Influence of Age on Warfarin Dose, Anticoagulation Control, and Risk of Hemorrhage

Objective We assessed the influence of age on warfarin dose, percentage time in target range (PTTR), and risk of major hemorrhage. Design Warfarin users recruited into a large prospective inception cohort study were categorized into three age groups: young (younger than 50 yrs), middle aged (50–70 yrs), and elderly (older than 70 yrs). The influence of age on warfarin dose and PTTR was assessed using regression analysis; risk of major hemorrhage was assessed using proportional hazards analysis. Models were adjusted for demographic, clinical, and genetic factors. Setting Two outpatient anticoagulation clinics. Participants A total of 1498 anticoagulated patients. Outcomes Warfarin dose (mg/day), PTTR, major hemorrhage. Results Of the 1498 patients, 22.8% were young, 44.1% were middle aged, and 33.1% were elderly. After accounting for clinical and genetic factors, compared with young warfarin users, warfarin dose requirements were 10.6% lower among the middle aged and an additional 10.6% lower for the elderly. Compared with young patients, middle-aged and elderly patients spent more time in target international normalized ratio (INR) range (p<0.0001), despite having fewer INR assessments (p<0.0001). Compared with young warfarin users, absolute risk of hemorrhage was marginally higher among the middle aged (p=0.08) and significantly higher among the elderly (p=0.016). Compared with young warfarin users, after adjustment, the relative risk of hemorrhage increased by 31% for each age category (p=0.026). Conclusions In a real-world setting, despite achieving better anticoagulation control, elderly patients had a higher risk of major hemorrhagic events. As the population ages and the candidacy for oral anticoagulation increases, strategies that mitigate the elevated risk of hemorrhage need to be identified

High brightness formamidinium lead bromide perovskite nanocrystal light emitting devices

Formamidinium lead halide (FAPbX3) has attracted greater attention and is more prominent recently in photovoltaic devices due to its broad absorption and higher thermal stability in comparison to more popular methylammonium lead halide MAPbX3. Herein, a simple and highly reproducible room temperature synthesis of device grade high quality formamidinium lead bromide CH(NH2)2 PbBr3 (FAPbBr3) colloidal nanocrystals (NC) having high photoluminescence quantum efficiency (PLQE) of 55-65% is reported. In addition, we demonstrate high brightness perovskite light emitting device (Pe-LED) with these FAPbBr3 perovskite NC thin film using 2,2′,2″-(1,3,5-Benzinetriyl)-tris(1-phenyl-1-H-benzimidazole) commonly known as TPBi and 4,6-Bis(3,5-di(pyridin-3-yl)phenyl)-2-methylpyrimidine (B3PYMPM) as electron transport layers (ETL). The Pe-LED device with B3PYMPM as ETL has bright electroluminescence of up to 2714 cd/m2, while the Pe-LED device with TPBi as ETL has higher peak luminous efficiency of 6.4 cd/A and peak luminous power efficiency of 5.7 lm/W. To our knowledge this is the first report on high brightness light emitting device based on CH(NH2)2 PbBr3 widely known as FAPbBr3 nanocrystals in literature. © The Author(s) 2016

Interleukin-10 (IL-10) Pathway: Genetic Variants and Outcomes of HIV-1 Infection in African American Adolescents

promoter sequence have been reported to influence pathogenesis or acquisition of HIV-1 infection. T-cell increased by 31±0.9% and 17±8% every 3 months for AA and AG genotype, respectively. gene family to HIV-1/AIDS

Predictors of NOAC versus VKA use for stroke prevention in patients with newly diagnosed atrial fibrillation: Results from GARFIELD-AF.

INTRODUCTION: A principal aim of the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) was to document changes in treatment practice for patients with newly diagnosed atrial fibrillation during an era when non-vitamin K antagonist oral anticoagulants (NOACs) were becoming more widely adopted. In these analyses, the key factors which determined the choice between NOACs and vitamin K antagonists (VKAs) are explored. METHODS: Logistic least absolute shrinkage and selection operator regression determined predictors of NOAC and VKA use. Data were collected from 24,137 patients who were initiated on AC ± antiplatelet (AP) therapy (NOAC [51.4%] or VKA [48.6%]) between April 2013 and August 2016. RESULTS: The most significant predictors of AC therapy were country, enrolment year, care setting at diagnosis, AF type, concomitant AP, and kidney disease. Patients enrolled in emergency care or in the outpatient setting were more likely to receive a NOAC than those enrolled in hospital (OR 1.16 [95% CI: 1.04-1.30], OR: 1.15 [95% CI: 1.05-1.25], respectively). NOAC prescribing seemed to be favored in lower-risk groups, namely, patients with paroxysmal AF, normotensive patients, and those with moderate alcohol consumption, but also the elderly and patients with acute coronary syndrome. By contrast, VKAs were preferentially used in patients with permanent AF, moderate to severe kidney disease, heart failure, vascular disease, and diabetes and with concomitant AP. CONCLUSION: GARFIELD-AF data highlight marked heterogeneity in stroke prevention strategies globally. Physicians are adopting an individualized approach to stroke prevention where NOACs are favored in patients with a lower stroke risk but also in the elderly and patients with acute coronary syndrome

Pharmacogenetics of warfarin dosing in patients of African and European ancestry

Despite the introduction of direct acting oral anticoagulants, warfarin remains the most commonly prescribed oral anticoagulant. However, warfarin therapy is plagued by the large inter- and intrapatient variability. The variability in dosing fueled research to identify clinical and genetic predictors and develop more accurate dosing algorithms. Observational studies have demonstrated the significant impact of single nucleotide polymorphisms in CYP2C9 and VKORC1 on warfarin dose in patients of European ancestry and African-Americans. This evidence supported the design and conduct of clinical trials to assess whether genotype-guided dosing results in improved anticoagulation control and outcomes. The trial results have shown discordance by race, with pharmacogenetic algorithms improving dose and anticoagulation control among European ancestry patients compared with African-American patients. Herein, we review the evidence from observational and interventional studies, highlight the need for inclusion of minority race groups and propose the need to develop race specific dosing algorithms

Room-Temperature Lasing in Colloidal Nanoplatelets via Mie-Resonant Bound States in the Continuum

7 pags., 4 figs.Solid-state room-temperature lasing with tunability in a wide range of wavelengths is desirable for many applications. To achieve this, besides an efficient gain material with a tunable emission wavelength, a high quality-factor optical cavity is essential. Here, we combine a film of colloidal CdSe/CdZnS core-shell nanoplatelets with square arrays of nanocylinders made of titanium dioxide to achieve optically pumped lasing at visible wavelengths and room temperature. The all-dielectric arrays support bound states in the continuum (BICs), which result from lattice-mediated Mie resonances and boast infinite quality factors in theory. In particular, we demonstrate lasing from a BIC that originates from out-of-plane magnetic dipoles oscillating in phase. By adjusting the diameter of the cylinders, we tune the lasing wavelength across the gain bandwidth of the nanoplatelets. The spectral tunability of both the cavity resonance and nanoplatelet gain, together with efficient light confinement in BICs, promises low-threshold lasing with wide selectivity in wavelengths.This work was supported by the A*STAR SERC Pharos programme (grant number 152 73 00025; Singapore). D.R.A. and J.A.S.-G. acknowledge support from the Spanish Ministerio de Ciencia e Innovacion (NANOTOPO FIS2017-91413-EXP, ́ MELODIA PGC2018-095777-B-C21, and a FPU Ph.D. Fellowship FPU15/03566, MCIU/AEI/FEDER, UE). H.V.D. gratefully acknowledges support from TUBA. The authors acknowledge Vytautas Valuckas (IMRE, A*STAR) for SEM characterization

Room-Temperature Lasing in Colloidal Nanoplatelets via Mie-Resonant Bound States in the Continuum

Solid-state room-temperature lasing with tunability in a wide range of wavelengths is desirable for many applications. To achieve this, besides an efficient gain material with a tunable emission wavelength, a high quality-factor optical cavity is essential. Here, we combine a film of colloidal CdSe/CdZnS core-shell nanoplatelets with square arrays of nanocylinders made of titanium dioxide to achieve optically pumped lasing at visible wavelengths and room temperature. The all-dielectric arrays support bound states in the continuum (BICs), which result from lattice-mediated Mie resonances and boast infinite quality factors in theory. In particular, we demonstrate lasing from a BIC that originates from out-of-plane magnetic dipoles oscillating in phase. By adjusting the diameter of the cylinders, we tune the lasing wavelength across the gain bandwidth of the nanoplatelets. The spectral tunability of both the cavity resonance and nanoplatelet gain, together with efficient light confinement in BICs, promises low-threshold lasing with wide selectivity in wavelengths.Agency for Science, Technology and Research (A*STAR)Submitted/Accepted versionThis work was supported by the A*STAR SERC Pharos programme (grant number 152 73 00025; Singapore). D.R.A. and J.A.S.-G. acknowledge support from the Spanish Ministerio de Ciencia e Innovación (NANOTOPO FIS2017-91413-EXP, MELODIA PGC2018-095777-B-C21, and FPU PhD Fellowship FPU15/03566, MCIU/AEI/FEDER, UE). H.V.D. gratefully acknowledges support from TUBA. The authors acknowledge Vytautas Valuckas (IMRE, A*STAR) for SEM characterization