Left atrial appendage thrombus in patients with atrial fibrillation who underwent oral anticoagulation

Background: Electric cardioversion of atrial fibrillation (AF) is associated with an increased risk of embolism, with embolic material existing in the heart cavities. The initiation of oral anticoagulation therapy reduces the risk of thromboembolic events. The aims of this study were to evaluate the prevalence of left atrial appendage (LAA) thrombi in non-valvular AF, to compare vitamin K antagonists (VKAs) and non-vitamin K oral anticoagulants (NOACs) with respect to thrombus prevalence, and to evaluate the rate of LAA thrombus persistence on repeat transesophageal echocardiography (TEE) after treatment change. Methods: We enrolled 160 consecutive AF patients who presented with an AF duration > 48 h and had undergone TEE before cardioversion. Results: Left atrial appendage thrombus was observed in 12 (7.5%) patients, and spontaneous echo contrast 4 was observed in 19 (11.8%) patients; the incidence was similar between the NOAC and VKA groups (8.9% vs. 3.6% and 12.4% vs. 18.5 %, respectively). Among patients on NOAC, thrombus prevalence was detected in 8.4% of users of rivaroxaban, 8% of users of dabigatran, and 12.5% of users of apixaban. Conclusions: The LAA thrombus developed in 7.5% of patients despite anticoagulation therapy, demonstrating similar prevalence rates among patients either on NOAC or VKA. Lower mean LAA flow velocity and a history of vascular disease were independent predictors of embolic material in the LAA. It seems that in the case of embolic materials in LAA under NOAC treatment, switching to VKA provides additional clinical benefit to the patients

Projektowanie opartego na programie MS Word narzędzia CAT w celu zminimalizowania tarcia poznawczego

Celem niniejszej pracy magisterskiej jest przeprowadzenie analizy trzech narzędzi CAT: memoQ, Memsource Cloud oraz Wordfast Classic, ze szczególnym uwzględnieniem jakości projektowania interakcji, które zostało zastosowane w tych programach oraz przygotowanie na jej podstawie koncepcyjnego projektu narzędzia CAT, mającego na celu zminimalizowanie tarcia poznawczego odczuwanego przez użytkownika.Niniejsza praca składa się z części teoretycznej oraz empirycznej i została podzielona na trzy rozdziały. Pierwsze dwa rozdziały zawierają przegląd literatury przedmiotu związanej z tematem pracy. Rozdział pierwszy poświęcony jest typologiom technologii tłumaczeniowych, definicji narzędzi CAT oraz rozważań związanych z tym jak narzędzia CAT ułatwiają lub utrudniają proces tłumaczeniowy. Rozdział drugi składa się z podłoża teoretycznego pojęć z psychologii poznawczej, które są ważne w kontekście analizy interakcji człowiek–komputer oraz dyskusji dotyczących powszechnych, błędnych założeń na temat oprogramowania, jego wad oraz metodologii projektowania oprogramowania, którą można zastosować celem uniknięcia lub pozbycia się jego niedoskonałości. Rozdział trzeci określa cele pracy, pytania badawcze, kontekst badań oraz metody pozyskiwania danych. Badanie przeprowadzono w dwóch modułach. Pierwszy moduł zawiera analizę interfejsów użytkownika i działania wybranych narzędzi CAT w odniesieniu do wytycznych metodologii projektowania oprogramowania zorientowanego na cele. Drugi moduł przedstawia projekt koncepcyjny narzędzia CAT oparty na wynikach analizy z modułu pierwszego.Niniejsza praca demonstruje, że metodologia projektowania oprogramowania zorientowanego na cele może zostać zastosowana, aby poprawić przejrzystość interfejsu użytkownika i zachowania zarówno istniejących jak i przyszłych narzędzi CAT oraz pokazuje, że do osiągnięcia powyższych celów nie jest konieczne zmniejszanie liczby funkcji tychże programów. Niniejsza praca podkreśla wagę procesu projektowania oprogramowania dla tłumaczy, który stawia na pierwszym miejscu ich cele oraz wykazuje potrzebę podobnych badań, które uwzględniałyby programowanie w procesie projektowania oraz obejmowały większą liczbę metodologii projektowania oprogramowania.The present dissertation aims to analyse three CAT tools – memoQ, Memsource Cloud, Wordfast Classic – with the focus on the quality of interaction design that has been implemented in these programs, and to prepare a conceptual design of a CAT tool with a view to minimalise user’s cognitive friction based on the results of the analysis.The dissertation consists of theoretical and empirical part and is divided into three chapters. The first two chapters provide a review of the literature relevant to the subject of the dissertation. Chapter One focuses on the typologies of translation technology, definition of CAT tools, and the ways in which CAT tools can both facilitate and hamper the translation process. Chapter Two consists of the theoretical background for the concepts from cognitive psychology that are relevant for analysing human-computer interaction and a discussion of common misconceptions about software, software deficiencies, and software design principle that can be used to address these deficiencies. Chapter Three outlines the research objectives, research questions, the research context, and methods of data collection. The research was administered in two modules; the former includes the analysis of the user interfaces and behaviour of the selected CAT tools with the guidelines of goal-directed software design in mind, the latter focuses on the presentation of the conceptual design of a CAT tool which is informed by the results of the analysis from module one.The dissertation demonstrates that the principle of goal-directed software design can be utilised to improve the clarity of user interfaces and the behaviour of both existing and future CAT tools, and that it is not necessary to remove functionalities from the programs to achieve this goal. The dissertation highlights the importance of the design process of CAT software that values and prioritises the objectives of the translators, as well as the need for similar research involving the programming and including a broader scope of design principles

Uncertainty Assessment of the Vertically-Resolved Cloud Amount for Joint CloudSat–CALIPSO Radar–Lidar Observations

The joint CloudSat–Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observation (CALIPSO) climatology remains the only dataset that provides a global, vertically-resolved cloud amount statistic. However, data are affected by uncertainty that is the result of a combination of infrequent sampling, and a very narrow, pencil-like swath. This study provides the first global assessment of these uncertainties, which are quantified using bootstrapped confidence intervals. Rather than focusing on a purely theoretical discussion, we investigate empirical data that span a five-year period between 2006 and 2011. We examine the 2B-Geometric Profiling (GEOPROF)-LIDAR cloud product, at typical spatial resolutions found in global grids (1.0°, 2.5°, 5.0°, and 10.0°), four confidence levels (0.85, 0.90, 0.95, and 0.99), and three time scales (annual, seasonal, and monthly). Our results demonstrate that it is impossible to estimate, for every location, a five-year mean cloud amount based on CloudSat–CALIPSO data, assuming an accuracy of 1% or 5%, a high confidence level (>0.95), and a fine spatial resolution (1°–2.5°). In fact, the 1% requirement was only met by ~6.5% of atmospheric volumes at 1° and 2.5°, while the more tolerant criterion (5%) was met by 22.5% volumes at 1°, or 48.9% at 2.5° resolution. In order for at least 99% of volumes to meet an accuracy criterion, the criterion itself would have to be lowered to ~20% for 1° data, or to ~8% for 2.5° data. Our study also showed that the average confidence interval: decreased four times when the spatial resolution increased from 1° to 10°; doubled when the confidence level increased from 0.85 to 0.99; and tripled when the number of data-months increased from one (monthly mean) to twelve (annual mean). The cloud regime arguably had the most impact on the width of the confidence interval (mean cloud amount and its standard deviation). Our findings suggest that existing uncertainties in the CloudSat–CALIPSO five-year climatology are primarily the result of climate-specific factors, rather than the sampling scheme. Results that are presented in the form of statistics or maps, as in this study, can help the scientific community to improve accuracy assessments (which are frequently omitted), when analyzing existing and future CloudSat–CALIPSO cloud climatologies

Management of coronary disease in patients with advanced kidney disease

BACKGROUND Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. RESULTS At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P=0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P=0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P=0.03). CONCLUSIONS Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction

Health status after invasive or conservative care in coronary and advanced kidney disease

BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of <30 ml per minute per 1.73 m2 or receipt of dialysis). A secondary objective of the trial was to assess angina-related health status. METHODS We assessed health status with the Seattle Angina Questionnaire (SAQ) before randomization and at 1.5, 3, and 6 months and every 6 months thereafter. The primary outcome of this analysis was the SAQ Summary score (ranging from 0 to 100, with higher scores indicating less frequent angina and better function and quality of life). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate the treatment effect with the invasive strategy. RESULTS Health status was assessed in 705 of 777 participants. Nearly half the participants (49%) had had no angina during the month before randomization. At 3 months, the estimated mean difference between the invasive-strategy group and the conservative-strategy group in the SAQ Summary score was 2.1 points (95% credible interval, 120.4 to 4.6), a result that favored the invasive strategy. The mean difference in score at 3 months was largest among participants with daily or weekly angina at baseline (10.1 points; 95% credible interval, 0.0 to 19.9), smaller among those with monthly angina at baseline (2.2 points; 95% credible interval, 122.0 to 6.2), and nearly absent among those without angina at baseline (0.6 points; 95% credible interval, 121.9 to 3.3). By 6 months, the between-group difference in the overall trial population was attenuated (0.5 points; 95% credible interval, 122.2 to 3.4). CONCLUSIONS Participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease did not have substantial or sustained benefits with regard to angina-related health status with an initially invasive strategy as compared with a conservative strategy

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used