ABSTRACT
Background: Screening for atrial fibrillation (AF) is attractive because AF can remain undiagnosed and AF-related stroke can be prevented by anticoagulants (OAC). Methods: A randomized trial of screening for AF in individuals ≥70 years old without AF. Stroke and major bleeding are the efficacy and safety outcomes, ascertained from claims databases and electronic health records. Screening is done using a Zio®XT 14-day continuous cardiac rhythm patch monitor and compared, 1:1, to usual care. Use of OAC for detected AF is decided by patients and their physicians. The planned sample size was 52,000 recruited from U.S. primary care practices. Enrollment was severely hampered by the COVID-19 pandemic and stopped May 31, 2021 with 11,931 participants. Follow-up for stroke and bleeding events continues. Here, we report patch monitor findings from the 5,965 participants randomized to the screening arm. Results: 5,720 (96%) participants returned patches with analyzable data, the largest sample of patch monitor AF screening to date. Median (IQR) age was 75 (72, 79) years;57% were women. Median wear time was 13.9 (13.7, 14.0) days and median analyzable time was 98.4% (95.6, 99.5). 255 (4.5%) participants had AF, including 30 (0.5%) with 100% AF. 100% AF was more common in those age ≥80 (1.0%) than among younger participants (0.40%), p<.01. In the 225 participants with paroxysmal AF (PAF), median AF “burden” was 0.48% (0.016-2.5) of time monitored [78 (3.2, 454) minutes]. Median number of AF episodes during monitoring was 3 (1, 19). Median longest single AF episode was 60 (3-278) minutes. AF burden and length of longest episode were highly correlated (r=0.79, p<.001). Neither of these measures of PAF were associated with either age or sex. Conclusion: In GUARD-AF’s older primary care population, 0.5% of screened participants had persistent AF and 4% had PAF detected within 2 weeks of monitoring. In those with PAF, average AF burden was low but >25% had an episode of ≥4.6 hours of continuous AF, suggesting increased stroke risk. The need for stroke-preventive interventions (e.g., OAC) for screen-detected PAF remains a critically important research question.
ABSTRACT
As a new president takes over in Washington, three intertwined threats imperil the world. One is internal. The others are external. The internal threat is a potent and increasingly anti-patriotic, anti-competitive, anti-meritocratic, and sky-is-the-limit federal deficit spending political current that is simultaneously diminishing and destabilizing American and global economic vitality. The two major external threats are the rising military power of Russia, China, North Korea, and Iran and a global economic malaise sowing the seeds of discontent. America's role in containing the spread of new wave authoritarianism, and fostering competitiveness and global prosperity is critical, but domestic politics is preventing the Biden administration from adequately responding to these challenges. Biden's America is adrift. America is key to the survival of the free world. America is currently a beleaguered superpower. This book is possibly the first to address the politics shaping the likely course of America's new president in world affairs. It is politics, not idealist and realist abstractions, which determine international security. The world is concerned about what course Biden will take and the likely consequences. It will be the most carefully researched of such books. The book deals explicitly and extensively with issues such as spreading authoritarianism, the emerging new Cold War, global growth retardation, civic discord, economic sanctions, arms control, soft power and the deteriorating correlation of forces. The China weapons section of the book draws from the latest assessment made by the American Department of Defense. The book also includes a section on China's new technology generating innovation model and a chapter on Covid-19. © 2021 by World Scientific Publishing Co. Pte. Ltd. All rights reserved.
ABSTRACT
Uncertainty and its profound impact on the management of infrastructure project portfolios is introduced. The advent of COVID-19 is depicted as a defining event in the management of infrastructure. This study applies the Black Scholes option valuation model and real options analysis to determine value for money in front-end engineering for Australian megaprojects. The findings indicate that despite the fact all current Australian infrastructure projects examined had a positive net present value and a benefit to cost ratio greater than one, almost sixty percent of the planned expenditure was for projects for which real options analysis indicated the engineering as being poor value for money. The paper concludes with recommendations to manage the national portfolio of infrastructure projects as a pipeline of carefully chosen pre-engineered options, some of which are constructible projects and others being non-asset, demand management solutions. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.
ABSTRACT
We speculate that COVID-19 will drive engineering asset owners to require governance entities such as boards of management (BoM), to elevate engineering asset management (EAM) to being a corporate level strategy and core competence. We sought to understand whether there was a fit-for-purpose conceptualization of EAM as a corporate level strategy. Our research considered foundational Asset Management (AM) prescriptions finding that the available AM models have distinct gaps as to the roles of governance entities and of CEO’s in asset management where these are actively involved in the policy and practice of asset management. Using the Victorian Government Asset Management Accountability Framework as an example of active top-level involvement we identified a ‘bottom-up’ approach, incomplete integration with the whole organization and positioning of AM planning subsequent to strategic level planning as barriers to effective corporate level asset management strategy implementation. Responding to those findings we offer a program of future research aimed at developing fit-for-purpose strategic EAM tools to assist those BoM’s who seek to elevate EAM to a corporate level strategy. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.