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BackgroundTelemedicine use increased as a response to health care delivery changes necessitated by the COVID-19 pandemic. However, lack of standardized curricular content creates gaps and inconsistencies in effectively integrating telemedicine training at both the undergraduate medical education and graduate medical education levels. ObjectiveThis study evaluated the feasibility and acceptability of a web-based national telemedicine curriculum developed by the Society of Teachers of Family Medicine for medical students and family medicine (FM) residents. Based on the Association of American Medical Colleges telehealth competencies, the asynchronous curriculum featured 5 self-paced modules; covered topics include evidence-based telehealth uses, best practices in communication and remote physical examinations, technology requirements and documentation, access and equity in telehealth delivery, and the promise and potential perils of emerging technologies. MethodsA total of 17 medical schools and 17 FM residency programs implemented the curriculum between September 1 and December 31, 2021. Participating sites represented 25 states in all 4 US census regions with balanced urban, suburban, and rural settings. A total of 1203 learners, including 844 (70%) medical students and 359 (30%) FM residents, participated. Outcomes were measured through self-reported 5-point Likert scale responses. ResultsA total of 92% (1101/1203) of learners completed the entire curriculum. Across the modules, 78% (SD 3%) of participants agreed or strongly agreed that they gained new knowledge, skills, or attitudes that will help them in their training or career; 87% (SD 4%) reported that the information presented was at the right level for them; 80% (SD 2%) reported that the structure of the modules was effective; and 78% (SD 3%) agreed or strongly agreed that they were satisfied. Overall experience using the national telemedicine curriculum did not differ significantly between medical students and FM residents on binary analysis. No consistent statistically significant relationships were found between participants’ responses and their institution’s geographic region, setting, or previous experience with a telemedicine curriculum. ConclusionsBoth undergraduate medical education and graduate medical education learners, represented by diverse geographic regions and institutions, indicated that the curriculum was broadly acceptable and effective.

BackgroundJapan is a superaging society unparalleled in the world. Elderly people who need medical care do not receive adequate support in the community. As a new service to address this issue, a small-scale multifunctional in-home care nursing service called Kantaki was created in 2012. Kantaki, in collaboration with a primary physician, operates 24 hours a day and provides various nursing services (home visits, home care, day care, and overnight stays) to older people living in the community. The Japanese Nursing Association is working hard to promote this system; however, its low utilization rate is an issue. ObjectiveThis study aimed to determine factors influencing the utilization rate of Kantaki facilities. MethodsThis was a cross-sectional study. A questionnaire on the operation of Kantaki was sent to all administrators of Kantaki facilities operating in Japan from October 1 to December 31, 2020. A multiple regression analysis was used to determine factors associated with a high utilization rate. ResultsResponses from 154 of the 593 facilities were analyzed. The average utilization rate for all valid responding facilities was 79.4%. The average number of actual users and the break-even point were almost equal, resulting in little surplus profit from facility operations. A multiple regression analysis showed that factors that had a significant impact on the utilization rate included the break-even point, a surplus of users relative to the break-even point (ie, the margin of revenues), the number of months in office of the administrator, the type of corporation (ie, nonprofit), and Kantaki’s profit from operating home-visit nursing offices. The break-even point, a surplus of users relative to the break-even point, and the number of months in office of the administrator were robust. In addition, support for reducing the burden on family helpers, a service sought by the system, significantly and negatively affected the utilization rate. In the analysis that removed the most influential factors, the cooperation of the home-visit nursing office, Kantaki’s profit from operating the home-visit nursing office, and the number of full-time care workers were significantly related. ConclusionsTo improve the utilization rate, managers need to stabilize their organization and increase profitability. However, a positive relationship was found between the break-even point and utilization rate, suggesting that simply increasing users did not contribute to cost reduction. Moreover, providing services that meet the needs of individual clients may result in lower utilization rates. These results, which are inconsistent with common sense, reflect the divergence between the assumptions underlying the system’s design and actual conditions. To solve these issues, institutional reforms, such as an increase in nursing care fee points, may be necessary.

Selama beberapa tahun terakhir, pertumbuhan ekonomi kabupaten/kota di Kepulauan Nias semakin melambat. Oleh karena itu, penelitian ini bertujuan untuk menganalisis lebih dalam pengaruh PAD, dana perimbangan dan efisiensi pengelolaan keuangan daerah terhadap pertumbuhan ekonomi kabupaten/kota di Kepulauan Nias, baik pengaruh langsung maupun tidak langsung melalui belanja modal. Penelitian ini merupakan penelitian deskriptif kuantitatif. Penelitian dilakukan pada seluruh kabupaten/kota di Kepulauan Nias dan menggunakan data sekunder. Data diperoleh secara online pada laman DJKP Kementerian Keuangan dan BPS Provinsi Sumatera Utara dengan periode observasi dari tahun 2011-2019. Metode analisis data menggunakan metode analisis jalur (path analysis). Hasil penelitian menunjukkan bahwa PAD berpengaruh positif tidak signifikan terhadap belanja modal. Dana perimbangan dan efisiensi pengelolaan keuangan daerah secara parsial berpengaruh positif dan signifikan terhadap belanja modal. Dana perimbangan dan efisiensi pengelolaan keuangan daerah secara parsial berpengaruh negatif dan signifikan terhadap pertumbuhan ekonomi. Sedangkan PAD dan belanja modal secara parsial berpengaruh positif tapi tidak signifikan terhadap pertumbuhan ekonomi. Selanjutnya, belanja modal ditemukan mampu memediasi pengaruh dana perimbangan terhadap pertumbuhan ekonomi. Belanja modal juga mampu memediasi pengaruh efisiensi pengelolaan keuangan daerah terhadap pertumbuhan ekonomi. Akan tetapi, disisi lain belanja modal tidak memediasi pengaruh PAD terhadap pertumbuhan ekonomi. Penelitian ini berimplikasi pada perumusan kebijakan peningkatan PAD, penentuan alokasi belanja modal dan peningkatan pertumbuhan ekonomi di Kepulauan Nias.

Hyperhomocysteinemia is an important risk factor for cerebral infarction. Herein, we report on a 30-year-old man previously diagnosed with epilepsy who presented with right hemiplegia and total aphasia. Magnetic resonance imaging showed a fronto-temporal ischemic lesion due to occlusion of the left middle cerebral artery. Clinical testing and imaging demonstrated that he had hyperhomocysteinemia induced by multiple factors including the C677T polymorphism on 5.10-methylenetetrahydrofolate reductase (MTHFR), and multiple vitamin deficiencies. The C677T polymorphism on MTHFR is closely related to hyperhomocysteinemia and folate deficiency in epileptic patients who are taking multiple anti-convulsants. Given hyperhomocysteinemia can independently cause stroke at a young age, physicians should periodically examine plasma homocysteine and serum folic acid levels in epileptic patients who are on long-term regimens of multiple anti-epileptic drugs.

Agricultural companies that produce utilitarian products must prioritize corporate social responsibility (CSR) efforts to uphold their reputation (Rep) and ensure long-term sustainability through superior performance. This study aims to examine the relationship between corporate responsibility and corporate financial and marketing performance, with differentiation strategy (Diff), firm size (FS), internationalization (Int), perceived external pressure (PEP), and altruism (Alt) acting as drivers of CSR initiatives. Employing a quantitative research approach, this study utilized the fuzzy inference system (FIS) to identify the predictive relationships between variables. Purposive sampling was employed to select five legally incorporated agricultural companies in East Java. The findings indicated that, at specific value thresholds, Diff, FS, Int, PEP, or Alt could serve as drivers of CSR efforts and were associated with corporate financial performance (CFP) and corporate marketing performance (CMP) from the perspectives of CSR, Rep, and PEP. The FIS output models, aligned with the proposed hypotheses, demonstrated that certain values of these input variables positively influence the direction of the output variables. Therefore, company policymakers should carefully consider the value levels of these variables and strive to maintain them to enhance CSR efforts and improve financial and marketing performance effectively. These factors were vital for the sustainability of agricultural companies in East Java.

Plaque rupture, plaque erosion, and COVID-19 infection can cause acute coronary syndromes (ACS). We illustrate case examples demonstrating the distinctive and characteristic pathologic findings underlying each of these various causes of acute myocardial infarction. A deeper understanding of the pathophysiology of ACS is necessary for the development of newer agents and techniques to improve outcomes after ACS. (Level of Difficulty: Advanced.)

Abstract Pulmonary arterial hypertension (PAH), an intractable disease with a poor prognosis, is commonly treated using pulmonary vasodilators modulating the endothelin, cGMP, and prostacyclin pathway. Since the 2010s, drugs for treating pulmonary hypertension based on mechanisms other than pulmonary vasodilation have been actively developed. However, precision medicine is based on tailoring disease treatment to particular phenotypes by molecular‐targeted drugs. Since interleukin‐6 (IL‐6) is involved in the development of PAH in animal models, and some patients with PAH have elevated IL‐6 levels, the cytokine is expected to obtain potentials for therapeutic targeting. Accordingly, we identified a phenotype with elevated cytokine activity of the IL‐6 family in the PAH population by combining case data extracted from the Japan Pulmonary Hypertension Registry with a comprehensive analysis of 48 cytokines using artificial intelligence clustering techniques. Including an IL‐6 threshold ≥2.73 pg/mL as inclusion criteria for reducing the risk of insufficient efficacy, an investigator‐initiated clinical study using satralizumab, a recycling anti‐IL6 receptor monoclonal antibody, for patients with an immune‐responsive phenotype is underway. This study is intended to test whether use of patient biomarker profile can identify a phenotype responsive to anti‐IL6 therapy.

Abstract Residual pulmonary hypertension (PH) negatively impacts long‐term results following pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH). We sought to reveal whether modern PH therapy with PH‐targeted medicine and balloon pulmonary angioplasty (BPA) improved long‐term results of residual PH after PEA. Long‐term findings of 80 patients who survived PEA between 2011 and 2019 were retrospectively investigated. One month after PEA, 30 patients developed residual PH defined as mean pulmonary artery pressure (mPAP) ≥25 mmHg, of whom 23 were treated by PH‐targeted medicine and 9 by BPA. Patients with residual PH acquired considerably better functional status and exercise capacity after PEA, however, exhibited significantly worse survival rates than those without. Eleven patients died during follow‐up: 8 patients with residual PH and 3 controls. Among patients with residual PH, the deceased had a significantly lower %decrease in mPAP from 1 month to 1 year following PEA (7.4 [−32.6 to 8.0] % vs. 10.4 [3.7−27.8] %, p = 0.03) and higher mPAP at 1 year following PEA (39.5 [33.25−42.5] vs. 27 [26−34] mmHg, p

A form of crime that often occurs in Indonesia is money laundering. Indonesia is declared as one of the Non-Cooperative Countries and Territories (NCTTs) countries with the threat of sanctions for termination of international banks with Indonesian banks, other countries will reject Letters of Credit (L/C) issued by Indonesian banks and Indonesian financial institutions will be charged high fees in every financial transaction with foreign institutions. Indonesia itself only criminalized money laundering in 2002 with the enactment of Law Number 15 of 2002. The Criminal Asset Forfeiture Bill is carried out by the in rem forfeiture method by asserting that a legal action is taken against the asset, not against the individual (in rem personam) with emphasis on assets allegedly derived or used in criminal acts. Allowing criminal actors to continue to control the proceeds and instruments (assets) of criminal acts will provide opportunities for criminal actors or other parties to enjoy the proceeds of crime and reuse the proceeds of crime for other crimes, so that the Criminal Asset Forfeiture Bill is indispensable in preventing and eradicating Money Laundering. Keywords: Money Laundering, Aset Forfeiture, Follow The Money, Criminal Act.

Metabolites from clove (Syzygium aromaticum L.) have been extensively studied for various pharmacological uses, including quercetin. Endophytic bacteria isolated from plant tissues can produce similar secondary metabolites as their host plants. However, little is known about the antioxidant activity of the endophytic bacterial extract from clove leaves. Amongst the potential bacterial groups, the genera of Bacillus have been widely studied as a source of antioxidants. Thus, this study, we examined the potential antioxidant properties of Bacillus sp., isolated from clove leaves. We have successfully isolated ten endophytic bacteria, of which only one isolate (P1U2) was found non-pathogenic based on a hemolytic assay. Based on the 16S rRNA sequence, P1U2 shared the highest similarity to Fictibacillus phosphorivorans. The extract of extracellular metabolites of P1U2 contains quercetin compounds, based on LC-MS analysis. The results of the antioxidant activity test using the DPPH assay showed that the P1U2 extract had an IC50 value of 161 mg/ml. The supplementation of the extract on culture media reduced the ability of S. cerevisiae to decolorize mutagen malachite green and increased cell viability. Furthermore, the addition of 161 ppm extract was able to counteract UV mutagens effects of UV exposure and toxicity of malachite green, significantly increasing the growth of S. cerevisiae. Suggesting the bioactivity of the extract in combating mutagens. To the best of our knowledge, this is the first study to report a quercetin-rich extract derived from endophytic bacteria, F. phosphorivorans. Thus, further study is required to optimize the synthesis of quercetin from isolate P1U2.

Abstract Cold snare polypectomy (CSP), for the treatment of colorectal polyps, has become widespread due to its low incidence of adverse events compared to that of endoscopic procedures such as endoscopic mucosal resection. However, we experienced a case of large hematoma development shortly after CSP for a colorectal adenoma despite no bleeding during the procedure. The patient underwent CSP for a 7‐mm type Isp lesion in the ascending colon. She returned the following day because of hematochezia. Computed tomography showed a 70‐mm, high‐intensity mass in the ascending colon, consistent with the large hematoma that was detected by colonoscopy. Although the patient initially had right‐sided abdominal pain, it gradually improved with conservative treatment. The hematoma decreased in size, and she was discharged 20 days after emergency admission. Although CSP can be a favorable alternative to more invasive procedures and is expected to be performed more frequently, adverse events, such as that described in this case, should be anticipated.

AbstractGallbladder torsion is a rare disease that requires immediate surgical intervention to avoid maternal and/or foetal sepsis and death. However, preoperative diagnosis is challenging because the disease has no specific symptoms. A 37-year-old pregnant woman at 34 weeks of gestation presented with severe epigastric pain. Ultrasonography and computed tomography scan findings showed a distended gallbladder without stones, floating from the hepatic bed, and laboratory examination demonstrated normal liver function; therefore, we made a diagnosis of gallbladder torsion and performed a caesarean section and an open cholecystectomy under general anaesthesia. This is the first report wherein gallbladder torsion in pregnancy was diagnosed preoperatively. Gallbladder torsion should be considered as a differential diagnosis in case of such imaging findings.

ABSTRACT The potential for post-disaster conflict often occurs in affected communities. Especially in the process of distributing incoming donations to each affected area. This study raises the topic of potential conflicts that arise after the earthquake in Malang. The conflicts that arise are motivated by several factors and their dynamics. In addition to the potential for post-earthquake conflict, this research tries to present a solution with the role of local community social capital in conflict resolution. The social capital found in the field is the value of harmony, racket, and mutua cooperation. The method used in this research is to use the theoretical framework of motives, incentives, and opportunities. The results of the study indicate that the potential for post-disaster conflict is based on the mental condition of the community which is still unstable and economic factors that are less stable due to the disaster. Thus, collaboration between the role of the stakeholder and social capital is needed to help earthquake survivors for surviving. KEY WORDS Disaster; Conflict; Social Capital ABSTRAK Potensi konflik pasca bencana kerap terjadi dalam masyarakat terdampak, Khususnya pada proses pendistribusian bantuan donasi yang masuk pada setiap daerah terdampak. Penelitian ini mengangkat topik terkait potensi konflik yang muncul pasca bencana gempa di Malang. Konflik yang timbul dilatar belakangi oleh beberapa faktor dan dinamikanya. Selain potensi konflik pasca gempa, penelitian ini berusaha menampilkan solusi dengan peranan modal sosial masyarakat setempat dalam penyelesaian konflik. Modal sosial yang ditemukan di lapangan yaitu nilai rukun, raket, dan gotong royong. Metode yang digunakan dalam penelitian ini berupa kualititaif dengan pendekatan studi kasus. Dari hasil penelitian menunjukkan timbulnya potensi konflik pasca bencana didasari pada kondisi masyarakat secara mental yang masih labil dan faktor ekonomi yang kurang stabil akibat bencana. Dengan demikian kolaborasi anatara peran stackholder dan modal sosial sangat dibutuhkan untuk membantu penyintas gempa bangkit kembali. KATA KUNCI Bencana; Konflik; Modal Sosial

The policy problem of enforcing traffic violations by children during the Covid-19 pandemic is important to discuss based on the impact on the safety of children and the safety of others. The safety impacts are both caused by the threat of accidents and the threat to safety due to the spread of Covid-19. Specifically, this study will address the policy problems of enforcing traffic violations against children during the Covid-19 pandemic in three aspects, namely positive legal aspects, Islamic law and legal culture. This research was conducted at the Tulang Bawang Police Resort by interviewing the traffic department and studying traffic violation documents. Data analysis uses an analytical normative approach based on positive legal theory, Islamic law and legal culture. Legally, the enforcement of traffic violations by children during the Covid-19 pandemic is based on policy regulations. Legally, the policy is positive in accordance with the provisions of the Government Administration Act. According to Islamic law, the policy contains dharuriyat matters and culturally the law of children and their parents as well as law enforcement officers to put forward a culture of obeying the law.

The application of project based blended learning in analyzing mathematical spatial literacy is described in this article. The research method used is descriptive quantitative. Participants in the study consisted of 33 students of class XI at one public high school in Bandung Regency. The type of research used is pre-experimental with a one-shot case study design, the subject is taken by simple random sampling using purposive sampling technique. Data analysis in this study is quantitative data analysis in the form of descriptive statistical tests and differential statistical tests. Based on the results of calculations using descriptive statistical tests that students in the high category were 10 students (3%), the medium category was 21 students (64%) and the low category was 2 students (6%). The results of the differential analysis for the normality test of the data are not normally distributed and from the results of the calculation of the median test obtained 0,0148782 ≥ 0,025, this means that the results of this test conclude that at a 95% confidence interval, the median mathematical spatial literacy ability of students after the Project based blended learning model is applied can reach KKM. Penerapan project based blended learning dalam menganalisis literasi spasial matematis dideskripsikan dalam artikel ini. Metode penelitian yang digunakan adalah deskriptif kuantitatif. Partisipan dalam penelitian terdiri dari 33 siswa kelas XI pada satu SMA Negeri Kabupaten Bandung. Jenis penelitian yang digunakan pre-experimental dengan desain one shot case study, subjek diambil secara simple random sampling dengan menggunakan teknik purposive sampling. Analisis data dalam penelitian ini adalah analisis data kuantitatif berupa uji statistik deskriptif dan uji statistik iferensial. Berdasarkan hasil perhitungan menggunakan uji statistik deskriptif bahwa siswa yang memiliki kategori tinggi 10 siswa (3%), kategori sedang 21 siswa (64%) dan kategori rendah 2 siswa (6%). Hasil analisis iferensial untuk uji normalitas data tidak berdistribusi normal dan dari hasil perhitungan uji median diperoleh 0,0148782 ≥ 0,025, ini berarti Hasil pengujian ini memberikan kesimpulan bahwa pada selang kepercayaan 95%, median kemampuan literasi spasial matematis siswa setela diterapkan model Project based blended learning dapat mencapai KKM.

The thought process needed to formulate problems and solutions so that these solutions can become effective information processing agents in solving problems is called computational thinking (CT). The process of implementing learning using the CT approach is related to those provided by Google for Education, namely abstraction, algorithm design, decomposition, and pattern recognition. CT is a term that refers to the main ideas and concepts in the fields of informatics and computer science, so the proposed Community Service (PkM) activity this time will introduce looping and branching materials. Learning is taught and presented in a fun way, and then activities are carried out that discuss the problems that exist around the students of SMAN 5 Pekanbaru. It is hoped that by injecting the CT concept it can foster students' creativity, foster a culture of information, algorithms, and computational thinking, and involve students in utilizing information technology, computers, and applications from an early age

In electoral politics, the relationship between bureaucrats and politicians is increasingly obvious because the interests between the two meets at one point, namely power. As a result, ASN, which should be neutral in elections and elections, is drawn into the vortex of political currents, especially in the implementation of the Pilkada which is in direct contact with the interests of the bureaucrats and ASN. This phenomenon occurs in almost all of Indonesia during the Pilkada, especially since the candidate who is advancing is the incumbent candidate. This practice also occurred in the 2020 West Sumatra gubernatorial election. Bureaucrats became one of the supporters and loyalists (brokers) of the candidates who came forward. One of the pairs of candidates who have a lot of contact with these bureaucrats is the pair Mahyeldi-Audy. One of them is the appointment of three Padang City Government officials to become officials in the West Sumatra Provincial Government, although they have gone through the screening process, there are still allegations of remuneration for the contributions of the three bureaucrats in winning Mahyeldi-Audy. To analyze the problems above, the method used is a qualitative approach and the type of research used is a literature review. In this study, it is explained that in the process of selecting the governor, bureaucrats and PKS collaborate in collecting votes according to their respective duties. This collaboration was one of the decisive factors for Mahyeldi and PKS's victory in the West Sumatra gubernatorial election. the practice of political brokers and pig-barrel politics explains the relationship between bureaucrats and politicians. Bureaucrats who have a strong social network engine are able to get votes in their respective environments, especially those senior bureaucrats are community leaders who have supporters. Coupled with pragmatic politics that prioritizes money politics in elections, making these bureaucrats and politicians a force in the winning process.

The results of the test using 5 data of malaria parasite test imagery found that image 1 has an average accuracy value of the energy of 0.55627, homogeneity average of 0.8371, PSNR of 6.1336db, and MSE of 0.24358. Image 2 has an average energy accuracy value of 0.22274, an average Homonegity of 0.98532, a PSNR of 6.1336db, and an MSE of 0.24358. Image 3 has an energy average accuracy value of 0.28735, a Homonegity average accuracy value of 0.9793, a PSNR of 6.133db, and an MSE of 0.24358. Image 4 has an energy average accuracy value of 0.32907 and an average homogeneity accuracy value of 0.97073, PSNR 6.133db, and MSE 0.24358. Image 5 has an average accuracy value of 0.74102, Homonegity average of 0.99844, PSNR of 6.133db, and MSE of 0.4358. Image 6 has an accuracy value of 0.34758 energy, an average accuracy value of homogeneity of 0.99129, a PNSR of 6.133db, and an MSE of 0.24358. Obtained the rule if the average value of energy > = 0.50 then the pattern of malaria parasites is very clear, namely Image 1 and image 5 with a pattern of malaria parasites is very clear.

Abstrak Bakso merupakan produk olahan yang digemari oleh masyarakat, sehingga banyak dilakukan pembuatan bakso ikan sebagai upaya peningkatan konsumsi ikan. Fortifikasi daun kelor telah dilakukan untuk meningkatkan kandungan protein dan zat besi pada bakso ikan. Proses pembuatan bakso ikan menjadi produk instan dilakukan sebagai upaya mempermudah dan memperpanjang masa simpannya. Penelitian ini bertujuan untuk menentukan perlakuan terbaik pada pembuatan bakso ikan etong dengan penambahan daun kelor yang akan dijadikan bakso instan dan mengetahui karakteristik fisikokimia bakso instan tersebut. Bakso ikan etong dibuat dengan variasi penambahan daun kelor segar sebesar 0% (A0), 5% (A1), 10% (A2), dan 15% (A3) dari berat daging ikan. Bakso ikan terbaik dipilih menggunakan metode De Garmo berdasarkan kandungan protein dan Fe. Hasil perlakuan terbaik berdasarkan analisis De Garmo adalah bakso A3. Bakso instan A3 memiliki karakteristik kadar air 11,82 % bb, protein 33,17% bb, zat besi 1,27 mg/100 g bb, waktu rehidrasi 13 menit, dan kecerahan 65,62. Kata Kunci : Abstract Meatballs are processed products favored by the community, so the manufacturing of fish meatballs could increase fish consumption. Fortification of moringa leaves was carried out to increase the protein and iron content of fish meatballs. The fish meatball processing into an instant product was done to extend the shelf life. This study aimed to determine the best treatment of triggerfish meatballs with the addition of moringa leaves to produce instant meatballs and evaluate the physicochemical characteristics of producing instant meatballs. Triggerfish meatball was made with the addition of fresh moringa leaves by 0% (AO), 5% (A1), 10% (A2), and 15% (A3) of the weight of the fish. The best fish meatball was selected using the De Garmo method based on protein and Fe values. The best treatment result based on De Garmo’s analysis was the A3 treatment with the following characteristics: water content 11.82% ww, protein 33.17% ww, iron 1.27 mg/100 g ww, rehydration time 13 min, and lightness 65.62.

Peningkatan jumlah kasus COVID-19 berlangsung cukup cepat dan menyebar ke berbagai negara dalam waktu singkat, sehingga WHO menetapkan COVID-19 sebagai pandemi. Salah satu upaya dalam memutus mata rantai penyebaran COVID-19 terutama di fasilitas pelayanan kesehatan adalah dengan penggunaan APD yang sesuai, baik pemasangan maupun pelepasan APD. Survey awal pada Klinik Arafah Kota Padang adalah tidak pernah dilakukannya sosialisasi pemasangan dan pelepasan APD, petugas tidak mengetahui tatacara pemasangan dan pelepasan APD dengan benar. Dalam sosialisasi ini dilakukan pre-test dan post-test dengan penyebaran kuesioner dalam peningkatan pengetahuan petugas. Kegiatan dilakukan dengan metode pemaparan materi, pemutaran video, diskusi dan simulasi. Dari kegiatan ini diketahui telah terjadi peningkatan pengetahuan petugas akan tatacara pemasangan dan pelepasan APD serta penggunaan APD sesuai tempat pelayanan. Petugas juga diketahui secara perlahan dan konsisten patuh dalam penggunaan APD di tempat pelayanan, pemasangan APD serta pelepasan APD. Disarankan sosialisasi ini dapat dilakukan kepada fasilitas pelayanan kesehatan lainnya dikarenakan kurangnya sosialisasi tentang tata cara pemasangan dan pelepasan APD kepada petugas kesehatan terutama di klinik pratama.

This research aims to find out the governance at the Talangagung Education Tourism Final Processing Site (TPA) to overcome the waste problem. Waste is a community product that can cause environmental problems. Talangagung Educational Tourism Landfill, the largest landfill in Malang Regency has major challenges in waste management. The volume of waste at the Talangagung education tourism landfill every year continues to increase. Waste that is not managed properly will be based on the environment because it can cause pollution. This research is focused on waste to energy conducted by Talangagung Education Tourism Landfill in waste management. Paying attention to waste governance refers to Good Environmental Governance which involves all members of the public both from the government, the private sector, and the general public. This research uses qualitative descriptive methods with primary data through interviews and observations, as well as secondary data derived from research-related literature studies. The result in the implementation of waste governance at the Talangagung education tourism landfill with energy waste can meet the principles of good governance that produce benefits for the surrounding community. In conclusion, Talangagung Education Tourism Landfill can carry out waste governance with the latest energy for better environmental sustainability.

Abstract Background Resistant starch (RS) is beneficial for human health. Loss of starch branching enzyme IIb (BEIIb) increases the proportion of amylopectin long chains, which greatly elevates the RS content. Although high RS content cereals are desired, an increase in RS content is often accompanied by a decrease in seed weight. To further increase the RS content, genes encoding active-type starch synthase (SS) IIa, which elongates amylopectin branches, and high expression-type granule-bound SSI (GBSSI), which synthesizes amylose, were introduced into the be2b mutant rice. This attempt increased the RS content, but further improvement of agricultural traits was required because of a mixture of indica and japonica rice phonotype, such as different grain sizes, flowering times, and seed shattering traits. In the present study, the high RS lines were backcrossed with an elite rice cultivar, and the starch properties of the resultant high-yielding RS lines were analyzed. Results The seed weight of high RS lines was greatly improved after backcrossing, increasing up to 190% compared with the seed weight before backcrossing. Amylopectin structure, gelatinization temperature, and RS content of high RS lines showed almost no change after backcrossing. High RS lines contained longer amylopectin branch chains than the wild type, and lines with active-type SSIIa contained a higher proportion of long amylopectin chains compared with the lines with less active-SSIIa, and thus showed higher gelatinization temperature. Although the RS content of rice varied with the cooking method, those of high RS lines remained high after backcrossing. The RS contents of cooked rice of high RS lines were high (27–35%), whereas that of the elite parental rice was considerably low (

Penelitian ini membahas tentang pengembangan media audio visual ASHATAL (Arahan Shalat Digital) yang bertujuan untuk membantu siswa kelas II SD dalam memahami materi mengenai tata cara dan bacaan shalat, serta membantu guru untuk menyampaikan bahan ajar dengan menggunakan platform digital sehingga keterbatasan ruang dan waktu dapat teratasi. Metode penelitian yang digunakan yaitu metode Design & Development (D&D) dengan menggunakan model tahapan ADDIE. Pada tahap analisis, terdapat tiga aspek utama yaitu analisis materi pembelajaran, pengguna, dan perangkat yang digunakan. Desain media mengembangkan dua komponen yaitu audio dan visual dalam bentuk aplikasi buku digital. Media audio visual ASHATAL (Arahan Shalat Digital) diuji cobakan kepada guru Pendidikan Agama Islam (PAI), siswa kelas II di salah satu SD Negeri di Kecamatan Sumedang Utara, dan ahli materi untuk mendapatkan penilaian terhadap pengembangan media yang digunakan. Berdasarkan penilaian produk, diperoleh validasi dari ahli materi dengan rata-rata sebesar 100% terkait isi materi dan kualitas media. Penilaian dari guru Pendidikan Agama Islam (PAI) diperoleh rata-rata sebesar 100% terkait isi materi dan kualitas media. Serta penilaian yang dilakukan oleh siswa diperoleh rata-rata sebesar 86%. Hal tersebut membuktikan bahwasannya media audio visual ASHATAL (Arahan Shalat Digital) sangat cocok digunakan oleh siswa di sekolah dasar khususnya sebagai media yang dapat membantu guru dalam menyampaikan materi bahan ajar kepada siswa.

The east coast of Bintan Island is an area that has a wide distribution of seagrass with good conditions for the association of Strombus sp in the seagrass ecosystem. This research aims to identify seagrass coverage and abundance of golden snails (Strombus sp) and study the association of golden snails (Strombus sp.) in seagrass ecosystems on the east coast of Bintan Island. This research was conducted on the East Coast of Bintan Island from June until July 2021 (Teluk Bakau Village, Malang Rapat Village and Berakit Village). The tools and materials used in this research were GPS, 1x1 m quadrant transect, roller meter, digital scales, calliper, multitester, hand refractometer, pH meter, pipe (20cm), sieve net, stationery and aluminium foil. The sampling method used three transects with a distance of 100 m towards the sea with a distance between transects of 50 m, with a 1 x 1 m quadrant transect beginning from point 0 until 100 m. Data analysis used in this research were seagrass coverage, Strombus sp. abundance and PCA (Principal Component Analysis) analysis which relates the abundance of barking snails, seagrass cover, water physicochemical parameters and substrate. Strombus sp. found are Strombus urceus, Strombus canarium and Strombus turturella. The Strombus urceus type has a high 4,3 ind/m2 abundance value compared to other types of Strombus sp. at all stations. Types of Strombus canarium and Strombus turturella were mostly found in low seagrass cover and associated with seagrass species Halophila, Thalassia hemprichii and Halodule uninervis, while Strombus urceus species were mostly found in medium and dense seagrass cover and positively associated with Enhalus acoroides, Thallasia hemprichi, Cymodocea rotundata. Pesisir Timur Pulau Bintan merupakan wilayah yang memiliki sebaran lamun yang luas dengan kondisi baik bagi asosiasi Strombus sp. pada ekosistem lamun. Tujuan dari penelitian ini untuk mengidentifikasi tutupan lamun dan kelimpahan siput gonggong (Strombus sp.) dan mempelajari asosiasi siput gonggong (Strombus sp.) pada ekosistem lamun di pesisir Timur Pulau Bintan. Penelitian ini dilakukan di Pesisir Timur Pulau Bintan pada bulan Mei hingga Juni 2021 (Desa Teluk Bakau, Desa Malang Rapat dan Desa Berakit). Alat dan bahan yang digunakan dalam penelitian ini adalah GPS, transek kuadran 1x1 m, rol meter, timbangan digital, jangka sorong, multitester, hand refracstometer, pH meter, pipa paralon (20cm), sieve net, alat tulis dan alumunium foil. Metode sampling menggunakan 3 transek dengan panjang 100 m ke arah laut dengan jarak antar transek yaitu 50 m, dengan transek kuadran 1 x 1 m dimulai dari titik 0 sampai 100 m. Analisis data yang digunakan dalam penelitian ini yaitu tutupan lamun, kelimpahan Strombus sp., serta analisis PCA (Principal Component Analysis) yang menghubungkan antar variabel kelimpahan siput gonggong, tutupan lamun, parameter fisika kimia perairan dan substrat. Jenis Strombus sp. yang dijumpai diantaranya Strombus urceus, Strombus canarium dan Strombus turturella. Jenis Strombus urceus memiliki nilai 4,3 ind/m2 kelimpahan yang tinggi dibandingkan dengan jenis Strombus sp. lain pada seluruh stasiun. Jenis Strombus canarium dan Strombus turturella banyak ditemukan pada tutupan lamun yang rendah serta berasosiasi dengan jenis lamun Halophila, Thalassia hemprichii dan Halodule uninervis, sedangkan jenis Strombus urceus banyak ditemukan pada tutupan lamun yang sedang dan padat serta berasosiasi positif dengan Enhalus acoroides, Thallasia hemprichi, Cymodocea rotundata.

The effect of gamma-irradiation on bacterial cellulose (BC) was investigated in terms of improving its properties as scaffolds for tissue engineering. BC pellicles were exposed to 25, 50, and 75 kGy gamma-ray irradiation, and X-ray diffraction analyses showed that the crystallinity of the BC decreased as stronger irradiation accelerated BC’s degradation. Fourier transform infrared spectroscopy of the irradiated BC revealed the appearance of a new peak at 1724 cm–1, indicating the formation of a new carbonyl group due to the cleavage of glycosidic linkages of the BC. Rat bone marrow stromal cells seeded on the gamma-irradiated BC incubated in an osteogenic medium for 14 days produced calcium, a late marker for osteogenic differentiation, as shown by Alizarin Red S (ARS) staining. Gamma-irradiated BC with higher irradiation doses showed intense ARS staining indicating higher calcium deposition. These findings demonstrate the feasibility of using gamma-irradiated BC as a cytocompatible 3D scaffold for bone tissue regeneration.

Abstract There are conflicting reports regarding the efficacy of cortisol as a stress marker in altitude training due to the influence of the circadian rhythm. This study aimed to verify whether the automated measurement of salivary cortisol concentration via sequential sampling could detect the differences in exercise stress between two altitudes. We enrolled 12 elite female long-distance runners living near sea level. For the first higher-altitude camp, the runners lived at 1800 m and trained at 1700 m for 7 days. For the second lower-altitude camp, they lived at 1550 m and trained at 1300 m for 7 days. Their saliva was sequentially collected on the last 2 days during each camp which involved different intensity exercises in the morning and afternoon. The salivary cortisol concentrations were measured using electrochemiluminescence immunoassay. Before dinner, the basal salivary cortisol concentrations were significantly higher in the higher-altitude camp. The rate of change in the salivary cortisol concentration during the morning exercise was significantly higher in the higher-altitude camp than in lower-altitude camp (p = 0.028) despite the same exercise programs and intensities. Salivary cortisol level measurements during the athletes' circadian rhythms could detect the differences in acclimatization and exercise stress between two altitudes.

Hate speech acts on social media often become criminal law complaints offenses with the aim of obtaining justice. This study uses a qualitative descriptive method that aims to describe hate speech acts on Whatsapp status. The research data comes from the screenshot of the Whatsapp status obtained by the researcher from BAP (News of the Judiciary), the researcher as a linguist witness. The data presented in the BAP according to the chronology or context of the event were analyzed using Searle's speech acts. Based on the analysis, the writer found several kinds of hate speech acts, namely (1) insulting expressive and warning directives; (2) derogatory expressive and directive (giving warning); (3) expressive accusing and assertive (giving statements); (4) assertive accusing, assertive inciting, expressive insulting, and threatening commissive; (5) commissive, challenging, and expressive insulting; (6) expressive contempt and assertive accusing; (7) derogatory expressiveness; (8) assertive accusing, expressive insulting; (9) commissive threats; (10) expressive insulting, assertive admitting, and assertive accusing.

Bilingual children are always interesting to be studied because they might have different uniqueness in experiencing their language development. Eleven years old Indonesian participant in this research experienced to have a special condition which makes her difficult to focus, but then, exposed to more than one language since she was a young age. Along with the proper parenting styles, this study gives empirical insight into the factors and strategies that contributed to maximising the children’s language development. Data were taken from observation of the video taken from the participant 3-4 years old until now, interviews with both the child and mother, and documentation showed that innate factors and strategies including watching and listening, imitating and repeating, storytelling and self-talking, doing minimal grasp strategy, code-switching and move-on strategies, and giving educational support and motivations are supported to the child to have the bilingual capacity in her communication. However, the milestone or stages of children’s bilingual development has not been investigated yet. Thus, to get a deeper understanding, future studies should investigate the milestone of children’s bilingual language development the findings can be extended to which could inform other researchers about what should be conducted next in the case that the longitudinal observation is needed.

The purpose of this study was to determine the value of character education in the Novel Shoes Dahlan by Khrisna Pabichara. The research method uses a descriptive qualitative approach. The results of this study are that there are character education values in the form of (1) hard work in the form of parents having a hard work spirit to meet the needs of their children, as well as a child having a hard work spirit to achieve goals with their sweat, (2) independent in the form of not being too dependent on others, (3) discipline in the form of parents training their children about discipline. The child instills discipline in his daily life, (4) nationalist and (5) religious in the form of always praying before doing something. The relevance of character education in Indonesian is that creative literary works are born from the art of language and are likened to a description of human sociocultural life. Literary works can describe human life in various forms. The values possessed by literary works are accepted and understood by the reader, which will indirectly provide a picture of the reader's attitude and personality. Literature not only has a role in inculcating noble character but also has a role in character building since childhood.

Pada tahun 2020, terdapat 1,1 milyar orang yang mengalami kehilangan penglihatan di seluruh dunia. Jumlah ini diproyeksikan akan terus bertambah hingga mencapai 1,76 milyar orang pada tahun 2050. Penyebab utama kebutaan untuk anak-anak dan remaja adalah penyakit mata, yang dapat dicegah apabila dilakukan deteksi dan penanganan lebih dini. Oleh sebab itu, pada penelitian ini diusulkan metode berbasis Convolutional Neural Network (CNN) untuk mendeteksi penyakit mata pada citra fundus. Metode yang diusulkan menggunakan metode transfer learning dengan arsitektur jaringan MobileNetV2 sebagai base model. Arsitektur head model yang diusulkan, yang terdiri dari lapisan global average pooling dan diikuti oleh 2 lapisan fully-connected, mampu memberikan akurasi yang paling tinggi dan efisiensi paling baik dibandingkan dengan arsitektur head model lainnya. Eksperimen pada dataset citra fundus yang terdiri dari 601 citra dengan berbagai macam penyakit mata menunjukkan bahwa metode yang diusulkan mampu memberikan performa yang baik dengan nilai akurasi sebesar 72%, precision sebesar 72%, recall sebesar 72%, dan F1-score sebesar 72%. Hasil eksperimen menunjukkan bahwa metode yang diusulkan dapat memberikan akurasi yang lebih tinggi dan lebih efisien dibandingkan dengan menggunakan arsitektur CNN lainnya, seperti ResNet50V2, InceptionV3, InceptionResNetV2, VGG16, dan VGG19.

Abstract This article sheds light on the diversity of meanings and connotations that tend to be lost or hidden in translations between different conceptualizations of nature in East and South-East Asia. It reviews the idea of “nature” in Chinese, Japanese, Vietnamese, Filipino, Tagalog, Cebuano, Lumad, Indonesian, Burmese, Nepali, Khmer, and Mongolian. It shows that the conceptual subtleties in the conceptualization of nature often hide wider and deeper cosmological mismatches. It concludes by suggesting that these diverse voices need to be represented in global reports on sustainability, which can be fostered by the direct involvement of experts from diverse traditions of thought who have access and interpretative knowledge of sources in languages other than English. To take into consideration the diversity of conceptualizations of nature can lead to better decisions about sustainability and improve the acceptability and efficiency of environmental policies in each local context, as well as internationally. Solutions and policies on the ground must be designed based on the local conceptual and cultural frames.

Background: COVID-19 is an infectious disease caused by a new type of virus named SARS-CoV-2. There is still no specific treatment for COVID-19; the antibiotic is used for therapy and to prevent severe disease, so the increasing use of antibiotics in COVID-19 patients will lead to a detrimental impact and the risk of antibiotic resistance. Purpose: This study aims to analyze antibiotic use frequency and determine the number of DDD per 100 bed-days in July – December 2020 at Bhayangkara Hospital Surabaya. Methods: This research was a descriptive study with a retrospective study design conducted at Bhayangkara Hospital Surabaya in May – June 2021. The data were collected from 94 medical records, inclusion criteria: all ages; asymptomatic, mild, and moderate categories; all hospitalized patients in July-December 2020 who received antibiotics; the exclusion criteria: non-confirmed COVID-19 patients who had comorbidities and received antibiotics; the patient who died. The variables: frequency of antibiotic use with calculating the number of DDD/100 bed-days and percentage of COVID-19 patients who received antibiotics during hospitalization. Results: The frequency of antibiotic use in asymptomatic, mild, and moderate COVID-19 patients: 86.56 DDD/100 bed-days, the most antibiotic use was azithromycin at 50.42 DDD/100 bed-days and Levofloxacin at 22.70 DDD/100 bed-days. All asymptomatic, mild, and moderate COVID-19 patients (100%) at Bhayangkara Hospital Surabaya were treated with antibiotics, whereas the condition of patients was 5.32% asymptomatic, 48.94% mild, and 45.74% moderate. Conclusion: There is overuse of antibiotics in asymptomatic, mild and moderate COVID-19 patients at Bhayangkara Hospital Surabaya.

Abstract Liquid droplets of a host protein, formed by liquid–liquid phase separation, recruit guest proteins and provide functional fields. Recruitment into p53 droplets is similar between disordered and folded guest proteins, whereas the diffusion of guest proteins inside droplets depends on their structural types. In this study, to elucidate how the recruitment and diffusion properties of guest proteins are affected by a host protein, we characterized the properties of guest proteins in fused in sarcoma (FUS) droplets using single-molecule fluorescence microscopy in comparison with p53 droplets. Unlike p53 droplets, disordered guest proteins were recruited into FUS droplets more efficiently than folded guest proteins, suggesting physical exclusion of the folded proteins from the small voids of the droplet. The recruitment did not appear to depend on the physical parameters (electrostatic or cation–π) of guests, implying that molecular size exclusion limits intermolecular interaction-assisted uptake. The diffusion of disordered guest proteins was comparable to that of the host FUS, whereas that of folded proteins varied widely, similar to the results for host p53. The scaling exponent of diffusion highlights the molecular sieving of large folded proteins in droplets. Finally, we proposed a molecular recruitment and diffusion model for guest proteins in FUS droplets.

Abstract Watchful waiting (WW) is one of the standard approaches for newly diagnosed follicular lymphoma (FL) patients with low‐tumor burden. However, the impact of WW in FL patients at the first progression, remains unclear. We reviewed 206 FL patients who experienced the first progression after responding to the initial treatment at our institution between 1998 and 2017. Patients were classified into either the WW cohort (132 patients) or the immediate treatment cohort (74 patients). Overall, the median follow‐up from the first progression was 79.8 months (range, 2.1–227.0 months). In the WW cohort, the estimated median time to next treatment (TNT) was 19.7 months (95% confidence interval [CI], 13.4–30.2), and 76.5% (95% CI, 68.0–84.1) of the patients subsequently underwent the second‐line treatment at 5 years. There was a significant difference in the median time to treatment failure in the WW cohort (72.8 months; 95% CI, 64.6–94.0) compared to the immediate treatment cohort (23.3 months; 95% CI, 13.4–38.8) (HR, 2.13; 95% CI, 1.48–3.06), whereas overall survival and the cumulative incidence of histological transformation were not significantly different between two cohorts. In a multivariate analysis, rituximab refractory status, progression of disease within 24 months from the induction of first‐line therapy, and a high Follicular Lymphoma International Prognostic Index score at diagnosis were significantly associated with shorter TNT. Interestingly, 15 patients (11%) of the WW cohort experienced spontaneous tumor regression during WW, and their TNT (median, 82.1 months, 95% CI, 11.7‐NA) was longer than that of the remaining patients in the WW cohort (median, 16.5 months, 95% CI, 13.0–25.4), with a significant difference (p = 0.01). The results of the present study suggested that WW could be a safe and reasonable option even at the first progression for the selected FL patients, without a negative impact on clinical outcomes.

Abstract Background The potential risk and association of bovine leukemia virus (BLV) with human remains controversial as it has been reported to be both positive and negative in human breast cancer and blood samples. Therefore, establishing the presence of BLV in comprehensive human clinical samples in different geographical locations is essential. Result In this study, we examined the presence of BLV proviral DNA in human blood and breast cancer tissue specimens from Japan. PCR analysis of BLV provirus in 97 Japanese human blood samples and 23 breast cancer tissues showed negative result for all samples tested using long-fragment PCR and highly-sensitive short-fragment PCR amplification. No IgG and IgM antibodies were detected in any of the 97 human serum samples using BLV gp51 and p24 indirect ELISA test. Western blot analysis also showed negative result for IgG and IgM antibodies in all tested human serum samples. Conclusion Our results indicate that Japanese human specimens including 97 human blood, 23 breast cancer tissues, and 97 serum samples were negative for BLV.

United Nations (UN) Security Council (UNSC) resolutions (UNSCRs) are adopted by a vote of the five permanent members and ten non-permanent members of the UNSC. Each UNSCR is understood to be part of the “primary responsibility for the maintenance of international peace and security” of the UN. The Indonesian government has been encouraged by various parties to make a legal instrument that would enforce the UNSCRs. Such an instrument would serve to bridge and reduce gaps in the rule of law regarding the enforcement of UNSCRs for nations. However, the government of Indonesia faces several challenges in implementing legal instruments for the UNSCRs. This article maintains that it is crucial to study accommodative policies regarding the national enforcement of UNSCRs by considering the example of Singapore. Singapore has special laws that respond to UNSCRs (The UN Act Chapter 339-UN Act). UN Act 339 is the legal umbrella in Singapore for the government’s implementation of UNSCRs. The UN Act is also an attempt by the Singaporean government to carry out its international obligations to the United Nations.

Mathematics teaching process in kindergarten must adapt to the pandemic situation which require learning from distance. This research develops an Android-based application for learning mathematical concepts, named EduGame Maru, consisting of five types of games: recognizing numbers, algebra, statistics, geometry, and probability. This research aimed to create an interactive, innovative, and practical application as a digital medium. The method used in this research was the RD model, with 4D development (define, design, develop, and disseminate). The EduGame Maru application received a validation result of "very feasible for use," with 3.36 points from media expert validators and 3.64 points from material expert validators, so the average was 3.50. Meanwhile, during the testing at Kindergarten Labschool, Universitas Pendidikan Indonesia, Serang Campus, EduGame Maru application got 3.56 points from the teacher's assessment. In this case, the EduGame Maru application did not only train cognitive abilities but also help children to understand early mathematical concepts by applying the NCTM (National Council of Teachers of Mathematics) principles. Therefore, it can be concluded that EduGame Maru can help teachers and parents optimize the cognitive aspects of children aged 4-6 years, especially early mathematical concepts during online learning.

Pegagan is a plant that plays an important role in health because of its secondary metabolite. However, many secondary metabolites tend to be unstable when exposed to UV light and oxygen such as flavonoid and terpenoid. The purpose of this study was to formulate the ethanolic extract of pegagan leaves into nanoparticle preparations to increase the stability of the extract. Nanoparticle preparations were made using the emulsion solvent evaporation method using Poly-Lactic-Co-Glycolic Acid (PLGA) and polyvinyl alcohol (PVA). PLGA acts as a polymer that will coat the extract and PVA as a stabilizer. Variations in the concentration of PLGA used were 50 mg, 75 mg, and 100 mg, while the concentration of PVA used was 40 mg and the extract concentration was 158 mg. Determination of the best formula is done by looking at the results of the percent encapsulation efficiency obtained from the three formulas, namely 93.68%, 85.35%, and 88.76%, respectively. Based on these results, formula 1 was determined as the best formula. The particle size obtained in the best formula was 288.1667±3.4195 nm, the polydispersity index (PDI) was 0.371±0.0045 and the zeta potential value was -10.6333±0.1154. A physical stability test (cycling test method) of the best formula found a decrease in pH of 0.54 and no organoleptic changes or precipitate formed.

Abstract Adenosine causes the anti-inflammatory effect of MTX; however, the contributions of synoviocyte adenosine receptors (AdoRs) are unknown, and matrix metalloproteinase 3 (MMP-3) is released by fibroblast-like synoviocytes in response to inflammatory signaling. To understand the mechanism of the clinical observation that the matrix proteinase-3 concentration of patients with rheumatoid arthritis treated successfully with methotrexate does not usually normalize, we investigated the effects of A2A AdoR activation and inhibition on tumor necrosis factor-alpha (TNFα)-induced MMP-3 release by MH7A human rheumatoid synovial cells. MH7A cells constitutively expressed membrane-associated A2A AdoRs, and HENECA enhanced intracellular cAMP. Stimulation with TNFα markedly enhanced release of MMP-3 from MH7A cells, whereas HENECA partially and dose-dependently inhibited TNFα-evoked MMP-3 release. Similarly, dbcAMP partially inhibited TNFα-induced MMP-3 release. Pretreatment with ZM241385 reversed the inhibitory effects of HENECA. Further, TNFα induced p38 MAPK and ATF-2 phosphorylation, whereas HENECA suppressed p38 MAPK and ATF-2 phosphorylation. We concluded that adenosine signaling via A2A AdoRs, adenylyl cyclase, and cAMP reduces TNFα-induced MMP-3 production by interfering with p38 MAPK/ATF-2 activity. Activation of A2A AdoR signaling alone using HENECA did not reduce TNFα-induced MMP-3 production to the basal levels, which may explain why MTX usually decreases but does not eliminate serum MMP-3.

Abstract Background This study aimed to evaluate whether hypereosinophilia is a clinical biomarker of immune checkpoint inhibitor-induced hypopituitarism in patients with renal cell carcinoma treated with nivolumab plus ipilimumab. Methods This was a retrospective cohort study conducted at Jichi Medical University Saitama Medical Center between January 2018 and December 2020. In total, 12 patients with renal cell carcinoma who presented with immune checkpoint inhibitor-induced hypopituitarism were enrolled in this study. The clinical parameters and symptoms at baseline, last visit, and onset of hypopituitarism were analyzed. Results The median period from the initial treatment with immune checkpoint inhibitors to the onset of hypopituitarism was 82.5 (range: 56–196) days. Most patients developed hypopituitarism within 6 months. One patient presented with hypophysitis and 11 patients presented with isolated adrenocorticotropic hormone deficiency. The major symptoms noted at onset were fatigue (66.7%) and loss of appetite (41.7%). None of the patients had symptoms during the last visit. However, four developed hypereosinophilia. Eosinophil fraction (%) and eosinophil count (/µL) increased during the last visit and at the onset of hypopituitarism, respectively. The serum sodium and plasma glucose levels were similar. Conclusions The eosinophil count increased before the onset of hypopituitarism. Thus, hypereosinophilia can be an early predictor of hypopituitarism.

Abstract Background Intense conversion of tropical forests into agricultural systems contributes to habitat loss and the decline of ecosystem functions. Plant-pollinator interactions buffer the process of forest fragmentation, ensuring gene flow across isolated patches of forests by pollen transfer. In this study, we identified the composition of pollen grains stored in pot-pollen of stingless bees, Tetragonula laeviceps, via dual-locus DNA metabarcoding (ITS2 and rbcL) and light microscopy, and compared the taxonomic coverage of pollen sampled in distinct land-use systems categorized in four levels of management intensity (forest, shrub, rubber, and oil palm) for landscape characterization. Results Plant composition differed significantly between DNA metabarcoding and light microscopy. The overlap in the plant families identified via light microscopy and DNA metabarcoding techniques was low and ranged from 22.6 to 27.8%. Taxonomic assignments showed a dominance of pollen from bee-pollinated plants, including oil-bearing crops such as the introduced species Elaeis guineensis (Arecaceae) as one of the predominant taxa in the pollen samples across all four land-use types. Native plant families Moraceae, Euphorbiaceae, and Cannabaceae appeared in high proportion in the analyzed pollen material. One-way ANOVA (p > 0.05), PERMANOVA (R² values range from 0.14003 to 0.17684, for all tests p-value > 0.5), and NMDS (stress values ranging from 0.1515 to 0.1859) indicated a lack of differentiation between the species composition and diversity of pollen type in the four distinct land-use types, supporting the influx of pollen from adjacent areas. Conclusions Stingless bees collected pollen from a variety of agricultural crops, weeds, and wild plants. Plant composition detected at the family level from the pollen samples likely reflects the plant composition at the landscape level rather than the plot level. In our study, the plant diversity in pollen from colonies installed in land-use systems with distinct levels of forest transformation was highly homogeneous, reflecting a large influx of pollen transported by stingless bees through distinct land-use types. Dual-locus approach applied in metabarcoding studies and visual pollen identification showed great differences in the detection of the plant community, therefore a combination of both methods is recommended for performing biodiversity assessments via pollen identification.

Abstract Aims The relief of congestion is essential for the prevention of worsening heart failure (HF) resulting in hospitalizations. Assessment of the degree of organ congestion in the chronic phase of HF is important for determining therapeutic strategies. The aim of this study was to evaluate the efficacy of shear wave (SW) elasticity for assessing congestion and clinical outcomes in patients with chronic HF. Methods and results We prospectively enrolled 345 consecutive patients with chronic HF who underwent SW elastography at outpatient clinic. Patients were divided into two groups according to the median value of SW elasticity: low group (SW elasticity

Abstract Aims Acute heart failure (AHF) is a clinical syndrome with a poor prognosis and a major public health concern worldwide. The aim of this study was to investigate whether carperitide administration improves the 1 year prognosis of patients with AHF and to check whether there is an optimal dose of the drug. Methods and results We analysed the data of COOPERATE‐HF‐J (the Consortium for Pooled Data Analysis regarding Hospitalized Patients with Heart Failure in Japan), combining two cohorts (NARA‐HF and REALITY‐AHF), which included 2435 patients with acute decompensated heart failure. The patients were divided into no carperitide (NO‐ANP, n = 1098); very low‐dose carperitide (VLD‐ANP,

Genetic modification to restore cell functions in the brain can be performed through the delivery of biomolecules in a minimally invasive manner into live neuronal cells within brain tissues. However, conventional nanoscale needles are too short (lengths of ~10 µm) to target neuronal cells in ~1‐mm‐thick brain tissues because the neuronal cells are located deep within the tissue. Here, we report the use of nanoscale‐tipped wire (NTW) arrays with diameters

Objectives: No population pharmacokinetics (PK) model of isoniazid (INH) has been reported for the Indonesian population with tuberculosis (TB). Therefore, we aimed to develop a population PK model to optimize pharmacotherapy of INH on the basis of therapeutic drug monitoring (TDM) implementation in Indonesian patients with TB. Materials and methods: INH concentrations, N-acetyltransferase 2 (NAT2) genotypes, and clinical data were collected from Dr. Soetomo General Academic Hospital, Indonesia. A nonlinear mixed-effect model was used to develop and validate the population PK model. Results: A total of 107 patients with TB (with 153 samples) were involved in this study. A one-compartment model with allometric scaling for bodyweight effect described well the PK of INH. The NAT2 acetylator phenotype significantly affected INH clearance. The mean clearance rates for the rapid, intermediate, and slow NAT2 acetylator phenotypes were 55.9, 37.8, and 17.7 L/h, respectively. Our model was well-validated through visual predictive checks and bootstrapping. Conclusions: We established the population PK model for INH in Indonesian patients with TB using the NAT2 acetylator phenotype as a significant covariate. Our Bayesian forecasting model should enable optimization of TB treatment for INH in Indonesian patients with TB.

Abstract Background The pathogenesis of chronic thromboembolic pulmonary hypertension (CTEPH) is considered to be associated with chronic inflammation; however, the underlying mechanism remains unclear. Recently, altered gut microbiota were found in patients with pulmonary arterial hypertension (PAH) and in experimental PAH models. The aim of this study was to characterize the gut microbiota in patients with CTEPH and assess the relationship between gut dysbiosis and inflammation in CTEPH. Methods In this observational study, fecal samples were collected from 11 patients with CTEPH and 22 healthy participants. The abundance of gut microbiota in these fecal samples was assessed using 16S ribosomal ribonucleic acid (rRNA) gene sequencing. Inflammatory cytokine and endotoxin levels were also assessed in patients with CTEPH and control participants. Results The levels of serum tumor necrosis factor-α (TNF-α), interleukin (IL)-6, IL-8, and macrophage inflammatory protein (MIP)-1α were elevated in patients with CTEPH. Plasma endotoxin levels were significantly increased in patients with CTEPH (P

Introduction: Shallots are one of the horticultural products in great demand by the public. Excessive heavy metal content in shallot will affect people's health who consume it. This study examines the health risks of the people who consume shallot products produced in Srigading Village. Methods: Determination of sampling locations was carried out by purposive sampling method on shallot cultivation land that was ready to harvest, as many as 30 points, in September 2021. Soil and shallot samples were tested for the heavy metal content of Pb, Cd, Co, and Ni. The public health risk assessment was analyzed by looking at the Transfer Factor (TF) value, daily intake, health risk index, hazard index, and cancer risk. Results and Discussion: The concentration of heavy metals in shallots is Pb 19.14 – 30.04 mg kg-1, Cd 1.03 – 2.21 mg kg-1, Co 8.58 – 15.08 ppm, and Ni 6.00 – 10.09 mg kg-1. The average value of Transfer Factor (TF) shows metal uptake by shallots with metal levels Cd (1.07) > Pb (1.03) > Ni (0.73) > Co (0.46). The average daily dose shows that the daily consumption in children is higher than the daily dose for adults. Conclusion: Children are more at risk of being exposed to heavy metals compared to adults in consuming shallots based on the hazard index value. The continuous use of chemical fertilizers and chemical pesticides in shallot farming must be controlled to prevent the increase of accumulation of heavy metals in land and agricultural products.

Background and Objectives: Adenoid cystic carcinoma (ACC) of the head and neck is generally slow-growing but has a high potential for local recurrence and metastasis to distant organs. There is currently no standard pharmacological treatment for recurrent/metastatic (R/M) ACC, and there are cases in which immune checkpoint inhibitors (ICIs) are administered for ACC according to head and neck squamous cell carcinoma (HNSCC). However, the efficacy of ICIs for ACC remains unclear, and the predictive biomarkers need to be elucidated. Materials and Methods: The Center for Cancer Genomics and Advanced Therapeutics (C-CAT) database enabled the retrospective but nationwide analysis of 263 cases of ACC of the head and neck. Then, we examined and reported four cases of ACC that received ICIs and comprehensive genomic profiling (CGP) in our institution. Results: The C-CAT database revealed that 59 cases out of 263 received ICIs, and the best response was 8% of objective response rate (ORR) and 53% of disease control rate (DCR) (complete response, CR 3%, partial response, PR 5%, stable disease, SD 44%, progressive disease, PD 19%, not evaluated, NE 29%). The tumor mutational burden (TMB) in ACC was lower overall compared to HNSCC and could not be useful in predicting the efficacy of ICIs. Some cases with MYB structural variants showed the response to ICIs in the C-CAT database. A patient with MYB fusion/rearrangement variants in our institution showed long-term stable disease. Conclusions: ICI therapy is a potential treatment option, and the MYB structural variant might be a candidate for predictive biomarkers for immunotherapy in patients with R/M ACC.