Grand Paris : Eau et Changement Global

International audienceComment améliorer la gestion de l'eau dans ces mégapoles de plus de 10 millions d'habitants tant en ce qui concerne l'accès à l'eau qu'à l'assainissement, mais aussi la gestion du naturel, comment intégrer l'adaptation au changement climatique ou la gouvernance globale de l'eau urbaine ? Comment le changement climatique affecte-t-il les problèmes avec l'eau rencontrés par ces mégapoles, mais aussi les solutions projetées ? Cette problématique bouleverse-t-elle les façons de concevoir la gestion de l'eau, les investissements prévus, les habitudes des services et les actions traditionnelles menées

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Evolutions techniques de l'assainissement de l'agglomération parisienne

Ouvrage collecti

Table ronde. Eau et ville : s'adapter au changement climatique

National audienc

The emergence of systems for the source separation and valorization of human waste in greater Paris : from necessity to implementation.

International audienceThe use of sewers to transport human excreta away from inhabited zones now causes particularly acute problems in megacities. Given the major global changes faced by wastewater management systems, these huge population centres highlight the limitations of the traditional sanitation management model. Apart from the frequent overloads on centralised wastewater management systems, there is their deep footprint in terms of energy expenditure, greenhouse gas emissions and continuing frequent pollution of aquatic environments. Yet managed separately, these excreta could be used as fertiliser: their agricultural application would represent a move away from the waste remediation model and an opportunity for mutual benefit between urban and agricultural zones, supplying the latter with lasting, local and nonfossil fertilising materials. Focusing on the case of the Paris conurbation, we provide a crosscutting analysis of the current opportunities for implementing source separation systems in a highly concentrated population centre. More specifically, we examine the technical, organisational and economic obstacles and drivers around the production of fertilisers from human excreta, in particular from urine, under good sanitary and agronomic conditions. We show the buildup of evidence about the incoherence of the current wastewater management system and the need for a paradigm shift. Nonetheless, pilot projects remain difficult to implement (due to political, sociocultural, economic, regulatory and technical obstacles, which are particularly tough in the case of a megacity). Despite this, there has been a recent shift in the dynamics, with projects emerging on the margins of urban planning. A key factor in their success is adaptation to different territorial configurations. Backed by individuals and groups with specific priorities, these projects offer a glimpse of the possibility of devising new sociotechnical systems for managing human waste

The emergence of systems for the source separation and valorization of human waste in greater Paris : from necessity to implementation.

International audienceThe use of sewers to transport human excreta away from inhabited zones now causes particularly acute problems in megacities. Given the major global changes faced by wastewater management systems, these huge population centres highlight the limitations of the traditional sanitation management model. Apart from the frequent overloads on centralised wastewater management systems, there is their deep footprint in terms of energy expenditure, greenhouse gas emissions and continuing frequent pollution of aquatic environments. Yet managed separately, these excreta could be used as fertiliser: their agricultural application would represent a move away from the waste remediation model and an opportunity for mutual benefit between urban and agricultural zones, supplying the latter with lasting, local and nonfossil fertilising materials. Focusing on the case of the Paris conurbation, we provide a crosscutting analysis of the current opportunities for implementing source separation systems in a highly concentrated population centre. More specifically, we examine the technical, organisational and economic obstacles and drivers around the production of fertilisers from human excreta, in particular from urine, under good sanitary and agronomic conditions. We show the buildup of evidence about the incoherence of the current wastewater management system and the need for a paradigm shift. Nonetheless, pilot projects remain difficult to implement (due to political, sociocultural, economic, regulatory and technical obstacles, which are particularly tough in the case of a megacity). Despite this, there has been a recent shift in the dynamics, with projects emerging on the margins of urban planning. A key factor in their success is adaptation to different territorial configurations. Backed by individuals and groups with specific priorities, these projects offer a glimpse of the possibility of devising new sociotechnical systems for managing human waste

The emergence of systems for the source separation and valorization of human waste in greater Paris : from necessity to implementation.

International audienceThe use of sewers to transport human excreta away from inhabited zones now causes particularly acute problems in megacities. Given the major global changes faced by wastewater management systems, these huge population centres highlight the limitations of the traditional sanitation management model. Apart from the frequent overloads on centralised wastewater management systems, there is their deep footprint in terms of energy expenditure, greenhouse gas emissions and continuing frequent pollution of aquatic environments. Yet managed separately, these excreta could be used as fertiliser: their agricultural application would represent a move away from the waste remediation model and an opportunity for mutual benefit between urban and agricultural zones, supplying the latter with lasting, local and nonfossil fertilising materials. Focusing on the case of the Paris conurbation, we provide a crosscutting analysis of the current opportunities for implementing source separation systems in a highly concentrated population centre. More specifically, we examine the technical, organisational and economic obstacles and drivers around the production of fertilisers from human excreta, in particular from urine, under good sanitary and agronomic conditions. We show the buildup of evidence about the incoherence of the current wastewater management system and the need for a paradigm shift. Nonetheless, pilot projects remain difficult to implement (due to political, sociocultural, economic, regulatory and technical obstacles, which are particularly tough in the case of a megacity). Despite this, there has been a recent shift in the dynamics, with projects emerging on the margins of urban planning. A key factor in their success is adaptation to different territorial configurations. Backed by individuals and groups with specific priorities, these projects offer a glimpse of the possibility of devising new sociotechnical systems for managing human waste