Health financing: challenges and opportunities, coverage and cost

This policy panel will present and debate proposals for the next steps in reforming the U.S. health care system. Which challenge deserves the highest priority – providing universal access; instituting better measures of quality and outcomes and better management systems; or reining in costs? How should these challenges be addressed? What keeps us from “having it all”? Does the fundamental obstacle lie in market behavior, inadequate or asymmetric information, lack of political will, or the human psyche? How would the proposed reforms tackle the underlying issue and help us maintain a sustainable balance between health care access, quality and cost – and between our health care goals and other important policy objectives – in future years?Health care reform

Perencanaan Pattern Full Scale untuk Secondary Recovery dengan Injeksi Air pada Lapangan “Jan” Lapisan X1 dan Lapisan X2

Lapangan “JAN” pada tugas akhir yang berjudul “Perencanaan Pattern Full Scale untuk SecondaryRecovery dengan Injeksi Air Pada Lapangan JAN lapisan X1 dan lapisan X2” sudah berproduksisejak tahun 1976.Seiring dengan berjalannya produksi, tekanan pada reservoir menurun, sampaisudah tidak dapat memenuhi nilai keekonomisannya.Perencanaan pattern yang digunakan padatugas akhir ini adalah perencanaan pattern secara kualitatif.Perencanaan secara kualitatif adalahperencanaan yang dilakukan dengan menganalisis produksi dari suatu lapangan. Langkah-langkahyang harus dilakukan untuk analisis produksi antara lain adalah analisis production performance,analisis scatter plot, analisis bubble map terhadap grid map. Berdasarkan kesimpulan dapat terlihatPattern full scale pada lapangan “JAN” merupakan tipe peripheral

Lipid Profile, Blood Glucose Level and Body Mass Index (BMI) in Second Trimester of Pregnancy: Screening with Gestational Diabetes: Profil Lipid, Gula Darah dan Indeks Massa Tubuh (IMT) pada Kehamilan Trimester II: Skrining Kejadian Kehamilan dengan Diabetes Melitus

Abstract Objective: To find out lipid profile data, blood sugar and Body Mass Index in trimester II pregnancy to the incidence of pregnancy with diabetes mellitus. Methods: This study is a cross sectional study. The number of samples obtained was 42 samples where all were taken in the second trimester. Samples taken from RSUP Prof. Dr. R. D. Kandou Manado and networking hospitals around Manado that meet the inclusion and exclusion criteria. All patient patients were explained about the research procedure and the signing of consent information. Blood samples were taken for examination of blood sugar (fasting blood sugar and 2 hours post-prandial blood sugar) and lipid profiles (total cholesterol, HDL, LDL, triglycerides). After the data is collected, it is included in the SPSS version 22.0 program for data analysis. Results: Found 2 subjects (4.76%) who had abnormal fasting blood sugar and found 4 subjects (9.53%) who had abnormal 2-prandial 2-hour blood sugar. For lipid profiles, it was found 16 subjects (38.1%) who had abnormal total cholesterol levels, for LDL there were 13 subjects (30.96%) who had abnormal levels, for HDL there were 4 subjects (11.9%) who had abnormal levels and for triglycerides there were 23 subjects (54.76%) who had abnormal levels. There was a significant negative correlation between LDL cholesterol and fasting blood sugar (p = 0.002; r = - 0.455), and so did total cholesterol with fasting blood sugar (p = 0.047; r = - 0.302). There was a significant correlation between BMI and total cholesterol (p = 0.013; r = 0.371). There was 1 subject (2.38%) diagnosed with gestational diabetes melt and fasting blood sugar at 190 mg / dL, for prandial 2 hours post blood sugar at 309 mg / dL and for triglycerides at 617 mg / dL. Conclusions: Based on this study found the incidence of gestational diabetes mellitus 2.38% of all trimester II pregnancies. There is a positive but not significant correlation between blood sugar and triglycerides, whereas there is no significant relationship between blood sugar and other lipid profiles. There is a positive but not significant correlation of BMI in trimester pregnancy with total cholesterol. Keywords: Blood sugar, Body Mass Index (BMI), lipid profile Abstrak Tujuan: Untuk mengetahui data profil lipid, gula darah dan Indeks Massa Tubuh pada kehamilan trimester II terhadap kejadian kehamilan dengan diabetes melitus. Metode: Studi ini merupakan studi potong lintang. Jumlah sampel yang didapatkan sebesar 42 sampel di mana seluruhnya diambil pada trimester II. Sampel diambil dari RSUP Prof. Dr. R. D. Kandou Manado dan rumah sakit jejaring sekitar Manado yang memenuhi kriteria inklusi dan eksklusi. Semua pasien-pasien dijelaskan mengenai prosedur penelitian dan penandatanganan inform consent baru dilakukan pengambilan sampel darah untuk pemeriksaan gula darah (gula darah puasa dan gula darah 2 jam postprandial) dan profil lipid (Kolesterol total, HDL, LDL, Trigliserida). Setelah data dikumpulkan, maka dimasukkan ke dalam program SPSS versi 22.0 untuk data analisis. Hasil: Ditemukan 2 subjek (4,76%) yang memiliki gula darah puasa abnormal dan ditemukan 4 subjek (9.,53%) yang memiliki gula darah 2 jam postprandial yang abnormal. Untuk profil lipid, ditemukan 16 subjek (38,1%) yang memiliki kadar kolesterol total abnormal, untuk LDL ditemukan sebanyak 13 subjek (30,96%) yang memiliki kadar abnormal, untuk HDL ditemukan 4 subjek (11,9%) yang memiliki kadar abnormal dan untuk trigliserida ditemukan 23 subjek (54,76%) yang memiliki kadar abnormal. Terdapat korelasi negatif signifikan antara kolesterol LDL dengan gula darah puasa (p = 0,002 ; r = – 0,455), dan begitu juga dengan kolestrol total terhadap gula darah puasa (p = 0,047 ; r = – 0,302). Terdapat korelasi signifikan antara IMT dengan kolesterol total (p = 0,013 ;r = 0,371). Terdapat 1 subjek (2,38%) yang terdiagnosis diabetes melitus gestasional di mana gula darah puasa sebesar 190 mg/dL, untuk gula darah 2 jam postprandial sebesar 309 mg/dL dan untuk trigliserida sebesar 617 mg/dL. Kesimpulan: Berdasarkan penelitian ini ditemukan kejadian diabetes melitus gestasional 2,38% dari seluruh kehamilan trimester II. Terdapat korelasi positif tetapi tidak bermakna antara gula darah dengan trigliserida, sedangkan tidak terdapat hubungan bermakna antara gula darah dengan profil lipid lainnya. Terdapat korelasi positif tetapi tidak bermakna IMT pada kehamilan trimester dengan kolestrol total. Kata kunci: gula darah, Indeks Massa Tubuh (IMT), profil lipi

Response of External Radiotherapy Alone in Stage IIB – IIIC Cervical Cancer Patients : Respon Radioterapi Eksterna Pasien Kanker Serviks Stadium IIB – IIIC

Objective: To investigate the therapeutic response and toxicity in cervical cancer patients with stage IIB-IIIC who undergo external radiation. Methods: This was a retrospective study using the medical records of the Obstetric Oncology and Radiotherapy Department at Prof. Dr. R. D. Kandou Hospital Manado. The research subjects were stage IIB-IIIC cervical cancer patients who underwent external radiation from September 2016 to December 2020. External radiation was administrated using 60Cobalt. The statistical analysis assessments in this study was carried out using descriptive analysis, while the analysis of the relationship was carried out using the Chi-Square method. The toxicity assessments were carried out from first day started external radiation up until 1 month after the therapy was deemed completed. Results : As many as 413 cervical cancer patients underwent external radiation during the study. However, only 192 cervical cancer patients with stage IIB-IIIC met the inclusion criteria in this study. The complete response to the therapy based on the findings was 65.6%, the partial response was 31.8%, the stable response was 1.6%, and the progressive response was 1%. In statistical analysis there was a significant association between cervical cancer stage and Overall Treatment Time with response to external radiotherapy. However, no significant association between tumor size and histopathological type with response to external radiotherapy. There were hematological toxicity (45.8%), skin toxicity (45.3%), gastrointestinal toxicity (6.3%) and urinary tract toxicity (2.6%). Conclusions: External radiotherapy response was a complete response where there was an association between cervical cancer stage and Overall Treatment Time with response to external radiotherapy, whereas there is no significant association found between the tumor size and histopathological type based on this research's findings. Most toxicity were hematology with complaints of anemia and thrombocytopenia Keywords: cervical cancer, external radiation response, toxicity.   Abstrak   Tujuan: Untuk mengetahui respon terapi dan efek samping pasien kanker serviks stadium IIB-IIIC yang menjalani radioterapi eksterna. Metode: Penelitian ini adalah penelitian deskriptif rektrospektif dengan menggunakan rekam medis Poli Onkologi Kandungan dan Instalasi Radioterapi RSUP Prof. Dr. R. D. Kandou Manado. Subyek penelitian adalah pasien kanker serviks stadium IIB-IIIC yang menjalani radiasi eksterna mulai September 2016 sampai Desember 2020. Radiasi eksterna dilakukan dengan sinar 60Cobalt. Penilaian analisis statistika pada penelitian ini menggunakan analisis deskriptif dan analisis hubungan menggunakan metode Chi Square. Penilaian efek samping dilakukan sejak hari pertama pasien memulai radiasi eksterna sampai 1 bulan setelah dinyatakan selesai menjalani radioterapi eksterna. Hasil: Selama periode penelitian didapatkan 413 pasien kanker serviks yang menjalani radiasi eksterna namun hanya 192 pasien kanker serviks stadium IIB-IIIC yang memenuhi kriteria inklusi pada penelitian ini. Respon terapi komplit sebesar 65,6%, respon terapi parsial sebesar 31,8%, respon terapi tidak berubah sebesar 1,6%, dan respon terapi progresif sebesar 1%. Pada analisis statistik terdapat hubungan bermakna stadium kanker serviks dan Overall Treatment Time dengan respon radioterapi eksterna, dan tidak terdapat hubungan bermakna ukuran tumor dan jenis histopatologi dengan respon radioterapi eksterna. Didapatkan efek samping hematologi (45,8%), efek samping kulit (45,3%), efek samping gastrointestinal (6,3%) dan efek samping traktus urinarius (2,6%). Kesimpulan: Respon radioterapi eksterna berupa complete response dimana terdapat hubungan bermakna antara stadium kanker serviks dan Overall Treatment Time dengan respon radioterapi eksterna. Tidak terdapat hubungan bermakna antara ukuran tumor dan jenis histopatologi. Efek samping terbanyak yaitu hematologi dengan keluhan berupa anemia dan trombositopenia. Kata kunci:  efek samping, kanker serviks, respon radiasi eksterna

Germ Patterns and Antibiotic Susceptibility in Pregnancy and Labor with Risk of Infections : Pola Kuman dan Sensitivitas Antibiotik pada Kehamilan dan Persalinan dengan Faktor Risiko Infeksi

Objective: To determine the pattern of germs and antibiotic susceptibility tests in pregnant women related to risk factors for infection in preterm PROM cases, the threat of preterm labor, pathological fluor albus, and prolonged labor in Manado city. Method: This study is a cross-sectional descriptive study. A total of 21 samples were obtained, consisting of six preterm PROM cases, five premature contraction cases, five pathological fluor albus cases, and five prolonged labor cases. The study was conducted in Kandou General Hospital and Affiliated Hospitals, Manado. All patients were informed about the study and signed informed consent. Germ pattern and antibiotics susceptibility data were analyzed. Results: Of 21 samples, the detected microorganisms included Staphylococcus aureus (12), Coagulase-negative staphylococcus (2), mixed microorganisms (Staphylococcus aureus + Candida sp, Coagulase-negative staphylococcus + Candida sp), Bacillus sp and Candida sp. The susceptible and safe antibiotics for pregnancy were Ampicillin / Sulbactam and Meropenem. The resistant antibiotics were Ceftriaxone, Tetracycline, and Neomycin. Conclusion: The most common type of bacteria found in pregnant women and women in labor was Staphylococcus aureus. Susceptible and safe antibiotics for pregnancy were Ampicillin / Sulbactam and Meropenem. Keywords: antibiotic sensitivity test, germ pattern, pregnancy and labor infection.   Abstrak Tujuan: Mengetahui pola kuman dan uji sensitivitas antibiotik pada perempuan hamil terkait faktor risiko infeksi pada kasus KPD preterm, ancaman partus prematurus, fluor albus patologis dan partus lama di kota Manado. Metode: Studi ini merupakan studi deskriptif potong lintang. Jumlah sampel yang didapatkan sebesar 21 sampel di mana terbagi pada masing-masing kasus KPD preterm 6 sampel, ancaman partus prematurus 5 sampel, fluor albus patologis 5 sampel dan partus lama 5 sampel. Sampel diambil dari RSUP Prof. Dr. R. D. Kandou Manado dan Rumah Sakit Jejaring di kota Manado yang memenuhi kriteria inklusi dan eksklusi. Semua pasien dijelaskan mengenai prosedur penelitian dan penandatanganan inform consent baru dilakukan pengambilan sampel. Data dianalisis dengan cara deskriptif tentang pola kuman dan uji sensitivitas antibiotik pada kehamilan dan persalinan dengan faktor risiko infeksi. Hasil: Dari 21 sampel, sebaran jenis mikroorganisme diantaranya Staphylococcus areus (12), Staphylococcus non koagulase (2), mikroorganisme campuran (Staphylococcus aureus + Candida sp, Staphylococcus non koagulase + Candida sp), Bacilus sp dan Candida sp. Hasil uji sensitivitas antibiotik yang sensitif dan aman untuk kehamilan di antaranya Ampicillin/Sulbactam dan Meropenem. Hasil uji sensitivitas antibiotik yang resisten adalah Ceftriaxone, Tetracycline dan Neomycin. Kesimpulan: Jenis mikroorganisme paling banyak adalah Staphylococcus aureus. Hasil uji sensitivitas antibiotik yang sensitif dan aman untuk kehamilan di antaranya Ampicillin/Sulbactam dan Meropenem. Kata kunci: infeksi kehamilan dan persalinan, pola kuman, uji Sensitivitas antibioti

Hierarchy and Wave Functions in a Simple Quantum Cosmology

Astrophysical observations indicate the expansion of the universe is accelerating. Applying the holographic entropy conjecture to the cosmological horizon in an accelerating universe suggests the universe has only a finite number of degrees of freedom. This is consistent with a closed universe arising from a quantum fluctuation, with zero total quantum numbers. If space-time has eleven dimensions, and the universe began as a closed force-symmetric ten-dimensional space with characteristic dimension L, seven of the space dimensions must have collapsed to generate the three large space dimensions we see. The holographic conjecture then suggests the initial length scale L must be roughly twenty orders of magnitude larger than the Planck length. Accordingly, the nuclear force must be roughly forty orders of magnitude stronger than gravity, possibly resolving the force hierarchy problem. A wavefunction for the radius of curvature of the universe can be obtained from the Schrodinger equation derived by Elbaz and Novello. The product of this wavefunction and its complex conjugate can be interpreted as the probability density for finding a given radius of curvature in one of the infinity of measurements of the radius of curvature possible (in principle) at any location in a homogeneous isotropic universe.Comment: 4 pages, no figures, abstract corrected to insert omitted word

Hubungan Jumlah Trombosit Dan Jumlah Leukosit Pada Pasien Anak Demam Berdarah Dengue

: Dengue hemorrhagic fever (DHF) is an acute fever disease with high mortality and morbidity in many regions of the world. Leucopenia and thrombocytopenia are two of several laboratory findings that could be found in the course of DHF. This was an analytical retrospective study with a cross sectional design. Samples were patients diagnosed with DHF in Prof. Dr. R.D Kandou General Hospital Manado during the period of 2012. The inclusion criteria were patients <15 years, were diagnosed as DHF according to WHO 1997 criteria, and were examined for platelet and white blood cell count. This study used the medical record data which were analyzed statistically by using the Pearson's correlation test. There were 137 children with DHF during the period of 2012. Samples were 56 children that fulfiled the inclusion criteria. The Pearson correlation test showed a P value 0.801 and correlation coefficient r = -0.034 that indicated that there was a negative correlation which was not significant. Conclusion: There was no significant correlation between the number of thrombocytes and leukocytes in children with dengue hemorrhagic fever

Classical and quantum dynamics of confined test particles in brane gravity

A model is constructed for the confinement of test particles moving on a brane. Within the classical framework of this theory, confining a test particle to the brane eliminates the effects of extra dimensions, rendering them undetectable. However, in the quantized version of the theory, the effects of the gauge fields and extrinsic curvature are pronounced and this might provide a hint for detecting them. As a consequence of confinement the mass of the test particle is shown to be quantized. The condition of stability against small perturbations along extra dimensions is also studied and its relation to dark matter is discussed.Comment: 15 pages, no figures, extended, references adde

Energy composition of the Universe: time-independent internal symmetry

The energy composition of the Universe, as emerged from the Type Ia supernova observations and the WMAP data, looks preposterously complex, -- but only at the first glance. In fact, its structure proves to be simple and regular. An analysis in terms of the Friedmann integral enables to recognize a remarkably simple time-independent covariant robust recipe of the cosmic mix: the numerical values of the Friedmann integral for vacuum, dark matter, baryons and radiation are approximately identical. The identity may be treated as a symmetry relation that unifies cosmic energies into a regular set, a quartet, with the Friedmann integral as its common genuine time-independent physical parameter. Such cosmic internal (non-geometrical) symmetry exists whenever cosmic energies themselves exist in nature. It is most natural for a finite Universe suggested by the WMAP data. A link to fundamental theory may be found under the assumption about a special significance of the electroweak energy scale in both particle physics and cosmology. A freeze-out model developed on this basis demonstrates that the physical nature of new symmetry might be due to the interplay between electroweak physics and gravity at the cosmic age of a few picoseconds. The big `hierarchy number' of particle physics represents the interplay in the model. This number quantifies the Friedmann integral and gives also a measure to some other basic cosmological figures and phenomena associated with new symmetry. In this way, cosmic internal symmetry provides a common ground for better understanding of old and recent problems that otherwise seem unrelated; the coincidence of the observed cosmic densities, the flatness of the co-moving space, the initial perturbations and their amplitude, the cosmic entropy are among them.Comment: 32 page