We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
New drugs to target different pathways in pulmonary hypertension has resulted in increased combination therapy, but details of this use in infants are not well described. In this large multicenter database study, we describe the pharmacoepidemiology of combination pulmonary vasodilator therapy in critically ill infants.
Methods:
We identified inborn infants discharged home from a Pediatrix neonatal ICU from 1997 to 2020 exposed to inhaled nitric oxide, sildenafil, epoprostenol, or bosentan for greater than two consecutive days. We compared clinical variables and drug utilisation between infants receiving simultaneous combination and monotherapy. We reported each combination’s frequency, timing, and duration and graphically represented drug use over time.
Results:
Of the 7681 infants that met inclusion criteria, 664 (9%) received combination therapy. These infants had a lower median gestational age and birth weight, were more likely to have cardiac and pulmonary anomalies, receive cardiorespiratory support, and had higher in-hospital mortality than those receiving monotherapy. Inhaled nitric oxide and sildenafil were most frequently used, and utilisation of combination and monotherapy for all drugs increased over time. Inhaled nitric oxide and epoprostenol were used in infants with a higher gestational age, earlier postnatal age, and shorter duration than sildenafil and bosentan. Dual therapy with inhaled nitric oxide and sildenafil was the most common combination therapy.
Conclusion:
Our study revealed an increased use of combination pulmonary vasodilator therapy, favouring inhaled nitric oxide and sildenafil, yet with considerable practice variation. Further research is needed to determine the optimal combination, sequence, dosing, and disease-specific indications for combination therapy.
We analyse the effect of drop-deformation-induced change in streamline topology on the scalar transport rate (the Nusselt number $Nu$) in an ambient planar linear flow. The drop-phase resistance is assumed dominant, and the drop deformation is characterised by the capillary number ($Ca$). For a spherical drop ($Ca = 0$) in an ambient planar extension, closed streamlines lead to $Nu$ increasing with the Péclet number ($Pe$), from $Nu_0$, corresponding to purely diffusive transport, to $4.1Nu_0$, corresponding to a large-$Pe$ diffusion-limited plateau. For non-zero $Ca$, we show that the flow field consists of spiralling streamlines densely wound around nested tori foliating the deformed drop interior. Now $Nu$ increases beyond the aforementioned primary plateau, saturating in a secondary one that approaches $22.3Nu_0$ for $Ca \rightarrow 0$, $Pe\,Ca \rightarrow \infty$. The enhancement appears independent of the drop-to-medium viscosity ratio. We further show that this singular dependence, of the transport rate on drop deformation, is generic across planar linear flows; chaotically wandering streamlines in some of these cases may even lead to a tertiary enhancement regime.
Yoga has been demonstrated to have a range of beneficial effects on individuals with substance use disorders, including opioid use disorders. We initiated a randomized clinical trial to find out the efficacy of add-on yoga among patients with opioid dependence stabilized on treatment to find out whether it led to improvement in sleep and quality of life. However, the rate of enrolment into the study was quite low.
Objectives
In this interim analysis, we present the preliminary data on the reasons for non-enrolment in the yoga trial.
Methods
The single-centre trial involved 1:1 randomization of patients with opioid dependence stabilized on medications (naltrexone or buprenorphine) for a period of at least 4 weeks into two groups (add-on yoga or wait-list control). The yoga included asanas and panchakosha meditation, taught for a period of 7 days and to be practiced by the participants for a period of 12 weeks. We recorded the reasons for non-participation among those who did not participate and asked them questions about their views on yoga.
Results
Of the 310 patients recruited between August 2022 and July 2023 (99.7% male, mean age 34 years, 56.5% married), 255 (82.3%) could not be enrolled in the trial. The most common reasons for non-enrolment were not having time for training (n = 206, 80.8%), not having time for doing yoga (n = 180, 70.6%), not having a smartphone for continued training or contact (n = 31, 12.2%), distance from the center (n = 17, 5.5%) do not feel the need for yoga (n = 16, 5.2%), injury or disability (n = 9, 3.5%), old age or medical condition (n = 7, 2.7%), already doing gym exercises (n = 7, 2.7%), nature of job (n = 5, 2.0%), do not have knowledge of yoga (n = 5, 2.0%), and do not think yoga would be useful (n = 4, 1.6%). Among those who could not be enrolled, 35.1% reported doing yoga sometime in the past, and 21.6% reported that at least one of the family members did yoga. When asked whether they would be interested if yoga was available online, 16 (5.2%) responded ‘yes’ and 45 (14.5%) responded ‘maybe’.
Conclusions
Expressed time constraints may be an important factor deterring patients with opioid dependence from engaging in yoga as an add-on yoga. There are other reasons as well that may deter patients from such an intervention. The findings should be seen in the light of the limitation of a single medically oriented center, and patients already stabilized on treatment.
Twelve lacustrine sediment samples from a relict lake in the Kalla Glacier valley were co-dated using AMS radiocarbon (14C) and infrared stimulated luminescence (IRSL) dating methods. In general, the radiocarbon ages of bulk organic matter were older by a minimum of 1500 years compared to (age depth) modeled luminescence ages after fading corrections. This is observed for the first time in the lake sediments of High Himalayan Crystalline zone. A combination of lipid n-alkane data, Raman spectra and geochemical proxies suggested that this was due to ancient organic carbon (OCancient) that is a mixture of pre-aged (OCpre-aged) and petrogenic (OCpetro) organic carbon within older glacial moraine debris that served as sediment source to the lake. Raman spectra suggest the presence of moderate to highly graphitized OCpetro in all the profile samples. The OCpetro contributed 0.064 ± 0.032% to the sediment and the lake stored 2.5 ± 0.7 Gg OCpetro at variable rates during the last 16 kyr, with the mean burial flux 160 kg OCpetro yr−1. This study implies (1) employing another independent dating method in addition to radiocarbon method using bulk sediment organic matter, if the carbon content is low, to observe any discrepancy, and (2) a need to investigate on the fate of OCpetro as many such small lakes become relict in this region.
We aimed to assess risk of COVID-19 infection & seroprotection status in healthcare workers (HCWs) in both hospital and community settings following an intensive vaccination drive in India.
Setting:
Tertiary Care Hospital
Methods:
We surveyed COVID-19 exposure risk, personal protective equipment (PPE) compliance, vaccination status, mental health & COVID-19 infection rate across different HCW cadres. Elecsys® test for COVID-19 spike (Anti-SARS-CoV-2S; ACOVs) and nucleocapsid (Anti-SARS-CoV-2; ACOV) responses following vaccination and/or COVID-19 infection were measured in a stratified sample of 386 HCW.
Results:
We enrolled 945 HCWs (60.6% male, age 35.9 ± 9.8 years, 352 nurses, 211 doctors, 248 paramedics & 134 support staff). Hospital PPE compliance was 90.8%. Vaccination coverage was 891/945 (94.3%). ACOVs neutralizing antibody was reactive in 381/386 (98.7%). ACOVs titer (U/ml) was higher in the post-COVID-19 infection group (N =269; 242.1 ± 35.7 U/ml) than in the post-vaccine or never infected subgroup (N = 115, 204.1 ± 81.3 U/ml). RT PCR + COVID-19 infections were documented in 224/945 (23.7%) and 6 HCWs had disease of moderate severity, with no deaths. However, 232/386 (60.1%) of HCWs tested positive for nucleocapsid ACOV antibody, suggesting undocumented or subclinical COVID-19 infection. On multivariate logistic regression, only female gender [aOR 1.79, 95% CI 1.07–3.0, P = .025] and COVID-19 family contact [aOR 5.1, 95% CI 3.84–9.5, P < .001] were predictors of risk of developing COVID-19 infection, independent of association with patient-related exposure.
Conclusion:
Our HCWs were PPE compliant and vaccine motivated, with immunization coverage of 94.3% and seroprotection rate of 98.7%. There was no relationship between HCW COVID-19 infection to exposure characteristics in the hospital. Vaccination reduced disease severity and prevented death in HCW.
The interaction of telone with acid and base saturated montmorillonite furnished adsorption isotherms which possessed combined features of H (high affinity) and C (linear rising) class isotherms; a fall in pH, an increase in electrical conductivity and formation of chloride ions. The observations were indicative of a process of chemisorption, both at the planar and lateral sites of montmorillonites, followed by penetration and swelling of the substrate micropores with telone. A reaction mechanism for the process of chemisorption has been proposed.
We report the results of our analysis of six gravity-mode pulsating hot subdwarf stars observed in the short cadence mode by Transiting Exoplanet Survey Satellite. We detected at least 10 pulsation periods in each star, searched for multiplets, and used an asymptotic period spacing to identify modes. We used a grid of evolutionary and pulsation models calculated with the MESA and GYRE, along with spectroscopic parameters and modal degree identification, to derive the physical properties of the stars. We checked the relation between the helium content and pulsations and found that no pulsator exists among the extremely helium-rich hot subdwarfs, while the number of detected pulsators in other helium groups increases as the helium content decreases. We found p- and g-mode hot subdwarfs pulsators in all Galactic populations.
Normally, the reported gain of the microstrip patch antenna is within 8 dBi. Using properly located three shorting pins on three bisectors, the present work reports a method to convert the non-radiating TM11 mode of equilateral triangular patch antennas (ETPAs) to a deformed TM11 radiating mode. The boresight gain of ETPA operating in TM11 mode is enhanced from −10.75 to 12.1 dBi at 5.43 GHz. The boresight measured gain is further enhanced to 14.2 dBi at 5.52 GHz by using a triangular surface-mounted short horn (SMSH) of about ${{\lambda }}/5$ height. The aperture efficiency of the ETPA with the shorting pins is 84.2%. The aperture efficiency is further improved to 94.2% using the SMSH. The measured boresight cross-polarization and side-lobe level are −40 and −29 dB, respectively. The nature of the electricfield and surface current distribution is analyzed, using both the characteristic mode analysis method and high-frequency structure simulator, to understand the role of shorting pin and coaxial feed in converting the non-radiating TM11 mode to the radiating mode. A systematic design process also is presented for a fast design of shorting pin-loaded ETPA on the suitable substrate at a specified frequency.
The Culicidae mosquito family breeds in various natural and artificial water bodies. Phytotelmata are plant structures that hold water and are used by many mosquito species during their life cycle. Mosquitoes are disease vectors, and phytotelmata play an important role in harbouring them. Investigating these phytotelmata will facilitate to develop appropriate site specific vector control strategy. Approximately 750 phytotelmata in 16 locations on Car Nicobar Island was examined. Mosquito larvae were collected from different habitats such as tree holes, root holes, leaf axils, and bamboo stumps. On average, the number of larvae per 10 ml of water ranged from 0.003 to 3.833. Among the 16 mosquito species identified, there were vectors of malaria (Anopheles sundaicus), dengue (Aedes aegypti and Aedes albopictus) and filariasis (Culex quinquefasciatus), belonging to seven genera. The most common phytotelmata were coconut trees (17.5%) followed by Java apple trees (10.3%) and bamboo stumps (7.1%). The most widespread mosquito species was Aedes edwardsi, followed by Aedes malayensis and Ae. albopictus, and the per cent of phytotelmata that contained these species were 42.6, 22.0, and 16.8% respectively. Anopheles mosquitoes had the highest container index (6.1%) in root holes, while Aedes and Culex mosquitoes were more frequently found in bamboo stumps. The alpha biodiversity indices indicated that the mosquito population in Car Nicobar Island was highly diverse (S = 16; DMg = 36.9). Tree holes showed the highest diversity, as all 16 species were collected from them. Assessment of phytotelmata, there is a significant relationship observed between mosquito genus, village, habitat, and tree families, on the remote island of Car Nicobar. Considering the presence of disease-transmitting mosquito vectors in the phytotelmata, these habitats should be considered when implementing control measures to eliminate mosquito-borne infections.
Heart University [https://www.heartuniversity.org/] is a free educational website providing structured training curricula with knowledge-based testing and access to webinars and conference recordings for practicing and in-training providers of paediatric and congenital cardiac care. To date, there are over 15,000 registered website users from over 140 countries on Heart University, with over 2,000 training modules and/or recorded educational videos. Heart University has developed an “asynchronous” educational lecture series entitled “Pediatric and Congenital Cardiac Care in Resource-Limited Settings.” This recorded lecture series is specifically focused on topics relevant to practicing paediatric and/or congenital cardiac care in low-resource settings.
A relatively new initiative, “Cardiology Across Continents,” supplements the existing educational resources for providers of paediatric and/or congenital cardiac care in low-income countries and lower-middle-income countries by providing an additional live, interactive, case-based forum. Sessions occur every 1–2 months and focus on challenging cases from diagnostic or management perspective with a view to promote collaboration between partnered institutions. “Cardiology Across Continents” is an expanding initiative that facilitates learning and collaboration between clinicians across varied practice settings via interactive case discussions. We welcome trainees and providers of paediatric and congenital cardiac care to join the sessions and invite any insight that can enhance learning for clinicians around the world. This manuscript describes “Cardiology Across Continents” and discusses the development, history, current status, and future plans of Heart University.
NASA’s all-sky survey mission, the Transiting Exoplanet Survey Satellite (TESS), is specifically engineered to detect exoplanets that transit bright stars. Thus far, TESS has successfully identified approximately 400 transiting exoplanets, in addition to roughly 6 000 candidate exoplanets pending confirmation. In this study, we present the results of our ongoing project, the Validation of Transiting Exoplanets using Statistical Tools (VaTEST). Our dedicated effort is focused on the confirmation and characterisation of new exoplanets through the application of statistical validation tools. Through a combination of ground-based telescope data, high-resolution imaging, and the utilisation of the statistical validation tool known as TRICERATOPS, we have successfully discovered eight potential super-Earths. These planets bear the designations: TOI-238b (1.61$^{+0.09} _{-0.10}$ R$_\oplus$), TOI-771b (1.42$^{+0.11} _{-0.09}$ R$_\oplus$), TOI-871b (1.66$^{+0.11} _{-0.11}$ R$_\oplus$), TOI-1467b (1.83$^{+0.16} _{-0.15}$ R$_\oplus$), TOI-1739b (1.69$^{+0.10} _{-0.08}$ R$_\oplus$), TOI-2068b (1.82$^{+0.16} _{-0.15}$ R$_\oplus$), TOI-4559b (1.42$^{+0.13} _{-0.11}$ R$_\oplus$), and TOI-5799b (1.62$^{+0.19} _{-0.13}$ R$_\oplus$). Among all these planets, six of them fall within the region known as ‘keystone planets’, which makes them particularly interesting for study. Based on the location of TOI-771b and TOI-4559b below the radius valley we characterised them as likely super-Earths, though radial velocity mass measurements for these planets will provide more details about their characterisation. It is noteworthy that planets within the size range investigated herein are absent from our own solar system, making their study crucial for gaining insights into the evolutionary stages between Earth and Neptune.
Tight focusing with very small f-numbers is necessary to achieve the highest at-focus irradiances. However, tight focusing imposes strong demands on precise target positioning in-focus to achieve the highest on-target irradiance. We describe several near-infrared, visible, ultraviolet and soft and hard X-ray diagnostics employed in a ∼1022 W/cm2 laser–plasma experiment. We used nearly 10 J total energy femtosecond laser pulses focused into an approximately 1.3-μm focal spot on 5–20 μm thick stainless-steel targets. We discuss the applicability of these diagnostics to determine the best in-focus target position with approximately 5 μm accuracy (i.e., around half of the short Rayleigh length) and show that several diagnostics (in particular, 3$\omega$ reflection and on-axis hard X-rays) can ensure this accuracy. We demonstrated target positioning within several micrometers from the focus, ensuring over 80% of the ideal peak laser intensity on-target. Our approach is relatively fast (it requires 10–20 laser shots) and does not rely on the coincidence of low-power and high-power focal planes.
To identify urinary catheter (UC)–associated urinary tract infection (CAUTI) incidence and risk factors.
Design:
A prospective cohort study.
Setting:
The study was conducted across 623 ICUs of 224 hospitals in 114 cities in 37 African, Asian, Eastern European, Latin American, and Middle Eastern countries.
Participants:
The study included 169,036 patients, hospitalized for 1,166,593 patient days.
Methods:
Data collection took place from January 1, 2014, to February 12, 2022. We identified CAUTI rates per 1,000 UC days and UC device utilization (DU) ratios stratified by country, by ICU type, by facility ownership type, by World Bank country classification by income level, and by UC type. To estimate CAUTI risk factors, we analyzed 11 variables using multiple logistic regression.
Results:
Participant patients acquired 2,010 CAUTIs. The pooled CAUTI rate was 2.83 per 1,000 UC days. The highest CAUTI rate was associated with the use of suprapubic catheters (3.93 CAUTIs per 1,000 UC days); with patients hospitalized in Eastern Europe (14.03) and in Asia (6.28); with patients hospitalized in trauma (7.97), neurologic (6.28), and neurosurgical ICUs (4.95); with patients hospitalized in lower–middle-income countries (3.05); and with patients in public hospitals (5.89).
The following variables were independently associated with CAUTI: Age (adjusted odds ratio [aOR], 1.01; P < .0001), female sex (aOR, 1.39; P < .0001), length of stay (LOS) before CAUTI-acquisition (aOR, 1.05; P < .0001), UC DU ratio (aOR, 1.09; P < .0001), public facilities (aOR, 2.24; P < .0001), and neurologic ICUs (aOR, 11.49; P < .0001).
Conclusions:
CAUTI rates are higher in patients with suprapubic catheters, in middle-income countries, in public hospitals, in trauma and neurologic ICUs, and in Eastern European and Asian facilities.
Based on findings regarding risk factors for CAUTI, focus on reducing LOS and UC utilization is warranted, as well as implementing evidence-based CAUTI-prevention recommendations.
The citrate-induced desorption kinetics of pre-adsorbed Se from montmorillonite (Mt) and its complexes with hydroxyaluminum (HyA-Mt) and hydroxyaluminosilicate (HAS-Mt) were studied. The mole fraction of pre-adsorbed Se released in 24 h from different clays followed the trends of Mt>> HAS-Mt> HyA-Mt with a significant increase with elevated citrate concentration in the desorbing solution. In contrast, the amount of Se adsorbed per unit mass of different clays followed a clear-cut opposite trend of HyA-Mt>HAS-Mt>>Mt. The Se desorption kinetics in different systems indicated multiple rate characteristics; where an initial fast reaction (0.25–2 h) was followed by a slow reaction (2–16 h). Of the six different kinetic models tested (zero-, first-, and second-order; power function, Elovich, and parabolic diffusion), the second-order rate equation showed the overall best fit to the fast and slow desorption kinetic data from the clays. Based on second-order rate constants, the rates of the mole fraction of Se desorption by citrate from different clay systems at 298 K followed the order Mt > HAS-Mt >> HyA-Mt. For both fast and slow reaction, the rates of desorption increased proportionally with the level of citrate. Replicate experiments conducted across a range of temperature (288–318 K) yielded Arrhenius parameters that followed the order HyA-Mt > HAS-Mt >> Mt. Considering that a lower mole fraction of Se desorption after a particular reaction period, slower desorption kinetics, and a greater activation energy of desorption are the indices of increased adsorption bond strength, the results clearly indicate that HyA- and HAS-interlayering and coatings on Mt not only augmented its Se adsorption affinity and capacity, but also increased the adsorption bond strength. Silication in HyA not only reduced the Se adsorption capacity, but also weakened the adsorption bond strength. This establishes a significant role of HyA/HAS-interlayering and coating on Mt in influencing the rate of citrate-induced release of Se. Reduction in surface-positive potential following citrate adsorption on the clay surface, a direct ligand exchange between Se and citrate, and structural dissolution are possible mechanisms responsible for citrate-induced Se desorption in the present study.
In the present paper, filamentous structure formation, associated turbulent spectrum, and density cavity formation phenomena have been investigated for low-β plasma applicable to the auroral region. A set of dimensionless equations governing the dynamics of three dimensionally propagating inertial Alfvén wave (3D-IAW) and perpendicularly propagating magnetosonic wave (PMSW) has been developed. Ponderomotive force due to 3D-IAW has been included in the dynamics of the PMSW. Numerical simulation has been performed to study the nonlinear coupling of these two waves. From the obtained results, we found that the field intensity localization takes place which may further lead to the additional dissipation/turbulence process for particle heating and acceleration in space plasma. The associated turbulent spectrum is obtained with scaling nearly k−4.28 at smaller scales (in the dissipation range). Relevance of the obtained results with the observations reported by various spacecrafts such as Hawkeye and Heos 2 has been discussed. Also, density fluctuations (depletion) of ∼0.10 n0 are calculated, which are consistent with the FAST spacecraft observation reported.
The present study was conducted to elucidate (1) the influence of kisspeptin (KP) on the in vitro development of preantral follicles (PFs) and (2) evolution of KP receptor gene (KISS1R) expression during ovarian follicular development in sheep. Kisspeptin was supplemented (0–100 µg/ml) in the culture medium of PFs for 6 days. The cumulus–oocyte complexes (COCs) from cultured PFs were subsequently matured to metaphase II (MII) for an additional 24 h. The proportions of PFs exhibiting growth, antrum formation, average increase in diameter, and maturation of oocytes to MII stage were the indicators of follicular development in vitro. The expression of the kisspeptin receptor gene at each development stages of in vivo developed (preantral, early antral, antral, large antral and COCs from Graafian follicles) and in vitro cultured PFs supplemented with KP was assessed using a real-time polymerase chain reaction. The best development in all the parameters under study was elicited with 10 µg/ml of KP. Supplementation of KP (10 µg/ml) in a medium containing other growth factors (insulin-like growth factor-I) and hormones (growth hormone, thyroxine, follicle-stimulating hormone) resulted in better PF development. The KISS1R gene was expressed in follicular cells and oocytes at all the development stages of both in vivo developed and in vitro cultured follicles. Higher KISS1R gene expression was supported by culture medium containing KP along with other hormones and growth factors. Accordingly, it is suggested that one of the mechanisms through which KP and other growth factors and hormones influence the ovarian follicular development in mammals is through the upregulation of expression of the KP receptor gene.
The North-Eastern region (NER) of India falls under the Eastern Himalayan region and it is a bio-diversity hub. Diverse maize landraces with wide adaptability to extreme climatic and soil scenario like heavy rainfall, drought and acidic soil conditions have been grown in NER since time immemorial. However, maize diversity in NER region has drastically reduced due to introduction of high yielding varieties and hybrids. Modern maize breeding programmes are focused on high yield but other unique traits like stay green trait, prolificacy (more than one fertile ear per plant), self-fertilizing ability are also important and the local germplasm of the NER region can contribute with these unique traits. Prior to the selection of any lines in several breeding programmes, assessment of genetic diversity and population structure are basic requirements. Hence, in the present study assessment of genetic diversity and population structure study in 30 maize inbreds developed from different germplasm of NER was undertaken using SSR markers, selected for their broad distribution throughout the genome, in order to assess the extent of allelic diversity among the lines and whether any population structure could be established. In addition to assessing molecular diversity, the study aims to evaluate the potential for yield and other beneficial and unique alleles that have high potential to contribute in the genetic enhancement programme of maize.
Mental disorders are the leading cause of disease burden, affecting 13% of all people globally in 2019. However, there is scarce evidence on the burden of mental disorders in Nepal. This study used the Global Burden of Disease Study 2019 data to assess the prevalence and disability-adjusted life-years (DALYs) of mental disorders in Nepal between 1990 and 2019. In 2019, there were 3.9 million (95% UI: 3.6–4.3) people with mental disorders in Nepal. Major depressive disorders (1.1 million; 95% UI: 0.9–1.2 million) and anxiety disorders (0.9 million; 95% UI: 0.8–1.2 million) were the most prevalent mental disorders in 2019. Attention deficit hyperactive disorder, conduct disorder, and autism spectrum disorders were present twice as high in males than in females. The proportional contribution of mental disorders to the total disease burden has tripled between 1990 (1.79% of all DALYs) and 2019 (5.5% of all DALYs). In conclusion, the proportional contribution of mental disorders to total disease burden has increased significantly in the last three decades in Nepal, with apparent sex and age differentials in prevalence and DALY rates. Effective program and policy responses are required to prepare the health system for reducing the growing burden of mental health disorders in Nepal.