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Geologic reconstructions of the Main Himalayan Thrust in Nepal show a laterally extensive midcrustal ramp, hypothesized to form the downdip boundary of interseismic locking. Using a recent compilation of interseismic GPS velocities and a simplified model of fault coupling, we estimate the width of coupling across Nepal using a series of two-dimensional transects. We find that the downdip width of fault coupling increases smoothly from 70 to 90 km in eastern Nepal to 100–110 km in central Nepal, then narrows again in western Nepal. The inferred coupling transition is closely aligned with geologic reconstructions of the base of the midcrustal ramp in central and eastern Nepal, but in western Nepal, the data suggest that the location is intermediate between two proposed ramp locations. The result for western Nepal implies either an anomalous coupling transition that occurs along a shallowly dipping portion of the fault or that both ramps may be partially coupled and that a proposed crustal-scale duplexing process may be active during the interseismic period. We also find that the models require a convergence rate of 15.5 ± 2 mm/year throughout Nepal, reducing the geodetic moment accumulation rate by up to 30% compared with earlier models, partially resolving an inferred discrepancy between geodetic and paleoseismic estimates of moment release across the Himalaya.

Daniel J Kahn,1 Jane L Hubbard,2 Stephen Dunn,3 Alex Hoyt1 1School of Nursing, MGH Institute of Health Professions, Boston, MA, USA; 2Metabolism & Nutrition Research, Massachusetts General Hospital Translational & Clinical Research Center, Boston, MA, USA; 3Medical Education, Fenway Community Health Center, Boston, MA, USACorrespondence: Daniel J Kahn, MGH Institute of Health Professions, 36 First Ave, Boston, MA, 02129, USA, Email dkahn@mghihp.eduPurpose: Diet/nutrition is the first-line non-pharmacological therapy in the treatment of diabetes. Diet/nutrition counseling is infrequently provided by primary care providers (PCPs), who have limited nutrition education in both medical and advanced practice provider curricula. This quality improvement project aimed to improve knowledge and attitude, and frequency of diet/nutrition counseling by PCPs among patients with uncontrolled diabetes (glycosylated hemoglobin A1c ≥ 8%), by providing an online continuing medical education (CME) program on diabetes diet/nutrition.Methods: At a community health center in New England, PCPs attended a live 50-minute online CME program that was developed internally, which taught PCPs current diet/nutrition guidelines and recommendations related to diabetes. Knowledge was assessed prior to and two weeks following the program, utilizing a 10-question tool, the Nutrition Management of Diabetes Assessment (NMDA). Similarly, attitude was evaluated using two subscales of the Nutrition in Patient Care Survey (NIPS): Nutrition in routine care and Physician efficacy. Chart audits of patients with uncontrolled diabetes were evaluated to assess PCPs documentation of diet/nutrition counseling four weeks prior to and six weeks following the CME program.Results: In September 2023, PCPs (n = 29) completed the CME program. There was an improvement in knowledge in the NMDA amongst PCPs (36% difference, p < 0.001). Attitude scores from two subscales of the NIPS were evaluated and both showed improvement, however only physician efficacy was significant (15% difference, p < 0.01). There was a positive difference in the trend of diet/nutrition counseling after the education program (p < 0.05).Conclusion: An online CME program improved diabetes diet/nutrition knowledge and attitude of PCPs and improved counseling practices for patients living with uncontrolled diabetes. The education program provided PCPs current standards of care guidelines/recommendations, which they can utilize when counseling patients with diabetes. PCPs would benefit from dedicated continuing education programs regarding diet/nutrition therapy for chronic illnesses.Keywords: diabetes, nutrition, medical education, nutrition education, primary care provider