Search

Background Cardioversion in patients with atrial fibrillation (AF) can cause cardioembolic stroke, and effective clinical management is necessary to reduce morbidity and mortality. Currently, transesophageal echocardiography (TEE) is the accepted standard to diagnose cardiogenic thromboemboli; however, a negative TEE does not eliminate the possibility of left atrial thrombus. The objective of this study was to evaluate the diagnostic value of supplementing the TEE with additional noninvasive markers to ensure thrombus absence. Methods A prospective study was conducted on 59 patients who underwent TEE for suspected intra‐cardiac thrombi. The TEE indications included acute ischemic stroke (45.7%) and AF or flutter (59.3%). D‐dimer level and white blood cell counts were assessed. Results A negative D‐dimer level (

The 2018 U.S. pivot in information and cyberspace degraded Russian operations in the 2018 election. Following pervasive Russian information power operations during the U.S. 2016 elections, the United States progressed from a policy of preparations and defense in information and cyberspace to a policy of forward engagement. U.S recognition of renewed great power competition coupled with Russia’s inability to compete diplomatically, militarily (conventionally), or economically, inspires Russia to continues to concentrate on information power operations. This great game in cyberspace was virtually uncontested by the U.S. prior to 2017. Widespread awareness of Russian aggression in 2016 served as a catalyst which highlighted the enormity of Russian campaigns and the crippling constraints on U.S. information power. This catalyst pivoted the U.S. from a passive policy of preparations and defense in information and cyberspace to a policy of forward engagement that successfully attenuated Russian efforts in 2018. By examining information power from theory development and Russian practice to recent reports and primary sources we find that the U.S. demonstrated the capability and willingness to defend forward successfully during the 2018 elections. Going forward, the U.S. must continue and expand efforts to contest cyberspace and counter disinformation to secure our democracy and the U.S. 2020 presidential election.

Background: Because of a lack of comparative data on anticoagulant use in the advanced chronic kidney disease (CKD) population, guidelines recommend warfarin for atrial fibrillation and venous thromboembolism (VTE) treatment in these patients. However, apixaban has specific dosing recommendations in CKD leading to use in clinical practice. Objective: To evaluate major bleeding, stroke, and thromboembolism rates in patients with CKD stage 4, stage 5, and dialysis on apixaban or warfarin therapy. Methods: This was a retrospective cohort study of patients with advanced CKD receiving apixaban or warfarin. The primary outcome was the occurrence of major bleeding at 3 months after enrollment. Secondary outcomes included occurrence of major bleeding, occurrence of ischemic stroke, and recurrence of VTE at 3 to 6 and 6 to 12 months. Results: A total of 604 patients were included in the analysis. The percentage of apixaban and warfarin patients with a major bleed at 0 to 3, 3 to 6, and 6 to 12 months were 8.3% versus 9.9% ( P=0.48), 1.4% versus 4% ( P=0.07), and 1.5% versus 8.4% ( P

We have prototyped a multimedia tool to visualize the readiness of US Army War Reserve equipment. In contrast to previous efforts, our system allows the readiness to be visualized across several dimensions and to mediate existing heterogeneous data sources. Our front end Java applet enables multimedia and multidimensional visualization and allows a small client to access the mediation server from any networked location. The mediation server employed in this application is the Heterogeneous Reasoning and Mediator System (HERMES) which works with existing data and knowledge paradigms to resolve conflicts and generate sophisticated conclusions.