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Energy Resources (DERs) are being integrated into the power market by customers rather than large scale energy suppliers, thereby slowly transforming the centralized, unidirectional market to a decentralized, bidirectional market and transitioning customers into prosumers. Various system architectures are used in the real field to coordinate the energy distribution in the micro/ mini-grids integrated with DERs, all of which have their strengths, weaknesses and challenges. Peer-to-peer (P2P) is an emerging architecture in the field of electrical energy trading and Distributed Generation (DG) management that can be applied in local energy markets. This paper focuses on P2P energy trading, with an in-depth discussion on its various operating algorithms, their principles, characteristics, features and scope through state of art review on P2P. Furthermore, the energy system of Nepal is used as a case study in this paper, and the micro/mini-grids of Nepal and their associated challenges, constraints and opportunities for improvement are discussed. Finally, an energy trading model is proposed to address the problems occurring in the specific case of Nepalese energy market.

Background Accreditation of curriculum by students may be useful in further modification of teaching and learning methods in medical colleges of any country specially Nepal. Course curriculum of medical sciences is made by learned professors of Universities, politicians and the government officers without consulting the students for whom it is made. In Nepal, Medical education is an experimental integrated teaching of four and half years for MBBS degree. Until now it has not been assessed as to what type of Doctors we are producing. This paper aims on the objective to find out whether integrated teaching or classical medical studies produce better doctors.   Methods The present study was done to assess the teaching, learning and evaluation procedures adopted in Nepal Medical College, Kathmandu by getting feedback from students of 4th (Basic Sciences), 5th-7th semesters and feedback was also taken from a few final year students (Clinical Sciences). A total of nearly two hundred students from this institution participated in this study. A multi-graded questionnaire was prepared and a pilot study of 20 students was done and the results were discussed among the authors to modify the questionnaire. This modified questionnaire was used in the main study. The same questionnaire was used for eliciting feedback from clinical students. The present study was undertaken from August 2008-January 2009. Results Out of 200 medical students, the mean age was found to be 19.4 ± 3 years SD. In gender distribution, male students (61%) were higher than female students (39%). Most of the medical students (70%) wanted to become doctor, to become rich and famous, 90% wanted to go to US (Massive brain drain). 90% of the students perceived that Anatomy is the most interesting and most relevant basic science subject for clinical studies and in Anatomy theory hours of teaching is to be increased (60%). Community Medicine was the most uninteresting subject of Basic sciences and if they are assured of attendance which subject they would not like to attend community medicine classes. 85% wanted that Pharmacology should be reduced in first four semesters and should be extended to seventh semester like Community Medicine. The best teaching method is Chalk and Board Method (60%) and followed by LCD slides (20%). Conclusion: Overall the results were alarming and may be taken up seriously by the policy makers. They can bring about amendments in course curriculum of universities in future.Keywords: Medical Education; Under-graduate; Post- Graduate; Nepal Medical College. DOI: http://dx.doi.org/10.3126/nje.v1i3.5575 Nepal Journal of Epidemiology 2011;1(3) 95-100

The evaluation of the introduction of NOACs should consider safety, budget concerns and the quality of oral anticoagulation care achieved by each country. Prospective registries will be important in developing countries to better elucidate the comparative safety, efficacy and cost-effectiveness of NOACs and VKAs as NOACs are introduced into practice.

*Objective: To study the impact of educational intervention on the pattern and incidence of potential drug-drug interactions (DDIs). Method: All patients admitted to Internal Medicine wards of Manipal Teaching Hospital during the study period were included. Patient details were collected using a patient profile form and the datum from the filled forms was analyzed using Micromedex electronic database. An intervention was carried out through a presentation during clinical meeting and personal discussion. The target groups for the intervention included doctors and the nurses. Results: Altogether 435 patients during preintervention and 445 during postintervention were studied. The incidence of potential DDIs was 53% (preintervention) and 41% (postintervention) [chi-square =11.27, p=0.001]. The average number of drugs per patient was 8.53 (pre-intervention) and 7.32 (post-intervention) [t=3.493, p=0.001]. Sixtyfour percent of the potential DDIs were of 'Moderate' type and 58% had a 'Delayed' onset in both the phases. Seventy percent of the potential DDIs during the pre-intervention phase and 61% during post-intervention phase had a 'Good' documentation status. Pharmacokinetic mechanism accounted for 45% of the potential DDIs during preintervention and 36% in the post-intervention phase. Cardiovascular drugs accounted for 36% of the potential DDIs during pre-intervention and 33.2% during post-intervention phase. Furosemide was the high risk drug responsible for DDIs in both phases. The most common potential DDIs observed were between amlodipine and atenolol (4.82%) (preintervention) and frusemide and aspirin (5.20%) (postintervention). Conclusion: There was an association between potential DDIs and age, sex, and polypharmacy. IMPACTO DE UNA INTERVENCION EDUCATIVA EN EL ESQUEMA E INCIDENCIAS DE INTERACCIONES MEDICAMENTOSAS POTENCIALES EN NEPAL RESUMENObjetivo: Estudiar el impacto de una intervención educativa en el esquema y la incidencia de las interacciones medicamentosas potenciales (DDI). Método: Se incluyó a todos los pacientes que visitaron el servicio de medicina interna del Hospital Universitario de Manipal. Los detalles de los pacientes se recogieron utilizando un formulario de perfil de paciente y los datos fueron analizados utilizando la base de datos electrónica Micromedex. Se realizó una intervención mediante una reunión clínica y discusión personal. El grupo diana eran los médicos y los enfermeros. Resultados: Se estudiaron 435 pacientes durante la pre-intervención y 445 durante la post-intervención. Las incidencia de DDI potenciales fue del 53% (pre-intervención) y 41% (post-intervención) [chi cuadrado=11,27, p=0,001]. La media de medicamentos por paciente fue de 8,53 (preintervención) y 7,32 (post-intervención) [t=3,493, p=0,001]. El 64% de las DDI potenciales eran de tipo 'Moderadas' y el 58% tenía una iniciación 'Retrasada' en ambas fases. El 70% de las DDI potenciales durante la fase de pre-intervención y el 61% en la post-intervención tenían un estado de documentación 'Bueno'. Mecanismo...