Immutable Storage of EV Charge Records Using Blockchain Technology

After the first successful implementation of the decentralized and distributed digital currency, Bitcoin, its core disruptive technology called Blockchain has been the subject of interest for many people and business organizations in order to harness its power. This thesis is an attempt to understand blockchain technology and its use cases in the field of electric mobility. The primary goal of this thesis was to develop a prototype based on blockchain technology, to store immutable charge records of electric vehicles for Liikennevirta Oy, aimed to strengthen trust and data integrity of customers. The project started with preliminary research on different available platforms in order to find a suitable platform to meet the requirement of the business. Design of the network architecture and the smart contract were done consecutively after the selection of the platform. Manual deployment of the prototype was done to Amazon Cloud Service using a single instance of Elastic Cloud Compute for testing purpose. As a result, a permissioned blockchain network, a smart contract (chaincode) and a REpresentational State Transfer (REST) Application Programming Interface (API) server were developed using Hyperledger Fabric platform and Hyperledger Composer tool. The charge data record is stored in the nodes of the network when the electric vehicle charging process is initiated or stopped. Another potential use case of blockchain technology to build a decentralized roaming platform for electric mobility providers has been realized and discussed in this thesis. In conclusion, Blockchain technology itself leaves no doubt for maintaining the integrity of stored data. However, it has no control over the truth of the data being asked to be stored as it is influenced by outside factors such as human and sensors. The developed prototype also relies on the authenticity of data supplied by charging stations to provide trust and transparency

Multimodality imaging for repaired tetralogy of Fallot

Despite complete repair at an optimal time in the current era, almost all patients with tetralogy of Fallot will have residual anatomic and hemodynamic sequelae, which make ongoing surveillance of paramount importance. Echocardiography suffices surveillance matrix in most pre-operative cases unless there is a specific question about coronary artery anomaly or branch pulmonary arteries when cardiac catheterization or computed tomography scan can be extremely helpful. For long-term follow-up of repaired tetralogy of Fallot patients, several diagnostic/imaging monitoring modalities are available; however, no single modality is perfect in terms of obtaining all the necessary information. A multimodality approach is suggested for long-term surveillance where a diagnostic test is selected based on the clinical circumstances/questions raised and institutional preference/expertise

A case of acute encephalitis syndrome and cranial nerve palsy secondary to scrub typhus: A rare presentation from Western Nepal

Key Clinical Message This case report highlights the importance of considering scrub typhus as a differential diagnosis for acute encephalitis with cranial nerve palsy in the region of the tsutsugamushi triangle. Abstract Scrub typhus is a zoonotic rickettsiosis caused by the bacterium Orientia tsutsugamushi. This disease is endemic to a region called the tsutsugamushi triangle that extends from Southeast Asia to the Pacific Ocean. We report a 17‐year‐old girl from western Nepal who presented with fever, headache, vomiting, and altered sensorium, as well as bilateral lateral rectus palsy, dysphagia, regurgitation of food, dysarthria, and left‐sided upper motor neuron type facial palsy. Following laboratory and imaging tests, the patient was diagnosed with scrub typhus and was treated successfully with high‐dose dexamethasone and doxycycline. This case highlights the importance of considering scrub typhus in the differential diagnosis of encephalitis with cranial nerve palsy, especially in the region of the tsutsugamushi triangle. It also emphasizes the need for timely diagnosis and treatment of scrub typhus to prevent the development of various complications and ensure earlier recovery of patients

Prehospital emergency care for trauma victims in Nepal: a mixed-methods study

BackgroundThe prehospital care system in Nepal is poorly developed, with multiple providers, limited coordination of services and no national coverage. There is little published evidence reporting the prehospital care of patients with trauma, data which are important to inform the development of the prehospital care system. ObjectivesIn order to understand the challenges of providing prehospital care to trauma patients, the study aimed to explore the burden of trauma presenting to prehospital care providers and the experience of providing care to these patients. DesignWe used a mixed-method study that included secondary data analysis and qualitative semi-structured interviews. SettingNepal (Kathmandu Valley, Chitwan, Pokhara, and Butwal)ParticipantsStaff employed by the Nepal Ambulance Service including ambulance drivers, emergency medical technicians, dispatch officers, and service managers.Data sourcesData describing callouts by the Nepal Ambulance Service over one year. Callout data were anonymised and analysed descriptively. Semi-structured interviews were audio-recorded, transcribed, translated, and analysed using inductive thematic analysis.ResultsOf 1,408 trauma calls received, 48.4% (n=682) resulted in prehospital care being provided. The most common mechanism of injury was falls (35.8%), followed by road traffic crashes (19.1%) and the commonest types of injuries were fractures (33.1%) and spinal injuries (10.1%). Mean time from call to arrival at hospital was 48 minutes (range 20 minutes-6 hours). Seventeen staff described factors facilitating effective prehospital care, including having adequate resources, systems and training. Barriers to delivering prehospital care included the expectations and behaviour of patients' relatives and bystanders, a lack of public awareness of the role and provision of prehospital care, and poor road and traffic conditions.LimitationsFor some data fields, data were missing, limiting the ability to precisely determine patient needs and response times. The qualitative data may have been subject to responder bias if participants felt uncomfortable reporting something that may have reflected badly on their employer. ConclusionsTrauma is a major reason for requesting prehospital care, which can be delivered in less than an hour from receiving a call to arrival at the hospital. Multiple factors impede the effective delivery of care which could be addressed through further development across the prehospital care system. Future workQualitative research to explore the perceptions and experiences of trauma victims, road users, emergency department staff, police officers, members of organisations involved in prehospital care, firefighters, and policy-makers would complement the findings from this study. Specific issues raised, such as the difficulties experienced when handing over patients between prehospital and hospital care providers warrant further exploration

Study of Antibacterial Activity of Root Bark, Leaves, and Pericarp Extracts of Diploknema butyracea and Evaluation of Prospective Antioxidant Activity.

This study was aimed to determine the antibacterial activity of root bark, leaves, and pericarp extract of Diploknema butyracea and to evaluate the prospective antioxidant activity, total flavonoid, polyphenol, and carbohydrate content. The plant parts were collected and extracted by cold maceration, using hexane, ethyl acetate, methanol, and distilled water. Phytochemical screening of different samples of D. butyracea in different solvents revealed the presence of varied extent of alkaloid, saponin, terpenoid, anthraquinones, tannin, cardiac glycoside, flavonoid, carbohydrate, polyphenol, protein and amino acid, resin, and phytosterol. Our study showed that methanolic root bark extract exhibited the potent antimicrobial activity against Staphylococcus aureus, Staphylococcus epidermidis, and Klebsiella pneumonia with an average zone of inhibition of 17.33 mm, 14.33 mm, and 13.0 mm, respectively. Surprisingly, all of the extracts were insensitive to Escherichia coli. The lowest minimum bactericidal concentration (MBC), 4.6 mg/ml, was observed with the aqueous pericarp extract against S. epidermidis and the highest was of 50 mg/ml shown by ethyl acetate pericarp against K. pneumonia. Our results showed that both the polar and nonpolar components present in the different parts of D. butyracea exhibit prominent antibacterial activities against different bacterial strains. The in vitro 2,2-diphenyl-1-picrylhydrazyl (DPPH) free radical scavenging activity showed that the methanol extract of root barks displayed the most potent antioxidant activity (IC50 : 6.1 µg/ml). The total polyphenol content of the plant part extracts was observed between 19.48 ± 0.23 and 123.48 ± 1.84 µg gallic acid equivalent/mg of dry extract weight. Likewise, flavonoid content ranged from 40.63 ± 1.28 µg to 889.72 ± 3.40 μg quercetin equivalent/mg of dry extract weight and total carbohydrate content ranged from 11.92 ± 0.60 µg to 174.72 ± 0.60 µg glucose equivalent per/mg dry extract weight. Overall, our study showed that the root bark, pericarp, and leaves extract of D. butyracea evinced prominent antibacterial properties against various pathogenic bacterial strains

Cardiovascular involvement in multisystem inflammatory syndrome in children with COVID-19

In children, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections typically result in a less severe coronavirus 19 (COVID-19) presentation than in adults. However, a subset of children presents with severe multisystem inflammation associated with recent SARS-CoV-2 infection or COVID-19 exposure in the previous weeks. The Center for Disease Control (CDC) has termed this condition a multisystem inflammatory syndrome in children (MIS-C). MIS-C causes significant cardiovascular involvement, which can be a determinant of clinical course and outcomes. A subset of MIS-C patients presents with hypotension and shock either from acute myocardial dysfunction or systemic vasodilation, with at least of third of patients developing cardiac manifestations from the illness. In addition, myocarditis, pericarditis, valvular regurgitation, coronary artery involvement, and arrhythmias have been reported, with a smaller subset of patients requiring extracorporeal membrane oxygenation. Here, we report our institutional experience of MIS-C over the last year and present a narrative review of cases reported in the literature. In addition, we discuss the clinical protocol of diagnosis and acute and follow-up management of these patients with MIS-C

Operational Gaps in Implementing the COVID-19 Case Investigation and Contact Tracing in Madhesh Province of Nepal, May–July 2021

In Nepal, case investigation and contact tracing (CICT) was adopted as an important public health measure to reduce COVID-19 transmission. In this study, we assessed the performance of CICT in Madhesh Province of Nepal against national benchmarks, using routine programmatic data reported by district CICT teams. Between May and July 2021, 17,943 COVID-19 cases were declared in the province, among which case investigation was performed for 30% (95% CI: 29.6–31.0%) within 24 h (against 80% benchmark). As a result of case investigations, 6067 contacts were identified (3 contacts per 10 cases), of which 40% were traced and tested for SARS-CoV-2 infection (against 100% benchmark). About 60% of the contacts tested positive. At most 14% (95% CI: 13.1% to 14.9%) of traced contacts underwent a 14-day follow-up assessment (against 100% benchmark). We found the performance of the CICT program in Madhesh Province to be sub-optimal and call for corrective measures to strengthen CICT in the province and the country at large. Similar studies with wider geographical scope and longer time frames are needed to identify and address deficiencies in data recording and reporting systems for COVID-19, in low- and middle-income countries like Nepal and others

COVID-19 Amongst Travelers at Points of Entry in Nepal: Screening, Testing, Diagnosis and Isolation Practices

WHO recommends surveillance for COVID-19 among travelers at Points of Entry (POE) to countries. At 13 selected POE at the Nepal-India border, between March 2021 and July 2021, we describe the screening, testing, diagnosis and isolation practices of COVID-19 amongst travelers. Those who stayed in India or elsewhere for > one day and those who did not have a negative RT-PCR result within the last 72 h of travel were tested for COVID-19 with rapid antigen diagnostic tests. Daily surveillance reports maintained at POE were used for analysis. Of 337,338 travelers screened, 69,886 (21%) were tested and 3907 (6%) were diagnosed with COVID-19. The proportions tested averaged 15% during April-May when screened numbers were high and increased to 35% in July when screened numbers had decreased. The proportions diagnosed positive peaked at 10% in April-May, but decreased to below 1% in June and July. Testing coverage varied from 0–99% in the different POE. Most COVID-19 cases were Nepalese, male, <60 years of age, migrant workers and presented with fever. Of COVID-19 cases, 32% had home-based isolation, 64% underwent community-based isolation and the remainder either went to hospital or returned to India. In conclusion, about one fifth of travelers overall were tested, with coverage varying considerably over time and among different POE. Strengthening surveillance processes at POE is needed

The burden of injuries in Nepal: Findings from the NIHR Global Health Research Group

Background: Injuries cause significant harm and may lead to disability yet are largely preventable. Understanding the epidemiology and determinants of injury in any given context is an essential step towards effective prevention. In Nepal, surveys suggest that injuries on the road, at home and at work are a problem, but in the absence of injury surveillance, robust death registration or police records, the true burden is unclear. For those who are injured, access to prehospital care is variable. Objectives: (i) To understand the epidemiology of injuries (ii) To identify potentially modifiable risk factors to inform the development of prevention interventions (iii) To build capacity and capability for injury prevention research.Design: Observational, secondary data analysis and qualitative methods were used. We worked with communities, practitioners and stakeholders to identify potential participants, develop study protocols and disseminate findings.Setting: Nepal.Participants: Patients, communities and road users, health system practitioners and managers, professionals (e.g. police, engineers, journalists) and local and national decision makers.Main outcome measures: epidemiological evidence of the burden of injuries, evidence to inform future intervention development. Data sources: participants, health services, police and information in the public domain.Review methods: Reviews were conducted systematically with evidence synthesised narratively.Results: The Nepal Injury Research Centre was established, and a cadre of researchers trained. Three researchers and our data manager completed Masters degree courses and all researchers developed their skills by leading at least one project from protocol development through to publication. A review of publications reporting injuries indicated that existing epidemiological evidence mostly arose from case series at high risk of bias. A review of existing legislation showed policy gaps and incomplete implementation or enforcement. Surveillance studies and a household survey showed the high burden of injuries at home, work and on the roads and the neglected issue of suicide. Previously unreported inequalities by age, sex, ethnic group and income level were identified. Existing health, police and death registration data systems are at high risk of under-reporting and misclassification. Road traffic injury emerged as a major concern; road users fear being injured as pedestrians, passengers or drivers, the economic burden of road injuries has increased three-fold over eight years and potentially modifiable risk factors were identified. The provision of first response services is highly variable, and the public and practitioners are fearful of prosecution in the event of poor outcomes. We found it is feasible to train the traffic police in first response and for them to use their skills at traffic collisions. Research priorities for suicide prevention were identified.Limitations: Studies were limited by the quality of the data available through existing systems, with data often incomplete or poorly coded. Our studies were largely conducted in one district with topography typical of many areas of Nepal. However, our findings may not be generalisable to all districts. Conclusions: Our programme identified the inequitable and significant burden of injuries in Nepal. There is the potential to develop existing legislation and health and transport systems to reduce the incidence and consequences of injury.Future work: Research should focus on interventions to reduce injury risk on the roads and at home/work, to develop the first response system and standardise care, and to strengthen injury data systems