Early clopidogrel versus prasugrel use among contemporary STEMI and NSTEMI patients in the US: insights from the National Cardiovascular Data Registry.

BACKGROUND: P2Y12 antagonist therapy improves outcomes in acute myocardial infarction (MI) patients. Novel agents in this class are now available in the US. We studied the introduction of prasugrel into contemporary MI practice to understand the appropriateness of its use and assess for changes in antiplatelet management practices. METHODS AND RESULTS: Using ACTION Registry-GWTG (Get-with-the-Guidelines), we evaluated patterns of P2Y12 antagonist use within 24 hours of admission in 100 228 ST elevation myocardial infarction (STEMI) and 158 492 Non-ST elevation myocardial infarction (NSTEMI) patients at 548 hospitals between October 2009 and September 2012. Rates of early P2Y12 antagonist use were approximately 90% among STEMI and 57% among NSTEMI patients. From 2009 to 2012, prasugrel use increased significantly from 3% to 18% (5% to 30% in STEMI; 2% to 10% in NSTEMI; P for trend <0.001 for all). During the same period, we observed a decrease in use of early but not discharge P2Y12 antagonist among NSTEMI patients. Although contraindicated, 3.0% of patients with prior stroke received prasugrel. Prasugrel was used in 1.9% of patients ≥75 years and 4.5% of patients with weight <60 kg. In both STEMI and NSTEMI, prasugrel was most frequently used in patients at the lowest predicted risk for bleeding and mortality. Despite lack of supporting evidence, prasugrel was initiated before cardiac catheterization in 18% of NSTEMI patients. CONCLUSIONS: With prasugrel as an antiplatelet treatment option, contemporary practice shows low uptake of prasugrel and delays in P2Y12 antagonist initiation among NSTEMI patients. We also note concerning evidence of inappropriate use of prasugrel, and inadequate targeting of this more potent therapy to maximize the benefit/risk ratio.

Impacts of land use change and climate variations on annual inflow into Miyun Reservoir,Beijing, China

The Miyun Reservoir, the only surface water source for Beijing city, has experienced water supply decline in recent decades. Previous studies suggest that both land use change and climate contribute to the changes of water supply in this critical watershed. However, the specific causes of the decline in the Miyun Reservoir are debatable under a non-stationary climate in the past 4 decades. The central objective of this study was to quantify the separate and collective contributions of land use change and climate variability to the decreasing inflow into the Miyun Reservoir during 1961–2008. Different from previous studies on this watershed, we used a comprehensive approach to quantify the timing of changes in hydrology and associated environmental variables using the long-term historical hydrometeorology and remote-sensing-based land use records. To effectively quantify the different impacts of the climate variation and land use change on streamflow during different sub-periods, an annual water balance model (AWB), the climate elasticity model (CEM), and a rainfall–runoff model (RRM) were employed to conduct attribution analysis synthetically. We found a significant (p  <  0.01) decrease in annual streamflow, a significant positive trend in annual potential evapotranspiration (p  <  0.01), and an insignificant (p  >  0.1) negative trend in annual precipitation during 1961–2008. We identified two streamflow breakpoints, 1983 and 1999, by the sequential Mann–Kendall test and double-mass curve. Climate variability alone did not explain the decrease in inflow to the Miyun Reservoir. Reduction of water yield was closely related to increase in actual evapotranspiration due to the expansion of forestland and reduction in cropland and grassland, and was likely exacerbated by increased water consumption for domestic and industrial uses in the basin. The contribution to the observed streamflow decline from land use change fell from 64–92 % during 1984–1999 to 36–58 % during 2000–2008, whereas the contribution from climate variation climbed from 8–36 % during the 1984–1999 to 42–64 % during 2000–2008. Model uncertainty analysis further demonstrated that climate warming played a dominant role in streamflow reduction in the most recent decade (i.e., 2000s). We conclude that future climate change and variability will further challenge the water supply capacity of the Miyun Reservoir to meet water demand. A comprehensive watershed management strategy needs to consider the climate variations besides vegetation management in the study basin.

An ontological characterization of time-series and state-sequences for data mining

Time-series and sequences are important patterns in data mining. Based on an ontology of time-elements, this paper presents a formal characterization of time-series and state-sequences, where a state denotes a collection of data whose validation is dependent on time. While a time-series is formalized as a vector of time-elements temporally ordered one after another, a state-sequence is denoted as a list of states correspondingly ordered by a time-series. In general, a time-series and a state-sequence can be incomplete in various ways. This leads to the distinction between complete and incomplete time-series, and between complete and incomplete state-sequences, which allows the expression of both absolute and relative temporal knowledge in data mining.

The promised land

Examines the House of Lords ruling in Thorner v Curtis on whether the claimant could rely on proprietary estoppel against the estate of the deceased, who had died intestate, based on an assurance given by the deceased that the claimant would inherit the deceased's farm. Reviews case law on proprietary estoppel and testamentary promises, and considers the possible application of constructive trust doctrine in similar cases.

Killing fields. [Review of Rebel land: among Turkey's forgotten peoples by Christopher de Bellaigua]

Alev Adil explores a region still enraged by a 'crime on the sly'

FARM-Africa South Africa Northern Cape land reform and advocacy programme 2004-2008: final evaluation

FARM-Africa South Africa has played a crucial and important role in filling the gap that existed after the return of land to communities by government in the Northern Cape. Their support to farmer communities during the post-settlement phase has been critical for making productive use of land. During 2004-2008, FARM-SA has worked in 20 community projects in the Northern Cape, benefiting 745 poor households.

Heavy metals in the Fal estuary, Cornwall: A study of long term contamination by mining waste and its effects on estuarine organisms. Occasional Publication of the Marine Biological Association 2

The Fal Estuary System in West Cornwall has, over many centuries, received inputs of heavy metals from various mining activities. In this context its most important tributary is the Carnon River. Analyses of organisms from the Fal Estuary have shown that some species contain abnormally high concentrations of Cu, Zn and As, especially those living in Restronguet Creek.