Rancang Bangun Sistem Simulasi Denyut Nadi Pergelangan Tangan pada Vital Sign Simulator sebagai Media Pembelajaran Keterampilan Medik Mahasiswa Kedokteran

Salah satu kompetensi yang harus dikuasai oleh mahasiswa kedokteran/calon dokter adalah keterampilan klinik. Komponen keterampilan klinik ini meliputi pemeriksaan fisik berupa tanda vital (vital sign) dari seorang pasien. Diperlukan pelatihan keterampilan pemeriksaan tanda vital khususnya denyut nadi untuk meningkatkan kompetensi calon dokter tersebut. Oleh karena itu perlu dikembangkan simulator denyut nadi pada pergelangan tangan/artery radialis berbasis simulasi pasien berupa jaket/kaos menset yang dilengkapi “sistem pintar”. Dengan demikian mahasiswa kedokteran dapat berlatih pengukuran tanda vital dengan tetap memperhatikan etika komunikasi dan profesionalisme. Pada penelitian ini rancang bangun sistem simulasi denyut nadi dengan menggunakan mikrokontroller ATMega16 dan aktuator berupa katup solenoid serta pompa udara. Data yang ditampilkan di LCD berupa pencacah denyut nadi, set point jumlah denyut nadi, dan timer.Dari penelitian ini dihasilkan rancang bangun alat simulasi denyut nadi pada pergelangan tangan/artery radialis dengan rentang 0-180 denyut/menit dan memiliki tingkat akurasi sebesar 99,98% dari metode Palpasi dan 99,95% dari metode penggunaan sensor piezoelectric

Does switching from oral extended-release methylphenidate to the methylphenidate transdermal system affect health-related quality-of-life and medication satisfaction for children with attention-deficit/hyperactivity disorder?

Background: To evaluate health-related quality of life (HRQL) and medication satisfaction after switching from a stable dose of oral extended-release methylphenidate (ER-MPH) to methylphenidate transdermal system (MTS) via a dose-transition schedule in children with attention-deficit/hyperactivity disorder (ADHD). Methods: In a 4-week, multisite, open-label study, 171 children (164 in the intent-to-treat [ITT] population) aged 6-12 years diagnosed with ADHD abruptly switched from a stable dose of oral ER-MPH to MTS nominal dosages of 10, 15, 20, and 30 mg using a predefined dose-transition schedule. Subjects remained on the scheduled dose for the first week, after which the dose was then titrated to an optimal effect. The ADHD Impact Module-Children (AIM-C), a disease-specific validated HRQL survey instrument measuring child and family impact, was used to assess the impact of ADHD symptoms on the lives of children and their families at baseline and study endpoint. Satisfaction with MTS use was assessed via a Medication Satisfaction Survey (MSS) at study endpoint. Both the AIM-C and MSS were completed by a caregiver (parent/legally authorized representative). Tolerability was monitored by spontaneous adverse event (AE) reporting. Results: AIM-C child and family HRQL mean scores were above the median possible score at baseline and were further improved at endpoint across all MTS doses. Similar improvements were noted for behavior, missed doses, worry, and economic impact AIM-C item scores. Overall, 93.8% of caregivers indicated a high level of satisfaction with their child's use of the study medication. The majority of treatment-emergent AEs (> 98%) were mild to moderate in intensity, and the most commonly reported AEs included headache, decreased appetite, insomnia, and abdominal pain. Seven subjects discontinued the study due to intolerable AEs (n = 3) and application site reactions (n = 4). Conclusion: This study demonstrates that MTS, when carefully titrated to optimal dose, may further improve child and family HRQL, as well as behavioral, medication worry, and economic impact item scores, as measured by the AIM-C in subjects switching to MTS from a stable dose of routinely prescribed oral ER-MPH after a short treatment period. Furthermore, following the abrupt conversion from oral ER-MPH to MTS, the majority of caregivers reported being highly satisfied with MTS as a treatment option for their children with ADHD. Trial Registration: NCT0015198

The Hubble Constant

I review the current state of determinations of the Hubble constant, which gives the length scale of the Universe by relating the expansion velocity of objects to their distance. There are two broad categories of measurements. The first uses individual astrophysical objects which have some property that allows their intrinsic luminosity or size to be determined, or allows the determination of their distance by geometric means. The second category comprises the use of all-sky cosmic microwave background, or correlations between large samples of galaxies, to determine information about the geometry of the Universe and hence the Hubble constant, typically in a combination with other cosmological parameters. Many, but not all, object-based measurements give $H_0$ values of around 72-74km/s/Mpc , with typical errors of 2-3km/s/Mpc. This is in mild discrepancy with CMB-based measurements, in particular those from the Planck satellite, which give values of 67-68km/s/Mpc and typical errors of 1-2km/s/Mpc. The size of the remaining systematics indicate that accuracy rather than precision is the remaining problem in a good determination of the Hubble constant. Whether a discrepancy exists, and whether new physics is needed to resolve it, depends on details of the systematics of the object-based methods, and also on the assumptions about other cosmological parameters and which datasets are combined in the case of the all-sky methods.Comment: Extensively revised and updated since the 2007 version: accepted by Living Reviews in Relativity as a major (2014) update of LRR 10, 4, 200

Accreting Millisecond X-Ray Pulsars

Accreting Millisecond X-Ray Pulsars (AMXPs) are astrophysical laboratories without parallel in the study of extreme physics. In this chapter we review the past fifteen years of discoveries in the field. We summarize the observations of the fifteen known AMXPs, with a particular emphasis on the multi-wavelength observations that have been carried out since the discovery of the first AMXP in 1998. We review accretion torque theory, the pulse formation process, and how AMXP observations have changed our view on the interaction of plasma and magnetic fields in strong gravity. We also explain how the AMXPs have deepened our understanding of the thermonuclear burst process, in particular the phenomenon of burst oscillations. We conclude with a discussion of the open problems that remain to be addressed in the future.Comment: Review to appear in "Timing neutron stars: pulsations, oscillations and explosions", T. Belloni, M. Mendez, C.M. Zhang Eds., ASSL, Springer; [revision with literature updated, several typos removed, 1 new AMXP added

The Murchison Widefield Array Transients Survey (MWATS). A search for low-frequency variability in a bright Southern hemisphere sample

We report on a search for low-frequency radio variability in 944 bright (>4 Jy at 154 MHz) unresolved, extragalactic radio sources monitored monthly for several years with the Murchison Widefield Array. In the majority of sources, we find very low levels of variability with typical modulation indices 2.8 yr) with time-averaged modulation indices M¯¯¯¯¯=3.1−7.1M¯=3.1−7.1 per cent. With 7/15 of these variable sources having peaked spectral energy distributions, and only 5.7 per cent of the overall sample having peaked spectra, we find an increase in the prevalence of variability in this spectral class. We conclude that the variability seen in this survey is most probably a consequence of refractive interstellar scintillation and that these objects must have the majority of their flux density contained within angular diameters less than 50 milliarcsec (which we support with multiwavelength data). At 154 MHz, we demonstrate that interstellar scintillation time-scales become long (∼decades) and have low modulation indices, while synchrotron-driven variability can only produce dynamic changes on time-scales of hundreds of years, with flux density changes less than one milli-jansky (without relativistic boosting). From this work, we infer that the low-frequency extragalactic southern sky, as seen by SKA-Low, will be non-variable on time-scales shorter than 1 yr

Radio & Optical Interferometry: Basic Observing Techniques and Data Analysis

Astronomers usually need the highest angular resolution possible, but the blurring effect of diffraction imposes a fundamental limit on the image quality from any single telescope. Interferometry allows light collected at widely-separated telescopes to be combined in order to synthesize an aperture much larger than an individual telescope thereby improving angular resolution by orders of magnitude. Radio and millimeter wave astronomers depend on interferometry to achieve image quality on par with conventional visible and infrared telescopes. Interferometers at visible and infrared wavelengths extend angular resolution below the milli-arcsecond level to open up unique research areas in imaging stellar surfaces and circumstellar environments. In this chapter the basic principles of interferometry are reviewed with an emphasis on the common features for radio and optical observing. While many techniques are common to interferometers of all wavelengths, crucial differences are identified that will help new practitioners avoid unnecessary confusion and common pitfalls. Concepts essential for writing observing proposals and for planning observations are described, depending on the science wavelength, angular resolution, and field of view required. Atmospheric and ionospheric turbulence degrades the longest-baseline observations by significantly reducing the stability of interference fringes. Such instabilities represent a persistent challenge, and the basic techniques of phase-referencing and phase closure have been developed to deal with them. Synthesis imaging with large observing datasets has become a routine and straightforward process at radio observatories, but remains challenging for optical facilities. In this context the commonly-used image reconstruction algorithms CLEAN and MEM are presented. Lastly, a concise overview of current facilities is included as an appendix.Comment: 45 pages, 14 Figures; an abridged version of a chapter to appear in Volume 2 of Planets, Stars and Stellar Systems, to be published in 2011 by Springe

Competitive Tendering In The Netherlands: Central Planning Or Functional Specifications?

Institute of Transport and Logistics Studies. Faculty of Economics and Business. The University of Sydne

Global diversity and antimicrobial resistance of typhoid fever pathogens: Insights from a meta-analysis of 13,000 Salmonella Typhi genomes

Background: The Global Typhoid Genomics Consortium was established to bring together the typhoid research community to aggregate and analyse Salmonella enterica serovar Typhi (Typhi) genomic data to inform public health action. This analysis, which marks 22 years since the publication of the first Typhi genome, represents the largest Typhi genome sequence collection to date (n=13,000). Methods: This is a meta-analysis of global genotype and antimicrobial resistance (AMR) determinants extracted from previously sequenced genome data and analysed using consistent methods implemented in open analysis platforms GenoTyphi and Pathogenwatch. Results: Compared with previous global snapshots, the data highlight that genotype 4.3.1 (H58) has not spread beyond Asia and Eastern/Southern Africa; in other regions, distinct genotypes dominate and have independently evolved AMR. Data gaps remain in many parts of the world, and we show the potential of travel-associated sequences to provide informal ‘sentinel’ surveillance for such locations. The data indicate that ciprofloxacin non-susceptibility (>1 resistance determinant) is widespread across geographies and genotypes, with high-level ciprofloxacin resistance (=3 determinants) reaching 20% prevalence in South Asia. Extensively drug-resistant (XDR) typhoid has becomedominant in Pakistan (70% in 2020) but has not yet become established elsewhere. Ceftriaxone resistance has emerged in eight non-XDR genotypes, including a ciprofloxacin-resistant lineage (4.3.1.2.1) in India. Azithromycin resistance mutations were detected at low prevalence in South Asia, including in two common ciprofloxacin-resistant genotypes. Conclusions: The consortium’s aim is to encourage continued data sharing and collaboration to monitor the emergence and global spread of AMR Typhi, and to inform decision-making around the introduction of typhoid conjugate vaccines (TCVs) and other prevention and control strategies

Linking early-life NMDAR hypofunction and oxidative stress in schizophrenia pathogenesis.

Molecular, genetic and pathological evidence suggests that deficits in GABAergic parvalbumin-positive interneurons contribute to schizophrenia pathophysiology through alterations in the brain's excitation-inhibition balance that result in impaired behaviour and cognition. Although the factors that trigger these deficits are diverse, there is increasing evidence that they converge on a common pathological hub that involves NMDA receptor hypofunction and oxidative stress. These factors have been separately linked to schizophrenia pathogenesis, but evidence now suggests that they are mechanistically interdependent and contribute to a common schizophrenia-associated pathology