KEBIJAKAN KEPALA SEKOLAH DALAM PENINGKATAN EFEKTIVITAS PEMBELAJARAN ONLINE PADA MASA COVID-19 DI SMA NEGERI 2 TANJUNG JABUNG TIMUR

Penelitian ini membahas Tentang Kebijakan Kepala sekolahDalam Peningkatan Efektivitas Pembelajaran Online Pada Masa Covid-19 Di SMA Negeri 2 Tanjung Jabung Timur. Selanjutnya dapat dijadikan refrensi dan motivasi terhadap pengembangan literasi terutama dalam peningkatan efektifitas pembelajaran siswa hingga tercapainya tujuan pembelajaran sesuai yang diharapkan. Penelitian ini menggunakan pendekatan kualitatif deskriftif dengan mengunakan metode pengumpulan data observasi, wawancara dan dokumentasi. Tahap teknik analisis data meliputi reduksi data, penyajian data dan verifikasi data, sedangkan pengecekan keterpercayaan data dilakukan dengan perpanjangan keikutsertaan, ketelitian pengamatan, triangulasi dan melakukan konsultasi ke pembimbing. Hasil penelitian menunjukkan bahwa: (1)Kebijakan Kepala Sekolah dalam peningkatan Efektivitas Pembelajaran Online Pada Masa Covid-19 Di Sman 2 Tanjung Jabung Timurdiantaranya sebagai a). daring dan luring, b). Kurikulum. 3) pembelajaran, melalui beberapa tahapan sebagai berikut: 1) Perencanaan, 2) Pengorganisasian, 3) Pengawasan Yang dilakukan langsung oleh kepala sekolah.(2). Faktor Pendorong dan Penghambat Penerapan Kebijakan Kepalah Sekolah Dalam peningkatan Efektivitas Pembelajaran Online Pada Masa Covid�19 di SMAN 2 Tanjung Jabung Timurseperti:a). Tersedianya perangkat handphone bagi siswa dan guru. 2). Adanya groupWhatsap, 3). Guru dapat memahami tingkat kepedulian orang tua terhadap anaknya dalam hal belajar, 4). Kerjasama yang baik antara orang tua engan guru. Adapun faktor penghambat yaitu, terkendala dalam sinyal dan kuota internet. Sinyal yang tidak stabil serta terbatasnya kuota internet membuat guru dan siswa dalam proses pembelajaran daring/luring tersebut tidak berjalan dengan maksimal. Faktor penghambat lainnya dalam mengimplementasikan pembelajaran daring/luring di SMAN 2 Tanjung Jabung Timur, yaitu dari antusias siswa yang kurang, (3) Efektivitas Pembelajaran SMAN 2 Tanjung Jabung Timur. Telah berjlan dengan efektiv namun belum maksimal

Factors associated with the usage of pharmacy value-added services at public health clinics in the state of Perlis, Malaysia

Pharmacy value-added services were developed to make it easier for patients to refill their chronic prescriptions in public health facilities in Malaysia. However, little is known about patients’ awareness, attitudes and practice towards pharmacy value-added services provided by health clinics. This study was conducted to investigate factors associated with the usage of pharmacy value-added services at public health clinics in Perlis, Malaysia. A cross-sectional study was conducted from January to March 2021 at the pharmacy waiting area of all public health clinics in Perlis. All patients (≥18 years old) taking chronic medications and with the need to follow-up at the health clinic in Perlis were recruited in this study using quota sampling. Data was collected using a validated self-administered questionnaire. Descriptive analyses on the usage, awareness and attitudes of respondents were performed, followed by multiple logistic regression. A total of 582 patients responded to this study (response rate, 97.0%). Only 12.9% of respondents used pharmacy value-added services offered by health clinics. Age, gender, ethnicity, education level, occupation, monthly household income, length of stay in Perlis, distance from home to the clinic, total awareness and attitudes scores were factors significantly associated with the practice of pharmacy value-added services after adjusting for other variables (p<0.05). In conclusion, the proportion of patients using pharmacy value-added services at health clinics in Perlis is still low. The study’s findings suggest that a more extensive promotion of pharmacy value-added services is needed to ensure more patients could benefit from these services

Ulnar dimelia variant: a case report

We report a case of ulnar dimelia, commonly called mirror hand, in a 2-month-old female child who had restriction of elbow flexion and forearm rotation. There was no facial or other internal organ malformation. Radiographs revealed seven triphalangeal digits with double ulnae (one following the other) and absent radius. To the best of the authors’ knowledge, this is the first report of this mirror hand deformity in which fingers are symmetrical while duplicated ulnae are not

The Clinical Relevance of Manometric Esophagogastric Junction Outflow Obstruction Can Be Determined Using Rapid Drink Challenge and Solid Swallows

INTRODUCTION: Esophagogastric junction outflow obstruction (EGJOO) defined on high-resolution esophageal manometry (HRM) poses a management dilemma given marked variability in clinical manifestations. We hypothesized that findings from provocative testing (rapid drink challenge and solid swallows) could determine the clinical relevance of EGJOO. METHODS: In a retrospective cohort study, we included consecutive subjects between May 2016 and January 2020 with EGJOO. Standard HRM with 5-mL water swallows was followed by provocative testing. Barium esophagography findings were obtained. Cases with structural obstruction were separated from functional EGJOO, with the latter categorized as symptom-positive or symptom-negative. Only symptom-positive subjects were considered for achalasia-type therapies. Sensitivity and specificity for clinically relevant EGJOO during 5-mL water swallows, provocative testing, and barium were calculated. RESULTS: Of the 121 EGJOO cases, 76% had dysphagia and 25% had holdup on barium. Ninety-seven cases (84%) were defined as functional EGJOO. Symptom-positive EGJOO subjects were more likely to demonstrate abnormal motility and pressurization patterns and to reproduce symptoms during provocative testing, but not with 5-mL water swallows. Twenty-nine (30%) functional EGJOO subjects underwent achalasia-type therapy, with symptomatic response in 26 (90%). Forty-eight (49%) functional EGJOO cases were managed conservatively, with symptom remission in 78%. Although specificity was similar, provocative testing demonstrated superior sensitivity in identifying treatment responders from spontaneously remitting EGJOO (85%) compared with both 5-mL water swallows (54%; P < 0.01) and barium esophagography (54%; P = 0.02). DISCUSSION: Provocative testing during HRM is highly accurate in identifying clinically relevant EGJOO that benefits from therapy and should be routinely performed as part of the manometric protocol

Triggering the internationalization of Malaysian quantity surveying firms

Although there is an increasing trend of services being traded across borders, quantity surveying (QS) firms in the construction sector remain under-researched. The triggers for the increasing globalization of QS firms are not clear, nor how these triggers are perceived by managers at different levels. A questionnaire was administered in over 84 QS consultancy firms, and the results were analyzed using the repertory grid technique, allowing a comparison between the general respondents and a focus group of senior managers. The findings show that senior managers with significant experience realize the importance of a strong internal capability of the QS firm and the capability to develop innovative offerings, coupled with an awareness of the target market and the ability to secure revenue through key contracts. Firm- and location-specific factors were more important than other competitive advantages or foreign markets’ characteristics when deciding to globalize

High Effective Coverage of Vector Control Interventions in Children After Achieving Low Malaria Transmission in Zanzibar, Tanzania.

\ud \ud Formerly a high malaria transmission area, Zanzibar is now targeting malaria elimination. A major challenge is to avoid resurgence of malaria, the success of which includes maintaining high effective coverage of vector control interventions such as bed nets and indoor residual spraying (IRS). In this study, caretakers' continued use of preventive measures for their children is evaluated, following a sharp reduction in malaria transmission. A cross-sectional community-based survey was conducted in June 2009 in North A and Micheweni districts in Zanzibar. Households were randomly selected using two-stage cluster sampling. Interviews were conducted with 560 caretakers of under-five-year old children, who were asked about perceptions on the malaria situation, vector control, household assets, and intention for continued use of vector control as malaria burden further decreases. Effective coverage of vector control interventions for under-five children remains high, although most caretakers (65%; 363/560) did not perceive malaria as presently being a major health issue. Seventy percent (447/643) of the under-five children slept under a long-lasting insecticidal net (LLIN) and 94% (607/643) were living in houses targeted with IRS. In total, 98% (628/643) of the children were covered by at least one of the vector control interventions. Seasonal bed-net use for children was reported by 25% (125/508) of caretakers of children who used bed nets. A high proportion of caretakers (95%; 500/524) stated that they intended to continue using preventive measures for their under-five children as malaria burden further reduces. Malaria risk perceptions and different perceptions of vector control were not found to be significantly associated with LLIN effective coverage While the majority of caretakers felt that malaria had been reduced in Zanzibar, effective coverage of vector control interventions remained high. Caretakers appreciated the interventions and recognized the value of sustaining their use. Thus, sustaining high effective coverage of vector control interventions, which is crucial for reaching malaria elimination in Zanzibar, can be achieved by maintaining effective delivery of these interventions

Adverse clinical sequelae after skin branding: a case series

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

The ADAMTS (A Disintegrin and Metalloproteinase with Thrombospondin motifs) family

The ADAMTS (A Disintegrin and Metalloproteinase with Thrombospondin motifs) enzymes are secreted, multi-domain matrix-associated zinc metalloendopeptidases that have diverse roles in tissue morphogenesis and patho-physiological remodeling, in inflammation and in vascular biology. The human family includes 19 members that can be sub-grouped on the basis of their known substrates, namely the aggrecanases or proteoglycanases (ADAMTS1, 4, 5, 8, 9, 15 and 20), the procollagen N-propeptidases (ADAMTS2, 3 and 14), the cartilage oligomeric matrix protein-cleaving enzymes (ADAMTS7 and 12), the von-Willebrand Factor proteinase (ADAMTS13) and a group of orphan enzymes (ADAMTS6, 10, 16, 17, 18 and 19). Control of the structure and function of the extracellular matrix (ECM) is a central theme of the biology of the ADAMTS, as exemplified by the actions of the procollagen-N-propeptidases in collagen fibril assembly and of the aggrecanases in the cleavage or modification of ECM proteoglycans. Defects in certain family members give rise to inherited genetic disorders, while the aberrant expression or function of others is associated with arthritis, cancer and cardiovascular disease. In particular, ADAMTS4 and 5 have emerged as therapeutic targets in arthritis. Multiple ADAMTSs from different sub-groupings exert either positive or negative effects on tumorigenesis and metastasis, with both metalloproteinase-dependent and -independent actions known to occur. The basic ADAMTS structure comprises a metalloproteinase catalytic domain and a carboxy-terminal ancillary domain, the latter determining substrate specificity and the localization of the protease and its interaction partners; ancillary domains probably also have independent biological functions. Focusing primarily on the aggrecanases and proteoglycanases, this review provides a perspective on the evolution of the ADAMTS family, their links with developmental and disease mechanisms, and key questions for the future

Hypoglycemia Assessed by Continuous Glucose Monitoring Is Associated with Preclinical Atherosclerosis in Individuals with Impaired Glucose Tolerance

Hypoglycemia is associated with increased risk of cardiovascular adverse clinical outcomes. There is evidence that impaired glucose tolerance (IGT) is associated with cardiovascular morbidity and mortality. Whether IGT individuals have asymptomatic hypoglycemia under real-life conditions that are related to early atherosclerosis is unknown. To this aim, we measured episodes of hypoglycemia during continuous interstitial glucose monitoring (CGM) and evaluated their relationship with early manifestation of vascular atherosclerosis in glucose tolerant and intolerant individuals. An oral glucose tolerance test (OGTT) was performed in 79 non-diabetic subjects. Each individual underwent continuous glucose monitoring for 72 h. Cardiovascular risk factors and ultrasound measurement of carotid intima-media thickness (IMT) were evaluated. IGT individuals had a worse cardiovascular risk profile, including higher IMT, and spent significantly more time in hypoglycemia than glucose-tolerant individuals. IMT was significantly correlated with systolic (r = 0.22; P = 0.05) and diastolic blood pressure (r = 0.28; P = 0.01), total (r = 0.26; P = 0.02) and LDL cholesterol (r = 0.27; P = 0.01), 2-h glucose (r = 0.39; P<0.0001), insulin sensitivity (r = −0.26; P = 0.03), and minutes spent in hypoglycemia (r = 0.45; P<0.0001). In univariate analyses adjusted for gender, minutes spent in hypoglycemia were significantly correlated with age (r = 0.26; P = 0.01), waist circumference (r = 0.33; P = 0.003), 2-h glucose (r = 0.58; P<0.0001), and 2-h insulin (r = 0.27; P = 0.02). In a stepwise multivariate regression analysis, the variables significantly associated with IMT were minutes spent in hypoglycemia (r2 = 0.252; P<0.0001), and ISI index (r2 = 0.089; P = 0.004), accounting for 34.1% of the variation. Episodes of hypoglycemia may be considered as a new potential cardiovascular risk factor for IGT individuals

Groundwater resources assessment using integrated geophysical techniques in the southwestern region of Peninsular Malaysia.

Combined geophysical techniques such as multi-electrode resistivity, induced polarization, and borehole geophysical techniques were carried out on volcano-sedimentary rocks in the north of Gemas as part of the groundwater resource’s investigations. The result identifies four resistivity units: the tuffaceous mudstone, tuffaceous sandstone, the tuff bed, and the shale layer. Two types of aquifer systems in terms of storage were identified within the area: one within a fracture system (tuff), which is the leaky area through which vertical flow of groundwater occurs, and an intergranular property of the sandy material of the aquifer which includes sandstone and tuffaceous sandstone. The result also reveals that the aquifer occupies a surface area of about 3,250,555 m2 with a mean depth of 43.71 m and a net volume of 9.798 × 107 m3. From the approximate volume of the porous zone (28 %) and the total aquifer volume, a usable capacity of (274.339 ± 30.177) × 107 m3 of water in the study area can be deduced. This study provides useful information that can be used to develop a much broader understanding of the nature of groundwater potential in the area and their relationship with the local geology