New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

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

Gestão do varejo lojista em shopping center: um estudo do Plaza Shopping em Niterói

O mercado de shopping Center vem apresentando nos últimos anos fortes registros de crescimento e consolidação no Brasil. Consequentemente, o número de empreendimentos e o volume de vendas estão crescendo, contribuindo para o desenvolvimento do varejo brasileiro. Grandes redes de varejo, como lojas de departamentos, supermercados, e redes de franquia estão se espalhando por todas as capitais no país. Em contrapartida, em janeiro de 2009, A CONECS (Conselho nacional de Entidades de comércio em Shopping Center), através de uma pesquisa de campo, apontou que o relacionamento e o grau de satisfação entre lojistas e empreendedores de shoppings centers de todo o país está insuficiente. O dado mais relevante foi referente ao tempo médio de ocupação dos lojistas nos empreendimentos. Segunda a pesquisa os pequenos e médios empresários, que possuem lojas de pequeno porte, não conseguem permanecer por mais de 05 anos nos shoppings. Diante do exposto, esta pesquisa tem como principal objetivo verificar se as práticas de gestão aplicadas por pequenas lojas estão competitivas, comparadas a médias e grandes lojas. Para isso, foi feita uma pesquisa de campo, em que os gerentes de lojas de pequeno, médio e grande porte, situado no Plaza Shopping Niterói, relataram como está sendo feita a gestão dos seus negócios

Using the MACBETH Method to improve the scenario analysis tool PESTEL in large civil construction projects

The paper presents a methodological study performing a prioritization of the PESTEL analysis factors on the pre-construction and assembly environments of large civil engineering projects. The objective is to test if it is possible to use the decision making support methodology MACBETH to generate a hierarchy scale among criteria that might behave as a Pareto distribution. According to an expert choice, four of the ten alternatives represent 72.16% of the preference of the consulted expert. The answer does not represent a Pareto distribution, but does not invalidate the hypothesis. It is possible that the judgment of some specialist comes closer to such a phenomenon

Using the MACBETH Method to improve the scenario analysis tool PESTEL in large civil construction projects

The paper presents a methodological study performing a prioritization of the PESTEL analysis factors on the pre-construction and assembly environments of large civil engineering projects. The objective is to test if it is possible to use the decision making support methodologyMACBETH to generate a hierarchy scale among criteria that might behave as a Pareto distribution. According to an expert choice, four of the ten alternatives represent 72.16% of the preference of the consulted expert. The answer does not represent a Paretodistribution, but does not invalidate the hypothesis. It is possible that the judgment of some specialist comes closer to such a phenomenon.El artículo presenta un estudio metodológico que realiza una priorización de los factores de análisis PESTEL en los entornos de pre-construcción y montaje de grandes proyectos de ingeniería civil. El objetivo es comprobar si es posible utilizar la metodología de apoyo a la toma de decisiones MACBETH para generar una escala de jerarquía entre los criterios que podrían comportarse como una distribución de Pareto. Según una elección de un experto, cuatro de las diez alternativas representan 72,16% de la preferencia del experto consultado. La respuesta no representa una distribución de Pareto, pero no invalida la hipótesis. Es posible que el juicio de algún especialista se acerque a tal fenómeno

Uncertainty principle in niche assessment: A solution to the dilemma redundancy vs. competitive exclusion, and some analytical consequences

There has been a categorically unresolved crucial question in ecology and evolutionary theory for manydecades; perhaps from the times of Charles Darwin himself: Is it possible, under natural conditions,that two species can perform a commonly shared ecological niche? There are two extreme conventionalresponses that have kept divided the scientific community in this regard for almost forty years: (a) No;that is to say, the well-known competitive exclusion principle (CEP). (b) Yes; that is to say, the well-knownhypothesis of full functional redundancy (HFR). Obviously, the reliability of both responses depends on anunderlying and even more essential requisite: that the ecological niche of a given species can be assessedwith such accuracy as we could want in order to detect the degree in which it is shared between coexistingspecies. This article is the seventh in a continuous series of interconnected recent publications that pro-motes an alternative understanding of ecology and evolutionary biology which is in favor of strong andmutually fruitful analytical links between biology and physics. This article analyzes the statistical behav-ior of ecological niches by taking into account two indicators that are essential to perform the ecologicalniche of all species: species diversity per plot (Hp) and eco-kinetic energy (Ee) as a proxy for trophic energyin a scalar field Hp, Eein which an oscillating performance of ecological niches is deployed. According toour results, in the same measurement in which the accuracy of Hpassessments increases (reduction ofHp’s standard deviation: Hp) the accuracy of Eeassessment decreases (increment of Ee), and vice versa, inagreement with a pattern that is completely equivalent to that of the Heisenberg’s uncertainty principlein quantum mechanics (i.e.: Hp· Ee 1/2heec/2 ; where heec: ecological equivalent of Planck’s con-stant found in previous publications). As a result, the ecological niche is, even in principle in addition toin practice, indeterminable with enough exactness to arrive to a categorical response to the above-statedquestion. This means that CEP and HFR are simultaneously true and false in the same measure, becausethe only feasible option to keep the functional stability of ecosystems is a wave-like combination of bothoptions: when species are pushed to a high degree of coexistence (increase of partition of the gradient) in regard to Hpvalues (a trend in favor of HFR), their degree of coexistence in regard to Eevalues dimin-ishes (decrease of partition of the Eegradient, a trend in favor of CEP), and vice versa. The final sections ofthe article highlight the eco-evolutionary, biogeographical and socio-economic meaning of this result, byoffering plausible alternative explanations to a wide spectrum of phenomena that appear to be only par-tially understood so far, e.g.: the contradictory results about the relationship between body size, speciesdiversity and macroevolutionary rates; the general environmental scenario in favor of macroevolutionaryleaps with a low probability to leave footprints in the fossil record; the unnecessary, although stimu-lant, influence of geographic isolation to promote evolutionary changes; the island rule; and the generalmeaning of the interaction between nature and society