Failures of land tenancy in Pakistan

The Government of Sindh must urgently come up with measures to improve land tenancy to ensure the end of bonded labour. Drawing on fieldwork from the region, Abdul Waheed Jamali explores the plight of bonded labourers and the failures of the current Sindh Tenancy Act

Protecting small farmers in Pakistan in the wake of the new seed Act

As a result of the Seed (Amendment) Act, farmer friendly seed policies have been replaced by legislation which favours multinational corporations. Abdul Waheed Jamali discusses why this is a problem, and draws on Sindh as a case study to explore how state governments can support existing public bodies to support small farmers

Rangelands versus the economic argument: the case of Tharparkar, Pakistan

The discovery of coal in Tharparkar and changing agricultural practices are threatening the agricultural rangelands and consequently, the rights to livelihood and the food security of local farmers, writes Abdul Waheed Jamali

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

Recent advances in Bio-mass by electrochemically strategies generated hydrogen gas production: Environmentally sustainable technologies innovation

The potential of green hydrogen as in transitioning to a free pollution energy infrastructure. Green hydrogen gas is produced using renewable energy sources, typically through the process of electrolysis, and is considered environment friendly because it does not emit carbon dioxide when produced. While solar water redox reaction using photochemical and electrochemical methods is an elegant way to harvest green hydrogen production, it can be challenging to make this process economically competitive, especially for low-cost products like hydrogen. To address this challenge, the proposes a solution, which is to produce hydrogen during the photoelectrochemical process. In this demonstration of the (photo)electrochemically generated hydrogen (H2) for the homogeneous and hydrogenation. The coupled process offers greater stability compared to direct electrochemical hydrogenation and it provides more flexibility in controlling the chemical reactions involved. Overpotential refers to the extra energy required to drive a reaction and coupling the processes can help minimize this overpotential. An overall ∼58 conversion of the produced hydrogen is confirmed for this process, indicating the efficiency of the approach. Additionally, a techno-economic assessment of the proa strategy to make green hydrogen production economically competitive by co-producing value-added chemicals, using ascorbic acid. This approach enhances the economic feasibility of green hydrogen production but also adds value to the process by producing valuable chemical products. © 2023 Elsevier Lt

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)