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

Considerations for sustainable influenza vaccine production in developing countries

Through its Global Action Plan for Influenza Vaccines (GAP), the World Health Organization (WHO) in collaboration with the United States Department of Health and Human Services has produced a checklist to support policy-makers and influenza vaccine manufacturers in identifying key technological, political, financial, and logistical issues affecting the sustainability of influenza vaccine production. This checklist highlights actions in five key areas that are beneficial for establishing successful local vaccine manufacturing. These five areas comprise: (1) the policy environment and health-care systems; (2) surveillance systems and influenza evidence; (3) product development and manufacturing; (4) product approval and regulation; and (5) communication to support influenza vaccination. Incorporating the checklist into national vaccine production programmes has identified the policy gaps and next steps for countries involved in GAP’s Technology Transfer Initiative. Lessons learnt from country experiences provide context and insight that complement the checklist’s goal of simplifying the complexities of influenza prevention, preparedness, and vaccine manufacturing

Assessment and decision-making in a Caribbean damselfish: nest-site quality influences prioritization of courtship and brood defence

In systems where territory quality varies, animals are expected to exhibit plasticity in behaviour in order to maximize fitness relative to their present territory quality. This requires assessment of territory quality followed by decision-making in relation to the priority of activities necessary for survival and reproduction. We examined how differences in territory quality of beaugregory damselfish (Stegastes leucostictus) influence the prioritization of courtship and egg defence by comparing behavioural responses of males defending artificial sites (high quality) with males defending natural sites (low quality) when presented with an egg predator, a conspecific female, and a simultaneous choice between both. A significant three-way interaction of territory quality, presentation type and stimulus was observed for time near stimuli. In paired presentations, males defending low-quality territories spent more time near a female and less near an egg predator; while males on high-quality territories spent more time near a predator than a female. Additionally, comparing single and paired presentations reveals that behaviours towards egg predators remain constant while behaviours towards females decrease with paired stimuli. These data suggest that territory quality and ecological context impact decision-making and the relative values of potential reproduction and/or past reproductive effort

Caribbean damselfish with varying territory quality: correlated behaviors but not a syndrome

The behavioral syndrome hypothesis suggests that individual animals within a population behave differently due to specific behavioral types, and these should be consistent across behaviors or in different contexts. In contrast, for animals that live within an environment in which territory quality can change over time, natural selection should have favored behavioral flexibility and modulation of the cost of defense in relation to territory quality. This would require assessment of the territory followed by displays of appropriate types and intensities of behavior. We examined the territorial behavior of male beaugregory damselfish (Stegastes leucostictus) by enhancing territory quality using artificial breeding sites and comparing their behavior to males on lower quality natural sites. When male fish were defending high-quality artificial territories, they had higher levels of aggression toward male conspecifics and courtship toward females than when on low-quality natural territories. We also found that aggression and courtship behaviors were correlated on natural sites but not on artificial sites. Behaviors were not correlated within individuals when males switched from natural to artificial territories or from artificial to natural territories. These results indicate that males assess their current territories and adjust behaviors accordingly and that courtship and aggressive behaviors are not linked within a permanent behavioral syndrome. Copyright 2009, Oxford University Press.