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

Bioperformance interpretation of a two-stage bioreactor with cell recycle considering residence time and internal age distributions of biomass

International audienc

Aeration strategy: a need for very high ethanol performance in Saccharomyces cerevisiae fed-batch process

International audienceIn order to identify an optimal aeration strategy for intensifying bio-fuel ethanol production in fermentation processes where growth and production have to be managed simultaneously, we quantified the effect of aeration conditions—oxygen limited vs non limited culture (micro-aerobic vs aerobic culture)—on the dynamic behaviour of Saccharomyces cerevisiae cultivated in very high ethanol performance fed-batch cultures. Fermentation parameters and kinetics were established within a range of ethanol concentrations (up to 147 g l−1), which very few studies have addressed. Higher ethanol titres (147 vs 131 g l−1 in 45 h) and average productivity (3.3 vs 2.6 g l−1 h−1) were obtained in cultures without oxygen limitation. Compared to micro-aerobic culture, full aeration led to a 23% increase in the viable cell mass as a result of the concomitant increase in growth rate and yield, with lower ethanol inhibition. The second beneficial effect of aeration was better management of by-product production, with production of glycerol, the main by-product, being strongly reduced from 12 to 4 g l−1. We demonstrate that aeration strategy is as much a determining factor as vitamin feeding (Alfenore et al. 2002) in very high ethanol performance (147 g l−1 in 45 h) in order to achieve a highly competitive dynamic process

Towards a Microbial Production of Fatty Acids as Precursors of Biokerosene from Glucose and Xylose Vers une production microbienne d’acides gras en vue de l’application biokérosène à partir de glucose et xylose

The aviation industry considers the development of sustainable biofuels as one of the biggest challenges of the next ten years. The aim is to lower the environmental impact of the steadily increasing use of fossil fuels on climate change, yielding greater energy independence and fuel security. Thus, the development of a new route for the production of lipids from renewable non-food resources is now being promoted with the recent ASTM certification of hydrotreated oils. Our study focuses on the potential of growth of the oleaginous yeast Rhodotorula glutinis using glucose and xylose which can come from renewable lignocellulosic substrates and of lipid accumulation using glucose as substrate. Experiments were carried out in fed-batch mode which allowed feed flux management. Carbon fluxes were controlled with modifying xylose/glucose ratios to quantify metabolism in optimal growth condition. Besides, the management of carbon and nitrogen fluxes allowed characterizing lipid accumulation. Thus, it has been shown that the yeast Rhodotorula glutinis can simultaneously consume glucose and xylose. When the ratio xylose/glucose increased, the growth rate and the carbon conversion yield into biomass decreased: it was of 0.36 h-1 and 0.64 Cmol x*.Cmol glu-1 for pure glucose, it was of 0.15 h-1 and 0.56 Cmol.Cmol-1 for 10% xylose and it was of 0.037 h-1 and 0.18 Cmol.Cmol-1 for pure xylose. The necessity to maintain residual growth and to manage carbon fluxes to optimize lipid accumulation performance was revealed. Lipid accumulation on glucose engendered a final biomass concentration of 150 gCDW.L-1, microbial production (72% of lipids) and maximal productivity over 1.48 glip.L-1.h-1. The culture temperature is an important parameter to modulate the lipid profile. The results were encouraging. Lipid accumulation using lignocellulosic feedstock was shown to be a highly promising route. <br> Le développement de filières de production de molécules énergétiques en substitution au kérosène constitue un défi majeur pour l’industrie aéronautique afin de minimiser l’impact environnemental de son activité et de répondre à ses besoins en énergie, dont la demande est croissante. Le développement d’une nouvelle voie de production de lipides à partir de ressources renouvelables non alimentaires ouvre des perspectives prometteuses avec la certification ASTM des huiles hydrotraitées. Les travaux expérimentaux consistent en l’étude, d’une part, des potentialités de croissance de la levure oléagineuse Rhodotorula glutinis à partir de glucose et/ou xylose, substrats osidiques issus des ressources lignocellulosiques, et d’autre part, des potentialités d’accumulation de lipides à partir de glucose. Des cultures en mode fed-batch ont permis le contrôle des flux d’alimentation : en carbone, en condition de croissance, selon un ratio xylose/glucose variable pour la quantification du métabolisme, et en azote, en condition de production de lipides. Il a été montré que la levure Rhodotorula glutinis est capable de consommer simultanément le glucose et le xylose. Le taux de croissance et le rendement de conversion du carbone en biomasse diminuent en fonction de la composition du mélange xylose/glucose : à savoir 0,36 h-1 et 0,43 Cmol. x*.Cmol glu-1 sur glucose pur, 0,15 h-1 et 0,56 Cmol.Cmol-1 sur 10 % de xylose, 0,037 h-1 et 0,18 Cmol.Cmol-1 sur xylose pur. Par ailleurs, lors d’expérimentation en condition. d’accumulation lipidique, il a été mis en évidence la nécessité de maintenir une croissance résiduelle par le contrôle des flux d’azote et de carbone. Lors de la phase de production de lipides sur glucose, il a été ainsi obtenu une concentration finale en biomasse de 150 gCDW.L-1 contenant 72 % de lipides en masse; la productivité volumétrique maximale atteint 1,5 glip.L-1.h-1, avec un rendement de conversion du glucose en lipides égal à 95 % du rendement théorique limite La température de culture se révèle un paramètre opératoire important pour la modulation du profil lipidique. Ces résultats sont originaux et ils ont permis l’obtention de très hautes performances, en culture intensive. Ils argumentent des potentialités de développement d’une stratégie de production de lipides par conversion de toutes les fractions osidiques des substrats lignocellulosiques pour des usages biokérosène après hydrotraitement

Multi-objective particle swarm optimization (MOPSO) of lipid accumulation in Fed-batch cultures

Dynamic optimization of fermentation processes could demand the use of multiple criteria to attain certain objectives, which in most cases are conflicting to each other. The use of Pareto optimal sets supplies the necessary information to take decisions about the trade-offs between objectives. In this work, a multi-objective optimization algorithm based on particle swarm optimization (MOPSO) is used to optimize lipid contents in fermentations with Yarrowia lipolytica. A reduced model was developed to shorten the computation time of MOPSO. A pattern search algorithm was sequentially coupled to MOPSO to execute a dynamic optimization handling physical constraints. Three cases are analyzed to emphasize the response of our control strategy. Simulation results showed that MOPSO - pattern search algorithm achieved high lipid fraction and productivity