Adoptability of Lean Construction Techniques in Pakistan’s Construction Industry

There is a philosophy in the construction industry to reduce the cost of a project by reducing construction waste and improving productivity. With lower expenses, lean construction emphasizes the cost of the project at a minimum cost. Globally, the philosophy has gained a wide range of popularity in the construction sector. The Lean Construction has helped practitioners with several tools and techniques to implement at different stages of a construction project. Following global trends, this study has investigated lean practices in Pakistan. With the potential advantages experienced by its implementation in Pakistan's construction projects and the level of implementation of various types of tools and techniques has been analyzed. To achieve the goal, the study had tried to capture construction projects in which four shareholders are being represented, which are clients, consultants, contractors and material suppliers. Overall 34 completed questionnaires were collected and then analyzed. The results of the analysis have indicated that pull approach, standard of work, time consuming, visualization tools, the integrated project delivery methods and the quality failure in safe limits are common lean techniques which are being implemented to the local construction industry. While there are major benefits of waste reduction, client satisfaction, better communication, visual control and proper task management to build appropriate work are the key benefits of lean construction

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Effect of climate change on mountain water resources : the case study from European Alps & Himalaya region

Gebirgsregionen sind heute die wichtigste und zuverlässigste Quelle für frisches Wasser. Allerdings steht zu erwarten, dass sich diese Situation im vorhergesagten Wandel des Klimas im 21. Jahrhundert erheblich verändern wird. In diesem Zusammenhang wird die Verfügbarkeit von Frischwasser mit einem Modellierungsansatz analysiert. Dabei werden zukünftige Veränderungen für zwei hydrologisch charakteristische Regionen in mittleren und hohen Höhenlagen in den österreichischen Alpen sowie der Karakorum Region in Pakistan vorhergesagt. Ein örtlich verteiltes hydrologisches Modellierungssystem (PREVAH) wurde dazu entwickelt und eingesetzt um um die hydrologischen Prozesses in den Wasserreservoirs zu simulieren. Dabei wurder der Klimawandel mit hilfe eines sogenannten Delta Ansatzes mit berücksichtigt. Die Modellierungergebnisse der ersten Fallstudie im Bereich der Kitzbühler Ache in den Österreichischen Alpen ergeben eine Verschiebung von einem Regen/Schnee dominierten System zu einem von Regen dominierten System. Ein Rückgang der Schneemenge sowie ein verkürzter Zeitraum mit durchgängiger Schneedecke ist zu beobachten. Auf Grund der Veränderungen der Niederschlagsmengen und deren Form (Schnee zu Regen) ist eine Veränderung der saisonal verfügbaren Wassermenge zu erwarten. Dabei nehmen die Wassermengen im Winter zu während sie Frühjahr, Sommer und Herbst abnehmen. Die zu erwartenden Veränderungen sind sowohl mit für einzelne Monate sowie Saisonen durchaus signifikant, weniger aber bei Betrachtung des Gesamtjahres. Die Größenordnung der Veränderung hängt stark vom gewählten Szenario ab. Die Veränderung des im Mittel verfügbaren Wassers werden durch den Unterschied zwischen dem gesamten Fluß und dem Umweltfluss (Q95) ermittelt. Simulationen deuten auf höhere Wasserverfügbarkeit in den Wintermonaten und verringerte Verfügbarkeit im Sommer hin. Im Jahresmittel zeigen die Modelle aber eine leicht erhöhte Verfügbarkeit von Wasser. Die Ergebnisse zeigen dass Regionen stromabwärts die stark von Regionen stromaufwärts abhängig sind speziell im Sommer mit einem Rückgang der verfügbaren Wassermenge konfrontiert sein werden. Die Ergebnisse und Beobachtungen bieten einen Ausblick auf die zukünftigen Verhältnisse in den Wasserreservoirs der Europäischen Alpen in mittleren Lagen. Die Modellierungsergebnisse in der zweiten Fallstudie im Hunza Reservoir basieren auf der Analyse der hydrologischen Parameter hinsichtlich der postulierten Szenarien für den Klimawandel. Die Modellierungsergebnisse zeigen dass eine Anstieg der Temperatur zu einem starken Anstieg des Wasserflußes im Frühjahr und Sommer führt und insgesamt mit einem Anstieg des gesamten Wasserflußes zu rechnen ist. Im Gegensatz zur Kitzbühler Ache sind die Temperaturverhältnisse in dieser hoch gelegenen Region (7500m Seehöhe) von Herbst bis in das Frühjahr unter dem Gefrierpunkt. Deshalb hat ein Anstieg der Temperatur von 1 bis 4C keine signifikante Auswirkung auf die Form des Niederschlags oder die die Schmelzprozesse. Folglich ist mit keiner signifikanten Veränderung des saisonalen Volumens. mit Ausnahme im Spätfrühling und Sommer, zu rechnen. Zusammenfassend ist ein Anstieg des Wasserflusses (mehr als 75%) nur zur Zeit der Schneeschmelze zu, wie auch derzeit, zu beobachten. Somit ist aufgrund der starken saisonalen Prägung des Wasserflußes (mehr als zwei Drittel der Wassermenge sind in einem sehr kurzen Zeitraum von wenigen Wochen im Sommer verfügbar) und dem Rückgang der Kapazität der Dämme der Bau neuer Reservoirs dringend empfohlen. Die zusätzliche Speicherkapazität würde nicht nur die Gefahr von Fluten reduzieren sondern auch die Kontroll- und Regulierungsfunktion bestehender Dämme verbessern. Die Verteilung des Wassers im Indus Bewässerungssystem (IBIS) is zur Gänze mit Hilfe großer Reservoirs kontrolliert. Der vorhergesagte Trend für den Wasserfluss würden zu einem zukunftsorientierten Management bestehender und zukünftiger Reservoirs am Indus Fluss beitragen. Damit wäre eine bessere und nachhaltige Kontrolle der Wasserreserven für die Bewässerung und Stromversorgung erzielbar. Darüber hinaus liefert die Studie auch Lösungsansätze für aktuelle und zukünftige nachhaltige Wasserwirtschaft für das Indus Becken. Die vorgeschlagenen Ansätze können auch auf andere große Wasservorräte in Semi-ariden und Ariden Regionen angewandt werden.Mountain regions are the most important and reliable supply sources of global fresh water resources, but their future role in fresh water availability is likely to be changed during projected 21st century climate change. In this context, future water availability scenario is analyzed through a modeling approach developed to project future changes in two distinct hydro-logical characteristics flow regimes and subsequent water availability in two sampling catchments located in middle & high altitude mountain ranges of Austrian Alps & Karakorum Range Pakistan respectively. A spatially distributed hydrological modeling system PREVAH was developed & applied to simulate the catchment hydrological processes. The climate change scenarios were incorporated within model simulations by means of the so-called delta approach. The modeling results of the first case study area Kitzbühl Ache catchment located in Austrian Alps predict a shift from a rainfall-snowmelt dominated flow regime to a rainfall dominated flow regime in future. A decrease in snow accumulation and a shortening in snow cover duration is also observed. Due to the projected changes in seasonal precipitation amount, change in form (snow to rain), a change in seasonality of stream flow and available water resource occurs. There will be an increase in winter flow, and a decrease in spring, summer and autumn flow. The typical low flow period during winter shifts to a low flow period during late summer and autumn. The observed changes are significant on monthly and seasonal scales than on an annual basis. However, the magnitude of the effect at all scales depends strongly on the choice of the scenario. The changes in mean available water is assessed through the difference b/w total flow and environmental flow (Q95) regime, model simulations project higher water availability trends in winter and decreasing trends in summer. However, at mean annual scale, most of the scenarios show slightly higher available water. These results indicate that the downstream regions depending on upstream mountain water resources, particularly in summer, may face decline in water availability at the end of 21st century. These values and observations provide a future vision within middle mountainous catchments in the European Alps. The modeling results of the other case study area Hunza catchment are based on the sensitivity analysis of the hydrological parameters towards the hypothetical climate change scenarios. The modeling results show that the increase in temperature produces large increase in late spring and summer flow volume and subsequently in total flow volume. Contrary to findings in Kitzbühl Ache catchment, the temperature regime of this particular high altitude basin (over 7500 m a.s.l) from autumn to early spring months is below freezing point, therefore the increase of 1 to 4C have no any significant influence over the form of precipitation or melting process, and hence no significant change observed in seasonal flow volumes, except in late spring & summer. In nutshell, flow volume increased (more than 75%) is available only in melt season summer as like in present conditions. Therefore, due to seasonality of river flow (where more than 2/3 water will be available in just short span of few weeks in summer) and decreasing capacity of existing dams, this study highly favors the construction of new reservoirs. The additional storage capacity would not only result in reducing the magnitude of potential threats of increasing flood events, but would also enhance the controlling and regulating capacity of existing dams. The water distribution in Indus Basin Irrigation System (IBIS) is fully controlled and regulated through large reservoirs. Thus, predicted flow trends would contribute in successful forward-looking management of existing and proposed reservoirs on Indus River and accordingly let a better and long-lasting control of water supply for irrigation and power supplies. Furthermore, study also provides a solution under current & future sustainable water resource development & management within the Indus Basin. The recommended options can be adopted for other large basins in semi-arid to arid regions.Dip.-Ing. Abdul Nasir LaghariAbweichender Titel laut Übersetzung des VerfassersUniversität Innsbruck, Dissertation, 2017OeB

Effects of Climate Change on Mountain Waters: A Case Study of European Alps

The Alps play a vital role in the water supply of the region through the rivers Danube, Rhine, Po and Rhone while they are crucial to the ecosystem. Over the past two centuries, we witnessed the temperature to increase by +2 degrees, which is approximately three times higher than the global average. Under this study, the Alps are analyzed using regional climatic models for possible projections in order to understand the climatic changes impact on the water cycle, particularly on runoff. The scenario is based on assumptions of future greenhouse gases emissions. The regional model results show the consistent warming trend in the last 30-year span: temperature in winter may increase by 3 to 4.5°C and summers by 4 to 5.5°C. The precipitation regime may also be altered: increasing about 10- 50% in winter and decreasing about 30-60% in summer. The changes in the amount of precipitation are not uninformed. Differences are observed particularly between the North West and South East part of the Alps. Due to the projected changes in alpine rainfall and temperature patterns, the seasonality of alpine flow regime will also be altered: massive rise will occur in winter and a significant reduction in summer. The typical low flow period during winter will also be shifted to late summer and autumn

Techno-Economic Analysis of Solar PV Electricity Supply to Rural Areas of Balochistan, Pakistan

Rural electrification is a fundamental step towards achieving universal access to electricity by 2030. On-grid rural electrification remains a costly proposition, therefore the need to consider off-grid renewable energy solutions is inevitable. However, the critical issue pertaining to local power generation through renewable energy is the absence of area-specific production capacity and economic viability data for the different renewable energy technologies. This paper addresses this issue for Pakistan’s Balochistan province by assessing the area’s potential and economic feasibility of using solar PV for rural electrification. The results suggest that the Balochistan province has the best solar irradiance value in the world. Furthermore, optimal tilt angles calculated for respective regions can significantly increase solar energy yield. The economic feasibility study, carried out for solar PV systems, reveals that the electricity generated using solar PV costs Rs. 7.98 per kWh and is considerably cheaper than conventional electricity, which costs approximately Rs. 20.79 per kWh. Similarly, solar PV systems could mitigate 126,000 metric tons of CO2 annually if 100% of the unelectrified households adopted solar PV systems. Based on these research findings, this paper proposes a policy that would serve as a guideline for the government to extend solar PV-based off-grid rural electrification projects in Balochistan as well as on a national scale

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research