Design Measures to Improve Performance of Fill Dams Under Earthquake Loading

Fill dams of height 50 meters or more are increasingly being planned, designed and constructed in highly seismic areas of the world. These dams incorporate various earthquake design measures. The design measures have been critically examined. Design guides with respect to free board, core base width, crest width, type and material of core and material of shells have been reviewed. Some examples of actual changes made in the design, for the seismicity of the region have been given (Table II). Finally, a table of pertinent data of over 50 high dams located in highly seismic areas of the world is included (Table I)

Benefits of High-Intensity Intensive Care Unit Physician Staffing under the Affordable Care Act

The Affordable Care Act signed into law by President Obama, with its value-based purchasing program, is designed to link payment to quality processes and outcomes. Treatment of critically ill patients represents nearly 1% of the gross domestic product and 25% of a typical hospital budget. Data suggest that high-intensity staffing patterns in the intensive care unit (ICU) are associated with cost savings and improved outcomes. We evaluate the literature investigating the cost-effectiveness and clinical outcomes of high-intensity ICU physician staffing as recommended by The Leapfrog Group (a consortium of companies that purchase health care for their employees) and identify ways to overcome barriers to nationwide implementation of these standards. Hospitals that have implemented the Leapfrog initiative have demonstrated reductions in mortality and length of stay and increased cost savings. High-intensity staffing models appear to be an immediate cost-effective way for hospitals to meet the challenges of health care reform

FAKTOR RISIKO TERJADINYA GAGAL GINJAL KRONIK DI RSUP PROF. DR. R. D. KANDOU MANADO

FAKTOR RISIKO TERJADINYA GAGAL GINJAL KRONIK DI RSUP PROF. DR. R. D. KANDOU MANADOIntan Logani1), Heedy Tjitrosantoso1), Adithya Yudistira1)1)Program studi farmasi FMIPA UNSRAT Manado, 95115 ABSTRACT Risk factors are factor which can increase the incidence of a disease. Chronic Kidney Disease (CKD) is a progressive development of kidney disease and usually lasts for one year. Increased chronic renal disease can be caused by several risk factors. This study aims to find out what are the risk factors of Chronic Kidney Disease (CKD) in the Prof. Dr. R. D. Kandou Hospital, Manado. This type of research is included in the type of observational research with prospective data retrieval. This research was conducted prospectively during December 2016 - February 2017 at the inpatient installation of Prof. Dr. R. D. Kandou Hospital, Manado. This study was conducted on 50 records of patient medical records and through interviews of respondents with chronic kidney disease. The results showed that the risk factors of Chronic Kidney Disease in inpatients at Prof. Dr. R. D. Kandou Hospital, Manado was the patient with a history of hypertension, uric acid, diabetes mellitus, with a long history of ≥10 years of illness, irregular use of medication during previous history, and the use of painkillers. Other risk factors lie in the patient's lifestyle which includes smoking habits, meat consumption, coffee consumption, high salt content consumption, excessive sugar consumption, lack of sleep and lack of exercise.  Keywords: Risk factor, Chronic Kidney Disease (CKD) ABSTRAKFaktor risiko adalah suatu faktor yang dapat meningkatkan timbulnya suatu  penyakit. Gagal Ginjal Kronik (GGK) merupakan perkembangan gagal ginjal yang bersifat progresif dan biasanya berlangsung selama satu tahun. Meningkatnya penyakit gagal ginjal kronik dapat disebabkan oleh beberapa faktor risiko. Penelitian ini bertujuan untuk mengetahui apa saja faktor risiko terjadinya Gagal Ginjal Kronik (GGK) di RSUP Prof. Dr. R. D. Kandou Manado. Jenis penelitian ini termasuk dalam  jenis penelitian observaional dengan  pengambilan data secara prospektif. Penelitian ini dilakukan secara prospektif selama bulan Desember 2016 – Februari 2017 di instalasi rawat inap RSUP Prof. Dr. R. D. Kandou Manado. Penelitian ini dilakukan terhadap 50 catatan rekam medik pasien dan melalui wawancara terhadap responden dengan penyakit gagal ginjal kronik. Hasil penelitian menunjukan bahwa faktor risiko terjadinya Gagal Ginjal Kronik pada pasien rawat inap di RSUP Prof. Dr. R. D. Kandou Manado ialah pasien dengan riwayat hipertensi, riwayat asam urat, riwayat diabetes melitus, dengan lama menderita riwayat penyakit ≥10 tahun, penggunaan obat yang tidak teratur selama menderita riwayat penyakit dahulu, serta penggunaan obat penghilang nyeri. Faktor risiko lain terdapat pada pola hidup pasien yang meliputi kebiasaan merokok, konsumsi daging, konsumsi kopi, konsumsi kandungan garam tinggi, konsumsi gula berlebihan, kurang tidur  dan kurang olahraga.Kata Kunci : faktor risiko, gagal ginjal kronik (GGK) 

Recovery of Pacemakers and Defibrillators for Analysis and Device Advance Directives: Electrophysiologists’ Perspectives

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87183/1/PACE_3032_sm_SuppMat.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/87183/2/j.1540-8159.2011.03032.x.pd

The Usefulness of CDX-2 for Differentiating Primary and Metastatic Ovarian Carcinoma: An Immunohistochemical Study Using a Tissue Microarray

Distinguishing primary ovarian carcinoma from metastatic carcinoma to the ovary is often difficult by histologic examination alone. Recently an immunohistochemical marker CDX-2 was found to be of considerable diagnostic value in establishing the gastrointestinal origin of metastatic tumors. The aim of this study was to determine whether CDX-2 can distinguish between these malignancies. Paraffin-embedded tissue sections from 57 primary ovarian tumors and 40 metastatic tumors to the ovary were immunostained for CDX-2, and results were compared to the ancillary immunohistochemical results for CK7/CK20, CEA, CA125, and her-2/neu. CDX-2 immunoreactivity was observed in most of metastatic carcinomas with colorectal (91%) and appendiceal (100%) origin, however CDX-2 was negative in all primary ovarian carcinomas, except for the mucinous subtype. Almost all primary ovarian carcinomas including the mucinous subtype showed diffuse and strong immunoexpression for CK7. CEA and CA125 were mainly found in metastatic and primary ovarian carcinoma, respectively. Her-2/neu overexpression was only noted in a small proportion of primary and metastatic ovarian carcinomas. These results suggest that CDX-2 is very useful immunohistochemical marker for distinguishing metastatic colorectal carcinoma to the ovary from primary ovarian carcinoma, including the mucinous subtype. Furthermore, combination with CDX-2 and CK7 strengthen the differential diagnosis between these tumors

Total laparoscopic hysterectomy versus total abdominal hysterectomy with bilateral salpingo-oophorectomy for endometrial carcinoma: a randomised controlled trial with 5-year follow-up

This report is on recovery and long-term outcomes in a small-scale randomised controlled trial (RCT) after total laparoscopic hysterectomy versus total abdominal hysterectomy in (potential) endometrial carcinoma patients. An RCT was performed among women with atypical endometrial hyperplasia and endometrial carcinoma scheduled for hysterectomy in a teaching hospital in The Netherlands. Women were randomised to total laparoscopic hysterectomy versus total abdominal hysterectomy both with bilateral salpingo-oophorectomy and were followed until 5 years after the intervention. Patients completed the RAND 36-Item Short Form Health Survey (RAND-36), Quality of Recovery-40 (QoR-40) and Recovery Index-10 (RI-10) until 12 weeks after surgery. Main outcome measure was quality of life and recovery in the first 12 weeks after surgery. A linear mixed model was used for statistical analysis while accounting for baseline values where applicable. Seventeen women were included, of whom 11 allocated to the laparoscopic arm and 6 to the abdominal arm. Laparoscopic hysterectomy performed better on all scales and subscales used in the study. A statistically significant treatment effect, favouring laparoscopic hysterectomy, was found in the total RAND-36 (difference between groups 142 units, 95% confidence interval 46; 236). Clinical follow-up was completed after median 60 months, but this study was too small for conclusions regarding the safety and survival. Laparoscopic hysterectomy results in better postoperative quality of life in the first 12 weeks after surgery when compared with abdominal hysterectomy

The pandemic has taught us to work together to solve problems

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