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Abstract Field-particle energy exchange is important to the magnetic reconnection process, but uncertainties regarding the time evolution of this exchange remain. We investigate the temporal dynamics of field-particle energy exchange during magnetic reconnection, using Magnetospheric Multiscale mission observations of an electron-only reconnection event in the magnetosheath. The electron energy is in local minimum at the x-line due to a density depletion, while the magnetic energy is in local maximum due to a guide field enhancement. The electromagnetic energy transport comes almost entirely from guide field contributions and is confined within the reconnection plane, while the most significant contribution to electron energy transport is independent of the drift velocity with additional out-of-plane signatures. Multi-spacecraft analysis suggests that the guide field energy is decreasing while the electron density is increasing, both evolving such that the system is moving toward a more uniform distribution of magnetic and thermal energy.

There is a substantial trade in renewable environmental products, including medicinal and spice plants. Yet, their production networks remain largely unknown. Here, using a global production network approach, we unravel the trade for such products in the Himalayan foothills of Nepal, focusing on how values are created, enhanced, and captured. We conducted quantitative interviews with harvesters (n = 25), traders (n = 12), and central wholesalers (n = 2) in 2014–15 and with traders (n = 5) in 2021–22 in Kailali District of Sudurpaschim Province, Nepal. All traders from the district were interviewed in both case years. We found that harvesters created and enhanced value by wild-harvesting, cultivating, and air-drying 10 products from nine species in 2014–15 and 14 products from 13 species in 2021–22. The total annual trade increased from 151 to 340 tons in the period, and the value rose from USD 103,939 to USD 125,800 (in 2021–22 prices). The trade was dominated by the cultivated tejpat leaves (Cinnamomum tamala) and the leaves of kadipatta (Murraya koenigii) in 2021–22. Traders and central wholesalers enhanced value through transport, not processing. Secondary processing in the district was limited, resulting in missed opportunities for added value through processing. Non-firm actors captured value in connection to issuing collection, trade, and export permits. An average of 68 % of volume and 86 % of harvester value were sourced from cultivation, showing the growing importance of these species for supplementary rural income in the lowlands. The process of increased commercialisation reflects similar changes in the neighbouring countries. Finally, we conclude that the global production network approach can be applied to examine the dynamics of South-South trade in renewable environmental products, even in the absence of a lead firm.

Cardiovascular disease is the leading cause of death in women, and women with chronic kidney disease (CKD) experience especially elevated risk. This study examined the association between testosterone and vascular function in 61 reproductive-aged females with CKD. Testosterone levels and measures of vascular function were assessed, including pulse wave velocity, aortic augmentation, flow-mediated dilation (FMD), and velocity time integral. Multivariable linear regression analyses assessed the relationship between testosterone and each measure of vascular function. No associations were observed between testosterone and vascular function outcomes, although a significant positive association between testosterone-to-estradiol ratio and FMD was demonstrated. Although testosterone levels were not independently predictive of vascular function, the level of testosterone relative to estradiol was associated with FMD and may therefore influence endothelial function in the high-risk population of reproductive-aged female patients with CKD. Résumé: Alors que les maladies cardiovasculaires sont la cause principale de décès chez les femmes, les femmes atteintes d’une maladie rénale chronique (MRC) sont exposées à un risque particulièrement élevé. La présente étude vise à examiner l’association entre la testostérone et la fonction vasculaire de 61 femmes en âge de procréer atteintes d’une MCV. Nous avons évalué les concentrations de testostérone et les mesures de la fonction vasculaire, soit la vélocité de l’onde de pouls, l’augmentation de l’aorte, la dilatation médiée par le flux (DMF) et l’intégrale temps-vitesse. Les analyses multivariées de régression linéaire ont permis d’évaluer la relation entre la testostérone et chacune des mesures de la fonction vasculaire. Aucune association n’a été observée entre la testostérone et les résultats de la fonction vasculaire, bien qu’une association positive significative entre le ratio testostérone/œstradiol et la DMF ait été démontrée. Bien que les concentrations de testostérone n’étaient pas indépendamment prédictives de la fonction vasculaire, les concentrations de la testostérone relativement à l’œstradiol ont été associées à la DMF et peuvent par conséquent influencer la fonction endothéliale au sein de la population exposée à un risque élevé composée de patientes en âge de procréer atteintes d’une MRC.

Background: Various adjuvants have been added in Brachial plexus block but only few studies have reported the use of dexmedetomidine. Alpha 2 agonist Dexmedetomidine used as an adjuvant to the local anesthetic has been suggested to prolong the duration of peripheral nerve block. The objective of this study is to compare the effect adding Dexmedetomidine to Ropivacaine in Supraclavicular brachial plexus block Materials and Methods: A Quantitative, comparative cross sectional prospective study was conducted in 78 patients randomly allocated into three groups. Group R received 30ml of 0.5% Ropivacaine, Group B received 30ml of 0.5% Ropivacaine + 50mcg of Dexmedetomidine for supraclavicular block and Group Y received 30ml of 0.5% Ropivacaine 0.5% for supraclavicular block and intravenous Dexmedetomidine 50mcg . The onset time to sensory and motor blockade, duration of sensory and motor block and duration of analgesia were recorded. Results: The onset of Sensory block and motor block was earlier in group B than in group Y and group R. The duration of sensory block and motor block duration was also prolonged in group B when compared with group Y and group R. The duration of analgesia was significantly longer in group B, and group Y when compared to group R. Conclusion: Dexmedetomidine as an adjuvant to Ropivacaine decreases the sensory as well as motor block onset time, prolongs sensory and motor block duration and also increases the duration of analgesia. The action of Dexmedetomidine most probably is local rather than centrally mediated.

We report observations of reconnection exhausts in the Heliospheric Current Sheet (HCS) during Parker Solar Probe Encounters 08 and 07, at 16 R s and 20 R s , respectively. Heliospheric current sheet (HCS) reconnection accelerated protons to almost twice the solar wind speed and increased the proton core energy by a factor of ∼3, due to the Alfvén speed being comparable to the solar wind flow speed at these near-Sun distances. Furthermore, protons were energized to super-thermal energies. During E08, energized protons were found to have leaked out of the exhaust along separatrix field lines, appearing as field-aligned energetic proton beams in a broad region outside the HCS. Concurrent dropouts of strahl electrons, indicating disconnection from the Sun, provide further evidence for the HCS being the source of the beams. Around the HCS in E07, there were also proton beams but without electron strahl dropouts, indicating that their origin was not the local HCS reconnection exhaust.

BackgroundDengue is one of the newest emerging diseases in Nepal with increasing burden and geographic spread over the years. The main objective of this study was to explore the epidemiological patterns of dengue since its first outbreak (2006) to 2019 in Nepal.MethodsThis study is a retrospective analysis that covers the last 14 years (2006-2019) of reported dengue cases from Epidemiology Diseases Control Division (EDCD), Ministry of Health and Population, Government of Nepal. Reported cases were plotted over time and maps of reported case incidence were generated (from 2016 through 2019). An ecological analysis of environmental predictors of case incidence was conducted using negative binomial regression.ResultsWhile endemic dengue has been reported in Nepal since 2006, the case load has increased over time and in 2019 a total of 17 992 dengue cases were reported from 68 districts (from all seven provinces). Compared to the case incidence in 2016, incidence was approximately five times higher in 2018 [incidence rate ratio (IRR): 4.8; 95% confidence interval (CI) 1.5-15.3] and over 140 times higher in 2019 (IRR: 141.6; 95% CI 45.8-438.4). A one standard deviation increase in elevation was associated with a 90% decrease in reported case incidence (IRR: 0.10; 95% CI 0.01-0.20). However, the association between elevation and reported cases varied across the years. In 2018 there was a cluster of cases reported from high elevation Kaski District of Gandaki Province. Our results suggest that dengue infections are increasing in magnitude and expanding out of the lowland areas to higher elevations over time.ConclusionsThere is a high risk of dengue outbreak in the lowland Terai region, with increasing spread towards the mid-mountains and beyond as seen over the last 14 years. Urgent measures are required to increase the availability of diagnostics and resources to mitigate future dengue epidemics.

Abstract Background Follow-up assessment of visceral leishmaniasis (VL) treated cases is important to monitor the long term effectiveness of treatment regimens. The main objective of this study was to identify the gaps and challenges in the follow-up of treated VL cases, to monitor treatment outcome and to assess the impact of COVID-19 on VL elimination services and activities. Methods Clinicians treating VL patients, district focal persons for VL, and patients treated for VL in seven high endemic districts in Nepal during 2019–2022 were interviewed to collect data on challenges in the follow-up of VL treated patients as per national strategy. Results Follow up status was poor in two districts with the largest number of reported cases. The majority of cases were children under 10 years of age (44.2%). Among 104 VL treated cases interviewed, 60.6% mentioned that clinicians had called them for follow-up but only 37.5% had complied. Among 112 VL treated cases followed up, 8 (7.14%) had relapse and 2 (1.8%) had PKDL. Among 66 cases who had VL during the COVID-19 lock down period, 32 (48.5%) were diagnosed within 1 week; however, 10 (15.1%) were diagnosed only after 4 weeks or more. During the COVID-19 pandemic, there was no active search for VL because of budget constraints and lack of diagnostic tests, and no insecticide spraying was done. Conclusion Relapses and PKDL are challenges for VL elimination and a matter of concern. Successful implementation of the national strategy for follow up of treated VL cases requires addressing elements related to patients (awareness, transport, communication) clinicians (compliance) and organization of service delivery (local health worker training and deployment). COVID-19 did not have much impact on VL diagnosis and treatment; however, public health programmes including active case detection and insecticide spraying for vector control were severely reduced.

Objectives: This study aims to assess health science students’ knowledge and attitude about COVID-19 epidemiology, management, and prevention; and the association of knowledge and attitude with various sociodemographic characteristics. Methods: An online survey was done among 524 undergraduate health science students using a pre-tested questionnaire across 19 health science institutions in Nepal from 30 June to 11 August 2021. All subjects were enrolled in the study after informed consent. Outcomes were Knowledge level, attitude level, and predictors of knowledge level and attitude level. Bivariate analysis was done to determine the association between variables. Results: Of 524 students, 42.9% were male, and 57.1% were female. More than half (54.6%) and the majority (85.1%) participants had good knowledge and attitude, respectively. Approximately three-fifths (59.4%) of the participants were from the B. P. Koirala Institute of Health Sciences (BPKIHS). Students in BPKIHS (odds ratio = 1.774; 95% confidence interval = 1.243–2.533), junior years (odds ratio = 8.892; 95% confidence interval = 5.814–13.599), age less than 23 years (odds ratio = 2.985; 95% confidence interval = 2.089–4.266) were more likely to have good knowledge. Students under 23 years (odds ratio = 24.160; 95% confidence interval: 9.570–60.992) and those in junior years (odds ratio = 4.460; 95% confidence interval = 3.753–5.300) were likely to have a good attitude level. Students in BPKIHS (odds ratio = 0.443; 95% confidence interval = 0.272–0.722) were less likely to have a good attitude. Conclusions: Overall, health science students had adequate knowledge and a good attitude regarding COVID-19. However, students lacked knowledge regarding infectiousness, transmission, post-vaccination observation period, remdesivir use, convalescent plasma therapy, and awake-prone positioning. Knowledge and attitude scores were associated with age, stream, and study institution.

Background: Ropivacaine is a common choice for supraclavicular brachial plexus block. Dexmedetomidine and Dexamethasone are frequently added to local anesthetics for improved effects. With limited comparative evidence, this study aimed to assess Dexmedetomidine and Dexamethasone as adjuvants to Ropivacaine in ultrasound-guided supraclavicular brachial plexus block. Methods: This prospective double-blind study enrolled patients aged 18-60, scheduled for elective upper limb surgery below mid-humeral level. They were randomly assigned into three groups: Ropivacaine alone, Ropivacaine with Dexmedetomidine (1 mcg/kg), or Ropivacaine with Dexamethasone (8 mg). The study aimed to compare sensory and motor blockade onset and duration, postoperative analgesia duration, and adverse event occurrence among the groups. Results: Ninety-eight patients participated in the study. All three groups showed similar characteristics in terms of age, weight, gender, ASA grade, and surgery duration. The onset and duration of sensory and motor block were comparable between the Dexamethasone and Dexmedetomidine groups. A significant difference was observed when comparing the Ropivacaine only group to either of the other two groups or when comparing all three groups. Similarly, postoperative analgesia duration was comparable between the Dexamethasone and Dexmedetomidine groups while it differed significantly when comparing all three groups or when comparing the Ropivacaine only group to either of the other groups. Ropivacaine with Dexmedetomidine group experienced notable occurrence of bradycardia. Conclusion: Dexamethasone and Dexmedetomidine as adjuvants to 0.5% Ropivacaine for ultrasound-guided supraclavicular brachial plexus blockade have comparable effects on sensory and motor blockade onset and duration, along with postoperative analgesia duration. Dexmedetomidine, however, is linked to more bradycardia compared to Dexamethasone.

Background & objectives: The successful elimination program of visceral leishmaniasis (VL) in Nepal decreased the incidence to less than 1 per 10,000 population leading to the consolidation phase. However, new VL cases have been recorded from new districts, threatening the elimination goal. This study monitors the geographical spread of VL and identifies potential risk factors. Methods: VL data of 2017–2020 were obtained from the Epidemiology and Disease Control Division (EDCD) of Nepal and mapped. Telephonic interviews with 13 VL patients were conducted. Results: The incidence maps indicate that VL is spreading to new areas. The target incidence exceeded four times in hilly and twice in mountainous districts. VL cases occurred in 64 of 77 districts in all three regions (mountainous, hilly and Terai). Interviews showed a correlation between travel history (private, commercial and for studies) and the spread of VL cases to new foci. Interpretation & conclusion: One major challenge of VL elimination in the maintenance phase is the spread of infection through travelers to new foci areas, which needs to be under continuous surveillance accompanied by vector control activities. This should be confirmed by a large-scale analytical study.

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.