This study investigates the structural challenges and reform needs of Nepal’s public pension system, with a particular focus on government schoolteachers. Drawing on pensioner data from fiscal year 2011–12 to 2023–24, the study identifies a sharp increase in the number of retirees, with the teaching sector exhibiting the highest average annual growth rate among all public sectors. This trend is closely linked to rising life expectancy, which correlates strongly (R=0.8568) with the growing number of pensioners. The delayed and uneven implementation of the contribution-based Pension Fund Act, 2075, has created legal ambiguity, especially for transitional appointees, and contributed to administrative inefficiencies and inter-agency coordination gaps. The lack of actuarial valuation further impedes evidence-based pension planning. In response, the study proposes a Mixed Pension Scheme that preserves non-contributory benefits for legacy teachers while introducing a contributory model for new entrants. Comparative analysis of SAARC countries, including India, Bangladesh, Bhutan, and Pakistan, supports the feasibility of phased, multi-pillar reforms. The study recommends regular actuarial assessments and designates the Employees Provident Fund as the most capable institution to manage teacher pensions, due to its administrative experience and financial credibility. The findings call for urgent, balanced reform to ensure sustainability, equity, and fiscal resilience.

Background: To identify patients at the highest risk for acute care utilization, health care systems have developed “hot spotter” programs. Homelessness is a robust social determinant of acute care utilization. Objectives: To describe the prevalence, patterns, and correlates of meeting criteria for a hot spotter program among housing-insecure adults in the US Veterans Health Administration (VHA). Research Design: Among veterans on the VHA Homeless Registry in Fiscal Years 2018–2022 (N=1,469,893), we identified those who met criteria for a Hot Spotter Report [ie, ≥1 hospital admissions and/or ≥2 emergency department (ED) visits in at least one quarter], described their patterns of acute care use, and examined differences in patient characteristics and outpatient service use between those who met report criteria in multiple quarters (vs. one). Results: Thirty percent (N=446,974) met report criteria in at least one quarter; most (56%) met report criteria in ≥2 quarters. Diagnoses of depression (58%) and/or a substance use disorder (51%) were common; however, the rate of hospitalization in an acute medical setting during the cohort period was twice that of being hospitalized in an acute mental health setting (50% vs. 25%). Being on the Hot Spotter Report in multiple quarters (vs. one) was associated with more chronic conditions (M=5.08 vs. 3.29), higher rates of suicidality (23.7% vs. 11.7%), and higher likelihood of all types of outpatient care ( P <0.0001). Conclusions: Given rates of chronic medical conditions and medical hospitalizations, it may behoove hot spotter programs to increase care coordination with medical respite programs to support patients in the postacute phase.

Objective To compare characteristics of rural veterans using VA brick and mortar (B&M), VA video‐to‐home telehealth (VA VTH), or VA community care network (CCN) for mental healthcare. Methods Rural VA patients that received at least 2 days of mental healthcare in fiscal year 2023 were classified as B&M, VA VTH, or CCN patients based on where they received the plurality of care. Bivariate differences in characteristics were determined via SMDs. Adjusted differences in characteristics were estimated using nested dichotomies logistic regression and reported as odds ratios (factor) or predicted probabilities (continuous). Results The analyses demonstrate that rural VA patients ( N = 177,514) using VA VTH or CCN were younger (OR = 0.77), more often female (OR = 1.64), Asian/Pacific Islander (OR = 1.27), had higher psychiatric comorbidity (OR = 1.20), had greater drive times (OR = 1.15), and lived in counties with higher county broadband coverage (OR = 1.06) compared to those using B&M VA care. Among those using VA VTH or CCN, rural black patients were less likely to use CCN (OR = 0.68). Conclusions Off‐site modes of care like CCN and VA VTH have the potential to address long wait‐ and drive‐times for in‐person VA care that are especially pertinent for rural patients. As such, it is important to ensure that these care alternatives are being utilized by all strata of rural VA patients, and to identify differences in their use. Relevance to Clinical Practice This large retrospective cohort study provides clinicians insight into the characteristics of veterans using alternatives to on‐site mental healthcare, allowing them to be better prepared to provide care to patients using those modalities.

Malaria remains a major public health concern in Ethiopia, including urban settings such as Jimma Town. Despite long-standing interventions, progress toward elimination targets has been inconsistent. Regular assessment of surveillance system performance is crucial for early detection, timely reporting, and effective response. To evaluate the performance of the malaria surveillance system and examine malaria trends in Jimma Town, Southwest Ethiopia, from 2012 to 2016 Ethiopian Fiscal Years (EFY), focusing on core system attributes and factors associated with recent increases in malaria cases. A facility-based cross-sectional study using a mixed-method design was conducted from October 14 to 31, 2024. Quantitative data were collected from malaria registers and the District Health Information System version 2 (DHIS2), while qualitative data were obtained through interviews with surveillance focal persons. A total of 10 health facilities (public and private) were assessed. Descriptive analysis summarized malaria trends, and thematic analysis examined system performance and challenges. Eight key informants participated, half with more than five years of experience. All public facilities adhered to national guidelines, whereas reporting consistency was lower among private clinics. The surveillance system was generally simple and flexible but limited by incomplete reporting, weak feedback mechanisms, and inadequate private-sector engagement. Malaria cases rose dramatically from 432 in 2012 to 11,824 in 2016 EFY, with Plasmodium falciparum accounting for 56.4% of infections. The largest increases occurred among school-aged children and adults, and the contribution of private facilities to case reporting grew from 47% to 66%. Although functional, the malaria surveillance system in Jimma Town is constrained by data incompleteness, limited feedback, and poor integration of private providers. Major limitations include reliance on routine data and a small qualitative sample size. Strengthening data quality assurance, enhancing routine analysis and feedback, and improving collaboration with private facilities are essential to advance Ethiopia's malaria elimination efforts.

In November 2012, the U.S. Marine Corps announced a policy change to the female Physical Fitness Test (PFT), replacing the flexed arm hang with pull-ups. This change, which became effective on January 1, 2017, aimed to standardize fitness requirements and facilitate gender integration into combat roles. Musculoskeletal injuries (MSKIs) are a leading cause of medical encounters and non-deployability among service members. Upper extremity (UE) injuries are particularly relevant given the physical demands of pull-ups. A retrospective open cohort study was conducted using data from the Military Health System Data Repository (MDR) from fiscal years 2010-2023. International Classification of Diseases (ICD)-9 and ICD-10 codes identified UE injuries in female Marines. Single and multigroup interrupted time series analyses were used to assess changes in injury rates surrounding the PFT policy change. A total of 49,910 female Marines were included in this study, of whom 6,125 (12.3%) had at least one UE MSKI. The overall trend of UE MSKIs decreased both before and after the PFT policy change. The immediate change post-policy showed no significant changes in UE MSKIs at the time of intervention. However, specific groups experienced significant decreases in MSKI rates at the intervention: Marines ages 20-29 years, those of Black race, junior enlisted ranks, and those with overweight body mass index. The findings highlight positive impacts of the PFT policy change on reducing MSKI rates among specific subgroups of female Marines. These results inform future policy adjustments aimed at mitigating injury risks while promoting operational readiness across diverse demographics.

BackgroundUnderstanding the burden of various skin diseases can help guide funding allocation for skin disease research. A 2015 cross-sectional study found a partial correlation between US skin disease burden according to the 2010 Global Burden of Disease (GBD) study and National Institutes of Health (NIH) funding in 2012-2013.ObjectiveThis study aims to identify trends, correlations, and disparities in US skin disease burden and NIH research funding allocation using the latest data from the GBD 2021 and NIH funding data from the fiscal years 2021-2022.MethodsA cross-sectional analysis was conducted to compare the disability-adjusted life years for 15 skin conditions from the GBD 2021 with NIH funding for these conditions in 2021-2022. Data were sourced from the GBD Results tool and the NIH RePORTER database.ResultsNIH funding for skin disease research and US skin disease burden according to the GBD 2021 were partially correlated, with several outliers. Malignant skin melanoma and pruritus were relatively overfunded, while psoriasis and urticaria were relatively underfunded.ConclusionsDisease burden is just one of the many important factors that must be considered when allocating resources, including funding to encourage research efforts to improve patient outcomes and positively impact public health.

Road traffic injuries are a major global public health concern and a leading cause of death and disability among children and adolescents, particularly those aged five to fourteen years who are more vulnerable due to increased exposure to road hazards and limited understanding of traffic safety. This qualitative case study aimed to explore the experiences and perceptions of school children injured in road traffic accidents and to examine their health-seeking behaviors following the incidents. The study was conducted in Butwal Sub-Metropolitan City, Rupandehi District, Nepal, focusing on cases reported during the fiscal year 2078/2079. Participants included five injured school children and their parents. Data were collected through in-depth interviews with children, semi-structured interviews with parents and the participants’ hospital treatment documents and they were analyzed thematically using Flyvbjerg (2011) seven-step framework. Findings exposed critical gaps in the quality of emergency care in government hospitals, such as inadequate staff training and lack of child friendly environments. In contrast, private hospitals were perceived as offering better care due to superior facilities and resource availability, despite higher costs. The study underlines the crucial need to strengthen emergency healthcare services, improve pre-hospital care, ensure equitable access to treatment and foster public private collaboration.

Development and implementation of standardized study enrollment metrics for a VA healthcare system clinical research consortium: A 6-year follow-up assessment.

Since the fiscal year 2022, `Support Program for Life Science and Drug Discovery Research (BINDS Phase II)', funded by the Japan Agency for Medical Research and Development (AMED), has been supporting structural analysis research in Japan, promoting the further development of various advanced structural analysis technologies. The BINDS project aims to offer more timely and cutting-edge support by establishing a new macromolecular crystallography endstation (MX-ES) at NanoTerasu, Japan's first fourth-generation synchrotron-radiation facility. MX-ES has been equipped with microbeam focusing optics and a state-of-the-art measurement system for fully automated, high-throughput data collection from cooled crystals. Commissioning and initial experiments have been completed. User operations are expected to begin in the second half of the fiscal year 2025.

Status of the Generative AI Implementation Technology Study Group’s Initiatives in Fiscal Year 2025

Increase in the age of onset of pediatric acute otitis media after the Covid-19 pandemic: A study at a primary emergency medical center.

Prevalence of HPV vaccine-associated symptoms in unvaccinated Japanese adolescents: A descriptive study from the VENUS study database.

The Three-fer: How Biosimilars Reduce Cost, Expand Access, and Improve Margin.

This empirical study investigates the determinants of lending interest rates in Nepalese commercial banks, utilizing panel data spanning fiscal years 2073/74 to 2080/81. Employing multiple linear regression and correlation analyses, the research examines the influence of key financial variables—namely, interest rate on deposits, impairment charge rate, operating expenses, and non-operating expenses—alongside macroeconomic indicators such as inflation and economic growth. The findings reveal that the interest rate on deposits exerts a statistically significant positive effect on lending rates, indicating its central role in banks’ pricing strategies. Inflation also demonstrates an important moderating influence, suggesting that lending rates are responsive to macroeconomic price dynamics. Conversely, impairment charges, operating and non-operating expenses, and economic growth did not exhibit significant linear associations. The financial model accounted for 92.6% of the variance in lending rates, reflecting high explanatory power. These results offer valuable insights into the cost-driven nature of interest rate formation and the sensitivity of lending behavior to inflation, with implications for monetary policy and financial regulation in emerging economies.

Introduction: Road traffic accidents are a major public health concern in Nepal, causing significant morbidity and mortality. The study goal was to determine the trends of road traffic injuries in Nepal from Fiscal Years 2020/21 to 2024/25 (mid-July 2020 – mid-July 2025). Methods: A descriptive retrospective study was conducted to analyze de-identified and pooled road traffic accident records from Nepal, following receipt of ethical clearance from the Nepal Health Research Council (ERB no. 607_2025). Data was analyzed using Microsoft Excel 2019. Results: The findings show that road traffic accidents have shown an apparent spike from FY 2020/21 to 2024/25, with both vehicle collisions and accident incidences ascended significantly. Reported vehicle crashes rose from 33135 in FY 2020/21 to 43165 in FY 2024/25, while total RTAs increased from 20640 to 28692 over the same period. RTAs surged in six provinces of Nepal. Two-wheelers, four-wheelers, and public transport vehicles accounted for the majority of incidents. Speeding 46398 (44.08%), mechanical failure 1173 (39.14%), potholes 685 (21.69%), pedestrian road crossings 5523 (79.55%), and unfavourable weather conditions like fog and mist 122 (26.23%) were major contributing factors. Although injuries increased significantly, fatality rates did not rise same proportion. Conclusions: The results show that road traffic accidents are becoming more common in Nepal, especially involving motorbikes, four-wheelers, and public vehicles. Reducing accident rates and their effects may require increased road safety enforcement, better infrastructure, and awareness-raising initiatives.

Importance Emergency department (ED) visits for people with dementia often involve care (including the admission or discharge decision) with lasting effects on quality of life. Home time—a claims-based measure of days alive and outside of institutional care—provides a patient-centered way to assess downstream outcomes of ED care in this population. Objective To examine variations in home time following an ED visit by patient, facility, and visit characteristics among veterans with dementia. Design, Setting, and Participants This national retrospective cohort study used US Department of Veterans Affairs (VA) health care system data sources. Participants were veterans aged 65 to 110 years with dementia with an eligible Veterans Health Administration ED visit in fiscal years 2017 (October 1, 2016, through September 30, 2017) and/or 2018 (October 1, 2017, through September 30, 2018). Data were analyzed from May 1, 2024, to May 15, 2025. Exposures Patient, ED facility, and ED visit factors. Main Outcomes and Measures Home time, operationalized for modeling as days not at home in the 180 days after the index ED visit. Associations between patient, ED facility, and ED visit characteristics and home time were assessed using a negative binomial model. Results The study included 51 707 veterans with dementia (mean [SD] age, 79.9 [8.59] years; 97.6% male; 52.2% married). The mean (SD) number of days not at home within 180 days was 21.7 (34.5). Of the total cohort, 4.5% never returned home in the 180 days after their ED visit, while 18.2% had all subsequent days at home. ED admission (vs discharge) disposition was the factor associated with the largest increase in days not at home (rate ratio [RR], 3.18; 95% CI, 3.08-3.29). Patient factors associated with more days not at home included very high frailty (RR, 1.27; 95% CI, 1.21-1.33), unhoused status (RR, 1.50; 95% CI, 1.39-1.63), unmarried status (never married: RR, 1.24 [95% CI, 1.16-1.32]; divorced, separated, or widowed: RR, 1.24 [95% CI, 1.20-1.28]), and depression (RR, 1.13; 95% CI, 1.09-1.17). Conclusions and Relevance The findings of this cohort study suggest that home time offers a patient-centered measure of post-ED outcomes for individuals with dementia. Future work should refine its application, particularly regarding the ED disposition decision, to better evaluate the long-term impact of ED care decisions.

Nepal has been experiencing an unprecedented scale of youth migration over the last decade. For many households, sending a young family member abroad for work or study has become a normal survival strategy rather than an exception. This situation has created a serious national debate: is Nepal losing its most productive human resources in the form of brain drain, or can migration still contribute positively to development as brain gain? Using secondary data from government reports, Nepal Rastra Bank publications, census data, international organizations, and existing academic studies, this paper examines the economic, social, and institutional impacts of youth migration on Nepal’s development process. Recent data indicate that more than 2.5 million Nepalis have migrated abroad during the last three years alone, while remittance inflows reached approximately NPR 1.723 trillion in fiscal year 2024/25, accounting for nearly 28.6 percent of GDP (Nepal Rastra Bank [NRB], 2025). Although remittances have played a critical role in reducing poverty, stabilizing foreign exchange reserves, and supporting household consumption, Nepal is increasingly facing labor shortages in agriculture, health, education, and technical fields. Demographic imbalance, declining productivity, weak innovation capacity, and low productive use of remittance raise serious concerns about the sustainability of remittance-led growth.This paper argues that, in the absence of strategic policies focused on domestic employment generation, quality education, skill retention, and structured diaspora engagement, youth migration in Nepal is more likely to remain a net brain drain. However, with appropriate institutional reforms and long-term planning, migration can still be transformed into brain gain. The paper concludes with policy-oriented recommendations aimed at aligning migration with Nepal’s broader development goals.

In Balochistan the government schools’ budget is devolved and allocated based on students' enrollment at the gross-root levels. The high and higher secondary schools administer the budget and distribute it among the middle and primary schools in the close vicinity, as fixed in the clustering System. The system is identified in term as education cluster budget. It Ensures transparency in the utilization of the budget. The education officers in all districts are made responsible for evaluating the efficacy and transparent utilization of this budget. The process is called an internal audit. The present study was carried out to evaluate the utilization of the cluster budget and identify the flaws in utilizing this budget. For this purpose, the evaluation research method was adopted to scrutinize and asses the fair consumption of allocated budget. The data was gathered from the principals and head teachers of the high and higher secondary schools in the district Quetta. The district has 138 high and higher secondary schools; however, due to time constraints this study was limited to collecting data from 57 schools. The findings outlined unsatisfactory conclusions in identifying governance, academic and procedural flaws. The schools’ heads were found involved in corrupt practices while showing fake bills, misuse of budget, weak documentation and no or weak delivery in many cases. The study categorized the results into three parts: satisfactory, non-satisfactory, and worst or corrupt, based on different indicators. Contextually, 10 schools were found to be satisfactory, 33 schools were in the category of non-satisfactory, and 14 schools were declared worst or corrupt and completely failed in fulfilling the required targets.

This study aims to analyze and compare the financial performance of PT HM Sampoerna Tbk, PT Gudang Garam Tbk, and PT Indonesian Tobacco Tbk during the 2021–2024 period using time series and cross-sectional approaches. The research employs a quantitative descriptive method based on secondary data obtained from audited annual financial statements published by the Indonesia Stock Exchange. Financial performance is measured using liquidity, activity, solvency, and profitability ratios. Time series analysis is applied to observe performance trends over four years, while cross-sectional analysis is used to compare company performance in the 2024 fiscal year. The results show that PT HM Sampoerna Tbk demonstrates the most balanced and stable financial performance, characterized by efficient asset utilization, strong solvency, and consistent profitability. PT Gudang Garam Tbk exhibits very strong liquidity and a conservative capital structure, but relatively lower operational efficiency and profitability. Meanwhile, PT Indonesian Tobacco Tbk shows higher profit potential accompanied by declining liquidity, increasing leverage, and greater financial risk. In conclusion, differences in company scale, operational efficiency, and financial strategy significantly influence financial sustainability in the Indonesian tobacco industry.

Nepal’s 2015 constitution introduced federalism as a mechanism to promote responsive and accountable local governance. Within this framework, the Local Government Institutional Self-Assessment, mandated by the Ministry of Federal Affairs and General Administration, functions as a key internal instrument enabling municipalities to evaluate their governance capacities, particularly accountability practices. This study investigates local government accountability through the Local Government Institutional Self-Assessment, mapping variations in performance across provinces and municipality categories, and critically assessing its effectiveness in advancing genuine accountability reforms. Employing secondary analysis of publicly available Local Government Institutional Self-Assessment reports from 2020 to 2024, the research examines how local governments document their accountability practices. A stratified sample of twenty-three municipalities comprising metropolitan, sub-metropolitan, municipal, and rural municipalities was selected based on initial reporting in fiscal year 2019/ 2020. Findings highlight notable disparities in accountability scores across provinces and municipality types, persistent deficiencies in grievance handling and audit implementation despite formal compliance, and a troubling disconnect between self-reported strengths and citizen dissatisfaction. The study concludes that the Local Government Institutional Self-Assessment, in its current design, risks perpetuating ritualistic compliance rather than fostering substantive accountability, particularly for marginalized communities. Policy recommendations emphasize revising the Local Government Institutional Self-Assessment indicators to better capture the quality of accountability practices, improving transparency in reporting, and strengthening the integration of self-assessment outcomes with targeted capacity-building initiatives.