Patient safety and estimation of renal function in patients prescribed new oral anticoagulants for stroke prevention in atrial fibrillation

OBJECTIVE: In clinical trials of dabigatran and rivaroxaban for stroke prevention in atrial fibrillation (AF), drug eligibility and dosing were determined using the Cockcroft-Gault equation to estimate creatine clearance as a measure of renal function. This cross-sectional study aimed to compare whether using estimated glomerular filtration rate (eGFR) by the widely available and widely used Modified Diet in Renal Disease (MDRD) equation would alter prescribing or dosing of the renally excreted new oral anticoagulants. PARTICIPANTS: Of 4712 patients with known AF within a general practitioner-registered population of 930 079 in east London, data were available enabling renal function to be calculated by both Cockcroft-Gault and MDRD methods in 4120 (87.4%). RESULTS: Of 4120 patients, 2706 were <80 years and 1414 were ≥80 years of age. Among those ≥80 years, 14.9% were ineligible for dabigatran according to Cockcroft-Gault equation but would have been judged eligible applying MDRD method. For those <80 years, 0.8% would have been incorrectly judged eligible for dabigatran and 5.3% would have received too high a dose. For rivaroxaban, 0.3% would have been incorrectly judged eligible for treatment and 13.5% would have received too high a dose. CONCLUSIONS: Were the MDRD-derived eGFR to be used instead of Cockcroft-Gault in prescribing these new agents, many elderly patients with AF would either incorrectly become eligible for them or would receive too high a dose. Safety has not been established using the MDRD equation, a concern since the risk of major bleeding would be increased in patients with unsuspected renal impairment. Given the potentially widespread use of these agents, particularly in primary care, regulatory authorities and drug companies should alert UK doctors of the need to use the Cockcroft-Gault formula to calculate eligibility for and dosing of the new oral anticoagulants in elderly patients with AF and not rely on the MDRD-derived eGFR

The Origin of Primordial Dwarf Stars and Baryonic Dark Matter

I present a scenario for the production of low mass, degenerate dwarfs of mass $>0.1 M_{\odot}$ via the mechanism of Lenzuni, Chernoff & Salpeter (1992). Such objects meet the mass limit requirements for halo dark matter from microlensing surveys while circumventing the chemical evolution constraints on normal white dwarf stars. I describe methods to observationally constrain this scenario and suggest that such objects may originate in small clusters formed from the thermal instability of shocked, heated gas in dark matter haloes, such as suggested by Fall & Rees (1985) for globular clusters.Comment: TeX, 4 pages plus 2 postscript figures. To appear in Astrophysical Journal Letter

Results on the nucleon spin structure

SMC performed an investigation of the spin structure of the nucleon by measuring deep inelastic scattering of polarised muons off polarised protons and deuterons. A summary of the results for spin structure functions and sum rules is given.Comment: 8 pages, LaTeX, Talk given at the Workshop on "Symmetry and Spin - PRAHA98", Prag, September 1998. Proceedings to be published by Czech. Journ. Phy

Popcorn : production and marketing

"K. E. Ziegler, Iowa State University; R. B. Ashman, Purdue University; G. M. White, University of Kentucky; and D. S. Wysong, University of Nebraska ; Reviewers: M. A. Hanna, University of Nebraska Seed Research Committee, Popcorn Institute, IL R. L. Nielsen, Purdue University M. S. Zuber, University of Missouri."--First page.K. E. Ziegler (Iowa State University), R. B. Ashman (Purdue University), G. M. White (University of Kentucky), and D. S. Wysong (University of Nebraska), M. A. Hanna (University of Nebraska Seed Research Committee, Popcorn Institute, IL), R. L. Nielsen (Purdue University), M. S. Zuber (University of Missouri)New 2/85/5

Next-to-Leading Order Analysis of Inclusive and Semi-inclusive Polarized Data

We present a combined next-to-leading order QCD analysis to data on both inclusive and semi-inclusive polarized deep inelastic scattering asymmetries. Performing NLO QCD global fits with different sets of observables, we evaluate the impact of the very recent semi-inclusive results presented by SMC in the extraction of NLO polarized parton distributions.Comment: 22 pages, 4 figures include

Gamma ray astronomy and baryonic dark matter

Recently, Dixon et al. have re-analyzed the EGRET data, finding a statistically significant diffuse $\gamma$-ray emission from the galactic halo. We show that this emission can naturally be explained within a previously-proposed model for baryonic dark matter, in which $\gamma$-rays are produced through the interaction of high-energy cosmic-ray protons with cold $H_2$ clouds clumped into dark clusters - these dark clusters supposedly populate the outer galactic halo and can show up in microlensing observations. Our estimate for the halo $\gamma$-ray flux turns out to be in remarkably good agreement with the discovery by Dixon et al. We also address future prospects to test our predictions.Comment: 9 pages, 1 figure included, to appear in ApJ 510, L103 (1999

Patient safety and estimation of renal in function in patients prescribed new oral anticoagulants for stroke prevention in atrial fibrillation: a cross-sectional study

OBJECTIVE: In clinical trials of dabigatran and rivaroxaban for stroke prevention in atrial fibrillation (AF), drug eligibility and dosing were determined using the Cockcroft-Gault equation to estimate creatine clearance as a measure of renal function. This cross-sectional study aimed to compare whether using estimated glomerular filtration rate (eGFR) by the widely available and widely used Modified Diet in Renal Disease (MDRD) equation would alter prescribing or dosing of the renally excreted new oral anticoagulants. PARTICIPANTS: Of 4712 patients with known AF within a general practitioner-registered population of 930 079 in east London, data were available enabling renal function to be calculated by both Cockcroft-Gault and MDRD methods in 4120 (87.4%). RESULTS: Of 4120 patients, 2706 were <80 years and 1414 were ≥80 years of age. Among those ≥80 years, 14.9% were ineligible for dabigatran according to Cockcroft-Gault equation but would have been judged eligible applying MDRD method. For those <80 years, 0.8% would have been incorrectly judged eligible for dabigatran and 5.3% would have received too high a dose. For rivaroxaban, 0.3% would have been incorrectly judged eligible for treatment and 13.5% would have received too high a dose. CONCLUSIONS: Were the MDRD-derived eGFR to be used instead of Cockcroft-Gault in prescribing these new agents, many elderly patients with AF would either incorrectly become eligible for them or would receive too high a dose. Safety has not been established using the MDRD equation, a concern since the risk of major bleeding would be increased in patients with unsuspected renal impairment. Given the potentially widespread use of these agents, particularly in primary care, regulatory authorities and drug companies should alert UK doctors of the need to use the Cockcroft-Gault formula to calculate eligibility for and dosing of the new oral anticoagulants in elderly patients with AF and not rely on the MDRD-derived eGFR

Novel Quark Fragmentation Functions and the Nucleon's Transversity Distribution

We define twist-two and twist-three quark fragmentation functions in Quantum Chromodynamics (QCD) and study their physical implications. Using this formalism we show how the nucleon's transversity distribution can be measured in single pion inclusive electroproduction.Comment: 10 pages, uses PHYZZX macro package, 2 PostScript figures (added using FIGURES). MIT-CTP-215