Estimating environmental efficiency of the selected Asian countries: does convergence exist?

Environmental degradation has attained much attention from researchers and policymakers at national and global levels. The ever-increasing energy use in production methods is considered one of the fundamental reasons for environmental degradation. The concept of environmental efficiency in the wake of sustainable growth evolved in the last three decades. The present study has been designed to estimate environmental efficiency using the Malmquist-Luenberger productivity index (MLI) using annual data from 43 Asian countries from 1990 to 2019. The MLI is an established econometric approach to estimate cases where input variables are used to get output variables in desirable and undesirable forms. Labor, capital, and energy consumption are input variables, while carbon dioxide (CO2) emissions (undesirable variable) and gross domestic product (undesirable variable) are taken as output variables. The results suggested that, on average, environmental efficiency has decreased by 0.3% over the period in selected Asian countries. Cambodia, Turkey, and Nepal have the highest total factor productivity (TFP) output growth rate on average among 43 Asian countries. These countries are excellent examples of sustainable development that balances environmental protection and efficiency. On the other hand, Kuwait, Mongolia, and Yemen showed the least TFP growth. The study also employed unconditional and convergence tests where the countries' conditional convergence is based on foreign direct investment, population density, inflation, industrialization, and globalization. Some policy implications for Asian countries are also discussed at the end of the study.

Effect of environmental taxes on environmental innovation and carbon intensity in China: an empirical investigation.

Environmental taxes are deemed to be an important carbon mitigating factor and also encourage the producers to adopt environmentally friendly technologies. Therefore, the main objective of the analysis is to evaluate the environmental taxes on environmental innovations and carbon intensity in China. The novel quantile autoregressive distributed lag (QARDL) is applied to investigate the model empirically. From the results, we confer that the short and long run estimated coefficients of environmental taxes are positive and significant at most quantiles in the environmental innovation model, implying that the higher the rate of environmental taxes, the higher the rate of environment-related innovations. However, the estimates of environmental taxes are significant and negative in both short and long run at more than half quantiles in the carbon emissions model, suggesting the positive role of environmental taxes in reducing carbon emissions. In general, our findings imply that an increase in environment-related taxes helps reduce carbon intensity and promote environmental innovation in China. The study suggests that policymakers in China should promote environmental innovation and expand the environmental tax base to achieve the objective of carbon neutrality.

A novel lens of stock market capitalization and environmental degradation.

This research article examines the impact of stock market capitalization on carbon emissions using forty high carbon-emitting countries from 1996 to 2018. This study adopts the Driscoll-Kraay method that simultaneously tackles heteroscedasticity, autocorrelation, and contemporaneous correlation issues. We find an inverted U relationship between stock market capitalization (SMC) and environmental degradation. We propose an extended environmental Kuznets curve based on SMC while energy intensity, industrialization, and urbanization increase emissions in sample countries. The quadratic method, SLM test, and derivative graphing detect the consensus of the inverted U relationship. The weak-negative SMC2 coefficient reveals that the dangerous impact of capitalization declines gradually and finally curbs the environmental degradation challenges. The relationship is strong in highly polluted countries with overvalued stock markets. The study catches no policy synergies between the growing stock market and increased carbon emissions. Stock market capitalization should be integrated into climate change adaptation strategies at national and regional levels, primarily to address the dark effect of environmental degradation.

Exploring the asymmetric determinants of consumption and production-based CO2 emissions in China.

Environmental pollution has intensified significantly in the last few decades. Policymakers have considered this issue due to its direct influence on human lives throughout the globe. This study explores the asymmetric determinants of consumption-based and production-based CO2 emissions for China, for time horizon 1990-2019. ARDL and NARDL regression approaches have been adopted for empirical investigation. The ARDL regression method reveals that GDP does not produce any impact on production-based and consumption-based CO2 emissions, while energy use contributes as an increasing determinant of consumption-based and production-based CO2 emissions in the long-run. The NARDL regression method reveals that a positive shock in GDP is beneficial for a decline of consumption-based CO2 emissions, while it does not reduce production-based CO2 emissions in the long-run. However, negative shock in GDP contributes as an increasing determinant of consumption-based CO2 emissions. Results also report that positive shock in energy use behaves as an increasing agent of consumption-based and production-based CO2 emissions in the long-run, while negative shock in energy use produces a decline in production-based CO2 emissions in the long-run. Thus, policymakers should adopt such demand and supply sides' management policies that contribute to controlling CO2 emissions.

Echocardiographic changes following hemodialysis initiation in patients with advanced chronic kidney disease and symptomatic heart failure with reduced ejection fraction.

BACKGROUND: In patients without overt cardiac disease, the degree of left ventricular hypertrophy (LVH) gets worse following hemodialysis (HD) initiation; however, in patients with both advanced chronic kidney disease (CKD) and symptomatic heart failure (HF) with reduced ejection fraction (EF), the short-term effect of HD on LVH and LV geometry has not been examined. We hypothesized that left ventricular mass index (LVMI) would decrease following HD initiation in CKD patients with symptomatic HF. METHODS: We retrospectively evaluated changes in LVMI, LV geometry, and LV fractional shortening (LVFS), assessed by 2D transthoracic echocardiography (TTE), in 41 patients with HF initiating HD while hospitalized from 1995 to 2006. HF was defined by LVEF ≤ 45% or dyspnea plus two of the following: raised jugular venous pressure, bibasilar crackles, pulmonary venous hypertension, interstitial edema on chest X-ray, or both. TTE was performed within 3 months prior to first HD and repeated 8.6 ± 5.2 months after start of HD. TTE recordings were obtained from storage and analyzed by a cardiologist blinded to patient clinical characteristics. RESULTS: Before initiation of HD, LVMI in 39 patients was 167.9 ± 53.1 g/m2 and it decreased by -24.3 ± 35.4 g/m2 by follow-up, p < 0.001. 26% of patients with concentric LVH at baseline had concentric remodeling or eccentric LVH at follow-up. LVFS did not significantly change over time in all 41 patients with HF (25.7 ± 8.7% vs. 26.4 ± 8.7%, p = 0.66). However, in an expanded analysis of all 69 patients with serial TTEs, a 1% increase in LVFS after starting HD was associated with a 16% reduction in risk of cardiovascular hospitalization at follow-up (HR 0.84, 95% CI 0.73 - 0.96, p = 0.01). CONCLUSIONS: LVMI decreases following HD initiation in CKD patients with symptomatic HF and reduced LVEF, possibly due to relief of venous congestion. Increase in LVFS following HD initiation predicts improved cardiac outcome.

Impact of prior antibiotic use in culture-negative endocarditis: review of 86 cases from southern Pakistan.

BACKGROUND: A large number of patients treated at our hospital for endocarditis have negative cultures. Taking into consideration the fact that many of these patients receive antibiotics prior to referral, we decided to study culture-negative endocarditis in Pakistan. METHODS: The medical records of all patients admitted to the Aga Khan University Hospital, Pakistan, for the period from 1988 to 2001, with an underlying diagnosis of infective endocarditis (IE) and negative cultures, were reviewed. RESULTS: Of the 159 patients diagnosed with IE by revised Duke criteria, 86 (54.1%) had persistent negative cultures. More than half of these patients (52%) had received antibiotics before being referred to our center. Patients with culture-negative endocarditis were less likely to be classified as definite endocarditis by revised Duke criteria (p<0.001, 95% CI 0.07-0.3) or to have large vegetations (p=0.021, 95% CI 0.05-0.5), and more likely to have a mitral valve prolapse (p=0.003, 95% CI 1.6-2.3). Definite endocarditis (p=0.042, 95% CI 1.02-7.4), heart failure (p=0.008, 95% CI 1.4-12.7), renal failure (p=0.017, 95% CI 1.16-40.7), embolism (p=0.019, 95% CI 1.2-38.8), and neurological complications (p=0.02, 95% CI 1.16-9.2) were associated with an increased mortality. CONCLUSION: Culture-negative endocarditis is very common among patients with IE in Pakistan. The presentation, laboratory findings, and complications are similar to those for culture-positive endocarditis. It is postulated that previous antibiotic treatment is the most common cause of culture-negative endocarditis in our hospital.

Infective endocarditis in patients with congenitally malformed hearts: characterization of the syndrome in a developing country.

OBJECTIVE: Cardiac surgery for correction or palliation of congenital cardiac disease in infancy and childhood remains a privilege that is rarely accessible to two-thirds of the world's population. This imbalance has created a unique spectrum of illness in patients with underlying congenital cardiac disease and complicating infective endocarditis in developing countries, including Pakistan. In this study, we characterize endocarditis as seen in such patients presenting in Karachi. PATIENTS AND SETTINGS: We reviewed retrospectively patients admitted to Aga Khan University with underlying congenitally malformed hearts and endocarditis between 1991 and 2004. RESULTS: We identified 48 patients with endocarditis according to the modified Duke Criterions, with just over half the cases (54%) classified as definite endocarditis. Of the patients, 23 (49%) patients were more than 16 years old. Uncorrected left-to-right-shunts, tetralogy of Fallot, and congenital mitral valvar disease were the most common underlying defects. Patients with cyanotic defects, particularly of the complex type, were underrepresented (4%). Only 11 (22.9%) of the patients had a previous palliative or corrective surgery. In one-third of the patients (16), streptococcal species were identified as the microbiologic cause of endocarditis, and 22 (45.8%) had culture-negative endocarditis. In contrast, Staphylococcus aureus and enterococci caused endocarditis in only one patient each. There were no differences in mortality or complications between cyanotic and acyanotic congenital defects. Surgery was performed in nine (18.7%) patients with endocarditis, and of these, 13 (27.1%) died. CONCLUSIONS: In contrast to the developed world, endocarditis in the developing countries, such as Pakistan, complicates uncorrected left-to-right shunts and tetralogy of Fallot, probably because patients with complex cyanotic defects fail to survive long after birth due to the lack of available surgery. Almost half of patients had culture-negative endocarditis, likely related to several factors.

Attitudes towards genetic diagnosis in Pakistan: a survey of medical and legal communities and parents of thalassemic children.

OBJECTIVES: It was the aim of this study to assess the attitudes of doctors, medical students, lawyers, parliament members and parents of thalassemic children towards genetic diagnosis in Pakistan. STUDY DESIGN: A cross-sectional descriptive survey was conducted among representative samples. RESULTS: Five hundred and seventy doctors, 49 lawyers, 178 medical students, 89 parents of thalassemic children and 16 members of parliament (MPs) were included in the survey. The groups showed considerable difference in their attitudes towards different aspects of the issue. A large proportion (88.5%) agreed to the idea of genetic diagnostic screening, especially the parents of thalassemic patients. Premarital carrier screening was favored by 77% of the respondents. Prenatal screening was most favored by the parents of thalassemic children (94.4%). Likewise, a majority of parents of thalassemic children were in favor of abortion in case of an affected fetus. Genetic self-screening was also favored most by the parents of thalassemic patients (78.2%). Only 24% of the doctors favored making genetic screening mandatory, whereas 63% of the parents agreed to the idea. CONCLUSION: Attitudes regarding genetic diagnosis are markedly different among various societal groups in Pakistan. The parents of the affected children strongly favor genetic screening as does the medical community, though not as strongly as the parents. The legislative groups, particularly the MPs, are reserved in their support. Genetic diagnosis can help decrease the disease burden in the future. However, it raises a number of ethical issues, which need to be addressed. It is important to educate the population about potential benefits as well as ethical dilemmas involved so that the general public is able to make the right decisions for themselves and their families.

Systemic delivery of antisense oligoribonucleotide restores dystrophin expression in body-wide skeletal muscles.

Antisense oligonucleotide-mediated alternative splicing has great potential for treatment of Duchenne muscular dystrophy (DMD) caused by mutations within nonessential regions of the dystrophin gene. We have recently shown in the dystrophic mdx mouse that exon 23, bearing a nonsense mutation, can be skipped after intramuscular injection of a specific 2'-O-methyl phosphorothioate antisense oligoribonucleotide (2OMeAO). This skipping created a shortened, but in-frame, transcript that is translated to produce near-normal levels of dystrophin expression. This expression, in turn, led to improved muscle function. However, because DMD affects muscles body-wide, effective treatment requires dystrophin induction ideally in all muscles. Here, we show that systemic delivery of specific 2OMeAOs, together with the triblock copolymer F127, induced dystrophin expression in all skeletal muscles but not in cardiac muscle of the mdx dystrophic mice. The highest dystrophin expression was detected in diaphragm, gastrocnemius, and intercostal muscles. Large numbers of fibers with near-normal level of dystrophin were observed in focal areas. Three injections of 2OMeAOs at weekly intervals enhanced the levels of dystrophin. Dystrophin mRNA lacking the targeted exon 23 remained detectable 2 weeks after injection. No evidence of tissue damage was detected after 2OMeAO and F127 treatment either by serum analysis or histological examination of liver, kidney, lung, and muscles. The simplicity and safety of the antisense protocol provide a realistic prospect for treatment of the majority of DMD mutations. We conclude that a significant therapeutic effect may be achieved by further optimization in dose and regime of administration of antisense oligonucleotide.