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Bootstraps need boots : one Tory's lonely fight to end poverty in Canada
\"For more than four decades, Hugh Segal has been one of the leading voices of progressive conservatism in Canada. A self-described Red Tory warrior who disdained \"boot strap\" approaches to poverty, he has always promoted policies, especially a basic annual income, to help the most economically vulnerable. Why would a life-long Tory support something so radical? In this revealing memoir, Segal shares how his life and experiences brought him to this most unlikely of places, beginning with his childhood in a poor immigrant family in Montreal to his time as a chief of staff for Prime Minister Mulroney and to his more recent work as an advisor on basic income for the Ontario Liberal government. This book is a passionate argument for why a basic annual income makes economic sense - and for why it is the right thing to do.\"-- Provided by publisher.
Book
Invasive Treatment Strategy for Older Patients with Myocardial Infarction
Whether a conservative strategy of medical therapy alone or a strategy of medical therapy plus invasive treatment is more beneficial in older adults with non-ST-segment elevation myocardial infarction (NSTEMI) remains unclear.
We conducted a prospective, multicenter, randomized trial involving patients 75 years of age or older with NSTEMI at 48 sites in the United Kingdom. The patients were assigned in a 1:1 ratio to a conservative strategy of the best available medical therapy or an invasive strategy of coronary angiography and revascularization plus the best available medical therapy. Patients who were frail or had a high burden of coexisting conditions were eligible. The primary outcome was a composite of death from cardiovascular causes (cardiovascular death) or nonfatal myocardial infarction assessed in a time-to-event analysis.
A total of 1518 patients underwent randomization; 753 patients were assigned to the invasive-strategy group and 765 to the conservative-strategy group. The mean age of the patients was 82 years, 45% were women, and 32% were frail. A primary-outcome event occurred in 193 patients (25.6%) in the invasive-strategy group and 201 patients (26.3%) in the conservative-strategy group (hazard ratio, 0.94; 95% confidence interval [CI], 0.77 to 1.14; P = 0.53) over a median follow-up of 4.1 years. Cardiovascular death occurred in 15.8% of the patients in the invasive-strategy group and 14.2% of the patients in the conservative-strategy group (hazard ratio, 1.11; 95% CI, 0.86 to 1.44). Nonfatal myocardial infarction occurred in 11.7% in the invasive-strategy group and 15.0% in the conservative-strategy group (hazard ratio, 0.75; 95% CI, 0.57 to 0.99). Procedural complications occurred in less than 1% of the patients.
In older adults with NSTEMI, an invasive strategy did not result in a significantly lower risk of cardiovascular death or nonfatal myocardial infarction (the composite primary outcome) than a conservative strategy over a median follow-up of 4.1 years. (Funded by the British Heart Foundation; BHF SENIOR-RITA ISRCTN Registry number, ISRCTN11343602.).
Journal Article
Buckley : William F. Buckley Jr. and the rise of American conservatism
Documents the legacy of a leading architect of the American conservative movement, tracing his 1955 launch of the influential \"National Review\" and his television show \"Firing Line,\" as well as his role in promoting modern values about the free market, religion, and an aggressive foreign policy.
Book
PCI in Patients Undergoing Transcatheter Aortic-Valve Implantation
In a trial of percutaneous coronary intervention or conservative treatment in patients undergoing TAVI, PCI was associated with a lower risk of a composite of death, MI, or urgent revascularization at a median of 2 years.
Journal Article
Conservative oxygen therapy for mechanically ventilated adults with sepsis: a post hoc analysis of data from the intensive care unit randomized trial comparing two approaches to oxygen therapy (ICU-ROX)
PurposeSepsis is a common reason for intensive care unit (ICU) admission and mortality in ICU patients. Despite increasing interest in treatment strategies limiting oxygen exposure in ICU patients, no trials have compared conservative vs. usual oxygen in patients with sepsis.MethodsWe undertook a post hoc analysis of the 251 patients with sepsis enrolled in a trial that compared conservative oxygen therapy with usual oxygen therapy in 1000 mechanically ventilated ICU patients. The primary end point for the current analysis was 90-day mortality. Key secondary outcomes were cause-specific mortality, ICU and hospital length of stay, ventilator-free days, vasopressor-free days, and the proportion of patients receiving renal replacement therapy in the ICU.ResultsPatients with sepsis allocated to conservative oxygen therapy spent less time in the ICU with an SpO2 ≥ 97% (23.5 h [interquartile range (IQR) 8–70] vs. 47 h [IQR 11–93], absolute difference, 23 h; 95% CI 8–38), and more time receiving an FiO2 of 0.21 than patients allocated to usual oxygen therapy (20.5 h [IQR 1–79] vs. 0 h [IQR 0–10], absolute difference, 20 h; 95% CI 14–26). At 90-days, 47 of 130 patients (36.2%) assigned to conservative oxygen and 35 of 120 patients (29.2%) assigned to usual oxygen had died (absolute difference, 7 percentage points; 95% CI − 4.6 to 18.6% points; P = 0.24; interaction P = 0.35 for sepsis vs. non-sepsis). There were no statistically significant differences between groups for secondary outcomes but point estimates of treatment effects consistently favored usual oxygen therapy.ConclusionsPoint estimates for the treatment effect of conservative oxygen therapy on 90-day mortality raise the possibility of clinically important harm with this intervention in patients with sepsis; however, our post hoc analysis was not powered to detect the effects suggested and our data do not exclude clinically important benefit or harm from conservative oxygen therapy in this patient group.Clinical Trials RegistryICU-ROX Australian and New Zealand Clinical Trials Registry number ACTRN12615000957594.
Journal Article
America last : the right's century-long romance with foreign dictators
Why is today's Republican Party, which claims to be the defender of American values, so drawn to the Russian dictator Vladimir Putin and the brazenly illiberal Victor Orban, who has crushed an independent judiciary and political dissent in Hungary? As Heilbrunn shows, the affection conservatives display for foreign autocrats, though a striking and seemingly inexplicable fact of our current moment, dates to the First World War. Since that time, leading intellectuals, journalists and politicians on the right have always been drawn to what they perceive as the impressive strength of authoritarians abroad who offered models of how to fight back against liberalism and progressivism domestically. In this account, Heilbrunn argues that dictator worship is a longstanding romantic impulse that fits firmly within the modern American political tradition - and shows what it means for us today.
Book
Whatever happened to tory Scotland?
Explores the history and ideas of the Scottish Conservative Party since its creation in 1912. The Scottish Conservative Party has played a significant role in the politics of Scotland during the last century. This book explores the nature of the party, its standing in Scotland, its influence on the Union and its role in the Scottish Parliament. In particular it asks how the party lost support so dramatically in Scotland, from a majority of votes and seats at the 1955 general election to a single constituency and 17% of the vote in 2010. Divided into 2 parts: The Rise and Fall of Unionist Scotland and In the Political Wilderness Includes contributions from leading academics and political commentators including Richard Finlay, Colin Kidd, Catriona Macdonald, James Mitchell and Alex Massie
eBook
Parental preferences in treatment of acute uncomplicated appendicitis comparing surgery to conservative management with antibiotics and their views on research participation
Studies show that conservative management in acute uncomplicated appendicitis (AUA) is an alternative to surgery. This study aims to determine factors affecting parental preference in management of AUA and their decision for research participation. We conducted surveys on parents whose children were admitted with suspicion of appendicitis but later confirmed not to have appendicitis. Information on appendicectomy versus conservative treatment with antibiotics was provided using a fixed script and standard information leaflet. Questionnaires covered factors influencing decisions, opinions regarding research, treatment preference and demographic data. We excluded parents not fluent in English. Of 113 respondents, 71(62.8%) chose antibiotics, 39(34.5%) chose appendicectomy, and 3(2.7%) had no preference. Reasons given for choosing antibiotics were fear of surgical risks and preferring less invasive treatment. Those choosing appendicectomy expressed preference for definitive treatment and fear of recurrence. Majority were against randomisation (n = 89, 78.8%) and blinding (n = 90, 79.7%). Over half found difficulty involving their child in research (n = 65, 57.5%). Most thought that research is important (66.4%) and beneficial to others (59.3%). Parents who perceived their child as healthy found research riskier (p = 0.039). Educated parents were more likely to find research beneficial to others (p = 0.012) but less accepting of randomisation (p = 0.001).Conclusion: More parents appear to prefer conservative treatment for acute uncomplicated appendicitis. Researchers must consider parental concerns regarding randomisation and blinding.What is Known:• Conservative management of acute uncomplicated appendicitis in paediatric patients is safe and effective, sparing the child the need for an operation; however, neither conservative nor surgical management is proven to be superior.• Randomised controlled trials provide the highest level of evidence, but it is challenging to recruit paediatric patients as participants in such clinical trials.What is New:• More parents prefer conservative management of uncomplicated appendicitis over surgical management for their children due to fear of surgical risks and complications• Randomisation in trial design is significantly associated with a parent’s decision to reject their child’s participation in a clinical trial.
Journal Article