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- Bhatt, Deepak L., et al.
(author)
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Rationale, design and baseline characteristics of the effect of ticagrelor on health outcomes in diabetes mellitus patients Intervention study
- 2019
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In: Clinical Cardiology. - : Wiley. - 0160-9289 .- 1932-8737. ; 42:5, s. 498-505
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Journal article (peer-reviewed)abstract
- In the setting of prior myocardial infarction, the oral antiplatelet ticagrelor added to aspirin reduced the risk of recurrent ischemic events, especially, in those with diabetes mellitus. Patients with stable coronary disease and diabetes are also at elevated risk and might benefit from dual antiplatelet therapy. The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS, NCT01991795) is a Phase 3b randomized, double-blinded, placebo-controlled trial of ticagrelor vs placebo, on top of low dose aspirin. Patients >= 50 years with type 2 diabetes receiving anti-diabetic medications for at least 6 months with stable coronary artery disease as determined by a history of previous percutaneous coronary intervention, bypass grafting, or angiographic stenosis of >= 50% of at least one coronary artery were enrolled. Patients with known prior myocardial infarction (MI) or stroke were excluded. The primary efficacy endpoint is a composite of cardiovascular death, myocardial infarction, or stroke. The primary safety endpoint is Thrombolysis in Myocardial Infarction major bleeding. A total of 19 220 patients worldwide have been randomized and at least 1385 adjudicated primary efficacy endpoint events are expected to be available for analysis, with an expected average follow-up of 40 months (maximum 58 months). Most of the exposure is on a 60 mg twice daily dose, as the dose was lowered from 90 mg twice daily partway into the study. The results may revise the boundaries of efficacy for dual antiplatelet therapy and whether it has a role outside acute coronary syndromes, prior myocardial infarction, or percutaneous coronary intervention.
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- Fox, Anthony D., et al.
(author)
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Seeking explanations for recent changes in abundance of wintering Eurasian Wigeon (Anas penelope) in northwest Europe
- 2016
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In: Ornis Fennica. - 0030-5685. ; 93:1, s. 12-25
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Journal article (peer-reviewed)abstract
- We analysed annual changes in abundance of Eurasian Wigeon (Anas penelope) derived from mid-winter International Waterbird Census data throughout its northwest European flyway since 1988 using log-linear Poisson regression modelling. Increases in abundance in the north and east of the wintering range (Norway, Sweden, Denmark, Germany, Switzerland), stable numbers in the central range (Belgium, Netherlands, UK and France) and declining abundance in the west and south of the wintering range (Spain and Ireland) suggest a shift in wintering distribution consistent with milder winters throughout the range. However, because over 75% of the population of over 1 million individuals winters in Belgium, the Netherlands, UK and France, there was no evidence for a major movement in the centre of gravity of the wintering distribution. Between-winter changes in overall flyway abundance were highly significantly positively correlated (P = 0.003) with reproductive success measured by age ratios in Danish hunter wing surveys and less strongly and inversely correlated (P = 0.05) with mean January temperatures in the centre of the wintering range, suggesting that winter severity may also contribute to influence survival. However, adding winter severity to a model predicting population size based on annual reproductive success alone did not contribute to more effectively modelling the observed changes in population size. Patterns in annual reproductive success seem therefore to largely explain the recent dynamics in population size of northwest European Wigeon. Summer NAO significantly and positively explained 27% of variance in annual breeding success. Other local factors such as eutrophication of breeding sites and changes in predation pressure undoubtedly contribute to changes in the annual production of young and differences in hunting pressure as well as winter severity affect annual survival rates. However, it seems likely that the observed flyway population trend since 1988 has been mostly influenced by climate effects on the breeding grounds affecting reproductive success and marginally on the winter quarters affecting survival. We urge improved demographic monitoring of the population to better assess annual survival and reproductive success. We also recommend development of an adaptive management framework to remove uncertainties in our knowledge of Wigeon population dynamics as information is forthcoming to better inform management, especially to attempt to harmonise the harvest with annual changes in demography to ensure sustainable exploitation of this important quarry species now and in the future.
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