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

Biogeography of the Tropical Pacific

Many previous biogeographic regionalizations of the islands and reefs of the tropical Pacific are unsatisfactory: the regions as defined are heterogeneous, localities with unlike biotas are grouped together, and those with similar characteristics are placed in separate categories. Often distinctions appear to be based on cultural or political rather than biogeographic considerations. Criteria are defined for the establishment of biogeographic boundaries. Instead of the hierarchical schemes often utilized, it is proposed that the basis of biogeographic regionalization be typological. A distinction is made between the biogeographic characteristics of atolls and other reef islands, elevated limestone (makatea) islands, and high (often volcanic) islands. It is concluded that if the first two categories are filtered out, the treatment of the biogeography of the third group and hence the regionalization of the Pacific becomes relatively unproblematical

Modelling approaches for coastal simulation based on cellular automata: the need and potential

The paper summarizes the theoretical and practical needs for cellular automata (CA)-type models in coastal simulation, and describes early steps in the development of a CA-based model for estuarine sedimentation. It describes the key approaches and formulae used for tidal, wave and sediment processes in a prototype integrated cellular model for coastal simulation designed to simulate estuary sedimentary responses during the tidal cycle in the short-term and climate driven changes in sea-level in the long-term. Results of simple model testing for both one-dimensional and two-dimensional models, and a preliminary parameterization for the Blackwater Estuary, UK, are shown. These reveal a good degree of success in using a CA-type model for water and sediment transport as a function of water level and wave height, but tidal current vectors are not effectively simulated in the approach used. The research confirms that a CA-type model for the estuarine sediment system is feasible, with a real prospect for coupling to existing catchment and nearshore beach/cliff models to produce integrated coastal simulators of sediment response to climate.. sea-level change and human actions