Long-term risk of adverse outcomes according to atrial fibrillation type.

Sustained forms of atrial fibrillation (AF) may be associated with a higher risk of adverse outcomes, but few if any long-term studies took into account changes of AF type and co-morbidities over time. We prospectively followed 3843 AF patients and collected information on AF type and co-morbidities during yearly follow-ups. The primary outcome was a composite of stroke or systemic embolism (SE). Secondary outcomes included myocardial infarction, hospitalization for congestive heart failure (CHF), bleeding and all-cause mortality. Multivariable adjusted Cox proportional hazards models with time-varying covariates were used to compare hazard ratios (HR) according to AF type. At baseline 1895 (49%), 1046 (27%) and 902 (24%) patients had paroxysmal, persistent and permanent AF and 3234 (84%) were anticoagulated. After a median (IQR) follow-up of 3.0 (1.9; 4.2) years, the incidence of stroke/SE was 1.0 per 100 patient-years. The incidence of myocardial infarction, CHF, bleeding and all-cause mortality was 0.7, 3.0, 2.9 and 2.7 per 100 patient-years, respectively. The multivariable adjusted (a) HRs (95% confidence interval) for stroke/SE were 1.13 (0.69; 1.85) and 1.27 (0.83; 1.95) for time-updated persistent and permanent AF, respectively. The corresponding aHRs were 1.23 (0.89, 1.69) and 1.45 (1.12; 1.87) for all-cause mortality, 1.34 (1.00; 1.80) and 1.30 (1.01; 1.67) for CHF, 0.91 (0.48; 1.72) and 0.95 (0.56; 1.59) for myocardial infarction, and 0.89 (0.70; 1.14) and 1.00 (0.81; 1.24) for bleeding. In this large prospective cohort of AF patients, time-updated AF type was not associated with incident stroke/SE

Negotiating By Own Standards? The Use and Validity of Human Rights Norms in UN Climate Negotiations

Since its inception, the UN Framework Convention on Climate Change has been inclined to natural scientific and technocratic perceptions of climate change challenges and policy solutions. Furthermore, states have traditionally been depicted as the main subjects of international climate politics. Only in 2010, concrete references to human rights were incorporated into UN climate agreements. This has a double binding force: First, states thereby re-emphasize the principal validity of those standards that they have acknowledged—qua signature and/or ratification—as guiding their actions: the social and political rights that are captured in the Universal Declaration of Human Rights and the two binding human rights covenants. Second, the incorporation of human rights norms into UN climate agreements officially and formally broadens the normative scope of negotiating and implementing these policies. However, after 2010, states have neither substantiated this engagement nor further built on it argumentatively. In contrast, human rights references are—again—mostly absent from states’ positioning in UNFCCC politics. In this article, we aim at explaining this empirical puzzle. In the first part, we elaborate our theoretical approach and carve out the functional, political and legal linkages between human rights and climate politics. Building upon participatory observation, expert interviews and analysis of primary and secondary documents, this will then be followed by explaining parties’ anew reluctance to further apply a human rights-based approach in climate politics