BackgroundImportance of awareness of medical ethics and its integration into medical curriculum has been frequently highlighted. Study 1 aimed to assess the knowledge, attitude, and reported practices of medical ethics among clinicians at Patan Academy of Health Sciences, a tertiary care teaching hospital in Nepal. Study 2 was conducted to assess whether there was a difference in knowledge, attitude, and reported practices of medical ethics among doctors who received formal medical ethics education during undergraduate studies and those who did not.MethodsTwo (...) cross-sectional surveys using self-administered questionnaires were conducted. Study 1 included 72 participants; interns, medical officers, and consultants working at Patan Academy of Health Sciences. Study 2 was a comparative study conducted among 54 medical officers who had received formal medical ethics education (Group 1) and 60 medical officers who did not (Group 2).ResultsParticipants who had completed post-graduate education had higher knowledge (p = 0.050), practice (p < 0.001), and overall combined scores (p = 0.011). Participants with ethics education had higher knowledge (p < 0.001), attitude (p = 0.001), practice (p < 0.001), and overall score (p < 0.001). Most participants preferred consulting colleagues if an ethical dilemma arose. Fewer participants had heard of the Declaration of Helsinki. Most participants thought doctors to be most capable of judging what is best for the patient (Study 1: 70.42%, Study 2 Group 1: 42.59%, Group 2: 80%). Case scenarios in which participants demonstrated poor practice were ethical issues concerning truth-telling, end-of-life decisions, treating HIV/aids patients, treating a minor, and reporting colleague’s errors.ConclusionsThis study found that participants who have received medical ethics education have higher knowledge, attitude, and practice scores. The results further justify the need for medical ethics education to be a part of the core medical curriculum. A blame-free environment where seniors can be approached for advice should be created. Research ethics should also be given attention. During medical ethics training, ethical issues where doctors perform poorly should be given more priority and should be discussed in a country-specific context. (shrink)

All activities which are taking place in the Cosmos also exist in a human body in subtle micro-scale. Plexuses centers in a human body are the most mysterious kinds of energies. The six-center plexus system is the path of the Kundalini shakti, the primordial cosmic energy of a person. Each plexus has its own propensities (vibrating words/dimensions/vritti) and an acoustic root. These plexuses control some cluster of words of sounds and corresponding physical organs in human body. The 50 main propensities (...) of the human’s unit mind are expressed through the vibration-expression of these plexuses. These vibrations cause hormones to secrete from the corresponding glands of the human’s body. These plexuses can play very important roles in curing the diseases. According to the Theory of Nikola Tesla’s 369, there are all together 1 to 9 digital root numbers exist. All other higher or lower numbers are the combination of those digital root numbers. This statement seems quite true when we compare it with Theory of Absolutivity. If 3, 6, 9 numbers are arranged together it makes a letter Ohm (AUM) which represents actually a Sagun Bramh/Nikola Tesla’s 369 triangle which is a part of NirgunBramh having higher dimensions. Number zero is the NirgunBramh (having all the qualities but in dormant form) which does not possess any quality in action. Number 3, 6, 9 forming as an equilateral triangle of static, mutative and sentient forces representing the Black-hole which is a part of Sagun Bramh projecting Himself as a Visible World through Big-bang along with forming five basic elements such as Ethereal, Areal, Fire, Liquid and Solid. According to the biological science, life emerged in this planet from matter about four billion years ago in the form of DNA that carried the software for the development of billion of species on the way to its final destination in humans. These facts also fully support the above hypothesis of universe formations. (shrink)

The Cosmos we live in consists of Invisible Prakriti and Visible World. In Visible World, we do live. All the galaxies, Milky Ways, nebulas and planets, stars, and physical bodies belong to this world are governed by the physical and mathematical laws of nature. Prakriti which is invisible spiritually governed and wave-formed existed even before the Big-Bang. Purush holds the Visible World and Prakriti around makes entire Cosmos in existence. Purush which is an absolutely positively charged and quality less with (...) no traces of negative portions always existed, neither being created nor destroyed. A fraction of a Purush known as Omega Point appears into the portion of Prakriti due to some causal effect for further expansion of the Visible World. Purush is situated in the middle of the cylindrical universe surrounded by the Prakriti and Visible World. Theories proposed by different scientists and philosophers to verify the Purush seem to be incomplete trial and error of the zigzag puzzle show. Today, our scientists, cosmologists, and mathematicians are trying to explain the function of the universe through only four physical dimensions of science, which seems to be incomplete without explaining the transcendental factors while dealing with the living bodies. (shrink)

A development project introduces various changes into a community. Some of these changes are positive while others are negative or warrant better planning. Evaluation reports designed strictly for quantitative, targetoriented physical and fiscal achievements often overlook many of these changes. Our personal field observations and experiences with an agricultural development project showed us several examples of impacts brought about in the local farming system in some hill districts of Nepal. These impacts cannot be neglected and project evaluation and progress reports (...) should accommodate such changes. (shrink)

Background The allocation of scarce deceased donor kidneys is a complex process. Transplant providers are increasingly relying on constructs such as frailty and cognitive function to guide kidney transplant (KT) candidate selection. Patient views of the ethical issues surrounding the use of such constructs are unclear. We sought to assess KT candidates’ attitudes and beliefs about the use of frailty and cognitive function to guide waitlist selection.Methods KT candidates were randomly recruited from an ongoing single-center cohort study of frailty and (...) cognitive function. Semi-structured interviews were conducted, and thematic analysis was performed. Inductively derived themes were mapped onto bioethics principles.Results Twenty interviews were conducted (65% contact rate, 100% participation rate) (60% male; 70% White). With respect to the use of frailty and cognitive function in waitlisting decisions, four themes emerged in which participants: (1) valued maximizing a scarce resource (utility); (2) prioritized equal access to all patients (equity); (3) appreciated a proportional approach to the use of equity and utility (precautionary utility); and (4) sought to weigh utility- and equity-based concerns regarding social support. While some participants believed frailty and cognitive function were useful constructs to maximize utility, others believed their use would jeopardize equity. Patients were uncomfortable with using single factors such as frailty or cognitive impairment to deny someone access to transplantation; participants instead encouraged using the constructs to identify opportunities for intervention to improve frailty and cognitive function prior to KT.Conclusions KT candidates’ values mirrored the current allocation strategy, seeking to balance equity and utility in a just manner, albeit with conflicting viewpoints on the appropriate use of frailty and cognitive impairment in waitlisting decisions. (shrink)

Verbal autopsy presents the opportunity to understand the disease burden in many low-income countries where vital registration systems are underdeveloped and most deaths occur in the community. Advances in technology have led to the development of software that can provide probable cause of death information in real time, and research considering the ethical implications of these advances is necessary to inform policy. Our research explores these ethical issues in rural Nepal using a public health ethics framework. We considered the burdens (...) and benefits of VA and giving cause of death information to families of the deceased through qualitative research with VA interviewers, community members, national policy stakeholders and international academics. Burdens can be experienced differently, and it is important to balance the emotional burden of VA with utilization of the data to inform planning and increased access to health services. The training, support and supervision of VA interviewers should be prioritized if VA is taken to scale. Initial and ongoing community engagement is recommended in addition to engaging ethical, legal, health and policy personnel in developing protocols and systems. Integrating rigorous research while cautiously moving forward is recommended to ensure systems and responses to concerns are relevant to contexts. (shrink)

Recently, there has been an increased interest in developing statistical methodologies for analyzing single case experimental design data to supplement visual analysis. Some of these are simulation-driven such as Bayesian methods because Bayesian methods can compensate for small sample sizes, which is a main challenge of SCEDs. Two simulation-driven approaches: Bayesian unknown change-point model and simulation modeling analysis were compared in the present study for three real datasets that exhibit “clear” immediacy, “unclear” immediacy, and delayed effects. Although SMA estimates can (...) be used to answer some aspects of functional relationship between the independent and the outcome variables, they cannot address immediacy or provide an effect size estimate that considers autocorrelation as required by the What Works Clearinghouse Standards. BUCP overcomes these drawbacks of SMA. In final analysis, it is recommended that both visual and statistical analyses be conducted for a thorough analysis of SCEDs. (shrink)

Domestic violence is one of the most common forms of violence against women. Domestic violence during pregnancy is associated with adverse perinatal and maternal outcomes. We aimed to assess whether domestic violence was associated with mode of delivery, low birthweight and preterm birth in two sites in Nepal. In this prospective cohort study we consecutively recruited 2004 pregnant women during antenatal care at two hospitals between June 2015 and September 2016. The Abuse Assessment Screen was used to assess fear and (...) violence. Having ever experienced either fear or violence was defined as any domestic violence. Obstetric outcomes were obtained from hospital records for 1381 women, selecting singleton pregnancies only. Mode of delivery was assessed as birth by cesarean section or not. A birthweight of less than 2500 g was defined as low birthweight and preterm birth as birth before completion of 37 weeks gestation. Descriptive and multiple logistic regression analyses were performed to assess associations. Twenty percent of the women reported any domestic violence. Among all 1381 women, 37.6% gave birth by cesarean section. Of those women who delivered by cesarean section, 84.7% had an emergency cesarean section. Less than 10% of the babies were born prematurely and 13.5% were born with low birthweight. We found no significant association between exposure to any domestic violence during pregnancy and risk of a low birthweight baby or birth by cesarean section. However, having experienced both violence and fear was significantly associated with giving birth to a preterm infant [aOR 2.33 ]. Domestic violence is common in Nepal. This is a potential risk factor for severe morbidity and mortality in newborns. We found that the risk of having a preterm baby was higher for pregnant women who experienced both fear and violence. This should be recognized by the health sector. In this study, no significant differences were found in the rate of cesarean section nor low birthweight for women who had experienced any domestic violence compared to those who did not. (shrink)