METODE PEMBELAJAAN DISKUSI DALAM PENINGKATAN KOMPETENSI PESERTA DIKLAT

The Implementation of effective learning methods that expected to improve the effectiveness of teaching and learning can walk dynamically, so that the goals and objectives of any training material that given will be absorb as well as possible by the training participants. Thus the selection of appropriate learning methods is a necessity in learning process to improve the competence of training participants which is a blend of knowledge, skills, motivation, attitude and personal characteristics shown in behavior and the influence performance of the training participants. Use of discussion teaching method has many advantages, meanwhile, from the aspects that discussed by the participants can grow up even from the outside aspects which discussed by the lecturers. The increase of competence training participants in terms of knowledge is more focused on the understanding of science and to share experiences, while the competence of attitude measured with the change the behavior of training participants after join the training where they more be patient to face the society behavior, also the training of participant skills who have a skills in problem solving in his organization. Widyaiswara as a facilitator can determine the successful in improving the competence of training participants. Therefore the trainers should be able to do their duties in a professional manner with mastering the type of effective learning methods such as discussion teaching methods

Prestroke Physical Activity and Adverse Health Outcomes after Stroke in the Atherosclerosis Risk in Communities Study

Background and Purpose: The association of physical activity (PA) before stroke (prestroke PA) with long-term prognosis after stroke is still unclear. We examined the association of prestroke PA with adverse health outcomes in the ARIC study (Atherosclerosis Risk in Communities). Methods: We included 881 participants with incident stroke occurring between 1993 and 1995 (visit 3) and December 31, 2016. Follow-up continued until December 31, 2017 to allow for at least 1-year after incident stroke. Prestroke PA was assessed using a modified version of the Baecke questionnaire in 1987 to 1989 (visit 1) and 1993 to 1995 (visit 3), evaluating PA domains (work, leisure, and sports) and total PA. We used Cox proportional hazards models to quantify the association between tertiles of accumulated prestroke PA levels over the 6-year period between visits 1 and 3 and mortality, risk of cardiovascular disease, and recurrent stroke after incident stroke. Results: During a median follow-up of 3.1 years after incident stroke, 676 (77%) participants had adverse outcomes. Highest prestroke total PA was associated with decreased risks of all-cause mortality (hazard ratio, 0.78 [95% CI, 0.63-0.97]) compared with lowest tertile. In the analysis by domain-specific PA, highest levels of work PA were associated with lower risk for all-cause (hazard ratio, 0.77 [95% CI, 0.62-0.96]) and cardiovascular mortality (hazard ratio, 0.45 [95% CI, 0.29-0.70]), and highest levels of leisure PA were associated with lower all-cause mortality (hazard ratio, 0.72 [95% CI, 0.58-0.89]) compared with lowest tertile of PA. No significant associations for sports PA were observed. Conclusions: Higher levels of total prestroke PA as well as work and leisure PA were associated with lower risk of mortality after incident stroke. Public health strategies to increase lifetime PA should be encouraged to decrease long-term mortality after stroke

Life's Simple 7 at Midlife and Risk of Recurrent Cardiovascular Disease and Mortality after Stroke: The ARIC study

Background: Stroke is a leading cause of morbidity and mortality among adults in the U.S. Ideal levels of the Life's Simple 7 (LS7) are associated with lower cardiovascular disease (CVD) and all-cause mortality. However, the association of LS7 with CVD, recurrent stroke, and all-cause mortality after incident stroke is unknown. Methods: We used data from the ARIC study, a cohort of 13,508 adults from four US communities, 45–64 years old at baseline (1987–1989). Cardiovascular hospitalizations and mortality were ascertained in follow-up through December 31st, 2017. We defined cardiovascular health (CVH) based on AHA definitions for LS7 (range 0-14) and categorized CVH into four levels: LS7 0-3, 4-6, 7-9, and ≥10 (ideal LS7), according to prior studies. Outcomes included incident stroke, CVD, recurrent stroke, all-cause mortality, and a composite outcome including all the above. Adjusted hazard ratios (95% CI) were estimated with Cox proportional hazards regression models. Results: Median (25%-75%) follow-up for incident stroke was 28 (18.6-29.2) years. Participants with incident stroke were 55.7 (SD 5.6) years-old at baseline, 53% were women and 35% Black. Individuals with LS7 score ≥10 had 65% lower risk (HR: 0.35; 95% CI: 0.29-0.41) of incident stroke than those with LS7 4-6 (reference group). Of 1,218 participants with incident stroke, 41.2% (n=502) had composite CVD and 68.3% (n=832) died during a median (25%-75%) follow-up of 4.0 (0.76-9.95) years. Adjusted HR (95% CI) for stroke survivors with LS7≥10 at baseline were 0.74 (0.58-0.94) for the composite outcome, 0.38(0.17-0.85) for myocardial infarction, 0.60 (0.40-0.90) for heart failure, 0.63 (0.48-0.84) for all-cause mortality, and 0.65 (0.39-1.08) for recurrent stroke. Conclusions: Good and excellent midlife cardiovascular health are associated with lower risks of incident stroke and CVD after stroke. Clinicians should stress the importance of a healthy lifestyle for primary and secondary CVD prevention

Development and implementation of clinical guidelines : an artificial intelligence perspective

Clinical practice guidelines in paper format are still the preferred form of delivery of medical knowledge and recommendations to healthcare professionals. Their current support and development process have well identified limitations to which the healthcare community has been continuously searching solutions. Artificial intelligence may create the conditions and provide the tools to address many, if not all, of these limitations.. This paper presents a comprehensive and up to date review of computer-interpretable guideline approaches, namely Arden Syntax, GLIF, PROforma, Asbru, GLARE and SAGE. It also provides an assessment of how well these approaches respond to the challenges posed by paper-based guidelines and addresses topics of Artificial intelligence that could provide a solution to the shortcomings of clinical guidelines. Among the topics addressed by this paper are expert systems, case-based reasoning, medical ontologies and reasoning under uncertainty, with a special focus on methodologies for assessing quality of information when managing incomplete information. Finally, an analysis is made of the fundamental requirements of a guideline model and the importance that standard terminologies and models for clinical data have in the semantic and syntactic interoperability between a guideline execution engine and the software tools used in clinical settings. It is also proposed a line of research that includes the development of an ontology for clinical practice guidelines and a decision model for a guideline-based expert system that manages non-compliance with clinical guidelines and uncertainty.This work is funded by national funds through the FCT – Fundação para a Ciência e a Tecnologia (Portuguese Foundation for Science and Technology) within project PEst-OE/EEI/UI0752/2011"

Mesenchymal stem cell-based therapy for ischemic stroke

Ischemic stroke represents a major, worldwide health burden with increasing incidence. Patients affected by ischemic strokes currently have few clinically approved treatment options available. Most currently approved treatments for ischemic stroke have narrow therapeutic windows, severely limiting the number of patients able to be treated. Mesenchymal stem cells represent a promising novel treatment for ischemic stroke. Numerous studies have demonstrated that mesenchymal stem cells functionally improve outcomes in rodent models of ischemic stroke. Recent studies have also shown that exosomes secreted by mesenchymal stem cells mediate much of this effect. In the present review, we summarize the current literature on the use of mesenchymal stem cells to treat ischemic stroke. Further studies investigating the mechanisms underlying mesenchymal stem cells tissue healing effects are warranted and would be of benefit to the field

Measurement and assessment of exposure to ultrasonic noise at workstations in view of new regulations

Zawodowa ekspozycja na hałas ultradźwiękowy, zaliczany do szkodliwych czynników fizycznych środowiska pracy, może powodować niekorzystne zmiany w zdrowiu pracowników. W celu oceny stopnia narażenia pracowników na ten czynnik i określenia związanego z nim ryzyka zawodowego, konieczne są pomiary hałasu ultradźwiękowego na stanowiskach pracy i jeśli jest to uzasadnione, ograniczanie występującego zagrożenia. W artykule przedstawiono nowe zasady pomiarów hałasu ultradźwiękowego dostosowane do znowelizowanych w 2001 r. przepisów prawnych dotyczących najwyższych dopuszczalnych natężeń (NDN) omawianego czynnika.Occupational exposure to ultrasonic noise - one on the physical agents in the working environment - can cause adverse effects on workers’ health. In order to evaluate workers’ exposure to this agent and to determine resultant risk, it is necessary to measure ultrasonic noise at workstations and, if this is justified, to reduce the hazard. This paper presents new methods of measuring and evaluating ultrasonic noise, which are adjusted to the new regulations on threshold limit values of this type of noise

Selection of personal protective equipment for preventing hand-arm vibration syndrome

W artykule przedstawiono wyniki badań skuteczności ochrony wnoszonej przez wybrane rękawice antywibracyjne przy ich zastosowaniu do prac różnymi narzędziami ręcznymi. Wykazano, że rękawice antywibracyjne są pomocnym środkiem w profilaktyce zespołu wibracyjnego, choć nie zawsze ograniczają ryzyko zawodowe pojawienia się tej choroby do poziomu dopuszczalnego ze względu na ochronę zdrowia. Wykazano też, że rękawice antywibracyjne powinny być dobierane do narzędzi lub ich typów.The paper presents research results relating to the effectiveness of an antivibration glove in reducing vibration when it is worn by users of various vibratory tools. It bas bean shown that antivibration gloves can be a helpful measure in preventing the occupational risk of hand-transmitted vibration damage. In order to achieve as maximum a degree of protection as possible, It is necessary to select antivibration gloves for particular vibratory tools