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

A BIM-based collaborative design platform for variegated specialty design

With the increase in complexity of engineering projects and design quality in the construction industry, the traditional two-dimensional "Information Island" approach to design is becoming less able to meet current design needs due to its lack of coordination and information sharing. Collaborative design using a Build Information Modeling (BIM) technology platform promises to provide an effective means of designing and communicating through networking and real-time data sharing. This paper first analyzes the shortcomings of the two-dimensional design process and the potential application of collaborative design. By combining the attributes of BIM, a preliminary BIM-based building design collaborative platform is developed to improve the design approach and support a more collaborative design process. A real-life case is presented to demonstrate the feasibility and validity of the platform and its use in practice. From this, it is shown that BIM has the potential to realize effective information sharing and reduce errors, thereby improving design quality. The BIM-based building design collaborative platform presented is expected to provide the support needed for the extensive application of BIM in collaborative design and promote a new attitude to project management

Preparation of Tl-Ba-Ca-Cu-O thin films by diffusion of Tl into laser evaporated Ba2Ca2Cu3Ox films

Preparation of superconducting Tl-Ba-Ca-Cu-O thin films by diffusion of Tl into laser evaporated Ba2Ca2Cu3Ox thin films is reported. From a sintered Ba2Ca2Cu3Ox bulk sample we prepared using a pulsed Nd:YAG laser, Ba-Ca-Cu-O thin films on sapphire and SrTiO3 single-crystal substrates. Subsequently the films were loaded with Tl by simultaneously annealing the films together with a sintered Tl2Ba2Ca2Cu3O10 sample both enclosed in a small stainless steel box; in our procedure Tl contamination was reduced to a minimum. Tc values near 100 K and critical currents of 5·103 A/cm2 at 77 K were obtained

Diurnal Blood Pressure Rhythmicity in Relation to Environmental and Genetic Cues in Untreated Referred Patients

No previous study has addressed the relative contributions of environmental and genetic cues to the diurnal blood pressure rhythmicity. From 24-hour ambulatory recordings of systolic blood pressure obtained in untreated patients (51% women; mean age, 51 years), we computed the night-to-day ratio in 897 and morning surge in 637. Environmental cues included season, mean daily outdoor temperature, atmospheric pressure, humidity and weekday, and the genetic cues 14 single nucleotide polymorphisms in 10 clock genes. Systolic blood pressure averaged (+/- SD) 126.7 +/- 11.9 mmHg, night-to-day ratio 0.86 +/- 0.07, and morning surge 24.8 +/- 10.7 mmHg. In adjusted analyses, night-to-day ratio was 2.4% higher in summer and 1.8% lower in winter (P&lt;0.001) compared with the annual average with a small effect of temperature (P=0.079); morning surge was 1.7 mmHg lower in summer and 1.1 mmHg higher in winter (P&lt;0.001). The other environmental cues did not add to the night-to-day ratio or morning surge variance (P0.37). Among the 14 genetic variations, only CLOCK rs180260 was significantly associated with morning surge after adjustment for season, temperature, and other host factors and after Bonferroni correction (P=0.044). In CLOCK rs1801260 C allele carriers (n=83), morning surge was 3.7 mmHg higher than in TT homozygotes (n=554). Of the night-to-day ratio and morning surge variance, season and temperature explained approximate to 8% and approximate to 3%, while for genetic cues, these proportions were approximate to 1% or less. In conclusion, environmental compared with genetic cues are substantially stronger drivers of the diurnal blood pressure rhythmicity

Development and Application of a Next Generation Air Sensor Network for the Hong Kong Marathon 2015 Air Quality Monitoring

This study presents the development and evaluation of a next generation air monitoring system with both laboratory and field tests. A multi-parameter algorithm was used to correct for the impact of environmental conditions on the electrochemical sensors for carbon monoxide (CO) and nitrogen dioxide (NO2) pollutants. The field evaluation in an urban roadside environment in comparison to designated monitors showed good agreement with measurement error within 5% of the pollutant concentrations. Multiple sets of the developed system were then deployed in the Hong Kong Marathon 2015 forming a sensor-based network along the marathon route. Real-time air pollution concentration data were wirelessly transmitted and the Air Quality Health Index (AQHI) for the Green Marathon was calculated, which were broadcast to the public on an hourly basis. The route-specific sensor network showed somewhat different pollutant patterns than routine air monitoring, indicating the immediate impact of traffic control during the marathon on the roadside air quality. The study is one of the first applications of a next generation sensor network in international sport events, and it demonstrated the usefulness of the emerging sensor-based air monitoring technology in rapid network deployment to supplement existing air monitoring