Pengembangan Agrowisata Di Pulau Nusakambangan(agritoarism Dewlopment of Nusakambangan Isi.and)

Penelitian dalam rangka menyusun rencana induk pengembangan pariwisata telah Dilakukan di Pulau Nusakambangan. Salah satu program yang diusulkan dalam Rencana Induk PengembanganPariwisata Pulau Nusakambangan 2001-2005 adalah pengembangan agrowisata. Lokasi yang diperuntukkan menjadi kawasan agrowisata terletak di sekitar bekas Lapas ( Lembaga Pemasyarakatan) Karanganyar dengan luas area sekitar 100ha. Tulisani ni bertujuan untuk menginformasikan kelayakan investasi dalam pengembangan agrowisata di Karang anyar yang merupakan bagian dari pengembangan pariwisata Pulau Nusakambangan. Hasil analisis dengan menggunakan kriteria investasi terhadap Salak pondoh yang diambil sebagai contoh komoditas yang hendak dikembangkan diperoleh hasil : (1) NPV dengan discount factor ( dt) 30% sebesar 5.906.591,8 dan dengan df 26% sebesar 9.450.546,9 (;2 ) IRR : 36,6%; ( 3) Net B / C : 4,45;( 4) ROI = 345,3%; dan (5) BEP untuk produk 21.895,6 k g dan untuk hargaR p 1.112,219/kg. Berdasarkan hasil analisis tersebut disimpulkan salak pondoh termasuk komoditas yang layak investiasi untuk pengembangan agrowisata.D isarankan, k omoditas lain yang direkomendasikan untuk pengembangan agrowisata yang diminati oleh calon investor hendaknya dilakukan analisis seperti metode di atas untuk menilai kelayakani ivestasinya

The impact of mixing treatments on cloud modelling in 3D simulations of hot Jupiters

This is the author accepted manuscript. The final version is available from Oxford University Press via the DOI in this recordData availability: The research data supporting this publication are openly available at https://doi.org/10.7910/DVN/NLT6MSWe present results of 3D hydrodynamical simulations of HD209458b including a coupled, radiatively-active cloud model (EddySed). We investigate the role of the mixing by replacing the default convective treatment used in previous works with a more physically relevant mixing treatment ( ) based on global circulation. We find that uncertainty in the efficiency of sedimentation through the sedimentation factor sed plays a larger role in shaping cloud thickness and its radiative feedback on the local gas temperatures – e.g. hot spot shift and day-to-night side temperature gradient – than the switch in mixing treatment. We demonstrate using our new mixing treatments that simulations with cloud scales which are a fraction of the pressure scale height improve agreement with the observed transmission spectra, the emission spectra, and the Spitzer 4.5 m phase curve, although our models are still unable to reproduce the optical and UV transmission spectra. We also find that the inclusion of cloud increases the transit asymmetry in the optical between the east and west limbs, although the difference remains small (. 1%).Leverhulme TrustScience and Technology Facilities Council (STFC)Medical Research Council (MRC

Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers

__Background__ Intrahepatic cholestasis of pregnancy is associated with adverse perinatal outcomes, but the association with the concentration of specific biochemical markers is unclear. We aimed to quantify the adverse perinatal effects of intrahepatic cholestasis of pregnancy in women with increased serum bile acid concentrations and determine whether elevated bile acid concentrations were associated with the risk of stillbirth and preterm birth. __Methods__ We did a systematic review by searching PubMed, Web of Science, and Embase databases for studies published from database inception to June 1, 2018, reporting perinatal outcomes for women with intrahepatic cholestasis of pregnancy when serum bile acid concentrations were available. Inclusion criteria were studies defining intrahepatic cholestasis of pregnancy based upon pruritus and elevated serum bile acid concentrations, with or without raised liver aminotransferase concentrations. Eligible studies were case-control, cohort, and populationbased studies, and randomised controlled trials, with at least 30 participants, and that reported bile acid concentrations and perinatal outcomes. Studies at potential higher risk of reporter bias were excluded, including case reports, studies not comprising cohorts, or successive cases seen in a unit; we also excluded studies with high risk of bias from groups selected (eg, a subgroup of babies with poor outcomes were explicitly excluded), conference abstracts, and Letters to the Editor without clear peer review. We also included unpublished data from two UK hospitals. We did a random effects meta-analysis to determine risk of adverse perinatal outcomes. Aggregate data for maternal and perinatal outcomes were extracted from case-control studies, and individual patient data (IPD) were requested from study authors for all types of study (as no control group was required for the IPD analysis) to assess associations between biochemical markers and adverse outcomes using logistic and stepwise logistic regression. This study is registered with PROSPERO, number CRD42017069134. __Findings__ We assessed 109 full-text articles, of which 23 studies were eligible for the aggregate data meta-analysis (5557 intrahepatic cholestasis of pregnancy cases and 165136 controls), and 27 provided IPD (5269 intrahepatic cholestasis of pregnancy cases). Stillbirth occurred in 45 (0·91%) of 4936 intrahepatic cholestasis of pregnancy cases and 519 (0·32%) of 163947 control pregnancies (odds ratio [OR] 1·46 [95% CI 0·73–2·89]

Cesarean Scar Pregnancy, Incidence, and Recurrence: Five-Year Experience at a Single Tertiary Care Referral Center

(Obstet Gynecol. 2018;132:1285–1295)Cesarean scar pregnancy, in which a gestational sac implants on the site of a previous hysterotomy, is associated with life-threatening complications. Although numerous treatment modalities have been described (expectant management, methotrexate, intrauterine balloon compression, resection, and more), data on optimal treatment modalities, pregnancy outcomes, treatment decisions, and patient counseling are limited. In order to add to the available literature, the authors of the present study described the treatment and follow-up of women with cesarean scar pregnancy at Yale-New Haven Hospital, a tertiary care center, from 2013 to 2018

Cesarean Scar Pregnancy, Incidence, and Recurrence Five-Year Experience at a Single Tertiary Care Referral Center

OBJECTIVE: To describe the treatment and subsequent pregnancy outcomes in patients with cesarean scar pregnancies at a single institution over 5 years. METHODS: This is a case series of all cesarean scar pregnancies diagnosed from May 2013 to March 2018 at Yale-New Haven Hospital. Data were collected on each patient using electronic medical record review and included patient demographics; medical, surgical, and obstetric history; pregnancy characteristics; treatment modalities used; response to therapy; complications; and subsequent pregnancy outcomes. RESULTS: Thirty cases of cesarean scar pregnancies were diagnosed in 26 patients, including one recurrence in one patient and three recurrences in another. Forty-six percent of cesarean scar pregnancies were in Hispanic women. The median number of prior cesarean deliveries was two. Mean gestational age at the time of diagnosis was 46 days (SD +/- 10). Fetal cardiac activity was detected in 18 cases. Three patients initially were erroneously diagnosed with a viable intrauterine pregnancy and failed medical termination. Others opted for termination through systemic methotrexate alone (n=4), systemic and local methotrexate (n=12), systemic and local methotrexate with potassium chloride injected into the gestational sac (n=3), potassium chloride injection with laparotomy and wedge resection (n=1), methotrexate with bilateral uterine artery embolization (n=2), or intrauterine balloon (n=4). Five patients who underwent expectant management or methotrexate therapy had retained products of conception and required hysteroscopy and curettage. One patient opted for hysterectomy after failed curettage. After complete resolution of cesarean scar pregnancies, there were 10 subsequent spontaneous conceptions in eight patients, including four recurrent cesarean scar pregnancies, four term pregnancies, and one spontaneous abortion. One viable normally located pregnancy is ongoing. CONCLUSION: There is a wide array of treatment modalities available for cesarean scar pregnancies. Women with a cesarean scar pregnancy are at risk for its recurrence in the future, although normal pregnancy after a cesarean scar pregnancy is also possible. Safe outcomes depend on timely diagnosis and multidisciplinary care by skilled clinicians

Ursodeoxycholic acid in intrahepatic cholestasis of pregnancy: a systematic review and individual participant data meta-analysis

Background: Ursodeoxycholic acid is commonly used to treat intrahepatic cholestasis of pregnancy, yet its largest trial detected minimal benefit for a composite outcome (stillbirth, preterm birth, and neonatal unit admission). We aimed to examine whether ursodeoxycholic acid affects specific adverse perinatal outcomes. Methods: In this systematic review and individual participant data meta-analysis, we searched PubMed, Web of Science, Embase, MEDLINE, CINAHL, Global Health, MIDIRS, and Cochrane without language restrictions for relevant articles published between database inception, and Jan 1, 2020, using search terms referencing intrahepatic cholestasis of pregnancy, ursodeoxycholic acid, and perinatal outcomes. Eligible studies had 30 or more study participants and reported on at least one individual with intrahepatic cholestasis of pregnancy and bile acid concentrations of 40 \u3bcmol/L or more. We also included two unpublished cohort studies. Individual participant data were collected from the authors of selected studies. The primary outcome was the prevalence of stillbirth, for which we anticipated there would be insufficient data to achieve statistical power. Therefore, we included a composite of stillbirth and preterm birth as a main secondary outcome. A mixed-effects meta-analysis was done using multi-level modelling and adjusting for bile acid concentration, parity, and multifetal pregnancy. Individual participant data analyses were done for all studies and in different subgroups, which were produced by limiting analyses to randomised controlled trials only, singleton pregnancies only, or two-arm studies only. This study is registered with PROSPERO, CRD42019131495. Findings: The authors of the 85 studies fulfilling our inclusion criteria were contacted. Individual participant data from 6974 women in 34 studies were included in the meta-analysis, of whom 4726 (67\ub78%) took ursodeoxycholic acid. Stillbirth occurred in 35 (0\ub77%) of 5097 fetuses among women with intrahepatic cholestasis of pregnancy treated with ursodeoxycholic acid and in 12 (0\ub76%) of 2038 fetuses among women with intrahepatic cholestasis of pregnancy not treated with ursodeoxycholic acid (adjusted odds ratio [aOR] 1\ub704, 95% CI 0\ub735\u20133\ub707; p=0\ub795). Ursodeoxycholic acid treatment also had no effect on the prevalence of stillbirth when considering only randomised controlled trials (aOR 0\ub729, 95% CI 0\ub704\u20132\ub742; p=0\ub725). Ursodeoxycholic acid treatment had no effect on the prevalence of the composite outcome in all studies (aOR 1\ub728, 95% CI 0\ub786\u20131\ub791; p=0\ub722), but was associated with a reduced composite outcome when considering only randomised controlled trials (0\ub760, 0\ub739\u20130\ub791; p=0\ub7016). Interpretation: Ursodeoxycholic acid treatment had no significant effect on the prevalence of stillbirth in women with intrahepatic cholestasis of pregnancy, but our analysis was probably limited by the low overall event rate. However, when considering only randomised controlled trials, ursodeoxycholic acid was associated with a reduction in stillbirth in combination with preterm birth, providing evidence for the clinical benefit of antenatal ursodeoxycholic acid treatment. Funding: Tommy's, the Wellcome Trust, ICP Support, and the National Institute for Health Research