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Influenza D virus (IDV) utilizes bovines as a primary reservoir with periodical spillover to other hosts. We have previously demonstrated that IDV binds both 9-O-acetylated N-acetylneuraminic acid (Neu5,9Ac2) and 9-O-acetylated N-glycolylneuraminic acid (Neu5Gc9Ac). Bovines produce both Neu5,9Ac2 and Neu5Gc9Ac, while humans are genetically unable to synthesize Neu5Gc9Ac. 9-O-Acetylation of sialic acids is catalyzed by CASD1 via a covalent acetyl-enzyme intermediate. To characterize the role of Neu5,9Ac2 and Neu5Gc9Ac in IDV infection and determine which form of 9-O-acetylated sialic acids drives IDV entry, we took advantage of a CASD1 knockout (KO) MDCK cell line and carried out feeding experiments using synthetic 9-O-acetyl sialic acids in combination with the single-round and multi-round IDV infection assays. The data from our studies show that (i) CASD1 KO cells are resistant to IDV infection and lack of IDV binding to the cell surface is responsible for the failure of IDV replication; (ii) feeding CASD1 KO cells with Neu5,9Ac2 or Neu5Gc9Ac resulted in a dose-dependent rescue of IDV infectivity; and (iii) diverse IDVs replicated robustly in CASD1 KO cells fed with either Neu5,9Ac2 or Neu5Gc9Ac at a level similar to that in wild-type cells with a functional CASD1. These data demonstrate that IDV can utilize Neu5,9Ac2- or non-human Neu5Gc9Ac-containing glycan receptor for infection. Our findings provide evidence that IDV has acquired the ability to infect and transmit among agricultural animals that are enriched in Neu5Gc9Ac, in addition to posing a zoonotic risk to humans expressing only Neu5,9Ac2.IMPORTANCEInfluenza D virus (IDV) has emerged as a multiple-species-infecting pathogen with bovines as a primary reservoir. Little is known about the functional receptor that drives IDV entry and promotes its cross-species spillover potential among different hosts. Here, we demonstrated that IDV binds exclusively to 9-O-acetylated N-acetylneuraminic acid (Neu5,9Ac2) and non-human 9-O-acetylated N-glycolylneuraminic acid (Neu5Gc9Ac) and utilizes both for entry and infection. This ability in effective engagement of both 9-O-acetylated sialic acids as functional receptors for infection provides an evolutionary advantage to IDV for expanding its host range. This finding also indicates that IDV has the potential to emerge in humans because Neu5,9Ac2 is ubiquitously expressed in human tissues, including lung. Thus, results of our study highlight a need for continued surveillance of IDV in humans, as well as for further investigation of its biology and cross-species transmission mechanism.

Despite the availability of successful vaccines, measles outbreaks have occurred frequently in recent years, presumably due to the lack of proper vaccination implementation. Moreover, measles cases in adult groups, albeit small in number, indicate that the previously neglected adult group may need to be brought into vaccine coverage to achieve WHO's goal of measles eradication from the globe. In this study, we develop a novel transmission dynamics model to describe measles cases in adults and children to evaluate the role of adult infection in persistent measles cases and vaccination programs for eradication. Analysis of our model, validated by measles cases from outbreaks in Nepal, provides the vaccination reproduction number (conditions for measles eradication or persistence) and the role of contact network size. Our results highlight that while children are primary targets for measles outbreaks, a small number of infections in adults may act as a reservoir for measles, causing obstacles to eradication. Furthermore, our model analysis shows that while impactful controls can be achieved by children-focused vaccines, a combined adult-child vaccination program may help assert eradication of the disease.

Introduction The Nepal Family Cohort study uses a life course epidemiological approach to collect comprehensive data on children’s and their parents’ environmental, behavioural and metabolic risk factors. These factors can affect the overall development of children to adulthood and the onset of specific diseases. Among the many risk factors, exposure to air pollution and lifestyle factors during childhood may impact lung development and function, leading to the early onset of respiratory diseases. The global incidence and prevalence of respiratory diseases are rapidly increasing, with the rate of increase in Nepal being the highest. Although the cohort will primarily focus on respiratory health, other health outcomes such as cardiovascular, metabolic and mental health will be assessed to provide a comprehensive overall health assessment. All other health outcomes are self-reported following doctor diagnosis. Some of these health outcomes will be quality controlled during the follow-up by measuring disease specific markers. Our cohort study will likely provide evidence of risk factors and policy recommendations.Methods and analysis Using a life-course epidemiology approach, we established a longitudinal study to address the determinants of lung health and other health outcomes from childhood to adulthood. The baseline data collection (personal data anonymised) was completed in April 2024, and 16 826 participants (9225 children and 7601 parents) from 5829 families were recruited in different geographical and climate areas (hills and plains) of Nepal. We plan to follow up all the participants every 2–3 years.Descriptive analysis will be used to report demographic characteristics and compare rural and semi-urban regions. A linear regression model will assess the association between air pollution, particularly household air pollution (HAP) exposure, and other lifestyle factors, with lung function adjusted for potential confounders. A two-stage linear regression model will help to evaluate lung development based on exposure to HAP.Ethics Ethical approval was obtained from the Nepal Health Research Council, Kathmandu, Nepal, and McMaster University, Hamilton, Canada. Permissions were obtained from two municipalities where the study sites are located. Parents provided signed informed consent and children their assent.Dissemination Findings will be disseminated through traditional academic pathways, including peer-reviewed publications and conference presentations. We will also engage the study population and local media (ie, research blogs and dissemination events) and prepare research and policy briefings for stakeholders and leaders at the local, provincial and national levels.

Reliable tree species diversity and carbon stock data are crucial for establishing a baseline and aiding monitoring and management decision-making to ensure ecosystem functions and services, including carbon management. However, such data are not available for many primary forests, especially in developing countries like Nepal. For this study, we generated primary baseline data on tree species diversity, biomass, and carbon stock for forests under different management regimes in one of the critical landscapes of western Nepal. We sampled 94 clusters of concentric circular sample plots placed systematically at the nodes of 3 km by 3 km square grids in biological corridors (managed by community forest user groups) and a national park's buffer zones (managed by buffer zone user groups) to study the tree species composition and estimate the carbon stock. The number of tree species and botanical families reported in different sites did not differ significantly. The basal area was found to be highest in Brahmadev Corridor where tree density per unit area was also highest. Our study sites showed a basal area ranging from 26.42 to 40.65 m2/ha, which is higher than previously reported from similar forests. The total biomass (302.12 to 496 tons/ha) and carbon stock (142 to 233.12 tons/ha), both being highest in Brahmadev Corridor, were within the range of comparable data and national averages. The number of stems in all sites showed the reverse J-shaped pattern, indicating a stable population and good species recruitment. The buffer zones had a large proportion of forest area with the highest carbon stock classes of 300–400 tons/ha. The basal area and diameter at breast height showed a significant positive correlation with carbon stock, indicating that the basal area is a key determinant of carbon stock. Our study provides disaggregated information on tree species diversity, the quality of forests in terms of stem density and size-class distribution, and carbon stock and its distribution in different carbon stock classes in two forest management regimes. In this sense, our study is the first of its kind in providing important insights into forest and carbon management because areas with different carbon stocks need different management prescriptions.

The rapid increase in biomass and plastic waste poses significant environmental challenges. Co-pyrolysis of biomass with plastic wastes offers a promising avenue for sustainable waste management and renewable energy generation. This study covers several novel aspects: First, it investigates the impacts of feedstock composition and operating conditions in pyrolysis (individual feedstock) and co-pyrolysis (biomass and plastic wastes). The study reveals that synergistic effects, specifically improved yields and optimized temperature, exist in the co-pyrolysis of biomass and plastic wastes compared to individual feedstock. Secondly, a suitable blended machine learning predictive model (with Random Forest, Gradient Boosting Regressor, and XGBoost) and robust optimization framework are developed to address model accuracy, non-linear interactions, and uncertainties in pyrolysis such as temperature, heating rate, and biomass-to-plastic ratio. This study predicts the bio-oil yield quantitatively (amount) and qualitatively (composition) with high accuracy (R2 > 0.97). Thirdly, key factors contributing to yield include plastic content (18 %) and biomass type (13 %) have been identified through Gini feature importance and Shapley Additive Explanation (SHAP) analysis. Furthermore, multi-objective optimization techniques reveal the most optimal bio-oil yield under specific conditions, supported by uncertainty analysis, which confines bio-oil yield to a range of 30–50 %. Finally, it also demonstrates a case study to find the optimal bio-oil yield and quality conditions using co-pyrolysis of local resources, i.e., biomass (wood and bagasse) and plastic wastes. The case study suggests optimal conditions like > 50 °C heating rate, 60 % plastic content in a blend of wood and HDPE. This study assists industries and policymakers to assess and understand the viability of co-pyrolysis, optimal design parameters, and process impacts.

Sentiment and emotion embody intrinsic experience of human cognition, both of which profoundly influences cognitive processes in humans. The commonality between sentiment and emotion leads to a fact that sentiment classification and emotion recognition are two correlated tasks in cognitive science and artificial intelligence. One task improves its performance by leveraging similarities and differences across tasks. However, recent works have often treated them as two separately different tasks, where their commonalities are largely neglected. To fill this gap, we propose a multi-task interactive graph attention network with position encodings, termed MIP-GAT. The main proposal is a multi-interactive graph layer where syntactic dependency connection, cross-task connection and position encodings are constructed and incorporated into a unified graphical structure. Empirical evaluation on two benchmarking datasets, i.e., CMU-MOSEI and GoEmotions, shows the effectiveness of the proposed model over state-of-the-art baselines. In addition, we also explore the superiority and limitations of the proposed model.

The Ozone Mapping and Profiler Suites (OMPS) Nadir Mapper (NM) is a grating spectrometer within the OMPS nadir instruments onboard the SNPP, NOAA-20, and NOAA-21 satellites. It is designed to measure Earth radiance and solar irradiance spectra in wavelengths from 300 nm to 380 nm for operational retrievals of the nadir total column ozone. This study presents calibration and validation analysis results for the NOAA-21 OMPS NM SDR data to meet the JPSS scientific requirements. The NOAA-21 OMPS SDR calibration derives updates of several previous OMPS algorithms, including the dark current correction algorithm, one-time wavelength registration from ground to on-orbit, daily intra-orbit wavelength shift correction, and stray light correction. Additionally, this study derives an empirical scale factor to remove 2.2% of systematic biases in solar flux data, which were caused by pre-launch solar calibration errors of the OMPS nadir instruments. The validation of the NOAA-21 OMPS SDR data is conducted using various methods. For example, the 32-day average method and radiative transfer model are employed to estimate inter-sensor radiometric calibration differences from either the SNPP or NOAA-20 data. The quality of the NOAA-21 OMPS NM SDR data is largely consistent with that of the SNPP and NOAA-20 OMPS data, with differences generally within ±2%. This meets the scientific requirements, except for some deviations mainly in the dichroic range between 300 nm and 303 nm. The deep convective cloud target approach is used to monitor the stability of NOAA-21 OMPS reflectance above 330 nm, showing a variation of 0.5% over the observed period. Data from the NOAA-21 VIIRS M1 band are used to estimate OMPS NM data geolocation errors, revealing that along-track errors can reach up to 3 km, while cross-track errors are generally within ±1 km.

INTRODUCTION: Genomic alterations in the juxtamembrane exon 14 splice sites in NSCLC lead to increased MET stability and oncogenesis. We present the largest cohort study of MET Exon 14 (METex14) using whole transcriptome sequencing. METHODS: A total of 21,582 NSCLC tumor samples underwent complete genomic profiling with next-generation sequencing of DNA (592 Gene Panel, NextSeq, whole exome sequencing, NovaSeq) and RNA (NovaSeq, whole transcriptome sequencing). Clinicopathologic information including programmed death-ligand 1 and tumor mutational burden were collected and RNA expression for mutation subtypes and MET amplification were quantified. Immunogenic signatures and potential pathways of invasion were characterized using single-sample gene set enrichment analysis and mRNA gene signatures. RESULTS: A total of 533tumors (2.47%) with METex14 were identified. The most common alterations were point mutations (49.5%) at donor splice sites. Most alterations translated to increased MET expression, with MET co-amplification resulting in synergistic increase in expression (q < 0.05). Common coalterations were amplifications of MDM2 (19.0% versus 1.8% wild-type [WT]), HMGA2 (13.2% versus 0.98% WT), and CDK4 (10.0% versus 1.5% WT) (q < 0.05). High programmed death-ligand 1 > 50% (52.5% versus 27.3% WT, q < 0.0001) and lower proportion of high tumor mutational burden (>10 mutations per megabase, 8.3% versus 36.7% WT, p < 0.0001) were associated with METex14, which were also enriched in both immunogenic signatures and immunosuppressive checkpoints. Pathways associated with METex14 included angiogenesis and apical junction pathways (q < 0.05). CONCLUSIONS: METex14 splicing alterations and MET co-amplification translated to higher and synergistic MET expression at the transcriptomic level. High frequencies of MDM2 and CDK4 co-amplifications and association with multiple immunosuppressive checkpoints and angiogenic pathways provide insight into potential actionable targets for combination strategies in METex14 NSCLC.

Subarachnoid hemorrhage is a neurological emergency in which arterial blood accumulates in the subarachnoid space with cerebral aneurysmal rupture being the most common cause. Subarachnoid hemorrhage is often misdiagnosed in the emergency department and mortality rates range from 8% to 67%. It may be the manifestation of the chronicity of the migraine. The difference in severity or quality compared to previous headaches, and other symptoms, particularly neck stiffness, but also seizure, syncope, focal neurological deficit, and vomiting are the key factors differentiating subarachnoid hemorrhage from the migraine. We report a case of a 37-year-old female with a previous history of migraines who presented with acute onset of excruciating headaches in the occiput associated with nausea, vomiting, and photophobia in whom a non-contrast computed tomography scan of the head showed hyper-densities involving the bilateral cerebral cortical sulcus and Sylvian fissure and the cerebral angiography showed a complex aneurysm in anterior communicating artery.

The demand for trade has led to unsustainable harvesting of medicinal plants, causing a decline in their population in natural habitats. This presents a notable problem, however, there is a lack of information regarding the severity of the threat to these resources. To address this, a study was conducted to identify high-value medicinal plants in the Annapurna Conservation Area in Nepal and evaluate their potential endangerment by using the Rapid Vulnerability Assessment method (RVA). The study also calculated the distribution of these plants in different habitats and their population size. Results showed that there were 19 threatened, high-value medicinal plants in the region frequently used by local communities and with high trade values. Rhizome/roots were the most commonly used plant parts (58%), followed by whole plants (37%). The wild population of these plants was found to be low, with varying abundance among different habitats. Overexploitation driven by high trade demand, low population density, and critical life forms were identified as the main threats to these plants. The study placed Dactylorhiza hatagirea and Neopicrorhiza scrophulariiflora in the highest threat category. Effective conservation and management measures, both in-situ and ex-situ, were suggested based on the population and threat status of these high-value medicinal plants.

UNLABELLED: The identification of molecules that can bind covalently to KRAS G12C and lock it in an inactive GDP-bound conformation has opened the door to targeting KRAS G12C selectively. These agents have shown promise in preclinical tumor models and clinical trials. FDA has recently granted approval to sotorasib for KRAS G12C mutated non-small cell lung cancer (NSCLC). However, patients receiving these agents as monotherapy generally develop drug resistance over time. This necessitates the development of multi-targeted approaches that can potentially sensitize tumors to KRAS inhibitors. We generated KRAS G12C inhibitor-resistant cell lines and observed that they exhibit sensitivity toward selinexor, a selective inhibitor of nuclear export protein exportin1 (XPO1), as a single agent. KRAS G12C inhibitors in combination with selinexor suppressed the proliferation of KRAS G12C mutant cancer cell lines in a synergistic manner. Moreover, combined treatment of selinexor with KRAS G12C inhibitors resulted in enhanced spheroid disintegration, reduction in the number and size of colonies formed by G12C mutant cancer cells. Mechanistically, the combination of selinexor with KRAS G12C inhibitors suppressed cell growth signaling and downregulated the expression of cell cycle markers, KRAS and NF-kB as well as increased nuclear accumulation of tumor suppressor protein Rb. In an in vivo KRAS G12C cell-derived xenograft model, oral administration of a combination of selinexor and sotorasib was demonstrated to reduce tumor burden and enhance survival. In conclusion, we have shown that the nuclear transport protein XPO1 inhibitor can enhance the anticancer activity of KRAS G12C inhibitors in preclinical cancer models. SIGNIFICANCE: In this study, combining nuclear transport inhibitor selinexor with KRAS G12C inhibitors has resulted in potent antitumor effects in preclinical cancer models. This can be an effective combination therapy for cancer patients that do not respond or develop resistance to KRAS G12C inhibitor treatment.

Abstract The focus of this study is to analyze the impact of big five personality traits (proxied by agreeableness, conscientiousness, extraversion, emotional stability, and openness and social support) on social entrepreneurship intention of the students of Tribhuvan University, with the objective to examine the effect of these five personality traits and social support on social entrepreneurship intention as also the moderating effect of gender. Most of the studies focused on the impact of personality traits on social entrepreneurial intention, but ignored the situational factors proxied here by the social support. There are contradictory and contractionary findings while examining impact of big five personality traits on SEI. Most of the studies (Nga & Shamuganathan in Journal of Business Ethics, 95(2), 259–282, 2010; Yusuf & Kamil in Global Journal of Research in Social Sciences, 2(1), 65–73, 2015; Hsu & Wang in Innovations in Education and Teaching International, 56(3), 385–395, 2018; Bernardino et al. in International Journal of Gender and Entrepreneurship, 10(1), 61–82, 2018; and Seyoum et al. in Journal of Small Business and Enterprise Development, 28(3), 337–359, 2021). Similarly, studies on these issues are almost ignored in Nepalese academics and therefore the researchers attempted to assess the impact of big five personality traits on SEI which is new in the Nepalese context. The sample size was determined using Cochran’s (John Wiley & Sons Incorporated, 1977) formula. The data were collected based on five-point Likert scale questionnaire administered personally and online on 385 samples and were analyzed using SMART PLS software. Structure equation modeling was used to examine the impact of the big five personality traits and social support on social entrepreneurship intention and bootstrap multi-group analysis to check the moderating effect of gender. Cronbach Alpha and composite reliability (CR) were used to check reliability, variance inflation factor (VIF) to check multicollinearity, K-S and Shapiro–Wilk test to check the normality of the data, and Fornell and Larcker criterion and HTMT ratio to check the discriminant validity. The study found that all the proxies of big five personality traits and social support positively and significantly impact on social entrepreneurship intention, but gender does not moderate the relationship. The big five personality traits remain one of the major determinants in creating entrepreneurial intention among students. The reason why, university can adopt programs to educate big five personality traits in order to develop entrepreneurial intention among graduate level students. Similarly, social support helps generate entrepreneurial intentions. The study findings confirm the effect of social support in creating entrepreneurial intention and create the scope to use TPB theory in creating entrepreneurial intention. As well, it helps university to develop programs and courses for the creating entrepreneurial intention among graduate level students.

Recently, cylindrical lithium-ion battery cells have been widely used in electric vehicles due to efficient automated production and cheap kilowatt-hour capacity. For optimal operation of a cell, the internal temperature of the cell should be maintained within the range of 15–35 °C by employing suitable cooling mechanism. This study comprehensively compares multiple air-cooling configurations specifically designed for lithium-ion battery three-series and three-parallel (3S3P) modules using. The methodology involves an experimental phase to measure the parameters of Bernardi's equation, essential for calculating heat generation with consideration of both Joule's heat and entropic heat. Subsequently, a numerical simulation using Ansys Fluent examines battery heat generation within the 3S3P modules, employing diverse air-cooling configurations. Each configuration undergoes simulation with the aid of design of experiments and parametric analysis, allowing the observation of cooling behavior across various input parameters. To ensure reliability of simulation, the cooling of the unit cell module is simulated under similar conditions. The comparison between these simulated results and experimental values is conducted to validate the accuracy of the overall analysis methodology. The heat measurements indicated a unit cell heat output of 0.9028 W at an average rate of 0.85C. Among the investigated air-cooling configurations, the SIDO (Single Input Double Output) arrangement stood out as the most effective in maintaining a consistently lower average cell temperature, as determined through the application of the response curve method. This study emphasizes the importance of air-cooling design for improving the performance and safety of lithium-ion battery modules used in electric vehicles.

This clinical case presents a patient with NSCLC who experienced on-target resistant mutations and tumor cell transformation from adenocarcinoma to large cell neuroendocrine and small cell carcinoma. Our patient was successfully treated with a combination of targeted therapy, immunotherapy and chemotherapy based on genetic and histologic changes that occurred in a period of five years.

BACKGROUND: Nuclear protein transport is essential in guiding the traffic of important proteins and RNAs between the nucleus and cytoplasm. Export of proteins from the nucleus is mostly regulated by Exportin 1 (XPO1). In cancer, XPO1 is almost universally hyperactive and can promote the export of important tumor suppressors to the cytoplasm. Currently, there are no studies evaluating XPO1 amplifications and mutations in NSCLC and the impact on outcomes. METHODS: Tumor samples were analyzed using next-generation sequencing (NGS) (NextSeq, 592 Genes), immunohistochemistry (IHC), and whole transcriptome sequencing (WTS, NovaSeq) (Caris Life Sciences, Phoenix, AZ). Survival was extracted from insurance claims data and calculated from time of tissue collection to last contact using Kaplan-Meier estimate. RESULTS: Among 18,218 NSCLC tumors sequenced, 26 harbored XPO1 mutations and 24 had amplifications. XPO1 mutant tumors were more likely to have high TMB (79% vs. 52%, p = 0.007) and less likely to have high PD-L1 (32% vs. 68%, p = 0.03). KRAS co-mutations were seen in 19% (n = 5) and EGFR co-mutations were rare (n = 2). Among the 17,449 NSCLC tumors with clinical data, there were 24 XPO1 mutant. Comparison of survival between XPO1 mutant and WT showed a negative association with a hazard ratio (HR) of 1.932 (95% CI: 1.144-3.264 p = 0.012). XPO1 amplification was not associated with survival. CONCLUSIONS: XPO1 pathogenic mutations were associated with a poor survival in NSCLC. Although XPO1 mutations are rare in NSCLC, further studies to assess its associations with treatment responses are warranted.

Abstract Adenoviral vectors have been utilized for a variety of gene therapy applications. Our group has incorporated bioluminescent, fluorographic reporters, and/or suicide genes within the adenovirus genome for analytical and/or therapeutic purposes. These molecules have also been incorporated as capsid components. Recognizing that incorporations at either locale yield potential advantages and disadvantages, our report evaluates the benefits of transgene incorporation versus capsid incorporation. To this end, we have genetically incorporated firefly luciferase within the early region 3 or at minor capsid protein IX and compared vector functionality by means of reporter readout.

Background: COVID-19 pandemic has created many serious challenges to the frontline workers in their day-to-day job activities. Job satisfaction among healthcare workers is most predominant component to smooth functioning of institutional activities and to improve the quality of patient care. Objective: To find out job satisfaction among frontline healthcare workers during COVID-19 pandemic. Methods: A cross-sectional study was conducted among 228 healthcare workers (doctors and nurses) working in Chitwan Medical College Teaching Hospital (CMC-TH) during the COVID-19 pandemic. A simple random sampling technique was used to select the sample and a self-administered structured questionnaire with a job satisfaction scale was used to collect the data. Obtained data were analyzed in SPSS version 20 for Windows using descriptive and inferential statistics. Results: The majority (71.1%) of the healthcare workers were ambivalent whereas few (18%) were satisfied, and 11.0% were dissatisfied with their job during the COVID-19 pandemic. Healthcare workers' median percentage satisfaction score was higher on the domains of coworkers (70.8%), nature of work (70.8%), and supervision (70.8%) whereas lower on fringe benefits (54.2%), and contingent rewards (54.2%) other domains. There was a statistically significant association between job satisfaction level with age (p=0.037), marital status (p=

Solar irrigation pumps (SIPs) are emerging as a popular technology to address water, energy, and climate change challenges in South Asia while enhancing livelihoods and food security. SIPs are deemed to be a women-friendly renewable energy technology (RET) due to their design, operating system, and safety. While the gender dimensions of natural resources are well documented, the extent to which the water, energy, and food (WEF) policies—including policies to promote SIP technologies in the countries of South Asia—conceptualize and operationalize gender equality and social inclusion (GESI) is not well understood. Therefore, in this study, we reviewed 39 WEF sectoral policies of Bangladesh and Nepal by adopting a gender-transformative analysis approach to rank the policies on a continuum ranging from a scale of 0–3 (denoting gender-unaware, gender-aware, gender-responsive, and gender-transformative). We found that the governments in both countries commit to gender equality and women’s advancement in their WEF sector policies, institutions, and decision-making by ensuring gender and justice principles in their constitutions and national development frameworks. However, these higher-level aspirational principles are not always operationalized in the WEF sector policies. We found that the WEF policies are aware of the need to include GESI and social equity in sectoral programming, yet operational rules for their implementation often fail to challenge structural barriers. Such barriers hinder women and marginalized groups from participating in and benefiting from WEF policies, including the deployment of SIP technologies. This calls for a transformation not only in project implementation but also in the policymaking processes of WEF sectors in the South Asian region.

BackgroundInformal caregivers played a significant role in caring for COVID-19 patients during hospitalization in Nepal. This study aimed to understand the experiences of family caregivers attending to their relatives in a COVID-19 hospital in Nepal.MethodsA descriptive phenomenological approach was adopted to understand the caregiver's experience in supporting their relatives admitted to the COVID-19 hospital of the BP Koirala Institute of Health Sciences (BPKIHS). Thirteen caregivers of COVID-19 positive patients were purposively selected from April to June, 2022. Face-to-face interviews were conducted at a caregiver residential facility using the interview schedule developed by the department for the purpose of data collection after obtaining ethical clearance from the Institutional review committee of BPKIHS. Data were audio recorded and manually analyzed.ResultsAmong the 13 caregivers, six were male and seven were female. The findings were categorized into five domains: challenges encountered, changes in physical and mental health, changes in roles and responsibilities, positive experiences, and strategies to ease caregiving tasks. Major challenges included financial burdens, communication problems, stigmatization, Insecurity, substandard accommodation, and visitor restrictions. Caregivers reported negative emotions, unmet physical health needs, and shifts in family and occupational roles. Despite these challenges, caregivers attempted to cope positively and acknowledged the efforts of healthcare personnel and other family members. Suggestions for improving caregiving included providing essential medical and basic services within the hospital, enhancing accommodation facilities, establishing proper communication channels, and allowing visitations.ConclusionsCaregivers of COVID-19 patients face significant challenges during the caregiving process. Enhancing hospital services, promoting effective communication, fostering positive attitudes, and ensuring a safe environment can facilitate caregiving tasks.

The cross-border mobility of malaria cases poses an obstacle to malaria elimination programmes in many countries, including Nepal. Here, we develop a novel mathematical model to study how the imported malaria cases through the Nepal-India open-border affect the Nepal government's goal of eliminating malaria by 2026. Mathematical analyses and numerical simulations of our model, validated by malaria case data from Nepal, indicate that eliminating malaria from Nepal is possible if strategies promoting the absence of cross-border mobility, complete protection of transmission abroad, or strict border screening and isolation are implemented. For each strategy, we establish the conditions for the elimination of malaria. We further use our model to identify the control strategies that can help maintain a low endemic level. Our results show that the ideal control strategies should be designed according to the average mosquito biting rates that may depend on the location and season.

Agricultural technologies are often promoted as a medium for women’s economic empowerment, which can transform unequal gender relations in rural agrarian societies. This paper investigates three solar irrigation pump (SIP) schemes implemented by state and non-state actors and examines their impacts on women and marginal farmers. We utilize a theory of change framework intended to evaluate the effectiveness of livelihood interventions and guide the design of gender transformative interventions. Our analysis relies on 63 qualitative interviews, 9 key informant interviews and 4 telephonic interviews with social mobilisers from the Saptari District in Nepal. The findings shed light on the unequal social and gender relations that have skewed the adoption and benefits of SIP technology. Gender and social inequalities persist, with limited adoption and benefit of SIP among women and smallholders. Women’s involvement in strategic decisions related to SIP adoptions, installations and usages is limited. This study underscores the importance of strategic interventions that foster meaningful women’s empowerment and ensure equitable distribution and benefits from SIP technology. Assessing the effectiveness of SIPs in empowering women, it is crucial to consider whether the resulting access, ownership, or decision-making opportunities challenge, reinforce, or reproduce unequal gender and social relations.

The enactment of a new Constitution in 2015 in Nepal marked a shift to a representative system of federal governance. Earlier in 2002, the country's Tenth Five Year Plan had committed to a core focus on gender equality and social inclusion (GESI) in national policies and governance. How do these two strategic shifts in policy align in the case of WASH projects in rural Nepal? Applying a feminist political lens, we review the implementation of WASH initiatives in two rural districts to show that deep-rooted intersectional complexities of caste, class, and gender prevent inclusive WASH outcomes. Our findings show that the policy framing for gender equitable and socially inclusive outcomes have not impacted the WASH sector, where interventions continue as essentially technical interventions. While there has been significant increase in the number of women representatives in local governance structures since 2017, systemic, informal power relationship by caste, ethnicity and gender entrenched across institutional structures and cultures persist and continue to shape unequal gender-power dynamics. This is yet another example that shows that transformative change requires more than just affirmative policies.

Parkinson’s disease is a neurodegenerative disease resulting from the loss of dopamine-secreting neurons present in the substantia nigra of the brain. Parkinson’s disease is classified as early-onset and late-onset disease based on the time of its presentation. Since young patients with Parkinson’s disease have an atypical clinical presentation and have to deal with their careers, raising families, or both at the time of diagnosis and also have a higher risk of drug-related side effects, it poses unique challenges for the patient, clinical team, and community. We present the case of a 40-year-old female with young onset Parkinson’s disease from rural Nepal and the challenges faced during and after the disease in a resource-limited setting.

Purpose – The purpose of this study is to evaluate the prescribing pattern of proton pump inhibitors (PPIs) in patients visiting the outpatient general medical clinic in a Tertiary Care Teaching Hospital. Design/methodology/approach – A hospital-based cross-sectional study was conducted in 419 patients aged ≥18 years, visiting the outpatient general medicine clinic of a tertiary hospital and prescribed with at least one PPI, from July to September 2016 using a purposive sampling technique. Descriptive statistics were performed using IBM-SPSS 20.0 (IBM Corporation, Armonk, NY, USA). Findings – Patients were mostly less than 30 years (30.78%) and female (58.95%). Pantoprazole was the most frequently prescribed PPIs (57.04%). The majority of PPIs were prescribed for acid peptic disorder (APD) (33.65%), followed by non-steroidal anti-inflammatory drugs (NSAIDs) prophylaxis (30.79%). Most of the PPIs were prescribed for twice-daily administration (68.26%). Nearly one-fourth (21.72%) of the patients presented with at least one additional medical condition, and almost all (99%) patients were receiving at least one additional drug along with PPIs. Originality/value – The study suggests that PPIs are frequently prescribed and their use has been extended to other conditions that in fact do not require acid anti-secretory therapy. Result has highlighted the need for an interdisciplinary collaboration between pharmacists and medical professionals for the rational use of PPIs and promotion of PPIs prescription from the National List of Essential Medicines.

Introduction: Metabolic syndrome, a constellation of features such as obesity, hypertension, dyslipidemia and insulin resistance is of common occurrence in patients with psoriasis. Systemic inflammation is supposed to play a significant role in both conditions. The co-occurrence of metabolic syndrome and psoriasis can result in clinical consequences. The aim of this study was to find out the prevalence of metabolic syndrome among patients with psoriasis attending the Outpatient Department of Dermatology, Venereology and Leprology in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted in the Outpatient Department of Dermatology, Venereology and Leprology from 4 July 2022 to 4 May 2023. The ethical approval was obtained from Institutional Review Committee (Reference number: CMC-IRC/078/079-300). Patients aged more than 18 years diagnosed with psoriasis who provided written consent were enrolled in the study. Pregnant female patients and those who did not give informed consent were excluded from the study. Convenience sampling method was used. Point estimate and 90% Confidence Interval were calculated. Results: Among 72 patients with psoriasis, the prevalence of metabolic syndrome was 15 (20.83%) (12.98-28.68, 90% Confidence Interval). Obesity 13 (86.67%) and hypertriglyceridemia 13 (86.67%) were the frequent most individual components of metabolic syndrome. Conclusions: The prevalence of metabolic syndrome among psoriatic patients was lower than other studies done in similar settings.

Objective To determine the prevalence and associated factors of self-care behaviours among people with hypertension in the Kathmandu district of Nepal.Design Cross-sectional study.Setting Municipalities of Kathmandu district, Nepal.Participants We enrolled 375 adults aged ≥18 years with a minimum 1-year duration of hypertension using multistage sampling.Outcome measures We used the Hypertension Self-care Activity Level Effects to assess self-care behaviours and collected data through face-to-face interviews. We conducted univariate and multivariable logistic regression analyses to determine the factors associated with self-care behaviours. The results were summarised as crude and adjusted ORs (AORs) with 95% CIs.Results The adherence to antihypertensive medication, Dietary Approach to Stop Hypertension (DASH) diet, physical activity, weight management, alcohol moderation, and non-smoking were 61.3%, 9.3%, 59.2%, 14.1%, 90.9%, and 72.8%, respectively. Secondary or higher education (AOR: 4.42, 95% CI: 1.11 to 17.62), Brahmin and Chhetri ethnic groups (AOR: 3.30, 95% CI: 1.26 to 8.59) and good to very good perceived health (AOR: 3.96, 95% CI: 1.60 to 9.79) were positively associated with DASH diet adherence. Males (AOR: 2.05, 95% CI: 1.19 to 3.55) had higher odds of physical activity. Brahmin and Chhetri ethnic groups (AOR: 3.44, 95% CI: 1.63 to 7.26) and secondary or higher education (AOR: 4.70, 95% CI: 1.62 to 13.63) were correlates of weight management. Secondary or higher education (AOR: 2.47, 95% CI: 1.16 to 5.29), body mass index ≥25 kg/m2 (AOR: 1.83, 95% CI: 1.04 to 3.22) and income above the poverty line (AOR: 2.24, 95% CI: 1.08 to 4.63) were positively associated with non-smoking. Furthermore, Brahmin and Chhetri ethnic groups (AOR: 4.51, 95% CI: 1.64 to 12.40), males (AOR: 0.17, 95% CI: 0.06 to 0.50) and primary education (AOR: 0.26, 95% CI: 0.08 to 0.85) were associated with alcohol moderation.Conclusion The adherence to the DASH diet and weight management was particularly low. Healthcare providers and policymakers should focus on improving self-care by designing simple and affordable interventions for all patients with hypertension.