Left and right ventricular myocardial deformation and late gadolinium enhancement:incremental prognostic value in amyloid light-chain amyloidosis

Background: Previous cardiac magnetic resonance (CMR) studies have shown that both late gadolinium enhancement (LGE) and left ventricular (LV) strain have prognostic value in amyloid light-chain (AL) amyloidosis, but the right ventricular (RV) strain has not yet been studied. We aim to determine the incremental prognostic value of LV and RV LGE and strain in AL amyloidosis. Methods: This prospective study recruited 87 patients (age, 56.9 +/- 9.1 years; M/F, 56/31) and 20 healthy subjects (age, 52.7 +/- 8.1 years; M/F, 11/9) who underwent CMR. The LV LGE was classified into no, patchy and global groups. The RV LGE was classified into negative and positive groups. Myocardial deformation was measured using a dedicated software. Follow-up was performed for all-cause mortality using Cox proportional hazards regression and Kaplan-Meier curves. Results: During a median follow-up of 21 months, 34 deaths occurred. Presence of LV LGE [HR 2.44, 95% confidence interval (CI), 1.10-5.45, P=0.029] and global longitudinal strain (GLS) (HR 1.13 per 1% absolute decrease, 95% CI, 1.02-1.25, P=0.025) were independent LV predictors. RV LGE (HR 4.07, 95% CI, 1.09-15.24, P=0.037) and GLS (HR 1.10 per 1% absolute decrease, 95% CI, 1.00-1.21, P=0.047) were independent RV predictors. Complementary to LV LGE, LV GLS impairment or RV LGE further reduced survival (both log rank P Conclusions: This study confirms the incremental prognostic value of LV GLS and RV LGE in AL amyloidosis, which refines the conventional risk evaluation based on LV LGE. GLS based on non-contrast-enhanced CMR are promising new predictors

Sulfonated reduced graphene oxide modification layers to improve monovalent anions selectivity and controllable resistance of anion exchange membrane

Graphene oxide with lamellar structure has attracted research interest in various fields. In this study, sulfonated reduced graphene oxide (S-rGO) nanosheets with negatively charged sulfonic acid groups were synthesized via a facile distillation-precipitation polymerization, followed by hydrazine reduction. The sulfanilic acid was grafted on the graphene oxide sheets to separate GO nanosheets each other and provide anion channels for anions selectivity. These nanosheets were used to modify anion exchange membranes (AEMs), and to enhance the membrane monovalent anions selectivity and the modification layer conductivity, in order to meet industrial requirements. The permselectivity and separation efficiency were used to evaluate selectivities of the modified membranes. The results show that the unmodified AEM has no monovalent selectivity, while the permselectivity and separation efficiency of S-rGO modified AEMs (reduced by hydrazine hydrate steam in 10 min) increases from 0.65 to 1.80 and from -0.13 to 0.31 (in 40 min), respectively; and from 0.72 to 2.30 and from -0.07 to 0.28 (in 80 min), respectively

Current situations and future directions for mental health system governance in Nepal:Findings from a qualitative study

Background: Assessing and understanding health systems governance is crucial to ensure accountability and transparency, and to improve the performance of mental health systems. There is a lack of systematic procedures to assess governance in mental health systems at a country level. The aim of this study was to appraise mental health systems governance in Nepal, with the view to making recommendations for improvements. Methods: In-depth individual interviews were conducted with national-level policymakers (n = 17) and district-level planners (n = 11). The interview checklist was developed using an existing health systems governance framework developed by Siddiqi and colleagues as a guide. Data analysis was done with NVivo 10, using the procedure of framework analysis. Results: The mental health systems governance assessment reveals a few enabling factors and many barriers. Factors enabling good governance include availability of mental health policy, inclusion of mental health in other general health policies and plans, increasing presence of Non-Governmental Organizations (NGOs) and service user organizations in policy forums, and implementation of a few mental health projects through government-NGO collaborations. Legal and policy barriers include the failure to officially revise or fully implement the mental health policy of 1996, the existence of legislation and several laws that have discriminatory provisions for people with mental illness, and lack of a mental health act and associated regulations to protect against this. Other barriers include lack of a mental health unit within the Ministry of Health, absence of district-level mental health planning, inadequate mental health record-keeping systems, inequitable allocation of funding for mental health, very few health workers trained in mental health, and the lack of availability of psychotropic drugs at the primary health care level. Conclusions: In the last few years, some positive developments have emerged in terms of policy recognition for mental health, as well as the increased presence of NGOs, increased presence of service users or caregivers in mental health governance, albeit restricted to only some of its domains. However, the improvements at the policy level have not been translated into implementation due to lack of strong leadership and governance mechanisms

Insights on the Impacts of Hydroclimatic Extremes and Anthropogenic Activities on Sediment Yield of a River Basin

Streamflow and sediment flux variations in a mountain river basin directly affect the downstream biodiversity and ecological processes. Precipitation is expected to be one of the main drivers of these variations in the Himalayas. However, such relations have not been explored for the mountain river basin, Nepal. This paper explores the variation in streamflow and sediment flux from 2006 to 2019 in central Nepal’s Kali Gandaki River basin and correlates them to precipitation indices computed from 77 stations across the basin. Nine precipitation indices and four other ratio-based indices are used for comparison. Percentage contributions of maximum 1-day, consecutive 3-day, 5-day and 7-day precipitation to the annual precipitation provide information on the severity of precipitation extremeness. We found that maximum suspended sediment concentration had a significant positive correlation with the maximum consecutive 3-day precipitation. In contrast, average suspended sediment concentration had significant positive correlations with all ratio-based precipitation indices. The existing sediment erosion trend, driven by the amount, intensity, and frequency of extreme precipitation, demands urgency in sediment source management on the Nepal Himalaya’s mountain slopes. The increment in extreme sediment transports partially resulted from anthropogenic interventions, especially landslides triggered by poorly-constructed roads, and the changing nature of extreme precipitation driven by climate variability