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

Mendelian randomization supports bidirectional causality between telomere length and clonal hematopoiesis of indeterminate potential

Human genetic studies support an inverse causal relationship between leukocyte telomere length (LTL) and coronary artery disease (CAD), but directionally mixed effects for LTL and diverse malignancies. Clonal hematopoiesis of indeterminate potential (CHIP), characterized by expansion of hematopoietic cells bearing leukemogenic mutations, predisposes both hematologic malignancy and CAD. TERT (which encodes telomerase reverse transcriptase) is the most significantly associated germline locus for CHIP in genome-wide association studies. Here, we investigated the relationship between CHIP, LTL, and CAD in the Trans-Omics for Precision Medicine (TOPMed) program (n = 63,302) and UK Biobank (n = 47,080). Bidirectional Mendelian randomization studies were consistent with longer genetically imputed LTL increasing propensity to develop CHIP, but CHIP then, in turn, hastens to shorten measured LTL (mLTL). We also demonstrated evidence of modest mediation between CHIP and CAD by mLTL. Our data promote an understanding of potential causal relationships across CHIP and LTL toward prevention of CAD

Neutron flux enhancement in the NRAD reactor

In 1987 a series of experiments were conducted at the NRAD reactor facility at Argonne National Laboratory - West (ANL-W) to investigate the possibility of increasing the thermal neutron content at the end of the reactor's east beam tube through the use of hydrogenous flux traps. It was desired to increase the thermal flux for a series of experiments to be performed in the east radiography cell, in which the enhanced flux was required in a relatively small volume. Hence, it was feasible to attempt to focus the cross section of the beam to a smaller area. Two flux traps were constructed from unborated polypropylene and tested to determine their effectiveness. Both traps were open to the entire cross-sectional area of the neutron beam (as it emerges from the wall and enters the beam room). The sides then converged such that at the end of the trap the beam would be 'focused' to a greater intensity. The differences in the two flux traps were primarily in length, and hence angle to the beam as the inlet and outlet cross-sectional areas were held constant. It should be noted that merely placing a slab of polypropylene in the beam will not yield significant multiplication as neutrons are primarily scattered away

Breeding tropical shearwaters use distant foraging sites when self-provisioning

To determine whether breeding tropical shearwaters use "at-distance" locations during the long-trip phase of their bimodal foraging cycle,we deployed PTT satellite trackingdevices on adult Wedge-tailed Shearwaters Ardenna pacifica of the Great Barrier Reef (GBR), Australia, over three breeding seasons. During the long-trip phase (8–14 d), a component of a bimodal pattern of foraging not seen previously in a tropical shearwater, birds travelled to distant sites in the Coral Sea between 300 and 1 100 km from the breeding colony, primarily to the north and east. At-distance foraging sites were in deeper water and closer to seamounts than were near-colony foraging sites used for chick provisioning, a combination of features indicating enhanced prey availability at these at-distance locations. These findings imply that long-term reproductive success at this and likely other GBR colonies is strongly dependent on the continued stability of these at-distance locations,yet at present all are outside the current Great Barrier Reef Marine Park management zone. To adequately conserve GBR seabirds and other marine species using these resources, a conservation strategy integrated with current management practices is needed for the open waters of the Coral Sea