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

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

Genome-wide Trans-ethnic Meta-analysis Identifies Seven Genetic Loci Influencing Erythrocyte Traits and a Role for RBPMS in Erythropoiesis

Genome-wide association studies (GWASs) have identified loci for erythrocyte traits in primarily European ancestry populations. We conducted GWAS meta-analyses of six erythrocyte traits in 71,638 individuals from European, East Asian, and African ancestries using a Bayesian approach to account for heterogeneity in allelic effects and variation in the structure of linkage disequilibrium between ethnicities. We identified seven loci for erythrocyte traits including a locus (RBPMS/GTF2E2) associated with mean corpuscular hemoglobin and mean corpuscular volume. Statistical fine-mapping at this locus pointed to RBPMS at this locus and excluded nearby GTF2E2. Using zebrafish morpholino to evaluate loss of function, we observed a strong in vivo erythropoietic effect for RBPMS but not for GTF2E2, supporting the statistical fine-mapping at this locus and demonstrating that RBPMS is a regulator of erythropoiesis. Our findings show the utility of trans-ethnic GWASs for discovery and characterization of genetic loci influencing hematologic traits

Effect of Active Surveillance Intervention on Incidence of Methicillin-Resistant Staphylococcus aureus (MRSA)Infections in Surgical Intensive Care Unit

研究背景及目的 抗藥性金黃色葡萄球菌 (Methicillin-resistant Staphylococcus aureus, MRSA) 是醫療照護相關感染重要的致病菌，許多研究顯示如果病人發生MRSA醫療照護相關感染會增加死亡風險及住院費用，所以控制MRSA醫療照護相關感染是很重要的議題。 鼻腔帶有MRSA會增加醫療照護相關MRSA感染的風險，尤其是住加護病房的病人。先前在荷蘭的隨機分派臨床試驗結果顯示，運用主動篩檢措施及去移生治療，可以有效減少MRSA感染，但類似措施是否在常規的臨床情境下仍然可以產生控制MRSA感染的作用？目前還不清楚。本研究的目的為探討在外科加護病房例行主動篩檢及去移生治療的介入措施對MRSA感染的影響。 方法 本研究採用回溯性世代研究法，研究期間自2007年1月1日至2011年6月30日止，研究地點在北部某區域教學醫院外科加護病房，該院共有702床，其中外科加護病房共有18床。 本研究的介入措施為在病人入住外科加護病房後，進行鼻腔主動篩檢，早期偵測無症狀的MRSA帶菌者，當細菌培養出是MRSA後，使用mupirocin藥膏及chlorhexidine抗菌劑進行鼻腔及皮膚連續5天的去移生治療，並施予接觸隔離及環境清潔。 本研究期間總共區分為4個階段，第一階段是從2007年1月到2007年9月，為baseline階段，沒有執行介入措施，當時MRSA感染管制措施僅有接觸隔離、環境清潔，病人感染培養出MRSA後才進行去移生治療。第二階段是從2007年10月到2008年4月，因為有申請到經費，所以執行介入措施。第三階段是從2008年5月到2009年8月，因為研究計畫結束，沒有經費無法繼續執行，而停止介入措施。第四階段是從2009年9月到2010年9月，因為MRSA感染率再度升高，院方同意將介入措施的內容列入外科加護病房常規感染管制措施。 本研究除了比較有無執行介入措施對外科加護病房MRSA感染的影響外，並利用向衛生署統計室申請的內政部死亡檔及健保資料庫重大傷病檔資料，分析有介入及無介入期間病人1年內死亡率及新發重大傷病率 (severe morbidity) 的差異。所謂新發重大傷病是指病人住外科加護病房後，新產生長期呼吸器依賴或長期洗腎，而獲核發重大傷病證明。 利用SAS統計軟體進行資料分析，統計的方法包含類別變項利用χ2 test,連續變項利用t test，利用Poisson regression分析感染率的變化，Kaplan-Meier及log- rank test檢定mortality及severe morbidity的差異，並利用Logistic regression, Cox regression進行單變項及多變項分析。 結果 研究期間前後共有2373的病人入住外科加護病房。研究期間外科加護病房MRSA感染密度從3.58 ‰ 降至0.18 ‰，以Logistic regression進行多變項分析調整其他干擾因子作用後，發現執行介入措施是在外科加護病房發生MRSA感染的獨立保護因子 (adjusted odds ratio [OR]: 0.1, 95% CI, 0.02-0.4 )。研究期間從入住外科加護病房後到出院期間的MRSA感染密度則從1.42 ‰ 降至0.24 ‰，以Logistic regression進行多變項分析調整其他干擾因子作用後，發現執行介入措施也是從入住外科加護病房後到出院期間發生MRSA感染的獨立保護因子 (adjusted OR: 0.3, 95% CI, 0.1-0.8)。 另外利用行政院衛生署統計室提供的死亡及重大傷病資料庫，追蹤第一階段及第二階段病人住外科加護病房後180天內死亡及新發重大傷病率情形，以Cox regression進行多變項分析調整其他干擾因子作用後，發現執行介入措施也是180天內死亡 (adjusted Hazard ratio [HR]: 0.4, 95% CI, 0.3 - 0.6) 及180天內死亡或出現新發重大傷病的獨立保護因子(adjusted HR: 0.4, 95% CI, 0.3 - 0.6)。 進行成本分析，發現有MRSA感染的病人住加護病房期間平均醫療費用約新台幣75萬元，比沒有MRSA感染的病人多出64萬元。介入期間共減少13個病人發生感染，經比較病人的醫療費用與介入成本，結果發現投資1元於介入措施可節省30元的醫療費用。 結論 本研究結果顯示在外科加護病房常規運用主動篩檢及去移生治療可以有效減少MRSA感染，另外也降低病人的死亡或出現新發重大傷病的風險及醫療費用。建議可將主動鼻腔篩檢措施納入常規加護病房感染管制政策，以維護病人安全，提升醫療服務品質。Background and aim: Methicillin-resistant Staphylococcus aureus (MRSA) is a one of the leading pathogens in healthcare-associated infections. Patients with healthcare-associated MRSA infections suffer increased mortality and morbidity, as well as prolonged hospital stays and extra medical costs. Strategies to prevent systemic S. aureus infections by eliminating nasal carriage of S. aureus have been proposed, as a substantial proportion of S. aureus bacteremia cases appear to be of endogenous origin from colonies in the nasal mucosa. A recent randomized controlled trial conclusively showed that active surveillance to identify asymptomatic MRSA carriers followed by MRSA eradication can effectively reduce surgical-site MRSA infection rates. Nevertheless, whether similar intervention strategies can also reduce MRSA infections in non-RCT daily practice remains unclear. This study aimed to evaluate the effectiveness of routine active surveillance culture followed by a mupirocin treatment of MRSA carriers in controlling healthcare–associated MRSA infections in surgical ICU patients. Methods: This retrospective cohort study was conducted in the surgical intensive care unit (SICU) of a tertiary care, university-affiliated teaching hospital in northern Taiwan. This hospital has a 702-bed capacity, with 18 beds (all single-bed rooms) in the SICU. The study was conducted from January 2007 through September 2010. The intervention consisted of active surveillance cultures from the anterior nares of all patients admitted to the SICU for the identification of asymptomatic MRSA carriers. When the nasal swab culture was positive for MRSA, the MRSA was eradicated by administration of mupirocin ointment to the nares three times a day for 5 days, and the skin was decolonized with 4% chlorhexidine gluconate once daily for 5 days. Contact precautions were also employed,” if this maintains the intended meaning. The study period was divided into four stages. The first period (from January to September 2007) was the baseline period, and no active intervention was conducted. Contact precautions, eradication and environmental disinfection before patient discharge were performed only when clinical cultures were positive for MRSA. Active intervention, which was supported by a research grant from the hospital, was initiated at the start of the second period, lasting from October 2007 through April 2008. The intervention was halted in the third period (from May 2008 through August 2009), due to a lack of research grants. The intervention was resumed in the fourth period (from September 2009 through September 2010) after a surge in the SICU MRSA infection rate in the third period prompted the hospital leadership to provide financial support for active MRSA interventions. We compared healthcare-associated MRSA infection rates between patients admitted during the intervention and non-intervention periods. We further surveyed the Department of Health Death registry database and the National Health Insurance database to obtain information on 1-year outcomes. All causes of 1-year mortality and severe morbidity rates in patients admitted during the intervention and non-intervention periods were analyzed. Severe morbidity was defined as the onset of permanent dialysis or ventilator dependence registered with a catastrophic illness card by the National Health Insurance. Results: During the study period, a total of 2373 patients were admitted to the SICU. The MRSA infection rate in the surgical ICU was 3.58‰ (period 1), 0.42‰ (period 2), 2.21‰ (period ), and 0.18‰ (period 4). Multiple logistic regression analysis showed that intervention is an independent protective factor for MRSA infection in ICUs (adjusted odds ratio [OR]: 0.1, 95% CI, 0.02-0.4), after adjusting for the effects of potential confounding factors. The in-hospital MRSA infection rates was 1.42‰ (period 1), 0.29‰ (period 2), 0.75‰ (period ), and 0.24‰ (period 4). Multiple logistic regression analysis showed that intervention is an independent protective factor for in-hospital MRSA infection (adjusted OR: 0.3, 95% CI, 0.1-0.8), after adjusting for the effects of potential confounding factors. The time to mortality or to the onset of severe morbidity in the patients admitted during periods 1 and 2 were analyzed by multiple Cox regression analysis, which showed that intervention is an independent protective factor for mortality or the onset of severe morbidity (adjusted hazard ratio [HR]: 0.4, 95% CI, 0.3-0.6), after adjusting for the effects of potential confounding factors. The median costs of SICU hospitalization for patients with healthcare-associated MRSA infections were NT $754,845, an excess of NT$640,000 in comparison with patients without healthcare-associated MRSA. The number of MRSA cases averted by the intervention was estimated to be 13 during the intervention period. For every dollar spent on interventions, $30 can be saved in medical costs. Conclusion: Our study results showed that routine active surveillance and MRSA eradication in the SICU can effectively reduce MRSA infection rates, mortality, and the onset of severe morbidity, as well as medical costs. We recommend routine active surveillance and eradication intervention in SICUs to increase patient safety and enhance the quality of medical services

Rhagophthalmus giallolateralus Ho, sp. nov.

Rhagophthalmus giallolateralus Ho sp. nov. (Fig. 4 B, 5 D, 5 E, 5 F, 6 C, 6 D, 7 C, 7 D, 8 C, 8 D, 9 A, 10 C, 10 D, 13) Type. Holotype, TAIWAN: Dongjyu, Lienchiang County, Taiwan, 1 male (bathed samples), 26 -IV- 2010, Jian-Hua Wang. (ESRI); Paratype: TAIWAN: Dongjyu, Lienchiang County, Taiwan, 2 males, 2 females, 23 -V- 2011, Hua-Te Fang. (ESRI). Holotype is deposited in ARI; four paratypes are deposited in NMNS and ESRI. Etymology. This species is named for its yellowish margin on the elytra. Giallo- means the color yellow and - lateralus means the lateral margin. Diagnosis. The enlarged flagellar segments 4–9 are similar to R. flavus which occurs in Malaysia and Thailand, but in R. flavus a lens-like sensillum adheres to each enlarged segment (Kawashima and Satô, 2001). In Matzu Archipelago, R. beigansis and R. giallolateralus can be simply distinguished from males in the elytra, and the genitalia. The elytra of R. giallolateralus have a yellow margin which is lacking in R. beigansis. Also, there are clear differences in the number of segments of the antennae and maxillary palps, and in the relative position and shape of the female labial palps. In R. beigansis the antennae are 5 -segmented, the maxillary palps are 4 segmented, and the labial palps (Fig. 9 A, 9 B) are slender and protrude beyond the anterior margin of the head. In R. giallolateralus the antennae are 8 -segmented, the maxillary palps are 5 segmented, and the labial palps are wider and shorter, almost not reaching the anterior head margin. Male. Body mostly dark brown, dorsal surface covered with light yellow pubescence. Head and pronotum shiny. Head capsule black; compound eyes blackish, extending to upper and lower area, concave dorsally; antennae brown; mandibles dark brown; maxillae dark brown; labium dark brown to brownish; pronotum dark brown; elytra dark brown, with obvious orange-yellowish or yellowish brown on each margin; ventral surface of thorax orangeyellowish; coxae and trochanters orange-yellow, femora mainly brown to dark brown, orange-yellow at base and apex, tibiae and tarsi dark brown; abdomen dark brown to blackish, with light yellow or white markings along posterior margin of segments. Body ovoid from above, blunt at front and thinnest behind, punctuation separated in dorsal view. Head wider than long, semi-circular, widest at basal margin, but narrower than the apical and basal width of pronotum, punctures separated and surrounding antenna and mouthparts; compound eyes meniscus-like in dorsallateral view, concave basally. Antennae 12 -segmented, 1.77 mm in length; scape short and thick; pedicel, similar to scape in shape; 1 st to 3 rd flagellar segments filiform, weakly broad posteriorly with length longer than scape and pedicel; 4 th to 9 th flagellar segments slightly serrate, length and shape are almost the same, lens-like sensillum located at antero-ventral side of 9 th flagellomere; 10 th flagellomere (terminal segment) spindle shaped, slender, and tapering at its apex. Pronotum transverse, semi-circular in dorsal view, anterior margin very broadly rounded with no distinct anterolateral corners and merging into the divergent lateral margins; right angles formed at the junction of lateral and basal margin, basal margin straight or weakly wavy, the widest part of pronotum, but a little narrower than humeral width of elytra; punctation separated, spread uniformly over surface; PW/HW 1.14, PW/PL 1.51, PW/PA 1.17, PW/EW 0.68, PW/EHW 0.83. Elytra elongate, contiguous along inner margin, outer margins slightly expanded; extending to, or slightly before abdominal apex; lateral margin straight and nearly parallel-sided, width contracting over apical 1 / 7; punctation separated, pubescence uniform over surface; EL/PL 5.37, EL/EW 2.40, EW/EHW 1.24. Legs slender; femur with lateral margin straight and parallel-sided; tibia slightly conical, thicker at apex than base; tarsi 5 -segmented, each segment clavate, with 2 claws apically, empodium or arolium not distinguished; HFL/HTL 0.96. Male genitalia 0.9 mm in length, trilobed without punctation and pubescence, basal plate large, covering the basal part of aedeagus and parameres in ventral view, basal margin arcuate and protruded towards base without angle, basal 1 / 2 of lateral margins dispersed, gradually separated towards apex, then subparalleled on apical 1 / 2; aedeagus shorter than parameres, bluntly cone-like, lateral margin arcuate, gradually converging towards bluntly rounded apex, grooves not apparent over surface; parameres dipper-like, apical parts protruding towards apex ventrally and surrounding the outer side of the aedeagus; basal margin narrow, forming an incisive arcuate-shape at the basal end, the outer lateral margin straight, converging rapidly towards inner side near apex, forming right angles at marginal junction, inner side straight in dorsal view, dark bands located at basal 1 / 2. Female. Larviform, 18.52 ± 1.64 mm (range: 16.32–20.44, n= 9) in length, 2.35 ± 0.17 mm (range: 2.18–2.72, n= 9) wide at basal margin of pronotum. Body yellowish or brownish. Head small, with small compound eyes. Antennae 8 -segmented, maxillary palp 5 -segmented, labial palp 3 -segmented. Labial palps are tightly shrunk. There are two sets of luminous organs. The first set is a large luminous organ on 7 th ventral abdominal segment and the second consists of three spot-like luminous organs on most segments. Two on both body sides extending from the mesothorax to the 9 th abdominal segment, and one dorsally from the middle of the mesothorax to the 8 th abdominal segment. Measurement in mm. BL: 10.99 (holotype) (range: 10.84–11.02); HW: 2.35 (range: 2.33–2.38); PL: 1.77 (range: 1.77–1.82); PA: 2.29 (range: 2.29–2.31); PB: 2.68 (2.68–2.99); PW: 2.68 (range: 2.68–2.74); EL: 9.51 (range: 9.51–10.17); EW: 3.97 (range: 3.91–3.97); EHW: 3.21 (range: 3.21–3.30); HFL: 2.12 (range: 2.11–2.15); HTL: 2.20 (range: 2.12–2.20). Distribution. TAIWAN: Dongjyu, Matzu Archipelago, Lienchiang County. Remark. The vegetation in habitats of R. giallolateralus consists of thick grass mainly, or of forests or lofty herbs, e.g. Miscanthus floridulus (Labill.). Adults occur in February to April, females are active between 6: 30 and 8:00 at night. The behavioral display, fecundity and characteristics of the eggs are similar to Rhagophthalmus beigansis. Discussion Rhagophthalmidae species have little capacity to migrate due to the wingless form of adult females, and it would be expected that isolated populations like the two described here would diverge significantly. Two Rhagophthalmus species addressed here were found in Beigan islet and Dongjyu islet separately. These islets are less than 40 km apart, but no population of these species was found in other neighboring islands. With virtually no capacity to migrate the species are totally dependent on the existing habitat of these islets and conservation of these fragile environments is thus very important. Habitat fragmentation and human activities have already been identified as the major stress to such island populations (Atkinson, 1989; Hess, 1990). Since the populations of these two Rhagophthalmus species were distributed in a somewhat fragmentary nature across the islands, further study could evaluate the habitat fragmentation. Wittmer and Ohba (1994) discovered R. ohbai in Iriomote island. Because of its distinctive distribution, ecological habitat, and biological features, the Ministry of the Environment, Japan designated R. ohbai as an emergency conservative species. The species was then investigated in a series of related studies (Ohba, 1997). The islets of Beijan and Dongjyu, are only 6.44 and 2.64 km 2 in area. Because of the instability and vulnerability in island ecology, and the dependence of Rhagophthalmus on the existing habitat, further investigation of the two Rhagophthalmus distributed in Matzu Archipelago is necessary with the aim of protecting the fragile environment. Few investigations thus far have focused on the behavior, habitat and breeding methods of Rhagophthalmidae (Ohba et al., 1996; Ohba, 1997, 2004). Male genitalia have to date presented the most useful characteristics for identification of Rhagophthalmus species (Wittmer & Ohba, 1994; Kawashima & Satô, 2001; Kawashima & Sugaya, 2003; Li et al., 2008). Males, being nocturnal and non-luminous are difficult to collect (Li et al., 2008). Increased awareness of the genus and its distribution and improved collection methods should hopefully address this situation.Published as part of Ho, Jen-Zon, Chen, Young-Fa, Cheng, Su-Han, Tsai, Xi-Lian & Yang, Ping-Shin, 2012, Two new species of Rhagophthalmus Motschulsky (Coleoptera: Rhagophthalmidae) from Matzu Archipelago, Taiwan with biological commentary, pp. 1-13 in Zootaxa 3274 on pages 9-13, DOI: 10.5281/zenodo.21479

Rhagophthalmus beigansis Ho, sp. nov.

&lt;i&gt;Rhagophthalmus beigansis&lt;/i&gt; Ho sp. nov. &lt;p&gt;(Figs 4 A, 5A, 5B, 5C, 6A, 6B, 7A, 7B, 8A, 8B, 9B, 10A, 10B, 11, 12, 13)&lt;/p&gt; &lt;p&gt; &lt;b&gt;Type.&lt;/b&gt; Holotype. Male. TAIWAN: Beigan, Lienchiang County, Taiwan, 29-IV-2011, Jing-Han Hu. (ARI). Paratypes: TAIWAN: Beigan, Lienchiang County, Taiwan, 4 males, 4 females, 8-V-2011, Hua-Te Fang. (ESRI, NMNS).&lt;/p&gt; &lt;p&gt; &lt;b&gt;Etymology.&lt;/b&gt; This species is named after Beigan islet where it was collected.&lt;/p&gt; &lt;p&gt; &lt;b&gt;Diagnosis.&lt;/b&gt; This new species is similar to &lt;i&gt;R&lt;/i&gt;. &lt;i&gt;ohbai&lt;/i&gt; but differs in the male genitalia, the female luminous organ and the appendage of the female head. In the male genitalia of &lt;i&gt;R. beigansis&lt;/i&gt;, the posterior basal piece is sharp and a space exists between the paramere and medial lobe; whereas in R. &lt;i&gt;ohbai&lt;/i&gt;, the posterior basal piece is cylindrical and the paramere is almost attached to the medial lobe. The female in &lt;i&gt;R. beigansis&lt;/i&gt; has three spot-like luminous organs, two on both sides of the body between the mesothorax and the 9th abdominal segment and one in the middle (dorsally) between them mesothorax and the 8th abdominal segments. This is significantly different from &lt;i&gt;R&lt;/i&gt;. &lt;i&gt;ohbai&lt;/i&gt; where the 9th abdominal segment has no luminous organs (Ohba &lt;i&gt;et al&lt;/i&gt;., 1996). In labial palps of &lt;i&gt;R. beigansis&lt;/i&gt; also protrudes more at the position of the base attachment than in &lt;i&gt;R&lt;/i&gt;. &lt;i&gt;ohbai&lt;/i&gt;. Finally the number segments of the antennal and maxillary palps in &lt;i&gt;R. beigansis&lt;/i&gt; are 5 and 4, but in &lt;i&gt;R&lt;/i&gt;. &lt;i&gt;ohbai&lt;/i&gt;, are 7 or 8 and 5.&lt;/p&gt; &lt;p&gt; &lt;b&gt;Male.&lt;/b&gt; Body mostly dark brown or black, moderately shiny, pubescence light yellow, covering almost all the dorsal surface. Head capsule black, not glossy; compound eyes blackish; antennae brown to orange-yellowish; mandibles dark brown; maxillae dark brown; labrum brownish; pronotum dark brown, darker in center of disk and paler brown towards the sides; elytra dark brown, paler brown towards the base; ventral thorax orange-yellowish or yellowish brown; coxae, trochanters, and femora of all legs orange-yellowish or yellowish brown; tibiae and tarsi brownish or dark brown; abdomen dark brown in anterior segments, then darker brown to blackish in the terminal segments, with orange-yellowish or yellowish brown posterior margins.&lt;/p&gt; &lt;p&gt;Body spindle or oval-shaped when viewed from above, tiny punctures scattered on the dorsal side of elytra.&lt;/p&gt; &lt;p&gt;Head longer than wide, width of posterior margin wider than the apical margin of pronotum, but slightly narrower than the basal width of pronotum, odontoid protrusions surrounding whole surface of head besides appendages, more clearly and more closely clustered around compound eyes.&lt;/p&gt; &lt;p&gt;Antennae 12 segmented, 1.68 mm (range: 1.37&ndash;1.68) long; scape cylindrical; barrel-shaped pedicel longer than scape in length; 1st flagellar segment longer than remaining segments, slightly clavate, broader towards the apex,; 2nd to 4th flagellar segments also slightly expanded towards their apices with flagellar segment 2 about half as long as 1, 3 and 4 subequal slightly shorter than 2, 5&ndash;8 more broadly expanded at their apices than preceding segments, approximately subequal in length and shorter than more basal segments; flagellar segment 9 weakly expanded to one side, (asymmetrically clavate) with a lens-like sensillum located at the antero-ventral side of the segment; 10th flagellar segment very narrow in apical half.&lt;/p&gt; &lt;p&gt;Pronotum approximately semi-circular from above, basal margin slightly less than the width across elytral humeri; apical margin protruding forwardly, broadly rounded and anterolateral corners are broadly rounded and obtuse; basal margin straight or slightly arcuate; posterolateral corners acute and pointed; separated odontoid protrudings spread all over the surface of pronotum, more densely aggregated over central disc, gradually reducing in number from center to edges; PW/HW 1.12, PW/PL 1.46, PW/PA 1.39, PW/EW 0.73, PW/EHW 0.95.&lt;/p&gt; &lt;p&gt;Elytra elongate slightly oval in outline, inner margins contiguous along their length and outer margins very slightly convex sided; contracting in apical 1/3 where the elytra are narrowest, discrete punctures and pubescence over surface of elytra; EL/PL 4.96, EL/EW 2.48, EW/EHW 1.30.&lt;/p&gt; &lt;p&gt;Legs slender, femur slightly enlarged at the middle; tibia straight, slightly thinner than femur; tarsus 5-segmented, pretarsus with 2 claws and no empodium or arolium obvious between the claws; HFL/HTL 0.95.&lt;/p&gt; &lt;p&gt;Male genitalia 0.95 mm long, trilobate, glabrous, with no punctures, odontoid protrusions and pubescence; basal plate large and well sclerotized, covering basal 1/2 of parameres when viewed from below, anterior margin blunt and round, slightly arcuate, lateral margins subparallel, with a broad straight vertical groove formed at the center of the apex; aedeagus subequal to parameres in length, tapering to a rounded apex; parameres with strongly developed apices inturning but not reaching to the aedeagus; clear dark banks at basal 1/3. Basal plate of male genitalia large and roughly straight in each margin, is a critical characteristic on identify.&lt;/p&gt; &lt;p&gt; &lt;b&gt;Female.&lt;/b&gt; Larviform, 17.26&plusmn; 2.97 mm (range: 10.48&ndash;23.41, n=27) in length, 2.05&plusmn; 0.30 mm (range: 1.44&ndash;2.97, n=27) wide across basal margin of pronotum. Body color yellowish or brownish. Head small, with small compound eyes. Antennae 5 segmented, maxillary palp 4 segmented, labial palp 3 segmented. Labial palps are protruding beyond the anterior head margin. There are two sets of luminous organs in female. The first set is a large luminous organ on 7th ventral abdominal segment and the second has three spot-like luminous organs on most segments. Each segment has three small spot-like luminous organs, two on both body sides from mesothorax to 9th abdominal segments and one on dorsal middle from mesothorax to 8th abdominal segments.&lt;/p&gt; &lt;p&gt; &lt;b&gt;Measurement in mm.&lt;/b&gt; BL: 8.86 (holotype)(range: 8.34&ndash;11.72); HW: 2.11 (range: 2.06&ndash;2.13); PL: 1.62 (range: 1.57&ndash;1.64); PA: 1.70 (range: 1.69&ndash;1.70); PB: 2.37 (2.37&ndash;2.37); PW: 2.37 (range: 1.2&ndash;2.69); EL: 8.04 (range: 8.00&ndash;8.11); EW: 3.24 (range: 3.20&ndash;3.25); EHW: 2.49 (range: 2.41&ndash;2.49); HFL: 1.81 (range: 1.79&ndash;1.86); HTL: 1.91 (range: 1.88&ndash;1.93).&lt;/p&gt; &lt;p&gt; &lt;b&gt;Distribution.&lt;/b&gt; TAIWAN: Beigan, Matzu Archipelago, Lienchiang County.&lt;/p&gt; &lt;p&gt; &lt;b&gt;Remarks.&lt;/b&gt; Individuals of &lt;i&gt;R. beigansis&lt;/i&gt; are nocturnal throughout their life cycle. The vegetation within the habitat is either thick grass or forest. Larvae prey on millipedes observed in the laboratory. Adults appeared in April to May, with the female displaying the luminous behavior between 7:00 to 8: 30 p. m. (Fig. 10). After mating, the female laid 101.4&plusmn;26.26 eggs (range: 68&ndash;151, n=10) that were 0.8&ndash;1.1mm in size, oval-shaped and yellow-white in color. In addition, eggs were attended (Fig. 11).&lt;/p&gt;Published as part of &lt;i&gt;Ho, Jen-Zon, Chen, Young-Fa, Cheng, Su-Han, Tsai, Xi-Lian &amp; Yang, Ping-Shin, 2012, Two new species of Rhagophthalmus Motschulsky (Coleoptera: Rhagophthalmidae) from Matzu Archipelago, Taiwan with biological commentary, pp. 1-13 in Zootaxa 3274&lt;/i&gt; on pages 4-9, DOI: &lt;a href="http://zenodo.org/record/214798"&gt;10.5281/zenodo.214798&lt;/a&gt

Factor analysis for the clustering of cardiometabolic risk factors and sedentary behavior, a cross-sectional study.

BackgroundFew studies have reported on the clustering pattern of CVD risk factors, including sedentary behavior, systemic inflammation, and cadiometabolic components in the general population.ObjectiveWe aimed to explore the clustering pattern of CVD risk factors using exploratory factor analysis to investigate the underlying relationships between various CVD risk factors.MethodsA total of 5606 subjects (3157 male, 51.5±11.7 y/o) were enrolled, and 14 cardiovascular risk factors were analyzed in an exploratory group (n = 3926) and a validation group (n = 1676), including sedentary behaviors.ResultsFive factor clusters were identified to explain 69.4% of the total variance, including adiposity (BMI, TG, HDL, UA, and HsCRP; 21.3%), lipids (total cholesterol and LDL-cholesterol; 14.0%), blood pressure (SBP and DBP; 13.3%), glucose (HbA1C, fasting glucose; 12.9%), and sedentary behavior (MET and sitting time; 8.0%). The inflammation biomarker HsCRP was clustered with only adiposity factors and not with other cardiometabolic risk factors, and the clustering pattern was verified in the validation group.ConclusionThis study confirmed the clustering structure of cardiometabolic risk factors in the general population, including sedentary behavior. HsCRP was clustered with adiposity factors, while physical inactivity and sedentary behavior were clustered with each other