A Descriptive study on trekking attributes in Nepal using importance-performance analysis

Since the opening of its doors to the outside world, Nepal has seen a large growth in tourist arrivals. One of the fast growing tourist markets attracted to Nepal is the trekking vacationers. In order for the suppliers and decision makers of the trekking product to be able to meet the demand of users it is important that they are able to target the development in the appropriate direction. A lack of communication among the components of the tourism industry has resulted in a lack of cooperation. The purpose of this study is to develop an instrument that enhances communication allowing for better cooperation between the users, suppliers, and decision makers of the trekking industry. Unlike other studies using the same technique, this study is a model for the comparison of the perceptions of the different components. An evaluation tool known as Importance-Performance Analysis was adapted for the purpose of this study. This tool determines the perceptions of the different components of the industry in six phases. First, the attributes of the trekking industry in Nepal were identified. Second, a survey was developed and conducted on the trekking agencies in Nepal. Third, the data was gathered and compiled into a manageable size for interpretation. Then, the means of the perceptions of the attributes were plotted for visual interpretation on an two-dimensional action grid of four quadrant. The last two phases of the study are left for further research. They include: conducting the previous four phases on the other two components and comparing the results of the perceptions of each group to develop strategic action plans for the development of the industry . This study determined that the suppliers of the trekking industry in Nepal felt there were specific areas of the industry that were not receiving the appropriate recognition, funding, and commitment. These areas were ranked according to their significance relative to each other. It was found that the major areas of concern were the attributes in the environmental and health and safety groups . There were also a few attributes in the information and promotion, transportation as well as the hiking facilities group that were considered to be of significant concern. The attributes in the lodging group were found to be either doing well or are of low concern. Furthermore, the majority of the attributes in the hiking facilities group were found to be doing well. However a considerable amount were also found to be receiving too much significance

Isolated entrapment of the brachialis branch of the musculocutaneous nerve: a case report

Non peer reviewe

Risk factors of hospitalization for carpal tunnel syndrome among the general working population

Objectives Carpal tunnel syndrome (CTS) causes a considerable amount of sick leave and healthcare costs. The etiology of CTS is multifactorial, involving both personal and occupational risk factors. To date, few prospective cohort studies on occupational risk factors of CTS have examined the general working population. Methods The study population consisted of participants from the Northern Finland Birth Cohort of 1966 who attended the 31-year follow-up in 1997 and were working >= 3 days a week in a paid job (N=6326). Information on socio-economic status, weight and height, smoking, exposure to occupational physical factors, and long-term illnesses was collected at baseline in 1997. Data on hospitalizations due to CTS came from the Care Register for Health Care, 1997-2016. Results Between 1997 and 2016, 3.4% of the participants had been hospitalized (attended secondary care) for CTS. After adjusting for confounders, women [hazard ratio (HR) 3.77, 95% confidence interval (CI) 2.70-5.25], overweight/obese participants (HR 1.69, 95% CI 1.29-2.22), smokers (HR 1.48, 95% CI 1.12-1.96), farmers and manual workers (HR 3.02, 95% CI 1.85-4.92 compared with upper clerical workers), lower clerical workers (HR 1.74, 95% CI=1.08-2.80), workers exposed to hand vibration (HR 2.29, 95% CI 1.48-3.54) and participants with physically demanding jobs (HR 1.71, CI 1.06-2.76) were at increased risk of hospitalization for CTS. Physically demanding work increased the risk of hospitalization for CTS for overweight/obese participants at baseline, but not for participants of normal weight. Conclusions Excess body mass and occupational physical factors increase the risk of hospitalization for CTS. Excess body mass potentiates the adverse effects of strenuous work on CTS.Peer reviewe

The nutritional significance of cheese in the UK diet

Cheese currently suffers from an adverse nutritional image largely due to a perceived association between saturated fatty acid, cholesterol and the salt content of cheese with cardiovascular disease. However, cheese is also a rich source of essential nutrients such as, proteins, lipids, vitamins and minerals that play an integral part of a healthy diet. This review outlines the composition, structure and physiological characteristics of the nutritionally significant components of cheese, whilst presenting some of the controversies that surround the role of cheese in dietary guidelines and the potential cheese has to improve health in the UK population

Science and technology roadmap for graphene, related two-dimensional crystals, and hybrid systems

We present the science and technology roadmap for graphene, related two-dimensional crystals, and hybrid systems, targeting an evolution in technology, that might lead to impacts and benefits reaching into most areas of society. This roadmap was developed within the framework of the European Graphene Flagship and outlines the main targets and research areas as best understood at the start of this ambitious project. We provide an overview of the key aspects of graphene and related materials (GRMs), ranging from fundamental research challenges to a variety of applications in a large number of sectors, highlighting the steps necessary to take GRMs from a state of raw potential to a point where they might revolutionize multiple industries. We also define an extensive list of acronyms in an effort to standardize the nomenclature in this emerging field.Peer ReviewedPostprint (published version

The Use of a Ti-Ni Shape Memory Alloy Ring Bone Fixator During the Retrograde Nailing of Supracondylar Femoral Fractures

Purpose: To identify the effects of using a Ti-Ni shape memory alloy ring shaped bone fixator (SMA-rBF) during the retrograde nailing of supracondylar femoral fractures. Materials and Methods: The authors reviewed 25 patients with a supracondylar femoral fracture treated by retrograde intramedullary nailing with or without SMA-rBF (group S, 12/25; group N, 13/25). Radiological measurements of angular deformity were performed and functional assessments were made using the Sanders grading system

Inhibition of rainbow trout acetylcholinesterase by aqueous and suspended particle-associated organophosphorous insecticides

Spraydrift and edge-of-field runoff are important routes of pesticide entry into streams. Pesticide contamination originating from spraydrift usually resides in the water phase, while pesticides in contaminated runoff are to a large extent associated with suspended particles (SPs). The effects of two organophosphorous insecticides (OPs), chloropyrifos (CPF) and azinphos-methyl (AZP), on acetylcholinesterase (AChE) activity in rainbow trout were compared between two exposure scenarios, simulating spraydrift- and runoff-borne contamination events in the Lourens River (LR), Western Cape, South Africa. NOECs of brain AChE inhibition, determined after 1 h of exposure followed by 24 h of recovery, were 0.33 μg l−1 for aqueous CPF, 200 mg kg−1 for SP-associated CPF and 20 mg kg−1 for SP-associated AZP (at 0.5 g l−1 SP). The highest aqueous AZP concentration tested (3.3 μg l−1) was without significant effects. Previously reported peak levels of aqueous CPF in the LR (not, vert, similar0.2 μg l−1) are close to its NOEC (this study), suggesting a significant toxicological risk to fish in the LR. By contrast, reported levels of SP-associated OPs in the LR are 20–200-fold lower than their NOECs (this study). In a comparative in situ study, trout were exposed for seven days at agricultural (LR2, LR3) and upstream reference (LR1) sites. No runoff occurred during the study. Brain AChE was significantly inhibited at LR3. However, OP levels at LR3 (CPF 0.01 μg l−1; AZP 0.14 μg l−1) were minor compared to concentrations having effects in the laboratory (see above). Additionally, muscle AChE activity was significantly higher in caged trout from LR1 than in animals maintained in laboratory tanks

Advances in the Use of LTS and HTS SQUIDS in Electromagnetic NDE

Of the electromagnetic sensors currently under investigation for nondestructive evaluation (NDE), the superconducting quantum interference device (SQUID) arguably has the greatest potential. The characteristics [1] which make it suitable for eddy current NDE are: high sensitivity even in large ambient fields (detection of sub-nT signals); operation from very low frequencies (a few Hz or less) to very high frequencies (potentially MHz) permitting detection of surface and subsurface flaws; and high spatial resolution. Spatial resolution is related to the physical size of the device, which is often less than 1 mm square, even when the need to maintain its other properties is taken into account. This often allows the SQUID to be treated theoretically and practically as an ideal point sensor. However, it must be operated in a cryogenic environment: low temperature superconductor (LTS) SQUIDs need liquid helium and liquid nitrogen (LN2) is needed even for high temperature superconductor (HTS) SQUIDs. This makes it difficult to reduce the specimen-to-sensor stand-off below approximately 1 mm.</p

Pharmacological agents for preventing morbidity associated with the haemodynamic response to tracheal intubation

Background: Several drugs have been used in attenuating or obliterating the response associated with laryngoscopy and tracheal intubation. These changes are of little concern in relatively healthy patients but can lead to morbidity and mortality in the high risk patient population.Objectives: The primary objective of this review was to determine the effectiveness of pharmacological agents in preventing the morbidity and mortality resulting from the haemodynamic changes in response to laryngoscopy and tracheal intubation in adult patients aged 18 years and above who were undergoing elective surgery in the operating room setting.SEARCH Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2011, Issue 6), MEDLINE (1950 to June 2011), EMBASE (1980 to June 2011), and the bibliographies of published studies. We reran our search from June 2011 to December 2012 and will deal with these studies when we update the review.SELECTION CRITERIA: We included randomized controlled trials (RCTs) that compared a drug used as an intervention for preventing or attenuating the haemodynamic response to tracheal intubation to a control group, and that mentioned mortality, major morbidity, arrhythmia or electrocardiogram (ECG) evidence of ischaemia in the methodology, results, or discussion section of the reports.DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted the outcome data.MAIN Results: We included 72 RCTs. The included trials studied the effects of 32 drugs belonging to different pharmacological groups. Only two trials mentioned the primary outcome of morbidity and mortality related to the haemodynamic response to tracheal intubation. Of the secondary outcomes, 40 of the included trials observed arrhythmia only, 11 observed myocardial ischaemia only and 20 observed both arrhythmias and myocardial ischaemia. Arrhythmias were observed in 2932 participants and myocardial ischaemia in 1616 participants. Arrhythmias were observed in 134 out of 993 patients in the control group compared to 80 out of 1939 in the intervention group. The risk of arrhythmias was significantly reduced with pharmacological interventions in the pooled data (Peto odds ratio (OR) 0.19, 95% CI 0.14 to 0.26, P \u3c 0.00001, I(2)= 47%). Local anaesthetics, calcium channel blockers, beta blockers and narcotics reduced the risk of arrhythmia in the intervention group compared to the control group. Myocardial ischaemia was observed in 21 out of 604 patients in the control group compared to 10 out of 1012 in the treatment group; the result was statistically significant (Peto OR 0.45, 95% CI 0.22 to 0.92, P = 0.03, I(2) = 19%). However, in subgroup analysis only local anaesthetics significantly reduced the ECG changes indicating ischaemia, but this evidence came from one study. The majority of the studies had a negative outcome. Hypotension and bradycardia were reported with 40 g kg(-1) intravenous alfentanil, chest rigidity with 75 ug kg(-1) alfentanil, and increased bronchomotor tone with sympathetic blockers.There were 17 studies which included high risk patients. Pharmacological treatment in this group resulted in the reduction of arrhythmias when the data from nine trials looking at arrhythmias were pooled (Peto OR 0.18, 95% CI 0.05 to 0.59, P = 0.005, I(2) = 80%). The analysis from four studies was not included. Three of these trials looked at the effect of sympathetic blockers but arrhythmias or myocardial ischaemia was observed throughout the perioperative period in two studies and some patients had arrhythmias due to atropine premedication in the third study. In the fourth study the authors mentioned myocardial ischaemia in the objectives section but did not report it in the results.AUTHORS\u27 CONCLUSIONS: The risk of arrhythmias associated with tracheal intubation was significantly reduced with pre-induction administration of local anaesthetics, calcium channel blockers, beta blockers and narcotics compared to placebo. Pharmacological intervention also reduced the risk of ECG evidence of myocardial ischaemia in the pooled data. Lignocaine pretreatment showed a significant effect but evidence came from one study only. The data suggested that there may be a reduction in ECG evidence of myocardial ischaemia with beta blocker pretreatment but this difference was not statistically significant. There is a need to focus on outcomes rather than haemodynamic measurements alone when studying this response in future trials