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

Caminos hacia la gobernanza participativa del patrimonio cultural

La base teórica, se fue enriqueciendo progresivamente con el trabajo conjunto realizado con representantes políticos y administrativos de las instituciones gubernamentales, incluidos también actores religiosos. Un gran cambio en el enfoque de Gestión de la Preservación de la Ciudad se produjo en 2011, cuando el proyecto pasó de involucrar a actores representativos a diseñar prácticas de intervención para involucrar las perspectivas de los ciudadanos. Los barrios seleccionados se consideran depositarios de importantes valores patrimoniales culturales que actualmente se encuentran en situación de riesgo y cuyas condiciones de habitabilidad están disminuyendo progresivamente. Durante las caminatas transversales, los participantes interactuaron con actores locales y fueron invitados a responder preguntas relacionadas con los diferentes temas de la conferencia. Enfoques participativos, participación pública, participación de la comunidad, participación de la sociedad civil, comunidades del patrimonio, etc. son expresiones cada vez más utilizadas en la gestión y conservación del patrimonio. Las estrategias culturales con el objetivo de lograr una mayor equidad social y entornos urbanos socialmente más inclusivos se han desarrollado desde finales de la década de 1990.The theoretical basis, was progressively enriched with the joint work carried out with political and administrative representatives of government institutions, including also religious actors. A large shift in the City Preservation Management approach came in 2011, when the project moved beyond involving representative actors, to design intervention practices to involve citizen’s perspectives. The selected neighborhoods are considered as repositories of significant cultural heritage values which are currently at risk and where conditions of habitability are progressively decreasing. During the transect walks participants interacted with local actors and were invited to respond questions related to the different conference topics. Participatory approaches, public participation, community involvement, engaging civil society, heritage communities, etc. are increasingly used expressions in heritage management and conservation. Cultural strategies with the objective of achieving greater social equity and more socially inclusive urban environments have been developed since the late 1990s

Adopting and integrated and holistic perspective for improving conservation of built heritage

Architectural heritage corresponds to one of the most studied cultural products. Recent contributions in this field compel us to understand its conservation far beyond physical interventions. Thus, the aim of this paper is two-fold: 1) Identifying these major shifts of paradigm, to improve current conservation practices, and 2) describing the challenges for managers behind its practical implementation. By analyzing scientific peer-reviewed papers, and official documents of international organizations, three key approaches to be incorporated, were identified that might be called: multi-scale, multi-dimensional and multi-actor approach. But, integrating these approaches is fraught of difficulties. In fact, based on lessons learned through almost 10 years of practiceled research and scientific research carried out in South America, at least four main challenges are discussed: 1) to reach real participation 2) to design gathering information system; 3) to implement a systemic thinking for analysis of data; and 4) to move from projects towards processes.Leuve

The heritage as a resource: the change of paradigms in urban conservation from an international perspective

El artículo estudia la emergente noción de patrimonio como recurso para el desarrollo desde dos entradas1: la disciplina de la conservación urbana y los discursos globales en torno a la cultura y el desarrollo. Al examinar los avances en ambas y aclarar los vínculos entre la ciudad, los entornos históricos y la sostenibilidad, se identifican un conjunto de valiosos puntos de vista que invitan a repensar las estrategias de desarrollo urbano en las ciudades históricas andinas y ecuatorianas.The article looks at the emerging notion of the heritage as a resource to the development from two inputs: the discipline of urban conservation and the global discourse on culture and development. To review progress on both and clarify the links between the city, historical environments and sustainability, a set of valuable views are identified to rethink strategies for urban development in the Andean and Ecuadorian cities

Reflexiones sobre el sentido del patrimonio cultural. Caso Cuenca, Ecuador

Con motivo del segundo siglo de la independencia de la ciudad de Cuenca, esta contribución pretende reflexionar sobre el proceso dinámico de convertirse en Patrimonio de la Humanidad, y algunos de los actores clave que intervienen en ese proceso de reconocimiento. En orden cronológico, la primera sección describe el entorno sociocultural y físico a escala nacional y local en los siglos XVIII y XIX, con base en descripciones relevantes escritas por visitantes extranjeros. La segunda sección identifica algunos eventos, considerados como hitos en la transición de Cuenca de una ciudad colonial hacia una ciudad moderna, enfatizando el debate global entre transformación y conservación durante el siglo XX. El tercer apartado se refiere a los actores clave en la valorización de Cuenca como patrimonio, inicialmente como patrimonio nacional (1982) y posteriormente como Patrimonio de la Humanidad (1999).On the occasion of the second century of the independence of the city of Cuenca, this contribution aims to reflect on the dynamic process of becoming a World Heritage Site, and some of the key actors involved in that recognition process. In chronological order, the first section describes the socio-cultural and physical environment at the national and local scale in the 18th and 19th century, based on relevant descriptions written by foreign visitors. The second section identifies some events, considered as milestones in the transition of Cuenca from a colonial city towards a modern city, emphasizing the global debate between transformation and conservation during the 20th century. The third section refers to the key actors in the valorization of Cuenca as heritage, initially as national heritage (1982) and later as World Heritage Site (1999). It concludes highlighting the “mestizaje” as an essential aspect of its outstanding universal values

Validation of the BCH-ontology

In the heritage domain, capturing facts and knowledge for preventive conservation of Built Cultural Heritage (BCH) requires access to a large variety of data. It is a multidisciplinary activity and uses heterogeneous terminologies. In this regard, the BCH-ontology has been developed to facilitate integration and exchange of heterogeneous built cultural heritage information. The BCH-ontology reuses three already developed ontologies: Geneva City Geographic Markup Language (Geneva CityGML), Monument Damage ontology (Mondis), and CIDOC Conceptual Reference Model (CIDOC-CRM). Additionally, it provides a complete semantic framework by defining some classes and properties for improving BCH management. This paper presents the validation of the BCH-ontology ontological model to determine whether the ontology is able to represent BCH data under a preventive conservation approach. The San Luis seminary is a historical building built in the late XIX century in Cuenca-Ecuador and it is employed as use case. This validation allowed the identification of further use cases where the ontology offers a potential additional value in the BCH-domain.Valenci

Desafíos de los procesos de producción y construcción en adobe en América Latina

El adobe es considerado uno de los sistemas más antiguos y de mayor difusión en el mundo, el mismo que tras el fracaso de los paradigmas de progreso de inicios del siglo XX, vinculados a la tecnificación y estandarización de la construcción, ha sido motivo de importantes estudios que revelan su potencial para construir alternativas habitacionales innovadoras y garantizar la conservación del patrimonio mundial edificado en tierra. Reconociendo el vínculo que se establece en la conservación del patrimonio intangible –know how- con la conservación e innovación de la arquitectura en tierra, el presente artículo pretende acercarse a la realidad que enfrenta la producción de adobe en América Latina, sus fortalezas y limitaciones, e identificar estrategias que podrían reforzar la vigencia de esta práctica constructiva. Tras la revisión de fuentes secundarias se utilizó la tecnica aplicada de la entrevista semi estructurada a expertos reconocidos a nivel internacional de la red PROTERRA. Esta información fue complementada con entrevistas semiestructuradas a productores y constructores del contexto local: Cuenca y Susudel, así como la aplicación del enfoque de cadenas productivas para el entendimiento y articulación de estrategias de creación de cadenas de valor alrededor del adobe como elemento constructivo. La investigacion revela parte de los desafios multidimensionales (económico, ambiental, social y cultural) que enfrentan los procesos de produccion y construcción en adobe, además de los principales factores que han incidido en el desplazamiento progresivo de esta práctica.Finalmente se identifican algunas de las estrategias comunes para promover y potenciar esta practica constructiva.The adobe is considered one of the oldest and most widespread systems in the world, the same that after the failure of the paradigms of progress of the early twentieth century, linked to the technification and standardization of construction, has been the reason for important studies that reveal its potential to build innovative housing alternatives and ensure the conservation of world heritage built on land. Recognizing the link established in the conservation of intangible heritage –know how- with the conservation and innovation of architecture on land, this article aims to approach the reality facing adobe production in Latin America, its strengths and limitations, and identify strategies that could reinforce the validity of this constructive practice. After the review of secondary sources, the semi-structured interview technique applied to internationally recognized experts of the PROTERRA network was used. This information was complemented with semi-structured interviews with producers and builders of the local context: Cuenca and Susudel, as well as the application of the productive chain approach to the understanding and articulation of strategies to create value chains around adobe as a constructive element. The research reveals part of the multidimensional challenges (economic, environmental, social and cultural) that adobe production and construction processes face, in addition to the main factors that have influenced the progressive displacement of this practice.Finally some of the Common strategies to promote and strengthen this constructive practice.Asunció

The role of the university in maintaining vernacular heritage buildings in the southern region of Ecuador

Over the last decade, the University of Cuenca (UC), located in southern Ecuador, through its Faculty of Architecture and its City Preservation Management (CPM) project, has progressively become a key player in addressing the complex task of conserving architectural cultural heritage. In particular, UC has directly contributed to broadening the scope of conservation practices by encouraging the protection of modest examples of vernacular earth-based architecture. This article reflects on innovative conservation strategies for this type of UC-led architecture, where the greatest strength has been the adoption of a participatory approach in different urban and rural contexts considered as living labs for research. Besides, this contribution shows the potential role that the academic actor can play as a platform for the exchange of scientific and empirical knowledge at a local and international territorial scale.Leuve

Place attachment and challenges of historic cities: a qualitative empirical study on heritage values in Cuenca, Ecuador

The effect of heritage on place attachment is assessed by understanding how people “value” their heritage environment. In addition, the purpose of this paper is to assess the effects of place attachment on residential and investment trends according to two different social groups: local inhabitants and foreign immigrants. Design/methodology/approach: A single case study design for Santa Ana de los Ríos de Cuenca including an open-ended survey, combined with Likert-scale analysis. The survey protocol and questions for the respondent groups were structured according to place identity, place dependency and sense of place. Findings: The analysis bridges the gap between theory and practice and demonstrates interesting similarities as well as differences between both foreign and local respondent groups in terms of the attributes they consider as cultural heritage and their preferences in terms of residential or investment location choice. The research demonstrates that an increased understanding of place attachment as the link between place dependency and sense of place in a specific location can assist in defining effective built heritage policies in favour of local sustainability. Originality/value: The analysis of place attachment in relation to the origin of respondents revealed different perceptions on the role that a heritage environment might play on attracting or influencing displacement of local inhabitants and foreign immigrants. Based on original empirical data collection in Cuenca, Ecuador, this study identified research lines and actions which should be prioritised for improving management of this World Heritage Site.The effect of heritage on place attachment is assessed by understanding how people “value” their heritage environment. In addition, the purpose of this paper is to assess the effects of place attachment on residential and investment trends according to two different social groups: local inhabitants and foreign immigrants. Design/methodology/approach: A single case study design for Santa Ana de los Ríos de Cuenca including an open-ended survey, combined with Likert-scale analysis. The survey protocol and questions for the respondent groups were structured according to place identity, place dependency and sense of place. Findings: The analysis bridges the gap between theory and practice and demonstrates interesting similarities as well as differences between both foreign and local respondent groups in terms of the attributes they consider as cultural heritage and their preferences in terms of residential or investment location choice. The research demonstrates that an increased understanding of place attachment as the link between place dependency and sense of place in a specific location can assist in defining effective built heritage policies in favour of local sustainability. Originality/value: The analysis of place attachment in relation to the origin of respondents revealed different perceptions on the role that a heritage environment might play on attracting or influencing displacement of local inhabitants and foreign immigrants. Based on original empirical data collection in Cuenca, Ecuador, this study identified research lines and actions which should be prioritised for improving management of this World Heritage Site

Cultural significance: linking actors and methods

Central to the entire discipline of architectural heritage conservation is the concept of cultural significance. It refers to the collection of values associated with a cultural property which act as a guide for decision making process. However, recent evidence suggests that cultural values belong to a dynamic and complex system which changes permanently. As result of that, new values might be added to previous ones, while in other cases, irreparable losses might be triggered. Thus, preservation of architectural properties is clearly conditioned by the capacity to reveal the major range of values through the implication of a variety of actors. The case study of two traditional neighborhoods of Cuenca, Ecuador seeks to examine similarities and complementarities on cultural values identification by two different actors: academic and civil members. A holistic approach is utilised, integrating the most recent recommendations from the cultural field referred to the cultural mapping and recommendations from the Socio-praxis discipline. This study makes a major contribution to research on values-based management by proposing a methodology to link an interdisciplinary approach with an active community participation. The paper has been divided into four parts. The first part describes the conceptual framework, the second presents a brief description of the territorial context of analysis, while the third part presents the methodological process and tools utilized to identify cultural values. Finally, the conclusion gives a brief summary and critique of the findings concerning to the values identified as well as to the utilized methods.Central to the entire discipline of architectural heritage conservation is the concept of cultural significance. It refers to the collection of values associated with a cultural property which act as a guide for decision making process. However, recent evidence suggests that cultural values belong to a dynamic and complex system which changes permanently. As result of that, new values might be added to previous ones, while in other cases, irreparable losses might be triggered. Thus, preservation of architectural properties is clearly conditioned by the capacity to reveal the major range of values through the implication of a variety of actors. The case study of two traditional neighborhoods of Cuenca, Ecuador seeks to examine similarities and complementarities on cultural values identification by two different actors: academic and civil members. A holistic approach is utilised, integrating the most recent recommendations from the cultural field referred to the cultural mapping and recommendations from the Socio-praxis discipline. This study makes a major contribution to research on values-based management by proposing a methodology to link an interdisciplinary approach with an active community participation. The paper has been divided into four parts. The first part describes the conceptual framework, the second presents a brief description of the territorial context of analysis, while the third part presents the methodological process and tools utilized to identify cultural values. Finally, the conclusion gives a brief summary and critique of the findings concerning to the values identified as well as to the utilized methods