Small Business and Livelihood: A Study of Pashupatinath UNESCO Heritage Site of Nepal

Small businesses in world heritage sites provide services to visitors and livelihood for residents. Besides the cultural and religious values promoted by these businesses, they also provide socioeconomic support to their owners. The Pashupatinath temple is known as Hindu's major religious and pilgrimage destination in South Asia. Hundreds of businesses around the temple provide services to visitors. This study evaluates the socioeconomic impacts of these small businesses around Pashupatinath temple. Using a survey of 110 businesses, binary logistic regression models find that the owners of larger businesses selling religious supplies in this area are more likely to own houses in Kathmandu and to be more satisfied with their businesses. The study also finds that businesses without permanent stalls faced severe hardship during the COVID-19 pandemic. This study assessed the socioeconomic status of a business owner through house ownership in Kathmandu, and finds that small businesses operating in the premises of the religious heritage site of Pashupatinath temple have a positive relation to the livelihood of the business owners and their families. It concludes that small-scale business in world heritage sites directly contributes to local livelihoods and economies. © 2022 by the authors.

Impact of COVID 19 on outcome of primary percutaneous coronary intervention in Nepal

Background and Aims: The COVID 19 pandemic have affected the patients with ST segment elevation myocardial infarction as the number of patients presenting with STEMI declined substantially and those who underwent primary PCI had poor outcome. Our aim was to analyze the in-hospital and 30-days mortality in STEMI undergoing Primary PCI during second wave of COVID 19. Method(s): A prospective cohort study was conducted at Shahid Gangalal National Heart Centre, Bansbari, Kathmandu. Convenience sampling of patients who underwent primary PCI were enrolled in this study and were followed up for 30 days. Numerical variables were described as Mean +/- Standard Deviation (SD) and categorical variables were described as frequency and percentage. p values were calculated and considered significant if < 0.05. Result(s): During this study period of 2 months from 1st May 2021 to 30th June 2021, 97 patients with STEMI underwent primary PCI, including 12 (12.47%) COVID 19 positive cases. 30 days mortality was 15.4% including in-hospital mortality of 11.34%. Among COVID 19 positive cases, in-hospital mortality was 33.33% and 30-days mortality was 55.55% which was significantly higher than non COVID 19 patient who underwent primary PCI (P=0.003). Conclusion(s): Overall, mortality rate of primary PCI during COVID 19 second wave has been increased and mortality of COVID 19 positive patients who underwent primary PCI was significantly higher than non-COVID 19 patients who underwent primary PCI. Copyright © 2022 Cardiac Society of Nepal. All rights reserved.

Sustainable development and finance post-pandemic - future directions and challenges

Sustainable development, finance and related global policies and mechanisms have evolved over the decades. Today, regional initiatives for classifying sustainable activities exist, and several decades' research and development of ecosystem services and natural capital have identified and tested alternative economic models. The World Bank has the potential to finance them and sustainability at the landscape scale is achievable. But economic and environmental values can come into conflict. In developing countries, sustainable alternatives exist in business activities such as coastal and marine tourism. Financing small businesses through sound digital infrastructure is critical, as is the use of public fiscal instruments for the sustainable use of natural resources. Despite its developed status, renewable energy policies in the EU are leading to forest destruction. Financial vehicles such as green bonds have a similar potential. To avoid greenwashing, more focus needs to be on meeting the needs of those at the base of the economic pyramid, resourcing them with smart technologies and valuing civic engagement. Climate finance must be ethical and its allocation have integrity;this will foster community resilience. To avoid repeating the mistakes of terrestrial development, the world's oceans need to be protected and new business models adopted in this expanding frontier. Now is the time for all sectors to create a sustainable future for the planet and its inhabitants in the post-COVID, postcarbon era to come. © 2022 Walter de Gruyter GmbH, Berlin/Boston.

Evaluating the governance of sustainable development: The quality and legitimacy of the blue economy

This chapter analyses multi-stakeholder perspectives on the governance and sustainability of different blue economy initiatives from both developed and developing countries. The study was conducted in 2020 using an anonymous online survey following an analytical method based on principles, criteria and indicators. Respondents rated the quality of these initiatives on a Likert scale (1-5) based on 11 indicators. The results show that the Sustainable Ocean Initiative received the highest score, while Marine permaculture scored the lowest. blue economy initiatives were considered inclusive by respondents;however, resources and capacity were deemed insufficient. Respondents from the Global South (developing countries) rated the initiatives higher than those from the Global North (developed countries) perhaps because developing countries are the prime beneficiaries of these programmes and receive more funding and assistance. These findings support policy and decision-makers formulating policies based on stakeholders' opinions and focussing on low-scoring initiatives. The blue economy is a growing sector with high potential for sustainable development;however, various factors, notably the COVID-19 pandemic, are obstructing its advancement. Therefore, effective communication, collaborative efforts and substantial and sustainable finance are vital for ensuring the sustainability of the blue economy in both the Global North and the Global South. © 2022 Walter de Gruyter GmbH, Berlin/Boston.

Sustainable ocean development and the blue economy

Part 5 of this Handbook begins with a general introduction to the concepts and definitions underlying the notion of the blue economy and continues with an exploration of challenges and controversies confronting the sustainable development of the marine environment. The tensions inherent in the idea that the marine environment can be both exploited for human use and protected for its intrinsic natural values, reflect the origins of the concept of sustainable development itself and these are explored in the chapters presented in this section. These cover an examination of the ethics and values underpinning the blue economy, the role that blue finance can play in advancing sustainable development, particularly for tourism and local communities dependent on the oceans for their wellbeing. The views of various stakeholders on the quality and legitimacy of the governance of a range of blue economy initiatives are also explored, as is the extent to which, philosophically speaking, ocean development can be understood as genuinely sustainable, whatever the rhetoric may be. A concluding chapter from practitioners of marine permaculture completes the perspectives of the contributing authors on the complexities and contradictions within humanity's use of the many and various resources of the world's oceans and in the wake of COVID-19. © 2022 Walter de Gruyter GmbH, Berlin/Boston.

CLINICAL OUTCOMES OF USING PROPOFOL IN PATIENTS WITH COVID-19 ON MECHANICAL VENTILATION

SESSION TITLE: Critical Care Management of COVID-19 SESSION TYPE: Original Investigations PRESENTED ON: 10/17/2022 01:30 pm - 02:30 pm PURPOSE: Acute respiratory distress syndrome (ARDS), due to Coronavirus disease 2019 (COVID-19) Is associated with a significant rate of mortality. The ideal sedative(s) of choice in mechanically ventilated COVID-19 patients is still unclear. Here we report the clinical outcomes of using propofol for more than 48 hours vs any other sedative in such patients. METHODS: This was a retrospective study of patients admitted to an intensive care unit (ICU) at Trumbull Regional Medical Centre and Sharon Regional Medical Centre between February 2020 and January 2022 with COVID-19 viral pneumonia. Our study consisted of 176 patients with moderate to severe ARDS as per Berlin’s criteria who were mechanically ventilated for atleast 48 hours. The primary outcome was mortality at 28 days from the date of intubation. Secondary outcomes included ventilator free days during the first 28 days after intubation (defined as being alive and free from mechanical ventilation), mortality at the end of hospitalization, length of stay, and readmission rate. RESULTS: Out of 176 patients, 100 patients received sedation with propofol for more than 48 hours (test group) and 76 patients received other sedative agents or received propofol for less than 48 hours (control group). We compared the outcomes of the two different groups using paired t-test. The average age of the study population (63 vs 67 p=0.061), gender((0.44 vs 0.49 females p=0.54), BMI (34.93 vs 34.08 p=0.54), and oxygen requirement on admission (0.73 vs 0.64 p= 0.227) were not statistically different between the test and control groups respectively. Prevalence of comorbidities including diabetes, hypertension, chronic kidney disease, active cancer, and COPD were not significantly different between the two groups. There was a significant difference in the primary outcome of mortality at day 28 from intubation between the test and control group (0.62 vs 0.84 p=0.001). A significant difference in the secondary outcome of mortality at the end of hospitalization between the test group and control group (0.67 vs 0.84 p =0.009) was also observed. There were no statistically significant differences in the rest of secondary outcomes. CONCLUSIONS: In this retrospective study, using propofol for more than 48 hours was associated with decreased mortality at day 28 (22%) as well as at end of hospitalization (17%) in mechanically ventilated COVID-19 patients. Propofol is known to have antiviral effects as well as immunosuppressive effects on biosynthesis of inflammatory cytokines by macrophages which is likely responsible for the mortality benefits that we encountered in this study. CLINICAL IMPLICATIONS: Even though we found mortality benefits with using propofol in our study population, further investigations using prospective studies with a larger study population are required and clinicians need to be cautious with the complications associated with long term use of propofol. DISCLOSURES: No relevant relationships by Arooj Ahmed no disclosure submitted for Manuel Bautista;No relevant relationships by Apeksha Gupta No relevant relationships by Anirudh Jaglan no disclosure on file for Saman Karki;no disclosure submitted for Ritha Kartan;No relevant relationships by Tamandeep Kaur No relevant relationships by Sanjay Mahat No relevant relationships by Krutarth Pandya No relevant relationships by Stuti Patel No relevant relationships by Janki Patel no disclosure on file for Kim Porter;No relevant relationships by Aayush Pradhan No relevant relationships by Arun Pyakuryal No relevant relationships by Pratik Saha No relevant relationships by Parth Shah