Role of Community Health Volunteers Since the 2015 Nepal Earthquakes: A Qualitative Study

Objective: Nepal female community health volunteers (FCHVs) were the first available health personnel in communities during the 2015 Nepal earthquakes. This study explored the facilitating factors and barriers of the FCHVs during health emergencies. Methods: In-depth interviews with 24 FCHVs and 4 health managers from 2 districts in Nepal (Gorkha and Sindhupalchowk) were conducted using semi-structured interview guides. The qualitative data were analyzed using thematic analysis methods. Results: FCHVs were the first responders to provide services after the earthquakes and were well accepted by the local communities. Different models of supervision existed, and differences in the workload and remuneration offered to FCHVs were described. A wide range of disaster-related knowledge and skills were required by FCHVs, and lack of prior training was an issue for some respondents. Furthermore, lack of access to adequate medical supplies was a major barrier for FCHVs in the 2015 earthquakes. The 5 identified themes were discussed. Conclusion: Providing regular disaster response training for FCHVs and strong leadership from the public sector with sustained investments will be essential for increasing the capacities of community health workforces to prepare for and reduce the impacts of future health emergencies in resource-poor settings

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Tuning transport properties of B and C sites vacancy defects Graphene/h-BN heterostructures: first-principles study

The goal of this study is to investigate the thermoelectric properties of Graphene/h-BN (G/h-BN), 1B vacancy defect in G/h-BN (G/h-BN_1B), 1C vacancy defect in G/h-BN (G/h-BN_1C) and 2C vacancy defects in G/h-BN (G/h-BN_2C) heterostructures (HS) materials by using first-principles calculations based on spin-polarized DFT-D2 perspective and semi-classical Boltzmann transport theory. We found that all the studied materials are stable. We have computed the Seebeck coefficient (S), thermoelectric power factor (P), electrical conductivity (σ) and electronic contribution of thermal conductivity (K) to study the transport properties of considered materials. The temperature dependent (at constant energy), S of the above materials have positive and negative values at 300 K because the sign of S changes for different types of charge carriers. In addition, it is found that G/h-BN has a symmetry curve but defected materials have slightly asymmetry curves in S verses chemical potential (µ) plot at different constant temperatures. The asymmetry is caused by asymmetric effective mass. We have estimated the P of considered materials by taking constant and found that P of G/h-BN_1B is higher than that of other materials. An expected σ of G/h-BN follows the exponentially increasing nature with an increase in temperature. The σ of defected materials has greater values than that of G/h-BN. In addition, we have calculated the temperature dependent (at constant energy) K of mentioned materials and found them to be increased with the increase in temperatures. K of G/h-BN increases somehow exponentially; however, K of defected materials has a more-less linear nature. Among them, K of G/h-BN_1B retains a higher value at 300 K. By the evaluation of S, P, σ and K, we concluded that defected materials are more promising materials than G/h-BN in the field of thermoelectricity

Prehospital Emergency Care in Low- and Middle-Income Countries: A Systematic Review

Background:An under-developed and fragmented prehospital Emergency Medical Services (EMS) system is a major obstacle to the timely care of emergency patients. Insufficient emphasis on prehospital emergency systems in low- and middle-income countries (LMICs) currently causes a substantial number of avoidable deaths from time-sensitive illnesses, highlighting a critical need for improved prehospital emergency care systems. Therefore, this systematic review aimed to assess the prehospital emergency care services across LMICs. Methods:This systematic review used four electronic databases, namely: PubMed/MEDLINE, CINAHL, EMBASE, and SCOPUS, to search for published reports on prehospital emergency medical care in LMICs. Only peer-reviewed studies published in English language from January 1, 2010 through November 1, 2022 were included in the review. The Newcastle-Ottawa Scale (NOS) and Critical Appraisal Skills Programme (CASP) checklist were used to assess the methodological quality of the included studies. Further, the protocol of this systematic review has been registered on the International Prospective Register of Systematic Reviews (PROSPERO) database (Ref: CRD42022371936) and has been conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results:Of the 4,909 identified studies, a total of 87 studies met the inclusion criteria and were therefore included in the review. Prehospital emergency care structure, transport care, prehospital times, health outcomes, quality of information exchange, and patient satisfaction were the most reported outcomes in the considered studies. Conclusions:The prehospital care system in LMICs is fragmented and uncoordinated, lacking trained medical personnel and first responders, inadequate basic materials, and substandard infrastructure

Sixty-five years of forest restoration in Nepal: Lessons learned and way forward

The increasing incidence of forest and land degradation is affecting billions of people, and causing loss of biodiversity and ecosystem services. Realizing the importance of forest restoration in moderating those impacts, various global and regional forest restoration initiatives (including Bonn Challenge 2011 and UN Decade on Ecosystem Restoration (2021–2030) have been launched. But the gap between restoration commitments and their ground realities is becoming a huge challenge because of the limited knowledge on forest restoration approach as well as underlying socio-economic and ecological factors impacting the restoration undertaking. Moreover, few studies have comprehensively looked at institutional, socio-economic, and ecological aspects of forest restoration in a common framework. By employing a systematic review of the literature (n = 64), review of policies, plans and project reports (n = 58) and expert survey (n = 22), this study has navigated the rise and fall of Nepal’s 65 years of forest restoration practices. Our study found that Nepal’s forest restoration interventions from 1956 to the early 1980s got mixed results because of the limited integration of socio-economic and ecological concerns in restoration programs. However, forest restoration works after the mid-1980 s charted a more successful pathway because of (1) policies favouring decentralized decision making and local institutions; (2) devolution of rights and responsibilities; (3) firmed commitment for and adoption of multistakeholder partnership for the forest and landscape restoration; (4) recognition of multifunctionality of forest ecosystems; (5) accommodation of socio-economic and ecological concerns in restoration program; 6) adoption of multiple restoration approaches at multiple scales; and 7) capacity development and extension services. As institutional, socio-economic, and ecological factors are often been overlooked in forest and landscape restoration initiatives, the inferences we made and suggestions we provided can inform the policymakers and practitioners (of Nepal and other countries) in translating regional and global restoration commitments into action

Population and conservation threats to the vulnerable Sarus crane Grus antigone in Nepal

Abstract Globally, biodiversity is declining due to habitat loss and degradation, over‐exploitation, climate change, invasive species, pollution, and infrastructure development. These threats affect the populations of large waterbird species, such as Sarus crane (Grus antigone), which inhabits agricultural–wetland ecosystems. Despite the burgeoning built‐up areas and diminishing agricultural and wetland spaces, scant research investigates the impact of these changing land uses on the globally vulnerable Sarus crane in Nepal. During the pre‐breeding season from April to June 2023, our comprehensive study meticulously scrutinized Sarus crane population status and factors associated with the occurrences and conservation challenges across 10 specific districts of Nepal. Our study documented a total of 690 individuals of Sarus cranes in five districts. The Lumbini Province has 685 individuals, occupying 11 roosting sites. Conversely, the remaining five districts have no Sarus cranes presence during this period. Wetland, farmland and built‐up areas exhibited a significantly positive influence on Sarus crane occurrences in the Lumbini Province. Additionally, we recorded 47 fatalities of Sarus cranes over the past 13 years in the Lumbini Province due to electrocution and collisions. Our study provides a baseline dataset crucial for developing conservation policies, particularly during the dry season when Sarus crane populations tend to congregate in larger flocks. The adaptation of the Sarus crane to urbanized landscapes exposes them to several anthropogenic threats in the coming days. Therefore, protecting wetlands and farmland areas and adopting transboundary conservation approaches are imperative for the long‐term conservation of the Sarus crane and its habitat