Among patients with unstable angina or myocardial infarction without ST-segment elevation, prasugrel did not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGY ACS ClinicalTrials.gov number, NCT00699998.).

Objective Lacunar strokes are a leading cause of cognitive impairment and vascular dementia. However, adequate characterization of cognitive impairment is lacking. The aim of this study was to estimate the prevalence and characterize the neuropsychological impairment in lacunar stroke patients. Methods All English-speaking participants in the SPS3 trial (NCT: 00059306) underwent neuropsychological testing at baseline. Raw scores were converted to z-scores using published norms. Those with impairment (z≤-1.5) in memory and/or non-memory domains were classified as having Mild Cognitive Impairment (MCI). Results Among the 1636 participants, average z scores on all tests were below zero with the largest deficits seen on tests of episodic memory (range of means -0.65 to -0.92), verbal fluency (mean -0.89), and motor dexterity (mean -2.5). Forty-seven percent were classified as having MCI: 36% amnestic, 37% amnestic multidomain, 28% non-amnestic. Of those with Rankin score 0-1 and Barthel score=100, 41% had MCI. Younger age [odds ratio (OR) per 10-yr increase=0.87], male sex (OR 1.3), less education (OR 0.13-0.66 compared to 0-4 yrs education), post-stroke disability (OR 1.4), and impaired activities of daily living (OR 1.8) were independently associated with MCI. Conclusions In this large, well characterized cohort of lacunar stroke patients, MCI was present in nearly half, including many with minimal or no physical disabilities. Cognitive dysfunction in lacunar stroke patients may commonly be overlooked in clinical practice but may be as important as motor and sensory sequelae.

Background and Purpose Inflammatory biomarkers predict incident and recurrent cardiac events, but their relationship to stroke prognosis is uncertain. We hypothesized that high-sensitivity C-reactive protein (hsCRP) predicts recurrent ischemic stroke after recent lacunar stroke. Methods Levels of Inflammatory Markers in the Treatment of Stroke (LIMITS) was an international, multicenter, prospective ancillary biomarker study nested within Secondary Prevention of Small Subcortical Strokes (SPS3), a Phase III trial in patients with recent lacunar stroke. Patients were assigned in factorial design to aspirin versus aspirin plus clopidogrel, and higher versus lower blood pressure targets. Patients had blood samples collected at enrollment, and hsCRP measured using nephelometry at a central laboratory. Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals (HR, 95%CI) for recurrence risks before and after adjusting for demographics, comorbidities, and statin use. Results Among 1244 lacunar stroke patients (mean 63.3 ± 10.8 years), median hsCRP was 2.16 mg/L. There were 83 recurrent ischemic strokes (including 45 lacunes), and 115 major vascular events (stroke, myocardial infarction, vascular death). Compared with the bottom quartile, those in the top quartile (hsCRP >4.86 mg/L) were at increased risk of recurrent ischemic stroke (unadjusted HR 2.54, 95%CI 1.30–4.96), even after adjusting for demographics and risk factors (adjusted HR 2.32, 95%CI 1.15–4.68). HsCRP predicted increased risk of major vascular events (top quartile adjusted HR 2.04, 95%CI 1.14–3.67). There was no interaction with randomized antiplatelet treatment. Conclusions Among recent lacunar stroke patients, hsCRP levels predict risk of recurrent strokes and other vascular events. HsCRP did not predict response to dual antiplatelets.

Racial (black-white) comparisons were made on four dependent measures (MMPI) to probe three issues generated by previous inconsistent findings in this area. Issues were (a) defining primary sources of variance, (6) comparability of dependent measures, and (c) effect of selection criteria, in the form of common requirements for profile validity, on outcome. White counterparts were matched with 160 blacks on sex, socioeconomic status (education and occupation), hospital status, age, and duration of illness. Phase 1 analysis (# = 320) used all profiles. Phase 2 analysis (# = 116) was limited to valid profiles. Results showed (a) race to be a primary source of variance, (b) dependent measures are not entirely comparable, and (c) application of selection criteria is a powerful parameter influencing outcome. Blacks elevated Scales F, 1, 5, 8, 9, and the overall profile mean, more often elevated Scale 8 as the highest single point code, Scale 1 as the second-highest code, and produced more 8-6 and 2-4 codes than whites. Whites elevated Scale 3, more often elevated Scale 7, as the highest and as the second-highest point code, and produced 2-7 and 4-7 codes more frequently than did blacks.

Twenty-nine desirable internship applicants were surveyed to determine their ranking of 14 potential factors influencing their choice of internship. Geographical site was important, as were various program variables. Reputation and amount of supervision were not strikingly important nor were work load and stipend level. Implications for recruitment are discussed.Each year approximately 1,500 graduate students in professional psychology migrate from their campus to internship settings, but little is known about the reasons for their choices. Data compiled by the Association for Psychology Internship Centers (APIC) indicate that approximately 10% of the intern positions were unfilled for the 1980-1981 year and that for the past 3 years, the number of unfilled internship positions has been two to five times greater than the number of unplaced interns. Therefore, intern candidates rather than sites seem to make the choice and the competition for desirable, prospective interns is increasing.Each year the University of Texas Health Science Center at San Antonio receives approximately 150 completed applications for internship training. These applications are reviewed by a psychology faculty committee, and the applicants are ranked on the basis of a procedure reported elsewhere (Stedman et al, 1981). Of those applying for 1980-1981, 9 were selected out of 38 who were considered highly desirable. After the remaining 28 had chosen their internship sites, they were asked to respond to a survey about their selection process. (The nine candidates who chose to come to our setting were excluded from the survey because they might feel constrained to be overly tactful.) The survey requested the individuals to rank the relative influence that 14 potential factors played in their internship site selection. Twenty-six of the 29 individuals responded-an extremely high return rate.A Wilcoxon rank-order correlation was computed, comparing the ranks assigned to each factor by each applicant. The calculation indicated a highly significant statistical difference (p = p < .0001) in the relative rank assigned to the various factors. Table 1 presents, in decreasing importance, the factors in order of the mean rank assigned.The results are illuminating. First, the desirable nature of this group of applicants is documented by the fact that almost all of them received multiple offers and therefore assigned a very low ranking to the absence of an offer from our facility as a reason for deciding to go elsewhere. Equally interesting is the salience given to geographical location in choosing a site. Program variables, such as diversity of program, theoretical orientation, and so forth, were important but no more so than variable of location. Surprisingly, reputation and the amount of supervision available do not appear to be striking factors, and work load and the stipend level also appear relatively unimportant. Although the real variation in work load is difficult to determine objectively, the senior author's experience is that it varies widely, ...