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Clinical and subclinical (covert) stroke is a cause of cognitive loss and functional impairment. In the AVERROES trial, we performed serial brain magnetic resonance imaging (MRI) scans in a subgroup to explore the effect of apixaban, compared with aspirin, on clinical and covert brain infarction and on microbleeds in patients with atrial fibrillation. We performed brain MRI (T1, T2, fluid-attenuated inversion recovery, and T2* gradient echo sequences) in 1,180 at baseline and in 931 participants at follow-up. Mean interval from baseline to follow-up MRI scans was 1.0 year. The primary outcome was a composite of clinical ischemic stroke and covert embolic pattern infarction (defined as infarction >1.5 cm, cortical-based infarction, or new multiterritory infarction). Secondary outcomes included new MRI-detected brain infarcts and microbleeds and change in white matter hyperintensities. Baseline MRI scans revealed brain infarct(s) in 26.2% and microbleed(s) in 10.5%. The rate of the primary outcomes was 2.0% in the apixaban group and 3.3% in the aspirin group (hazard ratio [HR] 0.55; 0.27-1.14) from baseline to follow-up MRI scan (mean duration of follow-up: 1 year). In those who completed baseline and follow-up MRI scans, the rate of new infarction detected on MRI was 2.5% in the apixaban group and 2.2% in the aspirin group (HR 1.09; 0.47-2.52), but new infarcts were smaller in the apixaban group (P = .03). There was no difference in proportion with new microbleeds on follow-up MRI (HR 0.92; 0.53-1.60) between treatment groups. Apixaban treatment was associated with a nonsignificant trend toward reduction in the composite of clinical ischemic stroke and covert embolic-pattern infarction and did not increase the number of microbleeds in patients with atrial fibrillation compared with aspirin.

In this trial, the factor Xa inhibitor apixaban was shown to reduce the risk of stroke or systemic embolism, as compared with aspirin, without a significant increase in the risk of major bleeding. Apixaban is an alternative to aspirin for patients who cannot take warfarin.. Atrial fibrillation is a common arrhythmia that increases the risk of stroke. 1 Vitamin K antagonist therapy is more effective than aspirin for the prevention of stroke in patients with atrial fibrillation, but its use is limited by a narrow window for a therapeutic benefit and by the need for lifelong coagulation monitoring owing to a marked variation in its effect both from one patient to another and within the individual patient. 2 Maintaining the international normalized ratio (INR) in the therapeutic range is challenging and for many patients is achieved less than 60% of the time — a finding that counteracts . . .

Rheumatic heart disease (RHD) is a neglected disease affecting 33 million people, mainly in low and middle income countries. Yet very few large trials or registries have been conducted in this population. The INVICTUS program of research in RHD consists of a randomized-controlled trial (RCT) of 4500 patients comparing rivaroxaban with vitamin K antagonists (VKA) in patients with RHD and atrial fibrillation (AF), a registry of 17,000 patients to document the contemporary clinical course of patients with RHD, including a focused sub-study on pregnant women with RHD within the registry. This paper describes the rationale, design, organization and baseline characteristics of the RCT and a summary of the design of the registry and its sub-study. Patients with RHD and AF are considered to be at high risk of embolic strokes, and oral anticoagulation with VKAs is recommended for stroke prevention. But the quality of anticoagulation with VKA is poor in developing countries. A drug which does not require monitoring, and which is safe and effective for preventing stroke in patients with valvular AF, would fulfill a major unmet need. The INVestIgation of rheumatiC AF Treatment Using VKAs, rivaroxaban or aspirin Studies (INVICTUS-VKA) trial is an international, multicentre, randomized, open-label, parallel group trial, testing whether rivaroxaban 20 mg given once daily is non-inferior (or superior) to VKA in patients with RHD, AF, and an elevated risk of stroke (mitral stenosis with valve area ≤2 cm2, left atrial spontaneous echo-contrast or thrombus, or a CHA2DS2VASc score ≥2). The primary efficacy outcome is a composite of stroke or systemic embolism and the primary safety outcome is the occurrence of major bleeding. The trial has enrolled 4565 patients from 138 sites in 23 countries from Africa, Asia and South America. The Registry plans to enroll an additional 17,000 patients with RHD and document their treatments, and their clinical course for at least 2 years. The pregnancy sub-study will document the clinical course of pregnant women with RHD. INVICTUS is the largest program of clinical research focused on a neglected cardiovascular disease and will provide new information on the clinical course of patients with RHD, and approaches to anticoagulation in those with concomitant AF.

Rather, teachers who support their students' pursuit of understanding the relationships among numbers are providing the most meaningful instruction; from the base of number sense, children with significant LBLD, memory, and processing speed issues will become better at computation. The program includes three essential components that are significantly different from a textbook approach: 1) Development of number sense - students work through a program that helps them induce meaning from the quantity-symbol associations in mathematics through visual-spatial and hands-on experiences; 2) Computational fluency - children move from the physical representations of numbers systematically until the symbol representations make enough sense to promote computational speed and accuracy; and 3) Thinking - the program focuses largely on developing logical reasoning skills in children so that they see themselves as problem solvers in mathematics, rather than followers of rote algorithms and prescribed procedures.

Irving Steingart conducted a workshop focusing on the emergency of enactments during the course of clinical work. Highlights of the workshops are presented.

Highlights of \"Women and Desire: The Karen Horney Lecture on Feminine Psychology\" are offered. This panel was held in Oct 1999 as part of the scientific meetings of the Association for the Advancement of Psychoanalysis.

Lewis describes Douglas H. Ingram's lecture at the Oct 17, 1996 meeting of the Association for the Advancement of Psychoanalysis. Ingram's topic was \"Basic Reassurance Revisited.\"

The purpose of this study was to explore the developmental education process within the community college system in Mississippi. Tinto's (1993) Integration Theory and Astin's (1993) Theory of Student Involvement were employed as a framework to assess and understand the relationship between academic integration, social integration, student involvement, and rates of completion. This concurrent mixed method study identified best practices related to the successful completion of developmental education courses from the vantage point of the faulty and administration at the community college. A total of ten faculty and administrators from five of the community colleges in Mississippi were given a 13-item interview questionnaire and participated in a face-to-face interview to gather these best practices. The theoretical perspective of \"interpretivism\" was used to understand the interviewees' responses, thereby identifying common themes among those who were interviewed. Secondly, a total of 186 The purpose of this study was to explore the developmental education process within the community college system in Mississippi. Tinto's (1993) Integration Theory and Astin's (1993) Theory of Student Involvement were employed as a framework to assess and understand the relationship between academic integration, social integration, student involvement, and rates of completion. This concurrent mixed method study identified best practices related to the successful completion of developmental education courses from the vantage point of the faulty and administration at the community college. A total of ten faculty and administrators from five of the community colleges in Mississippi were given a 13-item interview questionnaire and participated in a face-to-face interview to gather these best practices. The theoretical perspective of \"interpretivism\" was used to understand the interviewees' responses, thereby identifying common themes among those who were interviewed. Secondly, a total of 186 Mississippi Community College students participated in the study by completing the Modified Institutional Integration and Student Involvement Questionnaire. The data were analyzed through a multivariate analysis of variance (MANOVA). The MANOVA provided a p-value for each dependent variable indicating if the difference and interaction as statistically significant. Additionally, a One-Way ANOVA was also conducted. The final results of this study included a list of 10 best practices that were based on the interviews with faculty members and administrators from some of the community colleges in Mississippi. Secondly, the study found that 72.9% of community college students enrolled in developmental math continue on and complete intermediate algebra or college algebra. Additionally, 36.5% of community college students enrolled in developmental English continue on and complete English Composition I. Further, the results indicated by this study is that there was not a difference between developmental education students and non-developmental education students as it pertained to the faculty interaction subscales and the student interaction subscales. However, there was a difference between the involvement of developmental education students and non-developmental education students. The developmental education students were more involved with outside activities than the non-developmental education students. Mississippi Community College students participated in the study by completing the Modified Institutional Integration and Student Involvement Questionnaire. The data were analyzed through a multivariate analysis of variance (MANOVA). The MANOVA provided a p-value for each dependent variable indicating if the difference and interaction as statistically significant. Additionally, a One-Way ANOVA was also conducted. The final results of this study included a list of 10 best practices that were based on the interviews with faculty members and administrators from some of the community colleges in Mississippi. Secondly, the study found that 72.9% of community college students enrolled in developmental math continue on and complete intermediate algebra or college algebra. Additionally, 36.5% of community college students enrolled in developmental English continue on and complete English Composition I. Further, the results indicated by this study is that there was not a difference between developmental education students and non-developmental education students as it pertained to the faculty interaction subscales and the student interaction subscales. However, there was a difference between the involvement of developmental education students and non-developmental education students. The developmental education students were more involved with outside activities than the non-developmental education students.