Patterns and outcomes of switching direct oral anticoagulants in non-valvular atrial fibrillation: A real-world experience from Spain.

AIMS: The aim is to evaluate a management program for direct oral anticoagulants (DOACs) in non-valvular atrial fibrillation (NVAF) patients according to their profiles, appropriateness of dosing, patterns of crossover, effectiveness and safety. This is an observational and longitudinal prospective study in a cohort of patients attended in daily clinical practice in a regional hospital in Spain with 3-year a follow-up plan for patients initiating dabigatran, rivaroxaban or apixaban between JAN/2012-DEC/2016. METHODS: We analyzed 490 episodes of treatment (apixaban 2.5 9.4%, apixaban 5 21.4%, dabigatran 75 0.6%, dabigatran 110 12,4%, dabigatran 150 19.8%, rivaroxaban 15 17.8% and rivaroxaban 20 18.6%) in 445 patients. 13.6% of patients on dabigatran, 9.7% on rivaroxaban, and 3.9% on apixaban switched to other DOACs or changed dosing. RESULTS: Apixaban was the most frequent DOAC switched to. The most frequent reasons for switching were toxicity (23.8%), bleeding (21.4%) and renal deterioration (16.7%). Inappropriateness of dose was found in 23.8% of episodes. Rates of stroke/transient ischemic attack (TIA) were 1.64/0.54 events/100 patients-years, while rates of major, clinically relevant non-major (CRNM) bleeding and intracranial bleeding were 2.4, 5, and 0.5 events/100 patients-years. Gastrointestinal and genitourinary bleeding were the most common type of bleeding events (BE). On multivariable analysis, prior stroke and age were independent predictors of stroke/TIA. Concurrent platelet inhibitors, male gender and age were independent predictors of BE. CONCLUSION: This study complements the scant data available on the use of DOACs in NVAF patients in Spain, confirming a good safety and effectiveness profile.

Eckhaus instability and homoclinic snaking.

Homoclinic snaking is a term used to describe the back and forth oscillation of a branch of time-independent spatially localized states in a bistable, spatially reversible system as the localized structure grows in length by repeatedly adding rolls on either side. This behavior is simplest to understand within the subcritical Swift-Hohenberg equation, but is also present in the subcritical regime of doubly diffusive convection driven by horizontal gradients. In systems that are unbounded in one spatial direction homoclinic snaking continues indefinitely as the localized structure grows to resemble a spatially periodic state of infinite extent. In finite domains or in periodic domains with finite spatial period the process must terminate. In this paper we show that the snaking branches in general turn over once the length of the localized state becomes comparable to the domain, and examine the factors that determine the location of the termination point or points, and their relation to the Eckhaus instability of the spatially periodic state.

Thermal Rossby waves in a rotating annulus. Their stability.

Nonlinear thermal convection in a fast rotating annulus about its axis, with slightly inclined ends, radial gravity and heating, is studied numerically for a fluid of Prandtl number sigma=0.7 and different values of the radius ratio and rotation rate. The properties of the rotating waves that appear after the Hopf bifurcation of the conductive state are analyzed. Near the critical Rayleigh number, different types of solutions with the same wave number coexist, and they are classified as a function of their connection with the two types of modes identified in the linear analysis for this Prandtl number. For different rotation rates, the stability of the primary solutions as a function of the radius ratio is also studied. The shape of the stability regions and the type of dominant disturbances that limit these regions are very sensitive to the proximity to the value of the radius ratio for which the type of dominant mode changes.

Patrones y resultados del cambio de anticoagulantes orales directos en la fibrilación auricular no valvular: experiencia en la práctica clínica en España / Patterns and outcomes of switching direct oral anticoagulants in non-valvular atrial fibrillation: A real-world experience from Spain

Objetivos El objetivo consistía en evaluar un programa de gestión de anticoagulantes orales directos (ACOD) en pacientes con fibrilación auricular no valvular (FANV) según sus perfiles, idoneidad de la dosis, patrones de cambio de tratamiento, efectividad y seguridad Se trató de un estudio observacional, prospectivo y longitudinal en una cohorte de pacientes atendidos en la práctica clínica cotidiana en un hospital regional español con un plan de seguimiento de 3 años para pacientes que iniciaron el tratamiento con dabigatrán, rivaroxabán o apixabán entre enero de 2012 y diciembre de 2016. Métodos Se analizaron 490 episodios de tratamiento (apixabán 2,5mg, 9,4%; apixabán 5mg, 21,4%; dabigatrán 75mg, 0,6%; dabigatrán 110mg, 12,4%; dabigatrán 150mg, 19,8%; rivaroxabán 15mg, 17,8%; rivaroxabán 20mg, 18,6%) en 445 pacientes. En el 13,6% de los pacientes tratados con dabigatrán, el 9,7% de los tratados con rivaroxabán y el 3,9% de los tratados con apixabán se cambió a otros ACOD o se modificó la dosis. Resultados El ACOD al que se cambió con mayor frecuencia fue el apixabán. Los motivos más frecuentes para cambiar de tratamiento fueron toxicidad (23,8%), hemorragia (21,4%) y deterioro renal (16,7%). En el 23,8% de los episodios se constató una inadecuación de la dosis. Las tasas de ictus y accidentes isquémicos transitorios (AIT) fueron de 1,64 y 0,54 eventos/100 años/paciente, respectivamente, mientras que las de hemorragias importantes, no importantes, pero clínicamente relevantes (NICR) e intracraneales fueron de 2,4, 5 y 0,5 eventos/100 años/paciente, respectivamente. Las hemorragias digestivas y genitourinarias fueron el tipo más frecuente de eventos hemorrágicos. En el análisis multifactorial, el ictus previo y la edad fueron factores predictivos independientes de ictus/AIT. El uso concomitante de antiagregantes plaquetarios, el sexo masculino y la edad fueron factores predictivos independientes de eventos hemorrágicos (AU)

Aims The aim is to evaluate a management program for direct oral anticoagulants (DOACs) in non-valvular atrial fibrillation (NVAF) patients according to their profiles, appropriateness of dosing, patterns of crossover, effectiveness and safety. This is an observational and longitudinal prospective study in a cohort of patients attended in daily clinical practice in a regional hospital in Spain with 3-year a follow-up plan for patients initiating dabigatran, rivaroxaban or apixaban between Jan/2012 and Dec/2016. Methods We analyzed 490 episodes of treatment (apixaban 2.5, 9.4%; apixaban 5, 21.4%; dabigatran 75, 0.6%; dabigatran 110, 12.4%; dabigatran 150, 19.8%; rivaroxaban 15, 17.8% and rivaroxaban 20, 18.6%) in 445 patients. 13.6% of patients on dabigatran, 9.7% on rivaroxaban, and 3.9% on apixaban switched to other DOACs or changed dosing. Results Apixaban was the most frequent DOAC switched to. The most frequent reasons for switching were toxicity (23.8%), bleeding (21.4%) and renal deterioration (16.7%). Inappropriateness of dose was found in 23.8% of episodes. Rates of stroke/transient ischemic attack (TIA) were 1.64/0.54 events/100 patients-years, while rates of major, clinically relevant non-major (CRNM) bleeding and intracranial bleeding were 2.4, 5, and 0.5 events/100 patients-years. Gastrointestinal and genitourinary bleeding were the most common type of bleeding events (BE). On multivariable analysis, prior stroke and age were independent predictors of stroke/TIA. Concurrent platelet inhibitors, male gender and age were independent predictors of BE. Conclusion This study complements the scant data available on the use of DOACs in NVAF patients in Spain, confirming a good safety and effectiveness profil (AU)

Salud percibida y salud real: prevalencia en las personas mayores de 60 años / Perceived health and real health: prevalence among persons aged 60 and older / Saúde percebida e saúde real: prevalência nas pessoas idosas de 60 anos

Objetivo: Analizar el estado de salud de la población mayor de 60 años y la relación que existe entre la autopercepción de la salud que tienen las personas mayores y su salud real; se valoró la mediación en esta relación de aspectos sociodemográficos como la edad y el género. Método: Diseño descriptivo, transversal, de prevalencia. Localización: 15 centros de día y 10 residencias de la provincia de Almería (España). Participantes: 1,220 personas mayores de 60 años (M = 70.9; DT = 7.9), de los cuales el 48.3% son hombres y el 51.7% mujeres. Mediciones: Se analizó el género, la edad, el estado civil, la presencia o no de diferentes enfermedades y problemas de salud, y el nivel de salud percibido. Resultados: Los problemas de salud relacionados con los huesos y articulaciones son los más frecuentes. Existen diferencias significativas (p = 0.000) en la percepción de la salud entre ambos géneros; los hombres tienen una mejor percepción de su salud. Hay una relación negativa y significativa (p < 0.001) entre la edad y la percepción de la salud. Tanto el número de enfermedades (r2 = 0.251) como la edad (r2 = 0.010) y el género (r2 = 0.002) forman parte del modelo explicativo de la percepción de salud. Conclusiones: El número de enfermedades, la edad y el género son variables que explican una cuarta parte de la variable subjetiva salud percibida, por tanto ofrecen indicios de poder ser utilizadas en la planificación de las políticas sanitarias.

Objective: To analyze the health of the population aged 60 and older, and the relationship between their perception of their health and their real condition. The relationship with social-demographic issues such as gender was also assessed. Method: Descriptive, transversal and prevalence study of 15 Day and 10 Residential Centers in the province of Almería (Spain), with 1,220 persons aged 60 and older (M = 70.9, SD = 7.9), 48.3% male and 51.7% female. Measurements Gender, age, civil status, and the presence of pathologies and health problems, as well as the perceived health level were all assessed. Results: Health problems related to bones and articulations were the most reported. There are significant differences (P=0.000) in the perception of health between both genders; males have a better perception of their health. There is a negative and significant relation (P < .001) between age and the perception of health. The number of illnesses (r2 = 0.251), age (r2 = 0.010), and gender (r2 = 0.002) are all part of the explicative model of the perception of health. Conclusions: The number of illnesses, age, and gender are variables which explain a quarter of the subjective perception of health variable, and thus, they indicate a possible use in the planning of health policies.

Objetivo: Analisar o estado de saúde da população idosa de 60 anos e, a relação que existe entre a auto percepção da saúde que realizam as pessoas idosas e a sua saúde real. Valorizou-se a intermediação de aspetos sócio demográficos como a idade e o género. Método: Desenho descritivo, transversal de prevalência. Localização: 15 centros de dia e 10 moradias da província de Almería (na Espanha). Participantes: 1220 pessoas idosas de 60 anos (M = 70.9; DT = 7.9), das quais o 48.3% são homens e o 51.7% são mulheres. Medições Analisou-se o género, a idade, o estado civil, a presença e a não presença de diferentes patologias e problemas de saúde e, o nível de saúde percebido. Resultados: Os problemas de saúde relacionados com os ossos e as articulações são os mais frequentes. Existem diferenças significativas (p = 0.000) na percepção de saúde entre ambos os géneros, os homens têm uma melhor percepção da sua saúde. Há uma relação negativa e significativa (p < 0.001) entre a idade e a percepção da saúde. Tanto o número de doenças (r2 = 0.251) como a idade (r2 = 0.010) e o género (r2 = 0.002) formam parte do modelo explicativo da percepção da saúde. Conclusõeso: O número de doenças, a idade e o género são variáveis que explicam uma quarta parte da variável subjetiva "saúde percebida", portanto, oferecem índicios de poderem ser utilizadas na planificação de políticas sanitárias.

Numerical analysis of the Eckhaus instability in travelling-wave convection in binary mixtures.

The Eckhaus stability boundaries of travelling periodic roll patterns arising in binary fluid convection is analysed using high-resolution numerical methods. We present results corresponding to three different values of the separation ratio used in experiments. Our results show that the subcritical branches of travelling waves bifurcating at the onset of convection suffer sideband instabilities that are restabilised further away in the branch. If this restabilisation is produced after the turning point of the travelling-wave branch, these waves do not become stable in a saddle node bifurcation as would have been the case in a smaller domain. In the regions of instability of the uniform travelling waves we expect to find either transitions between states of different wave number or modulated travelling waves arising in these bifurcations.

Subharmonic instabilities of Tollmien-Schlichting waves in two-dimensional Poiseuille flow.

The stability of the upper branch of shear traveling waves in two-dimensional Poiseuille flow, when the total flux through the channel is held constant, is considered. Taking into account the length of the periodic channel, perturbations of the same wave number (superharmonic), and different wave number (subharmonic) of the uniform wave trains are imposed. We mainly consider channels long enough to contain M=4 and M=8 basic wavelengths. In these cases, subharmonic bifurcations are found to be dominant except in a small region of parameters. From this type of bifurcation, we show that if the wave number is decreased, the periodic train of finite amplitude waves evolves continuously towards the stable localized wave packets obtained in long channels by other authors and whose existence has been associated to the vicinity of an inverted Hopf bifurcation. Depending on the basic wave number of the periodic train destabilized, different types of solutions for a given length of the channel can be obtained. Furthermore, for moderate Reynolds numbers, configurations of linearly stable wave trains exist, provided that their basic wave number is alpha approximately 1.5.

Onset of oscillatory binary fluid convection in finite containers.

The onset of oscillatory convection in binary fluid mixtures in a two-dimensional domain with realistic boundary conditions on all boundaries is determined as a function of the fluid parameters and the aspect ratio Gamma of the container. The first unstable mode has either odd or even parity under left-right reflection. Depending on Gamma and the separation ratio S, this mode has the form of a standing wave, or a "chevron," consisting of a pair of waves propagating outwards from the cell center (or, in some cases, inwards towards it). Codimension--two points at which odd and even parity modes are simultaneously marginally stable are determined, as are various Takens-Bogdanov points. For fixed Sinfinity, and to the gap (in Rayleigh number and oscillation frequency) between successively unstable modes. The results quantify the parameter regime in which the weakly nonlinear dynamics of the system can be described in terms of the interaction of the first odd and even parity oscillatory modes.

Oscillatory binary fluid convection in large aspect-ratio containers.

Direct numerical simulations of chevrons, blinking states, and repeated transients in binary fluid mixtures with a negative separation ratio heated from below are described. The calculations are performed in two-dimensional containers for experimental parameter values and boundary conditions. Quantitative agreement with the experiments of Kolodner [Phys. Rev. E 47, 1038 (1993)] is obtained, and the origin of the blinking and repeated transient states is elucidated.

Thermal and inertial modes of convection in a rapidly rotating annulus

The nature of the primary instabilities that arise in a fluid contained in a fast rotating cylindrical annulus with slightly inclined plane top and bottom boundaries, radial gravity, and internal heating is numerically analyzed. It is shown that for moderate and high Prandtl numbers, the onset of convection is described by a competition of azimuthal thermal modes with different radial structure, which dominate in different regions of the parameter space. By the combined effect of the inclined ends and rotation, there are modes that are attached to the heated wall and slanted to the prograde direction of rotation, and others which are straight and fill the convective layer. Nevertheless, for very small Prandtl numbers the velocity field of the dominant modes corresponds essentially to the inertial solution of the Poincare equation, and the temperature perturbation is forced by this velocity field. In addition, a detailed exploration of the critical Rayleigh numbers and precession frequencies of the convective modes versus the radius ratio and the Coriolis parameter, for different Prandtl numbers, is presented.