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

Greenhouse gas emissions from the international maritime transport of New Zealand's imports and exports

Greenhouse gas emissions from international maritime transport are exempt from liabilities under the Kyoto Protocol. Research into quantifying these emissions is ongoing, and influences policy proposals to reduce emissions. This paper presents a cargo-based analysis of fuel consumption and greenhouse gas emissions from New Zealand's international maritime transport of goods. Maritime transport moves 99.5% (by mass) of New Zealand's internationally traded products. It is estimated that 73% of visiting vessels' activity can be directly attributed to the movement of goods in and out of New Zealand. A cargo-based methodology was used to estimate that the international maritime transport of New Zealand's imports and exports consumed 2.5 million tonnes (Mt; 2.6 billion litres) of fuel during the year 2007, which generated 7.7 Mt of carbon dioxide (CO2) emissions. Double-counting of emissions would occur if a similar method was applied to all New Zealand's trading partners. In contrast, since few large vessels refuel in New Zealand, the National Greenhouse Gas Inventory listed 2007 international maritime transportation emissions as 0.98 Mt of CO2, calculated from fuel bunkered for international transport. The results, therefore, show a significant difference between activity-based and bunker-fuel methodologies in quantifying New Zealand's emissions. International policy implications are discussed.International maritime transport Greenhouse gas emissions New Zealand international trade

Energy use of integral refrigerated containers in maritime transportation

The global trading of perishable goods is possible through the application of product refrigeration and atmospheric control during transportation. A mean energy consumption rate of 2.7 kW/TEU was assumed in this study, but was found to have potential variations of around ±60%. New Zealand's maritime trade was considered as a case study for the year 2007 to place the effect of refrigerated transport in context. For individual refrigerated containers, approximately 19% of the energy use related to its journey is used for refrigeration purposes. In 2007, approximately 18% and 61% of New Zealand's imported and exported food products by mass, respectively, required some form of refrigeration during transportation. Maintaining the refrigerated state of imports and exports to and from New Zealand during maritime transportation consumed approximately 280 GWh of electricity. Assuming all this electricity was generated onboard vessels using auxiliary engines, approximately 61 kt of fuel was consumed and 190 kt of CO2 produced. Refrigeration is of particular importance to the many greenhouse gas or carbon footprinting studies conducted around the world. Implications are discussed in the context of greenhouse gas emissions from the transport of apples from NZ to the UK and long-term storage of UK apples.Refrigerated shipping containers Carbon footprinting Greenhouse gas emissions

Carbon emissions from international cruise ship passengers' travel to and from New Zealand

Greenhouse gas emissions from international transport contribute to anthropogenic global warming, yet these emissions are not liable under the Kyoto Protocol. International attention is being given to quantifying such emissions. This paper presents the results of research into international cruise ship journeys to and from New Zealand. CO2 emissions from such journeys were calculated using an activity based, or "bottom-up", model. Emissions factors for individual journeys by cruise ships to or from New Zealand in 2007 ranged between 250 and 2200 g of CO2 per passenger-kilometre (g CO2 per p-km), with a weighted mean of 390 g CO2 per p-km. The weighted mean energy use per passenger night for the "hotel" function of these cruise vessels was estimated as 1600 MJ per visitor night, 12 times larger than the value for a land-based hotel. Using a simple price elasticities calculation, international cruise journeys for transport purposes were found to have a greater relative decrease in demand than plane journeys when the impact of carbon pricing was analysed. The potential to decrease the CO2 emissions per p-km was examined, and if passenger accommodation was compacted and some luxury amenities dispensed with values similar to those of economy-class air travel were obtained.Greenhouse gas emissions Cruise ship tourism International transport