Standalone and RTK GNSS on 30,000 km of North American Highways

There is a growing need for vehicle positioning information to support Advanced Driver Assistance Systems (ADAS), Connectivity (V2X), and Automated Driving (AD) features. These range from a need for road determination (<5 meters), lane determination (<1.5 meters), and determining where the vehicle is within the lane (<0.3 meters). This work examines the performance of Global Navigation Satellite Systems (GNSS) on 30,000 km of North American highways to better understand the automotive positioning needs it meets today and what might be possible in the near future with wide area GNSS correction services and multi-frequency receivers. This includes data from a representative automotive production GNSS used primarily for turn-by-turn navigation as well as an Inertial Navigation System which couples two survey grade GNSS receivers with a tactical grade Inertial Measurement Unit (IMU) to act as ground truth. The latter utilized networked Real-Time Kinematic (RTK) GNSS corrections delivered over a cellular modem in real-time. We assess on-road GNSS accuracy, availability, and continuity. Availability and continuity are broken down in terms of satellite visibility, satellite geometry, position type (RTK fixed, RTK float, or standard positioning), and RTK correction latency over the network. Results show that current automotive solutions are best suited to meet road determination requirements at 98% availability but are less suitable for lane determination at 57%. Multi-frequency receivers with RTK corrections were found more capable with road determination at 99.5%, lane determination at 98%, and highway-level lane departure protection at 91%.Comment: Accepted for the 32nd International Technical Meeting of the Satellite Division of The Institute of Navigation (ION GNSS+ 2019), Miami, Florida, September 201

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Global Burden of Cardiovascular Diseases and Risks, 1990-2022

Age-standardized CVD mortality rates by regionranged from 73.6 per 100,000 in High-income Asia Pacific to432.3 per 100,000 in Eastern Europe in 2022. Global CVDmortality decreased by 34.9% from 1990 to 2022. Ischemicheart disease had the highest global age-standardized DALYsof all diseases at 2,275.9 per 100,000. Intracerebralhemorrhage and ischemic stroke were the next highest CVDcauses for age-standardized DALYs. Age-standardized CVDprevalence ranged from 5,881.0 per 100,000 in South Asia to11,342.6 per 100,000 in Central Asia. High systolic bloodpressure accounted for the largest number of attributableage-standardized CVD DALYs at 2,564.9 per 100,000globally. Of all risks, household air pollution from solid fuelshad the largest change in attributable age-standardizedDALYs from 1990 to 2022 with a 65.1% decrease

Analysis of Outcomes in Ischemic vs Nonischemic Cardiomyopathy in Patients With Atrial Fibrillation A Report From the GARFIELD-AF Registry

IMPORTANCE Congestive heart failure (CHF) is commonly associated with nonvalvular atrial fibrillation (AF), and their combination may affect treatment strategies and outcomes