Development of Monsoonal Rainfall Intensity-Duration-Frequency (IDF) Relationship and Empirical Model for Data-Scarce Situations: The Case of the Central-Western Hills (Panchase Region) of Nepal

Intense monsoonal rain is one of the major triggering factors of floods and mass movements in Nepal that needs to be better understood in order to reduce human and economic losses and improve infrastructure planning and design. This phenomena is better understood through intensity-duration-frequency (IDF) relationships, which is a statistical method derived from historical rainfall data. In Nepal, the use of IDF for disaster management and project design is very limited. This study explored the rainfall variability and possibility to establish IDF relationships in data-scarce situations, such as in the Central-Western hills of Nepal, one of the highest rainfall zones of the country (~4500 mm annually), which was chosen for this study. Homogeneous daily rainfall series of 8 stations, available from the government's meteorological department, were analyzed by grouping them into hydrological years. The monsoonal daily rainfall was disaggregated to hourly synthetic series in a stochastic environment. Utilizing the historical statistical characteristics of rainfall, a disaggregation model was parameterized and implemented in HyetosMinute, software that disaggregates daily rainfall to finer time resolution. With the help of recorded daily and disaggregated hourly rainfall, reference IDF scenarios were developed adopting the Gumbel frequency factor. A mathematical model [i = a(T)/b(d)] was parameterized to model the station-specific IDF utilizing the best-fitted probability distribution function (PDF) and evaluated utilizing the reference IDF. The test statistics revealed optimal adjustment of empirical IDF parameters, required for a better statistical fit of the data. The model was calibrated, adjusting the parameters by minimizing standard error of prediction; accordingly a station-specific empirical IDF model was developed. To regionalize the IDF for ungauged locations, regional frequency analysis (RFA) based on L-moments was implemented. The heterogeneous region was divided into two homogeneous sub-regions; accordingly, regional L-moment ratios and growth curves were evaluated. Utilizing the reasonably acceptable distribution function, the regional growth curve was developed. Together with the hourly mean (extreme) precipitation and other dynamic parameters, regional empirical IDF models were developed. The adopted approach to derive station-specific and regional empirical IDF models was statistically significant and useful for obtaining extreme rainfall intensities at the given station and ungauged locations. The analysis revealed that the region contains two distinct meteorological sub-regions highly variable in rain volume and intensity

Impact of a structured yoga program on blood pressure reduction among hypertensive patients: study protocol for a pragmatic randomized multicenter trial in primary health care settings in Nepal

Abstract Background Hypertension control remains a major global challenge. The behavioral approaches recommended for blood pressure reduction are stress reduction, increased exercise and healthy dietary habits. Some study findings suggest that yoga has a beneficial effect in reducing blood pressure. However, the role of yoga on blood pressure has received little attention in existing health care practices in developing countries. This study will be conducted in primary health care facilities in Nepal to assess the effectiveness of a pragmatic yoga intervention to complement standard practice in further reducing blood pressure. Methods This will be multicentric, two arms, randomized, nonblinded, pragmatic trial. It will be conducted in seven District Ayurveda Health Centers (DAHCs) in Nepal between July 2017 and June 2018. The study participants will consist of hypertensive patients with or without antihypertensive medication attending to the outpatient department (OPD). One hundred and forty participants will be randomized to treatment or control groups by using a stratified block randomization. At the study site, the treatment arm participants will receive an intervention consisting of five days of structured yoga training and practice of the same package at home with a recommendation of five days a week for the following 90 days. Both the intervention and control groups will receive two hours of health education on lifestyle modifications. The primary outcome of this trial will be the change in systolic blood pressure and it will be assessed after 90 days of the intervention. Discussion This study will establish the extent to which a yoga intervention package can help reduce blood pressure in hypertensive patients. If proven effective, study findings may be used to recommend the governing bodies and other stakeholders for the integration of yoga in the national healthcare system for the treatment and control of hypertension. Trial registration Clinical Trial Registry- India (CTRI); CTRI Reg. No- CTRI/2017/02/007822. Registered on 10/02/2017

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.The aim of this study was to inform vaccination prioritization by modelling the impact of vaccination on elective inpatient surgery. The study found that patients aged at least 70 years needing elective surgery should be prioritized alongside other high-risk groups during early vaccination programmes. Once vaccines are rolled out to younger populations, prioritizing surgical patients is advantageous