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

Assessment of Radionuclides in the Savannah River Site Environment Summary

This document summarizes the impact of radionuclide releases from Savannah River Site (SRS) facilities from 1954 through 1996. The radionuclides reported here are those whose release resulted in the highest dose to people living near SRS

Assessment of Neptunium, Americium, and Curium in the Savannah River Site Environment

A series of documents has been published in which the impact of various radionuclides released to the environment by Savannah River Site (SRS) operations has been assessed. The quantity released, the disposition of the radionuclides in the environment, and the dose to offsite individuals has been presented for activation products, carbon cesium, iodine, plutonium, selected fission products, strontium, technetium, tritium, uranium, and the noble gases. An assessment of the impact of nonradioactive mercury also has been published.This document assesses the impact of radioactive transuranics released from SRS facilities since the first reactor became operational late in 1953. The isotopes reported here are 239Np, 241Am, and 244Cm

Assessment of activation products in the Savannah River Site environment

This document assesses the impact of radioactive activation products released from SRS facilities since the first reactor became operational late in 1953. The isotopes reported here are those whose release resulted in the highest dose to people living near SRS: {sup 32}P, {sup 51}Cr, {sup 60}C, and {sup 65}Zn. Release pathways, emission control features, and annual releases to the aqueous and atmospheric environments are discussed. No single incident has resulted in a major acute release of activation products to the environment. The releases were the result of normal operations of the reactors and separations facilities. Releases declined over the years as better controls were established and production was reduced. The overall radiological impact of SRS activation product atmospheric releases from 1954 through 1994 on the offsite maximally exposed individual can be characterized by a total dose of 0.76 mrem. During the same period, such an individual received a total dose of 14,400 mrem from non-SRS sources of ionizing radiation present in the environment. SRS activation product aqueous releases between 1954 and 1994 resulted in a total dose of 54 mrem to the offsite maximally exposed individual. The impact of SRS activation product releases on offsite populations also has been evaluated

Assessment of selected fission products in the Savannah River Site environment

Most of the radioactivity produced by the operation of a nuclear reactor results from the fission process, during which the nucleus of a fissionable atom (such as 235U) splits into two or more nuclei, which typically are radioactive. The Radionuclide Assessment Program (RAP) has reported on fission products cesium, strontium, iodine, and technetium. Many other radionuclides are produced by the fission process. Releases of several additional fission products that result in dose to the offsite population are discussed in this publication. They are 95Zr, 95Nb, 103Ru, 106Ru, 141Ce, and 144Ce. This document will discuss the production, release, migration, and dose to humans for each of these selected fission products

The ocean is not deep enough: pressure tolerances during early ontogeny of the blue mussel Mytilus edulis

Early ontogenetic adaptations reflect the evolutionary history of a species. To understand the evolution of the deep-sea fauna and its adaptation to high-pressure, it is important to know the effects of pressure on their shallow-water relatives. In this study we analyse the temperature and pressure tolerances of early life history stages of the shallow-water species Mytilus edulis. This species expresses a close phylogenetic relationship with hydrothermal-vent mussels of the subfamily Bathymodiolinae. Tolerances to pressure and temperature are defined in terms of fertilisation success and embryo developmental rates in laboratory-based experiments. In Mytilus edulis, successful fertilisation under pressure is possible up to 500atm (50.66MPa), at 10 ºC, 15 ºC and 20 ºC. A slower embryonic development is observed with decreasing temperature and with increasing pressure; principally, pressure narrows the physiological tolerance window in different ontogenetic stages of M. edulis, and slows down metabolism. This study provides important clues on possible evolutionary pathways of hydrothermal vent and cold-seep bivalve species and their shallow-water relatives. Evolution and speciation patterns of species derive mostly from their ability to adapt to variable environmental conditions, within environmental constraints, which promote morphological and genetic variability, often differently for each life history stage. The present results support the view that a direct colonisation of deep-water hydrothermal vent environments by a cold-eurythermal shallow-water ancestor is indeed a possible scenario for the Mytilinae, challenging previous hypothesis of a wood/bone to seep/vent colonization pathway

Assessment of mercury in the Savannah River Site environment

Mercury has been valued by humans for several millennia. Its principal ore, cinnabar, was mined for its distinctive reddish-gold color and high density. Mercury and its salts were used as medicines and aphrodisiacs. At SRS, mercury originated from one of the following: as a processing aid in aluminum dissolution and chloride precipitation; as part of the tritium facilities` gas handling system; from experimental, laboratory, or process support facilities; and as a waste from site operations. Mercury is also found in Par Pond and some SRS streams as the result of discharges from a mercury-cell-type chlor-alkali plant near the city of Augusta, GA. Reactor cooling water, drawn from the Savannah River, transported mercury onto the SRS. Approximately 80,000 kg of mercury is contained in the high level waste tanks and 10,000 kg is located in the SWDF. Additional quantities are located in the various seepage basins. In 1992, 617 wells were monitored for mercury contamination, with 47 indicating contamination in excess of the 0.002-ppm EPA Primary Drinking Water Standard. More than 20 Savannah River Ecology Laboratory (SREL) reports and publications pertinent to mercury (Hg) have been generated during the last two decades. They are divided into three groupings: SRS-specific studies, basic studies of bioaccumulation, and basic studies of effect. Many studies have taken place at Par Pond and Upper Three Runs Creek. Mercury has been detected in wells monitoring the groundwater beneath SRS, but not in water supply wells in excess of the Primary Drinking Water Limit of 0.002 ppm. There has been no significant release of mercury from SRS to the Savannah River. While releases to air are likely, based on process knowledge, modeling of the releases indicates concentrations that are well below the SCDHEC ambient standard