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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Applications of the Random Coupling Model for stacked printed circuit boards

International audienceResonant phenomena in computer or server casings have not been studied yet from the information security point of view. Couplings that can occur in reverberant environment may have an impact on confidentiality, integrity and availability of information. Therefore, it is of high interest to have tools able to quantify these coupling. Because of the diversity of shapes and geometries of casings, a statistical approach should be considered. It will lead to the assessment of the probability that a current, or a voltage, reaches a given magnitude. This quantity may be a relevant input for a risk analysis process. We will highlight that a statistical model, namely the Random Coupling Model (RCM), may be applied to determine statistical quantities related to induced currents at several ports inside an equipement chassis

Applications of the Random Coupling Model to Assess Induced Currents or Voltages in Reverberant Environment

International audienceCoupling in electronic devices may be a threat for the security of the information they process. Indeed, a current flowing into a conductor may radiate an electromagnetic field that will couple onto other conductors creating parasitic signals. If this current conveys sensitive information, its confidentiality may not be guaranteed. Moreover, depending on the amplitude of these parasitic signals, dysfunction may occur. It is thus valuable to assess the coupling effects in order to evaluate the probability that a current or a voltage reaches a given magnitude. This relevant quantity may be an input for a risk analysis process. In this study, we will focus on the study of couplings in reverberant cavities, and especially into the chassis of desktop computers. We will highlight that the Random Coupling Model (RCM) may be applied to determine statistical quantities related to induced currents or voltages between several ports placed inside a reverberant environment. Comparisons with experimental data, for several system configurations, show that the application of this model is relevant and allows to rapidly obtain the percentiles of the induced currents. At first, the coupling between two monopoles is studied, and then the coupling between printed circuit boards that are stacked together is investigated. Finally, the effect of adding broadband absorbers in casings is assessed

Application du modèle de couplages aléatoire pour l’évaluation de probabilités d’occurrence de courants induits

National audienc

AVALIAÇÃO DO SERVIÇO DA UNIDADE DE ATENÇÃO PRIMÁRIA À SAÚDE PARQUE GUARANI

Introdução: a Atenção Primária à Saúde (APS) corresponde ao nível primário de organização da atenção à saúde, que objetiva atender, de forma regionalizada, padronizada e contínua às necessidades de saúde da comunidade local, associandoações curativas a preventivas e buscando melhorar a resolutividade dos casos