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 Submaximal Test for the Assessment of Knee Extensor Endurance Capacity

PURPOSE: We aimed to develop an undemanding test for endurance capacity of the knee extensor muscles, which can also be applied to frail participants. We hypothesized 1) that the first objective indications for peripheral fatigue during incremental unilateral repetitive isometric knee extensor contractions could be used to assess a fatigue threshold (FT), 2) that torque at FT would depend on training status, and 3) that this torque could easily be sustained for 30 min. METHODS: Five trained and five untrained participants performed 5-min bouts of 60 repetitive contractions (3-s on and 2-s off). Torque, set at 25% maximal voluntary contraction (MVC), was increased by 5% MVC in subsequent bouts. The highest torque for which rectified surface EMG remained stable during the bout was defined as the FT. On separate occasions, 30-min bouts were performed at and above the FT to assess sustainable torque. Changes in gas exchange parameters, HR, and RPE were monitored to corroborate FT. RESULTS: At FT (RPE = 5.7 ± 1.7), torque was higher (P < 0.05) in trained (41.4% ± 5.8% MVC) than in untrained participants (30.5% ± 1.8% MVC). Sustainable torque was ~4% higher than (P < 0.05) and significantly related to FT (

Interactions between givenness and clause order in children's processing of complex sentences

Understanding complex sentences that contain multiple clauses referring to events in the world and the relations between them is an important development in children's language learning. A number of theoretical positions have suggested that factors like syntactic structure (clause order), iconicity (whether the order of clauses reflects the order of events), and givenness (whether information is shared between speakers) affect ease of comprehension. We tested these accounts by investigating how these factors interact in British English-speaking children's comprehension of complex sentences with adverbial clauses (after, before, because, if), while controlling for language level, working memory and inhibitory control. 92 children in three age groups (4, 5 and 8 years) and 17 adults completed a picture selection task. Participants heard an initial context sentence, followed by a two-clause sentence which varied in: (1) the order of the main and subordinate clause; (2) the order of given and new information; and (3) whether the given information occurred in the main or subordinate clause. Accuracy and response times were measured. Our results showed that given-before-new improves comprehension for four- and five-year-olds, but only when the given information is in the initial subordinate clause (e.g., “Sue crawls on the floor. Before she crawls on the floor, she hops up and down”). Temporal adverbials (after, before) were processed faster than causal adverbials (because, if). These effects were not found for the eight-year-olds, whose performance was more similar to that of the adults. Providing a context sentence also improved performance compared to presenting the test sentences in isolation. We conclude that existing accounts based on either ease of processing or information structure cannot fully account for these findings, and suggest a more integrated explanation which reflects children's developing language and literacy skills

Concomitant use of contraceptives and potentially teratogenic medicinal products--results from a study using pharmacy dispensing data in the Netherlands

Item does not contain fulltextThe objective of this study was to analyze to what extent potentially teratogenic medicinal products are dispensed concomitantly with contraceptives. Data on dispensed medicinal products in this population-based study were obtained from the Dutch Foundation for Pharmaceutical Statistics. For over 178 potentially teratogenic medicinal products, concomitant use of contraceptives was assessed. The proportion of potentially teratogenic medicinal products dispensed concomitantly with a contraceptive varied significantly from 40.9% (95% CI 40.7-41.2) in 2005 to 43.4% in 2009 (95% CI 44.2-43.7). Significant differences existed as well between age categories with the lowest proportions of concomitant use of contraceptives for any potentially teratogenic drug in women aged 36 through 45 years (35.0%, 95% CI 34.9-35.1) in comparison to those aged 26 through 35 years (47.1%, 95% CI 46.9-47.3) and 15 through 25 years (53.6%, 95% CI 53.4-53.8). Although our data retrieval did not cover the use of nonpharmacological forms of contraception such as condoms and sterilization and as situations may occur during which the use of drugs with (low) teratogenic potential is a balanced decision, our results raise doubts about the safe use of medicinal products with teratogenic potential

Modulation of litter decomposition by the soil microbial food web under influence of land use change

Soil microbial communities modulate soil organic matter (SOM) dynamics by catalyzing litter decomposition. However, our understanding of how litter-derived carbon (C) flows through the microbial portion of the soil food web is far from comprehensive. This information is necessary to facilitate reliable predictions of soil C cycling and sequestration in response to a changing environment such as land use change in the form of agricultural abandonment. To examine the flow of litter-derived C through the soil microbial food web and it’s response to land use change, we carried out an incubation experiment with soils from six fields; three recently abandoned and three long term abandoned fields. In these soils, the fate of 13C-labeled plant litter was followed by analyzing phospholipid fatty acids (PLFA) over a period of 56 days. The litter-amended soils were sampled over time to measure 13CO2 and mineral N dynamics. Microbial 13C-incorporation patterns revealed a clear succession of microbial groups during litter decomposition. Fungi were first to incorporate 13C-label, followed by G− bacteria, G+ bacteria, actinomycetes and micro-fauna. The order in which various microbial groups responded to litter decomposition was similar across all the fields examined, with no clear distinction between recent and long-term abandoned soils. Although the microbial biomass was initially higher in long-term abandoned soils, the net amount of 13C-labeled litter that was incorporated by the soil microbial community was ultimately comparable between recent and long-term abandoned fields. In relative terms, this means there was a higher efficiency of litter-derived 13C-incorporation in recent abandoned soil microbial communities compared to long-term abandoned soils, most likely due to a net shift from SOM-derived C toward root-derived C input in the soil microbial food web following land-abandonment.</p