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This study aims to examine the administrative service delivery practices within the local government of Nepal and explore the intricate perceptions of the interplay between governance, service delivery, and citizens. The objectives include understanding the contextual elements that shape states, addressing concerns of developing nations, emphasizing service delivery, prioritizing citizen viewpoints, and tackling governance issues. Utilizing a mixed-methods approach grounded on post-positivism, the study employs purposeful sampling to select rural municipalities in Nepal. Data collection involves a quantitative institutional survey to assess the current state of public administrative services, with survey respondents comprising service providers and citizens. The respondents reported higher levels of satisfaction with the efficiency, timeliness, and resource availability of administrative services. However, the study also revealed gaps and disparities in the knowledge and perceptions of administrative practices and governance among different respondent groups and ecological regions. Emphasizing the significant advantages of collaboration, decentralization, people-centric development, and meaningful engagement, the study highlights the need for further research and policy interventions to enhance public service delivery and governance of local government in Nepal.

Introduction:: The Industrial Internet of Things (IIoT) is a technology that connects devices to collect data and conduct in-depth analysis to provide value-added services to industries. The integration of the physical and digital domains is crucial for unlocking the full potential of the IIoT, and digital twins can facilitate this integration by providing a virtual representation of real-world entities. Objectives:: By combining digital twins with the IIoT, industries can simulate, predict, and control physical behaviors, enabling them to achieve broader value and support industry 4.0 and 5.0. Constituents of cooperative IIoT domains tend to interact and collaborate during their complicated operations. Methods:: To secure such interaction and collaborations, we introduce a blockchain-based cross-domain authentication protocol for IIoT. The blockchain maintains only each domain’s dynamic accumulator, which accumulates crucial materials derived from devices, decreasing the overhead. In addition, we use the on-chain accumulator to effectively validate the unlinkable identities of cross-domain IIoT devices. Results:: The implementation of the concept reveals the fact that our protocol is efficient and reliable. This efficiency and reliability of our protocol is also substantiated through comparison with state-of-the-art literature. In contrast to related protocols, our protocol exhibits a minimum 22.67% increase in computation cost efficiency and a 16.35% rise in communication cost efficiency. Conclusion:: The developed protocol guarantees data transfer security across the domain and thwarts IoT devices from potential physical attacks. Additionally, in order to protect privacy, anonymity and unlinkability are also guaranteed.

Abstract In this paper, we explore correlators of a series of theories in anti-de Sitter space: we present comprehensive results for interactions involving scalars, gluons, and gravitons in multiple dimensions. One aspect of our investigation is the establishment of an intriguing connection between the kinematic factors of these theories; indeed, such a connection directly relates these theories among themselves and with other theories of higher spin fields. Besides providing several explicit results throughout the paper, we also highlight the interconnections and relationships between these different theories, providing valuable insights into their similarities and distinctions.

Studying public-private partnership practices in textbook publishing and distribution in Nepal offers insights into effective strategies for improving education quality through collaboration between government and private sectors. The objective of the study is to assess the effectiveness of public-private partnerships (PPPs) in enhancing education quality through improved textbook publishing and distribution mechanisms. The methodology employed in this study integrates descriptive and explanatory research approaches. It utilizes a structured questionnaire comprising 40 items rated on a 5-point Likert scale to evaluate different dimensions of PPPs concerning school textbook publication and distribution in Nepal. In this study, representatives from private organizations involved in textbook publishing and distribution in Nepal were interviewed. Sampling is conducted through random selection from a pool of 390 private organizations, aiming to ensure representation across various sectors. The model developed from this analysis had a strong explanatory power, with the identified independent variables explaining up to 48% of the variability in improving education quality through PPPs. The study concludes that emphasizing transparency, accountability, and effective communication within public-private partnerships significantly contributes to enhancing education quality through improved textbook publishing and distribution mechanisms, supported by strong correlations between these factors and overall education quality, as revealed by advanced statistical methods.

Abstract Background Low skeletal muscle mass (LSMM) and/or, function associated with an increased risk of treatment‐related toxicities and inferior overall survival (OS) among adults with solid malignancies. However, the association between LSMM and treatment‐related toxicities among adults with haematologic malignancies remains unclear. Methods Using a pre‐published protocol (CRD42020197814), we searched seven bibliographic databases from inception to 08/2021 for studies reporting the impact of LSMM among adults ≥18 years with a known haematologic malignancy. The primary outcome of interest was OS, and secondary outcomes included progression free survival (PFS) and non‐relapse mortality (NRM). These effect sizes were quantified in terms of hazards ratio (HR) along with 95% confidence interval (CI) and pooled across studies using a DerSimonian–Laird random‐effects model. Heterogeneity was assessed using the Cochran's Q and the I2 statistic. All hypothesis testing was two‐sided with an alpha of 0.05. Results Of 3791 studies screened, we identified 20 studies involving 3468 patients with a mean age of 60 years; 44% were female and the most common malignancy was diffuse large B‐cell lymphoma (42%). Most studies measured muscle mass using single slice computed tomography imaging at the L3 level. The presence of LSMM was associated with worse OS (pooled HR = 1.81, 95% CI = 1.48–2.22, P

Abstract Background Strategies to enhance clinicians’ adherence to validated imaging decision rules and increase the appropriateness of imaging remain unclear. Objective To evaluate the effectiveness of various implementation strategies for increasing clinicians’ use of five validated imaging decision rules (Ottawa Ankle Rules, Ottawa Knee Rule, Canadian C-Spine Rule, National Emergency X-Radiography Utilization Study and Canadian Computed Tomography Head Rule). Design Systematic review. Methods The inclusion criteria were experimental, quasi-experimental study designs comprising randomised controlled trials (RCTs), non-randomised controlled trials, and single-arm trials (i.e. prospective observational studies) of implementation interventions in any care setting. The search encompassed electronic databases up to March 11, 2024, including MEDLINE (via Ovid), CINAHL (via EBSCO), EMBASE (via Ovid), Cochrane CENTRAL, Web of Science, and Scopus. Two reviewers assessed the risk of bias of studies independently using the Cochrane Effective Practice and Organization of Care Group (EPOC) risk of bias tool. The primary outcome was clinicians’ use of decision rules. Secondary outcomes included imaging use (indicated, non-indicated and overall) and knowledge of the rules. Results We included 22 studies (5-RCTs, 1-non-RCT and 16-single-arm trials), conducted in emergency care settings in six countries (USA, Canada, UK, Australia, Ireland and France). One RCT suggested that reminders may be effective at increasing clinicians’ use of Ottawa Ankle Rules but may also increase the use of ankle radiography. Two RCTs that combined multiple intervention strategies showed mixed results for ankle imaging and head CT use. One combining educational meetings and materials on Ottawa Ankle Rules reduced ankle injury imaging among ED physicians, while another, with similar efforts plus clinical practice guidelines and reminders for the Canadian CT Head Rule, increased CT imaging for head injuries. For knowledge, one RCT suggested that distributing guidelines had a limited short-term impact but improved clinicians’ long-term knowledge of the Ottawa Ankle Rules. Conclusion Interventions such as pop-up reminders, educational meetings, and posters may improve adherence to the Ottawa Ankle Rules, Ottawa Knee Rule, and Canadian CT Head Rule. Reminders may reduce non-indicated imaging for knee and ankle injuries. The uncertain quality of evidence indicates the need for well-conducted RCTs to establish effectiveness of implementation strategies.

Abstract Background Tuberculosis (TB) remains a major public health problem in Nepal, high in settings marked by prevalent gender and social inequities. Various social stratifiers intersect, either privileging or oppressing individuals based on their characteristics and contexts, thereby increasing risks, vulnerabilities and marganilisation associated with TB. This study aimed to assess the inclusiveness of gender and other social stratifiers in key health related national policies and the Health Management Information System (HMIS) of National Tuberculosis Programme (NTP) by conducting an intersectional analysis of TB cases recorded via HMIS. Methods A desk review of key policies and the NTP’s HMIS was conducted. Retrospective intersectional analysis utilized two secondary data sources: annual NTP report (2017–2021) and records of 628 TB cases via HMIS 6.5 from two TB centres (2017/18–2018/19). Chi-square test and multi-variate analysis was used to assess the association between social stratifers and types of TB, registration category and treatment outcome. Results Gender, social inclusion and concept of intersectionality are incorporated into various health policies and strategies but lack effective implementation. NTP has initiated the collection of age, sex, ethnicity and location data since 2014/15 through the HMIS. However, only age and sex disaggregated data are routinely reported, leaving recorded social stratifiers of TB patients static without analysis and dissemination. Furthermore, findings from the intersectional analysis using TB secondary data, showed that male more than 25 years exhibited higher odds [adjusted odds ratio (aOR) = 4.95, 95% confidence interval (CI): 1.60–19.06, P = 0.01)] of successful outcome compared to male TB patients less than 25 years. Similarly, sex was significantly associated with types of TB (P

Abstract Amidst intensifying global agricultural water demand, optimizing management practices and understanding the role of soil amendments, particularly biochar (BC), in modulating soil water dynamics are critical. Here, we review the potential impacts of BC on soil water dynamics, elucidate mechanistic underpinnings, and identify critical research gaps and prospective avenues. In general, BC modifies soil structure, hydraulic properties, surface albedo, and heat fluxes, which influence soil water storage, energy balance, and irrigation paradigms. Depending on soil texture and BC properties, BC demonstrates a greater reduction in bulk density and saturated hydraulic conductivity in coarse-textured soils compared to fine-textured soils. BC application generally increases water holding capacity (WHC) while exhibiting no consistent impact on soil water infiltration. Increased WHC of soils results from increased porosity, surface area, and soil aggregation. Increased porosity arises from a confluence of factors, encompassing new pores formation, reorganization of pores, increased soil aggregation, dilution effects of BC, reduced soil compaction, and biotic interactions, including increased population of burrowing invertebrates. BC tends to increase plant-available water in coarser soils, attributed to its hydrophilic nature, augmented specific surface area, and enhanced overall porosity. However, BC may induce soil water repellency, contingent upon variables such as feedstock composition, pyrolysis temperature, and specific soil attributes. While BC exhibits transformative potential in enhancing soil hydraulic properties, scalability concerns and economic viability pose challenges to its widespread agricultural application. Overall, BC offers promising avenues for sustainable water management. However, it is imperative to explore large-scale applications and conduct long-term field studies across different management, climate, and soil types to fully understand how different types of BC impact soil water dynamics. Graphical Abstract

IntroductionGlucagon-like peptide 1 receptor agonists (GLP-1 RA) have been extensively used to treat obesity in recent years. These novel drugs are effective at reducing body weight and also the risk of major adverse cardiovascular events in individuals with type 2 diabetes. However, the data of its efficacy in reducing cardiovascular events in individuals without type 2 diabetes is not as robust. We aim to update and conduct a systematic review and meta-analysis to assess the same.MethodsThe study was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guideline. Researchers searched PubMed, EMBASE, and Clinicaltrails.gov for English literature from inception to 2024. Randomized Controlled trails enrolling adult participants (age ≥ 18 years) who are overweight or obese (BMI > 25 Kg/m2) with a comparison of all cardiovascular events between patients taking GLP1-RA and placebo were included. The analysis was done by Revman version 5.4.ResultsA total of 17 RCTs among 34,419 participants were included in the analysis. The pooled risk ratio from 17 studies illustrated that patients with GLP-1 RA had a significantly lower risk of cardiovascular events compared to patients who had a placebo (RR = 0.75; 95% confidence interval 0.64–0.89, p-value = 0.0008). Semaglutide was found to have a statistically significant greatest risk reduction than other drug types.ConclusionsThis meta-analysis found that GLP-1 RA significantly reduced all types of cardiovascular events in overweight and obese patients without diabetes. Semaglutide was found to be superior to others in CV event reductions. But still, the results of ongoing trials are needed.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=553048, PROSPERO (CRD42024553048).

Multidetector computed tomography is considered a reliable, non-invasive modality for diagnosing myocardial bridging. The prevalence of myocardial bridges varies greatly based on the technique used to identify the anomaly. We aimed to evaluate the frequency and morphological features of myocardial bridging in patients who underwent ECG-gated 640 slice Multidetector computed tomography coronary angiography at Shahid Gangalal National Heart Centre.

75% of the world's poor reside in rural areas where the local economy is tied to agriculture. We interpret new panel data on COVID-19 from Nepal and Bangladesh in relation to agricultural seasonality. Conditions in April–June 2020 were comparable to a typical lean season even though the pandemic arrived at harvest time. Income losses stem from both depressed local employment as well as lower migration and remittances. We also document indirect adverse health impacts on nutrition and mental health. Findings are specific to the nature of economic activity at harvest, and effective pandemic policy must evolve with the agricultural season.

This study aims to examine the key economic indicators with private sector credit and economic growth in Nepal. Commercial banks and other financial institutions lend money to businesses and individuals for investment and consumption. This study aims to analyze key economic indicators in Nepal, including Real Gross Domestic Product (RGDP), Private Sector Credit (PSC), and Gross Capital Formation (GCF), spanning from 1975 to 2022. Employing a quantitative methodology, econometric techniques such as time series analysis, regression modeling, and hypothesis testing were utilized to examine the long-term relationships among these variables, with a particular focus on the impact of Private Sector Credit on Economic Growth (EG). The findings, derived from comprehensive econometric analyses including co-integration tests and vector error correction models, reveal significant insights into Nepal's economic performance and financial system. Results indicate that Private Sector Credit plays a crucial role in stimulating economic growth, with approximately 40.07% of the previous year's imbalance influenced by the long-term elasticity of independent variables. These findings offer valuable insights for policymakers, businesses, and investors, facilitating informed decision-making to promote sustainable economic development in Nepal. Further research is recommended to explore the correlation between the diversification of Private Sector Credit types and economic growth more comprehensively.

Rapid urbanization has caused a worldwide increase in the discharge of wastewater effluent. Although Nepal has a noteworthy history of wastewater management, progress in this field has been hindered by persistent issues. These problems encompass insufficient sewer coverage, deficient treatment and sludge disposal facilities, inadequate treatment infrastructure, lack of coherent institutional frameworks, and a lack of comprehensive planning. This review provides a glimpse into Nepal's current urban wastewater landscape while also offering a concise historical overview of its wastewater management trends. The study gathered data, information from government organizations, as well as related research, review articles, and reports from 1999 to 2023. Our findings reveal that more than 85% of urban households in Nepal rely on onsite sanitation, with limited access to septage treatment facilities. The ratio of wastewater treatment to generation is disconcertingly low, further emphasized by the concentration of centralized treatment plants in the capital city. This low ratio underscores the inadequacy of the existing wastewater system and the novice approaches of the government, which contribute to the poor sewerage facilities in Nepal. This study unequivocally highlights the imperative need for functional and institutional hierarchy emphasizing local communities, substantial changes in resource allocation, governance practices, and technical infrastructure. HIGHLIGHTS Nepal is struggling with urban wastewater challenges due to a lack of infrastructure.; Over 85% of urban households are mainly relying on onsite sanitation systems.; Two of seven provinces provide public sewerage systems covering about 10% of the total households.; Advanced treatment technologies are suggested in conjunction with conventional ones.; Proper resource allocation, good governance, and technical skills enhancement are urgent in countries like Nepal, to achieve SDG-6.;

This study aims to examine the degree of financial literacy and practices of financial knowledge among MBA students in Nepal. Four prominent universities were selected for study: Tribhuvan University, Kathmandu University, Pokhara University, and Purbanchal University. The descriptive and analytical research approach was applied to analyze the data. Data were collected through questionnaires from 320 students by using convenience and stratified sampling methods. The analysis was conducted using the SPSS software system. The results highlight the complex interplay of factors influencing financial behavior and literacy among MBA students, emphasizing the importance of education, familial influence, and media exposure in shaping financial attitudes and decision-making. The study delves into several key aspects of financial behavior, influence, attitude, literacy, and knowledge sources among MBA students. Notably, respondents displayed positive financial behaviors such as reading for knowledge enhancement and prudent spending practices. Parental influence emerged as the most significant factor shaping financial decisions, followed by media and internet exposure. Respondents generally exhibited a favorable financial outlook and demonstrated understanding in various financial literacy domains, though areas for improvement, particularly in investment risk comprehension, were identified. The study shows how education, family influence, and media exposure affect MBA student’s financial think, how people handle finance, like their education and where they get information from. This is seen as reflected in financial literacy scores ranging from 1.43 to 3.86, with an average of 2.405 and a standard deviation of 0.449, suggesting below-average scores and reduced unpredictability.

Nepal’s non-life insurance sector holds immense potential to drive economic growth and boost the nation towards a secure financial future. Embracing this potential is a goal and a pivotal catalyst for substantial change. The study aims to determine how the non-life insurance sector can drive economic growth in Nepal. The methodology of this study uses quantitative analysis of financial data from 2013 to 2022 from 20 non-life insurance companies in Nepal and econometric modeling to assess the sector’s impact on economic growth. Using Panel EGLS (Estimated Generalized Least Squares) regression analysis, the findings show that with one-unit increments in total investment, total premium, and total tax paid, GDP is expected to change by approximately 591.52, –920.54 and 8,470.65 units, respectively. In contrast, the coefficient for total profit is –910.3477 and is not statistically significant. The study’s main conclusion implies that the insurance sector contributes to the country’s economic growth by investing in productive activities and paying taxes to the government. Still, it also imposes a cost on the economy by charging high premiums to the insured. The profitability of the insurance sector does not affect the GDP, which indicates that the insurance sector is competitive and efficient or that other factors determine the GDP besides the insurance sector. This study contributes to a deeper understanding of the non-life insurance sector’s role in Nepal’s economic development and informs evidence-based policy decisions.

Abstract Due to their distinctive morphology, significant surface-to-volume ratio, and metal-like electrical conductivity, MXenes have emerged as highly promising gas-sensing materials. Traditional MXene-based gas sensors predominantly rely on the electrical conductivity of MXenes for signal transduction. However, it is crucial to explore alternative signal transduction mechanisms to fully unlock the potential of MXenes in gas sensing applications. In this study, we have successfully showcased the development of a mass-transduction-based MXene gas sensor, utilizing MXenes as the adaptable receptor and MQTF as the transducer. The interaction between the gas analyte and MXenes induces a change in mass, resulting in a resonant frequency shift of the MQTF. This signal transduction mechanism eliminates the dependency on the electrical conductivity of MXenes, offering a broader range of possibilities for chemical modification of MXenes without concerns about compromising their conductivity. By engineering Ti3C2Tx surfaces, we have demonstrated high sensitivity and selectivity tuning of MXene-MQTF gas sensors for detecting CO, SO2, and NH3. This antisymmetric mass-transduction-based (low-cost, stable, sensitive, and practical tuning fork-based) MXene gas sensor demonstrated exceptional sensing performance, customizable selectivity, and high cost-effectiveness. This study paves the way for designing high-performance MXene-based chemical sensors and expands the scope of potential applications in air quality monitoring, wearable devices, the Internet of Things (IoT), and robotics.

This study aims to analyze the reliability of Nepal’s industrial policies, focusing on the effects of macroeconomic variables on implementation and outcomes. This paper assesses Nepal’s industrial policies, emphasizing the need for improvements, export promotion, and human capital development while recognizing the importance of strategic planning and context-specific approaches for economic growth, stability, and development. The analytical and descriptive approaches have been applied to analyze the data by collecting secondary data sources that include official publications, which encompass 47 time series variables from 1974 to 2020. The findings provide mixed evidence for the economic impacts of liberalization, with exports and liberalization driving overall GDP growth. In contrast, other factors like economic openness, tourism, and their relationship with industrial GDP remain statistically insignificant. The paper indicates that remittances and investment have the most substantial impact on GDP, raising it by 1.86 and 1.21 units per unit increase, respectively. Exports have a moderate impact on industrial GDP (0.403 units). Export-oriented industries and tourism lack significant associations with either type of GDP. Liberalization significantly boosted both GDP and industrial GDP, with an increase of 179465.3 and 49595.62 units, respectively. Imports also jumped post-liberalization, driven by higher remittances as 1.215 units per unit increase. This study on industrial policies in developing economies, focusing on Nepal, adds valuable insights. The findings can ensure policymaking, boost economic growth, and strengthen Nepal’s industrial sector.

The traditional bundle relaying scheme rarely utilizes the impact of selfish nodes in Vehicular Delay Tolerant Networks (VDTNs) that may not be able to transmit messages to other nodes because of limited resources in the road transport system. Here the Railway Transport System (RTS) is used to transfer the data from one end to another end into the network. In RTS, the proposed approach utilizes stationary nodes deployed along the railway tracks (usually at railway stations) with a large memory size, known as Track Side Units (TSUs), and mobile nodes which are trains equipped with devices having large buffer capacity and message relaying capability. In this paper, the VDTN scenario is developed using RTS in which all nodes have high buffer capacity and power availability hence storage and transfer of message bundles will be done through all nodes. Further, this paper proposed a novel model for transmitting data in VDTN environment using an Efficient Deterministic Bundle Relaying Scheme with Bulk Bundle Release (DBRS-BBR). To validate this, a mathematical model of queuing processes, M/G/1: FIFO/ $\infty /\infty $ , is applied at the TSUs and mobile units, and a Deterministic Scheduling technique is applied for relaying the bundles. To evaluate the proposed DBRS-BBR scheme, different performance measures are used, including Mean Queueing Delay, Mean Transit Delay, and Mean End-To-End Delay. This proposed scheme has the potential to improve message bundle transmission in remote areas and it outperforms the existing Probabilistic Bundle Relaying Scheme with Bulk Bundle Release (PBRS-BBR) in terms of various performance measures.

Device-to-device communication in the Internet of Things (IoT) enables seamless data exchange, aiding automation, monitoring, and control. Yet, sustainability challenges arise due to energy-limited devices. This paper presents a novel method for Indoor IoT sensors to function without batteries. A broadband rectenna on low-cost FR4 substrate is proposed, mitigating battery constraints. It integrates a circularly polarized (CP) antenna with an Artificial Magnetic Conductor (AMC) and a RF-to-DC rectifier. A coplanar waveguide fed CP (CPW-CP) antenna achieves a broad axial ratio bandwidth (ARBW) of 19.6% (AR $\Omega $ load. PCE variation within ARBW is only 5-8%. The RF-DC rectifier is integrated with the enhanced gain CPW-CP antenna to form a rectenna which is fabricated and measured. The experimental results comply with the simulated results, and the experimental validation demonstrates the rectenna’s effectiveness in charging a 0.1 pF capacitor within 2 ms in an indoor environment equipped with a Wi-Fi router. This innovative design marks a promising step towards addressing energy constraints in IoT devices, facilitating their long-term operation and deployment in diverse settings.

This study aims to explore the relationship between economic growth and performance in Nepal, identifying key drivers for growth. Studying the nexus between economic growth and economic performance in Nepal is crucial for understanding how these factors interact within the nation’s specific context. Growth of gross domestic product (GDP) is represented as the primary indicator for evaluating economic performance, reflecting the overall well-being of a nation's economy. Economic performance encompasses a broader spectrum, including indicators such as employment rate, inflation, income distribution and overall economic stability. Using E-Views 10, a descriptive and analytical research approach has been applied to analyze time series secondary data from 1990–2021 using an econometric model. This study found that faster-growing economies typically experience increased jobs, higher investment, more exports, and often lower inflation. These relationships are part of a long-run equilibrium relationship. In the event of an economic shock disrupting this equilibrium, the economy tends to naturally return to the equilibrium over time. This study found that short-term causality running from lagged GDP, gross capital formation (GCF), exports, human development index (HDI), and employment ratio influence immediate GDP growth. These variables wield a short-term influence over GDP growth; for instance, a sudden surge in exports can prompt a temporary boost in economic growth. This indicates that there is a long-term sustained link between GDP growth and the independent variables rather than merely a short-term event.

The capacity of foreign trade to substantially raise GDP via increased exports, heightened competition, and enhanced efficiency holds the key to bolstering economic growth and prosperity. Recognizing this transformation underscores the importance of shaping Nepal’s economic policies and development strategies for achieving lasting sustainable growth. The objective of this study is to investigate how trade openness has affected Nepal’s economic growth, given its importance in the nation’s overall development. By analyzing the correlation between trade openness and economic expansion, policymakers and researchers can uncover the role of international trade in driving Nepal’s economic advancement. The research methodology involves constructing a regression model using the Autoregressive Distributed Lag bound test, with variables analyzed in growth form and subjected to the Augmented Dickey-Fuller and residual tests. The study’s results indicate a strong positive relationship between trade openness and economic growth in Nepal from 1975 to 2020, with a long-term equilibrium observed. Short-term deviations from equilibrium are quickly corrected at 38.23% annually, highlighting the importance of balanced export and import growth for economic development. The study concludes that trade openness drives Nepal’s economic growth for sustainable development and environmental protection. It offers valuable insights for policymakers and stakeholders to enhance economic growth and overall development of the country.

Hypersensitivity to aspirin is rare disorder occurring in 1.88% of the patients. Aspirin-hypersensitive patients requiring single antiplatelet agent may be treated with clopidogrel, an alternative antiplatelet agent. However, aspirin desensitization is more cost-effective than the usage of clopidogrel in these patients. Furthermore, aspirin desensitization is of greater value in patients requiring dual antiplatelet therapy, for example following procedures like percutaneous transluminal coronary angioplasty (PTCA) instead of using non-aspirin-based combinations. Herein, we report a 74-year-old hypertensive male presented with features of acute coronary syndrome and planned for percutaneous transluminal coronary angioplasty of RCA followed by dual antiplatelet therapy. Since he had aspirin allergy, desensitization was done using rapid desensitization protocol for which he responded well. This case highlights the importance of aspirin-desensitization in patients with aspirin allergy instead of choosing non-aspirin based antiplatelet agents.

Abstract Purpose The US Food and Drug Administration authorized lecanemab for the therapeutic use of Alzheimer's disease (AD) in January 2023. To assess the effectiveness and safety of lecanemab in treating AD, we thoroughly examined the studies that are currently accessible. Method Preferred Reporting Items for Systematic Reviews and Meta‐Analysis recommendations were followed. In order to find relevant studies on lecanemab, we carried out a thorough literature search utilizing the electronic databases MEDLINE via PubMed, Cochrane, Web of Science, EBSCOhost, and Scopus. Excluding any research using experimental animals, we looked at lecanemab's effectiveness and side effects in treating AD in human clinical trials. Three randomized controlled studies were included. Findings According to studies, lecanemab lessens clinical deterioration and reduces brain amyloid‐beta plaques (difference,.45; 95% confidence interval,.67 to.23; p

Background: Systemic Lupus Erythematosus is a multi-systemic disease that has a high morbidity rate. Choroids usually have a distinct structural makeup in different systemic disorders which makes it easier to be used as a potential tool for the study of disease activity. Methods: This study was an observational cross-sectional prospective study with a total of 51 Systemic Lupus Erythematosus patients and 51 normal controls were included. The choroidal thickness values were determined using the Spectralis Spectral Domain Optical Coherence Tomography instrument (Heidelberg Engineering). Results: The results showed that the mean subfoveal, nasal, and temporal choroidal thickness in Systemic Lupus Erythematosus patients with ocular manifestations had thinner choroidal thickness compared to normal controls with p

Considering recent earthquakes and the COVID-19 pandemic, disaster preparedness has come to the forefront of the public health agenda in Nepal. To strengthen the developing health system, many initiatives are being implemented at different levels of society to build resiliency, one of which is through training and education. The first International Conference on Disaster Preparedness and Management convened in Dhulikhel, Nepal on December 1–3, 2023. It brought together international teaching faculty to help deliver didactic and simulation-based sessions on various topics pertaining to disaster preparedness and management for over 140 Nepali healthcare professionals. This paper focuses on the tabletop exercise-based longitudinal workshop portion of the conference on disaster leadership and communication, delivered by United States-based faculty. It delves into the educational program and curriculum, delivery method, Nepali organizer and US facilitator reflections, and provides recommendations for such future conferences, and adaptation to other settings.

Whitefly-transmitted viruses have emerged as a major threat to cucurbit production in the United States during the past several decades. Cucurbit chlorotic yellows virus (CCYV), Cucurbit yellow stunting disorder virus (CYSDV), and Cucurbit leaf crumple virus (CuLCrV) are the main arthropod-borne plant viruses in cucurbit crops, including yellow squash (Cucurbita pepo). Symptoms of these viruses include interveinal chlorosis, chlorotic spots, yellowing, and curling of the leaves. The evaluation of specific viruses affecting a plant is challenging because of the prevalence of mixed infections in naturally infected fields. To devise an efficient breeding-based management approach, two PI lines (PI 171625 and PI 171627) were screened in a greenhouse to assess their resistance to individual infections of CCYV and CuLCrV. These lines were compared against a susceptible cultivar Gentry in two separate trials. PI 171627 displayed delayed symptoms, a reduced virus load, and a smaller area under the disease progress curve (AUDPC) compared with PI 171625 and susceptible cultivar Gentry when the plants were infected with CCYV. However, the AUDPC for CuLCrV was the same for both genotypes and the commercial line. Accession PI 171627, which displayed delayed and milder symptoms, could potentially provide a source for resistance against CCYV for breeding program. Future research is needed to comprehend the underlaying mechanism to understand this response.

A case of a 61-year male presented with chief complaints of fever for three months. Diagnosis of hemophagocytic lymphohistiocytosis was made after liver biopsy when Positron-Emission Tomography revealed multiple fluoro deoxy glucose avid lesions in the liver. The patient of this disease typically presents with fever, splenomegaly, hyperferritinemia, hypertriglyceridemia, raised liver enzymes, and marrow features suggestive of hemophagocytosis. The treatment is usually systemic corticosteroids, chemotherapy with etoposide, cyclosporine, or hematopoietic stem cell transplantation, depending on the cause. A diagnosis like hemophagocytic lymphohistiocytosis can easily be missed in developing countries with low resources like Nepal. Hence, this disease should be suspected in patients presenting with pyrexia of unknown origin by treating physicians.

The use of flume tanks for tomato processing has been identified as a potential source of cross-contamination, which could result in foodborne illness. This study's objective was to assess the efficacy of peroxyacetic acid (PAA) at a concentration of ≤80 mg/L in preventing Salmonella enterica cross-contamination under various organic loads in a benchtop model tomato flume tank. The stability of 80 mg/L PAA at different chemical oxygen demand (COD) levels was also tested. Tomatoes were spot inoculated with a five-serovar rifampin-resistant (rif+) Salmonella cocktail (106 or 108 colony forming unit (CFU)/tomato). Inoculated (n = 3) and uninoculated (n = 9) tomatoes were introduced into the flume system containing 0–80 mg/L PAA and 0 or 300 mg/L COD. After washing for 30, 60, or 120 s, uninoculated tomatoes were sampled and analyzed for cross-contamination. All experiments were conducted in triplicate. Increasing the organic load (measured as COD) affected the stability of PAA in water with significantly faster dissociation when exposed to 300 mg/L COD. The concentration of PAA, inoculum level, COD levels, and time intervals were all significant factors that affected cross-contamination. Cross-contamination occurred at the high inoculum level (108 CFU/tomato) even when 80 mg/L PAA was present in the model flume tank, regardless of the organic load level. When the tomatoes were contaminated at a level of 106 CFU/tomato, concentrations as low as 5 mg/L of PAA were effective in preventing cross-contamination at 0 mg/L COD; however, 100 % tomatoes (9/9) were positive when the organic load increased to 300 mg/L COD. When the PAA concentration was increased to 10 mg/L, it effectively prevented cross-contamination in the tank, regardless of the presence of organic load. These results suggest that using PAA at concentrations below the maximum limit remains effective in limiting bacterial cross-contamination and offers a more environment-friendly option for tomato packinghouse operators.

Article accepted. The article will be published here soon. Pending final quality checks.