The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

MODELAGEM DE RÁDIO ENLACE: UMA ABORDAGEM USANDO REALIDADE VIRTUAL

This paper describes an application of non-immersive Virtual Reality Modeling Language (VRML) in a Digital Terrain Model (DTM) visualization and analysis. The objective seeks for adequate sites for antenna placement. Geometrical and physical considerations are employed to model the problem, the data and the solution. Thee-dimensional models and databases can be made available on the Internet and over in tracts using VRML worlds, allowing the implementation of a complete project. An example in VRML is shown

Parâmetros biofísicos na detecção de mudanças na cobertura e uso do solo em bacias hidrográficas

O estudo de parâmetros biofísicos como o Índice de Vegetação da Diferença Normalizada (NDVI), albedo e temperatura da superfície (LST), aplicado a ecossistemas, tem sido relevante para o entendimento de mudanças relacionadas à degradação do meio ambiente. Algumas alterações que provocam desequilíbrio de interações ecológicas em ecossistemas, como o desmatamento, a mineração, a agricultura inadequada e o superpastejo, entre outros, estão interrelacionadas. Para avaliação de mudanças temporais relacionadas à degradação do ecossistema caatinga obtiveram-se as imagens da diferença de três parâmetros: NDVI, albedo e temperatura da superfície, para os anos de 1985 e 2001 (estação seca), utilizando-se imagens TM. Este estudo foi aplicado à bacia do rio Brígida onde há uma exploração intensa dos recursos naturais, em que os resultados mostram aumento na temperatura da superfície, diminuição do NDVI e pouca variação no albedo da superfície evidenciando, assim, que entre os anos de 1985 e 2001 houve avanço na degradação dos recursos naturais, nesta bacia

Can the toxicity of polyethylene microplastics and engineered nanoclays on flatfish (Solea senegalensis) be influenced by the presence of each other?

Microplastics and nanomaterials are applied in a myriad of commercial and industrial applications. When leaked to natural environments, such small particles might threaten living organisms' health, particularly when considering their potential combination that remains poorly investigated. This study investigated the physiological and biochemical effects of polyethylene (PE; 64-125 μm in size, 0.1, 1.0, and 10.0 mg·L-1) single and combined with an engineered nanomaterial applied in antifouling coatings, the copper-aluminium layered double hydroxides (Cu-Al LDH; 0.33, 1.0, and 3.33 mg·L-1) in the flatfish Solea senegalensis larvae (8 dph) after 3 h exposure, in a full factorial design. Particles ingestion, histopathology, and biochemical biomarkers were assessed. Fish larvae presented <1 PE particles in their gut, independently of their concentration in the medium. The histological health index showed minimal pathological alterations at PE combined exposure, with a higher value observed at 1 mg LDH·L-1 × 0.1 mg PE·L-1. Gut deformity and increased antioxidant defences (catalase), neurotransmission (acetylcholinesterase), and aerobic energy production (electron transport system) were observed at PE ≥ 1.0 mg·L-1. No oxidative damage (lipid peroxidation) or alterations in the detoxification capacity (glutathione-S-transferase) was observed on single and combined exposures. PE, combined or not with Cu-Al LDH, does not seem to compromise larvae's homeostasis considering levels reported so far in the marine and aquaculture environments. However, harsh effects are expected with MP contamination rise, as projections suggest.publishe

Evidências de validade das Matrizes Progressivas Avançadas de Raven em universitários Validity Evidence of Raven's Advanced Progressive Matrices in university students

O objetivo do estudo foi encontrar evidências de validade das Matrizes Progressivas Avançadas de Raven em universitários. Participaram 369 universitários de duas universidades privadas do estado de São Paulo, sendo 104 (28,2%) do sexo masculino e 265 (71,8%) do feminino. Em relação aos cursos, 167 (45,3%) são de Psicologia, 111 (30,1%) de Administração de Empresas, 54 (14,6%) de Gestão de Recursos Humanos e 37 (10%) de Pedagogia. Os resultados demonstraram que houve diferença significativa com relação ao gênero, com um melhor desempenho do sexo masculino (t=4,21 e p<0,01). A análise de variância (ANOVA) mostrou que ocorreu diferença significativa entre as médias obtidas em cada curso (F=13,8 e p<0,00), e os cursos que se diferenciaram de acordo com o teste ad-hoc de Tukey foram os de Administração e Psicologia. Os resultados demonstraram que o instrumento utilizado mostrou-se preciso para avaliar aspectos da inteligência geral em universitários.<br>The aim of the study was to find validity evidence of Raven's Advanced Progressive Matrices in university students. The sample consisted of 369 university students from two private universities in the state of Sao Paulo, being a 104 (28,2%) of the masculine and 265 (71,8%) of the feminine. Regarding the courses, 167 (45,3%) is of Psychology, 111 (30,1%) is of Business Administration, 54 (14,6 %) is of Management of Human Resources and 37 (10%) is of Pedagogy. The results showed statistically significant difference of sex, with males having better performance in the instrument (t=4.21; p<0.01). The analysis of variance (ANOVA) showed significant difference between averages of the courses (F=13,8; p<0,00), and the courses that are differentiated in accordance with the test ad-hoc of Tukey were Administration and Psychology that obtained scores bigger than the others courses. The results demonstrated what the used instrument showed precisely to value aspects of the general intelligence at university students