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Background Patients with atrial fibrillation (AF) are prone to cardiovascular events and anticoagulation-related bleeding complications. We hypothesized that patients with anemia are at increased risk for these outcomes. Methods We performed a post hoc analysis of the ARISTOTLE trial, which included >18,000 patients with AF randomized to warfarin (target international normalized ratio, 2.0-3.0) or apixaban 5 mg twice daily. Multivariable Cox regression analysis was used to determine if anemia (defined as hemoglobin <13.0 in men and <12.0 g/dL in women) was associated with future stroke, major bleeding, or mortality. Results Anemia was present at baseline in 12.6% of the ARISTOTLE population. Patients with anemia were older, had higher mean CHADS2 and HAS-BLED scores, and were more likely to have experienced previous bleeding events. Anemia was associated with major bleeding (adjusted hazard ratio [HR], 1.92; 95% CI, 1.62-2.28; P < .0001) and all-cause mortality (adjusted HR, 1.68; 95% CI, 1.46-1.93; P <. 0001) but not stroke or systemic embolism (adjusted HR, 0.92; 95% CI, 0.70-1.21). The benefits of apixaban compared with warfarin on the rates of stroke, mortality, and bleeding events were consistent in patients with and without anemia. Conclusions Chronic anemia is associated with a higher incidence of bleeding complications and mortality, but not of stroke, in anticoagulated patients with AF. Apixaban is an attractive anticoagulant for stroke prevention in patients with AF with or without anemia.

This paper is a case study of user involvement in the requirements specification for project ISLE: Interactive Spoken Language Education. Developers of Spoken Language Dialogue Systems should involve users from the outset, particularly if the aim is to develop novel solutions for a generic target application area or market. As well as target end-users, SLDS developers should identify and consult ‘meta-level’ domain experts with expertise in human-to-human dialogue in the target domain. In our case, English language teachers and publishers provided generic knowledge of learners' dialogue preferences; other applications have analogous domain language experts. These domain language experts can help to pin down a domain-specific sublanguage which fits the constraints of current speech recognition technology: linguistically-naive end-users may expect unconstrained conversational English, but in practice, dialogue interactions have to be constrained in vocabulary and syntax. User consultation also highlighted a need to consider how to integrate speech input and output with other modes of interaction and processing; in our case the input speech signal is processed by speech recogniser, stress and mispronunciation detectors, and output responses are text and graphics as well as speech. This suggests a need to revisit the definition of ‘dialogue’: other SLDS developers should also consider the merits of multimodality as an adjunct to pure spoken language dialogue, particularly given that current systems are not capable of accurately handling unconstrained English

Genomes of all priority bacterial pathogens for biodefense purposes and more than one hundred other bacteria have been sequenced. In addition four hundred bacterial genome-sequencing projects are in progress. These achievements provide new possibilities for reliable identification of bacteria on a molecular level by retrieving their genomic information. We present a mass spectrometric approach to link these resources with genomic information encoded in bacterial proteins. Amino acid sequencing of tryptic peptides is performed from bacterial protein extracts. The results of searching tandem mass spectra of peptide ions against a comprehensive bacterial proteome database are analyzed using probability based scoring. This is followed by bacterial identification with an algorithm that uses phylogenetic relationships between bacterial species as a part of a hierarchical decision tree process., See also ADM001736, Proceedings of the Army Science Conference (24th) held in Orlando, FL on 29 Nov-2 Dec 2004. The original document contains color images. Performed in cooperation with Science and Technology Corporation, Edgewood, MD and University of Alberta Department of Chemistry, Edmonton, Alberta.