Pengaruh Pijat Perineum Menggunakan Minyak VCO (Virgin Coconut Oil) Terhadap Laserasi Jalan Lahir pada Persalinan Normal: The Effect of Perineal Massage Using VCO (Virgin Coconut Oil) Oil on Lacerations of the Birth Canal in Normal Childbirth

Birth canal laceration is the second cause of bleeding after uterine atony, which occurs in almost the first delivery and sometimes also in subsequent deliveries. In 2020 in the Maranggen 1 Health Center working area, there were 1013 deliveries, with 43.3% experiencing perineal lacerations. For this reason, an intervention is needed to prevent perineal lacerations, one of which is perineal massage which can increase perineal elasticity. The perineal massage can collaborate with VCO (Virgin Coconut Oil), where VCO contains variety of natural moisturizers and antioxidants that are important for skin care. In addition, it is relatively inexpensive and can be made at home. This study aims to determine the effect of perineal massage using VCO toward birth canal lacerations on mothers with normal delivery. This study used a quasi-experimental type using post-test only control group design. The study population was all pregnant women with gestational age starting at 37 weeks in the working area of the Mranggen I Health Center Demak. The sample was 60 respondents consisting of 30 control and 30 intervention groups. Meanwhile, the data was collected using observation. Data analysis consisted of univariate and bivariate analysis of the Chi-Square test technique. The results showed that perineal massage using VCO affected birth canal lacerations in normal delivery in the working area of the Mranggen 1 Health Center Demak (p-value 0.000 <0.05). Abstrak Laserasi jalan lahir merupakan penyebab keempat perdarahan setelah atonia uteri, retensio plasenta dan sisa plasenta yang terjadi pada hampir persalinan pertama dan tidak jarang juga pada persalinan berikutnya. Pada tahun 2020 di Wilayah kerja Puskesmas Maranggen 1 tercatat sejumlah 1013 persalinan dengan 43,3% diantaranya mengalami laserasi perineum. Untuk itu dibutuhkan suatu intervensi untuk mencegah laserasi perineum salah satunya adalah dengan pijat perineum yang dapat meningkatkan elastisitas perineum Pijat perineum sendiri dapat dikolaborasikan dengan minyak VCO (Virgin Coconut Oil), dimana minyak VCO banyak mengandung pelembab alami dan aktioksidan yang penting untuk perawatan kulit, selain itu harga yang relative murah dan dapat di buat sendiri dirumah. Penelitian ini bertujuan untuk mengetahui pengaruh pijat perineum menggunakan minyak VCO terhadap laserasi jalan lahir pada ibu dengan persalinan normal. Penelitian ini menggunakan jenis quasi eksperimen menggunakan desain Post-test Only Control Group Design. Populasi penelitian seluruh ibu hamil dengan usia kehamilan mulai 37 minggu di wilayah kerja Puskesmas Mranggen I Demak, sampelnya sebesar 60 responden yang terdiri dari 30 kelompok control dan 30 kelompok intervensi. Pengumpulan data menggunakan observasi. Analisis data terdiri dari analisis univariat dan bivariat teknik uji Chi Square. Hasil penelitian bahwa pijat perineum menggunakan minyak VCO berpengaruh terhadap laserasi jalan lahir pada persalinan normal di wilayah kerja Puskesmas Mranggen 1 Demak (p-value 0,000 < 0,05

PENGARUH PEER EDUCATION TERHADAP SELF EFFICACY DAN MOTIVASI PADA IBU MENYUSUI DALAM PEMBERIAN ASI

Keberhasilan ibu dalam pemberian ASI dipengaruhi beberapa faktor, diantaranya self efficacy dan motivasi ibu dalam pemberian ASI. Rendahnya motivasi dan self efficacy ibu menyusui disebabkan kurangnya pengetahuan ibu tentang menyusui, ibu mengalami kendala dalam menyusui, dan kurangnya keterpaparan informasi mengenai ASI. Upaya peningkatan self efficacy dan motivasi ibu salah satunya dapat dilakukan dengan sharing berupa peer education. Intervensi tersebut dapat meningkatkan pengetahuan dan keyakinan diri ibu sehingga self efficacy dan motivasi ibu juga meningkat. Tujuan penelitian ini adalah untuk meningkatkan self efficacy dan motivasi ibu dalam pemberian ASI. Penelitian ini menggunakan desain quasi eksperiment dengan pendeketan pre and post with control group. Sampel berjumlah 50 responden, sampel diambil dengan stratified random. Instrumen yang digunakan adalah kuesioner karakteristik responden, kuesioner BSES-SF dan kuesioner BMIMS. Analisa data menggunakan uji Wilcoxon, Paired T-Test, Independen T-test. Uji Wilcoxon didapat hasil nilai p value pada kelompok kontrol 0,850 dan kelompok intervensi didapat hasil nilai p value 0,000. Uji Paired T-test didapat hasil nilai p value pada kelompok kontrol 0,594 dan kelompok intervensi didapat hasil nilai p value 0,000. Uji Independen T-test didapatkan nilai p value 0,000 < 0,05 artinya ada pengaruh self efficacy dan motivasi ibu dalam pemberian ASI sebelum dan sesudah pemberian paket sukses menyusui antara kelompok intervensi dan kelompok kontrol. Kesimpulannya adalah terdapat pengaruh yang signifikan antara peer edukasi terhadap peningkatan self efficacy dan motivasi ibu dalam pemberian ASI. Peer edukasi dapat dijadikan salah satu solusi dalam meningkatkan self efficacy dan motivasi ibu menyusu

Collaborative care for the detection and management of depression among adults receiving antiretroviral therapy in South Africa: study protocol for the CobALT randomised controlled trial

Background: The scale-up of antiretroviral treatment (ART) programmes has seen HIV/AIDS transition to a chronic condition characterised by high rates of comorbidity with tuberculosis, non-communicable diseases (NCDs) and mental health disorders. Depression is one such disorder that is associated with higher rates of non-adherence, progression to AIDS and greater mortality. Detection and treatment of comorbid depression is critical to achieve viral load suppression in more than 90% of those on ART and is in line with the recent 90-90-90 Joint United Nations Programme on HIV/AIDS (UNAIDS) targets. The CobALT trial aims to provide evidence on the effectiveness and cost-effectiveness of scalable interventions to reduce the treatment gap posed by the growing burden of depression among adults on lifelong ART. Methods: The study design is a pragmatic, parallel group, stratified, cluster randomised trial in 40 clinics across two rural districts of the North West Province of South Africa. The unit of randomisation is the clinic, with outcomes measured among 2000 patients on ART who screen positive for depression using the Patient Health Questionnaire (PHQ-9). Control group clinics are implementing the South African Department of Health’s Integrated Clinical Services Management model, which aims to reduce fragmentation of care in the context of rising multimorbidity, and which includes training in the Primary Care 101 (PC101) guide covering communicable diseases, NCDs, women’s health and mental disorders. In intervention clinics, we supplemented this with training specifically in the mental health components of PC101 and clinical communications skills training to support nurse-led chronic care. We strengthened the referral pathways through the introduction of a clinic-based behavioural health counsellor equipped to provide manualised depression counselling (eight sessions, individual or group), as well as adherence counselling sessions (one session, individual). The co-primary patient outcomes are a reduction in PHQ-9 scores of at least 50% from baseline and viral load suppression rates measured at 6 and 12 months, respectively. Discussion: The trial will provide real-world effectiveness of case detection and collaborative care for depression including facility-based counselling on the mental and physical outcomes for people on lifelong ART in resource-constrained settings

The breakthrough listen search for intelligent life: a wideband data recorder system for the Robert C. Byrd green bank telescope

The Breakthrough Listen Initiative is undertaking a comprehensive search for radio and optical signatures from extraterrestrial civilizations. An integral component of the project is the design and implementation of wide-bandwidth data recorder and signal processing systems. The capabilities of these systems, particularly at radio frequencies, directly determine survey speed; further, given a fixed observing time and spectral coverage, they determine sensitivity as well. Here, we detail the Breakthrough Listen wide-bandwidth data recording system deployed at the 100-m aperture Robert C. Byrd Green Bank Telescope. The system digitizes up to 6 GHz of bandwidth at 8 bits for both polarizations, storing the resultant 24 GB/s of data to disk. This system is among the highest data rate baseband recording systems in use in radio astronomy. A future system expansion will double recording capacity, to achieve a total Nyquist bandwidth of 12 GHz in two polarizations. In this paper, we present details of the system architecture, along with salient configuration and disk-write optimizations used to achieve high-throughput data capture on commodity compute servers and consumer-class hard disk drives

Manganese and cobalt redox cycling in laterites; Biogeochemical and bioprocessing implications

This research was developed during the PhD studies of Agustín Solano Arguedas in the University of Manchester, United Kingdom. PhD scholarship was funded by the Ministerio de Ciencia, Tecnología y Telecomunicaciones (MICITT) of the Government of Costa Rica and the Universidad de Costa Rica (UCR). Agustín Solano Arguedas is a researcher at the Unidad de Recursos Forestales (Reforesta, Unit of Forest Resources) of the Instituto de Investigaciones en Ingeniería (INII, Engineering Research Institute), UCR.Cobalt is essential for the modern technology that underpins the decarbonisation of our economies, but its supply is limited leading to its designation as a critical metal. Cobalt biogeochemistry is poorly understood, yet knowledge of how biogeochemical cycling impacts cobalt behaviour could assist the development of new techniques to recover cobalt from ores, and so improve the security of supply. Laterites are an important source of cobalt, they are primarily processed for nickel using energy or chemical intensive processes, with cobalt recovered as a by-product. Metal-reducing conditions were stimulated in laterite sediment microcosms by the addition of simple and cheaply available organic substrates (acetate or glucose). At the end of the experiment the amount of easily recoverable cobalt (aqueous or extractable with acetic acid) increased from < 1% to up to 64%, which closely mirrored the behaviour of manganese, while only a small proportion of iron was transformed into an easily recoverable phase. Sequencing of the microbial community showed that the addition of organic substrates stimulated the growth of indigenous prokaryotes closely related to known manganese(IV)/iron(III)-reducers, particularly from the Clostridiales, and that fungi assigned to Penicillium, known to produce organic acids beneficial for leaching cobalt and nickel from laterites, were identified. Overall, the results indicate that the environmental behaviour of cobalt in laterites is likely to be controlled by manganese biogeochemical cycling by microorganisms. These results are compelling given that similar behaviour was observed in four laterites (Acoje, Çaldağ, Piauí and Shevchenko) from different continents. A new bioprocessing strategy is proposed whereby laterites are treated with an organic substrate to generate metal-reducing conditions, then rinsed with acetic acid to remove the cobalt. Not only are organic substrates environmentally-friendly and potentially sourced from waste carbon substrates, a minimal amount of iron oxides was mobilised and consequently less waste generated.Natural Environment Research Council/[CoG3 NE/M011518/1]/NERC/Reino UnidoDiamond Light Source/[SP16735]//Reino UnidoDiamond Light Source/[SP17313]//Reino UnidoOffice of Science User Facility/[DE-AC02-05CH11231]//Estados UnidosUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ingeniería::Instituto Investigaciones en Ingeniería (INII

Serological response and breakthrough infection after COVID-19 vaccination in patients with cirrhosis and post-liver transplant

BACKGROUND: Vaccine hesitancy and lack of access remain major issues in disseminating COVID-19 vaccination to liver patients globally. Factors predicting poor response to vaccination and risk of breakthrough infection are important data to target booster vaccine programs. The primary aim of the current study was to measure humoral responses to 2 doses of COVID-19 vaccine. Secondary aims included the determination of factors predicting breakthrough infection. METHODS: COVID-19 vaccination and Biomarkers in cirrhosis And post-Liver Transplantation is a prospective, multicenter, observational case-control study. Participants were recruited at 4-10 weeks following first and second vaccine doses in cirrhosis [n = 325; 94% messenger RNA (mRNA) and 6% viral vaccine], autoimmune liver disease (AILD) (n = 120; 77% mRNA and 23% viral vaccine), post-liver transplant (LT) (n = 146; 96% mRNA and 3% viral vaccine), and healthy controls (n = 51; 72% mRNA, 24% viral and 4% heterologous combination). Serological end points were measured, and data regarding breakthrough SARS-CoV-2 infection were collected. RESULTS: After adjusting by age, sex, and time of sample collection, anti-Spike IgG levels were the lowest in post-LT patients compared to cirrhosis (p < 0.0001), AILD (p < 0.0001), and control (p = 0.002). Factors predicting reduced responses included older age, Child-Turcotte-Pugh B/C, and elevated IL-6 in cirrhosis; non-mRNA vaccine in AILD; and coronary artery disease, use of mycophenolate and dysregulated B-call activating factor, and lymphotoxin-α levels in LT. Incident infection occurred in 6.6%, 10.6%, 7.4%, and 15.6% of cirrhosis, AILD, post-LT, and control, respectively. The only independent factor predicting infection in cirrhosis was low albumin level. CONCLUSIONS: LT patients present the lowest response to the SARS-CoV-2 vaccine. In cirrhosis, the reduced response is associated with older age, stage of liver disease and systemic inflammation, and breakthrough infection with low albumin level

Modelling of the effect of ELMs on fuel retention at the bulk W divertor of JET

Effect of ELMs on fuel retention at the bulk W target of JET ITER-Like Wall was studied with multi-scale calculations. Plasma input parameters were taken from ELMy H-mode plasma experiment. The energetic intra-ELM fuel particles get implanted and create near-surface defects up to depths of few tens of nm, which act as the main fuel trapping sites during ELMs. Clustering of implantation-induced vacancies were found to take place. The incoming flux of inter-ELM plasma particles increases the different filling levels of trapped fuel in defects. The temperature increase of the W target during the pulse increases the fuel detrapping rate. The inter-ELM fuel particle flux refills the partially emptied trapping sites and fills new sites. This leads to a competing effect on the retention and release rates of the implanted particles. At high temperatures the main retention appeared in larger vacancy clusters due to increased clustering rate

Impact of fast ions on density peaking in JET: fluid and gyrokinetic modeling

The effect of fast ions on turbulent particle transport, driven by ion temperature gradient (ITG)/ trapped electron mode turbulence, is studied. Two neutral beam injection (NBI) heated JET discharges in different regimes are analyzed at the radial position ρ$_{t}$=0.6, one of them an L-mode and the other one an H-mode discharge. Results obtained from the computationally efficient fluid model EDWM and the gyro-fluid model TGLF are compared to linear and nonlinear gyrokinetic GENE simulations as well as the experimentally obtained density peaking. In these models, the fast ions are treated as a dynamic species with a Maxwellian background distribution. The dependence of the zero particle flux density gradient (peaking factor) on fast ion density, temperature and corresponding gradients, is investigated. The simulations show that the inclusion of a fast ion species has a stabilizing influence on the ITG mode and reduces the peaking of the main ion and electron density profiles in the absence of sources. The models mostly reproduce the experimentally obtained density peaking for the L-mode discharge whereas the H-mode density peaking is significantly underpredicted, indicating the importance of the NBI particle source for the H-mode density profile