Towards a Strategic Concept: A NATO Strategy for Eurasia in the 2020s

The North Atlantic Treaty Organization (NATO) is an alliance in crisis, part of a larger, global crisis surrounding the credibility and survival of the American-led world order at a systemic level. NATO was originally created in 1949 to defend Europe against the Soviet threat, or in the words of Lord Ismay, to “keep the Soviet Union out, the Americans in, and the Germans down.” In other words, NATO’s main goal was collective defense, exemplified by Article 5 of the Washington Treaty. However, after the end of the Cold War and the elimination of the Soviet threat, NATO’s responsibilities expanded to collective defense, crisis management, and collective security, taking on more out of area operations in new locations across the Eurasian super continent – such as in the Balkans and Afghanistan. The title of this report, “Towards a Strategic Concept,” makes clear its objective. The 12 members of this Task Force have drawn on their own areas of interest and specialization to make a limited set of recommendations towards a new NATO strategic concept for the next decade. To tackle this broad issue, we have divided our report into three geographical areas that will have a significant impact on NATO in the coming decades (West Eurasia, Mid-Eurasia, and East Eurasia) with a final section dedicated to discussions of emerging issues affecting the globe – such as climate change and cybersecurity

UP-BEAT (Upper Limb Baby Early Action-observation Training): protocol of two parallel randomised controlled trials of action-observation training for typically developing infants and infants with asymmetric brain lesions

Introduction: Infants with asymmetric brain lesions are at high risk of developing congenital hemiplegia. Action-observation training (AOT) has been shown to effectively improve upper limb motor function in adults with chronic stroke. AOT is based on action observation, whereby new motor skills can be learnt by observing motor actions. This process is facilitated by the Mirror Neuron System, which matches observed and performed motor actions. This study aims to determine the efficacy of AOT in: (1) influencing the early development of reaching and grasping of typically developing infants and (2) improving the upper limb activity of infants with asymmetric brain lesions

Latinx brain health disparities in cognitive aging: The role of acculturation on brain integrity and cognition among older HIV+ adults

BackgroundThe US Latinx population is the largest ethnoracial minority group and the fastest growing sector of the aging population (Escarce et al., 2006; US Census Bureau, 2008). Compared to non- Latinx whites (NLW), the Latinx population bears a disproportionate dementia burden secondary to multiple etiologies (e.g., Alzheimer- s, HIV- infection; Babulal et al., 2018; Rivera Mindt et al., 2014). Yet, little is understood regarding the sociocultural factors underlying these significant brain health disparities. This aim of cross- sectional study was to investigate indices of brain integrity, cognition, and acculturation in older HIV+ Latinx and NLW adults.MethodParticipants included 75 older HIV+ adults (Age: M=60 yrs [SD=6.9]; Education: M=13.6 yrs [SD=3.1]; 47% Latinx [primarily Caribbean heritage] & 53% NLW; and 71% male) who completed multimodal neuroimaging (structural MRI and resting state fMRI [rs- fMRI]), cognitive (seven domains; e.g., leaning, memory, executive function), neuromedical (HIV clinical indices [HIV viral load]), and sociocultural (e.g., acculturation [Abbreviated Multidimensional Acculturation Scale, AMAS]) evaluations. Global and domain- specific Average T- scores were computed on individual tests based on demographically- adjusted norms.ResultCompared to the NLW group, the Latinx group had greater white matter lesion volumes ([mL], FLAIR; Cohen- s d=1.13, p<.01) and lower hippocampal and posterior cingulate intrinsic activity (rs- fMRI fALFF values; d- s =.61 - .67), and worse global cognition, learning, memory, and processing speed (ds=.53 - .83, ps< .05), with the largest effects in learning and memory. Lower acculturation to US majority culture (i.e., AMAS US Total Score) was related to reduced intrinsic activity of the right hippocampus and posterior cingulate cortex at the trend level (rs- fMRI fALFF values; rs=.61 - .63, ps<.10) and worse global cognition, learning, memory, and processing speed (rs = .39 - .51, ps<.05).ConclusionThese findings highlight marked disparities in brain integrity and cognition in older HIV+ Latinx adults. Acculturation may be an important factor for understanding these disparities. Future longitudinal research is needed with HIV- controls, larger sample sizes, and the inclusion of other Latinx subpopulations (i.e., Mexican- American, South American) to extend the current findings and inform culturally- targeted interventions to promote Latinx brain health. Acknowledgements: The authors thank the Alzheimer- s Association for their support of this study (AARGD- 16- 446038).Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163840/1/alz046503.pd

Physician adjudication of angioedema diagnosis codes in a population of patients with heart failure prescribed angiotensin-converting enzyme inhibitor therapy

PURPOSE: Our objective was to calculate the positive predictive value (PPV) of the ICD-9 diagnosis code for angioedema when physicians adjudicate the events by electronic health record review. Our secondary objective was to evaluate the inter-rater reliability of physician adjudication. METHODS: Patients from the Cardiovascular Research Network previously diagnosed with heart failure who were started on angiotensin-converting enzyme inhibitors (ACEI) during the study period (July 1, 2006 through September 30, 2015) were included. A team of two physicians per participating site adjudicated possible events using electronic health records for all patients coded for angioedema for a total of five sites. The PPV was calculated as the number of physician-adjudicated cases divided by all cases with the diagnosis code of angioedema (ICD-9-CM code 995.1) meeting the inclusion criteria. The inter-rater reliability of physician teams, or kappa statistic, was also calculated. RESULTS: There were 38 061 adults with heart failure initiating ACEI in the study (21 489 patient-years). Of 114 coded events that were adjudicated by physicians, 98 angioedema events were confirmed for a PPV of 86% (95% CI: 80%, 92%). The kappa statistic based on physician inter-rater reliability was 0.65 (95% CI: 0.47, 0.82). CONCLUSIONS: ICD-9 diagnosis code of 995.1 (angioneurotic edema, not elsewhere classified) is highly predictive of angioedema in adults with heart failure exposed to ACEI