Implications of H.E.S.S. observations of pulsar wind nebulae

In this review paper on pulsar wind nebulae (PWN) we discuss the properties of such nebulae within the context of containment against cross-field diffusion (versus normal advection), the effect of reverse shocks on the evolution of offset ``Vela-like'' PWN, constraints on maximum particle energetics, magnetic field strength estimates based on spectral and spatial properties, and the implication of such field estimates on the composition of the wind. A significant part of the discussion is based on the High Energy Stereoscopic System ({\it H.E.S.S.} or {\it HESS}) detection of the two evolved pulsar wind nebulae Vela X (cocoon) and HESS J1825-137. In the case of Vela X (cocoon) we also review evidence of a hadronic versus a leptonic interpretation, showing that a leptonic interpretation is favored for the {\it HESS} signal. The constraints discussed in this review paper sets a general framework for the interpretation of a number of offset, filled-center nebulae seen by {\it HESS}. These sources are found along the galactic plane with galactic latitudes $|b|\sim 0$, where significant amounts of molecular gas is found. In these regions, we find that the interstellar medium is inhomogeneous, which has an effect on the morphology of supernova shock expansion. One consequence of this effect is the formation of offset pulsar wind nebulae as observed.Comment: to appear in Springer Lecture Notes on Neutron Stars and Pulsars: 40 years after their discovery, eds. W. Becke

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