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

Resilience in Pre-Columbian Caribbean House-Building: Dialogue Between Archaeology and Humanitarian Shelter

This is the final version of the article. It first appeared from Springer via http://dx.doi.org/10.1007/s10745-015-9741-5This paper responds to questions posed by archaeologists and engineers in the humanitarian sector about relationships between shelter, disasters and resilience. Enabled by an increase in horizontal excavations combined with high-resolution settlement data from excavations in the Dominican Republic, the paper presents a synthesis of Caribbean house data spanning a millennium (1400 BP- 450 BP). An analysis of architectural traits identify the house as an institution that constitutes and catalyses change in an emergent and resilient pathway. The ?Caribbean architectural mode? emerged in a period of demographic expansion and cultural transition, was geographically widespread, different from earlier and mainland traditions and endured the hazards of island and coastal ecologies. We use archaeological analysis at the house level to consider the historical, ecological and regional dimensions of resilience in humanitarian actionThank you to the Museo del Hombre Dominicano for collaboration on the site of El Cabo, to the Netherlands Organisation for Scientific Research and the Faculty of Archaeology, Leiden University for supporting the archaeological research. Kate Crawford?s post-doctoral post at the Department of Civil, Environmental and Geomatic Engineering at University College London was funded by the Engineering and Physical Sciences Research Council

Evaluación de barreras vegetales en el manejo integrado de la mancha anular del papayo (PRSV-P) en Michoacán, México Evaluation of plant barriers in an integrated management of papayo ringspot in Michoacan, Mexico

El efecto de barreras vegetales como componente de un programa de manejo integrado (MI), se validó y adaptó en 1999 en Michoacán, México, para controlar la Mancha Anular del Papayo, enfermedad causada por el Papaya ringspot potyvirus type-P (PRSV-P). Se estableció un experimento en parcelas divididas con dos factores experimentales: barreras vegetales (Hibiscus sabdariffa), y componentes de MI: MI sin aspersión de citrolina (1.5%) (MI-A), MI sin eliminación de plantas con síntomas iniciales de virosis antes de floración (MI-D) y MI. Las barreras vegetales sembradas 20 días antes del trasplante del papayo y el desplante retrasaron en 19 días el inicio del progreso de epidemias en el MI lo que resultó en una mayor producción (14.2%) que el resto de tratamientos, aunque fue superado por MI-A en vigor (4% en diámetro de tallo). La citrolina fue fitotóxica, disminuyó el vigor de plantas (5.3%) y no limitó significativamente el desarrollo de la enfermedad ya que la intensidad de las epidemias (X0 = 47días, Yf = 84% y ABCPE = 3220% días) fue similar al testigo. El uso de barreras vegetales por si sola aparentemente no es suficiente para la reducción de la incidencia y dispersión de la enfermedad. Los áfidos más abundantes, con reconocida capacidad transmisora del PRSV-P, fueron Aphis gossypii, A. nerii, A. spiraecola y Macrosiphum euphorbiae, los cuales representaron aproximadamente el 13% del total de áfidos capturados.<br>The effect of plant barriers as a component of an integrated management program (IM) was validated and adapted in 1999, in Michoacan, Mexico, to control papaya ringspot, caused by papaya ringspot potyvirus type-P (PRSV-P). A split-plot design was established with two experimental factors: plant barriers and components of IM: IM without oil sprinkling (IM-O), IM without plant rouging (IM-R), and complete IM. Plant barriers (Hibiscus sabdariffa), sowed 20 days before papaya transplanting, and plant rouging delayed the epidemics onset in 19 days thus IM resulted in the highest yield (14.2%) than the rest of the treatments, but it was less effective than IM-O in vigor (4% in stem diameter). Oil sprinkling was phytotoxic and caused a 5.3% vigor reduction. The oil effect on the disease progress was not clear, since the epidemic intensity (epidemic onset X0 = 47 days after transplanting, final incidence Yf = 81% and area under disease progress curve ABCPE = 3220 %days) was similar to the control treatment. Plant barriers alone may not be sufficient to reduce disease incidence and spreading. The more abundant winged aphids known as PRSV-P vectors were Aphis gossypii, A. nerii, A. spiraecola and Macrosiphum euphorbia, which represented approximately 13% of the total captured aphids

Comparison of international normalized ratio audit parameters in patients enrolled in GARFIELD-AF and treated with vitamin K antagonists

Vitamin K antagonist (VKA) therapy for stroke prevention in atrial fibrillation (AF) requires monitoring of the international normalized ratio (INR). We evaluated the agreement between two INR audit parameters, frequency in range (FIR) and proportion of time in the therapeutic range (TTR), using data from a global population of patients with newly diagnosed non-valvular AF, the Global Anticoagulant Registry in the FIELD\u2013Atrial Fibrillation (GARFIELD-AF). Among 17\ua0168 patients with 1-year follow-up data available at the time of the analysis, 8445 received VKA therapy (\ub1antiplatelet therapy) at enrolment, and of these patients, 5066 with 653 INR readings and for whom both FIR and TTR could be calculated were included in the analysis. In total, 70\ua0905 INRs were analysed. At the patient level, TTR showed higher values than FIR (mean, 56\ub70% vs 49\ub78%; median, 59\ub77% vs 50\ub70%). Although patient-level FIR and TTR values were highly correlated (Pearson correlation coefficient [95% confidence interval; CI], 0\ub7860 [0\ub7852\u20130\ub7867]), estimates from individuals showed widespread disagreement and variability (Lin's concordance coefficient [95% CI], 0\ub7829 [0\ub7821\u20130\ub7837]). The difference between FIR and TTR explained 17\ub74% of the total variability of measurements. These results suggest that FIR and TTR are not equivalent and cannot be used interchangeably