Revisiting the EKC framework concerning COP-28 carbon neutrality management: Evidence from Top-5 carbon embittering countries

In the aftermath of the 28th Conference of the Parties (CoP) climate summit in the UAE, the majority of developing countries encounter challenges in attaining their objectives of carbon neutrality for a sustainable economy. The association of economic factors such as economic growth, governance structures, forest area, renewable energy consumption, technological innovation, and urbanization with environmental elements (carbon footprint) is vital for sustainable economic development and environmental management strategies. Therefore, this research reveals this association in five selected high-emitting countries spanning from 1990 to 2022. This research utilizes the Environmental Kuznets Curve (EKC) framework to investigate the interrelationship between these variables. To do so, this study employs the cross-sectional autoregressive distributed lags (CS-ARDL) statistical technique to determine the short- and long-term impacts of the variables under investigation on carbon footprint. In contrast, the mean group (MG) and common correlated effect mean group (CCEMG) have been applied for robustness. The findings revealed that GDP, urbanization, and forest area have positive associations with carbon footprints, whereas GDP square, renewable energy consumption, technological innovation, and governance effectiveness have inverse relationships with carbon footprints. These findings provide all stakeholders with valuable policy recommendations and management advice for accelerating the transition of renewable energy to low-carbon and green growth.

A causal link between financialization and ecological status: a novel framework for Asian countries?

Sustainable finance and green trade are essential to accomplish the green growth agenda. Though the literature prevails, little is known about the inclusive influence of financialization and trade openness on ecological status rather than just focusing on air pollution or inconclusive element. This study aims to analyze the role of financial dimensions and trade openness with environmental performance in the context of three panels of Asian countries consisting of low, middle, and high-income over the period 1990-2020. The estimated outcomes from the novel panel, the Granger non-causality technique, demonstrate that financialization further contributes to environmental deterioration instead of preserving the environmental quality. Regarding the low and middle-income economies, the authorities should enhance gains from trade openness to develop energy efficiency and ecological status policies. In the case of high-income Asian countries, they are even more desperate to consume energy and ignore the ecological challenges. The findings of this research offer various policy suggestions to accomplish sustainable development objectives.

Moving towards sustainability: how do low-carbon energy, current account balance, and reserves induce environmental deterioration in the Big 3?

Promoting financial sustainability is the focus of current state policies while addressing the concerns of environmental pollution. The alarming impacts of climate change on economies motivate us to revisit an intensive empirical study to explore the dynamic relationships of low-carbon energy, current account balance, and reserves with carbon dioxide (CO₂) emissions in the most polluted countries across the globe for the years 1981-2020. We applied the dynamic autoregressive distributive lag (D-ARDL) simulation model to investigate the short and long-run connection. The empirical outcomes of the study uncover that in the short run, a 1% increase in renewable energy reduces CO₂-based emissions by 0.417%, 0.169%, and 0.619% in China, the USA, and India, respectively. We further explored that China's and the USA's economic growth causes environmental deterioration. In contrast, a 1% increase in current account balances improves the environmental quality of China and India by 0.3% and 0.6%, respectively. This research concludes that model variables significantly impact the environment. Therefore, it is necessary to draw policy implications to increase the consumption of low-carbon energy to sustain economic growth by limiting the adverse impacts of economic activities.

Sustainable environment, energy and finance in China: evidence from dynamic modelling using carbon emissions and ecological footprints

This study investigates sustainable finance along with sustainable economic factors on both carbon emissions and ecological footprints in China. A novel Dynamic Autoregressive Distributed Lag technique is applied; results revealed sustainable finance exerts positive/negative influence on carbon emissions in the long and short run, respectively. Results are robust with ecological footprints that sustainable finance placed a lucrative cause to preserve the environment. Sustainable economic factors show a positive impact on carbon emissions in the long run, whilst economic growth, energy consumption and exports improve environmental quality. Conversely, in the short run, urbanisation supports the environment whilst economic development, energy use and exports exert a positive impact. In addition, this study suggests useful policy implications for the stakeholders.

When would the dark clouds of financial inclusion be over, and the environment becomes clean? The role of national governance

On one side, the rapid progress in financial development boosts economic growth. On the other hand, it forces both the developed and emerging countries to play the role of good governance that help save the environment. The current study aims to identify the role of national governance in the relationship between financial inclusion and ecological footprints. To attain the study's objective, we use a novel method of moments quantile regression (MMQR) on a panel data set of 65 countries from 2004 to 2017. The empirical outcomes reveal that financial inclusion has a significant positive and heterogeneous impact on ecological footprints. This effect varies across quantiles, and when moving from lower to upper quantiles, the impact of financial inclusion on environment escalates. National governance plays an important role to moderate the relationship between financial inclusion and ecological footprint negatively. Moreover, GDP and REC display a significant positive and negative influence on ecological footprints, respectively. We obtain similar and robust findings from the alternative panel estimation techniques, including FMOLS, FEOLS, and DOLS. The policy implications from this research can be considered to achieve sustainable and eco-friendly environmental goals.

95 DOCUMENTATION OF URINARY CATHETER INDICATION AND INSERTION PROCEDURE FOR MEDICAL INPATIENTS AT A UNIVERSITY TEACHING HOSPITAL

Background

Approximately 25% of inpatients have urinary catheters at some point during their hospital stay; over half are deemed inappropriate. This is significant as catheter-associated urinary tract infections (CAUTI) increase morbidity, mortality and length of hospitalisation. Lack of medical documentation and clinician awareness of catheters have been identified as risk factors for inappropriate catheterisation. The aim of this audit was to assess inpatient urinary catheter use among medical inpatients to determine if the indication and insertion procedure were clearly documented.

Methods

The audit was conducted over one day and included all medical inpatients aged 18 years and above. Emergency Department and High Dependency patients were excluded. Data was collected using standardised data collection sheets and involved a review of medical/nursing notes. Data was benchmarked against Health Service Executive guidelines.

Results

27 of 132 medical inpatients (20%) had a urinary catheter in situ on the day of audit. 37% (n = 10) had long-term urinary catheters in situ prior to admission and are not considered further. Of the remaining 63% (n = 17), 9 were female (53%), 8 were male (47%), and the average age was 75 years. Indication was documented in nursing notes for 76% and in medical notes for 53%. Indications included monitoring urinary output (29%), urinary retention (24%), sepsis (18%), comfort (6%) and haematuria (6%). Catheter insertion procedure was documented in nursing notes for 59% and in medical notes for 12%.

Conclusion

One fifth of medical inpatients had urinary catheters on the day of audit. 63% of these patients did not have a catheter prior to admission. Overall medical documentation of catheter indication and insertion procedure is poor. Better documentation would likely improve clinician awareness of their patient’s catheters and prompt earlier review of appropriateness. Education sessions, insertion proforma stickers and catheter review reminder systems are suggested to improve documentation.

A numerical efficient splitting method for the solution of two dimensional susceptible infected recovered epidemic model of whooping cough dynamics: Applications in bio-medical engineering

Background and Objective The positivity property of the non-linear dynamical systems is one of the essential features in different fields of bio-medical engineering, science and many more. The state variables, involving in the models, describing the natural phenomenon such as concentration, density and population size etc. must be positive. Therefore, the computing techniques used to solve the system of non-linear differential equations must be consisted with the continuous nature of the models. But, unfortunately there are some existing techniques in the literature that do not preserve the positivity property, especially for the multi-space dimensional models. So there is a gap in the literature that should be filled up, by constructing the positivity preserving numerical algorithms. In this study, we consider a susceptible-infected-recovered (SIR) reaction diffusion epidemic model in two space dimensions from biomedical engineering and solved numerically to observe the behavior of the model. Since the state variables involved in this system are population densities therefore we design a novel computational method which is time efficient because of its splitting structure and holds the positivity as well as other important structure of epidemic system. Methods Three different computational techniques are designed to examine the numerical solution of SIR model of infectious disease. Two approaches are well-known existing computing methods named as forward Euler finite difference (FD) method and backward Euler operator splitting finite difference (OS-FD) method. The third approach is operator splitting nonstandard finite difference (OS-NSFD) method which is devised by using the NSFD rules. Results The proposed OS-NSFD technique retains efficiently the stability of equilibria as well as the positivity. Graphical behavior depicts that the existing computing methods can not get success to preserve the structure of the epidemic system of whooping cough dynamics. At the same time OS-NSFD computing method is proven to be reliable and suitable for the system of bio-medical engineering mathematically and graphically. Conclusion A reliable and novel computing technique is developed for the solution of two dimensional reaction diffusion problem. This technique preserves all the imperative characteristics of the model under study. Also the time efficiency of this method makes it easy to find the solution of physical system in two space dimension. The comparison with other techniques shows the efficacy and reliability of the designed technique.

Spatio-temporal numerical modeling of reaction-diffusion measles epidemic system

In this work, we investigate the numerical solution of the susceptible exposed infected and recovered measles epidemic model. We also evaluate the numerical stability and the bifurcation value of the transmission parameter from susceptibility to a disease of the proposed epidemic model. The proposed method is a chaos free finite difference scheme, which also preserves the positivity of the solution of the given epidemic model.

Big data and visual analytics in anaesthesia and health care

Advances in computer technology, patient monitoring systems, and electronic health record systems have enabled rapid accumulation of patient data in electronic form (i.e. big data). Organizations such as the Anesthesia Quality Institute and Multicenter Perioperative Outcomes Group have spearheaded large-scale efforts to collect anaesthesia big data for outcomes research and quality improvement. Analytics--the systematic use of data combined with quantitative and qualitative analysis to make decisions--can be applied to big data for quality and performance improvements, such as predictive risk assessment, clinical decision support, and resource management. Visual analytics is the science of analytical reasoning facilitated by interactive visual interfaces, and it can facilitate performance of cognitive activities involving big data. Ongoing integration of big data and analytics within anaesthesia and health care will increase demand for anaesthesia professionals who are well versed in both the medical and the information sciences.

The Amplatzer duct occluder: experience in 209 patients

OBJECTIVES

The aim of the study was to assess the safety and efficacy of the Amplatzer ductal occluder (ADO) in transcatheter occlusion of patent ductus arteriosus (PDA).

BACKGROUND

Transcatheter closure of small to moderate sized PDAs is an established procedure. The ADO is a self-expandable device with a number of salutary features, notably its retrievability, ease of delivery via small 5F to 7F catheters and a range of sizes suitable even for the larger PDAs.

METHODS

Between November 1997 and August 1999, the ADO was successfully implanted in 205 of 209 patients with PDA. The inclusion criteria for this device occlusion method were patients with clinical and echocardiographic features of moderate to large PDA, weighing > or =3.5 kg as well as asymptomatic adolescents and adults with PDA measuring > or =5.0 mm on two-dimensional (2D) echocardiogram. Occlusion was achieved via the antegrade venous approach. Follow-up evaluations were performed with 2D echocardiogram, color-flow mapping and Doppler measurement of the descending aorta and left pulmonary artery velocity at 24 h and 1, 3, 6 and 12 months after implantation.

RESULTS

Two hundred and five patients had successful PDA occlusion using this device. The patients were between two months and 50 years (median 1.9) and weighed between 3.4 kg and 63.2 (median 8.4). Infants made up 26% of the total patients. The PDA measured from 1.8 to 12.5 mm (mean 4.9) at the narrowest diameter. Forty-four percent of patients achieved immediate complete occlusion. On color Doppler the closure rates at 24 h and 1 month after implant were 66% and 97%, respectively. At 6 and 12 months all except one patient attained complete occlusion. Device embolization occurred in three patients; in two this was spontaneous, and in the other it was due to catheter manipulation during postimplant hemodynamic measurement. Mild aortic narrowing was seen in an infant.

CONCLUSIONS

Patent ductus arteriosus occlusion using ADO is safe and efficacious. It is particularly useful in symptomatic infants and small children with relatively large PDA. Embolization can be minimized by selection of appropriate sized devices, and caution should be exercised in infants <5 kg.

Electrocardiographic artefact with SSEP monitoring unit during scoliosis surgery

A case of somatosensory evoked potential (SSEP) induced electrocardiographic artefact simulating supraventricular tachycardia (SVT) is described in a three year old girl with Goldenhar syndrome, during anterior thoracoscopic discectomy with posterior spinal fusion for scoliosis. Adenosine was administered for this misinterpreted EKG with coincidental cessation of SVT like trace.

The Alagille's syndrome and its anaesthetic considerations

Alagille's syndrome is an inherited disorder affecting multiple organ systems. Most characteristic is the paucity of the interlobular bile ducts with cholestasis. The anaesthetic plan for these patients should be based on careful preoperative preparation and attention to the issues involving hepatobiliary, cardiac, neurodevelopmental, nutritional, haematological, ocular and facial abnormalities. We report the case of a five-and-a-half-year old patient with Alagille's syndrome who sustained a pathological fracture of the femur and was scheduled for closed reduction and application of a hip spica cast. Relevant anaesthetic issues are discussed.

Oral and nasotracheal light wand guided intubation after failed fibreoptic bronchoscopy

Fibreoptic bronchoscopic guided tracheal intubation is often the first choice for clinicians familiar with the technique, when faced with a patient in whom tracheal intubation presents known or possible difficulties. Regardless of the technique chosen, anticipated and unanticipated problems may arise. We report three patients with known difficult airways that illustrate the utility of light wand guided oral and nasotracheal intubation when tracheal intubation with fibreoptic bronchoscopy proved impossible.

Serum parathyroid hormone suppression by intravenous 1,25-dihydroxyvitamin D3 in patients on maintenance haemodialysis

Secondary hyperparathyroidism in patients with end-stage renal disease is characterised by elevated circulating levels of parathyroid hormone, due to inadequate synthesis of calcitriol, the active metabolite of vitamin D. Recent studies suggest that administration of calcitriol may directly suppress parathyroid (PTH) secretion independent of changes in serum calcium. We have studied the effect of intravenous calcitriol administration on the PTH level in 14 patients on maintenance haemodialysis with serum PTH levels above 2,000 pmol/l over a 16-week period. There was a significant reduction in the PTH level (65%) and a rise of serum calcium to the normal range. There was a significant reduction in serum PTH levels before the serum calcium concentrations increased, suggesting that calcitriol directly inhibits PTH release. In conclusion, intravenous treatment with calcitriol is of clinical importance, because it suppresses hypersecretion of PTH in uraemic patients, with minimal side effects.

The importance of the perfusion index in the evaluation of captopril renography for transplant renal artery stenosis

Severe renal artery stenosis (RAS) is a relatively uncommon complication following renal transplantation but is a curable cause of hypertension which demands reliable early diagnosis to reduce morbidity, mortality and graft loss. Captopril renography has been used for a number of years as a method of detecting RAS mainly in native kidneys, with only a few studies concerning the transplant situation. Controversy still exists as to the diagnostic accuracy of this test and as to the most appropriate interpretation criteria with which to establish a positive result. This paper reports the evaluation of 26 captopril renography investigations on hypertensive renal transplant patients with a suspected diagnosis of RAS. Each renogram study was correlated with an arteriogram as the 'gold standard' which was undertaken within 28 days of the renography. A sensitivity of 92%, a specificity of 86% and an accuracy of 88% were achieved by including a consideration of the change in perfusion to the kidney between pre- and post-challenge studies. It is concluded that captopril renography is a useful screening test for the detection of transplant renal artery stenosis (TRAS).

Pattern of renal disease in children

In 1992 a total of 1298 patients with renal diseases were seen in the medical outpatients department. Eight hundred and forty-seven (65.2%) had urinary tract infection and 265 (20.5%) had nephrotic syndrome. Two hundred and twenty patients required inpatient care, which constituted 3.3% of total number of patients admitted to medical wards. Sixty-four (29%) of admitted patients with renal disease had nephrotic syndrome, 29 (13.1%) had acute renal failure due to various causes including haemolytic uraemic syndrome. The average stay was 5.8 days per patient and mean bed occupancy was 3.4 beds per day. Various renal diseases in children together form an important group of disorders often requiring long term care and this should be taken into account when planning provision of child health services particularly at tertiary care level.

Quality control of dose calibrators

Radionuclide dose calibrators are instruments that require regular checks and proper usage to ensure that they are operating correctly. The responsibility for the accuracy of the activity and the resultant estimate of the dose delivered to the patient rests with the persons administering the radiopharmaceutical. Hence, it is essential that accurate measurements of radioactivity be provided by the dose calibrator in use in every nuclear medicine department. The routine testing of the calibrator would ensure the user that the overall characteristics of the instrument are within acceptable limits. The quality control of two dose calibrators was carried out elaborately and their performance was evaluated from various aspects of quality control such as geometry effect, instrument linearity, precision test, instrument accuracy etc. It was found that one of the calibrators was having non-linear response resulting in an error of 18% from the decay-predicted activity. It also showed a saturation effect beyond 310 mCi. Hence, it needed repair or recalibration. However, the other calibrator was working satisfactorily. This study also helped us in realizing certain operational pitfalls of the dose calibrators.