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A war like no other : the Constitution in a time of terror
\"Owen Fiss has been a leading legal scholar for over thirty years, yet before 2001 it would have seemed unlikely for him to write about national security and the laws of war; his focus was civil procedure and equal protection, but when the War on Terror began to shroud legal proceedings in secrecy, he realized that the bulwarks of procedure that shield the individual from the awesome power of the state were dissolving, perhaps irreparably, and that it was time for him to speak up. The ten chapters in this volume cover the major legal battlefronts of the War on Terror from Guantánamo to drones, with a focus on the constitutional implications of those new tools. The underlying theme is Fiss's concern for the offense done to the U.S. Constitution by the administrative and legislative branches of government in the name of public safety and the refusal of the judiciary to hold the government accountable. A War Like No Other will be an essential intellectual foundation for all concerned about constitutional rights and the law in a new age. \"-- Provided by publisher.
Book
Conduction system pacing vs biventricular resynchronization in heart failure with reduced ejection fraction and left bundle branch block: Rationale and design of the PhysioSync-HF Trial
•Conduction system pacing, also termed physiologic pacing, is a novel alternative to biventricular resynchronization that may improve left ventricular remodeling while minimizing costs.•PhysioSync-HF is an investigator-led, randomized, multicenter clinical trial comparing conduction system pacing and biventricular resynchronization on heart failure-related outcomes in 179 patients with heart failure with reduced ejection fraction and left bundle branch block.•Half of trial participants are women, and most are non-White, ensuring patient representativeness and generalizability.
Cardiac resynchronization therapy reduces heart failure hospitalizations and mortality in patients with heart failure with reduced ejection fraction (HFrEF) and left bundle branch block (LBBB). Conduction system pacing, which directly activates the His-Purkinje system, has emerged as a safe alternative to traditional biventricular resynchronization that may offer clinical benefits at lower costs.
The PhysioSync-HF trial is an investigator-led, randomized, multicenter clinical trial designed to assess whether conduction system pacing is noninferior to biventricular resynchronization on heart failure-related outcomes in patients with HFrEF and LBBB. The study population consists of 179 adults with symptomatic heart failure (New York Heart Association [NYHA] class II-III), left ventricular ejection fraction (LVEF) ≤35%, and LBBB (QRS ≥130 ms). Patients were randomized 1:1 to receive conduction system pacing or biventricular resynchronization and followed for 12 months postprocedure. The primary endpoint is a hierarchy of all-cause death, any hospitalization for heart failure, any urgent visit for heart failure, and change in LVEF from baseline. The key secondary endpoint is the mean total direct medical cost per patient. Additional endpoints include assessments of health-related quality of life, functional capacity, and safety. Enrollment began in November 2022 and concluded in December 2023.
PhysioSync-HF will determine whether conduction system pacing is noninferior to biventricular resynchronization on heart failure-related outcomes in patients with HFrEF with LBBB.
NCT05572736.
*In selected sites. 6MWT indicates 6-minute walk test; CPET, cardiopulmonary exercise test; ECG, electrocardiogram; EQ-5D, EuroQol Group 5-Dimensions questionnaire; HF, heart failure; KCCQ, Kansas City Cardiomyopathy Questionnaire; LVEF, left ventricular ejection fraction. [Display omitted]
Journal Article
Chronic pacing and adverse outcomes after transcatheter aortic valve implantation
ObjectiveMany patients undergoing transcatheter aortic valve implantation (TAVI) have a pre-existing, permanent pacemaker (PPM) or receive one as a consequence of the procedure. We hypothesised that chronic pacing may have adverse effects on TAVI outcomes.Methods and resultsFour groups of patients undergoing TAVI in the Placement of Aortic Transcatheter Valves (PARTNER) trial and registries were compared: prior PPM (n=586), new PPM (n=173), no PPM (n=1612), and left bundle branch block (LBBB)/no PPM (n=160). At 1 year, prior PPM, new PPM and LBBB/no PPM had higher all-cause mortality than no PPM (27.4%, 26.3%, 27.7% and 20.0%, p<0.05), and prior PPM or new PPM had higher rehospitalisation or mortality/rehospitalisation (p<0.04). By Cox regression analysis, new PPM (HR 1.38, 1.00 to 1.89, p=0.05) and prior PPM (HR 1.31, 1.08 to 1.60, p=0.006) were independently associated with 1-year mortality. Surviving prior PPM, new PPM and LBBB/no PPM patients had lower LVEF at 1 year relative to no PPM (50.5%, 55.4%, 48.9% and 57.6%, p<0.01). Prior PPM had worsened recovery of LVEF after TAVI (Δ=10.0 prior vs 19.7% no PPM for baseline LVEF <35%, p<0.0001; Δ=4.1 prior vs 7.4% no PPM for baseline LVEF 35–50%, p=0.006). Paced ECGs displayed a high prevalence of RV pacing (>88%).ConclusionsIn the PARTNER trial, prior PPM, along with new PPM and chronic LBBB patients, had worsened clinical and echocardiographic outcomes relative to no PPM patients, and the presence of a PPM was independently associated with 1-year mortality. Ventricular dyssynchrony due to chronic RV pacing may be mechanistically responsible for these findings.Trial registration number(ClinicalTrials.gov NCT00530894).
Journal Article
The theory of monopoly capitalism : an elaboration of Marxian political economy
\"In 1966, Paul Baran and Paul Sweezy published Monopoly Capital, a monumental work of economic theory and social criticism that sought to reveal the basic nature of the capitalism of their time. Their theory, and its continuing elaboration by Sweezy, Harry Magdoff, and others in Monthly Review magazine, infl uenced generations of radical and heterodox economists. They recognized that Marx's work was unfi nished and itself historically conditioned, and that any attempt to understand capitalism as an evolving phenomenon needed to take changing conditions into account. Having observed the rise of giant monopolistic (or oligopolistic) fi rms in the twentieth century, they put monopoly capital at the center of their analysis, arguing that the rising surplus such fi rms accumulated--as a result of their pricing power, massive sales efforts, and other factors--could not be profi tably invested back into the economy. Absent any \"epoch making innovations\" like the automobile or vast new increases in military spending, the result was a general trend toward economic stagnation--a condition that persists, and is increasingly apparent, to this day. Their analysis was also extended to issues of imperialism, or \"accumulation on a world scale,\" overlapping with the path-breaking work of Samir Amin in particular. John Bellamy Foster is a leading exponent of this theoretical perspective today, continuing in the tradition of Baran and Sweezy's Monopoly Capital. This new edition of his essential work, The Theory of Monopoly Capitalism, is a clear and accessible explication of this outlook, brought up to the present, and incorporating an analysis of recently discovered \"lost\" chapters from Monopoly Capital and correspondence between Baran and Sweezy. It also discusses Magdoff and Sweezy's analysis of the fi nancialization of the economy in the 1970s, '80s, and '90s, leading up to the Great Financial Crisis of the opening decade of this century. Foster presents and develops the main arguments of monopoly capital theory, examining its key exponents, and addressing its critics in a way that is thoughtful but rigorous, suspicious of dogma but adamant that the deep-seated problems of today's monopoly-fi nance capitalism can only truly be solved in the process of overcoming the system itself. \"-- Provided by publisher.
Book
Sustained clinical benefit of cardiac resynchronization therapy in non-LBBB patients with prolonged PR-interval: MADIT-CRT long-term follow-up
Objective
In MADIT-CRT, patients with non-LBBB (right bundle branch block or nonspecific ventricular conduction delay) and a prolonged PR-interval derived significant clinical benefit from cardiac resynchronization therapy with defibrillator (CRT-D) compared to an implantable cardioverter defibrillator (ICD)-only. We aimed to study the long-term outcome of non-LBBB patients by baseline PR-interval with CRT-D versus ICD-only.
Methods
Non-LBBB patients (
n
= 534) were dichotomized based on baseline PR-interval: normal PR (PR < 230 ms), and markedly prolonged PR (PR ≥ 230 ms). The primary end point was heart failure (HF) or death. Secondary end points were HF only and all-cause death.
Results
In patients with a prolonged PR-interval, CRT-D treatment related to a 67 % significant reduction in the risk of HF/death (HR = 0.33, 95 % CI 0.16–0.69,
p
= 0.003), 69 % decrease in HF (HR = 0.31, 95 % CI 0.14–0.68,
p
= 0.003), and 76 % reduction in the risk of death (HR = 0.24, 95 % CI 0.07–0.80,
p
= 0.020) compared to ICD-only (median follow-up 5.8 years). In normal PR-interval patients, CRT-D therapy was associated with a trend towards increased risk of HF/death (HR = 1.49, 95 % CI 0.98–2.25,
p
= 0.061), and significantly increased mortality (HR = 2.27, 95 % CI 1.16–4.44,
p
= 0.014). Significant statistical interaction with the PR-interval was demonstrated for all end points. Results were consistent for QRS 130–150 ms and QRS > 150 ms.
Conclusion
In MADIT-CRT, non-LBBB patients with a prolonged PR-interval derive sustained long-term clinical benefit with reductions in heart failure or death from CRT-D implantation, compared to an ICD-only. Our findings support implantation of CRT-D in non-LBBB patients with prolonged PR-interval irrespective of baseline QRS duration.
Journal Article
Watchdogs on the hill : the decline of congressional oversight of U.S. foreign relations
\"An essential responsibility of the U.S. Congress is holding the president accountable for the conduct of foreign policy. In this in-depth look at formal oversight hearings by the Senate Armed Services and Foreign Relations committees, Linda Fowler evaluates how the legislature's most visible and important watchdogs performed from the mid-twentieth century to the present. She finds a noticeable reduction in public and secret hearings since the mid-1990s and establishes that American foreign policy frequently violated basic conditions for democratic accountability. Committee scrutiny of the wars in Iraq and Afghanistan, she notes, fell below levels of oversight in prior major conflicts.Fowler attributes the drop in watchdog activity to growing disinterest among senators in committee work, biases among members who join the Armed Services and Foreign Relations committees, and motives that shield presidents, particularly Republicans, from public inquiry. Her detailed case studies of the Truman Doctrine, Vietnam War, Panama Canal Treaty, humanitarian mission in Somalia, and Iraq War illustrate the importance of oversight in generating the information citizens need to judge the president's national security policies. She argues for a reassessment of congressional war powers and proposes reforms to encourage Senate watchdogs to improve public deliberation about decisions of war and peace.Watchdogs on the Hill investigates America's national security oversight and its critical place in the review of congressional and presidential powers in foreign policy\"-- Provided by publisher.
Book
Adaptive versus conventional cardiac resynchronisation therapy in patients with heart failure (AdaptResponse): a global, prospective, randomised controlled trial
Continuous automatic optimisation of cardiac resynchronisation therapy (CRT), stimulating only the left ventricle to fuse with intrinsic right bundle conduction (synchronised left ventricular stimulation), might offer better outcomes than conventional CRT in patients with heart failure, left bundle branch block, and normal atrioventricular conduction. This study aimed to compare clinical outcomes of adaptive CRT versus conventional CRT in patients with heart failure with intact atrioventricular conduction and left bundle branch block.
This global, prospective, randomised controlled trial was done in 227 hospitals in 27 countries across Asia, Australia, Europe, and North America. Eligible patients were aged 18 years or older with class 2–4 heart failure, an ejection fraction of 35% or less, left bundle branch block with QRS duration of 140 ms or more (male patients) or 130 ms or more (female patients), and a baseline PR interval 200 ms or less. Patients were randomly assigned (1:1) via block permutation to adaptive CRT (an algorithm providing synchronised left ventricular stimulation) or conventional biventricular CRT using a device programmer. All patients received device programming but were masked until procedures were completed. Site staff were not masked to group assignment. The primary outcome was a composite of all-cause death or intervention for heart failure decompensation and was assessed in the intention-to-treat population. Safety events were collected and reported in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT02205359, and is closed to accrual.
Between Aug 5, 2014, and Jan 31, 2019, of 3797 patients enrolled, 3617 (95·3%) were randomly assigned (1810 to adaptive CRT and 1807 to conventional CRT). The futility boundary was crossed at the third interim analysis on June 23, 2022, when the decision was made to stop the trial early. 1568 (43·4%) of 3617 patients were female and 2049 (56·6%) were male. Median follow-up was 59·0 months (IQR 45–72). A primary outcome event occurred in 430 of 1810 patients (Kaplan-Meier occurrence rate 23·5% [95% CI 21·3–25·5] at 60 months) in the adaptive CRT group and in 470 of 1807 patients (25·7% [23·5–27·8] at 60 months) in the conventional CRT group (hazard ratio 0·89, 95% CI 0·78–1·01; p=0·077). System-related adverse events were reported in 452 (25·0%) of 1810 patients in the adaptive CRT group and 440 (24·3%) of 1807 patients in the conventional CRT group.
Compared with conventional CRT, adaptive CRT did not significantly reduce the incidence of all-cause death or intervention for heart failure decompensation in the included population of patients with heart failure, left bundle branch block, and intact AV conduction. Death and heart failure decompensation rates were low with both CRT therapies, suggesting a greater response to CRT occurred in this population than in patients in previous trials.
Medtronic.
Journal Article