How Useful Is The Genuine Savings Rate As A Macroeconomic Sustainability Indicator For Countries And Regions? Australia And Queensland Compared

This paper demonstrates how macroeconomic indicators of sustainable development can be applied to the Queensland economy. We derive a Genuine Savings Rate (GSR) for Queensland for the period 1989 to 1999, which is then compared with the World Bank estimate of Australia's GSR for the same period. Specifically, we examine how well a single "headline" indicator based on the World Bank's GSR performs as a measure of overall sustainability. In doing so, we review criticisms of the GSR and compare its potential policy directives with those emerging from the use of net state savings and then the GSR as part of a suite of indicators.

The Grasscutter: An Untapped Resource of Africa’s Grasslands

The grasscutter (or Greater cane rat – Thryonomys swinderianus) is a common rodent in Africa, south of the Sahara. Its distribution ranges from The Gambia to southern Sudan, across the continent down to south Namibia and South Africa (Fritzinger 1995). The grasscutter grows to \u3e 0.5 m in length and weighs ~8 kg. It has characteristic rounded ears, a short nose, coarse bristly hair, and forefeet smaller than its hind feet. Grasscutters are herbivores and their natural diet is mainly grasses and cane, but they also eat bark, fallen fruits, nuts and many different kinds of cultivated crops. Grasscutters get their name from the way they cut the grasses and other foods with their incisors, producing a chattering sound that is relatively loud and very distinguishable (Mills 1997). The meat is highly preferred by a wide range of West Africans and is gaining some acceptance in Central and Southern Africa (Van Zyl et. al. 1999a, Adu et. al 2005). The meat commands a premium price compared to other meat sources, with its sale being a major industry in both urban and rural centres (Adu et al. 2005). Grasscutter farming is therefore being promoted in most countries in West Africa as a model for poverty reduction (Baptist and Mensah 1986). Though various aspects of captive grasscutter production have been studied, it has a low uptake rate as a new farming venture (Anang et. al. 211). This paper therefore attempts to create a broader and clearer picture of the potential of grasscutter farming in parts of Africa where the animal occurs

Control, care, and conviviality in the politics of technology for sustainability

This article discusses currently neglected distinctions between control, care, and conviviality in the politics of technology for sustainability. We conceptualize control as the ambition to maintain fictitious borders between hierarchically ordered categories such as subjects and objects. This ambition is materialized into a wide range of Modern technological innovations, including genome editing and deep sea mining. Contrasting with control, we conceptualize values of care that constitute socio-technical practices where connections are prioritized over categories and hierarchy is countered with egalitarian commitment. In caring practices, objects are thus treated as subjects, often within political contexts that are dominated by ambitions to control. Building on care, we explore hopes for conviviality as mutualistic autonomy and decolonial self-realization to orient plural socio-technical pathways for moving beyond Modernity. We argue that such pathways are crucial for democratic transformations to sustainability. We illustrate our concepts using two brief case studies of agricultural developments. The first case discusses the politics of control in agricultural biotechnologies in Belgium. The second case reports on care within rural people's coping strategies in a south Indian "green revolution" landscape laden with control. In conclusion, we emphasize the need to situate attempted materializations of control, care, and conviviality in specific historical junctures. Situated understandings of the interplay between control, care, and conviviality can help realize sustainability that does not reproduce the centralizing, control-driven logic of Modern technocratic development

The Dangers of Decoupling: Earth System Crisis and the 'Fourth Industrial Revolution'

The question of whether global capitalism can resolve the earth system crisis rests on the (im)possibility of ‘absolute decoupling’: whether or not economic growth can continue indefinitely as total environmental impacts shrink. Ecomodernists and other techno‐optimists argue for the feasibility of absolute decoupling, whereas degrowth advocates show that it is likely to be neither feasible in principle nor in the timeframe needed to ward off ecological tipping points. While primarily supporting the degrowth perspective, I will suggest that the ecomodernists have a wildcard in their pocket that hasn’t been systematically addressed by degrowth advocates. This is the ‘Fourth Industrial Revolution’, which refers to convergent innovations in biotechnology, nanotechnology, artificial intelligence, 3D printing, and other developments. However, I will argue that while these innovations may enable some degree of absolute decoupling, they will also intensify emerging risks in the domains of biosecurity, cybersecurity, and state securitization. Overall, these technologies will not only place unprecedented destructive power in the hands of non‐state actors but will also empower and incentivize states to create a global security regime with unprecedented surveillance and force mobilization capacities. This reinforces the conclusion that mainstream environmental policies based on decoupling should be reconsidered and supplanted by alternative policy trajectories based on material‐energetic degrowth, redistribution, and technological deceleration

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362