSERM U1219- Centre Inserm Epidémiologie et Biostatistique, Bordeaux, France / Bordeaux University Hospital. Department of Internal Medicine, Bordeaux, France.Université Paris Sud, UMR 1018, le Kremlin Bicêtre, Paris, France / Inserm, UMR 1018, le Kremlin Bicêtre, Paris, France / AP-HP, Hôpital de Bicêtre, Service de Santé Publique, le Kremlin Bicêtre, Paris, France.Inserm, UMR 1018, le Kremlin Bicêtre, Paris, France / AP-HP, Hôpital de Bicêtre, Service de Santé Publique, le Kremlin Bicêtre, Paris, France.Southern Alberta Clinic, Calgary, AB, Canada / Department of Medicine, University of Calgary, Calgary, AB, Canada.Southern Alberta Clinic, Calgary, AB, Canada / Department of Medicine, University of Calgary, Calgary, AB, Canada.Instituto de Salud Carlos III. Centro Nacional de Epidemiologia. Madrid, Spain.Instituto de Salud Carlos III. Centro Nacional de Epidemiologia. Madrid, Spain.Fundacao Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brasil.Fundacao Oswaldo Cruz. Programa de Computação Científica, Rio de Janeiro, Brasil.Hospital Universitari Germans Trias i Pujol, Badalona, Spain.Yale University School of Medicine. Department of Internal Medicine, New Haven.Yale University School of Medicine. Department of Internal Medicine, New Haven / VA Connecticut Healthcare System, West Haven, CT.Harvard T.H. Chan School of Public Health. Department of Epidemiology. Boston / Harvard T.H. Chan School of Public Health. Department of Biostatistics, Boston / Harvard-MIT Division of Health Sciences and Technology, Boston, MA.Clinical guidelines recommend immediate initiation of combined antiretroviral therapy for all HIV-positive individuals. However, those guidelines are based on trials of relatively young participants

Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016 : a systematic analysis for the Global Burden of Disease Study 2016

Background Traumatic brain injury (TBI) and spinal cord injury (SCI) are increasingly recognised as global health priorities in view of the preventability of most injuries and the complex and expensive medical care they necessitate. We aimed to measure the incidence, prevalence, and years of life lived with disability (YLDs) for TBI and SCI from all causes of injury in every country, to describe how these measures have changed between 1990 and 2016, and to estimate the proportion of TBI and SCI cases caused by different types of injury. Methods We used results from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016 to measure the global, regional, and national burden of TBI and SCI by age and sex. We measured the incidence and prevalence of all causes of injury requiring medical care in inpatient and outpatient records, literature studies, and survey data. By use of clinical record data, we estimated the proportion of each cause of injury that required medical care that would result in TBI or SCI being considered as the nature of injury. We used literature studies to establish standardised mortality ratios and applied differential equations to convert incidence to prevalence of long-term disability. Finally, we applied GBD disability weights to calculate YLDs. We used a Bayesian meta-regression tool for epidemiological modelling, used cause-specific mortality rates for non-fatal estimation, and adjusted our results for disability experienced with comorbid conditions. We also analysed results on the basis of the Socio-demographic Index, a compound measure of income per capita, education, and fertility. Findings In 2016, there were 27.08 million (95% uncertainty interval [UI] 24.30-30.30 million) new cases of TBI and 0.93 million (0.78-1.16 million) new cases of SCI, with age-standardised incidence rates of 369 (331-412) per 100 000 population for TBI and 13 (11-16) per 100 000 for SCI. In 2016, the number of prevalent cases of TBI was 55.50 million (53.40-57.62 million) and of SCI was 27.04 million (24 .98-30 .15 million). From 1990 to 2016, the age-standardised prevalence of TBI increased by 8.4% (95% UI 7.7 to 9.2), whereas that of SCI did not change significantly (-0.2% [-2.1 to 2.7]). Age-standardised incidence rates increased by 3.6% (1.8 to 5.5) for TBI, but did not change significantly for SCI (-3.6% [-7.4 to 4.0]). TBI caused 8.1 million (95% UI 6. 0-10. 4 million) YLDs and SCI caused 9.5 million (6.7-12.4 million) YLDs in 2016, corresponding to age-standardised rates of 111 (82-141) per 100 000 for TBI and 130 (90-170) per 100 000 for SCI. Falls and road injuries were the leading causes of new cases of TBI and SCI in most regions. Interpretation TBI and SCI constitute a considerable portion of the global injury burden and are caused primarily by falls and road injuries. The increase in incidence of TBI over time might continue in view of increases in population density, population ageing, and increasing use of motor vehicles, motorcycles, and bicycles. The number of individuals living with SCI is expected to increase in view of population growth, which is concerning because of the specialised care that people with SCI can require. Our study was limited by data sparsity in some regions, and it will be important to invest greater resources in collection of data for TBI and SCI to improve the accuracy of future assessments. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd.Peer reviewe