Tribhuvan University

The requirements of higher cement content and numerous admixtures in self-compacting concrete (SCC) yield a comparatively high production due to the high cement consumption that limits its use in everyday construction. As a result, it is prudent to consider alternatives for decreasing the environmental effects while producing a cost-effective SCC. Therefore, this study aims to investigate the fresh mechanical, durability, and microstructural characteristics as well as the environmental impacts of self-compacting concrete (SCC) incorporating waste banana leaf ash (BLA) to determine the optimum percentage of BLA. Concrete mixtures with 10%, 20%, and 30% OPC substitutions were investigated. Test findings revealed that all the fresh mixes performed within the EFNARC (2002) recommended limit. Despite the fact that increasing concentrations of BLA reduced the mechanical properties, concentrations of up to 20% BLA demonstrated strength comparable to the control mix. Furthermore, chloride ion penetration increased to 4%, with 20% BLA replacement falling into the moderate ion permeability zone. Finally, a relatively lower CO2-eq (maximum 29.13% reduction) per MPa indicates a significant positive impact due to the reduced Global Warming Potential (GWP).

Failure to meet early childhood developmental milestones leads to difficulty in schooling and social functioning. Evidence on the inequality in the burden of developmental delays across population groups, and identification of potential risk factors for suspected developmental delays (SDD) among younger children, are essential for designing appropriate policies and programs. This study explored the level of socioeconomic and maternal education-based inequality in the prevalence of SDD among Nepalese children at subnational level and identified potential risk factors. Individual-level data from the 2019 Nepal Multiple Indicator Cluster Survey was used to estimate the prevalence of SDD among children aged 3-4 years. Regression-based slope index of inequality (SII) and relative index of inequality were used to measure the magnitude of inequality, in terms of household socioeconomic status (SES) and mother's education, in the prevalence of SDD. In addition, a multilevel logistic regression model was used to identify potential risk factors for SDD. The national prevalence of SDD was found to be 34.8%, with relatively higher prevalence among children from rural areas (40.0%) and those from Karnali Province (45.0%) followed by Madhesh province (44.2%), and Sudhurpashchim Province (40.1%). The prevalence of SDD was 32 percentage points higher (SII: −0.32) among children from the poorest households compared to their rich counterparts at the national level. At the subnational level, such inequality was found to be highest in Lumbini Province (SII = −0.47) followed by Karnali Province (SII = −0.37), and Bagmati Province (SII = −0.37). The prevalence of SDD was 36 percentage points higher (SII: −0.36) among children whose mother had no formal education compared to children of higher educated mothers. The magnitude of education-based absolute inequality in SDD was highest in Lumbini Province (SII = −0.44). Multilevel logistic regression model identified lower levels of mother's education, disadvantaged SES and childhood stunting as significant risk factors for SDD. One in each three children in Nepal may experience SDD, with relatively higher prevalence among children from rural areas. Subnational level variation in prevalence, and socioeconomic and education-based inequality in SDD highlight the urgent need for province-specific tailored interventions to promote early childhood development in Nepal. OPEN 1 New ERA, Rudramati Marg, Kalopul, Kathmandu, Nepal.

Microbial fuel cell (MFC) is an alternative way for household organic waste treatment as it produces sustainable clean energy. Chemical parameters of the cauliflower leaf waste before treatment were 143.5 mg/g COD, 0.90 mg/g ammoniacal nitrogen, 67.8 mg/g phosphorous, 214.8 mg/g total reducing sugar and 0.53 mg/g soluble reducing sugar. After eight days of treatment in MFC at the optimised condition of multiwalled carbon nanotubules (MWCNT)’ coated graphite as anode and potassium ferricyanide added phosphate buffer as catholyte with an external resistance of 1000 Ω showed a reduction in COD, ammoniacal nitrogen, phosphorous and total reducing sugar by 24.7, 76.9, 22.5 and 53.4%, respectively, along with a maximum power density of 10.1 W/m³. Scanning electron microscopy (SEM) showed bacterial adherence in the graphite electrode and its molecular characterisation using 16S rRNA sequencing confirmed as Bacillus sps.

Organizations must cope with the current business demands and strive for a competitive advantage. Apart from many measures to enhance competitive advantage, employees’ innovative work behavior is instrumental. Hence, this study aims to measure the contribution of person-environment fit (person-job fit and person-organization fit) on innovative work behavior directly and indirectly through creating work engagement. Cross-sectional perceptual data were collected through surveys from the employees working in humanitarian non-profit organizations in Nepal. After ensuring the goodness of fit index, 499 responses were analyzed in the structural equation model showing path analysis with the help of AMOS. The conservation of resource theory was a foundation to test and analyze the hypotheses adopting positivist research philosophy and deductive reasoning approach. Regression analysis revealed a positive effect of person-job fit (B = .23, p < .001) and person-organization fit (B = .20, p < .001) on employees’ innovative work behavior. Work engagement mediated the influence of person-job fit and person-organization fit on innovative work behavior. Out of the total effect size of employees’ compatibility on innovative work behavior, 30% effect size of person-job fit and 23% effect size of person-organizational fit on innovative work behavior went through work engagement.

The highest reaches of our planet experience some of the most extreme weather on Earth and hold very significant supplies of freshwater for communities downstream. However, we know very little of the meteorological detail about this high-altitude frontier. We address this here with new winter weather observations from the upper reaches of Mount Everest (2019–2021). We show that substantial sublimation rates are possible, with losses up to 2.5mm day−1. Wind chill plunging to −83°C and frostbite possible in less than one minute also attest to the severe cold stress facing mountaineers attempting winter ascents of this most iconic peak.

Introduction Influenza viruses, due to rapid evolution, lead to great variability. There are 18 highly variable hemagglutinins (H1 to H18) and 11 distinct NAs (N1 to N11) for type A.Influenza type B has no subtypes due to fixed on small antigenic variabilities.Due to rapid evolution and diversification, it is essential to understand genomic epidemiology to detect emerging strains and track their transmission. Methods Samples of the strain were cultivated in the MDCK cell lines for the preparation of neat virus. viral genome after extraction from the neat virus was sent to the National Institute of Infectious Disease, Japan for whole genome sequencing in 2016. The sequences were submitted to GISAID. The H1N1 virus genomes(n=18), from this study, were investigated against the reference genome A/California/07/2009 (GenBank: CY121680). Similarly, the Influenza type B virus genomes(n=27) were investigated against reference genome B/Brisbane/60/2008 (GenBank: KX058884) and B/Wisconsin/01/2010 (GenBank: JN993010). The mutational analyses were performed using Nextclade. The mutations present in the sequences were,subsequently, investigated. Finally, the phylogenetic analysis was done using the Nextclade and CLUSTAL Omega. Out of the 18 HA genome segments, of H1N1, all (n=12) except 6 isolates were of clade 6B, while the rest were of clade 6B.1.For Influenza Type B, out of the 27 HA genome segments, all of the genomes were of clade V1A when compared to B/Brisbane/60/2008. Similarly, when compared to reference genome B/Wisconsin/01/2010 (GenBank: JN993010), all (n=22) except 5 isolates were of clade Y3, while the rest were of clade Y2

Human pancreatic α -amylase (HPA), which works as a catalyst for carbohydrate hydrolysis, is one of the viable targets to control type 2 diabetes. The inhibition of α -amylase lowers blood glucose levels and helps to alleviate hyperglycemia complications. Herein, we systematically screened the potential HPA inhibitors from a library of natural products by molecular modeling. The modeling encompasses molecular docking, MM/GBSA binding energy calculations, MD simulations, and ADMET analysis. This research identified newboulaside B, newboulaside A, quercetin-3-O- β -glucoside, and sasastilboside A as the top four potential HPA inhibitors from the library of natural products, whose Glide docking scores and MM/GBSA binding energies range from -9.191 to -11.366 kcal/mol and -19.38 to -77.95 kcal/mol, respectively. Based on the simulation, among them, newboulaside B was found as the best HPA inhibitor. Throughout the simulation, with the deviation of 3Å (acarbose = 3Å), it interacted with ASP356, ASP300, ASP197, THR163, ARG161, ASP147, ALA106, and GLN63 via hydrogen bonding. Additionally, the comprehensive ADMET analysis revealed that it has good pharmacokinetic properties having not acutely toxic, moderately bioavailable, and non-inhibitor nature toward cytochrome P450. All the results suggest that newboulaside B might be a promising candidate for drug discovery against type 2 diabetes.

Diagnosis of hemophagocytic lymphohistiocytosis is a challenge in Nepal because of limited resources and the high prevalence of tropical febrile illness mimicking hemophagocytic lymphohistiocytosis. We retrospectively reviewed medical records of 21 patients who were diagnosed with hemophagocytic lymphohistiocytosis from 2010 to 2015 at a single center in Nepal. Two patients had a mutation in their perforin gene and underwent successful haploidentical stem cell transplantation. Marrow hemophagocytosis was found only in 57% of the patients. Five patients had hematological malignancy and were treated with disease-specific chemotherapy. Seven patients developed hemophagocytic lymphohistiocytosis secondary to an infection, including visceral leishmaniasis, scrub typhus, and Epstein Barr virus. EBV-associated hemophagocytic lymphohistiocytosis was refractory to hemophagocytic lymphohistiocytosis 94 protocol, including the addition of rituximab. Malignancy and infection-associated hemophagocytic lymphohistiocytosis was more common. The most common clinical presentations included fever, splenomegaly, hyponatremia, liver function derangement, hyperfibrinogenemia, hyperferritinemia, and cytopenia. With a mortality of 29% in our study cohort, hemophagocytic lymphohistiocytosis should be considered a lethal disease, and clinicians should maintain a high index of suspicion to diagnose this disease.

Adolescent friendly health services (AFHS) are designed to make health services accommodate the unique needs of adolescents. AFHS are characterized by three basic characteristics (programmatic, health facilities and health service providers) that should be applied. However, limited is known about the use of AFHS in the context of Nepal. This study aimed to assess the extent of AFHS utilization and associated factors among higher secondary students in the Jumla district of Nepal. A cross-sectional quantitative study was conducted in October-November 2017. Data were collected from a random sample of 528 aged 16-19 years old using a self-administered survey in their classroom. Adjusted Odds Ratios (AOR) and a 95% confidence level were estimated to measure the strength of association between the outcome variable (utilization of AFHS) and independent variable using multivariable logistic regression. Knowledge related to AFHS, measured by a seven-item scale, was based on information about the availability of AFHS. More than two-thirds (67.05%) of adolescents had utilized AFHS at least once in the last twelve months before the survey. In mul-tivariable logistic regression analysis, knowledge level [AOR = 14.796, 95%CI (5.326-41.099)], cost of services [AOR = 2.971, 95%CI (1.764-5.003)], satisfaction from services [AOR = 1.817, 95%CI (1.037-3.185)] and availability of waiting room [AOR = 1.897, 95%CI (1.096-3.283)] were significantly associated with the utilization of AFHS. The utilization of AFHS was less than the country's target of universal utilization in this study. Adolescents' knowledge level about AFHS was importantly associated with its utilization. Utilization increases with lower service costs, client satisfaction, and availability of waiting rooms in the health facility. The health planners should make efforts to create a conducive environment for the adolescent by training the AFHS providers, particularly those who work in

The Tibeto-Himalayan Region is famous for its geography, climatic influence, and exceptional and immense biodiversity. The “mountain-geobiodiversity hypothesis (MGH)” explores the interaction of topography, climate, and biology in the evolution of mountain biodiversity. We tested this hypothesis in the Himalayas and the Hengduan Mountains on a group of caddisflies that are endemic to this region. We investigated one caddisfly species pair from each mountain respectively, each pair containing one species inhabiting high elevation and one inhabiting low elevation. We incorporated genomic and ecological evidence to reveal population structure, demographic history, and potential habitat range dating back to the last glacial maximum (LGM) of each species. The results indicated that in both mountains, the high-elevation species showed strong local differentiation, while the low-elevation species were shaped by hydro-morphology indicating greater regional dispersal activity. Results of demographic history and species distribution modelling supported demographic expansions for all species during the LGM linked to an increase in potential habitats. Caddisfly species in the Himalayas generally exhibited an East-West oriented dispersal. Species from the Hengduan Mountains showed greater connectivity on the North-South orientation, suggesting that species have a higher chance to survive in the Hengduan Mountains by both in-situ displacement (along the elevational gradients) and long-distance dispersal (along the latitudinal gradients) during glaciation. Our study demonstrates that historical geodiversity and climate fluctuations interact and influence the diversification of caddisflies in the Tibeto-Himalayan Region, thus supporting the MGH.

In the current literature, clinical registry cohorts related to ocular inflammation are few and far between, and there are none involving multi-continental international data. Many existing registries comprise administrative databases, data related to specific uveitic diseases, or are designed to address a particular clinical problem. The existing data, although useful and serving their intended purposes, are segmented and may not be sufficiently robust to design prognostication tools or draw epidemiological conclusions in the field of uveitis and ocular inflammation. To solve this, we have developed the Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS) Clinical Registry. OASIS collects prospective and retrospective data on patients with all types of ocular inflammatory conditions from centers all around the world. It is a primarily web-based platform with alternative offline modes of access. A comprehensive set of clinical data ranging from demographics, past medical history, clinical presentation, working diagnosis to visual outcomes are collected over a range of time points. Additionally, clinical images such as optical coherence tomography, fundus fluorescein angiography and indocyanine green angiography studies may be uploaded. Through the capturing of diverse, well-structured, and clinically meaningful data in a simplified and consistent fashion, OASIS will deliver a comprehensive and well organized data set ripe for data analysis. The applications of the registry are numerous, and include performing epidemiological analysis, monitoring drug side effects, and studying treatment safety efficacy. Furthermore, the data compiled in OASIS will be used to develop new classification and diagnostic systems, as well as treatment and prognostication guidelines for uveitis.

Healthcare in Afghanistan is already in crisis. Banning girls and women from education will only make this worse.

Background. Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease that currently lacks reliable diagnostic biomarkers. The meta-analysis is performed with an aim to evaluate the diagnostic potential of cerebrospinal fluid (CSF) total tau (t-tau), phosphorylated-tau (p-tau), and their ratio in ALS patients. Methods. A comprehensive search for literature published between the 1 st of January 2000 and the 15 th of May 2022 was performed in databases PubMed, medRxiv, and Google Scholar. The retrieved articles were first screened by title and abstract, and later, full-text screening was performed based on the eligibility criteria. Data on p-tau and t-tau levels and p-tau/t-tau ratio in ALS patients and controls were extracted, and a meta-analysis was performed using random-effects models in Review Manager version 5.4. Results. Data were analyzed from seven studies reporting p-tau and t-tau levels and their ratio among ALS patients and controls. The number of total study participants was 1,100. In ALS patients, the levels of p-tau didn't differ significantly with controls (standardized mean difference (SMD): 0.14 (95% CI:-0.41 to 0.70); p = 0:61). In contrast, there were significantly elevated levels of t-tau and significantly lowered p-tau/t-tau ratio in ALS (SMD: 1.76 (95% CI: 0.53 to 2.98); p = 0:005 and SMD:-3.09 (95% CI:-5.33 to-0.86); p = 0:007, respectively). Conclusion. Our meta-analysis study supports the role of core CSF biomarkers of neurodegeneration: t-tau and p-tau/t-tau ratio as a diagnostic biomarker of amyotrophic lateral sclerosis. This study found that t-tau is elevated while p-tau/t-tau ratio is lowered in ALS.

Individuals may develop different attitudes on bioethics in general and reproductive ethics in particular, due to the effects of different sociocultural environments. Individuals' attitudes toward surrogacy are affected positively or negatively depending on religious and cultural environments. This study was conducted to determine and compare the attitudes of different religions toward surrogacy. This study is cross-sectional and collected from individuals living in Turkey, India, Iran, the Turkish Republic of Northern Cyprus, Madagascar, Nepal, Nigeria, Pakistan, Mexico, England, and Japan between May 2022 and December 2022. The study was conducted with individuals belonging to Islam, Christianity, Hinduism, Buddhism, and Atheism. The study was conducted with 1177 individuals from different religions who agreed to participate in the study by snowball sampling method. The introductory Information Form and "Attitude Questionnaire Toward Surrogacy" were used as data collection tools. R programming language 4.1.3 was used for regression analysis with machine learning approach and artificial neural networks, and SPSS-25 was used for other statistical analyses. There was a significant difference between the total mean score of the individuals' Attitudes toward Surrogacy Questionnaire and their religious beliefs (p < 0.05). When the results of the analysis of the regression model with the dummy variable, which was carried out with the aim of revealing the effects of religious belief on the attitude toward surrogacy, are examined, statistical estimates of the regression model show that the model is significant and usable F(4,1172) = 5.005, p = 0.001). It explains 1.7% of the total variance of the level of religious belief's attitude toward surrogacy. In the regression model, when the t-test results regarding the significance of the regression coefficient are examined, among the participants, it was determined that the mean score of those who believed in Islam (t = − 3.827, p < 0.001) and those who believed in Christianity (t = − 2.548, p < 0.001) was lower than the mean score of those who believed in Hinduism (Constant) (p < 0.05). Individuals' attitudes toward surrogacy differ according to their religion. The best performing algorithm for the prediction model was random forest (RF) regression. The contributions of the variables to the model were calculated with Shapley values (Shapley Additive Explanations (SHAP)). The SHAP values of the variables in the best performing model were examined to avoid bias in terms of comparison in the performance criterion. SHAP values (Shapley Additive Explanations) show the contribution or importance of each variable in the estimation of the model. It is determined that the most important variable that should be in the model to predict the Attitude Toward Surrogacy Survey variable is the Nationality variable. It is recommended that studies on attitudes toward surrogacy should be conducted by taking religious and cultural values into consideration.

Quality education at the age of foundation to produce dynamic manpower is a public concern in developing countries including Nepal. Preschool children do not get proper care and support from their parents due to insufficient knowledge of proper feeding habits, nutrition status and methods of psychosocial stimulation, which may affect their proper cognitive development. This study aimed to identify the factors that influence cognitive development in preschool children aged 3-5 years in Rupandehi district of western Terai, Nepal. In this school based cross-sectional survey, a total of 401 preschool children were selected using a multistage random sampling technique. The study was conducted from 4th February to 12th April, 2021 in Rupandehi district of Nepal. Data on the children's socio-economic and demographic status, level of psychosocial stimulation, nutritional status, and stage of cognitive development were collected through scheduled interviews and direct observation. Stepwise regression analysis was performed to determine the predictors of cognitive development in preschool children. A p-value less than 0.05 considered as statistical significance. Of 401 participants, 44.1% had a normal nutritional status based on height for age Z-score (HAZ). Only 1.2% of primary caregivers provided their children with high levels of psychosocial stimulation, and 49.1% of children had a medium level of cognitive development. Furthermore, cognitive development in preschoolers is positively associated with nutritional status based on the height for age z score (β = 0.280; p

Unlabelled: Guillain-Barré syndrome (GBS) is an immunological demyelinating disorder characterized by progressive, ascending flaccid weakness, usually resulting after infection or some immune stimulation. Its occurrence during pregnancy is rare and due to attribution of its symptoms to pregnancy, diagnosis might be delayed. Case presentation: A 39-year-old G4P3L2A0 woman at 13 weeks 6 days period of gestation presented with acute, symmetrical, ascending type of flaccid quadriparesis leading to slurring of speech, swallowing difficulty, and eventually respiratory failure. With the diagnosis of GBS, she was admitted to the intensive care unit, five sessions of plasma exchange were done along with physiotherapy and her symptoms started improving. After discharge she was on regular antenatal care visits and eventually, she delivered a healthy baby at term with an uneventful labor event and postpartum period. Clinical discussion: There is a huge maternal-fetal risk of respiratory failure, aspiration pneumonia, preterm delivery, possible use of forceps or vacuum, and operative interference due to GBS in pregnancy, whose causative agents are similar to that of the general population. The swinging pattern of risk of GBS in pregnancy might be due to immunological changes with predominant Th2 response seen in pregnancy. Treatment measures are similar as in the general population with initial symptomatic care and administration of disease-specific therapy later which consists of intravenous immunoglobulin and/or plasmapheresis. Conclusion: A well-timed diagnosis of GBS in pregnancy might allow successful management with the help of intensive monitoring with or without immunotherapy.