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Fiza Sarwar,1 Khan Alam,2 Chung Wai Chow,3 Muhammad Saeed,1 Riffat Naseem Malik1 1Environmental Biology and Ecotoxicology Laboratory, Department of Environmental Sciences, Quaid-i-Azam University, Islamabad, Pakistan; 2Department of Physics, University of Peshawar, Peshawar, Pakistan; 3Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, Toronto, CanadaCorrespondence: Fiza Sarwar; Riffat Naseem MalikEnvironmental Biology and Ecotoxicology Laboratory, Department of Environmental Sciences, Quaid-i-Azam University, Islamabad, PakistanEmail fiza.sarwar.baloch@gmail.com; r_n_malik@qau.edu.pkBackground: Particulate matter–associated microbes in the workplace are a burning issue in occupational toxicology. Studies have reported on respiratory infections among tannery cohorts. This study uniquely presents measurements of airborne bacterial concentrations associated with varied particulate-matter sizes, their exposure, and consequent severity in occupational respiratory problems, all for different microenvironments within leather tanneries.Methods: Analyses included molecular identification of isolates, computation of mass median aerodynamic diameter of aerosols, tannery process–exposure dose (TPED) to bacterial aerosols, and spirometry and symptom assessment of impaired pulmonary function.Results: The highest bacterial concentrations were for rawhide treatment and finishing units, showing 3.6× 103 and 3.7× 103 CFU/m3, respectively. Identified bacterial species included Ochrobactrum pseudogrignonense, Neisseria bacilliformis, Enterobacter cloacae, Alcaligenes faecalis, Klebsiella pneumoniae, and Corynebacterium spp. Maximum and minimum values of mass median aerodynamic diameter were 8.3 μm and 0.65 μm for buffing and snuffing and production units, respectively. The highest TPED was 1,516.9 CFU/kg for finishing units. Respiratory symptoms in order of incidence were dyspnea > phlegm > cough > wheezing and tachypnea (equivalent). Bronchodilator measurements of FEV1, FVC, and PEF represent decline in lung function. Of 26 patients identified with COPD, most were working in rawhide treatment.Conclusion: We conclude that exposure–infection synergy is also a cause of pulmonary ailments and COPD development, rather than the better-known exposure–smoking synergy.Keywords: respiratory symptoms, bacteria, lung function, COPD, tannery process, MMAD, infection, airborne

Microplastic (MP) pollution is a critical environmental challenge worldwide, however limited research is reported in remote lakes of Pakistan. This study assessed MPs (>5 mm) prevalence, distribution and risk perspective in water and sediment of eight remote and high-altitude lakes (>1500 m above sea level) of Gilgit Baltistan, Pakistan. The lakes exhibited an average abundance of 152.6 ± 104.6 to 12.1 ± 7 MP/kg of dry sediments and 2 ± 0.9 to 17.1 ± 17.2 MP/L of surface water. MPs <200 μm dominated in both matrices. Surface water predominantly contained polyester and polypropylene, while polypropylene and polyethylene dominated in sediments. The gradient of elevation did not show any pronounced impact on the fiber loading or MP count in both matrices. Backward air mass trajectory revealed that air masses vastly travelled from western-Asia, Arabian sea and Bay of Bengal with an average transmission distance of 2500-3500 km (500 m a.s.l) that can be a potential deposition MP source in the area. Pollution Load Index of the lakes were >1 exhibiting pollution. All other lakes except Batura and Borith manifested a moderate hazard index. Naltar lake along with aforementioned two lakes also manifested high polymer toxicity. Further research should emphasize understanding the mechanisms and biotic interactions in high-mountain ecosystems., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Maryem Mehboob reports financial support was provided by Campus France. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The coexistence of polystyrene microplastics (PSMPs) and copper (Cu) has become a pressing issue for croplands. However, limited literature is available regarding the interaction of PSMPs with essential micronutrients in Cu-contaminated soils. Therefore, the present study aimed to analyze the immobilization potential of PSMPs for micronutrient bioavailability in soil and Cu toxicity in maize (Zea mays L.). A pot experiment was conducted with maize variety "Islamabad gold" exposed to varying Cu concentrations (0, 50, 100, 200, and 400 mg/kg) and PSMPs (150-250 μm size, 0, 1, and 3% w/w) via soil spiking for 60 days. The concentrations of essential micronutrients (Zn, Cu, Mn, Fe) in soil and plant tissues were measured using an atomic absorption spectrophotometer. Moreover, malondialdehyde (MDA) and antioxidant activities (superoxide dismutase, ascorbate peroxidase, catalase, and peroxidase) were recorded. The concentration of Cu showed significant reduction in post-harvesting soil by 21, 24.8, 27.6, 29.2, and 30.2% from Cu0 to Cu400 mg/kg respectively from pre-sowing soil. On the other hand, the addition of 1%PSMPs and 3%PSMPs declined Cu by 16, 21.6, 24.4, 25.9, 27.8, and 12.6, 16.5, 19.9, 23.2, 25% from Cu0 to Cu400 mg/kg respectively. Maize showed significant improvement in growth under combined exposure of Cu and 3% PSMPs compared to individual exposure. The MDA level was decreased under the combined presence of Cu and PSMPs compared to individual Cu exposure. The percentage difference with 1%PSMPs was 98.1, 95.0, 92.0, 90.0, and 89.6%, while with 3%PSMPs was 93.2, 93.2, 87.7, 81.4, and 79.2% from Cu0 to Cu400 mg/kg respectively. Moreover, the impact of PSMPs was more prominent at a 3% dose compared to a 1% dose. The findings provided significant knowledge about the potential of PSMPs to mitigate Cu toxicity in maize. Future research should incorporate a variety of particle size distributions at natural conditions for variety-specific differences., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Iron-steel (IS) and textile (T) are among the major polluting industries worldwide which generate large quantities of effluents containing potentially toxic metals (PTMs). Irrigation application of these effluents due to freshwater shortage is a common practice in developing countries. The current research endeavors to investigate potentially toxic metals in IS and T effluents, contamination status and ecological risk assessment of irrigated soils, PTMs accumulation in grains of diverse wheat germplasm and human health risk appraisal. Soil irrigation with effluents significantly enhanced soil nitrate-nitrogen (T, 285.86 mg/kg; IS, 539.70 mg/kg), phosphorus (T, 8.35 mg/kg; IS, 11.44 mg/kg), organic matter (T, 6.05%; IS, 4.48%) and PTMs contents compared to control (C). Enrichment factor and geo-accumulation index revealed substantial contamination trend of PTMs in IS (Ni > Cr > Co > Cd > Pb > Zn > Mn) and T (Co > Cd > Ni > Cu > Cr) treated soils. Potential ecological risk index and modified potential ecological risk index placed T (very high risk) and IS (considerable risk) irrigated soils in respective categories, with highest risk contributions from Cd, Co and Ni. The interactive effects for PTMs accumulation in grains of 30 wheat genotypes were recorded significant. Average PTMs accumulation in grains for the three irrigation treatments was IS > T > C for Zn, Cr, Mn, Pb, Fe, Ni and T > IS > C for Co, Cd, Cu. Multivariate statistical analysis ( principal component analyses) was used to identify the wheat genotypes with higher or lower grain PTMs accumulative potential on effluent irrigation. The genotypes with a lower grain PTMs accumulation and human health risks are recommended for cultivation in agro-systems receiving IS and T effluents, in order to safeguard wheat crop and human health., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Autonomic dysreflexia (AD) is a common autonomic complication of spinal cord injury (SCI) characterized by a sudden increase is blood pressure triggered by peripheral stimulation, such as bladder distention. Iatrogenic AD events often occur during various medical procedures including urodynamic assessments (UDSs) used to evaluate lower urinary tract (LUT) function in individuals with SCI. To date, there are no established clinical practices that would allow early detection of the development of episodes of AD. Heart rate variability (HRV) is a reliable and non-invasive metric for evaluating autonomic regulation of the cardiovascular system, with demonstrated utility in people with SCI during UDSs. We aim to provide a comprehensive evaluation of cardiovascular function during UDS-induced AD using ultra-short-term HRV analysis and identify changes in cardiovascular dynamics to predict the onset of AD. We assessed cardiovascular data in a total of 24 participants with sensorimotor complete SCI above T6 (17 males, 7 females, median age = 43 [36-50] years) who experienced AD during UDS. We used continuous electrocardiographic recordings to evaluate HRV in 60 sec overlapping windows during filling cystometry. The mean of "normal-to-normal" heartbeats (meanNN), its standard deviation (SDNN), and the root mean square of successive differences (RMSSD) were calculated and used in all subsequent analyses. We found that SDNN and RMSSD diminished during the early phase of bladder filling and sharply increased during AD. Using the lowest point of statistical variability in heart rate (i.e., SDNN), we were able to predict AD events within 240 sec (percentile 25-percentile 75: 172-339 sec) before the first systolic blood pressure peak after AD onset (sensitivity = 0.667; specificity = 0.875). Our results indicated a temporary increase in sympathetic activity during the early phase of bladder filling, which is followed by an increase in parasympathetic outflow to the heart when AD occurs. These findings have significant clinical implications that extend beyond the context of UDS and demonstrate the importance of identifying early changes in HRV in order to accurately predict AD episodes in people living with SCI.

Since its regulatory approval over a half-century ago, botulinum toxin has evolved from one of the most potent neurotoxins known to becoming routinely adopted in clinical practice. Botulinum toxin, a highly potent neurotoxin produced by Clostridium botulinum, can cause botulism illness, characterized by widespread muscle weakness due to inhibition of acetylcholine transmission at neuromuscular junctions. The observation of botulinum toxin's anticholinergic properties led to the investigation of its potential benefits for conditions with an underlying etiology of cholinergic transmission, including autonomic nervous system dysfunction. These conditions range from disorders of the integument to gastrointestinal and urinary systems. Several formulations of botulinum toxin have been developed and tested over time, significantly increasing the availability of this treatment for appropriate clinical use. Despite the accelerated and expanded use of botulinum toxin, there lacks an updated comprehensive review on its therapeutic use, particularly to treat autonomic dysfunction. This narrative review provides an overview of the effect of botulinum toxin in the treatment of autonomic dysfunction and summarizes the different formulations and dosages most widely studied, while highlighting reported outcomes and the occurrence of any adverse events.

Objective. Electrical spinal cord stimulation (SCS) has emerged as a promising therapy for recovery of motor and autonomic dysfunctions following spinal cord injury (SCI). Despite the rise in studies using SCS for SCI complications, there are no standard guidelines for reporting SCS parameters in research publications, making it challenging to compare, interpret or reproduce reported effects across experimental studies. Approach. To develop guidelines for minimum reporting standards for SCS parameters in pre-clinical and clinical SCI research, we gathered an international panel of expert clinicians and scientists. Using a Delphi approach, we developed guideline items and surveyed the panel on their level of agreement for each item. Main results. There was strong agreement on 26 of the 29 items identified for establishing minimum reporting standards for SCS studies. The guidelines encompass three major SCS categories: hardware, configuration and current parameters, and the intervention. Significance. Standardized reporting of stimulation parameters will ensure that SCS studies can be easily analyzed, replicated, and interpreted by the scientific community, thereby expanding the SCS knowledge base and fostering transparency in reporting., (Creative Commons Attribution license.)

Per- and polyfluoroalkyl substances (PFASs) are a group of emerging contaminants, that have a wide range of applications in industrial and commercial products. The direct discharge of untreated industrial and domestic wastewater into freshwater bodies is a common practice in developing countries, which are the main contributors to PFASs in the aquatic environment. The situation is further worsened due to poor wastewater treatment facilities and weak enforcement of environmental regulations in countries like Pakistan. The current study was designed to assess PFASs contamination in muscle tissues of edible fish species from major tributaries of the Indus System, including Head Panjnad (HP), Head Trimmu (HT), Chashma Barrage (CB), Head Blloki (HB) and Head Qadirabad (HQ). The analysis of target PFAS was performed using ultrahigh-performance liquid chromatography coupled with a quadrupole Orbitrap high-resolution mass spectrometry. The highest levels of ∑17PFASs were observed in S. seenghala, C. mirigala from HB, and C. mirigala from HQ with a mean value of 45.4 ng g-1, 43.7 ng g-1, and 40.8 ng g-1, respectively. Overall, the compositional profile of fish samples was predominated by long-chain PFASs such as PFOA, PFOS, PFHpS, and PFDS. The accumulation of PFASs in fish species is dependent on the physiochemical properties of PFASs, characteristics of the aquatic environment, and fish species. Significant associations of PFASs with isotopic composition (p < 0.05), feeding habits (p < 0.05), and zones (p < 0.05) indicate that dietary proxies could be an important predictor of PFASs distribution among species. The C7-C10 PFASs exhibited bio-accumulative tendency with an accumulation factor ranging from 0.5 to 3.4. However, none of the fish samples had sufficiently high levels of PFOS to cause human health risk (HR < 1). For future studies, it is s recommended to conduct seasonal monitoring and the bioaccumulation pattern along trophic levels of both legacy and emerging PFASs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Regardless of the daunting challenge of arsenic (As) contamination in Pakistan, literature on tolerance and responsible factors in paddy fields remain elusive. In this regard, we aimed to explore physiochemical factors responsible for As availability in water-soil-rice systems. The study highlighted rice defense mechanisms to mitigate As toxicity on growth and yield. In the present study, basmati rice samples were collected along with irrigation and soil samples from control (<10 μg/L), low (11-25 μg/L), medium (26-100 μg/L), and high (>100 μg/L) contaminated regions. Oxidative stress markers (MDA and H 2 O 2 ) and antioxidant enzymatic assays (SOD, CAT, POD, APX) were measured by spectrophotometer. The Durov diagram was constructed by using Grapher software to identify prevalent water types in irrigation wells. Total As was measured in water, soil, and rice tissues by hydride generation-atomic absorption spectroscopy (HG-AAS). The Durov diagram showed that the majority of irrigation water was Ca-Mg-Cl type. Furthermore, the FTIR analysis identified different organic compounds, i.e., OH, CC, CI, and CBr, particularly in soil from high regions. The results indicated higher accumulation and translocation of As in the water-soil-rice system from a high region compared to control and other regions. Phenotypic traits, i.e., grain yield, biological yield, chlorophyll, and root parameters were significantly impacted under high As-contaminated region. A concentration-dependent increase was indicated in oxidative stress and antioxidant activities except for APX. Risk assessment indicated a higher hazard quotient (1.09) and carcinogenic risk (5.0 × 10 -03 ) due to grain consumption in high As-contaminated regions. The present study emphasized the need for strict regulations and policies to mitigate As calamity at the local level and protect human health., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

The potential of arsenic (As) tolerant and sensitive varieties of wheat (Triticum aestivum L.) has yet to be explored despite of alarming situation of arsenic toxicity. To fill this gap, the study aimed to explore the role of antioxidants, phytochelatins, and ascorbate-glutathione for As tolerance in wheat. A total of eight varieties were exposed to different arsenate treatments (0, 1, 5, 10, 50, 100, 200, 500, 1000, 2000, and 10,000 μM) initially to screen effective treatment as well as contrasting varieties via Weibull distribution frequency for further analysis. The Weibull analysis found 200 μM as the most effective treatment in the present study. Selected varieties were analyzed for accumulation of total As and As speciation, oxidative stress (malondialdehyde, hydrogen peroxide), antioxidants (superoxide dismutase, catalase, peroxidase), phytochelatins, and ascorbate-glutathione cycle (glutathione-S-transferase, glutathione reductase, glutathione peroxidase, ascorbate peroxidase). Tolerant varieties showed less accumulation and translocation of total As, arsenate, and arsenite to the shoots compared with sensitive varieties under 200 μM treatment. Low concentration in tolerant varieties correlated with better growth and development response. Tolerant varieties showed higher induction of metabolites (glutathione, phytochelatins) compared to sensitive ones. Furthermore, tolerant varieties showed better performance of antioxidant and ascorbate-glutathione cycle enzymes in response to As exposure. The findings of the present study provided great insight into the wheat tolerance mechanism upon As exposure between contrasting varieties., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

Leather tanneries are known for chemical laden work environments and pulmonic complaints among workers. This study presents an analysis of tannery micro-environments emphasizing on size-based variation in composition of particulate matter and consequent respiratory dysfunctions. Qualitative (FTIR, SEM-EDX) and quantitative assessment (elemental composition, carbon forms) of PM 10 and 2.5 has been employed. For lung function evaluation of workforce, spirometry with ATS proprieties was used. The peak concentrations of both PM 10 and 2.5 have been found at PU, FU, and B&S. The LTCR for only Cr is high for both PM 2.5 and PM 10 . HQ was high for Al, Cr, and Mn for both PM sizes. The maximum organic and secondary organic carbon in PM 10 was found at FU and in PM 2.5 at PU. The varied PM composition included carbohydrate (B&S, WMO), ether (S&S, P&S) and hydroxyl (B&S, S&S, P&S), proteins, polyenes, vinyl groups (S&S, P&S, FU), alcohols (PU and FU), and aldehyde present at PU. These results were armored by high organic and total carbon concentrations for the same sites. Therefore, PM are classified into biogenic (carbonaceous: microbial and animal remains) from PU and WMO, incidental (industrial, mixt physico-chemical character) from PU, FU, WMO, B&S and P&S, and geogenic (crustal mineral dust) from RHT, B&S, PU, and P&S. Furthermore, increase in metal concentrations in PM 10 (Cr, Mn, Co, Ni, V, As, Be, Ba, and Cd) and PM 2.5 (As, Pb) while TC, OC, and SOC in PM 2.5 caused depreciation overall lung function. The exposure to biogenic and incidental PM nature are key cause of pulmonic dysfunction., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Study Design: Cross-sectional OBJECTIVES: Neurogenic lower urinary tract dysfunction is common among people with spinal cord injury (SCI). Although single-use clean intermittent catheterization is recommended to facilitate routine bladder emptying, catheter re-use is common. Barriers associated with the preparation (i.e., cleaning) of catheters for re-use are unknown. This study examined barriers to catheter re-use in adult individuals with SCI by assessing (1) the time needed to clean a catheter, and (2) the perceived difficulty of the catheter cleaning routine., Setting: Laboratory METHODS: Twenty individuals with chronic SCI ( ≥ 1 year since injury; Group 1 = 10 with tetraplegia; Group 2 = 10 with paraplegia) completed the study. Using a standardized cleaning procedure (i.e., Milton method), catheter cleaning was timed for each participant. Perceived difficulty was assessed using a 5-point Likert scale. Functional impairment was assessed with the Upper Extremity Motor Score (UEMS)., Results: Significant between-group differences were observed for total cleaning time (Group 1 = 1584.1 ± 179.8 s; Group 2 = 1321.0 ± 93.8 s, p = 0.004) and perceived difficulty [Group 1 = 2.6 (2, 3); Group 2 = 2 (1.7, 2.3), p = 0.028]. Total cleaning time was significantly correlated with UEMS (ρ = -0.709, p ≤ 0.001) and perceived difficulty (ρ = 0.468, p = 0.037). UEMS emerged as an independent predictor of total cleaning time (R 2  = 0.745, β = -0.833, p ≤ 0.001)., Conclusions: Preparing catheters for re-use is time-intensive and difficult for people with higher SCI level, severity and more pronounced upper limb motor impairment, which was independently associated with total cleaning time. Performing this routine on a consistent basis would require a substantial time commitment and would have a profoundly negative impact on overall quality of life., (© 2023. The Author(s), under exclusive licence to International Spinal Cord Society.)

Introduction: Motor and autonomic dysfunctions are widespread among people with spinal cord injury (SCI), leading to poor health and reduced quality of life. Exercise interventions, such as locomotor training (LT), can promote sensorimotor and autonomic recovery post SCI. Recently, breakthroughs in SCI research have reported beneficial effects of electrical spinal cord stimulation (SCS) on motor and autonomic functions. Despite literature supporting the independent benefits of transcutaneous SCS (TSCS) and LT, the effect of pairing TSCS with LT is unknown. These therapies are non-invasive, customisable and have the potential to simultaneously benefit both sensorimotor and autonomic functions. The aim of this study is to assess the effects of LT paired with TSCS in people with chronic SCI on outcomes of sensorimotor and autonomic function., Methods and Analysis: Twelve eligible participants with chronic (>1 year) motor-complete SCI, at or above the sixth thoracic segment, will be enrolled in this single-blinded, randomised sham-controlled trial. Participants will undergo mapping for optimisation of stimulation parameters and baseline assessments of motor and autonomic functions. Participants will then be randomly assigned to either LT+TSCS or LT+Sham stimulation for 12 weeks, after which postintervention assessments will be performed to determine the effect of TSCS on motor and autonomic functions. The primary outcome of interest is attempted voluntary muscle activation using surface electromyography. The secondary outcomes relate to sensorimotor function, cardiovascular function, pelvic organ function and health-related quality of life. Statistical analysis will be performed using two-way repeated measures Analysis of variance (ANOVAs) or Kruskal-Wallis and Cohen's effect sizes., Ethics and Dissemination: This study has been approved after full ethical review by the University of British Columbia's Research Ethics Board. The stimulator used in this trial has received Investigation Testing Authorisation from Health Canada. Trial results will be disseminated through peer-reviewed publications, conference presentations and seminars., Trial Registration Number: NCT04726059., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Despite the risk of developing catheter-associated urinary tract infections (CAUTI), catheter reuse is common among people with spinal cord injury (SCI). This study examined the microbiological burden and catheter surface changes associated with short-term reuse. Ten individuals with chronic SCI reused their catheters over 3 days. Urine and catheter swab cultures were collected daily for analysis. Scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS) analyses were used to assess catheter surface changes. Catheter swab cultures showed no growth after 48 h (47.8%), skin flora (28.9%), mixed flora (17.8%), or bacterial growth (5.5%). Asymptomatic bacteriuria was found for most participants at baseline (n = 9) and all at follow-up (n = 10). Urine samples contained Escherichia coli (58%), Klebsiella pneumoniae (30%), Enterococcus faecalis (26%), Acinetobacter calcoaceticus-baumannii (10%), Pseudomonas aeruginosa (6%) or Proteus vulgaris (2%). Most urine cultures showed resistance to one or more antibiotics (62%). SEM images demonstrated structural damage, biofilm and/or bacteria on all reused catheter surfaces. XPS analyses also confirmed the deposition of bacterial biofilm on reused catheters. Catheter surface changes and the presence of antibiotic-resistant bacteria were evident following short-term reuse, which may increase susceptibility to CAUTI in individuals with SCI despite asymptomatic bacteriuria.

Heavy metals exposure through dust emissions pose a health risk to workers in coal and chromite mines. The processes involved in mining are noteworthy for the generation of heavy metal-contaminated dust which causes human health implications, especially to the workers that are mainly exposed to such toxins. This study determined pollution levels in coal and chromite mines and calculated the health risk of workers being exposed to heavy metal-contaminated dust. We used fractioned dust with particle sizes < 75, 75-106, and 107-150 µm to assess the pollution levels, anthropogenic impacts, geo-accumulation index, and enrichment factor for selected coal and chromite mines. Through a probabilistic approach, Monte Carlo simulations were used to determine health risks. The findings revealed that the smallest size dust fraction (< 75 μm) contained the highest metal concentrations. Ingestion was considered a prominent exposure route contributing to health risk. In the dust fraction (< 75 μm), chromite mines exhibited the highest Cr (340.6 mg/kg) and lowest Cd (8.4 mg/kg) concentrations. In coal mines, Mn (284.9 mg/kg) and Cd (2.1 mg/kg) were measured highest and lowest, respectively. Pollution assessment revealed dust to be moderately polluted. Health risk assessment showed that Cr in chromite mines exhibited a mean HI value of 1.16E + 00 that was higher than the safe level (HI > 1) having the potential to cause significant health risk to workers. In coal mines, the estimated total HI was 6E-1. Sensitivity analysis revealed concentration and exposure time to be the most influential parameters contributing to risk. Therefore, governmental and nongovernmental organizations must develop dust pollution control guidelines and mitigation measures to safeguard the health of mineworkers by limiting heavy metal exposure., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Spinal cord injury (SCI) results in severe cardiovascular dysfunction due to the disruption of supraspinal control. Autonomic dysreflexia (AD), an uncontrolled rise in blood pressure in response to peripheral stimuli including common bowel routine, digital anorectal stimulation (DARS), reduces the quality of life, and increases morbidity and mortality. Recently, spinal cord stimulation (SCS) has emerged as a potential intervention to mitigate unstable blood pressure following SCI. The objective of this case series was to test the real-time effect of epidural SCS (eSCS) at the lumbosacral spinal cord, the most common implant location, on mitigating AD in individuals with SCI. We recruited three individuals with cervical and upper thoracic motor-complete SCI who have an implanted epidural stimulator. We demonstrated that eSCS can reduce the elevation in blood pressure and prevent DARS-induced AD. The blood pressure variability analysis indicated that eSCS potentially reduced vascular sympathetic nervous system activity during DARS, compared to without eSCS. This case series provides evidence to support the use of eSCS to prevent AD episodes during routine bowel procedures, improving the quality of life for individuals with SCI and potentially reducing cardiovascular risks.

Per- and polyfluoroalkyl substances (PFASs) are a large group of chemicals reported in global environment and are responsible for various adverse impacts on humans and environment. We report a comprehensive study on occurrence of PFASs, including legacy, substitute and emerging ones, from Pakistan. Surface water samples were collected from five ecologically important freshwater reservoirs in Pakistan, namely, Head Panjnad (HP), Head Trimmu (HT), Chashma Barrage (CB), Head Blloki (HB), and Head Qadirabad (HQ). The detection frequencies of PFASs ranged between 37 %-100 %. The highest concentration of ∑ 15 PFASs was detected at HP (114.1 ng L -1 ), whereas the lowest at HQ (19.9 ng L -1 ). Among the analyzed PFASs, 6:2 fluorotelomer sulfonic acid (6:2 FTS) and perfluorooctanoic acid (PFOA) showed maximum mean concentrations of 9.1 ng L -1 and 7 ng L -1 at HP, followed by Perfluorooctane sulfonic acid (PFOS) with level of 0.99 ng L -1 at HT. The ecological risk assessment for selected species i.e., daphnid, mysid, fish and green algae showed that PFOS, perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA) exhibited moderate risk i.e., Hazard Quotients (HQs) < 1 to the modeled organisms, whereas perfluorobutane sulfonic acid (PFBS) showed the high risk to green algae (HQs = 8.6) and PFOA presented a high risk to all the organisms (HQs ranged between 1.04 and 7.38). The level of ∑PFASs at HP (114.1 ng L -1 ) exceed the EU guideline value of ∑PFASs in water (100 ng L -1 ), however the risk quotient (RQ mix ) values of all age groups were < 1 implying that the detected PFASs in water do not pose risk to human health. Source apportionment through Positive Matrix Factorization (PMF) showed that industrial effluent is the main source of PFASs in freshwater reservoirs. Comparable concentrations of legacy and substitute PFASs in this study indicate that legacy PFASs are still in use adjacent to ecologically important water reservoirs., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Gaze is directed to one location at a time, making peripheral visual input important for planning how to negotiate different terrain during walking. Whether and how the brain attends to this input is unclear. We developed a novel paradigm to probe the deployment of sustained covert visual attention by testing orientation discrimination of a Gabor patch at stepping and non-stepping locations during obstacle-crossing planning. Compared to remaining stationary, obstacle-crossing planning decreased visual performance (percent correct) and sensitivity ( d' ) at only the first of two stepping locations. Given the timing of the first and second steps before obstacle crossing relative to the Gabor patch presentation, the results suggest the brain uses peripheral vision to plan one step at a time during obstacle crossing, in contrast to how it uses central vision to plan two or more steps in advance. We propose that this protocol, along with multiple possible variations, presents a novel behavioral approach to identify the role of covert visual attention during obstacle-crossing planning and other goal-directed walking tasks., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Malik, Marigold, Chow and Lam.)

Introduction: Electrical spinal cord neuromodulation has emerged as a leading intervention for restoring autonomic functions, such as blood pressure, lower urinary tract (LUT), bowel, and sexual functions, following spinal cord injury (SCI). While a few preliminary studies have shown the potential effect of non-invasive transcutaneous spinal cord stimulation (tSCS) on autonomic recovery following SCI, the optimal stimulation parameters, as well as real-time and long-term functional benefits of tSCS are understudied. This trial entitled "Non-invasive Neuromodulation to Treat Bladder, Bowel, and Sexual Dysfunction following Spinal Cord Injury" is a pilot trial to examine the feasibility, dosage effect and safety of tSCS on pelvic organ function for future large-scale randomized controlled trials., Methods and Analysis: Forty eligible participants with chronic cervical or upper thoracic motor-complete SCI will undergo stimulation mapping and assessment batteries to determine the real-time effect of tSCS on autonomic functions. Thereafter, participants will be randomly assigned to either moderate or intensive tSCS groups to test the dosage effect of long-term stimulation on autonomic parameters. Participants in each group will receive 60 minutes of tSCS per session either twice (moderate) or five (intensive) times per week, over a period of six weeks. Outcome measures include: (a) changes in bladder capacity through urodynamic studies during real-time and after long-term tSCS, and (b) resting anorectal pressure determined via anorectal manometry during real-time tSCS. We also measure assessments of sexual function, neurological impairments, and health-related quality of life using validated questionnaires and semi-structured interviews., Ethics and Dissemination: Ethical approval has been obtained (CREB H20-01163). All primary and secondary outcome data will be submitted to peer-reviewed journals and disseminated among the broader scientific community and stakeholders., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Samejima et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Despite the growing concerns about arsenic toxicity, information on tolerance and responsible genetic factors in wheat remains elusive. To address that, the present study aimed to screen the wheat varieties against arsenic based on growth parameters, yield, grain accumulation, and associated genes. A total of 110 wheat varieties were grown in arsenic-contaminated regions to record physio-morphological traits. The wheat 90K Infinium iSelect SNP array was used for the genome-wide association model to identify genomic regions. Wheat varieties such as Punjab-81, AARI-11, and Daman showed arsenic concentrations >45 μg/kg in similar conditions as well as the impact on grain yield, chlorophyll, Thousand Kernel Weight, and plant height. Contrastingly, varieties like Kohistan-97, As-2002, Barani-70, and Pari-73 showed grain concentrations <5 μg/kg grown under highly contaminated conditions. Three significant loci associated with arsenic accumulation in grain were identified on chromosomes 6A (qASG1-6A) and 6B (qASG3-6B and qASG4-6B). Annotation at these loci identified 39 wheat genes among which several were important for growth and tolerance against stress. The candidate gene (TraesCS6B02G429400) responsible for Glutathione-S-transferase was identified in the present study and must be investigated further using a transcriptomic approach. The present study provided background information for breeding prospects to improve wheat yield and tolerance against arsenic., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Arsenic (As), and fluoride (F - ) are potent contaminants with established carcinogenic and non-carcinogenic impacts on the exposed populations globally. Despite elevated groundwater As and F - levels being reported from various regions of Pakistan no biomonitoring study has been reported yet to address the co-exposure impact of As and F - among school children. We aimed to investigate the effects of these two contaminants on dental fluorosis and intelligence quotient (IQ) along with the induction of oxidative stress in rural children under co-exposed conditions. A total of 148 children (5 to 16 years old) from the exposed and control group were recruited in the current study from endemic rural areas of Lahore and Kasur districts, Pakistan having elevated As and F - levels in drinking water than permissible limits. We monitored malondialdehyde and its probable association with antioxidants activity (SOD, CAT, and GR) as a biomarker of oxidative stress. GSTM1/T1 polymorphisms were measured to find the impact of As on health parameters. Mean urinary concentrations of As (2.70 vs. 0.016 µg/L, P < 0.000) and F - (3.27 vs. 0.24 mg/L, P < 0.000) as well as the frequency of dental fluorosis were found elevated among the exposed group. The cases of children with lower IQ were observed high in the exposed group. Additionally, lower concentrations of antioxidants (SOD, CAT, and GR) were found suggesting high susceptibility to F - toxicity. The findings suggest that F - accounted for high variations in health parameters of children under the co-exposure conditions with As., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Objective: The aim of the study was to examine the perception of pediatric emergency medicine (PEM) program directors (PDs), associate PDs (APDs) and first-year fellows regarding the preparedness of new PEM fellows who have graduated from pediatric residency programs., Methods: Unique surveys were created and electronically distributed to PEM PDs/APDs and first-year PEM fellows. Individual and institutional demographic information was collected. Using a 5-point Likert scale, survey items centered the perceived preparedness of first-year PEM fellows within 5 domains: professionalism, independence/autonomy, psychomotor skills, clinical evaluation and management, and academia/scholarship., Results: Forty percent (48/119) of eligible PDs and APDs and 56% (82/147) of eligible first-year PEM fellows responded. Most PDs/APDs strongly agreed or agreed that incoming fellows perform adequately in areas of professionalism, independence/autonomy, and clinical evaluation and management. The PDs/APDs perceived fellows to be less prepared in the academia/scholarship domain and several psychomotor skills. Most first-year PEM fellows perceived themselves as prepared in areas of professionalism and clinical evaluation and management. Fellows had varied feelings of preparedness in the domains of independence/autonomy, psychomotor skills, and academia/scholarship. Overall, most PDs/APDs (54%) and fellows (84%) feel that pediatric residency training was strong or very strong., Conclusions: Most respondents in both groups felt that in general, pediatric residency programs adequately train residents for PEM fellowship. Both groups felt that the strengths of general pediatric training were among the domains of professionalism and clinical evaluation and management, whereas psychomotor skills and academia and scholarship were areas of improvement. These findings may be used by general pediatric residency and PEM fellowship programs to guide curriculum development., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Exposure to heavy metals has been associated with the generation of reactive oxygen species (ROS) among exposed individuals in occupational and environmental settings. Dust is considered a significant contributor to airborne metal exposure, and previous data suggest that their levels in dust may vary based on its particle sizes. However, no biomonitoring study has been reported so far to address the metal-induced oxidative stress using different dust fractions, particularly in occupational settings. We designed a systematic cross-sectional study involving 110 chromite mine workers stratified into loaders (n = 28), extractors (n = 47) and operators (n = 35), and controls (n = 30) to find out the association between dust-bound metal exposure and oxidative stress using urinary creatinine-adjusted metal level as a biomarker of metal exposure. Results suggested elevated urinary levels of Cr 51.34 ± 8.6 along with Pb 34.29 ± 4.39, Cd 21.1 ± 2.6, and Ni 18.98 ± 3.01 µg/g creatinine in exposed (extractor group) workers. Correlating metal levels with oxidative stress revealed elevated malondialdehyde (MDA) levels of 62.28 ± 5.52 nM/dl among the extractors showing high levels of lipid peroxidation. Furthermore, blood superoxide dismutase (SOD) was also found significantly correlated (P = 0.000) with urinary toxic metal levels among exposed workers. We report the association between metal exposure and oxidative stress in exposed mining workers that may give rise to workers' susceptibility towards genetic and non-genetic health implications. The current study emphasized on the need for exposure control measures in the chromite ore mining activity areas., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Pharmaceuticals and personal care products (PPCPs) are emerging contaminants that have been extensively used in present time to improve the living standards. Their persistence in water resources due to various anthropogenic sources such as wastewater treatment plants, pharmaceutical industries, and runoff from agricultural and livestock farms has not only threaten aquatic life but their occurrence in groundwater has also raised concerns related to humans' wellbeing., Methods: Considering this as a neglected area of research in Pakistan, a systematic monitoring study was designed to investigate their occurrence, sources, and potential environmental and human health risks in groundwater from urban-rural areas of six cities. Ultra-High-Performance Liquid Chromatography-Tandem Mass Spectrometry (UHPLC-MS/MS) was used to analyze the collected samples preceded by solid-phase extraction., Results: Overall, 8 out of 11 selected PPCPs were detected in groundwater samples with detection frequency ranging from 5.5-65%. Their concentrations ranged from below limit of detection (

Background: The ease of instruction for point-of-care ultrasound (POCUS) to detect suprapatellar bursa (SPB) effusions in pediatric patients is unknown. Considering in person limitations because of the coronavirus pandemic, strategies for POCUS education by remote learning are necessary., Methods: We crafted a 90-minute didactic training that was presented via a remote learning format. The main outcome of interest was the interobserver reliability of SPB effusion assessment by novice sonologists compared with POCUS faculty. Novice sonologists were pediatric emergency medicine (PEM) fellows. Pediatric emergency medicine fellows interpreted longitudinal SPB examinations obtained in our pediatric emergency department from July 2013 to June 2020. Assessments were performed 2 months after the remote training. Pediatric emergency medicine fellows had a limited experience performing these musculoskeletal scans and were blinded to POCUS faculty and each other's assessments. Interobserver reliability was assessed with Cohen κ coefficient. Second, we calculated test characteristics of knee radiography compared with PEM POCUS faculty determination of SPB effusion by ultrasound. We further explored how effusion size measured by POCUS impacted the diagnosis by knee radiography. A receiver operator characteristic curve of knee radiography diagnosis of SPB effusion was created using the maximal height of SPB effusion by POCUS as the predictor variable., Results: A total of 116 SPB scans in 71 patients were assessed. From this group, 70 scans were of affected knees and 46 scans were of contralateral, asymptomatic knees. The mean age of patients was 10 years and 46% were girl. The prevalence of SPB effusions was 42%. The κ coefficients between the 3 novice sonologists and POCUS faculty were 0.75 (0.62-0.87), 0.77 (0.65-0.89), and 0.83 (0.72-0.93) with 88%, 89%, and 91% agreement. Knee radiography exhibited an overall sensitivity of 65% (95% confidence interval [CI], 46-79%), specificity of 84% (95% CI, 60-97%), negative predictive value of 55% (95% CI, 43-66%), and positive predictive value of 88% (95% CI, 73-96%) to diagnose SPB effusions. The area under the receiver operator characteristic curve was 0.850. With an SPB height cutoff of 4 mm as true positives, radiography had a sensitivity of 81% and a specificity of 83%., Conclusions: After a remote teleconference didactic session, PEM fellows were able to successfully diagnose SPB effusions using a longitudinal view with substantial interobserver reliability. Knee radiography exhibited limited sensitivity to rule out SPB effusions., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: Our primary aim was to describe pediatric residents' use of a workplace procedural training cart. An exploratory aim was to examine if the cart associated with increased resident procedural experiences with real patients., Methods: Guided by the procedural training construct of "Learn, See, Practice, Prove, Do, Maintain," we created a novel workplace procedural training cart with videos (learn and see) and simulation equipment (practice and prove). An electronic logbook recorded resident use data, and a brief survey solicited residents' perceptions of the cart's educational impact. We queried our electronic medical record to compare the proportion of real procedures completed by residents before and after the intervention., Results: From August 1 to December 31, 2019, 24 pediatric residents (10 interns and 14 seniors) rotated in the pediatric emergency department. Twenty-one cart encounters were logged, mostly by interns (67% [14/21]). The 21 cart encounters yielded 32 learning activities (8 videos watched and 24 procedures practiced), reflecting the residents' interest in laceration repair (50% [4/8], 54% [13/24]) and lumbar puncture (38% [3/8], 33% [8/24]). All users agreed (29% [6/21]) or strongly agreed (71% [15/21]) the cart encouraged practice and improved confidence in independently performing procedures. No changes were observed in the proportion of actual procedures completed by residents., Conclusions: A workplace procedural training cart was used mostly by pediatric interns. The cart cultivated residents' perceived confidence in real procedures but was not used by all residents or influenced residents' procedural behaviors in the pediatric emergency department., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Arsenic (As) contamination in groundwater is responsible for numerous adverse health outcomes among millions of people. Epigenetic alterations are among the most widely studied mechanisms of As toxicity. To understand how As exposure alters gene expression through epigenetic modifications, a systematic genome-wide study was designed to address the impact of multiple important single nucleotide polymorphisms (SNPs) related to As exposure on the methylome of drinking water As-exposed rural subjects from Pakistan. Urinary As levels were used to stratify subjects into low, medium and high exposure groups. Genome-wide DNA methylation was investigated using MeDIP in combination with NimbleGen 2.1 M Deluxe Promotor arrays. Transcriptome levels were measured using Agilent 8 × 60 K expression arrays. Genotyping of selected SNPs (As3MT, DNMT1a, ERCC2, EGFR and MTHFR) was measured and an integrated genetic risk factor for each respondent was calculated by assigning a specific value to the measured genotypes based on known risk allele numbers. To select a representative model related to As exposure we compared 9 linear mixed models comprising of model 1 (including the genetic risk factor), model 2 (without the genetic risk factor) and models with individual SNPs incorporated into the methylome data. Pathway analysis was performed using ConsensusPathDB. Model 1 comprising the integrated genetic risk factor disclosed biochemical pathways including muscle contraction, cardio-vascular diseases, ATR signaling, GPCR signaling, methionine metabolism and chromatin modification in association with hypo- and hyper-methylated gene targets. A unique pathway (direct P53 effector) was found associated with the individual DNMT1a polymorphism due to hyper-methylation of CSE1L and TRRAP. Most importantly, we provide here the first evidence of As-associated DNA methylation in relation with gene expression of ATR, ATF7IP, TPM3, UBE2J2. We report the first evidence that integrating SNPs data with methylome data generates a more representative epigenome profile and discloses a better insight in disease risks of As-exposed individuals., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

After decades of imposed regulations about reducing the primary emissions of persistent organic pollutants (POPs), these pollutants are still present in the environment. Soils are important repositories of such persistent semivolatile organic contaminants (SVOCs), and it is assumed that SVOCs sequestered in these reservoirs are being re-mobilized due to anthropogenic influence. In this study, concentrations of organochlorine pesticides (OCPs), polychlorinated biphenyls (PCBs), and polybrominated diphenyl ethers (PBDEs) in soil and air, their fugacities, fluxes and the soil-air partition coefficient (K SA ) were determined for three different land cover types (glacial, remote/mountainous and urban) of the Lesser Himalayan Region (LHR). The concentrations of OCPs, PCBs and PBDEs in soils and air ranged between 0.01 and 2.8, 0.81-4.8, 0.089-0.75 ng g -1 ; 0.2-106, 0.027-182, and 0.011-7.26 pg m -3 , respectively. The levels of SVOCs in the soil were correlated with soil organic matter (SOM) indicating that SOM is a substrate for the organic pollutants in soils. The Clausius-Clapeyron plots between ln P and inverse of temperature (1000/T) suggested that long range atmospheric transport was the major input source of PBDEs and higher chlorinated PCBs over the LHR. The uneven and wide distribution of local sources in LHR and up-slope enrichment of SVOCs explained the spatial variability and altitudinal patterns. The soils near mountain and urban lakes act as local sinks of SVOCs such as β-HCH, pp΄-DDT, CB-28, -118, -153, BDE-47, -99, and -154, with soil-air exchange fluxes tending more toward deposition. However, the soils near glacial lakes acted as local sources of more volatile congeners of α-HCH, γ-HCH, op'-DDT, pp'-DDE and lower to medium chlorinated PCBs such as CB-18, -28, -53, -42 and BDE-47, -99, with soil-air exchange tending more toward volatilization flux., (Copyright © 2021. Published by Elsevier Ltd.)

Increased E-waste generation during recent times has become a global concern, especially for developing countries that are at receiving end from the developed countries. Their improper handling and lacking management practices in developing countries including Pakistan are contributing enormous addition of toxicants into the environment and affecting the health of exposed workers associated with E-waste recycling activities. A systematic cross-sectional study was designed comprising workers associated with E-waste recycling activities in Peshawar city, Pakistan. The study aimed to investigate metal concentrations in dust, particulate matter and urine of exposed workers and correlate with oxidative stress and glutathione S-transferases genotypes (GSTM1 and GSTT1) that play a role in detoxification of metals in humans. A total of 120 blood samples comprising dismantlers (n = 52), repairers (n = 21), smelters (n = 17) and controls (n = 30) were collected. Results showed that metal concentrations were significantly higher in the dust (P = 0.020), particulate matter (P = 0.021) and urine samples (P = 0.00) as compared to controls. We observed significant increase in MDA (P = 0.00) and decrease in SOD (P = 0.00) and CAT (P = 0.00) levels among exposed subjects as compared to controls. Additionally, GSTT1 null genotype was more significantly associated with the dismantlers (P = 0.02). The study shows that E-waste workers are exposed to high level of toxic metals through dust and particulate matter, resulting in significant oxidative stress and related health implications, while GSTT1 null polymorphism is associated with increased susceptibility to these metals and induced health outcomes., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Antibiotics contamination in the water environment is a high priority global concern. Growing levels of antibiotics in freshwater resources, especially groundwater, due to anthropogenic sources such as pharmaceutical and veterinary applications, are alarming. The present study aims to investigate the occurrence, spatial distribution, source apportionment, ecological, and human health risks of antibiotics (n = 23) in groundwater samples (n = 144) of highly populated cities of Pakistan. The elevated level of antibiotics was detected in Faisalabad with the mean concentrations of 13.8 ng/L, followed by Gujrat (7.8 ng/L), Lahore (4.04 ng/L), Quetta 3.9 ng/L, Rawalpindi/Islamabad (2.29 ng/L), and Peshawar (2.03 ng/L), respectively. Out of 23 investigated antibiotics, tigecycline and ciprofloxacin were predominantly present in groundwater with average concentrations of 21.3 ng/L and 18.2 ng/L, respectively. The spatial distribution analyses revealed that among the targeted cities, Faisalabad, an industrial hub of the country, had the most polluted groundwater with dominant classes of antibiotics including quinolones (except flumequine), β-Lactams, tetracyclines, sulfonamides, and amphenicols, implying an elevated consumption of human and veterinary drugs in the city. The occurrence of targeted antibiotics varied greatly among cities (p < 0.05). PCA-MLR analysis confirmed domestic discharge (31%), animal husbandry (19%), and pharmaceutical/hospital discharge (48%) as the chief contributors to antibiotics contamination in groundwater of Faisalabad. The risk quotient (RQ) values of targeted antibiotics were reported as 1.16E-07 to 1.03E-02, and demonstrated that antibiotics pose no risks to human health, while hazard quotient (HQ) values were observed as 09.5E-05 to 6.6E-01, and only ciprofloxacin, flumequine, oxytetracycline, and sulfamethoxazole revealed moderate to low ecological risks to water species (0.1 < HQ < 1). Since, no detailed study has been conducted to evaluate the antibiotics' contamination in groundwater of Pakistan, this robust investigation provides a way forward to further explore the environmental and human health implications of antibiotics in major urban-rural settings in the region., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Issues regarding biomagnification of mercury (Hg) due to its persistence, bioaccumulation, and toxicity in freshwater lakes have gained much attention in the last two decades especially in remote regions of the world where anthropogenic inputs are considered as negligible. In this study, spatial distribution of total mercury (THg), interspecific accumulation patterns, trophic transfer, and associated health risks in fish of freshwater lakes (357-3107 masl) in Azad Kashmir, Pakistan, were investigated. THg concentrations in the regions were 0.20 ± 0.08 μg g -1 in glacial, 0.54 ± 0.21 μg g -1 in rural, and 1.35 ± 0.46 μg g -1 in urban region. Omnivorous, herbivorous, and carnivorous fish showed THg concentrations of 0.94, 0.85, and 0.49 μg g -1 . Regional, lake, trophic level, and specie-specific differences of THg accumulation were found significant in the study. Among growth parameters, length and age varied significantly among species, trophic levels, and lakes, whereas weight showed significant variation among lakes as well. Condition factor (K) showed significant differences within species, lakes, and trophic levels. Biomagnification was observed in all lakes with the trophic magnification slopes (TMS) ranging from 0.03 to 0.20 with an average of 0.094 ± 0.07. Isotopic values of nitrogen (δ 15 N) and condition factor were found to dominate THg accumulation trends; however, no significant health risks were found in the study.

Objectives: Pediatric emergencies can occur in pediatric primary care offices. However, few studies have measured emergency preparedness, or the processes of emergency care, provided in the pediatric office setting. In this study, we aimed to measure emergency preparedness and care in a national cohort of pediatric offices., Methods: This was a multicenter study conducted over 15 months. Emergency preparedness scores were calculated as a percentage adherence to 2 checklists on the basis of the American Academy of Pediatrics guidelines (essential equipment and supplies and policies and protocols checklists). To measure the quality of emergency care, we recruited office teams for simulation sessions consisting of 2 patients: a child with respiratory distress and a child with a seizure. An unweighted percentage of adherence to checklists for each case was calculated., Results: Forty-eight teams from 42 offices across 9 states participated. The mean emergency preparedness score was 74.7% (SD: 12.9). The mean essential equipment and supplies subscore was 82.2% (SD: 15.1), and the mean policies and protocols subscore was 57.1% (SD: 25.6). Multivariable analyses revealed that independent practices and smaller total staff size were associated with lower preparedness. The median asthma case performance score was 63.6% (interquartile range: 43.2-81.2), whereas the median seizure case score was 69.2% (interquartile range: 46.2-80.8). Offices that had a standardized process of contacting emergency medical services (EMS) had a higher rate of activating EMS during the simulations., Conclusions: Pediatric office preparedness remains suboptimal in a multicenter cohort, especially in smaller, independent practices. Academic and community partnerships using simulation can help address gaps and implement important processes like contacting EMS., Competing Interests: POTENTIAL CONFLICT OF INTEREST: Dr Whitfill is a board observer of a medical device company, 410 Medical, Inc (Durham, NC), which commercializes a device for fluid resuscitation; and the other authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2021 by the American Academy of Pediatrics.)

This study was carried out to screen historical diversity panel of bread wheat against municipal wastewater (MW) and remediated wastewater (RW) irrigation to find tolerant and sensitive genotypes and their impact on yield attributes. The experiment was conducted in randomized complete block design (RCBD) with three water treatments, i.e., tap water (TW), RW, and MW. Yield attributes, health risk assessment, water and soil chemistry were recorded. Principal component analysis (PCA) was used to identify tolerant and sensitive genotypes of wheat on the basis of metal accumulation. Metal accumulation in grains increased in pattern K > Fe > Zn in all irrigation treatments. Tolerant genotypes in MW showed lowest hazard quotient (HQ) and hazard index (HI) values (adults 0.62; children 0.67) for Fe and Zn as compared to sensitive genotypes (adults 1.53; children 1.70). However, HI values in sensitive and tolerant genotypes of RW were recorded < 1. Mean values of yield attributes, i.e., plant height, spike length, spikelet per spike, grains per plant, biological yield, grain yield, and thousand kernel weight, were recorded in pattern, i.e., MW > RW > TW. In this study, yield attributes and human health are affected in both cases of higher and lower concentration of Fe and Zn metal. It is suggested that tolerant genotypes can prove useful for cultivation in areas receiving MW and also provide molecular breeding opportunities for seeking tolerance against metal stresses., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.)

This article has been withdrawn at the request of the editor. The Publisher apologizes for any inconvenience this may cause., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Fish dwelling in remote mountain water systems are sensitive to long term exposure of POPs and can be used as an important bioindicator of POPs pollution in fragile mountain ecosystems. Current study aimed to investigate the concentrations and patterns of organic pollutants in fish tissues from different lakes of the Lesser Himalayan Region (LHR). OCPs, PCBs, PBDEs were analyzed in four common edible fish species of the LHR: Oncorhynchus mykiss, Labeo rohita, Hypophthalmichthys molitrix and Orechromis aureus. The fish were collected from lakes with different types of catchment areas (glacial, non-glacial mountain region and urban region) and extent of anthropogenic influence. The levels OCPs, PCBs and PBDEs analyzed in the selected fish species were in range of 0.21-587, 6.4-138 and 1.2-14 ng g -1 lw, respectively. The ∑DDTs, higher chlorinated PCBs, tetra- and penta-BDEs were more prevalent in urban and remote lakes whereas pp'-DDE, lower chlorinated PCBs and BDE-47 and -99 were predominant in fish species from glacial lakes. ∑DDTs, ∑PCBs and ∑PBDEs showed statistically significant differences (p < 0.05) among species, trophic guilds (carnivore, herbivore and omnivore) and feeding regimes (surface, bottom and column feeder) and ∑HCH showed a significant difference only among trophic guilds. The stable isotope values of δ 15 N and δ 13 C differed significantly among species for ∑HCH, ∑PCBs, ∑PBDEs (p < 0.05) and ∑DDT (p < 0.01). The range of δ 13 C values (-34 to -19‰) indicated the importance of littoral and pelagic sources of dietary carbon. Trophic position and dietary proxies were identified as important variables for explaining the variability of the studied compounds. Kohonen self-organizing maps (SOM) showed that in addition to trophic position and other physiological characteristics of fish, that the type of lakes and proximal sources of POPs were the most important predictors for distribution of organic contaminants in fish samples from LHR., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Current study explored the effects of municipal sewage (MS) irrigation on heavy metal phyto-accretion, biochemical responses and human health risks of diverse wheat genotypes along with recycled municipal sewage (RMS). Mean concentrations of PO 4 3- , NO 3 - -N, chemical oxygen demand, biological oxygen demand, K, Co, Cu, Cd, Cr and Ni were found higher in MS than irrigation criteria. This led to significant increase in heavy metal contents in roots, stem and grains of MS irrigated wheat genotypes compared to RMS and control treatments. No adverse health risk effects for individual or multiple metals were recorded in RMS irrigated wheat genotypes on grounds of lowest heavy metal accumulation. Multivariate techniques i.e. principal component analyses (PCA) and hierarchical agglomerative cluster analyses (HACA) identified tolerant (inefficient metal accumulators) and sensitive (efficient metal accumulators) wheat genotypes in MS and RMS. Tolerant wheat genotypes showed lowest accumulation of heavy metals, efficient biochemical mechanisms to combat oxidative stress and lower health risks to adults/children. Cultivation of identified tolerant wheat genotypes is recommended in areas receiving municipal wastes to reduce human and environmental health risks. Moreover, genetic potential of identified tolerant wheat genotypes from MS and RMS can be utilized in breeding heavy metal tolerant wheat germplasm worldwide.

Abstract: The cause of acute onset hip pain in children can be difficult to determine. Once trauma is excluded, the workup revolves around determining whether there is a hip effusion and eliminating orthopedic emergencies. Point-of-care-ultrasound can be used as an adjunct in the workup. In this article, we review (1) differential diagnosis of hip pain, with a focus on toxic synovitis; (2) the evaluation of a hip for the presence of effusion, including the point-of-care ultrasound technique; and (3) the management of toxic synovitis., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

The discovery and evolution of antibiotics for humans and animals are among the most significant milestones of the 20th century. However, antibiotics play a significant role in the induction and dissemination of antibiotic resistance genes (ARGs) in groundwater that has recently become the primary environmental concern. They are administrated to humans and animals on a large scale and are persistent in the environment. Long term impacts of antibiotics in the ecological environment are not still clearly understood, and their occurrence and consequences have become an important research topic worldwide. The hotspot reservoirs of antibiotics and ARGs include medical facilities, livestock farming, aquaculture, landfills, on-site sanitation systems, sewage, and wastewater treatment plants. Our meta-analysis demonstrated that antibiotics, including ciprofloxacin, sulfamethoxazole, erythromycin, and tetracycline were found at high concentrations while sulfonamide and tetracycline ARGs were more prevalent in groundwater. Moreover, the highest reported concentrations of targeted antibiotics were used to calculate hazard quotient (HQ) and risk quotient (RQ) in global groundwater bodies to estimate environmental and human health risks, respectively. Due to limited available ecotoxicity data, RQ and HQ can only be calculated for a few antibiotics in groundwater. The risk assessment of antibiotics demonstrated that antibiotics with their current groundwater levels pose no human health risks, whereas only ciprofloxacin, erythromycin, flumequine, and sulfamethoxazole revealed moderate to low risks to aquatic species. The occurrence of ARGs and antibiotic resistant bacteria (ARBs) in groundwater is also not likely to pose human health risk but consumption of groundwater contaminated with ARGs and ARBs might contribute to the development of antibiotic resistance in humans. The present review also sheds light on the relationship between ARGs, antibiotics, microbial communities, and environmental factors in groundwater, and reported a significant correlation between them. It also addresses prospects for future outlooks into further areas of relevant research., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

The present study quantified environmental impacts of the Rawalpindi Waste Management Company (RWMC) value chain in Pakistan for three consecutive years (2015-2018) using a cradle-to-grave life cycle assessment (LCA) approach. Energy potential from municipal solid wastes (MSW) was also predicted till the year 2050. Based on a functional unit of 1.0 tonne of MSW, the study analyzed inputs and outputs data through SimaPro v.8.3 applying CML 2000 methodology and cumulative exergy demand indicator (CExD). LCA revealed that operational activities of RWMC mainly contributed to marine aquatic ecotoxicity, i.e. 8962.83 kg1,4-DBeq t -1 MSW, indicating long-range transport of petrogenic hydrocarbons from the company's fleet gasoline combustion. Similarly, human toxicity potential, global warming potential and freshwater aquatic ecotoxicity potential were also found to be significant, i.e. 18.14 kg1,4-DBeq t -1 MSW, 15.79 kgCO 2 eq t -1 MSW and 6.22 kg1,4-DBeq t -1 MSW, respectively. The CExD showed that company activities consumed 827.14 MJ t -1 MSW exergy from nature, and gasoline used in MSW transport was the most exergy-intensive process, using 634.47 MJ exergy per tonne MSW disposed of. Projections for energy generation potential up to the year 2050 showed that MSW of Rawalpindi city will have the potential to produce 3901 megawatt of energy to fulfill the energy needs of the country. Possible stratagems to reduce environmental impacts from the municipal solid waste management (MSWM) value chain of RWMC include curtailing dependency on petrogenic and fossil fuels in mobile sources, optimization of waste collection methods and dumping routes, inclining attention toward suitable wastes-to-energy conversion technology and opting for a holistic approach of MSWM in Pakistan.

Pharmaceutically active compounds are newly recognized micropollutants which are ubiquitous in aquatic environment mainly due to direct discharge of treated and untreated wastewater from wastewater treatment plants. These contaminants have attracted mounted attention due to their toxic effects on aquatic life. They disrupt biological processes in non-target lower organisms upon exposure. Biodegradation, photo-degradation, and sorption are key processes which determine their fate in the environment. A variety of conventional and advanced treatment processes had been extensively investigated for the removal of pharmaceuticals from wastewater. However, due to structural complexity and varying operating parameters, complete removal seems ideal. Generally, due to high energy requirement of advanced treatment technology, it is considered cost ineffective. Transport of pharmaceutical compounds occurs via aquatic channels whereas sediments and aquatic colloids play a significant role as sinks for these contaminants. The current review provides a critical understanding of fate and toxicity of pharmaceutical compounds and highlights their vulnerability and occurrence in South Asia. Antibiotics, analgesics, and psychiatric drugs were found predominantly in the water environment of South Asian regions. Despite significant advances in understanding pharmaceuticals fate, toxicity, and associated risks since the 1990s, still substantial data gaps in terms of monitoring, human health risks, and legislation exist which presses the need to develop a more in-depth and interdisciplinary understanding of the subject., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

To date limited information's are available concerning unintentional productions, screening, profiling, and health risks of polychlorinated naphthalenes (PCNs) in ambient environment and occupational environment. Literature reveals that dust is a neglected environmental matrix never measured for PCNs. To our knowledge, this is the first study to investigate the concentrations and health risks of PCNs in indoor dust, air, and blood of major e-waste recycling hubs in Pakistan. Indoor air (n = 125), dust (n = 250), and serum (n = 250) samples were collected from five major e-waste hubs and their vicinity to measure 39 PCN congeners using GC-ECNI-MS. ∑ 39 PCN concentrations in indoor air, dust, and serum (worker > resident > children) samples ranged from 7.0 to 9583 pg/m 3 , from 0.25 to 697 ng/g, and from 0.15 to 401 pg/g lipid weight, respectively. Predominant PCN congeners in indoor air and dust were tri- and tetra-CNs, while tetra- and penta-CNs were dominant in human serum samples. The higher PCNs contribution was recorded at the recycling units, while the lower was observed at the shops of the major e-waste hubs. Higher contribution of combustion origin CNs in air, dust and human samples showed combustion sources at the major e-waste hubs, while Halowax and Aroclor based technical mixture showed minor contribution in these samples. Mean toxic equivalent (TEQ) concentrations of PCNs were 2.79E +00  pg-TEQ/m 3 , 1.60E -02  ng-TEQ/g, 8.11E -01  pg-TEQ/g, 7.14E -01  pg-TEQ/g, and 6.37E -01  pg-TEQ/g for indoor air, dust, and serum samples from workers, residents, and children, respectively. In our study, CNs- 66/67 and -73 in indoor air, dust, and human serum were the great contributors to total TEQ concentrations of PCNs. This first base line data directs government and agencies to implement rules, regulation to avoid negative health outcomes and suggests further awareness in regard of provision of proper knowledge to the target population., Competing Interests: Declaration of competing interest All the authors have declared that they have no competing interest., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

In this study, exposure to arsenic (As), lead (Pb), cadmium (Cd), copper (Cu) and zinc (Zn) was investigated in the blood, pectoral muscles and tail feathers of two terrestrial (spotted owlet; Athena brama and bank myna; Acridotheres ginginianus) and two aquatic (cattle egret; Bubulcus ibis and pond heron; Ardeola grayii) bird species inhabiting Pakistan. Food chain specimens, as well as the dietary proxies δ 15 N and δ 13 C, were also analyzed to validate potential trophic and dietary transfers of metals and As in birds. Zn was found to be the most prevalent metal in the tissues of birds followed by Pb, As, Cu, and Cd. The bioaccumulation of metals and As was higher in tail feathers reflecting the combined effect of both endogenous and exogenous contamination. Pectoral muscle and blood harbored lower levels of As and metals, indicating less recent exposure through diet. Aquatic birds feeding at higher trophic levels accumulated significantly higher concentrations of metals and As in their tissues (P < 0.05) and, therefore, may be at a greater risk of metal and As toxicity than terrestrial birds. Linear regression model depicts δ 15 N as a strong predictor of metals and As levels in the tissues of both aquatic and terrestrial birds, followed by the δ 13 C dietary proxy. All metals in aquatic species, except for Cd, as well as terrestrial species, except for Cu, exhibit bioaccumulative potential through the food chain (Trophic transfer factor: TTFs > 1) indicating potential harmful consequences for birds. Elevated concentrations of metals and As in tissues may cause harmful effects in birds potentially leading to declines in their populations., Competing Interests: Declaration of competing interest The authors declare no conflict of interest at personal and/or organizational level., (Copyright © 2020 Elsevier Inc. All rights reserved.)

In this study, we investigated metal- and metalloid-induced oxidative stress response in two aquatic (cattle egret (Bubulcus ibis) (n = 10), pond heron (Ardeola grayii) (n = 10)), as well as two terrestrial (spotted owlet (Athene brama) (n = 6) and bank myna (Acridotheres ginginianus) (n = 16)) bird species collected from the outskirts of Lahore city, Pakistan. For this purpose, glutathione (tGSH) and lipid peroxidation (thiobarbituric acid-reactive substances (TBARS)) levels and activities of antioxidant enzymes (superoxide dismutase (SOD); catalase (CAT)) were analyzed as biomarkers of oxidative stress against metal (Pb, Cd, Cu, Zn) and metalloid (As) concentrations in kidney liver and blood of birds. Our results depicted significant correlation for Pb, Cd, and As with oxidative stress biomarkers in birds. The levels of heavy metals and As and their corresponding effects on oxidative stress biomarkers were comparably higher in aquatic species (p ≤ 0.01) except for Pb and Zn. In comparison of species, SOD and tGSH activities were higher in bank myna and cattle egret, while CAT activity and TBARS concentrations were higher in pond heron and cattle egret, respectively. We deduced that tissues with higher accumulation of metal(loid)s such as liver and kidney were under a great risk to oxidative damage. The overall order of metal accumulation and subsequent oxidative damage among families followed the pattern as Strigidae ≥Ardieda ≥ Sturnidae with their respective trophic levels. Globally, metal- and As-induced oxidative stress is least emphasized in multiple tissues of birds that is needed to be addressed with focus on case-control studies using dose-response approach. Graphical abstract .

Background: There is some evidence that upper-body training modalities can improve not only aerobic capacity but also seated balance in people with spinal cord injury (SCI), even in those classified with motor-complete paralysis above T6. Here, we evaluated the effect of arm crank ergometry (ACE) "spin" training on trunk muscle recruitment and its effects on seated balance and aerobic capacity., Methods: Eight individuals with high-level complete and 6 with either a low-level complete or a motor-incomplete SCI participated in this study. Participants completed 5 weeks of a group ACE "spin" training protocol which featured modulations in cadence and resistance as well as back-supported and unsupported bouts. Surface electromyography was used to confirm trunk muscle recruitment during unsupported ACE. Changes in aerobic capacity (peak oxygen consumption) and seated balance control (center of pressure parameters) were assessed at pre- and post-intervention., Results: Unsupported ACE was effective for eliciting trunk muscle activity (P < .05). Following training, peak oxygen consumption significantly improved by an average of 16% (P = .005). Static sitting balance significantly improved from pre- to post-intervention, but only when tested with eyes closed as measured by a reduction in area (P = .047) and velocity of center of pressure (P = .013). No significant changes were observed in static sitting balance with eyes open or in dynamic sitting balance., Conclusion: Group ACE "spin" classes may benefit not only aerobic fitness but also static seated balance control in people with SCI., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Groundwater Arsenic (As) contamination is a global public health concern responsible for various health implications and a neglected area of environmental health research in Pakistan. Because of interindividual differences in genetic predisposition, As-related health issues may not be equally distributed among the As-exposed population. However, till date, no studies have been conducted including multiple SNPs involved in As metabolism and disease risk using a linear mixed effect model approach to analyze peripheral blood transcriptomics results., Objectives: In order to detect early responses on the gene expression level and to evaluate the impact of selected SNPs inferring disease risks associated with As exposure, we designed a systematic study to investigate blood transcriptomics profiles of 57 differentially exposed rural subjects living in drinking water As-contaminated settings of Lahore and Kasur districts in Punjab Province in southeast Pakistan. Exposure among the subjects was correlated with individual transcriptome responses applying urinary As profiles as the main biomarker for risk stratification., Methods: We performed whole genome gene expression analysis in blood of subjects using microarrays. Linear effect mixed models were applied for evaluating the combined impact of SNPs hypothetically increasing the risk for As exposure-induced health effects (GSTM1, GSTT1, As3MT, DNMT1, MTHFR, ERCC2 and EGFR)., Results: Our findings confirmed important signaling, growth factor, cancer and other disease related pathways known to be associated with increased As exposure levels. In addition, upon implementing our integrative SNPs-based genetic risk factor, pathways associated with an increased risk of NAFLD and diabetes appeared significantly enhanced by down-regulation of genes NDUFV3, IKBKB, IL6R, ADIPOR1, PPARA, OGT and FOXO1., Conclusion: We report the first comprehensive study applying state-of-the-art bioinformatics approaches to address multiple SNP-based inter-individual variability in adverse molecular responses among subjects exposed to drinking water As contamination in Pakistan thereby providing strong evidence of various gene expression targets associated with development of known As-related diseases., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The fluoride contamination in water is still a live discussion among the scientific community, because of its beneficial and injurious health effects inflicted on the human population. The magnitude of groundwater fluoride contamination is aggravated by increasing anthropogenic activities. Groundwater is supposedly the main source through which people are highly exposed to fluoride, compared with other sources of exposure. Among human populations, fluoride-related health issues span from mild effects on teeth and bones to severe kidney problems, neurotoxicity, and even cancer. Nowadays, fluoride toxicity is gaining much attention in the endemic areas due to its adverse impact on the children's cognitive function, since children are more susceptible to fluoride toxicity as compared to adults. The primary mechanism behind the neurotoxicity of fluoride is still not clearly understood. However, knowingly, fluoride disrupts the biochemical mechanism and thus alters the normal functioning of the brain. Several human studies are suggestive of lowering children's IQ who was exposed to fluoride during their childhood. The conclusive findings of past research suggest that the fluoride concentration in potable water tends to grossly affect the children's IQ level. However, the body of proof is limited, because most of the studies are concentrated in few countries, and have their own limitations and data gaps. The grave implications of fluoride toxicity, therefore, demand extensive and properly designed research to bridging the data gap in developing countries. Furthermore, spanning research work across all the endemic areas of the world could generate larger database, helping resolve the issue on a large scale.

Introduction: Individuals with motor-incomplete SCI (m-iSCI) remain limited community ambulators, partly because they have difficulty with the skilled walking requirements of everyday life that require adaptations in inter-joint coordination and range of motion of the lower limbs. Following locomotor training, individuals with SCI show improvements in skilled walking and walking speed, however there is limited understanding of how adaptations in lower limb kinematics following training contribute to improvements in walking., Objective: To determine the relationship between changes in lower limb kinematics (range of motion and inter-joint coordination) and improvements in walking function (walking speed and skilled walking) following locomotor training., Methods: Lower limb kinematics were recorded from 8 individuals with chronic m-iSCI during treadmill walking before and after a 3-month locomotor training program. Data were also collected from 5 able-bodied individuals to provide normative values. In individuals with SCI, muscle strength was used to define the stronger and weaker limb. Motion analysis was used to determine, hip, knee and ankle angles. Joint angle-angle plots (cyclograms) were used to quantify inter-joint coordination. Shape differences between pre-and post-training cyclograms were used to assess the changes in coordination and their relation to improvements in walking function. Walking function was assessed using the 10MWT for walking speed and the SCI-FAP for skilled walking. Comparing pre- and post-training cyclograms to the able-bodied pattern was used to understand the extent to which changes in coordination involved the recovery of normative motor patterns., Results: Following training, improvements in skilled walking were significantly related to changes in hip-ankle coordination (ρ = - .833, p = 0.010) and knee range of motion (ρ = .833, p = 0.010) of the weaker limb. Inter-joint coordination tended to revert towards normative patterns, but not completely. No relationships were observed with walking speed., Conclusion: Larger changes in hip-ankle coordination and a decrease in knee range of motion in the weaker limb during treadmill walking were related to improvements in skilled walking following locomotor training in individuals with SCI. The changes in coordination seem to reflect some restoration of normative patterns and the adoption of compensatory strategies, depending on the participant.

Waste dumping sites are considered as significant disposal pathway for waste contaminants including pesticides. In the present study OCPs were analyzed in soils of waste dumping sites of Pakistan. The mean concentrations of OCPs were in the order: ∑DDTs>∑HCHs>∑Endosulfan>∑HCB>Heptachlor. Order of overall ∑OCPs contamination with respect to location was Lahore>Sukkur>Karachi>Kamoki>Faisalabad>Hyderabad>Losar>Gujrat>Peshawar. Distribution of OCPs in solid waste dumping site was mainly influenced by textural classes, input history and pollution source. Soil texture was the dominant factor for retention of OCPs, whereas TOC and black carbon has not significantly impacted the concentrations of OCPs. Diagnostic ratios indicated the historical input, anaerobic degradation pathway and use of technical mixtures of DDTs in majority of waste dumping sites whereas for HCHs recent as well as past usage of technical mixture was prevalent in most of the areas. Regression analysis revealed a weak positive correlation of OCPs with socioeconomic indices (HDI, Population, waste generation) which is linked with history of use of these contaminants in the respective areas. Forecasted waste generation quantity for the year 2026 showed that waste generation amount will get doubled by the year 2026 suggesting the need properly designed waste management system., (Copyright © 2018. Published by Elsevier Inc.)