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)

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: 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

C–O–H2 ternary diagram for evaluation of carbon activity in CH4-containing gas mixtures

The C–O–H2 ternary diagram is presented to characterize the carbon activity in equilibrium with gas mixtures containing CH4, CO, CO2, H2O, and H2 at different temperatures and pressures. The three reactions for carbon deposition from CH4, CO, and CO + H2 are considered jointly, and the combined equilibrium carbon activity is calculated. The lines on the diagram show a set of gas compositions that is in equilibrium with a defined value of carbon activity at a given temperature and pressure. It was possible to verify that carbon activity in equilibrium with the direct reduction process gas of Midrex is 0.15 and of Energiron ZR is 8.5, explaining the higher carbon content in the reduced iron for the latter. In the case of steam reforming of methane and methanol, carbon activity in usual industrial conditions are of 0.35 and 0.73 respectively. Finally steam reforming of ethanol was evaluated and it was shown that carbon deposition is expected at 240 °C but would be avoided at temperatures of 500 °C and higher in equilibrium conditions. The proposed diagram could be useful in many chemical, catalytic, and metallurgical processes for study or prevention of carbon formation

Phase Transformations from Quartz to Cristobalite

Two quartz types used in the silicon and ferrosilicon industry were heated to temperatures of 1600 and 1700 °C. The parameters varied were the temperature and the holding time at maximum temperature. The amount of quartz, cristobalite and intermediate amorphous phase were measured using XRD and the internal standard method. Type P showed a much larger ability to transform to cristobalite at lower temperatures than type A. Type P had a larger amount of alkali and alkaline earth impurities. This could have enhanced the transformation to cristobalite. For quartz type A the amount of cristobalite was larger at 1600 °C than 1700 °C. This can also be seen for some of the samples of type P at shorter holding times.acceptedVersio

Working towards an increase in manganese ferroalloy production in South Africa - a research agenda

CITATION: Steenkamp, J. D., et al. 2018. Working towards an increase in manganese ferroalloy production in South Africa - a research agenda. Journal of the Southern African Institute of Mining and Metallurgy, 118(6):645-654, doi:10.17159/2411-9717/2018/v118n6a13.The original publication is available at http://www.scielo.org.zaAlthough South Africa is endowed with one of the largest land-based deposits of manganese ore, in the order of 80% of the ore mined is exported for beneficiation elsewhere. The past 15 years has seen a decline in the production of manganese ferroalloys locally due to a steep rise in the price of electricity, among other factors. As local beneficiation of South Africa's resources is a national priority, a research agenda to increase manganese ferroalloy production in South Africa was developed. Inputs were obtained from various role-players in the value chain, including local smelter operations, research institutions both local and abroad, and companies providing support to the industry. Ninety-five research opportunities were identified and grouped into twenty-one research themes. The results are reported here in the context of a review of relevant Infacon papers and Mintek reports. As implementation of such a research agenda could be done through the development of a technology roadmap, the paper concludes with an example from Norway where a roadmap was developed to increase the use of natural gas in metal production.http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2225-62532018000600016Publisher's versio

Mathematical Modeling of Furnace Drainage While Tapping Slag and Metal Through a Single Tap-Hole

Furnace tapping is a critical operation on pyrometallurgical furnaces known for unpredictable performance in many cases. A reduced order mathematical model capable of predicting tapping rates of both slag and metal is presented. The model accounts for separate liquid phases and particle bed resistance to flow. The model is compared for consistency against results from both a water-model experiment and computational fluid dynamics simulations. The model is applied to study drainage from a typical ferro-manganese furnace. The model results show that particle bed conditions in the immediate vicinity of the tap-hole strongly influence tapping rates and that the slag/metal interface deformation due to suction pressure near to the tap-hole is significant and must be accounted for in such modelspublishedVersio

Phase Transformations from Quartz to Cristobalite

Two quartz types used in the silicon and ferrosilicon industry were heated to temperatures of 1600 and 1700 °C. The parameters varied were the temperature and the holding time at maximum temperature. The amount of quartz, cristobalite and intermediate amorphous phase were measured using XRD and the internal standard method. Type P showed a much larger ability to transform to cristobalite at lower temperatures than type A. Type P had a larger amount of alkali and alkaline earth impurities. This could have enhanced the transformation to cristobalite. For quartz type A the amount of cristobalite was larger at 1600 °C than 1700 °C. This can also be seen for some of the samples of type P at shorter holding times

Damring formation during rotary kiln chromite pre-reduction: Effects of pulverized carbonaceous fuel selection and partial pellet melting

Electricity consumption is the largest cost contributing factor in the production of ferrochrome. Currently the pelletized chromite pre-reduction process (solid-state reduction of chromite) is the process option with the lowest specific electricity consumption (MWh/ton). In this process, pelletized chromite is fed into a rotary kiln at 1573 K (1300 °C), where partial pre-reduction takes place. Damring formation (material build-up) in the rotary kiln causes routine shutdowns, resulting in loss of revenue. The damring formation is possibly caused by melting of the ash of the pulverized coal used to fire the kiln and/or the partial melting of the chromite pellets. Ash fusion temperatures of twenty different samples were evaluated to assess the temperature at which the pulverized coal ash will start to contribute to damring formation. Sessile drop tests were used to assess the softening behavior of different ore types (e.g., UG2, MG, and LG metgrade), as well as softening of composite chromite pellets made from these ores. Actual damrings were also analyzed using scanning electron microscopy with energy dispersive X-ray spectroscopy. Results indicate that it is mainly the pulverized coal ash that will contribute to damring formation, and not ore or pellet softening. Multiple-linear regression was used to derive equations to predict the ash fusion temperatures of the pulverized coal ash, which can be used by ferrochrome producers to optimize pulverized coal selection.publishedVersion© The Author(s) 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made