Final Report: Computer Simulation of Osmosis and Reverse Osmosis in Structured Membranes

Molecular simulation methods were developed as part of this project to increase our fundamental understanding of membrane based separation systems. Our simulations clarified for example that steric (size) effects had a significant impact on the desalination membranes. Previously it was thought the separation was entirely driven by coulombic force (attractive/repulsive forces at the membrane surfaces). Steric effects played an important role, because salt ions in brackish water are never present alone, but are strongly hydrated which effectively increases their size, and makes it impossible to enter a membrane, while the smaller water molecules can enter more readily. Membrane surface effects did play a role in increasing the flux of water, but not in the separation itself. In addition we also developed simulation methods to study ion exchange, gas separations, and pervaporation. The methods developed were used to once again increase our fundamental understanding of these separation processes. For example our studies showed that when the separation factor of gases in membranes can be significantly affected by the presence of another gas, it is generally because the separation mechanism has changed. For example in the case of nitrogen and carbon dioxide, in their pure state the separation factor is determined by diffusion, while in mixtures it is influenced more by adsorption in the membrane (zeolite in our case) Finally we developed a new technique using the NMR chemical shift to determine intermolecular interactions for mixtures. For polar-nonpolar systems such as Xe dissolved in water we were able to significantly improve the accuracy of gas solubilities, which are very sensitive to the cross interaction between water and Xe

Transforming Financial Services: The Impact of FinTech Innovation on the Customer Adoption

This study aimed to determine the correlations between FinTech innovation, banking sector transformation, and customer adoption of FinTech-based services in Pakistan's banking sector. Data was collected from Pakistani bank employees using a quantitative research methodology. A survey questionnaire was used to gather responses on innovation in fintech, banking sector transformation, and customer uptake of fintech-based services. The results showed a strong positive correlation between FinTech innovation and customer uptake in the banking industry, which was mediated by banking sector transformation. This highlights the importance of banks altering their business models and services to effectively utilise FinTech solutions. By adopting FinTech innovations and supporting banking sector change, financial institutions can increase consumer uptake, position themselves for sustainable growth, and remain competitive in the rapidly changing financial services industry. This study provides valuable insights for banking executives and decision-makers seeking to enhance customer service and support the growth of the banking industry in innovation and resilience

Designing EthAKUL: A mobile just-in-time learning environment for bioethics in Pakistan

In developing countries such as Pakistan, bioethics has not been included in mainstream thinking in medical education. The authors’ experiences suggest that current methods of teaching bioethics are problematic as students are unable to translate theory to practice. Alternative pedagogies, such as just-in-time learning (JiTL) using mobile devices, may be able to foster the development and implementation of ethical reasoning among nurses, doctors, and medical and nursing students. This research was conceived to determine the effectiveness of mobile JiTL – anytime, anyplace learning through mobile devices – for teaching bioethics. After obtaining ethical clearance, a participatory design (PD) approach was adopted to ensure input from all stakeholders for the design of ‘EthAKUL’, comprising a mobile app, five modules and just-in-time pedagogy. The name of the app is an acronym evoking ethics, learning and the university where the project originated. As a part of the design process, three PD workshops were held with junior doctors, nurses, nursing students, medical students and bioethics teaching faculty, and five meetings were held with faculty members, to discuss functional specifications and user-acceptance testing of the app. The feedback related to the nature of common ethical issues encountered in clinical settings, the existing process of teaching and learning bioethics, and the requested features of the app were recorded. These data sets were analyzed and synthesized into functional and technical specifications for the mobile app. The software programmers developed the app with the close involvement of the stakeholders. The development of teaching content continued alongside this process. While this enabled EthAKUL’s developers to incorporate needs of all stakeholders, challenges were encountered in the process relating to the pragmatic and conceptual aspects of JiTL, ML and PD. We discuss the implications of this research in bringing about transformative changes in higher education

EFFECT OF SUPPLEMENTAL IRRIGATION ON WHEAT WATER PRODUCTIVITY UNDER RAINFED ECOLOGY OF POTHOHAR, PAKISTAN

For rainfed ecology, water is the most limiting natural resource and its effective utilization is indispensable in order to optimize crop water productivity. A field study on wheat crop was carried out to asses the impact of different irrigation depths through sprinkler irrigation system at three phonological stages viz. tilleing, anthesis and grain filling. Randomized Complete Block Design (RCBD) was used in the trail and had three repeats.  The area under study received 195 mm seasonal rainfall. Supplemental irrigation depths at three phonological stages, using small quantities of water through sprinkler irrigation system, significantly promoted the crop growth. The irrigation depth 25 mm gave the maximum output for biological yield (6504 ), grain yield (2030 ), thousand grain weight (28), plant height (87 ) and spike length (10 ). The highest water productivity of 0.97 kg/m3 was achieved with 25 mm supplemental irrigation depth when applied at tillering and anthesis stages

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026

Background The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. We aimed to provide a comparative assessment of global health spending at the onset of the pandemic; characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic; and examine expectations for future health spending and put into context the expected need for investment in pandemic preparedness. Methods In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, we estimated four sources of health spending: development assistance for health (DAH), government spending, out-of-pocket spending, and prepaid private spending across 204 countries and territories. We used the Organisation for Economic Co-operation and Development (OECD)'s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) to estimate spending. We estimated development assistance for general health, COVID-19 response, and pandemic preparedness and response using a keyword search. Health spending estimates were combined with estimates of resources needed for pandemic prevention and preparedness to analyse future health spending patterns, relative to need. Findings In 2019, at the onset of the COVID-19 pandemic, US$9·2 trillion (95$7·3 trillion (95% UI 7·2–7·4) in 2019; 293·7 times the $24·8 billion (95$43·1 billion in development assistance was provided to maintain or improve health. The pandemic led to an unprecedented increase in development assistance targeted towards health; in 2020 and 2021, $1·8 billion in DAH contributions was provided towards pandemic preparedness in LMICs, and$37·8 billion was provided for the health-related COVID-19 response. Although the support for pandemic preparedness is 12·2% of the recommended target by the High-Level Independent Panel (HLIP), the support provided for the health-related COVID-19 response is 252·2% of the recommended target. Additionally, projected spending estimates suggest that between 2022 and 2026, governments in 17 (95% UI 11–21) of the 137 LMICs will observe an increase in national government health spending equivalent to an addition of 1% of GDP, as recommended by the HLIP. Interpretation There was an unprecedented scale-up in DAH in 2020 and 2021. We have a unique opportunity at this time to sustain funding for crucial global health functions, including pandemic preparedness. However, historical patterns of underfunding of pandemic preparedness suggest that deliberate effort must be made to ensure funding is maintained

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Final Report: Computer Simulation of Osmosis and Reverse Osmosis in Structured Membranes

Molecular simulation methods were developed as part of this project to increase our fundamental understanding of membrane based separation systems. Our simulations clarified for example that steric (size) effects had a significant impact on the desalination membranes. Previously it was thought the separation was entirely driven by coulombic force (attractive/repulsive forces at the membrane surfaces). Steric effects played an important role, because salt ions in brackish water are never present alone, but are strongly hydrated which effectively increases their size, and makes it impossible to enter a membrane, while the smaller water molecules can enter more readily. Membrane surface effects did play a role in increasing the flux of water, but not in the separation itself. In addition we also developed simulation methods to study ion exchange, gas separations, and pervaporation. The methods developed were used to once again increase our fundamental understanding of these separation processes. For example our studies showed that when the separation factor of gases in membranes can be significantly affected by the presence of another gas, it is generally because the separation mechanism has changed. For example in the case of nitrogen and carbon dioxide, in their pure state the separation factor is determined by diffusion, while in mixtures it is influenced more by adsorption in the membrane (zeolite in our case) Finally we developed a new technique using the NMR chemical shift to determine intermolecular interactions for mixtures. For polar-nonpolar systems such as Xe dissolved in water we were able to significantly improve the accuracy of gas solubilities, which are very sensitive to the cross interaction between water and Xe