bluuebunny/crossref_metadata_2025 huggingface dataset:
Seroprevalence of Chikungunya virus infection in a Tertiary Care Hospital, Warangal, Telangana, South India
Authors: Krishna Gudikandula , Sreedevi S , Khan Abdul
Published: November 2023

Introduction:

The Chikungunya virus, an Alpha virus belongs to the Togaviridae family which infects via the vector Aedes spp. mosquitoes, is the cause of the Chikungunya sickness.  The most prevalent symptoms are an abruptly rising temperature, rash, and acute arthralgia. Similar to other arboviral diseases such as Dengue and Japanese B encephalitis infections, it is a serious public health issue.

Methods: A total of 3027 blood samples were received from suspected cases of Chikungunya in the Tertiary Care Hospital, Warangal, Telangana. Over a period of 17 months, this study was conducted. Nearly 5-10ml of blood was collected from the patients after 5 days of fever, and the serum was separated. Using an IgM antibody capture ELISA kit manufactured by NIV (NIV, Pune, India).

Results: In our study population of 3027 during 12 months, 313 Chikungunya cases (10.34%) were found to be seropositive for Chikungunya by IgM ELISA. Most cases were from 0-10 Years (24.60%), followed by 11-20 years (17.25%). Regarding the sex ratio of the total affected cases, 53.35% were males, and 46.64% were females. A maximum number of positives were seen in September, November, and October, which were found to be 35.46%, 18.84%, and 17.57%.

Conclusion: The study found a seroprevalence rate of 23.06% for Chikungunya, with a notable increase in frequency during the monsoon season. Additionally, the virus was found to disproportionately affect individuals in the productive age range of the population.
Lung Abnormalities in Liver Cirrhosis
Authors: Muli Yaman  , Mustika Syifa
Published: November 2023

Regardless of preexisting lung illness, patients suffering from liver cirrhosis, especially decompensated liver cirrhosis can develop distinct pulmonary complications. Liver cirrhosis patients should be assessed for hepatopulmonary syndrome (HPS), portopulmonary hypertension (PoPH), hepatic hydrothorax (HH) and spontaneous bacterial empyema (SBEM)  which are the most clinically significant pulmonary consequences, in particular when dyspnea develops in conjunction with hepatic cirrhosis. These entities differ in terms of pathophysiology, clinical characteristics, diagnosis and suitable treatment options. This emphasize the need of specific diagnostic algorithm in liver cirrhosis patients presenting with dyspnea or other pulmonary symptoms. These pulmonary complications might be rare in patients with liver cirrhosis and portal hypertension but these complications might carry significant morbidity and mortality risks and, therefore, strong clinical suspicion is required to make an early accurate diagnosis. There are several medical therapies available for each condition in the multiple studies but most of the treatments and proceures doesn’t have significant benefit or have short lived benefit. The only treatment that changes the clinical prognosis of decompensated cirrhosis effectively in long term is liver transplantation. However liver transplantation also needs careful considerations as on some cases it might increase the risk of morbidity and mortality.

 

Keywords:  Cirrhosis Hepatis, Hepatopulmonary Syndrome, Portopulmonary Hypertension, Hepatic Hydrothorax, Spontaneous Bacterial Empyema
Best Recommended Exercise for patients with Hypertension
Authors: Tri Tjahjono Cholid , Lestari Defyna , Arthamin Maimun
Published: November 2023

Hypertension is known as a fatal yet preventable risk factor for cardiovascular disease and is responsible for majority of cardiovascular mortality. Hypertension is closely associated with sedentary lifestyle. Physical activity and/or exercise are shown to retard development of hypertension.

Exercise, combined with other measures of lifestyle behaviour and pharmacologic treatments, is recommended as an effective lifestyle behaviour for adults to prevent and treat hypertension.

The current exercise prescription for the treatment of hypertension is: cardiovascular mode, for 20-60 minutes, 3-5 days per week, at 40-70% of maximum oxygen uptake (VO2(max))..

Both aerobic and resistance exercise, should be performed simultaneously by hypertensive patients. Aerobic activity could include  walking, jogging, cycling, rowing swimming. While dynamic resistance training could include  free weights, resistance machines, and resistance bands. Functional exercises should be comprised of  step-ups, bodyweight exercises, and balance training.

After an exercise session, BP decreases, and this decline continues for up to 24 h; which is called post-exercise hypotension. Overall 5 mmHg decrease in BP with regular exercise may be encouraged. With a decrease of 5 mmHg in systolic BP, mortality due to coronary artery  disease decreases by 9%, mortality due to cerebrovascular accident  decreases by 14% and all-cause mortality decreases by 7%. Regular exercise should therefore be recommended for all individuals including normotensives, pre-hypertensives, and hypertensives.
Case Report: CMML in Young Age which Transformed to AML
Authors: Anggraini Wilujeng , Brahmantyo Herwindo
Published: November 2023

CMML (Chronic Myelomonocytic Leukemia) is a rare type of blood cancer that characterized with the presents of monocytes in the blood. 1,2 According to WHO it is categorized as overlapped manifestation of MDS (Myelodysplastic Syndrome) and MPD (Myeloproliferative Disease) or MPN (Myeloproliferative Neoplasm). 2,3 The origin cause of CMML is gene mutation on TET2 (60 %), SRSF2 (50 %), ASLX1 (40 %), and RAS (30 %). 1,3,4 Men are predominantly affected with incidence peak between 71 and 74 years of age, and the prevalence on young adult are very rare and considered to be closely related to the presence of gene mutations in ASLX1. 1,3,5  From several case reports, there were 63 % of CMML patients changed into secondary AML within 1-5 years due to somatic gene mutations in the ASLX1. 2,3,4,6  In this case, we report a 21-year-old male who is diagnosed with CMML and eventually transformed to AML.
Identify The Type of Pleural Effusion with Lung Ultrasound: A Case Report and State-of-Art
Authors: Ielo Simone , Fratini Antonio , Amante Edoardo , Spinelli Marcello
Published: November 2023

Pleural effusion is the most common pleural pathology and is seen in a large group of patients admitted to internal medicine wards.The purpose of this state of art literature review is to describe the various ultrasound findings that can be observed, to highlight the ability of lung ultrasound to facilitate differential diagnosis by pointing to a specific type of effusion and its cause.To this end, the clinical case description aims to demonstrate the above and promote the use of bedside lung ultrasound by considering this technique as the fifth physical examination technique after inspection, palpation, percussion and auscultation.
Cement and concrete decarbonisation roadmaps – a meta-analysis within the context of the United Kingdom
Authors: Marsh Alastair , Dillon Thomas , Bernal Susan
Published: November 2023

Decarbonisation is the most urgent issue facing the cement and concrete industries, with an aim to reach net-zero carbon dioxide emissions by 2050. In response to this, several decarbonisation roadmaps have been published in recent years, to explore routes for how different decarbonisation strategies can be used to achieve this aim. However, there is a lack of understanding around the similarities and differences between these roadmaps. In this study a meta-analysis of nine cement and concrete sector roadmaps was conducted, with a detailed focus on five roadmaps covering Europe emphasising their applicability within the context of the United Kingdom. Whilst there are some similarities amongst roadmaps in terms of the decarbonisation strategies which are consistently recommended, there are also key differences. Industry roadmaps oriented towards cement-based strategies, whilst non-industry roadmaps were more inclusive of concrete-based strategies. The significance of this study is to highlight the difficulties faced by policymakers and investors in choosing which strategies to prioritise, when there is still considerable uncertainty in the roadmap literature. Recommendations are made for a greater focus on consideration of the construction sector practices which provide more autonomy to practitioners to adopt and implement concrete-based strategies and dematerialisation in future iterations of industry roadmaps, and more research into the capital and operating costs of technological innovations
Understanding the manifestation of the conflict between traditional leaders and ward committees, A case of Greater Giyani Municipality, Limpopo Province, South Africa
Authors: Muchaku Shadreck , Magaiza Grey , Francis Joseph , Tshitangoni Mpho
Published: November 2023

In South African municipalities, there has been a coexistence between elected and traditional leaders for decades. However, this coexistence has often been marked by numerous conflicts. These conflicts take different forms and dimensions; while priority has been given to violent conflicts, these conflicts escalate and rescale when not dealt with. However, it appears priority has been given to violent conflicts, making it critical to understand and deal with all forms of conflicts before they escalate. Therefore, this study examined the nature of the conflict in the Greater Giyani municipality of South Africa. Purposive sampling was used to select 33 participants. Interviews were conducted with knowledgeable individuals to gain insight into the tensions between traditional and elected leaders. Codes and themes were electronically generated from the narratives of community members and key informants using ATLAS ti.22. The study concluded that existing conflict resolution mechanisms focus more on violent conflicts than embedded ones. Again, the current study demonstrated that non-violent conflict, if not dealt with, can escalate into violent conflict. Thus, these research findings pointed to the need for state and non-state actors to pay attention to all forms of conflict. By identifying different types of conflicts between community leaders, this study contributes to understanding how conflicts between TLs and WCs manifest and highlights the extent of common conflicts.

Keywords: active conflicts, overt, nature of conflicts, peace institutions
Gender and Far Right Extremism
Authors: Rodriguez Guervos Leyde
Published: November 2023

In the media and within the literature, far right extremism has been noted as being hypermasculine in character. Yet, the framing of these movements as being male dominated, though accurate, obscures the roles that women play within these spaces. This study furthers the academic understanding of the phenomenon by presenting a comprehensive examination of the role of gender within far right extremism as a political ideology and within far right extremist groups. Gendered differences are found in the actual support for these movements and in the motivating psychological factors behind such support. Gendered differences are also present in the roles that men and women perform within these groups, with women functioning as violent actors, thinkers, facilitators, promoters, activists, and exemplars, but being unable to access leadership positions within far right extremist groups.
Does Information Make Us Safer or More Secure?
Authors: Neal Patrick
Published: November 2023

On October 19th, 2023, Dr. Patrick Neal, Chief Social Scientist at AQ-IQ, presented Does Information Make Us Safer or More Secure? The presentation was followed by a question-and-answer period with questions from the audience and CASIS Vancouver executives. The key points discussed were data protection responsibilities and obligations, and management of excessive data for future-proofing projects and security.
Deep Space and Arctic Security Issues
Authors: Nadarajah Hema
Published: November 2023

On September 21, 2023, Dr. Hema Nadarajah from the Asia Pacific Foundation of Canada led the monthly digital roundtable for the Canadian Association for Security and Intelligence Studies Vancouver. Dr. Nadarajah identified geopolitical views and key actors relating to the Arctic and Deep Space, examined Canada's own role, and emphasized that the regions are not isolated entities.
Performance analysis of modified wavelet difference reduction methods in image compression and transmission
Authors: Bindulal T. S.
Published: November 2023

The wavelet difference reduction (WDR) method, a variant of run-length coding, finds its significance in data transmission applications. Over time, numerous enhanced iterations of WDR methods have emerged. Notably, the Adaptive Scalable WDR method exhibits superior coding gains, as evidenced by the peak signal-to-noise ratio (PSNR) and structural similarity index metric (SSIM), when compared to its predecessors. This paper conducts an exhaustive examination, encompassing both coding performance and time complexity, of various WDR methods vis-à-vis the conventional image compression algorithm SPIHT. Furthermore, it delves into the performance assessment of diverse coding techniques in the realm of encoding arbitrary-shaped objects. The analysis underscores that modified WDR variants demonstrate remarkable prowess in compression, rendering them invaluable for rapid transmission in bandwidth-constrained networks. To substantiate these findings, coding results (measured in terms of PSNR) are derived from the application of these algorithms to standard test images, MRI images, and video still images. The results reveal coding gains ranging from 0.5 dB to 1 dB for regular resolution images and a substantial 2 dB to 12 dB for scalable resolution scenarios, in comparison to traditional coding approaches. Consequently, this analysis underscores the convenience and superiority of modified WDR methods, not only for still images but also for encoding and transmitting arbitrary-shaped objects.
Avant-propos
Authors: Millet Claude
Published: November 2023

Ce numéro s’attache à montrer, à partir de l’étude d’oeuvres littéraires, de récits de voyages et d’ouvrages scientifiques, comment dans le second xviiie siècle et au xixe siècle, l’ordre de la nature se conçoit, concurremment au cadre des systématiques, dans celui d’une systémique ou du moins d’une vision holistique du vivant dont l’unité résulte des relations et des interactions qui lient les êtres qui la composent entre eux. 

Mots-clés : animaux, écologie, métaphore, métonymie, milieu, ordre de la nature, philosophie de la nature, plantes, unité.
Le mythe des Assassins, une métaphore politique : de Richard Coeur de Lion à Ben Laden
Authors: Berset Aurélien
Published: November 2023

Le mythe des Assassins concerne une secte musulmane médiévale perpétrant des meurtres politico-religieux. Toutes sortes de fantasmes sont venus se greffer à ce récit, notamment autour du Vieux de la Montagne, le dirigeant de la secte, qui enivrerait ses adeptes de haschisch dans un paradis artificiel. J’aimerais me pencher sur un aspect peu étudié de cette fable : sa mobilisation pour désigner des mouvements et des personnalités politiques réels. Je voudrais exposer différentes variantes politiques des remaniements de cette légende, à travers les oeuvres d’écrivains aussi divers que Germaine de Staël, André Malraux ou encore Amin Maalouf. Qu’est-ce qui permet d’expliquer la malléabilité de ce mythe utilisé à des fins politiques ainsi que sa puissance rhétorique ? 

Mots-clés : Assassins, politique, orientalisme, mythe, islam.
Pierrine Poget et les fondations de l’écriture
Authors: Carluccio Daniele
Published: November 2023

Cet article propose un commentaire de Fondations (2017) et de Warda s’en va (2021) de Pierrine Poget, qui montre comment la réparation des blessures intimes et le discours sur le monde y sont à la fois joués et déjoués, dans le sens d’une modestie du discours sur la littérature, et finalement d’une re-« fondation » de son autonomie. Il permet ainsi de questionner plusieurs tentatives récentes de compréhension de la littérature contemporaine, selon lesquelles celle-ci répare le monde, après avoir renoncé à son auto-référentialité (Gefen), emprunte les discours et les méthodes du savoir (Demanze), et d’abord existe (Faerber). Cet article privilégie la perspective de Jenny selon laquelle la littérature parle « de ce qui fait partie de notre expérience personnelle sans trouver à être symbolisé par aucun savoir établi ». 

Mots-clés : Poget, Fondations, Warda, littérature, contemporain.
« Quand les espèces se rencontrent » dans l’oeuvre de Victor Hugo
Authors: Guyvarc’h Morgan
Published: November 2023

Cet article interroge les formes que prend, dans l’oeuvre de Victor Hugo, la réflexion sur les êtres vivants en tant qu’êtres de relation, à partir de l’analyse du traitement littéraire réservé – dans le cadre de l’œuvre romanesque, théâtrale et poétique publiée de son vivant –, aux relations entre les humains et les animaux. Dans une perspective à dominante zoopoétique et stylistique, et selon une démarche voulue largement diachronique, il évalue la place et les modalités de la dénonciation des violences faites aux bêtes, qu’il ressaisit dans la perspective d’une incitation à repenser les relations anthropozoologiques en les fondant sur le regard compassionnel. Il questionne enfin la place laissée à la puissance d’agir des bêtes dans la relation interspécifique. 
Mots-clés : zoopoétique, animal, écologie, relation, vulnérabilité.
Il contributo di Vespasiano da Bisticci all’"Oratio funebris" per Giannozzo Pandolfini
Authors: Brazzale Denise
Published: November 2023

Nell’autunno del 1456 si spegneva il cavaliere fiorentino Giannozzo Pandolfini. La celebrazione del defunto, oltre alle cerimonie di rito, prevedeva l’invio di epistole consolatorie al primogenito Pandolfo Pandolfini e la “pubblicazione” di un’orazione funebre scritta da Giannozzo Manetti. L’orazione latina è il risultato di una particolare collaborazione tra l’umanista, residente a Napoli, e Vespasiano da Bisticci, noto cartolaio fiorentino. Il seguente contributo propone lo studio dell’apporto di Vespasiano all’orazione, l’analisi del rapporto con le Vite e, infine, uno sguardo sulle collaborazioni instaurate da Vespasiano con altri contemporanei per la redazione di opere a carattere commemorativo. 

Parole chiave: Vespasiano da Bisticci, Giannozzo Manetti, Giannozzo Pandolfini, Firenze, Oratio funebris.
Produttività potenziata. Edoardo Sanguineti e Luciano Berio, da "Esposizione" a "Laborintus II"
Authors: Hufnagel Henning
Published: November 2023

Nel presente saggio analizzo le dinamiche di collaborazione e di co-creazione tra Edoardo Sanguineti e Luciano Berio. Esamino come da una precedente collaborazione ritenuta da Berio esteticamente fallita, il balletto-performance Esposizione, nasca, in una configurazione collaborativa cambiata, Laborintus II. Sostengo l’ipotesi che uno dei presupposti che ha favorito la riuscita estetica di Laborintus II, rifocalizzando le menti creative su aspetti assenti in Esposizione, sia stato il ruolo dei committenti dell’opera alla ORTF, che in occasione del settimo centenario della nascita di Dante hanno richiesto a Berio e Sanguineti un’opera-omaggio del poeta della Commedia. Riutilizzando i materiali di Esposizione, ma attivando un dialogo con Dante, Berio e Sanguineti riuscirono a convertire il fallimento in successo. 

Parole chiave: co-creazione, intermedialità, intertestualità, Dante, Ann Halprin.
Scrivere assieme ai lettori: dialogo e creazione letteraria nella corrispondenza del "Corriere della Sera"
Authors: Pellizzato Giulia
Published: November 2023

Nel gennaio del 1974 il Corriere della Sera inaugura una rubrica multiautoriale di corrispondenza con i lettori, invitando il pubblico a contribuire proponendo «altri e nuovi argomenti, anche personali». Fra gli autori coinvolti c’è Goffredo Parise, che nell’ambito della rubrica sviluppa una particolare forma di scrittura collaborativa, dove gli stimoli dialogici travalicano barriere e gerarchie: tra scrittori e lettori, tra stili, tra argomenti personali e idee generali. Questa sperimentazione, innovativa sotto vari aspetti, verrà analizzata nel contesto storico, culturale e sociale del tempo. Ciò permetterà di riflettere anche teoricamente sul ruolo delle forme testuali dialogiche e sul ruolo dei lettori nei meccanismi di innovazione letteraria, alla luce del pensiero di Michail Bachtin. 

Parole chiave: Corriere della Sera, epistolari, lettori, Goffredo Parise, co-creazione dialogica.
En el vientre del Atlántico negro: el barco, la travesía y la memoria en la literatura latinoamericana contemporánea
Authors: López-Labourdette Adriana
Published: November 2023

Partiendo de la idea de un Atlántico negro (Gilroy 2014), este ensayo ahonda en las representaciones literarias del barco negrero, la travesía y los actos de (pos)memoria inscritos en un performance «1441-2018? / (VAE, 2021) y en tres novelas contemporáneas: Jonatás y Manuela de Luz Argentina Chiriboga (1994), La ceiba de la memoria, de Roberto Burgos Cantor (2009) y las Negras, de Yolanda Arroyo Pizarro (2012). 

Palabras clave: Atlántico negro, barco negrero, esclavización, posmemoria, colectividades remembrantes, narrativa de esclavos.
De la filología hispánica a la teoría literaria latinoamericana. Amado Alonso y José Sazbón, prologuistas de Saussure en América
Authors: González Muñiz Carlos
Published: November 2023

El crítico español Amado Alonso publicó en 1945, en Buenos Aires, la primera traducción al español del Cours de linguistique générale de Ferdinand de Saussure, precedida de un prólogo polémico. Treinta y dos años después, el filósofo argentino José Sazbón publicó Saussure y los fundamentos de la lingüística, una selección y nueva traducción de textos del ginebrino acompañados de una introducción. Mientras que Alonso enmarcó en la estilística su introducción del Cours al mundo hispánico, Sazbón hizo lo propio durante el auge del postestructuralismo. En este ensayo propongo que estas dos recepciones, contrastantes de la obra de Saussure, son coincidentes al ejemplificar la circulación trasatlántica de los saberes e ilustran dos polos esenciales de una misma tradición intelectual: el surgimiento y la consolidación de la teoría literaria latinoamericana. 

Palabras clave: Ferdinand de Saussure, Amado Alonso, José Sazbón, lingüística, historia intelectual latinoamericana.
Comparative Analysis of the Unmanned Aerial Vehicles and Terrestrial Laser Scanning Application for Coastal Zone Monitoring
Authors: Danchenkov Aleksandr , Belov Nikolay
Published: November 2023

The shallow sandy shores of the tideless sea are regularly affected by storm activity. Foredune ridge is a natural and anthropogenic object, a natural protective barrier that protects ecosystems and populated areas from the effects of dangerous hydrometeorological phenomena such as storm surges and wind-sand flux. In the course of impact of dangerous hydrometeorological phenomena, the foredune ridge integrity is disturbed, the composing material is washed away thus forming breakthroughs. Monitoring of the foredune state is an important stage in maintaining its condition and also provides an empirical basis for predicting the impact of hazardous events. The use of ground-based laser scanning technology as well as digital photogrammetry for the study of sensitive coastal zones is justified for these purposes. In this article, we compare the results of calculating the dynamics of the beach sand material and advance them according to the results of ground-based laser scanning and digital photogrammetry. Comparability is provided by high-density clouds of ground-scan points and digital photogrammetry in a single coordinate reference. Two sections of the sensitive coastal zone of the Curonian Spit (Russian sector of the South-Eastern Baltic) have been explored in advance. A comparison of the applicability of means for obtaining digital elevation models to evaluate the dynamics of sand material has been made. In comparison with TLS, the use of UAV with the SfM algorithm is limited to post-storm surveys, since the final accuracy does not provide for reliable lithodynamic studies due to the small scale of processes comparable to measurement errors.
RESPON RUMAH SAKIT SWASTA SOSIAL KEAGAMAAN TERHADAP ASURANSI SOSIAL: STUDI PENANGANAN KASUS MATERNAL DI RUMAH SAKIT NUR HIDAYAH BANTUL, YOGYAKARTA
Authors: Arrus Ferry  , Mubasysyir Hasanbasri  , Mohammad Hakimi
Published: November 2023

Background: The difference between the hospital real cost andthe tariff of INA-CBGs has negative impact on hospital causesfinancial losses, especially private hospital. The potential for thisloss is likely to encourage hospitals to establish a strategy tominimize losses. There are some distortions induced by theprospective payment system i.e. up-coding, cream skimming,readmission, and unbundling. Objective: The aim of this study was to determine Nur Hidayahhospital behaviour in response to INA-CBGs practice inmaternal management. Methods: This study was a quantitative research uses a casestudy approach. Secondary data from medical records, socialinsurance claim documents, records or reports regardingmaternal care and the regulation of social insurance services inthe period of January-June 2014 were use as the data sourcesof this study. Results: There was no evidence to support the practice of upcoding,cream skimming, readmission and unbundling inmaternal care at Nur Hidayah Hospital. Nur Hidayah Hospitalimplemented efficiency strategies and anti-fraud & abuse todeal with social insurance schemes. Conclusion: The INA CBGs-based payment resulted inincreased efficiency of the maternal care in Nur HidayahHospital.
IMPLEMENTASI VENTILATOR BUNDLE DAN RISIKO KEJADIAN INFEKSI NOSOKOMIAL PNEUMONIA DI RUANG PERAWATAN INTENSIF RUMAH SAKIT SURAKARTA
Authors: Rudy Suryo Handoyo  , Iwan Dwiprahasto  , Trisari Lestari
Published: November 2023

Background: Ventilator-associated pneumonia (VAP) inventilator assisted breathing patients is one of the mainconcerns in intensive care unit (ICU) because of its relation withhigh incidence and mortality rate. National infection surveillancein France found 12.4% of intubated patients during go infectedwith VAP, with mortality rate of 40-50%. Pneumonia could beprevented by implementing the right precaution, investigationsshow that with good management, VAP could be reduced until70%.

Methods: Quantitative study using observational analysis withcohort design. Data collected by observing compliance ofventilator-bundle in adult ICU with checklist. Implementation ofventilator-bundle could be observed directly and by checkingpatient's hemodynamic record. Ventilator-bundle consist ofhand hygiene, oral care with antiseptic, patient's body positionat ≥30° angle, sedation vacation, and weaning assessment,peptic ulcer prophylaxis, and prevention of deep veinthrombosis (DVT). This study use CPIS (clinical pulmonaryinfection score) to diagnose pneumonia.

Results: Ventilator-bundle compliance rate are recorded on82.9% and VAP on 11.1%, or 26.7 per 1000 ventilator days.Compliance with the ventilator bundle has no relationship withthe incidence of VAP. By using the odds ratio of noncompliancewith peptic ulcer prophylaxis has 8,5x risk of VAP (95% CI: 1.164to 62.094). This study proves the existence of the patients'factors associated with VAP which are duration of ventilationand incidence of spontaneous ETT pulling. Installation ofventilator for more than 5 days has 36 times greater risk of VAP(95% CI: 3.193 to 405.897). Spontaneous ETT pulling has 26times greater risk of VAP (95% CI: 1.796 to 376.303).

between ventilatorbundle compliance with VAP incidence. Thisresult caused by the limited subjects involves. Sample size ofthe study was limited because of the short duration of the study.
AKSESIBILITAS TERHADAP UTILISASI FASILITAS LAYANAN KESEHATAN DASAR DI PROVINSI PAPUA (RISKESDAS 2013)
Authors: Efraim Mudumi  , Mubasysyir Hasanbasri  , Lutfan Lazuardi
Published: November 2023

Background: Access to basic health services is a human rightin the health sector achieve social justice for all Indonesianpeople. Access to health care facilities in Papua remains a realchallenge for the government, especially if it is associated withthe goal to improve the health status, reduce morbidity andmortality. The difficulty of access to health facilities led todisparities in health status between regions in Indonesia.Objective: Analysis patterns utilization of health facilities andthe factors that access barriers to health centers in the provinceof Papua.Methods: Analysis of secondary data comes from a survey ofbasic health research in 2013 with the kind of cross-sectionalstudies.Results: Of the 4562 respondents as many as 3152 (69,09%)utilize health centers. Probability better utilization of healthcenters on the rich than the poor (OR = 4,17, 95% CI = 3,23-5,38). Participants private health insurance and social securityare more likely to utilize health centers (OR = 5,87, 95% CI =2,82-12,23). Living in the urban area increasing the utilization ofhealth centers compared with rural area (OR = 1,24, 95% CI =0,98-1,56). Probability health centers utilization in swamplandbetter than others (OR = 2,17, 95% CI = 1,36- 3,45). Time travelless than 30 minutes are more likely to utilize health centerscompared with a travel time more than 30 minutes (OR = 1,28,CI = 1,14-2,17). Motor vehicles are more likely to utilize healthcenters (OR = 3,00, CI = 2,36 to 3,81). Transportation costs ofmore than IDR100.000 is more likely to take advantage of healthcenter (OR = 2,59, 95% CI = 1,59-4,2).

Conclusion: The availability of health facilities, travel time,transport costs and the availability of transportation still bebarriers of accessibility. Utilization patterns varied types of basichealth facilities, primary health centers are the types of facilitiesthat the most widely used. There is inequity between the poorand rich in the utilization of basic health services.
KOMPETENSI MANAJEMEN DOKTER DI FASILITAS PELAYANAN KESEHATAN PADA DAERAH TERTINGGAL DI INDONESIA: KEBUTUHAN DAN TANGGUNG JAWAB INSTITUSI PENDIDIKAN KEDOKTERAN
Authors: Fury Maulina  , Riris Andono Ahmad  , Mubasysyir Hasanbasri
Published: November 2023

Background: challenges to work in underdeveloped areas andpeople's expectations of the quality of healthcare requiresdoctors who have public health program managementcompetencies. Objectives: identify perception of the needs and responsibilityof medical education institution to meet the managementcompetencies. Method: a mixed method study mixed method with sequentialexploratory. Results: Communication skills and respecting the right ofothers are the most needed competencies and the less neededcompetency is become chairman/leader of an activity.Competency to manage the organization's finances have notbeen met by a medical education institution and competencywhich has been met by medical education institutions is anupdating of medical knowledge actively. Conclusion: doctors need management competencies whileon duty in underdeveloped areas, but medical educationinstitutions are not yet fully meet its responsibilities in thefulfilment of these competencies.
PERUBAHAN PELAYANAN KLINIK NON-BPJS SEBELUM DAN SETELAH IMPLEMENTASI BADAN PENYELENGGARA JAMINAN SOSIAL (BPJS) KESEHATAN (Studi Kasus di Klinik Utama Rawat Inap Sumber Bahagia, Depok, Jawa Barat)
Authors: Gregorius Budi Rooseno Putro  , Hari Kusnanto
Published: November 2023

Background: The implementation of the BPJS Kesehatan as asingle payer healthcare cover back in 2014 in Indonesia starts anew era of a nationwide coverage of health insurance. Everycitizen should be a member of that program, according to thelaw. The state owned health services are the main providers ofthe services, along with the private owned hospitals and clinics,as long as they can fulfill the requirements given by thegovernment. But some small clinics are not eligible to met thecriteria of the BPJS Kesehatan, resulting in the inability to be theprovider. This can lead to the decrease of revenues of thoseclinics, and can cause bankruptcy. Objective: The main objective of this research is to find fewalternative strategies that can be applied by the non-BPJSclinics so they can still gain a significant portion of the healthservice industry business and even increase their revenues byapplying those strategies. Methods: This research is a case study conducted in a cliniccalled KURI Sumber Bahagia in the city of Depok, West Java,with using both quantitative data of patient visitation, that wasanalysed using a linear regression technique to determine thesignification effect of BPJS Kesehatan, as well as qualitativeinformation gathering by means of interviewing the stakeholdersin that clinic. The interview data would help theresearcher to explain the phenomena found by the statisticsmeasurements. Results: The statistic results of this research showed asignificant decrease (p<0,05) in patient visitation after theimplementation of BPJS Kesehatan back in 2014, especially intypes of services such as manual labour, sectio caeserea labor,infant immunisation in general, and birth control shots. Incontrast, there are several services that showed an increaseusage (p<0,05) even after BPJS Kesehatan, such as IUDsservices, Hepatitis A shots, and Cervical Cancer shots. Basedon the interview conducted afterwards, researcher found onmost health services, patients tend choose BPJS than privateclinics of the same services because it is cost efficient, but onsome services they were willing to pay out of pocket in privateclinics because the quality of services or the products that werenot available in BPJS Kesehatan (eg. NOVA T brand of IUD).Furthermore, the research also found the increase on serviceswhich are not available in BPJS Kesehatan (eg. Hepatitis Ashots, Cervical cancer shots). Conclusion: There are significant decreases of patientvisitation numbers in KURI Sumber Bahagia clinic since theimplementation of BPJS Kesehatan. This phenomenon isresponded by the clinic by giving a better quality services andproducts and also by providing other services in which notcovered by BPJS Kesehatan. Differentiation of services and quality services is proven effective to maintain and evenincrease patient visitation, which in the end can give a goodrevenues for the clinic.
PERSEPSI PASIEN KELAS III PBI DAN NON-PBI TERHADAP PELAYANAN RAWAT INAP DI RSUD dr. M. YUNUS BENGKULU
Authors: Johan  , Tjahjono Kuntjoro  , Rizaldy Pinzon
Published: November 2023

Background: Management of Public Hospital of dr. M. Yunuscontinues to strive on improving services quality for their patient,although the result has not been optimal. It demonstrated onachievement of Bed Occupancy Rate (BOR) of the 3rd inpatientclass in 2014 still 44,25% (Standard BOR by Health Ministry is60-85%) means most hospital bed have not utilized and patientnumber of the 3rd inpatient class showed decreasing from5.486 in 2013 becomes 3.813 in 2014. Objectives: Identifying perception of the 3rd class patienttowards inpatient services in dr. M. Yunus Public HospitalBengkulu, to know are there differences in perception betweeninsurance contribution and non-insurance contribution. Methods: This study was analytical observational researchusing cross sectional approach. Number of respondents of thisstudy were 130 patient as beneficiaries of health insurance and130 patient as non-beneficiaries of health insurance. Samplewas determined by proportional random sampling. The analysisused chi square test and qualitative data. Results: Patient perception to quality of service to come cut ofpaint 25.99 when compared to the cut of point / mean theoretical25 is categorized good results. The relationship between patientperception PBI towards service quality results are statisticallysignificant p < 0.05. OR value of 2:13 means that the patient'sperception PBI towards service quality is better than the 2:13time patients NonPBI. Patients' perceptions towards skills ofofficers of 26.17 when compared to the cut of point/meantheoretical 25 is categorized good results. The relationshipbetween the patient's perception PBI towards perceptions ofskills results are significant p < 0.05. Practically obtained ORvalue 1.87 means that the patient's perception towards skills ofofficers PBI better by 1.87 times compared to patients NonPBI. Conclusion: Perception of the third-class patient PBI and Non-PBI towards third class inpatient services has been good. Thereis a difference of perceptions between the groups of patientsPBI with NonPBI patient groups.
EFISIENSI RUMAH SAKIT JIWA PEMERINTAH DI PROVINSI JAWA TENGAH DAN DIY SEBELUM DAN SESUDAH JKN DENGAN MENGGUNAKAN TWO-STAGE DATA ENVELOPMENT ANALYSIS (DEA)
Authors: Rina Indrayanti  , Lutfan Lazuardi  , Mubasysyir Hasanbasri
Published: November 2023

Background: During a national health insuranceimplementation, efficiency improvement becomes an importantissue as a result of the change of a payment method from freefor service to fixed pricing mechanism of INA CBG's bycontaining cost and improving quality. Inefficiency occurs whena psychiatric hospital uses an excessive input resource toproduce a given level output.Objective: This study aimed to measure the level of efficiencyof government psychiatric hospitals in the provinces of CentralJava and Yogyakarta before and after the implementation ofJKN.

Methods: A descriptive quantitative study was conductedusing two-stage data envelopment analysis (DEA). The firststage was to measure hospital efficiency. Second stage usedpaired samples t-test to analyze different mean of BOR, LOS,BTO, TOI and cost efficiency score. This study used secondarydata from financial report, human resources report, hospitalpatient visit report of 5 psychiatric hospitals in central java andDIY province, period 2010 until 2014.Results: Efficiency measurement using DEA CRS inputorientedmodel obtained the mean of cost efficiency score was0,896. Mean of efficiency score decreased during a transitionperiod of national health insurance implementation from 0,947in 2013 became 0,866 in 2014. Soedjarwadi hospital was theonly one of a psychiatric hospital that achieved cost efficiency in2014. Paired samples t test analysis showed that there was nodifference of mean of BOR, LOS, BTO, TOI and score costefficiency before and after efficiency improvement in 2013 from2010. There was no difference of mean of BOR, LOS, BTO andscore efficiency before and after implementation of nationalhealth insurance. The only one variable had difference of meanbefore and after implementation of national health insurancewas TOI.Conclusion: Most psychiatric hospital in this study are stillinefficient. National health insurance has not been able toimprove efficiency in the early implementation period.Decreasing of efficiency score happened because of thedecreasing of hospital output.
POLA PEMANFAATAN PELAYANAN KESEHATAN DAERAH TERTINGGAL, PERBATASAN, KEPULAUAN, DAN TERPENCIL (DTPK-T) DI INDONESIA (ANALISIS DATA RISKESDAS 2013)
Authors: Sri Wiyanti  , Hari Kusnanto  , Mubasysyir Hasanbasri
Published: November 2023

Background: Utilization of health services is an importantelement in determining the health status of the community.Information on the utilization of health services are needed byhealth services management, in taking appropriate policy(Feldstein 1988). communities disadvantaged areas, islands,and remote border (DTPK-T) have limitations in the use ofhealth services, this is due to geographical conditions that aredifficult to reach, limited infrastructure and health humanresources that add to the complexity of the problem.Objectives: Reviewing and analyzing the patterns of utilizationof health services for people in underdeveloped regions, border,island, and remote.

Method: This study uses secondary data from the Basic HealthResearch (RISKESDAS) in 2013, with a cross-sectional design.In this study focused to see the pattern of utilization of the publicin disadvantaged areas, border, island, and remote in obtaininghealth services at the health center.

Results: Least developed society, border, island, and remoteuse more health centers, out of total 42.623 respondents,approximately 18.882 people or 43.5% are utilizing the serviceshealth centers, physician practices 19.5%, gender, economicstatus, education, travel time and transportation costs, doctor'sdiagnosis of the disease in the suffering of both communicableand non-communicable, rural location had a significant effect onhealth care utilization, while the category of regions did not havea significant effect on the utilization of health centers.Conclusion: People in, Less developed, border, island, andremote areas (DTPK-T) have made use of basic health carefacilities (health centers), in addressing health issues. Specialpolicies are needed in order to improve the quality of care byproviding health resources, infrastructure, and availability ofdrugs.
DETERMINAN KUNJUNGAN ANTENATAL CARE DI AREA PEDESAAN INDONESIA (Analisis Data Riskesdas 2013)
Authors: Elsi Arisanti  , M. Hakimi  , Mubasysyir Hasanbasri
Published: November 2023

Background: AKI is an indicator to determine the health statusin a country. The maternal mortality ratio in Indonesia was228/100.000 live births in 2008 to 220/100.000 live births in2010 and there was an increase to 359/100.000 live births in2013, while the MDGs target for 2015 was 102 per 100.000 livebirths. In Indonesia, the main causes of maternal death arebleeding, hypertension and infection. Antenatal care has beenproven effective in early detection of conditions that causematernal death. social approaches also need to be consideredas indirect causes such as socio-demographic factors,unavailability of birth attendants, costs. In public healthsciences, the social approach is a social determinant of health.The use of Antenatal Care is not optimal due to the limitedsupport of the health system and the influence of socioeconomicconditions and the rural environment.Purpose: To identify determinants of antenatal care visits inrural areas in Indonesia based on data analysis of Riskesdas2013.Methods: This type of research is quantitative using data fromthe 2013 Basic Health Research. Respondents in this studywere mothers who had been pregnant and gave birth during theperiod of January 1st 2010 to 2013 aged 10-59 years and live inrural Indonesia

Results: After a statistical test was carried out, the antenatalcare visits in rural Indonesia were 90.41%. The factors that mostinfluenced antenatal care visits in rural areas were informationon knowledge of the availability of midwives for practice (Pvalue= 0.001, OR = 2.01) and information on knowledge of theavailability of posyandu (P-value = 0.001, OR = 1.93).

Conclusion: Antenatal care visits in rural Indonesia are stillquite high. There is a relationship between individual factors andhealth system factors on antenatal care visits in rural areas.Individual factors cannot stand alone without health systemfactors. Health system factors are more important thanindividual factors. There needs to be an increase in the qualityand quantity of information for health cadres and the communityabout the importance of antenatal care visits.
IMPLEMENTASI KEBIJAKAN JKN OLEH PEMBERI PELAYANAN KESEHATAN DI KABUPATEN KEPULAUAN ANAMBAS
Authors: Irawati Sagala  , Laksono Trisnantoro  , Retna Siwi Padmawati
Published: November 2023

Background: Anambas Islands Regency is a district that iscategorized as a DTPK area. In the health context, rural andremote areas are often associated with limited public transportation,poor road infrastructure, long distances to health carefacilities and difficulties in recruiting and retaining healthworkers. As a result there is a significant impact on the provisionof adequate health services. The availability of insufficient resourcesat every health facility in Anambas Islands Regency isalso an obstacle because in implementing JKN every healthfacility in Anambas Islands Regency must meet thecredentialing requirements set by BPJS Kesehatan.Objective: Analyzing the implementation of JKN policies byhealth service providers in Anambas Islands Regency.

Methods: Descriptive research with qualitative methods usinga single case study design

Results: Implementation of policy NHI by health care providersboth in health centers and hospitals are still many haveconstraints such as limited power specialist, especially inhospitals, general practitioners definitive still lacking in somehealth facilities, the limited infrastructure in health centers andhospitals that cause will not want the patient should be referred.This adds to the burden of transportation costs to society asocean freight rates are quite expensive though some things canbe addressed as a problem of information and improvement ofbureaucratic structures, but it can not prevent the public to bereferred.Conclusions: The implementation of the JKN policy is notsuitable for implementation in Anambas Islands Regency as aDTPK area because the benefits received by the communityfrom JKN are limited due to the many obstacles faced by healthservice providers.
ANALISIS PEMBIAYAAN PENANGGULANGAN GIZI BURUK PADA BALITA DI KABUPATEN LOMBOK TENGAH PROVINSI NUSA TENGGARA BARAT
Authors: Irna Agustina  , Toto Sudargo  , Diah Ayu Puspandari
Published: November 2023

Background: According to WHO more than 50% of infant andchild mortality is related to malnutrition, a nutritional problemthat needs to be solved quickly and appropriately. Based on theresults of PSG Kadarzi years 2012-2015 the prevalence ofemaciation according to indices of BB /TB or BB/PB was 7,43%,7,32%, 9,81%, and 7,6%. Those number fluctuate but if thisnutritional problem is ignored it will cause problems ofdevelopment in the future. Consider this phenomenon we canfind out how the financing of prevention of malnutrition in CentralLombok regency issued by government and society.

Objective: Identify financing countermeasures of malnutritionamong children under five years old in the district of  Central Lombok, West Nusa Tenggara (NTB)

Methods: This research is a descriptive study and crosssectionalresearch design with quantitative dates. This researchwas conducted in Central Lombok regency, West NusaTenggara Province. The subjects of this study were the motheror malnourished children keeper as many as 30 people. Thedata analysis was conducted by descriptive the financingcountermeasures of malnutrition in Central Lombok regency.

Results: From the search results and interviews it showed thatthe malnutrition countermeasures costs spent by thegovernment was IDR2.816.913,00/person/year and the amountof public expenses was IDR7.874.100,00/person/year. Thelarge proportion of the cost of government was 26,35% and bythe public was 73,65%.Conclusion: The society expenses were 2,79 times as high asgovernment expenses on malnutrition countermeasures onchildren under five in Central Lombok regency.