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Hipertensi menjadi masalah utama bagi masyarakat di Indonesia dengan prevalensi mencapai 32,2%. Berbagai jenis terapi pengobatan sudah banyak direkomendasikan salah satu yang direkomendasikan dari JNC VIII adalah penggunaan kombinasi antihipertensi konvensional. Kementerian kesehatan melalui B2P2TOOT juga berhasil memproduksi jamu antihipertensi tersaintifikasi yang ditujukan sebagai terapi komplementer. Saat ini masalah efektivitas dalam mencapai target tekanan darah masih menjadi masalah untuk terapi antihipertensi konvensional maupun jamu saintifik. Selain itu besarnya biaya yang dikeluarkan untuk masing-masing terapi juga menjadi pertimbangan bagi pasien dalam menentukan jenis terapi yang akan dipilih. Berdasarkan permasalah tersebut, makan akan di teliti cost effectiveness analysis antara jamu saintifik antihipertensi dengan kombinasi antihipertensi konvensional. Rancangan penelitian yang digunakan yaitu observasional analitik dan analisis data menggunakan metode Incremental Cost Effectiveness Ratio (ICER) dan diinterpretasikan menggunakan Cost Effectiveness Plane (CEP). Pengambilan data biaya menggunkan perspektif provider sebagai penyedia layanan kesehatan. Responden sebanyak 44 pasien, terdiri dari 18 pasien dengan terapi kombinasi antihipertensi konvensional di Puskemas Kalibakung, dan 26 pasien dengan terapi jamu saintifik antihipertensi di Wisata Kesehatan Jamu Kalibakung. Hasil persentase efektivitas keberhasilan terapi kombinasi antihipertensi konvensional mencapai 47%, sedangkan persentase efektivitas keberhasilan terapi jamu saintifik antihipertensi mencapai 53,8%. Total biaya rata rata per pasien untuk terapi kombinasi antihipertensi konvensional sebanyak Rp 115.561, dan untuk terapi jamu saintifik antihipertensi sebanyak Rp 102.138. Data tersebut kemudian dianalsis dengan ICER dan didapatkan nilai ICER Rp -2.029/pasien. Interpretasi nilai ICER menggunakan CEP menyimpulkan bahwa terapi jamu saintifik antihipertensi lebih cost effective dibandingkan terapi kombinasi antihipertensi konvensional karena nilai ICER berada di area SouthEast.

Abstract The 2023 monkeypox (mpox) epidemic was caused by a subclade IIb descendant of a monkeypox virus (MPXV) lineage traced back to Nigeria in 1971. Person-to-person transmission appears higher than for clade I or subclade IIa MPXV, possibly caused by genomic changes in subclade IIb MPXV. Key genomic changes could occur in the genome’s low-complexity regions (LCRs), which are challenging to sequence and are often dismissed as uninformative. Here, using a combination of highly sensitive techniques, we determine a high-quality MPXV genome sequence of a representative of the current epidemic with LCRs resolved at unprecedented accuracy. This reveals significant variation in short tandem repeats within LCRs. We demonstrate that LCR entropy in the MPXV genome is significantly higher than that of single-nucleotide polymorphisms (SNPs) and that LCRs are not randomly distributed. In silico analyses indicate that expression, translation, stability, or function of MPXV orthologous poxvirus genes (OPGs), including OPG153, OPG204, and OPG208, could be affected in a manner consistent with the established “genomic accordion” evolutionary strategies of orthopoxviruses. We posit that genomic studies focusing on phenotypic MPXV differences should consider LCR variability.

The study of the natural abundance of nitrogen-stable isotopes is an aspect of viticulture research that has received limited attention. While stable isotopes of carbon, oxygen and hydrogen have received significant attention, nitrogen isotope ratio (δ15N) remains a less studied yet potentially informative parameter. This paper explores the implications of δ15N measurements in grapevines, shedding light on its utility as an indicator for nitrogen sources, plant water status, and within-field variability. The study examines the influence of nitrogen sources, dose, and sampling organs on δ15N values, revealing distinct trends in petioles, berries, and seeds. Organic fertilisers led to higher δ15N values compared to inorganic sources, while increasing nitrogen doses exhibited a much weaker effect on δ15N. Moreover, δ15N values vary spatially within vineyards, associating with its topography and potential soil composition, soil management and water availability. Our results highlight the importance of considering δ15N in viticulture, suggesting its integration with δ13C for comprehensive insights into nitrogen cycling and soil management practices. The findings advocate for further research to harness the full potential of δ15N as a valuable tool in viticultural studies.

Inventory control is one of the key areas of research in logistics. Using the SCOPUS database, we have processed 9,829 articles on inventory control using triangulation of statistical methods and machine learning. We have proven the usefulness of the proposed statistical method and Graph Attention Network (GAT) architecture for determining trend-setting keywords in inventory control research. We have demonstrated the changes in the research conducted between 1950 and 2021 by presenting the evolution of keywords in articles. A novelty of our research is the applied approach to bibliometric analysis using unsupervised deep learning. It allows to identify the keywords that determined the high citation rate of the article. The theoretical framework for the intellectual structure of research proposed in the studies on inventory control is general and can be applied to any area of knowledge.

Background: Little is known about the incidence of influenza among admissions to the cardiac intensive care unit (C-ICU), accuracy of clinical suspicion, and influenza vaccination uptake. We evaluated the incidence of influenza at C-ICU admission during the influenza season, potential underdiagnosis, and vaccination uptake. Methods: Prospective study at five C-ICUs during the 2017-2020 influenza seasons. A nasopharyngeal swab was collected at admission from patients who consented (n = 788). Testing was with Xpert®XpressFlu/RSV. Results: Influenza was detected in 43 patients (5.5%) (40 FluA; 3 FluB) and clinically suspected in 27 (62.8%). Compared to patients without influenza, patients with influenza more frequently had heart failure (37.2% vs 22.8%, P = 0.031), previous contact with relatives with influenza-like illnesses (23.3% vs 12.5%, P = 0.042), antimicrobial use (67.4% vs 23.2%, P

Abstract Objective To determine the overall and procedure-specific incidence of surgical site infections (SSI) caused by Staphylococcus aureus (S. aureus) as well as risk factors for such across all surgical disciplines in Europe. Methods This is a retrospective cohort of patients with surgical procedures performed at 14 European centres in 2016, with a nested case–control analysis. S. aureus SSI were identified by a semi-automated crossmatching bacteriological and electronic health record data. Within each surgical procedure, cases and controls were matched using optimal propensity score matching. Results A total of 764 of 178 902 patients had S. aureus SSI (0.4%), with 86.0% of these caused by methicillin susceptible and 14% by resistant pathogens. Mean S. aureus SSI incidence was similar for all surgical specialties, while varying by procedure. Conclusions This large procedure-independent study of S. aureus SSI proves a low overall infection rate of 0.4% in this cohort. It provides proof of principle for a semi-automated approach to utilize big data in epidemiological studies of healthcare-associated infections. Trials registration The study was registered at clinicaltrials.gov under NCT03353532 (11/2017).

Grapevine pruning is an agronomical operation required to regulate growth and yield, improve fruit quality, and maintain plant health and vigour. However, the intensification of the crop in the last decades, driven by efforts to increase productivity and decrease costs, has led to reduced attention to this operation. The aim of this study was to investigate whether different pruning styles during the first years of vineyard training affect grapevine development. Three pruning styles were followed in a newly planted cv. “Tempranillo” vineyard for four consecutive pruning seasons: (i) respectful (RESP), where pruning cuts were always made leaving protection wood between the cut and vine perennial structures, and the preferential sap flow path was chosen; (ii) aggressive (AGGR), where no protection wood was left and, when possible, the nonpreferential sap flow path was followed; and (iii) winegrape grower (WIN), where the common practices used in the area were followed, which corresponds to an intermediate style between RESP and AGGR. In general, the RESP style increased the vegetative development compared to WIN and AGGR styles over the years and produced a higher yield in the first production year, although the intensity of the effect was not the same in the two vineyards considered. This was the first effort to systematically assess the effects of respectful pruning techniques on vine vegetative growth and demonstrate scientifically its impact.

Background: Home pharmacy care is expected to be able to provide a pharmaceutical service that not only reduces the incidence of drug interactions and side effects but also increases the effectiveness of therapy and patient compliance in using drugs. Aims: The study aimed to analyze the costs incurred for the home pharmacy care program for diabetic patients at the pharmacy. Methods: This analysis used the independent variable by providing a program of home pharmacy care. The dependent variable was the cost of running the program of home pharmacy care. The sample was the pharmacist in charge of the pharmacies in the Banyumas and Cilacap districts, which provide a home pharmacy care service program. The sample was conducted by purposive sampling method. Sampling was done by direct interviews with pharmacists who signed informed consent. Break Even Point (BEP) was calculated to determine the number of patients who must be served. The pharmacoeconomic analysis used is Cost Analysis using the activity-based costing (ABC) method. Results: The lowest rate for home pharmacy care services is Rp. 17,000, and the highest is Rp.31,000 without including home pharmacy care services. Conclusions: Pharmacies continue to benefit from the home pharmacy care program, and there is no provision for home pharmacy care service rates. Keywords: Activity Based Costing (ABC), Diabetes Mellitus, Home pharmacy care (HPC)

ABSTRACT The etiology of nosocomial pneumonia (NP) in non-mechanically ventilated patients [hospital-acquired pneumonia (HAP)] is poorly understood because of difficulties in obtaining reliable respiratory samples. While it is thought to resemble that of mechanically ventilated patients [ventilator-associated pneumonia (VAP)], few studies compare etiology in both groups. We compared the etiology of bacteremic NP (bNP) episodes in HAP and VAP over 10 years in our institution. We defined NP in adults according to the American Thoracic Society criteria. bNP episodes were defined as significant isolates in ≥1 blood culture concordant with ≥1 respiratory pathogen isolated with 40%. IMPORTANCE This study on bacteremic nosocomial pneumonia (bNP) demonstrates the importance of this condition both in patients undergoing and not undergoing mechanical ventilation. Staphylococcus aureus, Enterobacterales, and non-fermenting Gram-negative bacilli are all causative agents in ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia (HAP), with a predominance of S. aureus in HAP and of Pseudomonas aeruginosa in VAP. Mortality in this condition is very high. Therefore, new therapeutic and preventive approaches should be sought.

Background: Vulvovaginal candidiasis (VVC) is caused by biofilm formation and epithelial invasion. In addition, Escherichia coli (EC) can establish a vaginal intracellular reservoir modulating Candida spp. biofilm production. We aimed to analyze the behavior of Candida albicans (CA) and EC biofilm both in single cultures and in co-cultures. Methods: We prospectively collected CA and EC isolates from vaginal swabs over 6 months. We selected positive cultures with both CA and EC (cases) and a comparator group with either CA or EC (controls). We analyzed overall biomass production and metabolic activity in single cultures and in co-cultures based on staining assays, confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM) to assess biofilm occupation. We also analyzed clinical manifestations. Results: We cultured 455 samples, 16 (3.5%) of which had CA and EC (cases); only CA or EC (controls) was detected, respectively, in 72 (15.8%) and 98 (21.5%). Biomass production and metabolic activity were significantly more pronounced in co-cultures in both groups. CLSM and SEM, on the other hand, showed the biofilm of each species to be significantly reduced when they were cultured together, with higher values in CA (percentage biofilm reduction: CA, 95.8% vs. EC, 36.2%, p

Osteoarthritis merupakan penyakit dengan terapi jangka panjang dan memiliki beban biaya yang besar. Penelitian farmakoekonomi ini bertujuan untuk melihat efektivitas biaya dari jamu santifik dalam pengobatan osteoarthritis menggunakan perspektif pasien. Analisis efektivitas biaya dipresentasikan dalam bentuk Incremental Cost Effectiveness Ratio (ICER). Efektivitas terapi dileporkan berdasarkan nilai keberhasilan terapi dan dan Quality Adjusted Life Year (QALY). Komponen biaya yang diukur meliputi biaya langsung medis maupun non-medis. Analisis sensitivitas univariat dilakukan untuk melihat pengaruh dari variable penelitian terhadap nilai ICER. Pasien berjumlah 50 orang yang berpartisipasi dalam penelitian ini dimasukkan ke dalam terapi jamu saintifik (40%) dan terapi konvensional osteoarthritis (60%). Biaya pada kelompok yang menggunakan jamu saintifik lebih tinggi jika dibandingkan dengan terapi konvensional osteoarthritis (38.993±2.873 vs 31.511±1.833). Efektivitas terapi jamu saintifik lebih tinggi jika dibandingkan terapi konvensional osteoarthritis namun perbedaan tersebut tidak bermakna secara statistik (95,0% vs 93,3%; p value 0,808), begitu juga dengan utility index jamu saintifik yang lebih besar dibandingkan terapi konvensional osteoarthritis (0,88±0,07 vs 0,77±0,15; p value 0,093). Nilai ICER untuk 1 unit penambahan efektivitas terapi bernilai Rp 437.765, sedangkan ICER untuk penambahan 1 unit kualitas hidup bernilai Rp 67.654. Faktor yang paling mempengaruhi nilai ICER adalah biaya jamu. Terapi jamu saintifik osteoarthritis merupakan terapi yang cost-effective dibandingkan terapi konvensional osteoarthritis.

IntroductionInfections caused by carbapenem-resistant Enterobacterales (CRE) and carbapenem-resistant Pseudomonas aeruginosa, including isolates producing acquired carbapenemases, constitute a prevalent health problem worldwide. The primary objective of this study was to determine the distribution of the different carbapenemases among carbapenemase-producing Enterobacterales (CPE, specifically Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae complex, and Klebsiella aerogenes) and carbapenemase-producing P. aeruginosa (CPPA) in Spain from January 2014 to December 2018.MethodsA national, retrospective, cross-sectional multicenter study was performed. The study included the first isolate per patient and year obtained from clinical samples and obtained for diagnosis of infection in hospitalized patients. A structured questionnaire was completed by the participating centers using the REDCap platform, and results were analyzed using IBM SPSS Statistics 29.0.0.ResultsA total of 2,704 carbapenemase-producing microorganisms were included, for which the type of carbapenemase was determined in 2692 cases: 2280 CPE (84.7%) and 412 CPPA (15.3%), most often using molecular methods and immunochromatographic assays. Globally, the most frequent types of carbapenemase in Enterobacterales and P. aeruginosa were OXA-48-like, alone or in combination with other enzymes (1,523 cases, 66.8%) and VIM (365 cases, 88.6%), respectively. Among Enterobacterales, carbapenemase-producing K. pneumoniae was reported in 1821 cases (79.9%), followed by E. cloacae complex in 334 cases (14.6%). In Enterobacterales, KPC is mainly present in the South and South-East regions of Spain and OXA-48-like in the rest of the country. Regarding P. aeruginosa, VIM is widely distributed all over the country. Globally, an increasing percentage of OXA-48-like enzymes was observed from 2014 to 2017. KPC enzymes were more frequent in 2017–2018 compared to 2014–2016.DiscussionData from this study help to understand the situation and evolution of the main species of CPE and CPPA in Spain, with practical implications for control and optimal treatment of infections caused by these multi-drug resistant organisms.

El objetivo de este artículo es construir un diagnóstico del proyecto político de la élite de Chile, a través del prisma de la teoría de la hegemonía de Antonio Gramsci (1891-1937). Este enfoque permite interpretar los lineamientos del Estado y la sociedad chilena desde la transición hasta el 18 de octubre de 2019. Las bases del proyecto hegemónico previo al estallido social que se había reconstruido a partir de retazos de la caída de la dictadura se enfrentan a una crisis de autoridad que abre un tiempo político nuevo y todavía en desarrollo. El artículo aporta una lectura desde la teoría política gramsciana para entender qué elementos de dicho proyecto han dejado de ser creíbles en la sociedad chilena.

El objetivo de este artículo es proponer una reflexión y análisis respecto de los desafíos epistemológicos, éticos y políticos del trabajo social a la luz del proceso constituyente que vive Chile, tomando como referencia de esta discusión los aportes teóricos de Antonio Gramsci. En términos metodológicos, este trabajo se sustenta desde una perspectiva hermenéutica crítica, que articula la revisión y el análisis documental con las experiencias históricas concretas. Se sostiene que, en este proceso constituyente, se pone en juego un proyecto de carácter contra-hegemónico, y, por tanto, la disciplina debería experimentar rupturas con los anclajes conservadores heredados de la dictadura y el largo período de transición a la democracia. El proceso constituyente se configura como una posibilidad no solo de profundización de la democracia, sino que permitiría generar las condiciones para avanzar en una reforma cultural y moral.