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

Care of dying patients in hospital Palliative care teams have helped.

EDITOR, - It is disappointing that Mina Mills and colleagues make no comment in their paper on the care of dying patients in hospital about changes that may have led to improvements in the past decade.1 Their study showed a lack of nursing care for dying patients, but whether this poor standard of care was applied to all patients admitted to hospitals in the study is not clear. For example, what was the standard of care for patients with stroke or other chronic disability? A similar study performed 10 years after the original would have been useful in showing any improvements or otherwise in practice. Nursing care may still be a problem, but perhaps this reflects general attitudes and staffing levels rather than a specific failure to address the needs of dying patients

A 7400-year tree-ring chronology in northern Swedish Lapland: Natural climatic variability expressed on annual to millennial timescales

Tree-ring widths from 880 living, dry dead, and subfossil northern Swedish pines (Pinus sylvestris L.) have been assembled into a continuous and precisely dated chronology (the Tornetrask chronology) covering the period 5407 BC to AD 1997. Biological trends in the data were removed with autoregressive standardization (ARS) to emphasize year-to-year variability, and with regional curve standardization (RCS) to emphasize variability on timescales from decades to centuries. The strong association with summer mean temperature (June-August) has enabled the production of a temperature reconstruction for the last 7400 years, providing information on natural summer-temperature variability on timescales from years to centuries. Numerous cold episodes, comparable in severity and duration to the severe summers of the seventeenth century, are shown throughout the last seven millennia. Particularly severe conditions suggested between 600 and 1 BC correspond to a known period of glacier expansion, The relatively warm conditions of the late twentieth century do not exceed those reconstructed for several earlier time intervals, although replication is relatively poor and confidence in the reconstructions is correspondingly reduced in the pre-Christian period, particularly around 3000, 1600 and 330 BC. Despite the use of the RCS approach in chronology construction, the 7400-year chronology does not express the full range of millennial-timescale temperature change in northern Sweden

Microzooplankton along a transect from northern continental Norway to Svalbard

In the framework of the Italian International Polar Year project entitled Evolution of a Glacial Arctic Continental Margin: the Southern Svalbard Ice Stream-dominated Sedimentary System, a study was carried out on microzooplankton distribution and biomass along a south-to-north transect extending from northern Norway to the Svalbard Archipelago, from 65&#x00B0; to 78&#x00B0;N. Tintinnids, heterotrophic dinoflagellates, aloricate cilates and micrometazoans were the main groups observed in the samples collected at 17 surface stations from 9 to 13 July 2008. Total microzooplankton abundance ranged from 17 to 438 ind l&#x2212;1. Tintinnids and heterotrophic dinoflagellates were the most abundant organisms, ranging from 1.5 to 292.5 ind l&#x2212;1 and from 0 to 232 ind l&#x2212;1, respectively. Micrometazoans (mainly copepod nauplii) reached a maximum of 45.5 ind l&#x2212;1, whereas aloricate ciliates were scarce at all stations. Microzooplankton carbon content ranged from 0.87 to 5.18 &#x00B5;g C l&#x2212;1. In particular, tintinnids and micrometazoans made up the largest part of the microzooplankton biomass. Parafavella denticulata, Parafavella gigantea, Acanthostomella norvegica and Ptychocylis obtusa were the most common species among tintinnids, whereas Leprotintinnus pellucidus was recorded in only one station close to Svalbard. Protoperidinium was the most representative genus among heterotrophic dinoflagellates. The community of naked ciliates was dominated by Strombidiidae and Holotrichia. A clearly increasing gradient in both abundance and number of taxa was observed from south to north, with the temperature decreasing from 13.3 to 2.5&#x00B0;C