Need for HTA supported risk factor screening for hypertension and diabetes in Nepal: A systematic scoping review.

Objective: Health Technology Assessment (HTA) is a comprehensive and important tool for assessment and decision-making in public health and healthcare practice. It is recommended by the WHO and has been applied in practice in many countries, mostly the developed ones. HTA might be an important tool to achieve universal health coverage (UHC), especially beneficial to low-and-middle-income countries (LMIC). Even though the Package for Essential Non-communicable Diseases (PEN) has already been initiated, there is a clear policy gap in the HTA of any health device, service, or procedure, including the assessment of cardiovascular risk factors (CVRFs) in Nepal. Hence, we carried out the review to document the HTA supported evidence of hypertension and diabetes screening, as CVRFs in Nepal. Materials and methods: We searched in PubMed, Cochrane, and Google Scholar, along with some gray literature published in the last 6 years (2016-2021) in a systematic way with a controlled vocabulary using a well-designed and pilot tested search strategy, screened them, and a total of 53 articles and reports that matched the screening criteria were included for the review. We then, extracted the data in a pre-designed MS-Excel format, first in one, and then, from it, in two, with more specific data. Results: Of 53 included studies, we reported the prevalence and/or proportion of hypertension and diabetes with various denominators. Furthermore, HTA-related findings such as cost, validity, alternative tool or technology, awareness, and intervention effectiveness have been documented and discussed further, however, not summarized due to their sparingness. Conclusion: Overall, the prevalence of DM (4.4-18.8%) and HTN (17.2-70.0%) was reported in most studies, with a few, covering other aspects of HTA of DM/HTN. A national policy for establishing an HTA agency and some immediately implementable actions are highly recommended.

National and Provincial Estimates of Catastrophic Health Expenditure and its Determinants in Nepal.

BACKGROUND: Despite various supply-side efforts, out of pocket expenditure occupies a considerable portion of healthcare financing in Nepal. With the recent process of federalization in country, there is additional scope for contextualized planning at provincial level to prevent catastrophic health expenditure among Nepalese households. In this context, this study intends to estimate the proportion of population facing catastrophic health expenditure at national and provincial level and identify the determinants of catastrophic health expenditure. METHODS: This study involved analysis of Nepal Living Standard Survey III, which was a cross sectional study. Out of 5,988 households comprising 28,460 individuals, data from total of 7,911 individuals who reported having acute or chronic illness was extracted and analyzed in the study. RESULTS: In the study, 11.11% of households had faced catastrophic health expenditure. Catastrophic health expenditure was found to be 11.3% in Province 1, 9.4% in Province 2, 10.7% in Bagmati Province, 10% in Gandaki Province, 11.7% in Lumbini Province, 13.3% in Karnali Province and 13.4% in Sudurpaschim Province. Household size, literacy status of household head, consumption quintile, urban or rural residence, type of illness and type of health facility visited were identified as determinants of catastrophic health expenditure. CONCLUSIONS: A tenth of households, most of whom lying below poverty line, residing in rural areas, suffering from chronic illness are facing catastrophic healthcare burden. The government needs to pursue its equity-oriented strategies preventing catastrophic health expenditure and impoverishment associated with it.

A new nanowire-based lithium hexaoxotungstate anode for lithium-ion batteries.

This study reports one dimensional lithium hexaoxotungstate (Li6WO6), with a diameter in the range of 200-500 nm, as a novel anode material for lithium-ion batteries. The electrochemical performance of lithium hexaoxotungstate was investigated and a discharge capacity of 705 mA h g-1 was achieved after 50 cycles, along with an excellent rate capability. The 1D morphology of the material is believed to provide excellent transport properties, resulting in a high rate capability. The remarkable electrochemical performance of the Li6WO6 nanowires indicates that this new class of anode holds a lot of promise for future deployment in energy storage devices.

Universal Access to Essential Medicines: An Evaluation of Nepal's Free Health Care Scheme.

BACKGROUND: Access to medicine for the poor is recognized to be difficult task and one of the major challenges in achieving universal health coverage, particularly in low-and- middle income countries. In order to ensure the availability of essential medicines free of cost in public health facilities, Nepal has also commenced Free Health Care Services (FHCS). So, this study aims to evaluate availability, expiry, and stock-out duration of essential medicines at front line service providers in Nepal. METHODS: Cross-sectional survey was conducted 28 public health facilities, 7 district warehouses, and 14 private pharmacies in 7 districts of Nepal. The survey was conducted during the March and April 2014. Survey tools recommended by the WHO operational package for assessing, monitoring and evaluating country pharmaceutical situations was used with slight modification as per Nepal's situation. RESULTS: The availability of medicine was found to be 92.44% in this study. The percentage of expired medicines in district warehouse was found to be 8.40. The average stock-out duration in district warehouse was 0.324 days. CONCLUSIONS: Although the availability of essential medicines at peripheral health facilities was found to be satisfactory with lesser proportion of expired medicines, a strong monitoring and evaluation of expired and stock medicines are desirable to maintain and improve the access to essential medicines.

Mesoporous TiO2 coating on carbon-sulfur cathode for high capacity Li-sulfur battery.

In this paper, a meso-porous TiO2 (titania) coating is shown to effectively protect a carbon-sulfur composite cathode from polysulfide dissolution. The cathode consisted of a sulfur impregnated carbon support coated with a few microns thick mesoporous titania layer. The carbon-sulfur cathode is made using activated carbon powder (ACP) derived from biomass. The mesoporous titania coated carbon-sulfur cathodes exhibit a retention capacity after 100 cycles at C/3 rate (433 mA g -1) and stabilized at a capacity around 980 mA h g-1. The electrochemical impedance spectroscopy (EIS) of the sulfur cathodes suggests that the charge transfer resistance at the anode, (R act) is stable for the titania coated sulfur electrode in comparison to a continuous increase in R act for the uncoated electrode implying mitigation of polysulfide shuttling for the protected cathode. Stability in the cyclic voltammetry (CV) data for the first 5 cycles further confirms the polysulfide containment in the titania coated cathode while the uncoated sulfur electrode shows significant irreversibility in the CV with considerable shifting of the voltage peak positions. Raman spectroscopy and X-ray photoelectron spectroscopy (XPS) studies confirm the adsorption of soluble polysulfides by mesoporous titania.

Incommensurate Graphene Foam as a High Capacity Lithium Intercalation Anode.

Graphite's capacity of intercalating lithium in rechargeable batteries is limited (theoretically, 372 mAh g-1) due to low diffusion within commensurately-stacked graphene layers. Graphene foam with highly enriched incommensurately-stacked layers was grown and applied as an active electrode in rechargeable batteries. A 93% incommensurate graphene foam demonstrated a reversible specific capacity of 1,540 mAh g-1 with a 75% coulombic efficiency, and an 86% incommensurate sample achieves above 99% coulombic efficiency exhibiting 930 mAh g-1 specific capacity. The structural and binding analysis of graphene show that lithium atoms highly intercalate within weakly interacting incommensurately-stacked graphene network, followed by a further flexible rearrangement of layers for a long-term stable cycling. We consider lithium intercalation model for multilayer graphene where capacity varies with N number of layers resulting LiN+1C2N stoichiometry. The effective capacity of commonly used carbon-based rechargeable batteries can be significantly improved using incommensurate graphene as an anode material.

High rate and durable, binder free anode based on silicon loaded MoO3 nanoplatelets.

In order to make fast-charging batteries a reality for electric vehicles, durable, more energy dense and high-current density resistant anodes need to be developed. With such purpose, a low lithiation potential of 0.2 V vs. Li/Li(+) for MoO3 nanoplatelet arrays is reported here for anodes in a lithium ion battery. The composite material here presented affords elevated charge capacity while at the same time withstands rapid cycling for longer periods of time. Li2MoO4 and Li(1.333)Mo(0.666)O2 were identified as the products of lithiation of pristine MoO3 nanoplatelets and silicon-decorated MoO3, respectively, accounting for lower than previously reported lithiation potentials. MoO3 nanoplatelet arrays were deposited using hot-wire chemical vapor deposition. Due to excellent voltage compatibility, composite lithium ion battery anodes comprising molybdenum oxide nanoplatelets decorated with silicon nanoparticles (0.3% by wt.) were prepared using an ultrasonic spray. Silicon decorated MoO3 nanoplatelets exhibited enhanced capacity of 1037 mAh g(-1) with exceptional cyclability when charged/discharged at high current densities of 10 A g(-1).