Best Second Oral Agent to Metformin to Manage Type 2 Diabetes

Diabetes is a major health concern in the United States with many long-term complications, such as heart disease, stroke, kidney failure, blindness, and amputation. According to the Center for Disease Control, as of 2020, 34.1 million of US adult had diabetes and 88 million were prediabetic. Due to the severe complications, it is important to manage diabetes with lifestyle changes and pharmacotherapies. Many oral agents such as metformin, sodium glucose transporter 2 inhibitors (SGLT2i), and sulfonylureas are used in the management of type II diabetes. Metformin is typically the first line pharmacotherapy. However, when metformin alone is not enough to adequately control hyperglycemia, combination therapy is recommended. The goal of this literature review is to investigate differences in safety and efficacy when using monotherapies (metformin, SGLT2i, sulfonylureas) and combination therapy (metformin- SGLT2i versus metformin-sulfonylureas) in management of type II diabetes. A comprehensive literature review was done using different electronic databases such as Pub-Med, Clinical Key, Cochrane Library, access medicine, CINAHL Complete and Dynamed Plus. Review of the literature showed each monotherapy reduces A1c to some extent. SGLT2i users had better cardio-protectiveness than sulfonylureas. The use of metformin-SGLT2i has significantly greater reduction in hemoglobin A1c (HbA1c), and body weight compared to metformin-sulfonylureas. However, sulfonylureas are more widely used because they are cheaper and well-studied. Studies also stated that sulfonylurea cause more hypoglycemic episodes compared to metformin or SGLT2 inhibitors

The applicability of the Neale Analysis of Reading Ability-second revised British edition (NARA II) in the South African context.

Psychological tests are closely tied to the context in which they were designed. Within the South African context, the inequalities of apartheid played a major role in test development and use, and it relies on various international tests that may not be suitable to the context and on local tests that may not include all linguistic groups. There is a need for psychological tests that are in use to be reliable, valid and free from bias. Thus, this research examined the applicability of the Neale Analysis of Reading Ability-Second Revised British Edition (NARA II) in the South African context. Aspects of reliability, validity and bias were examined. A non-probability sample of 144 Grade Four first and second language learners attending one of four government schools in Gauteng were assessed on the NARA II. A non-probability sample of eight professionals (two teachers, one psychometrist, two educational psychologists, two speech therapists and one reading therapist and trainer) were interviewed for their views on the applicability of the NARA II. The research followed a mixed methods approach, namely a sequential explanatory strategy. The results demonstrated adequate internal consistency reliability, although this was lower than in the normative sample and other studies. Face validity and concurrent validity were adequate. The content validity of the NARA II was questionable within the South African context, suggesting it should be adapted for use in this country. Some evidence of bias based on gender, home language, population group, educational level of parents and the school learners attended was found. The qualitative data supported findings from the quantitative data. A thematic content analysis identified nine themes namely Suitability of the NARA II to the South African context, Similarities between the NARA II and reading tasks in school, Differences between the NARA II and reading tasks in school, Comprehension skills, Assessment tools utilised for reading in South Africa, Learner errors on reading, Foundations of reading, Benefits and Affordability. The overall conclusion is that adaptation of the NARA II and norming on the South African population be undertaken

The evaluation of different strategies to improve the diagnosis of tuberculosis in people living with HIV in resource-limited settings

Background The 2019 WHO screening and diagnostic algorithm for tuberculosis in people living with HIV (PLHIV) has 2 components: the WHO Xpert MTB/RIF (Xpert) algorithm and WHO Alere Determine TB-LAM (AlereLAM) algorithm. According to the WHO Xpert algorithm, WHO recommends that PLHIV be routinely screened for tuberculosis with the WHO foursymptom screen (W4SS; comprising any one of current cough, fever, night sweats, or weight loss) and, if the screen is positive, receive Xpert or Xpert MTB/RIF Ultra (Xpert Ultra) confirmatory testing. According to the WHO AlereLAM algorithm, WHO also recommends that PLHIV be routinely screened for tuberculosis using screening criteria and, if the screen is positive, receive urine lateral-flow lipoarabinomannan (LF-LAM) confirmatory testing with AlereLAM. We aimed: i. To determine the diagnostic accuracy of the W4SS and alternative screening tools and strategies in ambulatory PLHIV, including key subgroups, and to compare the diagnostic accuracy of the WHO Xpert algorithm with Xpert confirmatory testing for all ambulatory PLHIV ii. To determine the performance of the W4SS and alternative screening tools and strategies in HIV-positive inpatients and to compare the diagnostic accuracy of the WHO Xpert algorithm with Xpert confirmatory testing for all HIV-positive inpatients iii. To determine the performance of WHO screening criteria and alternative screening tools and strategies to guide LF-LAM testing in HIV-positive inpatients and to compare the performance of the WHO AlereLAM algorithm with AlereLAM and Fujifilm SILVAMP TB-LAM (FujiLAM; a novel LF-LAM test) confirmatory testing in all HIV-positive inpatients. iv. To develop and validate novel clinical prediction models (CPMs) for tuberculosis screening in outpatient PLHIV and to determine the clinical utility of these CPMs and WHO-recommended screening tools Methods We conducted a systematic review and individual participant data (IPD) meta-analysis. We updated a search of PubMed (MEDLINE), Embase, Cochrane Library, and conference 2 abstracts for publications from Jan 1, 2011, to March 12, 2018, done in a previous systematic review to include the period up to August 2, 2019 (objectives i and iv) and March 1, 2020 (objectives ii and iii). We also screened reference lists of identified pieces and contacted experts in the field. We included prospective cross-sectional studies, observational studies, and randomized trials that enrolled adult and adolescent (age ≥10 years) PLHIV irrespective of symptoms and signs of tuberculosis. We also included studies that enrolled outpatient PLHIV with a positive W4SS (objective iv only). We extracted study-level data using a standardized data extraction form, and we requested IPD from study authors. The reference standards were culture (objectives i, ii, and iv) and culture or Xpert (objective iii). For screening tools and strategies, we also used separate reference standards of Xpert (objective i and ii), AlereLAM (objective iii), and FujiLAM (objective iii). We selected these confirmatory tests as reference standards since these tests are the most likely confirmatory tests used in practice. We obtained pooled proportion estimates with a random-effects model, assessed diagnostic accuracy (i.e., sensitivity and specificity) by fitting random-effects bivariate models, and assessed diagnostic yield (i.e., proportion of total tuberculosis cases with a positive confirmatory test) descriptively. For CPMs, we first used logistic regression, allowing for non-linear relations, to develop an extended CPM (using backwards selection of C-reactive protein [CRP] and other predictors) and a CRP-only CPM (which only included CRP along with spline transformations); we then used internal-external cross-validation to evaluate discrimination, calibration, and clinical utility (i.e., decision curve analysis) of both CPMs and other screening strategies. Decision curve analysis plots net benefit across a range of risk thresholds. This systematic review has been registered with PROSPERO, CRD42020155895. Results i. We obtained data for 22 of 25 studies (n= 15,666 participants; 4,347 on antiretroviral therapy [ART]). W4SS sensitivity was 82% (95% CI 72, 89) and specificity was 42% (29, 57). CRP (≥10 mg/L) had similar sensitivity (77% [61, 88]), but higher specificity (74% [61, 83]; n=3571). Cough (lasting ≥2 weeks), haemoglobin (< 8 g/dL), body mass index (<18.5kg/m²), and lymphadenopathy had high specificities (80–90%) but low sensitivities (29–43%). The WHO Xpert algorithm had a sensitivity of only 58% (50,66) and a specificity of 99% (98, 100); Xpert for all had a sensitivity of 68% (57–76) and similar specificity. In the only study that compared both tests, the sensitivity of sputum Xpert Ultra was higher than sputum Xpert (73% [62, 81] vs 57% [47, 67]) and specificities were similar. Among outpatients on ART, W4SS sensitivity was 53% (35, 71) and specificity was 71% (51, 85). In this population, a parallel strategy (two or more screening tests offered at the same time) of W4SS with any chest X-ray abnormality had higher sensitivity (89% [70, 97]) and lower specificity (33% [17, 54]; n=2,670) than W4SS alone; at a 5% tuberculosis prevalence, this strategy would require 379 more Xpert tests per 1,000 PLHIV than W4SS but detect 18 more cases. Among outpatients not on ART, W4SS sensitivity was 85% (76, 91) and specificity was 37% (25, 51). CRP (≥10 mg/L) had a similar sensitivity (83% [79, 86]), but higher specificity (67% [60, 73]; n=3,187) and a sequential strategy (second screening test offered only if first screening test is positive) of W4SS then CRP (≥5 mg/L) also had similar sensitivity (84% [75, 90]) but higher specificity (64% [57, 71]; n=3187); at 10% tuberculosis prevalence, these CRP-based strategies would require 272 and 244 fewer Xpert tests per 1,000 PLHIV than W4SS but miss two and one more cases, respectively. ii. We obtained data for all six eligible studies (n=3,660 participants). The pooled proportion of inpatients eligible for Xpert was 90% (89, 91; n=3,658). Among screening tools to guide Xpert testing, W4SS and CRP (≥5 mg/L) had highest sensitivities (≥96%) but low specificities (≤12%); cough (≥2 weeks), haemoglobin (< 8 g/dL), body mass index (sensitivity of sputum Xpert Ultra was higher than sputum Xpert (73% [62, 81] vs 57% [47, 67]) and specificities were similar. Among outpatients on ART, W4SS sensitivity was 53% (35, 71) and specificity was 71% (51, 85). In this population, a parallel strategy (two or more screening tests offered at the same time) of W4SS with any chest X-ray abnormality had higher sensitivity (89% [70, 97]) and lower specificity (33% [17, 54]; n=2,670) than W4SS alone; at a 5% tuberculosis prevalence, this strategy would require 379 more Xpert tests per 1,000 PLHIV than W4SS but detect 18 more cases. Among outpatients not on ART, W4SS sensitivity was 85% (76, 91) and specificity was 37% (25, 51). CRP (≥10 mg/L) had a similar sensitivity (83% [79, 86]), but higher specificity (67% [60, 73]; n=3,187) and a sequential strategy (second screening test offered only if first screening test is positive) of W4SS then CRP (≥5 mg/L) also had similar sensitivity (84% [75, 90]) but higher specificity (64% [57, 71]; n=3187); at 10% tuberculosis prevalence, these CRP-based strategies would require 272 and 244 fewer Xpert tests per 1,000 PLHIV than W4SS but miss two and one more cases, respectively. ii. We obtained data for all six eligible studies (n=3,660 participants). The pooled proportion of inpatients eligible for Xpert was 90% (89, 91; n=3,658). Among screening tools to guide Xpert testing, W4SS and CRP (≥5 mg/L) had highest sensitivities (≥96%) but low specificities (≤12%); cough (≥2 weeks), haemoglobin (< 8 g/dL), body mass index (<18.5 kg/m²) and lymphadenopathy had higher specificities (61–90%) but low sensitivities (12–57%). The WHO Xpert algorithm had sensitivity of 76% (67, 84) and specificity of 93% (88, 96; n=637). Xpert for all had similar accuracy to the WHO Xpert algorithm: sensitivity was 78% (69, 85) and specificity was 93% (87, 96; n=639). We obtained data from all 5 identified studies (n=3,504). The pooled proportion of inpatients eligible for AlereLAM testing using WHO criteria was 93% (91, 95). Among screening tools to guide LF-LAM testing, WHO criteria, CRP (≥5 mg/L), and CD4 count (< 8 g/dL), body mass index (<18.5 kg/m2) lymphadenopathy, and WHO-defined danger signs had higher specificities but suboptimal sensitivities. AlereLAM for all had the same sensitivity (62% [47, 75]) and specificity (88% [64, 97]) as WHO AlereLAM algorithm. Sensitivities of FujiLAM and AlereLAM were 69% and 48%, while specificities were 88% and 96%, respectively. In 2 studies that 4 collected sputum and non-sputum samples for Xpert and/or culture, diagnostic yield of sputum Xpert was 40–41%, AlereLAM was 39–76%, and urine Xpert was 35– 62%. In one study, FujiLAM diagnosed 80% of tuberculosis cases (vs 39% for AlereLAM), and sputum Xpert combined with AlereLAM, urine Xpert, or FujiLAM diagnosed 61%, 81%, and 92% of all cases, respectively. Conclusion These findings informed the updated 2021 WHO guidelines on tuberculosis screening in PLHIV. Among outpatient PLHIV, the WHO-recommended W4SS has suboptimal diagnostic accuracy and clinical utility. CRP reduces the need for further Xpert confirmatory testing compared with W4SS without compromising sensitivity and has been included in the updated WHO tuberculosis screening guidelines. CRP also shows utility when used in a CPM. However, CRP data were scarce for outpatients on ART, necessitating future research on the accuracy of CRP in this subgroup. Chest X-ray can be useful in outpatients on ART when combined with W4SS. The WHO Xpert algorithm has suboptimal sensitivity; Xpert for all offers slight sensitivity gains and may be considered if resources permit. Among HIV-positive inpatients, WHO screening criteria and other potential screening tools to guide Xpert and AlereLAM testing have suboptimal performance. Based on these findings, WHO now strongly recommends Xpert testing in all medical HIV-positive inpatients in settings where tuberculosis prevalence is higher than 10%. The findings in this thesis also support that AlereLAM testing be implemented in all HIV-positive medical inpatients. 5 Routine FujiLAM testing in all HIV-positive medical inpatients may substantially improve tuberculosis diagnosis, but prospective evaluation of this novel assay is required

BACKGROUND OF MARRIAGE AND HARMONY BETWEEN THE BALINESE AND THE CHINESE WITHIN THE DESA PAKRAMAN IN BALI

Chinese and Balinese are two different ethnicities.they also have marriage preferences,because they belog to different social grouping. Althought they have their own social groups, srossed-marriages, i.e. Chinese and balinesa have taken place in Bali. There are many Chinese people become the members of desa pakraman which is as sign ( or features of identity ) on the Balinese people. It can be assumed that integrated relation of both ethnic groups are based on ethnic stereotypes, i.e. subjective overview about ethnicity. This article will discuss the stereotypes of both ethnic groups with regard to the context of crossed-marriage and the togethernees of both of the two different ethics in the desa pakraman IN Bali. The results of the analyses indicate that ethnic stereotypes to crossed-marriage and togetherness of Balinese and Chinese Desa Pakraman include subjective overview indicating same signs ( features ) that each ethnic group has. Those features are physic ( beautiful, hand some ), economic aspect, attitude, and social behavior. In choosing a future husband or wife, either physical orientations are not the same, values of other aspects ( economy, religion, and attitude ) are used as other consideration so that crossed-marriage of two different ethnics were taken place. It is have certain reasons to note that especially in the togetherness as part of traditions that were inherited from their ancestors. They thought that although they belong to different ethnicities, they still feel that they belong to a ‘family’. Apart from that, the Balinese, on one hand, exploit the desa pakraman Key words: Cross-ethnic marriage, desa pakraman, and living together

Penerapan Metode Kooperatif tipe Jigsaw pada Pembelajaran Menulis Teks Drama SMP Negeri 1 Driyorejo

Abstrak Penelitian ini dilatar belakangi oleh beberapa rumusan masalah, diantaranya sebagai berikut: (1) Bagaimana proses penerapan metode kooperatif tipe Jigsaw dalam pembelajaran menulis teks drama siswa kelas VIII SMP Negeri 1 Driyorejo Tahun Ajaran 2018/2019, (2) Bagaimana hasil belajar siswa kelas VIII SMP Negeri 1 Driyorejo Tahun Ajaran 2018/2019 dalam pembelajaran menulis teks drama dengan menggunakan metode kooperatif tipe Jigsaw, (3) Bagaimana respon siswa kelas VIII SMP Negeri 1 Driyorejo Tahun Ajaran 2018/2019 dalam pembelajaran menulis teks drama dengan menggunakan metode kooperatif tipe Jigsaw. Tujuan penelitian ini adalah untuk mengetahui: (1) Penerapan metode kooperatif tipe Jigsaw dalam pembelajaran menulis teks drama siswa kelas VIII SMP Negeri 1 Driyorejo Tahun Ajaran 2018/2019, (2) Hasil belajar siswa kelas VIII SMP Negeri 1 Driyorejo Tahun Ajaran 2018/2019 dalam pembelajaran menulis teks drama dengan menggunakan metode kooperatif jigsaw, (3) Respon siswa kelas VIII SMP Negeri 1 Driyorejo Tahun Ajaran 2018/2019 dalam pembelajaran menulis teks drama dengan menggunakan metode kooperatif jigsaw. Penelitian ini termasuk penelitian eksperimen dengan metode deskriptif kualitatif. Jenis eksperimen yang digunakan adalah eksperimen semu atau Quasi Experimemt dengan desain pembelajaran Pre-test dan Post-test. Teknik pengumpulan data yang digunakan dalam penelitian ini adalah observasi, penilaian unjuk kerja, angket. Observasi bertujuan untuk mengetahui aktivitas guru dan siswa saat pembelajaran. Penilaian unjuk kerja bertujuan untuk mengetahui hasil belajar siswa saat pretes dan postes. Angket bertujuan untuk mengetahui respon siswa terhadap penggunaan metode kooperatif tipe Jigsaw. Hasil penelitian ini pada proses penerapan kooperatif tipe jigsaw menunjukkan aktivitas guru dalam pembelajaran menulis teks drama tanpa menggunakan metode kooperatif tipe Jigsaw atau sebelum perlakuan (treatment) yang berada pada baik sebesar 38,46% dan yang berada pada sangat baik sebesar 61,54% sedangkan aktivitas guru dalam pembelajaran menulis teks drama dengan menggunakan metode kooperatif tipe Jigsaw atau setelah perlakuan (treatment) yang berada pada baik sebesar 41,7% yang berada pada sangat baik sebesar 58,3%. Serta aktivitas siswa dalam pembelajaran menulis teks drama tanpa menggunakan metode kooperatif jigsaw yang berada pada cukup sebesar 26,7%, lalu yang berada pada baik sebesar 53,3% dan yang berada pada sangat baik sebesar 20% sedangkan aktivitas siswa dalam pembelajaran menulis teks drama dengan menggunakan metode kooperatif jigsaw yang berada pada baik sebesar 53,3% dan yang berada pada sangat baik sebesar 46,7%. Hasil belajar siswa saat pre-test keseluruhan adalah 1858 dengan rata-rata kelas sebesar 53,8 dan hasil belajar siswa saat post-test keseluruhan adalah 2730,6 dengan rata-rata kelas sebesar 86,6 dengan perbedaan selisih nilai keseluruhan 872,6 dan perbedaan selisisih rata-rata kelas 32,8. Nilai keseluruhan kelas mengalami peningkatan sebesar 46,9% dan rata-rata kelas juga mengalami peningkatan sebesar 60,9%. Respon siswa terhadap pembelajaran menulis teks drama dengan metode kooperatif jigsaw, 90,6% menyatakan bahwa pembelajaran menggunakan metode kooperatif tipe Jigsaw membantu, menyenangkan, dan tidak membosankan dan 9,4% menyatakan bahwa pembelajaran dengan menggunakan metode kooperatif tipe Jigsaw Kata Kunci: Kooperatif, Jigsaw, Menulis, Teks Dram

OPTIMIZATION TECHNIQUE FOR SOFTWARE COST ESTIMATION USING NEURAL NETWORK

Last few decade software accomplishment admiration models developed, authentic estimates of the software activity beneath development is still unachievable goal. Recently advisers are alive on the development of new models and the advance of the absolute ones application bogus intelligence techniques. Designing of ANN (Artificial Neural Network) to archetypal a circuitous set of accord amid the abased capricious (effort) and the absolute variables (cost drivers) makes an apparatus for estimation. This cardboard presents an achievement assay of Multi ANNs in accomplishment estimation. We accept apish Back propagation ANN created by MATLAB Neural Network Apparatus application NASA dataset

Seawater irrigation systems for intensive marine shrimp farming in Thailand

The aim of the seawater irrigation system (SIS) is to clean up shrimp pond effluent and provide high quality seawater for shrimp farming. The system has 3 components: water intake; treatment reservoir and discharge system. There are criteria for site selection because shrimp farmers are required to form associations so they can work closely together. The construction site must be on the coastal area outside a mangrove forest and located away from a production agricultural area. All construction sites must have undergone an environmental impact assessment, and should be located on the area listed in Thailand's Coastal Zone Management Plan. Five SIS projects, which cover a culture area of 6,500 ha with 1,300 farmers (families), were completed and operated. The Department of Fisheries has planned for another 28 projects, that will cover almost 44,000 ha of culture area

LAPORAN PRAKTIK PENGALAMAN LAPANGAN (PPL) UNIVERSITAS NEGERI YOGYAKARTA

Praktik Pengalaman Lapangan (PPL) merupakan suatu kegiatan latihan kependidikan yang sifatnya intrakurikuler dan dilaksanakan oleh mahasiswa pendidikan. Praktik Pengalaman Lapangan diharapkan dapat menjadi bekal bagi mahasiswa sebagai latihan di dunia nyata untuk membentukan tenaga kependidikan professional yang memiliki nilai, sikap, pengetahuan dan keterampilan yang siap terjun langsung dalam dunia pendidikan. Pelaksanaan Praktik Pengalaman Lapangan (PPL) merupakan salah satu mata kuliah yang wajib ditempuh oleh mahasiswa sebagai salah satu syarat untuk menyelesaikan kuliah dan menyandang gelar sarjana pendidikan selain tugas akhir skripsi di Universitas Negeri Yogyakarta. Dalam hal ini Praktik Pengalaman Lapangan (PPL) bertujuan untuk menambah bekal mahasiswa menjadi tenaga pendidik. Praktik Pengalaman Lapangan (PPL) adalah suatu bentuk pendidikan yang memberikan pengalaman mengajar secara langsung bagi mahasiswa. Praktik Pengalaman Lapangan (PPL) dilaksanakan di SD NEGERI GADINGAN, tepatnya di Durungan, Gadingan, wates, Kulon Progo. ini dimulai pada tanggal 12 Agustus 2015 dan diakhiri pada tanggal 12 September 2015. Praktik Pengalaman Lapangan merupakan kegiatan pembelajaran di Sekolah. Dalam praktiknya perlu melakukan persiapan, diantaranya pembuatan RPP, serta media pembelajaran. Pelaksanaan Praktik Pengalaman Lapangan (PPL) memberikan mahasiswa pengalaman dalam mengajar, pengalaman mengajar ini sangat berguna bagi mahasiswa untuk menjadi seorang guru yang profesional. PPL juga berfungsi untuk memberikan gambaran yang tepat tentang sejauh mana kemampuan dan keterampilan mahasiswa dalam melaksanakan proses mengajar ataupun dalam praktik yang sudah dilakukan, sehingga mahasiswa dapat mengetahui kekurangan dan berusaha mengembangkannya agar kelak menjadi pengajar yang profesional