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

Phase Behavior of Aqueous Na-K-Mg-Ca-CI-NO3 Mixtures: Isopiestic Measurements and Thermodynamic Modeling

A comprehensive model has been established for calculating thermodynamic properties of multicomponent aqueous systems containing the Na{sup +}, K{sup +}, Mg{sup 2+}, Ca{sup 2+}, Cl{sup -}, and NO{sub 3}{sup -} ions. The thermodynamic framework is based on a previously developed model for mixed-solvent electrolyte solutions. The framework has been designed to reproduce the properties of salt solutions at temperatures ranging from the freezing point to 300 C and concentrations ranging from infinite dilution to the fused salt limit. The model has been parameterized using a combination of an extensive literature database and new isopiestic measurements for thirteen salt mixtures at 140 C. The measurements have been performed using Oak Ridge National Laboratory's (ORNL) previously designed gravimetric isopiestic apparatus, which makes it possible to detect solid phase precipitation. Water activities are reported for mixtures with a fixed ratio of salts as a function of the total apparent salt mole fraction. The isopiestic measurements reported here simultaneously reflect two fundamental properties of the system, i.e., the activity of water as a function of solution concentration and the occurrence of solid-liquid transitions. The thermodynamic model accurately reproduces the new isopiestic data as well as literature data for binary, ternary and higher-order subsystems. Because of its high accuracy in calculating vapor-liquid and solid-liquid equilibria, the model is suitable for studying deliquescence behavior of multicomponent salt systems

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Love and trauma in "The Lady with the Dog" and "The Great Gatsby"

This article carries out comparative literary research of the short story "The Lady with the Dog" by the Russian writer Anton Chekhov and the novel “The Great Gatsby” by the American writer F. Scott Fitzgerald for determining the possible mutual influence between these two authors and their works. For achieving the set goal, the article reveals the most significant similar incidents and differences in relation to the aspects of love, ego, and trauma that were selected for the analysis. The comparison relies on the Freudian view of love and trauma in order to analyze the psychological struggle after the loss of love experienced by the protagonists of the aforementioned literary works - Gurov and Gatsby. The scientific novelty consists in comprehensive comparison of the theme of love between the authors and their protagonists, as well as with the protagonists themselves. Unlike other existing scientific works, this publication compares the psychological aspects of not only love, but the trauma and ego of Gurov and Gatsby as well, revealing the similarities and differences between the aspects of love, ego and trauma alongside their perception by the protagonists. Both main characters fall in love with the women who are married to other men. Thus, they both have experienced a traumatic situation they could not cope with. The research sheds light on the similarities between Chekhov and Gatsby and their narrators in both case studies. The acquired results can be applied in practice of literary psychoanalytic criticism, as well as in practice of comparative research.Эта статья посвящена сравнительному литературному исследованию двух произведений, рассказа русского писателя Антона Чехова "Дама с собачкой" и романа его американского коллеги Ф. Скотта Фицджеральда "Великий Гэтсби". Цель авторов состоит в том, чтобы выявить возможное взаимное влияние между двумя этими авторами и их творчеством. Для достижения поставленной цели авторы стремятся определить наиболее значимые в свете избранных для анализа аспектов (любовь, эго, травма) схожие инциденты и различия. В исследовании используются исторические, аналитические, сравнительные и психоаналитические методы. В частности, авторы основывают свое сравнение на фрейдистском взгляде на любовь и травму, чтобы проанализировать психологическую борьбу после потери любви, пережитой обоими главными героями: Гуровым и Гэтсби. Новизна исследования заключается во всестороннем сравнении темы любви между авторами и их главными героями, а также с самими главными героями. В отличие от существующих научных работ авторами проведено сравнение психологических аспектов не только любви, но травмы и эго Гурова и Гэтсби. В частности, статья раскрывает сходства и различия аспектов любви, эго и травмы, а также то, как они воспринимаются обоими главными героями. Оба главных героя влюбляются в женщин, с которыми не могут быть, потому что они замужем за другими мужчинами. Таким образом, они оба пережили травмирующую ситуацию, с которой не могли справиться. Исследование проливает свет на сходство между Чеховым и Гэтсби и их рассказчиками в обоих тематических исследованиях. Полученные результаты могут быть использованы как в практике литературной психоаналитической критики, так и в практике сравнительных исследований

Estimativa do consumo de água na cultura da cenoura (Daucus carota, L.) v. nantes superior, para a região de piracicaba, através do método do balanço hídrico Estimation of carrot water consumption (Daucus carota, L.) t. nantes superior, in piracicaba county through the water balance methodology

O presente trabalho teve como objetivo estimar a demanda hídrica da cultura da cenoura (Daucus carota, L.) cv. Nantes Superior, pelo método do balanço hídrico sob condições de campo, para a região de Piracicaba, Estado de São Paulo (22&deg; 42' 30" S; 47&deg; 30' 00" W, à 560 metros de altitude). Os valores de evapotranspiração máxima obtidos pelo método do balanço hídrico foram correlacionados com os valores de evapotranspiração de referência estimados pelo método de Penman, objetivando a determinação do coeficiente de cultura. O consumo total de água considerando-se um ciclo vegetativo de 101 dias foi de 365 mm, gerando um consumo médio de 3,61 mm/dia. Nesta situação, o coeficiente de cultura médio encontrado foi de 1,1.<br>To estimate the evapotranspiration of a carrot crop (Daucus carota, L.) v. Nantes Superior, under field conditions, in Piracicaba (22&deg; 42' 30" S; 47&deg; 30' 00" W, at 560 m.), maximum evapotranspiration was determinated by the water balance method and correlated to the reference evapotranspiration estimated by Penman's method, in order to obtain the crop coefficient. The total water consumption of the vegetative cycle (101 days) was about 365 mm, with a mean of 3,61 mm/dia. In this situation the mean crop coefficient was 1.1

Lateral Organization in Lipid-Cholesterol Mixed Bilayers

Interactions between lipid and cholesterol molecules in membranes play an important role in the structural and functional properties of cell membranes. Although structural properties of lipid-cholesterol mixtures have been extensively studied, an understanding of the role of cholesterol in the lateral organization of bilayers has been elusive. In this article, we propose a simple yet powerful model, based on self-consistent mean-field theory and molecular dynamics simulations, for lipid bilayers containing cholesterol. Properties predicted by our model are shown to be in excellent agreement with experimental data. Our model predicts that cholesterol induces structural changes in the bilayer through the formation of regions of ordered lipids surrounding each cholesterol molecule. We find that the “smooth” and “rough” sides of cholesterol play crucial roles in formation and distribution of the ordered regions. Our model is predictive in that input parameters are obtained from independent atomistic molecular dynamics simulations. The model and method are general enough to describe other heterogeneous lipid bilayers, including lipid rafts