Aggression reduction

The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators High-dose atorvastatin after stroke or transients ischemic attack. N Engl J Med 2006 355 549-559. 

Albucher JF, Martel P, Mas JL (2005). Clinical practice guidelines diagnosis and immediate management of transient ischemic attacks in adults. Cerebrovascular Diseases 20 220-225 Amarenco P, Bogousslavsky J, Callahan A III for the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators (2006). High-dose atorvastatin after stroke or transient ischemic attack. 

Amarenco P, Goldstein LB, Szarek M, SUlesen H, Rudolph AE, Callahan A3, Hennerid M, Simunovic L, Zivin JA, Welch KMA Effects of intense low-density lipoprotein cholesterol reduction in patients with stroke or transient ischemic attack the stroke prevention by aggressive reduction in cholesterol levels (SPARCL) trial. Stroke 2007 38 pp. 3198-3204. 

These studies generally support the concept that hypertension accelerates development of peripheral vascular disease in certain populations. The presence of other risk factors such as hypercholesterolemia, smoking, diabetes, and male gender appear to markedly accentuate the effects of hypertension on development of this process. Thus, aggressive reduction in arterial pressure and reduction or elimination of other risk factors is clearly indicated in high-risk patients. 

In addition to achieving the o2one standard by the deadline, moderate and higher areas must demonstrate a total net VOC emissions reduction below the base year ia accordance with an aggressive schedule of percentage reductions. These reductions are 15% ia the first six years (through November 15, 1996), and 3%/yr thereafter. 

Worldwide demand for blast furnace coke has decreased over the past decade. Although, as shown in Figure 1, blast furnace hot metal production (pig iron) increased by about 4% from 1980 to 1990, coke production decreased by about 2% over the same time period (3). This discrepancy of increased hot metal and decreased coke production is accounted for by steady improvement in the amounts of coke required to produce pig iron. Increased technical capabihties, although not universally implemented, have allowed for about a 10% decrease in coke rate, ie, coke consumed per pig iron produced, because of better specification of coke quaUty and improvements in blast furnace instmmentation, understanding, and operation methods (4). As more blast furnaces implement injection of coal into blast furnaces, additional reduction in coke rate is expected. In some countries that have aggressively adopted coal injection techniques, coke rates have been lowered by 25% (4). 

Alter the environment to render it less eorrosive. This approach may be as simple as maintaining clean metal surfaces. It is well known that the chemistry of the environment beneath deposits can become substantially different than that of the bulk environment. This difference can lead to localized, underdeposit corrosion (see Chap. 4, Underdeposit Corrosion ). The pit sites produced may then induce corrosion fatigue when cyclic stresses are present. The specific steps taken to reduce corrosivity vary with the metal under consideration. In general, appropriate adjustments to pH and reduction or elimination of aggressive ions should be considered. 

Criteria for initiation of drug treatment now take into consideration total cardiovascular risk rather than blood pressure alone, such that treatment is now recommended for persons whose blood pressure is in the normal range but still bear a heavy burden of cardiovascular risk factors. Thus, the role of simultaneous reduction of multiple cardiovascular risk factors in improving prognosis in hypertensive patients is stressed. In addition, more aggressive blood pressure goals are recommended for hypertensive patients with comorbid conditions such as diabetes mellitus or renal insufficiency. 

Reductions in aggressive behavior after treatment with amphetamine and other psyehomotor stimulants are seen in children and adolescents who have been diagnosed with hyperkinesis or attention deficit disorder. There is considerable disagreement about these diagnostic categories and about whether the violent outbursts and uncontrolled episodes of aggressive behavior are limited to the early developmental period or continue into adulthood (Mendelson et al. 1971 Minde et al. 1972). 

The early report by Bradley (1937) on beneficial treatment effects with amphetamine in aggressive, destructive, irritable, and hyperactive boys was repeatedly eonfirmed by double-blind, placebo-controlled studies. Significant reductions in aggressive behavior and improvements in social interactions were found after treatment with 10 to 40 mg/day of d- or /-amphetamine for boys and girls, 5 to 14 years of age, who had been diagnosed as... 

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