Drawing on village-based data from Nepal, this paper explores the transferability of the Integrated Behavioural Model for Water, Sanitation and Hygiene (IBM-WASH) to the clean cooking sector and its ...potential to elucidate how barriers to improved cookstove adoption and sustained use intersect at different scales. The paper also explores the potential of IBM-WASH, behaviour settings theory and domestication analysis to collectively inform effective behaviour change techniques and interventions that promote both adoption and sustained use of health-promoting technologies. Information on cookstove use in the community since 2012 enables valuable insights to be gained on how kitchen settings and associated cooking behaviour were re-configured as homes and stoves were re-built following the April 2015 earthquake. The methodological approach comprised of semi-structured interviews, focus group discussions, direct observation and household surveys. The findings indicated that the IBM-WASH framework translated well to the improved cookstove sector, capturing key influences on clean cooking transitions across the model's three dimensions (context, psychosocial and technology) at all five levels. Understandings gained from utilising IBM-WASH were enhanced – especially at the individual and habitual levels – by domestication analysis and settings theory which elucidated how different cooking technologies were incorporated (or not) within physical structures, everyday lives and routine behaviour. The paper concludes that this combination of approaches has potential applicability for initiatives seeking to promote improved environmental health at community-wide scales.
•Transferability of IBM-WASH to the cookstove sector is explored for the first time.•Data from post-earthquake Nepal is used to test this transferability.•We demonstrate that the framework translates well to the cookstove sector.•Findings from IBM-WASH are enhanced by domestication analysis and settings theory.•This combination of approaches has broader applicability for health initiatives.
Household air pollution caused by inefficient cooking practices causes 4 million deaths a year worldwide. In Nepal, 86% of the rural population use solid fuels for cooking. Over 25% of premature ...deaths associated with air pollution are respiratory in nature. Here we aimed to identify molecular signatures of different cookstove and fuel type exposures in human airway epithelial cells, to understand the mechanisms mediating cook stove smoke induced lung disease. Primary human airway epithelial cells in submerged culture were exposed to traditional cook stove (TCS), improved cook stove (ICS) and liquefied petroleum gas (LPG) stove smoke extracts. Changes to gene expression, DNA methylation and hydroxymethylation were measured by bulk RNA sequencing and HumanMethylationEPIC BeadChip following oxidative bisulphite conversion, respectively. TCS smoke extract alone reproducibly caused changes in the expression of 52 genes enriched for oxidative stress pathways. TCS, ICS and LPG smoke extract exposures were associated with distinct changes to DNA methylation and hydroxymethylation. A subset of TCS induced genes were associated with differentially methylated and/or hydroxymethylated CpGs sites, and enriched for the ferroptosis pathway and the upstream regulator NFE2L2. DNA methylation and hydroxymethylation changes not associated with a concurrent change in gene expression, were linked to biological processes and molecular pathways important to airway health, including neutrophil function, transforming growth factor beta signalling, GTPase activity, and cell junction organisation. Our data identified differential impacts of TCS, ICS and LPG cook stove smoke on the human airway epithelium transcriptome, DNA methylome and hydroxymethylome and provide further insight into the association between indoor air pollution exposure and chronic lung disease mechanisms.
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•Traditional cookstove smoke alters gene expression, and DNAm/hm in epithelial cells•Improved cookstove smoke/LPG did not alter gene expression but did impact DNAm/hm•DNAm/hmc linked gene expression enriched for ferroptosis and NFE2L2 regulation•DNAm/hmc changes linked to processes and pathways important to airway health•Data provide insight into indoor air pollution contributions to lung disease
Background: Airway inflammation is a feature of many respiratory diseases and there is a need for newer, more effective anti-inflammatory compounds. The aim of this study was to develop an
ex vivo ...human lung explant model which can be used to help study the mechanisms underlying inflammatory responses and which can provide a tool to aid drug discovery for inflammatory respiratory diseases such as asthma and COPD.
Method: Parenchymal lung tissue from 6 individual donors was dissected and cultured with two pro-inflammatory stimuli, lipopolysaccharide (LPS) (1 µg/ml) and interleukin-1 beta (IL-1β) (10 ng/ml) in the presence or absence of dexamethasone (1 µM). Inflammatory responses were assessed using Luminex analysis of tissue culture supernatants to measure levels of 21 chemokines, growth factors and cytokines.
Results: A robust and reproducible inflammatory signal was detected across all donors for 12 of the analytes measured following LPS stimulation with a modest fold increase (<2-fold) in levels of CCL22, IL-4, and IL-2; increases of 2-4-fold in levels of CXCL8, VEGF and IL-6 and increases >4-fold in CCL3, CCL4, GM-CSF, IL-10, TNF-α and IL-1β. The inflammatory signal induced by IL-1β stimulation was less than that observed with LPS but resulted in elevated levels of 7 analytes (CXCL8, CCL3, CCL4, GM-CSF, IL-6, IL-10 and TNF-α). The inflammatory responses induced by both stimulations was supressed by dexamethasone for the majority of analytes.
Conclusions: These data provide proof of concept that this
ex vivo human lung explant model is responsive to inflammatory signals and could be used to investigate the anti-inflammatory effects of existing and novel compounds. In addition this model could be used to help define the mechanisms and pathways involved in development of inflammatory airway disease.
Abbreviations: COPD: Chronic Obstructive Pulmonary Disease; ICS: inhaled corticosteroids; LPS: lipopolysaccharide; IL-1β: interleukin-1 beta; PSF: penicillin, streptomycin and fungizone
Household air pollution (HAP) exposure and its consequences for human health have been a topic of interest in the medical and engineering research world for many years. Large populations in low and ...middle-income countries (LMICs) are exposed to HAP as a result of the combustion of solid biomass fuel, especially for household cooking. Short-term exposure to HAP may increase respiratory symptoms including cough and breathlessness, which on more prolonged exposure may cause serious respiratory damage and lead to premature death. Airway inflammation following exposure to inhaled pollutants is likely to be a key step in this process, and little is known about the mechanisms underlying responses to biomass smoke in human lung. The main aims of this thesis were to (i) quantify ‘real-life’ exposure to particulate matter of aerodynamic diameter smaller than 2.5 μm (PM2.5) and carbon monoxide (CO) measured during cooking on stoves in rural areas of Nepal in different geographical settings, (ii) assess the potential effect of biomass smoke extract generated in real life cooking on inflammatory responses in human lung tissue, and (iii) investigate the consequences of controlling biomass smoke exposure using improved cook stoves (with a flue to vent smoke out of the room) (ICS) on inflammatory responses in human lung tissue. Using eight different types of biomass fuels, it was identified that PM2.5 and CO emissions were higher with agricultural residue and cow dung compared to fuel wood. The real-life exposure was measured during cooking on a range of stoves in 103 households in 4 different Nepalese villages situated at altitudes between ~100 m to 4000 m above sea level. It was found that in a range of settings in rural Nepal from villages at all altitudes high levels of personal exposures to indoor pollutants occur and that the exposures are higher in villages at higher altitude. I demonstrated that the biomass smoke samples collected in a real-life environment from rural Nepal have pro-inflammatory effects in both human lung tissue and HBEC. An elevated level of pro-inflammatory cytokines and chemokines measured in the cell and tissue culture supernatant following biomass smoke exposure suggests that high levels of indoor exposures are likely to produce lung inflammation. The use of ICS was effective in reducing the overall indoor exposure, and the exposure reduction was about 51%. However, the use of ICS does not prevent pro-inflammatory responses in human lung as a similar pattern of inflammatory mediators was observed with the samples from ICS cooking. Overall, this study supports the need to reduce exposures in order to improve respiratory health in this setting. Furthermore, it suggests that additional methods other than those currently being trialled may be needed to reduce exposures to levels which will prevent lung inflammation from occurring in real-life settings.
Exposure to biomass smoke is believed to increase the risk of developing chronic obstructive pulmonary disease. However, little is known about the mechanisms underlying responses to biomass smoke in ...human lungs.
This study had two objectives: first, to quantify "real-life" exposures to particulate matter <2 μm in diameter (PM
) and carbon monoxide (CO) measured during cooking on stoves in rural areas of Nepal in different geographical settings; and second, to assess the effect of biomass smoke extracts on inflammatory responses in
human lung tissue.
Personal exposures to PM
and indoor near-stove CO concentrations were measured during cooking on a range of stoves in 103 households in 4 different Nepalese villages situated at altitudes between ∼100 and 4,000 m above sea level. Inflammatory profiles to smoke extracts collected in the field were assessed by incubating extracts with human lung tissue fragments and subsequent Luminex analysis.
In households using traditional cooking stoves, the overall mean personal exposure to PM
during cooking was 276.1 μg/m
(standard deviation SD, 265 μg/m
), and indoor CO concentration was 16.3 ppm (SD, 19.65 ppm). The overall mean PM
exposure was reduced by 51% (
= 0.04) in households using biomass fuel in improved cook stoves, and 80% (
< 0.0001) in households using liquefied petroleum gas. Similarly, the indoor CO concentration was reduced by 72% (
< 0.001) and 86% (
< 0.0001) in households using improved cook stoves and liquefied petroleum gas, respectively. Significant increases occurred in 7 of the 17 analytes measured after biomass smoke extract stimulation of human lung tissue (IL-8 interleukin-8, IL-6, TNF-α tumor necrosis factor-α, IL-1β, CCL2, CCL3, and CCL13).
High levels of real-life exposures to PM
and CO occur during cooking events in rural Nepal. These exposures induce lung inflammation
, which may partially explain the increased risk of chronic obstructive pulmonary disease in these communities.
Understanding patient satisfaction with pharmacy services can help to enhance the quality and monitoring of pharmacy services. Patient Satisfaction with Pharmacist Services Questionnaire 2.0 (PSPSQ ...2.0) is a valid and reliable instrument for measuring patient satisfaction with services from the pharmacist. The availability of the PSPSQ 2.0 in Nepalese version would facilitate patient satisfaction and enhance pharmacy services in Nepal. This study aims to translate the PSPSQ 2.0 into the Nepalese version, culturally adapt it and verify its reliability and validity in the Nepalese population.
The methodological and cross-sectional study design was used to translate, culturally adapt it, and validate PSPSQ 2.0 in Nepalese. The Nepalese version of PSPSQ 2.0 went through the full linguistic validation process and was evaluated in 300 patients visiting different community pharmacies in Kathmandu district, Nepal. Exploratory factor analysis was carried out using principal component analysis with varimax rotation, and Cronbach's alpha was used to evaluate the reliability.
Three-hundred patients were recruited in this study. Participants ranged in age from 21 to 83 years; mean age was 53.93 years (SD: 15.21). 62% were females, and 34% educational level was above 12 and university level. Only 7% of the participants were illiterate. Kaiser-Meyer-Olkinwas found to be 0.696, and Bartlett's test of sphericity was significant with a chi-square test value of 3695.415. A principal axis factor analysis conducted on the 20 items with orthogonal rotation (varimax). PSPSQ 2.0 Nepalese version (20 items) had a good internal consistency (Cronbach's alpha = 0.758). Item-total correlations were reviewed for the items in each of the three domains of PSPSQ 2.0.
The PSPSQ 2.0 Nepalese version demonstrated acceptable validity and reliability, which can be used in the Nepalese population for evaluating the satisfaction of patients with pharmacist services in both community pharmacy and research.
The appropriate design and operation of spillways are critical for dam safety. To enhance design practices and gain insights into flow hydraulics, both experimental and numerical modeling are ...commonly employed. In this study, we conducted a numerical investigation of flow over a mildly sloping (1V:3H) stepped spillway with various step geometries using a multi-phase mixture model with dispersed interface tracking in ANSYS Fluent. The model was validated against experimental data from Utah State University, focusing on water surface profiles over the crest, velocities, and air concentrations. The validated numerical model was used to simulate flow over different step geometries (i.e., 0.2 m H uniform Step, 0.1 m H uniform step, non-uniform steps, adverse slope steps, and stepped pool) for a range of discharges from 0.285 m3/s/m to 1.265 m3/s/m. While flow depths over the crest and velocities in the chute compared well with experimental results, air concentrations exhibited some deviation, indicating numerical limitations of the solver. The shift in the location of the inception point was found to be mainly influenced by a higher flow rate than the different design configurations over an identical mild slope. The downstream non-linear flow velocity curve with different flow rates indicated less effectiveness of the step roughness over a high flow rate as a result of the reduction in relative roughness. The theoretical velocity ratio indicated the least reduction in downstream velocity with the stepped pooled spillway due to the formation of a “stagnant pool”. A higher negative-pressure region due to flow separation at the vertical face of the steps was obtained by adverse slope steps, which shows that the risk of cavitation is higher over the adverse slope step spillway. Turbulent kinetic energy (TKE) was found to be higher for uniform 0.2 m H steps due to the strong mixing of flow over the steps. The least TKE was found at the steps of the stepped pool spillway due to the formation of a “stagnant pool”. Uniform 0.2 m H steps achieved the maximum energy dissipation efficiency, whereas the stepped pool spillway obtained the least energy dissipation efficiency, introducing higher flow velocity at the stilling basin with a higher residual head. The adverse slope and non-uniform steps were found to be more effective than the uniform 0.1 m H steps and stepped pool spillway. The application of uniform steps of higher drop height and length could achieve higher TKE over the steps, reducing the directional flow velocity, which reduces the risk of potential damage.
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