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Abstract Background Surgery for pediatric cleft lip and palate repair often utilizes high-dose opioids and inhaled anesthesia, thereby causing postoperative complications such as desaturation and/or severe agitation after anesthesia. These complications are detrimental to the child and medical personnel and cause tremendous psychologic stress to parents. Our aim is to decrease these complications through dexmedetomidine, an alpha-2 receptor agonist with anxiolytic, sympatholytic, and analgetic properties. Devoid of respiratory depressant effect, it allows patients to maintain effective ventilation and reduce agitation, postoperatively. Its unique anesthetic property may shed light on providing safe anesthesia and gentle emergence to this young, vulnerable population. Case presentation A total of 21 patients of Sundanese ethnicity, aged 3 months to 8 years (9 males and 12 females), underwent cleft lip or cleft palate surgery using total intravenous dexmedetomidine. Anesthesia was induced using sevoflurane, fentanyl, and propofol, and airway was secured. Intravenous dexmedetomidine 1.5 μg/kg was administered within 10 minutes, and a maintenance dose of 1.5 μg/kg/hour was continued as the sole anesthetic maintenance agent thereafter. Hemodynamics and anesthetic depth using Patient State Index (SEDLine™ monitor, Masimo Corporation, Irvine, CA, USA) were monitored carefully throughout the surgical procedure. Dexmedetomidine did not cause any hemodynamic derangements or postoperative complications in any of our patients. We found agitation in 9.5% (2/21) of patients. Conclusion Dexmedetomidine can be used as a total intravenous anesthetic agent to maintain anesthesia and provide gentle emergence to infants and young children undergoing cleft lip and palate repair.

Abstrak Latar Belakang: Diabetes melitus tipe 2 (DM tipe 2) adalah penyakit gangguan metabolik yang ditandai dengan peningkatan gula darah akibat penurunan sekresi insulin oleh sel beta pankreas atau ganguan fungsi insulin (resistensi insulin) atau kedua-duanya. Peningkatan kadar HbA1c dan peningkatan kadar D-dimer merupakan dua kondisi pemeriksan hematologi yang bisa ditemukan dalam perjalanan penyakit DM tipe 2. Objektif: Penelitian ini bertujuan untuk mengetahui korelasi kadar Hba1c dengan kadar D-dimer pada pasien diabetes melitus tipe 2 . Metode: Penelitian ini merupakan analitik dengan pendekatan cross sectional pada data sekunder pasien diabetes melitus tipe 2 yang dilakukan pemeriksaan kadar HbA1c dan kadar D-dimer dengan alat POCT. Sampel penelitian ini adalah pasien yang didiagnosis DM tipe 2 dengan kadar HbA1c terkontrol (≤7 %) di Rumah Sakit Umum (RSU) Prof. Dr. M Ali Hanafiah Batu Sangkar, Kabupaten Tanah Datar sebanyak 20 sampel. Waktu penelitian periode November 2020–April 2021. Hasil: Penelitian diperoleh nilai rerata untuk kadar HbA1c pasien DM tipe 2 sebesar 5,925% dan kadar D-dimer sebesar 432 ng/mL. Analisis statistik uji korelasi Pearson menunjukkan tidak terdapat korelasi yang bermakna antara kadar HbA1c dengan kadar D-dimer (r=0,081; p=0,257). Kesimpulan: Pada penelitian ini dapat disimpulkan tidak ditemukan korelasi antara kadar HbA1c dengan kadar D-dimer pada diabetes melitus tipe 2. Kata kunci: D-dimer, Diabetes Melitus Tipe 2, HbA1c Abstract Background: Type 2 Diabetes is a metabolic disorder characterized by increased blood sugar due to decreased insulin secretion by pancreatic beta cells or insulin function disorders (insulin resistance) or both. Increased levels of HbA1c and increased levels of D-dimer are two conditions for hematological examination that can be found in the course of Type 2 diabetes. Objective: This study aims to determine whether there was a correlation between HbA1c levels and D-dimer levels in patients with Type 2 diabetes. Methods: This study was an analytic study with a cross sectional approach to secondary data for patients with type 2. 2 diabetes who were examined for HbA1c levels and D-dimer levels using POCT. The sample of this study were patients diagnosed with type 2 diabetes with controlled HbA1c levels (≤7 %) at Prof. Dr. M Ali Hanafiah Batu Sangkar, Tanah Datar Regency as many as 20 samples. The research period was November 2020 - April 2021. Results: Data analysis used univariate and bivariate analysis with the Pearson correlation test. Correlation was significant if p 0.05) and the correlation value (r) was 0.081. Conclusion: So it can be concluded that there is a weak correlation between HbA1c levels and D-dimer levels in patients with Type 2 diabetes.

Indonesia is ranked as the most highly polluted country in Southeast Asia and the 26th on the list of the most polluted countries worldwide. Exercising in polluted spaces can have complex effects on inflammation and mitochondrial biogenesis in the lungs. The interaction between physical activity and pollution exposure may affect lung health. This study aimed to analyse the different effects of exercise in polluted open spaces and antioxidant administration on lung inflammation and mitochondrial biogenesis. The research approach used was a quantitative approach with a comparative descriptive design using random assignment technique. The research sample used male white rats (Rattus Norvegicus) Wistar strain aged 8-10 weeks with a body weight of 200-300 g obtained from Biofarma Animal Breeding Facility. The sampling technique used in this study was random assignment technique. In this study, the number of members of the treatment group was 5, so the total research sample amounted to 5 x 9, namely 45 samples. The results showed that there was a differentiation in the level of inflammation represented by the level of IL-6 and NF-κB and lung mitochondrial biogenesis level represented by PGC-1α, TOM20, and COX IV with moringa administration in physical activities, as indicated by the comparison of the mean values of the inflammatory process and lung mitochondrial biogenesis in the nine treatment groups. The implication of this research is that it is necessary to consider appropriate sport strategies or guidelines for individuals who exercise in a polluted environment to reduce the negative impact on the respiratory system and overall lung health.

Laminins are trimeric glycoproteins with important roles in cell-matrix adhesion and tissue organization. The laminin α, ß, and γ-chains have short N-terminal arms, while their C-termini are connected via a triple coiled-coil domain, giving the laminin molecule a well-characterized cross-shaped morphology as a result. The C-terminus of laminin alpha chains contains additional globular laminin G-like (LG) domains with important roles in mediating cell adhesion. Dynamic conformational changes of different laminin domains have been implicated in regulating laminin function, but so far have not been analyzed at the single-molecule level. High-speed atomic force microscopy (HS-AFM) is a unique tool for visualizing such dynamic conformational changes under physiological conditions at sub-second temporal resolution. After optimizing surface immobilization and imaging conditions, we characterized the ultrastructure of laminin-111 and laminin-332 using HS-AFM timelapse imaging. While laminin-111 features a stable S-shaped coiled-coil domain displaying little conformational rearrangement, laminin-332 coiled-coil domains undergo rapid switching between straight and bent conformations around a defined central molecular hinge. Complementing the experimental AFM data with AlphaFold-based coiled-coil structure prediction enabled us to pinpoint the position of the hinge region, as well as to identify potential molecular rearrangement processes permitting hinge flexibility. Coarse-grained molecular dynamics simulations provide further support for a spatially defined kinking mechanism in the laminin-332 coiled-coil domain. Finally, we observed the dynamic rearrangement of the C-terminal LG domains of laminin-111 and laminin-332, switching them between compact and open conformations. Thus, HS-AFM can directly visualize molecular rearrangement processes within different laminin isoforms and provide dynamic structural insight not available from other microscopy techniques.

This study was conducted to characterize and classify the soils of the Teaching and Research Farm, Rivers State University, Port Harcourt, covering 30 hectares of land area. A rigid grid soil survey method at a very detailed level (100 × 100) m² (1 ha) with two mapping units identified and delineated. Each of the mapping unit was represented by a soil profile described from the lowest end to the upper part of the profiles to avoid contamination. Soil samples were collected for laboratory analysis from the various horizons identified. The results obtained, indicated that the soils were of Inceptisols/ Cambisol order, Udepts at the suborder level, Eutrudepts Great group level and Typic Eutrudepts (subgroup level). Thus, the drainage, parent materials, climate (rainfall), and vegetation of the area along with the geologic material, formed from the sedimentary rocks that were weathered into coastal plain sands and buried under alluvium at various degrees at different locations in the study area, greatly affected the soils of Teaching and Research Farm, Rivers State University, Port Harcourt, which are primarily Inceptisols/ Cambisols.

This study tries to present a study on Understanding the basics of peacebuilding in Southeast Asia by bringing together three approaches, namely religious, educational, and psychosocial approaches. The focus of this research is, first, to identify an overview of the fundamental values and basic principles of peacebuilding adopted by peacebuilding organizations in Southeast Asia. Second, to identify approaches adopted by peacebuilding organizations that reflect the intersection of religious, educational, and psychosocial perspectives to build peace in Southeast Asian societies. This study finds that first, Peace in Southeast Asia is influenced by values and basic principles of harmony and peace-building such as spirituality, local wisdom, brotherhood or togetherness, deliberation, tolerance, ikhlas (voluntary), and equality. This value is embraced by peace-building organizations in Southeast Asia on the basis that on the one hand, each religion teaches about unity, while on the other hand, the spirit of unity will also make a significant contribution in the national context.

Amidst the social-cultural predominance of male ulama in the religious context, female ulama play important roles and yet are often trapped in life-role complexity and gender bias, as they have a responsibility in both the domestic and public domains. This study aims to explore the meaning of the experience of gratitude among female ulama based on the perspective of positive psychology, with reference to the PERMA (Positive emotion, Engagement, Relationship, Meaning, and Accomplishment) model, with further interpretation of gratitude (shukr) from Sufi psychology. Using a qualitative (phenomenological) approach, we held online in-depth interviews with five female ulama participants from across Indonesia and Germany. The research demonstrates the interconnection between themes related to gratitude according to PERMA-Model and the embodiment of gratitude (shukr) in Sufi psychology. These findings provide evidence to support the practical implication of the integrative intervention of positive and Sufi psychology for clinical purposes or to promote flourishing and well-being among women.

Introduction: The management of conjoined twins requires multidisciplinary teamwork. The complex problems in conjoined twin separation surgery are challenging for anesthesiologists without experience in the management of conjoined twins. Objective: To describe anesthetic management and utilization of teleanesthesia in conjoined twin separation surgery. Case Report: Sixty days-old pygopagus type conjoined twins, with a total body weight of 7030 grams. Both babies looked healthy, moved actively, found no respiratory function disorders, were hemodynamically stable and had no congenital abnormalities. The sacral region's computerized tomography scan (CT-scan) reveals conjoined twins with skin unification and subcutaneous in the perianal region and no internal-vertebral-spinal fusion. Two anesthesia teams performed the management of anesthesia. After confirming there was no cross-circulation with the atropine test, we alternately induced anesthesia by inhalation technique while maintaining spontaneous breathing. Anesthesia was maintained with sevoflurane 2.0-3.0 vol%, in a mixture of oxygen and air with a flow of 4 L/min using Jackson Reese. Circulating volume, hemodynamic stability, and normothermia were maintained intraoperatively. The separation surgery lasted 20 minutes, and the total surgical time for each baby was two hours. Awake extubation was performed immediately after the surgery was complete. Both babies underwent postoperative care at the PICU and were discharged on day 11. During the pre-operative for surgery, the local team conducted telemedicine consultations with the pediatric anesthesia team at Dr. Soetomo hospital and performed intra-anesthesia telementoring. Conclusion: Careful preparation and pre-operative evaluation, proper intra-anesthesia maintenance and monitoring, as well as good communication and teamwork, are keys to successful anesthesia management in conjoined twin separation surgery. Consultation and assistance from an experienced team during surgery using teleanesthesia are significantly beneficial to the anesthesiologist without experience in conjoined twin separation surgery.

It is inevitably believed that culture teaching is the pivotal feeling of integrating culture into the teaching of a language, including in the EFL setting. This study aims to explore the English teachers’ beliefs, attitudes, and the reflection of their beliefs and attitudes on the teaching syllabi. The sequential explanatory mix-methods design was applied in junior high schools in Ngawi. The data were obtained from 144 English teachers’ answers to a questionnaire and interviews with six teachers. Then, the data were analysed by using descriptive statistics, the independent sample T-test, and the Mann-Whitney test. The results indicated that the majority of junior high school English teachers believed in the importance of incorporating culture into their teaching of the language taught and students’ learning process. Moreover, both state and private junior high school English teachers showed similar beliefs and attitudes related to culture teaching. When they taught English, the culture associated with that language had also been taught so that the misconception of learning the language can be minimized. The result of teachers’ practices strongly indicates that the English teachers in Ngawi had implemented the teaching of culture and inserted various cultural elements in the process of their teaching and learning in the EFL classes.

The purpose of this study was to obtain empirical data related to student lifestyle analysis at the Indonesia University of Education during the COVID-19 pandemic. The method that will be used in this research is descriptive. By creating a database related to student physical activity at the Indonesian Education University during the COVID-19 pandemic. The instrument that will be used in this research is an instrument developed by Douglas & Donna named Fantastic Lifestyle Assessment. The results of the analysis show that the lifestyle or lifestyle of students within the Indonesian Education University during the Covid-19 Pandemic showed poor results where out of a total of 274 respondents 38% were in the low category and there were even 2 respondents in the dangerous zone category, and only a total of 13% were in poor condition. ideal and 48% are in the sufficient category. The Covid-19 pandemic has greatly disrupted the stability of lifestyle conditions through the parameters measured, namely the condition of family and friends, physical activity, nutritional or nutritional intake, cigarette consumption, alcohol consumption, sleep quality and stress levels, personality, ability to understand events, and satisfaction with career.

Some soils of coastal plain sands in South Southern Nigeria were assessed for oil palm and coconut cultivation. This research was carried out to evaluate the soils of the study area using rigid grid soil survey methodology at detailed scale. The study area (128.11 ha) was delineated into four soil mapping units based on soil type. A pedon was sunk in each mapping unit and described according to FAO. Three soil orders, including Entisols (Ahiara), Inceptisols (Kulfo) and Ultisols (Orlu), were identified. Parametric and limitation methods of land suitability evaluation were used. Major limitations to assessment were climate (mean annual temperatures) and soil physical properties (texture/structure). Aggregate suitability rating (both actual and potential) showed that Ultisols (pedons 3 and 4, covering 56.73 ha) was moderately suitable (S2) for coconut and marginally suitable (S3) for oil palm, Inceptisols (pedon 2, covering 54.25 ha) was marginally suitable (S3) for coconut but not suitable (NS) for oil palm, and Entisols (Pedon 1covering 17.13 ha) was not suitable (NS) for any of the crops. Thus, area with Entisols should not be used for cultivation of any of the crops due to major limitation in texture. Moreover, both assessment approaches captured the major limitations. Therefore, the use of any of the approaches employed in this study and for these crops becomes a matter of choice as both of them showed no major differences in the application of their procedures.

This study attempted to assess the soil suitability in the derived savanna zone of Edo State, Nigeria for the cultivation of some tree crops. The research specifically aimed to evaluate soil suitability for cashew and rubber supported by suitability maps for both crops. In terms of land suitability evaluation, mapping units 1 and 2, with an area coverage of 27.4 ha of the entire research area (100 ha) were found to be marginally suitable (S3) for rubber cultivation but moderately suitable (S2) for cashew. Mapping unit 3, with area coverage of 38 ha was found to be currently not suitable (N1) for rubber but marginally suitable (S3) for cashew cultivation. Mapping unit 4 representing area coverage of 34.7 ha was found to be permanently not suitable (N2) for rubber cultivation but marginally suitable (S3) for cashew. Thus, technically, rubber can only be cultivated in that land at marginal level with an expected productivity of 27.4 ha (27.4 %). Cashew can be cultivated at moderate and marginal levels with an expected yield of 27.4 ha (27.4 %) and 72.6 ha (72.6 %), respectively, of the total land area. Thus, the preferred crop for the studied is cashew. It is recommended that for any significant investment in cultivation of this crop, the priority is the moderate levels with an expected productivity of 27.4 ha or 27.4 % of total land area.

# Background Understanding biological causes of death and sociocultural factors influencing outcomes is critical to reducing mortality in low-resource settings. Verbal and Social Autopsy instruments (VASAs) query family members about events leading to an individual's death, resulting in quantitative, categorical data. This study sought to determine the value of a supplemental in-depth qualitative interview (VASA-QUAL). # Methods This cross-sectional study was conducted in two slum neighborhoods in Kampala, Uganda, among families who lost a child under five within the preceding six months. A trained, local researcher conducted the quantitative VASA and then administered the VASA-QUAL to family members. Quantitative data were analyzed using Stata V16.0; qualitative data were transcribed into English and analyzed using NVivo V12.0. The biomedical cause of death was determined using a panel of physicians to code verbal autopsy items. Quantitative VASA variables were compared with qualitative variables from the VASA-QUAL using a rubric of indicators derived from the Pathways to Survival framework. Kappa statistics and percent agreement were calculated to compare quantitative and qualitative data. Three coders independently rated whether qualitative data provided additional information that improved understanding of the cause of death. # Results 48 VASAs were conducted (child age range: 1 month to 52 months). Agreement on key indicators ranged from 81.2% (place of death) to 93.8% (recognition of illness), with Kappa coefficients ranging from -0.038 to 0.368. The qualitative component added or clarified information about pediatric illness and care-seeking across all indicators, including recognition of illness (94.0%), care-seeking decisions (79.0%), whether home care was provided (73.0%), and choice of outside care (85.0%). Qualitative interviews frequently included symptoms missing or denied in the quantitative VASA and clarified the chronological order of symptoms. Many qualitative interviews described complicated mechanisms of decision-making not captured in the quantitative survey. Both agreement across data types and whether meaningful information was added by the qualitative data varied by cause of death, although our sample size limited our ability to conduct statistical analysis in this regard. # Conclusions Supplementing quantitative VASA tools with an in-depth VASA-QUAL interview provided important additional information, but not consistently across indicators or causes of death. Despite challenges associated with feasibility, supplemental qualitative interviews may be an important tool for understanding the complexity of events leading up to childhood deaths.

Introduction: AKI (Acute Kidney Injury) complications in sepsis patients generally occur 24 hours after admission to ICU. Creatine Serum Concentration is a standard parameter to diagnose AKI. Unfortunately, the changes in creatine serum concentration will only be seen several days after the decrease of renal function to 50%. The low detection ability has been linked with time loss before preventive therapy is commenced. Furthermore, this instigates the need for biomarkers to ensure early detection. Objective: This study aimed to identify cut-off points of urine syndecan-1 and to measure the prediction ability of urine syndecan-1 towards the AKI occurrence in pediatric sepsis patients. Materials and methods: This study was a prospective cohort study performed at a single center in Dr. Soetomo General Hospital, Surabaya. The inclusion criterion was all children admitted to the resuscitation room from October until December 2019. Furthermore, urine sampling is carried out at 0, 6, 12, and 24 hours for a syndecan-1 urine examination, and every procedure performed on the patient will be recorded. This action was continued up to the third day and aimed to evaluate some factors related to AKI at 48-72 hours of admission. Result and Discussion: Out of 41 pediatric sepsis patients, 30 patients fulfilled the inclusion criteria and 57% had AKI. The value of urine syndecan-1 at hour-0 and hour-6 was significantly featured a cut-off point. Conclusion: The value of urine syndecan-1 at hour-0 and hour-6 are valid parameters to predict the occurrence of AKI grades 1, 2, and 3 in pediatric septic patients at 48-72 hours after their hospital admission. The best cut-off value of urine syndecan-1 at the 0th hour was 0.67 ng/ml.

Introduction: NRSD (Neonatal Respiratory Distress Syndrome) is one of the most frequent causes of newborns in intensive care (NICU). Several NICU centers are now using the High Flow Nasal Cannula (HFNC) in recent years. With the use of HFNC as a breath aid in preterm infants, HFNC had the same efficacy ratio as nasal Continuous Positive Airway Pressure (CPAP) (continuous or intermittent). Case Report: A three-day-old baby boy was admitted to anesthesia with respiratory failure due to grade II HMD with suspicion of congenital heart failure. The initial condition showed that a respiratory rate of 70-80x / minute, breathing of the nostrils and retractions in the intercostals and abdomen with 85% post ductal SpO2 with the help of a CPAP mask (Pinsp 10, Fio2 70%). There was a Ronchi sound in the right and left basal lungs, and hemodynamics obtained a pulse of 180-195x / minute, non-invasive blood pressure 95/34 mmHg (54), heart murmurs were not found. During day 1 - day three, the patient uses a CPAP mask until the patient vomits and being consulted to an Anesthesiologist. On day 3 - day seven, the patient uses HFNC; after day seven until day 10, the patient uses neonatal nasal canularis oxygen. Until day 10, the patient is still being treated at the NICU by administering oxygen 0.5 liters/minute with SpO2 ranging from 93-96% with stable conditions but still needing oxygen. Conclusion: The use of Modified High Flow Nasal Cannula (HFNC) in preterm infants with Neonatal Respiratory Distress Syndrome (NRSD) is more effective and efficient than CPAP. The use of HFNC was associated with a lower incidence of nasal trauma and pneumothorax than nasal CPAP.

Introduction: In children below six years old, OLV is challenging due to technical issues such as unavailable double-lumen tube(DLT) for this age group, unavailable visual-assisted airway technology in pediatric sizes and the unfamiliarity to pediatric airway management tecniques. We aim to report our approaches for three cases of OLV in infants and pediatrics patients undergoing surgery. Case report: Three cases of pediatric patients with lung masses aged two-month-old, 11-month-old and three years old are reported in this case series involving the use of a single lumen ETT and Fogarty embolectomy catheters as a surrogate for bronchial blocker with and without the use of a video-assisted device. Discussion: The sizes of the patient's airway and the equipment available significantly impact the choice of technique in pediatrics. Availability of a video-assisted airway device improves the working field's visualization provides a suctioning method and evaluation of the technique. Conclusion: Combining anatomical knowledge, sizing and modification of available equipment and simulation training is critical in providing one-lung ventilation for pediatric patients.

Building resilience is a great necessity, especially for adolescents who have spent most of their time at home with their families and have also had to cope with the pandemic situation. Resilience ensures that they persevere, adapt, and rise to the occasion when dealing with difficult circumstances. This study aims to empirically test the role of secure attachment and mindfulness in adolescent resilience in the New Normal era. The subjects were 220 adolescents, students at junior high school in the city of Semarang, selected using the convenience sampling technique. The study is a correlational quantitative research using regression analysis. The instrument employed involved scales, namely the Secure Attachment Scale, the Mindfulness Scale, and the Resilience Scale. The results show a significant and positive relationship between secure attachment and mindfulness in relation to adolescents’ resilience in the New Normal. The results, therefore, indicate that families should emphasize the development of psychological skills in adolescents, especially resilience, across the country.

Post anesthesia agitation is common problem in pediatric post anesthesia care unit. The incidences range from 10 to 80%. EA has been described as a dissociated state of consciousness in which the child is inconsolable, irritable, and uncooperative typically thrashing, crying, moaning or incoherent. This study was done to determine the incidence of emergence agitation and associated risk factors in pediatric patients who underwent general anesthesia. This descriptive and analytic study was performed on 105 pediatric patient aged 1-12 years that underwent general anesthesia for various elective diagnostic and surgeries at Dr. Soetomo Hospital between January and February 2016. The presence of emergence agitation was recorded using Pediatric Anesthesia Emergence Delirium (PAED) scale. The factors that linked with Emergence Agitation were recorded in a questionnaire. The data were analyzed using SPSS software with logistic regression. p - values less than 0.05 were considered as significant. Forty two (40%) children had Emergence Agitation. Preoperative anxiety (p = 0.006) and Pain (p=0.035) were associated with higher rates of post anesthetic emergence agitation. This study identified preoperative anxiety and pain as risk factors, which are associated with emergence agitation in children. To minimize the incidence of post anesthetic emergence agitation, these risk factors should be considered in the routine care by anesthetist.

Pendidikan seksual masih dianggap tabu oleh masyarakat, yang berdampak pada remaja memiliki pengetahuan tentang pendidikan seksual yang kurang. Akibatnya, remaja melakukan pencarian tentang “seks” dari sumber yang tidak dapat dipertanggung jawabkan. Penelitian ini bertujuan untuk mengetahui kebutuhan pendidikan seksual remaja berdasarkan hasil survei persepsi pendidikan seksual remaja. Pendekatan yang digunakan yaitu pendekatan kuantitatif dan kualitatif. Populasi dalam penelitian ini adalah siswa kelas IX SMA dan SMK di Bandung. Sampel penelitian diambil menggunakan sampel non-probabilitas dengan teknik random sampling, sehingga didapatkan 618 responden. Pengumpulan data didapatkan dari penyebaran instrumen persepsi pendidikan seksual pada remaja dan Focus Group Discussion (FGD) bersama guru-guru pada sekolah yang dijadikan responden. Analisis pengolahan data dilakukan dengan penentuan kelompok siswa dengan kategori dimulai dengan konversi skor mentah menjadi skor matang dan menggunakan batas ideal yang ditentukan serta berdasarkan hasil Focus Group Discussion (FGD). Hasil dalam penelitian ini menunjukkan bahwa remaja SMA dan SMK di kota Bandung telah memiliki persepsi pendidikan seksual pada kategori sehat. Artinya, remaja memiliki persepsi yang positif terhadap pendidikan seksual. Sehingga remaja seyogyanya orang yang dianggap lebih dewasa mampu memberikan pendidikan seksual yang tepat guna memfasilitasi peningkatan dorongan atau hasrat seksual untuk disalurkan pada kegiatan yang lebih positif dalam pengembangan diri remaja. Pendidikan seksual sehat harus berjalan beriringan dengan pertumbuhan, perkembangan remaja, nilai dan norama yang berlaku di masyarakat atau pendidikan sexsual secara konprehensif.

Background: Understanding biological causes of death and sociocultural factors that influence survival outcomes is crucial to reducing mortality in low-resource settings. Verbal and Social Autopsy instruments (VASAs) query family members about events leading up to an individual's death, resulting in quantitative, categorical data. We aimed to determine the value of a supplemental in-depth interview (known as VASA-QUAL) that generated detailed qualitative data in understanding childhood deaths. Methods: This cross-sectional study was conducted in Kawaala and Nakulabye in Kampala, Uganda between Feb 6 and March 7, 2020, using 20 village health team members to assist in the identification and recruitment of families within which a children younger than 5 years had died within the preceding 6 months. Family members were interviewed by a trained, local researcher who conducted the quantitative VASA and the VASA-QUAL in-depth interview. Quantitative data were analysed using Stata (v16.0), and qualitative data were transcribed into English and analysed using NVivo (v12.0). Three coders compared quantitative variables from the VASA with qualitative variables from the VASA-QUAL using a rubric of eight key indicators related to symptom recognition, decision making, care seeking, and treatments given, derived from the Pathways to Survival framework. Agreement across sources and new insights from qualitative data were recorded. Findings: 48 VASAs were conducted, reflecting 48 deaths of children between the ages of 1 month and 3 days to 52 months. Agreement on key indicators ranged from 77% (for illness recognition) to 100% (for following provider referral recommendations). The qualitative component added or clarified information about pediatric illness and care-seeking across all indicators, including information about recognition of illness (96% of cases), care-seeking decisions (81%), whether home care was provided (75%), and choice of outside care (92%). The qualitative interviews frequently included symptoms that were missing or denied in the quantitative VASA, and they often clarified the chronological order of symptoms identified via VASA. Many qualitative interviews described complicated mechanisms of decision making, involving multiple key players, which were not adequately captured in the quantitative survey. Interpretation: Supplementing quantitative VASA tools with an in-depth VASA-QUAL interview provided important additional information. Supplemental qualitative interviews are an important tool for understanding the complexity of events leading up to childhood deaths. Funding: The Northern Pacific Global Health Research Training Consortium, Fogarty International Center at the National Institutes of Health.

Pada lansia dapat terjadi gangguan gerak dan nyeri pada beberapa bagian tubuh seperti leher, bahu, leher, punggung bawah, lutut dan kaki dengan prevalensi terbesar adalah nyeri punggung bawah. Beberapa faktor yang dapat mempengaruhi timbulnya nyeri punggung bawah atau Low Back Pain (LBP) pada lansia dapat disebabkan kebiasaan duduk lama, mudah lelah, atau akibat penyakit tertentu seperti jatuh terduduk yang menyebabkan hernia nukleus pulposus (HNP) di daerah tulang lumbal. Fisioterapi berperan penting dalam kondisi tersebut. Penelitian ini adalah penelitian studi kasus pada seorang lansia dengan LBP karena HNP. Pemeriksaan dilakukan adalah pemeriksaan nyeri dengan Visual Analogue Scale (VAS) dan kemampuan fungsional dengan Oswestry Disability Index (ODI). Tindakan fisioterapi yang diberikan pada lansia menggunakan intervensi konvensional seperti Ultrasound (US), Transcutaneous Electrical Nerve Stimulation (TENS) dan latihan metode McKenzie. Dengan tindakan fisioterapi konvensional dan metode McKenize memberikan hasil yang baik pada penurunan nyeri dan peningkatan kemampuan fungsional. Dari penelitian ini dapat disimpulkan pelaksanaan terapi konvensional dan metode McKenzie dapat memberikan pengaruh yang baik pada lansia dengan LBP karena HNP

Gangguan umum muskuloskeletal yang terjadi pada guru adalah nyeri leher dan nyeri punggung bawah yang disebabkan duduk atau bekerja pada posisi statis sehingga memicu terjadinya cedera tertarik berulang. Program pengabdian kepada masyarakat dilaksanakan oleh Prodi Fisioterapi UKI untuk meminimalkan risiko tersebut pada para pegawai Sekolah Menengah Kejuruan Negeri 10 Cawang sebagai mitra pada program ini. Metode yang akan dilakukan pada kegiatan ini adalah dengan memberikan edukasi berupa penyuluhan, pemeriksaan ketidaknyamanan, dan memberikan penanganan mandiri berupa peregangan mandiri yang diajarkan kepada guru dan dapat dilakukan secara mandiri. Kegiatan pemeriksaan umum dilakukan dengan mengisikan kuisioner. Penanganan yang diberikan adalah edukasi melalui penyuluhan dan memberikan buku panduan peregangan. Pegawai yang mengikuti penyuluhan berjumlah 29 orang. Pada pemeriksaan awal didapati 16 orang mengalami nyeri leher dan 18 orang mengalami nyeri punggung bawah. Setelah dua bulan, didapati penuruan jumlah kejadian nyeri leher dan punggung bawah sebanyak 8 orang. Sebanyak 27 dari 29 mengaku mendapat manfaat melalui program pengabdian kepada masyarakat yang dilaksanakan. Dengan pelaksanaan penyuluhan peregangan mandiri disimpulkan terdapat penurunan prevalensi kejadian nyeri leher dan nyeri punggung bawah pada pegawai SMKN 10 Cawang.

One of activity that contributed to non-specific low back pain (LBP) is prolonged sitting. Therapeutic exercise that commonly used for management of non-specific LBP is McKenzie method while the Proprioceptive Neuromuscular Facilitation (PNF) exercise was rarely used for non-specific LBP. The purpose of the study is to find the effect of PNF and McKenzie method in lumbar range of motion (ROM) on non-specific LBP. A quasi-experimental study involving 36 subjects (students and staffs) from the university population. The subjects were assigned to three treatment groups: PNF group, McKenzie group and control group (hot pack and educational home exercise sheet) which underwent 12 treatment sessions distributed over three times in a week for four weeks duration. Subjects were measured on lumbar flexion and extension ROM by modified schober method. Measurement was performed at three points: pre-test, mid-test and post-test. The within-between groups repeated measures ANOVA were used to analyse the effectiveness of PNF and McKenzie treatments based on the measurement time. This study showed each treatment has significant improvement lumbar flexion ROM (p

In the general population, obesity is positively correlated with hypertension. On the other hand, there was hypothesis of “reverse epidemiology” in the relationship between body mass index (BMI) and blood pressure (BP) of hemodialysis (HD) patients. This study aimed to investigate the “reverse epidemiology” of the relationship between the two variables in Jakarta, Indonesia. Cross-sectional study was conducted at Cipto Mangunkusumo Hospital, Koja District Hospital, and Cengkareng District Hospital in July 2018. Total sampling was performed with a total of 525 HD patients aged >18 years. All data were analyzed from the medical records. Of 525 patients, 27.4% were obese. The post hoc analyses showed that obese patients had significantly lower post-HD systolic BP (P = 0.006) and diastolic BP (P = 0.004) than the normal-weight patients. The Chi-square analyses showed that the overweight group [odds ratio (OR) = 0.53; 95% confidence interval (CI) 0.31-0.87; P = 0.011] and the obese group (OR = 0. 63; 95% CI 0.400.97; P= 0.038) had significant protective effect (OR

The high demand for renewable energy makes a light harvester material (dye sensitizer) interesting to be developed by scientists. This research has been synthesized a series of material dye sensitizer based on derivatives of porphyrin and successfully investigated the influence of metals in photovoltaic performance. The derivatives of porphyrin used are TMPyP (5,10,15,20-tetrakis(1-methyl-4-pyridinio) tetra porphyrin (p-toluenesulfonate)) reacted by metal ions Fe(II), Co(II), Ni(II) and Cu(II). The larger atomic number of metals, the higher effective nuclear charge of the metal, resulting better photovoltaic performance. The highest performance of solar cell reached efficiency 4.65 %.

The study examined the perception of gender and academic qualifications on the application of computer-assisted instruction in secondary schools in Nigeria. The study was delimited to Ukwuani LGA, Delta state. Two research questions with two hypotheses propelled the direction of the study. A descriptive design of the survey method was utilized for the study. The population consisted of all secondary school teachers in Ukwuani LGA, Delta state. The simple random sampling technique was employed in selecting twenty (20) secondary schools from which an average of eleven teachers (11) were purposively selected from each school, constituting a total sample of 211. The instrument used to obtain information from respondents was the questionnaire titled: Computer Assisted Instruction Inventory (CAII). The items were designed by the researcher. The instrument was divided into three sections: A, B and C. Section A constituted the biographic information of respondents, B contained items on teachers' application of CAI method in teaching secondary school students and C was concerned with the aspects of the challenges facing Computer Assisted Instruction. The questionnaire adopted a 4-point Likert-type scale. The data collected were analyzed with frequency distribution, descriptive statistics, the t-test (IST) and the one-way analysis of variance. The statistics were chosen for the analyses because of their robust nature of comparing the means of two or 3 variables. Hypotheses were tested at 0.05 significant levels. The outcome of the research revealed that teachers do not readily apply CAI method in teaching secondary school students in Ukwuani LGA, Delta state. Challenges in the effective application of CAI method in teaching secondary school students in Ukwuani LGA, Delta state were indeed enormous. However, gender and academic qualifications did not have a significant effect on the use of CAI by teachers. Based on the conclusion reached, several recommendations were made which include among others that teachers’ should be adequately trained in computer education to maximize the use of Computer- Assisted Instruction method in teaching Secondary schools. Government should provide computers and related software in secondary schools by either supplying them directly or making financial provisions for school heads to purchase them and the government should provide solutions to the challenges of Computer Assisted Instruction services in schools by providing enabling environment in schools. Résumé Cette étude a abordé la perception du genre et des titres universitaires sur l'enseignement à l’aide de l’informatique dans les écoles secondaires au Nigeria. L'étude a été concentrée à la region d’Ukwuani en état Delta. Deux questions de recherche et deux hypothèses ont déterminé la trajectoire de l'étude. L'étude a été réalisée selon la méthode d'enquête descriptive. La population était composée de tous les enseignants du secondaire de la région d'Ukwuani, dans l'État du Delta. La technique d'échantillonnage par randomisation simple a été employée pour choisir vingt (20) écoles secondaires à partir desquelles une moyenne de onze (11) enseignants a été choisie à dessein dans chaque école, constituant ainsi un échantillon total de 211 personnes. L'instrument employé pour obtenir des informations des répondants était le questionnaire intitulé : Computer Assisted Instruction Inventory (CAII). Les questions ont été conçues par le chercheur. L'instrument était divisé en trois sections : La section A contenait les informations biographiques des personnes interrogées, la section B contenait des questions sur l'application par les enseignants de la méthode CAI dans l'enseignement aux élèves du secondaire, tandis que la section C concernait les aspects des défis auxquels l'enseignement à l’aide de l’informatique se fait face. Le questionnaire a adopté une balance de type liket à 4 points comme format dactylographié. Les données recueillies ont été analysées à l'aide de la distribution des fréquences, de statistiques descriptives, du test t (IST) et de l'analyse de variance à sens unique. Ces statistiques ont été choisies pour les analyses en raison de leur nature robuste de comparaison des moyennes de deux ou trois variables. Les hypothèses ont été évaluées à un niveau de signification de 0,05. Le résultat de la recherche a révélé que les enseignants n'appliquent pas facilement la méthode CAI dans l'enseignement aux élèves des écoles secondaires dans la region d'Ukwuani, Delta state. Les défis de l'application efficace de la méthode CAI dans l'enseignement aux élèves des écoles secondaires d'Ukwuani , Delta State, sont en effet immenses. Cependant, le rôle du sexe et des titres universitaires n'a pas eu d'effet significatif sur l'utilisation de l'EAO par les enseignants. Sur la base des conclusions tirées, plusieurs recommandations ont été formulées, dont les suivantes : les enseignants devraient recevoir une formation adéquate en informatique afin de maximiser l'utilisation de la méthode d'enseignement assisté par ordinateur dans les écoles secondaires. Le gouvernement devrait fournir des ordinateurs et des logiciels connexes dans les écoles secondaires, soit en les fournissant directement, soit en faisant des provisions financières aux chefs d'établissement pour les acheter, et le gouvernement devrait apporter des solutions aux défis des services d'enseignement à l’aide informatique dans les écoles en fournissant un milieu favorable dans les écoles. Mots clés: Enseignement à l’aide informatique, enseignement secondaire, enseignants des écoles secondaires

Background: Magnetic Resonance Imaging (MRI) and Computerized Tomography (CT) Scans might be challenging for children or patients with anxiety or claustrophobia. The use of general anesthesia aims to increase the success rate, but inadequate management can result in longer length of stay. Purpose: To analyze patients' length of stay on MRI and CT-scan with intravenous anesthesia. Methods: A descriptive observational study. The datas were collected retrospectively from the medical records in General Diagnostic Center. Total of 721 patients who underwent MRI or CT Scan procedures with intravenous anesthesia during 2017-2018. The data obtained were patients' age, sex, the type of procedure, physical status, comorbid, type of anesthesia drug, diagnostic procedure duration, length of observation in the Post Anesthesia Care Unit (PACU), and overall length of stay. Results: All MRI procedures used midazolam-propofol combination, and only one CT scan procedure used this combination, while the other used only propofol. Patients undergoing MRI had length of stay with a mean duration of 6,6,3±1,26 hours, compared to CT scans with 5,20 ±1,38 hours, due to the more prolonged procedure and observation duration in the PACU. Conclusion: Patients undergoing MRI had a longer length of stay than the ones doing CT scans.

Adversity quotient play an important role in the life of every student of Islamic boarding school, especially Quran reciter student. The life of the boarding school with strict regulations and a busy schedule of activities requires students to have a high adversity quotient. Only students who have the ability to control themselves and good interpersonal relationships can survive in the boarding school. This study aimed to test the effect of self-regulation and peer attachment on the adversity quotient of Quran reciter students. There were 127 students of Islamic boarding school situated in Ngaliyan Sub-district, Semarang City, involved as the samples, which were collected using sampling quota technique. The data were collected using self-regulation scale, peer attachment scale, and adversity quotient scale, and were analyzed using multiple regression technique. The result of the analysis showed that self-regulation and peer attachment have simultaneous and partial effects on adversity quotient. Simultaneously the two independent variables affect the adversity quotient by 40.9%, while partially self regulation can affect the adversity quotient greater, that is by 62.1%, and peer attachment affects by 12.8%. Activities that are oriented towards increasing self-regulation of students and increasing peer-attachment among students become important implications of the results of research.

Data from 8th Report of the Indonesian Renal Registry in 2015 reported that there was an increase in the prevalence of hemodialysis (HD) patients in Indonesia. Measures had been taken to reduce the cost of HD such as utilizing reusable dialyzer membrane. However, little is known on the impact of reusable dialyzer membrane on patients’ quality of life (QOL), and hence, this study was conducted. We conducted a multicenter study at Cipto Mangunkusumo Hospital, Koja District Hospital, and Cengkareng District Hospital with a total of 389 patients. Cipto Mangunkusumo Hospital represented single-use dialyzer group while, Koja and Cengkareng District Hospital represented reusable dialyzer group. Face-to-face interviews were conducted using Kidney Disease QOL-Short Form 36 questionnaires. Single-use dialyzer group’s scores were significantly higher than reusable dialyzer group’s scores in the following dimensions: kidney disease component summary (KDCS; 74.2 vs. 66.3; P

Background: Several studies have revealed the potential use of tocilizumab in treating COVID-19 since no therapy has yet been approved for COVID-19 pneumonia. Tocilizumab may provide clinical benefits for cytokine release syndrome in COVID-19 patients. Methods: We searched for relevant studies in PubMed, Embase, Medline, and Cochrane published from March to October 2020 to evaluate optimal use and baseline criteria for administration of tocilizumab in severe and critically ill COVID-19 patients. Research involving patients with confirmed SARS-CoV-2 infection, treated with tocilizumab and compared with the standard of care (SOC) was included in this study. We conducted a systematic review to find data about the risks and benefits of tocilizumab and outcomes from different baseline criteria for administration of tocilizumab as a treatment for severe and critically ill COVID-19 patients. Results: A total of 26 studies, consisting of 23 retrospective studies, one prospective study, and two randomised controlled trials with 2112 patients enrolled in the tocilizumab group and 6160 patients in the SOC group, were included in this meta-analysis. Compared to the SOC, tocilizumab showed benefits for all-cause mortality events and a shorter time until death after first intervention but showed no difference in hospital length of stay. Upon subgroup analysis, tocilizumab showed fewer all-cause mortality events when CRP level ≥100 mg/L, P/F ratio 200-300 mmHg, and P/F ratio

BackgroundAlthough under-five (U5) mortality in Uganda has dropped over the past two decades, rates in urban slum neighborhoods remain high. As part of a broader verbal and social autopsy study of U5 deaths, this study explored the perspectives of volunteer community health workers, called Village Health Teams (VHTs), on why children under five in Kampala's informal settlements are still dying despite living in close proximity to nearby health facilities.MethodsThis exploratory, qualitative study took place between January and March 2020 in the Rubaga division of Kampala, Uganda. VHTs from the slums of Kawaala and Nankulabye parishes, both located near a large government health center, were interviewed by a trained local interviewer to determine their perceptions of barriers to care-seeking and attribution for U5 childhood deaths. All interviews were audiotaped, transcribed into English, imported into NVivo V 12.0 and thematically analyzed using the Attride-Stirling framework.Results20 VHTs were interviewed, yielding two global themes, the first focusing on VHTs perceptions of their role in the community to promote positive health outcomes, and the second focusing on VHTs' perceptions of how prompt care-seeking is disincentivized. Within the latter theme, three inter-related sub-themes emerged: disincentives for care-seeking at the health system level, which can drive negative beliefs held by families about the health system, and in turn, drive incentives for alternative health behaviors, which manifest as "incentivized delays" to care-seeking.DiscussionThis study illustrates VHT perspectives on the complex interactions between health system disincentives and the attitudes and behaviors of families with a sick child, as well as the reinforcing nature of these factors. Findings suggest a need for multi-pronged approaches that sensitize community members, engage community and health system leadership, and hold providers accountable for providing high-quality care. VHTs have enormous potential to foster improvement if given adequate resources, training, and support.

Objective To observe the changes in blood pressure (BP) over 10 years and to investigate current BP association to serum uric acid (SUA) levels and cardiovascular risk factors in the epidemiological data of a target group of patients with prehypertension in 2007.Design Cross-sectional study.Setting Mlati Subdistrict, Sleman District, Yogyakarta Province, Indonesia.Participants A total of 733 patients from ‘Mlati Study Database’ in 2007 were selected by simple random sampling using statistical software. Subjects had both physical and laboratory examinations.Outcome measures Morning home BP and laboratory examination of urine (uric acid excretion and creatinine) and blood samples (SUA, blood urea nitrogen, creatinine, a lipid profile and fasting blood glucose levels).Results About 31.1% of 733 subjects with prehypertension became hypertensive after 10 years, 24.6% returned to normal tension and the rest of it remained in prehypertensive state. Mean (SD) of SUA levels in 2017 was significantly higher in men than in women (5.78 (1.25) mg/dL vs 4.52 (1.10) mg/dL, p

Elderly women experience loneliness related to unexpected situations of partner loss (husband's death). Loneliness can have an impact on subjective well-being, life satisfaction, quality of life, mental and physical health, and even death. The purpose of this study was to describe and understand experiences related to loneliness for elderly widows. The subjects involved were 6 (six) widows due to the death of their husbands (widowed), widows of more than 1 year, and no history of psychological disorders. Methods of data collection using interviews and observation. This study resulted in the conclusion that an elderly widow can experience loneliness due to the loss of a spouse who is taken away by death. Subjective well-being and perceived life satisfaction are the results of a religious coping strategy that is effective in over­coming loneliness experienced. When feelings of losing a spouse can be overcome by religious behavior, enthusiasm for survival and re-establishing social interaction, the elderly can feel well-being and life satisfaction.

Lupus cystitis is a rare complication of systemic lupus erythematosus (SLE). It is characterized by an increase in bladder wall thickness and may be associated with hydroureteronephrosis. Reports, mostly from East Asian countries, indicate that lupus cystitis usually presents with gastrointestinal tract symptoms such as diarrhea, nausea, or abdominal pain. Lower urinarytract symptoms such as dysuria, nocturia, polyuria, and suprapubic pain are also common presenting symptoms. We report a 22-year-old female patient who presented at Cipto Mangunkusumo Teaching Hospital in Indonesia, with profuse and prolonged vaginal bleeding without any other accompanying symptoms. She had a history of polyarthralgias, fever, bleeding gums, anemia, and thrombocytopenia 3 months earlier. Abdominal ultrasound examination revealed bilateral hydronephrosis and a thickened bladder wall; the other organs were normal. Laboratory examination confirmed the diagnosis of SLE complicated by lupus nephritis and lupus cystitis. The patient responded well to the treatment with methylprednisolone. The vaginal bleeding stopped within 2 days, and the laboratory parameters improved. She was discharged on oral methylprednisolone and is scheduled for detailed workup after 1 month.

This study was conducted to examine the role of emotion-focused coping as mediator of the relationship between personality traits and the level of problematic internet use. A total of 174 participants in the age range 18-29 (M = 23.1, SD = 2.7) have completed online questionnaires. The instruments used were Generalized Problematic Internet Use Scale 2 (GPIUS2), Big Five Inventory 44, and Brief COPE. The findings of this study show that emotional-focused coping did not work as a mediator in the three personality trait relationships (neuroticism, extraversion, & openness) with problematic internet use. Nevertheless, this study found that the direction of the relationship between the three variables has aligned with previous theories and findings. Allegations about the possibility of no significance are discussed. Key words: Emotional-focused coping, personality traits, problematic internet use Abstrak: Penelitian ini dilakukan untuk melihat peran mediasi coping berfokus emosi pada hubungan trait kepribadian dan tingkat penggunaan internet bermasalah. Sebanyak 174 orang partisipan dengan rentang usia 18-29 tahun (M = 23,1, SD = 2,7) telah mengisi kuesioner secara online. Terdapat tiga alat ukur untuk mengukur ketiga variabel, yakni Generalized Problematic Internet Use Scale 2 (GPIUS2), Big Five Inventory 44, dan Brief COPE. Hasil temuan dari penelitian ini menunjukkan bahwa coping berfokus emosi tidak dapat bekerja sebagai mediator dalam hubungan tiga trait kepribadian (neuroticism, extraversion, dan openness) dengan penggunaan internet bermasalah. Meskipun demikian, penelitian ini menemukan bahwa arah hubungan antara ketiga variabel telah sejalan dengan teori dan temuan sebelumnya. Dugaan mengenai kemungkinan tidak terjadi signifikansi didiskusikan.

Based on the Tredgold geometric approximation, a transparent contact stress capacity model for straight bevel gears is presented. A bevel load factor is defined which provides a kinetic link between the physical bevel gear and virtual spur gear. Three design cases of contact stress computations from different references are carried out and compared with AGMA estimates. Differences in results vary from 2.4% to 23.4% with the new model estimates, generally lower than AGMA values. The design sizing version of the new model is applied in two design cases. Comparison of the service load factor values for design sizing and design verification indicates a difference of 0.76% in case 4 and -1.65% in case 5. While more design cases are necessary for further verification of the design approach presented, it may however, be concluded from the results of our study that the design model presented appears reasonable.