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Namuna Shrestha, 1 Rajani Pokharel, 2 Anil Poudyal, 3 Ranjeeta Subedi, 3 Namra Kumar Mahato, 3 Nitisha Gautam, 3 Dirghayu KC, 3 Govinda Prasad Dhungana 4 1Chitwan Medical College, Chitwan, Nepal; 2Maharajgunj Medical Campus, Maharajgunj, Kathmandu, Nepal; 3Nepal Health Research Council, Kathmandu, Nepal; 4Department of Community Medicine and Public Health, Chitwan Medical College, Chitwan, NepalCorrespondence: Namuna Shrestha Tel +977 9841611718Email namunashrestha12@gmail.comBackground: Pregnancy in people Living with HIV/AIDS (PLHIV) involves significant public health risks, including the risk of HIV transmission to uninfected partners and the fetus. Despite the growing importance of fertility issues for HIV-infected people, little is known about their fertility desires in Nepal. This study, therefore, aimed to determine the magnitude of and factors associated with the fertility desire of PLHIV.Patients and Methods: A cross-sectional study was conducted among 280 PLHIV attending the antiretroviral therapy (ART) clinic in Teku Hospital, Nepal. A standard semi-structured questionnaire was administered to participants using systematic random sampling. Data were entered using Epi-data 3.1 and analyzed using SPSS software version 20.Results: Out of the total participants, 12.1% desired to have a child. Among those having this desire, 44.1% had not decided when to have a child. Reasons for desiring a child were having no children (44.1%), wanting to have a child of different sex than the previous one (29.4%), followed by wanting to have another child (26.5%). Factors such as being male (COR: 3.1, 95% CI: 1.3– 7.0), being ≤ 40 years of age (COR: 3.8, 95% CI: 1.5– 9.4), higher age at marriage (COR: 7.7, 95% CI: 1.5– 39.6), middle socio-economic status (COR: 3.5, 95% CI: 1.7– 7.3), having no children (COR: 22.9, 95% CI: 8.6– 60.8) or fewer children (COR: 74.8, 95% CI: 9.7– 575.1), greater CD4 count (COR: 2.8, 95% CI: 1.3– 5.9) and having moderate knowledge of prevention of mother-to-child transmission (COR: 5.4, 95% CI: 2.3– 12.7) had higher odds of having fertility desire.Conclusion: Around one in every ten participants had a desire for fertility despite their HIV status. This calls for special attention in promoting integrated services for HIV and reproductive health. It will be important to include counseling and other services for those with fertility desire alongside providing ART.Keywords: ART, factors, fertility desire, Nepal, PLHIV

With concerns still on the level of public awareness and knowledge of mental health, people who are diagnosed with mental health disorders are still having difficulties in receiving appropriate help. There is a need for better understanding and promoting awareness of what people experiencing such challenges are going through and identifying their needs. The study encompasses the lived experiences of individuals with mood disorders, how their diagnosis has changed their lifestyle, their interaction with others, the difficulties they experience, and how they are coping with their condition upon being aware of it. This study uses a qualitative research design and an interpretative phenomenological approach. The study conducted interviews to learn the lived experiences of nine (9) participants, where they could share their experience with changes and how they cope with the said changes. Results found that having a good support system and developing healthy coping mechanisms assist in managing the negative situations that people with mood disorders experience. Through the persistence of being discriminated against, stigmatized, and facing difficulties because of the limitations that accompany the diagnosis. Additionally, maintaining wellness, such as regularly monitoring their medication and lifestyle, can assist in regulating the symptoms and episodes of people with mood disorders. [ABSTRACT FROM AUTHOR]

Introdução: O vírus linfotrópico de células T humanas (HTLV) pertence à família dos retrovírus, tem transmissão sexual e parenteral e é associado à leucemia/linfoma de células T do adulto (LLTA) e à paraparesia espástica tropical/mielopatia associada ao HTLV (TSP/HAM). Até o momento, são conhecidos quatro subtipos de HTLV (1, 2, 3 e 4), sendo os subtipos 1 e 2 os mais importantes em termos de ’patogenia’ e ’epidemiologia’. Portadores assintomáticos do HTLV podem disseminá-lo na população. No Brasil, é obrigatória a pesquisa de anticorpos anti-HTLV-1/2 em todas as doações de sangue. Entre 2011-2016 notamos um discreto aumento no descarte sorológico devido HTLV, de 0,06% para 0,14%. Objetivo: Determinar a prevalência e incidência de HTLV-1/2 e HTLV-3 na população de doadores de sangue em nosso serviço. Métodos: De 220.340 doações realizadas no período de setembro de 2019 a julho 2021 em nossa Instituição, 407 (0,18%) apresentaram resultados positivos para HTLV. Destas, 223 (55%) foram incluídos no estudo. Realizamos PCR em tempo real para HTLV-1, 2, 3 segundo protocolo Moens et al., 2009 e teste de Imunoblot HTLV- Fujirebio®. Resultados: A prevalência de descarte sorológico para HTLV foi de 0,20%, 0,20% e 0,15%, nos anos de 2019, 2020 e 2021, respectivamente. Das 223 amostras avaliadas 165 (74%) apresentaram resultado reagente e 58 (26%) resultado indeterminado nos testes de triagem sorológica. Doadores reagentes para HTLV eram em sua maioria mulheres 98 (59,4%), com idade entre 18-38 anos, 96 (58,18%), com ensino médio 85 (51,5%), brancas 95 (57, 6%) e doadores de primeira vez 136 (82,4%). O resultado encontrado na PCR para os casos reagentes (n = 165) e indeterminados (n = 58) foi 47 (28,5%) e 7 (12,07%), respectivamente. Nenhuma amostra apresentou resultado positivo para HTLV-3. Em relação ao Imunoblot, os resultados positivos entre os reagentes e indeterminados na sorologia foram: 63 (38,18%) e 8 (13,8%), respectivamente. A prevalência e incidência encontrada para HTLV foi de 0,028% e 0,0013%, respectivamente. Conclusão e discussão: : O número exato de infectados por HTLV no mundo é desconhecido, pois a maior parte das pesquisas de prevalência e incidência deste vírus foi realizada em populações de doadores de sangue. No Brasil a prevalência para HTLV em doadores varia de 0,03% em Santa Catarina a 1,48% em Salvador Em nosso estudo encontramos uma prevalência de 0,028%. O monitoramento contínuo do da prevalência e perfil de doadores para todos os subtipos de HTLV é necessário, pois reflete a situação epidemiológica desta infecção na comunidade e contribui para definição de políticas públicas como medidas de incremento na segurança transfusional.

Congenital scoliosis is a three-dimensional spine deformity that includes a frontal plane deviation of the spine caused by vertebral and rib malformations. Even in mild cases of formation failures in the first 3 years of life, early intervention is recommended; a conservative approach may also be beneficial. Such cases for semi-emergency procedures necessitate a thorough examination of the pulmonary system. In mild cases, we recommend looking for pulmonary reserve as well as ways to improve lung function. The goal of this case report is to document the pulmonary changes that must be dealt with intraoperatively while maintaining spontaneous breathing.

Context/Background: Chronic diseases like diabetes are at risk of developing heart disease. Therefore, it is crucial to identify the high-risk population, which would help policymakers and interventionists focus on vulnerable groups. This study aims to determine the prevalence, risk factors, and coexistence of other diseases with diabetes. Methodology: Secondary data from Longitudinal Aging Study in India (LASI), Wave 1 (2017-18) was used for the study. A sample of 65,562 men and women aged 45 years and above have been included in the analysis. Univariate, bivariate, and multivariate statistical analysis was used for the analysis. Results: Overall, (12.4%) of Indians have self-reported diabetes. The prevalence of diabetes is (12.9%) among men and (11.9%) among women. Geographic variations were observed with higher rates in south India. Depression, lack of physical activity, obesity, increase in age, family history of diabetes, higher level of education, and wealth quintile were all significant risk factors for diabetes among men and women. Diabetes is associated with other chronic conditions such as heart disease, hypertension, and diseases of the bones and joints. Conclusions: Although self-reported data underestimate the disease burden, it is evident that the prevalence of self-reported diabetes is high. India should address the risk of diabetes by promoting and encouraging a healthy lifestyle.

Abstract Background The aim of this study was to compare the relative performance of total knee replacement constructs and discern if there is variability in performance in currently commonly used prostheses in the New Zealand Joint Registry (NZJR) using a noninferiority analysis. Methods All patients who underwent a primary total knee replacement (TKR) registered in the NZJR between 1st January 1999 to June 2020 were identified. Using a noninferiority analysis, the performance of total knee replacement prostheses were compared with the best performing contemporary construct. Construct all-cause revision rate was estimated using the 1-Kaplan Meier survival function method to estimate net failure. The difference in all-cause revision rates between the contemporary benchmark and all other constructs was tested. Results In total 110 183 TKR were recorded and 25 constructs (102 717 procedures) had > 500 procedures at risk at 3 years post-primary of which 5 were inferior by at least 20 % relative risk of which, one was inferior by at least 100 % relative risk. 14 constructs were identified with > 500 procedures at risk at 10 years with 5 inferior by at least 20 %, of which 2 were inferior by > 100 % relative risk. Conclusions We discerned that there is great variability in construct performance and at all time points, greater than 25 % of constructs are inferior to the best performing construct by at least 20 %. These results can help inform patients, clinicians and health care funders when considering TKR surgery.

This paper studies the patterns of individuals’ student loan repayment for up to 12 years, tracking borrowers through the formative ages of the early 20s to the late 30s. Using social sequence and cluster analysis to understand these longitudinal repayment histories, we identify five archetypes of loan repayment that describe borrowers’ experiences: persistent defaulters, perpetual payers, rapid full payers, late full payers, and consolidators. We find significant stratification by race/ethnicity, social class, and institutional sector into repayment clusters, with minoritized borrowers and those attending for-profit institutions more likely to experience adverse borrowing outcomes and to experience them for longer.

BACKGROUND: Lab-based simulators can help to reduce variability in prosthetics research. However, they have not yet been used to investigate the effects of sweating at the residuum-liner interface. This work sought to create and validate a simulator to replicate the mechanics of residual limb perspiration. The developed apparatus was used to assess the effects of perspiration and different liner designs. METHODOLOGY: By scanning a cast, an artificial residuum was manufactured using a 3D-printed, transtibial bone model encased in silicone, moulded with pores. The pores allowed water to emit from the residuum surface, simulating sweating. Dry and sweating cyclic tests were performed by applying compressive and tensile loading, while measuring the displacement of the residuum relative to the socket. Tests were conducted using standard and perforated liners. FINDINGS: Although maximum displacement varied between test setups, its variance was low (coefficient of variation

Objective: To evaluate the impact on health care access of the change in telemedicine delivery from a clinic-based model, in which patients connect with their healthcare provider from local telemedicine clinics, to a home-based model, in which patients independently connect from their homes., Study Design: In this retrospective analysis, we compared relative uptake in telemedicine services in Period 1 (01/01/2019 to 03/15/2020, prepandemic, clinic-based model) vs Period 2 (03/16/2020 to 06/30/2022, home-based model) within a tertiary pediatric hospital system. Using multivariable logistic regression, we investigated the influence of telemedicine delivery model on patient sociodemographic characteristics of completed telemedicine visits., Results: We analyzed 400 539 patients with 1 406 961 completed outpatient encounters (52% White, 35% Black), of which 62 920 (4.5%) were telemedicine. In the clinic-based model (Period 1), underserved populations had greater likelihoods of accessing telemedicine: Hispanic ethnicity (OR = 1.41, P = .028) vs reference group non-Hispanic, Medicaid (OR = 2.62, P < .001) vs private insurance, and low-income neighborhood (OR = 3.40, P < .001) vs medium-income. In aggregate, telemedicine utilization rapidly increased from Period 1 (1.5 encounters/day) to Period 2 (107.9 encounters/day). However, underserved populations saw less relative increase (Medicaid [OR = 0.28, P < .001], Hispanic [OR = 0.53, P < .001], low-income [OR = 0.23, P < .001])., Conclusions: We observe that the clinic-based model offers more equitable access, while the home-based model offers more absolute access, suggesting that a hybrid model that offers both home-based and clinic-based services may result in more absolute and equitable access to telemedicine., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest relevant to this article to disclose. Funding/Support: Dr Paul George was supported by NIH Grant T32HL139443-3., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Effective infection prevention and control (IPC) practices among healthcare workers are crucial to prevent the spread of COVID-19 and other infections in healthcare settings., Aim: To synthesise evidence on behaviour change theories, models, or frameworks applied to understand healthcare workers' IPC practices during the COVID-19 pandemic., Methods: PubMed, EBSCOhost interface, ProQuest interface, MEDLINE (Ovid), and grey literature were searched for primary studies published between December 2019 and May 2023. The Mixed Method Appraisal Tool evaluated the methodological quality of the studies. Two reviewers independently completed study selection, data extraction, and quality assessment., Results: The search yielded 2110 studies, of which 19 were included. Seven behaviour change theories, models, and frameworks were identified, with the Health Belief Model and Theoretical Domains Framework being the most employed. Based on these theories, models, and frameworks, the included studies identified cognitive, environmental, and social factors influencing healthcare workers' compliance with COVID-19 IPC practices., Discussion: This review offers insights into the critical role of behavioural change theories, models, or frameworks in understanding the factors influencing healthcare workers' compliance with IPC practices during COVID-19. It also highlights the potential of these theories in guiding the development of evidence-based interventions to improve healthcare workers' compliance with IPC practices., Competing Interests: The author(s) declare that no potential conflict of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: This review aimed to synthesize the evidence on infection prevention and control interventions for the prevention of health care-associated infection among health care workers or patients within primary care facilities., Methods: PubMed, CINAHL, EMBASE, and CENTRAL databases were searched for quantitative studies published between 2011 and 2022. Study selection, data extraction, and quality assessment using Cochrane and Joanna Briggs tools, were conducted by independent review with additional sensitivity checking performed on study selection., Results: Four studies were included. A randomized trial and a cross-sectional survey, respectively, found no statistical difference in laboratory-confirmed influenza in health care workers wearing N95 versus medical masks (P = .18) and a significant inverse association between the implementation of tuberculosis control measures and tuberculosis incidence (P = .02). For the prevention of surgical site infections following minor surgery, randomized trials found nonsterile gloves (8.7%; 95% confidence interval, 4.9%-12.6%) to be noninferior to sterile gloves (9.3%; 95% confidence interval, 7.4%-11.1%) and no significant difference between prophylactic antibiotics compared to placebo (P = .064). All studies had a high risk of bias., Conclusions: Evidence for infection prevention and control interventions for the prevention of health care-associated infection in primary care is very limited and insufficient to make practice recommendations. Nevertheless, the findings highlight the need for future research., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Hand hygiene (HH) is challenging in health care, but particularly in resource-limited settings due to a lack of training, resources, and infrastructure. This study aimed to evaluate the implementation of wall-mounted alcohol-based handrub (ABHR) at the point of care (POC) on HH compliance among health care workers in a Cameroon hospital., Methods: It was a three-stage before and after study. The first stage involved baseline collection of ABHR utilization and HH compliance data. The second stage included the implementation of ABHR at the POC, supported by an implementation strategy involving HH training, monitoring and feedback, and HH champions. The third stage involved postimplementation data collection on ABHR use and HH compliance., Results: 5,214 HH opportunities were evaluated. HH compliance significantly increased from 33.3% (baseline) to 83.1% (implementation stage) (P < .001) and to 87.2% (postimplementation stage) (P < .001). Weekly ABHR usage increased significantly during implementation (5,670 ml), compared to baseline, (1242.5 ml, P = .001), and remained high in postimplementation (7,740 ml)., Conclusions: Continuous availability of ABHR at POC, supported by implementation strategy, significantly increased HH compliance and ABHR use. Learning from this study could be used to implement ABHR at POC in other facilities., (Copyright © 2024 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Nutrition education is being used to encourage school adolescents to adopt healthy eating habits. To the best of our knowledge, very little study has been undertaken in Nepal to examine the effectiveness of nutrition education programs. This study aimed to assess the effect of nutrition education on nutritional knowledge, attitude, and diet quality among school-going adolescents in selected private schools in Nepal., Methods: A quasi-experimental study was conducted among 226 students aged 12 - 19 years of two selected private schools in Banepa municipality of Nepal. Students (n = 113) from the first school were assigned to intervention and the same number of students from the second school were enrolled in the study as the control. Over 12 weeks, students in the intervention group received one hour of nutrition education in the form of mini-lectures and interactive discussions, whilst students in the control group received no education. The student's two-sample t-test was used to compare two groups and to assess the effectiveness of the nutrition education program., Results: Between the intervention and control group, the magnitude of difference in knowledge score was 1.80 (95% CI: 1.11 - 2.49), emotional eating was 0.98 (95% CI: 0.42 - 1.54), uncontrolled eating was 3.60 (95% CI: 2.10 - 5.09), and cognitive restraint of eating was 2.26 (95% CI: 1.51 - 3.01)., Conclusions: A tailored health education intervention was found to be effective in increase nutritional knowledge and attitude among school-going adolescents. Adopting nutrition education interventions as part of public health school intervention builds positive knowledge, attitudes, and healthy eating habits in school-going adolescents., (© 2024. The Author(s).)

Introduction: The effects of problematic screen exposure in the early years have adverse effects on cognition, reasoning, executive, and social skills, and physical health. The study aimed to assess the prevalence of problematic screen exposure in children between 2 to 5 years of age visiting the Department of Paediatrics of a tertiary care centre., Methods: A descriptive cross-sectional study was conducted among caregivers of children aged 2 to 5 years of age in a tertiary care centre from 16 July 2023 to 30 September 2023 after an ethical clearance from the Institutional Review Committee. This study excluded children with chronic disease and behavioural disorders. The problematic screen exposure was assessed using the Problematic Screen Exposure Score. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval., Results: Among 310 respondents, 216 (69.67%) (64.55-74.79, 95% Confidence Interval) children had a high problematic screen exposure score. The mean age of children was 3.46±1.033 with 89 (41.20%) children having their first exposure before 12 months of age, 131 (60.64%) exceeding daily usage of >2 hr, and 198 (91.66%) children viewing age-inappropriate media content., Conclusions: The prevalence of high problematic screen exposure was comparable to that of the prevalence found in studies done in similar settings., Keywords: children; preschool; screen time.

Introduction: Stunting refers to low height for age, resulting from chronic undernutrition, often linked to poor socio-economic conditions, maternal health, infant care, and nutrition. It hinders children's physical and cognitive development. In Nepal, over half of children under five suffer from malnutrition. Despite efforts, stunting remains high but has decreased from 57% in 1996 to 25% in 2022. The aim of the study was to find out the prevalence of stunting among children aged 6 to 59 months visiting the outpatient Department of Pediatrics in a tertiary care centre., Methods: A descriptive cross-sectional study was conducted among children aged 6 to 59 months visiting the outpatient Department of Pediatrics in a tertiary care centre after obtaining ethical approval from the Institutional Review Committee from 27 April 2023 to 15 July 2023. Anthropometric measurements were taken. World health organization standard growth charts for Z score was used appropriately for the completed age in months and gender of the child. A pre-designed questionnaire was used for face-to-face interviews. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval., Results: Among 320 children, 46 (14.38%) (10.54-18.22, 95% Confidence Interval) children had stunting. Among those 46 children with stunting, 20 (43.47%) had severe stunting., Conclusions: The prevalence of stunting among children aged 6 to 59 months was found to be lower than other studies done in similar settings., Keywords: children; prevalence; stunting; undernutrition.

In this work, a numerical assessment of the optoelectrical properties of the ZnO-ZnSe-CdSe heterojunction for a thin and cost-effective solar cell was made by using the PC1D simulation software. The photovoltaic (PV) properties have been optimized by varying thicknesses of the absorber layer of the p-CdSe layer, the window layer of n-ZnSe, and the antireflection coating (ARC) layer of ZnO, a transparent conductive oxide with enhanced light trapping, and wide bandgap engineering. There is a positive conduction band offset (CBO) of ΔEc = 0.25 eV and a negative valence band offset (VBO) of ΔEv = 1.2 - 2.16 =  - 0.96 eV. The positive CBO prevents the flow of electrons from the CdSe to the ZnSe layer. Further, the impact of doping concentration on the performance of solar cells has been analyzed. The simulation results reveal the increase in the efficiency of solar cells by adding an ARC. The rapid and sharp increase in the efficiency with the thickness of the window layer beyond 80 nm is interesting, unusual, and unconventional due to the combined effect of morphology and electronics on a macro-to-micro scale. The thin-film solar cell with the structure of ZnO/ZnSe/CdSe exhibited a high efficiency of 11.98% with short-circuit current (I sc ) = 1.72 A, open-circuit voltage (V oc ) = 0.81 V and fill factor (FF) = 90.8% at an optimized thickness of 2 μm absorber layer, 50 nm window layer, and 78 nm ARC layer. The EQE of solar cells has been observed at about 90% at a particular wavelength at 470 nm (visible light range). Around 12% of efficiency from such a thin-layered solar cell is highly applicable., (© 2023. The Author(s).)

Background:  Many facets of a patient's life are affected by hypertension. Also, attitudes, values, and experiences, as well as patients' social and cultural circumstances, all play an essential role in the treatment of hypertension. The study's primary objective was to explore hypertensive women's perceptions of their illnesses., Methods:  The study was conducted using a qualitative phenomenological research approach from March 2021 to August 2021. A total of twelve hypertensive women were purposefully selected from the medical OPD of Gandaki Medical College Teaching Hospital and Research Centre (GMCTHRC). The necessary data were gathered using a semi-structured interview guide. In addition, the thematic analysis method was used to analyze the transcribed material. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used when drafting this paper., Results:  Four major themes were generated; i) Perceptions towards hypertension, ii) Diagnosis, treatment, and management of hypertension, iii) Adherence to medications, and iv) Experiences with health care and recommendations. The majority of hypertensive women considered hypertension to be a treatable non-communicable illness. Family members greatly aided drug adherence. There were, however, certain financial hurdles to medication compliance. For half of the patients, the healthcare systems were unsatisfactory., Conclusions:  The findings suggest that hypertensive women's non-adherence to medication is a common occurrence that reflects a conscious decision based on her knowledge and views of the medical illness and its treatment. The way women think about hypertension needs to alter. There were knowledge gaps discovered, emphasizing the need for more patient education.

Patients with B-lymphoid malignancies have been consistently identified as a population at high risk of severe COVID-19. Whether this is exclusively due to cancer-related deficits in humoral and cellular immunity, or whether risk of severe COVID-19 is increased by anticancer therapy, is uncertain. Using data derived from the COVID-19 and Cancer Consortium (CCC19), we show that patients treated for B-lymphoid malignancies have an increased risk of severe COVID-19 compared with control populations of patients with non-B-lymphoid malignancies. Among patients with B-lymphoid malignancies, those who received anticancer therapy within 12 months of COVID-19 diagnosis experienced increased COVID-19 severity compared with patients with non-recently treated B-lymphoid malignancies, after adjustment for cancer status and several other prognostic factors. Our findings suggest that patients recently treated for a B-lymphoid malignancy are at uniquely high risk for severe COVID-19., Significance: Our study suggests that recent therapy for a B-lymphoid malignancy is an independent risk factor for COVID-19 severity. These findings provide rationale to develop mitigation strategies targeted at the uniquely high-risk population of patients with recently treated B-lymphoid malignancies. This article is highlighted in the In This Issue feature, p. 171., (©2022 American Association for Cancer Research.)

Objective: This study aimed to determine population-based prevalence of chronic kidney disease (CKD) and its associated factors in Nepal., Study Design: The study was a nationwide population-based cross-sectional study., Setting and Participants: Cross-sectional survey conducted in a nationally representative sample of 12 109 Nepalese adult from 2016 to 2018 on selected chronic non-communicable diseases was examined. Multistage cluster sampling with a mix of probability proportionate to size and systematic random sampling was used for the selection of individuals aged 20 years and above., Primary and Secondary Outcome Measures: Primary outcome in this study was population-based prevalence of CKD in Nepal. A participant was considered to have CKD if the urine albumin-to-creatinine ratio was greater than or equal to 30 mg/g and/or estimated glomerular filtration rate is less than 60 mL/min/1.73 m 2 at baseline and in follow-up using modification of diet in renal disease study equations. The secondary outcome measure was factors associated with CKD in Nepal. The covariate adjusted association of risk factors and CKD was calculated using multivariable binary logistic regression., Results: The overall prevalence of CKD in Nepal was 6.0% (95% CI 5.5 to 6.6). Factors independently associated with CKD included older age (adjusted OR (AOR) 2.6, 95% CI 1.9 to 3.6), Dalit caste (AOR 1.6, 95% CI 1.1 to 2.3), hypertension (AOR 2.4, 95% CI 2.0 to 3.0), diabetes mellitus (AOR 3.2, 95% CI 2.5 to 4.1), raised total cholesterol (AOR 1.3, 95% CI 1.0 to 1.6) and increased waist-to-hip ratio (AOR 1.6, 95% CI 1.2 to 2.3)., Conclusion: This nationally representative study shows that the prevalence of CKD in the adult population of Nepal is substantial, and it is independently associated with several cardiometabolic traits. These findings warrant longitudinal studies to identify the causes of CKD in Nepal and effective strategies to prevent it., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: The burden of diabetes mellitus (DM) has increased globally, particularly in low-income and middle-income countries, including Nepal. Population-based nationally representative data on the prevalence of DM is limited. This paper presents the prevalence of DM and its associated risk factors in Nepal., Research Designs and Methods: This population-based study sampled 13 200 participants aged 20 years and above in 400 clusters of 72 districts of Nepal. The study used a standardised questionnaire adapted from the WHO STEPwise approach to non-communicable disease risk factor surveillance instrument and digitalised in Android-compatible mobile phones. Fasting and 2 hours postprandial blood samples were taken to test various biochemical parameters. Descriptive followed by multivariate analyses were done to assess the association between explanatory variables and the outcome variable., Primary Outcome Measures: Prevalence of DM., Results: The prevalence of DM was found to be 8.5% (95% CI 7.8% to 9.3%). The odds of DM occurrence were higher in the upper age groups (40-59 years at adjusted OR (AOR) 3.1 (95% CI2.3 to 4.2) and 60+ years at AOR 4.7 (95% CI 3.3 to 6.6)), compared with the group aged 20-39 years. Men were found to have higher odds of DM (AOR 1.3, 95% CI 1.1 to 1.6) compared with women. Urban residents had almost twice higher odds of DM (AOR 1.7, 95% CI 1.4 to 2.2) compared with rural residents. Participants with raised blood pressure (BP) (AOR 2.2, 95% CI 1.8 to 2.7), those who were overweight and obese (AOR 2.0, 95% CI 1.6 to 2.4) and those who had high triglycride level (≥150 mg/dL) (AOR 2.1, 95% CI 1.8 to 2.6) also had twice higher odds of DM compared with those with normal BP, an average body mass index and normal triglyceride level, respectively., Conclusions: Targeted interventions to higher risk groups as well as prevention and control of other associated biological risk factors might help to reduce the prevalence of DM in Nepal., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Hospitalized patients with COVID-19 have increased risks of venous (VTE) and arterial thromboembolism (ATE). Active cancer diagnosis and treatment are well-known risk factors; however, a risk assessment model (RAM) for VTE in patients with both cancer and COVID-19 is lacking., Objectives: To assess the incidence of and risk factors for thrombosis in hospitalized patients with cancer and COVID-19., Methods: Among patients with cancer in the COVID-19 and Cancer Consortium registry (CCC19) cohort study, we assessed the incidence of VTE and ATE within 90 days of COVID-19-associated hospitalization. A multivariable logistic regression model specifically for VTE was built using a priori determined clinical risk factors. A simplified RAM was derived and internally validated using bootstrap., Results: From March 17, 2020 to November 30, 2020, 2804 hospitalized patients were analyzed. The incidence of VTE and ATE was 7.6% and 3.9%, respectively. The incidence of VTE, but not ATE, was higher in patients receiving recent anti-cancer therapy. A simplified RAM for VTE was derived and named CoVID-TE (Cancer subtype high to very-high risk by original Khorana score +1, VTE history +2, ICU admission +2, D-dimer elevation +1, recent systemic anti-cancer Therapy +1, and non-Hispanic Ethnicity +1). The RAM stratified patients into two cohorts (low-risk, 0-2 points, n = 1423 vs. high-risk, 3+ points, n = 1034) where VTE occurred in 4.1% low-risk and 11.3% high-risk patients (c statistic 0.67, 95% confidence interval 0.63-0.71). The RAM performed similarly well in subgroups of patients not on anticoagulant prior to admission and moderately ill patients not requiring direct ICU admission., Conclusions: Hospitalized patients with cancer and COVID-19 have elevated thrombotic risks. The CoVID-TE RAM for VTE prediction may help real-time data-driven decisions in this vulnerable population., (© 2021 The Authors. Journal of Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis.)

Objectives: Healthcare workload has emerged as an important metric associated with poor outcomes. To measure workload, studies have used bed occupancy as a surrogate. However, few studies have examined frontline provider (fellows, nurse practitioners, physician assistants) workload and outcomes. We hypothesize frontline provider workload, measured by bed occupancy and staffing, is associated with poor outcomes and unnecessary testing., Design: A retrospective single-center, time-stamped orders, ordering provider identifiers, and patient data were collected. Regression was performed to study the influence of occupancy on orders, length of stay, and mortality, controlling for age, weight, admission type, Society of Thoracic Surgery-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality score, diagnosis, number of surgeries, orders, provider staffing, attending experience, and time fixed effects., Setting: Twenty-seven bed tertiary cardiac ICU in a free-standing children's hospital., Patients: Patients (0-18 yr) admitted to the pediatric cardiac ICU, January 2018 to December 2019., Interventions: None., Measurements and Main Results: There were 16,500 imaging and 73,113 laboratory orders among 1,468 patient admissions. Median age 6 months (12 d to 5 yr), weight 6.2 kg (3.7-16.2 kg); 840 (57.2%) surgical and 628 (42.8%) medical patients. ICU teams consisted of 16 attendings and 31 frontline providers. Mortality 4.4%, median stay 5 days (2-11 d), and median bed occupancy 89% (78-93%). Every 10% increase in bed occupancy had 7.2% increase in imaging orders per patient (p < 0.01), 3% longer laboratory turn-around time (p = 0.015), and 3 additional days (p < 0.01). Higher staffing (> 3 providers) was associated with 6% less imaging (p = 0.03) and 3% less laboratory orders (p = 0.04). The number of "busy days" (bed occupancy > 89%) was associated with longer stays (p < 0.01), and increased mortality (p < 0.01)., Conclusions: Increased bed occupancy and lower staffing were associated with increased mortality, length of stay, imaging orders, and laboratory turn-around time. The data demonstrate performance of the cardiac ICU system is exacerbated during high occupancy and low staffing., Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2021 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)

This paper numerically explores the possibility of ultrathin layering and high efficiency of graphene as a back surface field (BSF) based on a CdTe solar cell by Personal computer one-dimensional (PC1D) simulation. CdTe solar cells have been characterized and studied by varying the carrier lifetime, doping concentration, thickness, and bandgap of the graphene layer. With simulation results, the highest short-circuit current (I sc = 2.09 A), power conversion efficiency (h = 15%), and quantum efficiency (QE ~ 85%) were achieved at a carrier lifetime of 1 × 10 3 ms and a doping concentration of 1 × 10 17 cm -3 of graphene as a BSF layer-based CdTe solar cell. The thickness of the graphene BSF layer (1 mm) was proven the ultrathin, optimal, and obtainable for the fabrication of high-performance CdTe solar cells, confirming the suitability of graphene material as a BSF. This simulation confirmed that a CdTe solar cell with the proposed graphene as the BSF layer might be highly efficient with optimized parameters for fabrication.

Malonylation, which has recently emerged as an important lysine modification, regulates diverse biological activities and has been implicated in several pervasive disorders, including cardiovascular disease and cancer. However, conventional global proteomics analysis using tandem mass spectrometry can be time-consuming, expensive and technically challenging. Therefore, to complement and extend existing experimental methods for malonylation site identification, we developed two novel computational methods for malonylation site prediction based on random forest and deep learning machine learning algorithms, RF-MaloSite and DL-MaloSite, respectively. DL-MaloSite requires the primary amino acid sequence as an input and RF-MaloSite utilizes a diverse set of biochemical, physiochemical and sequence-based features. While systematic assessment of performance metrics suggests that both 'RF-MaloSite' and 'DL-MaloSite' perform well in all metrics tested, our methods perform particularly well in the areas of accuracy, sensitivity and overall method performance (assessed by the Matthew's Correlation Coefficient). For instance, RF-MaloSite exhibited MCC scores of 0.42 and 0.40 using 10-fold cross-validation and an independent test set, respectively. Meanwhile, DL-MaloSite was characterized by MCC scores of 0.51 and 0.49 based on 10-fold cross-validation and an independent set, respectively. Importantly, both methods exhibited efficiency scores that were on par or better than those achieved by existing malonylation site prediction methods. The identification of these sites may also provide important insights into the mechanisms of crosstalk between malonylation and other lysine modifications, such as acetylation, glutarylation and succinylation. To facilitate their use, both methods have been made freely available to the research community at https://github.com/dukkakc/DL-MaloSite-and-RF-MaloSite., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2020 The Authors.)

Background: Canonical Janus kinase 2 (JAK2) V617F and exon 12 mutations in myeloid neoplasms are well described. There are limited reports of other JAK2 variants of potential clinical relevance. This study was designed to survey JAK2 variants in patients with myeloproliferative neoplasms (MPNs) and acute myeloid leukemia (AML) and to determine their contributions to disease pathogenesis., Methods: Next-generation sequencing of the coding region of JAK2 and 27 other genes was performed on bone marrow DNA samples. The study population was classified into 3 cohorts: chronic MPNs only (the MPN cohort); MPNs transformed into AML (the MPN>>AML cohort); and AML only, with MPN>>AML patients excluded (the AML cohort)., Results: Testing was performed for 2154 patients, and non-V617F/non-exon 12 JAK2 sequence variants were identified in 114 (5.3%). They included 35 unique JAK2 variants across all functional domains. Sixteen of the 114 JAK2 variants occurred without somatic mutations in the remaining 27 genes. JAK2 variants were detected at a higher frequency in the MPN>>AML cohort (15.3%) in comparison with the MPN (4.6%; P < .001) and AML cohorts (5.2%; P < .001). Detected variants occurred at higher than expected frequencies in patients with MPNs and AML in comparison with the population, and N1108S had a significantly increased prevalence in patients with AML. A JAK2 variant in addition to JAK2 V617F (n = 13) in myelofibrosis was associated with an increased cumulative risk of transformation into AML (P = .003)., Conclusions: Specific JAK2 variants detected in MPNs may be predictors for transformation into AML., (© 2019 American Cancer Society.)

Study Objective: To study the variation in opioid prescribing among emergency physicians and facilities for discharged adult ED patients., Methods: We conducted a retrospective analysis of ED visits from five U.S. hospitals between January and May 2014 using records from Data to Intelligence (D2i). We examined physician- and facility-level variation in opioid prescription rates for discharged ED patients. We calculated unadjusted opioid prescription rates at the physician and facility levels and used a multivariable mixed-effect logistic regression model to examine within-facility physician variation in opioid prescription adjusting for patient and situational factors including time of presentation, ED census, and physician workload., Results: In 47,304 visits across five EDs, median patient age was 40 years old (IQR 28,55), and 89% had some form of insurance. There were 17,098 (36%) ED discharges with at least one opioid prescription. The unadjusted facility-level opioid prescription rate ranged from 24%-46%. Among 253 ED physicians, the adjusted opioid prescription rate varied from 22%-76%. Increased physician workload is related to decreased odds of opioid prescription at ED discharge for the lowest (<3 patients) and moderate (6-9 patients) physician workload levels, while the association weakened with increasing levels of workload., Conclusion: There was substantial physician and facility variation in opioid prescription for discharged adult ED patients. Emergency physicians were less likely to prescribe opioids when their workload was lower, and this effect diminished at high workload levels. Understanding situational and other factors that explain this variation is important given the rising U.S. opioid epidemic and the need for urgent intervention., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Newer treatment modalities are being investigated to improve upon historical outcomes with standard immunosuppressive therapy (IST) in aplastic anemia (AA). We analyzed outcomes of adult patients with AA treated with various combinatorial anti-thymoglobulin-based IST regimens in frontline and relapsed/refractory (R/R) settings. Pretreatment and on-treatment clinical characteristics were analyzed for relationships to response and outcome. Among 126 patients reviewed, 95 were treatment-naïve (TN) and 63, R/R (including 32 from the TN cohort); median ages were 49 and 50 years, respectively. Overall survival (OS) was superior in IST responders (P < .001). Partial response to IST was associated with shorter relapse-free survival (RFS), as compared with complete response (P = .03). By multivariate analysis, baseline platelet and lymphocyte count predicted for IST response at 3 and 6 months, respectively. While additional growth factor interventions led to faster count recovery, there were no statistically significant differences in RFS or OS across the various frontline IST regimens (i.e., with/without G-CSF or eltrombopag). While marrow cellularity did not correlate with peripheral-blood counts at 3 months, cytomorphological assessment revealed dyspoietic changes in all nonresponders with hypercellular-marrow indices. Covert dysplasia, identified through early bone marrow assessment, has implications on future therapy choices after IST failure. Salvage IST response depended upon prior response to ATG: prior responders (46%) vs. primary refractory (0%) (P < .01). In the R/R setting, there was no survival difference between IST and allogeneic stem cell transplant groups, with a trend toward superior OS in the former. Transplant benefits in the R/R setting may be underrealized due to transplant-related mortality., (© 2017 Wiley Periodicals, Inc.)

Background: Outcomes in patients with chronic myeloid leukemia in blast phase (CML-BP) are historically dismal. Herein, the authors sought to analyze the characteristics, prognostic factors, and survival outcomes in patients with CML-BP in the tyrosine kinase inhibitor (TKI) era., Methods: A total of 477 patients with CML-BP were treated with a TKI at some point during the course of their CML. Cox proportional hazard models identified characteristics that were predictive of survival. Overall survival and failure-free survival were assessed. Optimal cutoff points for specific parameters were identified using classification and regression tree (CART) analysis., Results: The median age of the patients was 53 years (range, 16-84 years) and 64% were male. Approximately 80% of patients initially were diagnosed in the chronic phase of CML at a median of 41 months (range, 0.7-298 months) before transformation to CML-BP. De novo CML-BP occurred in 71 patients. Approximately 72% of patients received TKI therapy before CML-BP. The initial therapy for CML-BP included a TKI alone (35%), a TKI with chemotherapy (46%), and non-TKI therapies (19%). The median overall survival was 12 months and the median failure-free survival was 5 months. In multivariate analysis, myeloid immunophenotype, prior TKI, age ≥58 years, lactate dehydrogenase level ≥1227 IU/L, platelet count < 102 K/μL, no history of stem cell transplantation, transition to BP from chronic phase/accelerated phase, and the presence of chromosome 15 aberrations predicted for a significantly increased risk of death. Achievement of major hematologic response and/or complete cytogenetic response to first-line treatment was found to be predictive of better survival. The combination of a TKI with intensive chemotherapy followed by stem cell transplantation appeared to confer the best outcome., Conclusions: Patients with CML-BP continue to pose a therapeutic challenge, have dismal outcomes, and require newer treatment approaches. Cancer 2017;123:4391-402. © 2017 American Cancer Society., (© 2017 American Cancer Society.)

Bleeding and thrombosis are long recognized complications of myelofibrosis (MF) and contribute significantly to its morbidity and mortality. However, so far, few studies have evaluated the frequency of these events, their characteristics, and their prognostic impact. Based on these studies, thrombotic events in MF are about as common as in essential thrombocytemia (ET) but less common than in polycythemia vera (PV), while bleeding events are relatively more common in MF than in ET or PV. The emergence of the concept of prefibrotic primary MF (PMF), which is associated with a higher frequency of thrombohemorrhagic complications than ET, and the growing evidence that prefibrotic PMF may also have a different thrombotic and bleeding risk profiles than fibrotic (overt) PMF have emphasized the need for a reappraisal of the risk of thrombosis and hemorrhage in patients with MF. In this review, we discuss the frequency of thrombosis and bleeding in patients with MF, including prefibrotic PMF and their established and potential risk factors.