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This report summarizes the present status of neutrino non-standard interactions (NSI). After a brief overview, several aspects of NSIs are discussed, including connection to neutrino mass models, model-building and phenomenology of large NSI with both light and heavy mediators, NSI phenomenology in both short- and long-baseline neutrino oscillation experiments, neutrino cross-sections, complementarity of NSI with other low- and high-energy experiments, fits with neutrino oscillation and scattering data, DUNE sensitivity to NSI, effective field theory of NSI, as well as the relevance of NSI to dark matter and cosmology. We also discuss the open questions and interesting future directions that can be pursued by the community at large. This report is based on talks and discussions during the Neutrino Theory Network NSI workshop held at Washington University in St. Louis from May 29-31, 2019 (https://indico.cern.ch/event/812851/), 104 pages; minor revision

The Zee model provides a simple model for one-loop Majorana neutrino masses. The new scalars can furthermore explain the long-standing deviation in the muon's magnetic moment and the recent CDF measurement of the $W$-boson mass. Together, these observations yield predictions for lepton flavor violating processes that are almost entirely testable in the near future. The remaining parameter space makes testable predictions for neutrino masses., Comment: 6 pages, 4 figures, Updated references, matches published version

In this descriptive cross-sectional study, the data on the prevalence of diabetes mellitus (DM) among tuberculosis (TB) patients at the Urban Directly Observed Treatment Centers in the Kathmandu, Bhaktapur, and Lalitpur districts of Nepal were collected. The prevalence of DM was assessed in 67 previously treated TB (PTTB) and 214 new TB patients. DM was diagnosed in 8 PTTB and 20 new TB patients. Clinical interviews identified 14 patients with DM, rapid blood glucose test was used to diagnose DM in 4 patients, and oral glucose tolerance test was used to diagnose DM in another 4 patients. Impaired glucose tolerance and impaired fasting glycemia were observed in 8 and 5 patients, respectively. The 18-24-year age group had the largest number of new TB patients (82, 38.3%). However, the incidence of DM among TB patients was higher in the >35-year age group. Moreover, DM was diagnosed in 24.2% of PTTB patients and in 23.1% of new TB patients. To determine the impact of DM screening in TB patients, a larger number of samples should be analyzed. DM screening for patients with TB is expected to start in developing countries. This should be initiated by conducting clinical interviews about DM and glucose tests using rapid kits.

Experimental hints for lepton flavor universality violation in beauty-quark decay both in neutral- and charged-current transitions require an extension of the Standard Model for which scalar leptoquarks (LQs) are the prime candidates. Besides, these same LQs can resolve the long-standing tension in the muon and the recently reported deviation in the electron $g-2$ anomalies. These tantalizing flavor anomalies have discrepancies in the range of $2.5\sigma-4.2\sigma$, indicating that the Standard Model of particle physics may finally be cracking. In this Letter, we propose a resolution to all these anomalies within a unified framework that sheds light on the origin of neutrino mass. In this model, the LQs that address flavor anomalies run through the loops and generate neutrino mass at the two-loop order while satisfying all constraints from collider searches, including those from flavor physics., Comment: 6 pages+ references, added references, matches published version

Introduction: Childhood tuberculosis has always been in shadows as Nepal’s Tuberculosis Program focused mainly on adults TB resulting in under diagnose with less than 10% of total TB cases notified. Lack of political commitment; absence of guideline and working group, qualified health personnel and diagnostics tool were major implementation challenges. Methodology: Assessment of childhood TB program was done and critical gap were identified. Childhood TB was prioritized in National TB strategic plan (2016-21). Collaborate with both international and national child experts, public and private organizations to develop guideline, building capacity of health care providers and establishing national working group. Childhood TB focused interventions were implemented in 40 high burden districts since March,2017 focusing on contact tracing, diagnosis, Prevention Therapy, malnourished children in the community and major hospitals. Results : Political commitment and multi-sectoral involvement, to manage childhood TB was achieved. A total of 93 doctors were trained in the Childhood TB management training and were identified as focal persons to manage childhood TB in their respective regions. Child focused intervention from March 2018-19 resulted in the diagnosis of 521 TB cases among 38,987 malnourished children and1,764 children were enrolled under TPT after contact tracing of 59,742 family members. With political commitment, prioritization of childhood TB, collaboration of both government and non-government sectors and interventions focusing childhood TB, a significant achievement can be attained in childhood TB management. Conclusion: Nepal has shown childhood TB management program can be strengthen if NTP prioritizes it, child focused interventions are implemented and collaborate with Child health division, pediatrics association, other government and non-government organizations to increase and strengthen the program.

The aim of this study was to compare costs and socio-economic impact of tuberculosis (TB) for patients diagnosed through active (ACF) and passive case finding (PCF) in Nepal. A longitudinal costing survey was conducted in four districts of Nepal from April 2018 to October 2019. Costs were collected using the WHO TB Patient Costs Survey at three time points: intensive phase of treatment, continuation phase of treatment and at treatment completion. Direct and indirect costs and socio-economic impact (poverty headcount, employment status and coping strategies) were evaluated throughout the treatment. Prevalence of catastrophic costs was estimated using the WHO threshold. Logistic regression and generalized estimating equation were used to evaluate risk of incurring high costs, catastrophic costs and socio-economic impact of TB over time. A total of 111 ACF and 110 PCF patients were included. ACF patients were more likely to have no education (75% vs 57%, P = 0.006) and informal employment (42% vs 24%, P = 0.005) Compared with the PCF group, ACF patients incurred lower costs during the pretreatment period (mean total cost: US$55 vs US$87, P $72 vs US$101, P

The CDF collaboration at Fermilab has recently reported a new precision measurement of the $W$~boson mass showing a substantial $7\sigma$ deviation from the Standard Model prediction. Moreover, Fermilab has recently confirmed the longstanding tension in the $(g-2)_\mu$ measurement. We propose a unified solution to these deviations within the simplest radiative neutrino mass model: the Zee model. Our analysis establishes non-trivial links between the origin of neutrino mass, the $(g-2)_\mu$ anomaly, and the $W$~boson mass shift while being consistent with lepton flavor violation and all other experimental constraints. We find that the mass spectrum of the physical scalars must be hierarchical to be consistent with the $W$~boson mass shift; remarkably, this is also the key to resolving the $(g-2)_\mu$ tension. Furthermore, this mass splitting offers a unique same-sign dimuon signal through which our model can be tested at the LHC., Comment: 5 pages + references, expanded LFV, added references, matches published version

Background Poisoning has become a major public health problem, with the intent in most cases being self-harm and commit suicide. This study highlights the psychological and clinical-epidemiological profile of patients visiting Scheer Memorial Adventist Hospital after poisoning. Methods This retrospective record-based study was done among poisoning patients of a hospital in Nepal from 1st January 2018 to 31st December 2020. Data were analyzed using STATA version-15. Results Out of 134 total poisoning cases, 71 had consumed organophosphate compounds. The majority of the cases were female (59.2% in organophosphate groups, 69.8% in non-organophosphate groups). The circumstances of poisoning were mostly suicidal (95.8% in organophosphate groups, 90.5% in non-organophosphate groups) and the reasons for this being mostly family disputes. Organophosphate groups had 8.41 times higher odds of having complications when compared to non-organophosphorus compounds. Conclusions The majority of the poisoning cases were suicidal in nature and family disputes being the major reason for the intake of a poisonous substance. This demands that more attention be given to psychological and family counseling to resolve any disputes, as well as psychological management of poisoning cases after medical management. Also, a strong regulatory mechanism should be imposed to control the easy access to poisonous substances.

We present a model of radiative neutrino masses which also resolves anomalies reported in $B$-meson decays, $R_{D^{(\star)}}$ and $R_{K^{(\star)}}$, as well as in muon $g-2$ measurement, $\Delta a_\mu$. Neutrino masses arise in the model through loop diagrams involving TeV-scale leptoquark (LQ) scalars $R_2$ and $S_3$. Fits to neutrino oscillation parameters are obtained satisfying all flavor constraints which also explain the anomalies in $R_{D^{(\star)}}$, $R_{K^{(\star)}}$ and $\Delta a_\mu$ within $1\, \sigma$. An isospin-3/2 Higgs quadruplet plays a crucial role in generating neutrino masses; we point out that the doubly-charged scalar contained therein can be produced in the decays of the $S_3$ LQ, which enhances its reach to 1.1 (6.2) TeV at $\sqrt s=14$ TeV high-luminosity LHC ($\sqrt s=100$ TeV FCC-hh). We also present flavor-dependent upper limits on the Yukawa couplings of the LQs to the first two family fermions, arising from non-resonant dilepton ($pp \rightarrow \ell^+ \ell^-$) processes mediated by $t$-channel LQ exchange, which for 1 TeV LQ mass, are found to be in the range $(0.15 - 0.36)$. These limits preclude any explanation of $R_{D^{(\star)}}$ through LQ-mediated $B$-meson decays involving $\nu_e$ or $\nu_\mu$ in the final state. We also find that the same Yukawa couplings responsible for the chirally-enhanced contribution to $\Delta a_\mu$ give rise to new contributions to the SM Higgs decays to muon and tau pairs, with the modifications to the corresponding branching ratios being at (2-6)% level, which could be tested at future hadron colliders, such as HL-LHC and FCC-hh., Comment: 43 pages + references, expanded $h \to \mu \mu$ discussion, added references, matches published version

We propose a pseudo-Goldstone boson dark matter (pGDM) particle in $SO(10)$ grand unified theory (GUT). Due to its Goldstone nature, this pGDM evades the direct DM detection experiments which, otherwise, severely constrain the parameter space of DM models. In $SO(10)$, the pGDM is embedded as a linear combination of the Standard Model (SM) singlet scalars in ${\bf 16_H}$ and ${\bf 126_H}$ representations. We consider two scenarios for the intermediate route of $SO(10)$ symmetry breaking (SB) to the SM: $SU(5) \times U(1)_X$ and Pati-Salam the $SU(4)_c \times SU(2)_L \times SU(2)_R$ (4-2-2) gauge groups. The vacuum expectation value of ${\bf 126_H}$, which triggers the breaking of $U(1)_X$ and 4-2-2 symmetry in the two scenarios, respectively, determines the pGDM lifetime whose astrophysical lower bound provides one of the most stringent constraints. For the 4-2-2 route to $SO(10)$, the successful SM gauge coupling unification requires the 4-2-2 breaking scale to be ${\cal O} (10^{11})$ GeV, and most of the parameter space is excluded. For the $SU(5) \times U(1)_X$ route, on the other hand, the $U(1)_X$ breaking scale can be significantly higher, and a wide range of the parameter space is allowed. Furthermore, the proton lifetime in the $SU(5)$ case is predicted to be $4.53 \times 10^{34}$ years, which lies well within the sensitivity reach of the Hyper-Kamiokande experiment. We also examine the constraints on the model parameter space from the Large Hadron Collider and the indirect DM search by Fermi-LAT and MAGIC experiments., Comment: 25 pages, 5 figures, Figures 3 revised, updated version accepted for publication in PRD

As part of a multisectoral response to gender-based violence (GBV), Nepal is testing the feasibility of having female community health volunteers (FCHVs) play a formal role in identifying GBV survivors and referring them to specialised services at health facilities. This study followed 116 FHCVs in Mangalsen municipality who attended a one-day orientation on GBV. Over the following year, data were collected from knowledge and attitude assessments of FCHVs, focus group discussions with FCHVs, and members of Mothers' Groups for Health. Most Significant Change stories were collected from FCHVs, in-depth interviews with stakeholders, and service statistics. Results show that the FCHVs' knowledge increased, attitudes changed, and confidence in addressing GBV grew. During the study period, FCHVs identified 1,253 GBV survivors and referred 221 of them to health facilities. In addition to assisting GBV survivors, FCHVs worked to prevent GBV by mediating conflicts and curbing harmful practices such as menstrual isolation. Stakeholders viewed FCHVs as a sustainable resource for identifying and referring GBV survivors to services, while women trusted them and looked to them for help. Results show that, with proper training and safety mechanisms, FCHVs can raise community awareness about GBV, facilitate support for survivors, and potentially help prevent harmful practices.

We present simple and predictive realizations of neutrino masses in theories based on the $SU(6)$ grand unifying group. At the level of the lowest-dimension operators, this class of models predicts a skew-symmetric flavor structure for the Dirac mass term of the neutrinos. In the case that neutrinos are Dirac particles, the lowest-order prediction of this construction is then one massless neutrino and two degenerate massive neutrinos. Higher-dimensional operators suppressed by the Planck scale perturb this spectrum, allowing a good fit to the observed neutrino mass matrix. A firm prediction of this construction is an inverted neutrino mass spectrum with the lightest neutrino hierarchically lighter than the other two, so that the sum of neutrino masses lies close to the lower bound for an inverted hierarchy. In the alternate case that neutrinos are Majorana particles, the mass spectrum can be either normal or inverted. However, the lightest neutrino is once again hierarchically lighter than the other two, so that the sum of neutrino masses is predicted to lie close to the corresponding lower bound for the normal or inverted hierarchy. Near future cosmological measurements will be able to test the predictions of this scenario for the sum of neutrino masses. In the case of Majorana neutrinos that exhibit an inverted hierarchy, future neutrinoless double beta experiments can provide a complementary probe.

In this work, we present a solution to the persistent tensions in the decay observables ${R}_{{D}^{(*)}}$ and ${R}_{{K}^{(*)}}$ by introducing a $SU(2{)}_{L}$ doublet and a $SU(2{)}_{L}$ triplet scalar leptoquarks (LQs) that reside at the TeV energy scale. Neutrinos that remain massless in the Standard Model receive naturally small masses at one-loop level via the propagation of the same LQs inside the loop. Such a common origin of apparently disjoint phenomenological observations is appealing, and we perform a comprehensive analysis of this setup. We identify the minimal Yukawa textures required to accommodate these flavor anomalies and to successfully incorporate neutrino oscillation data while being consistent with all experimental constraints. This scenario has the potential to be tested at the experiments by the future improved measurements in the lepton flavor violating processes. Furthermore, proper explanations of these flavor anomalies predict TeV scale LQs that are directly accessible at the LHC.

Models of radiative Majorana neutrino masses require new scalars and/or fermions to induce lepton number violating interactions. We show that these new particles also generate observable neutrino nonstandard interactions (NSI) with matter. We classify radiative models as type-I or II, with type-I models containing at least one Standard Model (SM) particle inside the loop diagram generating neutrino mass, and type-II models having no SM particle inside the loop. While type-II radiative models do not generate tree-level NSI, popular models which fall under the type-I category are shown, somewhat surprisingly, to generate observable NSI at tree-level, while being consistent with direct and indirect constraints from colliders, electroweak precision data and charged-lepton flavor violation (cLFV). We survey such models where neutrino masses arise at one, two and three loops. In the prototypical Zee model which generates neutrino masses via one-loop diagrams involving charged scalars, we find that diagonal NSI can be as large as ($8\%, 3.8\%, 9.3\%$) for ($\varepsilon_{ee},\varepsilon_{\mu \mu}, \varepsilon_{\tau \tau}$), while off-diagonal NSI can be at most ($10^{-3}\%, 0.56\%, 0.34\%$) for ($\varepsilon_{e\mu},\varepsilon_{e \tau}, \varepsilon_{\mu \tau}$). In one-loop neutrino mass models using leptoquarks (LQs), $(\varepsilon_{\mu\mu},\, \varepsilon_{\tau\tau})$ can be as large as $(21.6\%,\,51.7\%)$, while $\varepsilon_{ee}$ and $(\varepsilon_{e\mu},\, \varepsilon_{e\tau},\,\varepsilon_{\mu\tau})$ can at most be 0.6\%. The most stringent constraints on the diagonal NSI are found to come from neutrino oscillation and scattering experiments, while the off-diagonal NSI are mostly constrained by low-energy processes, such as atomic parity violation and cLFV. While our analysis is focused on radiative neutrino mass models, it essentially covers all NSI possibilities with heavy mediators., Comment: 122 pages, journal version

Arsenic is highly toxic and carcinogenic element that mainly enters into our body through drinking water and caused adverse effect even at low concentration. A new type of cation exchanger is developed from waste biomass of watermelon rind after increasing the carboxyl functional groups by saponification. Saponified Watermelon Rind (SWR) was further loaded with La(III) to attenuate the contamination of As(III) from water. Characterization of biosorbent was performed using Fourier Transform Infra-Red (FTIR) spectroscopy, Field emission Scanning Electron Microscopy (Fe-SEM,) Energy Dispersive X-ray (EDX) spectroscopy and zeta potential analysis. Arsenic speciation of sorption product through X-ray photoelectron spectroscopic (XPS) analysis revealed that As(III) is partially converted into As(V) during biosorption process. The biosorption tests for As(III) were explored under different operating conditions. La(III)-SWR towards As(III) biosorption was best described by Langmuir biosorption isotherm and pseudo second order kinetic model. At a pH of 12.08, the optimum biosorption capacity was found to be 37.73 ± 0.12, 48.78 ± 0.09, 62.50 ± 0.11 mg/g, respectively at temperatures 298 K, 303 K and 308 K. The existance of chloride and nitrate showed negligible interference whereas sulphate and phosphate significantly inhibits As(III) biosorption. Thermodynamic study showed spontaneous and endothermic nature As(III) biosorption onto La(III)-SWR. The sorbed As(III) was eluted almost completely using 2 M NaOH. The findings of this study insinuated that La(III)-SWR biosorbent investigated in this study can be a low cost, environmentally benign and eco-friendly material for the treatment of aqueous solution polluted with arsenic ions.

Background Worldwide tuberculosis (TB) takes more lives than any other infectious diseases. WHO estimates around 68,000 incident TB cases in Nepal. However, in 2018 only around 27,232 new TB cases were reported in the national system, resulting around 40,768 incident TB cases missing every year in Nepal. National Tuberculosis Control Center carried out this study in anti-retroviral therapy (ART) sites to estimate the prevalence of TB and identify the associated risk factors for TB among the people living with Human Immunodeficiency Virus (PLHIVs) in Nepal. Methods It was a cross-sectional institution-based study conducted between March and August 2018. Six ART sites with high caseloads of PLHIVs were selected. PLHIVs who were equal or above 18 years of age and were in ART program at the selected study sites were considered eligible for the study. Diagnosis of tuberculosis among PLHIVs who agreed to participate in the study was carried out as per the National Tuberculosis Management Guideline of National Tuberculosis Program of Nepal. Results Among 403 PLHIVs, tuberculosis was diagnosed in 40 (9.9%) individuals. Median age of the participants was 36 (30–43) years. Prevalence of TB was significantly higher among male PLHIVs than female PLHIVs (13.6% Vs 5.8%; P = 0.02) and Dalit ethnic group compared to Brahmin/Chettri (22.0%Vs5.9%, P = 0.01). The risk of developing TB was found significant among those with HIV stage progressed to WHO stage 3 and 4 (OR = 4.85, P.001) and with the family history of TB (OR = 4.50, P = 0.002). Conclusions Prevalence of TB among PLHIVs in Nepal was found 9.9%. Risk of developing TB was higher among PLHIVs who were male, Dalit, with HIV stage progressed to WHO stage 3 and 4 and with family history of TB. Hence, targeted interventions are needed to prevent the risk of developing TB among PLHIVs. Similarly, integrated, and comprehensive TB and HIV diagnosis and treatment services are needed for the management of TB/HIV co-infection in Nepal.

BackgroundThe World Health Organization (WHO) End TB Strategy has established a milestone to reduce the number of tuberculosis (TB)- affected households facing catastrophic costs to zero by 2020. The role of active case finding (ACF) in reducing patient costs has not been determined globally. This study therefore aimed to compare costs incurred by TB patients diagnosed through ACF and passive case finding (PCF), and to determine the prevalence and intensity of patient-incurred catastrophic costs in Nepal.MethodsThe study was conducted in two districts of Nepal: Bardiya and Pyuthan (Province No. 5) between June and August 2018. One hundred patients were included in this study in a 1:1 ratio (PCF: ACF, 25 consecutive ACF and 25 consecutive PCF patients in each district). The WHO TB patient costing tool was applied to collect information from patients or a member of their family regarding indirect and direct medical and non-medical costs. Catastrophic costs were calculated based on the proportion of patients with total costs exceeding 20% of their annual household income.The intensity of catastrophic costs was calculated using the positive overshoot method. The chi-square and Wilcoxon-Mann-Whitney tests were used to compare proportions and costs. Meanwhile, the Mantel Haenszel test was performed to assess the association between catastrophic costs and type of diagnosis.ResultsNinety-nine patients were interviewed (50 ACF and 49 PCF). Patients diagnosed through ACF incurred lower costs during the pre-treatment period (direct medical: USD 14 vs USD 32,P = 0.001; direct non-medical: USD 3 vs USD 10,P = 0.004; indirect, time loss: USD 4 vs USD 13,P P = 0.002) and non-medical (USD 30 vs USD 54,P = 0.022) costs among ACF patients. The prevalence of catastrophic direct costs was lower for ACF patients for all thresholds. A lower intensity of catastrophic costs was also documented for ACF patients, although the difference was not statistically significant.ConclusionsACF can reduce patient-incurred costs substantially, contributing to the End TB Strategy target. Other synergistic policies, such as social protection, will also need to be implemented to reduce catastrophic costs to zero among TB-affected households.

This study compared the yield of tuberculosis (TB) active case finding (ACF) interventions applied under TB REACH funding. Between June 2017 to November 2018, Birat Nepal Medical Trust identified presumptive cases using simple verbal screening from three interventions: door-to-door screening of social contacts of known index cases, TB camps in remote areas, and screening for hospital out-patient department (OPD) attendees. Symptomatic individuals were then tested using smear microscopy or GeneXpert MTB/RIF as first diagnostic test. Yield rates were compared for each intervention and diagnostic method. We evaluated additional cases notified from ACF interventions by comparing case notifications of the intervention and control districts using standard TB REACH methodology. The project identified 1092 TB cases. The highest yield was obtained from OPD screening at hospitals (n = 566/1092, 52%). The proportion of positive tests using GeneXpert (5.5%, n = 859/15,637) was significantly higher than from microscopy testing 2% (n = 120/6309). (OR = 1.4, 95%CI = 1.12–1.72, p = 0.0026). The project achieved 29% additionality in case notifications in the intervention districts demonstrating that GeneXpert achieved substantially higher case-finding yields. Therefore, to increase national case notification for TB, Nepal should integrate OPD screening using GeneXpert testing in every district hospital and scale up of community-based ACF of TB patient contacts nationally.

Tuberculosis (TB) is a major public health concern for Nepal like many other developing countries around the world. Economic barrier is one of the major problems in poor and marginalized population. Poor people mostly remain unaware of the treatment facilities and some find it difficult in seeking T.B treatment as they don’t trust the program and most of them don’t possess enough knowledge about the disease itself. Population residing in the remote areas of the countries can’t access the treatment facilities due to far distance of health facilities from there residence due to lack of roads and lack of transport. Thus difficult geography primarily in rural areas in the country acts as a barrier to access the health facility. TB infection faces add-on challenge with the advent of co-infection and possibility of increase in drug resistant TB. This is why detecting TB in its early stage would pose a number of advantages to the patient that would in turn help for early treatment. However, the challenges and barriers in early diagnosis remain that is being contributed by multifaceted factors. The lack of knowledge coupled with poor financial capacity to pay for the diagnosis especially in rural population prevents them from being diagnosed properly as well. Factors for not completing the treatment are when patient starts feeling better, lack of drugs, major side effects of the drugs and inadequate knowledge about advantages of completion of the drug treatment. The attitude of the hospital staff also in many cases leads to discontinuation of the treatment. Patient who have limited income and got financial support from their relatives explained about treatment going above their obtainable resources leading to early withdrawal from the treatment completion. Geography is one of the important issues for treatment completion as routine drug administration follow up in patient (farther from particular distance) is difficult and leads to exhaustion and withdrawal from the treatment.Journal of Manmohan Memorial Institute of Health Sciences Vol. 2 2016 p.76-80

Introduction: Malnutrition is a common problem in developing countries and often associated with co-morbidities. The present study was undertaken with objectives of to find out the comorbidities in children with severe acute malnutrition (SAM).Materials and Methods: This was a hospital based study carried in 77 children with SAM, diagnosed on the basis of WHO criteria.Results: The age group of children was 1- 5 years (median age 23 months) with about 39% between 1- 2 years. There were 38 males (49.3%). Low maternal education (60%), overcrowding (60%), lower- middle socioeconomic status (87%) were some of the predisposing factors observed. Pneumonia (51%), acute gastroenteritis (21%) and bacterial meningitis (8%) were common co- morbidities found. Associated abnormal laboratory parameters found were anemia (60%), leucocytosis (38%), hyboalbuminemia (36%) hyponetremia (31%), and hypokalemia (17%).Conclusion: Presence of infections and biochemical abnormalities require urgent attention in SAM cases and appropriate treatment in a hospital setting to improve their survival.J Nepal Paediatr Soc 2015;35(2):99-102

Background Healthcare centers are important sites for tuberculosis transmission, particularly in low-income settings where the burden of tuberculosis is high and infection control practices are often inadequate. This study aims to assess the knowledge, attitude, and practices of drug-resistant tuberculosis infection control among the healthcare workers under the National Tuberculosis Control Program in Nepal. Methods In this descriptive cross-sectional survey, we studied the healthcare workers from all the functioning drug-resistant tuberculosis treatment centers across Nepal between March 1, 2018 and March 15, 2018. Nepal Health Research Council provided ethical clearance. Trained enumerators obtained informed consent and conducted face-to-face interviews with a pretested questionnaire to collect data on the basic characteristics of healthcare workers, their self-reported knowledge, attitude, and practice on tuberculosis infection control. We assigned a score of one to the correct response and zero to the incorrect or no response and calculated a composite score in each of the knowledge, attitude, and practice domains. We ascertained the healthcare workers as having good knowledge, appropriate attitude, and optimal practices when the composite score was at least 50%. We summarized the numerical variables with median and interquartile range (IQR) and the categorical variables with proportions. Results A total of 95 out of 102 healthcare workers from 11 drug-resistant tuberculosis treatment centers participated in the study. There were 46 male and 49 female respondents. The median age was 33 years (IQR 26–42). The majority of them (53, 56%) were mid-level paramedics. The median work experience in drug-resistant tuberculosis was 2 years (IQR 1–5). We found 91 (96%) respondents had a good knowledge of tuberculosis infection control with the median knowledge score of 14 (IQR 12–14), 49 (52%) respondents had an appropriate attitude with the median attitude score of 5 (IQR 4–6) and 35 (37%) respondents had optimal practices with the median practice score of 5 (IQR 4–7). Conclusion Healthcare workers at the drug-resistant tuberculosis treatment centers in Nepal had good knowledge of tuberculosis infection control but it did not translate into an appropriate attitude or optimal practices. Disclosures All authors: No reported disclosures.

Aims: To study the admission patterns and outcome of children in a Pediatric Intensive Care Unit (PICU) in Nepal. Methods: Demographic profile, diagnosis, treatment, supportive measures and outcome of children admitted to the PICU of B P Koirala Institute of Health Sciences from April 2011 to March 2012 were reviewed. Results: 230 children were admitted to the PICU with male to female ratio of 1.7:1. Diagnoses included respiratory diseases (n=76, 33%), central nervous system diseases (n=43, 18.6%), infectious diseases (n=26, 11.3%), surgical problems (n=18, 7.8%), gastrointestinal diseases (n=17, 7.4%), cardiovascular diseases (n=15, 6.5%), poisonings (n=11, 4.8%), renal (n=9, 3.9%), hematological (n=3, 1.3%) and others (n=12, 5.4%). Out of 230 admitted children, 29 (12.6%) died, 19 (8.2%) left against medical advice and 5 (2%) were referred to other centers. Forty-one (17.8%) children received mechanical ventilation, among which 23 (56%) improved, 14 (34.1%) died and 4 (9.7%) children were taken away by caretakers against medical advice. Conclusion: Respiratory, central nervous system and infectious disease were the

Introduction : Neonatal period is the most susceptible period of life due to different causes, which in most cases are preventable. Every year millions of neonates are born and a large proportion of them are admitted to the neonatal intensive care unit (NICU) for various indications. One of the Millennium Development Goals is to reduce under five mortality by two thirds by 2015. Therefore, this study was conducted to identify the clinical profile, pattern of diseases and common causes of mortality and morbidity in neonates admitted to NICU. Materials and Methods : A retrospective study was conducted at level III Neonatal NICU of a tertiary -care teaching hospital from January, 2012 to December, 2012. Results : Total of 361 neonates were admitted in NICU. Eighty six neonates (23.8%) were admitted due to prematurity and 73 (20.2%) with birth asphyxia. Among birth asphyxia, 40(54.8%)were in HIE III, 27.4% and 17.8% in HIE II and HIE I, respectively. One hundred eighteen (32.6%) cases were diagnosed as sepsis. The overall mortality was 20.2% during hospital stay. Conclusions : Sepsis, prematurity and birth asphyxia were major causes for admission in NICU. All these etiologies are preventable up to some extent and, if detected earlier, can be effectively treated in order to reduce morbidity and mortality. DOI: http://dx.doi.org/10.3126/jnps.v33i3.8447 J. Nepal Paediatr. Soc. 2013;33(3):177-181

Background and objectives\ud \ud People receiving treatment for multidrug-resistant tuberculosis (MDR-TB) have high rates of depression. Psychosocial support in general, and treatments for depression in particular, form an important but neglected area of patient-centred care, and a key pillar in the global End TB strategy. We assessed the feasibility and acceptability of a psychosocial support package for people receiving treatment for MDR-TB in Nepal.\ud \ud Methods\ud \ud This feasibility study used a mixed quantitative and qualitative approach. We implemented the intervention package in two National Tuberculosis Programme (NTP) MDR-TB treatment centres and 8 sub-centres. We screened patients monthly for depression and anxiety (cut-off ≥24 and ≥17 respectively on the Hopkins Symptom Checklist) and also for low social support (cut-off ≤3 on the Multidimensional Scale of Perceived Social Support). Those who screened positive on either screening tool received the Healthy Activity Program (HAP), which uses brief counselling based on behavioural activation theory. Other aspects of the psychosocial package were information/education materials and group interactions with other patients.\ud \ud Results\ud \ud We screened 135 patients, of whom 12 (9%) received HAP counselling, 115 (85%) received information materials, 80 (59%) received an education session and 49 (36%) received at least one group session. Eight group sessions were conducted in total. All aspects of the intervention package were acceptable to patients, including the screening, information, group work and counselling. Patients particularly valued having someone to talk to about their concerns and worries. We were able to successfully train individuals with no experience of psychological counselling to deliver HAP.\ud \ud Conclusion\ud \ud This psychosocial support package is acceptable to patients. The information materials we developed are feasible to deliver in the current NTP. However, the structured psychological counselling (HAP), is not feasible in the current NTP due to time constraints. This requires additional investment of counsellors in TB clinics.

It is the hypothesis of the present study that a biocompatible material which mimics the nanometer topography of native bladder tissue will enhance cellular responses and lead to better tissue integration in vivo. Previous in vitro studies have verified the ability to successfully reduce the surface feature dimensions of poly(lactic-co-glycolic acid) (PLGA) and poly(ether urethane) (PU) films into the nanometer regime via chemical etching procedures. Results from these studies also provided the first evidence that bladder smooth muscle cell adhesion was enhanced on chemically treated nano-structured polymeric surfaces compared to their conventional counterparts. Although cell adhesion is necessary for a biomaterial's success, subsequent cell functions (such as long-term cell growth and proliferation) are also critical for tissue ingrowth and long-term implant survival. The present in vitro study, therefore, investigated the function of bladder smooth muscle cells on these novel, nano-structured polymers over the expanded periods of 1, 3 and 5 days. Results indicated that cell number was influenced by both surface roughness and surface chemistry changes; the important contributor, however, was increased nanometer surface roughness. This claim is supported by the fact that cell number was enhanced on nano-structured compared to conventional PLGA and PU once chemistry changes were eliminated using casting techniques.

Polymers currently utilized for tissue engineering applications do not possess surfaces with nanostructured features. However, the tissue that the polymers will replace is composed of proteins that have nanometer dimensions. Undoubtedly, in situ, cells are accustomed to interacting with surface roughness values in the nanometer regime due to the presence of such proteins in natural tissue. Therefore, the objective of this paper was to design, synthesize and evaluate (using in vitro cellular models) poly-lactic-co-glycolic acid (PLGA) with nanostructured surface features to serve as the next generation of more efficient tissue engineered materials. For this purpose, nanostructured PLGA was created by treating conventional PLGA with various concentrations of NaOH for select periods of time. To eliminate surface chemistry changes created though the etching process, PLGA was cast from silastic molds of NaOH-treated nanostructured PLGA. Results provided the first evidence of increased numbers of vascular cells (specifically, endothelial and aortic smooth muscle cells) and bladder smooth muscle cells on nanostructured compared with conventional PLGA substrates. For this reason, the present results suggest, for the first time, that PLGA should incorporate a high degree of nanostructured surface roughness to enhance tissue regeneration for vascular and bladder applications.

A reduction of material consumption in thin-film photovoltaic devices can make solar energy economically more viable. However, since thin films essentially absorb less light, there is an imminent need for existing technology to improve light harvesting. We present an effective approach of better light absorption, enhanced photocurrent generation and therefore higher quantum efficiency of poly (3-hexylthiophene): 1-(3-methoxycarbonyl) propyl-1-phenyl-[6, 6]-methanofullerene (P3HT:PCBM) bulk heterojunction photovoltaic/photodetector devices. We have integrated a thin semi-continuous gold film (SCGF) (~20nm) sputtered at percolation threshold between the active P3HT:PCBM layer and the indium-tin-oxide (ITO) electrode. At critical metal concentrations, i.e. percolation threshold, the light reaching the SCGF undergoes a broadband trapping with characteristic time of 200 fs, through complex interactions with fractal gold clusters. This thin SCGF together with the ITO serves as an anode. The interface between SCGF and the polymer represents the metaldielectric composite (MDC) that supports broad-band surface plasmon resonances that store electromagnetic radiation at the nanoscale and acts as an effective bulk type of concentrator without the need of increasing the photovoltaic device physical collection area. Here we report a six-fold enhancement in the integral quantum efficiency over the solar spectrum for device employing plasmon-active gold layer. Such enhancement is an important contribution for the future design of more efficient photodetecting/photovoltaic devices. The experimental results are supported by the theoretical modeling of metal-dielectric composites by block elimination method in 3D. The AC and DC responses of MDC, local field distribution, broad optical response and photon trapping in the percolating MDC were numerically calculated.

We report here an unusual case of post-traumatic isolated sixth nerve palsy occurring while nursing the patient in trendelenburg position. This is the first case to be reported in the available literature of posture induced delayed onset isolated post-traumatic sixth nerve palsy and highlights importance of avoiding head down position while nursing patients with head injury.DOI: http://dx.doi.org/10.3126/jkmc.v3i1.10921Journal of Kathmandu Medical College Vol. 3, No. 1, Issue 7, Jan.-Mar., 2014, Page: 32-33

An in vivo study was conducted to determine if an extracellular matrix (ECM) scaffold co-localized with autologous muscle tissue could achieve constructive remodeling of esophageal tissue without stricture. ECM derived from the porcine urinary bladder was processed, decellularized, configured into a tube shape, and terminally sterilized for use as a bioscaffold for esophageal reconstruction in a dog model. Twenty-two dogs were divided into four groups, three groups of five and one group of seven. Groups 1 and 2 were repaired with either ECM alone or muscle tissue alone, respectively. Groups 3 and 4 were repaired with ECM plus either a partial (30%) covering with muscle tissue or a complete (100%) covering with muscle tissue, respectively. Animals in groups 1 and 2 were sacrificed within approximately 3 weeks because of the formation of intractable esophageal stricture. Four of five dogs in group 3 and six of seven dogs in group 4 were survived for 26 days to 230 days and showed constructive remodeling of esophageal tissue with the formation of well organized esophageal tissue layers, minimal stricture, esophageal motility, and a normal clinical outcome. Mechanical testing of a subset of the remodeled esophageal tissue from animals in groups 3 and 4 showed progressive remodeling from a relatively stiff, non-compliant ECM tube structure toward a tissue with near normal biomechanical properties. We conclude that ECM bioscaffolds plus autologous muscle tissue, but not ECM scaffolds or muscle tissue alone, can facilitate the in situ reconstitution of structurally and functionally acceptable esophageal tissue.

Select prolonged functions of fibroblasts leading to extensive fibrous tissue encapsulation can be detrimental to numerous implant applications, including materials designed for the bladder, vasculature, and bone. Specifically, overextended functions of fibroblasts at the tissue–implant interface for orthopedic applications lead to callus formation, fibrous encapsulation events, and ultimately soft (not desirable hard-bony) tissue juxtaposition. Such events result in insufficient regeneration of bone and compromise the overall success of the implant. The objective of the present in vitro study was to determine, for the first time, fibroblast densities on NaOH-treated poly-lactic-co-glycolic acid co-polymers (PLGA), HNO 3 -treated polyurethane (PU), and NaOH-treated polycaprolactone (PCL). Previous studies have demonstrated increased bladder, vascular, and bone cell densities on chemically treated compared to unaltered PLGA, PU, and PCL films. Results of this study provided evidence of decreased fibroblast numbers on chemically treated PLGA, PU, and PCL after time periods of up to 5 days. Examination of these substrates revealed that all chemically modified polymers possessed a high degree of nanometer surface roughness compared to their respective unaltered polymers. In contrast, other material properties (such as chemistry and wettability) were different when comparing chemically treated PLGA, PU, and PCL films. Since fibroblasts are anchorage-dependent cells whose adhesion is a critical prerequisite to the prolonged, extensive formation of a fibrous-tissue containing extracellular matrix, the present in vitro results of decreased fibroblast densities on chemically degraded PLGA, PU, and PCL suggest that these materials may be suitable materials for numerous tissue-engineering applications and, thus, deserve further investigation.

Previous studies investigating the design of synthetic bladder wall substitutes have involved polymers with micro dimensional structures. Since the body is made up of nano-structured components (e.g., extracellular matrix proteins), the focus of the present in vitro study was to design nano-structured polymers for use as synthetic bladder constructs that mimic the topography of natural bladder tissue. In order to complete this task, novel nano-structured biodegradable polymeric films of poly-lactic-co-glycolic-acid (PLGA), poly-ether-urethane (PU), and poly-caprolactone (PCL) were fabricated and separately treated with various concentrations of NaOH (for PLGA and PCL) and HNO(3) (for PU) for select time periods. These treatments reduced the polymer surface feature dimensions from conventional micron dimensions to biologically inspired nanometer dimensions. Select cytocompatibility properties of these biomaterials were tested in vitro. Results provide the first evidence that adhesion of bladder smooth muscle cells is enhanced as polymer surface feature dimensions are reduced into the nanometer range. In addition, surface analysis results reveal that the polymer nanometer surface roughness is the primary design parameter that increases bladder smooth muscle cell adhesion. For this reason, the "next generation" of tissue-engineered bladder constructs with increased efficacy should contain surfaces with nanometer (as opposed to micron) surface features.

Biomaterials that successfully integrate into surrounding tissue should match not only the tissue's mechanical properties, but also its topography. The cellular response to a biomaterial may be enhanced in synthetic polymer formulations by mimicking the surface roughness created by the associated nano-structured extra-cellular matrix components of natural tissue. As a first step towards this endeavor, the goal of the present in vitro study was to use these design parameters to develop a synthetic, nano-structured, polymeric biomaterial that promotes cell adhesion and growth for vascular applications. In a novel manner, poly(lactic-co-glycolic acid) (PLGA) (50/50wt% mix) was synthesized to possess a range (from micron to nanometer) of surface features. Reduction of surface features was accomplished by treating conventional PLGA with various concentrations of NaOH for select periods of time. Results from cell experiments indicated that, compared to conventional PLGA, NaOH treated PLGA enhanced vascular smooth muscle cell adhesion and proliferation. However, PLGA prepared by soaking in NaOH decreased endothelial cell adhesion and proliferation compared to conventional PLGA. After further investigation, this finding was determined to be a result of chemical (and not topographical) changes during polymer synthesis. Surface chemistry effects were removed while retaining nano-structured topography by using polymer/elastomer casting methods. Results demonstrated that endothelial and smooth muscle cell densities increased on nano-structured cast PLGA. For these reasons, the present in vitro study provided the first evidence that nano-structured surface features can significantly improve vascular cell densities; such design criteria can be used in the synthesis of the next-generation of more successful tissue-engineered vascular grafts.

Polymers currently utilized for tissue engineering applications do not possess surfaces with nanostructured features. In contrast, the tissue that the polymers will regenerate is composed of proteins that have nanometer dimensions. Undoubtedly, the presence of proteins in natural tissue provide for surface roughness values in the nanometer regime. For this reason, the objective of the present study was to design, synthesize, and evaluate (using in vitro cellular models) the ability of poly-lactic-co-glycolic acid (PLGA) as the next generation of more efficient tissue engineering materials. Results provided the first evidence that osteoblasts (bone-forming cells), chondrocytes (cartilage synthesizing cells), aortic smooth muscle cells, and bladder smooth muscle cells adhered and proliferated more on nanostructured compared to conventional PLGA substrates. For this reason, the present results suggest that to enhance tissue regeneration, PLGA should incorporate a high degree of nanostructured surface features.

Polymers currently utilized for tissue engineering applications do not possess surfaces with nano-structured features. In contrast, the tissue that the polymers will regenerate is composed of proteins that have nanometer dimensions. Undoubtedly, the presence of proteins in natural tissue provide for surface roughness values in the nanometer regime. For this reason, the objective of the present study was to design, synthesize, and evaluate (using in vitro cellular models) poly-lactic-co-glycolic acid (PLGA) for use as the next generation of more efficient tissue engineered materials. Results provided the first evidence that osteoblasts (bone-forming cells), chondrocytes (cartilage synthesizing cells), aortic smooth muscle cells, and bladder smooth muscle cells adhered and proliferated more on nanostructured compared to conventionally structured PLGA substrates. For this reason, the present results suggest that to enhance tissue regeneration, PLGA should incorporate a high degree of nano-structured surface features.

Osteoblast (bone-forming cell) and chondrocyte (cartilage-synthesizing cell) adhesion on novel nanostructured polylactic/glycolic acid (PLGA) and titania composites were investigated in the present in vitro study. Nanostructured polymers were created by chemically treating micron-structured PLGA with select concentrations of NaOH for various periods of time. Dimensions of ceramics were controlled by utilizing either micron or nanometer grain size titania. Compared with surfaces with conventional or micron surface roughness dimensions, results provided the first evidence of increased osteoblast and chondrocyte adhesion on 100 wt% PLGA films with nanometer polymer surface roughness dimensions. Results also confirmed other literature reports of enhanced osteoblast adhesion on 100 wt% nanometer compared with conventional grain size titania compacts; however, the present study provided the first evidence that decreasing titania grain size into the nanometer range did not influence chondrocyte adhesion. Finally, osteoblast and chondrocyte adhesion increased on 70/30 wt% PLGA/titania composites formulated to possess nanosurface rather than conventional surface feature dimensions. The present study, thus, provided evidence that these nanostructured PLGA/titania composites may possess the ability to simulate surface and/or chemical properties of bone and cartilage, respectively, to allow for exciting alternatives in the design of prostheses with greater efficacy.

The objective of the present in vitro study was to determine vascular endothelial and smooth muscle cell responses to poly(lactic-co-glycolic acid) (PLGA) films that were exposed apriori to various degrees of alkaline degradation. To model the alkaline environment of blood in arteries, PLGA films were separately soaked in select concentrations (from 0.1 – 10 N) of NaOH for various periods of time (from 10 minutes to 1 hour). Vascular endothelial and smooth muscle cells were then separately allowed to adhere and/or proliferate on the different PLGA degraded surfaces. Results provided the first evidence that smooth muscle adhesion and proliferation increased with larger amounts of alkaline PLGA degradation. In contrast, endothelial cell adhesion and proliferation decreased with increasing amounts of alkaline PLGA degradation. In this manner, the present in vitro study suggests a possible mechanism for insufficient endothelialization on PLGA vascular implants in vivo.

Biomaterials that successfully integrate into surrounding tissue should match not only the tissue's mechanical properties, but also the dimensions of the associated nano-structured extra-cellular matrix (ECM) components. The goal of this research was to use these ideals to develop a synthetic, nano-structured, polymeric biomaterial that has cytocompatible and mechanical behaviors similar to that of natural vascular tissue. In a novel manner, poly-lactic acid/polyglycolic acid (PLGA) (50/50 wt.% mix) and polyurethane were separately synthesized to possess a range of fiber dimensions in the micron and nanometer regime. Preliminary results indicated that decreasing fiber diameter on both PLGA and PU enhanced arterial smooth muscle cell adhesion; specifically, arterial smooth muscle cell adhesion increased 23% when PLGA fiber dimensions decreased from 500 to 50 nm and increased 76% on nano-structured, compared to conventional structured, polyurethane. However, nano-structured PLGA decreased endothelial cell adhesion by 52%, whereas adhesion of these same cells was increased by 50% on polyurethane. For these reasons, the present in vitro study provides the first evidence that polymer fiber dimensions can be used to selectively control cell functions for vascular prosthesis.

Conventionally, studies investigating the design of synthetic bladder wall substitutes have involved polymers with micro-dimensional structures. Since the body is made up of nano-structured components (e.g., extracellular matrix proteins), our focus has been in the use of nano-structured polymers in order to design a three-dimensional synthetic bladder construct that mimics bladder tissue in vivo. In order to complete this task, we fabricated novel, nano-structured, biodegradable materials to serve as substrates for bladder tissue constructs and tested the cytocompatibility properties of these biomaterials in vitro. The results from our in vitro work to date have provided the first evidence that cellular responses (such as adhesion and proliferation) of bladder smooth muscle cells are enhanced as poly (lactic-co-glycolic acid) (PLGA) surface feature dimensions are reduced into the nanometer range.

We explore the parameter space of lepton flavor violating (LFV) neutral Higgs Yukawa couplings with the muon and tau leptons that can be probed at the high-luminosity Large Hadron Collider (HL-LHC) via the vector boson fusion~(VBF) Higgs production process. Our projected sensitivities for the Standard Model Higgs ($h$) LFV branching ratio ${\rm Br}(h \to \mu\tau)$ in the $pp \to h j j \to (h \to \mu \tau) jj$ channel at the HL-LHC are contrasted with the current and future low-energy constraints from the anomalous magnetic moment and electric dipole moment of the muon, as well as with other LFV observables, such as $\tau\to 3\mu$ and $\tau\to \mu\gamma$. We also study the LFV prospects of a generic beyond the Standard Model neutral Higgs boson ($H$) with a mass in the range of $m_{H}\in [20,800]~$GeV and give the projected model-independent upper limits on the VBF production cross-section of $Hjj$ times the branching ratio of $H\to \mu\tau$ at the HL-LHC. We interpret these results in the context of a two-Higgs doublet model as a case study., Comment: 16 pages, 8 figures, 6 tables. Revised version, to appear in Phys. Rev. D