Waterfall Resort Di Talawaan (Transformasi Konsep Falling Water Frank Lloyd Wright)

Kabupaten Minahasa Utara merupakan salah satu bagian dari wilayah di Provinsi Sulawesi Utara yang sangat kaya akan kehidupan sosial-budaya serta sumber daya alam yang potensial untuk dijadikan sebagai objek wisata. Salah satunya adalah Air Terjun Tunan (Tunan Waterfall) yang merupakan objek wisata andalan Kabupaten Minahasa Utara. Namun aksesbilitas jarak yang jauh, infrastruktur yang belum optimal dan fasilitas penunjang yang belum memadai menyebabkan para wisatawan lokal, nusantara, dan mancanegara hanya sekedar berkunjung saja tanpa menginap untuk menikmati lebih lama keindahan Air Terjun Tunan yang ada. Oleh karena itu, kehadiran resort di kawasan Air Terjun Tunan di Desa Talawaan ini diharapkan dapat memenuhi kebutuhan wisatawan dalam beristirahat, berekreasi, serta menikmati keindahan alam yang ada disekitar objek wisata Air Terjun. Transformasi Konsep Falling Water F.L. Wright merupakan tema yang diangkat dalam perencanaan Waterfall Resort tersebut. Pemahaman konsep Falling Water oleh Frank Lloyd Wright adalah bahwa bangunan merupakan bagian dari alam, terkesan seolah-olah muncul dari alam dimana F.L. Wright tidak menyukai simetris yang statis dengan memanfaatkan kedinamisan alam. Dengan mentransformasikan konsep Falling Water, penulis menggunakan teori transformasi oleh F.D.K. Ching dimana setiap bentuk ruang yang dihasilkan mengalami Perubahan-Perubahan, baik secara dimensional, Perubahan akibat pengurangan, dan Perubahan akibat penambahan. Pemahaman konsep Falling Water dan teori transformasi dirampung menjadi satu kesatuan sehingga bisa menghasilkan suatu perancangan yang diinginkan. Melalui perencanaan resort ini diharapkan bisa menjadi contoh untuk pengembangan fasilitas-fasilitas pariwisata di Kabupaten Minahasa Utara serta bisa meningkatkan kualitas serta kuantitas kerja Pemerintah Kabupaten Minahasa Utara dalam upaya pelestarian objek-objek wisata di Minahasa Utara

EFFECT OF SACUBITRIL/VALSARTAN ON NATRIURESIS, DIURESIS AND BLOOD PRESSURE IN HYPERTENSIVE PATIENTS

Aim. To study the effect of sacubitril/valsartan compared with valsartan on natriuresis, diuresis, blood pressure (BP) and the level of biomarkers in hypertensive patients.Material and methods. Hypertensive patients (n=16) received sacubitril/valsartan 400 mg QD or valsartan 320 mg QD for 7 days in a double-blind,-randomized, cross-over study. The change in 24-hour diuresis and natriuresis, fractional urinary sodium excretion, and BP level have been studied, as-well as soluble biomarkers: cyclic guanosine monophosphate (cGMP), plasma brain natriuretic peptide (BNP), mid-regional precursor of the atrial natriuretic-peptide (MR-proANP) and the N-terminal precursor of the brain natriuretic peptide (NT-proBNP).Results. The trend toward higher levels of 24-hour natriuresis on Day 1 (21%, p=0.068) was found in the sacubitril/valsartan group compared to-valsartan one. Fractional sodium excretion was significantly higher in the sacubitril/valsartan group on Day 1 after 6 hours (50%, p=0.004) and subsequent-samples up to 12 hours; the maximum effect was achieved 2-4 hours after taking the medication (mean value 2.08, p=0.005). Sacubitril/valsartan-therapy compared with valsartan therapy was associated with a significant increase in 24-hour diuresis on Day 1 (41%, p<0.05), but not on Day 7-(15%, p=0.134). Sacubitril/valsartan therapy, in contrast to valsartan therapy demonstrated a significant increase in 24 h cGMP urinary excretion-on Day 1 (95%, p<0.001) and Day 7 (83%, p=0.001). Sacubitril/valsartan lowered BP more effectively than valsartan [on Day 7, 12 hours after-taking the drug, the differences were13.6 mm Hg (p=0.004) for systolic and6.7 mm Hg (p=0.03) for diastolic BP. The decrease in the level of-NT-proBNP and MR-proANP in plasma and the transient increase in the level of BNP were found in the sacubitril/valsartan group. Both sacubitril/valsartan and valsartan therapies were well tolerated and safe.Conclusion. Sacubitril/valsartan therapy in hypertensive patients compared with valsartan therapy was associated with transient increase in natriuresis and diuresis, more pronounced decrease in BP and changes in biomarker levels reflecting persistent inhibition of neprilysin and decrease in myocardial wall tension

The Partition Function of Multicomponent Log-Gases

We give an expression for the partition function of a one-dimensional log-gas comprised of particles of (possibly) different integer charge at inverse temperature {\beta} = 1 (restricted to the line in the presence of a neutralizing field) in terms of the Berezin integral of an associated non- homogeneous alternating tensor. This is the analog of the de Bruijn integral identities [3] (for {\beta} = 1 and {\beta} = 4) ensembles extended to multicomponent ensembles.Comment: 14 page

TYPE 2 MYOCARDIAL INFARCTION: CLINICAL AND DEMOGRAPHIC FEATURES, LABORATORY AND INSTRUMENTAL ASSOCIATIONS

Background: Type 2 (T2) myocardial infarction (MI) is diagnosed in patients with acute coronary syndrome with increasing frequency. However, the information on etiology, pathogenetic mechanisms, instrumental and laboratory features is inconsistent. Purpose: to examine the clinical and demographic parameters, and results of routinely performed laboratory and instrumental test in patients with T2 MI and compare them with population characteristics of type 1 (T1) MI. Methods: We retrospectively included 450 consecutive patients admitted with acute MI diagnosed in accordance with the Third Universal Definition (2012) that underwent coronary angiography. T1 MI was diagnosed in the presence of intraluminal thrombus in the epicardial vessel, or absence of atherosclerotic plaque integrity with decreased myocardial blood flow (TIMI < 3). All other patients were classified as having T2 MI. We analyzed electronic medical records to obtain their data. Student’s t-test and chi-square methods were used to compare single variables in patients with T1 and T2 MI. Multiple logistic regression was then performed to establish independent association of studied parameters with the type of MI. Results: Type 2 MI was diagnosed in 175 (39%) patients and was associated with increasing age (p = 0.007) and female gender (p = 0.01). T2 MI patients more frequently present without ST segment elevation (p = 0.001) and have lower troponin values (p = 0.001). They also had more often had a previous MI (p < 0.001) and had undergone myocardial revascularisation (p = 0.002). The absence of obstructive coronary atherosclerosis was diagnosed in a small fraction of patients with T2 MI [12 (6.9%)]. Independent predictors of having T2 MI were the presence of anemia (p < 0.001), left bundle branch block (p = 0.019), the absence of ST-segment elevation (p = 0.001), age ≥ 70 years (p = 0.014) and the absence of local wall motion abnormalilties on echocardiography (p = 0.002). Conclusion: Type 2 myocardial infarction is diagnosed in a substantial proportion of MI patients and is independently associated with concomitant anemia, left bundle branch block, absence of ST-segment elevation, older age, and the echocardiographic absence of local hypo- and akinesia of the left ventricle

A Case Report of Differential Diagnosis of Causes of Severe Valvular Heart Disease (Takayasu's Arteritis, Infective Endocarditis and Myxomatous Degeneration) with the Key Role of Histological and PCR Examination

Aortic valve lesion is a common and may have diverse causes, from degenerative, congenital and infectious diseases to autoimmune conditions. We present a rare case of Takayasu arteritis and severe heart lesion due to the myxomatous degeneration of the aortic and mitral valves associated with development of infective endocarditis (IE) complicated by abscess, fistula, valve perforation and recurrent acute decompensated heart failure in a young female patient. A combined use of histopathological and PCR analyses of valve tissues was critically important for differential diagnosis of the valve lesions, as it made it possible to identify the true cause of the disease. The presence of Takayasu arteritis has played an indirect role by creating conditions for the development of immunosuppression and determining the disease severity and its progression

Linking databases on perinatal health: a review of the literature and current practices in Europe

BACKGROUND: International comparisons of perinatal health indicators are complicated by the heterogeneity of data sources on pregnancy, maternal and neonatal outcomes. Record linkage can extend the range of data items available and thus can improve the validity and quality of routine data. We sought to assess the extent to which data are linked routinely for perinatal health research and reporting. METHODS: We conducted a systematic review of the literature by searching PubMed for perinatal health studies from 2001 to 2011 based on linkage of routine data (data collected continuously at various time intervals). We also surveyed European health monitoring professionals about use of linkage for national perinatal health surveillance. RESULTS: 516 studies fit our inclusion criteria. Denmark, Finland, Norway and Sweden, the US and the UK contributed 76% of the publications; a further 29 countries contributed at least one publication. Most studies linked vital statistics, hospital records, medical birth registries and cohort data. Other sources were specific registers for: cancer (70), congenital anomalies (56), ART (19), census (19), health professionals (37), insurance (22) prescription (31), and level of education (18). Eighteen of 29 countries (62%) reported linking data for routine perinatal health monitoring. CONCLUSION: Research using linkage is concentrated in a few countries and is not widely practiced in Europe. Broader adoption of data linkage could yield substantial gains for perinatal health research and surveillance

Wallace Stevens\u27 Nature Religion: Agama Semesta Ciptaan Wallace Stevens

Penelitian ini bertujuan untuk mendeskripsikan pandangan, kepercayaan, dan sikap Amerika terhadap agama semesta sebagaimana terlihat dalam tiga pusi Wallace Stevens yang berjudul: "Sunday Morning", "Thirteen Ways of Looking at the Blackbird", dan "The Idea of Order at Key West". Penelitian ini dilaksanakan dengan studi pustaka yang memfokuskan perhatian pada sumber-sumber referensi yang berkaitan dengan topik yang dibicarakan. Penelitian dengan sudut pandang Kajian Amerika ini menggunakan pendekatan interdisipliner. Dengan melibatkan pendekatan filsafat, agama, sosiologi, dan sejarah peneliti mencoba menunjukkan bahwa agama semesta telah mendapat simpati yang mendalam sejak Amerika menyadari bahwa tradiri Kristen tak mampu memenuhi kebutuhan spiritual mereka. Hasil penelitian menunjukkan bahwa Amerika percaya pada kekuatan agama semesta yang mampu mengkomunikasikan aspek-aspek keindahan, kebenaran, kebijalcsanaan, dan kejeniusan. Kepercayaan ini telah mengantar Amerika untuk mencapai kehidupan beragama yang mendalam. Agama semesta jug mengubah perspektif amerika akan hubungan Tuhan, manusia, dan alam. Kata kunci: agama semesta sains dan teknologi abad kehilangan kepercayaan â Kristen tradisi

Ventricular-arterial coupling parameters and its prognostic value in patients with decompensated heart failure

Aim. To assess ventricular-arterial coupling (VAC) parameters and their prognostic value in patients with decompensated heart failure (HF).Material and methods. VAC parameters were evaluated upon admission using two-dimensional echocardiography in 355 patients hospitalized with decompensated HF. VAC was expressed as the ratio between arterial elastance (Ea) and end-systolic LV elastance (Ees). The optimal VAC range was considered 0,6-1,2. Parameters of left ventricular (LV) efficacy were calculated using the appropriate formulas. Differences were considered significant at p&lt;0,05.Results. The median values of Ea, Ees and VAC were 2,2 (1,7;2,9) mmHg/ml, 1,8 (1,0;3,0) mmHg/ml and 1,32 (0,75;2,21) respectively. In 63% of patients, VAC disorders were detected: 55% of patients had VAC &gt;1,2 (predominantly patients with HF with reduced ejection fraction (HFrEF)-79%), 8% of patients had VAC &lt;0,6 (all patients with HF with preserved ejection fraction (HFpEF)). Normal VAC was observed in 78%, 42%, and 1% of patients with HFpEF, HF with mid-range EF and HFrEF, respectively. There was significant correlation between Ea/Ees ratio and levels of NTproBNP (R=0,35), hematocrit (R=-0,29), hemoglobin (R=-0,26), pulmonary artery systolic pressure (PAPs) (R=0,18), dimensions of left atrium (R=0,32) and right ventricle (RV) (R=0,32). After 6 months, rehospitalization with decompensated HF was recorded in 72 (20,3%) patients, 42 (11,8%) patients died. Ea decrease &lt;2,2 mmHg/ml and PAPs increase &gt;45 mmHg increased the risk of rehospitalization with decompensated HF and all-cause mortality 2,5 and 3,7 times, respectively.Conclusion. Impaired VAC was diagnosed in 63% of patients with decompensated HF. However, the increased risk of all-cause mortality and rehospitalization with decompensated HF over the 6 months was associated with Ea decrease &lt;2,2 mmHg/ml and PAPs increase &gt;45 mmHg