The Value of Fundoplication in the Treatment of Type I Achalasia

BACKGROUND

Type I achalasia comprises 20% of achalasia and has nearly absent esophageal motor activity. Concerns that fundoplication decreases the effectiveness of Heller myotomy in these patients has increased adoption of peroral endoscopic myotomy (POEM). Hence, we compared outcomes after Heller myotomy with Dor fundoplication vs POEM.

METHODS

From 2005 to 2020, 150 patients with type I achalasia underwent primary surgical myotomy (117 Heller myotomy, 33 POEM). Patient demographics, prior treatments, timed barium esophagrams, Eckardt scores, and reinterventions were assessed between the 2 groups. Median follow-up was 5 years for Heller myotomy and 2.5 years for POEM.

RESULTS

The Heller myotomy group was younger, had fewer comorbidities, and lower body mass index vs POEM. Risk-adjusted models demonstrated clinical success (Eckardt ≤3) in 83% of Heller myotomies and 87% of POEMs at 3 years; longitudinal complete timed barium esophagram emptying and reintervention were also similar. An abnormal pH test result was documented in 10% (6 of 60) after Heller myotomy and in 45% (10 of 22) after POEM (P < .001).

CONCLUSIONS

Despite nearly absent esophageal contractility, Heller myotomy with Dor fundoplication and POEM result in similar long-term symptom relief, esophageal emptying, and occurrence of reintervention in patients with type I achalasia. There is decreased esophageal acid exposure with the addition of a fundoplication, without compromised esophageal drainage, allaying fears of a detrimental effect of a fundoplication. Hence, choice of procedure may be personalized based on patient characteristics and esophageal morphology and not solely on manometric subtype.

Environmental Consequences of Intensive Aquaculture Practices at Moyna Purba Medinipur West Bengal India with Special Reference to Carbon Footprint and Carbon Sequestration

Moyna of Purba Medinipur district is widely known as an aquaculture hub of West Bengal, India. Though very good production is achievable from this fish culture system, management practices are inappropriate, which could create the sustainability problem of this culture system. The present study was thus undertaken for the estimation of plankton population, water quality, carbon footprint and carbon sequestration of this intensive aquaculture practices. Information on spawn to fry, fry to fingerlings and grow-out culture were collected through the structured questionnaire from the fish farmers. The plankton density, primary productivity, carbon footprint and carbon sequestration were analyzed using standard procedures. The phytoplankton, zooplankton and primary productivity were maximum at the stocking period and minimum during the middle of culture period. The lowest feed conversion ratio (FCR) was noticed with the minimum amount of feed applied in the pond. The CO2-e emission ranged from 0.56 to 4.89 kg CO2-e/kg fish (av. 2.13) for the production levels of 5.0 to 10.7 t/ha/yr. The pond water developed salinity and ammonium-N increased from 0.01 to 0.50 mg/l. The ponds with high feed loading (28 to 32 t/ha/yr) had the highest average sediment accumulation rate (11.0 ± 3.0 cm/yr) and carbon sequestration (704 ± 30 g C/m2/yr).

Optical Monitoring of the Magnetization Switching of Single Synthetic-Antiferromagnetic Nanoplatelets with Perpendicular Magnetic Anisotropy

Synthetic antiferromagnetic nanoplatelets (NPs) with a large perpendicular magnetic anisotropy (SAF-PMA NPs) have a large potential in future local mechanical torque-transfer applications for e.g., biomedicine. However, the mechanisms of magnetization switching of these structures at the nanoscale are not well understood. Here, we have used a simple and relatively fast single-particle optical technique that goes beyond the diffraction limit to measure photothermal magnetic circular dichroism (PT MCD). This allows us to study the magnetization switching as a function of applied magnetic field of single 122 nm diameter SAF-PMA NPs with a thickness of 15 nm. We extract and discuss the differences between the switching field distributions of large ensembles of NPs and of single NPs. In particular, single-particle PT MCD allows us to address the spatial and temporal heterogeneity of the magnetic switching fields of the NPs at the single-particle level. We expect this new insight to help understand better the dynamic torque transfer, e.g., in biomedical and microfluidic applications.

Solvated electron-induced synthesis of cyclodextrin-coated Pd nanoparticles: mechanistic, catalytic, and anticancer studies

Herein, using in situ generated solvated electrons in the reaction media, a highly time-efficient, one-pot green approach has been employed to synthesize palladium (Pd) nanoparticles (NPs) coated with a molecular assembly of α-cyclodextrin (α-CD). The appearance of a shoulder peak at 280 nm in the UV-Vis absorption spectra indicated the formation of Pd NPs, which was further confirmed from their cubic phase XRD pattern. The nanomorphology varied considerably as a function of the dose rate, wherein sphere-shaped NPs (average size ∼ 7.6 nm) were formed in the case of high dose rate electron-beam assisted synthesis, while nanoflakes self-assembled to form nanoflower-shaped morphologies in a γ-ray mediated approach involving a low dose rate. The formation kinetics of NPs was investigated by pulse radiolysis which revealed the formation of Pd-based transients by the solvated electron-induced reaction. Importantly, no interference of α-CD was observed in the kinetics of the transient species, rather it played the role of a morphology directing agent in addition to a biocompatible stabilizing agent. The catalytic studies revealed that the morphology of the NPs has a significant effect on the reduction efficiency of 4-nitrophenol to 4-aminophenol. Another important highlight of this work is the demonstration of the morphology-dependent anticancer efficacy of Pd NPs against lung and brain cancer cells. Notably, flower-shaped Pd NPs exhibited significantly higher cancer cell killing as compared to spherical NPs, while being less toxic towards normal lung fibroblasts. Nonetheless, these findings show the promising potential of Pd NPs in anticancer treatment.

Incidence and Pattern of Patient-Perceived Oral Medicine Emergencies during Lockdown: Experience of Tertiary Health Care Centre of Eastern Nepal

Background There has been a significant drop in the number of patients seeking oral medicine care during the lockdown period. Objective To find the incidence and pattern of patient perceived oral medicine emergencies in the tertiary healthcare centre of eastern Nepal, during the lockdown period. Method The clinical profile of patients seeking oral medicine care between 30th April 2021 to 25th June 2021 (period of strict lockdown in Sunsari district) was recorded. Data were recorded in an excel sheet and transferred to Statistical Package for the Social Sciences version 11.5. Frequency and proportion were calculated. Result During the lockdown, 300 patients had visited the hospital with different oral diseases seeking the care of an oral physician. The average number of patients seeking oral medicine care per day was approximately six. Of the total patients, 110 patients had pain as their chief complaint, 48 had wound and 34 had a burning sensation in the mouth. Among them 82% perceived their complaint as an emergency. The provisional diagnosis was temporomandibular disorders in 40 patients, trigeminal neuralgia in 38 patients and 34 had carcinoma. Conclusion Patients seeking oral medicine care during the lockdown period had decreased by about one-third. Pertaining to oral medicine, pain in any orofacial area was the most common patient perceived emergency condition followed by wound and burning sensation. Maximum number of patients visiting the department perceived their complain as an emergency.

Study of Two Different Volumes of 0.75% Ropivacaine for Ultrasound Guided Supraclavicular Brachial Plexus Block on Successful Blockade and Diaphragmatic Motility

Background Use of ultrasound guidance during supraclavicular brachial plexus block allows the usage of a lower anesthetics dose and minimizing unwanted effects of the anesthesia. Objective To compare the success of sensory blockade and the incidence of hemidiaphragmatic dysfunction in patients receiving two different volume of 0.75% Ropivacaine for ultrasound guided supraclavicular brachial plexus block. Method A prospective randomized double-blinded comparative study was conducted. Group A patients (n=30) received 20 ml and Group B (n=30) received 25 ml of 0.75% Ropivacaine for ultrasound guided supraclavicular brachial plexus block. Hemodynamic parameters, oxygen saturation, diaphragmatic excursion, onset of sensory blockade and time for completion of blockade were measured. Independent t-test, Chi-square test and Mann-Whitney U test were used to analyze the data at p value of less than 0.05 using Statistical Package for Social sciences (version 11.5). Result At 30 minutes, 29 (96.67%) patients in group B and 27 (90.0%) patients in group A had no sensation in median, radial, ulnar, musculocutaneous and medial cutaneous nerves teritories; however, it was not significant statistically (p value > 0.05). At 30 minutes in Group A, 25 (83.33%) patients had no diaphragmatic hemiparesis and five (16.67%) patients had partial diaphragmatic hemiparesis. However, three (10%) patients had no diaphragmatic hemiparesis in Group B, 25 (83.33%) patients had partial and two (6.67%) patients had complete diaphragmatic hemiparesis and it was statistically significant (p < 0.05). Age and sex had no effect on diaphragmatic hemiparesis in both groups (p value > 0.05). Conclusion The patients receiving lower volume of Ropivacaine had less incidence of hemidiaphragmatic dysfunction with similar sensory blockade as compared to the patients receiving higher volume of Ropivacaine.

Familial hypercholesterolemia in community-based KHDC Nepal program-baseline data

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): HUG and Republic and Canton of Geneva – Service de solidarité internationaleBP Koirala Institute of Health Sciences

Familial hypercholesterolemia (FH) is either underdiagnosed or diagnosed after primary coronary events. Although homozygous variant of FH is considered rare, heterozygous FH is estimated to occur in about 1 in 200 to 300 individuals. There is no study pertaining to prevalence of FH in Nepal which could be a factor influencing cardiovascular morbidity and mortality.

We present a baseline data of FH in an ongoing in participants of community-based cardiovascular and kidney diseases preventive (KHDC Nepal) program in Mechinagar municipality in Eastern Nepal.

KHDC is a program to collaborate among health post, primary health center or equivalent, and local government along with community representatives created to educate, screen, and intervene for selective NCDs. This program is in alignment with the World Health Organization’s Package of Essential Noncommunicable (WHO PEN) disease interventions for primary health care in low-resource settings. General health status and lifestyle habits, physical examination, and blood pressure were assessed. Blood tests done included fasting lipid profile, serum creatinine, FBS, and HbA1c. A mechanism was developed to follow-up screened positive persons in the primary health centers. Referrals were made to the tertiary care center as needed.

We analyzed initial 7289 participants, 20 years or above, who were enrolled in KHDC program in the year 2020. We assessed for FH using Dutch Lipid Clinic Network(DLCN), Simon Broome and AHA criteria. Participants were categorized as definite, probable, possible, or no FH based on the scores of DLCN criteria; as definite and probable based on Simon Broome criteria and as clinically diagnosed FH based on AHA criteria.

The median age of the patient was 54 years, the majority being females (62.7%). A total of 70(0.96%) of the participants had elevated LDL-C levels of more than 190mg/dl detected during the screening and had no secondary cause for hyperlipidemia. According to DLCN criteria, 65(0.89%) participants were grouped under possible FH, 5(0.06%) were grouped under probable FH while none of them could be delineated as definite FH. According to Simon Broome criteria, 14(0.2%) participants were grouped under probable and none of them could be delineated as definite. According to AHA criteria, 10 (0.13%) participants were categorized as clinically diagnosed FH. DNA analysis was not available in our setup. Clinically manifested atherosclerotic disease was recorded in 5 participants. None of the participants were aware of the FH.

This community-based program of the adult population help create baseline data of FH in Nepal. Larger study with genetic analysis is likely to reveal true prevalence of FH in Nepal.

Awareness and Knowledge of Glaucoma and their Associated Factors among Staffs in a Tertiary-level Hospital in Central Nepal

Background Since glaucoma-related blindness may only be prevented with early identification and treatment, finding asymptomatic individuals in the target population is critical. It is thus important to determine the awareness and knowledge on glaucoma. Objective To determine the knowledge and awareness on glaucoma among the staff of a tertiary level hospital in central Nepal. Method This was a cross sectional study among the staffs of Dhulikhel Hospital who participated voluntarily in the study. The data was collected through the administration of semi-structured questionnaires. R version 4.0.3 (2020-10-10) was used for the data analysis. Categorical variables are presented as frequency (percentages) and the numerical ones are presented as mean (standard deviation). Adjusted odds ratio (AOR) with 95% confidence interval were estimated through logistic regression analysis for determining factors associated with awareness and knowledge of glaucoma. Result A total of 107 (89.2%) participants had heard about glaucoma of which 93 (86.9%) had good knowledge and 14(13.1%) had poor knowledge on glaucoma. The mean score of knowledge was 64.1±16.9. Only 47.7% of the participants said that glaucoma also has an asymptomatic course. We could not find an association of awareness and knowledge of glaucoma with any of the selected sociodemographic variables. Conclusion Although there was a fairly good glaucoma related awareness and knowledge among hospital staff, we found lack of understanding on some critical issues on glaucoma, mainly related to its asymptomatic nature. There is thus room for improvement in educating about glaucoma even in healthcare settings. Given the necessity of expanding glaucoma awareness in the public, hospital staff might potentially serve as messengers to the communities.

Multidimensional, High Precision Measurements of Beam Single Spin Asymmetries in Semi-inclusive π^{+} Electroproduction off Protons in the Valence Region

High precision measurements of the polarized electron beam-spin asymmetry in semi-inclusive deep inelastic scattering (SIDIS) from the proton have been performed using a 10.6 GeV incident electron beam and the CLAS12 spectrometer at Jefferson Lab. We report here a high precision multidimensional study of single π^{+} SIDIS data over a large kinematic range in Bjorken x, fractional energy, and transverse momentum of the hadron as well as photon virtualities Q^{2} ranging from 1-7  GeV^{2}. In particular, the structure function ratio F_{LU}^{sinϕ}/F_{UU} has been determined, where F_{LU}^{sinϕ} is a twist-3 quantity that can reveal novel aspects of emergent hadron mass and quark-gluon correlations within the nucleon. The data's impact on the evolving understanding of the underlying reaction mechanisms and their kinematic variation is explored using theoretical models for the different contributing transverse momentum dependent parton distribution functions.

Influence of land use and topography on distribution and bioaccumulation of potentially toxic metals in soil and plant leaves: A case study from Sekhukhuneland, South Africa

Potentially toxic metal (PTM) enrichment of the soil-plant system in ultramafic and mining regions is a global concern as it affects the food chain. With expanding mining industry, it is important to assess if anthropogenic factors (i.e., land use practices) have a greater influence in this regard compared to natural factors (i.e., topography). Localities in Sekhukhuneland, South Africa, were selected along an altitudinal gradient (i.e., topography: upper slope, footslope, valley and valley bottom) and a land use profile (i.e., rangelands, gardens, tailings and wastelands) to investigate the distribution of Co, Cr, Cu, Fe, Mg, Mn, Mo, Ni, Sr and Zn of natural (i.e., ultramafic geology) and anthropogenic (i.e., mining) origin in surface soil and plant leaf tissue. Plant life form was considered as an additional factor to evaluate PTM accumulation in leaves. Findings revealed a wider distribution range for Cr and Ni in the surface soil. Co, Cu, Mg, Mo, Sr and Zn were accumulated (bioaccumulation factor, BAF > 1) in leaf tissue of 74% of the evaluated plants of which 83% were indigenous. Grasses, forbs, dwarf shrubs and shrubs showed the highest accumulation levels. Despite an observed trend in the distribution of PTMs in soils and plant leaves along the altitudinal gradient, no significant differences were determined among the topographic positions. Land use practices, however, differed significantly indicating anthropogenic interference as a predominant determinant of PTM enrichment of soil-plant systems. Metal tolerant dominant plants in Sekhukhuneland could be classified as metallophytes. Indigenous species, accumulators and excluders, showed prospects for phytoremediation and rehabilitation of metal contaminated sites, respectively. Concentrations of Cr and Co in food and medicinal plant leaves exceeded the international permissible limits, which highlighted the necessity to estimate human health risks for PTMs in metalliferous sites.

Energy transfer in reconnection and turbulence

Reconnection and turbulence are two of the most commonly observed dynamical processes in plasmas, but their relationship is still not fully understood. Using 2.5D kinetic particle-in-cell simulations of both strong turbulence and reconnection, we compare the cross-scale transfer of energy in the two systems by analyzing the generalization of the von Kármán Howarth equations for Hall magnetohydrodynamics, a formulation that subsumes the third-order law for steady energy transfer rates. Even though the large scale features are quite different, the finding is that the decomposition of the energy transfer is structurally very similar in the two cases. In the reconnection case, the time evolution of the energy transfer also exhibits a correlation with the reconnection rate. These results provide explicit evidence that reconnection dynamics fundamentally involves turbulence-like energy transfer.

Awareness and Knowledge of Glaucoma and their Associated Factors among People Visiting a Tertiary Level Hospital in Central Nepal

Background Glaucoma is one of the major causes of irreversible blindness globally. Almost 60 million people globally are affected by glaucoma making it the second leading cause of blindness worldwide. Diagnosis of glaucoma early on is vital for timely management and prevention of blindness. However, it is challenging to diagnose it early because it is asymptomatic in the initial stage, and there is also the dearth of appropriate screening tools. Awareness, knowledge, and beliefs are believed to influence the treatment-seeking behavior of people as well as their uptake of services. Objective To assess the awareness and knowledge about glaucoma among general patients and patient attendants visiting Dhulikhel Hospital. Method We conducted a cross sectional quantitative study among general patients visiting Dhulikhel Hospital. We collected data using face-to-face interviews with semistructured questionnaires. We analyzed data in R version 4.0.3 (2020-10-10). We presented numerical variables as mean and standard deviation whereas categorical variables as frequency and percentage. We determined factors associated with awareness and knowledge of glaucoma using logistic regression analysis and estimated adjusted odds ratio (AOR) with 95% confidence interval. Result Of 379 participants, a total of 214 (56.5%) participants had heard about glaucoma. Out of the participants who heard about glaucoma, the mean knowledge score was 48.3±21.7 and 53.3% had good knowledge on glaucoma. The odds of having heard about glaucoma were two percent lower (AOR=0.98; 95%CI: 0.97-0.99; p-value 0.036) in the older participants compared to one year younger participant, 1.98 (95%CI:1.01-3.86; p-value 0.046) times higher among literates and 2.79 (95%CI: 1.76- 4.41; p-value < 0.001) times among participants with previous ocular examination. The odds of having good knowledge was 1.94 (95%CI: 1.10-3.42; p value 0.021) times among participants with previous ocular examinations. Conclusion The knowledge and awareness regarding glaucoma in a hospital-visiting population in central Nepal was low. Half of the participants were unaware of the disease glaucoma and half of the participants who heard of the glaucoma had poor knowledge on glaucoma.

Preterm Birth, Exasperation to the South Asian Countries

When a child is born before 37 weeks or 259 days of pregnancy, it is termed as preterm birth. Pre-term birth is prevalent in both developed and developing country. However, difference lies in their survival. In lower and middle income countries, most preterm babies die due to lack of even simple interventions. India ranks top in the world for deaths due to complications of preterm birth. Similarly, other South Asian countries, Pakistan, Bangladesh, Afghanistan and Nepal rank 3rd, 6th, 9th and 20th in the same. The aim of this review paper is to provide a landscape analysis on the burden of pre-term birth and challenges in the context of South Asian region. Databases such as PubMed, Scopus and Google Scholar were searched from 2000 to 2020 and 27 articles are included in the study. It was found that pre-term birth causes huge burden in the form of morbidity, mortality as well as socio economic losses. Preterm birth was associated with increased sepsis, cardiovascular disease, respiratory illness, hypothermia, neurological and gastrointestinal complications. South Asian countries have distinct challenges in eliminating or reducing preterm births which are: poor quality health surveillance data, inadequate trained health workforce, insufficient finance and funding, service delivery and other methodological challenges. Ending pre-term birth is important as it is directly related to Sustainable Development Goal 3. Therefore, there should be increase in priority given to increase financing, quality data gathering, adopting innovative measures as well as joint efforts of all the sectors to control the pre-term birth.

Mortality and long-term outcomes of palliative inotropes in ischemic and non-ischemic cardiomyopathy

Background

Palliative inotropes are frequently utilized for symptom management in patients with end stage heart failure who are unable to undergo durable advanced heart failure therapies. With the advent of improved medical management and early intervention, palliative inotropes may allow for improved patient outcomes than seen previously. In this study, we aim to investigate the survival and outcomes of palliative inotrope therapy and its impacts on ischemic versus non-ischemic cardiomyopathy.

Methods

We retrospectively analyzed 220 patients with American Heart Association Stage D heart failure who were discharged with palliative inotrope therapy after January 1, 2010. Patients who underwent mechanical circulatory support (MCS) or those who underwent heart transplant were excluded. Those with a history of coronary artery disease, myocardial infarction, history of percutaneous intervention, or coronary artery bypass grafting were assigned to ischemic cardiomyopathy (ICM), while patients without these findings were assigned to non-ischemic cardiomyopathy (NICM). Statistical analysis was completed using Chi-Square and Student's t-tests, wherein p&lt;0.05 was considered statistically significant.

Results

Of the 220 patients, 87 had NICM as opposed to 133 with ICM. Mean age was found to be higher among patients with ICM (70 [62–79]) compared to NICM (65 [55–72], p-value &lt;0.01). No significant difference was seen in total days on inotrope therapy (p=0.6). While more patients in both groups were placed on milrinone as opposed to dobutamine, there was no difference between patients with ischemic and NICM (p=0.66 and 0.51 respectively). Although a greater number of patients with NICM had been lost to follow up, admitted to hospice, or expired at 2 years (p&lt;0.01), survival at 3 months, 1 year, and 2 years showed no difference between both groups. No difference was seen in number of hospitalizations or clinic visits in one year. Both groups had similar complication rates with intravenous-access related PICC line infections and new arrhythmias. (See Table).

Conclusion

Despite more frequent use of durable mechanical support devices, many patients who are deemed unsuitable for invasive measures are treated with palliative inotrope therapy. We have found that there is no significant difference in survival, complications, and outcomes of patients on palliative inotropes among ischemic and NICM. These findings show the versatility of palliative inotrope therapy in end stage heart failure. Further studies with larger populations need to be evaluated.

Funding Acknowledgement

Type of funding sources: None.

Epidermoid Cyst of the Ear Lobule in Adult

An epidermoid cyst is one of the most common benign cysts of the skin. The cyst is filled with keratin flakes and its wall is composed of keratinized, stratified, squamous epithelium. Epidermoid cysts can occur anywhere on the body, usually along the lines of embryonic fusion and mostly on the face, scalp, neck, chest, and upper back. Around 80% of the epidermoid cysts are seen in ovaries and testicles whereas, in the head and neck, they account for only about 7% and 1.6% of epidermoid cysts are reported in the oral cavity. The condition can be congenital or acquired. Congenital causes are rare and may be caused by the entrapment of ectodermal elements intradermally or subcutaneously during embryogenesis. Acquired causes of an epidermoid cyst may result from traumatic or iatrogenic implantation of epithelial cells into the dermal layer or from obstruction of a pilosebaceous unit in the hair follicle. Surgical excision completes the treatment.

Knowledge and Practices of Child Protection among the School Health Nurses of Nepal

Background Child protection is burning issues in developing countries including Nepal. Child protection is one of the key works of the school health nurses. Objective To find out about the existing knowledge and practices of child protection among the school health nurses. Method This descriptive cross-sectional study was conducted among 130 school health nurses working in different schools throughout Nepal. The participants were selected using purposive sampling technique and were invited to participate via various online networks. Self-administered questionnaire was used to collect data. Duration of data collection was 20 December 2020 to 10 February 2021. Descriptive statistics was used to analyze and interpret the data. Result Among the 130 Participants, 88.5% belonged to less than 29 years age group and 67.7% had Proficiency Certificate Level in Nursing education. None of them has received training related to child protection recognition and response and 90.8% had work experience of less than 5 years. Eighty percent and 96.9% participants had knowledge regarding the meaning of child right and child abuse respectively. But 45.4% had knowledge on meaning of child neglect; 53.1% and 72.3% had the knowledge of physical abuse and noncontact sexual abuse respectively. Majority (86.9%) of the participants reported as relatives were the abuser and 63.8% replied as home is the common place for abuse. Similarly, 85.4% had received the information regarding child protection via television radio and newspaper. Only 36.1% has already been involved in child protection. The participants who went to local government (Palika), police and Non-government Organizations for coordination for child right issues were 9(19.1%), 7(14.8%) and 8(17.0%) respectively. Conclusion Most of the school health nurses are young without having experience of childhood abuse and received any child protection training before joining the job. They have good knowledge of child right, physical, sexual abuse except child neglect and existing legal arrangements. There is gap in knowledge and practice.

Anxiety, Depression and Functional Impairment among Health Care Workers during COVID-19 Pandemic: A Crosssectional Online Survey

Background COVID-19 is an infectious disease caused by a newly discovered coronavirus. The number of cases and dramatic loss of human life worldwide created psychological problems among general public, including health care workers. Objective To determine the burden of anxiety, depression, and functional impairment among health care workers in the early days of lockdown during the first wave of COVID-19 outbreak in Nepal. Method A hospital-based cross-sectional study was carried out among all the employees of Hospital for Children Eye ENT and Rehabilitation Services, Bhaktapur during the COVID-19 pandemic lockdown from April 3, 2020 to May 2, 2020 using an online questionnaire. The tools used were adopted from Nepali version of Hospital Anxiety and Depression scale (HADS) and Nepali version of WHO Disability Assessment Schedule (WHODAS 2.0). Result The mean age (SD) of the participants (n=86) was 32.53 (7.92) years. Male and female participants were equal in number. The point prevalence of anxiety and depression was 25.6% and 14.0%, respectively. Females had a higher prevalence of both anxiety (39.5% vs 11.6%, p < 0.01) and depression (18.6% vs 9.3%, p=0.351). Clinical and nonclinical staff both had a higher prevalence of both anxiety (31.0% and 20.5%, p=0.265) and depression (16.7% and 11.4%, p=0.478). The mean functional impairment score (WHODAS 2.0) among all participants and participants with anxiety and depression was 19.47 (95% CI: 18.13-20.80), 21.27 (95% CI: 18.08-24.46), and 19.92 (95% CI: 15.28- 24.56), respectively. Conclusion Anxiety and depression during the first lockdown due to COVID-19 pandemic were highly prevalent in clinical and non-clinical employees. Besides controlling the outbreak, special consideration should be given to mental health.

The eigenbuckling analysis of hexagonal lattices: closed-form solutions

Elastic instability such as the buckling of cellular materials plays a pivotal role in their analysis and design. Despite extensive research, the quantifi- cation of critical stresses leading to elastic instabi- lities remains challenging due to the inherent nonlinearities. We develop an analytical approach considering the spectral decomposition of the elasticity matrix of two-dimensional hexagonal lattice materials. The necessary and sufficient condition for the buckling is established through the zeros of the eigenvalues of the elasticity matrix. Through the analytical solution of the eigenvalues, the conditions involving equivalent elastic properties of the lattice were directly connected to the mathematical requirement of buckling. The equivalent elastic properties are expressed in closed form using geometric properties of the lattice and trigonometric functions of a non-dimensional axial force parameter. The axial force parameter was identified for four different stress cases, namely, compressive stress in the longitudinal and transverse directions separately and together and torsional stress. By solving the resulting nonlinear equations, we derive exact analytical expressions of critical eigenbuckling stresses for these four cases. Crucial parameter combinations leading to minimum buckling stresses are derived analytically. The exact closed-form analytical expressions derived in the paper can be used for quick engineering design calculations and benchmarking related experimental and numerical studies.

Observation of Beam Spin Asymmetries in the Process ep→e^{'}π^{+}π^{-}X with CLAS12

The observation of beam spin asymmetries in two-pion production in semi-inclusive deep inelastic scattering off an unpolarized proton target is reported. The data presented here were taken in the fall of 2018 with the CLAS12 spectrometer using a 10.6 GeV longitudinally spin-polarized electron beam delivered by CEBAF at JLab. The measured asymmetries provide the first opportunity to extract the parton distribution function e(x), which provides information about the interaction between gluons and quarks, in a collinear framework that offers cleaner access than previous measurements. The asymmetries also constitute the first ever signal sensitive to the helicity-dependent two-pion fragmentation function G_{1}^{⊥}. A clear sign change is observed around the ρ mass that appears in model calculations and is indicative of the dependence of the produced pions on the helicity of the fragmenting quark.

Photoproduction of the f_{2}(1270) Meson Using the CLAS Detector

The quark structure of the f_{2}(1270) meson has, for many years, been assumed to be a pure quark-antiquark (qq[over ¯]) resonance with quantum numbers J^{PC}=2^{++}. Recently, it was proposed that the f_{2}(1270) is a molecular state made from the attractive interaction of two ρ mesons. Such a state would be expected to decay strongly to final states with charged pions due to the dominant decay ρ→π^{+}π^{-}, whereas decay to two neutral pions would likely be suppressed. Here, we measure for the first time the reaction γp→π^{0}π^{0}p, using the CEBAF Large Acceptance Spectrometer detector at Jefferson Lab for incident beam energies between 3.6 and 5.4 GeV. Differential cross sections, dσ/dt, for f_{2}(1270) photoproduction are extracted with good precision due to low backgrounds and are compared to theoretical calculations.

Beam Spin Asymmetry in Semi-Inclusive Electroproduction of Hadron Pairs

A first measurement of the longitudinal beam spin asymmetry A_{LU} in the semi-inclusive electroproduction of pairs of charged pions is reported. A_{LU} is a higher-twist observable and offers the cleanest access to the nucleon twist-3 parton distribution function e(x). Data have been collected in the Hall-B at Jefferson Lab by impinging a 5.498-GeV electron beam on a liquid-hydrogen target, and reconstructing the scattered electron and the pion pair with the CLAS detector. One-dimensional projections of the A_{LU}^{sinϕ_{R}} moments are extracted for the kinematic variables of interest in the valence quark region. The understanding of dihadron production is essential for the interpretation of observables in single-hadron production in semi-inclusive DIS, and pioneering measurements of single-spin asymmetries in dihadron production open a new avenue in studies of QCD dynamics.

Peroral endoscopic myotomy provides effective palliation in type III achalasia

BACKGROUND

Type III achalasia outcomes have historically been met with limited success after conventional laparoscopic Heller myotomy (LHM) and pneumatic dilation. Peroral endoscopic myotomy (POEM) has emerged as a promising alterative for a multitude of reasons. Our objective was to investigate POEM outcomes in palliating type III achalasia.

METHODS

A retrospective analysis of a prospectively maintained database was conducted in a tertiary care institution between April 2014 and July 2019. The primary outcome was postoperative Eckardt score. We also explored the effect of lower esophageal sphincter (LES) integrated resting pressure (IRP) on manometry, barium column height and width, and complications. Standard statistical methods were applied using R.

RESULTS

A total of 518 patients in the achalasia database were identified, with 308 patients undergoing LHM and 210 undergoing POEM during the study period. POEM was used for type III achalasia in 36 patients (median age, 60 years; 61.7% male), with a median operative time of 85 minutes (interquartile range [IQR], 71-115 minutes) and follow-up of 1 year (IQR, 0.16-2.25 years). Within the POEM group, 11 patients (33%) had previous interventions, including Botox injections to the LES (n = 7), pneumatic dilation (n = 1), and LHM (n = 3). A significant decrease in median Eckardt score was observed (7 preoperatively [IQR, 6-8.75] vs 0 postoperatively [IQR, 0-1]; P < .01). Similar improvements after POEM were noted in median LES IRPs (25.5 mmHg vs 4.5 mmgHg; P < .01), 1-minute barium column height (10 cm vs 0 cm; P < .01), and 1-minute barium column width (2 cm vs 0 cm; P < .01). Patients reported a return to activities of daily living in a median of 7 days (IQR, 3-7 days). Three patients experienced complications, including mucosal perforation resolving with conservative management (n = 1), readmission for bleeding duodenal ulcer responding to proton pump inhibitors (n = 1), and readmission for dysphagia and rehydration (n = 1). Postoperative esophageal pH studies were conducted in 21 patients (62%), demonstrating a Demeester score of >14.72 in 13 patients (62%).

CONCLUSIONS

POEM provides effective and durable palliation for type III achalasia, as demonstrated by symptom relief, esophageal manometry, and radiographic measurement. Considering its low morbidity profile, POEM should be considered as first-line therapy in this challenging disease subtype.

Kinetic characteristics of ions in an inertial electrostatic confinement device

The kinetic analyses are quite important when it comes to understanding the particle behavior in any device as they start to deviate from a continuum nature. In the present study, kinetic simulations are performed using the particle-in-cell method to analyze the behavior of ions inside a cylindrical inertial electrostatic confinement fusion (IECF) device which is being developed as a tabletop neutron source. Here, the lighter ions, like deuterium, are accelerated by applying an electrostatic field between the chamber wall (anode) and the cathode (cylindrical gridded wire), placed at the center of the device. The plasma potential profiles obtained from the simulated results indicate the formation of multiple potential well structures inside the cathode grid depending upon the applied cathode potential (from -1 to -5 kV). The ion density at the core region of the device is found to be of the order of 10^{16}m^{-3}, which closely resembles the experimental observations. Spatial variation of ion energy distribution function has been measured in order to observe the characteristics of ions at different cathode voltages. Finally, the simulated results are compared and found to be in good agreement with the experimental profiles. The present analysis can serve as a reference guide to optimize the technological parameters of the discharge process in IECF devices.

Minimally Invasive "3-Stitch" Modification of the Dor Fundoplication: Simple and Effective

BACKGROUND

A 180-degree anterior (Dor) fundoplication is usually paired with an esophagogastric myotomy in the surgical treatment of achalasia. The traditional technique, however, is not easily reversible and the execution is variable. This study examined a simplified ''3-stitch'' Dor fundoplication that addressed these challenges and presented the results.

METHODS

A prospectively collected, longitudinal surgical achalasia database was queried for patients undergoing a Heller myotomy with '3-stitch 180-degree fundoplication from 2008 to 2019. Preoperative and postoperative Eckardt score, postoperative DeMeester score (24- or 48-hour pH studies), and endoscopic evidence of esophagitis were collected and analyzed to determine the effectiveness and safety of the fundoplication. Length of stay and complications were also considered.

RESULTS

The pH testing was performed in 296 patients, with 17% (50 of 296) demonstrating abnormal esophageal acid exposure. Of this group, only 8% (16 of 201) manifested clinical esophagitis on upper endoscopy. A total of 14% (7 of 50) of patients with abnormal esophageal acid exposure were symptomatic. Total postoperative Eckhardt scores for this cohort were 3 or lower in 92% of patients, with a dysphagia-specific score of 0 in 92%. The technical details of a modified 180-degree anterior fundoplication are described.

CONCLUSIONS

The 3-stitch Dor fundoplication is an effective addition to a minimally invasive Heller myotomy, with good palliation of symptoms and an acceptable rate of acid reflux. The simplified construction anticipates the potential progression of esophageal dysmotility in patients with achalasia, and the modified technique is reproducible and readily teachable.

Extraction of Beam-Spin Asymmetries from the Hard Exclusive π^{+} Channel off Protons in a Wide Range of Kinematics

We have measured beam-spin asymmetries to extract the sinϕ moment A_{LU}^{sinϕ} from the hard exclusive e[over →]p→e^{'}nπ^{+} reaction above the resonance region, for the first time with nearly full coverage from forward to backward angles in the center of mass. The A_{LU}^{sinϕ} moment has been measured up to 6.6  GeV^{2} in -t, covering the kinematic regimes of generalized parton distributions (GPD) and baryon-to-meson transition distribution amplitudes (TDA) at the same time. The experimental results in very forward kinematics demonstrate the sensitivity to chiral-odd and chiral-even GPDs. In very backward kinematics where the TDA framework is applicable, we found A_{LU}^{sinϕ} to be negative, while a sign change was observed near 90° in the center of mass. The unique results presented in this Letter will provide critical constraints to establish reaction mechanisms that can help to further develop the GPD and TDA frameworks.

A linear viscoelasticity for decadal to centennial time scale mantle deformation

The extended Burgers material (EBM) model provides a linear viscoelastic theory for interpreting a variety of rock deformation phenomena in geophysics, playing an increasingly important role in parameterizing laboratory data, providing seismic wave velocity and attenuation interpretations, and in analyses of solid planetary tidal dispersion and quality factor Q. At the heart of the EBM approach is the assumption of a distribution of relaxation spectra tied to rock grain boundary and interior granular mobility. Furthermore, the model incorporates an asymptotic long-term limiting behavior that is Maxwellian. Here we use the extensively developed linear theory of viscoelasticity to isolate those parameters of EBM that apply to both post-seismic relaxation processes involving flow of olivine rich upper mantle material and to studies of tides, where periods of forcing range from 12 h to 18.6 years. The isolated EBM parameters should also apply to theoretical and geodetic studies of glacial isostatic adjustment, especially when the initiation of continuous cryospheric surface unloading dates to the 20th or 21st century. Using analytical Laplace transformed solutions of Boussinesq's half-space load problem, we show that the effects of EBM transient rheology may have substantial influence on geodetic interpretations of unloading induced crustal motions even on time scales that are sub-decadal.

Constraining the External Capture to the ^{16}O Ground State and the E2 S Factor of the ^{12}C(α,γ)^{16}O Reaction

The ^{12}C(α,γ)^{16}O reaction is one of the most crucial reactions in nuclear astrophysics. The E2 external capture to the ^{16}O ground state (GS) has not been emphasized in previous analyses but may make a significant contribution to the ^{12}C(α,γ)^{16}O cross section depending on the value of the GS asymptotic normalization coefficient (ANC). In the present work, we determine this ANC to be 337±45  fm^{-1/2} through the ^{12}C(^{11}B,^{7}Li)^{16}O reaction using a high-precision magnetic spectrograph. This sheds light on the existing large discrepancy of more than 2 orders of magnitude between the previously reported ANC values. Based on the new ANC, we experimentally constrain the GS external capture and show that through interference with the high energy tail of the 2^{+} subthreshold state, a substantial enhancement in the GS S_{E2}(300) factor can be obtained (70±7  keV b) compared to that of a recent review (45 keV b), resulting in an increase of the total S factor from 140 to 162 keV b, which is now in good agreement with the value obtained by reproducing supernova nucleosynthesis calculations with the solar-system abundances. This work emphasizes that the external capture contribution for the ground state transition cannot be neglected in future analyses of the ^{12}C(α,γ)^{16}O reaction.

Size-dependent dynamic characteristics of graphene based multi-layer nano hetero-structures

Carbon-based nano hetero-structures are receiving increasing attention due their ability in multi-synchronous modulation of a range of mechanical and other critically desirable properties. In this paper, the vibration characteristics of two different graphene based heterostructures, graphene-hexagonal boron nitride (hBN) and graphene-molybdenum disulfide (MoS₂), are explored based on atomistic finite element approach. Such vibrational characteristics of nanostructures are of utmost importance in order to access their suitability as structural members for adoption in various nano-scale devices and systems. In the current analysis, the developed atomistic finite element model for nano-heterostructures is extensively validated first with the results available in literature considering elastic responses and natural frequencies. Thereafter a range of insightful new results are presented for the dynamic behaviour of various configurations of graphene-hBN and graphene-MoS₂ heterostructures including their size, chirality and boundary dependence. The investigation of tunable vibrational properties along with simultaneous modulation of other mechanical, electronic, optical, thermal and chemical attributes of such nano-heterostructures would accelerate their application as prospective candidates for manufacturing nanosensors, electromechanical resonators, and a wide range of other devices and systems across the length-scales.

Multi-drug Resistant and Extended Spectrum β-lactamase Producing Salmonella Species Isolated from Fresh Chicken Liver Samples

Background Emergence of antibiotic resistance among microbes contaminating the fresh meat products is a global public health concern as they can be easily transmitted to humans through their consumption and contact. Objective The current study was conducted to determine the distribution of antimicrobial resistance among Salmonella species isolated from fresh chicken liver samples with special emphasis on extended spectrum beta-lactamase (ESBL) production. Method A total of 200 fresh chicken liver samples were cultivated for the isolation of Salmonella and further subcultivated to detect extended spectrum beta-lactamase production among them. Antimicrobial susceptibility testing (AST) was done by disk diffusion method using a panel of 7 antimicrobials. Result Out of 200 samples analyzed, 61 (30.5%) samples harbored Salmonella species out of which 15 (7.5%) samples showed the presence of Salmonella Typhi. A significant association was noted in the incidence of Salmonella with various factors pertaining to the butchers, such as age, sex, literacy rate, practices of washing knives and chopping board, wearing aprons and gloves and type of water used (p < 0.05). Salmonella isolates were highly sensitive to amikacin (82.0%) and least sensitive to tetracycline (3.3%). All the isolates were resistant to colistin. Sixty (98.4%) isolates were identified as multi-drug resistant (MDR). The total number of extended spectrum betalactamase producers reported among Salmonella isolates was 29 (47.5%). Conclusion The results indicate that the fresh chicken liver samples sold in Bharatpur Metropolis are reservoirs of multi-drug resistant Salmonella, including extended spectrum betalactamase producers, that could potentially be transmitted to the humans by direct contact or through inadequate cooking.

Influence of pyrolysis parameters on phosphorus fractions of biosolids derived biochar

Transforming biosolids into biochar, through pyrolysis, could result in more sustainable waste management. Influence of pyrolysis conditions (temperature, heating rate and residence time) on physico-chemical properties of biosolids (collected at Mount Martha Water Recycling Plant, Melbourne), phosphorus fractions and phosphorus forms was investigated. Twelve different biochar samples were produced at 400, 500 and 600 °C, at two heating rates (5 and 20 °C/min) and at two residence times (30 and 120 min). Biochar yield, pH, electrical conductivity (EC), elements (C, H and N) and BET surface area were analysed. Sequential extraction of P in biosolids and resultant biochars was done using Hedley method. Characterization was completed with SEM images and results from ³¹P liquid state NMR. Increased temperatures would not only increase the alkalinity, decrease EC and increase the adsorption capacity by increasing the surface area but also convert the readily available P to a less available pool. Therefore, this nutrient might be released to soil slowly over a longer period of time. The results showed that temperature, along with residence time and heating rate, had a significant effect on the characteristics observed. Therefore, all these factors need to be carefully considered when preparing biochar for use as a soil amendment.

Exploring the Structure of the Bound Proton with Deeply Virtual Compton Scattering

In the past two decades, deeply virtual Compton scattering of electrons has been successfully used to advance our knowledge of the partonic structure of the free proton and investigate correlations between the transverse position and the longitudinal momentum of quarks inside the nucleon. Meanwhile, the structure of bound nucleons in nuclei has been studied in inclusive deep-inelastic lepton scattering experiments off nuclear targets, showing a significant difference in longitudinal momentum distribution of quarks inside the bound nucleon, known as the EMC effect. In this Letter, we report the first beam spin asymmetry (BSA) measurement of exclusive deeply virtual Compton scattering off a proton bound in ^{4}He. The data used here were accumulated using a 6 GeV longitudinally polarized electron beam incident on a pressurized ^{4}He gaseous target placed within the CLAS spectrometer in Hall-B at the Thomas Jefferson National Accelerator Facility. The azimuthal angle (ϕ) dependence of the BSA was studied in a wide range of virtual photon and scattered proton kinematics. The Q^{2}, x_{B}, and t dependencies of the BSA on the bound proton are compared with those on the free proton. In the whole kinematical region of our measurements, the BSA on the bound proton is smaller by 20% to 40%, indicating possible medium modification of its partonic structure.

Direct Observation of Proton-Neutron Short-Range Correlation Dominance in Heavy Nuclei

We measured the triple coincidence A(e,e^{'}np) and A(e,e^{'}pp) reactions on carbon, aluminum, iron, and lead targets at Q^{2}>1.5  (GeV/c)^{2}, x_{B}>1.1 and missing momentum >400  MeV/c. This was the first direct measurement of both proton-proton (pp) and neutron-proton (np) short-range correlated (SRC) pair knockout from heavy asymmetric nuclei. For all measured nuclei, the average proton-proton (pp) to neutron-proton (np) reduced cross-section ratio is about 6%, in agreement with previous indirect measurements. Correcting for single-charge exchange effects decreased the SRC pairs ratio to ∼3%, which is lower than previous results. Comparisons to theoretical generalized contact formalism (GCF) cross-section calculations show good agreement using both phenomenological and chiral nucleon-nucleon potentials, favoring a lower pp to np pair ratio. The ability of the GCF calculation to describe the experimental data using either phenomenological or chiral potentials suggests possible reduction of scale and scheme dependence in cross-section ratios. Our results also support the high-resolution description of high-momentum states being predominantly due to nucleons in SRC pairs.

First Measurements of the Double-Polarization Observables F, P, and H in ω Photoproduction off Transversely Polarized Protons in the N^{*} Resonance Region

First measurements of double-polarization observables in ω photoproduction off the proton are presented using transverse target polarization and data from the CEBAF Large Acceptance Spectrometer (CLAS) FROST experiment at Jefferson Lab. The beam-target asymmetry F has been measured using circularly polarized, tagged photons in the energy range 1200-2700 MeV, and the beam-target asymmetries H and P have been measured using linearly polarized, tagged photons in the energy range 1200-2000 MeV. These measurements significantly increase the database on polarization observables. The results are included in two partial-wave analyses and reveal significant contributions from several nucleon (N^{*}) resonances. In particular, contributions from new N^{*} resonances listed in the Review of Particle Properties are observed, which aid in reaching the goal of mapping out the nucleon resonance spectrum.

Slowdown in Antarctic mass loss from solid Earth and sea-level feedbacks

Geodetic investigations of crustal motions in the Amundsen Sea sector of West Antarctica and models of ice-sheet evolution in the past 10,000 years have recently highlighted the stabilizing role of solid-Earth uplift on polar ice sheets. One critical aspect, however, that has not been assessed is the impact of short-wavelength uplift generated by the solid-Earth response to unloading over short time scales close to ice-sheet grounding lines (areas where the ice becomes afloat). Here, we present a new global simulation of Antarctic evolution at high spatiotemporal resolution that captures all solid Earth processes that affect ice sheets and show a projected negative feedback in grounding line migration of 38% for Thwaites Glacier 350 years in the future, or 26.8% reduction in corresponding sea-level contribution.