Factors Influencing the Adoption of Smart-home Appliances: Users\u27 Perspectives

Smart appliances will be a significant part of the annual $300 billion smart-home market by 2025. Their use is expected to grow at a compounded annual growth rate of 31% for the foreseeable future. Currently, 12-16% of households use smart-home products in the U.S., including thermostats, TVs, refrigerators, coffee machines, garage door openers, and vision-equipped doorbells. Smart appliances provide significant benefits to us over traditional appliances. Smart appliances simplify our lives by automating various tasks in our homes and allowing us to monitor and control them remotely from our offices, grocery stores, and wherever we may be. Despite the usefulness and popularity of some smart appliances, recent research has shown that their adoption rate may not be increasing as expected. Every day, manufacturers rush to make appliances smarter through increased automation and connectivity without paying attention to consumers\u27 concerns about their use. However, if the manufacturers do not address consumers\u27 concerns about their smart appliances, they may not readily be adopted solely based on their features. Scholars have explored technology adoption through various sociology, psychology, and information science theories. The universal theory of acceptance and use of technology (UTAUT) combines these widely researched theories into a framework that can be used to explore the technology adoption process. This research qualitatively explores the critical factors antecedent to consumers\u27 adoption behavior of smart appliances using the UTAUT framework. The findings from this research have expanded the application of UTAUT to address the adoption of smart-home appliances. Further, to aid the adoption process, this research makes important suggestions to practitioners involved in developing, manufacturing, and marketing smart appliances: the need to focus on interoperability, the need to lower the consumers’ effort, and the need to handle consumers\u27 data ethically. Finally, the research also offers remedies to counteract consumers’ resistance to adopting smart appliances: providing an acceptable level of automation and connectivity in appliances

Female Community Health Volunteers’ (FCHVs) Involvement in Improving Maternal Health, Nepal

FCHV program has made a significant contribution to reducing maternal death in Nepal and is the foundation of Nepal’s community-based primary health care system. Though the FCHV has had a huge positive impact, to continue the development of the programs for reducing maternal death this program needs to be properly monitored, strictly implement the guidelines and re-think the farewell package for FCHV. Keywords: FCHV Program, Primary Health Care System DOI: https://doi.org/10.3126/jkahs.v2i3.2666

Comparison of High Resolution Computed Tomography with Intraoperative Findings in Patient with Chronic Suppurative Otitis Media, NAMS, Bir Hospital, Kathmandu, Nepal

Introduction: Chronic suppurative otitis media (CSOM) is an important cause of middle ear disease and its complications challenge both otologist and radiologist. The major benefit of HRCT is an excellent visualization of the osseous structure by means of special algorithms. This study compares the HRCT with intraoperative findings in patients with CSOM. Methods: This is an observational descriptive study conducted at NAMS Bir Hospital. Total of 30 patients, referred for HRCT from the department of ENT were studied. Comparison of HRCT findings was done with intraoperative findings regarding the status of EAC, ossicular chain, bony plate, inner ear structure and facing nerve canal was done, considering intraoperative findings as the gold standard. Results: Out of 30 patients, 16 patients had CSOM with cholesteatoma and 14 patients had CSOM without cholesteatoma.HRCT presented sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 87.5%, 85.7%, 87.5%, 85.7% and 86.7% respectively in diagnosing CSOM with cholesteatoma. HRCT presented sensitivity and specificity of 85.7% and 87.5% in identification of malleus erosion, sensitivity and specificity of 86.7% and 80%, in the identification of incus erosion. HRCT showed the specificity of 85% with relatively low sensitivity of 70% in identification of erosion of stapes. HRCT showed a sensitivity of 100% and specificity of 85.7%. HRCT presented sensitivity and specificity of 83.3% and 95.8% in diagnosing tegmen tympanum erosion. HRCT showed the highest sensitivity (100%) and specificity (100%) in diagnosing erosion of sigmoid sinus plate and mastoid cortex. HRCT showed relatively low sensitivity of  66.7% and 75% in diagnosing erosion of LSCC and facial canal respectively.HRCT detected soft tissue mass in the middle ear/mastoid in all 30 patients of CSOM. Hence, the sensitivity, specificity, positive predictive value and negative predictive value of HRCT for soft tissue mass in the middle ear and mastoid, all were 100%. Conclusion: The HRCT has a valuable role in preoperative evaluation of a case of CSOM. It has high sensitivity in diagnosing CSOM with cholesteatoma. However, HRCT has relatively low sensitivity for LSCC and facial nerve canal erosion. Keywords: HRCT, CSOM, Cholesteatoma, Preoperative evaluation DOI: http://doi.org/10.3126/jkahs.v2i2.2518

Knowledge and practice on menstrual hygiene among adolescent girls of selected slums in Kathmandu valley

Introductions: Hygiene related practices during menstruation are of considerable importance. This study assesses the existing level of knowledge on menstrual hygiene, and its compliance, among adolescent girls of selected slum areas in Kathmandu, Nepal. Methods: Descriptive cross sectional study design was applied and slums in Kathmandu district were selected conveniently as research site. Primary data were collected through interview by using structured questionnaire. The association between knowledge and practices were identified through chi square test. Results: There were 282 respondents for study. Less than half 121 (42.9%) had adequate knowledge related to menstruation and its hygiene. Two-third 185(65.6%) of the participants used sanitary pads, 183 (98.9%), washed hands after pad change, 271 (96.1%) cleaned perineal area during menstruation, 227(80.5%) were aware about the myth and 61.9% followed social norms and restriction related with menstruation. Age of the participant, their education level and the income sources were found statistically significant with their level of knowledge on menstruation. Conclusions: More than half of adolescent girls of slums in Kathmandu district had inadequate knowledge regarding menstruation and two-third practiced menstrual hygiene. Keywords: adolescent, slum, menarche, menstruation hygien

Etiology, Modalities of Zygomaticomaxillary Complex Fracture, open reduction and fixation.

Zygomatic complex fracture is second most common mid face fracture and frequent amongst the maxillofacial trauma. Fracture pattern ranges from simple to comminuted and from minimally displaced to severely displaced depending on various factors. 98 pati

COVID-19 Quarantine: A Key Part of Prevention in Nepal

As the Coronavirus (COVID-19) outbreak continues to evolve, globally, many countries have introduced preventive measures to reduce human-to-human transmission in areas where the virus that causes COVID-19 is already circulating in the population. Public health measures include quarantine, which involves the restriction of the movement of ill people from the rest of the population. With the rapid increase in the number of COVID-19 positive cases, the Government of Nepal has also introduced quarantine for the COVID-19 positive cases as well as the returning migrant workers and their accompanying family members. However, concerns over quarantine facilities in border areas of Nepal have been raised by the healthcare professionals quoting the facilities as risky. Hence, the quarantine facility needs to have minimum standards so that the infection is not spread further as well as improving the better health of those in quarantine rather than deteriorating their situation. The essentials such as adequate food, water, and hygiene provisions should be made available to the patients during the quarantine period and their health should be monitored. Other preventive measures such as social distancing and hand hygiene should be maintained within the quarantine facility

Global, regional, and national burden of neurological disorders, 1990–2016 : a systematic analysis for the Global Burden of Disease Study 2016

Background: Neurological disorders are increasingly recognised as major causes of death and disability worldwide. The aim of this analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 is to provide the most comprehensive and up-to-date estimates of the global, regional, and national burden from neurological disorders. Methods: We estimated prevalence, incidence, deaths, and disability-adjusted life-years (DALYs; the sum of years of life lost [YLLs] and years lived with disability [YLDs]) by age and sex for 15 neurological disorder categories (tetanus, meningitis, encephalitis, stroke, brain and other CNS cancers, traumatic brain injury, spinal cord injury, Alzheimer's disease and other dementias, Parkinson's disease, multiple sclerosis, motor neuron diseases, idiopathic epilepsy, migraine, tension-type headache, and a residual category for other less common neurological disorders) in 195 countries from 1990 to 2016. DisMod-MR 2.1, a Bayesian meta-regression tool, was the main method of estimation of prevalence and incidence, and the Cause of Death Ensemble model (CODEm) was used for mortality estimation. We quantified the contribution of 84 risks and combinations of risk to the disease estimates for the 15 neurological disorder categories using the GBD comparative risk assessment approach. Findings: Globally, in 2016, neurological disorders were the leading cause of DALYs (276 million [95% UI 247–308]) and second leading cause of deaths (9·0 million [8·8–9·4]). The absolute number of deaths and DALYs from all neurological disorders combined increased (deaths by 39% [34–44] and DALYs by 15% [9–21]) whereas their age-standardised rates decreased (deaths by 28% [26–30] and DALYs by 27% [24–31]) between 1990 and 2016. The only neurological disorders that had a decrease in rates and absolute numbers of deaths and DALYs were tetanus, meningitis, and encephalitis. The four largest contributors of neurological DALYs were stroke (42·2% [38·6–46·1]), migraine (16·3% [11·7–20·8]), Alzheimer's and other dementias (10·4% [9·0–12·1]), and meningitis (7·9% [6·6–10·4]). For the combined neurological disorders, age-standardised DALY rates were significantly higher in males than in females (male-to-female ratio 1·12 [1·05–1·20]), but migraine, multiple sclerosis, and tension-type headache were more common and caused more burden in females, with male-to-female ratios of less than 0·7. The 84 risks quantified in GBD explain less than 10% of neurological disorder DALY burdens, except stroke, for which 88·8% (86·5–90·9) of DALYs are attributable to risk factors, and to a lesser extent Alzheimer's disease and other dementias (22·3% [11·8–35·1] of DALYs are risk attributable) and idiopathic epilepsy (14·1% [10·8–17·5] of DALYs are risk attributable). Interpretation: Globally, the burden of neurological disorders, as measured by the absolute number of DALYs, continues to increase. As populations are growing and ageing, and the prevalence of major disabling neurological disorders steeply increases with age, governments will face increasing demand for treatment, rehabilitation, and support services for neurological disorders. The scarcity of established modifiable risks for most of the neurological burden demonstrates that new knowledge is required to develop effective prevention and treatment strategies. Funding: Bill & Melinda Gates Foundation

Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12·2 million (95% UI 11·0–13·6) incident cases of stroke, 101 million (93·2–111) prevalent cases of stroke, 143 million (133–153) DALYs due to stroke, and 6·55 million (6·00–7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8–12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1–6·2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70·0% (67·0–73·0), prevalent strokes increased by 85·0% (83·0–88·0), deaths from stroke increased by 43·0% (31·0–55·0), and DALYs due to stroke increased by 32·0% (22·0–42·0). During the same period, age-standardised rates of stroke incidence decreased by 17·0% (15·0–18·0), mortality decreased by 36·0% (31·0–42·0), prevalence decreased by 6·0% (5·0–7·0), and DALYs decreased by 36·0% (31·0–42·0). However, among people younger than 70 years, prevalence rates increased by 22·0% (21·0–24·0) and incidence rates increased by 15·0% (12·0–18·0). In 2019, the age-standardised stroke-related mortality rate was 3·6 (3·5–3·8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3·7 (3·5–3·9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62·4% of all incident strokes in 2019 (7·63 million [6·57–8·96]), while intracerebral haemorrhage constituted 27·9% (3·41 million [2·97–3·91]) and subarachnoid haemorrhage constituted 9·7% (1·18 million [1·01–1·39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79·6 million [67·7–90·8] DALYs or 55·5% [48·2–62·0] of total stroke DALYs), high body-mass index (34·9 million [22·3–48·6] DALYs or 24·3% [15·7–33·2]), high fasting plasma glucose (28·9 million [19·8–41·5] DALYs or 20·2% [13·8–29·1]), ambient particulate matter pollution (28·7 million [23·4–33·4] DALYs or 20·1% [16·6–23·0]), and smoking (25·3 million [22·6–28·2] DALYs or 17·6% [16·4–19·0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries.publishedVersio

Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12.2 million (95% UI 11.0-13.6) incident cases of stroke, 101 million (93.2-111) prevalent cases of stroke, 143 million (133-153) DALYs due to stroke, and 6.55 million (6.00-7.02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11.6% 10.8-12.2] of total deaths) and the third-leading cause of death and disability combined (5.7% 5.1-6.2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70.0% (67.0-73.0), prevalent strokes increased by 85.0% (83.0-88.0), deaths from stroke increased by 43.0% (31.0-55.0), and DALYs due to stroke increased by 32.0% (22.0-42.0). During the same period, age-standardised rates of stroke incidence decreased by 17.0% (15.0-18.0), mortality decreased by 36.0% (31.0-42.0), prevalence decreased by 6.0% (5.0-7.0), and DALYs decreased by 36.0% (31.0-42.0). However, among people younger than 70 years, prevalence rates increased by 22.0% (21.0-24.0) and incidence rates increased by 15.0% (12.0-18.0). In 2019, the age-standardised stroke-related mortality rate was 3.6 (3.5-3.8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3.7 (3.5-3.9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62.4% of all incident strokes in 2019 (7.63 million 6.57-8.96]), while intracerebral haemorrhage constituted 27.9% (3.41 million 2.97-3.91]) and subarachnoid haemorrhage constituted 9.7% (1.18 million 1.01-1.39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79.6 million 67.7-90.8] DALYs or 55.5% 48.2-62.0] of total stroke DALYs), high body-mass index (34.9 million 22.3-48.6] DALYs or 24.3% 15.7-33.2]), high fasting plasma glucose (28.9 million 19.8-41.5] DALYs or 20.2% 13.8-29.1]), ambient particulate matter pollution (28.7 million 23.4-33.4] DALYs or 20.1% 16.6-23.0]), and smoking (25.3 million 22.6-28.2] DALYs or 17.6% 16.4-19.0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries

Nepal as a Business Hub for Hydropower Industry : Introduction to Hydropower Industry of Nepal

Nepal at present is suffering from the energy crisis due to the lack of enough production of electricity in the country. The main purpose of this thesis is to evaluate the present situation of electricity crisis in Nepal and provide the information to the foreign investors about the investment opportunities in hydropower sector in Nepal. The theoretical section gives the details about Nepal and electricity production scenario in Nepal. It also gives the detail about the demand and supply of electricity, investment policies in hydropower, and risks in the investment of hydropower as well as the barriers of investment in hydropower in Nepal. Eventually, based on the theoretical overview as well as the empirical study deep analysis is done to make the conclusion of the thesis. The major problems of not being able to produce enough electricity in the country were found to be the lack of capital, lack of stable government and stable political situation. The investment policy of Nepal was found to be compatible for foreigner to invest in the country. Finally, the thesis was concluded with a finding that there are very good opportunities for investors to invest in hydropower sector in Nepal