Ischaemic stroke, haemorrhage and mortality in elderly patients with chronic kidney disease newly started on anticoagulation for atrial fibrillation: a population-based study from UK primary care

Objective To assess the association between anticoagulation, ischaemic stroke, gastrointestinal and cerebral haemorrhage, and all cause mortality in older people with atrial fibrillation and chronic kidney disease. Design Propensity matched, population based, retrospective cohort analysis from January 2006 through December 2016. Setting The Royal College of General Practitioners Research and Surveillance Centre database population of almost 2.73 million patients from 110 general practices across England and Wales. Participants Patients aged 65 years and over with a new diagnosis of atrial fibrillation and estimated glomerular filtration rate (eGFR) of <50 mL/min/1.73m2, calculated using the chronic kidney disease epidemiology collaboration creatinine equation. Patients with a previous diagnosis of atrial fibrillation or receiving anticoagulation in the preceding 120 days were excluded, as were patients requiring dialysis and recipients of renal transplants. Intervention Receipt of an anticoagulant prescription within 60 days of atrial fibrillation diagnosis. Main outcome measures Ischaemic stroke, cerebral or gastrointestinal haemorrhage, and all cause mortality. Results 6977 patients with chronic kidney disease and newly diagnosed atrial fibrillation were identified, of whom 2434 were on anticoagulants within 60 days of diagnosis and 4543 were not. 2434 pairs were matched using propensity scores by exposure to anticoagulant or none and followed for a median of 506 days. The crude rates for ischaemic stroke and haemorrhage were 4.6 and 1.2 after taking anticoagulants and 1.5 and 0.4 in patients who were not taking anticoagulant per 100 person years, respectively. The hazard ratios for ischaemic stroke, haemorrhage, and all cause mortality for those on anticoagulants were 2.60 (95% confidence interval 2.00 to 3.38), 2.42 (1.44 to 4.05), and 0.82 (0.74 to 0.91) compared with those who received no anticoagulation. Conclusion Giving anticoagulants to older people with concomitant atrial fibrillation and chronic kidney disease was associated with an increased rate of ischaemic stroke and haemorrhage but a paradoxical lowered rate of all cause mortality. Careful consideration should be given before starting anticoagulants in older people with chronic kidney disease who develop atrial fibrillation. There remains an urgent need for adequately powered randomised trials in this population to explore these findings and to provide clarity on correct clinical management

1937: Abilene Christian College Bible Lectures - Full Text

Delivered in the auditorium of Abilene Christian College, Abilene, Texas, February 193

Towards a New Paradigm for Intuitive Theatrical Lighting Control

A simplified model of a lighting process applied in theatrical productions is one that involves two key players. The first is that of the lighting designer, to produce a set of intentions and plans for the scenes that define the show. The second, the lighting technician, has the job of translating these designs into practice using control equipment, luminaires, and other technical instruments. The lighting design often becomes a ‘working document’ subject to change and adaptation as the physical reality of the design becomes apparent, and the input of other stakeholders is considered. This process can be a valuable creative tool, and also a difficult technical hurdle to overcome, depending on a varied number of factors. A common frustration with this process is that either the complexity of the task, or difficulty in communication can make it difficult for the final creative vision to be effectively realised. Strains may also arise in the case of small, often touring, theatre companies where the lighting designer and technician may be the same person, and frequently one of the performers as well. Considering the design aspect, there can be challenges in ensuring efficacy of lighting plans between venues in touring productions, with 2D lighting sketches or even 3D computer simulations confined to the paper or screen. From a technical perspective, the role of the lighting technician in theatres and performance situations has included the operation of lighting control equipment during shows. The equipment has evolved over time but has, until recently, been grounded upon the basis of faders and the mixing desk. It is argued that this paradigm has failed to keep pace with the change in other interactive technologies. The on-going research described in this paper explores existing and upcoming technologies in the field, whilst also seeking to understand the roles and communication workflows of those involved in theatrical lighting to find the best areas to seek improvement, adopting principles of user-centred design. The intention of this research is to develop a new paradigm, and manifestation of it, using a control method for lighting or projection that allows a more intuitive form of operation in theatre productions, which will be scalable and flexible

University of Saskatchewan Radiocarbon Dates VIII

This material was digitized as part of a cooperative project between Radiocarbon and the University of Arizona Libraries.The Radiocarbon archives are made available by Radiocarbon and the University of Arizona Libraries. Contact [email protected] for further information.Migrated from OJS platform February 202

Geological Survey of Canada Radiocarbon Dates X

This material was digitized as part of a cooperative project between Radiocarbon and the University of Arizona Libraries.The Radiocarbon archives are made available by Radiocarbon and the University of Arizona Libraries. Contact [email protected] for further information.Migrated from OJS platform February 202

Geological Survey of Canada Radiocarbon Dates VIII

This material was digitized as part of a cooperative project between Radiocarbon and the University of Arizona Libraries.The Radiocarbon archives are made available by Radiocarbon and the University of Arizona Libraries. Contact [email protected] for further information.Migrated from OJS platform February 202

Evidence for benthic oxygen production in Neoarchean lacustrine stromatolites

The evolution of oxygenic photosynthesis fundamentally altered the global environment, but the history of this metabolism prior to the Great Oxidation Event (GOE) at ca. 2.4 Ga remains unclear. Increasing evidence suggests that non-marine microbial mats served as localized ¡°oxygen oases¡± for hundreds of millions of years before the GOE, though direct examination of redox proxies in Archean lacustrine microbial deposits remains relatively limited. We report spatially distinct patterns of positive and negative cerium (Ce) anomalies in lacustrine stromatolites from the 2.74 Ga Ventersdorp Supergroup (Hartbeesfontein Basin, South Africa), which indicate that dynamic redox conditions within ancient microbial communities were driven by oxygenic photosynthesis. Petrographic analyses and rare earth element signatures support a primary origin for Ce anomalies in stromatolite oxides. Oxides surrounding former bubbles entrained in mats (preserved as fenestrae) exhibit positive Ce anomalies, while oxides in stromatolite laminae typically contain strong negative Ce anomalies. The spatial patterns of Ce anomalies in Ventersdorp stromatolites are most parsimoniously explained by localized Ce oxidation and scavenging around oxygen bubbles produced by photosynthesis in microbial mats. Our new data from Ventersdorp stromatolites supports the presence of oxygenic photosynthesis ¡«300 m.y. before the GOE, and add to the growing evidence for early oxygen oases in Archean non-marine deposit

SSU rRNA Gene Analysis of the Environmental and Biological Influences on Carbonate Precipitation within Hot Spring Microbial Mats in Little Hot Creek, CA

<p>R Markdown notebook and all data required to recreate the 16S rRNA Gene analysis figures found in Wilmeth et. al (In Submission), including mapping files, BIOM files, and R markdown notebook. </p