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Ramadan fasting is associated with changes in eating, physical activity, sleeping patterns, and medication. Unfortunately, only limited studies examine glucose variability in subjects with type 2 diabetes who fast in Ramadan. Our study aims to evaluate glucose variability in subjects with type 2 diabetes on oral antidiabetic agents using continuous glucose monitoring system (CGMS) during and after Ramadan fasting. This observational study was done in The Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia, which recruited 10 subjects with type 2 diabetes who underwent Ramadan fasting in 2019. These subjects were free from cardiovascular disease, kidney disease, severe liver disease, chronic gastrointestinal disease and autoimmune disease. Insertion of CGMS for measuring interstitial glucose was performed after at least 2 weeks of Ramadan fasting and 4 weeks after the end of the Ramadan fasting, with a minimum of 3 days observation. The mean amplitude of glycemic excursion (MAGE) during and after Ramadan were similar (p = 0.94). In line with this, the average interstitial glucose (p = 0.48), the maximum interstitial glucose (p = 0.35), the minimum interstitial glucose (p = 0.24), and the duration of hypoglycemia (p = 0.25) were also similar in both periods. Overall, nutritional intake and energy expenditure during both periods were comparable. Ramadan fasting is not associated with increased glucose variability in subjects with type 2 diabetes. Thus, Ramadan fasting is safe in subjects with type 2 diabetes with no complications.

Abstract Background This study presents a 4-year (January 2019–April 2023) X-band radar network-based bow echo observation over Great Bandung Indonesia. This study provides insight into the temporal and spatial variability of bow echo distribution and presents the atmospheric condition associated with the bow echo events. Temporal analysis is categorical into monthly, seasonally, and diurnal. The analysis was performed using X-band radar network and reanalysis data (ERA5). Result At least 26 bow echoes were identified across the Bandung basin from X-band radar network during the study period. From this total number of bow echoes, the observation of initiation modes is primarily generated from a weakly organized cell, with few coming from the squall line. The bow echo mostly evolved from noon until afternoon. The rainy season (December–January–February) and transition season (March–April–May) is the most frequent period of bow echo occurrence, with March being the most active month. Nevertheless, this study also found bow echo occurrence in the dry season (June–July–August). For the spatial analysis, the studied area is divided into two regions representing the eastern and western part of Bandung basin. The eastern region recorded the most intense occurrences with 14 events. The movement of bow echo in this region covered a shorter distance (average distance only 4.56 km), with all initiation modes occurring inside the region. The atmospheric condition within this region has less moisture flux, with higher CAPE and slightly higher surface temperature. Meanwhile, in the western region have different characteristics with higher moisture flux, a slight effect of CAPE and CINH, with longer distance and zonal movement direction of bow echo displacement. Conclusion These conditions indicate that local convection is the dominant mode of bow echo initiation mode in the eastern region of Bandung basin. Meanwhile, the monsoon effect influences the bow echo initiation mode in the western region. Given that the observed 4-year bow echo has different characteristics from previous studies of bow echo in mid latitudes, developing different criteria for bow echo detection in the tropics is crucial.

Abstract Background Primary care provides an important context to engage adolescents and their families in healthy lifestyles with the goal of reducing future behaviour-related health problems. Developing a valid tool to assess health professionals’ skills in behavioural change counselling is integral to improving the quality of clinical care provided to adolescents in Indonesia. Methods This work was nested within a project to develop a training program to enhance the behaviour-change counselling of adolescents and their parents by Indonesian primary care professionals. Initial item development was based on the content of the training module and the domain structure of the Behavioral Change Counselling Index (BECCI), a commonly used tool to assess counselling quality in healthcare settings. Expert panels were used to test content validity, while face validity was assessed by a group of trained psychologists. Inter-rater agreement was calculated prior to tests of construct validity and reliability, which involved psychologists rating 125 audio-taped counselling sessions between the health professional and adolescent patients, together with a parent. Results An initial 13-item tool was developed using a 1–5 Likert scale. Validity and reliability testing resulted in the decision to use a 14-item tool with a 0–3 Likert scale. The scale was found to have a Cronbach’s α coefficient of 0.839 (internal consistency), and there was strong inter-rater agreement (0.931). Conclusion The assessment tool known as the Adolescent Behavioural Change Counselling Assessment Tool, is a valid and reliable instrument to measure Indonesian health professionals’ behavioural-change counselling skills with adolescent patients. The tool provides an evaluation framework for future interventions that aim to improve health professionals’ skills in addressing adolescent behaviour-related health problems.

Abstract Background Obesity and its related cardiovascular-metabolic diseases are growing public health concerns. Despite global attention to obesity, its prevalence is steeply increasing in developing countries, especially in children and adolescents. Eating behaviours and physical activity are modifiable risk factors for obesity that can variably be shaped by families. Eating behaviours and physical activity are especially important during adolescence, given its significance as a foundational period for developing healthy lifestyles. This qualitative study aimed to explore barriers and opportunities around creating healthy lifestyles among adolescents in Indonesia, focussing on family environments from diverse socio-demographic backgrounds. Method In-depth interviews using a semi-structured guide were undertaken with consecutively recruited 10–18-year-old adolescents with overweight or obesity, and their parents, from three different sites: urban (Jakarta, the capital city of Indonesia), peri-urban (West Java Province) and rural (Banten Province). Thematic analysis was used to identify patterns of meaning. Results Nineteen dyads were interviewed. Thematic analysis revealed four themes: limited knowledge of healthy lifestyles; healthy lifestyles not a concern of daily life; limited parenting skills, including inequity around gender roles; and aspects of availability and accessibility. These interconnected barriers influenced lifestyle practices at home within the context of daily preferences and decisions around food and activities. Gender role inequity and healthy food accessibility were more prominent in rural families than in those from urban or peri-urban settings. Conclusions Healthy lifestyles in adolescence may be supported by strategies to enhance parenting skills, build individual motivation, and support the development of more enabling environments.

Based on the 10 years of planning, organizing, and implementing the project "International Street Art Festival Timisoara", this work is the preparation of the integration of textile arts in the academic and institutional coordinated use of the same for the urban regeneration projects through Street Art in Romania. There is a brief presentation of the concept used and the relationship between the different means of contemporary artistic expression means and the public space. Thus, the first part briefly describes the art that occupies the city with all the forms of visual expression currently used, which are implemented in the public space: from graffiti and street art to various installations and objects. Art in the public space involves a much wider audience than the art exhibited in galleries and is more prone to criticism, because it is directly intertwined with everyday life. We are all the public of this art in the urban environment, whether we like it or not. Following the main theme "Textile art - a new paradigm in public space" in the second part we will refer to four artists with different styles that shape the city with all its specific components. Their works are distinguished by strength, shape, size, color, political, or social importance. In the final part of the article, a pilot project for the use of textile art is proposed in the context of a major work of Street Art existing in Timisoara and known as "Undertown Street Art Gallery".

It has been analyzed impact of forest fire on the air quality using PM10 parameter and visibility during 2000 – 2014 in Palangka Raya, Central Kalimantan province. Palangka Raya is an affected forest fire area with a monsoonal rainfall type which has one peak of the rainy season in January and one peak of the dry season in August. Drought condition has an impact on rising forest fire intensity causes increasing of PM10 concentration and decresing of visibility in July to November moreover when there is an El Niño phenomenon. The result of PM10 analysis shows that the air quality index in Palangka Raya during December - June is in a good level category and still below the ambient air quality standard with an average concentration of 19 µg/m3. The impact of forest fire on declining air quality due to increasing of PM10 concentration occurred in July – November with an average concentration rising of 129 µg/m3. The El Niño phenomenon rises the PM10 concentration due to increasing of forest fires, but the increasing of PM10 is not comparable to the strength of El Niño, because of combustion condition and and human activities that play a role in forest fires. The worst impact of El Niño occurred in 2002, although the El Niño strength was only moderate, which is a half the time from July to November Palangka Raya covered air quality with dangerous levels with PM10 concentrations of more than µg/m3. A high PM10 concentration environment reduces the visibility significantly, which is visibility in the no fire condition about 8 km, but when the huge forest fire the visibility drops to 0.1 km.

IntroductionNewly graduated medical doctors in their internships are positioned to strengthen the front line in combating COVID-19. We developed a Massive Open Online Course (MOOC) to equip them with adequate knowledge for COVID-19 management. This paper aims to analyze the MOOC and evaluate participant satisfaction and increase in knowledge after completing the course.MethodsAn observational study was conducted. Quantitative data were obtained from questionnaires and pre- and post-tests. Responses to open-ended questions of the questionnaires were collected. Analysis using the Quality Reference Framework was also completed.ResultsThe MOOC consisted of fundamental knowledge of COVID-19 (Part A) and further enrichment (Part B), and the content was written in the Indonesian language. A total of 3,424 and 2,462 participants completed the course in August and November 2020, respectively. Most participants agreed that the platform was easy to navigate, the design was interesting, and the content was aligned with their needs. Pre- and post-test scores in Part A's subjects increased significantly. Factors contributing to and inhibiting usability and areas for improvement were further highlighted.DiscussionThe use of a specific quality framework facilitated a comprehensive evaluation of the MOOC's strengths, weaknesses, and areas for future improvements. The participants' satisfaction and pre- and post-test results showed that the current MOOC holds great potential benefit for continuing education for medical interns joining the frontliners during the pandemic. Future implementation should consider increasing the quality of learning resources, scaling up the platform and its technical supports, and enhancing organizational supports.

Abstract Background Fostering personal identity formation and professional development among undergraduate medical students is challenging. Based on situated learning, experiential learning and role-modelling frameworks, a six-week course was developed to remediate lapses in professionalism among undergraduate medical students. This study aims to explore the students’ perceptions of their personal identity formation and professional development following completion of the course. Methods This qualitative study, adopting a phenomenological design, uses the participants’ reflective diaries as primary data sources. In the pilot course, field work, role-model shadowing and discussions with resource personnel were conducted. A total of 14 students were asked to provide written self-reflections. Consistent, multi-source feedback was provided throughout the course. A thematic analysis was conducted to identify the key processes of personal and professional development among the students during remediation. Results Three main themes were revealed. First, students highlighted the strength of small group activities in helping them ‘internalise the essential concepts’. Second, the role-model shadowing supported their understanding of ‘what kind of medical doctors they would become’. Third, the field work allowed them to identify ‘what the “noble values” are and how to implement them in daily practice’. Conclusion By implementing multimodal activities, the course has high potential in supporting personal identity formation and professional development among undergraduate pre-clinical medical students, as well as remediating their lapses in professionalism. However, there are challenges in implementing the model among a larger student population and in documenting the long-term impact of the course.

Background: Excessive inspiratory effort could translate into self-inflicted lung injury, thus worsening clinical outcomes of spontaneously breathing patients with acute respiratory failure (ARF). Although esophageal manometry is a reliable method to estimate the magnitude of inspiratory effort, procedural issues significantly limit its use in daily clinical practice. The aim of this study is to describe the correlation between esophageal pressure swings (ΔP es ) and nasal (ΔP nos ) as a potential measure of inspiratory effort in spontaneously breathing patients with de novo ARF., Methods: From January 1, 2021, to September 1, 2021, 61 consecutive patients with ARF (83.6% related to COVID-19) admitted to the Respiratory Intensive Care Unit (RICU) of the University Hospital of Modena (Italy) and candidate to escalation of non-invasive respiratory support (NRS) were enrolled. Clinical features and tidal changes in esophageal and nasal pressure were recorded on admission and 24 h after starting NRS. Correlation between ΔP es and ΔP nos served as primary outcome. The effect of ΔP nos measurements on respiratory rate and ΔP es was also assessed., Results: ΔP es and ΔP nos were strongly correlated at admission (R 2  = 0.88, p < 0.001) and 24 h apart (R 2  = 0.94, p < 0.001). The nasal plug insertion and the mouth closure required for ΔP nos measurement did not result in significant change of respiratory rate and ΔP es . The correlation between measures at 24 h remained significant even after splitting the study population according to the type of NRS (high-flow nasal cannulas [R 2  = 0.79, p < 0.001] or non-invasive ventilation [R 2  = 0.95, p < 0.001])., Conclusions: In a cohort of patients with ARF, nasal pressure swings did not alter respiratory mechanics in the short term and were highly correlated with esophageal pressure swings during spontaneous tidal breathing. ΔP nos might warrant further investigation as a measure of inspiratory effort in patients with ARF., Trial Registration: NCT03826797 . Registered October 2016., (© 2022. The Author(s).)

Background: It is well known that benign tracheal stenosis represents an obstacle to open surgery, and that its treatment could be challenging. Two endoscopic techniques have so far been adopted to restore tracheal patency: balloon dilatation (BA) through laryngoscopy, and tracheal stenting (ST) with rigid bronchoscopy. The main objective of this study was to compare the efficacy of BA and ST to treat benign tracheal stenosis not eligible for surgery. We also compared the rate of adverse events in the two treatment groups., Methods: A retrospective, observational cohort study was carried out at the University Hospital of Modena (Italy) from November 2012 to November 2017 in two separate departments. Patients were considered to be "stabilized" (primary outcome) if they did not report significant respiratory symptoms, or restenosis in the long-term (2 years) following the endoscopic procedure., Results: Sixty-six patients were included in the study (33 in the BA and 33 in the ST group, respectively). Unadjusted Kaplan-Meier estimates showed a greater therapeutic effect of ST compared to BA at 2 years (hazard ratio = 3.9 95%CI [1.5-9.8], p  = .01). After adjusting for confounders, stratified analyses showed that this effect was significant in patients with complex stenosis, idiopathic etiology, and degree of stenosis >70%. Compared with BA, ST showed a higher rate of adverse events ( p  = .01)., Conclusions: Compared to BA, ST seems to be more effective in achieving stabilization of tracheal patency in complex benign tracheal stenosis, although burdened with a significantly higher number of adverse effects. These findings warrant future prospective study for confirmation. Level of evidence: 3., Competing Interests: The authors have no conflicts of interest to declare., (© 2022 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)

Objectives: To evaluate the effects of repeated cerebrospinal fluid (CSF) tap procedures in idiopathic normal pressure hydrocephalus (iNPH) patients ineligible for surgical treatment., Design: Prospective, monocentric, pilot study., Setting: University hospital., Participants: Thirty-nine patients aged 75 years and older, ineligible for shunting surgical intervention., Intervention: Repeated CSF taps., Measurements: All patients underwent a comprehensive geriatric assessment before and after each CSF tap. Adverse events were recorded., Results: No major side effect was reported. Eleven patients showed no response to the first CSF tap test and were excluded. In the remaining 28 patients, all physical and cognitive functions improved after the drainage procedures, except for continence (which seemed poorly influenced). According to clinical judgment, the mean time frame of benefit between CSF taps was 7 months. Patients withdrawing from the protocol during the clinical follow-up showed a worsening of functional and cognitive performances after the interruption., Conclusions/implications: Periodic CSF therapeutic taps are safe, allow a better control of iNPH symptoms, and prevent functional decline in geriatric patients., (Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. All rights reserved.)

Idiopathic normal-pressure hydrocephalus (iNPH) is a neurological disease that usually develops in the elderly. Natural history of iNPH is still unknown. It has been hypothesized that cerebrovascular diseases could have a role in etiology of chronic hydrocephalus and studies show an increased prevalence of cardiovascular diseases in iNPH patients. Moreover, evidences show a possible alteration of immune system in iNPH patients. Adenosine (Ado) is a metabolite produced in response to metabolic stress and injury. Adenosine and its receptors play an important role in vascular protection and in the modulation of inflammatory reactions and neuroinflammation. Our aim is to evaluate gene and protein expression of A1R and A2AR in the peripheral blood mononuclear cells (PBMCs) from iNPH patients compared to control subjects. We investigate if Ado system, that plays an important role in central nervous system, in vascular system, and also in inflammation, is involved in pathophysiology of iNPH disease. Our analysis showed that A1R mRNA levels and A1R density in PBMCs from iNPH patients were significantly lower than CT subjects (0.84 ± 0.12 and 2.42 ± 0.42, p<0.001 and 0.31 ± 0.02 and 0.42 ± 0.04, p=0.043; respectively). About A2AR, the gene expression in PBMCs was significantly lower in iNPH than CT (0.65 ± 0.09 and 1.5 ± 0.14, p<0.001) as well as there was a trend in protein expression: iNPH and CT (0.51 ± 0.05 and 0.62 ± 0.03; p=0.172). This preliminary study underlines the involvement of Ado system in iNPH disease whose pathophysiology is still unclear., (Copyright © 2016 Elsevier B.V. All rights reserved.)