An institutional analysis of sasi laut in Maluku, Indonesia

This study provides an understanding of the extent and functioning of community based coastal resource management systems in Maluku province, Indonesia and suggests recommendations for national, provincial and village government to support, maintain and develop effective traditional and indigenous resource management institutions. The study has shown that the Sasi Laut has benefits that can be used as a basis for building local level management institutions.Fisheries, Co-management, Resource management, Indonesia,

KEBIJAKAN, SEBUAH KEBUTUHAN DALAM DESENTRALISASI KESEHATAN

This article describes the concept, relevance, principles and milestones about policy. Based on William Dunn's framework, it also tries to describe the purposes of policy analysis and its implementation that are needed on health decentralization. In Indonesia the health decentralization has been implemented for some years but policy analysis is understood as regulation analysis which has been directed by the Department of Health. At present the implementation process of the health decentralization, the Central government still has double functions as policy maker and performer In fact based on regulations, the responsibilities have been delegated to District governments. Understanding the policy analysis on the implementation of health decentralization would provide challenges to interpretate in accordance with the local specific conditions.   Key words: policy, analysis, decentralization of healt

Selection of head and neck cancer patients for adaptive radiotherapy to decrease xerostomia

AbstractBackground and purposeThe aim of this study was to develop and validate a method to select head and neck cancer patients for adaptive radiotherapy (ART) pre-treatment. Potential pre-treatment selection criteria presented in recent literature were included in the analysis.Materials and methodsDeviations from the planned parotid gland mean dose (PG ΔDmean) were estimated for 113 head and neck cancer patients by re-calculating plans on repeat CT scans. Uni- and multivariable linear regression analyses were performed to select pre-treatment parameters, and ROC curve analysis was used to determine cut off values, for selecting patients with a PG dose deviation larger than 3Gy. The patient selection method was validated in a second patient cohort of 43 patients.ResultsAfter multivariable analysis, the planned PG Dmean remained the only significant parameter for PG ΔDmean. A sensitivity of 91% and 80% could be obtained using a threshold of PG Dmean of 22.2Gy, for the development and validation cohorts, respectively. This would spare 38% (development cohort) and 24% (validation cohort) of patients from the labour-intensive ART procedure.ConclusionsThe presented method to select patients for ART pre-treatment reduces the labour of ART, contributing to a more effective allocation of the department resources

Painful and painless mutations of SCN9A and SCN11A voltage-gated sodium channels

Chronic pain is a global problem affecting up to 20% of the world’s population and has a significant economic, social and personal cost to society. Sensory neurons of the dorsal root ganglia (DRG) detect noxious stimuli and transmit this sensory information to regions of the central nervous system (CNS) where activity is perceived as pain. DRG neurons express multiple voltage-gated sodium channels that underlie their excitability. Research over the last 20 years has provided valuable insights into the critical roles that two channels, NaV1.7 and NaV1.9, play in pain signalling in man. Gain of function mutations in NaV1.7 cause painful conditions while loss of function mutations cause complete insensitivity to pain. Only gain of function mutations have been reported for NaV1.9. However, while most NaV1.9 mutations lead to painful conditions, a few are reported to cause insensitivity to pain. The critical roles these channels play in pain along with their low expression in the CNS and heart muscle suggest they are valid targets for novel analgesic drugs

Network topology of NaV1.7 mutations in sodium channel-related painful disorders

Background: Gain-of-function mutations in SCN9A gene that encodes the voltage-gated sodium channel NaV1.7 have been associated with a wide spectrum of painful syndromes in humans including inherited erythromelalgia, paroxysmal extreme pain disorder and small fibre neuropathy. These mutations change the biophysical properties of NaV1.7 channels leading to hyperexcitability of dorsal root ganglion nociceptors and pain symptoms. There is a need for better understanding of how gain-of-function mutations alter the atomic structure of Nav1.7. Results: We used homology modeling to build an atomic model of NaV1.7 and a network-based theoretical approach, which can predict interatomic interactions and connectivity arrangements, to investigate how pain-related NaV1.7 mutations may alter specific interatomic bonds and cause connectivity rearrangement, compared to benign variants and polymorphisms. For each amino acid substitution, we calculated the topological parameters betweenness centrality (Bct), degree (D), clustering coefficient (CCct), closeness (Cct), and eccentricity (Ect), and calculated their variation (value= mutantvalue-WTvalue). Pathogenic NaV1.7 mutations showed significantly higher variation of |Bct| compared to benign variants and polymorphisms. Using the cut-off value \uc2\ub10.26 calculated by receiver operating curve analysis, we found that Bctcorrectly differentiated pathogenic NaV1.7 mutations from variants not causing biophysical abnormalities (nABN) and homologous SNPs (hSNPs) with 76% sensitivity and 83% specificity. Conclusions: Our in-silico analyses predict that pain-related pathogenic NaV1.7 mutations may affect the network topological properties of the protein and suggest |Bct| value as a potential in-silico marker

The History Learning Module Integrated Character Values

The history learning module integrated character values is an innovation in history learning in schools to support educational progress. This module serves as teaching material for the process of character formation of students obtained through independent learning to achieve the desired competency goals. This research uses the development (R and D) of the 4D model (define, design, development and dissemination). The results showed that the module was declared feasible based on the results of the validation of the experts, so the modules that had been developed were feasible, effective and practical to be used as teaching materials and learning resources by students in the history learning process. This module has the advantage that there are character values (love of the motherland, curiosity, religious and tolerance) in the material presented for the formation of students' character

Pain triangle phenomenon in possible association with SCN9A:A case report

Background: Voltage-gated sodium channels are essential for the generation and conduction of electrical impulses in excitable cells. Sodium channel Nav1.7, encoded by the SCN9A-gene, has been of special interest in the last decades because missense gain-of-function mutations have been linked to a spectrum of neuropathic pain conditions, including inherited erythermalgia (IEM), paroxysmal extreme pain disorder (PEPD), and small fiber neuropathy (SFN). Methods: In this case report, we present a 61-year-old woman who was referred to our tertiary referral center in a standard day care setting with suspicion of SFN. We performed additional investigations: skin biopsy to determine the intra-epidermal nerve fiber density (IENFD), quantitative sensory testing (QST), and blood examination (including DNA analysis) for possible underlying conditions. Results: The patient showed a clinical picture that fulfilled the criteria of IEM, PEPD, and SFN. DNA analysis revealed the heterozygous variant c.554G > A in the SCN9A-gene (OMIM 603415). This variant has already been described in all three human pain conditions separately, but never in one patient having symptoms of all three conditions. Because its pathogenicity has never been functionally confirmed, the variant is classified as a variance of unknown significance (VUS)/risk factor. This suggests that another genetic and/or environmental substrate plays a role in the development of neuropathic conditions like described. Conclusion: We have described this as the SCN9A-pain triangle phenomenon. Treatment should focus on pain management, genetic counseling, and improving/maintaining quality of life by treating symptoms and, if indicated, starting a rehabilitation program

Pain triangle phenomenon in possible association with SCN9A: A case report

BACKGROUND: Voltage-gated sodium channels are essential for the generation and conduction of electrical impulses in excitable cells. Sodium channel Nav 1.7, encoded by the SCN9A-gene, has been of special interest in the last decades because missense gain-of-function mutations have been linked to a spectrum of neuropathic pain conditions, including inherited erythermalgia (IEM), paroxysmal extreme pain disorder (PEPD), and small fiber neuropathy (SFN). METHODS: In this case report, we present a 61-year-old woman who was referred to our tertiary referral center in a standard day care setting with suspicion of SFN. We performed additional investigations: skin biopsy to determine the intra-epidermal nerve fiber density (IENFD), quantitative sensory testing (QST), and blood examination (including DNA analysis) for possible underlying conditions. RESULTS: The patient showed a clinical picture that fulfilled the criteria of IEM, PEPD, and SFN. DNA analysis revealed the heterozygous variant c.554G > A in the SCN9A-gene (OMIM 603415). This variant has already been described in all three human pain conditions separately, but never in one patient having symptoms of all three conditions. Because its pathogenicity has never been functionally confirmed, the variant is classified as a variance of unknown significance (VUS)/risk factor. This suggests that another genetic and/or environmental substrate plays a role in the development of neuropathic conditions like described. CONCLUSION: We have described this as the SCN9A-pain triangle phenomenon. Treatment should focus on pain management, genetic counseling, and improving/maintaining quality of life by treating symptoms and, if indicated, starting a rehabilitation program