Variation in annual volume at a university hospital does not predict mortality for pancreatic resections.

Annual volume of pancreatic resections has been shown to affect mortality rates, prompting recommendations to regionalize these procedures to high-volume hospitals. Implementation has been difficult, given the paucity of high-volume centers and the logistical hardships facing patients. Some studies have shown that low-volume hospitals achieve good outcomes as well, suggesting that other factors are involved. We sought to determine whether variations in annual volume affected patient outcomes in 511 patients who underwent pancreatic resections at the University of California, San Francisco between 1990 and 2005. We compared postoperative mortality and complication rates between low, medium, or high volume years, designated by the number of resections performed, adjusting for patient characteristics. Postoperative mortality rates did not differ between high volume years and medium/low volume years. As annual hospital volume of pancreatic resections may not predict outcome, identification of actual predictive factors may allow low-volume centers to achieve excellent outcomes

The Effect of Job Design, Cohesiveness, and Stress to Work Effectiveness of Teachers at PAUD Koja Sub District North Jakarta

The objective of this research was to determine the effect ofjob design, cohesiveness, and stress to work effectiveness of teacher PAUD at Koja Sub District, North Jakarta. The research was conducted by using a survey method with path analysis applied in testing hypothesis. The target population size of this research is 165 of teachers. Research samples selected as much as 117 teachers using simple random sampling technique. Based on this research of data obtained the following conclusions: (1) the job design has positive direct effect to work effectiveness, (2) the cohesivenessh aspositive direct effect towork effectiveness, (3) stress has negative direct effect to work effectiveness, (4) the job design has negative direct effect to stress,(5) cohesiveness have positive direct effect to stress. The conclusion is that the teacher’s work effectiveness is effected by the job design, cohesiveness, and teacher’s stress. Keywords: Work effectiveness, job design, cohesiveness, and stress DOI: 10.7176/JEP/10-18-20 Publication date:June 30th 201

Utilization of Health Facilities by Pregnant Women at Pekauman Community Health Center, Banjarmasin, Indonesia

The purpose of this study is to analyze the relationship between the use of government health facilities with predisposing factors (preference and self-efficacy) and reinforcing factors (support) in pregnant women. This survey research with a cross-sectional study design was conducted in the Pekauman Community Health Center's working area in Banjarmasin, Indonesia, with 125 respondents who had babies aged ? six months who lived in the Pekauman Community Health Center's working area who visited the integrated service post in August 2017. The analysis was performed using the Chi-Square test. The results of the study 89 respondents (71.2%) made use of antenatal care facilities; 92 respondents (73.6%) chose health facilities; 88 respondents (70, 4%) have high self-efficacy; 78 respondents (62.4%) received support (family, friends, social groups). This research concludes that there is a relationship between the preferences of pregnant women (p= 0.025) with the use of antenatal services in government health facilities; There was no relationship between self-efficacy (p= 0.096); there is no relationship between family support, friends, social groups (p= 0.227) with the use of antenatal care for pregnant women in government health facilities. It is suggested to conduct further research on the relationship between antenatal services for pregnant women in government health facilities with the completeness of health facilities and the level of respondent satisfaction

Kadar Timbel dalam Darah Siswa Sekolah Dasar di Sekitar Peleburan Aki Bekas di Kabupaten Tangerang dan Lamongan

Logam Timbel (Pb) merupakan salah satu logam berat yang dimanfaatkan secara luas dalam industri aki. Aki timbel yang sudah tidak terpakai masih memiliki nilai ekonomis lewat proses peleburan (smelting), namun logam timbel memiliki efek negatif terhadap kesehatan. Paparan timbel dalam darah (BLL/ Blood Lead Level) khususnya pada anak-anak dapat mengakibatkan penurunan tingkat kecerdasan, masalah kesehatan, bahkan berdampak sosial. Untuk mengetahui tingkat pajanan timbel yang dihasilkan pabrik peleburan aki bekas di Kabupaten Tangerang dan Kabupaten Lamongan, dilakukan pengukuran kadar timbel dalam darah siswa Madrasah Ibtidaiyah (MI) Baitussa'adah dan SDN Bulu Tengger yang terletak di sekitar pabrik tersebut. Pengukuran konsentrasi timbel dalam darah dilakukan dengan menggunakan Lead Care Portable Analyzer. Telah diperoleh rata-rata konsentrasi timbel dalam darah anak-anak MI Baitussa'adah mencapai 32,0 µg/dL, dengan konsentrasi minimum 15,5 µg/dL, konsentrasi maksimum tidak dapat dipastikan karena melampaui batas maksimum deteksi alat (65 µg/dL). Dari 69 sampel darah anak-anak SDN Bulu Tengger, diketahui rata-rata konsentrasi timbel dalam darah mencapai 11,8 µg/dL, dengan konsentrasi minimum 5 µg/dL, dan konsentrasi maksimum 30,8 µg/dL. Nilai tersebut jauh di atas nilai rujukan WHO tahun 1991 dan The Centers for Disease Control and Prevention's (CDC) tahun 2012. Hal ini menunjukkan pajanan timbel dari pabrik peleburan aki bekas sudah sangat membahayakan dan mengancam kesehatan masyarakat sekitar khususnya anak-anak usia sekolah

Pulmonary drug delivery: Role of antibiotic formulations for treatment of respiratory tract infections

Respiratory infections cause an extensive health problem in the world. The common treatment for respiratory infections is the administration of antibiotics orally or parenterally in a high dose. Unfortunately, these therapies of high-dose antimicrobials have many disadvantages, such as severe side effects. Consequently, the development of an inhaled formulation provides the delivery of the therapeutic dose of the drug to the organ of interest without overt systemic effects. Novel technological advances have led to the development of inhaled antibiotics. Recent particle engineering techniques for dry powder inhalers (DPI) or mesh nebulizers have higher aerosolization efficiencies and promote the delivery of high-dose antibiotics to the lungs. However, advanced formulation strategies are in high demand for the development of new formulations for more types of antibiotics. Despite all the current research, patient compliance with pulmonary dosage forms remains to be very low because of the inappropriate administration techniques. Hence, this review focuses on three key aspects of the pulmonary dosage forms of antibiotics; the marketed products, the formulation approaches under research and innovative formulation strategies for achieving drug delivery through the respiratory tract

Success rates of re-excision after positive margins for invasive lobular carcinoma of the breast.

Rates of positive margins after surgical resection of invasive lobular carcinoma (ILC) are high (ranging from 18 to 60%), yet the efficacy of re-excision lumpReceptor subtypeectomy for clearing positive margins is unknown. Concerns about the diffuse nature of ILC may drive increased rates of completion mastectomy to treat positive margins, thus lowering breast conservation rates. We therefore determined the success rate of re-excision lumpectomy in women with ILC and positive margins after surgical resection. We identified 314 cases of stage I-III ILC treated with breast conserving surgery (BCS) at the University of California, San Francisco. Surgical procedures, pathology reports, and outcomes were analyzed using univariate and multivariate statistics and Cox-proportional hazards models. We evaluated outcomes before and after the year 2014, when new margin management consensus guidelines were published. Positive initial margins occurred in 118 (37.6%) cases. Of these, 62 (52.5%) underwent re-excision lumpectomy, which cleared the margin in 74.2%. On multivariate analysis, node negativity was significantly associated with successful re-excision (odds ratio [OR] 3.99, 95% CI 1.15-13.81, p = 0.029). After 2014, we saw fewer initial positive margins (42.7% versus 25.5%, p = 0.009), second surgeries (54.6% versus 20.2%, p < 0.001), and completion mastectomies (27.7% versus 4.5%, p < 0.001). In this large cohort of women with ILC, re-excision lumpectomy was highly successful at clearing positive margins. Additionally, positive margins and completion mastectomy rates significantly decreased over time. These findings highlight improvements in management of ILC, and suggest that completion mastectomy may not be required for those with positive margins after initial BCS