Modern Anticoagulant Therapy for Atrial Fibrillation: Patient Adherence in Clinical Practice

Aim. To assess the adherence of doctors and patients to anticoagulant therapy for atrial fibrillation (AF).Materials and methods. An observational prospective study included 99 patients with AF at high risk of thromboembolic complications in Ryazan and Omsk. To study adherence, a questionnaire for quantitative assessment of treatment adherence ("QAA-25") was used. The questionnaire allows you to assess adherence by three main parameters separately: adherence to drug therapy, lifestyle modification and medical support. For the purposes of the study, adherence rates of less than 75% were regarded as insufficient, 75%. % or more as sufficient. To assess food preferences and determine the risk of changes in the activity of warfarin, a questionnaire of food preferences was used. The questionnaire allows you to assess the risk of alimentary increase (≥30 points) and decrease (≥60 points) of warfarin activity, as well as the overall risk of alimentary change (≥90 points) of warfarin activity in each patient, taking into account the volume and frequency of consumption of products that affect the activity of warfarin.Results. After the first visit, 99% of respondents received anticoagulant treatment. Rivaroxaban was the leader in prescribability among anticoagulants (36.7%). About a third of respondents were prescribed apixaban by a doctor (30.6%) and dabigatran  (17.3%)  and  warfarin  (19.4%)  were prescribed almost twice as rarely as rivaroxaban. Respondents with the highest rates of adherence to drug therapy, lifestyle modification and medical support are AF patients taking apixaban. The respondents who were prescribed rivaroxaban had the lowest level of adherence to drug therapy and lifestyle modification. And the lowest level of commitment to medical support is among respondents who have been prescribed warfarin. The number of people with a sufficient level of commitment did not reach half. Only 43.9% were ready to take prescribed medications and slightly more than a third (34.7%) agreed to come to appointments for a long time. But, despite the importance of lifestyle modification in patients with AF, only 16.3% of respondents said they were ready to give up bad habits, lose weight and lead a more active lifestyle. The proportion of people with sufficient adherence to drug therapy was the smallest in the group taking rivaroxaban (25.7%). The least number of respondents with sufficient commitment to medical support in the group taking dabigatran (25%). Only one in ten patients (11.1%) taking warfarin had a sufficient level of commitment to lifestyle modification. 15% of the study participants had an increased risk of alimentary changes in the activity of warfarin.Conclusion. Assessment of adherence to anticoagulant therapy by doctors in two regional centers (Omsk and Ryazan) showed high prescribability of preventive antithrombotic therapy, which corresponds to modern therapeutic approaches. At the same time, patients demonstrated rather low levels of adherence to drug therapy, lifestyle modification, and medical support

The electric vehicle in smart homes: a review and future perspectives

The electric mobility dissemination is forcing the adoption of new technologies and operation paradigms, not only focusing on smart grids, but also on smart homes. In fact, the emerging technologies for smart homes are also altering the conventional grids toward smart grids. By combining the key pillars of electric mobility and smart homes, this paper characterizes the paradigms of the electric vehicle (EV) in smart homes, presenting a review about the state of the art and establishing a relation with future perspectives. Since the smart home must be prepared to deal with the necessities of the EV, the analysis of both on board and off board battery charging systems are considered in the paper. Moreover, the in-clusion of renewable energy sources, energy storage systems, and dc electrical appliances in smart homes towards sustainability is also considered in this paper, but framed in the perspective of an EV off board battery charging system. As a pertinent contribution, this paper offers future perspectives for the EV in smart homes, including the possibility of ac, dc, and hybrid smart homes. Covering all of these aspects, exemplificative and key results are presented based on numerical simulations and experimental results obtained with a proof of concept prototype.FCT – Fundação para a Ciência e Tecnologia within the Project Scope: UID/CEC/00319/2019. This work has been supported by the FCT Project newERA4GRIDs PTDC/EEI-EEE/30283/2017, and by the FCT Project DAIPESEV PTDC/EEI-EEE/30382/2017. Tiago Sousa is supported by the doctoral scholarship SFRH/BD/134353/2017 granted by FC

Covalent enzyme coupling on cellulose acetate membranes for glucose sensor development

International audienceMethods for immobilizing glucose oxidase (GOx) on cellulose acetate (CA) membranes are compared. The optimal method involves covalent coupling of bovine serum albumin (BSA) to CA membrane and a subsequent reaction of the membrane with GOx, which has previously been activated with an excess of p-benzoquinone. This coupling procedure is fairly reproducible and allows the preparation of thin membranes (5-20 µm) showing high surface activities (1-3 U/cm2) which are stable over a period of 1-3 months. Electrochemical and radiolabeling experiments show that enzyme inactivation as a result of immobilization is negligible. A good correlation between surface activity of membranes and their GOx load is observed

Risk-based prioritization of pharmaceuticals in the natural environment in Iraq

Numerous studies have demonstrated the occurrence of pharmaceuticals in the natural environment, raising concerns about their impact on non-target organisms or human health. One region where little is known about the exposure and effects of pharmaceuticals in the environment is Iraq. Due to the high number of pharmaceuticals used by the public health sector in Iraq (hospitals and care centres) and distributed over the counter, there is a need for a systematic approach for identifying substances that should be monitored in the environment in Iraq and assessed in terms of environmental risk. In this study, a risk-based prioritization approach was applied to 99 of the most dispensed pharmaceuticals in three Iraqi cities, Baghdad, Mosul and Basrah. Initially, information on the amounts of pharmaceuticals used in Iraq was obtained. The top used medicines were found to be paracetamol, amoxicillin and metformin with total annual consumption exceeding 1000 tonnes per year. Predicted environmental concentrations (PECs) and predicted no-effect concentrations (PNECs), derived from ecotoxicological end-points and effects related to the therapeutic mode of action, were then used to rank the pharmaceuticals in terms of risks to different environmental compartments. Active pharmaceutical ingredients used as antibiotics, antidepressants and analgesics were identified as the highest priority in surface water, sediment and the terrestrial environment. Antibiotics were also prioritized according to their susceptibility to kill or inhibit the growth of bacteria or to accelerate the evolution and dissemination of antibiotic-resistant genes in water. Future work will focus on understanding the occurrence, fate and effects of some of highly prioritized substances in the environment

The role of off-board EV battery chargers in smart homes and smart grids: operation with renewables and energy storage systems

Concerns about climate changes and environmental air pollution are leading to the adoption of new technologies for transportation, mainly based on vehicle electrification and the interaction with smart grids, and also with the introduction of renewable energy sources (RES) accompanied by energy storage systems (ESS). For these three fundamental pillars, new power electronics technologies are emerging to transform the electrical power grid, targeting a flexible and collaborative operation. As a distinctive factor, the vehicle electrification has stimulated the presence of new technologies in terms of power management, both for smart homes and smart grids. As the title indicates, this book chapter focuses on the role of off-board EV battery chargers in terms of operation modes and contextualization for smart homes and smart grids in terms of opportunities. Based on a review of on-board and off-board EV battery charging systems (EV-BCS), this chapter focus on the off-board EV-BCS framed with RES and ESS as a dominant system in future smart homes. Contextualizing these aspects, three distinct cases are considered: (1) An ac smart home using separate power converters, according to the considered technologies; (2) A hybrid ac and dc smart home with an off-board EV-BCS interfacing RES and ESS, and with the electrical appliances plugged-in to the ac power grid; (3) A dc smart home using a unified 2 off-board EV-BCS with a single interface for the electrical power grid, and with multiple dc interfaces (RES, ESS, and electrical appliances). The results for each case are obtained in terms of efficiency and power quality, demonstrating that the off-board EV-BCS, as a unified structure for smart homes, presents better results. Besides, the off-board EV-BCS can also be used as an important asset for the smart grid, even when the EV is not plugged-in at the smart home.(undefined

Perspectives on utilization of edible coatings and nano-laminate coatings for extension of postharvest storage of fruits and vegetables

It is known that in developing countries, a large quantity of fruit and vegetable losses results at postharvest and processing stages due to poor or scarce storage technology and mishandling during harvest. The use of new and innovative technologies for reducing postharvest losses is a requirement that has not been fully covered. The use of edible coatings (mainly based on biopolymers) as a postharvest technique for agricultural commodities has offered biodegradable alternatives in order to solve problems (e.g., microbiological growth) during produce storage. However, biopolymer-based coatings can present some disadvantages such as: poor mechanical properties (e.g., lipids) or poor water vapor barrier properties (e.g., polysaccharides), thus requiring the development of new alternatives to solve these drawbacks. Recently, nanotechnology has emerged as a promising tool in the food processing industry, providing new insights about postharvest technologies on produce storage. Nanotechnological approaches can contribute through the design of functional packing materials with lower amounts of bioactive ingredients, better gas and mechanical properties and with reduced impact on the sensorial qualities of the fruits and vegetables. This work reviews some of the main factors involved in postharvest losses and new technologies for extension of postharvest storage of fruits and vegetables, focused on perspective uses of edible coatings and nano-laminate coatings.María L. Flores-López thanks Mexican Science and Technology Council (CONACYT, Mexico) for PhD fellowship support (CONACYT Grant Number: 215499/310847). Miguel A. Cerqueira (SFRH/BPD/72753/2010) is recipient of a fellowship from the Fundação para a Ciência e Tecnologia (FCT, POPH-QREN and FSE Portugal). The authors also thank the FCT Strategic Project of UID/ BIO/04469/2013 unit, the project RECI/BBB-EBI/0179/2012 (FCOMP-01-0124-FEDER-027462) and the project ‘‘BioInd Biotechnology and Bioengineering for improved Industrial and AgroFood processes,’’ REF. NORTE-07-0124-FEDER-000028 Co-funded by the Programa Operacional Regional do Norte (ON.2 – O Novo Norte), QREN, FEDER. Fundação Cearense de Apoio ao Desenvolvimento Científico e Tecnológico – FUNCAP, CE Brazil (CI10080-00055.01.00/13)