Topical 5-fluorouracil 1% for moderate to extensive ocular surface squamous neoplasia in 73 consecutive patients: Primary versus secondary treatment

IMPORTANCE

Ocular surface squamous neoplasia (OSSN) is a spectrum of malignancies that generally includes conjunctival intraepithelial neoplasia (CIN) and squamous cell carcinoma (SCC). OSSN can be treated with topical therapies including interferon α-2b (IFN), mitomycin C (MMC), or 5-fluorouracil 1% (5FU). Recently, due to unavailability of IFN and toxicity associated with MMC, therapy has shifted towards 5FU.

OBJECTIVE

Herein, we compare the use of 5FU 1% as a primary versus (vs) secondary treatment regimen in eyes with moderate to extensive OSSN.

DESIGN SETTING AND PARTICIPANTS

Retrospective cohort study of 73 consecutive patients with unilateral moderate to extensive OSSN treated at a single tertiary ocular oncology center from 2016 to 2023. Mean follow up time was 478.2 days overall, with 283.0 days for primary 5FU group and 860.3 days for secondary 5FU group.

INTERVENTION

Topical 5FU 1% 4 times daily for 2 weeks with option for 2-weekly extension until tumor control, either as primary treatment or as secondary treatment to surgical resection, topical IFN or topical MMC, or cryotherapy.

MAIN OUTCOMES

Outcome measures included tumor response, need for additional surgery, complications, and visual outcomes.

RESULTS

A comparison (primary vs secondary treatment) revealed no difference in mean tumor basal dimension (19.6 vs 17.2 mm, P = 0.46), thickness (3.7 vs 3.4 mm, P = 0.64), or tumor extent (4.4 vs 4.5 clock hours, P = 0.92). The primary treatment group showed greater complete tumor control (77% vs 38%, P = 0.04). Multivariable analysis comparison (primary vs secondary treatment) showed primary treatment more likely to achieve complete tumor control (P = 0.01). There was no difference in the complication rate from 5FU treatment between the groups. There was no difference in visual outcome, and no tumor-related metastasis (0%) or death (0%).

CONCLUSION AND RELEVANCE

Topical 5FU 1% is efficacious and safe as a primary or secondary treatment for moderate to extensive OSSN. Tumors treated with primary 5FU 1% demonstrated more complete resolution. In patients with moderate to extensive OSSN, primary treatment with topical 5FU 1% may be warranted.

Early-Life Digital Media Experiences and Development of Atypical Sensory Processing

Importance

Atypical sensory processing is challenging for children and families, yet there is limited understanding of its associated risk factors.

Objective

To determine the association between early-life digital media exposure and sensory processing outcomes among toddlers.

Design, Setting, and Participants

This multicenter US study used data that were analyzed from the National Children's Study (NCS), a cohort study of environmental influences on child health and development, with enrollment from 2011 to 2014. Data analysis was performed in 2023. The study included children enrolled in the NCS at birth whose caregivers completed reports of digital media exposure and sensory processing.

Exposures

Children's viewing of television or video at 12 months (yes or no), 18 months, and 24 months of age (hours per day).

Main Outcomes and measures

Sensory processing was reported at approximately 33 months of age on the Infant/Toddler Sensory Profile. Quadrant scores (low registration, sensation seeking, sensory sensitivity, and sensation avoiding) were categorized into groups representing typical, high, and low sensory-related behaviors, and multinomial regression analyses were performed.

Results

A total of 1471 children (50% male) were included. Screen exposure at 12 months of age was associated with a 2-fold increased odds of being in the high category of low registration (odds ratio [OR], 2.05; 95% CI, 1.31-3.20), while the odds of being in the low category instead of the typical category decreased for sensation seeking (OR, 0.55; 95% CI, 0.35-0.87), sensation avoiding (OR, 0.69; 95% CI, 0.50-0.94), and low registration (OR, 0.64; 95% CI, 0.44-0.92). At 18 months of age, greater screen exposure was associated with increased risk of high sensation avoiding (OR, 1.23; 95% CI, 1.03-1.46) and low registration (OR, 1.23; 95% CI, 1.04-1.44). At 24 months of age, greater screen exposure was associated with increased risk of high sensation seeking (OR, 1.20; 95% CI, 1.02-1.42), sensory sensitivity (OR, 1.25; 95% CI, 1.05-1.49), and sensation avoiding (OR, 1.21; 95% CI, 1.03-1.42).

Conclusions and Relevance

In this cohort study, early-life digital media exposure was associated with atypical sensory processing outcomes in multiple domains. These findings suggest that digital media exposure might be a potential risk factor for the development of atypical sensory profiles. Further research is needed to understand the relationship between screen time and specific sensory-related developmental and behavioral outcomes, and whether minimizing early-life exposure can improve subsequent sensory-related outcomes.

Mental health-related structural stigma and discrimination in health and social policies in Nepal: A scoping review and synthesis

AIMS

National policies can be used to reveal structural stigma and discrimination in relation to mental health. This review assesses how structural stigma and discrimination are manifested in the policies and legislations of Government of Nepal.

METHODS

Scoping review methodology was followed to review policy documents (acts of parliament, legislation, policies, strategies, guidelines and official directives) drafted or amended after 2010.

RESULTS

Eighty-nine policies were identified related to health, social welfare, development and regulations which were relevant to people with psychosocial and mental disabilities or have addressed the mental health agendas. Several critical policy failings and gaps are revealed, such as the use of stigmatizing language (e.g., 'insane' or 'lunatic'), inconsistencies within and between policies, deviation from international protocols defining legal capacity and consent, lack of inclusion of the mental health agenda in larger development policies and lack of cost-effective interventions and identification of financing mechanisms. Provisions for people living with mental health conditions included adequate standard of living; attaining standard mental health; the right to exercise legal capacity, liberty and security; freedom from torture or discrimination; and right to live independently. However, other policies contradicted these rights, such as prohibiting marriage, candidacy for and retention of positions of authority and vulnerability to imprisonment.

CONCLUSION

Mental health-related structural stigma and discrimination in Nepal can be identified through the use of discriminator language and provisions in the policies. The structural stigma and discrimination may be addressed through revision of the discriminating policies, integrating the mental health agenda into larger national and provincial policies, and streamlining policies to comply with national and international protocols.

Social inequalities and COVID-19 mortality between neighborhoods of Bariloche city, Argentina

BACKGROUND

The COVID-19 pandemic has shown how intraurban inequalities are likely to reinforce health and social inequalities. Studies at small area level help to visualize social inequialities hidden in large areas as cities or regions.

AIM

To describe the spatial patterning of COVID-19 death rates in neighborhoods of the medium-sized city of Bariloche, Argentina, and to explore its relationship with the socioeconomic characteristics of neighborhoods.

METHODS

We conducted an ecological study in Bariloche, Argentina. The outcome was counts of COVID-19 deaths between June 2020 and May 2022 obtained from the surveillance system and georeferenced to neighborhoods. We estimated crude- and age-adjusted death rates by neighborhood using a Bayesian approach through a Poisson regression that accounts for spatial-autocorrelation via Conditional Autoregressive (CAR) structure. We also analyzed associations of age-adjusted death rates with area-level socioeconomic indicators.

RESULTS

Median COVID-19 death rate across neighborhoods was 17.9 (10th/90th percentile of 6.3/35.2) per 10,000 inhabitants. We found lower age-adjusted rates in the city core and western part of the city. The age-adjusted death rate in the most deprived areas was almost double than in the least deprived areas, with an education-related relative index of inequality (RII) of 2.14 (95% CI 1.55 to 2.96).

CONCLUSION

We found spatial heterogeneity and intraurban variability in age-adjusted COVID-19 death rates, with a clear social gradient, and a higher burden in already deprived areas. This highlights the importance of studying inequalities in health outcomes across small areas to inform placed-based interventions.

Tribotronic and electrochemical properties of platinum-nanofluid interfaces formed by aqueous suspensions of 5 and 40 nm TiO2 nanoparticles

Nanoparticles (NPs) can be highly beneficial as additives to lubricating fluids, and the tribotronic response of charged NPs tuned by external fields represents an area of great technological potential. Tribotronic response, however, is expected to be highly size dependent, which represents a significant design challenge. To explore this issue, quartz crystal microbalance and cyclic voltammetry were employed to characterize nanotribological and electrochemical behavior of platinum-nanofluid interfaces formed by aqueous suspensions of different-sized negatively charged titanium dioxide (TiO2) NPs. Suspensions of 5, 40, and 100 nm NPs were all observed to reduced interfacial frictional drag forces upon introduction into pure water in zero field conditions, with reductions for the 40 nm NPs about twice those of 5 nm particles at comparable concentrations. Suspensions of 100 nm NPs produced even greater reductions, but rapidly precipitated from the suspension when left unstirred. NPs were also driven to and from Pt electrode surfaces by applying external electric fields with varying amplitudes and modulation frequencies. For electric fields of sufficient amplitude and duration, the 40 nm TiO2 nanosuspension exhibited tribological properties consistent with a reversible electrophoretic deposition of the NPs, accompanied by changes in the electrochemical attributes and increasing interfacial drag. The 5 nm NP properties were consistent with progressive reductions in interfacial drag forces at the NP-suspension interface linked to field-induced increases in concentration.

Association Between Telehealth and Missed Appointments Among Patients Experiencing Behavioral Health Challenges

This cohort study compares missed appointments between patients receiving telehealth and in-person care in behavioral health clinics in rural settings that cater to patients with relatively low income.

Spatial Inequities in Life Expectancy in Small Areas of Buenos Aires, Argentina 2015-2017

Studies of life expectancy (LE) in small areas of cities are relatively common in high-income countries but rare in Latin American countries. Small-area estimation methods can help to describe and quantify inequities in LE between neighborhoods and their predictors. Our objective was to analyze the distribution and spatial patterning of LE across small areas of Ciudad Autónoma de Buenos Aires (CABA), Argentina, and its association with socioeconomic characteristics. As part of the SALURBAL project, we used georeferenced death certificates in 2015-2017 for CABA, Argentina. We used a spatial Bayesian Poisson model using the TOPALS method to estimate age- and sex-specific mortality rates. We used life tables to estimate LE at birth. We obtained data on neighborhood socioeconomic characteristics from the 2010 census and analyzed their associations. LE at birth was higher for women (median of across neighborhoods = 81.1 years) compared to men (76.7 years). We found a gap in LE of 9.3 (women) and 14.9 years (men) between areas with the highest and the lowest LE. Better socioeconomic characteristics were associated with higher LE. For example, mean differences in LE at birth in areas with highest versus lowest values of composite SES index were 2.79 years (95% CI: 2.30 to 3.28) in women and 5.61 years (95% CI: 4.98 to 6.24) in men. We found large spatial inequities in LE across neighborhoods of a large city in Latin America, highlighting the importance of place-based policies to address this gap.

City-Level Travel Time and Individual Dietary Consumption in Latin American Cities: Results from the SALURBAL Study

There is limited empirical evidence on how travel time affects dietary patterns, and even less in Latin American cities (LACs). Using data from 181 LACs, we investigated whether longer travel times at the city level are associated with lower consumption of vegetables and higher consumption of sugar-sweetened beverages and if this association differs by city size. Travel time was measured as the average city-level travel time during peak hours and city-level travel delay time was measured as the average increase in travel time due to congestion on the street network during peak hours. Vegetables and sugar-sweetened beverages consumption were classified according to the frequency of consumption in days/week (5-7: "frequent", 2-4: "medium", and ≤1: "rare"). We estimate multilevel ordinal logistic regression modeling for pooled samples and stratified by city size. Higher travel time (Odds Ratio (OR) = 0.65; 95% Confidence Interval (CI) 0.49-0.87) and delay time (OR = 0.57; CI 0.34-0.97) were associated with lower odds of frequent vegetable consumption. For a rare SSB consumption, we observed an inverse association with the delay time (OR = 0.65; CI 0.44-0.97). Analysis stratified by city size show that these associations were significant only in larger cities. Our results suggest that travel time and travel delay can be potential urban determinants of food consumption.

The risk of eviction and the mental health outcomes among the US adults

•

Perceived risk of eviction among people living with rent arrears is associated with elevated mental health problems.

•

Prevalence of depression, anxiety, and pyschotropic medication use is higher in the at-risk of eviction group compared to the non-risk group.

•

Addressing the housing crisis is crucial in decreasing the mental health burden among people living in rented residences.

Although past studies establish a link between residential instability and poor mental health, studies investigating the association between perceived risk of eviction and mental health with nationally representative data are largely lacking. This study examines the association between self-reported risk of eviction and anxiety, depression, and prescription medication use for mental or emotional health reasons. This is a retrospective observational study using the repeated-cross sectional data (n = 14548; unweighted) using the US Census Bureau’s Household Pulse Survey from July 2021 to March 2022. Survey respondents aged 18 years and above who lived in rented residences and were not caught up with the rent payments at the time of the survey were included in the analysis. The descriptive summary shows a higher prevalence of depression (59.33 % vs 37.01 %), anxiety (67.01 % vs 43.28 %), and prescription medication use (26.57 % vs 23.68 %) among the respondents who are likely to face eviction in the next two months compared to the reference group not at the risk of eviction. When adjusted for demographic characteristics, family context, and socioeconomic setting, the odds of depression, anxiety, and prescription medication use in the at-risk eviction group were significantly higher than in the reference group. Specifically, odds ratios (ORs) [95 % CI] for depression, anxiety, and prescription medication use are 2.366 [2.364, 2.369], 2.650 [2.648, 2.653], and 1.172 [1.171, 1.174], respectively. These results suggest that the perceived risk of eviction is associated with elevated mental health problems. Addressing the housing crisis may help decrease the mental health burden among rented households.

Intraurban socioeconomic inequalities in life expectancy: a population-based cross-sectional analysis in the city of Córdoba, Argentina (2015-2018)

OBJECTIVES

To evaluate variability in life expectancy at birth in small areas, describe the spatial pattern of life expectancy, and examine associations between small-area socioeconomic characteristics and life expectancy in a mid-sized city of a middle-income country.

DESIGN

Cross-sectional, using data from death registries (2015-2018) and socioeconomic characteristics data from the 2010 national population census.

PARTICIPANTS/SETTING

40 898 death records in 99 small areas of the city of Córdoba, Argentina. We summarised variability in life expectancy at birth by using the difference between the 90th and 10th percentile of the distribution of life expectancy across small areas (P90-P10 gap) and evaluated associations with small-area socioeconomic characteristics by calculating a Slope Index of Inequality in linear regression.

PRIMARY OUTCOME

Life expectancy at birth.

RESULTS

The median life expectancy at birth was 80.3 years in women (P90-P10 gap=3.2 years) and 75.1 years in men (P90-P10 gap=4.6 years). We found higher life expectancies in the core and northwest parts of the city, especially among women. We found positive associations between life expectancy and better small-area socioeconomic characteristics, especially among men. Mean differences in life expectancy between the highest versus the lowest decile of area characteristics in men (women) were 3.03 (2.58), 3.52 (2.56) and 2.97 (2.31) years for % adults with high school education or above, % persons aged 15-17 attending school, and % households with water inside the dwelling, respectively. Lower values of % overcrowded households and unemployment rate were associated with longer life expectancy: mean differences comparing the lowest versus the highest decile were 3.03 and 2.73 in men and 2.57 and 2.34 years in women, respectively.

CONCLUSION

Life expectancy is substantially heterogeneous and patterned by socioeconomic characteristics in a mid-sized city of a middle-income country, suggesting that small-area inequities in life expectancy are not limited to large cities or high-income countries.

Factors Associated With Hospital Readmission Among Patients Experiencing Homelessness

INTRODUCTION

Homelessness is associated with increased acute care utilization and poor healthcare outcomes. This study aims to compare hospital readmission rates among patients experiencing homelessness and patients who are not homeless and assess the impact of different clinical and demographic characteristics on acute care utilization among patients experiencing homelessness.

METHODS

This was a retrospective study of patients encountered in 2018 and 2019 at ChristianaCare Health Systems. The analysis was done in August 2021. The prevalence of major chronic conditions among patients experiencing homelessness (n=1,329) and those not experiencing it (n=143,360) was evaluated. Patients experiencing homelessness were matched with nonhomeless patients using 1:1 propensity score matching. Time-to-event analysis approaches were used to analyze time-to-readmission and 30-day readmission rates.

RESULTS

The 30-day readmission rates were 42.8% among patients experiencing homelessness and 19.9% among matched patients not experiencing homelessness. The hazard of 30-day readmission among patients experiencing homelessness was 2.6 (95% CI=1.93, 3.53) times higher than that among the matched nonhomeless cohort. In patients experiencing homelessness, drug use disorder, major depressive disorder, chronic kidney disease, obesity, arthritis, HIV/AIDS, and epilepsy were associated with shortened time to readmission. Moreover, Black racial identity was associated with shortened time to readmission.

CONCLUSIONS

Patients experiencing homelessness had higher acute care utilization than those not experiencing homelessness. Black racial identity and several comorbidities were associated with increased acute care utilization among patients experiencing homelessness. Efforts to address upstream social determinants of health, destigmatization, and healthcare management accounting for the whole spectrum of clinical comorbidities might be important in promoting the health of people experiencing homelessness.

Food spending in the United States during the first year of the COVID-19 pandemic

The COVID-19 pandemic brought about a significant increase in the unemployment rate and a decline in consumer income. At the same time, the public health responses to the pandemic, such as lockdowns and business closures, disrupted the food supply chain. These pandemic-driven changes could lead to a shift in food spending behaviors and potentially exacerbate the food insecurity situation. Leveraging the nationally representative dataset from the 2017–2020 consumer expenditure surveys, we employ a two-part model to assess the changes in weekly household spending on total food, food-at-home (FAH), and food-away-from-home (FAFH) between the pre-pandemic and pandemic period in the United States. Our finding shows a predicted marginal decline in FAFH expenditure by 33.7% but an increase in FAH spending by 6.9% during the pandemic. The increase in FAH spending could not fully offset the decrease in FAFH spending, leading to a decline in total food spending by 12.6%. The results could provide a basis for future studies on food insecurity, nutrient intake, and healthy consumption during the pandemic.

Determinants of Telehealth Service Use among Mental Health Patients: A Case of Rural Louisiana

The COVID-19 pandemic decreased the in-person outpatient visits and accelerated the use of telehealth services among mental health patients. Our study investigated the sociodemographic and clinical correlates of the intensity of telehealth use among mental health patients residing in rural Louisiana, United States. The study sample included 7069 telehealth visits by 1115 unique patients encountered from 1 April 2020 to 31 March 2021 at six mental health outpatient clinics managed by the Northeast Delta Human Services Authority (NEDHSA). We performed a negative binomial regression analysis with the intensity of service use as the outcome variable. Being younger, female, and more educated were associated with a higher number of telehealth visits. The prevalence of other chronic conditions increased telehealth visits by 10%. The telehealth service intensity varied across the nature of mental health diagnoses, with patients diagnosed with the schizophrenia spectrum and other psychotic disorders utilizing 15% fewer telehealth visits than patients diagnosed with depressive disorders. The promotion of telehealth services among mental health patients in the rural setting might require the elimination of the digital divide with a particular focus on the elderly, less educated, and those with serious mental health illnesses such as schizophrenia and psychotic disorders.

Risky health behaviors during the COVID-19 pandemic: Evidence from the expenditures on alcohol, non-alcoholic beverages, and tobacco products

Background

The COVID-19 pandemic has increased mental stress among the population and, at the same time, has lowered consumer income. Alcohol, non-alcoholic beverages, and tobacco consumption are associated with multiple health conditions but the information on how the consumption pattern of these goods shifted during the pandemic remains limited.

Objective

To examine the consumer spending on alcohol, non-alcoholic beverages, and tobacco products during the COVID-19 pandemic compared to the pre-pandemic period.

Design

An observational study utilizing the expenditures data on alcohol, non-alcoholic beverages, and tobacco between 2017 and 2020 obtained from the US Consumer Expenditure Diary Survey.

Participants

18,808 respondents aged ≥ 21 years who answered the Consumer Expenditure Diary Survey.

Main Outcome Measure(s): Bi-weekly expenditure on alcohol, non-alcoholic beverages, and tobacco products.

Analysis

Multivariable linear regression models.

Results

A total of 18,808 respondents (mean [SD] age = 52.5[16.9] years; 53.8% females) were included. Compared to the pre-pandemic levels, household expenditures on alcohol, non-alcoholic beverages, and tobacco products significantly decreased during the pandemic period by 28.6%, 7.9%, and 15.5%, respectively, after controlling for the state-, individual-, and household-level characteristics. Individual age, race/ethnicity, income, and education were significant predictors of spending. Heterogeneities in expenditures were evident across subgroups, with less educated and low-income households cutting their alcohol expenses while the wealthy and more educated consumers spent more during the pandemic.

Conclusions and implications

Household expenditures on alcohol, non-alcoholic beverages, and tobacco products significantly decreased. The results might be beneficial in understanding consumer spending habits concerning risky health behaviors during the period of economic disruption.

Search for magnetic monopoles produced via the Schwinger mechanism

Electrically charged particles can be created by the decay of strong enough electric fields, a phenomenon known as the Schwinger mechanism¹. By electromagnetic duality, a sufficiently strong magnetic field would similarly produce magnetic monopoles, if they exist². Magnetic monopoles are hypothetical fundamental particles that are predicted by several theories beyond the standard model^3-7 but have never been experimentally detected. Searching for the existence of magnetic monopoles via the Schwinger mechanism has not yet been attempted, but it is advantageous, owing to the possibility of calculating its rate through semi-classical techniques without perturbation theory, as well as that the production of the magnetic monopoles should be enhanced by their finite size^8,9 and strong coupling to photons^2,10. Here we present a search for magnetic monopole production by the Schwinger mechanism in Pb-Pb heavy ion collisions at the Large Hadron Collider, producing the strongest known magnetic fields in the current Universe¹¹. It was conducted by the MoEDAL experiment, whose trapping detectors were exposed to 0.235 per nanobarn, or approximately 1.8 × 10⁹, of Pb-Pb collisions with 5.02-teraelectronvolt center-of-mass energy per collision in November 2018. A superconducting quantum interference device (SQUID) magnetometer scanned the trapping detectors of MoEDAL for the presence of magnetic charge, which would induce a persistent current in the SQUID. Magnetic monopoles with integer Dirac charges of 1, 2 and 3 and masses up to 75 gigaelectronvolts per speed of light squared were excluded by the analysis at the 95% confidence level. This provides a lower mass limit for finite-size magnetic monopoles from a collider search and greatly extends previous mass bounds.

Association between COVID-19 pandemic and the suicide rates in Nepal

BACKGROUND

Past works have linked the COVID-19 pandemic and subsequent public health responses such as isolation, quarantine, and lockdown to increased anxiety, sleep disorders, depressive symptoms, and suicidal ideation. Only a few studies, mostly carried out in high-income countries, have investigated the association between the pandemic and suicide rate. We seek to investigate the changes in the monthly suicide rates during the COVID-19 pandemic in Nepal, compared to the pre-pandemic suicide rates.

METHODS AND FINDINGS

This is a retrospective study investigating the changes in suicide rates in Nepal during the COVID-19 pandemic period (April 2020 to June 2021), compared to the pre-pandemic period (July 2017 to March 2020), adjusted for seasonality and long-term trend in the suicide rate. We performed analysis for the entire country as well as sub-sample analyses stratified by gender and provinces. A total of 24350 suicides deaths during four years of the study window were analyzed. We found an overall increase in the monthly suicide rate in Nepal with an average increase of 0.28 (CI: 0.12,0.45) suicide per 100,000 during the pandemic months. The increase in suicide rate was significant both among males (increase in rate = 0.26, CI: 0.02,0.50) and females (increase in rate = 0.30, CI: 0.18,0.43). The most striking increments in suicide rates were observed in June, July, and August 2020. The pattern of increased suicide rates faded away early on among males, but the effect was sustained for a longer duration among females. Sudurpaschim and Karnali provinces had the highest increase in suicide rates associated with the COVID-19 pandemic.

CONCLUSIONS

The COVID-19 pandemic is associated with an increased suicide rate in Nepal. The findings may inform policymakers in designing appropriate public health responses to the pandemic that are considerate of the potential impact on mental health and suicide.

Implementation of State Vaccine Incentive Lottery Programs and Uptake of COVID-19 Vaccinations in the United States

Importance

There is limited evidence on whether COVID-19 vaccine incentive lotteries help to increase vaccine uptake.

Objective

To estimate whether and to what extent statewide implementation of lottery programs is associated with COVID-19 vaccine uptake.

Design, Setting, and Participants

This cross-sectional study used data from 403 714 adults who answered the question, "have you received a COVID-19 vaccine?" on the Household Pulse Survey (HPS) and state-level daily vaccination rates for 11 states implementing a vaccine lottery program (ie, treated states) and 28 states with no such program (ie, control states). A difference-in-difference (DiD) analysis used responses to the HPS question and compared changes in vaccine uptake between treated and control states. The augmented synthetic control (ASC) analysis compared state-level daily new vaccination rates in treated states with their synthetic versions constructed from a donor pool of control states. Data were analyzed from March 17 to July 5, 2021.

Exposures

Announcement of the vaccine lottery programs and states implementing such programs.

Main Outcomes and Measures

The outcome variable in the DiD analysis was the binary indicator of self-reported vaccination status. In the ASC analysis, it was the state-level daily new first vaccine dose administered per 100 000 people (logarithm scale).

Results

A total of 403 714 individuals (mean [SD] age, 52.7 [15.7] years; 239 563 [weighted percentage, 51.6%] women; 31 746 [weighted percentage, 11.9%] Black; 39 709 [weighted percentage, 18.2%] Hispanic; 334 034 [weighted percentage, 76.4%] White) responded to the question in HPS regarding vaccination status. Overall, 80 949 respondents (weighted percentage, 28.1%) in the HPS were unvaccinated. A pooled analysis from both methods indicated that the lottery programs were associated with increased vaccinations. The ASC analysis revealed that lottery programs were associated with an increase of 0.208 log points (95% CI, 0.004-0.412 log points), implying an average 23.12% increment in the new daily vaccination rate. In state-specific analyses, both methods suggested that the vaccine lottery programs were helpful in Ohio (0.09 log points; P < .001), Maryland (0.26 log points; P < .001), Oregon (0.15 log points; P = .002), and Washington (0.37 log points; P < .001) but not in Arkansas, Kentucky, and West Virginia. The ASC analysis found that lottery programs were positively associated with vaccinations in New Mexico (0.32 log points; P < .001) and New York (0.33 log points; P = .001).

Conclusions and Relevance

The findings of this study suggest that lottery programs may be associated with decreased COVID-19 vaccine hesitancy, but that success might differ across states. The findings could also be useful in the ongoing debate on persuading US residents who are not yet vaccinated.

Spatiotemporal Analysis of Overall Health in the United States Between 2010 and 2018

Background

Although many previous studies have documented spatial heterogeneity in health outcomes across the United States at different geographic scales, spatiotemporal analyses to understand overall health are scant.

Methodology

We used the County Health Rankings (CHR) data to analyze the three types of health outcomes, viz., overall health, length of life, and quality of life for 2010-2018 in the contiguous United States employing hierarchal Bayesian methods. Composite scores were created to proxy these outcomes utilizing predefined weights of several variables as recommended by CHR. Our methods assumed a convolution of spatially structured and unstructured errors to model the overall spatial error. Spatial effects were modeled using conditional autoregressive distribution.

Results

The substantial disparity in these health outcomes was evident, with counties having poorer health outcomes mostly concentrated in the southeastern United States. Models that incorporated county-level demographic and socioeconomic characteristics partially explained the observed spatial heterogeneity in health outcomes. Interestingly, there was no time effect in any of the outcomes suggesting a perpetuation of health disparity over the years.

Conclusions

County-specific health policy interventions that take into account the contextual factors might be beneficial in improving population health and breaking the perpetuation of health disparity.

Ab Initio Computation of the Longitudinal Response Function in ^{40}Ca

We present a consistent ab initio computation of the longitudinal response function R_{L} in ^{40}Ca using the coupled-cluster and Lorentz integral transform methods starting from chiral nucleon-nucleon and three-nucleon interactions. We validate our approach by comparing our results for R_{L} in ^{4}He and the Coulomb sum rule in ^{40}Ca against experimental data and other calculations. For R_{L} in ^{40}Ca we obtain a very good agreement with experiment in the quasielastic peak up to intermediate momentum transfers, and we find that final state interactions are essential for an accurate description of the data. This work presents a milestone towards ab initio computations of neutrino-nucleus cross sections relevant for experimental long-baseline neutrino programs.

First Search for Dyons with the Full MoEDAL Trapping Detector in 13 TeV pp Collisions

The MoEDAL trapping detector consists of approximately 800 kg of aluminum volumes. It was exposed during run 2 of the LHC program to 6.46  fb^{-1} of 13 TeV proton-proton collisions at the LHCb interaction point. Evidence for dyons (particles with electric and magnetic charge) captured in the trapping detector was sought by passing the aluminum volumes comprising the detector through a superconducting quantum interference device (SQUID) magnetometer. The presence of a trapped dyon would be signaled by a persistent current induced in the SQUID magnetometer. On the basis of a Drell-Yan production model, we exclude dyons with a magnetic charge ranging up to five Dirac charges (5g_{D}) and an electric charge up to 200 times the fundamental electric charge for mass limits in the range 870-3120 GeV and also monopoles with magnetic charge up to and including 5g_{D} with mass limits in the range 870-2040 GeV.

A mini-Tn5-derived transposon with reportable and selectable markers enables rapid generation and screening of insertional mutants in Gram-negative bacteria

We re-engineered a classic tool for mutagenesis and gene expression studies in Gram-negative bacteria. Our modified Tn5-based transposon contains multiple features that allow rapid selection for mutants, direct quantification of gene expression and straightforward cloning of the inactivated gene. The promoter-less gfp-km cassette provides selection and reporter assay depending on the activity of the promoter upstream of the transposon insertion site. The cat gene facilitates positive antibiotic selection for mutants, while the narrow R6Kγ replication origin forces transposition in recipient strains lacking the pir gene and enables cloning of the transposon flanked with the disrupted gene from the chromosome. The suicide vector pCKD100, a plasmid that could be delivered into recipient cells through biparental mating or electroporation, harbours the modified transposon. We used the transposon to mutagenize Pectobacterium versatile KD100, Pseudumonas coronafaciens PC27R and Escherichia coli 35150N. The fluorescence intensities of mutants expressing high GFP could be quantified and detected qualitatively. Transformation efficiency from conjugation ranged from 1600 to 1900 CFU per ml. We sequenced the upstream flanking regions, identified the putative truncated genes and demonstrated the restoration of the GFP phenotype through marker exchange. The mini-Tn5 transposon was also utilized to construct mutant a library of P. versatile for forward genetic screens.

Clinical Evaluation of Residual Ridge Morphology of Maxillary Arch in Relation to Ageing and Length of Edentulism

Background: Ridge morphology is one of the important recognized factors affecting denture retention, stability, support and masticatory function in edentulous patients. The form of ridge affects the planning as well as determines the prognosis of treatment. The objective of this study was to assess maxillary residual ridge morphology according to American College of Prosthodontists (ACP) classification system and to find association between type of ridge morphology of maxillary arch with age and duration of edentulism.     Methods: The study was conducted among 87 completely edentulous patients above 40 years of age visiting department of prosthodontics Nepal Medical College. The morphology of maxillary residual ridges were clinically evaluated and classified according to criteria given by American College of Prosthodontists (ACP) classification system. The findings were associated with age, sex, duration of edentulism and complete       denture wear. Results: In this study, more than two thirds of the patients belonged to the age group of 60 – 80 years and their mean duration of edentulousness was seen to be 5.7 years. One fifth of the patients were using previous complete dentures. Type A maxillary ridge morphology was found to be the most prevalent. The type of maxillary ridge morphology was not found to be associated with either age or gender of an  individual however it varied significantly with length of edentulism and duration of complete denture wears.              Conclusions: Within limitations, it can be concluded that maxillary ridge morphology was not associated with age of an individual however the longer duration of edentulism or complete denture use would make the type of ridge morphology more unfavorable. Keywords: maxillary ridge; length of edentulism; residual ridge resorption; ridge morphology.

Tuning friction and slip at solid-nanoparticle suspension interfaces by electric fields

We report an experimental Quartz Crystal Microbalance (QCM) study of tuning interfacial friction and slip lengths for aqueous suspensions of TiO₂ and Al₂O₃ nanoparticles on planar platinum surfaces by external electric fields. Data were analyzed within theoretical frameworks that incorporate slippage at the QCM surface electrode or alternatively at the surface of adsorbed particles, yielding values for the slip lengths between 0 and 30 nm. Measurements were performed for negatively charged TiO₂ and positively charged Al₂O₃ nanoparticles in both the absence and presence of external electric fields. Without the field the slip lengths inferred for the TiO₂ suspensions were higher than those for the Al₂O₃ suspensions, a result that was consistent with contact angle measurements also performed on the samples. Attraction and retraction of particles perpendicular to the surface by means of an externally applied field resulted in increased and decreased interfacial friction levels and slip lengths. The variation was observed to be non-monotonic, with a profile attributed to the physical properties of interstitial water layers present between the nanoparticles and the platinum substrate.

Magnetic Monopole Search with the Full MoEDAL Trapping Detector in 13 TeV pp Collisions Interpreted in Photon-Fusion and Drell-Yan Production

MoEDAL is designed to identify new physics in the form of stable or pseudostable highly ionizing particles produced in high-energy Large Hadron Collider (LHC) collisions. Here we update our previous search for magnetic monopoles in Run 2 using the full trapping detector with almost four times more material and almost twice more integrated luminosity. For the first time at the LHC, the data were interpreted in terms of photon-fusion monopole direct production in addition to the Drell-Yan-like mechanism. The MoEDAL trapping detector, consisting of 794 kg of aluminum samples installed in the forward and lateral regions, was exposed to 4.0  fb^{-1} of 13 TeV proton-proton collisions at the LHCb interaction point and analyzed by searching for induced persistent currents after passage through a superconducting magnetometer. Magnetic charges equal to or above the Dirac charge are excluded in all samples. Monopole spins 0, ½, and 1 are considered and both velocity-independent and-dependent couplings are assumed. This search provides the best current laboratory constraints for monopoles with magnetic charges ranging from two to five times the Dirac charge.

Survey of current materials and impression techniques for Complete Dentures among Nepalese Prosthodontists

ABSTRACTBackground: Impression making is one of the critical factors in determining success or failure of complete denture therapy. The precise reproduction of edentulous foundation is essential for retention, stability, and support of the removable prosthesis. Evidence suggests that there is variability in materials and techniques regarding impressions making for complete dentures. There is little published information on studies conducted among Nepalese Prosthodontists. The purpose of this study was to evaluate current materials andmethods for impressions for complete denture prosthodontics in Nepal. Materials & Methods: A questionnaire based survey was conducted among Nepalese Prosthodontists. Ethical approval for the beginning of the study was obtained via Institutional Review Committee, Nepal Medical College. A self-administered anonymous questionnaire was distributed to the participants. Data were analyzed by using frequency distribution.Results: Majority of responses indicated use of irreversible hydrocolloid in stock metal tray for making the preliminary impression. The selective pressure was the predominantly used impression philosophy (78.3%). The most common material for the fabrication of custom trays was autopolymerizing acrylic resin (96.7%). All respondents border molded the custom tray prior to making the final impression. The final impression materials used were zinc oxide eugenol impression paste (73.3%), polyvinylsiloxane (11.7%), polyether (11.7%) and polysulphide (3.3%). Conclusion: Although there is variability in impression materials andtechniques used by Prosthodontists in Nepal for the fabrication of complete dentures, the results showed interesting trends. Most practitioners followed the traditional techniques of complete denture impression procedures.Keywords: complete denture; custom tray; edentulism; impression.

Alternative Technique of Iris Orientation in a Custom-Made Ocular Prosthesis

Accurate positioning of the iris is critical for the success of an ocular prosthesis. Precise duplication of size and location of the iris is essential for the establishment of realism, symmetry, and a natural-appearing gaze. This article explores an alternative procedure for positioning the iris in a custom-made ocular prosthesis using a pupillary distance ruler (PD ruler). The orientation and mediolateral dimension of the iris of the natural eye was measured from the graduated scale on a PD ruler and transferred on to the sculpted scleral wax pattern. The iris button was positioned in the marked area, and the established orientation was evaluated for symmetry and a natural-appearing gaze. Accurate, predictable, and easy positioning of the iris with the transfer of these dimensions to the definitive prosthesis provided a good result in terms of patient esthetics and satisfaction.

The Etiology of Upper Gastrointestinal Bleeding in Patients with Liver Cirrhosis in Dhulikhel Hospital

Background Acute upper gastrointestinal bleeding is a serious medical problem in cirrhotic patients. Patients with cirrhosis may develop upper gastrointestinal bleeding from a variety of lesions, including those due to portal hypertension, namely gastroesophageal varices and portal hypertensive gastropathy and other lesions as seen in the general population. Objective To investigate the etiology of upper gastrointestinal bleeding in liver cirrhotic patients. Method A retrospective review of 72 patients with liver cirrhosis and upper gastrointestinal bleeding from January 2013 to March 2016 was carried out at Dhulikhel Hospital. Child Pugh score was used to assess severity. Endoscopic diagnosis was documented. Result Out of 72 patients, 56 (77.8 %) were male and 16 (22.2%) were female. The most common age group was 30-42 years age. Fifty four cases of cirrhosis were associated with alcohol consumption. The Child-Pugh score was A in 20 patients (27.8%), B in 15 patients (20.8%) and C in 37 patients (51.4%). A combination of alcohol consumption and HCV infection was significantly associated with a higher Child-Pugh score (p=0.031). Twenty six (36.11%) patients had esophageal varices as cause of bleeding on endoscopic examination while 29(40.28%) had varices and other lesions identified at endoscopy. Of these 29 patients, 18 were found to have bled from esophageal varices, and 11 were found to have bled from coexisting lesion. Conclusion We found that variceal bleeding was the commonest cause of bleeding in cirrhotic patients, with 55 (78.5%) having varices and 44 (61%) actually bleeding from varices.

A Simplified Approach for Fabrication of a Lightweight Individualized Impression Tray with the Aid of Existing Obturator Prosthesis Using Lost Salt Technique

Maxillary defects resulting from ablative oncologic surgery can be extensive and usually have complex contours. Impression procedures for such defects can be time consuming and cumbersome, challenging the skills of even the most-experienced clinician. A well-oriented impression tray with proper extension and adequate contour is essential for successfully capturing the relevant details in impression. This article describes a method using the patient's existing obturator prosthesis to simplify and expedite the fabrication of a lightweight individualized impression tray directly on an irreversible hydrocolloid impression, thus avoiding the preliminary impression procedure for the patient.

Outcome of minimally invasive plate osteosynthesis in distal tibial fractures

Introduction: Distal tibial fractures present as a major challenge for the orthopedic trauma surgeons. Most non-operative treatments result in non-union or malunion and needs prolonged immobilization of the knee and ankle joints, with resulting stiffness. Open reduction and internal fixation as well as external fixation has high rate of infection and non-union. Minimally Invasive Plate Osteosynthesis has been shown to have a better outcome and has been the procedure of choice in most distal tibial fractures since the introduction of the locking compression plate. The objective of the study is to review the outcome of Minimally Invasive Percutaneous Osteosynthesis (MIPO) in unstable distal tibial fractures.Methods: Charts of patients who underwent MIPO from the year 2008 to 2013 for unstable distal tibial fractures over five years at Patan Hospital and Om Hospital were reviewed. All displaced closed fractures and Gustillo Anderson Type I and II fractures were included in the study. Plates consisted of the anatomically contoured 4.5 mm LCP and 3.5 mm LCP-Pilon form plate. A simple uniplanar external fixator was used to retain the reduction till the plate was inserted and secured with locking screws. The outcome of MIPO in distal tibial fractures were followed up and evaluated.  Clinical and radiological assessments were performed at 6 weeks, and at 3, 6, 9, 12 and 24 months.Results: Of the 75 patients (45 male, 30 female) age ranging from 19 to 70 years (mean 47 years), 5 patients were lost to follow-up. 28 patients at 3 months, 32 at 6 months, and 8 at 9 months met the criteria for a healed fracture. Two patients required autologous bone grafting at 9 months for non-union ultimately resulting in the fracture union at 16 months. There was one malunion attributable to the loss of reduction during plate fixation. There were no deep infections, no soft tissue complications and no failures of fixation. The cause of fracture were RTA (n=35), fall from height (n=9), twisting of ankle as a result of fall from standing height (n=22), and others (n=11). The mean time for surgery from the time of injury was 5 (range, 2 to 14) days; the mean hospital stay was 10 (range, 7 to 21) days.Conclusion: MIPO is an effective treatment for closed, unstable fractures of the distal tibia, avoiding the complications associated with more traditional methods of internal fixation and/or external fixation.Journal of Society of Surgeons of NepalVol. 17, No. 2, 2014, Page: 7-11

Plasmablastic Lymphoma

Plasmablastic lymphoma is a rare and aggressive lymphoma reported to be commonly associated with immunodeficiency state. It possesses a challenge to the clinician owing it aggressiveness and poor prognosis. No standard of care treatment is available for the disease. Here we report a case of an immunocompetant 67 years female who is unique in her presentation as she did not have any of the conventional clinical features and had a history of urothelial carcinoma three months back.

Thermal conductivity, thermal diffusivity, and volumetric heat capacity of silicone elastomer nanocomposites

Silicone elastomer (SiR) nanocomposites were prepared using multiwalled carbon nanotubes (MWCNT) and nano-graphite (NG). The morphology of the SiR nanocomposites has been studied using scanning electron microscopy and high-resolution transmission electron microscopy techniques. Detailed analysis of the morphology reveals a uniform distribution of the MWCNT and NG filler particles in the silicone matrix. On increasing the filler loading, a continuous network structure is formed and aggregation takes place. The effect of the MWCNT and NG loadings on the thermal properties of the silicone elastomer has been investigated. The thermal properties of the SiR nanocomposites were measured by a thermal properties analyzer based on the transient hot-wire method. Studies also suggest that incorporation of nanoparticles improves the thermal conductivity of SiR nanocomposites. The thermal conductivity of SiR nanocomposites increased from 0.200 W/(m K) to 0.440 W/(m K) and to 0.310 W/(m K) for 6 wt% MWCNT and NG loadings, respectively. Because of the positive temperature coefficient and the conductive nature of the nanoparticles, the thermal conductivity of the material increased on increasing the temperature. The thermal diffusivity and the volumetric heat capacity of the SiR nanocomposites were measured. The thermal diffusivity of the SiR nanocomposites increased from 0.1194 mm2/s to 0.3209 mm2/s and to 0.2050 mm2/s for 6 wt% MWCNT and NG loadings, respectively. This indicates that the temperature response becomes faster with MWCNT and NG loadings. The volumetric heat capacity of the silicone elastomer nanocomposites decreased from 1.80 MJ/(m3K) to 1.34 MJ/(m3K) and to 1.40 MJ/(m3K) for 6 wt% MWCNT and NG loadings, respectively. Thus, MWCNT particles are more effective in increasing the thermal conductivity and diffusivity of the SiR nanocomposites, when compared to NG fillers at any loading.

Search for Magnetic Monopoles with the MoEDAL Forward Trapping Detector in 13 TeV Proton-Proton Collisions at the LHC

MoEDAL is designed to identify new physics in the form of long-lived highly ionizing particles produced in high-energy LHC collisions. Its arrays of plastic nuclear-track detectors and aluminium trapping volumes provide two independent passive detection techniques. We present here the results of a first search for magnetic monopole production in 13 TeV proton-proton collisions using the trapping technique, extending a previous publication with 8 TeV data during LHC Run 1. A total of 222 kg of MoEDAL trapping detector samples was exposed in the forward region and analyzed by searching for induced persistent currents after passage through a superconducting magnetometer. Magnetic charges exceeding half the Dirac charge are excluded in all samples and limits are placed for the first time on the production of magnetic monopoles in 13 TeV pp collisions. The search probes mass ranges previously inaccessible to collider experiments for up to five times the Dirac charge.

Indoor Staying During Winter Season Makes People More Susceptible to Flu

An infectious diseases caused by RNA virus, the influenza is also commonly known as Flu. It mainly transmitted through air by coughs or sneezes of infected. The symptoms of flu like fever and headache are the result of the huge amounts of proinflammatory cytokines and chemokines (such as interferon or tumor necrosis factor) produced from influenza-infected cells. The activated vitamin has extreme effects on human immunity. Vitamin D prevents too much release of cytokines and chemokines. Staying much time indoor, away from contact of sunlight during winter season lowers the vitamin D level in human body. Thus, the chance of getting flu increases in winter season. Formulation of policy regarding vitamin D supplementation in diet for people such as elderly and with low sunlight exposure is hereby recommended. It will be beneficial to reduce influenza related morbidity and mortality during winter season.

Chlamydia trachomatis among HIV infected patients using PCR technique

Background and Objectives: Chlamydia trachomatis is a sexually transmitted organism and an important public health problem in the sexually active age group. Limited studies are found regarding the prevalence of Chlamydia trachomatis in Nepal. Moreover, no study in Nepal reports the association of Chlamydia and HIV infection. The current study attempts to determine the burden of Chlamydia on HIV positive patients. Material and Methods: A total of 117 HIV positive patients visiting a HIV clinic in Kathmandu, were screened for Chlamydia infection. For this, Urine samples were collected and analyzed using the Multiplex polymerase chain reaction technique (MPCR) and Agarose gel electrophoresis. DNA isolation was performed using QIAamp DNA and Blood mini kit handbook protocol. Results: C. trachomatis was detected in 4.27% of the total 117 HIV patients. Out of positive cases 60% were males and 40% were females. However, Chlamydia is found more prevalent among females (6.89%) than in males (3.4%). Eighty percent of positive cases were asymptomatic. Conclusion: Chlamydia infection was found less commonly among studied patients and most of those cases were asymptomatic. So there is difficulty in timely detection of C. trachomatis and track the clinical sequel, which might be devastating. Hence, routine checkup is recommended for all suspected cases for timely management of the disease Janaki Medical College Journal of Medical Sciences (2013) Vol. 1 (2): 3-10 DOI: http://dx.doi.org/10.3126/jmcjms.v1i2.9261

Chlamydia trachomatis detection in HIV infected patients using polymerase chain reaction

Introduction: Chlamydia trachomatis is a sexually transmitted organism and causes important public health problem in the sexually active age group. Limited studies are found regarding the prevalence of C. trachomatis in Nepal. Moreover, currently there are no any study in Nepal reporting the association of chlamydia and HIV infection. This study attempts to determine the burden of chlamydia on HIV positive patients. Materials and Methods: A total of 117 HIV positive patients visiting a HIV clinic in Kathmandu, were screened for chlamydia infection. For this, urine samples were collected and analyzed using the Polymerase Chain Reaction Technique (PCR). Results: C. trachomatis was detected in 4.2% of the total 117 HIV patients. Out of positive cases 60% were males and 40% were females. However, chlamydia was found more prevalent among females (6.8%) than males (3.4%). Eighty percent of positive cases were asymptomatic. Conclusions: Although, the prevalence of chlamydia infection was found less HIV patients, most of those cases were asymptomatic. Therefore, routine checkup is recommended for all suspected cases for timely management of the disease. DOI: http://doi.dx.org/10.3126/ijim.v2i1.8003 Int J Infect Microbiol 2013;2(1):12-16

Early initiation of community-based programmes in Nepal: a historic reflection

Community-based programmes have long been an integral part of Nepal's health sector strategy and has contributed to the progress seen in maternal and child health. This paper reviews three early community-based programmes - the acute respiratory infection programme and its evolution to the fully scaled-up community-based integrated management of childhood illness programme, the national vitamin A programme and the female community health volunteer programme - and how the Government of Nepal rapidly accepted them to address pressing maternal and child health issues in an evidence-informed manner, moving rapidly from research to feasibility studies, to implementation and scale-up.

Developing, piloting and scaling-up of Nepal's neonatal care program

The Community-based Newborn Care Package is a set of neonatal care interventions to be delivered through the existing government system of facility-based health workers and community based volunteers in Nepal. The package was developed by the government of Nepal in 2007 based on the evidence from Nepal and neighboring countries and designed to be implemented as a comprehensive package to improve newborn survival. This paper reviews the process, progress, and lessons learned from the program design, early-implementation and monitoring and provides future directives to improve upon this integrated package that uses a continuum of care approach from the pre-pregnancy to neonatal periods by involving the communities, health workers and the private sector.

Comparison of Maxillary Occlusal Plane with Various Craniofacial Reference Lines in Nepalese and Indian Young Adults

Orientation of occlusal plane for complete dentures play a vital role as it affects all the basic requirements of complete dentures. Depending on soft tissue landmarks for orienting occlusal plane seems to be unreliable. Cephalometrics were introduced in Prosthodontics to orient the occlusal plane in the same position as it was with the lost natural teeth. In the present study, 60 lateral cephalometric radiographs of a group of male and female dentulous subjects of Indian and Nepali origin (30 subjects in each group) were obtained and tracings were made. All the subjects selected were in the age group of 20-30 years in whom the facial growth was completed. Angular measurements were made between FH (Frankfort Horizontal plane)- CP (Camper's Plane), FH-OP (Occlusal Plane) and CP-OP and subjected to statistical analysis to determine the degree of separation between these planes in Indian and Nepalese ethnic groups. The absolute parallelism between the natural occlusal plane and Camper's plane were not proven in both Indian and Nepalese subjects involved in this study. This significantly reduces the reference values of these planes in Prosthodontics.

Developing community-based intervention strategies and package to save newborns in Nepal

In Nepal, the proportion of under 5 deaths that are neonatal (0-28 days) has been increasing in the last decade, due to faster declines in infant and child mortality than in neonatal mortality. This trend is likely due to a focus on maternal and child survival programs that did not adequately address newborn health needs. Policy and actions to save newborn lives resulted from increased attention to newborn deaths in 2001, culminating in the endorsement of the National Neonatal Health Strategy in 2004, a milestone that established newborn health and survival as a national priority. Operationalization of the National Neonatal Health Strategy took place in 2007 with the development of the Community-Based Newborn Care Package (CB-NCP). This paper describes how national stakeholders used global, regional and in-country research and policies to develop the CB-NCP, thus outlining key ingredients to make newborn health programming a reality in Nepal. A technical working group was constituted to review existing evidence on interventions to improve newborn survival, develop a tool to prioritize neonatal interventions, and conduct program learning visits to identify key components appropriate to the Nepal context that should be included in the Community Based Integrated Newborn Care Package. The group identified interventions based on the evidence of impact on newborn survival, potential mechanisms within the existing health system to deliver the interventions, and linkages with existing programs and different tiers of the health system. Not only was Nepal one of the first countries in south-east Asia where government adopted a national strategy to reduce neonatal deaths, but it was also one of the first to endorse a package of neonatal interventions for pilot testing and scaling up through existing community-based health systems that provide basic health services throughout the country. CB-NCP was designed to be gradually scaled up throughout the country by integration with Safe Motherhood and Child survival programs that are currently operating at scale. Under Ministry of health and Population leadership, a network of academia, professional bodies and partners developed a common vision for improving newborn health and survival, and launched district-level pilot programs to demonstrate and learn how newborn health interventions could be effectively and efficiently delivered and scaled up in Nepal.

Tamoxifen for Breast Cancer

Breast cancer is one of the common cancers. Hormonal therapy along with surgery, chemotherapy, radiotherapy and targeted therapy are vital modalities for the management of breast cancer. Tamoxifen has been the most widely used hormonal therapy for more than two decades. In this article we review the benefits, dose, duration and timing of Tamoxifen therapy in patients with breast cancer. Keywords: breast cancer, hormonal therapy, tamoxifen.