Effectiveness of NGOs in mountainous solid waste management: A case study from Healing Himalayas in Rakchham, Himachal Pradesh, India.

Non-governmental organizations (NGOs) play a critical role in addressing solid waste management (SWM) challenges in remote mountain communities, including the ecologically fragile Himalayan region. This study evaluates the impact of Healing Himalayas, an NGO, in Rakchham village, Himachal Pradesh, India. The objectives were to evaluate the effectiveness of Healing Himalayas' decentralized SWM model in promoting stakeholder engagement and resource recovery, assess the role of collaborations between local authorities and the NGO in financing waste management practices, investigate the influence of tourism and seasonal variations on solid waste generation patterns and waste management practices in Rakchham, and material recovery facilities, followed by glass (36.7%), paper/cardboard (18.4%) and metal (4.1%). A fee-based system involving the local village council funded waste operations. Waste generation exhibited significant seasonal fluctuations, with tourism influxes driving increased volumes. Healing Himalayas' initiatives promoted community participation, with over 15 awareness workshops conducted. Key challenges included limited financial resources, inadequate infrastructure, lack of advanced treatment facilities and need for context-specific solutions like efficient wet waste management in cold climates. The study highlights Healing Himalayas' decentralized model's success in fostering stakeholder engagement, behavioural change and resource recovery. The findings inform effective strategies for NGO-led waste management initiatives tailored to remote Himalayan communities.

Empowering Nursing Students to Prevent Medication Error-Related Harms: A Step Toward Improving Patient Safety.

Aim: Existing gaps in nursing curriculum particularly related to medication management such as administration and monitoring increase the propensity of nurses to commit medication errors during clinical practice. The present training program was conducted with an aim to sensitize and educate undergraduate nursing students on medication errors' related aspects. Methods: The participants were students pursuing bachelors nursing degree course (second and third year). The training "Medication errors: Role of Nurse practitioners" comprised of blended teaching methods such as theme lectures, hands on training exercises, small group case­based learning, role plays, and nursing officer's practical experiences. The participants' knowledge and perception about medication errors were assessed at baseline (pre-intervention phase) and 1 week after program (post-intervention phase) with the help of a structured self-administered questionnaire in English language. Results: A total of 110 nursing students participated in the program. Post program there was a consistent increase in the number of correct responses to all knowledge-based questions with a significant improvement in knowledge scores from baseline [Baseline: (mean ± SD) 12.62 ± 2.33; Post-training: 18.52 ± 2.22; P < .001]. There was a positive change in the perception about medication errors among students. The participants rated the overall quality of program as excellent [66 (60%)] or very good [40 (36.4%)]. More than 90% agreed on its applicability in their future practice. Conclusions: The training was quite successful in educating nursing students on medication errors. There is a constant need to educate nurses and other healthcare providers including doctors and pharmacists on medication safety related aspects with an ultimate goal to improve patient safety.

An educational program on antimicrobial resistance and stewardship for staff nurses in a public tertiary care hospital in India.

BACKGROUND: Nurses, the largest group among healthcare professionals, hold a pivotal position to positively influence antimicrobial management by virtue of being in constant touch with patients and their widespread engagement in multiple activities relating to antimicrobial use. However, the existing gap in nursing curriculum particularly in areas related to antimicrobial resistance and optimal use of these agents limits the clinical application of nurses' skills and pose barrier to their contribution towards achieving desirable outcomes in patient care. This training program was conducted to increase the nurses' awareness on antimicrobial resistance (AMR) and sensitize them on their role in optimal antimicrobial management and stewardship activities. METHODS: Training comprised of 4 modules focussing on topics like key concepts on antimicrobials, AMR, infection prevention and control, antibiotic allergy, optimal use of antibiotics and antimicrobial stewardship (AS). The participants' knowledge at baseline and 1 week after program were assessed. RESULTS AND CONCLUSIONS: 190 nurses participated in the program. Post program there was a consistent increase in the number of correct responses to all knowledge-based questions pertaining to 4 modules. A significant improvement in knowledge scores for all modules from baseline was also seen. The participants rated the overall quality of program as very good and agreed on its applicability in their practice. The training program was quite successful in educating nurses on critical issues related to AMR and AS. Nurses need to be constantly trained and sensitized for their potential contributions in the field of AMR and stewardship.

Dimensional accuracy of two rubber base impression materials as a function of spacer design and techniques in custom trays for fixed partial dentures.

BACKGROUND: A prostheses can't be better than the cast over which it has been fabricated. To make accurate casts, accurate impressions are mandatory. To get an accurate and dimensionally stable impression, various techniques and materials have been advocated. This study compares the most commonly used techniques and materials for dimensional accuracy. Two types of spacers were designed to compare the addition silicon and polyether and their techniques. METHODS: A metal die was used to make the impressions. A total of 60 impressions were made using multiple mix and monophasic techniques for addition silicon and polyether in custom trays. A travelling microscope was used to measure the dimensional accuracy of die stone casts retrieved from impressions. RESULTS: The results were compared using paired t test and SPSS software. The study was highly significant (p < 0.001). The polyether was more accurate than the addition silicon and spacer design I (adapted to the edentulous area) was more accurate than the design II (spacer over the abutments, not adapted to edentulous area). The multiple mix technique was more accurate than the monophasic for addition silicon. CONCLUSION: The combination of multiple mix technique with spacer design I for addition silicon gave the best accurate results.

Clinical Profile and Response to Treatment with Pegylated Interferon α 2b and Ribavirin in Chronic Hepatitis C-A Reappraisal from a Tertiary Care Center in Northern India.

AIM: To assess the clinical profile of 80 chronic hepatitis C patients in a tertiary health care center in Northern India and also to study the efficacy and tolerability of pegylated interferon (Peg-IFN) α 2b and ribavirin therapy in a cohort of chronic hepatitis C patients. METHODS: Thirty subjects with chronic hepatitis C (CH-C) with genotypes 2 and 3 received Peg-IFN α 2b 1.5 µg/kg subcutaneously weekly plus daily ribavirin 800 mg for 24 weeks .Subjects with genotype 1 infection received therapy for 48 weeks with ribavirin 1000 mg/day and Peg-IFN α 2b dose remained the same. The primary end point was the sustained viral response (SVR). Drug dosage was modified or temporarily discontinued if anemia or bone marrow suppression developed. RESULTS: The clinical profile of chronic hepatitis C infected patients showed decompensated cirrhosis in the more elderly patients. Genotype 3 was the commonest genotype and was seen in 21 (70%) patients. The mean baseline HCV RNA was high. SVR was achieved less commonly with genotype 1 than with genotype 2/3. Patients who became negative for HCV RNA at 4-weeks (rapid virological response or RVR) and 12 weeks (early virological response or EVR) of treatment showed significantly higher sustained virological response (SVR) rates. Similarly, patients who showed normalization of ALT level at 4-weeks and 12-weeks of treatment showed significant high rate of SVR. Overall treatment was well tolerated. CONCLUSION: In our region, CHC subjects have high viral load and genotype 3 being the most common. Treatment with Peg-IFN α 2b and ribavirin is effective and well tolerated. Genotype 1 was more resistant to the treatment. Patients who achieved RVR and EVR are more likely to achieve SVR. Although the numbers of patients in this study was small, considering the paucity of data of treatment from India, the data is relevant.

Correlation of age and hepatitis B virus DNA levels with histological activity in HBeAg negative chronic hepatitis B patients.

BACKGROUND: The relationship between age and serum HBV DNA levels with histological activity in chronic hepatitis B inactive carriers is still unclear. We evaluated the correlation between age and hepatitis B viral DNA levels with Metavir score in inactive chronic HBV carriers. METHODS: 50 patients (30 males and 20 females) were enrolled in the study after informed consent. Their blood samples were taken for routine investigations and specific tests for the study. Serum HBV DNA levels were quantified by real-time PCR. Metavir score was used for histologic grading. RESULTS: A1F0, A1F1, A1F2, A2F2 and A2F3 metavir scores were found in 41 (82%), 4 (8%), 1 (2%), 3 (6%), and 1 (2%) patients, respectively. There was significant correlation between age > 40 years and Metavir scores (p < 0.001). However there was no significant correlation between HBV DNA level with Metavir score (p = 0.074). CONCLUSION: Inactive carriers of 40 years of age or more should undergo liver biopsy to look for presence of significant histological findings despite having low HBV DNA level and normal SGPT level.

Acute pancreatitis associated with amoebic liver abscess.

We present a rare case of acute pancreatitis in a 50-year-old man with amoebic liver abscess. He had a right lobe liver abscess along with markedly elevated serum lipase and amylase levels and edematous pancreas. Liver abscess was aspirated. The patient was managed conservatively with antibiotics and improved without any complications. Acute pancreatitis associated with ALA is not reported in the literature till date.