Hubungan Paritas, Anemia, And Usia terhadap Kejadian Ketuban Pecah Dini di RSUD Raden Mattaher Kota Jambi 2017

Komplikasi yang timbul akibat Ketuban Pecah Dini yaitu dapat terjadi infeksi maternal ataupun neonatal, persalinan prematur, hipoksia karena kompresi tali pusat, deformitas janin meningkatnya insiden seksiosesarea, atau gagalnya persalinan normal. Tujuan penelitian ini adalah diketahuinya hubungan paritas,anemia, dan usia terhadap kejadian ketuban pecah dini di RSUD Raden Mattaher Jambi Tahun 2016. Penelitian ini merupakan penelitian deskriftif dengan desain case control dengan menggunakanpendekatan “Retrospective”. Penelitian ini dilaksanakan tanggal 23-24 Agustus 2016. Populasi adalahsejumlah ibu yang mengalami Ketuban Pecah Dini di RSUD Raden Mattaher Kota Jambi tahun 2015.Dengan jumlah ibu bersalin 301 ibu bersalin, dengan jumlah populasi sebanyak 93 orang. Sampel dalampenelitian ini adalah sebanyak 93 orang yang diambil dengan teknik Total Sampling. Analisis yangdigunakan adalah univariat dan bivariat.Hasil penelitian menunjukkan bahwa dari 96 responden sebagian besar memiliki paritas tidak berisikoyaitu sebanyak 50 responden (52,1%), responden tidak mengalami anemia yaitu sebanyak 77 responden(80,2%), dan responden memiliki usia tidak berisiko sebanyak 77 responden (83,3%). Hasil analisisterdapat hubungan paritas ibu dengan kejadian ketuban pecah dini pada ibu hamil di RSUD RadenMattaher Jambi Tahun 2016 dengan nilai p-value 0,025. Terdapat hubungan anemia dengan kejadianketuban pecah dini di RSUD Raden Mattaher Jambi Tahun 2016 dengan nilai p 0,040. Terdapathubungan usia ibu dengan kejadian ketuban pecah dini di RSUD Radan Mattaher Jambi Tahun 2016dengan nilai p-value 0,003.Maka dari itu bagi petugas melakukan peningkatan upaya preventif dengan pelayanan pencegahan komplikasi pada kehamilan ibu pada saat pelayanan antenatal care

3D printing and morphological characterisation of polymeric composite scaffolds

© 2020 Elsevier Ltd. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/.3D-printing is an efficient method of designing customised structures and producing synthetic bone grafts appropriate for bone implants. This research aimed to manufacture a new multi-functionalised 3D-printed poly(lactic acid)/carbonated hydroxyapatite (PLA/cHA) scaffolds with mass proportions of 100/0, 95/5 and 90/10 in a bid to verify their potential application in tissue regeneration. The filaments of these hybrid materials were obtained by extrusion technique and subsequently used to manufacture the 3D-printed scaffolds, using a fused deposition modelling (FDM) technique. The scaffolds were characterised based on their thermal properties, microstructure and geometry by differential scanning calorimetry (DSC), scanning electron microscopy (SEM) and energy dispersive x-ray spectroscopy (EDS), respectively, in addition to determination of their apparent porosities. The degradation of the scaffolds and the liberation of degradation products were evaluated in in vitro for different days under simulated physiological conditions. New microanalyses of mechanical behaviour of the materials: tensile and compression stresses, density, frequency analysis and optimisation with DSC were performed. While, evaluation of the surface luminance structure and the profile structure of the nanostructured PLA composite materials was done by SEM, in 3D printed form. The filter profile of cross-sectional view of the specimen was extracted and evaluated with Firestone curve of the Gaussian filter; checking the roughness and waviness profile of the structure. It was observed that the thermal properties of the composites were not affected by the manufacturing process. The microstructural analysis showed the effective incorporation of the ceramic filler in the polymer matrix as well as an acceptable PLA/cHA interaction. The degradation tests showed the presence of calcium and phosphorus in the studied medium, confirming their liberation from the composites during the incubation periods.Peer reviewedFinal Accepted Versio

Influence of egg shell as heterogeneous catalyst in the production of biodiesel via transesterification of Jatropha oil

The increase in energy demand together with the negative global environmental impacts of using fossil fuel for energy generations brings a question on dependability on it for sustainable economic growth. The way out is the use of renewable sources of energy such as biodiesel which has significant advantages over its counterpart (fossil fuel). Biodiesel can be produced through various methods such as transesterification, micro emulsion and pyrolysis. The influence of egg shell as heterogeneous catalysts in the production of biodiesel via transesterification of Jatropha oil was investigated. The physical and chemical properties of the catalyst were studied using scanning electron microscopy (SEM) and Xray fluoroscopy (XRF) characterizations. The crude Jatropha oil was transesterified and 0.1 wt%, 0.2 wt%, 0.3wt%, 0.5wt% and 0.5wt% of egg shell were used as heterogeneous catalyst during transesterification process. Fourier Transform Infrared (FTIR) was used to determine the functional group of the samples. SEM and FTIR characterizations indicate the presence of dispersed particles on the catalyst and ester (biodiesel) on the samples respectively. The maximum percentage of biodiesel yield is 94.3% at the application of 0.2wt% egg shell as catalyst using 1:6 oil to methanol ratio in 1hr at 60-65℃. This indicated that the egg shell has high potential to be used as catalyst in the production of biodiesel via transesterification of Jatropha oil

Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes

BACKGROUND: Data are lacking on the long-term effect on cardiovascular events of adding sitagliptin, a dipeptidyl peptidase 4 inhibitor, to usual care in patients with type 2 diabetes and cardiovascular disease. METHODS: In this randomized, double-blind study, we assigned 14,671 patients to add either sitagliptin or placebo to their existing therapy. Open-label use of antihyperglycemic therapy was encouraged as required, aimed at reaching individually appropriate glycemic targets in all patients. To determine whether sitagliptin was noninferior to placebo, we used a relative risk of 1.3 as the marginal upper boundary. The primary cardiovascular outcome was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. RESULTS: During a median follow-up of 3.0 years, there was a small difference in glycated hemoglobin levels (least-squares mean difference for sitagliptin vs. placebo, -0.29 percentage points; 95% confidence interval [CI], -0.32 to -0.27). Overall, the primary outcome occurred in 839 patients in the sitagliptin group (11.4%; 4.06 per 100 person-years) and 851 patients in the placebo group (11.6%; 4.17 per 100 person-years). Sitagliptin was noninferior to placebo for the primary composite cardiovascular outcome (hazard ratio, 0.98; 95% CI, 0.88 to 1.09; P<0.001). Rates of hospitalization for heart failure did not differ between the two groups (hazard ratio, 1.00; 95% CI, 0.83 to 1.20; P = 0.98). There were no significant between-group differences in rates of acute pancreatitis (P = 0.07) or pancreatic cancer (P = 0.32). CONCLUSIONS: Among patients with type 2 diabetes and established cardiovascular disease, adding sitagliptin to usual care did not appear to increase the risk of major adverse cardiovascular events, hospitalization for heart failure, or other adverse events

Multimessenger Search for Sources of Gravitational Waves and High-Energy Neutrinos: Results for Initial LIGO-Virgo and IceCube

We report the results of a multimessenger search for coincident signals from the LIGO and Virgo gravitational-wave observatories and the partially completed IceCube high-energy neutrino detector, including periods of joint operation between 2007-2010. These include parts of the 2005-2007 run and the 2009-2010 run for LIGO-Virgo, and IceCube's observation periods with 22, 59 and 79 strings. We find no significant coincident events, and use the search results to derive upper limits on the rate of joint sources for a range of source emission parameters. For the optimistic assumption of gravitational-wave emission energy of $10^{-2}$\,M$_\odot$c$^2$ at $\sim 150$\,Hz with $\sim 60$\,ms duration, and high-energy neutrino emission of $10^{51}$\,erg comparable to the isotropic gamma-ray energy of gamma-ray bursts, we limit the source rate below $1.6 \times 10^{-2}$\,Mpc$^{-3}$yr$^{-1}$. We also examine how combining information from gravitational waves and neutrinos will aid discovery in the advanced gravitational-wave detector era

Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12·2 million (95% UI 11·0–13·6) incident cases of stroke, 101 million (93·2–111) prevalent cases of stroke, 143 million (133–153) DALYs due to stroke, and 6·55 million (6·00–7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8–12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1–6·2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70·0% (67·0–73·0), prevalent strokes increased by 85·0% (83·0–88·0), deaths from stroke increased by 43·0% (31·0–55·0), and DALYs due to stroke increased by 32·0% (22·0–42·0). During the same period, age-standardised rates of stroke incidence decreased by 17·0% (15·0–18·0), mortality decreased by 36·0% (31·0–42·0), prevalence decreased by 6·0% (5·0–7·0), and DALYs decreased by 36·0% (31·0–42·0). However, among people younger than 70 years, prevalence rates increased by 22·0% (21·0–24·0) and incidence rates increased by 15·0% (12·0–18·0). In 2019, the age-standardised stroke-related mortality rate was 3·6 (3·5–3·8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3·7 (3·5–3·9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62·4% of all incident strokes in 2019 (7·63 million [6·57–8·96]), while intracerebral haemorrhage constituted 27·9% (3·41 million [2·97–3·91]) and subarachnoid haemorrhage constituted 9·7% (1·18 million [1·01–1·39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79·6 million [67·7–90·8] DALYs or 55·5% [48·2–62·0] of total stroke DALYs), high body-mass index (34·9 million [22·3–48·6] DALYs or 24·3% [15·7–33·2]), high fasting plasma glucose (28·9 million [19·8–41·5] DALYs or 20·2% [13·8–29·1]), ambient particulate matter pollution (28·7 million [23·4–33·4] DALYs or 20·1% [16·6–23·0]), and smoking (25·3 million [22·6–28·2] DALYs or 17·6% [16·4–19·0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries.publishedVersio

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019 : A systematic analysis for the Global Burden of Disease Study 2019

Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC