CVD-Synthesized Titanium Carbide Nanoflowers as High-Performance Anodes for Sodium-Ion Batteries.

Sodium-ion batteries (SIBs) have emerged as promising candidates for energy storage applications due to the abundance and low cost of sodium. However, the larger radius of sodium ions limits their diffusion kinetics within electrode materials and contributes to electrode volume expansion. Here, we successfully synthesized porous titanium carbide (TiC) nanoflowers through chemical vapor deposition (CVD). The TiC nanoflowers exhibit exceptional electrochemical performance as SIB anodes, with their porous structure enhancing the conductivity, mechanical stability, and Na-ion diffusion. The TiC nanoflowers demonstrate a high reversible specific capacity of 73.5 mAh g-1 at 1 A g-1 after 2500 cycles, corresponding to an impressive capacity retention of 80.81%. Additionally, we developed a full sodium-ion cell utilizing TiC nanoflowers as the anode and Na3V2(PO4)3 as the cathode, which demonstrates a substantial reversible capacity and outstanding cycling stability. Our work presents a promising strategy for synthesizing nanostructured TiC materials as anode electrodes for SIBs.

Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional study.

BACKGROUND: We report the main findings of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), which aimed to assess the burden of complications related to pregnancy, the coverage of key maternal health interventions, and use of the maternal severity index (MSI) in a global network of health facilities. METHODS: In our cross-sectional study, we included women attending health facilities in Africa, Asia, Latin America, and the Middle East that dealt with at least 1000 childbirths per year and had the capacity to provide caesarean section. We obtained data from analysis of hospital records for all women giving birth and all women who had a severe maternal outcome (SMO; ie, maternal death or maternal near miss). We regarded coverage of key maternal health interventions as the proportion of the target population who received an indicated intervention (eg, the proportion of women with eclampsia who received magnesium sulphate). We used areas under the receiver operator characteristic curves (AUROC) with 95% CI to externally validate a previously reported MSI as an indicator of severity. We assessed the overall performance of care (ie, the ability to produce a positive effect on health outcomes) through standardised mortality ratios. RESULTS: From May 1, 2010, to Dec 31, 2011, we included 314,623 women attending 357 health facilities in 29 countries (2538 had a maternal near miss and 486 maternal deaths occurred). The mean period of data collection in each health facility was 89 days (SD 21). 23,015 (7.3%) women had potentially life-threatening disorders and 3024 (1.0%) developed an SMO. 808 (26.7%) women with an SMO had post-partum haemorrhage and 784 (25.9%) had pre-eclampsia or eclampsia. Cardiovascular, respiratory, and coagulation dysfunctions were the most frequent organ dysfunctions in women who had an SMO. Reported mortality in countries with a high or very high maternal mortality ratio was two-to-three-times higher than that expected for the assessed severity despite a high coverage of essential interventions. The MSI had good accuracy for maternal death prediction in women with markers of organ dysfunction (AUROC 0.826 [95% CI 0.802-0.851]). INTERPRETATION: High coverage of essential interventions did not imply reduced maternal mortality in the health-care facilities we studied. If substantial reductions in maternal mortality are to be achieved, universal coverage of life-saving interventions need to be matched with comprehensive emergency care and overall improvements in the quality of maternal health care. The MSI could be used to assess the performance of health facilities providing care to women with complications related to pregnancy. FUNDING: UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP); WHO; USAID; Ministry of Health, Labour and Welfare of Japan; Gynuity Health Projects.

Dengue fever complicated with ST elevation myocardial infarction with atypical features: A case report.

Dengue fever is an arboviral infection whose presentation ranges from a mild febrile illness to a multisystem complicated syndrome. We report a case of 58-year-old female presenting with fever, myalgia, arthralgia, and vomiting who was found to be infected with dengue and had electrocardiography changes revealing ST-segment elevation myocardial infarction, a rare manifestation in dengue. Dengue fever can affect the cardiovascular system leading to conduction abnormalities, hypotension, arrhythmias, myocarditis, cardiomyopathy, and occasionally myocardial infarction, which has been reported in only a few case reports prior to this. The differentiation between myocarditis and myocardial infarction is essential for which echocardiography and coronary angiography can be helpful. It is essential to keep an eye on the cardiovascular complications in a dengue patient as the presentation can be quite subtle with devastating consequences.

Psychological/Personal recovery and its correlates in patients with first episode psychosis.

BACKGROUND: Recovery in psychosis is a multidimensional construct. The numbers of studies specially focusing on the recovery aspects in patients with first episode psychosis (FEP) are limited, with no study from India. Further, no study has looked specifically into the variables that affect recovery process in patients with FEP and little is known about factors which influence recovery in patients with FEP. AIM: To evaluate psychological recovery and its correlates in patients with FEP, currently in clinical remission. METHODOLOGY: One hundred three patients of FEP in clinical remission were assessed on Recovery Assessment Scale (RAS), Positive and Negative Syndrome Scale for Schizophrenia, Calgary Depression Rating Scale for Schizophrenia, Negative Symptom Assessment 16, Rosenberg Self-esteem Scale, Social and Occupational Functioning Assessment Scale, the Alcohol, Smoking and Substance Involvement Screening Test, Beck Cognitive Insight Scale, Internalized Stigma of Mental Illness Scale, the Everyday discrimination Scale, Subjective Scale to Investigate Cognition in Schizophrenia and social cognitive deficits in theory of mind was evaluated on the Social Cognition Rating Tools in Indian Setting-Theory of Mind. The needs of the participants were assessed on the Camberwell Assessment of Needs - Research version and Supplemental Assessment of Needs. Coping, social support, medication adherence were also assessed by standardized scales. RESULTS: The mean weighted score was highest for goal and success orientation subscale followed by seeking and relying on social support, personal confidence and hope, overcome the illness and awareness and control over the illness as assessed by 41 items of the RAS. The main factors identified to affect psychological recovery in patients with FEP were duration of untreated psychosis, greater psychopathology, lower self-esteem, total unmet need, feeling of discrimination and stigmatization. CONCLUSION: The present study suggests that treatment of FEP should be started at the earliest and issues such as residual psychopathology, lower self-esteem, total unmet need, feeling of discrimination and stigma during the remission phase should be addressed by psychosocial interventions to promote psychological recovery in patients with first episode psychosis.

Fire and forage quality: Postfire regrowth quality and pyric herbivory in subtropical grasslands of Nepal.

Fire is rampant throughout subtropical South and Southeast Asian grasslands. However, very little is known about the role of fire and pyric herbivory on the functioning of highly productive subtropical monsoon grasslands lying within the Cwa climatic region. We assessed the temporal effect of fire on postfire regrowth quality and associated pyric-herbivory in the subtropical monsoon grasslands of Bardia National Park, Nepal. Every year, grasslands are burned as a management intervention in the park, especially between March and May. Within a week after fire, at the end of March 2020, we established 60 m × 60 m plots within patches of burned grassland in the core area of the Park. We collected grass samples from the plots and determined physical and chemical properties of the vegetation at regular 30-day intervals from April to July 2020, starting from 30 days after fire to assess postfire regrowth forage quality. We counted pellet groups of cervids that are abundant in the area for the same four months from 2 m × 2 m quadrats that were permanently marked with pegs along the diagonal of each 60 m × 60 m plot to estimate intensity of use by deer to the progression of postfire regrowth. We observed strong and significant reductions in crude protein (mean value 9.1 to 4.1 [55% decrease]) and phosphorus (mean value 0.2 to 0.11 [45% decrease]) in forage collected during different time intervals, that is, from 30 days to 120 days after fire. Deer utilized the burned areas extensively for a short period, that is, up to two months after fire when the burned areas contained short grasses with a higher level of crude protein and phosphorus. The level of use of postfire regrowth by chital (Axis axis) differed significantly over time since fire, with higher intensity of use at 30 days after fire. The level of use of postfire regrowth by swamp deer (Rucervus duvaucelii) did not differ significantly until 90 days after fire, however, decreased significantly after 90 days since fire. Large-scale single event fires, thus, may not fulfil nutritional requirements of all species in the deer assemblage in these subtropical monsoon grasslands. This is likely because the nutritional requirements of herbivores differ due to differences in body size and physiological needs-maintenance, reproduction, and lactation. We recommend a spatiotemporal manipulation of fire to reinforce grazing feedback and to yield forage of high quality for the longest possible period for a sustainable high number of deer to maintain a viable tiger population within the park.

Saussurea talungensis (Asteraceae), a new species from Humla, Nepal Himalayas.

A new species Saussurea talungensis S.K.Ghimire & H.K.Rana, sp. nov. (sect. Strictae), from Talung valley of Humla district, Nepal, is described and illustrated. Morphologically, this species resembles Saussurea roylei and Saussurea lanata in habit, though it can be distinguished in having longer leaf petioles, purplish leaf margin, 1 or 3 capitula, shorter phyllaries, shorter receptacle bristles and the same anthers, comparatively shorter corolla with shorter lobes. Phylogenomic analysis also supports S. talungensis as a distinct species of Saussurea. Here, we provide taxonomic note, distribution map and phylogenomic inference to distinguish the new species and its allied members.

Right Ventricular Dimensions and Tricuspid Annular Plane Systolic Excursion among Medical Students of Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: The change in morphology and functions of the right ventricle is an important predictor of heart and lung disease. There is limited data on the normal dimension of the right ventricle. The study aimed to find the right ventricular diameter, its thickness, and tricuspid annular plane systolic excursion in healthy male medical students of a tertiary care hospital. METHODS: It is a descriptive cross-sectional study conducted in healthy medical students of Kathmandu Medical College and Teaching Hospital, from February-April, 2019. Ethical approval was taken from the institutional review committee (reference number 120720193). Convenient sampling method was used. We measured various dimensions of the right ventricle in different views. The data was analyzed in the Statistical Package for the Social Sciences. RESULTS: In the 96 male students included in the study, the mean right ventricular basal diameter was 36.45±3.49 mm, right ventricular mid cavity diameter was 29±3.63 mm, right ventricular longitudinal dimension was 65.72±7.52 mm, right ventricular outflow tract in parasternal long-axis view was 27.07±2.12 mm, proximal and distal right ventricular outflow in parasternal short-axis view was 25.33±2.57 mm and 20.08±1.99 mm, right ventricular thickness was 4.20±0.54 mm, and tricuspid annular plane systolic excursion was 23.02±3.54 mm. CONCLUSIONS: The study found that the values of right ventricular dimensions and the right ventricle's tricuspid annular plane systolic excursion among male medical students of a tertiary care hospital to be in accordance with the guidelines by the American Society of Echocardiography. The upper limits of the normal values of the right ventricle could be very helpful in clinical practice in determining the right ventricle dimension.

Perception and Practice among Community People and Health Service Providers on Care and Management of Burn Injuries in Nepal: A Qualitative Study.

BACKGROUND: According to WHO, burns are a serious public health problem and the second most common cause for injury in rural Nepal, accounting for 5% of disabilities. The overall objective of the study is to assess the prevailing perception and practice among community people and health service providers on care and management of burn injuries in Nepal. METHODS: This was a qualitative study conducted in 2016 representing all eco-development regions. A total of 40 key informants interviews with health personnel and 18 focus group discussions with the community people were conducted. RESULTS: There are very limited dedicated burn care facilities in Nepal. During discussion, the service providers and community people mentioned that a burn injury can affect any one irrespective of their age and socioeconomic status. The study showed that females are at higher risk for burn injury which is associated mostly with wood fire cooking.The burn cases in the hospitals were more during winter than insummer season. Among all the ethnic groups, Dalit and indigenous population were found more vulnerable towards burn injuries. Intentional burn injuries such as self-inflicted burns/suicidal attemptwere found to occur more in females.The community people had a good practice of taking the majority ofpatients having burn injury immediately to the hospital,if not, they at least provided them with a first aid treatment. CONCLUSIONS: Majority of burn injured cases are getting first aid treatment at the incident places and taking hospital immediately. Main reasons, who reached late, are unaware about seeking services and financial constraint. Overall, the community people are partially aware about the burn injury.

Perception of Community and Hospital Personnel on Burn Treatment and Outcome in Nepal.

INTRODUCTION: Globally, eleven million people sustain burn injuries every year enough to require medical attention. WHO has estimated Disability associated limited years of 84,000 per year just due to deformities and 2100 people die every year due to burn injuries in Nepal. The overall objective of the study is to explore the effectiveness of burn injuries treatment and management approach of hospitals. METHODS: This qualitative study approached to 40 Health Personnel for Key Informants Interviews and 18 Focus Group Discussions with community people at the ten referral hospitals of eight district from May-June 2016. Qualitative data were analyzed using AtLas.ti software. RESULTS: Female burn victims are brought late to the hospital compared to male patients and false reporting about incident is usually done by her attendants. More than three-fourth (80%) of the hospitals and about one-third male and female from FGD reported that the community people seek home remedy first rather than medical treatment. Majority of the medical doctors and nursing chiefs reported that first degree cases accounts for 50% of the total burn cases with a success rate of 80%. Medical and Nursing staff reported that deformities like hypertrophic scar, keloids, joint stiffness and compartment syndrome are mostly observed during the treatment. Hypothermia and sepsis were the major causes of death in most of the burn patients. CONCLUSIONS: Usually, people who engaged in house and agriculture works, have visited public health posts/hospitals more frequently due to financial constraints and transportation issues where quality of burn care services are unavailable.

Listening to "felt needs": investigating genital prolapse in western Nepal.

The global prevalence of genital prolapse is estimated to be 2-20% in women under age 45. In Nepal, genital prolapse appears to be widespread, but little published evidence exists to buttress this claim. This paper presents findings of two studies, one ethnographic and one clinic-based, in western Nepal. The ethnographic study involved 16 focus group discussions with 120 community members and key informants, and covered community perceptions and women's experience of prolapse and its perceived causes and consequences. The clinic-based study was conducted among 2,072 women who presented with gynaecological complaints and received a diagnosis. One in four of them had genital prolapse, of whom 95% had self-reported the prolapse. The most commonly perceived causes of prolapse were lifting heavy loads, including in the post-partum period. The adverse effects reported included difficulty urinating, abdominal pain, backache, painful intercourse, burning upon urination, white watery discharge, foul-smelling discharge, itching, and difficulty lifting, sitting, walking and standing. The results confirm prolapse as a significant public health problem in western Nepal. We strongly recommend developing systematic, rotational gynaecological clinics in rural districts, the use of a screening checklist and counselling for prevention and early management of genital prolapse by district health workers for family planning and antenatal patients.