According to DiMarzio, Speirs – commanding 2nd platoon, Dog Company – was given orders to halt their attack on Ste. Come-du-Mont and hold position while regimental headquarters co-ordinated a rolling barrage shelling fifteen targets in the vicinity of Ste. Come-du-Mont. 23 DiMarzio, who was lying in a prone position next to the sergeant, says he remembers the sergeant being drunk. As the order to hold position was given and relayed down the line the sergeant refused to obey, wanting to rush forward and engage the Germans. Once again, Speirs gave him the order to hold his position. 24, 25 Speirs told the man that he was too drunk to perform his duties and that he should remove himself to the rear. The sergeant refused and began to reach for his rifle. Speirs again warned the sergeant – who now levelled his rifle at Speirs. Art DiMarzio says he then saw Speirs shoot the sergeant in self- defence. 26
The role of testosterone in the cardiovascular (CV) health of men is controversial. Data suggest that both the condition and treatment of clinical hypogonadism is associated with decreased CV mortality; however, two recent studies suggest that hypogonadal subjects treated with testosterone replacement therapy have a higher incidence of new CV events. There has been increased media attention concerning the risk of CV disease in men treated with testosterone. Until date, there are no long-term prospective studies to determine safety. Literature spanning over the past 30 years has suggested that not only is there a possible increased CV risk in men with low levels of testosterone, but the benefits from testosterone therapy may even lower this risk. We review here the recent studies that have garnered such intense scrutiny. This article is intended as a thorough review of testosterone levels and CV risk, providing the clinician with the facts needed to make informed clinical decisions in managing patients with clinical hypogonadism.
One important aspect of medical care is test threshold, or what is an acceptable threshold for testing and potentially missing SAH? Explained in a different manner, at what threshold does further testing do more harm than good? 62,63 A miss rate of 1% in many diseases is deemed acceptable. Once this threshold of 1% is crossed, further testing may cause harm to the patient rather than providing a benefit. 62,63 For a patient with headache and concern for SAH, this means that if the initial test places the risk of missing SAH at less than 1%, LP will not assist the provider and patient but may cause further harm to the patient.