Anthropogenic depletion of Iran’s aquifers

Global groundwater assessments rank Iran among countries with the highest groundwater depletion rate using coarse spatial scales that hinder detection of regional imbalances between renewable groundwater supply and human withdrawals. Herein, we use in situ data from 12,230 piezometers, 14,856 observation wells, and groundwater extraction points to provide ground-based evidence about Iran’s widespread groundwater depletion and salinity problems. While the number of groundwater extraction points increased by 84.9% from 546,000 in 2002 to over a million in 2015, the annual groundwater withdrawal decreased by 18% (from 74.6 to 61.3 km³/y) primarily due to physical limits to fresh groundwater resources (i.e., depletion and/or salinization). On average, withdrawing 5.4 km³/y of nonrenewable water caused groundwater tables to decline 10 to 100 cm/y in different regions, averaging 49 cm/y across the country. This caused elevated annual average electrical conductivity (EC) of groundwater in vast arid/semiarid areas of central and eastern Iran (16 out of 30 subbasins), indicating “very high salinity hazard” for irrigation water. The annual average EC values were generally lower in the wetter northern and western regions, where groundwater EC improvements were detected in rare cases. Our results based on high-resolution groundwater measurements reveal alarming water security threats associated with declining fresh groundwater quantity and quality due to many years of unsustainable use. Our analysis offers insights into the environmental implications and limitations of water-intensive development plans that other water-scarce countries might adopt.

Groundwater is the backbone of water and food security in arid/semiarid areas, including Iran, with spatial and temporal changes due to natural surface water variability and scarcity. Groundwater provides about 60% of the total water supply in Iran (1), where agriculture is responsible for more than 90% of water withdrawal (2). Systematic groundwater extraction in Iran dates back at least two and a half millennia, when underground aqueducts known as “qanats” were excavated to transfer groundwater to the surface under the force of gravity (3). The Persian qanats that had facilitated development and agricultural production in Iran for thousands of years mostly dried up with technological advances and modernization of agriculture in the 20th century (4). Deep well drilling made groundwater overexploitation possible, while increased surface water damming and diversion reduced groundwater recharge, together drawing down groundwater tables (SI Appendix, Fig. S1) and making groundwater harvesting through historical qanats less feasible. Aggressive water resources development (1, 2, 5) to support the livelihood of over 80 million people and irrigate about 5.9 million ha of agricultural land heightened the pressure on groundwater. Iran’s water scarcity in the 21st century has been exacerbated by frequent droughts and climatic changes (2, 6). On average, more than half of the design capacity of Iran’s reservoirs was empty from 2003 to 2017 (7), increasing the reliance on groundwater. Consequently, Iran was ranked among the countries with the highest groundwater depletion rate in the 21st century, along with India, the United States, Saudi Arabia, and China (8).Iran is grappling with acute water management problems and tensions (9, 10). Groundwater overdraft has contributed to a host of contemporary socioecological problems, including the drying up of wetlands, desertification, sand and dust storms, deteriorating water quality, and population displacement (10, 11). Land subsidence due to groundwater depletion is now a manmade hazard to vital infrastructure and residents in vulnerable plains (12). Further, declining groundwater tables have degraded groundwater quality due to natural processes such as saltwater intrusion (13–15). The increasing strain on rural livelihoods and mounting tensions among groundwater users exacerbate food and water security risks (16), and create sociopolitical issues related to the migration of rural populations to urban areas (17).Groundwater assessments based on global models and remote sensing approaches have offered high-level characterizations of Iran’s groundwater resources (8, 18, 19). However, these investigations are limited by coarse spatial scales and large uncertainties due to lack of ground-truth data, hindering the detection of regional imbalances between renewable groundwater supply and human withdrawals. This study provides a statistical analysis of the major groundwater characteristics using a rich ground-based dataset (2002 to 2015) to determine the groundwater depletion and salinization in all 30 subbasins of Iran (SI Appendix, Fig. S2). The investigation of the temporal trend and spatial distribution of groundwater depletion and salinity provides valuable information for effective management of aquifers across Iran, and offers insights to other countries facing similar water security issues.     

Geographical variation and factors associated with colorectal cancer mortality in a universal health care system

OBJECTIVE:

To investigate the geographical variation and small geographical area level factors associated with colorectal cancer (CRC) mortality.

METHODS:

Information regarding CRC mortality was obtained from the population-based Manitoba Cancer Registry, population counts were obtained from Manitoba’s universal health care plan Registry and characteristics of the area of residence were obtained from the 2001 Canadian census. Bayesian spatial Poisson mixed models were used to evaluate the geographical variation of CRC mortality and Poisson regression models for determining associations with CRC mortality. Time trends of CRC mortality according to income group were plotted using joinpoint regression.

RESULTS:

The southeast (mortality rate ratio [MRR] 1.31 [95% CI 1.12 to 1.54) and southcentral (MRR 1.62 [95% CI 1.35 to 1.92]) regions of Manitoba had higher CRC mortality rates than suburban Winnipeg (Manitoba’s capital city). Between 1985 and 1996, CRC mortality did not vary according to household income; however, between 1997 and 2009, individuals residing in the highest-income areas were less likely to die from CRC (MRR 0.77 [95% CI 0.65 to 0.89]). Divergence in CRC mortality among individuals residing in different income areas increased over time, with rising CRC mortality observed in the lowest income areas and declining CRC mortality observed in the higher income areas.

CONCLUSIONS:

Individuals residing in lower income neighbourhoods experienced rising CRC mortality despite residing in a jurisdiction with universal health care and should receive increased efforts to reduce CRC mortality. These findings should be of particular interest to the provincial CRC screening programs, which may be able to reduce the disparities in CRC mortality by reducing the disparities in CRC screening participation.     

Formation of human hepatocytes by human hematopoietic stem cells in sheep

We took advantage of the proliferative and permissive environment of the developing preimmune fetus to develop a noninjury large animal model in sheep, in which the transplantation of defined populations of human hematopoietic stem cells resulted in the establishment of human hematopoiesis and led to the formation of significant numbers of long-lasting, functional human liver cells, with some animals exhibiting levels as high as 20% of donor (human) hepatocytes 11 months after transplantation. A direct correlation was found between hepatocyte activity and phenotype of transplanted cells, cell dose administered, source of cells used on a cell-per-cell basis (bone marrow, cord blood, mobilized peripheral blood), and time after transplantation. Human hepatocytes generated in this model retained functional properties of normal hepatocytes, constituted hepatic functional units with the presence of human endothelial and biliary duct cells, and secreted human albumin that was detected in circulation. Transplanting populations of hematopoietic stem cells can efficiently generate significant numbers of functional hepatic cells in this noninjury large animal model and thus could be a means of ameliorating or curing genetic diseases in which a deficiency of liver cells or their products threatens the life of the fetus or newborn.     

Evaluation of an Information Pamphlet for Women Considering Epidural Analgesia in Labour

Objective

This study sought to assess change in knowledge and preference for epidural use associated with use of an information pamphlet and to explore women's decision-making and information needs regarding pain relief in labour.

Mixed Mode Fracture Investigation of Rock Specimens Containing Sharp V-Notches

This work aims to assess both experimentally and analytically the fracture behavior of rock specimens containing sharp V-notches (SV-notches) subjected to mixed mode I/II loading. To this end, firstly, several mixed mode fracture tests were conducted on Brazilian disk specimens weakened by an SV-notch (SVNBD sample), performed in their corresponding center and with various notch opening angles. Secondly, the fracture resistance of the tested samples was predicted using a criterion named MTS-FEM. This approach is based on the maximum tangential stress (MTS) criterion, in which the tangential stress is determined from the finite element method (FEM). Additionally, in the present research, the required critical distance is calculated directly from finite element analyses performed on cracked samples. Comparing the experimental results and the analytical predictions, it is shown that the fracture curves obtained from the MTS-FEM criterion are in agreement with the experimental results. These results are achieved without the need for the calculation of stress series expansion coefficients, as an additional advantage of the proposed approach.     

Rare case of umbilical urachal sinus mimicking infected umbilical abscess: A case report

Incomplete obliteration of urachus during the fetal period can lead to urachal abnormalities. One of these abnormalities is the urachal sinus that can be asymptomatic, or it can be symptomatic by becoming infected or being malignant, and it can mimic other diseases'' symptoms. Although it is rare in adults, it should be considered a significant differential diagnosis in patients with abdominal pain or umbilical discharge. This article presents a young patient with urachal sinus mimicking umbilical pilonidal sinus symptoms.     

Acute burns during the COVID-19 pandemic: A one-year retrospective study of 611 patients at a referral burn centre in northern Iran

Patients with acute burns are more vulnerable to COVID-19 because of physiologically weak immune systems. This study aimed to assess and compare individual characteristics, clinical features, and clinical outcomes of acute burn among COVID-19 and non-COVID-19 patients. A retrospective study, with data collected from 611 acute burn patients with or without a COVID-19 diagnosis referred to a burn centre in Iran. Data were collected from April 2020 to 2021. The mean age of acute burns patients with COVID-19 was higher compared with acute burns patients with non-COVID-19 (47.82 vs. 32.59 years, P < .001). Acute burns occurred more frequently in COVID-19 patients with comorbidities compared with non-COVID-19 patients (48.72% vs. 26.92%, P = .003). 58.97% of COVID-19 patients and 55.42% of non-COVID-19 patients had grade II & III and II burns, respectively (P < .001). The mean total body surface area of the burn was higher in COVID-19 patients compared with non-COVID-19 patients (32.69% vs. 16.22%, P < .001). Hospitalisation in the intensive care unit (ICU) was higher in COVID-19 patients than in non-COVID-19 patients (76.92% vs. 15.73%, P < .001). Length of stay in hospital and ICU, the cost of hospitalisation, and waiting time for the operating room was higher in COVID-19 patients compared with non-COVID-19 patients (15.30 vs. 3.88 days, P < .001; 9.61 vs. 0.75 days, P < .001; 30 430 628.717 vs. 10 219 192.44 rials, P = .011; 0.84 vs. 0.24 min, P < .001, respectively). Intubation and mortality in-hospital were higher in COVID-19 patients compared with non-COVID-19 patients (41.02% vs. 6.99%, P < .001; 35.90% vs. 6.12%, P < .001, respectively). Therefore, it is recommended that health managers and policymakers develop a care plan to provide high-quality care to acute burns patients with COVID-19, especially in low-income countries.