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

The Future Landscape of High-Redshift Galaxy Cluster Science

Large scale structure and cosmolog

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Technology development of 3-D GaAs radiation detectors

A novel type of GaAs radiation detector featuring a three-dimensional array of electrodes that penetrate through the detector bulk and the fabrication technology required are described. Using a pulsed Nd: YAG laser we have obtained repeatable round holes of 30 μm diameter with little or no taper and smooth internal walls. With a pulsed Ti: Sapphire laser we have obtained repeatable holes of 100 μm diameter with coarse internal walls. Drilling damage to the substrate is discussed along with possible prevention steps and post-drilling treatment

Health assessment of converter transformer pressboard insulation based on FDS and digital image processing

The stable operation of the converter transformer is an essential task for power system operation reliability and security. Nowadays, Frequency domain spectroscopy (FDS) technology is prominently utilized for assessing oil-impregnated pressboard insulation. The present study examines the effect of the pressboard insulation material as a function of frequency and elevated temperature. The experimental analysis on oil-impregnated pressboard insulation is carried out at temperatures from 30 °C to 130 °C with an incremental rise of 20 °C intervals with frequency variation from 1 Hz to 10 MHz. The frequency-dependent permittivity, conductivity and loss tangent angle studies also confirm the deterioration of oil-impregnated pressboard insulation. The surface morphological changes inside the pressboard insulation are recorded with the help of scanning electron microscopy (SEM). The synergistic effect generated on pressboard insulation is examined by fiber width changeand image processing approach by randomly selecting the average of three local areas of SEM image. A canny operator is selected to extract the exact boundaries of images and more change is recorded in the edge detection count after 90 °C.The porosity and pore size distribution can be increased with elevated temperatures. A single-phase, 315 MVA valve side star winding with 60 discs of single-phase converter transformers model is developed in MATLAB Simulink. An impulse of 100 kV, 1.2/50μsec is applied across the star winding to identify the pressboard insulation degradation derived from FDS data with the help of mathematical morphology and wavelet transform technique. The energy of the wavelet coefficient on the neutral current capture during the impulse test adds a significant contribution to analyzing pressboard insulation degradation. The results presented are in good agreement with the published work

Solvers for Nonlinear Algebraic Equations: Where Are We Today?

The aim of this paper is to summarize the state-of-the-art in solving systems of nonlinear algebraic equations. We are interested in two aspects of the problem. First, the existing solvers and their robustness. Second, the existing test-problem libraries and their adequacy. We explore both issues from the engineering-oriented perspective (e.g. by approaching the solvers as black-box software). Experimental data illustrating our main points is presented and discussed