699 research outputs found

    Peran Pusat Pelayanan Terpadu Perempuan Dan Anak Dalam Pendampingan Anak-anak Korban Kekerasan Seksual Bermasalah Sosial Di Kabupaten Wonogiri

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    Sexual violence against children occurs in various places with various types of sexual violence. The majority of victims of sexual violence are children who have social problems example : poverty, children with disabilities and abandoned children who have no education and protection of the family is enough. Therefore, a program of social assistance is necessary. Wonogiri government show concern for child victims of sexual violence by launching Wonogiri Regulation 2 of 2013 on the implementation of the protection of victims of gender-based violence and child and continues to form an Integrated Services Center for Women and Children (P2TP2A) in 2013 as an intermediary between local government and child victims of sexual violence with social problem in a program of social assistance.This study aim is to know the origin Wonogiri local governments establish service centers Integrated Women and children as well as describe the performance of the programs Integrated Services Center for Women and Children on District Wonogiri to child victims of sexual violence with social problem. Data were collected through observation, interviews and related research. Qualitative data analysis techniques with analyzing in the form of description, depiction and conclusions on the object under study.From this research, it can be concluded that since forming Integrated Services Center for Women and Children assistance to child victims of sexual violence in Wonogiri social problems can be managed properly. Management program performance of assistance done by them already effective and sustainable as well as cooperation among agencies and civil society are evolving very helpful in improving the welfare of child victims of sexual abuse, although the lack of human resources from the Integrated Service Center of Women and children (P2TP2A) and lack of supervision of the Local Government in the performance of the related SKPD when doing assistance program an obstacle than an assistance program was established

    Exercise Intervention to Improve Functional Capacity in Older Adults After Acute Coronary Syndrome

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    More than one-half of patients admitted for acute coronary syndrome (ACS) are age 70years.MobilitylimitationsandsedentarybehaviorarecommoninolderACSpatientsandcontributetohighriskofrecurrenceandmortality(1).AlthougholderACSpatientsmaybenefitthemostfromparticipationinexercisebasedcardiacrehabilitation/secondarypreventionprograms(CR/SP),theyarelesslikelytoparticipateinsuchprograms(2).Whetheranearly,individualized,andlowcostphysicalactivity(PA)interventionincludingafewsupervisedsessionsandahomebasedprogrammightbefeasibleandeffectiveforimprovingfunctionalcapacityinthishighriskandundertreatedpopulationisunknown.TheHULK(PhysicalActivityInterventionforPatientsWithReducedPhysicalPerformanceAfterAcuteCoronarySyndrome;NCT03021044)trialisamulticenter,randomizedclinicaltrial.Adetailedstudyoutlineandstatisticalplanhavebeenpreviouslypublished(3).Inclusioncriteriawereage70 years. Mobility limitations and sedentary behavior are common in older ACS patients and contribute to high risk of recurrence and mortality (1). Although older ACS patients may benefit the most from participation in exercise-based cardiac rehabilitation/secondary prevention programs (CR/SP), they are less likely to participate in such programs (2). Whether an early, individualized, and low-cost physical activity (PA) intervention including a few supervised sessions and a home-based program might be feasible and effective for improving functional capacity in this high-risk and undertreated population is unknown. The HULK (Physical Activity Intervention for Patients With Reduced Physical Performance After Acute Coronary Syndrome; NCT03021044) trial is a multicenter, randomized clinical trial. A detailed study outline and statistical plan have been previously published (3). Inclusion criteria were age 70 years, hospitalization for ACS, and Short Physical Performance Battery (SPPB) score between 4 and 9 at the inclusion visit (30 5 days after hospital discharge). The SPPB is a scale that combines gait speed, chair stand, and balance tests. It ranges from 0 (worst) to 12 (best) and has predictive validity for mortality (4). Participants were randomized to usual care and health education (control group) or usual care and PA intervention (intervention group). The control group received a 20-min session and a detailed brochure stressing the importance of PA in cardiovascular health. The PA intervention consisted of four supervised sessions (1, 2, 3, and 4 months after hospital discharge), combined with an individualized home-based PA program. Centerbased sessions included a moderate standardized treadmill-walk, strength, and balance exercises (3). After the practice sessions, patients received a tailored PA home program (3). Weekly energy expenditure from PA was determined by a selfreported 7-day physical activity recall (kcal/week), and objectively measured by wearing an accelerometer (min/week). The primary endpoint was the 6- month SPPB. Secondary endpoints were 1-year SPPB and time engaged in PA. From January 2017 to April 2018, 235 patients were randomized (n ¼ 117, control group; n ¼ 118, intervention group). The median age was 76 (interquartile range [IQR]: 73 to 81) years, and 23% were female. Before the hospitalization, light and moderateintensive PA was performed by 66% and 14% of patients, respectively. Baseline characteristics, as well as baseline SPPB value (Figure 1), did not differ between groups. The adherence rates of the PA intervention group to the 1-, 2-, 3-, and 4-month scheduled supervised sessions were 100%, 89%, 85%, and 72%, respectively. The time engaged in PA progressively and significantly increased in the intervention group (Figure 1). At 6 months, the SPPB score was significantly higher in the intervention group (median: 9 [IQR: 8 to 11] vs. 7 [IQR: 5 to 8]; p < 0.001) (Figure 1). This improvement was supported by a significant increase in SPPB components of walking and chair rise (balance remained unchanged). The number of patients showing an increase of at least 1 point in SPPB score was 86 (74%) in the intervention group versus 46 (40%) in the control group (p < 0.001). The SPPB increase was maintained at the 1-year visit (Figure 1) and independent of sex and educational status. Typical CR/SP includes 3 weekly supervised exercise and educational sessions for 12 weeks. Despite the health benefits associated with these interventions, few eligible patients are referred or complete such programs (1). Our novel PA intervention was designed to address this issue. The attendance rate was high (72% [95% confidence interval: 64% to 80%]). The average weekly energy expenditure from PA in the intervention group increased 3.4 times, and SPPB score showed a mean increment of 2.0 points. This finding is notable given that an SPPB improvement of 1.0 point is generally considered a substantial clinically meaningful change (2). In addition, despite the absence of supervised sessions after the sixth month, the achievements were maintained until 1-year visit. If confirmed in future studies, our PA intervention model might help to mitigate the challenges related to limited health care resources and might increase the number of older adults receiving CR/SP

    Medium-density amorphous ice

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    Amorphous ices govern a range of cosmological processes and are potentially key materials for explaining the anomalies of liquid water. A substantial density gap between low-density and high-density amorphous ice with liquid water in the middle is a cornerstone of our current understanding of water. However, we show that ball milling "ordinary" ice Ih at low temperature gives a structurally distinct medium-density amorphous ice (MDA) within this density gap. These results raise the possibility that MDA is the true glassy state of liquid water or alternatively a heavily sheared crystalline state. Notably, the compression of MDA at low temperature leads to a sharp increase of its recrystallization enthalpy, highlighting that H2O can be a high-energy geophysical material

    Weak Interactions in Dimethyl Sulfoxide (DMSO)-Tertiary Amide Solutions: The Versatility of DMSO as a Solvent

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    The structures of equimolar mixtures of the commonly used polar aprotic solvents dimethylformamide (DMF) and dimethylacetamide (DMAc) in dimethyl sulfoxide (DMSO) have been investigated via neutron diffraction augmented by extensive hydrogen/deuterium isotopic substitution. Detailed 3-dimensional structural models of these solutions have been derived from the neutron data via Empirical Potential Structure Refinement (EPSR). The intermolecular center-of-mass (CoM) distributions show that the first coordination shell of the amides comprises ∼13-14 neighbors, of which approximately half are DMSO. In spite of this near ideal coordination shell mixing, the changes to the amide-amide structure are found to be relatively subtle when compared to the pure liquids. Analysis of specific intermolecular atom-atom correlations allows quantitative interpretation of the competition between weak interactions in the solution. We find a hierarchy of formic and methyl C-H···O hydrogen bonds forms the dominant local motifs, with peak positions in the range of 2.5-3.0 Å. We also observe a rich variety of steric and dispersion interactions, including those involving the O═C-N amide π-backbones. This detailed insight into the structural landscape of these important liquids demonstrates the versatility of DMSO as a solvent and the remarkable sensitivity of neutron diffraction, which is critical for understanding weak intermolecular interactions at the nanoscale and thereby tailoring solvent properties to specific applications

    Strong structuring arising from weak cooperative O-H···π and C-H···O hydrogen bonding in benzene-methanol solution

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    Weak hydrogen bonds, such as O-H···π and C-H···O, are thought to direct biochemical assembly, molecular recognition, and chemical selectivity but are seldom observed in solution. We have used neutron diffraction combined with H/D isotopic substitution to obtain a detailed spatial and orientational picture of the structure of benzene-methanol mixtures. Our analysis reveals that methanol fully solvates and surrounds each benzene molecule. The expected O-H···π interaction is highly localised and directional, with the methanol hydroxyl bond aligned normal to the aromatic plane and the hydrogen at a distance of 2.30 Å from the ring centroid. Simultaneously, the tendency of methanol to form chain and cyclic motifs in the bulk liquid is manifest in a highly templated solvation structure in the plane of the ring. The methanol molecules surround the benzene so that the O-H bonds are coplanar with the aromatic ring while the oxygens interact with C-H groups through simultaneous bifurcated hydrogen bonds. This demonstrates that weak hydrogen bonding can modulate existing stronger interactions to give rise to highly ordered cooperative structural motifs that persist in the liquid phase

    Blood ties: ABO is a trans-species polymorphism in primates

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    The ABO histo-blood group, the critical determinant of transfusion incompatibility, was the first genetic polymorphism discovered in humans. Remarkably, ABO antigens are also polymorphic in many other primates, with the same two amino acid changes responsible for A and B specificity in all species sequenced to date. Whether this recurrence of A and B antigens is the result of an ancient polymorphism maintained across species or due to numerous, more recent instances of convergent evolution has been debated for decades, with a current consensus in support of convergent evolution. We show instead that genetic variation data in humans and gibbons as well as in Old World Monkeys are inconsistent with a model of convergent evolution and support the hypothesis of an ancient, multi-allelic polymorphism of which some alleles are shared by descent among species. These results demonstrate that the ABO polymorphism is a trans-species polymorphism among distantly related species and has remained under balancing selection for tens of millions of years, to date, the only such example in Hominoids and Old World Monkeys outside of the Major Histocompatibility Complex.Comment: 45 pages, 4 Figures, 4 Supplementary Figures, 5 Supplementary Table

    Physical activity intervention for elderly patients with reduced physical performance after acute coronary syndrome (HULK study): Rationale and design of a randomized clinical trial

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    Background: Reduced physical performance and impaired mobility are common in elderly patients after acute coronary syndrome (ACS) and they represent independent risk factors for disability, morbidity, hospital readmission and mortality. Regular physical exercise represents a means for improving functional capacity. Nevertheless, its clinical benefit has been less investigated in elderly patients in the early phase after ACS. The HULK trial aims to investigate the clinical benefit of an early, tailored low-cost physical activity intervention in comparison to standard of care in elderly ACS patients with reduced physical performance. Design: HULK is an investigator-initiated, prospective multicenter randomized controlled trial (NCT03021044). After successful management of the ACS acute phase and uneventful first 1 month, elderly (≥70 years) patients showing reduced physical performance are randomized (1:1 ratio) to either standard of care or physical activity intervention. Reduced physical performance is defined as a short physical performance battery (SPPB) score of 4-9. The early, tailored, low-cost physical intervention includes 4 sessions of physical activity with a supervisor and an home-based program of physical exercise. The chosen primary endpoint is the 6-month SPPB value. Secondary endpoints briefly include quality of life, on-treatment platelet reactivity, some laboratory data and clinical adverse events. To demonstrate an increase of at least one SPPB point in the experimental arm, a sample size of 226 patients is needed. Conclusions: The HULK study will test the hypothesis that an early, tailored low-cost physical activity intervention improves physical performance, quality of life, frailty status and outcome in elderly ACS patients with reduced physical performance
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