EVALUASI DOSIS DIGOKSIN PADA PASIEN GAGAL JANTUNG DENGAN DISFUNGSI GINJAL DI RSUP DR. SARDJITO, YOGYAKARTA

Digoksin merupakan salah satu obat dengan kisaran terapi sempit yang paling banyak digunakan terutama pada penyakit yang berhubungan dengan jantung. Penyesuaian dosis digoksin pada pasien yang mengalami penurunan fungsi ginjal mutlak dilakukan agar kadar obat di dalam darah tepat. Penelitian ini dilakukan untuk mengevaluasi dosis digoksin pad a pasien gagal jantung dengan disfungsi ginjal. Penelitian ini merupakan penelitian retrospektif sekaligus prospektif pada pasien gagal jantung dengan disfungsi ginjal di RSUP Dr. Sardjito Yogyakarta periode Januari 2010 - Maret 2011. Pengumpulan data dilakukan menggunakan rekam medik pasien rawat inap. Analisis data dilakukan secara deskriptif. Hasil analisis dari 43 kasus yang diperoleh, pasien laki-laki mempunyai persentase yang lebih besar dibanding pasien perempuan (56 % : 44 %). Persentase pasien berdasarkan kelompok usia terbanyak pada pasien 50 - 59 tahun sebanyak 34,88 %. Pada perhitungan dosis secara farmakokinetik ditemukan bahwa dosis digoksin yang digunakan oleh pasien ada yang melebihi kadar maksimum digoksin di dalam darah. Dari 19 pasien wanita, 11 pasien menggunakan dosis yang melebihi kadar maksimum digoksin sedangkan dari 24 pasien pria, 14 pasien menggunakan dosis yang melebihi kadar maksimum digoksin. Metode perhitungan dosis ini menggunakan data literatur khususnya untuk nilai parameter farmakokinetika s eperti volume distribusi, waktu paro eliminasi, dan kliren digoksin. Oleh sebab itu, besar dosis yang tepat seperti yang dianjurkan dalam tesis ini dapat dianggap sebagai nilai teoritis. Selanjutnya ditemukan juga pasien tidak mendapatkan dosis muatan digoksin yang sesuai. Namun oleh karena penggunaan dosis digoksin bersifat individual maka dari keseluruhan ditemukan bahwa outcome clinic pasien umumnya membaik. Digoxin is a medicine with narrow therapeutic index. Digoxin is widely used for heart failure treatment. Adjustment of digoxin dose is needed in patient with renal dysfunction. This research were done to evaluate digoxin dose in heart failure patient with renal dysfunction. This research was retrospective and prospective research, performed in Dr. Sardjito hospital during January 2010 to March 2011. Data were collected from patient medical record and then evaluated with descriptive method. From 43 patients, percentage men compare to women were 56 % : 44 %. Most patients come from age of 50 - 59 (34.88%). Dose calculation based on pharmacokinetic concept found that some of digoxin dose in patients were exceed digoxin therapeutic concentration. From 19 women patients there were 11 patients use digoxin dose exceed djgoxin therapeutic concentration when calculate by pharmacokinetic while from 24 men patients there were 14 patients use digoxin dose exceed digoxin therapeutic concentration when calculate by phannacokinetic. Dose recalculation method was mostly based on literature data particularly for pharmacokinetic parameter values i.e. volume distribution, half life, and clearance. Therefore, the corrected doses suggested in this thesis should be regarded as theoretical estimates. Furthermore, it was also found that patients did not get appropriate lomling dose of digoxin. However, drug dosing for digoxin were individual dose, therefore overall found that patient clinical outcome was generally better

Self-Instruction Training Untuk Meningkatkan Derajat Academic Buoyancy Mahasiswa

This study aims to determine the effect of self-instruction training interventions in increasing the level of student academic buoyancy. Students need to have a high level of academic buoyancy in order to be able to overcome daily academic challenges and overcome the decline in academic self-regulation (Martin & Marsh, 2009). Students who have a low or moderate degree of academic buoyancy will have obstacles in overcoming daily academic challenges and academic setbacks. This condition causes low academic achievement that students have. In order to overcome this problem, this research examines whether self-instruction training interventions with CBT can help students increase their degree of academic buoyancy. This self-instruction technique is a behavior modification technique that has two uses, namely improving maladaptive mindsets, becoming positive mindsets, which are then used to direct individuals by giving positive instructions to themselves to make behavior changes to become more adaptive (Meichenbaum, in Martin & Pear 2015). This study uses a single subject design with AB research pattern. The participant of this study was a male student at the Faculty of Medicine, with a moderate degree of academic buoyancy. The results of the study show that the self-instruction training technique can increase the degree of academic buoyancy

Penerapan Metode Pembelajaran Outdoor Study terhadap Hasil Belajar Geografi

This research aimed to find out the differences of using outdoor study learning method toward students. This research was using experiment method by applying posttest control group design. The sample was two classes that were XI IPS 1 and XI IPS 2. The data was analyzed by using parametric statistic in which the hypothesis was using t-test through SPSS program. The results showed that (1) there was no significant difference between students score averages of pretest by using outdoor study and conventional,(2) there was significant difference between students posttest score averages that using outdoor study method and conventional in which score averages of outdoor study was higher than conventional ones, (3) there was a difference between students achievement n-Gain that was taught by using outdoor study and conventional ones in which n-Gain outdoor study was higher and it was included in middle criteria.Penelitian ini bertujuan untuk mengetahui perbedaaan penggunaan metode pembelajaran outdoor Study terhadap hasil belajar siswa. Penelitian ini menggunakan metode eksperimen dengan pretest-posttest control group design. Sampel kelas XI IPS 1 dan kelas XI IPS 2. Analisis data menggunakan uji statistik parametrik dimana uji hipotesis menggunakan uji-t pada program SPSS seri 20 for windows. Hasil penelitian menunjukkan bahwa (1) tidak ada perbedaan signifikan antara nilai rata-rata pretest siswa menggunakan metode outdoor study dengan konvensional, (2) ada perbedaan signifikan antara nilai rata-rata posttest siswa menggunakan metode outdoor study dengan konvensional dimana nilai rerata outdoor study lebih besar dari rata-rata konvensional (3) ada perbedaan n-Gain hasil belajar siswa yang diajarkan dengan metode outdoor study dengan konvensional, dimana n-Gain outdoor study lebih besar dan termasuk dalam kriteria sedang

Impact of faults on bus stability on an island 330kV mesh network on the Nigerian grid

This study carried out an assessment on the impact of faults on bus stability along the Benin-IkejaWest-Aiyede-Oshogbo-Benin (BIAOB) 330kV island network. The sensitivity of BIAOB as a ring network on the Nigerian grid aroused the interest behind its choice for this study. The network parameters were collated from the National Control Centre, Oshogbo and the network was modeled on the MATLAB 2015 environment using the obtained data. A high reactive power flow was observed in all the buses while the lowest voltage profile was observed on the Line-Line-Line-Ground (L-L-L-G) simulated in bus 1. This is an indication that symmetrical faults have the greatest impact on the network. Further results showed that the BIAOB network has a better voltage profile when compared with other radial network from existing literature. The paper concluded by recommending the closure of more radial network on the grid in order to improve its performance

Pemanfaatan Limbah Sekam Padi Menjadi Silika Gel

Sekam padi merupakan salah satu sumber penghasil silika terbesar, berpotensi sebagai bahan pembuatan silika gel. Abu sekam padi mengandung silika sebanyak 87%-97% berat kering. Sintesis silika gel dari abu sekam padi dilakukan dengan mereaksikan abu sekam padi menggunakan larutan NaOH 1N pada suhu 800C selama 1 jam dan dilanjutkan dengan penambahan larutan asam hingga pH=7. Gel yang dihasilkan selanjutnya didiamkan selama 18 jam kemudian dikeringkan pada suhu dikeringkan menggunakan oven pada suhu 800C hingga beratnya konstan. Hasil percobaan diperoleh bahwa silika gel dengan penambahan CH3COOH menghasilkan yield yang lebih besar dibandingkan penambahan HCl. Berdasarkan analisis FT-IR silika gel yang diperoleh memiliki gugus Si-O-Si dan gugus Si-OH. Silika gel dengan penambahan HCl memiliki surface area sebesar 65,558 m2/g, total pore volume 0,1935 cc/g, dan average pore size sebesar 59,0196 Å. Sedangkan silika gel dengan penambahan CH3COOH memiliki surface area sebesar 9,685 m2/g, total pore volume 0,02118 cc/g, dan average pore size sebesar 43,7357Å. Silika gel dengan penambahanCH3COOH memiliki kemampuan menyerap kelembaban udara yang lebih baik dibanding silika gel dengan penambahan HCl. Rice hull ash (RHA) is one of the biggest source of silica, potential for sintesis silica gel. RHA contains silica as many as 87 % -97 %. Synthesis of silica gel from rice hull ash was done by reaction using NaOH solution at temperature 800C for 1 hour and followed by the addition of an acid solution until pH=7. The gel were rested with time aging 18 hour, and then dried using oven at temperature 800C until constant weigh. The results obtained that the silica gel with the addition of CH3COOH produce higher yields than the addition of HCl. Based on FT-IR analysis, silica gel has a group of silanol (Si-`OH) and siloxan (Si-O-Si) group. Silica gel with the addition of HCl has a surface area 65,558 m2/g, a total pore volume 0,1935 cc/g, and average pore size 59,0196 Å. While the silica gel with the addition of CH3COOH has a surface area 9.685 m2/g, a total pore volume 0,02118 cc/g, and average pore size 43,7357 Å. Silica gel with the addition of CH3COOHhas the ability to absorb humidity better than silica gel with the addition of HCl

Optimasi Yield Etil P Metoksisinamat Pada Ekstraksi Oleoresin Kencur (Kaempferia Galanga) Menggunakan Pelarut Etanol

Kencur (Kaempferia galanga L.) banyak digunakan sebagai bahan baku obat tradisional (jamu), fitofarmaka, industri kosmetika, industri makanan, dan industri insektisida. Minyak atsiri rimpang kencur mengandung etil sinnamat dan metil p-metoksi sinamat (EPMS). Ekstraksi oleoresin kencur dilakukan dengan etanol sebagai pelarut. Optimasi yield EPMS diteliti terhadap perbandingan massa serbuk kering kencur dan etanol dan waktu ekstraksi. Perbandingan kencur : etanol yang digunakan adalah 1 : 2, 1 : 3, dan 1 : 4. Waktu operasi yang digunakan adalah 2 s.d 5 jam. Tahapan proses ekstraksi oleoresin kencur adalah preparasi bahan, ekstraksi, evaporasi dan pemurnian. Oleoresin hasil ekstraksi dianalisis dengan uji GC-MS untuk mengetahui kandungan EPMS dan kandungan minyak atsiri lain dalam oleoresin kencur. Oleoresin hasil ekstraksi berwarna coklat tua dengan yield antara 6-8%. Kandungan EPMS dalam oleoresin bervariasi antara 67,77 hingga 87,57%. Massa oleoresin optimal hasil ekstraksi adalah 6,09 gram pada perbandingan kencur dan etanol 1:4 selama 4 jam. Pendekatan persamaan hasil ekperimen ekstraksi kencur dan etanol menghasilkan titik optimal EPMS pada waktu ekstraksi 3,62 dengan massa EPMS 6,04 gram Lesser galangal (Kaempferia galanga L.) is widely used as a traditional medicine (herbal medicine), fitofarmaka, cosmetics industry, food industry, and insecticide industry. The essential oils in the Lesser galangal contain ethyl sinnamat and methyl p-methoxy cinnamic (EPMS). The oleoresin extraction of Lesser galangal was performed using ethanol as a solvent. Optimization of the EPMS yield was investigated to dry powder mass ratio of Lesser galangal and ethanol as well as the extraction time. The ratio of Lesser galangal : ethanol was  varied from 1: 2, 1: 3 and 1: 4. The chosen operating time were 2 to 5 hours. The procedure of the oleoresin extraction process of Lesser galangal includes the preparation of materials, extraction, evaporation and purification. The extracted oleoresin was analyzed by GC-MS to determine the content of Ethyl P-methoxycinnamate (EPMS) and other volatile oil content in the oleoresin of Lesser galangal. The extracted oleoresin color was light brown to dark brown with the yield of between 6.31 to 8.3%. The EPMS content of the oleoresin varies between 67.77 to 87.57%. The optimum mass of the extracted oleoresin was 6.09 gram for 1:4 ratio of Lesser galangal : ethanol and 4 hours of the extraction time. The equation approach of the experimental results of Lesser galangal and ethanol produced the EPMS optimum point at the extraction time of 3.62 hours and EPMS mass of 6.04 grams

The Charm of Processed Character Tempe and Business Diversification of Tempe Sanan Malang

In Kampung Sanan Malang, designated as a tourist destination for small householdbased industries, tempeh chips are its flagship product. The 636 tempeh artisans are from Sanan Malang Tempeh and Tempeh Chips Production Center Association. Members of this community have processed tempeh into 50 types of preparations like various flavors of tempeh chips, tempeh satay, mendol sticks, tempeh brownies cakes, dry tempeh, processed soybean stew to produce nata de soya, muffins, tempeh mud cakes, and bloeder cakes. The last innovation made in 2021 was named Character Tempeh. This new product is manufactured by utilizing a plastic mold. The problem is that no member of this community has been able to make their own desired shape of the character model, nor have they been able to make a more effective print. The solutions offered include making character models using plasticine and training in printing these models using food-grade RTV. At the end of this activity, artisans can produce processed character tempeh with unique and good quality so that it becomes a typical product of Sanan Malang. Keywords: character tempe, diversification, Sanan Malan

Beyond the public and private divide: Remapping transnational climate governance in de 21th century

This article provides a first step towards a better theoretical and empirical knowledge of the emerging arena of transnational climate governance. The need for such a re-conceptualization emerges from the increasing relevance of non-state and transnational approaches towards climate change mitigation at a time when the intergovernmental negotiation process has to overcome substantial stalemate and the international arena becomes increasingly fragmented. Based on a brief discussion of the increasing trend towards transnationalization and functional segmentation of the global climate governance arena, we argue that a remapping of climate governance is necessary and needs to take into account different spheres of authority beyond the public and international. Hence, we provide a brief analysis of how the public/private divide has been conceptualized in Political Science and International Relations. Subsequently, we analyse the emerging transnational climate governance arena. Analytically, we distinguish between different manifestations of transnational climate governance on a continuum ranging from delegated and shared public-private authority to fully non-state and private responses to the climate problem. We suggest that our remapping exercise presented in this article can be a useful starting point for future research on the role and relevance of transnational approaches to the global climate crisis

Exceptionally high incidence of symptomatic grade 2–5 radiation pneumonitis after stereotactic radiation therapy for lung tumors

<p>Abstract</p> <p>Background</p> <p>To determine the usefulness of dose volume histogram (DVH) factors for predicting the occurrence of radiation pneumonitis (RP) after application of stereotactic radiation therapy (SRT) for lung tumors, DVH factors were measured before irradiation.</p> <p>Methods</p> <p>From May 2004 to April 2006, 25 patients were treated with SRT at the University of Tokyo Hospital. Eighteen patients had primary lung cancer and seven had metastatic lung cancer. SRT was given in 6–7 fields with an isocenter dose of 48 Gy in four fractions over 5–8 days by linear accelerator.</p> <p>Results</p> <p>Seven of the 25 patients suffered from RP of symptomatic grade 2–5 according to the NCI-CTC version 3.0. The overall incidence rate of RP grade2 or more was 29% at 18 months after completing SRT and three patients died from RP. RP occurred at significantly increased frequencies in patients with higher conformity index (CI) (p = 0.0394). Mean lung dose (MLD) showed a significant correlation with V₅–V₂₀(irradiated lung volume) (p < 0.001) but showed no correlation with CI. RP did not statistically correlate with MLD. MLD had the strongest correlation with V₅.</p> <p>Conclusion</p> <p>Even in SRT, when large volumes of lung parenchyma are irradiated to such high doses as the minimum dose within planning target volume, the incidence of lung toxicity can become high.</p