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Mandatory reporting of infectious diseases (MRID) is an essential practice to prevent disease outbreaks. Disease notification is a mandatory procedure for most infectious diseases, even during non-pandemic periods in healthcare. The main rationale behind MRID is the protection of public health. The information and data provided by infectious disease reports are used for many purposes, such as preventing the spread and potential negative impact of infectious diseases, assessing the national and global situation regarding reported diseases, conducting scientific research and planning health policy. In this context, the relevant information benefits public health, health systems and scientific work. Additionally, the follow up and treatment of individuals with infectious diseases is a necessity in certain cases to protect those who cohabit with them. However, these benefits cannot be accepted as unrestricted justifications for MRID, since it is evident that reporting should be conducted within ethical and legal boundaries. MRID should only be devised and implemented with due regard to balancing potential benefits between all individuals, as well as between the individual and the rest of society. Disease notification systems that are not designed with a balancing and harm-reductionist approach may lead to stigmatisation and discrimination. This study aims to investigate the legal framework and ethical issues regarding the reporting of individuals diagnosed with COVID-19 in Turkey—which is a primary example of a developing country.

Background & Aims The Pre-TACE-Predict model was devised to assess prognosis of patients treated with trans-arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). However, before entering clinical practice, a model should demonstrate that it performs a useful role. Methods We performed an independent external validation of the Pre-TACE model in a cohort that differs in setting and time period from the one that generated the original model. Data from 826 patients treated with TACE for naïve HCC (2008-2018) were used to assess calibration and discrimination of the Pre-TACE-Predict model. Results The four risk-categories identified by the Pre-TACE-Predict model had gradient monotonicity, with median survivals of 52.0, 36.2, 29.9, and 14.1 months respectively. However, predicted survivals systematically underestimated observed survivals (R2: 0.667). A recalibration was adopted maintaining fixed the prognostic index and modifying the baseline survival function. This resulted in an almost perfect calibration (R2: 0.995) in all the four risk categories. Cox regressions showed that aetiology and macrovascular invasion, included in the Pre-TACE-Predict model, had no prognostic impact in the present study population, and that coefficients for tumour size and multiplicity were overestimated. The c-index was similar to that of the m-HAP-III, but higher than those of HAP, m-HAP-II and the six-and-twelve models. Conclusions The recalibration of Pre-TACE-Predict model improved the estimation of survival probabilities of HCC patients treated with TACE. The highest discriminatory ability of the Pre-TACE-model in comparison to other available models, together with risk stratification and recalibration, makes it the best prognostic tool currently available for these patients.

Background An enhanced surveillance schedule has been proposed for cirrhotics with viral etiology, who are considered at extremely high-risk of hepatocellular carcinoma (HCC). Aims We compared the 3- and 6-months surveillance interval, evaluating cancer stage at diagnosis and patient survival. Methods Data of 777 HBV and HCV cirrhotic patients with HCC diagnosed under a 3-months (n = 109, 3MS group) or a 6-months (n = 668, 6MS group) surveillance were retrieved from the Italian Liver Cancer database. Survival in the 3MS group was considered as observed and adjusted for lead-time bias, and survival analysis was repeated after a propensity score matching. Results The 3-months surveillance interval neither reduced the share of patients diagnosed outside the Milano criteria, nor increased their probability to receive curative treatments. The median survival of 6MS patients (55.0 months [45.9–64.0]) was not significantly different from the observed (47.0 months [35.0–58.9]; p = 0.43) and adjusted (44.9 months [33.4–56.4]; p = 0.30) survival of 3MS patients. A propensity score analysis confirmed the absence of a survival advantage for 3MS patients. Conclusions A tightening of surveillance schedule does not increase the diagnosis of early-stage tumors, the feasibility of curative treatments and the survival. Therefore, we should maintain the 6-months interval in the surveillance of viral cirrhotics.

Thermal energy storage systems utilising phase change materials have the potential to overcome the intermittency issues associated with most renewable energy sources, significantly contributing to the decarbonisation of the energy sector. While the concept of storing energy in the latent heat of a phase transition is not new, large scale systems employing this concept have not yet realised their full potential. This is in large part due to the shortcomings of conventionally used materials – whether it be issues with their flammability, chemical and thermal instability, corrosivity, poor cycling stability, or a combination of these. Ionic liquids offer a suite of inherent “green” properties that translate well into the field of phase change materials, namely low volatility, low flammability, and good thermal and chemical stability, alongside the potential to tune their chemical and phase properties. In this Perspective, we discuss the evolution and promise of the emerging field of ionic liquids for renewable thermal energy storage. Systems are considered from a holistic, sustainable point of view, demonstrating the importance of assessing material origins and synthetic pathways as well as system performance through lifecycle assessment. We elucidate the emerging design rules for optimising thermal properties, and in doing so attempt to provide an overview of promising emerging systems and future directions.

Primary and disseminated lymphoma of the female reproductive tract are rare types of lymphoma. However, in the setting of solid organ transplant, recipients have an approximately doubled risk of acquiring and dying from malignancy. Multiple treatment modalities are available for post-transplant lymphoproliferative diseases (PTLD), including chemotherapy, radiotherapy, surgery, and immunosuppression radiotherapy. We report a case of a 61-year-old female with multifocal nodal diffuse large B-cell lymphoma and a history of a renal transplant secondary to IgA nephropathy who developed metastatic diffuse large B-cell lymphoma to the uterus. While the baseline incidence of PTLD is elevated when compared with lymphoma in the general population, metastatic uterine lymphoma is rare. Awareness of reproductive organ involvement by lymphomas and increased malignancy risk in organ transplant patients are important considerations for diagnostic evaluation, including radiologic assessment.

This study was conducted to determine the effect of pentagon fraud (pressure, opportunity, rationalization, capability and arrogance) in detecting fraudulent financial reporting using F-Score in financial companies listed on the Indonesia Stock Exchange in 2017-2019. Using associative quantitative research methods. The population of this study are 100 companies with 49 sample of companies for 3 periods, so the sample total is 147 samples was obtained which was taken by purposive sampling technique. The testing method of this research is through multiple regression analysis with the SPSS 22 program. The results of the partial test analysis show that pressure and opportunity has significant effect in detecting fraudulent financial reporting. Whereas rationalization, capability and the arrogance variable has insignificant effect in detecting fraudulent financial reporting. The test results simultaneously are pressure, opportunity, rationalization, capability and arrogance has significant effect in detecting fraudulent financial reporting.

Background: Neoadjuvant chemotherapy is the initial therapy and the main pillar of treatment for locally advanced breast cancer (LABC). Currently, there is marker that widely accepted as a predictive factor for chemotherapy response in LABC. Elevated serum interleukin-6 (IL-6) levels and tumor sites have been proposed as prognostic markers for breast cancer. In this study, we aimed to examine the association between serum IL-6 levels with clinical response after the administration of neoadjuvant chemotherapy. Methods: This study is an observational analytic study with a cohort prospective character to determine the relationship between IL-6 serum levels and clinical response to anthracycline-based neoadjuvant chemotherapy in locally advanced breast cancer (LABC) patients at Dr. Soetomo General Hospital during April 2021 to September 2021 with a total sample of 38 patients. Results: Fourteen patients (77.8%) had a positive response in the low IL-6 level group and 4 patients (22.2%) had a negative response. In high IL-6 level group, 4 patients (40%) had a positive response and 16 patients (80%) had a negative response. The cut off of 15.495 pg/mL was used as cut off value for IL-6 to predict the clinical response to chemotherapy. The sensitivity, specificity, PPV, NPV, and accuracy of IL-6 to predict the clinical response after chemotherapy were 80.0%, 77.8%, 80.0%, 77.8%, and 78.9%, respectively. Conclusion: There is a relationship between serum IL-6 levels and clinical response to anthracycline-based neoadjuvant chemotherapy regimens in locally advanced breast cancer (LABC) patients. Keywords: interleukin-6, clinical response, locally advanced breast cancer.

The problems of health reproduction adolescents in Indonesia caused not optimal commitment and support of the government in the form of a policy that is set on the education of sexual and reproduction for adolescents in order of family, community, and school. To continue the struggle of the nation, it is hoped that youth have ethics and morals that are responsible for the good.This study aims to determine Adolescent Perceptions of Reproductive Health in students at the La Tansa Islamic Boarding School. The research method used is qualitative research with in-depth interviews. Informants will be conducted in-depth interviews are three informants students teenage daughter at Pondok Pesantren La Tansa. The results of the study showed that the discussion about health reproduction is not a thing taboo to talk about. In the handling of all the problems of health reproduction usually with medication to the doctor or even just be left alone (in the case of vaginal discharge ), but seldom of them that experience interference health reproduction. A sense of shame and is still considered taboo became one of the factors that did not perform the treatment when it occurs the problem. Many once the benefits that will be obtained when held counseling about health reproduction, but the media are used also should be expected to make the students understand to be things about the health of reproduction it alone. To conduct counseling health cottage boarding they rarely conduct outreach on the topic of this, in addition to the situation of a pandemic covid-19 now makes counseling difficult to do because be no crowd. Based on the results of the analysis and discussion of the research is that the perception of adolescents about health reproduction in Pondok Pesantren La Tansa year 2021 is still low because of lack of knowledge of teen-related health reproduction in pond ok boarding it.

The incidence of bleeding is increased in high risk patients with critical conditions in Intensive Care Unit (ICU). Appropriate prophylaxis medicine is necessary to reduce the incidence of stress ulcer bleeding during hospitalization in ICU which further can minimize the cost of patient care in the ICU. Currently, lansoprazole and pantoprazole are used as a stress ulcers prophylaxis. Nevertheless, there has not been sufficient evidence proving their effectiveness. This study was aimed to compare the effectiveness and cost between iv lansoprazole and iv pantoprazole as a stress ulcer prophylaxis in ICU. In this retrospective observational study, the data were obtained from medical records of all patients admitted to ICU in a District Hospital in Yogyakarta from January 2014 until December 2016. Effectiveness of therapy were obtained from objective data in the medical record by looking at the incidence of major (clinically significant) and minor (overt gastrointestinal) bleeding. Chi-square analysis was performed to analyze the difference of bleeding incidence. The average cost was presented as Expected Monetary Value (EMV), which consisted of the cost of prophylaxis and treatment of bleeding. The difference in average cost was analyzed using independent t-test. A total of 119 patients were included in this study. There were 62 patients in the lansoprazole group and 47 patients in the pantoprazole group. Forty eight patients (77,4%) from lansoprazole group and 35 patients (61,4%) from pantoprazole group did not experience any GI bleeding. There was no statistical difference in the incidence of GI bleeding between the two groups (CI 95%, P-value = 0.057). The EMV of lansoprazole group was higher than pantoprazole group IDR 645.122,57 and IDR 511.629,39 respectively. In conclusion, there was no significant difference regarding the effectiveness between iv lansoprazole and iv pantoprazole as stress ulcer prophylaxis. Costs for the prophylaxis of stress ulcers is lower on the use of pantoprazole compared to lansoprazole.

The prevalence of hypertension in the world in 2000 according to WHO worldwide there were 972 million people or 26.4% of the earth's inhabitants experienced hypertension. Of the 972 million people with hypertension, 333 million are in developed countries and the remaining 63 million are in developing countries, including Indonesia. Knowing the description of the incidence of controlled and uncontrolled hypertension at the Malingping Health Center in 2021. Descriptive research design. Samples were taken using the purposive sampling technique, namely 119 patients who came for treatment at the Malingping Health Center. The results were analyzed univariately. Based on the results of the study, it can be seen from 106 respondents who were not controlled (81.1%), while those who were controlled were 13 respondents (10.9%). Age of hypertensive patients included in the groupage > 60 years as many as 62 samples (52.1%). The sex of the patients was mostly female, namely 88 samples (73.9%). The incidence of hypertension sufferers in the working area of ​​Malingping Health Center is still uncontrolled, in the age group > 60 years and female.

Memodelkan Entity Relationship Diagram (ERD) dapat dilakukan secara manual, namun umumnya memperoleh pemodelan ERD secara manual membutuhkan waktu yang lama. Maka, dibutuhkan pembangkit ERD dari spesifikasi kebutuhan untuk mempermudah dalam melakukan pemodelan ERD. Penelitian ini bertujuan untuk mengembangkan sebuah sistem pembangkit ERD dari spesifikasi kebutuhan dalam Bahasa Indonesia dengan menerapkan beberapa tahapan-tahapan dari Natural Language Processing (NLP) sesuai kebutuhan penelitian. Spesifikasi kebutuhan yang digunakan tim peneliti menggunakan teknik document analysis. Untuk tahapan-tahapan dari NLP yang digunakan oleh peneliti yaitu: case folding, sentence segmentation, tokenization, POS tagging, chunking dan parsing. Kemudian peneliti melakukan identifikasi terhadap kata-kata dari teks yang sudah diproses pada tahapan-tahapan dari NLP dengan metode rule-based untuk menemukan daftar kata-kata yang memenuhi dalam komponen ERD seperti: entitas, atribut, primary key dan relasi. ERD kemudian digambarkan menggunakan Graphviz berdasarkan komponen ERD yang telah diperoleh Evaluasi hasil ERD yang berhasil dibangkitkan kemudian di evaluasi menggunakan metode evaluasi expert judgement. Dari hasil evaluasi berdasarkan beberapa studi kasus diperoleh hasil rata-rata precision, recall, F1 score berturut-turut dari tiap ahli yaitu: pada ahli 1 diperoleh 91%, 90%, 90%; pada ahli 2 diperoleh 90%, 90%, 90%; pada ahli 3 diperoleh 98%, 94%, 96%; pada ahli 4 diperoleh 93%, 93%, 93%; dan pada ahli 5 diperoleh 98%, 83%, 90%.

The implementation of national sports development must be in line with the national sports policies. TARSIL which is an abbreviation for trust, authority, responsibility, supervision, integration and local wisdom is considered as an ideal formula for policy making-regional autonomy related. The purpose of this study was to analyze the Indonesian Sports System (policy product) based on TARSIL values. This is a qualitative study whereby data were collected through observation, documentation, and interview. The Indonesian Sports System was used as the object of sports policy. Seven people actively participated in this study. Data analysis consisted of reduction, presentation, and conclusion drawing. The results showed that the Indonesian Sports System has been implementing TARSIL values. All components of TARSIL are stated in the Indonesian Sports System. However, not all indicators of those components were stated. We suggested that TARSIL values may be used as the consideration for the upcoming sports policies at either national or regional levels.

In heart failure with reduced ejection fraction, the interventional landscape has recently expanded. New transcatheter approaches are emerging for both mitral and tricuspid secondary (functional) regurgitation. Transcatheter therapies for mitral and tricuspid valve require a more tailored approach than for the aortic valve, because of more heterogeneous clinical scenarios, anatomic features, and mechanisms of valvular lesions.

A wave of sexual harassment complaints against a famed plant geneticist brings up thorny issues of permissiveness and power in Mexican labs

The purpose of this research is to detect fraudulent financial reporting in the property, real estate, and building construction sectors listed on the IDX based on the perspective of the fraud pentagon theory. The data collection technique used purposive sampling and data analysis using logistic regression. The results indicate that external pressure factors, ineffective monitoring, quality of external auditors, auditor turnover, rationalization proxied by auditor opinion, change of directors, and political connections affected FFR. Meanwhile, financial target factors, financial stability, institutional ownership, and the frequency of the appearance of the CEO image in the annual report do not affect FFR.ABSTRAKPenelitian ini bertujuan untuk mendeteksi kecurangan pelaporan keuangan pada sektor properti, real estate, dan konstruksi bangunan yang terdaftar di BEI berdasar perspektif teori fraud pentagon. Pengumpulan data menggunakan teknik purposive sampling dan analisis data menggunakan regresi logistik. Hasil penelitian menunjukkan bahwa faktor tekanan eksternal, pengawasan yang tidak efektif, kualitas auditor eksternal, pergantian auditor, rasionalisasi yang diproksikan dengan opini auditor, pergantian direksi, dan hubungan politik berpengaruh terhadap FFR. Sedangkan faktor target keuangan, stabilitas keuangan, kepemilikan institusional, dan frekuensi kemunculan gambar CEO dalam laporan tahunan tidak berpengaruh terhadap FFR.

Severe dengue virus infection often causes proteinuria through several mechanisms, such as leakage of plasma proteins caused by higher protein filtering in the kidneys. The condition of proteinuria in patients with dengue shock syndrome will affect the management, prognosis, and mortality of patients with dengue virus infection. The objectives of this study were to determine the presence of protein in urine samples in patients in which IgG/IgM dengue was detected, to determine the presence of protein in urine samples in patients without dengue infection, and to determine the relationship between proteinuria in dengue patients and the degree of disease severity. The study was conducted in March-June 2020 at the Clinical Laboratory and Inpatient Clinic of Vita Medika Kepung, Kediri Regency. The method used was the consecutive sampling technique. The minimum sample size was 100 respondents with criteria for suspected dengue infection, onset fever > 4 days, age > 2 years, and no indication of other infectious diseases (blood and urine), divided into two groups, group with positive dengue infection and non-dengue group. The results showed that proteinuria was detected in 26% of respondents, secondary dengue infection and positive serological test of IgG, IgM only IgG were detected in 24 (92.3%) respondents and positive IgG and IgM were found in 2 (7.7%) respondents, this was shown by the p-value = 0.000 in the Chi-Square test with a Prevalence Ratio (PR) value of 11,987. In addition, Chi-Square test results indicated that a higher urine protein/albumin led to more severe disease, with p-value = 0.012 and 0.025 (p

The increasing demand and widespread of renewable energy inherently compel the development of power electronics converter as an interface between consumers and the energy source/s. This paper presents a new two switched-impedance networks qZSI converter called High Ratio Two Switched-impedance quasi-Z-Source Inverter (HR2SZ-qZSI). Compared with the previous topology, this proposed HR2SZ-qZSI topology can achieve higher voltage gain with lower shoot-through duty ratio, and a higher boost factor. This paper also discusses comparative analysis between the previous topology and the proposed HR2SZ-qZSI topology. Furthermore, the simulation and experimental data are presented to prove the theoretical analysis of the proposed HR2SZ-qZSI topology. Despite the additional components needed, it accentuates that this proposed converter retains all features of qZSI: common ground point between the dc source and converter and smooth input current operation. Furthermore, almost all the devices rating including capacitor and diode voltage, and inductor current ripple are lower than the preceding relevant two switched-impedance qZSI family. Accordingly, this proposed HR2SZ-qZSI clearly a good power conditioning alternative for renewable generation system.

In recent years, the use of ride hailing mobile application services is increasing exponentially. Customers’ expectation of these phone services varies and change dynamically as the needs of each individual also vary. Customer reviews about mobile application are honest, voluntary opinions; and these could become essential input for mobile application providers to measure satisfaction. However, managing a large number of reviews into actionable plans could be challenging. This study combines the Term Frequency-Inverse Document Frequency (TF-IDF) and Multiple-Criteria Decision-Making (MCDM)-VIKOR approach to process 600 reviews into a meaningful insight to enhance ride hailing mobile application services. The four-phase method analysis concluded that application ease of use and affordability are the most important aspects that most contribute to customers’ satisfaction in ride hailing mobile application services.

Simple Summary This review proposes a comprehensive overview of the main prognostic systems for HCC classified as prognostic scores, staging systems, or combined systems. Prognostic systems for HCC are usually compared in terms of homogeneity, monotonicity of gradients, and discrimination ability. However, despite the great number of published studies comparing HCC prognostic systems, it is rather difficult to identify a system that could be universally accepted as the best prognostic scheme for all HCC patients encountered in clinical practice. In order to give a contribute in this topic, we conducted a study aimed at externally validate the MESH score and the CNLC classification using the ITA.LI.CA database. Abstract Prognostic assessment in patients with HCC remains an extremely difficult clinical task due to the complexity of this cancer where tumour characteristics interact with degree of liver dysfunction, patient general health status, and a large span of available treatment options. Several prognostic systems have been proposed in the last three decades, both from the Asian and European/North American countries. Prognostic scores, such as the CLIP score and the recent MESH score, have been generated on a solid statistical basis from real life population data, while staging systems, such as the BCLC scheme and the recent CNLC classification, have been created by experts according to recent HCC prognostic evidences from the literature. A third category includes combined prognostic systems that can be used both as prognostic scores and staging systems. A recent example is the ITA.LI.CA prognostic system including either a prognostic score and a simplified staging system. This review focuses first on an overview of the main prognostic systems for HCC classified according to the above three categories, and, second, on a comprehensive description of the methodology required for a correct comparison between different systems in terms of prognostic performance. In this second section the main studies in the literature comparing different prognostic systems are described in detail. Lastly, a formal comparison between the last prognostic systems proposed for each of the above three categories is performed using a large Italian database including 6882 HCC patients in order to concretely apply the comparison rules previously described.

Background and aims: In patients with hepatocellular carcinoma (HCC), macrovascular invasion (MaVI) limits treatment options and decreases survival. Detailed data on the relationship between MaVI extension and patients' characteristics, and its impact on patients' outcome are limited. We evaluated the prevalence and extension of MaVI in a large cohort of consecutive HCC patients, analysing its association with liver disease and tumour characteristics, as well as with treatments performed and patients' survival. Methods: We analysed data of 4774 patients diagnosed with HCC recorded in the Italian Liver Cancer (ITA.LI.CA) database (2008-2018). Recursive partition analysis (RPA) was performed to evaluate interactions between MaVI, clinical variables and treatment, exploring the inter-relationship determining overall survival. Results: MaVI prevalence was 11.1%, and median survival of these patients was 6.0months (95% CI, 5.1-7.1). MaVI was associated with younger age at diagnosis, presence of symptoms, worse Performance Status (PS) and liver function, high alphafetoprotein levels and large HCCs. MaVI extension was associated with worse PS, ascites and greater impairment in liver function. RPA identified patients' categories with different treatment indications and survival, ranging from 2.4months in those with PS>1 and ascites, regardless of MaVI extension (receiving best supportive care in 90.3% of cases), to 14.1months in patients with PS 0-1, no ascites and Vp1-Vp2 MaVI (treated with surgery in 19.1% of cases). Conclusions: MaVI presence and extension, together with PS and ascites, significantly affect patients' survival and treatment selection. The decision tree based on these parameters may help assess patients' prognosis and inform therapeutic decisions.

Purpose of review To review current evidence on the pathophysiology of COVID-19-related acute respiratory distress syndrome (ARDS) and on the implementation of lung protective ventilation. Recent findings Although multiple observations and physiological studies seem to show a different pathophysiological behaviour in COVID-19-ARDS compared with 'classical' ARDS, numerous studies on thousands of patients do not confirm these findings and COVID-19-ARDS indeed shares similar characteristics and interindividual heterogeneity with ARDS from other causes. Although still scarce, present evidence on the application of lung protective ventilation in COVID-19-ARDS shows that it is indeed consistently applied in ICUs worldwide with a possible signal towards better survival at least in one study. The levels of positive end-expiratory pressure (PEEP) usually applied in these patients are higher than in 'classical' ARDS, proposing once again the issue of PEEP personalization in hypoxemic patients. In the absence of robust evidence, careful evaluation of the patient is needed, and empiric settings should be oriented towards lower levels of PEEP. Summary According to the present evidence, a lung protective strategy based on low tidal volume and plateau pressures is indicated in COVID-19-ARDS as in ARDS from other causes; however, there are still uncertainties on the appropriate levels of PEEP.

Deep learning's breakthrough in the field of artificial intelligence has resulted in the creation of a slew of deep learning models. One of these is the Generative Adversarial Network, which has only recently emerged. The goal of GAN is to use unsupervised learning to analyse the distribution of data and create more accurate results. The GAN allows the learning of deep representations in the absence of substantial labelled training information. Computer vision, language and video processing, and image synthesis are just a few of the applications that might benefit from these representations. The purpose of this research is to get the reader conversant with the GAN framework as well as to provide the background information on Generative Adversarial Networks, including the structure of both the generator and discriminator, as well as the various GAN variants along with their respective architectures. Applications of GANs are also discussed with examples. Keywords: Generative Adversarial Networks (GANs), Generator, Discriminator, Supervised and Unsupervised Learning, Discriminative and Generative Modelling, Backpropagation, Loss Functions, Machine Learning, Deep Learning, Neural Networks, Convolutional Neural Network (CNN), Deep Convolutional GAN (DCGAN), Conditional GAN (cGAN), Information Maximizing GAN (InfoGAN), Stacked GAN (StackGAN), Pix2Pix, Wasserstein GAN (WGAN), Progressive Growing GAN (ProGAN), BigGAN, StyleGAN, CycleGAN, Super-Resolution GAN (SRGAN), Image Synthesis, Image-to-Image Translation.

The COVID-19 pandemic that attacks the world has made the attention of all medical personnel focused on this disease. The clinical picture is similar to other infectious diseases such as malaria, dengue, influenza, etc., which often leads to misdiagnosis. We report the case of a man, 31 years old, with a history of travel and complaints of high fever persisting for more than 7 days. On physical examination, the temperature was 39-40 C, others were within normal limits. Initial platelet count was 69 x 103/µL, leukocytes was 15.52 x 109/L, CRP was 96 mg/L. The blood smear found Plasmodium falciparum, and PCR SARS-CoV-2 was positive. Chest X-ray showed pneumonia. Dihydroartemisinin-piperaquine and primaquine therapies were administered for malaria, as well as favipiravir, azithromycin, and other symptomatic therapy for COVID-19. Platelets decreased to 38 x 103/µL while D-dimer level increased (> 20 mg/L). Anticoagulant was delayed. On monitoring after therapy, the platelets returned to normal, the D-dimer level decreased, and there was no bleeding. The co-infectious conditions of malaria and COVID-19 should be suspected in patients with suggestive symptoms and travel history from endemic areas, therefore both examinations should be performed. This co-infection has the potential to cause hyper inflammation and hypercoagulation and this is associated with a poor prognosis. Appropriate treatment is needed.

The Covid-19 pandemic demands that businesses go digital. Not only products must be marketed through technology, but the way of communication with consumers must also be arranged systematically to stabilize income. Among a number of tools designed to answer customer retention demands, CRM software was chosen because this tool can accommodate consumer data, business data, track consumer interactions, and track company prospects. The purpose of this activity is to conduct training and assistance in implementing Customer Relationship Management in increasing sales during the pandemic. This method uses a descriptive qualitative approach with training design in using Customer Relationship Management software. Instruments in the form of learning experience and literature study. This community partnership program involves business start-ups within the Muhammadiyah University of Lamongan, especially students majoring in Accounting and Management. The results of this study indicate that the application of CRM has an effect as an effort to increase business sales during the pandemic with a series of strategic CRM processes, operational CRM, analytical CRM. Essentially, both upper, middle, and even lower customers need good and quality service, it's just that the levels are different. When start-up actors apply the right and good CRM, it will automatically increase customer satisfaction which has an impact on increasing business sales.

Renewable energies are crucially needed right now. One of the them is ethanol as a non-fossil energy source. Data time-series of world demand for ethanol are very interesting to find its forecasting models, so that the production targets can be more accurate. Generalised auto-regressive conditional heteroscedasticity is one of the best models we use. Our findings AR(1) - Generalised Auto-Regressive Conditional Heteroskedasticity (GARCH) (1,1) modelsare considered as a good-fit measurement in predicting ethanol demand. Increasing the number of demand should be considered with the number of its processes. In this paper, we combine an analysis of economic considerations (predicting demand levels) with a political analysis of policies (describing renewable energy policy options).Keywords: Renewable energies, Ethanol, GARCH model, Forecasting, Energy policyJEL Classifications: C5, C53, H2, H25, Q4, Q47DOI: https://doi.org/10.32479/ijeep.11323

Hemoglobin is an iron-carrying oxygen transport protein protein in red cells in the blood of mammals and other animals. Hemoglobin consists of iron which is the carrier of O2. High and abnormal hemoglobin levels occur due to hemoconcentration due to dehydration. The number of red blood cells and hemoglobin molecules is not always increasing and decreasing simultaneously, for example the decrease in red blood cells along with slightly elevated or normal hemoglobin levels occur in cases of pernicious anemia, as well as slightly elevated or normal hemoglobin levels of hemoglobin decreases, occurs in iron deficiency anemia. The purpose of this research is to know the effect of green bean extract on changes of hemoglobin (Hb) level in Pregnant Women. The research design used was pre experimental research. The population in detail is all Pregnant Women, with acidental sampling technique in obtaining a sample of 16 people. The research instrument used is observation sheet and digital hemoglobin gauge and statistic test used is T test. The result of research of hemoglobin level before giving of green bean has average value (mean) is 10,494 and hemoglobin level after giving of green bean has average value (mean) is 11.238 this indicates an increase of hemoglobin level in student result of research done shows that there is an increase of Hb level in get p value 0,756 and 0,89. Then the T.Test data distribution test can be concluded p value

Abstract Importance The most common screening tool for depression is the Patient Health Questionnaire-9 (PHQ-9). Despite extensive research on the clinical and behavioral implications of the PHQ-9, data are limited on the relationship between PHQ-9 scores and social determinants of health and disease. Objective To assess the relationship between the PHQ-9 at intake and other measurements intended to assess social determinants of health. Design, Setting, and Participants Cross-sectional analyses of 2502 participants from the Baseline Health Study (BHS), a prospective cohort of adults selected to represent major demographic groups in the US; participants underwent deep phenotyping on demographic, socioeconomic, clinical, laboratory, functional, and imaging findings. Interventions None. Main Outcomes and Measures Cross-sectional measures of clinical and socioeconomic status (SES). Results In addition to a host of clinical and biological factors, higher PHQ-9 scores were associated with female sex, younger participants, people of color, and Hispanic ethnicity. Multiple measures of low SES, including less education, being unmarried, not currently working, and lack of insurance, were also associated with higher PHQ-9 scores across the entire spectrum of PHQ-9 scores. A summative score of SES, which was the 6th most predictive factor, was associated with higher PHQ-9 score after adjusting for 150 clinical, lab testing, and symptomatic characteristics. Conclusions and Relevance Our findings underscore that depression should be considered a comorbidity when social determinants of health are addressed, and both elements should be considered when designing appropriate interventions.

The purpose of this research aims to determine the impact of Local Own Revenue, Balanced Funds, Economic Growth, and Excess of Budget Calculation (SiLPA) on Capital Expenditure as long as the implications to provincial government financial performance in Indonesia from 2011 to 2019. The province government financial reports from across Indonesia as population and in 2011 to 2019 as samples. This type of research is known as causal associative research, with quantitative descriptive analysis techniques, and Panel Data Regression Analysis with The Random Effect Model as the selected model, with secondary data including time-series data and panel data in 2011 to 2019 from The Supreme Audit Agency of the Republic of Indonesia, the Central Bureau of Statistics, and other official publications. According to the research results, R2 was 79.08%. Partially Local Own Revenue had a positive value and did not affect Capital Expenditure. Balanced Funds, Economic Growth, and Excess of Budget Calculation had positive values and an effect on Capital Expenditures. Simultaneously, Local Own Revenue, Balanced Funds, Economic Growth, and Excess of Budget Calculation affect Capital Expenditure. Then Local Own Revenue, Balanced Funds, Economic Growth, Excess of Budget Calculation and Capital Expenditures simultaneously did not affect Financial Performance.

Vaname is one type of shrimp that is often cultivated in Indonesia. The shrimp farming system model consists of an extensive system (traditional) and an intensive system. This study aims to compare the abundance of plankton, water conditions, growth performance of vannamei shrimp (Litopenaeus vannamei) in intensive and extensive aquaculture systems in the waters of Banyuwangi Regency. Parameters measured include physical and chemical parameters, namely temperature, brightness, pH, dissolved oxygen, salinity, ammonia, and alkalinity, type and abundance of plankton. The research method used is descriptive method. The method of analysis is the abundance of plankton, and analysis of productivity, SR, FCR and growth of vannamei shrimp. The results showed that plankton in intensive pond waters were identified as many as 4 classes, namely phytoplankton class Chlorophyta, Cyanophyta and Chrysophyta, while zooplankton class Protozoa. In traditional ponds, it is not much different, only the Crpytophyta class as an additional identification result. The abundance of plankton in intensive ponds reaches 27,595 individuals per liter, while for extensive ponds the abundance of plankton reaches 37,641 individuals per liter. While the survival rate of shrimp in intensive ponds is around 86%, while in extensive ponds is 67%. The FCR value for extensive ponds is 1.02, while the FCR value for intensive ponds is 1.17. The final average weight of shrimp in intensive ponds was 11.76 g/head and 8.33 g/head in extensive ponds.Keyword : Vaname Shrimp, Intensive Cultivation, Extensive

The research, entitled Analysis of Business Plan Preparation Applications as an Effort to Achieve Business Success for Kediri City Entrepreneurs is a descriptive research, this study examines efforts to achieve business success through the preparation of a business plan. The application for the preparation of a business plan prepared by entrepreneurs Kediri city includes aspects of customer segments, customer relations, bargaining value, promotions, main resources, main activities, relationships with partners and sources of income for entrepreneurs. The population that became the respondents in this study was obtained from the results of the competition for the leading entrepreneur in Kediri city were 100 respondents. The purpose of this study was to determine: (1) the types of businesses found in Kediri city in terms of the results of the preparation of business plans for business practitioner in Kediri city, (2) the market segment that became the customer service orientation of the business practitioners in Kediri city, (3) the types of business promotions carried out by Kediri City entrepreneurs, (4) The way Kediri business practitioner in fostering relationships with customers, (5) Types of advantages/bargaining power provided by Kediri City entrepreneurs to consumers/customers, (6) Sources needed by business practitioners in Kediri city, (7) business partners for business practitioners in the city of Kediri, (8) sources of income from whatever is obtained from business practitioners Kediri city. Data analysis technique is qualitative descriptive analysis. The results of the study indicate that: (1) The types of businesses in the City of Kediri are in the fields of food, beverages, accessories, souvenirs, educational institution services, beauty services, batik, weaving, tailoring, Muslim clothing, t-shirt producing; (2) The market segments as costumer service orientation of the leading business practitioners in Kediri City are mostly adult and adolescent consumers; (3) the most business promotions are exhibitions, online media, social media, banners, business cards, brochures and direct selling; (4) Planning to build relationships with customers through intensive communication with customers, after-sales service and making membership cards (members); (5) The most advantage/bargaining power is to provide excellent service, affordable prices, quality products; (6) the most resource requirements planned are capital, labour, raw materials and equipment; (7) Most Business Partners are Government Agencies and supported by other partners; and (8) The source of income is from the sale of products and from several other sources of income as addition. Keywords: Business plan, customer segment, promotion, bargaining value, business partner.

Summary Background PD-1 and PD-L1 inhibitors are active in metastatic urothelial carcinoma, but positive randomised data supporting their use as a first-line treatment are lacking. In this study we assessed outcomes with first-line pembrolizumab alone or combined with chemotherapy versus chemotherapy for patients with previously untreated advanced urothelial carcinoma. Methods KEYNOTE-361 is a randomised, open-label, phase 3 trial of patients aged at least 18 years, with untreated, locally advanced, unresectable, or metastatic urothelial carcinoma, with an Eastern Cooperative Oncology Group performance status of up to 2. Eligible patients were enrolled from 201 medical centres in 21 countries and randomly allocated (1:1:1) via an interactive voice-web response system to intravenous pembrolizumab 200 mg every 3 weeks for a maximum of 35 cycles plus intravenous chemotherapy (gemcitabine [1000 mg/m2] on days 1 and 8 and investigator's choice of cisplatin [70 mg/m2] or carboplatin [area under the curve 5] on day 1 of every 3-week cycle) for a maximum of six cycles, pembrolizumab alone, or chemotherapy alone, stratified by choice of platinum therapy and PD-L1 combined positive score (CPS). Neither patients nor investigators were masked to the treatment assignment or CPS. At protocol-specified final analysis, sequential hypothesis testing began with superiority of pembrolizumab plus chemotherapy versus chemotherapy alone in the total population (all patients randomly allocated to a treatment) for the dual primary endpoints of progression-free survival (p value boundary 0·0019), assessed by masked, independent central review, and overall survival (p value boundary 0·0142), followed by non-inferiority and superiority of overall survival for pembrolizumab versus chemotherapy in the patient population with CPS of at least 10 and in the total population (also a primary endpoint). Safety was assessed in the as-treated population (all patients who received at least one dose of study treatment). This study is completed and is no longer enrolling patients, and is registered at ClinicalTrials.gov , number NCT02853305 . Findings Between Oct 19, 2016 and June 29, 2018, 1010 patients were enrolled and allocated to receive pembrolizumab plus chemotherapy (n=351), pembrolizumab monotherapy (n=307), or chemotherapy alone (n=352). Median follow-up was 31·7 months (IQR 27·7–36·0). Pembrolizumab plus chemotherapy versus chemotherapy did not significantly improve progression-free survival, with a median progression-free survival of 8·3 months (95% CI 7·5–8·5) in the pembrolizumab plus chemotherapy group versus 7·1 months (6·4–7·9) in the chemotherapy group (hazard ratio [HR] 0·78, 95% CI 0·65–0·93; p=0·0033), or overall survival, with a median overall survival of 17·0 months (14·5–19·5) in the pembrolizumab plus chemotherapy group versus 14·3 months (12·3–16·7) in the chemotherapy group (0·86, 0·72–1·02; p=0·0407). No further formal statistical hypothesis testing was done. In analyses of overall survival with pembrolizumab versus chemotherapy (now exploratory based on hierarchical statistical testing), overall survival was similar between these treatment groups, both in the total population (15·6 months [95% CI 12·1–17·9] with pembrolizumab vs 14·3 months [12·3–16·7] with chemotherapy; HR 0·92, 95% CI 0·77–1·11) and the population with CPS of at least 10 (16·1 months [13·6–19·9] with pembrolizumab vs 15·2 months [11·6–23·3] with chemotherapy; 1·01, 0·77–1·32). The most common grade 3 or 4 adverse event attributed to study treatment was anaemia with pembrolizumab plus chemotherapy (104 [30%] of 349 patients) or chemotherapy alone (112 [33%] of 342 patients), and diarrhoea, fatigue, and hyponatraemia (each affecting four [1%] of 302 patients) with pembrolizumab alone. Six (1%) of 1010 patients died due to an adverse event attributed to study treatment; two patients in each treatment group. One each occurred due to cardiac arrest and device-related sepsis in the pembrolizumab plus chemotherapy group, one each due to cardiac failure and malignant neoplasm progression in the pembrolizumab group, and one each due to myocardial infarction and ischaemic colitis in the chemotherapy group. Interpretation The addition of pembrolizumab to first-line platinum-based chemotherapy did not significantly improve efficacy and should not be widely adopted for treatment of advanced urothelial carcinoma. Funding Merck Sharp and Dohme, a subsidiary of Merck, Kenilworth, NJ, USA.

Elderly is a condition that will be experienced by each people, where the age range is from 45 to 75 years. The process adds up age followed also by changes that occur in body systems either physiologically or pathologically in the presence of comorbidities. One of the processes that occurs is function cerebellum descends by starting with a balance disturbance and then the brain system, resulting in the risk of falling. Elderly experiencing falls can be affected by some things such as disorders of the brain system, self it self and the environment. A part from anatomical factors, there is also a lighting environment usually the elderly always wake up at night, if the environment is less lighting then the risk of falling is higher and if the condition of waking up, the concentration and muscle power cannot be optimal, resulting in decreased balance so that the risk of falling is higher. One way to maintain and minimize the risk can be done the core stability exercise . Benefits of core stability exercise is to strengthen the core as the support of the body so that the body can be stable. Method: This type of research is experiment , using quasi experimental design with pre test and post test group design. The statistic test using Wilcoxon test . Sample of elderly at integrated healthcare center in Ngebel, totaled are 34 elderly. Elderly sample criteria age 60-74 years, do not use assistive devices and do not experience neurological disorders. Measure morse fall skale. Result: The results of the homogeneity test show that the significance value (p) core stability exercise of 0.323, because of the significance of p> 0.05 it can be concluded that the population is from the same variant or homogeneous. The calculation of the data normality test used the Shapiro-Wilk Test and is said to be normal if p> 0, 05. Data normality test results 0.085. Hypothesis Test with willcoxon test because it has a normal and homogeneous data distribution in the group. From the test results obtained with a value of P = 0.034, meaning P

Long distance running (LDR) is an exercise that has a relatively heavy load which can cause Delayed Onset Muscle Soreness (DOMS) and increase Reactive Oxygen Species (ROS) levels. Xanthine, one derivate of ROS will increase 10 times during aerobic activity which is metabolized to Uric Acid (mg/dL) (UA). Foam rolling (FR) is used for the recovery process. This study aims to determine the effect of long distance running on changes in UA levels and the effect of FR as an active recovery against changes in UA levels. This was a quasi-experiment study using a purposive sampling design, one-group repeated measure design of a sample population of young healthy males (17-25 years). The sample consisted of 10 trained young males in Semarang. The average value of UA before intervention was 4.43 mg/dL ± 0.51. In 90 minutes, it was 5.90 mg/dL ± 0.52, in 120 minutes was 5.71 mg/dL ± 0.72 and at 24 hours after intervention was 6.1 mg/dL ± 0.57. LDR has been shown to increase UA levels. FR which is done only once has not been able to reduce UA levels. The percentage of occurrence of post-LDR DOMS occurred at 24 hours.

Background: Patients with hypertension have twice as great exposed to heart disease and eight times as large as a stroke risk than who do not experience hypertension. Risk increase in blood pressure on the person who has overweight than people with normal weight. Women who have increased cholesterol levels in the blood more vulnerable for hypertension (Nikolov et al., 2015). Objectives: The purpose of this research aimed to determine a percentage of body fat and cholesterol levels of the elderly women in Posyandu, Geger Subdistrict, Madiun who occurrence of hypertension. Methods: This research using cross sectional design. The sample using purposive sampling technique with 38 respondent which satisfy the inclusion criteria. Instrument used is Bioelectrical Impedance Analysis tool. Statistical test used is spearman rho with a significance level of α < 0.05. Results: The results of this study showed that significant relationship between body fat percentage and blood pressure (p-value = .033; r = .304). Meanwhile, total cholesterol level did not show any relationship with blood pressure (p-value = .429; r = -.132). Conclusion: Fat Accumulation in the kidneys where the renin-angiotensin system is identified in human fat tissue, can cause impaired nephron function which causes blood pressure to rise. Thus, abdominal obesity accompanied by ectopic fat deposits can play an important role in the development of hypertension and should not be neglected when undertaking blood pressure-lowering therapy. Keywords: Body fat, cholesterol, elderly women.

Aim: To understand deeply how the trend of technology has motivated entrepreneurs to become entrepreneurs who have a high entrepreneurial spirit through a review of dozens of international publications interested in discussing technology trends and implications for business people with a high entrepreneurial spirit. Method: Search for data electronically on several Google scholar-based data and other literary sources. Then we analyze the data by involving data coding, evaluation, in-depth interpretation, and concluding the principle of all data that is valuable and reliable. We emphasize secondary data from several international publications focused on the theme of this study. Result: The positive impact of technology trends on business success through the spirit of referring to technology-driven business governance and entrepreneurship has colored the findings of this study. The skills and enthusiasm of the impact of technology trends on business people are evident in adapting business people to the adoption of modern technology across businesses and in various service and goods industries. Conclusion: These findings have become the basis for many groups such as industry, education, and policymaking in many countries.

The study in the current article intends to explore the conception of the presence of the Islamic religious movement known as Muhammadiyah, which still remains to this day in relation to the life of the Muslim community, including its socio-religious, cultural, economic, and political aspects. Accordingly, a proper understanding of Muhammadiyah is not only achieved through a religious approach, but also by examining social-historical conditions, which is by demonstrating the extent that its presence in conducting religious activities correlates with the true concept of Islam (Muslim Public Good). The current study aims to observe the models and strategies utilized by Muhammadiyah’s champions in repositioning and reflecting on religious movements, which have been framed at both conceptual and practical level. Subsequently, the framing strategies were used as a social capital to carry out their religious activities. For issues that are practical in nature, the study in this article is a description and elaboration about the aspirations, perceptions, intentions, ideas, goals, and thoughts pertaining to a social system inspired by the spirit of religiosity in Indonesia, in general, and Islam in Java, in particular, within the Muhammadiyah tradition as a Muslim public good (the true Islam).

Forest and land fires in Riau Province for the period of 2019 caused enormous losses, many aspects were disturbed by the fires, namely economic, health and bilateral relations which were most affected. Meanwhile, the government seems slow in dealing with forest and land fires and resolving their impacts. The slow pace of government action has prompted groups outside the government to participate in efforts to accelerate the handling of forest and land fires in Riau. From this background, this study looks at the role of groups outside the government (pressure groups) in encouraging the acceleration of forest and land fire prevention in Riau in 2019. This study uses a qualitative approach with descriptive data analysis. Sources of data were obtained from interviews, review of legal products, articles, related documents and news sources from the mass media. This research shows that the existence of the student action movement, environmental activists and other civil society organizations, is able to accelerate the government to take preventive and curative actions to tackle forest and land fires in Riau Province. The presence of this pressure group is also a bridge of interests between the people and the state so that corrections to inappropriate state policies can be immediately carried out to prevent forest and land fires.

Portal vein embolization with N-butyl-cyanoacrylate plus iodized oil generates greater and faster liver regeneration as seen at CT compared with standard polyvinyl alcohol particles plus coils, all...

BACKGROUND: Gray hair is a physiological process of aging that occurs in everyone. Premature hair graying (PHG) is the term when early hair gray at an unusual age. The causes of PHG are multifactorial, genetic, nutritional, and environmental, including oxidative stress. Free radicals caused interference with cellular responses that cause direct damage to various proteins and DNA in the long term. The body’s defense mechanisms likely antioxidant enzymes, including catalase, glutathione peroxidase (GPx), and superoxide dismutase (SOD) was activated against free radicals. AIM: We aimed to evaluate markers of oxidative stress and associated with severe graying at young age. MATERIALS AND METHODS: We recruited consecutive 40 respondents with PHG and healthy controls, male sex and aged 0.05), while serum SOD, catalase, and GPx level, indicators of antioxidant were significantly lower (p < 0.001, p = 0.017 and p < 0.001, respectively) in PHG compared to controls. The correlation between oxidative stress and graying severity was not significant (p > 0.05), but the association between onset and severity of graying was significant (p < 0.001). CONCLUSIONS: Respondents with PHG had increased of pro-oxidants and decreased of antioxidants compared than controls. The severity of graying is equivalent to the level of oxidative stress. The supplement of antioxidants is likely recommended in PHG.

This research aims to reveal the effectiveness of the use of the Android-based carom games comic integrated to discovery learning (MIKIMOM) in improving critical thinking and mathematical representation in the teaching of physics. It is quantitative research with the quasi experimental research design. It was conducted in two phases, with the first phase for empirical try out of the test and second phase for the application of MIKIMOM to reveal the effectiveness of the developed media in teaching. The empirical try out was conducted to 261 grade XI MIA students. The application of the media was conducted to 32 students of grade X MIA 3 State Senior High School (SSHS) 2 Banguntapan as an experimental class using MIKIMOM and 32 students of grade X MIA 4 State Senior High School (SSHS) 2 Banguntapan as an experimental class using the Powerpoint (PPT) media. The data were collected using a critical thinking and mathematical representation test which was valid and reliable according to the empirical testing. The data were analyzed using the QUEST program to see the validity and reliability of the test items, and the MANOVA test to see the effectiveness of the media. The research finding shows that MIKIMOM is effective in improving the critical thinking and mathematical representation of the students with the scores of 0.287 (large effect size) and 0.179 (medium effect size)

Background: There are various microorganisms which caused pneumonia in developing countries such as Indonesia. The diagnosjs of pneumonia is still mainly confirmed by Chest X-ray which is unspecific to determine the etiology of pneumonia due to its low accuracy. On the other hand, the higher accuracy diagnostic tool, Computed Tomography (CT) scan, is not cost-effective. Therefore, an alternative diagnostic tool with high precision, affordability, and user-friendly is highly needed. Lung ultrasound (LUS) is an alternative diagnostic device. This study aims to investigate the diagnostic accuracy level of LUS in diagnosing pneumonia. Methods: Literature-researches was done in five databases namely PubMed/MEDLINE, ScienceDirect, Proquest, Cochrane and EBSCO/MEDLINE using keywords according to the clinical scenario. The articles were appraised with CEEBM worksheet. Results: Four articles met the inclusion and exclusion criteria. Sensitivity of LUS ranged around 85-97% and specificity ranged around 8694%. All appraised articles recommended the use of LUS for its high sensitivity in confirming diagnosjs of pneumonia and other lung diseases, and its favorable bedside use especially for critically ill patients. Lung US was also considered as being more inexpensive with less radiation exposure compared to CT scan or other radiographic imaging. Conclusion: Examination using LUS had a high diagnostic value in confirming the diagnosis of pneumonia.

Background: Outcome expectancy could mediate the psychological effects of exercise-related interventions, which implies that part of the psychological benefits of physical activity could be ascribed to placebo effects. (Szabo & Kocsis, 2017) Purpose: Knowing the effects of relaxation breathing on Anxiety in patients with psychosocial problems in the family during the pandemic Methods: The type of research used is quantitative quasi experimental, non-equivalent, control group pretest and posttest design. The population in this study was some family members who have anxiety problem with the sample of 39 respondents. Samples were taken using purposive sampling technique. Results: The average levels a score before 61,08% and after 60,82% deep breath of relaxation with p value = 0.043 (

Introduction: Nephrolithiasis is a urinary tract stone disease that can be found in the kidneys, ureters, bladder, and urethra. This disease is the three most common diseases in the field of urology besides urinary tract infections and benign prostate enlargement. Kidney stones are the most common, with an estimated lifetime prevalence as high as 15%. Bladder stones have significant morbidity but occur much less frequently than kidney stones. Many factors cause reduced urine flow and cause obstruction, one of which is urine static and decreased urine volume due to dehydration and inadequate fluid intake, this can increase the risk of nephrolithiasis. Low urine flow is a common abnormal symptom. In addition, various conditions that trigger nephrolithiasis such as the composition of various stones are the main factors in identifying the cause of nephrolithiasis. Aims of this article is to review risk factors and pathophysiology of nephrolithiasis. Discussion: Symptoms associated with urinary tract stones depend on the location of the stone, the size of the stone, and any complications that have occurred. Usually, stones in the kidney calyx are asymptomatic. When the stone falls off and descends into the narrow ureter, it becomes symptomatic. Stones generally get stuck in the narrowest part of the ureter, such as the uretero-pelvic junction, when the ureter crosses the iliac vasa, and the uretero-vesical junction. The main symptom of ureteric stones is often an acute onset of pain in the back. This pain can be colicky or not. Colic pain occurs because the peristaltic activity of the smooth muscle of the calical system or ureter increases in an attempt to remove stones from the urinary tract. The increase in peristalsis causes the intraluminal pressure to increase so that there is stretching of the nerve terminals that provide a sensation of pain. The pain can radiate from the pelvis and to the ipsilateral groin. Other symptoms include nausea, vomiting and hematuria. Hematuria can occur macros or microscopy from urinalysis. Hematuria occurs as a result of trauma to the urinary tract mucosa caused by stones. Conclusion: Nephrolithiasis is rock-forming salt reaches a urine concentration that exceeds the equilibrium point between the dissolved component and crystallization occurs. There are several risk factors that nephrolithiasis occurs due to various causes. Therapy and lifestyle changes are interventions that can change risk factors, but there are also risk factors that cannot be changed.

Introduction: Dentigerous cyst is a pathological epithelial cavity that surrounds an unerupted tooth crown. Dentigerous cysts are usually associated with impacted teeth, mandibular third molars, first and second premolars and canines. Dentigerous cysts can occur at any age, but most cases of these cysts occur at the age of approximately 20 years. Men are affected more often than women. Purpose.To find out how the mechanism of dentigerous cysts. The cyst cavity is lined with epithelial cells derived from the epithelial enamel that is reduced from the tooth-forming organs. According to its pathogenesis, the pressure exerted by an erupted tooth on the follicle can block venous flow leading to accumulation of exudate between the reduced enamel epithelium and the crown of the tooth. These cysts are mostly due to fluid accumulation either between the reduced enamel epithelium and the enamel or between the layers of the enamel organ. This fluid accumulation occurs as a result of the pressure exerted by the erupting tooth on the affected follicle, which blocks venous flow, thus inducing rapid transudation of serum in the capillary walls. Discussion: The expansion of the dentigerous cyst causes the release of bone resorbing factor and an increase in the osmolarity of the cyst fluid as a result of the discharge of inflammatory cells, the discharge of residual epithelial enamel and tooth enamel, and desquamation of epithelial cells into the lumen of the cyst. In theory, the fluid will cause cystic proliferation. because the hyperosmolar content produced by cellular breakdown and cell products causes an osmotic gradient to pump fluid into the lumen of the cyst or it can also be said that an increase in the osmolarity of cyst fluid is the result of a shortcut to inflammatory cells and desquamation of epithelial cells into the lumen of the cyst resulting in a dentigerous cyst. Conclusion: The dentigerous cysts that surround the unerupted dental crowns are caused by the accumulation of fluid either between the reduced enamel epithelium or between the layers of the enamel organs. Dentigerous cysts can cause infection, pain, swelling, root dislocation, and resorption of adjacent tooth roots.

Asnake Balche Bade,1 Teshale Ayele Mega,2 Getandale Zeleke Negera3 1School of Pharmacy, Institute of Health Science, Arbaminch University, Arbaminch, Ethiopia; 2School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 3Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Oromia Regional State, EthiopiaCorrespondence: Teshale Ayele MegaAddis Ababa University, P.O. Box: 9086, Addis Ababa, EthiopiaTel +251 91 3144738Email tesh.ayu2016@gmail.comBackground: Clinicians use sputum culture conversion as an interim indicator of the efficacy of multi-drug resistant tuberculosis (MDR-TB) treatment and to determine treatment duration. Yet, limited studies have been published in Ethiopia.Objective: The objective of this study was to determine the predictors of delayed culture conversion among patients receiving MDR-TB treatment at selected treatment centers in Ethiopia.Patients and Methods: A multi-center observation study was conducted among MDR-TB patients in South and Southwestern Ethiopia from April 14 to May 14, 2019. The data of patients treated from January 2013 to July 2019 were reviewed using a data abstraction tool. The data were analyzed. Descriptive statistics was computed using SPSS version 21 software program. Cox regression was used to identify predictors of delayed culture conversion. Hazard ratios with a two-sided p-value < 0.05 were considered statistically significant.Results: Of 200 included MDR-TB patients, 108 (54%) were males. Majority,159 (79.5%) of the patients had a culture conversion time of less than two months, while 15 (7.5%) had delayed culture conversion (greater than 120 days). Patient’s registration group (after loss to follow- (adjusted hazard ratio (AHR)=16.215, 95% CI [3.839, 68.498]), after treatment failure (AHR=12.161, 95% CI [2.516, 58.793]), history of previous TB treatment (AHR=4.007, 95% CI [3.115, 62.990])) and low BMI (AHR= 1.257; 95% CI [0.725,1.547] were identified as a risk factors for delayed culture conversion.Conclusion: Our finding showed that nearly 80% of the patients achieve sputum culture conversion by the second month of treatment. Delayed culture conversion was more likely among patients with malnutrition (BMI< 18.5kg/m2), after treatment failure, previous TB treatment, and after lost to follow-up.Keywords: culture conversion, predictors, MDR-TB, Ethiopia

Renal Disease was a chronic disease that the most attacking people in Indonesia. Damage to this vital organ in the human body greatly affected a person's health condition, one of which was anemia. This study aimed to determine the effectiveness of Durante hemodialysis PRC transfusions on hemoglobin levels. The method used was Pre-experimental design, with the One group pre-post test design approach. With a sample of 49 patients who underwent regular hemodialysis at RSUD dr. Iskak Tulungagung. Data were obtained by direct observation. Processed by computerized methods with a statistical t-test, the significance level (α) was 0.05. The study results showed that the hemoglobin levels of the pre-Durante hemodialysis PRC transfusion patients were 4-5 mg/dl (53.06%), and the hemoglobin levels of the post-Durante hemodialysis PRC transfusion patients were 6.1-7 mg/dl (34.69%). The results of statistical tests showed that there was an increase in hemoglobin levels in patients who received Durante hemodialysis PRC transfusion by 1.22 mg/dl because p-value = 0.000 < 0.05 (α) means that there was an effect. It could be concluded that the delivery of Durante hemodialysis PRC transfusion could help increase hemoglobin levels. This finding was very helpful for chronic Renal Disease patients undergoing hemodialysis, who have been using erythropoietin preparations because PRC transfusions were cheaper and more effective when compared to using erythropoietin preparations

Adolescents are prone to nutrition problem, such as the lack of nutrition, overweight, and obesity caused by sedentary behaviours. Adolescents’ activities are influenced by their surrounding environment, such as family, friends, and duration of gadget use. Nutrition Education is a method to help increasing the adolescent’s knowledge about the importance of increasing physical activity and the consequence of sedentary behaviours for adolescents. Knowing the most effective method was the purpose of the study. This study used a quasi-experimental method with control group pre-test post-test design. The study was carried on three groups of adolescents, namely the lecture group, website group, and control group, for two months on school days. The instrument used was ASAQ (Adolescents Sedentary Activity Questionnaire) analysed by one-way ANOVA. The subjects of this study were adolescents aged 15-16 years old. This study used purposive sampling to select the subjects. The results showed that Nutrition Education using the interpersonal lecture method could increase 23.7 points of adolescent knowledge compared to Nutrition Education using the website method (6.2 points). Nutrition Education could increase the adolescent’s knowledge but it did not have a significant effect on adolescent’s physical activity on school days. Some activities of the adolescents were quite high, especially the learning activities of the lecture group (471.7 ± 53.5) and the website group (471.7 ± 53.5). The sleep activity also increased significantly in the lecture group (p = 0.040), website group (p = 0.003), and control group (p = 0.015). Meanwhile, the screen time activity decreased significantly (p = 0.011) in the lecture group due to various factors. Further research related to the factors affecting the duration of adolescent’s screen time on school days needs to be conducted.

The spread of COVID-19 has almost never been predicted by any part of the world. This affects most business fields in terms of global supply, world demand, and the confidence of economic actors. The spread of COVID-19 has caused several business activities which become the driving force of the economy stopped due to government policies. The stay at home policy disrupts the performance of the business field, most of which conduct physical buying and selling transactions. And it has directly impact to a negative economic growth both globally and in every region of Indonesia, including Sumatra including 10 provinces within. For this reason, a SWOT analysis is needed to determine the best strategies that can drive economic growth. This analysis based on logics to enhance Strength and Opportunities, nevertheless at the same time could minimize weakness and overcoming Threats. The results of the position of the Cartesian diagram in this study were to diversify products / technologies both e-commerce and fintech and to carry out the results of the SWOT matrix strategy. After analyzing the SWOT matrix, the results in this study were to choose the S-T strategy, namely using strength to overcome threats.

This study aims to analyze the process of lecturing the theory and practice of physical education at the Salatiga State Islamic Institute (IAIN Salatiga) using the google clasroom media. The method used is qualitative with a phenomenological approach and case study design to examine in depth the aspects that influence the use of google classroom media in the physical education learning. The results of this study are the physical education e-learning using google classroom at IAIN Salatiga can be used as a solution to the limitations of theoretical and practical in the physical education learning. Furthermore, it makes it easier for lecturers to deliver physical education material and makes it easier for students to learn physical education material. Internet signal access is a major obstacle in e-leraning physical education using google classroom at IAIN Salatiga.

Post-partum is the period during which the internal and external reproduction organs will gradually return to their pre-pregnancy state. Uterine involution or uterine contraction is a process in which the uterus returns to its pre-pregnancy state weighing about 60 grams. The process of uterine involution is influenced by uterine contractions which are stimulated by the oxytocin hormone, a process which can be facilitated by a combination of oxytocin and endorphin massage. With the release of endorphins, the mother will feel more comfortable and the oxytocin hormone can be stimulated, so that uterine contractions can work normally and increase the process of uterine involution. This study involves a literature review which aimed to summarize the results of studies which explain that the effect of oxytocin and endorphin massage to uterine involution in postpartum. The data was collected from Pubmed and Google Scholar databases with these keywords: combination of oxytocin and endorphine massage; uterine involution; and maternal postpartum. Only 3 journals had the required inclusion criteria. The results showed that the combination of oxytocin massage and endorphin massage was effective in reducing the height of uterine fun in post-partum mothers. The combination of oxytocin massage and endorphin massage can be developed for increasing uteri involution. Keywords: Combination, oxytocin and endorphin massage, uterine involution, postpartum