Search

Introduction: Job satisfaction is an attitudinal variable representing the extent to which people like or dislike their jobs. It is a critical factor influencing healthcare quality, patient outcomes, and overall well-being in medical professionals. This study aimed to determine Job Satisfaction among medical doctors in Nepal. Methods: A descriptive cross-sectional study was conducted among medical doctors of Nepal between June 2023 and August 2023 after obtaining ethical approval from the Ethical Review Board of Nepal Health Research Council. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 380 participants, 63 (16.58%) (12.84-20.32 at 95% Confidence Interval) expressed satisfaction. The number of satisfied participants above 40 years were 10 (16%) and less than 40 years were 53 (84%). Out of 63, 46 (73.02%) were male and 17 (26.98%) were females. Conclusions: Job satisfaction among doctors practicing in Nepal was found to be lower than the studies conducted in similar settings.

Key Clinical Message Although it is very uncommon, SLE may initially present with recurrent episodes of EM‐like rash. Despite the various possibilities underlying their association, prompt identification, and treatment of SLE in patients presenting with EM is important to prevent death or serious organ damage. Abstract Rowell's syndrome (RS) is an uncommon presentation of systemic lupus erythematosus (SLE) with erythema multiforme (EM)‐like lesions associated with specific serological changes, including positive rheumatoid factor (RF), speckled antinuclear antibody (ANA), positive rheumatoid factor, or anti‐La antibodies in the serum. Our case, a 41‐year‐old male, presented with features of EM. Upon investigation, we identified underlying systemic lupus erythematosus, marking a rare instance of SLE presenting for the first time as EM. Classical or true EM is precipitated by trigger factors such as infective agents like the herpes simplex virus, Mycoplasma pneumoniae, drugs like anticonvulsants, antibiotics, and non‐steroid anti‐inflammatory drugs, any underlying malignancy, or connective tissue disorders, and is not associated with any specific serological abnormalities. EM cases associated with LE lesions where an EM trigger factor is missing are considered an RS diagnostic criterion. In this case report, the importance of considering SLE in patients presenting initially with recurrent episodes of EM‐like rash is emphasized. RS should be considered, especially when there is no evidence of triggering factors. Early diagnosis and prompt treatment of SLE are crucial to preventing death and irreversible organ damage.

Agricultural productivity relies upon energy input in the form of improved seeds, fertilizers, chemicals, irrigation and mechanization including management practices. This energy input is crucial for enhancing crop yields and meeting the demands of an ever-growing population. The increasing demand for rice production from an ever-increasing population and the dwindling nature of natural resources as a result of their continuous and excessive use underscore the urgency of studying energy use efficiency and sustainability in rice production. By conducting this experiment, the goal was to assess the yields, economics, and energy use efficiencies in rice. The experiment employed a Randomized Complete Block Design (RCBD) with three replications, comprising ten treatment combinations viz. US-312 + 60:30:20 kg NPK ha−1, US-312 + 0:30:20 kg NPK ha−1, US-312 + 60:0:20 kg NPK ha−1, US-312 + 60:30:0 kg NPK ha−1, US-312 + 0:0:0 kg NPK ha−1, Sukhadhan-2+60:30:20 kg NPK ha−1, Sukhadhan-2+0:30:20 kg NPK ha−1, Sukhadhan-2+60:0:20 kg NPK ha−1, Sukhadhan-2+60:30:0 kg NPK ha−1, Sukhadhan-2+ 0:0:0 kg NPK ha−1. Results revealed that the highest grain yield and yield attributes were obtained from US-312 + 60:30:20 kg NPK ha−1 (4.98 t ha−1) followed by US-312 + 60:30:0 kg NPK ha−1 (4.76 t ha−1), and US-312 + 60:0:20 kg NPK ha−1 (4.54 t ha−1). The highest energy use efficiency of 3.95 was observed under US-312 + 60:30:0 kg NPK ha−1 which was supported by the highest output energy obtained from grain and biomass yield (153 GJ ha−1) and the highest net energy (117 GJ ha−1). The benefit-cost ratio was found highest in US-312 + 60:30:20 kg NPK ha−1 (1.98), signifying its economic viability and potential profitability. In the context of the western mid-hills of Nepal, the rice variety US-312, coupled with a nutrient composition of 60:30:20 kg NPK ha−1 proved to be an optimal selection. This combination demonstrated higher grain yields and noteworthy economic efficiency.

ABSTRACT: The increasing demand for cage-free (CF) poultry farming raises concern regarding air pollutant emissions in these housing systems. Previous studies have indicated that air pollutants such as particulate matter (PM) and ammonia (NH3) pose substantial risks to the health of birds and workers. This study aimed to evaluate the efficacy of electrostatic particle ionization (EPI) technology with different lengths of ion precipitators in reducing air pollutants and investigate the relationship between PM reduction and electricity consumption. Four identical CF rooms were utilized, each accommodating 175 hens of 77 wk of age (WOA). A Latin Square Design method was employed, with 4 treatment lengths: T1 = control (0 m), T2 = 12 ft (3.7 m), T3 = 24 ft (7.3 m), and T4 = 36 ft (11.0 m), where room and WOA are considered as blocking factors. Daily PM concentrations, temperature, and humidity measurements were conducted over 24 h, while NH3 levels, litter moisture content (LMC), and ventilation were measured twice a week in each treatment room. Statistical analysis involved ANOVA, and mean comparisons were performed using the Tukey HSD method with a significance level of P ≤ 0.05. This study found that the EPI system with longer wires reduced PM2.5 concentrations (P ≤ 0.01). Treatment T2, T3, and T4 led to reductions in PM2.5 by 12.1%, 19.3%, and 31.7%, respectively, and in small particle concentrations (particle size >0.5 μm) by 18.0%, 21.1%, and 32.4%, respectively. However, no significant differences were observed for PM10 and large particles (particle size >2.5 μm) (P < 0.10), though the data suggests potential reductions in PM10 (32.7%) and large particles (33.3%) by the T4 treatment. Similarly, there was no significant impact of treatment on NH3 reduction (P = 0.712), possibly due to low NH3 concentration (

Background : Sickle cell anemia is the most common hemoglobinopathy in the world. The study aimed to evaluate the iron profile and its association with socio-demographic characteristics in patients with sickle cell disease. Methods: A hospital-based descriptive cross-sectional study was conducted to know the iron profile and its socio-demographic association in patients with sickle cell disease. Results: The average serum iron, TIBC, and transferrin saturation were 16.75 ± 6.40 mcgMole/L, 69.46 ± 16.94 mcg/dl and 25.15 ± 12.51% respectively. The serum ferritin ranged from 10.00 to 3000.00 ng/ml. The proportion of participants with normal serum iron, TIBC, serum ferritin, and transferrin saturation were 86.10%, 0.00%, 33.90% and 36.40% respectively. All of the participants of this study had low TIBC (1005), and more than half of the participants had elevated serum ferritin (56.40%). Conclusions: Iron overload is a common complication of sickle cell disease. There was no association of age and sex with iron profile. The TIBC variation between the Chaudhary ethnic group compared to other ethnic groups signifies the ethnic role in the iron profile. Keywords: Ethnicity; iron overload; sickle cell disease; total iron binding capacity.

Key Clinical Message Wilson's disease is a genetic disorder of copper metabolism that primarily manifests with hepatic and neurological features. Kayser–Fleischer rings (KF rings) are pathognomonic of Wilson's disease and helps in establishing its diagnosis.

Objectives To evaluate the feasibility of using the NeuroMotion smartphone application for remote General Movements Assessment for screening infants for cerebral palsy in Kathmandu, Nepal.Method Thirty-one term-born infants at risk of cerebral palsy due to birth asphyxia or neonatal seizures were recruited for the follow-up at Paropakar Maternity and Women’s Hospital, 1 October 2021 to 7 January 2022. Parents filmed their children at home using the application at 3 months’ age and the videos were assessed for technical quality using a standardised form and for fidgety movements by Prechtl’s General Movements Assessment. The usability of the application was evaluated through a parental survey.Results Twenty families sent in altogether 46 videos out of which 35 had approved technical quality. Sixteen children had at least one video with approved technical quality. Three infants lacked fidgety movements. The level of agreement between assessors was acceptable (Krippendorf alpha 0.781). Parental answers to the usability survey were in general positive.Interpretation Engaging parents in screening of cerebral palsy with the help of a smartphone-aided remote General Movements Assessment is possible in the urban area of a South Asian lower middle-income country.

Introduction: Intimate partner violence (IPV) is a significant public health, human rights, and development issue. While existing evidence posits that addressing social norms is key to IPV prevention, successful IPV interventions that include a norms approach are limited in number and methodological rigor and rarely include a formal investigation of the diffusion of intervention impact. We contribute novel findings to this intellectual and programmatic space with evidence on a social and behavior change communication (SBCC) intervention (Change Starts at Home) in Nepal designed to prevent IPV and shift social norms towards greater gender equity. Methods: Participants included 442 married women across 13 communities assessed at three timepoints: before intervention (baseline), at the completion of the core couple's curriculum and edutainment (midline), and at the conclusion of the diffusion curriculum (endline). Generalized estimating equations with propensity-score adjustments were used to determine change in outcomes at midline and endline for two intervention conditions (direct beneficiary, N = 173; and resident of the intervention community, (N = 178) relative to control (N = 91). Results: IPV victimization significantly decreased in both intervention conditions at midline, with larger reductions in direct beneficiaries. At endline, direct beneficiaries had sustained reduction in IPV relative to control participants. Positive injunctive norms also significantly improved by midline for both intervention groups, whereas improvements in descriptive norms for intervention groups were matched by improvements in the control group at both midline and endline. Several secondary outcomes showed significant improvements for both intervention groups at midline and/or endline, including in-law violence, financial decision-making, communication, and relationship quality, with additional improvements for the direct beneficiaries in attitudes, leadership, GBV advocacy, and diffusion. Conclusion: This study sheds light on the effectiveness of the Change intervention, the role of addressing social norms in IPV prevention efforts, and the benefits of organized diffusion.

Key Clinical Message Patients mimicking appendicitis symptoms in a rural setting or those post‐appendectomy, indicating cecal volvulus, should always be considered. Swift action can prevent catastrophic consequences. Abstract We present a case of a 14‐year‐old female who initially underwent open appendectomy for acute appendicitis and subsequently experienced symptoms of abdominal distention, vomiting, and fever. Her condition deteriorated following the appendectomy, despite a prior appendectomy for similar symptoms at a different facility. A computed tomography (CT) scan identified cecal volvulus as the underlying issue. This led to the performance of a laparotomy, cecopexy, and decompressive ileostomy. After six weeks, ileostomy closure was successfully carried out, and the patient currently enjoys good health. This case highlights the significance of considering uncommon factors as potential contributors to postoperative complications in young patients.

Abstract Globally, biodiversity is declining due to habitat loss and degradation, over‐exploitation, climate change, invasive species, pollution, and infrastructure development. These threats affect the populations of large waterbird species, such as Sarus crane (Grus antigone), which inhabits agricultural–wetland ecosystems. Despite the burgeoning built‐up areas and diminishing agricultural and wetland spaces, scant research investigates the impact of these changing land uses on the globally vulnerable Sarus crane in Nepal. During the pre‐breeding season from April to June 2023, our comprehensive study meticulously scrutinized Sarus crane population status and factors associated with the occurrences and conservation challenges across 10 specific districts of Nepal. Our study documented a total of 690 individuals of Sarus cranes in five districts. The Lumbini Province has 685 individuals, occupying 11 roosting sites. Conversely, the remaining five districts have no Sarus cranes presence during this period. Wetland, farmland and built‐up areas exhibited a significantly positive influence on Sarus crane occurrences in the Lumbini Province. Additionally, we recorded 47 fatalities of Sarus cranes over the past 13 years in the Lumbini Province due to electrocution and collisions. Our study provides a baseline dataset crucial for developing conservation policies, particularly during the dry season when Sarus crane populations tend to congregate in larger flocks. The adaptation of the Sarus crane to urbanized landscapes exposes them to several anthropogenic threats in the coming days. Therefore, protecting wetlands and farmland areas and adopting transboundary conservation approaches are imperative for the long‐term conservation of the Sarus crane and its habitat.

Introduction Hospital-based studies have demonstrated topical applications of sunflower seed oil (SSO) to skin of preterm infants can reduce nosocomial infections and improve survival. In South Asia, replacing traditional mustard with SSO might have similar benefits.Methods 340 communities in Sarlahi, Nepal were randomised to use mustard oil (MO) or SSO for community practice of daily newborn massage. Women were provided oil in late pregnancy and the first month post partum, and visited daily through the first week of life to encourage massage practice. A separate data collection team visited on days 1, 3, 7, 10, 14, 21 and 28 to record vital status and assess serious bacterial infection.Results Between November 2010 and January 2017, we enrolled 39 479 pregnancies. 32 114 live births were analysed. Neonatal mortality rates (NMRs) were 31.8/1000 (520 deaths, 16 327 births) and 30.5/1000 (478 deaths, 15 676 births) in control and intervention, respectively (relative risk (RR)=0.95, 95% CI: 0.84, 1.08). Among preterm births, NMR was 90.4/1000 (229 deaths, 2533 births) and 79.2/1000 (188 deaths, 2373 births) in control and intervention, respectively (RR=0.88; 95% CI: 0.74, 1.05). Among preterm births

Abstract Introduction Previous studies have reported a decreased risk of dementia with herpes zoster vaccination. Given this background, this systematic review and meta‐analysis aimed to investigate the association between herpes zoster vaccination and the risk of dementia. Methods We searched five databases until November 2023 for case–control, cross‐sectional, or cohort studies investigating the association of herpes zoster vaccination and dementia. Odds ratios and 95% confidence intervals (95% CIs) were pooled in the meta‐analysis. Meta‐regression, subgroup, and sensitivity analysis were also conducted. Results We evaluated a total of five studies (one cross‐sectional, one case–control, and four cohort studies) that included a total number of 103,615 patients who were vaccinated with herpes zoster vaccine. All the studies were of high quality, ranging from 7 to 9. Due to the high heterogeneity (I2 = 100%, p

Background: Oral Pathology curriculum is taught as didactic lectures which promotes rote learning. This study intends to introduce and assess the impact of Case based Learning in student’s performance and to obtain the perception of students towards it. Methods: This cross-sectional study was conducted from March 2021 to January 2022 among dental undergraduate students (N=25) of Gandaki Medical College, Pokhara. The syllabus of Potentially Malignant Oral Lesions and Oral Cancer were covered for BDS third year students by didactic lectures, followed by Case Based Learning sessions (session I- Oral Leukoplakia, session II- Oral Squamous Cell Carcinoma). A pre-test and post-test, containing Multiple Choice questions relevant to the topics, were administered before and after the interventions. Students’ perceptions were collected using feedback questionnaire. The scores obtained in the pre and post-test were compared by Wilcoxon pair test and Mann Whitney U test. The level of significance was set at p

AbstractProtected vegetable farming has emerged as a potential approach to improve the yield and quality of produce around the globe. In Nepal, it has a short history since 1996, but over the past decade, investment in protected structures has been gaining momentum. This paper discusses the findings of the study in the area of profitability and the determinants of protected vegetable farming in Nepal. The study was conducted in seven districts of Nepal by selecting 90 respondents growing vegetables under protected structures. Descriptive statistics and multinomial logistic regression were used to analyze data. The financial analysis showed a significantly higher benefit–cost ratio and payback period in temporary structures than those in semi-permanent and permanent structures. The productivity of vegetables under different types of protected structures was statistically similar to average productivity of 191.55 mt./ha/year. The multinomial logistic regression studied among 15 explanatory variables found 10 explanatory variables to be significant whether at 1% or 5% or 10% probability level. The variables, namely, gender, education, family type, household members involved in agriculture, experience in vegetable farming and subsidies received, were found to have a significant and positive influence on the adoption of semi-permanent and permanent structures, whereas the variables, namely, age, membership in farmers group, record keeping and technician visit, were found to have a significant and negative influence. The findings of the study would have implications for the policymakers, suppliers of the structure installment materials and farmers regarding the promotion and adoption of different types of protected structures.

BackgroundCorneal ulcers are a common cause of blindness in low-income and middle-income countries, usually resulting from traumatic corneal abrasions during agricultural work. Antimicrobial prophylaxis of corneal abrasions can help prevent corneal ulcers, but delays in the initiation of therapy are frequent. We aimed to assess whether a community-based programme for corneal ulcer prevention would reduce the incidence of corneal ulceration.MethodsA cluster-randomised trial was performed in village development committees (VDCs) in Nepal. VDCs in the catchment area of Bharatpur Eye Hospital, Nepal with less than 15 000 people were eligible for inclusion. We randomly assigned (1:1) VDCs to either an intervention group or a control group. In the intervention VDCs, existing female community health volunteers (FCHVs) were trained to diagnose corneal abrasions and provide a 3-day course of ophthalmic antimicrobials to their patients. In the control VDCs, FCHVs did not provide this intervention. Participants were not masked given the nature of the intervention. Both groups were followed up for 3 years for photographic evidence of corneal ulceration. The primary outcome was the incidence of corneal ulceration, determined by masked assessment of corneal photographs. The analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT01969786.FindingsWe assessed 112 VDCs, of which 24 were enrolled. The study was performed between Feb 4, 2014, and Oct 20, 2017. 12 VDCs were randomly assigned to the intervention group and 12 to the control group. 252 539 individuals were included in the study (130 579 in the intervention group and 121 960 in the control group). FCHVs diagnosed and provided antimicrobials for 4777 corneal abrasions. The census identified 289 corneal ulcers among 246 893 person-years in the intervention group (incidence 1·21 cases [95% CI 0·85-1·74] per 1000 person-years) and 262 corneal ulcers among 239 170 person-years in the control group (incidence 1·18 cases [0·82-1·70] per 1000 person-years; incidence rate ratio 1·03 [95% CI 0·63-1·67]; p=0·93). Medication allergy was self-reported in 0·2% of participants.InterpretationWe did not detect a reduction in the incidence of corneal ulceration during the first 3 years of a community-based corneal ulcer prevention programme. Further study might be warranted in more rural areas where basic eye care facilities are not available.FundingNational Eye Institute.

Background: Intestinal infections with Helicobacter pylori mainly occur during childhood. If contracted, these infections may cause chronic gastritis, frequently leading to peptic ulcer disease in later life. This study aims to detect the prevalence of H. pylori infections in patients with active gastritis. Methods: The study included 150 participants who were consuming daily anti-gastritis drugs to reduce the gas and were considered active gastritis patients and were recruited from Lekhnath 12, now known as Pokhara metropolitan-30, from May 2018 to March 2019. They were screened for H. pylori antibodies for detection of infection by the immunochromatographic rapid detection kit, and the data were analyzed using SPSS 2016. Results: Serum anti-Helicobacter pylori antibodies were used to detect the presence of Helicobacter pylori in these participants. Among the 150 participants, 54 were males (36%) and 96 were females (64%). The results showed that 47 (31.3%) of the patients were positive for anti-Helicobacter pylori test. The age group 30 to 40 had the highest prevalence of 21 (14.0%). Using public water showed the highest prevalence with a P value of 0.04. Conclusion: There should be an additional aspect required for the diagnosis and treatment of gastritis, which is the healthcare providers' and patients' awareness of the cause and most efficient treatments for this medical condition. Using only anti-gastritis drugs is not sufficient; treatment against Helicobacter pylori requires the right pathway of treatment by the use of several antibiotics.

Abstract The Balmuccia peridotite exposes relatively fresh mantle rocks at the Earth’s surface, and as such it is of interest for geologists and geophysicists. The outcrop is a kilometre-scale feature, yet its extent at depth is insufficiently imaged. Our aim is to provide new constraints on the shape of the density anomaly this body represents, through 3D gravity modelling. In an effort to avoid personal or methodology bias, we hereby launch an invitation and call for participative modelling. We openly provide all the necessary input data: pre-processed gravity data, geological map, in situ rock densities, and digital elevation model. The expected inversion results will be compared and jointly analysed with all participants. This approach should allow us to conclude on the shape of the Balmuccia peridotite body and the associated uncertainty. This crowd effort will contribute to the site surveys preparing a scientific borehole in the area in frame of project DIVE.

Abstract Since the M w 7.9 Gorkha earthquake of April 25, 2015, the seismicity of central and western Nepalese Himalaya has been monitored by an increasing number of permanent seismic stations. These instruments contribute to the location of thousands of aftershocks that occur at the western margin of the segment of the Main Himalayan Thrust (MHT) that ruptured in 2015. They also help to constrain the location of seismic clusters that originated at the periphery of the fault ruptured by the Gorkha earthquake, which may indicate a migration of seismicity along the fault system. We report here a seismic crisis that followed the Lamjung earthquake, a moderate M w 4.7 event (M L 5.8, M Lv 5.3) that occurred on May 18, 2021, about 30 km west of the Gorkha earthquake epicenter at the down-dip end of the locked fault zone. The study of the hypocentral location of the mainshock and its first 117 aftershocks confirms mid-crustal depths and supports the activation of a 30–40° dipping fault plane, possibly associated with the rupture of the updip end of the MHT mid-crustal ramp. The cluster of aftershocks occurs near the upper decollement of the thrust system, probably in its hanging wall, and falls on the immediate northern margin of a region of the fault that has not been ruptured since the 1344 or 1505 CE earthquake. The spatio-temporal distribution of the first 117 aftershocks shows a typical decrease in the associated seismicity rate and possible migration of seismic activity. Since then, the local seismicity has returned to the pre-earthquake rate and careful monitoring has not revealed any large-scale migration of seismicity towards the locked fault segments. Graphical Abstract

Abstract Background Minimally Invasive Tissue Sampling (MITS) has been successfully used to establish the cause of death in low- and middle-income countries, mostly in stillbirths and neonates. The objective of this study was to determine the causes of death among adults using MITS in the Gandaki province of Nepal and to find out the contribution of MITS to identify the causes of death. Methods A multicentric hospital-based pilot study was conducted to enroll 100 cases of adult deaths. The specimens of cerebrospinal fluid, blood, brain, lungs, and liver tissue were collected utilizing MITS. These specimens underwent standard histopathological, serological, and microbiological analyses. The findings from MITS, and if available, clinical records and forensic autopsy findings were compiled and the cause of death panel identified the causes of death. The final cause of death allocated to each case was based on the WHO International Medical Certificate of Death. Results Among a total of 100 cases enrolled during the study period, infectious cause attributed to the immediate cause of death in 77 (77%), cardiovascular in 10 (10%), neurological in 8 (8%), malignancy in two (2%), and gastrointestinal and hepatobiliary cause in one (1%) case. The mean age of the cases was 50.8 ± 15.9 years and 76 (76%) were males. MITS established the cause of death in the causal chain of events in 81(81%) cases and identified the cause of death significantly more with infectious than non-infectious causes (p

We present a list of grasshoppers of two families from Ghyalchok, Gorkha district with four new species records for Nepal. The checklist of species is given to provide basic information on the grasshopper diversity of that region. With detailed information of all species recorded and plates with photos from different angles of each species, the present work shall contribute towards a better understanding of grasshoppers of Nepal's Ghyalchok, Gorkha region. This study contributes to future revisionary works on grasshopper diversity and distribution in Nepal. We surveyed 13 different localities of Ghyalchok for three years from 2019–2022, following visual count, while the specimens were collected by using a sweep net or by handpicking where feasible. We recorded 29 species of grasshoppers, of which 26 species belong to Acrididae and 3 species to Pyrgomorphidae. Four grasshopper species, Phlaeoba antennata antennata Brunner von Wattenwyl, 1893; Bibracte burmana burmana Ramme, 1941; Caryanda cachara (Kirby, 1914) and Gonista bicolor (Haan, 1942) are recorded for the first time from Nepal.

Abstract Background With an increasing burden of stroke, it is essential to minimize the incidence of stroke and improve stroke care by emphasizing areas that bring out the maximum impact. The care situation remains unclear in the absence of a national stroke care registry and a lack of structured hospital-based data monitoring. We conducted this systematic review and meta-analysis to assess the status of stroke care in Nepal and identify areas that need dedicated improvement in stroke care. Methods A systematic literature review was conducted to identify all studies on stroke epidemiology or stroke care published between 2000 and 2020 in Nepal. Data analysis was done with Statistical Package for Social Sciences (SPSS) and Comprehensive Meta-analysis (CMA-3). Results We identified 2533 studies after database searching, and 55 were included in quantitative and narrative synthesis. All analyses were done in tertiary care settings in densely populated central parts of Nepal. Ischemic stroke was more frequent (70.87%) than hemorrhagic (26.79%), and the mean age of stroke patients was 62,9 years. Mortality occurred in 16.9% (13-21.7%), thrombolysis was performed in 2.39% of patients, and no studies described thrombectomy or stroke unit care. Conclusion The provision of stroke care in Nepal needs to catch up to international standards, and our systematic review demonstrated the need to improve access to quality stroke care. Dedicated studies on establishing stroke care units, prevention, rehabilitation, and studies on lower levels of care or remote regions are required.

Abstract Discrete data such as counts of microbiome taxa resulting from next-generation sequencing are routinely encountered in bioinformatics. Taxa count data in microbiome studies are typically high-dimensional, over-dispersed, and can only reveal relative abundance therefore being treated as compositional. Analyzing compositional data presents many challenges because they are restricted to a simplex. In a logistic normal multinomial model, the relative abundance is mapped from a simplex to a latent variable that exists on the real Euclidean space using the additive log-ratio transformation. While a logistic normal multinomial approach brings flexibility for modeling the data, it comes with a heavy computational cost as the parameter estimation typically relies on Bayesian techniques. In this paper, we develop a novel mixture of logistic normal multinomial models for clustering microbiome data. Additionally, we utilize an efficient framework for parameter estimation using variational Gaussian approximations (VGA). Adopting a variational Gaussian approximation for the posterior of the latent variable reduces the computational overhead substantially. The proposed method is illustrated on simulated and real datasets.

Abstract Background Despite the effectiveness of glucagon-like peptide-1 agonist (GLP-1A) in the treatment of diabetes, its large molecular weight and high hydrophilicity result in poor cellular permeability, thus limiting its oral bioavailability. To address this, we developed a chimeric GLP-1A that targets transporter-mediated endocytosis to enhance cellular permeability to GLP-1A by utilizing the transporters available in the intestine, particularly the apical sodium-dependent bile acid transporter (ASBT). Methods In silico molecular docking and molecular dynamics simulations were used to investigate the binding interactions of mono-, bis-, and tetra-deoxycholic acid (DOCA) (monoDOCA, bisDOCA, and tetraDOCA) with ASBT. After synthesizing the chimeric GLP-1A-conjugated oligomeric DOCAs (mD-G1A, bD-G1A, and tD-G1A) using a maleimide reaction, in vitro cellular permeability and insulinotropic effects were assessed. Furthermore, in vivo oral absorption in rats and hypoglycemic effect on diabetic db/db mice model were evaluated. Results In silico results showed that tetraDOCA had the lowest interaction energy, indicating high binding affinity to ASBT. Insulinotropic effects of GLP-1A-conjugated oligomeric DOCAs were not different from those of GLP-1A-Cys or exenatide. Moreover, bD-G1A and tD-G1A exhibited improved in vitro Caco-2 cellular permeability and showed higher in vivo bioavailability (7.58% and 8.63%) after oral administration. Regarding hypoglycemic effects on db/db mice, tD-G1A (50 μg/kg) lowered the glucose level more than bD-G1A (50 μg/kg) compared with the control (35.5% vs. 26.4%). Conclusion GLP-1A was conjugated with oligomeric DOCAs, and the resulting chimeric compound showed the potential not only for glucagon-like peptide-1 receptor agonist activity but also for oral delivery. These findings suggest that oligomeric DOCAs can be used as effective carriers for oral delivery of GLP-1A, offering a promising solution for enhancing its oral bioavailability and improving diabetes treatment. Graphical Abstract

Polynucleotide Kinase-Phosphatase (PNKP) is a bifunctional enzyme that possesses both DNA 3'-phosphatase and DNA 5'-kinase activities, which are required for processing termini of single- and double-strand breaks generated by reactive oxygen species (ROS), ionizing radiation and topoisomerase I poisons. Even though PNKP is central to DNA repair, there have been no reports linking PNKP mutations in a Microcephaly, Seizures, and Developmental Delay (MSCZ) patient to cancer. Here, we characterized the biochemical significance of 2 germ-line point mutations in the PNKP gene of a 3-year old male with MSCZ who presented with a high-grade brain tumor (glioblastoma multiforme) within the cerebellum. Functional and biochemical studies demonstrated these PNKP mutations significantly diminished DNA kinase/phosphatase activities, altered its cellular distribution, caused defective repair of DNA single/double stranded breaks, and were associated with a higher propensity for oncogenic transformation. Our findings indicate that specific PNKP mutations may contribute to tumor initiation within susceptible cells in the CNS by limiting DNA damage repair and increasing rates of spontaneous mutations resulting in pediatric glioma associated driver mutations such as ATRX and TP53.

We report measurements of the parity-conserving beam-normal single-spinelastic scattering asymmetries $B_n$ on $^{12}$C and $^{27}$Al, obtained withan electron beam polarized transverse to its momentum direction. Thesemeasurements add an additional kinematic point to a series of previousmeasurements of $B_n$ on $^{12}$C and provide a first measurement on $^{27}$Al.The experiment utilized the Qweak apparatus at Jefferson Lab with a beam energyof 1.158 GeV. The average lab scattering angle for both targets was 7.7degrees, and the average $Q^2$ for both targets was 0.02437 GeV$^2$ (Q=0.1561GeV). The asymmetries are $B_n$ = -10.68 $\pm$ 0.90 stat) $\pm$ 0.57 (syst) ppmfor $^{12}$C and $B_n$ = -12.16 $\pm$ 0.58 (stat) $\pm$ 0.62 (syst) ppm for$^{27}$Al. The results are consistent with theoretical predictions, and arecompared to existing data. When scaled by Z/A, the Q-dependence of all thefar-forward angle (theta < 10 degrees) data from $^{1}$H to $^{27}$Al can bedescribed by the same slope out to $Q \approx 0.35$ GeV. Larger-angle data fromother experiments in the same Q range are consistent with a slope about twiceas steep.

Nitrogen cycling in pasture soils differing in drainage characteristics and fertilization legacy needs more research to determine efficient nutrient management strategies. This study compared differences in nitrate (NO3−), ammonium (NH4+), inorganic N (IN = NO3− + NH4+), potentially mineralizable nitrogen (PMN), loss-on-ignition carbon (C), and soil pH in 10, 0.7 ha pastures in Eatonton, Georgia, historically fertilized with the same amount of N as either broiler litter (BL; >15 years, 6 pastures) or mineral fertilizer (Min; 4 pastures). We sampled to 90 cm (0–5, 5–10, 10–20, 20–40, 40–60, and 60–90 cm) on a 20 m grid. An analysis of variance indicated that below 5 cm BL pastures had significantly greater amounts of NO3−, IN, PMN, and soil pH compared to Min pastures. Comparisons of drainage classes (well drained~WD, moderately well drained~MWD, and somewhat-poorly drained~SPD) for each BL and Min were analyzed using linear regression for C:IN, C:PMN, pH: NO3−, and pH: NH4+ with all depths combined. In MWD soils, BL had 0.1 and 0.2 mg N kg−1 greater PMN and IN, respectively, for each unit increase in C. In WD soils NO3− decreased in BL by 7.4 and in Min by 12.1 mg N kg−1, while in MWD soils, this level decreased in BL by 7.8 and in Min by 4.5 mg N kg−1 for each pH unit. Five years after N fertilization stopped, BL soils have retained more inorganic N but are losing more NO3− at a greater rate in the MWD soils when all depths are considered. These losses are a combination of plant uptake, emissions, runoff and leaching. While more research is needed, these results strongly suggest the need to design N fertilization practices with drainage class and fertilization legacy in mind to improve N-use efficiency.

In the United States, several land use and land cover (LULC) data sets are available based on satellite data, but these data sets often fail to accurately represent features on the ground. Alternatively, detailed mapping of heterogeneous landscapes for informed decision-making is possible using high spatial resolution orthoimagery from the National Agricultural Imagery Program (NAIP). However, large-area mapping at this resolution remains challenging due to radiometric differences among scenes, landscape heterogeneity, and computational limitations. Various machine learning (ML) techniques have shown promise in improving LULC maps. The primary purposes of this study were to evaluate bagging (Random Forest, RF), boosting (Gradient Boosting Machines [GBM] and extreme gradient boosting [XGB]), and stacking ensemble ML models. We used these techniques on a time series of Sentinel 2A data and NAIP orthoimagery to create a LULC map of a portion of Irion and Tom Green counties in Texas (USA). We created several spectral indices, structural variables, and geometry-based variables, reducing the dimensionality of features generated on Sentinel and NAIP data. We then compared accuracy based on random cross-validation without accounting for spatial autocorrelation and target-oriented cross-validation accounting for spatial structures of the training data set. Comparison of random and target-oriented cross-validation results showed that autocorrelation in the training data offered overestimation ranging from 2% to 3.5%. The XGB-boosted stacking ensemble on-base learners (RF, XGB, and GBM) improved model performance over individual base learners. We show that meta-learners are just as sensitive to overfitting as base models, as these algorithms are not designed to account for spatial information. Finally, we show that the fusion of Sentinel 2A data with NAIP data improves land use/land cover classification using geographic object-based image analysis.

Naturally occurring homoisoflavonoids isolated from some Liliaceae plants have been reported to have diverse biological activities (e.g., antioxidant, anti-inflammatory, and anti-angiogenic effects). The exact mechanism by which homoisoflavonones exert anti-neuroinflammatory effects against activated microglia-induced inflammatory cascades has not been well studied. Here, we aimed to explore the mechanism of homoisoflavonoid SH66 having a potential anti-inflammatory effect in lipopolysaccharide (LPS)-primed BV2 murine microglial cells. Microglia cells were pre-treated with SH66 followed by LPS (100 ng/mL) activation. SH66 treatment attenuated the production of inflammatory mediators, including nitric oxide and proinflammatory cytokines, by down-regulating mitogen-activated protein kinase signaling in LPS-activated microglia. The SH66-mediated inhibition of the nucleotide-binding oligomerization domain-like receptor family pyrin domain containing 3 (NLRP3) inflammasome complex and the respective inflammatory biomarker-like active interleukin (IL)-1β were noted to be one of the key pathways of the anti-inflammatory effect. In addition, SH66 increased the neurite length in the N2a neuronal cell and the level of nerve growth factor in the C6 astrocyte cell. Our results demonstrated the anti-neuroinflammatory effect of SH66 against LPS-activated microglia-mediated inflammatory events by down-regulating the NLRP3 inflammasome complex, with respect to its neuroprotective effect. SH66 could be an interesting candidate for further research and development regarding prophylactics and therapeutics for inflammation-mediated neurological complications.

This study evaluated the synergistic effects of prebiotics containing galacto-oligosaccharides (GOS) and/or mannan oligosaccharides (MOS), essential oil blend (EOB), and onion peel (OPE) on fermentation characteristics using the rumen simulation technique (RUSITEC) system. Three rumen-cannulated, non-lactating Holstein Friesian cows were the inoculum donors. The substrate used for the study was a total mixed ration (TMR), which consisted of corn silage, alfalfa hay, and concentrate at 6:2:2, respectively. Sixteen fermentation vessels were randomly allotted to four treatments with four replicates each over a 9-day period in a completely randomized design. The treatments assessed include: control [TMR only], GEO [TMR + GOS + EOB + OPE], MEO [TMR + MOS + EOB + OPE], and OLEO [TMR + OLG + EOB + OPE]. OLG comprises GOS and MOS in equal proportion. EOB was included at 3 µL/g, while OPE, GOS, MOS, and OLG were added at 30 mg/g TMR. Results showed that pH, gas volume, effluent volume, and ammonia-N were not affected (p > 0.05) by the different additives. Similarly, greenhouse gas (GHG) emissions and nutrient digestibility were not affected by the treatments. Compared to the control, total volatile fatty acids (VFA) were decreased (p < 0.05) by 14.8, 10.8, and 8.5% with GEO, MEO, and OLEO inclusion, respectively, while the molar proportion of acetate was increased (p = 0.011) by 3.3, 1.1, and 3.8% with GEO, MEO, and OLEO inclusion, respectively. MEO increased isobutyrate (p = 0.001) and branched chain VFA (p = 0.013) contents; however, GEO and OLEO inclusion reduced them. Overall, the interaction of EOB, OPE, GOS, and/or MOS did not affect nutrient digestibility or GHG emissions but reduced VFA production. Further research is recommended to assess the dose effect of the additives on GHG emissions and VFA production; and to determine the long-term effects of these interventions on the rumen microbiome and animal performance.