Integrated assessment of irrigation and agriculture management challenges in Nepal: An interdisciplinary perspective.

Agriculture plays a critical role in ensuring food and nutrition security, livelihood, and rural employment in Nepal. Despite substantial investments and institutional reforms, irrigation projects have faced consistently low performance. While existing studies have shed light on technical aspects of irrigation performance, they often focus on specific themes rather than holistic evaluations of sustainability. This research systematically assesses barriers and challenges to effective irrigation water management in Nepal by assessing and ranking the challenges faced by three irrigation systems in western Nepal: Mahakali, Rani Jamara Kulariya, and Babai. To investigate these challenges, we collected data from 449 households, which provided insights into 33 indicators representing key barriers to effective irrigation and agricultural management. The identified challenges were categorized into four broad thematic areas: physical and structural, agricultural and water, socioeconomic and market, and gender and governance. A comprehensive evaluation was conducted to compare these challenges among the three irrigation schemes, different thematic areas, and various locations within each scheme (namely, the head, mid, and tail sections of the system). The findings revealed that timely access and availability of fertilizers, spring water availability and fair market prices of agricultural products are the most significant challenges. The Babai irrigation system faced the most substantial challenges among the three systems, particularly in the mid section. These findings emphasize the interconnectedness of these challenges, highlighting the need for a holistic approach to planning, implementation, and management. Integrated strategies are essential to address socioeconomic, market, and endogenous farming issues, ensuring reliable irrigation water availability for sustainable agricultural production.

Implantless Supplementary Fixation of Anterior Cruciate Ligament in Tibia with "Make and Use" Anchor.

Supplementary fixation after anterior cruciate ligament reconstruction may be necessary in some situations. There are several methods described for supplementary fixation with their advantages and disadvantages. Anchor fixation is preferred by many because it does not require a second surgery for removal. However, anchors are costly. We described the "make and use" all-suture anchor, which can be made instantly whenever required. We modified "make and use" all-suture anchors for supplementary fixation after ACL reconstruction. This technical note aims to describe the method of supplementary fixation using the "make and use" all-suture anchor.

Ramp Tear among Patients Undergoing Arthroscopic Anterior Cruciate Ligament Reconstruction in a Tertiary Care Centre.

Introduction: Ramp tear is a specific injury that affects the posterior horn of the medial meniscus and its meniscosynovial or meniscocapsular attachments. The actual prevalence of ramp lesion is unknown due to the high probability of misdiagnosis or underdiagnosis caused by the low sensitivity of imaging modalities and poor visualization during arthroscopy. This study aimed to find out the prevalence of ramp tear among patients undergoing arthroscopic anterior cruciate ligament reconstruction in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients undergoing arthroscopic anterior cruciate ligament reconstruction after getting ethical approval from the Institutional Review Committee. Data from 1 March 2019 to 31 December 2022 was collected between 1 May 2023 to 30 May 2023 from medical records. The study included all patients who underwent arthroscopic anterior cruciate ligament reconstruction. Patients with a previous history of medial meniscus injury or repair and undergoing revision anterior cruciate ligament reconstruction were excluded. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Out of 412 patients who underwent arthroscopic anterior cruciate ligament reconstruction, 53 (12.86%) (9.63-16.09, 95% Confidence Interval) had ramp tears. The mean age of patients with ramp tears was 28.64±7.57 years. Among 53 patients, 42 (79.24%) were male and 11 (20.75%) were female. Conclusions: The prevalence of ramp tears in patients undergoing arthroscopic anterior cruciate ligament reconstruction in a tertiary care centre was found to be lower than other studies done in other international studies. Keywords: anterior cruciate ligament injuries; anterior cruciate ligament reconstruction; arthroscopy.

Domino effect of a natural cascade alpine lake system on the Third Pole.

Third Pole natural cascade alpine lakes (NCALs) are exceptionally sensitive to climate change, yet the underlying cryosphere-hydrological processes and associated societal impacts are largely unknown. Here, with a state-of-the-art cryosphere-hydrology-lake-dam model, we quantified the notable high-mountain Hoh-Xil NCALs basin (including Lakes Zonag, Kusai, Hedin Noel, and Yanhu, from upstream to downstream) formed by the Lake Zonag outburst in September 2011. We demonstrate that long-term increased precipitation and accelerated ice and snow melting as well as short-term heavy precipitation and earthquake events were responsible for the Lake Zonag outburst; while the permafrost degradation only had a marginal impact on the lake inflows but was crucial to lakeshore stability. The quadrupling of the Lake Yanhu area since 2012 was due to the tripling of inflows (from 0.25 to 0.76 km3/year for 1999 to 2010 and 2012 to 2018, respectively). Prediction of the NCALs changes suggests a high risk of the downstream Qinghai-Tibet Railway, necessitating timely adaptions/mitigations.

Assessing the snow cover dynamics and its relationship with different hydro-climatic characteristics in Upper Ganges river basin and its sub-basins.

Snowmelt is an important source of water in upstream part of the Ganges river basin (GRB), which provides water for different purposes to its 655 million inhabitants. However, studies assessing relationship between snow cover dynamics and changes in hydro-climatic variables are limited within this region, motivating the current research. In this study, MODIS snow cover product (MOD10A1) was used to assess the snow cover area (SCA) dynamics within the Upper Ganges river basin (UGRB) and its sub-basins for the time period of 2002-2014; available climate and hydrological data were used to assess the hydrological characteristics within three selected sub-basins in Nepal; and relationships between snow cover and different hydro-climatic variables are established for three sub-basins owing to availability of hydro-climatic data. Results show that the average annual maximum SCA is around 24.6-47.5% for UGRB and its sub-basins. Upper Yamuna river basin (UYRB) with lowest mean elevation among the sub-basins shows a single SCA peak in spring within an annual cycle, whereas UGRB and the higher sub-basins show an additional lower peak in fall mainly resulted from snow sublimation. During 2002-2014, SCA shows slight decreasing trends for UGRB (Kendall's Tau τ = -0.039) and the higher elevation zones B (3001-4500 m a.s.l.) and C (>4500 m a.s.l.) of most sub-basins, with significance in Zone C of SaRB (τ = -0.070) and KoRB (τ = -0.062). Annual discharge for Gandaki river basin (GaRB) and Koshi river basin (KoRB) shows non-significant decreasing trends (τ = -0.182, -0.303) which are resulted from decreasing discharge in different seasons in different sub-basins. Seasonal correlation analysis indicates an important water supply from rainfall in GaRB and combined water supply from rainfall and snowmelt in KoRB, along with dominant contribution of precipitation in monsoon months and snowmelt in non-monsoon months for all the three sub-basins.

Future snow projections in a small basin of the Western Himalaya.

Snow is a crucial component of the hydrological cycle in the Western Himalaya. Water from snowmelt is used in various sectors in downstream regions, thus playing a critical role in securing the livelihoods of millions of people. In this study, we investigated the future evolution of snow cover and snowmelt in the Panjshir catchment of Afghanistan, a sub-basin of the Indus, in the Western Himalaya. We applied a three-step approach to select a few global climate model (GCM) simulations from CMIP5 climate datasets for RCP4.5 and RCP8.5, which showed reasonable performance with ERA5-Land dataset for the chosen historical period (1981-2010). The selected model simulations were then segregated into two groups: those projecting a cold-wet climate and those projecting a warm-dry climate by the end of the 21st century (2071-2100). These GCMs were downscaled to a higher resolution using empirical statistical downscaling. To simulate the snow processes, we used the distributed cryospheric-hydrological J2000 model. The results indicate that the model captures well the snow cover dynamics for the historical period when compared with the daily MODIS-derived snow cover. The J2000 model was then forced by climate projections from the selected GCMs to quantify future changes in snow cover area, snow storage and snowmelt. While a 10-18% reduction in annual snow cover area is projected in the cold-wet models, a 22-36% reduction is projected in the warm-dry models. Similarly, the snow cover area is projected to decrease in all elevation bands under climate change. At the seasonal scale, across all models and scenarios, the snow cover in the autumn and spring seasons are projected to reduce by as much as 25%, with an increase in winter and spring snowmelt and a decrease in summer snowmelt. The projected changes in the seasonal availability of snowmelt-driven water resources are likely to have direct implications for water-dependent sectors in the region and call for a better understanding of water usage and future adaptation practices.

Glaciohydrology of the Himalaya-Karakoram.

Understanding the response of Himalayan-Karakoram (HK) rivers to climate change is crucial for ~1 billion people who partly depend on these water resources. Policy-makers tasked with sustainable water resources management require an assessment of the rivers' current status and potential future changes. We show that glacier and snow melt are important components of HK rivers, with greater hydrological importance for the Indus basin than for the Ganges and Brahmaputra basins. Total river runoff, glacier melt, and seasonality of flow are projected to increase until the 2050s, with some exceptions and large uncertainties. Critical knowledge gaps severely affect modeled contributions of different runoff components, future runoff volumes, and seasonality. Therefore, comprehensive field observation-based and remote sensing-based methods and models are needed.

A systematic framework for the assessment of sustainable hydropower potential in a river basin - The case of the upper Indus.

Siloed-approaches may fuel the misguided development of hydropower and subsequent target-setting under the sustainable development goals (SDGs). While hydropower development in the Indus basin is vital to ensure energy security (SDG7), it needs to be balanced with water use for fulfilling food (SDG2) and water (SDG6) security. Existing methods to estimate hydropower potential generally focus on: only one class of potential, a methodological advance for either of hydropower siting, sizing, or costing of one site, or the ranking of a portfolio of projects. A majority of them fall short in addressing sustainability. Hence, we develop a systematic framework for the basin-scale assessment of the sustainable hydropower potential by integrating considerations of the water-energy-food nexus, disaster risk, climate change, environmental protection, and socio-economic preferences. Considering the case of the upper Indus, the framework is developed by combining advances in literature, insights from local hydropower practitioners and over 30 datasets to represent real-life challenges to sustainable hydropower development, while distinguishing between small and large plants for two run-of-river plant configurations. The framework first addresses theoretical potential and successively constrains this further by stepwise inclusion of technical, economical, and sustainability criteria to obtain the sustainable exploitable hydropower potential. We conclude that sustainable hydropower potential in complex basins such as the Indus goes far beyond the hydrological boundary conditions. Our framework enables the careful inclusion of factors beyond the status-quo technological and economic criterions to guide policymakers in hydropower development decisions in the Indus and beyond. Future work will implement the framework to quantify the different hydropower potential classes and explore adaptation pathways to balance SDG7 with the other interlinked SDGs in the Indus.

Towards the assessment of sediment connectivity in a large Himalayan river basin.

Sediment connectivity, defined as the degree of linkage between the sediment sources to downstream areas, is one of the most important properties that control landscape evolution in river basins. The degree of linkages amongst different parts of a catchment depends mainly on the hinterland characteristics (e.g. catchment morphology, slope, shape, relief, and elevation), channel characteristics (e.g. slope, stream network density, valley confinement), and the combined effects of vegetation (e.g. land use changes and land abandonment). This paper evaluates the sediment connectivity of the upper Kosi basin covering an area of ~52,731 km2 including Tibet and Nepal at different spatial scales. We have computed the index of connectivity (IC) using the equations originally proposed by Borselli et al. (2008) and modified by Cavalli et al. (2013) to evaluate the potential connection of sediment source areas to the primary channel network as well to the catchment outlet. Our results highlight significant spatial variability in sediment connectivity across the basin and provide important insights on structural sediment dynamics in a complex geological and geomorphological setting. We compare our results with the observed sediment load data at certain outlets and demonstrate that sediment flux in different sub-basins is controlled by variable slope distribution and land use and land cover that are strongly related to the structural connectivity. We argue that IC model can be extremely beneficial to understand sediment dynamics at catchment scale in a large river basin (~103-104 km2 scale), where systematic field investigations for mapping hillslope-channel linkages are not feasible.

Future changes in hydro-climatic extremes in the Upper Indus, Ganges, and Brahmaputra River basins.

Future hydrological extremes, such as floods and droughts, may pose serious threats for the livelihoods in the upstream domains of the Indus, Ganges, Brahmaputra. For this reason, the impacts of climate change on future hydrological extremes is investigated in these river basins. We use a fully-distributed cryospheric-hydrological model to simulate current and future hydrological fluxes and force the model with an ensemble of 8 downscaled General Circulation Models (GCMs) that are selected from the RCP4.5 and RCP8.5 scenarios. The model is calibrated on observed daily discharge and geodetic mass balances. The climate forcing and the outputs of the hydrological model are used to evaluate future changes in climatic extremes, and hydrological extremes by focusing on high and low flows. The outcomes show an increase in the magnitude of climatic means and extremes towards the end of the 21st century where climatic extremes tend to increase stronger than climatic means. Future mean discharge and high flow conditions will very likely increase. These increases might mainly be the result of increasing precipitation extremes. To some extent temperature extremes might also contribute to increasing discharge extremes, although this is highly dependent on magnitude of change in temperature extremes. Low flow conditions may occur less frequently, although the uncertainties in low flow projections can be high. The results of this study may contribute to improved understanding on the implications of climate change for the occurrence of future hydrological extremes in the Hindu Kush-Himalayan region.

Lost wire? Ultrasound can find it for you!

The use of ultrasound (US) in clinical practice is becoming increasingly popular. This unique case highlights the importance of this technology in management of a complication arising from a central line placement in an intensive care unit (ICU).

An uncommon cause of acute pulmonary edema.

Acute cardiogenic pulmonary edema secondary to catecholamine-induced cardiomyopathy is a very uncommon and fatal initial presentation of pheochromocytoma. However, with early clinical suspicion and aggressive management, the condition is reversible. This case report describes a patient who presented with hypertension, dyspnea, and cough with bloody streaks, and who recovered within 48 hours after appropriate treatment.

Primary cardiac sarcoma presenting as acute left-sided heart failure.

Primary cardiac sarcomas are rare malignant tumors of the heart. Clinical features depend on the site of tumor and vary from symptoms of congestive heart failure to thromboembolism and arrhythmias. Echocardiography is helpful but definitive diagnosis is established by histopathology. Surgical resection is the mainstay of treatment, and the role of chemotherapy and radiotherapy is unclear. We report a case of primary cardiac sarcoma which presented with signs and symptoms of acute left-sided heart failure.

Successful treatment of methicillin-resistant Staphylococcus aureus bacteraemia and cholecystitis.

Although Staphylococcus aureus can cause a variety of infections, involvement of the biliary tract is rare. We present a middle-aged Caucasian woman who presented with methicillin-resistant S aureus (MRSA) bacteraemia. Subsequent investigation revealed a diagnosis of acute cholecystitis with MRSA-positive specimen cultures. The patient showed clinical improvement after vancomycin therapy and laparoscopic cholecystectomy. This case adds to the growing list of infections that can be attributed to MRSA.