Quality of Life of Patients with Chronic Obstructive Pulmonary Disease Attending a Tertiary Care Hospital, Kavre, Nepal.

Background Chronic Obstructive Pulmonary Disease (COPD) is one of the most common chronic health conditions and is increasingly becoming a major public health problem among the elderly population. As the chronic obstructive pulmonary disease is not curable, evaluation of and methods to improve quality of life among such patients is of utmost importance. Objective The objective of the study was to assess the quality of life among patients living with chronic obstructive pulmonary disease. Method This is a cross-sectional carried out in Dhulikhel Hospital, Kathmandu University Hospital, Nepal in 2017-2018. A total of 274 patients aged 40 years and above were selected for this study. The quality of life of participants was assessed through the widely used shorter version ST George's Respiratory Questionnaire (SGRQ-C). Result The mean age of the participants was 68.19 (SD ± 10.36) years, with the age range of 40-94 years. More than half (55.5%) of respondents were females, 55% were from rural areas, 42.7% were illiterate and 53.3% were from joint families. Agriculture (35.4%) and homemakers (32.5%) were the most prevalent occupation. The mean total score for all domains of quality of life was 68.06 (±18.87). The mean quality of life scores for symptom, activity, and impact domains was 70.11 (±22.33), 67.59 (±20.41), 67.64 (±20.41) respectively which suggested marked impairments in quality of life in all SGRQ-C domains. The symptoms and impact domains were most affected during the activity. Among socio-demographic variables, educational status, ethnicity, number of family members, type of family and economic status had a statistically significant effect on the quality of life. Initial health condition, smoking habit, number of cigarettes smoked, and years of smoking had statistically significant effects on quality of life. Conclusion Patients with chronic obstructive pulmonary disease have a low quality of life in three components of symptom, activity, and impact domains. Major factors associated with poor quality of life were low educational status, large family size, poor health condition, and smoking.

The role of stress reactivity and pre-injury psychosocial vulnerability to psychological and physical health immediately after traumatic injury.

BACKGROUND: Traumatic injuries can have long-term negative impacts on health, especially psychological health. A biopsychosocial approach is recommended to identify those likely to experience psychosocial stress, however large individual differences exist in stress reactivity and post-injury health that remain unexplored. Therefore, we investigated autonomic nervous system (ANS) stress responses and pre-existing psychosocial vulnerability as contributors to health in individuals who sustained a traffic-related injury. METHODS: 120 adults with traffic-related injury and 112 non-injury controls underwent an integrative ANS (cardiac and skin conductance) assessment and a health-related assessment at 3-6 weeks post-injury. Propensity score matching based on six pre-injury psychosocial vulnerability factors (age, sex, education, prior mental/physical health, socioeconomic status) guided the definition of high vulnerability (HV) and low vulnerability (LV) injury subgroups, with the LV subgroup having similar propensity scores to non-injury controls. A three-group comparative analysis of ANS responsivity (baseline, reactivity, recovery/rebound) and post-injury health was performed. RESULTS: The HV subgroup exhibited the most negative immediate post-injury mental health profile and less adaptive ANS response patterns, indicating greater stress vulnerability/reactivity. Significant differences were found for psychological health (elevated psychological distress and catastrophizing), but not physical health (injury factors, pain, fatigue, physical wellbeing). HV participants showed sympathetic predominance at resting baseline (lower parasympathetic activity and/or elevated heart rate) compared to the LV and control groups, as well as smaller parasympathetic decrease during a cognitive task compared to controls. Despite preserved capacity for restoring initial homeostasis in both injury subgroups during recovery, there was some indication of blunted post-task sympathetic deactivation (larger sympathetic decrease) and reduced overall ANS adaptability (reduction in total power of heart rate variability spectrum), suggesting relative reduced capacity to face stressors compared to controls. CONCLUSIONS: Findings suggest that baseline resting ANS regulation, particularly parasympathetic activity, and pre-injury psychosocial factors are key contributors to individual psycho-biological responses following traumatic injury, and are therefore potential stress vulnerability markers. Post-stress recovery patterns may represent a novel physiological signature for a "biological intrinsic" vulnerability early after the injury. These findings provide direction for improved early identification and management of injured individuals, including innovative preventive interventions that target ANS regulation.

Doping-free bandgap tunability in Fe2O3 nanostructured films.

A tunable bandgap without doping is highly desirable for applications in optoelectronic devices. Herein, we develop a new method which can tune the bandgap without any doping. In the present research, the bandgap of Fe2O3 nanostructured films is simply tuned by changing the synthesis temperature. The Fe2O3 nanostructured films are synthesized on ITO/glass substrates at temperatures of 1100, 1150, 1200, and 1250 °C using the hot filament metal oxide vapor deposition (HFMOVD) and thermal oxidation techniques. The Fe2O3 nanostructured films contain two mixtures of Fe2+ and Fe3+ cations and two trigonal (α) and cubic (γ) phases. The increase of the Fe2+ cations and cubic (γ) phase with the elevated synthesis temperatures lifted the valence band edge, indicating a reduction in the bandgap. The linear bandgap reduction of 0.55 eV without any doping makes the Fe2O3 nanostructured films promising materials for applications in bandgap engineering, optoelectronic devices, and energy storage devices.

Correction: Doping-free bandgap tuning in one-dimensional Magnéli-phase nanorods of Mo4O11.

Correction for 'Doping-free bandgap tuning in one-dimensional Magnéli-phase nanorods of Mo4O11' by Duy Van Pham et al., Nanoscale, 2016, 8, 5559-5566.

Temperature-dependent ultraviolet photoluminescence in hierarchical Zn, ZnO and ZnO/Zn nanostructures.

The temperature-dependent effects on the ultraviolet (UV) photoluminescence (PL) enhancement, blueshift, thermal quenching, and chromaticity of the two-dimensional (2D) Zn nanosheets, 2D-hierarchical ZnO nanostructures, and 2D-hierarchical ZnO/Zn nanostructures are presented. In this study, 2D Zn nanosheets were synthesized using a hot-plate metal vapor deposition technique, after which 2D-hierarchical ZnO nanostructures and ZnO/Zn were prepared from the 2D Zn nanosheets by a simple thermal annealing method. The enhancement and blueshift of the UV PL emissions from the three nanostructures at low temperatures arose from three distinct PL mechanisms. For the ZnO nanostructures, the UV PL emission enhancements and blueshifts at low temperature were due to the conversion of the free excitons (FXs) to neutral-donor-bound-excitons (D0Xs). The ZnO/Zn nanostructures possessed the highest UV PL intensities among the three nanostructures, because the free electrons from the Zn portions across the metal-semiconductor heterojunctions greatly assisted in enhancing the PL emissions. The enhancement and thermal quenching were quantitatively analyzed with simple normalization methods. The results show that all three kinds of nanostructures are excellent candidates for use in UV light emitters.

Copper Oxide/Reduced Graphene Oxide Nanocomposite-Catalyzed Synthesis of Flavanones and Flavanones with Triazole Hybrid Molecules in One Pot: A Green and Sustainable Approach.

An efficient, green, and sustainable synthesis of new hybrid molecules containing flavanone with triazole by merging the Michael addition and Click reaction using a copper oxide/reduced graphene oxide nanocomposite in one pot is reported. The catalyst can easily be recycled and reused in seven consecutive runs without compromising the product yields. Other notable advantages include using water as a reaction medium and obtaining good to excellent yields, low catalyst loading, high atom efficiency, high substrate variation, and good results in the gram scale reaction.

Outcome Analysis of Neonates following Laparotomy for Acute Abdomen: A Prospective Study.

Background Low and middle-income countries (LMIC) bear the majority of the global pediatric surgical burden. Despite increasing volume of pediatric surgeries being performed in LMIC, outcomes of these surgeries in low and middle-income countries remain unknown due to lack of robust data. Objective The objective of our study was to collect data on and evaluate neonatal surgical outcomes at a tertiary level center in India. Method The surgical outcomes data of all neonates undergoing laparotomy between February 15, 2015 and October 14, 2015, at Sir Ganga Ram Hospital, New Delhi, India was collected prospectively. Descriptive statistics were used to determine the rates of various postoperative outcomes. Result A total of 37 neonatal surgeries were performed during the study period. The mean age of the neonates on the day of surgery was 7 days (range: 1-30 days). Most of the neonates (72.9%, n=27) were males. About 40% (n=15) of the neonates were preterm and 15 (40.5%) of them were small for gestational age. In our study, 10 neonates (28.6%) needed ventilation for 48 hours or less after surgery and 5 neonates (13.5%) were kept Nil per Oral (NPO) postoperatively for more than 10 days. Out of 37 neonates, 4 (10.80%) developed a surgical site infection and 8 neonates (21.6%) had postoperative sepsis. The in-hospital mortality rate among neonates undergoing laparotomy during the study period was 8.1 deaths per 100 neonates. Conclusion Co-ordination of care among pediatric surgeons, neonatologists, nursing and anesthesia team is required for optimal surgical outcome.

Impact of cuticle photoluminescence on the color morphism of a male damselfly Ischnura senegalensis (Rambur, 1842).

In this study the damselfly Ischnura senegalensis (Rambur, 1842) was first found to produce strong photoluminescence (PL) emissions from various colored-body portions, such as the eighth abdominal segment of the tail. The colors of the colored-body portions can be enhanced or modified by the PL emissions for assistance in reducing intrasexual and male harassment, and improving mature mating and conspecific identity. Therefore, the PL emissions that contribute to the color modification and coloration are involved in the cuticle evolution of the damselflies. The micro-PL confocal images verify that the PL emissions can strongly influence the surface colors of the cuticle, and demonstrate why the damselfly Ischnura senegalensis is called a bluetail.

Terahertz spin-wave waveguides and optical magnonics in one-dimensional NiO nanorods.

The two-magnon (2M) spin waves with a magnon frequency of 43 THz, generated by a polarized laser, were first observed in one-dimensional (1D) NiO nanorods. The 1D NiO nanorods of ∼700 nm length, which have perfectly in-plane antiferromagnetic spins lying on the (200) and (100) faces, are the smallest spin-wave waveguides. Due to the magneto-optical Faraday effect (MOFE), the significant change in the Faraday intensity can show the 2M information in the NiO nanorods. There are only two 2M-on and 2M-off states at various applied alternating-current magnetic fields and laser-incident angles, which make the 1D NiO nanorods excellent optical nanomagnonics.

Duplex DNA-Invading γ-Modified Peptide Nucleic Acids Enable Rapid Identification of Bloodstream Infections in Whole Blood.

UNLABELLED: Bloodstream infections are a leading cause of morbidity and mortality. Early and targeted antimicrobial intervention is lifesaving, yet current diagnostic approaches fail to provide actionable information within a clinically viable time frame due to their reliance on blood culturing. Here, we present a novel pathogen identification (PID) platform that features the use of duplex DNA-invading γ-modified peptide nucleic acids (γPNAs) for the rapid identification of bacterial and fungal pathogens directly from blood, without culturing. The PID platform provides species-level information in under 2.5 hours while reaching single-CFU-per-milliliter sensitivity across the entire 21-pathogen panel. The clinical utility of the PID platform was demonstrated through assessment of 61 clinical specimens, which showed >95% sensitivity and >90% overall correlation to blood culture findings. This rapid γPNA-based platform promises to improve patient care by enabling the administration of a targeted first-line antimicrobial intervention. IMPORTANCE: Bloodstream infections continue to be a major cause of death for hospitalized patients, despite significant improvements in both the availability of treatment options as well their application. Since early and targeted antimicrobial intervention is one of the prime determinants of patient outcome, the rapid identification of the pathogen can be lifesaving. Unfortunately, current diagnostic approaches for identifying these infections all rely on time-consuming blood culture, which precludes immediate intervention with a targeted antimicrobial. To address this, we have developed and characterized a new and comprehensive methodology, from patient specimen to result, for the rapid identification of both bacterial and fungal pathogens without the need for culturing. We anticipate broad interest in our work, given the novelty of our technical approach combined with an immense unmet need.

Impact of Nanosize on Supercapacitance: Study of 1D Nanorods and 2D Thin-Films of Nickel Oxide.

We synthesized unique one-dimensional (1D) nanorods and two-dimensional (2D) thin-films of NiO on indium-tin-oxide thin-films using a hot-filament metal-oxide vapor deposition technique. The 1D nanorods have an average width and length of ∼100 and ∼500 nm, respectively, and the densely packed 2D thin-films have an average thickness of ∼500 nm. The 1D nanorods perform as parallel units for charge storing. However, the 2D thin-films act as one single unit for charge storing. The 2D thin-films possess a high specific capacitance of ∼746 F/g compared to 1D nanorods (∼230 F/g) using galvanostatic charge-discharge measurements at a current density of 3 A/g. Because the 1D NiO nanorods provide more plentiful surface areas than those of the 2D thin-films, they are fully active at the first few cycles. However, the capacitance retention of the 1D nanorods decays faster than that of the 2D thin-films. Also, the 1D NiO nanorods suffer from instability due to the fast electrochemical dissolution and high nanocontact resistance. Electrochemical impedance spectroscopy verifies that the low dimensionality of the 1D NiO nanorods induces the unavoidable effects that lead them to have poor supercapacitive performances. On the other hand, the slow electrochemical dissolution and small contact resistance in the 2D NiO thin-films favor to achieve high specific capacitance and great stability.

Doping-free bandgap tuning in one-dimensional Magnéli-phase nanorods of Mo4O11.

We synthesized one-dimensional (1D) Magnéli-phase nanorods of Mo4O11 using the hot filament metal-oxide vapor deposition technique. The 1D Magnéli-phase Mo4O11 nanorods synthesized at 1000, 1050, 1100, 1150, and 1200 °C contain varying combinations of two orthorhombic (α) and monoclinic (η) phases, and various mixtures of Mo(4+), Mo(5+) and Mo(6+) cations, while those synthesized at a higher temperature look bluer. The shifts of the transmittance maximum and absorbance minimum of the 1D Magnéli-phase Mo4O11 nanorods are inversely and linearly proportional to the elevated temperature, verifying that the bandgaps (Eg) are inversely proportional to the elevated temperature. The bandgap (Eg) of the 1D Magnéli-phase Mo4O11 nanorods can be tuned by simply controlling the synthesis temperature without doping with other materials, giving the 1D Magnéli-phase Mo4O11 nanorods good potential for use in optoelectronic nanodevices and bandgap engineering.

Size-controllable synthesis of Bi/Bi2O3 heterojunction nanoparticles using pulsed Nd:YAG laser deposition and metal-semiconductor-heterojunction-assisted photoluminescence.

We synthesized Bi/Bi2O3 heterojunction nanoparticles at various substrate temperatures using the pulsed laser deposition (PLD) technique with a pulsed Nd:YAG laser. The Bi/Bi2O3 heterojunction nanoparticles consisted of Bi nanoparticles and Bi2O3 surface layers. The average diameter of the Bi nanoparticles and the thickness of the Bi2O3 surface layer are linearly proportional to the substrate temperature. The heterojunctions between the Bi nanoparticles and Bi2O3 surface layers, which are the metal-semiconductor heterojunctions, can strongly enhance the photoluminescence (PL) of the Bi/Bi2O3 nanoparticles, because the metallic Bi nanoparticles can provide massive free Fermi-level electrons for the electron transitions in the Bi2O3 surface layers. The enhancement of PL emission at room temperature by metal-semiconductor-heterojunctions make the Bi/Bi2O3 heterojunction nanoparticles potential candidates for use in optoelectronic nanodevices, such as light-emitting diodes (LEDs) and laser diodes (LDs).

Conditions, preventable deaths, procedures and validation of a countrywide survey of surgical care in Nepal.

BACKGROUND: To determine a true denominator of worldwide surgical need, it is imperative to include estimations at a population-based level, to capture those individuals unable to access surgical care. This study was designed to validate the Surgeons OverSeas Assessment of Surgical need (SOSAS) tool with the addition of a visual physical examination, and describe the prevalence of surgical conditions, deaths possibly averted with access to surgical care, and the number of surgical procedures performed annually, in Nepal. METHODS: The SOSAS tool, developed to measure the prevalence of surgical conditions at a population level and used in two African countries, was employed. Fifteen of the 75 districts of Nepal were chosen proportional to population. Responses were recorded for the head of the household for demographic information and recalled deaths, and two randomly selected household members underwent a verbal head-to-toe interview for surgical conditions and a visual physical examination by a trained physician. RESULTS: A total of 1350 households were surveyed (2695 respondents). Observed agreement between the verbal response and physical examination findings was 94·6 per cent. Some 10·0 (95 per cent c.i. 8·9 to 11·2) per cent of respondents had a current condition requiring surgical care and 23 per cent of deaths may have been averted with proper access to surgical care. An estimated 291·8 major operations per 100 000 population are performed annually in Nepal. CONCLUSION: The visual physical examination component validated the SOSAS tool, and justified the estimates of previous studies in Sierra Leone and Rwanda. These data provide insights into the health needs of Nepal and provide evidence to develop surgical programmes, assist with monitoring and evaluation, and help with advocacy for increased resources in Nepal.

Impact of Surgical Waiting-List Times on Scoliosis Surgery: The Surgeon's Perspective.

STUDY DESIGN: Survey. OBJECTIVE: The aim of this study was to evaluate the surgeon's perspective on the potential impact of prolonged surgical waitlists on the surgical care and perioperative management of patients with scoliosis. SUMMARY OF BACKGROUND DATA: The long waits for surgical treatment of scoliosis found in some countries may have serious implications for the complexity of surgery and perioperative care required if the curve progresses while waiting. The surgeon's perspective on this problem provides important information that needs to be taken into account during resource allocation. METHODS: Radiographs from 13 patients who had waited more than 6 months for scoliosis surgery were selected. Each patient had radiographs from the time of surgical booking and immediately preoperatively. The radiographs and a questionnaire were sent to 3 surgeons to canvass their surgical and postoperative plan. The surgeons were blinded to the fact that the radiographs were of the same patients at 2 time points. The patients' actual course of treatment was documented. RESULTS: Data for 11 patients were available for analysis. The average wait for surgery was 24 months (range, 17-30 mo). The mean curve progression was 25.3° while on the waitlist, from an average of 52° to 77°. By the time the patients had to undergo surgery, more anterior releases were added to posterior instrumentation alone in the surgical plan. Mean estimated operative time increased by 2.2 hours, mean estimated length of hospital stay increased by 1 day, and the estimated level of difficulty of surgery increased 2.33 grades. The predicted estimated blood loss also increased. CONCLUSION: From the surgeon's perspective, lengthy waitlists have a significant negative impact on the perioperative and postoperative care of patients with scoliosis by increasing the complexity of surgery. The actual course of treatment corresponded to the responses from these different surgeons. LEVEL OF EVIDENCE: N/A.

Photoluminescence mechanisms of metallic Zn nanospheres, semiconducting ZnO nanoballoons, and metal-semiconductor Zn/ZnO nanospheres.

We utilized a thermal radiation method to synthesize semiconducting hollow ZnO nanoballoons and metal-semiconductor concentric solid Zn/ZnO nanospheres from metallic solid Zn nanospheres. The chemical properties, crystalline structures, and photoluminescence mechanisms for the metallic solid Zn nanospheres, semiconducting hollow ZnO nanoballoons, and metal-semiconductor concentric solid Zn/ZnO nanospheres are presented. The PL emissions of the metallic Zn solid nanospheres are mainly dependent on the electron transitions between the Fermi level (E(F)) and the 3d band, while those of the semiconducting hollow ZnO nanoballoons are ascribed to the near band edge (NBE) and deep level electron transitions. The PL emissions of the metal-semiconductor concentric solid Zn/ZnO nanospheres are attributed to the electron transitions across the metal-semiconductor junction, from the E(F) to the valence and 3d bands, and from the interface states to the valence band. All three nanostructures are excellent room-temperature light emitters.

Response of single leukemic cells to peptidase inhibitor therapy across time and dose using a microfluidic device.

Single-cell methodologies are revealing cellular heterogeneity in numerous biological processes and pathologies. For example, cancer cells are characterized by substantial heterogeneity in basal signaling and in response to perturbations, such as drug treatment. In this work, we examined the response of 678 individual U937 (human acute myeloid leukemia) cells to an aminopeptidase-inhibiting chemotherapeutic drug (Tosedostat) over the course of 95 days. Using a fluorescent reporter peptide and a microfluidic device, we quantified the rate of reporter degradation as a function of dose. While the single-cell measurements reflected ensemble results, they added a layer of detail by revealing unique degradation patterns and outliers within the larger population. Regression modeling of the data allowed us to quantitatively explore the relationships between reporter loading, incubation time, and drug dose on peptidase activity in individual cells. Incubation time was negatively correlated with the number of peptide fragment peaks observed, while peak area (which was proportional to reporter loading) was positively correlated with both the number of fragment peaks observed and the degradation rate. Notably, a statistically significant change in the number of peaks observed was identified as dose increased from 2 to 4 µM. Similarly, a significant difference in degradation rate as a function of reporter loading was observed for doses ≥2 µM compared to the 1 µM dose. These results suggest that additional enzymes may become inhibited at doses >1 µM and >2 µM, demonstrating the utility of single-cell data to yield novel biological hypotheses.

An efficient methodology for measurement of the average electrical properties of single one-dimensional NiO nanorods.

We utilized a metal tantalum (Ta) ball-probe to measure the electrical properties of vertical-aligned one-dimensional (1D) nickel-oxide (NiO) nanorods. The 1D NiO nanorods (on average, ~105 nm wide and ~700 nm long) are synthesized using the hot-filament metal-oxide vapor deposition (HFMOVD) technique, and they are cubic phased and have a wide bandgap of 3.68 eV. When the 1D NiO nanorods are arranged in a large-area array in ohmic-contact with the Ta ball-probe, they acted as many parallel resistors. By means of a rigorous calculation, we can easily acquire the average resistance RNR and resistivity ρNR of a single NiO nanorod, which were approximately 3.1 × 10(13) Ω and 4.9 × 10(7) Ω.cm, respectively.

Citation classics in pediatric orthopaedics.

BACKGROUND: The purpose of this study was to identify the clinical pediatric orthopaedic articles with at least 100 citations published in all orthopaedic journals and to examine their characteristics. METHODS: All journals dedicated to orthopaedics and its subspecialties were selected from the Journal Citation Report 2001 under the subject category "orthopedics." Articles cited 100 times or more were identified using the database of the Science Citation Index Expanded (SCI-EXPANDED, 1900 to present). The articles were ranked in a comprehensive list. Two authors independently reviewed the full text of each article and applied the inclusion and exclusion criteria to the list of articles. The 2 lists were then compared. All disagreements were resolved by consensus with input from the senior author. The final list of pediatric orthopaedic articles was then compiled. RESULTS: There were a total of 49 journals under the search category "orthopedics." Five journals were excluded as they were non-English journals. The remaining 44 journals were screened for articles with at least 100 citations. A total of 135 clinical pediatric orthopaedic articles cited at least 100 times were included. The most cited article was cited 692 times. The mean number of citations per article was 159 (95% confidence interval, 145-173). All the articles were published between 1949 and 2001, with 1980 and 1989 producing the most citation classics (34). The majority (90) originated from the United States, followed by the United Kingdom (12) and Canada (11). Scoliosis/kyphosis was the most common topic with 26 papers. The second most common subject was hip disorders (24). Therapeutic studies were the most common study type (71). Ninety-seven papers were assigned a 4 for level of evidence. CONCLUSIONS: The list of citation classics in pediatric orthopaedic articles is useful for several reasons. It identifies important contributions to the field of pediatric orthopaedics and their originators; it facilitates the understanding and discourse of modern pediatric orthopaedic history and reveals trends in pediatric orthopaedics.

Effective photoluminescence in a large-area array of Ta2O5 nanodots.

We describe here the synthesis of a large-area Ta2O5 nanodot array by utilizing the hot filament metal vapor deposition technique. The Ta2O5 nanodots arranged in a large-area array on a Si wafer had an average diameter of -8 nm. X-ray photoemission spectroscopy (XPS) revealed the stoichiometric Ta and O compositions of the Ta2O5 nanodots. Raman spectroscopy showed the Ta2O5 nanodots to be of orthorhombic (beta) crystal. Photoluminescence (PL) spectroscopy showed the green and red light emissions of the beta-Ta2O5 nanodots at room temperature.