Search

available with the full text.

In the present work, the replacement feasibility of AISI 304 (Cr-Ni) with low nickel AISI 201 (Cr-Mn-N-Ni) stainless steel has been studied by employing dissimilar welding. Three different welding speeds were selected for gas tungsten arc welding process. The solidification mode and delta-ferrite content were predicted using WRC-1992 diagram, and conventional ferritescope was also used to calculate delta-ferrite. The microstructural analysis of weldments revealed the presence of lathy ferrite morphology dominated by vermicular ferrite for high and medium welding speed specimens, whereas low welding speed specimen depicts only vermicular morphology of ferrite in the weldments. Further, SEM–EDS analysis of weldments was carried out on weldments and indicated for the precipitation at fusion boundary. The tensile strength and microhardness was evaluated to establish structure–property correlation. It was observed that the weldments with higher welding speed depicted better mechanical properties. Failure of the tensile specimens took place in the fusion zone of AISI 201 side (adjacent to fusion boundary) in all three weldments. XRD analysis of fractured surfaces confirmed the formation of intermetallic compounds as Cr23C6 and martensite (small amount), which were responsible for deterioration of mechanical properties and failure of weld joints in fusion zone. Fractographic investigation of fractured surfaces revealed the presence of dimple-like morphology which leads to ductile fracture.

Background Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal. Health systems can improve CVD health outcomes even in resource-limited settings by directing efforts to meet critical system gaps. This study aimed to identify Nepal’s health systems gaps to prevent and manage CVDs. Methods We formed a task force composed of the government and non-government representatives and assessed health system performance across six building blocks: governance, service delivery, human resources, medical products, information system, and financing in terms of equity, access, coverage, efficiency, quality, safety and sustainability. We reviewed 125 national health policies, plans, strategies, guidelines, reports and websites and conducted 52 key informant interviews. We grouped notes from desk review and transcripts’ codes into equity, access, coverage, efficiency, quality, safety and sustainability of the health system. Results National health insurance covers less than 10% of the population; and more than 50% of the health spending is out of pocket. The efficiency of CVDs prevention and management programs in Nepal is affected by the shortage of human resources, weak monitoring and supervision, and inadequate engagement of stakeholders. There are policies and strategies in place to ensure quality of care, however their implementation and supervision is weak. The total budget on health has been increasing over the past five years. However, the funding on CVDs is negligible. Conclusion Governments at the federal, provincial and local levels should prioritize CVDs care and partner with non-government organizations to improve preventive and curative CVDs services.

IntroductionIn Nepal, approximately 31% of adult industrial employees have diabetes. While the prevention of type 2 diabetes through behavioural intervention has been disseminated, worksite could be an effective platform for the translation of this knowledge into action as employed adults spend most of their workday waking hours at workplaces.Methods and analysisWe will conduct a randomised controlled trial to assess the effectiveness of a behavioural and a canteen intervention on diabetes risk reduction among those who are prediabetic at two worksites in eastern Nepal. We will recruit 162 adult full-time factory workers with haemoglobin A1c (HbA1c) of 5.7%–6.4% at baseline or fasting blood sugar of 100–125 mg/dL. The 8–14 months’ control period will be followed by the behavioural intervention where half of the participants will be randomised to receive the behavioural intervention and half will act as a control and will not receive any intervention. Then, all participants will receive the canteen intervention. The analysis will be intent-to-treat, comparing the difference in the change in HbA1c% between the behavioural intervention group and the control group using a two-sample t-test. The within-participant changes in HbA1c after 6 or more months on the canteen intervention among those not randomised to the behavioural intervention in the previous period will be assessed using the paired t-test.Ethics and disseminationEthical approval was obtained from the Institutional Review Board at Yale School of Public Health, New Havens, USA and the Nepal Health Research Council.Trial registration numberNCT04161937.

The present work investigates the influence of filler materials composition on the bimetallic joints between nickel based Super C-276 alloy and Ti-stabilized Grade 321 using multi-pass pulsed current gas tungsten arc welding process. The analysis was carried out to determine the correlationship between the morphology of the weld metals and the resultant mechanical properties and corrosion resistance. Four different filler materials including ERNiCrMo-4, ERNiCrMo-3, ERNiCr-3 and ER347 were employed. The microstructural analysis revealed fully austenitic structure along with variation in the dendritic morphology from cellular/columnar to an equiaxed structure near weld center line for different filler materials. SEM-EDS point analysis results displayed the existence of white particles (both Mo and Nb-rich) in the weld as well as at the weld boundaries occupying the interdendritic regions on account of their low solubility in the matrix. Compositional analysis revealed that the ERNiCr-3 weld had greater degree of Nb-rich precipitation occurred along the migrated grain boundaries which causes cracking in the weld during modified Huey test. Mechanical test results indicates that amongst all dissimilar weldments, welds fabricated by employing ERNiCrMo-4 and ERNiCrMo-3 showed the optimum properties. In conclusion, for the dissimilar joining of Super C-276 alloy and Ti stabilized Grade 321, ERNiCrMo-4 filler material (followed by ERNiCrMo-3) offers superior properties compared to other filler materials employed.

Background: Sexual minorities are at high risk of contracting and spreading HIV/AIDS. Several studies in Nepal and around the world depict issues of HIV/AIDS and other problems of sexual minorities.Objective: The present study was carried out with the aim to investigate and evaluate knowledge and attitude of sexual minorities regarding HIV/AIDS.Methods: A cross-sectional study was conducted for a period of eight months starting from June 2009. Sixty six respondents accomplished quantitative interviews and face-to-face interviewer-administered demographic, knowledge and attitude of HIV/AIDS survey. Descriptive and inferential analysis was done using Statistical Package for Social Sciences version 16. A five point Likert scale was used to assess attitude of the respondents. Pearson’s chi-square test was used to compare the association between knowledge and selected socio-demographic variables. Spearman’s correlation test was used to make out the degree of relationship between knowledge and attitude.Results: Among 66 sexual minorities, 34.84% were gay, 28.78% were transgender, 25.75% were bisexuals and 10.60% were lesbians. Nearly 47% of the respondents showed adequate knowledge with mean knowledge score of 29. With the mean attitude score of 39, 45.5% showed positive attitude towards HIV infection. The findings depicted an association between knowledge and participation of respondents on training/awareness program (p

The present study addressed the weldability of Hastelloy C-276 and Type 321 austenitic stainless steel (ASS) dissimilar combination used for manufacturing of high-temperature equipments in nuclear power plants. Investigation of the microstructural evolutions across the different welding passes and their subsequent effect on the mechanical properties and corrosion resistance would be helpful in better understanding and pave way for the frequent application of such dissimilar joints in the industrial applications. The problem of segregation associated with the multi-pass gas tungsten arc welding process was also investigated systematically. The fusion zone microstructures exhibited a transition from columnar to an equiaxed dendritic structure with varying passes. The topologically closed packed (TCP) phases (such as P and μ) were observed in the fusion zone as well as at the weld interface of Hastelloy C-276. Polarization test was performed to evaluate the corrosion resistance and results indicated that the Cr and Mo depleted zones formed around the TCP phases might be responsible for decreased E pit value for fusion zone. The novelty of this work is to explore the possibilities of substitution of an expensive Hastelloy C-276 with a cost-effective Ti-stabilized Type 321 ASS.

Austenitic stainless steels are often used to handle organic acids such as acetic acid (CH3COOH), which are extensively used in food contact applications and chemical industries for manufacturing medicines, nutrition and various chemical amalgams. In the present investigation an attempt has been made to compare the corrosion behavior of Cr–Ni (AISI type 304), Cr–Mn–Ni (type 201) and Cr (type 430) stainless steel for economical replacement of higher cost Cr–Ni grade. Immersion testing was performed at room temperature and boiling temperature in acetic acid. Atomic absorption spectroscopy was carried out to evaluate metal ion concentration in the immersion solution. The surface morphology of pit formation was characterized using scanning electron microscopy coupled with energy dispersive X-ray spectroscopy. The effect of elemental leaching on electrical conductivity of the immersion solution was evaluated and correlated with pH measurements. A new mechanism has been proposed for the pit formation due to manganese sulfide inclusions. The replacement compatibility was further confirmed with anodic polarization testing and a successful replacement was established for room temperature applications.

In the present investigation, an attempt has been made to join Hastelloy C-276 nickel-based superalloy and AISI 321 austenitic stainless steel using ERNiCrMo-4 filler. The joints were fabricated by continuous and pulsed current gas tungsten arc welding processes. Experimental studies to ascertain the structure-property co-relationship with or without pulsed current mode were carried out using an optical microscope and scanning electron microscope. Further, the energy-dispersive spectroscope was used to evaluate the extent of microsegregation. The microstructure of fusion zone was obtained as finer cellular dendritic structure for pulsed current mode, whereas columnar structure was formed with small amount of cellular structure for continuous current mode. The scanning electron microscope examination witnessed the existence of migrated grain boundaries at the weld interfaces. Moreover, the presence of secondary phases such as P and μ was observed in continuous current weld joints, whereas they were absent in pulsed current weld joints, which needs to be further characterized. Moreover, pulsed current joints resulted in narrower weld bead, refined morphology, reduced elemental segregation and improved strength of the welded joints. The outcomes of the present investigation would help in obtaining good quality dissimilar joints for industrial applications and AISI 321 ASS being cheaper consequently led to cost-effective design also.

Sumitra Sharma,1 Bhuvan KC,2 Asmita Khatri3 1Department of Nursing, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal; 2School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia; 3Bachelor of Science in Nursing, Department of Nursing, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal Introduction: Male involvement in reproductive health is an essential component in promoting maternal and family health. In Nepal, men are not actively engaged in most maternal and child health (MCH) services nor in other reproductive health programs. There is a need to know about the understanding of key professionals in such practices. This study explores gendered perspectives among teachers and health professionals to understand the factors contributing to male involvement in reproductive health.Methods: The data were collected through two focus group discussions (FGDs) and seven key informant interviews (KIIs). FGDs were held among male teachers of selected schools, and KIIs were conducted with health professionals of the health post of Bungamati, Lalitpur. An unstructured interview guide was used to explore their experiences and perceptions. All KIIs and FGDs were recorded, translated and transcribed verbatim.Results: Findings show limited male involvement in reproductive health. Participants reported several hindering and challenging factors such as sociocultural and psychological norms, lack of education, and misinformation and dominance of female as health care providers in many MCH clinics. Perceived motivating factors included positive attitude in men, literacy and awareness, inclusion of reproductive health in school curriculum and certain incentives. Participants also recommended a range of strategies for increasing men’s involvement in reproductive health in Nepal.Conclusion: Men’s education and attitude, knowledge and awareness, sociocultural factors, psychological factors, health system factors, and policies play important roles in male involvement in reproductive health. Programs on effective implementation of men involvement in reproductive health initiatives should address the barriers and challenges to men’s supportive activities. This study also suggests increasing literacy of reproductive health among men that enhances their positivity and motivates them to participate in reproductive health services. Keywords: male participation, maternal and child health, reproductive health

Not available.Journal of Kathmandu Medical CollegeVol. 7, No. 2, Issue 24, Apr.-Jun., 2018, Page: 45-46

Background: Although in recent decades risk factors of Coronary Artery Disease (CAD) have markedly increased, little is known about its relationship among Asian females. The principal aim of the study is to determine the prevalence of CAD risk factors among a target female population in Nepal.Methods: A case control study was conducted at tertiary cardiac centre of Kathmandu from August 2013 to September 2014. Study participants identified with CAD (n=52) were matched for age with controls (n=52). Anthropometric and laboratory data were collected and a semi-structured interview was utilized to obtain information on socio-demographic, behavioural, psychosocial and physiological/biochemical risk factors. Variables were assessed using frequency tables and Pearson’s Chi-Square tests for two independent proportions. Binary logistic regression was used to investigate the potential predictors of CAD.Results: CAD was significantly associated with ethnicity, ever smoked, harmful use of alcohol, moderate physical activity, more than 12 sitting hours per day, family history, total cholesterol, HDL-C and hypertension. Regression analysis indicated alcohol intake (P

The present investigation articulates the effect of two varying welding heat inputs on the bimetallic weldments of superalloy C-276/stabilized grade 321 using pulsed current gas tungsten arc welding process. Experimental studies to understand the metallurgical as well as mechanical properties were carried out. The microstructures obtained in the high heat input weld consisted of columnar and cellular dendritic structure. On the other hand, the low heat input weld showed the occurrence of equiaxed and cellular dendritic structure. Moreover, the precipitation of Mo-rich intermetallic compounds was noticed in the fusion zone and at the interface of superalloy C-276. The absence of such precipitation in the low heat input weld resulted in an improved strength of the bimetallic weldments. Furthermore, the Polarization test was also conducted, which caused the higher heat input weld to corrode first at the regions around the intermetallic compounds and hence reduced Epit value was obtained.

Chikungunya fever is an emerging mosquito-borne disease caused by the infection with chikungunya virus (CHIKV). The CHIKV has been rarely detected in mosquito vectors from Northern India, since vector surveillance is an effective strategy in controlling and preventing CHIKV transmission. Thus, virological investigation for CHIKV among mosquitoes of Aedes (A.) species was carried out in the Lucknow district during March 2010 to October 2011. We collected adult mosquitoes from areas with CHIKV positive patients. The adult Aedes mosquito samples were pooled, homogenized, clarified and tested for CHIKV by nonstructural protein 1 (nsP1) gene based polymerase chain reaction (PCR). A total 91 mosquito pools comprising of adult A. aegypti and A. albopictus were tested for CHIKV. The partial envelope protein (E1) gene sequences of mosquito-borne CHIKV strains were analyzed for genotyping. Of 91 pools, 6 pools of A. aegypti; and 2 pools of A. albopictus mosquitoes were identified positive for CHIKV by PCR. The phylogenetic analysis revealed clustering of CHIKV strains in two sub-lineages within the monophyletic East-Central South African (ECSA) genotype. Novel amino acid changes at the positions 294 (P294L) and 295 (S295F) were observed during analysis of amino acid sequence of the partial E1 gene. This study demonstrates the genetic diversity of circulating CHIKV strains and reports the first detection of CHIKV strains in Aedes vector species from the state of Uttar Pradesh. These findings have implication for vector control strategies to mitigate vector population to prevent the likelihood of CHIKV epidemic in the near future.

This study explores the sexual health problems and treatment-seeking behaviour of men in a Mumbai slum population. Men consider wet dreams, masturbation, early ejaculation, sexual weakness, and other semen-related issues as serious sexual health problems. Suppression of sexual desire was one of the major causes perceived by men for wet dreams, whereas masturbation was seen as the major cause for perceived early ejaculation and distortion in the shape of penis. Excessive loss of semen in any form, including through masturbation and frequent intercourse, was seen as causing most sexual health problems. These beliefs impact on subsequent behaviour, including treatment seeking. In this community-based study, about 45% of men reported to be currently suffering from one or more sexual health problems. One in every four who reported experiencing any problem sought treatment, mostly from the private sector that included a large number of unqualified and untrained providers. The present analysis stresses the impor...

Conducted in a Mumbai slum population, this study examines the vocabulary men use to describe sexual health problems, cultural views about categorization, and the views of local health practitioners. Structured qualitative methods including free-listing, pile sorting and ratings were used. In addition to sexually transmitted infections, men are equally or more concerned about the quality and quantity of semen and 'impotence', which includes erectile deficiencies and premature ejaculation. A number of problems that may be indicative of the presence of STIs are thought to be transmitted through both sexual contact and other means subsumed under the category garmi. Men, as well as untrained non-allopathic sexual health practitioners, perceived the indiscreet wastage of semen through excessive masturbation, wet dreams or excessive sexual desire to be a major cause of these problems. A comprehensive reproductive health programme should address these male sexual health problems in order to motivate men to play ...

The European Working Time Directive (EWTD) was introduced in 1993 and was heralded as both a challenge and an opportunity for the NHS to modernize its services Continuity of care is usually viewed as the ongoing relationship between a patient and a single practitioner. Fragmentation of this continuity by many doctors being involved in a patient's management may weaken this relationship. The effect of the EWTD on junior doctors training in various specialities is well studied, we however were interested to assess the effect of the EWTD on the patient-doctor relationship in a maxillofacial setting and aimed for this paper to serve as an indicator of current practice and facilitate future research in this area. Seventy-five consecutive patients were studied with 72 patient proformas analysed. Our findings show greater same consultant patient contact than that of the specialist registrars and senior house officers. We feel that this is largely due to new work patterns introduced through the advent of the EWTD.