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Quality by Design (QbD) approach was used to facilitate stability indicating HPLC method development of linagliptin (LIN) in tablet dosage form. The method was developed using the PrimesilC18, 250 mm x 4.6 mm, 5µ column using the mobile phase consisting of 0.3% TEA: methanol. (60:40 v/v) pH 4.5 adjusted with o-phosphoric acid. Design of experiment tools was used for optimization of the chromatographic conditions. A three-level Box-Behnken design was employed and statistical analysis of the experimental data showed the significant influential factor of chromatographic conditions. The design space suggested that the current center point parameters could be further modified results with better acceptability for the response parameters. The performance of the optimized method was validated according to ICH guidelines. Linagliptin was exposed to different stress conditions (acid, base, neutral, oxidative, thermal and photolytic) and chromatograms recorded at 292 nm. The degradation of linagliptin followed zero order kinetics for acidic, oxidative and neutral hydrolysis whereas for basic hydrolysis first-order kinetics under experimental conditions. Peak purity plots were evaluated for the degraded sample. The results obtained suggest that the method can be adopted for its analysis and is stability indicating as well. The three-level design helps in understanding the interaction among factors rather than one time one variation as carried out in routine method development. DOI: http://dx.doi.org/10.17807/orbital.v12i2.1194

Introduction: The outbreak of coronavirus disease in Nepal led medical colleges to suspend in person teaching-learning activities and ultimately online platform was introduced to deliver the contents of medical education. The objective of this study was to describe the perception of medical students towards online teaching-learning introduced during the COVID-19 outbreak in Nepal. Methods: An online survey using a descriptive cross-sectional study design was carried out among 515 undergraduate medical students currently enrolled in medical colleges in Nepal. A semi-structured questionnaire in Google form was utilized to collect data. The link of the Google form was sent to the potential respondents through email and social media. Descriptive statistics, including frequency, percentage, mean, and standard deviation were used to analyze data in SPSS vs20. Ethical approval was sought from Nepal Health Research Council to conduct this study, and digital informed consent was taken from study respondents. Results: The overall score of perception of online teaching-learning was 17.61±7.19, which indicated many problems in this method of teaching-learning. The mean score of perception of online teaching-learning was found to be different across sex, location of enrolled medical colleges, having a personal electronic device, having an internet connection at residence, having separate room/space for attending online classes, and self-rated computer skills. Moreover, only 28 (5.4%) of respondents had perceived online teaching-learning as a better method of delivering content of medical curricula. Conclusions: Surveyed medical students in Nepal were found to perceive many problems in online teaching-learning. Moreover, management and faculty members need to take the necessary measures for enhancing the online teaching-learning quality.

Background: Leadership is the behavior of an individual when directing the activities of a group toward a shared goal. In the health-care system, doctors’ responsibilities extend beyond clinical treatment. They should be efficient to lead a team in the patient care setting and within the broader framework of health-care systems. Good medical leadership is vital in delivering high-quality health care. Incorporating leadership skills in medical undergraduates will help them act as leaders and members of the health-care team. Aims and Objectives: The aims and objectives of the study are to enhance leadership skills and to assess the improvement in leadership skills of the participating medical undergraduate students. Materials and Methods: In this prospective study, medical undergraduate students posted in otorhinolaryngology clinics took part in various activities in two subsequent community otorhinolaryngology programs. Students were given different roles and responsibilities in the community programs to improve their leadership skills. Students filled out a pre- and post-activity self-assessment leadership trait questionnaire form for each community program. Results: 88 students participated in the study. The overall percentage leadership score increased significantly from the first pre-activity questionnaire (Q1) to the first post-activity questionnaire (Q2) (P

Elective postoperative ventilation in patients undergoing "on pump" open heart surgery has been a standard practice. Ultra fast-track extubation in the operating room is now an accepted technique for "off pump" coronary artery bypass grafting. We tried to incorporate these experiences in on pump open heart surgery and compare the haemodynamic and respiratory parameters in the immediate postoperative period, in patients on standard postoperative ventilation for 8-12 hours. After ethical committee′s approval and informed consent were obtained, 72 patients, between 28 and 45 years of age, undergoing on pump open heart surgery, were selected for our study. We followed same standard anaesthetic, cardiopulmonary bypass (CPB) and cardioplegic protocol. Thirty-six patients (Group E) were randomly allocated for immediate extubation following operation, after fulfillment of standard extubation criteria. Those who failed to meet these criteria were not extubated and were excluded from the study. The remaining 36 patients (Group V) were electively ventilated and extubated after 8-12 hours. Standard monitoring for on pump open heart surgery, including bispectral index was done. The demographic data, surgical procedures, preoperative parameters, aortic cross clamp and cardiopulmonary bypass times were comparable in both the groups. Extubation was possible in more than 88% of cases (n=32 out of 36 cases) in Group E and none required reintubation for respiratory insufficiency. Respiratory, haemodynamic parameters and postoperative complications were comparable in both the groups in the postoperative period. Therefore, we can safely conclude that immediate extubation in the operating room after on pump open heart surgery is an alternative acceptable method to avoid postoperative ventilation and its related complications in selected patients.

Background: Otomycosis is a superficial mycotic infection of the external auditory canal. Clinical presentation, along with otoscopic findings, is sufficient to make the diagnosis in most of the cases. Treatment includes aural cleaning followed by the instillation of anti-fungal ear drops. In the recent years, there has been an increasing trend of antifungal resistance for the commonly used antifungals such as fluconazole and clotrimazole. Drug sensitivity patterns have also shown variability from one region to another. Aims and Objectives: To evaluate the clinico-mycological profile along with antifungal susceptibility pattern and treatment outcome of primary otomycosis. Materials and Methods: A total of 230 clinically diagnosed patients of primary otomycosis were included in this prospective study. Microbiological causes were evaluated by KOH wet mount and culture of samples collected from external auditory meatus using sterile swabs. Fungal culture was done on Sabouraud dextrose agar with chloramphenicol at 25°C and 37°C. Anti-fungal susceptibility test was done by disk diffusion method using medium Muller-Hilton agar with glucose and methylene blue. All the patients were treated with the removal of fungal debris with topical clotrimazole instillation and were followed up after 7 days. Non-responders were treated with topical itraconazole. Results: Male-to-female ratio in study participants was 1:1.3. The most frequently observed risk factor was the instillation of oil in the ear (20%). Ear itching was the commonest symptom (70.9%). Positive fungal growth was seen in 203 (88.3%) cases. Aspergillus was present in 185 (91.1%) cases, followed by Candida in 18 (8.9%) cases. Voriconazole had the highest sensitivity followed by itraconazole. 167 (83.3%) patients responded to primary treatment (topical Clotrimazole), 36 (16.7%) patients were non-responders. Conclusion: All the clinically suspected patients should be evaluated for fungal positivity, which may further guide in the selection of appropriate anti-fungal agents. Awareness regarding the predisposing factors for otomycosis in the general population may result in a significant drop in the incidence of otomycosis.

Abstract Introduction: Nepal is a country in South‐east Asia with high suicide. There is ongoing trend of emerging research on suicide from Nepal but there is lack of validated scale in measuring literacy or stigma. In the view of poor media reporting and large treatment gap, this study was conducted. All previous validation studies were done in non‐Hindu populations. Methods: A cross‐sectional study was planned where the short forms of Nepalese literacy of suicide scale (LOSS‐SF‐Nep) and Stigma of Suicide Scale (SOSS‐SF‐Nep) were validated using standard procedure at a medical college in southern Nepal. Medical and nursing students of all batches were approached offline after successful pretesting. The psychometric properties of the scales were tested, and the statuses of literacy and stigma were assessed. Patient Health Questionnaire‐9 and General Anxiety Disorder Scale‐7 were used for revealing depression and generalized anxiety. Results: Three hundred and nineteen Nepalese students participated and most of them were males, belonged to nuclear family, upper‐middle socioeconomic status and represented 46 out of 77 districts of Nepal. The mean score of LOSS‐SF‐Nep was 6.36 ± 1.92 and literacy ranged from 37.9% to 89.7%. The deeper exposure to suicidal patients was associated with better literacy. Factor analysis of SOSS‐SF‐Nep revealed three subscales: stigmatization, isolation/depression, and normalization/glorification and had acceptable psychometric properties. Gender, occupation of head of the family, region and years of education, using mental health services, and depression were associated with variable literacy or stigma. Conclusion: Literacy and stigma scales were validated in Nepali, and SOSS factor structures were revealed with modified descriptors. The literacy and stigma levels in medical students were calculated for the first time in Nepal and Hindu majority population.

Non-point source pollution poses a continuous threat to the quality of Great Lakes waters. To abate this problem, the Great Lakes Agricultural Stewardship Initiative (GLASI) was initiated in Ontario, Canada, with the primary aim of reducing phosphorus pollution. Therefore, a case-study analysis of the Wigle Creek watershed, one of the six priority watersheds under the GLASI program, was undertaken to evaluate the effectiveness of various existing and potential future Best Management Practices (BMPs) and to identify BMPs that might aid in mitigating the watershed’s contribution to phosphorus loads reaching Lake Erie. Given the watershed’s very flat topography, hydrological/nutrient modeling proved an extremely challenging exercise. The Soil and Water Assessment Tool (SWAT) model was used in this evaluation. Several digital elevation model (DEM) options were considered to accurately describe the watershed and represent flow conditions. A 30 m resolution DEM, implementing a modified burning in of streams based on ground truthing, was finally employed to develop the SWAT model’s drainage framework. The model was first calibrated for flow, sediment, and phosphorus loads. The calibrated model was used to evaluate the ability of potential BMPs (minimum tillage, no-till, retiring croplands into pasture, retiring croplands into forest, winter wheat cover crop, and vegetative filter strips) to reduce phosphorus loads compared to implemented practice. Converting all croplands into pasture or forest significantly decreased P loads reaching Lake Erie. Comparatively, a winter wheat cover crop had minimal effect on reducing phosphorus loading.

Introduction: COVID-19 outbreak brought unprecedented pressure on dental and oral health care workers leading to increased depression. This study aimed to find the prevalence of depression among online respondent oral healthcare workers during the COVID-19 pandemic. Methods: A descriptive cross-sectional study was conducted from 24 June 2020 to 13 July 2020 among oral health care workers in a tertiary care centre. Ethical approval was taken from the Ethical Review Board (Reference number: 2710). Convenience sampling method was used. The data were collected using a questionnaire through Google Forms. Point estimate and 95% confidence interval were calculated. Results: Among 133 oral health care workers, the prevalence of depression was found to be 29 (21.80%) (14.78-28.82, 95% Confidence Interval). Conclusions: The prevalence of depression among oral health care workers was lower than similar studies done in similar settings.

Purpose: The purpose of this paper is to examine the impact of team building and employee empowerment on employee competencies and examine the moderating role of organizational learning culture in between these relationships. Design/methodology/approach: An integrated research model is developed by combining resource-based view, signalling theory and experiential learning theory. The validity of the model is tested by applying moderated structural equation modelling (MSEM) approach to the data collected from 653 employees working in cement manufacturing companies. The reliability and validity of the dimensions are established through confirmatory factor analysis and the related hypotheses are tested by using MSEM. Findings: The findings suggest that organizational learning culture significantly strengthens the relationships of team building and employee empowerment on employee competencies. Research limitations/implications: The research is undertaken in Indian cement manufacturing companies which cannot be generalized across a broader range of sectors and international environment. Practical implications: The findings of the study have potential to help decision makers of manufacturing companies to develop strategies which will enable them to improve employee competency, to formulate effective human resource development interventions and to enhance the capability of the employees to achieve desired goals and objectives of the organization. Originality/value: The research is unique in its attempt to combine three frameworks to build a new theoretical model explaining the importance organizational learning culture along with team building and employee empowerment.

Purpose: This study is based on social exchange theory and aims at understanding the role of employee engagement as a mediator between employee voice and organizational effectiveness. Design/methodology/approach: Data was collected to test the mediating role of employee engagement between employee voice and organizational effectiveness. The respondents were employees in different IT companies located in major cities in India. The model was tested for full and partial mediation of employee engagement using structural equation modeling. Findings: Considering the self-reported survey from 232 employees from companies in the IT sector, the findings reveal that there exists a significant association between employee voice and organizational effectiveness. The results reflect a close association between employee engagement and organizational effectiveness too. However, no significant association was found between employee voice and organizational effectiveness. Employee engagement is found to mediate the relationship between employee voice and organizational effectiveness. Research limitations/implications: The foremost limitation of the study is the sample group that is limited to employees working in IT companies in Bangalore city. The results cannot be generalized to the entire IT industry in India. Although attempts are made to eliminate common method bias, there are chances of an overstated relationship by common method variance that cannot be neglected completely. Practical implications: The paper will provide a deep insight to the practitioners about the role of employee voice in the engagement of employees. It will also indicate to the managers how the effectiveness of an organization can be heightened by creating opportunities for employees to voice their opinion in the organization. Originality/value: The present study indicated that though there is an association between the independent variable, employee voice, and the dependent variable, organizational effectiveness, the relationship becomes more significant in the presence of employee engagement between them.

Introduction Despite carrying a disproportionately high burden of depression, patients in low-income countries lack access to effective care. The collaborative care model (CoCM) has robust evidence for clinical effectiveness in improving mental health outcomes. However, evidence from real-world implementation of CoCM is necessary to inform its expansion in low-resource settings.Methods We conducted a 2-year mixed-methods study to assess the implementation and clinical impact of CoCM using the WHO Mental Health Gap Action Programme protocols in a primary care clinic in rural Nepal. We used the Capability Opportunity Motivation-Behaviour (COM-B) implementation research framework to adapt and study the intervention. To assess implementation factors, we qualitatively studied the impact on providers’ behaviour to screen, diagnose and treat mental illness. To assess clinical impact, we followed a cohort of 201 patients with moderate to severe depression and determined the proportion of patients who had a substantial clinical response (defined as ≥50% decrease from baseline scores of Patient Health Questionnaire (PHQ) to measure depression) by the end of the study period.Results Providers experienced improved capability (enhanced self-efficacy and knowledge), greater opportunity (via access to counsellors, psychiatrist, medications and diagnostic tests) and increased motivation (developing positive attitudes towards people with mental illness and seeing patients improve) to provide mental healthcare. We observed substantial clinical response in 99 (49%; 95% CI: 42% to 56%) of the 201 cohort patients, with a median seven point (Q1:−9, Q3:−2) decrease in PHQ-9 scores (p

Abstract Background Traditional medical education in much of the world has historically relied on passive learning. Although active learning has been in the medical education literature for decades, its incorporation into practice has been inconsistent. We describe and analyze the implementation of a multidisciplinary continuing medical education curriculum in a rural Nepali district hospital, for which a core objective was an organizational shift towards active learning. Methods The intervention occurred in a district hospital in remote Nepal, staffed primarily by mid-level providers. Before the intervention, education sessions included traditional didactics. We conducted a mixed-methods needs assessment to determine the content and educational strategies for a revised curriculum. Our goal was to develop an effective, relevant, and acceptable curriculum, which could facilitate active learning. As part of the intervention, physicians acted as both learners and teachers by creating and delivering lectures. Presenters used lecture templates to prioritize clarity, relevance, and audience engagement, including discussion questions and clinical cases. Two 6-month curricular cycles were completed during the study period. Daily lecture evaluations assessed ease of understanding, relevance, clinical practice change, and participation. Periodic lecture audits recorded learner talk-time, the proportion of lecture time during which learners were talking, as a surrogate for active learning. Feedback from evaluation and audit results was provided to presenters, and pre- and post-curriculum knowledge assessment exams were conducted. Results Lecture audits showed a significant increase in learner talk-time, from 14% at baseline to 30% between months 3–6, maintained at 31% through months 6–12. Lecture evaluations demonstrated satisfaction with the curriculum. Pre- and post-curriculum knowledge assessment scores improved from 50 to 64% (difference 13.3% ± 4.5%, p = 0.006). As an outcome for the measure of organizational change, the curriculum was replicated at an additional clinical site. Conclusion We demonstrate that active learning can be facilitated by implementing a new educational strategy. Lecture audits proved useful for internal program improvement. The components of the intervention which are transferable to other rural settings include the use of learners as teachers, lecture templates, and provision of immediate feedback. This curricular model could be adapted to similar settings in Nepal, and globally.

Purpose: The purpose of the study is to examine the impact of human resource development (HRD) interventions on organizational effectiveness by means of employee competencies which are built by some of the selected HRD interventions. Design/methodology/approach: An integrated research model has been developed by combining the principal factors from the existing literature. The HRD interventions chosen are training, performance management and career management (development). The validity of the model is tested by applying structural equation modeling (SEM) approach to the information collected from 290 executive and non-executive employees working in two medium size cement manufacturing companies. The reliability and validity of the dimensions are established through confirmatory factor analysis (CFA) and the related hypotheses are tested by using SEM. Findings: The result indicates that the selected HRD interventions have an impact on building of employee competencies, which in turn is instrumental in improving organizational effectiveness. Research limitations/implications: The research is undertaken in Indian cement manufacturing companies which cannot be generalized across a broader range of sectors and international environment. Practical implications: The findings of the study have potential to help decision makers of manufacturing companies to develop strategies which will enable them to improve employee competency, to formulate effective HRD interventions and to enhance the capability of the employees to achieve desired goals and objectives of the organization. Originality/value: The research is unique in its attempt to measure employee competencies for organizational effectiveness by combining the existing scales of individual competences. The article contributes to the HRD literature, integrating HRD interventions and employee competencies into a comprehensive research model that influence organizational effectiveness.

Background Chronic obstructive pulmonary disease accounts for a significant portion of the world’s morbidity and mortality, and disproportionately affects low/middle-income countries. Chronic obstructive pulmonary disease management in low-resource settings is suboptimal with diagnostics, medications and high-quality, evidence-based care largely unavailable or unaffordable for most people. In early 2016, we aimed to improve the quality of chronic obstructive pulmonary disease management at Bayalpata Hospital in rural Achham, Nepal. Given that quality improvement infrastructure is limited in our setting, we also aimed to model the use of an electronic health record system for quality improvement, and to build local quality improvement capacity.Design Using international chronic obstructive pulmonary disease guidelines, the quality improvement team designed a locally adapted chronic obstructive pulmonary disease protocol which was subsequently converted into an electronic health record template. Over several Plan-Do-Study-Act cycles, the team rolled out a multifaceted intervention including educational sessions, reminders, as well as audits and feedback.Results The rate of oral corticosteroid prescriptions for acute exacerbations of chronic obstructive pulmonary disease increased from 14% at baseline to >60% by month 7, with the mean monthly rate maintained above this level for the remainder of the initiative. The process measure of chronic obstructive pulmonary disease template completion rate increased from 44% at baseline to >60% by month 2 and remained between 50% and 70% for the remainder of the initiative.Conclusion This case study demonstrates the feasibility of robust quality improvement programmes in rural settings and the essential role of capacity building in ensuring sustainability. It also highlights how individual quality improvement initiatives can catalyse systems-level improvements, which in turn create a stronger foundation for continuous quality improvement and healthcare system strengthening.

This study explores the antecedents for organizational change readiness for altering the status quo and empirically validates few potent tools which facilitate change. By drawing on change management literature, this study examines the influence of employee voice (EV) and employee involvement (EI) on commitment-to-change (CTC), considering the latter as a mediating variable in the relation between antecedent human resources practices (EV and EI) and organizational change readiness (OCR). Subsequently, the moderating role of transformational leadership was analyzed on these posited relationships. The hypotheses proposed in the research model are tested on a sample of 516 employees from an Indian public sector organization, applying Baron and Kenny's (1986) technique for establishing mediation and Ping's approach to moderated structured equation modeling for moderation. The findings suggest that CTC partially mediates the relationship between EV and OCR, but it does not mediate between EI and OCR. Likewise, the study results also empirically validate that the relationship between EV and CTC is enhanced if leadership is transformational, also the hypothesis positing the moderating role of transformational leadership between EI and CTC was supported. [ABSTRACT FROM AUTHOR]