An engineering perspective of water sharing issues in Pakistan

Water sharing within the states/provinces of a country and cross-border is unavoidable. Conflicts between the sharing entities might turn more severe due to additional dependency on water, growing population, and reduced availability as a result of climate change at many locations. Pakistan, being an agricultural country, is severely water stressed and heading toward a worsening situation in the near future. Pakistan is heading toward water scarcity as water availability in the Indus basin is becoming critical. Being a downstream riparian of India and Afghanistan in the Indus basin, water availability depends on the releases of water from both countries. The Indus Water Treaty is governing the water distribution rights between India and Pakistan. However, there exists no proper agreement between Pakistan and Afghanistan and the construction of new dams on the Kabul River is another threat to water availability to Pakistan. Correct implementation of the Indus Water Treaty with India is required, together with an effective agreement with Afghanistan about the water sharing. In addition to water shortage, poor management of water resources, inequitable sharing of water, lack of a systematic approach, old-fashioned irrigation practices, and growing agricultural products with large water footprints are all exacerbating the problem. The water shortage is now increasingly countered by the use of groundwater. This sudden high extraction of groundwater is causing depletion of the groundwater table and groundwater quality issues. This water shortage is exacerbating the provincial conflicts over water, such as those between Punjab and Sindh provinces. At one end, a uniform nationwide water allocation policy is required. At the same time, modern irrigation techniques and low-water-footprint agricultural products should be promoted. A fair water-pricing mechanism of surface water and groundwater could be an effective measure, whereas a strict policy on groundwater usage is equally important. Political will and determination to address the water issues are required. The solutions must be based on transparency and equity, by using engineering approaches, combined with comprehensive social support. To develop a comprehensive water strategy, a dedicated technopolitical institute to strengthen the capabilities of nationwide expertise and address the issues on a regular basis is required to overcome the complex and multidimensional water-related problems of the country

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Characterization and medicinal applications of Karakoram shilajit; angiogenesis activity, antibacterial properties and cytotoxicity

Shilajit is a natural substance found in the Himalayan region from Nepal to Pakistan. It is a decomposition product of Royle’s spurge , white clover , and different species of molds. The decomposition takes place over a time span of centuries by the action of microorganism. In the present study, shilajit samples from four different origins including siachen khaplu shilajit (SKS), kharmang pari saspolo shilajit (KPSS), kharmang ghandus shilajit (KGS), and kharmang shilajit center (KSC) of district Skardu, Pakistan were investigated. These samples were characterized using scanning electron microscopy (SEM), Energy-dispersive x-ray spectroscopy (EDS), x-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), and UV-visible spectroscopy (UV/vis). SEM revealed a notable difference in the shape and size of collected samples. All samples were found to possess crystalline nature, which is confirmed from XRD. The presence of multi-components and complex silicates confirmed the presence of humic substances (HS) in shilajit. A slight disparity in physiological properties of four samples were revealed due to geographical variations and ecological conditions, which determine the natural synthesis of shilajit. All samples exhibited antibacterial effects against Gram negative bacteria; Escherichia coli (E.coli) . About 76%, 98%, and 100% of bacteria were killed by SKS, both KPSS and KGS, and KSC samples, respectively. The cell viability analysis revealed that the KPSS (66%) and KGS (53%) were cyto-compatible as compared to the SKS (23%) and KSC (25%) samples. The Chick Chorionic Allantoic Membrane (CAM) assay was used to observe the angiogenic potential for SKS, KSC, and KGS samples. Hence, shilajit sample could be a potential candidate for the medicinal applications and offer a new approach to biomedical applications

A study on the effect of bioactive glass and hydroxyapatite-loaded Xanthan dialdehyde-based composite coatings for potential orthopedic applications

Abstract The most important challenge faced in designing orthopedic devices is to control the leaching of ions from the substrate material, and to prevent biofilm formation. Accordingly, the surgical grade stainless steel (316L SS) was electrophoretically deposited with functional composition of biopolymers and bioceramics. The composite coating consisted of: Bioglass (BG), hydroxyapatite (HA), and lawsone, that were loaded into a polymeric matrix of Xanthan Dialdehyde/Chondroitin Sulfate (XDA/CS). The parameters and final composition for electrophoretic deposition were optimized through trial-and-error approach. The composite coating exhibited significant adhesion strength of “4B” (ASTM D3359) with the substrate, suitable wettability of contact angle 48°, and an optimum average surface roughness of 0.32 µm. Thus, promoting proliferation and attachment of bone-forming cells, transcription factors, and proteins. Fourier transformed infrared spectroscopic analysis revealed a strong polymeric network formation between XDA and CS. scanning electron microscopy and energy dispersive X-ray spectroscopy analysis displayed a homogenous surface with invariable dispersion of HA and BG particles. The adhesion, hydrant behavior, and topography of said coatings was optimal to design orthopedic implant devices. The said coatings exhibited a clear inhibition zone of 21.65 mm and 21.04 mm with no bacterial growth against Staphylococcus aureus (S. Aureus) and Escherichia coli (E. Coli) respectively, confirming the antibacterial potential. Furthermore, the crystals related to calcium (Ca) and HA were seen after 28 days of submersion in simulated body fluid. The corrosion current density, of the above-mentioned coating was minimal as compared to the bare 316L SS substrate. The results infer that XDA/CS/BG/HA/lawsone based composite coating can be a candidate to design coatings for orthopedic implant devices

Urban Heat Island vulnerability mapping using advanced GIS data and tools

Urban Heat Island (UHI) is a phenomenon that can cause hotspots in city areas due to dense, impervious infrastructure and minimal vegetation cover. UHI hotspots may become worse in extreme heat events that are already affecting many regions across the globe due to increased frequent hot extremes, human-induced warming in cities, and rapidly growing urbanization, as documented by the latest IPCC report 2021. In seeking to support designers, planners, and decision-makers in developing and implementing adaptation strategies and measures to make our cities sustainable and resilient, reliable projections and modelling are required. In this study, we modelled UHI vulnerability using high-resolution spatial data, advanced geospatial tools, and socio-demographic data. This modified vulnerability approach drew upon UHI index maps and 20 select customized indicators of heat exposure, population sensitivity, and mobility/adaptive capacity. The indicators were Delphi evaluated and weighted, and the methodology was applied against the City of Greater Geelong municipality in Australia. The resulting UHI index maps indicated significant hotspots in areas of high building density, commercial/industrial zones, newly constructed sites, and zones with low urban green infrastructure. These UHI maps, in combination with selected indicators, highlighted the areal concentration of heat risk areas and vulnerable locations for the sensitive human population. The highlighted areas were primarily concentrated in high building density and high population density areas, which was seen through correlation curves. However, the building density showed a weak correlation, and population per meshblock indicated a strong correlation with UHI measurements. This study provides a comprehensive analysis of risk mapping and vulnerability assessment using GIS geospatial data for the advancement of a major local government area and concludes that this methodology has replicability incomparable geographical regions

Comparison of Oncologic Outcomes and Treatment-Related Toxicity of Carbon Ion Radiotherapy and En Bloc Resection for Sacral Chordoma

AbstractImportance: Maximal resection is the preferred management for sacral chordomas but can be associated with unacceptable morbidity. Outcomes with radiotherapy are poor. Carbon ion radiotherapy (CIRT) is being explored as an alternative when surgery is not preferred.Objective: To compare oncologic outcomes and treatment-related toxicity of CIRT and en bloc resection for sacral chordoma.Design, setting, and participants: Univariable logistic regression was performed to evaluate the association between treatment type and oncologic and toxicity outcomes in this retrospective cohort study. Nearest-neighbor propensity score matching was used to match the CIRT cohort with the en bloc resection cohort and 10 National Cancer Database (NCDB) cohorts separately, with the objective of obtaining more homogeneous cohorts when comparing treatments. Patient- and tumor-related characteristics from 2 institutional cohorts were collected for patients diagnosed with sacral chordomas between April 1, 1994, and July 31, 2017. The NCDB was queried for data on patients with sacral chordoma from January 1, 2004, to December 31, 2016, as a comparator in overall survival (OS) analyses. Data analysis was conducted from February 24, 2020, to January 16, 2021.Exposures: En bloc resection, incomplete resection, photon radiotherapy, proton radiotherapy, and CIRT.Main outcomes and measures: Overall survival was estimated using the Kaplan-Meier method and compared using the Cox proportional hazards model. Peripheral motor nerve toxic effects were scored using Common Terminology Criteria for Adverse Events, version 4.03.Results: A total of 911 patients were included in the study (NCDB: n = 669; median age, 64 [IQR, 52-74] years; 410 [61.3%] men; CIRT: n = 188; median age, 66 [IQR, 58-71] years; 128 [68.1%] men; en bloc surgical resection: n = 54; median age, 53.5 [IQR 49-64] years, 36 [66.7%] men). Comparison of the propensity score-matched institutional en bloc resection and CIRT cohorts revealed no statistically significant difference in OS (CIRT: median OS, 68.1 [95% CI, 44.0-102.6] months; en bloc resection: median OS, 58.6 [95% CI, 25.6-123.5] months; P = .57; hazard ratio, 0.71 [95% CI, 0.25-2.06]; P = .53). The CIRT cohort experienced lower rates of peripheral motor neuropathy (odds ratio, 0.13 [95% CI, 0.04-0.40]; P < .001). On comparison of the propensity score-matched NCDB cohorts with the CIRT cohort, significantly higher OS was found for CIRT compared with margin-positive surgery without adjuvant radiotherapy (CIRT: median OS, 64.7 [95% CI, 57.8-69.7] months; margin-positive surgery without adjuvant radiotherapy: median OS, 60.6 [95% CI, 44.2-69.7] months, P = .03) and primary radiotherapy alone (CIRT: median OS, 64.9 [95% CI 57.0-70.5] months; primary radiotherapy alone: 31.8 [95% CI, 27.9-40.6] months; P < .001).Conclusions and relevance: These findings suggest that CIRT can be used as treatment for older patients with high performance status and sacral chordoma in whom surgery is not preferred. CIRT might provide additional benefit for patients who undergo margin-positive resection or who are candidates for primary photon radiotherapy