A cluster-randomized controlled trial of a computerized antithrombotic risk assessment tool to optimize stroke prevention in general practice: A study protocol

Background: Therapy for stroke prevention in older persons with atrial fibrillation (AF) is underutilized despite evidence to support its effectiveness. To prevent stroke in this high-risk population, antithrombotic treatment is necessary. Given the challenges and inherent risks of antithrombotic therapy, decision-making is particularly complex for clinicians, necessitating comprehensive risk:benefit assessments. Targeted interventions are urgently needed to support clinicians in this context; the Computerized Antithrombotic Risk Assessment Tool (CARAT) offers a unique approach to this clinical problem. Methods/design. This study (a prospective, cluster-randomized controlled clinical trial) will be conducted across selected regions in the state of New South Wales, Australia. Fifty GPs will be randomized to either the 'intervention' or 'control' arm, with each GP recruiting 10 patients (aged ≥65 with AF); target sample size is 500 patients. GPs in the intervention arm will use CARAT during routine patient consultations to: assess risk factors for stroke, bleeding and medication misadventure; quantify the risk/benefit ratio of antithrombotic treatment, identify the recommended therapy, and decide on the treatment course, for an individual patient. CARAT will be applied by the GP at baseline and repeated at 12 months to identify any changes to treatment requirements. At baseline, the participant (patients and GPs) characteristics will be recorded, as well as relevant practice and clinical parameters. Patient follow up will occur at 1, 6, and 12 months via telephone interview to identify changes to therapy, medication side effects, or clinical events. Discussion. This project tests the utility of a novel decision support tool (CARAT) in improving the use of preventative therapy to reduce the significant burden of stroke. Importantly, it targets the interface of patient care (general practice), addresses the at-risk population, evaluates clinical outcomes, and offers a tool that may be sustainable via integration into prescribing software and primary care services. GP support and guidance in identifying at risk patients for the appropriate selection of therapy is widely acknowledged. This trial will evaluate the impact of CARAT on the prescription of antithrombotic therapy, its longer-term impact on clinical outcomes including stroke and bleeding, and clinicians perceived utility of CARAT in practice. Trial registration. Australian New Zealand Clinical Trials Registry: ACTRN12613000060741. © 2014 Bajorek et al.; licensee BioMed Central Ltd

Contemporary approaches to managing Atrial fibrillation: A survey of Australian general practitioners

© 2015, Australasian Medical Journal Pty Ltd. All rights reserved. Background Recent attention to the management of atrial fibrillation (AF) and stroke prevention has emphasised the need to support the use of existing pharmacotherapy through available services and resources, in preference to using the new, more expensive, novel oral anticoagulants. In this regard, general practitioners (GPs) are at the core of care. Aims To survey Australian GPs regarding their approach to managing AF, particularly in relation to stroke prevention therapy, and to identify the range of services to support patient care. Methods A structured questionnaire, comprising quantitative and qualitative responses, was administered to participating GPs within four geographical regions of NSW (metropolitan, regional, rural areas). Results Fifty GPs (mean age 53.74±9.94 years) participated. Most (98 per cent) GPs regarded themselves as primarily responsible for the management of AF, only referring patients to specialists when needed. However, only 10 per cent of GPs specialised in “heart/vascular health”. Most (76 per cent) GPs offered point-of-care international normalised ratio (INR) testing, with 90 per cent also offering patient support via practice nurses and home visits. Overall, key determinants influencing GPs’ initiation of antithrombotic therapy were: “stroke risk”/”CHADS2 score”, followed by “patients’ adherence/compliance”. GPs focused more on medication safety considerations and the day-to-day management of therapy than on the risk of bleeding. Conclusion Australian GPs are actively engaged in managing AF, and appear to be well resourced. Importantly, there is a greater focus on the benefits of therapy during decision-making, rather than on the risks. However, medication safety considerations affecting routine management of therapy remain key concerns, with patients’ adherence to therapy a major determinant in decision-making

АТРИБУТЫ ИННОВАЦИОННОЙ ЭКОНОМИКИ РОССИИ

Transition to innovative economy requires creating a number of new characteristics: presence of economic strategy involving infrastructure creation and reorganization; relevant aim multitude; taking legal and economical action in implementing new resource-saving and ecological technologies. Main problems requiring active solution for innovative economy formation are explained.Переход к инновационной экономике требует создания ряда новых атрибутов: наличия экономической стратегии, предусматривающей создание и реструктуризацию инфраструктуры; соответствующей совокупности целей; принятия мер законодательного и экономического характера по использованию новых ресурсосберегающих и экологичных технологий. Обоснованы основные проблемы, требующие активного решения для формирования инновационной экономики

МОДЕЛЬ ОЦЕНКИ РЕФОРМИРОВАНИЯ ЭКОНОМИКИ РОССИИ

The topic origin suppositions are shown and investigation domain is appeared too. The economy scientific problem statement is derived and its state is analysed. The complex study apparatus is shown and modelling problem is formulated. The scenario analysis is suggested as base approach in theoretical study. The analogy of risks and expenditures estimation to classic portfolio analysis is established. Estimation of economy reformation efficiency is suggested. Details of economy previous adaptation stage and its necessary institutional support are discussed.Указаны предпосылки возникновения темы, и обозначена область исследования. Приведена постановка научной проблемы экономики и проанализировано ее состояние. Указан аппарат комплексного исследования и сформулирована задача моделирования. В качестве основного подхода в теоретическом исследовании предлагается сценарный анализ. В оценке рисков и затрат установлена аналогия с классическим портфельным анализом. Предложена оценка эффективности процесса реформирования экономики. Обсуждены детали предварительного этапа адаптации экономики и ее необходимая институциональная поддержка

Оценка потенциальных запасов пресной воды в айсбергах

According to the forecast of the global shortage of fresh water it is expected that the global demand for drink‑ ing water will be increased up to 400 km3 per a year. As the main potential resources of drinking water it is proposed to use table Antarctic icebergs. Mathematical and phenomenological models of heat exchange between the icebergs and the environment, and a process of melting of ices floes in the warm sea water are discussed. The ablation processes on the daily and lower surfaces of icebergs at different modes of towing them to points of utilization is analyzed. The most optimal technology is to fill tankers with water taken from the freshwater layer under icebergs, and then subsequent delivery of the water to points of utilization. Using of the phenomenon of fresh-salt stratified Lake Vanda is considered as one of promising technologies of the industrial water production.В условиях растущего потребления пресной питьевой воды актуальны поиски новых её ресурсов. К ним можно отнести Антарктические столовые айсберги и пресно-солёные озёра антарктических оазисов. Приведена модель теплообмена айсбергов с окружающей средой. Показана бесперспективность буксирования айсбергов в пункты их предполагаемой утилизации. Выполнены оценки и расчёты утилизации айсбергов в водах Антарктики, которые доказывают устойчивость этого процесса за счёт эффекта «двойной» диффузии. Рассмотрена также модель использования эффекта пресно-солёного озера Ванда с устойчивой стратификацией плотности вод в поле силы тяжести

A weighted Markov decision process

The two most commonly considered reward criteria for Markov decision processes are the discounted reward and the long-term average reward. The first tends to "neglect" the future, concentrating on the short-term rewards, while the second one tends to do the opposite. We consider a new reward criterion consisting of the weighted combination of these two criteria, thereby allowing the decision maker to place more or less emphasis on the short-term versus the long-term rewards by varying their weights. The mathematical implications of the new criterion include: the deterministic stationary policies can be outperformed by the randomized stationary policies, which in turn can be outperformed by the nonstationary policies; an optimal policy might not exist. We present an iterative algorithm for computing an e-optimal nonstationary policy with a very simple structure

KKbar photoproduction from protons

We study the contribution of the Drell mechanism driven by K^+ and K^- exchange to the reaction gamma N -> KKbar N. Our calculation implements the full KN and KbarN reaction amplitudes in the form of partial wave amplitudes taken from a meson-exchange model (KN) and a partial wave analysis (KbarN), respectively. Comparing our results to data of the LAMP2 collaboration we observe that the Drell mechanism alone cannot describe the large Lambda(1520) photoproduction rate observed experimentally. We argue that the discrepancy could be due to significant contributions from K*-meson exchange with subsequent excitation of the Lambda(1520) resonance. After adding such contributions to our model a good agreement of the LAMP2 experiment is achieved. When applying the same model to the recent SAPHIR data we find an excellent description of the K^+p spectrum and can determine the parameters of the Lambda(1600) P01 resonance, M_R = 1617 +/- 2 MeV and Gamma_R = 117 +/- 4 MeV, from the K^-p mass distribution.Comment: updated version, analysis of new CLAS data included, 11 pages, 11 figure

The Role of Tetrahydrobiopterin and Dihydrobiopterin in Ischemia/Reperfusion Injury When Given at Reperfusion

Reduced nitric oxide (NO) bioavailability and increased oxidative stress are major factors mediating ischemia/reperfusion (I/R) injury. Tetrahydrobiopterin (BH4) is an essential cofactor of endothelial NO synthase (eNOS) to produce NO, whereas dihydrobiopterin (BH2) can shift the eNOS product profile from NO to superoxide, which is further converted to hydrogen peroxide (H2O2) and cause I/R injury. The effects of BH4 and BH2 on oxidative stress and postreperfused cardiac functions were examined in ex vivo myocardial and in vivo femoral I (20 min)/R (45 min) models. In femoral I/R, BH4 increased NO and decreased H2O2 releases relative to saline control, and these effects correlated with improved postreperfused cardiac function. By contrast, BH2 decreased NO release relative to the saline control, but increased H2O2 release similar to the saline control, and these effects correlated with compromised postreperfused cardiac function. In conclusion, these results suggest that promoting eNOS coupling to produce NO and decrease H2O2 may be a key mechanism to restore postreperfused organ function during early reperfusion

Пожарная и промышленная безопасность на предприятиях нефтегазодобывающей отрасли

Работа посвящена анализу теоретических основ обеспечения пожарной безопасности, улучшению практических приемов и методах противопожарной защиты, при повседневной эксплуатации установки подготовки нефти на опасном производственном объекте в области пожарной безопасности. В результате исследования изучены методы эксплуатации установки подготовки нефти на опасном производственном объекте, позволяющие не только предотвратить возникновение аварии или пожара, но и быстро ликвидировать последствия. Противопожарные мероприятия существенно повышают уровень пожарной безопасности своих объектов и снижают потери от пожаров.The work is devoted to the analysis of the theoretical foundations of fire safety, improvement of practical techniques and methods of fire protection, in the daily operation of the oil treatment plant at a hazardous production facility in the field of fire safety. As a result of the study, the methods of operation of an oil treatment plant at a dangerous production facility were studied, allowing not only to prevent an accident or fire, but also to quickly eliminate the consequences. Fire-fighting measures significantly increase the level of fire safety of their facilities and reduce losses from fires