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Health facilities with referral status for COVID-19 cases, reported a decrease in non-COVID inpatients, compared to facilities with non-referral status. The decrease in bed utilization (BOR) was very significant in several health facilities including Langsa Hospital 10-15% before 65-75%,. This study aims to study the Determinants of Factors Affecting the Decrease in Bed Utilization (BOR) at Langsa Hospital during the COVID-19 Pandemic Period in 2021. The research approach uses descriptive qualitative data collection techniques through in-depth interviews and informants are determined by purposive sampling of key informants, namely 4 inpatients and 2 supporting informants. The total number of informants is 6 people. The research instrument is the researcher himself and data collection through interviews, documentation and field observations. Data analysis technique with taxonomy. The results of the study, namely the availability of services due to reduced facilities, hospital policies in implementing health care programs, priority to hospitals from patients in independent practice health care services and community stigma regarding the confirmation of COVID-19 status in each patient, were the driving factors for the decrease in BOR at Langsa Hospital in the 2021 COVID-19 pandemic. It is recommended that the Langsa Hospital management coordinate with IPSRS for the availability of facilities, the health promotion section conducts more effective promotion and socialization methods and nursing provides training on effective communication.

Recurrent laryngeal nerve (RLN) injury is one of the main complications of total thyroidectomy. If the injury is bilateral, total airway obstruction, aphonia and hoarseness of voice could be precipitated. Hence, it is wise for the operating surgeon to be guided by neural monitoring during thyroidectomy. We present a valuable experience handling a middle-aged man with a huge papillary thyroid carcinoma . He needed an urgent thyroidectomy due to obstructive symptoms. We highlight our intraoperative dexterity in handling his surgery in the context of continuous monitoring of RLN using electromyography.

An estimated 37,000 cisgender and transgender women work as sex workers in Malaysia, a population that has been disproportionately affected by the HIV epidemic. Although Malaysia provides no-cost antiretroviral therapy (ART) to people with HIV, little is known about sex workers' engagement in the HIV care continuum. We analyzed data from 57 HIV-infected cisgender women (n = 33) and transgender women (n = 24) sex workers from a respondent-driven sampling study on HIV prevalence among sex workers in Kuala Lumpur, Malaysia. We examined the proportion of women who were newly diagnosed with HIV, had a baseline CD-4 count test, were initiated and retained on antiretroviral treatment (ART). Overall, only 26.3% had ever been HIV tested and almost 60% were newly diagnosed. Only a small proportion of cisgender (15.2%) and transgender (12.5%) women were currently taking ART. Interventions to enhance sex workers' engagement in the HIV care continuum are urgently needed. Deployment of evidence-based strategies to improve linkage and retention in HIV care should be adapted to address the unique needs of this important key population.

OBJECTIVE The goal of this study was to assess the social determinants that influence access and outcomes for pediatric neurosurgical care for patients with Chiari malformation type I (CM-I) and syringomyelia (SM). METHODS The authors used retro- and prospective components of the Park-Reeves Syringomyelia Research Consortium database to identify pediatric patients with CM-I and SM who received surgical treatment and had at least 1 year of follow-up data. Race, ethnicity, and insurance status were used as comparators for preoperative, treatment, and postoperative characteristics and outcomes. RESULTS A total of 637 patients met inclusion criteria, and race or ethnicity data were available for 603 (94.7%) patients. A total of 463 (76.8%) were non-Hispanic White (NHW) and 140 (23.2%) were non-White. The non-White patients were older at diagnosis (p = 0.002) and were more likely to have an individualized education plan (p < 0.01). More non-White than NHW patients presented with cerebellar and cranial nerve deficits (i.e., gait ataxia [p = 0.028], nystagmus [p = 0.002], dysconjugate gaze [p = 0.03], hearing loss [p = 0.003], gait instability [p = 0.003], tremor [p = 0.021], or dysmetria [p < 0.001]). Non-White patients had higher rates of skull malformation (p = 0.004), platybasia (p = 0.002), and basilar invagination (p = 0.036). Non-White patients were more likely to be treated at low-volume centers than at high-volume centers (38.7% vs 15.2%; p < 0.01). Non-White patients were older at the time of surgery (p = 0.001) and had longer operative times (p < 0.001), higher estimated blood loss (p < 0.001), and a longer hospital stay (p = 0.04). There were no major group differences in terms of treatments performed or complications. The majority of subjects used private insurance (440, 71.5%), whereas 175 (28.5%) were using Medicaid or self-pay. Private insurance was used in 42.2% of non-White patients compared to 79.8% of NHW patients (p < 0.01). There were no major differences in presentation, treatment, or outcome between insurance groups. In multivariate modeling, non-White patients were more likely to present at an older age after controlling for sex and insurance status (p < 0.01). Non-White and male patients had a longer duration of symptoms before reaching diagnosis (p = 0.033 and 0.004, respectively). CONCLUSIONS Socioeconomic and demographic factors appear to influence the presentation and management of patients with CM-I and SM. Race is associated with age and timing of diagnosis as well as operating room time, estimated blood loss, and length of hospital stay. This exploration of socioeconomic and demographic barriers to care will be useful in understanding how to improve access to pediatric neurosurgical care for patients with CM-I and SM.

Langerhans cell histiocytosis (LCH) is a proliferative disease of histiocytic cells that rarely affects adults. Different therapeutic options have been used in the treatment of this condition depending on the severity of the disease. However, the management of LCH is often controversial when a resection with clean margins is not achieved. We present a 37-year-old male who was diagnosed with LCH affecting the middle third of the clavicle. The patient was subjected to a wide resection of the lesion creating a large bone defect. The reconstruction was then performed using a 3-D printed porous pseudo-prosthesis (Ti6AL4V) which was fixed using an anatomical clavicular plate (Depuy-Synthes, Raynham, MA, USA) and locking screws. The implant trabeculae were filled with bioactive bone graft substitute (GlassBONETM, Noraker, France). After two years of follow-up the patient was pain free, had a full range of movement, and scored 100 on the Constant Scale and 2.5 points on the disabilities of the arm, shoulder and hand score (DASH). Moreover, in this case, the implantation of the 3-D printed pseudo-prosthesis avoided the use of adjuvant therapies such as radiotherapy. The use of a 3-D printed pseudo-prosthesis achieved an excellent clinical and functional outcome in the treatment of a large bone defect, following a resection of a LCH of the clavicle. 3-D printed pseudo-prostheses could be useful instruments for the treatment of bone defects following large bone resections in musculoskeletal tumors.

Malignant mesotheliomas (MMs) are malignancies of the mesothelium, with primary deposits originating in the pleura, peritoneum, pericardium and the tunica vaginalis (ie, testicular). Metastatic spread is commonly reported to affect the liver, adrenal glands, kidney and contralateral lung (in cases of malignant pleural mesothelioma). Metastases to distant sites are uncommon. Spread to the oral cavity in particular is very rare. A total of 23 cases of metastatic spread to the oral cavity have been reported in the literature to date; of those, 9 cases have been to the tongue. Given the rarity of the site of metastasis, the management remains challenging. This case highlights a rare site of metastasis in MM, discusses treatment options available and briefly talks about technical limitations in treating a mobile structure such as the tongue. Good palliative and supportive care is crucial in managing cases where no curative treatment is possible.

Background: The level of independence among schizophrenia patients is still a problem that must be resolved. The development of appropriate relevant instruments is needed. This study aims to develop a nursing rehabilitation therapy instrument to increase the independence of schizophrenia patients in the hospital setting. Methods: This study used a research and development study design. The study was conducted in a Psychiatric Hospital in Surabaya, Indonesia from August to December 2020. The total sample in this study consisted of 100 nurses determined by a simple random sampling technique. In addition, 50 medical records were observed. The inclusion criteria were nurses who cared for patients with schizophrenia with a minimum work experience of 1 year. Respondents were excluded from the study if they did not follow the study through to completion. The data collection process was done online by filling in a Google form. The data was analysed using descriptive statistics and a FGD followed with 10 nurses to discuss the new instrument. Results: The data found that a rehabilitation therapy instrument is not currently available (53%). The FGD results show that it is necessary to develop the nurse’s knowledge and to provide adequate facilities and rooms, as well as to develop instruments to use as measuring tools in order to evaluate the rehabilitation therapy given. Conclusion: Rehabilitation therapy instruments are important to develop for schizophrenia patients. It is hoped that the development of the instrument in this study will optimise the rehabilitation of schizophrenia patients.

Background Locally advanced breast cancer is commonly found in Indonesia. In this group of patients, aggressive treatment such as axillary lymph nodes dissection (ALND) with or without regional nodal irradiation (RNI) will increase the risk of breast cancer treatment-related lymphedema (BCRL) in our patients. Lymphaticovenular anastomosis (LVA) has been established as a minimally invasive approach in lymphedema surgery. In this study, we report our first experience of LVAs in BCRL patients. Methods This was a cross-sectional study taken from breast cancer patients receiving ALND with or without RNI. From December 2018 until June 2020, we collected and described general patient information, tumor characteristics, diagnostic methods, and the outcome of LVA. Postoperative subjective symptoms scores (lymphedema quality-of-life score [LeQOLiS]) and lymphedematous volume (upper extremity lymphedema [UEL] index) were compared with preoperative ones. Results Seventy patients experienced BCRL with the mean age of 54.8 (9.4) years and mean body mass index of 28.1 (4.5). ALND was performed in 66 (97.1%) cases and RNI was given in 58 (82.9%) patients. Thirty-one (44.3%) patients were in the International Society of Lymphology stage 1, 24 (34.3%) in stage 2A, and 15 (21.4%) in stage 2B. The mean lymphatic vessel diameter was 0.5 (0.26) mm and 0.80 (0.54) mm for the vein. Lymphosclerosis severity was 7 (4%) in S0 type, 129 (74.1%) in S1 type, 37 (21.3%) in S2 type, and 1 (0.6%) in S3 type. In histopathology examination, S1 types were in lower grade injury, while S2 and S3 types were in the higher grade. Seven (53.8%) cases of S2 type showed severe fibrosis from trichrome staining. Postoperative LeQOLiSs were significantly lower than preoperative ones (5.6 ± 2.4 vs. 3.7 ± 2.6; p = 0.000). With the mean follow-up of 7.4 (3.7) months, the overall UEL index reduction was 9.2%; mean –11 (16.8). Postoperative UEL index was significantly lower than preoperative ones (117.7 ± 26.5 vs. 106.9 ± 18.5; p = 0.000). No complications were observed during this period. Conclusion LVA reduced the subjective symptoms and UEL index in BCRL cases. Future studies using updated imaging technologies of the lymphatic system and longer follow-up time are needed to confirm our results.

The Faculty of Biology at the National University has a Microbiology and Genetics laboratory which is used for practicum activities, research, and fieldwork lectures. At the analysis stage, problems were found, namely in recording the use of equipment and materials used by students for research activities still using conventional methods, this resulted in delays in managing and conveying information. Adequate lecture facilities are an important aspect in helping the teaching and learning process. Based on the background of the problem, the author aims to make the equipment monitoring process more efficient, using Android-based devices. The author uses the Sequential search method in the process of monitoring equipment in the laboratory. This research was tested using black-box testing and white box testing by distributing questionnaires conducted using a Likert scale with a value range of 5 to 25 student correspondents with an average value for software testing = 4.6; Interface = 4.44; Software features = 4.32; item search feature = 4.08; with the final mean = 4.09.

In the era of Society 5.0, technological progress is unstoppable. Technological advances in the era of society 5.0 have become the main needs of humans in helping daily work. Technology is used as a medium for finding information to transportation tools that are integrated with the intervention of digital technology. Almost every company has technology to support their business development needs. And especially in agencies in this era, employee data is also processed using technology, but with the integration of employee data into technology, a lot of sensitive data must be protected in order to avoid misuse by irresponsible people. Therefore, the main objective of this research is to develop the application of the Message Diggest Algorithm (MD5) Cryptography Algorithm in employee data applications. This application is very appropriate to make it easier for companies to manage their employee data and ensure data security. To secure sensitive data from each employee, the process carried out is by encrypting each sensitive data so that it is not easy to read by others who have no interest or authority over the data. And the desktop-based application was made using Visual Basic. The research was carried out with two methods, namely the method to test the compilation speed of MD5 and to test the validation of the decrypted data from the MD5. And from the results of the study, the average speed of 500-515 milliseconds and data consistency obtained valid results from all tests.

The Academic Administration division (BAA) plays a role in the process of issuing student certificates at the National University. Although the data has been computerized, the process of issuing the letter is still manual so it is less effective and efficient. Students must come to the BAA unit to apply for the issuance of a student certificate, including for data correction purposes if needed. This will require more effort for students in terms of time, energy and material. This research is to design a Web-Based Student Certificate Making System that can simplify the service process and submission of a certificate for students at the National University. This system is integrated and responsive and is accessed online. The application was developed with the waterfall model and utilizes the Unified Modeling Language (UML) tool and uses the PHP programming language. The result of this study is the existence of a web-based certificate application design that can facilitate students in obtaining student certificates at the National University. The results of testing the application using the white-box and black-box methods, indicate that the logic and functionality of the application is running well and can be used by the BAA unit of the National University.

Family Archive Restoration Service (LARASKA) is a national archival institution that is present directly in the midst of people who have difficulty in handling community archives damaged by disasters. Since its launch in 2019, LARASKA has helped as many as 790 families and has repaired 33,193 archives. LARASKA ANRI is a service provided to the public free of charge by following established procedures. On February 21, 2021, exactly 1 day after the flood-hit Jabodetabek, the LARASKA ANRI team established a command post at the location to help people who have difficulty coming directly to ANRI. Thus, it is hoped that important public archives or documents as evidence of organizational accountability, both government and private, as well as evidence of community civil rights can be saved. The aim of the researchers from this study was to build a website-based LARASKA application to make it easier for the public to use the online application and conduct assessment analysis using the PIECES Framework.

E-commerce or online stores appear to provide convenience for the public in the field of information technology, Budi Luhur is a shop in the field of selling household needs such as cabinets, plate racks, spring beds, sofas, and electronics. But the problem is that until now, how to market their products still using manuals such as brochures, posters, and orders that are still recorded manually with books, so that the store requires costs that are sometimes not small in number to print brochures which will later be used to convey information to customers manually. To overcome these problems, it is necessary to create a system at the Budi Luhur store that can make it easier for customers and shop owners to make transactions. The design of Budi Luhur's E-Commerce System uses a Software development methodology, namely the waterfall method. This method is used by researchers to develop Software systems by having a Software life flow sequentially starting from analysis, design, coding and testing. To design the system using E-CRM (Electronic Electronic Customer Relationship Management), CodeIgniter Framework, PHP programming language and MySQL database.

The BRT unit is a part of the National University that manages electronic equipment including repairing or maintenance in the event of a breakdown. Usually, BRT unit technicians carry out the process of repairing electronic equipment based on complaints received from staff/employees. However, so far the complaint process is still manual and recorded using simple tools such as excel, word and ledgers. This causes the process of electronic complaints and maintenance to be slow. Therefore, in this study, a web-based electronic complaint and maintenance application will be developed at the National University. The application was developed based on the waterfall model using the PHP programming language and using a MySQL database using the First in First Out (FIFO) method. The results of this study are the availability of applications that can help the processing of electronic complaints and maintenance data to be more effective and efficient. Testing of the application was carried out using the White-box and Black-box methods and testing on 3 flowcharts including the Staff/Employee Logic flowchart, Admin Logic flowchart and Technician Logic flowchart with white-box testing calculated cyclomatic complacity and resulted in Cyclomotic Complexity = 8, Region = 8 with path Independent Path = 8 where the result shows that all the logic and functionality of the application has been running well.

Tiara Brand is a self-produced clothing business. The process of selling products at Tiara Brand is done by promoting their products through social media. This process is considered less effective, because customers have to order through another application, namely WhatsApp. Business owners also find it difficult to promote their products widely. Based on these problems, this study will discuss the design and creation of a website-based e-commerce application using the CodeIgniter framework, so that it is easier for customers to buy products from Tiara Brand, because it can be done on the same website. In addition, business owners can also more easily manage each transaction and can promote their products to customers without regional restrictions. the steps of this research are made in the form of a flowchart and go through stages consisting of; 1) Data collection, 2) Literature study, 3) Design, 4) Program code preparation, and 5) Application testing and using the String Matching Algorithm as an implementation of the application being built. The results of the research are the construction of a website that not only displays the products being sold, but can also be used for transactions and has the potential to develop Tiara Brand selling online.

Computers have become a huge requirement to support human performance. Computers also often experience Hardware damage such as processors, VGA, motherboards, memory, mouse, keyboards, hard disks, optical drives, monitors. Until now, many computer users still do not have sufficient knowledge of the initial diagnosis of computer Hardware damage which causes a lot of computer users to pay a lot of money to find out and repair the damage that occurs to Computer Hardware. In this Expert System application research development, the authors use a combination of two inference methods, namely the Forward Chaining method and the Certainty Factor Method. The programming tools used in the development of this Expert System application is using the Sublime Text 3 application while the database uses MySQL with PHP as the programming language. The purpose of this Expert System application is made to assist computer users in making an initial diagnosis of a damaged computer Hardware along with the causes and solutions to overcome the damage.

Life in the current era of technology is almost every line connected to the internet, as well as when doing business. Website is a container used for business development and improvement. One form of this is to create an attractive website display as a strategy to increase product quality and quantity. This research aims to; 1) The creation of a marketing information system facility with the application of CRM using the web-based React.JS framework as the main purpose of the research, and 2) Understanding and describing the benefits of implementing a Marketing Information System with CRM Applications using the web-based React.JS framework as a marketing strategy to improve quality and product quantity. To implement this research, the researcher uses the Agile method. A website-based marketing system with the implementation of Customer Relationship Management (CRM) at Reswara Digital printing produces structured and detailed data storage and the delivery of product information to consumers can be carried out optimally.

Smart city promotes the unification of conventional urban infrastructure and information technology (IT) to improve the quality of living and sustainable urban services in the city. To accomplish this, smart cities necessitate collaboration among the public as well as private sectors to install IT platforms to collect and examinemassive quantities of data. At the same time, it is essential to design effective artificial intelligence (AI) based tools to handle healthcare crisis situations in smart cities. To offer proficient services to people during healthcare crisis time, the authorities need to look closer towards them. Sentiment analysis (SA) in social networking can provide valuable information regarding public opinion towards government actions. With this motivation, this paper presents a new AI based SA tool for healthcare crisis management (AISA-HCM) in smart cities. The AISA-HCM technique aims to determine the emotions of the people during the healthcare crisis time, such as COVID-19. The proposed AISA-HCM technique involves distinct operations such as pre-processing, feature extraction, and classification. Besides, brain stormoptimization (BSO) with deep belief network (DBN), called BSODBN model is employed for feature extraction. Moreover, beetle antenna search with extreme learning machine (BAS-ELM) method was utilized for classifying the sentiments as to various classes. The use of BSO and BAS algorithms helps to effectively modify the parameters involved in the DBN andELMmodels respectively. The performance validation of the AISA-HCM technique takes place using Twitter data and the outcomes are examined with respect to various measures. The experimental outcomes highlighted the enhanced performance of the AISA-HCM technique over the recent state of art SA approaches with the maximum precision of 0.89, recall of 0.88, Fmeasure of 0.89, and accuracy of 0.94. © 2022 Tech Science Press. All rights reserved.

The development of Information Technology (IT) is growing very rapidly. The rapid development of IT makes internet technology the main communication tool that is in great demand by the public. With the internet technology will facilitate and speed up the search for information, information is very important in supporting the course of a company to achieve the desired goals. Online transactions are a necessity that answers the problems that arise today. In online transactions, a person can freely make purchases, sales and find things he wants to do without having to meet with buyers or sellers through laptops, computer devices, or smartphones. For this reason, the authors design a web-based musical instrument sales system so that people can easily get information about selling musical instruments online quickly and precisely both regarding products, profiles, prices, and also how to shop at online stores and can directly make sales transactions. The author makes the design of this information system using UML (Unified Modeling Language), the Waterfall method, and Agile the author implements to create a website-based E-commerce application. As a result, users can shop and view information about musical instruments.

Contains fulltext : 219533.pdf (Publisher’s version ) (Closed access) Medical students' attitudes towards patients with addiction and towards other chronic conditions might be comparable. Positive attitudes towards such conditions can be developed during medical education. This study evaluated medical students' attitudes towards patients with addiction, dementia, and diabetes, and how such attitudes change during training. This is an observational prospective cohort study. Participants (N = 100) were students who recruited from Primary and Community Care training, which consisted of theoretical courses and a clinical rotation. The Medical Condition Regard Scale was used to measure the attitudes and a repeated-measures analysis was performed to compare them. Before training, students' attitudes towards patients with addiction were more negative than towards dementia and diabetes. The attitudes towards addiction remained stable during the entire training, whereas the attitudes towards dementia and diabetes remained stable during the theoretical courses but decreased after the clinical rotation. These findings emphasize a need to pay attention to students’ attitude development towards patients with chronic diseases, addiction in particular, during medical training. 11 p.

During the covid-19 pandemic, family income has decreased relatively. However, the cost of living is relatively the same, even increasing for health financing needs. Young people, namely students at school, have a lifestyle that needs to be managed, especially in using money. The purpose of this community service is to provide briefing for high school students from the Cirebon Penabur Christian Education Board regarding financial management during the pandemic so that their needs are fulfilled; lecturers of the Faculty of Economics and Business, Krida Wacana Christian University can apply their knowledge to the community, especially to students; as well as a means of training and non-formal education for students of the Faculty of Economics and Business through interacting with the community directly. The scope of this activity is counseling about personal finance cycles, financial planning and tips, financial records, and an introduction to the use of financial calculators. The method of activity used is counseling, joint discussion, and question and answer, as well as providing feedback at the end of the event. The results of this activity are to increase students' knowledge and insight about financial management during the pandemic; lecturers and students of the Faculty of Economics and Business can apply their knowledge to the community. Participants were enthusiastic and asked about things to use money in their daily lives. Through this activity, students are invited to begin to distinguish between needs and wants and to manage finances well, so that the necessities of life can be fulfilled and have savings or investments from an early age.

Background: Lung cancer is still the leading cause of death for malignancies worldwide. Urokinase plasminogen activator (uPA), its soluble receptor (suPAR), and its inhibitor (PAI-1) play an important role in tumor invasion and metastasis. This study aimed to evaluate the differences in the urokinase plasminogen activator system (uPA, suPAR, and PAI-1) in lung cancer patients before and after chemotherapy.Methods: This research was an observational analytical study with a cross-sectional design. The subjects were 30, consisting of 17 lung cancer patients before chemotherapy and 13 lung cancer patients after chemotherapy for 4 or 6 cycles. The levels of serum uPA, suPAR, and PAI-1 were measured by enzyme-linked immunosorbent assay (ELISA). Results: In lung cancer patients before chemotherapy, there were no significant (p>0.05) differences in levels of serum uPA, suPAR, and PAI-1 between patients with stage III and IV. The highest serum uPA and suPAR levels were found in adenocarcinoma cell types and the highest serum PAI-1 level in adenoepidermoid cell types. After chemotherapy, serum suPAR and PAI-1 were significantly (p < 0.05) decreased in lung cancer patients. However, there were no significant (p>0.05) differences in the levels of serum uPA, suPAR, and PAI-1 between patients with chemotherapy responses for stable and progressive diseases. Conclusion: This study revealed that suPAR and PAI-1 levels were decreased in lung cancer patients who had received chemotherapy. This can occur due to decreased tumor cells activity.

Aims: To determine the proportion of UK patients with type 2 diabetes (T2D) who meet the cardiovascular (CV) or combined CV/core eligibility criteria of the CV outcome trials (CVOTs) of UK-marketed glucagon-like peptide-1 receptor agonists (GLP-1 RAs) showing CV benefit (dulaglutide in REWIND, liraglutide in LEADER and injectable semaglutide in SUSTAIN-6). Materials and Methods: Adults with T2D on/before June 2018 were identified from the UK Clinical Practice Research Datalink GOLD primary care database and linked to Hospital Episode Statistics data (Protocol 19_262). Patient CV and clinical data were evaluated against the CVOTs’ eligibility criteria. Data were analysed descriptively. Results: The study cohort (N=33,118 patients with T2D) had a mean (SD) age of 66.0 (13.3) years and 56.6% were male. Almost two-thirds (64.5%) of the study cohort met the CV criteria for REWIND, versus 43.0% for both LEADER and SUSTAIN-6. The proportions of the study cohort who met the CVOTs’ criteria of ‘established CV disease’ and ‘CV risk factors only’ for REWIND were 22.4% and 42.1%, respectively, versus 38.7% and 4.3%, respectively, for both LEADER and SUSTAIN-6. The proportion of patients satisfying both CV and core criteria was 44.4% for REWIND, 13.3% for LEADER and 13.5% for SUSTAIN-6. Study findings remained consistent when restricted to GLP-1 RA users. Conclusions: REWIND captured a trial population more representative of the real-world T2D population in the UK than LEADER or SUSTAIN-6 with regard to both CV and combined CV/core eligibility criteria.

Objectives We investigated weight changes following antiretroviral therapy (ART) initiation, the development of metabolic syndrome (MetS) and its association with all-cause mortality among Asian adults living with HIV. Methods Participants enrolled in a regional Asian HIV-infected cohort with weight and height measurements at ART initiation were eligible for inclusion in the analysis. Factors associated with weight changes and incident MetS (according to the International Diabetic Federation (IDF) definition) were analysed using linear mixed models and Cox regression, respectively. Competing-risk regression models were used to investigate the association of MetS with all-cause mortality. Results Among 4931 people living with HIV (PLWH), 66% were male. At ART initiation, the median age was 34 [interquartile range (IQR) 29-41] years, and the median (IQR) weight and body mass index (BMI) were 55 (48-63) kg and 20.5 (18.4-22.9) kg/m2 , respectively. At 1, 2 and 3 years of ART, overall mean (± standard deviation) weight gain was 2.2 (±5.3), 3.0 (±6.2) and 3.7 (±6.5) kg, respectively. Participants with baseline CD4 count ≤ 200 cells/µL [weight difference (diff) = 2.2 kg; 95% confidence interval (CI) 1.9-2.5 kg] and baseline HIV RNA ≥ 100 000 HIV-1 RNA copies/mL (diff = 0.6 kg; 95% CI 0.2-1.0 kg), and those starting with integrase strand transfer inhibitor (INSTI)-based ART (diff = 2.1 kg; 95% CI 0.7-3.5 kg vs. nonnucleoside reverse transcriptase inhibitors) had greater weight gain. After exclusion of those with abnormal baseline levels of MetS components, 295/3503 had incident MetS [1.18 (95% CI 1.05-1.32)/100 person-years (PY)]. The mortality rate was 0.7 (95% CI 0.6-0.8)/100 PY. MetS was not significantly associated with all-cause mortality in the adjusted model (P = 0.236). Conclusions Weight gain after ART initiation was significantly higher among those initiating ART with lower CD4 count, higher HIV RNA and an INSTI-based regimen after controlling for baseline BMI. Greater efforts to identify and manage MetS among PLWH are needed.

Purpose This research set out to investigate the quality service and self-determination theory (SDT) that contributes to the continuance usage of m-banking. Design/methodology/approach A valid of 310 respondents who experienced and intensified using the m-banking is collected. The proposed research model is empirically tested using structural equation modelling. Findings The result informs that the service quality can not only be significantly mediated by the SDT, but it also has a direct effect to the satisfaction. It also informs that the satisfaction and the perceived usefulness indeed have a significant effect to the continuance usage intention of the m-banking. In addition, it also demonstrates that the perceived competence and perceived relatedness of the SDT significantly influence satisfaction and perceived usefulness towards the continuance usage intention of the m-banking. Practical implications Practically, the results inform the bank management the factors to be taken into account to increase the motivation of the existing customers for them to continue using the m-banking. Originality/value Theoretically, these results contribute to the existing literatures of the m-banking by introducing the SDT that determines the continuance usage intention of it.

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.

Background: Breast cancer is the leading cause of cancer death in women worldwide. Breast cancer has been classified into several molecular subgroups with different prognostic consequences based on immunohistochemistry and molecular pathology. The prognosis that commonly used is 5-years survival. In this study we aimed to examine the relationship between luminal subtype and 5-year survival rate in patients with early post-mastectomy breast cancer. Methods: We recruited early breast cancer patient who underwent modified radical mastectomy (MRM) in Dr. Soetomo General Hospital (Surabaya, Indonesia) between 2010 – 2014. Breast cancer tissues were collected during surgery for immunohistochemistry. The patients’ 5-years survival data was obtained from medical records and by phone call to the patients or to the close relatives of the patients. Breast cancer subtype was determined based on the result of immunohistochemistry Results: A total of 84 patients was included in this study. The majority of patients were aged >40 years (72/84; 85.7%). There were 39 patients (39/84; 46.4%) with luminal A subtype and 45 patients (45/84; 53.6%) with luminal B subtype. Seventy-four patients were diagnosed as invasive ductal carcinoma histologically. Almost all of the patients were able to survive within 5 years (81/84; 96.4%). We found that luminal B had a 1.071 times higher risk of dying within 5 years after therapy than luminal type A, although the analysis did not show significant results (P = 0.101). Conclusion: Luminal B was the most prevalent breast cancer subtype in Surabaya, Indonesia. The prevalence of breast cancer was higher in patients aged >40 years. There was no significant difference between the 5-years survival of luminal A and luminal B subtypes. Keywords: survival, locally advanced breast cancer, luminal subtype, mastectomy.

Colon cancer is the third most common cause of death from cancer worldwide. Recently, natural products have been widely used as an alternative therapy for colon cancer. Previous studies have reported that Nigella sativa has chemopreventive activity in vitro and in vivo . This study aimed to evaluate the effect of Nigella sativa seed (NSS) on rat-colon cell after initiation of 7,12-dimethylbenz [ a ] anthracene . Rats were divided into five groups, 12 rats in each group: Group I was given 7,12dimetilbenz [ a ] anthracene (DMBA) orally 20 mg/kgBW twice a week for five weeks, group V is the solvent control group was given corn oil. The other three groups were given DMBA + NSS, at the dosage of 250 mg/kgBW, 500 mg/kgBW and 750 mg/kgBW. NSS extract was dissolved in corn oil and administered daily per oral during the next two weeks before and during the initiation of DMBA. After 16 weeks, all rats were sacrificed . H&E staining showed that necrosis activity was lower in treated groups compared to DMBA group. AgNOR staining show ed mAgNOR was significantly decrease following the increasing dose of NSS ( 250 mg/kgBW , 5 0 0 mg/kgBW and 7 50 mg/kgBW ) were subsequently 1 .62 ± 0 .086, 1 . 60 ± 0 .101 and 1 . 3 9 ± 0 .049 (p

Neonatal hemochromatosis (NH) is a rare fatal liver disease accompanied by hepatic and extrahepatic iron overload.1-3 Gestational alloimmune liver disease (GALD) is a materno-fetal alloimmune disorder and leading cause of NH.2,4,5 This condition allows an interplay between the maternal adaptive immune system and the fetus, resulting in an allograft to the mother. The mother becomes sensitized to an alloantigen expressed by the fetus and forms specific reactive antibodies. Immunoglobulin G (IgG) is transported through the placenta and attacks the fetal hepatocytes, resulting in severe loss of hepatocytes and fetal iron overload.3,6 Liver transplantation has been the only definitive treatment for NH for many years, with a survival rate of ±35%. Conventional therapy containing antioxidants and chelation agents reportedly have very poor success, with survival rate of only 10-20%. A new treatment paradigm involving intravenous immunoglobulin (IVIG) and exchange transfusion (ET) therapy has shown significant success in survival rate in NH, decreasing the need for liver transplantation.3,7,8 Here we present a case of NH caused by GALD and treated successfully with a combination of IVIG therapy and ET. We also aimed to evaluate the efficacy of IVIG and ET therapy for NH.

The outcome of SARS-CoV-2 infection is determined by multiple factors, including the viral, host genetics, age, and comorbidities. This study investigated the association between prognostic factors and disease outcomes of patients infected by SARS-CoV-2 with multiple S protein mutations. Fifty-one COVID-19 patients were recruited in this study. Whole-genome sequencing of 170 full-genomes of SARS-CoV-2 was conducted with the Illumina MiSeq sequencer. Most patients (47%) had mild symptoms of COVID-19 followed by moderate (19.6%), no symptoms (13.7%), severe (4%), and critical (2%). Mortality was found in 13.7% of the COVID-19 patients. There was a significant difference between the age of hospitalized patients (53.4 ± 18 years) and the age of non-hospitalized patients (34.6 ± 19) (p = 0.001). The patients’ hospitalization was strongly associated with hypertension, diabetes, and anticoagulant and were strongly significant with the OR of 17 (95% CI 2–144; p = 0.001), 4.47 (95% CI 1.07–18.58; p = 0.039), and 27.97 (95% CI 1.54–507.13; p = 0.02), respectively; while the patients’ mortality was significantly correlated with patients’ age, anticoagulant, steroid, and diabetes, with OR of 8.44 (95% CI 1.5–47.49; p = 0.016), 46.8 (95% CI 4.63–472.77; p = 0.001), 15.75 (95% CI 2–123.86; p = 0.009), and 8.5 (95% CI 1.43–50.66; p = 0.019), respectively. This study found the clade: L (2%), GH (84.3%), GR (11.7%), and O (2%). Besides the D614G mutation, we found L5F (18.8%), V213A (18.8%), and S689R (8.3%). No significant association between multiple S protein mutations and the patients’ hospitalization or mortality. Multivariate analysis revealed that hypertension and anticoagulant were the significant factors influencing the hospitalization and mortality of patients with COVID-19 with an OR of 17.06 (95% CI 2.02–144.36; p = 0.009) and 46.8 (95% CI 4.63–472.77; p = 0.001), respectively. Moreover, the multiple S protein mutations almost reached a strong association with patients’ hospitalization (p = 0.07). We concluded that hypertension and anticoagulant therapy have a significant impact on COVID-19 outcomes. This study also suggests that multiple S protein mutations may impact the COVID-19 outcomes. This further emphasized the significance of monitoring SARS-CoV-2 variants through genomic surveillance, particularly those that may impact the COVID-19 outcomes.

This study analyzes the implementation of control policies and procedures in the government expenditure cycle, particularly at the central government, starting from control at the phase of commitment, goods/services received, before payment and at the time of payment. The research was conducted by analyzing the content of the regulations in the implementation of state budget expenditures.The results show that the implementation of controls in the government expenditure cycle has been fulfilled according to international practice. The application of this control is important for financial managers to ensure that the budget execution process is carried out properly.

Plagiarism is a serious problem in an academic environment because it breaches academic honesty and integrity, copyright law, and publication ethics. This paper aims at revealing English as a Foreign Language (EFL) lecturers’ responses in dealing with some factors affecting students’ plagiarism practice in Indonesian Higher Education context. This study employed a qualitative method with case study approach. Eight experienced EFL lecturers were conveniently recruited, and the data were analyzed using thematic analysis technique. The results revealed that EFL students perpetrated plagiarisms due to three factors; 1) convenient access to online resources allowed the EFL students to retrieve some information without properly citing the sources, 2) Questionable lecturers’ assessment, and 3) Student has poor academic writing-skills. The plagiarism practices are apparent in the Indonesian educational context, and this may produce other negative consequences, such as academic dishonesty and poor academic writing. However, further investigation is necessary to examine the relative contribution of each factor on students’ plagiarism practice.

Introduction: This study describes the effect of antibiotic therapy on salivary catalase kinetic parameters (CAT) at neonatal at risk of sepsis. Methods: Study is conducted from February – June 2015. Salivary samples are obtained from 20 neonates (5 normal-healthy neonates and 15 neonates at risk of sepsis) at Ulin General Hospital, Banjarmasin, Indonesia. The samples were placed in four different groups: P0 as control group (saliva + hydrogen peroxide/H2O2), P1 (saliva + 2 mg Ampicillin + H2O2), P2 (saliva + 0.2 mg Gentamicin + H2O2), P3 (saliva + 2 mg Ampicillin + 0.2 mg Gentamicin + H2O2). The solution is incubated at 37oC and 40oC before catalase (CAT) activity is measured. Catalase activity is measured by using a spectrophotometer at 240 nm. Kinetic parameters are measured at different concentrations of H2O2 and temperature. Kinetic parameters are represented by the Michaelis-Menten constant (Km) and the maximum reaction speed (Vmax) obtained through the Lineweaver-Burk curve plot. Results: The Km of Catalase on the saliva of neonates at risk of sepsis treated with antibiotics (4.37, 1.84, 0.12, and 0.23, 3.74, 1.5, for P1, P2, P3 respectively) was lower than the control group (17.61 and 12.54), both at 37ºC and 40ºC. Similarly, Vmax of the neonates at risk of sepsis treated with antibiotics (0.46, 0.34, 0.04 and 0.07, 0.20, 0.24) was lower than the control group (1.47 and 0.53) at 37ºC and 40ºC. Conclusion: The study shows that the Catalase activity at the saliva of newborns at risk of sepsis treated with antibiotic was lower than the control group.

In agreement with problem-solving skills, identifying conceptual understanding is an important topic in physics. The purpose of this study was to analyze the conceptual understanding of physics teacher prospective students on direct current based electric material “Knowledge in Piece” Theory. The study used a mixed-method approach with an explanatory model with 148 Physics Pre-service at the Jambi University, Indonesia. Data were collected using tests and interviews. The students were given a test using reasoned multiplechoice question developed to find out the understanding of student concepts, while unstructured interviews were conducted to confirm student answers that were not clear.Data analysis was done by using a rubric which as developed based on the possible reasons for student’ answer to the concept of direct current electricity. The result of study showed that understanding the concept of students in direct current electricity material is still not very good, this is shown from the study data only 6 people (4%) of 148 students who can activate the concept well and completely. The findings show that student understanding is still in the form of concept pieces. Students are not able to connect concepts properly. When asked about sub-material students have an understanding, but when the problem is given is complete enough students are not able to connect every concept to the sub-material that they understand correctly. These results give strength that the students' understanding had not been coupled coherently so that the less dominant resource would be delayed to activate than the more dominant resource.

The management of the COVID-19 pandemic in this area is racing towards a balance between the safety of economic conditions and overall health conditions. This management is expected to prioritize saving lives as much as possible in the short term with the disaster relief paradigm, and then economic recovery and prosperity in the medium and long term. Social safety net during disaster relief is needed not only for the poor but also vulnerable middle-class people. A distribution policy mix is needed to accelerate the process and the quality of disbursements.Policies for Micro, Small and Medium Enterprises and banks are directed at reducing liquidity. In the mid-term recovery process, the focus of the policy is on reducing pressure from the supply side. Ensuring the business world can operate immediately, maintaining the sustainability of the logistics sector and encouraging industrial independence. Keywords : safety of economic conditions and overall health conditions.

Many cases of fraud in the form of corruption and bribery are findings of external examinations. It shows internal supervision is not sufficient. The internal supervision of companies and local governments have not been able to detect fraud. In this study, we suspect the internal auditors' workload, which makes their ability to detect fraud poor. If the company or local government has implemented risk management, the workload will not be as heavy as if it has not implemented risk management. The company and local government can apply a Risk-based internal audit if they have implemented risk management. Based on this explanation, conclude that finding auditor expertise of the fraud is influenced by workload, the implementation of risk management, and risk-based internal controls. The population of this research is the internal auditors of the provincial government of North Sumatra. This study uses primary data obtained from distributing questionnaires to the research sample. Data were analyzed using multiple regression analysis with the help of PLS applications. The findings showed that risk management application and risk-based supervision audit has a significant effect on detecting fraud and the workload is not affect to the ability to detect of fraud finding. The interviews with several informants concluded that if they have implemented risk management and risk-based internal audits, the internal auditors will not have a high workload. Because since the beginning, it has been identified which activities have an increased risk.

Introduction: Breast cancer is global problem and commonly in women. Tumor markers can assess tumor progression and response therapy. CEA is used as diagnostic, progression and response therapy. The treatment aims to suppress tumor development. Traditional medicine is considered beneficial and has minimal effect in suppressing tumor. Recent study, extracts of Allium sativum, Curcuma longa and Zingiber officinale consider useful as anti-cancer. However, no studies that discuss combined extraction Allium sativum, Curcuma longa and Zingiber of CEA levels. Method: Open label clinical trial with one group pretest posttest design , held on June 28, 2021 – July 18, 2021, was conducted at USU Hospital and the population was breast cancer survivor community in Medan. Samples were taken by consecutive sampling. Those who met inclusion and exclusion criteria will be measured for CEA before and after administration of extract Allium sativum, Curcuma longa and Zingiber officinale with dose 500 mg twice a day for 28 days. T test or wilcoxon test was used to measure comparison and analyzed with SPSS version 22th. Results: 21 subjects who participated, only 20 subjects were analyzed with mean age of 52.7 years, majority stage III A or IIIB (30%). Median CEA before intervention 2.05 (0.70-12.20) g/mL and after intervention of 2.7 (0.8-12.40) g/mL, increasing value and not statistically significant with p>0.05 ( p=0,238).Conclusion: Median CEA value increased before and after intervention and not statistically significant. Keywords: Breast Cancer, CEA, Allium sativum, Curcuma longa and Zingiber officinale.

ntroduction: Breast cancer requires high nutrition, oxygen and metabolism where VEGF-triggered angiogenesis is needed. VEGF is triggered via the HIF-1 pathway and also via the NF-Kappa B pathway. VEGF is associated with tumor growth and metastasis. Some plant extracts have anti-angiogenesis effects such as Curcuma longa, Allium sativum and Zingiber officinale. Objective: To determine serum levels of SGOT, SGPT, ureum, creatinine, albumin and VEGF before and after administration of Curcuma longa, Allium sativum and Zingiber officinale extracts Method: An open label clinical trial study with a one group pretest posttest design involving 21 patients from breast cancer community in Medan collected by consecutive sampling from June – July 2021 in USU hospital where these patients met the inclusion criteria. All patients were tested for complete blood count, urea, creatinine, SGOT, SGPT, albumin, serum VEGF before and after being given a combination extract of Curcuma longa 150 mg, Allium sativum 200 mg and Zingiber officinale 150 mg twice daily for 28 days. Statistical analysis was performed by paired analytical T test or Wilcoxon. Results: The study involved 20 subjects. From the examination of kidney function obtained results before and after the administration of a combination extract VEGF results before and after the administration of the combination (1110(760-7893) μg / ml vs. 864 (532-5650 μg / ml, p = 0.001). Conclusion: VEGF serum breast cancer patients had a significant reduction after being given a combination of extracts of Allium sativum, Curcuma longa and Zingber officinale. Keywords: VEGF, Allium sativum, Curcuma longa, Zingiber officinale.

This article aims to describe and interpret the Zapin Arab and Zapin Malay dances. Zapin dance comes from Arabic and developed within the scope of the Malay community. At first the Zapin dance culture was brought by merchants from Gujarat to various regions in the archipelago in the XV century. Zapin dance has a heroic background, because the movement was originally a sense of uplifting the spirit of the companions of the prophet for war. The development of Zapin Arabic and Malay dances are both expressed in the form of performing arts. The problem in this research is focused on the structure of the Malay zapin dance. In order to approach this problem, the structuralism theory reference from Levi Strauss' model is used. Structural theory is applied to describe Malay society. The data were collected through statements and experiences of sources, observation, and document review, then analyzed descriptively qualitatively. Data analysis uses textual and contestual interpretations, namely interpreting denotative and connotative structures. This study concludes that, (1) the Arabic Zapin dance has Arabic cultural content, and (2) the Malay Zapin dance is an Islamic expression of Malay culture.

Introduction: Breast cancer is the most common malignancy in women. Progressivity of breast cancer evaluated through examination of tumor markers. Serum Ca 15-3 is tumor markers used to assess the progression. Various treatments have been developed to suppress the progression, one of which the provision of plant extractions. Extracts of Allium sativum, Curcuma longa and Zingiber officinale considered useful as anti-cancer, but no research discusses the combined benefits of extracts against breast cancer, especially Ca 15 -3. Method: Open label clinical trial study with one group pretest posttest design was conducted at USU hospital on June 28, 2021 to July 18, 2021. Population came from breast cancer survivor community in Medan, consecutive sampling technique. Samples that met inclusion and exclusion criteria were examined for Ca 15 -3 before and after administration of extract Allium sativum, Curcuma longa and Zingiber officinale with dose 500 mg twice a day for 28 days. Data were analyzed using SPSS version 22. Results: Of 20 breast cancer patients analyzed with mean age of 52.7 years, majority stage III A or III B breast cancer (30%). Median CA 15-3 before administration of extracts of Allium sativum, Zingiber and Curcuma longa 12.82 (3.29-45.81) g/mL and after administration of extracts 8.24 (2.83-47.46) g/mL, decrease but not statistically significant. Conclusion: There was decrease in median CA 15-3 before and after extraction, but not statistically significant. Keywords: Breast Cancer, CA 15 – 3, Allium sativum, Curcuma longa and Zingiber officinale.

INTRODUCTION Chiari I malformation (CMI) and hydrocephalus often coexist, with no clear understanding of the cause-and-effect relationship. In the absence of other associated etiologies, the traditional teaching has been to treat the hydrocephalus first, partly to minimize the risk of cerebrospinal fluid (CSF) leak from CMI decompression in the setting of elevated ICP. We describe a series of consecutive pediatric patients with CMI and hydrocephalus, the majority of whom were managed with posterior fossa decompression. METHODS A retrospective review was conducted on consecutive children who presented to the senior author with both hydrocephalus and CMI, with emphasis on rationale for and outcomes of surgical intervention, including the need for additional surgery. RESULTS There were 14 patients aged 2 weeks to 16 years (median 2 years) who presented with Chiari I and hydrocephalus. Four of these underwent posterior fossa decompression without duraplasty (PFD) as first-line therapy (one of whom eventually required duraplasty), 7 had PFD with duraplasty (PFDD), 1 received a ventriculoperitoneal shunt (VPS), and two had endoscopic third ventriculostomy (ETV). Of the 11 who had PFD/D, 9 (90%) had significant symptom improvement/resolution, 7 (55%) showed decrease in ventricle size, and 1 (10%) required VPS placement for persistent hydrocephalus. Both ETV patients improved clinically, and 1 showed decrease in ventricle size. There were no pseudomeningoceles, infections, or neurological deficits. One CSF leak occurred after an ETV and was successfully treated with wound revision. CONCLUSION In patients with both CMI and hydrocephalus, treating the CMI first in an effort to avoid a shunt can be safe and effective. In this series, PFDD in the setting of hydrocephalus did not result in CSF leak or pseudomeningocele. While limited by a small sample size, these data support a causative relationship between CMI and hydrocephalus.

BACKGROUND: Type 1 leprosy reaction is a delayed hypersensitivity reaction caused by increased response of cellular-mediated immunity to Mycobacterium leprae. Manifestations include skin and nerve lesions, edema, and permanent disabilities. There are several risk factors that should be recognized to prevent disabilities. AIM: The aim of this study was to analyze the relationship of risk factors to the occurrence of type 1 leprosy reaction in leprosy patients treated at the Outpatient Clinic of Dr. Soetomo General Hospital. METHODS: This study was an analytical study with retrospective observational study design. Data were secondary from the medical records of leprosy patients at the Outpatient Clinic of Dr. Soetomo General Hospital from January 2017 to December 2019. RESULTS: Out of 364 patients in the Outpatient Clinic, 190 (52.2%) had leprosy without a reaction and 65 (17.9%) had type 1 reaction. Analysis showed that age, leprosy type, and treatment regimen were significantly associated with the incidence of type 1 reaction (p = 0.023; 0.003 and 0.004, respectively), with the leprosy type as the most dominant risk factor. Age 15–34 years old; leprosy types BB, BL, and BT; and the MB MDTL therapeutic regimen are risk factors for the occurrence of type I leprosy reaction. CONCLUSION: There is a statistically significant correlation between the risk factor and the occurrence of type 1 leprosy reaction in leprosy patient. The risk factor that has significant correlation is age 15–34 years; leprosy types BB, BL, and BT; and the MB MDTL therapeutic regimen. The most significant risk factor for the occurrence of type 1 leprosy reaction from our study is the type of leprosy (BB, BL, and BT).

Pellets are compressed feed, compacted through a mechanical process. Pellets can be molded in the form of lumps and small cylinders with different diameters, lengths, and levels of strength. The right moisture content value will maximize the quality of the pellets and increase the value of the Pellet Durability Index(PDI). Many factors affect the moisture content in the feed such as changing the steam pressure configuration, adding moisture to the mixing process, changing the retention time configuration, and other methods. The method tested was to provide variations on the configuration of retention time and steam pressure on the Pressure Reducing Valve (PRV) which aims to determine the increase in moisture content in the feed. Variations of retention time configuration tested were 50 seconds, 55 seconds, 60 seconds, 65 seconds, 70 seconds with variations in the Steam pressure configuration in the test were 1.4 bar and 1.6 bar. The test results prove that the retention time of 65 seconds with a steam pressure of 1.4 bar is the best configuration with an increase in moisture content of 2.67% with a difference in moisture content of bagging to the mixing of -0.46.

The budgeting process, Internal Control and organizational characteristics are important. The research findings are expected the budgeting process, the internal control and organizational characteristics. Purpose of research aim to know the effect a Budgeting Process, Internal Control, Organizational Characteristics on Church Organizational Performance. This research a survey explanatory research design were 236 respondents who were church operational in Medan, North Sumatra Province, Indonesia. The data use is primary and analyzed using the Structural Equation Modeling analysis test. This type of research is quantitative. The results show that there is no influence of budgeting process indicators and organizational characteristics on performance.

Active implementation of economic diplomacy in the foreign policy of Uzbekistan is one of the priorities of today. Because, in the active promotion of economic diplomacy, it is important to attract investment, increase tourism and export potential. The growing role of economic diplomacy in the system of international relations shows that it should be applied in the foreign policy of Uzbekistan. The article discusses the current work in this direction and its prospects.

The purpose of this research is to analyze and test the impact of accounting information systems on good university governance, the research designed used to test the hypothesis causal-comparative (Causal-Comparative Research method), universities in Medan, North Sumatera Indonesia. a sample of 25 private universities in the city of Medan. Data collection techniques are how to arrange interview instruments, perform data triangulation. Interviews were carried out later in this study, data will be analyzed using statistical analysis. The data were processed using Smart PLS data processing tools. The results of the study were the impact of accounting information system on organizational performance through Good University’s private governance in Medan City, North Sumatera, Indonesia.

The decision by pulmonary embolism response teams (PERTs) to utilize anticoagulation (AC) with or without systemic thrombolysis (ST) or catheter-directed therapies (CDT) for pulmonary embolism (PE) is a balance between the desire for a positive outcome and safety. Our primary aim was to develop a predictive model of in-hospital mortality for patients with high- or intermediate-risk PE managed by PERT while externally validating this model. Our secondary aim was to compare the relative safety and efficacy of ST and CDT in this cohort. Consecutive patients hospitalized between June 2014 and January 2020 at the Cleveland Clinic Foundation and The University of Rochester with acute high- or intermediate-risk PE managed by PERT were retrospectively evaluated. Groups were stratified by treatment strategy. The primary outcome was in-hospital mortality, and secondary outcome was major bleeding. A logistic regression model to predict the primary outcome was built using the derivation cohort, with 100-fold bootstrapping for internal validation. External validation was performed and the area under the receiver operating curve (AUC) was calculated. Of 549 included patients, 421 received AC alone, 71 received ST, and 64 received CDT. Predictors of major bleeding include ESC risk category, PESI score, hypoxia, hemodynamic instability, and serum lactate. CDT trended towards lower mortality but with an increased risk of bleeding relative to ST (OR = 0.42; 95% CI [0.15, 1.17] and OR = 2.14; 95% CI [0.9, 5.06] respectively). In the multivariable logistic regression model in the derivation institution cohort, predictors of in-hospital mortality were age, cancer, hemodynamic instability requiring vasopressors, and elevated NT-proBNP (AUC = 0.86). This model was validated using the validation institution cohort (AUC = 0.88). We report an externally-validated model for predicting in-hospital mortality in patients with PE managed by PERT. The decision by PERT to initiate CDT or ST for these patients had no impact on mortality or major bleeding, yet the long-term efficacy of these interventions needs to be elucidated.

Obstetrics is a medical science that specializes in the study of pregnancy and childbirth. This includes the process before during and after a woman gives birth. The scope of obstetrics includes, antepartum bleeding, postpartum hemorrhage, preterm pregnancy problems, complications in vaginal delivery, pregnancy with gastrointestinal disorders, hypertension in pregnancy, bleeding in the external and internal genitalia, and other diseases. Abortion was the most common disease group in this study, which was 71.4%. Abortion is the termination of pregnancy before the fetus can live outside the uterus at the age of

Conventional doors usually consist of a key housing and a key saddle to open it. In the current pandemic situation that has arisen due to COVID-19, so every human being is required to take precautions such as wearing a mask, keeping a distance, washing hands, not touching anything if not unnecessary. Research Methods Literature Study, Collection of supporting materials and tools, Program Design and Realization, Testing and Analysis of Program results, Making Final Report. The automatic door control system with a body temperature sensor is a prototype made to prevent the spread of COVID-19 by reducing direct physical contact that is spread through droplets attached to conventional doorknobs. Technology can be implemented in crowded areas such as shopping centers, offices, restaurants that are placed in indoor areas or indoor areas that are not exposed to direct sunlight. The components used are Arduino Uno Rev 3, Infrared Sensor, MLX90614 Temperature Sensor, 16x2 LCD, Buzzer, L298N Motor Driver, DC Motor, 12v Adapter, and LED

Proton pump inhibitors (PPIs) are one of the most frequently used drugs worldwide. Previous research has shown that they could increase the risk of fracture and interfere with the fracture healing process. In this study, we analyzed the effect of PPIs on the risk of fracture non-union in patients with femoral and tibial shaft fractures. A case–control study was conducted at our institution, including a total of 254 patients who underwent fixation surgery for a femoral or tibial shaft fracture between January 2012 and December 2017. We defined cases as patients who experienced a delayed union (case group A; n = 44), or non-union (cases group B; n = 12). Cases were matched by age, sex, and fractured bone, to 144 controls who did not experience delayed fracture union and did not require further procedures. A conditional logistic regression analysis was performed adjusted to potential confounders, and to the proportion of days covered (PDC) with PPIs. Adjusted ORs (95% CI) for undergoing a nail dynamization following a tibial or femoral shaft fracture were 1.38 (0.70–2.65) for any use PPIs. Patients with a longer PPI treatment courses (PDC ≥ 0.5) had an adjusted OR of 1.86 (0.70–4.76) for undergoing nail dynamization when compared with controls. Contrastingly, patients with a PDC