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

Managing service as a strategic profit center/ Blumberg

vii, 232 hal. ; 23,5 c

Managing service as a strategic profit center/ Blumberg

vii, 232 hal. ; 23,5 c

Management systems for field service productivity improvement

The effectiveness of field services provided for the maintenance of crucial equipment is shown to have a significant impact on market share. Identification of the service level required by customers is essential. Programmes are described for the design of optimal services and for the optimisation of service levels by way of an investment evaluation procedure.

Modeling Vertical Structure of Open‐Channel Flows

A three‐dimensional hydrodynamic model is applied to flows in open channels. The model incorporates a second‐moment turbulence‐closure model that has demonstrated considerable skill in simulating turbulent flows in laboratory experiments and in various geophysical and engineering boundary layers. The closure model consists of differential equations for turbulence energy and turbulence length scale. The remaining second‐moment equations are reduced to a set of algebraic equations in which tendency, advection, and diffusion terms are omitted. To account for the effect of the free surface on the bulk of the channel flow, a modification of the macroscale equation is introduced; the rest of the model equations and their attendant nondimensional constants remain unchanged. The model performance is assessed using laser‐Doppler anemometer measurements on the centerline of a large number of laboratory, smooth and rough, homogeneous and stratified, open‐channel flows with different values of the aspect ratio. Good agreement is found between the model and data in every case. Because the model is based upon a self‐consistent framework and is able to reproduce the many experiments provided here, the model can be used with confidence in environmental applications