Actions to halt biodiversity loss generally benefit the climate.

The two most urgent and interlinked environmental challenges humanity faces are climate change and biodiversity loss. We are entering a pivotal decade for both the international biodiversity and climate change agendas with the sharpening of ambitious strategies and targets by the Convention on Biological Diversity and the United Nations Framework Convention on Climate Change. Within their respective Conventions, the biodiversity and climate interlinked challenges have largely been addressed separately. There is evidence that conservation actions that halt, slow or reverse biodiversity loss can simultaneously slow anthropogenic mediated climate change significantly. This review highlights conservation actions which have the largest potential for mitigation of climate change. We note that conservation actions have mainly synergistic benefits and few antagonistic trade-offs with climate change mitigation. Specifically, we identify direct co-benefits in 14 out of the 21 action targets of the draft post-2020 global biodiversity framework of the Convention on Biological Diversity, notwithstanding the many indirect links that can also support both biodiversity conservation and climate change mitigation. These relationships are context and scale-dependent; therefore, we showcase examples of local biodiversity conservation actions that can be incentivized, guided and prioritized by global objectives and targets. The close interlinkages between biodiversity, climate change mitigation, other nature's contributions to people and good quality of life are seldom as integrated as they should be in management and policy. This review aims to re-emphasize the vital relationships between biodiversity conservation actions and climate change mitigation in a timely manner, in support to major Conferences of Parties that are about to negotiate strategic frameworks and international goals for the decades to come.

How public values for threatened species are affected by conservation strategies.

While the imminent extinction of many species is predicted, prevention is expensive, and decision-makers often have to prioritise funding. In democracies, it can be argued that conservation using public funds should be influenced by the values placed on threatened species by the public, and that community views should also affect the conservation management approaches adopted. We conducted on online survey with 2400 respondents from the general Australian public to determine 1) the relative values placed on a diverse set of 12 threatened Australian animal species and 2) whether those values changed with the approach proposed to conserve them. The survey included a contingent valuation and a choice experiment. Three notable findings emerged: 1) respondents were willing to pay $60/year on average for a species (95% confidence interval: $23 to $105) to avoid extinction in the next 20 years based on the contingent valuation, and $29 to $100 based on the choice experiment, 2) respondents were willing to pay to reduce the impact of feral animals on almost all presented threatened species, 3) for few species and respondents, WTP was lower when genetic modification to reduce inbreeding in the remaining population was proposed.

Policy choice and riverine water quality in developing countries: An integrated hydro-economic modelling approach.

Industrialization and urbanization, as a result of rapid economic development, have led to the deterioration of water quality in many rivers in developing countries. The Kelani River in Sri Lanka provides drinking water to Colombo and a range of market and non-market ecosystem services; but these services are threatened by deteriorating water quality. We apply a hydro-economic model that accounts for spatial patterns of water quality and abatement cost variability between firms in the catchment. The hydro-economic model combines a hydrological model of water quality with an economic optimization model to determine a cost-effective policy under alternate policy regimes. These include: the existing policy based on effluent concentration standards, effluent trading and effluent trading with multiple zones and an effluent tax. Tradeable permits with multiple zones are the least cost policy option that accounts for both spatial externalities and abatement costs. However, given current institutional capabilities, an effluent tax would be a more realistic second best policy as a transition from the current policy of effluent concentration standards to a policy based on the quantity of effluents.

Industrial pollution and the management of river water quality: a model of Kelani River, Sri Lanka.

Water quality of the Kelani River has become a critical issue in Sri Lanka due to the high cost of maintaining drinking water standards and the market and non-market costs of deteriorating river ecosystem services. By integrating a catchment model with a river model of water quality, we developed a method to estimate the effect of pollution sources on ambient water quality. Using integrated model simulations, we estimate (1) the relative contribution from point (industrial and domestic) and non-point sources (river catchment) to river water quality and (2) pollutant transfer coefficients for zones along the lower section of the river. Transfer coefficients provide the basis for policy analyses in relation to the location of new industries and the setting of priorities for industrial pollution control. They also offer valuable information to design socially optimal economic policy to manage industrialized river catchments.

Comparing cross-sectional and longitudinal approaches to tuberculosis patient cost surveys using Nepalese data.

The World Health Organization has supported the development of national tuberculosis (TB) patient cost surveys to quantify the socio-economic impact of TB in high-burden countries. However, methodological differences in the study design (e.g. cross-sectional vs longitudinal) can generate different estimates making the design and impact evaluation of socio-economic protection strategies difficult. The objective of the study was to compare the socio-economic impacts of TB estimated by applying cross-sectional or longitudinal data collections in Nepal. We analysed the data from a longitudinal costing survey (patients interviewed at three time points) conducted between April 2018 and October 2019. We calculated both mean and median costs from patients interviewed during the intensive (cross-sectional 1) and continuation (cross-sectional 2) phases of treatment. We then compared costs, the prevalence of catastrophic costs and the socio-economic impact of TB generated by each approach. There were significant differences in the costs and social impacts calculated by each approach. The median total cost (intensive plus continuation phases) was significantly higher for the longitudinal compared with cross-sectional 2 (US$119.42 vs 91.63, P < 0.001). The prevalence of food insecurity, social exclusion and patients feeling poorer or much poorer were all significantly higher by applying a longitudinal approach. In conclusion, the longitudinal design captured important aspects of costs and socio-economic impacts, which were missed by applying a cross-sectional approach. If a cross-sectional approach is applied due to resource constraints, our data suggest that the start of the continuation phase is the optimal timing for a single interview. Further research to optimize methodologies to report patient-incurred expenditure during TB diagnosis and treatment is needed.

Comparing Additionality of Tuberculosis Cases Using GeneXpert or Smear-Based Active TB Case-Finding Strategies among Social Contacts of Index Cases in Nepal.

This study compares the yield and additionality of community-based active tuberculosis (TB) active case-finding strategies using either smear microscopy or GeneXpert as the TB diagnostic test. Active case-finding strategies screened social contacts of index cases and high-risk groups in four districts of Nepal in July 2017-2019. Two districts (Chitwan and Dhanusha) applied GeneXpert testing and two districts (Makwanpur and Mahotarri) used smear microscopy. Two control districts implemented standard national TB program activities. Districts implementing GeneXpert testing screened 23,657 people for TB, tested 17,114 and diagnosed 764 TB cases, producing a yield of 4.5%. Districts implementing smear microscopy screened 19,961 people for TB, tested 13,285 and diagnosed 437 cases, producing a yield of 3.3%. The screening numbers required were 31 for GeneXpert and 45.7 for smear districts. The test numbers required were 22.4 and 30.4 for GeneXpert and smear. Using the TB REACH additionality method, social contact tracing for TB through GeneXpert testing contributed to a 20% (3958/3322) increase in district-level TB notifications, smear microscopy 12.4% (3146/2798), and -0.5% (2553/2566) for control districts. Therefore, social contact tracing of TB index cases using GeneXpert testing should be implemented throughout Nepal within the TB FREE initiative to close the notification gap and accelerate progress toward END TB strategy targets.

Communicating conservation: how do the Nepalese print media portray caterpillar fungus? An analysis of newspaper coverage from 2008-2021.

Caterpillar fungus (Ophiocordyceps sinensis) makes an economically important contribution to livelihoods of the local people in the Himalaya. Its extraordinarily high market price as an aphrodisiac, and pressure in the natural habitats due to overharvesting and climate change, have attracted local and global media attentions. Despite the wide media coverage on various social and environmental aspects of the caterpillar fungus, a consolidated analysis of the news and featured articles about the different dimensions of the caterpillar fungus is lacking. In this paper, we assess how the Nepalese print media have portrayed the social, economic, governance, and biological dimensions of caterpillar fungus conservation and management. We conducted a thematic analysis of newspaper articles published for fourteen years from 2008-2021 in seven national daily newspapers in Nepal. We used an inductive method to extract the keywords from the printed newspapers, resulting in 3,777 keywords from 681 news items belonging to eight thematic areas. Based on the similarities and differences in the keywords, the news items were categorized into eight themes: impacts of caterpillar fungus harvesting (28% news coverage), trade of caterpillar fungus (16%), general information about the fungus (15%), harvesting of the fungus (14%), governance mechanisms (14%), challenges to the harvesters (6%), policy gaps (4%), and institutional and policy responses (3%). We found that Nepalese media highlighted the socio-economic and environmental impacts of caterpillar fungus harvesting but presented less information about the government response to its conservation, gaps in knowledge and governance mechanisms necessary to conserve the fungus. The thematic analysis of media reporting can help in devising long term conservation and management policies of the caterpillar fungus, particularly focussing on the issues frequently reported by the national media.

Barriers and facilitators to accessing tuberculosis care in Nepal: a qualitative study to inform the design of a socioeconomic support intervention.

OBJECTIVE: Psychosocial and economic (socioeconomic) barriers, including poverty, stigma and catastrophic costs, impede access to tuberculosis (TB) services in low-income countries. We aimed to characterise the socioeconomic barriers and facilitators of accessing TB services in Nepal to inform the design of a locally appropriate socioeconomic support intervention for TB-affected households. DESIGN: From August 2018 to July 2019, we conducted an exploratory qualitative study consisting of semistructured focus group discussions (FGDs) with purposively selected multisectoral stakeholders. The data were managed in NVivo V.12, coded by consensus and analysed thematically. SETTING: The study was conducted in four districts, Makwanpur, Chitwan, Dhanusha and Mahottari, which have a high prevalence of poverty and TB. PARTICIPANTS: Seven FGDs were conducted with 54 in-country stakeholders, grouped by stakeholders, including people with TB (n=21), community stakeholders (n=13) and multidisciplinary TB healthcare professionals (n=20) from the National TB Programme. RESULTS: The perceived socioeconomic barriers to accessing TB services were: inadequate TB knowledge and advocacy; high food and transportation costs; income loss and stigma. The perceived facilitators to accessing TB care and services were: enhanced championing and awareness-raising about TB and TB services; social protection including health insurance; cash, vouchers and/or nutritional allowance to cover food and travel costs; and psychosocial support and counselling integrated with existing adherence counselling from the National TB Programme. CONCLUSION: These results suggest that support interventions that integrate TB education, psychosocial counselling and expand on existing cash transfer schemes would be locally appropriate and could address the socioeconomic barriers to accessing and engaging with TB services faced by TB-affected households in Nepal. The findings have been used to inform the design of a socioeconomic support intervention for TB-affected households. The acceptability, feasibility and impact of this intervention on TB-related costs, stigma and TB treatment outcomes, is now being evaluated in a pilot implementation study in Nepal.

How to reduce household costs for people with tuberculosis: a longitudinal costing survey in Nepal.

The aim of this study was to compare costs and socio-economic impact of tuberculosis (TB) for patients diagnosed through active (ACF) and passive case finding (PCF) in Nepal. A longitudinal costing survey was conducted in four districts of Nepal from April 2018 to October 2019. Costs were collected using the WHO TB Patient Costs Survey at three time points: intensive phase of treatment, continuation phase of treatment and at treatment completion. Direct and indirect costs and socio-economic impact (poverty headcount, employment status and coping strategies) were evaluated throughout the treatment. Prevalence of catastrophic costs was estimated using the WHO threshold. Logistic regression and generalized estimating equation were used to evaluate risk of incurring high costs, catastrophic costs and socio-economic impact of TB over time. A total of 111 ACF and 110 PCF patients were included. ACF patients were more likely to have no education (75% vs 57%, P = 0.006) and informal employment (42% vs 24%, P = 0.005) Compared with the PCF group, ACF patients incurred lower costs during the pretreatment period (mean total cost: US$55 vs US$87, P < 0.001) and during the pretreatment plus treatment periods (mean total direct costs: US$72 vs US$101, P < 0.001). Socio-economic impact was severe for both groups throughout the whole treatment, with 32% of households incurring catastrophic costs. Catastrophic costs were associated with 'no education' status [odds ratio = 2.53(95% confidence interval = 1.16-5.50)]. There is a severe and sustained socio-economic impact of TB on affected households in Nepal. The community-based ACF approach mitigated costs and reached the most vulnerable patients. Alongside ACF, social protection policies must be extended to achieve the zero catastrophic costs milestone of the End TB strategy.

Inactivation of Escherichia coli O157:H7 and natural microbiota on spinach leaves using gaseous ozone during vacuum cooling and simulated transportation.

The aim of this study was to integrate an ozone-based sanitization step into existing processing practices for fresh produce and to evaluate the efficacy of this step against Escherichia coli O157:H7. Baby spinach inoculated with E. coli O157:H7 (approximately 10(7) CFU/g) was treated in a pilot-scale system with combinations of vacuum cooling and sanitizing levels of ozone gas (SanVac). The contribution of process variables (ozone concentration, pressure, and treatment time) to lethality was investigated using response-surface methodology. SanVac processes decreased E. coli O157:H7 populations by up to 2.4 log CFU/g. An optimized SanVac process that inactivated 1.8 log CFU/g with no apparent damage to the quality of the spinach had the following parameters: O3 at 1.5 g/kg gas-mix (935 ppm, vol/vol), 10 psig of holding pressure, and 30 min of holding time. In a separate set of experiments, refrigerated spinach was treated with low ozone levels (8 to 16 mg/kg; 5 to 10 ppm, vol/vol) for up to 3 days in a system that simulated sanitization during transportation (SanTrans). The treatment decreased E. coli populations by up to 1.4 log CFU/g, and the optimum process resulted in a 1.0-log inactivation with minimal effect on product quality. In a third group of experiments, freshly harvested unprocessed spinach was inoculated with E. coli O157:H7 and sequentially subjected to optimized SanVac and SanTrans processes. This double treatment inactivated 4.1 to > or = 5.0 log CFU/g, depending on the treatment time. These novel sanitization approaches were effective in considerably reducing the E. coli O157: H7 populations on spinach and should be relatively easy to integrate into existing fresh produce processes and practices.

Severe life-threatening hypersensitivity reaction to polidocanol in a case of recurrent aneurysmal bone cyst.

Aneurysmal bone cysts (ABC) are expansile lytic lesions constituting around 1% of all benign bone tumors with an annual incidence of 1.4/100000. A variety of treatments are available ranging from curettage with or without bone grafting (autologous or allogeneic), curettage with use of adjuvants [Polymethylmethacrylate (PMMA) bone cement, high speed burr, phenol, liquid nitrogen], wide en-block excision with or without reconstruction, selective arterial embolization of the feeding vessels, radiation therapy, high precision megavoltage radiotherapy and percutaneous radio-nuclide ablation, sclerotherapy (ethibloc, aetoxisclerol, alcohol gel, polidocanol). The optimal treatment is debatable due to various indications and contraindications of different modalities of treatment. Recent data suggest that percutaneous sclerotherapy with polidocanol is safe and effective alternative to surgery for treatment of ABCs as it has minimal side effects. We are reporting the first case of life-threatening adverse reaction to intra-lesional polidocanol in a three-year-old boy with a proximal femoral aneurysmal bone cyst. The importance of reporting this case is to make people aware regarding the adverse reaction of polidocanol and to highlight the precautions one should follow while using polidocanol for aneurysmal bone cysts.

Remnant Lipoprotein Cholesterol Independently Associates With In-Stent Restenosis After Drug-Eluting Stenting for Coronary Artery Disease.

This study evaluated the prognostic value of remnant lipoprotein cholesterol (RLP-C) as a predictor of in-stent restenosis (ISR) after drug-eluting stent (DES) implantation in patients with coronary artery disease (CAD). Consecutive patients with CAD (n = 612) who underwent both successful coronary DES implantation and follow-up angiography ranging from 6 to 24 months were enrolled. The independent predictors of ISR were explored by multivariate logistic regression analysis; 95 (15.52%) patients were identified to have ISR. Multivariate logistic regression analysis showed that RLP-C concentration (odds ratio [OR]: 4.245, 95% confidence interval [CI]: 2.493-7.229), age (OR: 1.026, 95% CI: 1.002-1.051), diabetes mellitus (DM; OR: 1.811, 95% CI: 1.134-2.892), and lesion length (OR: 1.013, 95% CI: 1.002-1.024) were associated with ISR. Via subgroup analysis, we found that RLP-C was independently associated with ISR in both CAD with DM (OR: 4.154, 95% CI: 1.895-9.104) and CAD without DM (OR: 4.455, 95% CI: 2.097-9.464) groups. In the analysis of the receiver operating characteristics curve, RLP-C level >0.515 mmol/L exhibited 77.9% sensitivity and 56.5% specificity (area under the curve: 0.705, 95% CI: 0.648-0.762) in predicting ISR. In conclusion, RLP-C is independently associated with the development of ISR in patients with CAD after DES implantation.

Epidemiological Profile and Risk Factors for Acquiring HBV and/or HCV in HIV-Infected Population Groups in Nepal.

HBV and HCV infections are widespread among the HIV-infected individuals in Nepal. The goals of this study were to investigate the epidemiological profile and risk factors for acquiring HBV and/or HCV coinfection in disadvantaged HIV-positive population groups in Nepal. We conducted a retrospective study on blood samples from HIV-positive patients from the National Public Health Laboratory at Kathmandu to assay for HBsAg, HBeAg, and anti-HCV antibodies, HIV viral load, and CD4+ T cell count. Among 579 subjects, the prevalence of HIV-HBV, HIV-HCV, and HIV-HBV-HCV coinfections was 3.62%, 2.93%, and 0.34%, respectively. Multivariate regression analysis indicated that spouses of HIV-positive migrant labourers were at significant risk for coinfection with HBV infection, and an age of >40 years in HIV-infected individuals was identified as a significant risk factor for HCV coinfection. Overall our study indicates that disadvantaged population groups such as intravenous drug users, migrant workers and their spouses, female sex workers, and men who have sex with HIV-infected men are at a high and persistent risk of acquiring viral hepatitis. We conclude that Nepalese HIV patients should receive HBV and HCV diagnostic screening on a regular basis.

Mega Prosthetic Replacement of Elbow for Resistant Nonunion of Distal Humerus.

INTRODUCTION: Fractures of the distal humerus are a rare entity accounting for approximately 2% of the humeral fractures. Non union of the distal humerus is further rare and poses a major challenge. These fractures usually respond to open reduction and bone grafting but some may fail multiple surgical attempts at union and hence are labelled as "resistant" non union. We report a case of resistant non union of the distal humerus which was managed by total elbow arthroplasty. CASE PRESENTATION: A 49-year-old male presented to the out patient department with history of a compound comminuted fracture of the distal end of the humerus approximately 25 years back. The fracture was treated with multiple debridements and plaster cast application. There was involvement of the radial and the ulnar nerves as well. The patient continued to use the disabled upper limb with severe difficulties in activities of daily living (ADL). The patient finally presented to us for regaining some range of motion and improvement in his ADL. In view of the grossly distorted anatomy, bone loss and chronic nature of the problem, patient was offered total elbow arthroplasty. The Wadsworth extensile posterior approach was used for exposure of the non union site. The fragments were found to be small, osteoporotic and deformed. In view of the distorted anatomy, the elbow was finally salvaged with mega-prosthetic replacement of the elbow. Posterior elbow splint was used for 2 weeks and active as well as passive range of motion was started after that. The post-operative Mayo elbow score improved from 50 to 80 and the patient was able to achieve a range of motion from 10 degrees to 110 degrees. CONCLUSION: Total elbow arthroplasty can be used as a salvage procedure for resistant non union of the elbow with failed multiple failed attempts at union. It can also be used as a definitive procedure for severely distorted non union with massive bone loss with satisfactory functional results.

Heating and sterilization technology for long-duration space missions: transport processes in a reusable package.

Long-duration space missions require a high-quality, shelf-stable food supply but must also contend with packaging waste after use. We have developed a package, adapted from a military pouch, that enables heating of foods to serving temperature. After the food is consumed, the package may be reused for containment and sterilization of waste, and, potentially, for packaging and sterilizing foods grown on a Mars base. Packages are equipped with electrodes to permit ohmic heating of internal constituents. Heat transfer within the package was modeled using the energy transport equation, coupled with the Laplace equation for electric field strength distribution. The model was verified by temperature measurements during a sample experimental run, and it was used to optimize the package design. Waste sterilization within the package was also studied and confirmed. Mass transfer (electrode component migration) was studied by inductively coupled plasma mass spectrometry; the findings have shown concentrations within products to be well below current daily dietary exposure levels. Microbiological studies for sterilization indicated the need for package redesign to ensure parallel electrode configuration, as well as the use of supplemental external heaters along the nonelectrode walls of the package. Temperature profiles during heating of these packages have been determined.