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Papers by amrit thapa

Indian Journal of Sleep Medicine, Jun 19, 2024

Background/objective: Reduced dimensions of the upper airway tract may affect the functionality t... more Background/objective: Reduced dimensions of the upper airway tract may affect the functionality to the extent of distorting the vertical growth of the face. However, human adaptability also tries to compensate for the anatomic alterations so that vital functions of the body like respiration are not grossly hampered. The present study aims to determine the correlation of forced expiratory volume in one second (FEV1) with oropharyngeal volume (OPV) in individuals exhibiting reduced hypopharyngeal space. Materials and methods: About 36 patients with reduced hypopharyngeal airway space (HAS), as measured on lateral cephalograms from a tertiary care government hospital, were included in this cross-sectional study. Forced expiratory volume in one second and OPV were measured using spirometry and acoustic pharyngometry (AP) respectively. Results: The study population, comprised 15 males and 21 females with a mean age of 17.6 ± 4.7 years. A statistically significant positive correlation was observed between age with BMI and FEV1 (p = 0.001, < 0.000 respectively) and BMI with FEV1 (p = 0.004). No statistically significant correlation was found between mean HAS with OPV (p = 0.140) and with FEV1 (p = 0.503). Further, no significant correlation was also observed between OPV and FEV1 (p = 0.958) also. One sample t-test showed a statistically significant difference between the mean HAS and predicted normative with a mean difference of-3.52 mm (p = 0.000). Limitations: The present study, being cross-sectional, had the limitation of choosing a homogenous group of participants with reduced HAS. However, the authors suggest a comparative study including patients with various growth patterns and occurrence of obstructive sleep apnea. Conclusion/Implications: The authors conclude that reduced hypopharyngeal space alone does not affect the respiratory function and overall volume of the oropharyngeal region.

Journal of Contemporary Orthodontics, Feb 15, 2024

To evaluate changes in hypopharyngeal airway space and effective length of mandible in skeletal C... more To evaluate changes in hypopharyngeal airway space and effective length of mandible in skeletal Class II patients following Twin Block Appliance (TBA) therapy. Further, the study also aims to compare the post functional changes being observed between males and females. Materials and Methods: This is a prospective study on 15 Pre-adolescents (08 males and 07 females; mean age: 10.75 ± 0.91years) who underwent functional jaw orthopaedics with TBA. Lateral cephalogram at Pre treatment stage (T1) and post functional phase of TBA (T2) were obtained. The cephalometric parameters were measured and paired t test was done for comparison of pre and post functional changes. Results: The mean period of functional phase of TBA therapy was 18 ± 02 months. The cephalometric changes post functional jaw orthopaedics were statistically insignificant when compared males Vs females (P > 0.05). However, mean increase of in the effective length of mandible and hypopharyngeal space (T2-T1) was 4.0± 1.16 mm and 1.47±0.57 mm respectively, which were statistically highly significant (P<0.5). Conclusions: 1. TBA therapy in skeletal Class II patients significantly increases the effective mandibular length and hypo-pharyngeal space post functional phase; 2. No significant differences were observed between males and females with respect to post functional cephalometric changes in mandibular length and hypopharyngeal space. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International, which allows others to remix, and build upon the work noncommercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Journal of Contemporary Orthodontics, Dec 14, 2023

Most of the several cephalometric analyses used for the diagnosis of sagittal dysplasia, Point A ... more Most of the several cephalometric analyses used for the diagnosis of sagittal dysplasia, Point A is the most widely used indicator for ascertaining of maxillary position. By the virtue of difficulty in locating point A in many cases, alternative methods had been proposed for precise location of point A but there are only few studies on the reliability of these alternative points. Point M is one such indicator for evaluating the sagittal position of maxilla. The objective of this study is to measure and compare the reliability of point A and point M. Materials and Methods: Lateral cephalogram of 50 subjects (11-20 years) were included in the study consisting of all types of skeletal malocclusions. Point A and point M were identified by two different group of orthodontists. Linear and angular measurements through both the points were analysed and compared between the observers using interclass correlation. Results: Interclass correlation coefficient of linear and angular parameters of point M was found to be higher than point A. Conclusion: Point M may be considered as more reliable alternative for point A in two dimensional cephalometric analysis. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International, which allows others to remix, and build upon the work noncommercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Journal of Health and Allied Sciences

Introduction: Drug utilization research deals with the quality of care focusing on potentially in... more Introduction: Drug utilization research deals with the quality of care focusing on potentially inappropriate medication (PIM), The objectives of the study were to assess the drug utilization pattern (class of drugs used, average number of drugs per prescription per encounter, number of drug prescribed in generic name and antibiotics in prescription) and potentially inappropriate medications and their categories among elderly inpatients. Methods: It was a prospective observational study carried out in the medical department of Western Regional Hospital, one of the tertiary level public referral hospital in Pokhara, Nepal. One hundred and two patients of both sexes, age above 65 years and who were hospitalized in medical department were selected. The patients were followed until their discharge to obtain complete information about the drugs being used. Patient data collection form and Updated 2012 Beers Criteria were used to assess drug utilization patterns and determine PIM respectiv...

Higher Education Quarterly

Debate continues on the effects of the global proliferation of private higher‐educational institu... more Debate continues on the effects of the global proliferation of private higher‐educational institutions, especially for‐profit institutions. We examine two related questions for Peru using mixed methods: Who attends private institutions and what are their perceived advantages/disadvantages? Longitudinal quantitative data suggest higher‐educational segmentation starting early in life, whereby young people from wealthier households attended private institutions and those from poorer households attended public ones. Interviews with teachers, students, and staff provide insights on perceived strengths and drawbacks of higher‐educational marketization and highlight the importance of family background in higher‐educational choices, governmental regulation, and close monitoring of higher‐educational quality.

Water

Snowmelt significantly contributes to meltwater in most parts of High Mountain Asia. The Karakora... more Snowmelt significantly contributes to meltwater in most parts of High Mountain Asia. The Karakoram region is one of these densely glacierized and snow-covered regions. Several studies have reported that glaciers in the Karakoram region remained stable or experience slight mass loss. This trend has called for further investigation to understand changes in other components of the cryosphere. This study estimates the comparative snow cover area (SCA) and snowline altitude (SLA) changes between 2003 and 2018 in the Karakoram region and its subbasins, including Hunza, Shigar, and Shyok. We used three different 8-day composite snow products of the Moderate Resolution Imaging Spectroradiometer (MODIS) in this study including (1) Original Aqua (MYD10A2), (2) Original Terra (MOD10A2), and (3) Improved Terra-Aqua (MOYDGL06*) snow products from 2003 to 2018. We used Mann–Kendall and Sen Slope methods to assess trends in the SCA and SLA. Our results show that the original snow products are sign...

Bodhi: An Interdisciplinary Journal

There is a long history of more than six decades of technological development and its incorporati... more There is a long history of more than six decades of technological development and its incorporation in education. A large volume of literature and research focuses on the importance of technology integration in order to create an educational environment conducive to a higher-order learning opportunity. Adaptation of technology became more pertinent in the present context of COVID-19 pandemic. However, there are concerns about whether all learners worldwide are getting equitable access to technology in learning. In this context, this paper studies some policy documents from Nepal to explore how technology is integrated to enhance learning. Further, this paper compares Nepal's technological integration based on the common core state standards from the United States. This literature review identifies that Nepal's educational authorities need serious attention to invest in technological infrastructure and prepare for technology integration in education. This paper aims to inform...

Satellite-based as well as reanalysis-based datasets are widely available and useful in detecting... more Satellite-based as well as reanalysis-based datasets are widely available and useful in detecting spatial and temporal variability of rainfall at a finer resolution. These products have been widely used in weather forecasting, hydrological and climate studies. However, the accuracy of these satellite products varies spatially and across different datasets. In this study, the accuracy of five satellite-based precipitation products with different spatial resolutions i.e., CHIRPS, ERA5, TRMM, GPM, and Terra Clim available on Google Earth Engine (GEE) were compared with India Meteorological Department (IMD) grided data in six climate zones in India. The statistics such as RMSE, R , MSE, and PBIAS were computed. It was observed that the performance of each product varies in different climatic zones. The GPM was observed to have high accuracy in arid, semi-arid, and tropical wet zones. TRMM showed a good match in tropical wet & dry, tropical wet, and semi-arid zones. Terra Clim and ERA5 s...

Science of The Total Environment, 2021

Snowmelt is an important source of water in the upstream part of the Ganges river basin (GRB), wh... more Snowmelt is an important source of water in the upstream part of the Ganges river basin (GRB), which provides water for different purposes to its 655 million inhabitants. However, studies assessing relationship between snow cover dynamics and changes in hydro-climatic variables are limited within this region, which has motivated the current research. In this study, MODIS snow cover product (MOD10A1) was used to assess the snow cover area (SCA) dynamics within the Upper Ganges river basin (UGRB) and its sub-basins for the time period of 2002-2014; available climate and hydrological data were used to assess the hydrological characteristics within three selected sub-basins in Nepal; and relationships between snow cover and different hydro-climatic variables are established for three sub-basins owing to availability of hydro-climatic data. Results show that the average annual maximum SCA is around 24.6-47.5% for UGRB and its sub-basins. Upper Yamuna river basin (UYRB) with lowest mean elevation among the sub-basins shows a single SCA peak in spring within an annual cycle, whereas UGRB and the higher sub-basins show an additional lower peak in fall mainly resulted from snow sublimation. During 2002-2014, SCA shows slight decreasing trends for UGRB (τ =-0.039) and the higher altitude zones B (3001-4500 m asl) and C (> 4500 m asl) of most sub-basins, with significance only in Zone C of SaRB (τ =-0.070) and KoRB (τ =-0.062). Annual discharge (all rivers) shows non-significant decreasing trends (τ =-0.359 to-0.051) which are resulted from decreasing discharge in different seasons in different sub-basins. Seasonal correlation analysis indicates an important water supply from rainfall in Gandaki river basin (GaRB) and combined water supply from rainfall and snowmelt in Koshi river basin (KoRB), along with dominant contribution of precipitation in monsoon months and snowmelt in non-monsoon months for all the three sub-basins. Improved snow products with less effects of cloud cover and longer time series would help draw more robust conclusions related to SCA changes.

School Community Journal, 2016

This article provides a preliminary report on the construct validity and internal consistency of ... more This article provides a preliminary report on the construct validity and internal consistency of the Community Scale. The Community Scale was developed to acknowledge the perceptions of community members and to promote a student-led School Community Partnership Process within the larger context of school climate improvement efforts. A brief history of the development of the Community Scale provides context for the current study of its psychometric properties. Results relating to factor analyses and reliability coefficients based on data collected from community members associated with two schools in Illinois, one school in Connecticut, and one school in Minnesota are then presented. Findings show that the Community Scale (version 2.0) measures two dimensions of school–community collaborations and support. The scale shows acceptable construct validity and acceptable to good internal consistency, with scope for even stronger psychometric properties as the scale is refined further.

In the Nepal Himalayas snow and avalanches can cause major disasters. Snow melt water is also an ... more In the Nepal Himalayas snow and avalanches can cause major disasters. Snow melt water is also an important water resource, especially during the dry season. We combine data from robust automatic solar-powered snow/weather measurement stations with simulations from a numerical snow model to provide useful regional estimates of snow depth, snow water equivalent, extent of snow-covered area and the snow line elevation in near real-time. The resulting snow maps may be useful for e.g. hydropower and disaster risk reduction applications.

Journal of Climate Change, 2015

Climatic time series data are often nonlinear and non-stationary and hence the use of traditional... more Climatic time series data are often nonlinear and non-stationary and hence the use of traditional techniques may not be suitable for their analysis. This research is focused on the monthly series of air temperature and precipitation data of 25 years from 1988 to 2012 at Langtang Meteorological Station (LMS), Kyangjing in Langtang River basin, Nepal to extract multi-scale cycles and trends. To address the non-linearity and non-stationary of these time series, we used Empirical Mode Decomposition (EMD) method. EMD decomposed LMS temperature and precipitation series into different oscillatory modes called Intrinsic Mode Functions (IMFs) and residue called trend. The extracted IMFs are subjected to Fast Fourier Transform (FFT) to determine their average period along with their power density. There exist oscillations of 1 year, 3.13 years, 6.25 years, 8.33 years and 12.5 years in temperature data. Among these cycles, only 1 year cycle is distinguished from Gaussian white noise at 95% confidence level. The air temperature at LMS, Kyangjing reflects monotonic positive trend till 2006 but remains as nearly steady state around 3°C from the end of 2006. Similarly, the precipitation data is embedded with cycles of 6 months, 1 year, 2.08 years, 2.27 years and 8.33 years of which only the first three are statistically significant at 95% confidence level. The precipitation shows a mixed trend with decreasing pattern till mid 1990s, increasing pattern till mid 2000s and again decreasing pattern till 2012. One year cycle is dominant in both the time series data. The above results reflect that temperature and precipitation fluctuates on various time scales. The effect of the changes in temperature and precipitation has already been manifested in the form of melting glaciers in this region. The causes for these oscillations might be related to phenomenon like Quasi-biennial Oscillation (QBO), solar activity, El Nino, monsoon climate dynamics and other local characteristics of the basin.

International Journal of Educational Development, 2013

In developed countries, the evidence on the impact of school type on student performance is mixed... more In developed countries, the evidence on the impact of school type on student performance is mixed. Researchers are also interested in finding out the effect of private school competition on educational outcomes. The evidence on this for developed countries is mixed as well. What is the effect in developing countries? There are not sufficient studies for developing countries to reach one conclusion. Using data from the survey of the Ministry of Education, Nepal-2005 for School Leaving Certificate Exam (SLC), this dissertation attempts to seek answers to the above two issues for the case of Nepal. The first part of this study analyzes private and public school performance using OLS and logistic models. The study adopts the propensity score matching technique to account for the selection bias problem. The second part of this dissertation attempts to explore the impact of private school competition on public school performance using the number of private schools in the neighborhood as a continuous measure of competition. A binary measure of competition is also used where school is defined to face competition if there is more than one private school in the vicinity of the sample public school. However, in this analysis, there exists an identification problem because private school enrollment is likely to be correlated with public school performance. To address this problem, the study uses the existence of a motorable road within an hour's walking distance from the sample school as an instrument for number of private schools in the neighborhood. The results from the OLS and logistic estimation on the effect of school type on student performance show that public schools consistently have a negative relationship with student performance. On the impact of private school competition on public school performance, the OLS results show no significant relationship using both continuous and binary measures of competition. In contrast, the IV method indicates a positive and significant impact of private school competition on public school performance, which holds true for both types of measures of private school competition.

International Journal of Applied Behavioral Economics, 2013

This study explores the perceptions of workers on the influence of psychological capital on their... more This study explores the perceptions of workers on the influence of psychological capital on their earnings using qualitative data analysis. Workers from diverse socio-economic groups, cultures and occupations in New York City were interviewed using both individual interviews as well as focused groups to find out their viewpoints on psychological capital and its impact on their earnings. The analysis of this paper suggests that workers perceive psychological capital to play a meaningful role in influencing their earnings. In particular, the results indicate that psychological capital workers perceive to be important for their earnings are self-confidence, motivation, positive attitude, ambition and perseverance.

Journal of Craniofacial Surgery, 2012

Background: Class II skeletal malocclusion due to mandibular deficiency is considered a risk fact... more Background: Class II skeletal malocclusion due to mandibular deficiency is considered a risk factor for sleep disorders due to oropharyngeal airway deficiencies. In view of the above, a prospective interventional study was undertaken to evaluate upper airway dimensional changes and position of hyoid bone by comparing pretreatment and posttreatment lateral cephalograms. The objective also included the establishment of the ratio of mandibular advancement to increase in airway dimensions. Patients and Methods: Pretreatment and posttreatment lateral cephalograms of 20 adults (13 females and 7 males) with skeletal class II malocclusion treated by combined orthodontics and bilateral sagittal split ramus osteotomy was evaluated for changes in posterior airway space (PAS), superior airway space (SAS), minimum airway space (MAS), hyoid bone position (MP-H), effective mandibular length (Co-Gn), mandibular corpus length (Go-Pg), and pogonion position (N perpendicular-Pg). The cephalograms were manually traced by a single operator and the data analyzed using MINITAB 13.2 version software. Results: There was a statistically highly significant (P = 0.0001) increase in PAS, SAS, MP-H, Co-Gn, and Go-Pg. The mean ratio of mandibular advancement to increase PAS, SAS, and MAS was 1:0.35, 1:0.34, and 1:0.24, respectively. Hyoid bone moved superiorly and in an anterior direction by 2.1 T 2.8 mm and was found to be statistically highly significant (P = 0.0001). Conclusions: The study showed an overall increase in airway dimension and improvement in hyoid position. Thus, the procedure may be considered beneficial in reducing upper airway collapsibility and preventing sleep disorders due to oropharyngeal airway deficiencies in skeletal class II malocclusion.

International Journal of Otorhinolaryngology and Head and Neck Surgery, Nov 9, 2023

The presence of a normal airway and the proper functioning of its various components play a cruci... more The presence of a normal airway and the proper functioning of its various components play a crucial role in the growth and development of craniofacial structures. Various authors in their studies have quoted significant relationships between oro-pharyngeal airway dimensions and development of dentofacial and craniofacial structures. 1,2 Both hereditary and environmental factors contribute to the morphology of the human face and consequently, the airway. Environmental factors can have a significant impact on airway development and function such as rhinitis and asthma, environmental irritants and infections have often been associated with a vertical growth pattern along with obstruction of the upper and lower pharyngeal airways. Narrow pharyngeal airway is one of the ABSTRACT Background: Objective of the study was to determine linear and volumetric changes in pharyngeal airway dimensions in class III patients treated by different modalities of orthognathic surgery and to compare the results of different orthognathic surgical modalities, and determine the change at the position of the hyoid bone. Methods: Pre and Post-treatment lateral cephalogram of 53 class III adult patients who were treated by different modalities of orthognathic surgery studied to assess the changes in pharyngeal airway dimensions and hyoid bone position after orthognathic surgery. 28 patients were treated with mandibular set back, and 25 patients were treated with Bijaw surgery. Lateral cephalogram records were taken before treatment (T1), after surgery (T2), the end of the fixed treatment (T3) and 1 year after debonding (T4). Results: Interception of both surgical modalities has significant impact on various skeletal and pharyngeal parameters i.e., BMeH (0.00), PNS (0.009), MPS (0.13), GOP (0.001), IPS (0.007), SAS (0.006), and MAS (0.00). OJ (overjet) and OB (overbite) was significant especially after time interval of one year. In Bijaw groups, PPST4 parameter was significantly increased (0.0000), SPST4 (0.000), GOP (0.000), EPS (0.000) and IPS parameter was significantly decreased (0.045). Significant difference was observed in T4 time interval in superior pharyngeal airway space, posterior airway space and middle airway space with (p<0.05). Conclusions: Pharyngeal airway is significantly altered following orthognathic surgery in class III patients and it depends on the type of surgical modality employed were Bijaw surgery has significant impact on oropharyngeal and hypopharyngeal airway space.

Journal of Insomnia and Sleep Disorders Severe mandibular hypoplasia sometime associated with sig... more Journal of Insomnia and Sleep Disorders Severe mandibular hypoplasia sometime associated with significant morbidity and mortality in infants and children due to compromised upper airway space airway. They may exhibit frequent episodes of oxygen desaturation, hypoxemia, hypercarbia, acidosis, persistent inspiratory stridor, severe sternal retraction, and poor feeding (secondary to airway compromise). Children with long-term airway obstruction exhibit failure to thrive, daytime sleepiness, hemodynamic derangements, developmental disabilities, malnutrition, increased pulmonary morbidity, and death [1].

International Journal of Otorhinolaryngology and Head and Neck Surgery, 2021

The purpose of this original case study was to present the efficiency of combined orthodontic and... more The purpose of this original case study was to present the efficiency of combined orthodontic and distraction osteogenesis (DO) in severe maxillary hypoplasia along with importance of tongue graft for closure of large residual palatal defect. DO has been successfully chosen in lengthening and widening the maxilla transversely to relieve anterior dental crowding and transverse discrepancies between the dental arches. A UCLP (unilateral cleft lip and palate), 15 year old male with the chief complaint of esthetic and functional problems because of skeletal class III malocclusion with anterior crossbite and severe midline shift was taken up for this modality of treatment. Considering the severity of malocclusion, combined orthodontic and DO treatment was considered adequate which was likely less invasive and equally stable procedure. RED (rigid external distractor) was used for distraction after initial alignment followed by closure of residual large palatal defect with tongue graft. Re...

Oligodontia characterized by agenesis of more than six permanent teeth excluding third molars, is... more Oligodontia characterized by agenesis of more than six permanent teeth excluding third molars, is commonly associated with syndromes and rarely presents itself as an independent entity. Although its association with various syndromes has been studied extensively with great interest, its association with polycystic ovary syndrome (PCOS) has been rarely documented. PCOS is a condition manifested by pubertal hirsutism, menstrual irregularities and enlarged cystic ovaries. This case report presents multidisciplinary management of a case of oligodontia & PCOS with agenesis of twenty three permanent teeth. Oligodontia with PCOS is an extremely rare entity and has been presented only once in literature review. As oligodontia, PCOS has also shown genetic predisposition and several genes such as CYp11A, insulin gene, and follistatin gene have been identified but none has proven linkage to conclusive significant evidence. This occurrence of oligodontia with PCOS postulates a theory of genetic...