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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Indirect involvement of armorphous carbon layer on convective heat transfer enhancement using carbon nanofibers

In this work, an experimental heat transfer investigation was carried out to investigate the combined influence of both amorphous carbon (a-C) layer thickness and carbon nanofibers (CNFs) on the convective heat transfer behavior. Synthesis of these carbon nanostructures was achieved using catalytic chemical vapor deposition process on a 50 μm nickel wire at 650 °C. Due to their extremely high thermal conductivity, CNFs are used to augment/modify heat transfer surface. However, the inevitable layer of a-C that occurs during the synthesis of the CNFs layer exhibits low thermal conductivity which may result in insulating the surface. In contrast, the amorphous layer helps in supporting and mechanically stabilizing the CNFs layer attachment to the polycrystalline nickel (Ni270) substrate material. To better understand the influences of these two layers on heat transfer, the growth mechanism of the CNFs layer and the layer of carbon is investigated and growth model is proposed. The combined impact of both a-C and CNFs layers on heat transfer performance is studied on three different samples which were synthesized by varying the deposition period (16 min, 23 min, and 30 min). The microwire samples covered with CNF layers were subjected to a uniform flow from a nozzle. Heat transfer measurement was achieved by a controlled heat dissipation through the microwire to attain a constant temperature during the flow. This measurement technique is adopted from hot wire anemometry calibration method. Maximum heat transfer enhancement of 18% was achieved. This enhancement is mainly attributed to the surface roughness and surface area increase of the samples with moderate CNFs surface area coverage on the sample

CFD modeling of ash deposition for co-combustion of MBM with coal in a tangentially fired utility boiler

Ash deposition is one of the main challenges that needs to be tackled in response to increased percentage of biomass co-firing in pulverized fuel boilers. In this study, a model has been developed to investigate the slagging behavior of meat and bone meal (MBM) at higher co-firing rates in the Maasvlakte boiler operated by E.ON Benelux. The model includes the combustion of solid fuels in a tangentially fired boiler and post-processing of ash deposition on the heat exchange surfaces. The deposition tendency of the impacting ash particles is predicted on the basis of ash viscosity, which is calculated with the Urbain viscosity model. Thermodynamic equilibrium is used to calculate the various fuel ash properties for both oxidizing and reducing conditions. On the basis of the thermal heat input, solid fuel combustion is modeled and evaluated for various co-firing rates which consists of 0%, 12.5%, 25% and 40% of MBM. The calculation results show that the deposition propensity is the highest for a co-firing ratio of 25% MBM. The preferred deposition locations in the boiler calculated by the CFD model are in line with observations in operational practice

Influence of microscale surface modification on impinging flow heat transfer performance

An experimental approach has been used to investigate the influence of a thin layer of carbon nanotubes (CNTs) on the convective heat transfer performance under impinging flow conditions. A successful synthesis of CNT layers was achieved using a thermal catalytic vapor deposition process (TCVD) on silicon sample substrates. Three different structural arrangements, with fully covered, inline, and staggered patterned layers of CNTs, were used to evaluate their heat transfer potential. Systematic surface characterizations were made using scanning electron microscope (SEM) and confocal microscopy. The external surface area ratio of fully covered, staggered, and inline arrangement was obtained to be 4.57, 2.80, and 2.89, respectively. The surface roughness of the fully covered, staggered, and inline arrangement was measured to be (Sa = 0.365 μm, Sq = 0.48 μm), (Sa = 0.969 μm, Sq = 1.291 μm), and (Sa = 1.668 μm, Sq = 1.957 μm), respectively. On average, heat transfer enhancements of 1.4% and − 2.1% were obtained for staggered and inline arrangement of the CNTs layer. This is attributed to the negligible improvement on the effective thermal resistance due to the small area coverage of the CNT layer. In contrast, the fully covered samples enhanced the heat transfer up to 20%. The deposited CNT layer plays a significant role in reducing the effective thermal resistance of the sample, which contributes to the enhancement of heat transfer