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

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities 1,2 . This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity 3�6 . Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55 of the global rise in mean BMI from 1985 to 2017�and more than 80 in some low- and middle-income regions�was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing�and in some countries reversal�of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories. © 2019, The Author(s)

Ammonia deposition near hot spots: Process, models and monitoring methods

Atmospheric reduced nitrogen (NHx) mainly originates from hot spots, which can be considered as intensive area or point sources. A large fraction of the emitted NHx may be recaptured by the surrounding vegetation, hence reducing the contribution of these hot spots to long-range transport of NHx. This paper reviews the processes leading to local recapture of NHx near hot spots, as well as existing models and monitoring methods. The existing models range from research models to more operational models that can be coupled with long-range transport model provided the necessary information on emissions is available. Local recapture of NH3 ranges from 2% to 60% within 2 km of a hot-spot and it is sensitive to source height atmospheric stability, wind speed, structure of the surrounding canopies, as well as stomatal absorpton, which mainly depends on green leaf area index and stomatal NH3 compensation point of vegetation, and finally, cuticular deposition, which depends primarily on vegetation wetness. The main uncertainties and limitations on NHx recapture models and monitoring techniques are discussed. Due to the decrease of sulphur and nitrogen oxides emissions under a series of UNECE protocols, reduced nitrogen (NHx), has become the dominant pollutant in Western Europe contributing to acidification of ecosystems (e.g. Vestreng and Storen 2000). At the global scale NHx and NOx emissions are comparable, although large uncertainties exist on NHx emissions (Dentener and Crutzen 1994; Bouwman et al. 1997). Moreover, NHx deposition, with other nitrogen (N) deposition, leads to eutrophication and changes in the biodiversity of semi-natural ecosystems (Van Breemen and van Dijk 1988; Roelofs et al. 1985; Fangmeier et al. 1994; Krupa 2003; EEA 2003). Although atmospheric ammonia (NH3) is not a greenhouse gas (GHG), deposition of NHx may lead to increased GHG emissions (N2O) (Melillo et al. 1989) or reduced consumpton of CH4. Additionally, ammonium sulphate aerosols (NH4)2SO4, contribute to half of the negative radiatve forcing of the atmosphere due to aerosols (Houghton et al. 2001; Adams et al. 2001), as well as contriuting to impacts of secondary aerosol on human health

Critical loads of nitrogen deposition and critical levels of atmospheric ammonia for semi-natural Mediterranean evergreen woodlands

Nitrogen (N) has emerged in recent years as a key factor associated with global changes, with impacts on biodiversity, ecosystems functioning and human health. In order to ameliorate the effects of excessive N, safety thresholds such as critical loads (deposition fluxes) and levels (concentrations) can be established. Few studies have assessed these thresholds for semi-natural Mediterranean ecosystems. Our objective was therefore to determine the critical loads of N deposition and long-term critical levels of atmospheric ammonia for semi-natural Mediterranean evergreen woodlands. We have considered changes in epiphytic lichen communities, one of the most sensitive comunity indicators of excessive N in the atmosphere. Based on a classification of lichen species according to their tolerance to N we grouped species into response functional groups, which we used as a tool to determine the critical loads and levels. This was done for a Mediterranean climate in evergreen cork-oak woodlands, based on the relation between lichen functional diversity and modelled N deposition for critical loads and measured annual atmospheric ammonia concentrations for critical levels, evaluated downwind from a reduced N source (a cattle barn). Modelling the highly significant relationship between lichen functional groups and annual atmospheric ammonia concentration showed the critical level to be below 1.9 μg m−3, in agreement with recent studies for other ecosystems. Modelling the highly significant relationship between lichen functional groups and N deposition showed that the critical load was lower than 26 kg (N) ha−1 yr−1, which is within the upper range established for other semi-natural ecosystems. Taking into account the high sensitivity of lichen communities to excessive N, these values should aid development of policies to protect Mediterranean woodlands from the initial effects of excessive N

SNIFFER UKPIR15 Atmospheric Deposition Model for Screening Combustion Sources Against Habitat Impacts- Final Report

SCAIL-Combustion has been developed to provide estimates of potential environmental impacts from SO2 and NOx emissions on nearby conservation sites, from which a decision could be made whether complex dispersion and deposition modelling is needed. This report summarises the development of the screening model. THe model may be found at http://www.scail.ceh.ac.uk

Assessment methods for ammonia hot-spots

To date, most attention in modelling NH3 dispersion and deposition has focused on the regional and Euopean scale, and little attention has been given to dealing with NH3 in hot-spot areas. The Working Group addressed the issue of hot-spots with four main objectives: *Identify what are the main issues of hot-spots and their consequences at different scales. *Review current modelling methods for accounting for NH3 dispersion and deposition in hot-spots. *Examine the status of methods for effect assessment and air monitoring in NH3 hot-spots. *Recommend broad principles for assessment approaches in ammonia hot-spots, including spatial approaches and the interactions between transboundary ammonia emission reduction targets and other policy measures

Farm nitrogen balances in six European landscapes as an indicator for nitrogen losses and basis for improved management

Improved management of nitrogen (N) in agriculture is necessary to achieve a sustainable balance between the production of food and other biomass, and the unwanted effects of N on water pollution, greenhouse gas emissions, biodiversity deterioration and human health. To analyse farm N-losses and the complex interactions within farming systems, efficient methods for identifying emissions hotspots and evaluating mitigation measures are therefore needed. The present paper aims to fill this gap at the farm and landscape scales. Six agricultural landscapes in Poland (PL), the Netherlands (NL), France (FR), Italy (IT), Scotland (UK) and Denmark (DK) were studied, and a common method was developed for undertaking farm inventories and the derivation of farm N balances, N surpluses and for evaluating uncertainty for the 222 farms and 11 440 ha of farmland included in the study. In all landscapes, a large variation in the farm N surplus was found, and thereby a large potential for reductions. The highest average N surpluses were found in the most livestock-intensive landscapes of IT, FR, and NL; on average 202±28, 179±63 and 178±20 kg N ha−1 yr−1, respectively. All landscapes showed hotspots, especially from livestock farms, including a special UK case with large-scale landless poultry farming. Overall, the average N surplus from the land-based UK farms dominated by extensive sheep and cattle grazing was only 31±10 kg N ha−1 yr−1, but was similar to the N surplus of PL and DK (122±20 and 146±55 kg N ha−1 yr−1, respectively) when landless poultry farming was included. We found farm N balances to be a useful indicator for N losses and the potential for improving N management. Significant correlations to N surplus were found, both with ammonia air concentrations and nitrate concentrations in soils and groundwater, measured during the period of N management data collection in the landscapes from 2007–2009. This indicates that farm N surpluses may be used as an independent dataset for validation of measured and modelled N emissions in agricultural landscapes. No significant correlation was found with N measured in surface waters, probably because of spatial and temporal variations in groundwater buffering and biogeochemical reactions affecting N flows from farm to surface waters. A case study of the development in N surplus from the landscape in DK from 1998–2008 showed a 22% reduction related to measures targeted at N emissions from livestock farms. Based on the large differences in N surplus between average N management farms and the most modern and Nefficient farms, it was concluded that additional N-surplus reductions of 25–50 %, as compared to the present level, were realistic in all landscapes. The implemented N-surplus method was thus effective for comparing and synthesizing results on farm N emissions and the potentials of mitigation options. It is recommended for use in combination with other methods for the assessment of landscape N emissions and farm N efficiency, including more detailed N source and N sink hotspot mapping, measurements and modelling

Remote sensing of LAI, chlorophyll and leaf nitrogen pools of crop- and grasslands in five European landscapes

Leaf nitrogen and leaf surface area influence the exchange of gases between terrestrial ecosystems and the atmosphere, and play a significant role in the global cycles of carbon, nitrogen and water. The purpose of this study is to use field-based and satellite remote-sensing-based methods to assess leaf nitrogen pools in five diverse European agricultural landscapes located in Denmark, Scotland (United Kingdom), Poland, the Netherlands and Italy. REGFLEC (REGularized canopy reFLECtance) is an advanced image-based inverse canopy radiative transfer modelling system which has shown proficiency for regional mapping of leaf area index (LAI) and leaf chlorophyll (CHLl) using remote sensing data. In this study, high spatial resolution (10–20 m) remote sensing images acquired from the multispectral sensors aboard the SPOT (Satellite For Observation of Earth) satellites were used to assess the capability of REGFLEC for mapping spatial variations in LAI, CHLland the relation to leaf nitrogen (Nl) data in five diverse European agricultural landscapes. REGFLEC is based on physical laws and includes an automatic model parameterization scheme which makes the tool independent of field data for model calibration. In this study, REGFLEC performance was evaluated using LAI measurements and non-destructive measurements (using a SPAD meter) of leaf-scale CHLl and Nl concentrations in 93 fields representing crop- and grasslands of the five landscapes. Furthermore, empirical relationships between field measurements (LAI, CHLl and Nl and five spectral vegetation indices (the Normalized Difference Vegetation Index, the Simple Ratio, the Enhanced Vegetation Index-2, the Green Normalized Difference Vegetation Index, and the green chlorophyll index) were used to assess field data coherence and to serve as a comparison basis for assessing REGFLEC model performance. The field measurements showed strong vertical CHLl gradient profiles in 26% of fields which affected REGFLEC performance as well as the relationships between spectral vegetation indices (SVIs) and field measurements. When the range of surface types increased, the REGFLEC results were in better agreement with field data than the empirical SVI regression models. Selecting only homogeneous canopies with uniform CHLl distributions as reference data for evaluation, REGFLEC was able to explain 69% of LAI observations (rmse = 0.76), 46% of measured canopy chlorophyll contents (rmse = 719 mg m−2) and 51% of measured canopy nitrogen contents (rmse = 2.7 g m−2). Better results were obtained for individual landscapes, except for Italy, where REGFLEC performed poorly due to a lack of dense vegetation canopies at the time of satellite recording. Presence of vegetation is needed to parameterize the REGFLEC model. Combining REGFLEC- and SVI-based model results to minimize errors for a "snap-shot" assessment of total leaf nitrogen pools in the five landscapes, results varied from 0.6 to 4.0 t km−2. Differences in leaf nitrogen pools between landscapes are attributed to seasonal variations, extents of agricultural area, species variations, and spatial variations in nutrient availability. In order to facilitate a substantial assessment of variations in Nl pools and their relation to landscape based nitrogen and carbon cycling processes, time series of satellite data are needed. The upcoming Sentinel-2 satellite mission will provide new multiple narrowband data opportunities at high spatio-temporal resolution which are expected to further improve remote sensing capabilities for mapping LAI, CHLl and Nl