Modification and pathways of Southern Ocean Deep Waters in the Scotia Sea

An unprecedented high-quality, quasi-synoptic hydrographic data set collected during the ALBATROSS cruise along the rim of the Scotia Sea is examined to describe the pathways of the deep water masses flowing through the region, and to quantify changes in their properties as they cross the sea. Owing to sparse sampling of the northern and southern boundaries of the basin, the modification and pathways of deep water masses in the Scotia Sea had remained poorly documented despite their global significance. Weddell Sea Deep Water (WSDW) of two distinct types is observed spilling over the South Scotia Ridge to the west and east of the western edge of the Orkney Passage. The colder and fresher type in the west, recently ventilated in the northern Antarctic Peninsula, flows westward to Drake Passage along the southern margin of the Scotia Sea while mixing intensely with eastward-flowing Circumpolar Deep Water (CDW) of the antarctic circumpolar current (ACC). Although a small fraction of the other WSDW type also spreads westward to Drake Passage, the greater part escapes the Scotia Sea eastward through the Georgia Passage and flows into the Malvinas Chasm via a deep gap northeast of South Georgia. A more saline WSDW variety from the South Sandwich Trench may leak into the eastern Scotia Sea through Georgia Passage, but mainly flows around the Northeast Georgia Rise to the northern Georgia Basin. In Drake Passage, the inflowing CDW displays a previously unreported bimodal property distribution, with CDW at the Subantarctic Front receiving a contribution of deep water from the subtropical Pacific. This bimodality is eroded away in the Scotia Sea by vigorous mixing with WSDW and CDW from the Weddell Gyre. The extent of ventilation follows a zonation that can be related to the CDW pathways and the frontal anatomy of the ACC. Between the Southern Boundary of the ACC and the Southern ACC Front, CDW cools by 0.15°C and freshens by 0.015 along isopycnals. The body of CDW in the region of the Polar Front splits after overflowing the North Scotia Ridge, with a fraction following the front south of the Falkland Plateau and another spilling over the plateau near 49.5°W. Its cooling (by 0.07°C) and freshening (by 0.008) in crossing the Scotia Sea is counteracted locally by NADW entraining southward near the Maurice Ewing Bank. CDW also overflows the North Scotia Ridge by following the Subantarctic Front through a passage just east of Burdwood Bank, and spills over the Falkland Plateau near 53°W with decreased potential temperature (by 0.03°C) and salinity (by 0.004). As a result of ventilation by Weddell Sea waters, the signature of the Southeast Pacific Deep Water (SPDW) fraction of CDW is largely erased in the Scotia Sea. A modified form of SPDW is detected escaping the sea via two distinct routes only: following the Southern ACC Front through Georgia Passage; and skirting the eastern end of the Falkland Plateau after flowing through Shag Rocks Passage

Altered Growth Trajectory in Children Born to Mothers with Gestational Diabetes Mellitus and Preeclampsia

Purpose: Gestational diabetes mellitus (GDM) and preeclampsia are leading causes of mortality and morbidity in mothers and children. High childhood body mass index (BMI) is among their myriad of negative outcomes. However, little is known about the trajectory of the child BMI exposed to GDM and co-occurring preeclampsia from early to mid-childhood. This study examined the independent and joint impact of GDM and preeclampsia on childhood BMI trajectory. Methods: A population-based sample of 356 mothers were recruited from OB/GYN clinics in New York. Their children were then followed annually from 18 to 72 months. Maternal GDM and preeclampsia status were obtained from medical records. Child BMI was calculated based on their height and weight at annual visits. Results: Hierarchical Linear Modeling was used to evaluate the trajectories of child BMI exposed to GDM and preeclampsia. BMI trajectory by GDM decreased (t-ratio = -2.24, ��=.45, 95% CI=-.05-.95, p = .07), but the trajectory by preeclampsia increased over time (t-ratio = 3.153, ��=.65, 95%CI=.11-1.18, p = .002). Moreover, there was a significant interaction between the two (t-ratio = -2.24, ��=-1.244, 95%CI=.15-2.33, p = .02), such that the BMI of children born to mothers with both GDM and preeclampsia showed consistent increases over time. Conclusions: GDM and preeclampsia could be used as a marker for childhood obesity risk and the identification of a high-risk group, providing potential early intervention. These findings highlight the importance of managing obstetric complications, as an effective method of child obesity prevention

What is the best approach to adopt for identifying the domains for a new measure of health, social care and carer-related quality of life to measure quality-adjusted life years? Application to the development of the EQ-HWB

Economic evaluation combines costs and benefits to support decision-making when assessing new interventions using preference-based measures to measure and value benefits in health or health-related quality of life. These health-focused instruments have limited ability to capture wider impacts on informal carers or outcomes in other sectors such as social care. Sector-specific instruments can be used but this is problematic when the impact of an intervention straddles different sectors.An alternative approach is to develop a generic preference-based measure that is sufficiently broad to capture important cross-sector outcomes. We consider the options for the selection of domains for a cross-sector generic measure including how to identify domains, who should provide information on the domains and how this should be framed. Beyond domain identification, considerations of criteria and stakeholder needs are also identified.This paper sets out the case for an approach that relies on the voice of patients, social care users and informal carers as the main source of domains and describes how the approach was operationalised in the ‘Extending the QALY’ project which developed the new measure, the EQ-HWB (EQ health and wellbeing instrument). We conclude by discussing the strengths and limitations of this approach. The new measure should be sufficiently generic to be used to consistently evaluate health and social care interventions, yet also sensitive enough to pick up important changes in quality of life in patients, social care users and carers

The EQ Health and Wellbeing: Overview of the Development of a Measure of Health and Wellbeing and Key Results

Objectives: Existing measures for estimating quality-adjusted life-years are mostly limited to health-related quality of life. This article presents an overview of the development the EQ Health and Wellbeing (EQ-HWB), which is a measure that encompasses health and wellbeing. Methods: Stages: (1) Establishing domains through reviews of the qualitative literature informed by a conceptual framework. (2) Generation and selection of items to cover the domains. (3) Face validation of these items through qualitative interviews with 168 patients, social care users, general population, and carers across 6 countries (Argentina, Australia, China, Germany, United Kingdom, United States). (4) Extensive psychometric testing of candidate items (using classical, factor analysis, and item response theory methods) on > 4000 respondents in the 6 countries. Stakeholders were consulted throughout. Results: A total of 32 subdomains grouped into 7 high-level domains were identified from the qualitative literature and 97 items generated to cover them. Face validation eliminated 36 items, modified 14, and added 3. Psychometric testing of 64 items found little difference in missing data or problems with response distribution, the conceptual model was confirmed except in China, and most items performed well in the item response theory in all countries. Evidence was presented to stakeholders in 2 rounds of consultation to inform the final selection of items for the EQ-HWB (25-item) and the short version of EQ-HWB (9-items). Conclusions: EQ-HWB measures have been developed internationally for evaluating interventions in health, public health, and social care including the impact on patients, social care users, and carers

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

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

Effects of Different Levels of Intraocular Stray Light on Kinetic Perimetry Findings

<div><p>Purpose</p><p>To evaluate the effect of different levels of intraocular stray light on kinetic perimetry findings.</p><p>Methods</p><p>Twenty-five eyes of 25 healthy young participants were examined by automated kinetic perimetry (Octopus 900) using Goldmann stimuli III4e, I4e, I3e, I2e, and I1e. Each stimulus was presented with a velocity of 3°/s at 24 meridians with 15° intervals. Four levels of intraocular stray light were induced using non-white opacity filter (WOF) filters and WOFs applied to the clear plastic eye covers of the participants. The visual acuity, pupil diameter, isopter area, and kinetic sensitivity of each meridian were analyzed for each WOF density.</p><p>Results</p><p>Visual acuity deteriorated with increasing WOF densities (p < 0.01). With a visual acuity of 0.1 LogMAR units, the isopter areas for III4e, I4e, I3e, I2e, and I1e decreased by -32.7 degree² (-0.2%), -255.7 degree² (-2.6%), -381.2 degree² (-6.2%), -314.8 degree² (-12.8%), and -59.2 degree² (-15.2%), respectively; kinetic sensitivity for those stimuli decreased by -0.1 degree (-0.1%), -0.8 degree (-1.4%), -1.6 degree (-3.7%), -2.7 degree (-9.7%), and -1.7 degree (-16.2%), respectively. The pupil diameter with each WOF density was not significantly different.</p><p>Conclusion</p><p>Kinetic perimetry measurements with a high-intensity stimulus (i.e., III4e) were unaffected by intraocular stray light. In contrast, measurements with the I4e, I3e, I2e, and I1e stimuli, especially I2e and I1e, were affected. Changes in the shape of the isopter resulting from opacity must be monitored, especially in cases of smaller and lower-intensity stimuli.</p></div