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Laboratorium ergonomi yang diteliti merupakan salah satu dari fasilitas dari pendidikan tinggi vokasi pada jenjang diploma. Laboratorium ergonomi digunakan untuk berbagai kegiatan praktikum antara lain pengukuran data antropometri, work sampling, serta biomekanika. Kegiatan tersebut dilakukan selama 8 jam per hari sehingga memerlukan penerangan yang sesuai dengan standar agar tidak menimbulkan penyakit akibat kerja, yaitu gangguan penglihatan dan berkurangnya konsentrasi pada saat beraktifitas. Analisa penerangan di ruangan akan dikaji sesuai dengan Permenaker 05 Tahun 2018. Laboratorium ergonomi terbagi menjadi 3 ruangan yaitu ruang teknisi, ruang dosen, dan laboratorium utama. Penentuan titik pengukuran dilakukan sesuai dengan SNI 7062:2019 dengan jenis penerangan umum. Hasil pengukuran rata-rata intensitas pencahayaan pada laboratorium ergonomi adalah sebesar 101,23 lux, 136,63 lux, dan 161,58 lux. Ketiga ruangan tersebut belum memenuhi standar pencahayaan pada peraturan. Faktor-faktor yang berpengaruh kondisi tersebut yaitu: adanya jendela persegi di ruangan ini tertutup oleh komponen bangunan gedung sehingga menghalangi sinar matahari sebagai pencahayaan alami masuk ke dalam ruang laboratorium ergonomi.

Context: Inflammatory factors and oxidative stress were discovered to play significant roles in the progression of chronic kidney disease (CKD). There is, however, no research on the direct impact of high plasma angiotensin converting enzyme (ACE) and interleukin (IL)-6 levels on CKD prognosis, particularly in non-hemodialysis patients. Aims: To investigate the potential role of plasma ACE and IL-6 levels in CKD prognosis. Methods: A total of 75 non-dialysis CKD patients participated in this cross-sectional study. The estimated glomerular filtration rate (e-GFR) and albuminuria were used to determine the prognosis of CKD. The plasma ACE and IL-6 levels were measured using an enzyme-linked immunoassay (ELISA). Spearman's rank correlational analysis was used to examine the relationship between ACE and IL-6 plasma levels with the prognosis of CKD. Results: The result showed a statistically significant correlation between age and plasma ACE (p = 0.038, r = 0.241), serum creatinine, and urine albumin-creatinine ratio with CKD prognosis (p

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD). Klotho expression was reduced in patients with CKD, leading to vascular calcification, endothelial dysfunction, and atherosclerosis. We investigated the role of the klotho G395A gene polymorphism and plasma klotho level in the ten-year risk of atherosclerotic cardiovascular disease (ASCVD) and CVD mortality in CKD patients.METHODS: We used the PCR-CTPP assay method to genotype klotho G395A single nucleotide polymorphism (SNP) in 72 non-dialysis CKD patients. The klotho level was determined using the enzyme-linked immunoassay (ELISA) method. Path analysis was used to determine the relationship between the klotho G395A SNP, plasma klotho level, ASCVD risk score, and CVD mortality risk score.RESULTS: Our results showed that the GA genotype had lower plasma klotho levels than the GG genotype (path coefficient=-0.185, p=0.000). There was a significant negative correlation between plasma klotho level and the ASCVD risk score (r=-0.243, p=0.040), but no significant correlation was found between plasma klotho level and the CVD mortality risk score (r=-0.145, p=0.225). Path analysis showed that plasma klotho level had a significant negative direct effect on ASCVD risk score (path coefficient=-0.272, p=0.000) and an indirect effect on CVD mortality risk score (path coefficient=0.187, p=0.005).CONCLUSION: Klotho G395A SNP might reduce lower plasma klotho levels, which increased ASCVD and CVD mortality risk scores in non-dialysis CKD patients. However, other risk factors such as age, CKD stages, hypertension, and smoking should be taken into consideration. Therefore, large-scale genetic association studies with adjusted variables could be conducted in various ethnic groups for a more robust result.KEYWORDS: klotho, single nucleotide polymorphism, cardiovascular disease, chronic kidney disease

The purpose of this study is to analyze as well as provide input to a company, namely through the development of an information system that is currently used to process data for travel car rental services. Currently the computer application is one of the important factors for a company in managing all company activities to be more effective and easier. Even the use of technology through information systems has become the main requirement to show the quality of a field and become the most important capital in winning the competition. The information system for travel car rental services at Tirtayasa Trans needs to be designed because currently it is still using a separate data processing method in a spreadsheet application, where each daily or monthly transaction is grouped in each file so that this makes the filtering and reporting process difficult. The research method used in writing is a descriptive review method with a data collection technique approach, namely through observation, interviews, and literatur study. In addition, at the system development stage, the waterfall system is used. The design of this computer application can help companies to improve performance and car rental services in order to compete well in the world of travel car rental business.

A man in his late 50s had reduced left ventricle systolic function and hypokinesia of the anteroseptal, anterior, anterolateral, and septal walls. Lung ultrasound demonstrated multiple B-lines in both lung fields. What would you do next?

IntroductionPeripartum cardiomyopathy (PPCM) is a potentially life-threatening pregnancy-related heart disease. Genetic roles such as gene polymorphisms may relate to the etiology of PPCM. This study analyzes the association between single nucleotide gene polymorphism (SNP) guanine nucleotide–binding protein beta-3 subunit (GNB3) C825T and insertion/deletion (I/D) of the angiotensin-converting enzyme (ACE) gene with the incidence of PPCM.MethodsAn analytic observational study with a case–control design was conducted at the Integrated Cardiac Service Center of Dr. Soetomo General Hospital, Surabaya, Indonesia. PPCM patients of the case and control groups were enrolled. Baseline characteristic data were collected and blood samples were analyzed for SNP in the GNB3 C825T gene and for I/D in the ACE gene by using the polymerase chain reaction, restriction fragment length polymorphism, and Sanger sequencing. We also assessed ACE levels among different ACE genotypes using a sandwich-ELISA test.ResultsA total of 100 patients were included in this study, with 34 PPCM cases and 66 controls. There were significant differences in GNB3 TT and TC genotypes in the case group compared with that in the control group (TT: 35.3% vs. 10.6%, p = 0.003; TC: 41.2% vs. 62.5%, p = 0.022). The TT genotype increased the risk of PPCM by 4.6-fold. There was also a significant difference in the ACE DD genotype in the case group compared with that in the control group (26.5% vs. 9.1%, p = 0.021). DD genotypes increased the risk of PPCM by 3.6-fold. ACE levels were significantly higher in the DD genotype group than in the ID and II genotype groups (4,356.88 ± 232.44 pg/mL vs. 3,980.91 ± 77.79 pg/mL vs. 3,679.94 ± 325.77 pg/mL, p ConclusionThe TT genotype of GNB3 and the DD genotype of the ACE are likely to increase the risk of PPCM. Therefore, these polymorphisms may be predisposing risk factors for PPCM incidence. ACE levels were significantly higher in the DD genotype group, which certainly had clinical implications for the management of PPCM patients in the administration of ACE inhibitors as one of the therapy options.

Background Cardiac myxoma is the most common type of primary cardiac tumor, with the majority located in the atrial wall. The tumor is attached to valvular structures in a few cases, of which the pulmonary valve is the least affected. Pulmonary valve myxoma may have different clinical manifestations from the more common cardiac myxomas because of its vital position. A misdiagnosis of these types of cardiac myxoma may be detrimental to the care and well-being of patients. Therefore, this systematic review aims to define the clinical characteristics of pulmonary valve myxoma and how this differs from a more common cardiac myxoma. Methods Employed literature was obtained from PubMed, ScienceDirect, Scopus, Springer, and ProQuest without a publication year limit on August 23, 2022. The keyword was “pulmonary valve myxoma.” Inclusion criteria were as follows: (1) case report or series, (2) available individual patient data, and (3) myxoma that is attached to pulmonary valve structures with no evidence of metastasis. Non-English language or nonhuman subject studies were excluded. Johanna Briggs Institute checklists were used for the risk of bias assessment. Data are presented descriptively. Results This review included 9 case reports from 2237 articles. All cases show a low risk of bias. Pulmonary valve myxoma is dominated by males (5:4), and the patient’s median age is 57 years with a bimodal distribution in pediatric and geriatric populations. The clinical manifestation of pulmonary valve myxoma is often unspecified or asymptomatic. However, systolic murmur in the pulmonary valve area is heard in 67% of cases. Echocardiography remains the diagnostic modality of choice in the majority of cases. Tumor attached to the pulmonary cusps or annulus and extended to adjacent tissues in all cases. Therefore, valve replacement or adjacent tissue reconstructions are required in 77% of cases. The recurrence and mortality are considerably high, with 33% and 22% cases, respectively. Conclusions Pulmonary valve myxoma is more common in males with a bimodal age distribution, and its outcomes seem worse than usual cardiac myxomas. Increasing awareness of its clinical symptoms, early diagnosis, and complete myxoma resection before the presence of congestive heart failure symptoms are important in achieving excellent outcomes. A firm embolization blockade is needed to prevent myxoma recurrence.

Game merupakan hiburan yang digemari semua kalangan baik dari anak-anak hingga orang dewasa, industri game memiliki ratingnya tersendiri dengan dibatasi oleh usia para pemainnya mulai dari usia 3 tahun hingga ke semua usia. Game ini memiliki jalan cerita dan visualisasi yang akan membuat pemain penasaran dengan akhir ceritanya. Game “The Meet” merupakan permainan game horor dimana pemain diharuskan menyelesaikan objektif untuk segera tidur kedalam rumah barunya. Dalam game ini menggunakan softwareUnreal Engine 4, dengan menerapkan kecerdasan buatan FSM (Finite State Machine). FSM digunakan pada karakter NPC (Non playable Character) yaitu karakter digerakan oleh kecerdasan buatan yang digunakan untuk mendukung game tersebut. Seperti karakter Kuntilanak dan Pocong yang digunakan tiga hal yaitu : Roam, Chase Player dan Patrol. FSM (Finite State Machine) pada pintu dan kunci terdapat dua hal : tertutup dan terbuka, FSM (Finite State Machine) pada nyawa karakter terdapat dua hal : berkurang dan bertambah. FSM (Finite State Machine) pada saklar terdapat dua hal : menyala dan mati. Pada pengujian metode FSM (Finite State Machine)yang diterapkan pada musuh sebagaian besar responden menyatakan bahwa fungsi dari masing-masing state telah berjalan dengan baik, artinya presentase penilaian sekisar 60 user didapatkan hasil yang menunjukan bahwa 74% menyatakan Baik, 22.66% menyatakan Cukup dan 3.33% menyatakan Kurang.

The population administration system is part of the state administration system, which has avery important role in the government to manage population data. Increasing populationawareness and participation to participate in supporting the development planning of thepopulation administration system to improve services to the public. In line with the objectives ofthe administration of population administration, population registration and civil registrationare an important part of the population administration system that needs to be managed as wellas possible to provide benefits for government improvement and development. Sampler Villageis one of the villages that already use information systems and computers in carrying out dailyactivities. This population information system was built by applying auto control to input errorsthat often occur, besides that it is also equipped with auto control for data that is exchangedwhich causes data redundancy as well as control over information users because it has beenequipped with good user security features so that it is more guaranteed that data will not belost. stolen or lost. Some of these features apply to several important transactions for serviceadministration, including the process of submitting a letter of introduction for a ResidentIdentity Card (KTP), Family Card (KK), birth certificates, and death certificates so that this isexpected to help the process of serving residents and village office tasks become more efficient.faster and more effectively by the expected needs.

Penelitian ini untuk menganalisis pengaruh profitabilitas dan leverage terhadap perataan laba serta mengalisis good corporate governance dalam memoderasi pengaruh profitabilitas dan leverage terhadap perataan laba pada perusahaan manufaktur sub sektor makanan dan minuman yang terdaftar di Bursa Efek Indonesia pada periode 2016-2019. Metode penelitian dalam penelitian ini menggunakan metode deskriptif dan verifikatif. Metode pengambilan sampel dalam penelitian ini menggunakan metode purposive sampling. Sampel penelitian diperoleh sebnayak 19 perusahaan. Teknik analisis data yang digunakan adalah analisis uji asumsi klasik, regresi data panel dan moderate regression analysis (MRA) dan pengujian hipotesis. Hasil pengujian menunjukkan bahwa profitabilitas berpengaruh positif signifikan terhadap praktik perataan laba, dan leverage berpengaruh positif signifikan terhadap praktik perataan laba. Good Corporate Governance diproksikan dengan Kepemilikan Institusional tidak mampu memoderasi pengaruh positif profitabilitas terhadap praktik perataan laba namun good corporate governance mampu memoderasi dengan memperlemah pengaruh positif leverage terhadap praktik perataan laba.

We report three cases of acute myocardial infarction caused by left anterior descending (LAD) artery occlusion presenting as ST elevation in the inferior. Therefore, coronary angiography showed an occlusion of the LAD coronary artery. Our cases show the rare occurrence of left coronary circulation dominance affecting inferior leads. These cases show an unusual and very rare form of left dominance coronary circulation where LAD is wrapped around the apex and continuing as a posterior descending artery. This would make inferior myocardial infarction because of occluded LAD or determine as wrapped LAD.

Dok di perusahaan galangan kapal memiliki potensi bahaya akibat kegagalan pada ganjal kapal. Hal ini dapat menyebabkan kerusakan kapal dan kecelakaan pada pekerjaan perbaikan dan pemeliharaan kapal karena seluruh berat kapal sepenuhnya bertumpu pada ganjal tersebut. Salah satu penyebab kegagalan ganjal kapal adalah kesalahan dalam pemilihan material yang digunakan sehingga tidak kuat menopang beban kapal yang ada diatasnya. Oleh karena itu penelitian ini dilakukan untuk memberikan rekomendasi kayu ganjal kapal untuk dok pada galangan kapal. Rekomendasi dilakukan dengan cara membandingkan kayu yang digunakan saat ini dengan kayu yang memiliki kelas kuat diatasnya menurut PKKI 1961 dan melakukan komparasi dengan SNI 7973-2013 tentang spesifikasi desain untuk konstruksi kayu, untuk mengetahui nilai sifat mekanik dari masing-masing kayu. Nilai sifat mekanik digunakan sebagai material properti untuk simulasi pembebanan menggunakan software Ansys. Parameter yang diamati dalam penelitian ini adalah nilai von mises stress, total deformasi dan faktor keamanan. Berdasarkan hasil komparasi kelas kuat kayu pada PKKI 1961 dengan SNI 7973-2013 serta simulasi pembebanan Ansys dapat disimpulkan bahwa rekomendasi jenis kayu secara berurutan dari yang paling kuat dan aman untuk material ganjal kapal adalah kayu ulin, bangkirai, meranti dan trembesi.

Background True isolated posterior myocardial infarction is an uncommon finding of acute coronary syndrome, with an incidence rate of 3–7%. The prevalence rates of isolated posterior myocardial infarction in men and women are 72% and 28%, respectively. This uncommon finding may be attributed to multiple factors, such as unremarkable changes on 12-lead electrocardiography, a lack of awareness or knowledge, and an absence of diagnostic consensus, which leads to reperfusion delay and poor clinical outcomes. Case summary Herein, we report three cases of acute myocardial infarction presenting as isolated ST-segment elevation in the posterior leads (V7–V9): Asian men aged 57, 62, and 53 years, who presented with ST-segment depression in V1–V3 that resolved gradually. Coronary angiography revealed a total/critical occlusion of the proximal circumflex coronary artery in all three cases. Routine and accurate interpretations of 15-lead electrocardiography (12-lead with additional V7–V9) resulted in a better sensitivity for isolated posterior myocardial infarction diagnoses, followed by a timely and opportune primary percutaneous coronary intervention. Conclusions Isolated posterior myocardial infarction is a rare but potentially fatal event that is often accompanied by atypical and subtle changes on 12-lead electrocardiography (especially in the V1–V3 precordial leads) and may remain undetected by physicians. Therefore, the comprehensive and routine application of posterior leads is a crucial addition to the standard diagnosis and management of acute coronary syndrome in patients with subtle ST-segment changes who do not fulfill the criteria for ST-elevation myocardial infarction.

Natural disasters are unexpected natural events, have a major impact on every level of society, especially coastal areas such as power generation companies that use coal as a natural resource. Every company hopes to be able to anticipate early and quickly so that employees are maintained and safe. The face attendance system is a monitoring tool combined with a smart gate with a face recognition concept that can be monitored online. Faces that have been registered can be recognized so that the device will act as a trigger to open the door, and vice versa if the face is not recognized, the device will still record and act as a trigger for the door to remain closed. The implementation of the facial attendance system can be used as a data source to calculate the number of employees who are still in and out of the company when a natural disaster occurs.

Electrocardiography is the fastest bedside tool for rapidly identifying patients with acute coronary syndromes who require emergency reperfusion therapy. Some of the circumstances that make identification more complex are bundle branch block patterns. ST elevation in the right bundle branch block (RBBB) can still be detected, but the left bundle branch block (LBBB) must use specific criteria such as Sgarbossa and Barcelona. We present a patient with anteroseptal ST-segment elevation (STEMI), total AV block (TAVB) with ventricular escape rhythm RBBB pattern, and then turned into a LBBB pattern. Fortunately, it immediately turned into sinus rhythm after reperfusion therapy. It is essential to be able to identify STEMI in patients with BBB patterns. In addition, to provide the best possible outcomes for the patient, we must understand that the best way to manage STEMI with TAVB is to immediately install a temporary pacemaker and initiate reperfusion therapy.

BACKGROUND AND AIMS: Opioid use in heart failure (HF) management is controversial, and whether rapid symptomatic relief outweighs the risks of opioid use in HF remains unknown. This study aimed to explore the clinical outcomes of opioid administration in patients with acute or chronic HF. METHODS: A systematic search for eligible studies was conducted in databases (MEDLINE, Scopus, Web of Science, EBSCO) and registries (ClinicalTrials.gov, WHO Clinical Trial Registry) until June 8, 2022. Odds ratios (ORs) or adjusted OR (aORs) and mean difference (MD) or standardized MD were quantified for binary and continuous outcomes, respectively. Meta-regression was performed using the restricted maximum likelihood method. RESULTS: A total of 20 studies (154,736 participants) were included. In acute HF, opioid use presented a high risk for in-hospital mortality (OR = 2.35; 95% confidence interval (CI): 1.03-5.38; I2 = 97%), invasive (OR = 2.78; 95%CI: 1.17-6.61; I2 = 93%) and noninvasive (OR = 2.97; 95%CI: 1.06-8.28; I2 = 95%) ventilations, intensive care unit admission (OR = 3.62; 95%CI: 3.11-4.21; I2 = 6%), and inotrope use (OR = 2.54; 95%CI: 1.94-3.32; I2 = 63%). In chronic HF New York Heart Association (NYHA) Class II/III, opioid use improved ventilatory efficiency (MD = -3.16; 95%CI: (-4.78)-(-1.54); I2 = 0%), and exercise test duration (MD = 69.24; 95%CI: 10.11-128.37; I2 = 89%). CONCLUSIONS: Opioids are not recommended for acute HF management; however, they showed an advantage in exercise testing by improving ventilatory efficiency, chemosensitivity, and exercise test duration in stable patients with chronic HF NYHA Class II/III. Nonetheless, larger randomized controlled trials and individual patient-level data meta-analyses are warranted.

We report an uncommon case of simultaneous cardio-cerebral infarction, due to Inferior – right ventricle ST Segment Elevation Myocardial Infarction (STEMI) with acute ischemic stroke. Incidence of cardio cerebral infarction is exceptionally rare, with an incidence rate as low as 0.009%. Hemodynamic compromise in patients with acute myocardial infarction may result in the cerebral blood flow reduction that cause hemodynamic stroke. Due to the rarity of this condition, there were no recommended therapeutics strategy. Mechanical reperfusion with PCI procedure may be a superior choice in the settings of acute cardio-cerebral infarction for restoring hemodynamic stability.

Background Electrocardiogram (ECG) is a widely accessible diagnostic tool that can easily be obtained on admission and can reduce excessive contact with coronavirus disease 2019 (COVID‐19) patients. A systematic review and meta‐analysis were performed to evaluate the latest evidence on the association of ECG on admission and the poor outcomes in COVID‐19. Methods A literature search was conducted on online databases for observational studies evaluating ECG parameters and composite poor outcomes comprising ICU admission, severe illness, and mortality in COVID‐19 patients. Results A total of 2,539 patients from seven studies were included in this analysis. Pooled analysis showed that a longer corrected QT (QTc) interval and more frequent prolonged QTc interval were associated with composite poor outcome ([WMD 6.04 [2.62‐9.45], P = .001; I 2:0%] and [RR 1.89 [1.52‐2.36], P, Electrocardiography abnormalities on admission, including longer QTc interval and prolonged QTc interval, longer QRS duration, a faster heart rate, the presence of LBBB, PAC, PVC, T‐wave inversion, and ST‐depression are significantly associated with an increased composite poor outcome in patients with COVID‐19.

Salah satu upaya pemerintah agar dapat meningkatkan pertumbuhan ekonomi yang merata adalah melalui program pembangunan strategis atau pembangunan nasional, Melalui Program Pemulihan Ekonomi Nasional Pemerintah Republik Indonesia saat ini sedang mengembangan Kawasan Industri Terpadu (KIT) yang berlokasi di Kabupaten Batang. Dengan adanya konsep green building, gedung rumah susun pada kawasan industri terpadu batang diharapkan dapat memenuhi segala aspek bangunan ramah lingkungan. Green building adalah gedung yang menggabungkan konsep tata letak lahan yang baik, energi listrik yang efisien, penggunaan air yang hemat, kondisi ruangan yang nyaman, material gedung yang ramah lingkungan, serta sikap dalam membangun dan mengoperasikan gedung secara green. Gedung Rumah Susun Kawasan Industri Terpadu Batang merupakan bangunan gedung bertingkat dengan lima lantai pertama yang dibangun dikawasan tersebut. Pada penelitian ini menggunakan versi terbaru yaitu versi 1.2 yang menggunakan referensi greenship, untuk ketentuan pengukuran/penilaian kriteria didasarkan pada kondisi Gedung Rumah Susun Kawasan Industri Terpadu Batang yang telah selesai dibangun, sehingga penelitian ini menilai ke tahap Penilaian Akhir. Hasil evaluasi diolah menggunakan metode logika fuzzy melalui aplikasi Matlab dengan mengacu pada Pedoman Penilaian Versi 1.2 dan skema untuk Penilaian Penghijauan pada Bangunan Baru. Setelah penilaian selesai, gedung Rumah Susun Kawasan Industri Terpadu Batang mendapat nilai 81,0 (Gold). Berdasarkan hasil tersebut gedung rumah susun dapat mencapai greenship yang diharapkan, oleh karena itu konsep perancangan desain sangat penting sehingga gambaran desain bangunan gedung ramah lingkungan dapat dikonsepkan sejak awal.

Interleukin-6 (IL-6) has been identified as an important pro-inflammatory factor involved in mediating the severity of chronic kidney disease (CKD). This study sought to determine the effect of plasma IL-6 levels on atherosclerotic cardiovascular disease (ASCVD) and cardiovascular mortality risk scores in Javanese CKD patients. We also analyzed the frequency of IL-6 G174C single nucleotide polymorphism (SNP) in the population. This study was a cross-sectional study involving seventy-three patients of Javanese ethnic origin with stable chronic kidney disease. We assessed the ASCVD risk score, cardiovascular mortality score, genotyping of IL-6 G174C SNP, and plasma IL-6 levels in these patients. The genotype distribution and allele frequencies of the IL-6 G174C SNP were predominated by the G genotype/allele (GG: 97.26%, GC: 1.37%, CC: 1.37%, G-allele: 97.95%, and C-allele: 2.05%). Despite the fact that plasma IL-6 levels did not directly affect cardiovascular mortality risk, further analysis revealed its direct effect on the ASCVD risk score (path coefficient = 0.184, p = 0.043, 95% CI = 0.018–0.380), which in turn affected cardiovascular mortality risk (path coefficient = 0.851, p =

The increasing rate of cardiovascular disorders contributes to rising hospitalized patients receive chronic oral beta-blocker therapy. Beta-blockers remain one of the fundamental therapy for chronic heart failure. Still, their role in decompensated heart failure and severe sepsis during hospitalization is often debated and inconsistent in clinical practice. In recent years, evidence of the efficacy and clinical outcomes of beta-blockers in acute heart failure (AHF) have accumulated. Clinical research indicates that chronic beta-blockade withdrawals should be prevented, or as soon as hemodynamic stabilization and euvolemic condition are reached, it should be reinstituted. As a subset of AHF patients with low cardiac output required inotropes, the choice of proper agent is fundamental. Different inotropic agents such as inhibitors of the phosphodiesterase, levosimendan, and dobutamine also their associations with beta-blockers are discussed.

The left main coronary artery (LMCA) ST-elevation myocardial infarction has been associated with significant morbidity and mortality. Older age and cardiogenic shock are independent predictors for in-hospital mortality. Here, we report a case of an 89-year-old Javanese man with a history of smoking presented with total LMCA occlusion complicated by cardiogenic shock in an octogenarian that was saved by stenting in thrombolysis in myocardial Infarction Flow III right coronary artery.

Customer loyalty is a commitment to using the product. Customer loyalty is achieved through satisfaction, brand image, service quality, and digital banking. This study aims to determine the effect of brand image, service quality, and digital banking on customer loyalty through customer satisfaction as an intervening variable at Bank Syariah Indonesia Pekalongan Pemuda. This research is quantitative research. The population amounted to 48,200. Sample of 100 respondents with the slovin formula, standard error 10%. Accidental sampling technique using a questionnaire. Data analysis techniques in the form of instrument tests, classical assumption tests, path analysis, hypothesis testing and coefficient of determination tests. The results showed that brand image significantly affects satisfaction with a beta value of 0.421 and a significance of 0.00. Service quality has no effect and is not significant to customer satisfaction with a beta value of -0.029 and a significance of 0.545. Digital banking has no effect and is not significant to customer satisfaction with a beta value of -0.002 and a significance of 0.964. Brand image significantly affects customer loyalty with a beta value of 0.436 and a significance of 0.001. Service quality has no effect and is not significant to customer loyalty with a beta value of 0.091 and a significance of 0.194. Digital banking has a significant effect on customer loyalty with a beta value of 0.392 and a significance of 0.00. Customer satisfaction significantly affects customer loyalty with a beta value of 0.504 and a significance value of 0.001. Customer satisfaction mediates the effect of brand image on customer loyalty with a t value = 2.178. Customer satisfaction does not mediate the effect of service quality on customer loyalty with a t value of -0.454. Customer satisfaction does not mediate the effect of digital banking on customer loyalty with a t value of 0.037.Keywords: Brand Image, Service Quality, Digital Banking, Customer Satisfaction, and Customer Loyalty.

Hypertension is one of the most common morbidities in COVID-19. Previous studies demonstrated that hypertension increases composite poor outcomes in patients with COVID-19. Beta-blockers is widely used as one of the most common antihypertensive agents. Beta-blockers may hold potential benefits in COVID-19 treatment, with current evidence of the potential mechanism of beta-blockers remains scarce. However, several mechanisms were suggested, including decreasing RAAS pathway activity and lowering the ACE2 levels, reducing cytokine storms, and may be beneficial in reducing mortality in ARDS related COVID-19. Further large-scale randomized clinical trials should be conducted before a definite recommendation can be drawn.

School is one of the places that plays an important role in educating a child, especially in matters relating to behavior, intellectual intelligence, emotional intelligence and spiritual intelligence. All of that will be built from an early age which is based in the school environment, therefore how important schools are for children. Vocational High School is a level with education equivalent to Senior High School whose education has a certain field with the aim of graduating ready to work. The attendance or attendance system is needed by schools to assess a student's achievement. However, there is a problem where some schools currently use conventional methods in giving presence to their students, including SMKN 1 Kota Serang. This problem can result in the duration of teaching and learning time being reduced and the resulting data information is inaccurate. With the presence of a computerized attendance system that will make this problem resolved, therefore the authors intend to design and create an attendance or attendance system that facilitates schools, especially in terms of student attendance or attendance. For this study, the authors used Radio Frequency Identification (RFID) as a medium for automatic student attendance combined with web-based applications using the PHP programming language and MySQL Database Management System for processing student attendance data. For the system development method, the author uses the Waterfall method so that it can facilitate the design of the attendance system or student attendance.

Aims This study aimed to compare the outcomes of the administration of LMWH and UFH in hospitalized COVID-19 patients. Methods and results We systematically searched several databases and included observational studies or clinical trials that compared the outcomes of the administration of LMWH and UFH in hospitalized COVID-19 patients. A total of nine studies comprising 9637 patients were included. Metanalysis showed that LMWH administration was associated with a lower in-hospital mortality and 28/30-day mortality compared with UFH administration {[relative risk (RR) 0.44; 95% confidence interval (95% CI) 0.32–0.61; I2: 87.9%] and (RR 0.45; 95% CI 0.24–0.86; I2: 78.4%), respectively}. Patient with LMWH had shorter duration of hospital and ICU length of stay compared with UFH {[weighted mean difference (WMD) −2.20; 95% CI −3.01 to −1.40; I2:0%] and (WMD −1.41; 95% CI −2.20 to −0.63; I2: 0%), respectively}. The risk of ICU admission or mechanical ventilation was lower in patients who received LMWH than in those who received UFH (RR 0.67; 95% CI 0.55–0.81; I2: 67.3%). However, there was no difference in the incidence of bleeding with LMWH compared with UFH (RR 0.27; 95% CI 0.07–1.01; I2: 64.6%). Conclusion Our meta-analysis showed that administration of LMWH was associated with better outcomes compared with UFH in hospitalized COVID-19 patients. Prospective cohorts and RCTs are urgently needed to explore the definitive effect of LMWH to provide direct high-certainty evidence. PROSPERO registration number: CRD42021271977

Atrial fibrillation (AF) is the most common rhythm disorder seen in doctors' offices and emergency departments (EDs). In both settings, an AF holistic pathway including anticoagulation or stroke avoidance, better symptom management, and cardiovascular and comorbidity optimization should be followed. However, other considerations need to be assessed in the ED, such as haemodynamic instability, the onset of AF, the presence of acute heart failure and pre-excitation. Although the Advanced Cardiovascular Life Support guidelines (European Society of Cardiology guidelines, Acute Cardiac Care Association/European Heart Rhythm Association position statements) and several recent AF publications have greatly assisted physicians in treating AF with rapid ventricular response in the ED, further practical clinical guidance is required to improve physicians' skill and knowledge in providing the best treatment for patients. Herein, we combine multiple strategies with supporting evidence-based treatment and experiences encountered in clinical practice into practical stepwise approaches. We hope that the stepwise algorithm may assist residents and physicians in managing AF in the ED.

The association between angiotensin-converting enzyme insertion/deletion (ACE I/D) polymorphisms and plasma ACE levels may allow for the optimization of a preventive intervention to reduce cardiovascular morbidity and mortality in the chronic kidney disease (CKD) population. In this study, we aimed to analyze the association between ACE I/D polymorphism and cardiovascular mortality risk among non-hemodialyzed chronic kidney disease patients. This cross-sectional study examined 70 patients of Javanese ethnic origin with stable CKD who did not receive hemodialysis. ACE I/D polymorphisms, plasma ACE levels, atherosclerotic cardiovascular disease (ASCVD) risk, and cardiovascular mortality risk were investigated. As per our findings, the I allele was found to be more frequent (78.6) than the D allele (21.4), and the DD genotype was less frequent than the II genotype (4.3 vs. 61.4). The ACE I/D polymorphism had a significant direct positive effect on plasma ACE levels (path coefficient = 0.302, p = 0.021). Similarly, plasma ACE levels had a direct and significant positive effect on the risk of atherosclerotic cardiovascular disease (path coefficient = 0.410, p = 0.000). Moreover, atherosclerotic cardiovascular disease risk had a significant positive effect on cardiovascular mortality risk (path coefficient = 0.918, p = 0.000). The ACE I/D polymorphism had no direct effect on ASCVD and cardiovascular mortality risk. However, our findings show that the indirect effects of high plasma ACE levels may be a factor in the increased risk of ASCVD and cardiovascular mortality in Javanese CKD patients.

Heart failure patients with reduced ejection fraction (HFrEF) respond well to pharmacological therapy and show a better prognosis. Heart failure patients with reduced ejection fraction and type 2 diabetes who were given SGLT-2 inhibitor therapy showed a strong and consistent reduction in the risk of death and hospitalization. The therapy that has recently begun to be investigated for its benefits for heart failure from the SGLT-2 inhibitor class is Dapagliflozin. The systematic review aims to analyze the effect of Dapagliflozin on the prognosis of HFrEF patients with type 2 diabetes mellitus. Material and Methods: The literature was searched from e-database PubMed, ScienceDirect, and ClinicalTrial.gov. Quality assessment was done using the Critical Appraisal Skills Program (CASP) Randomized Controlled Trial Standard Checklist. Results: A total of 22,167 patients from 4 RCTs eligible studies were included. The analysis results of all of the included studies indicate that Dapagliflozin affected the patient's prognosis. Two studies discuss mortality and hospitalization, and two studies discuss symptoms, functional status, and Quality of Life (QoL). Conclusion: Dapagliflozin can improve the prognosis of HFrEF patients with type 2 DM. The improved prognosis includes reduced mortality, reduced hospitalizations by minimizing disease worsening, reducing symptoms, improving functional status and QoL.Keyword: SGLT 2 inhibitor; Dapagliflozin; Prognosis; Cardiovascular disease; Diabetes.

The purpose of this study was to analyze the fertilizer supply system at PT.Gresik Cipta Sejahtera which is a system that helps process fertilizer inventory data so that it is expected to provide input on how to implement better data processing in the current era of information technology, this fertilizer supply system is carried out. with several stages of coordination through incoming letters of request to data collection based on recaptulation from the inventory by utilizing semi-computerized parts related, seeing that there are scattered data resulting in frequent inconsistencies of data so that data errors encourage checking that repeated so that a lot of time and energy is wasted, this is deemed ineffective and efficient. With the existence of computerization, it can make it easier for companies to monitor the warehouse section so that work in the warehouse section is more efficient and efficient, so that it can reduce obstacles that have occurred so far. The analysis method used to describe the inventory system at PT. Gresik Cipta Sejahtera uses the method of observation, interviews, and uses literature. The tools used to describe the system using DFD (Data Flow Diagram)

The decision making process is the individual steps in choosing an appropriate alternative choice from the various alternatives available to solve the problem. The purpose of this study is to describe the decision making process of high school students with high mathematical abilities in solving social arithmetic problems. The research approach used in this study is qualitative research. While the type of research is a qualitative descriptive study. The process of collecting data uses several instruments consisting of mathematics ability tests, social arithmetic problem solving tests, and interview guidelines. This research was conducted on 11th grade high school students in one of the state high schools in Sidoarjo. The subjects of this study consisted of one student with high mathematical abilities. The data collection method in this study began with the provision of mathematics ability tests for all students followed by selecting one subject with high mathematical ability through several considerations. The next step, the subject is given a problem solving test and interviewed to get the decision making process carried out by the subject. The results showed that students with high mathematical abilities carried out a series of activities in the stages of the decision making process, namely define the decision, understand the context, identify the options, prioritise the options, evaluate the consequences, review the decisions, and take actions.

The quality of education in Indonesia is still far from being expected. It is different from Taiwan. The government and people realize that a strong commitment to build and develop a national education system is a key determinant of the success of the state to maintain students’ achievement. The purpose of this study is to respond the correlation of teacher teaching experience (TTE) and instructional delivery on teacher’s competence (TCC), classroom curriculum (CC), and personal competencies (PC) by examining teachers in the primary schools from Taiwan and Indonesia. This study explores the differences between Taiwan and Indonesia cohort in TCC, CC, PC and correlation between TTE and TCC, CC, PC to bring learners` achievement. The results shown that the TCC, CC, PC are different from Taiwan and Indonesia. Then, TEE is statistically significant on TCC, CC, and PC. The techno teaching of each country is compiled by the ministry of education, and then the primary school is given the authority to develop techno teaching or students’ achievement in accordance with the conditions of each region and students’ demand in Indonesia which includes a teacher’s competencies that are supported to succeed the education especially in primary school.

This study aims to be able to assist PT Luhai Industri Indonesia in processing data of new raw materials by making appropriate decisions with prices that are quite economical but with good enough quality, while the data processing techniques here use the decision support system method to determine adequate raw material production good and efficient. So not only is the information needed faster, the time needed to process the data will be faster. In the process of building a decision support system for the selection of raw materials for production using a system development method with a weighted product that uses a multiplication formula to link the rating of each attribute, where the rating must be raised first with the weight of the attribute concerned, in this study will use a method approach Waterfall in the development of the system from collecting data for user needs to the data to be processed into an attribute and weighting with the weighted product method in determining decisions on the final result of the software to be made, while the tools used in research to describe the flow of the system this is by using a structured method namely UML (Unfield Method Language) in describing the functional program model. This decision support system software will be built with Visual Studio 2010 programming language with a client server system so to adjust the system here will use MySQl as the database.

KONI (Indonesian National Sports Committee) Banten Province is an organization that acts as the parent in the field of sports that continues to foster outstanding athletes from several categories at the local, national, and international levels. In the world of sports, Koni plays an important role in cultivating and fostering athletes. To determine qualified athletes from various categories so that they are ready to take part in a sporting event can be seen from their physical condition and achievements. In this athlete's recommendation must go through the calculation stages manually from physical records, achievements and all trainers who understand it. To solve this problem, we need a system to help process athlete data from several categories which are then used as recommendations for athletes who are ready to be included in an event. Athlete data information systems are built on the basis of assisting in athlete data processing to be more effective and faster, this system is designed with the Waterfall development method in which the program flow design uses Flowcharts so that it becomes clearer how the athlete's information system can run according to good data processing mechanisms from the start of input, process and output. The programming language used is a visual basic language that has been popular and has proven its ability in handling data processing, which on this occasion the database is MySQL. This information system is certainly not immune to weaknesses whose hopes for the future to continue to be developed in order to continue to be useful and easy to operate.

Indonesian Basic Health Research in 2018 showed the prevalence of pneumonia, pulmonary tuberculosis (TB) and lung cancer in Indonesia 4.0% 0.4% and 0.18%, respectively. However, the number of lung specialists is small. According to the Indonesian Lung Specialist Association webpage, the number of doctors joined in the association up to 2008 were 452. This amount is very less when compared with existing lung disease cases. Thus, the handling of lung disease will be too late. The use of ANFIS for early detection of lung disease is growing. However, the systems designed are need preprocessing data to be executed and still applied for one type of disease. This paper will design a desktop application based on ANFIS expert system to detect lung disease early, i.e. for pneumonia, pulmonary TB and lung cancer. The system will work based on simple symptoms expressed by the patient. Subtractive clustering is used for clustering process. The results of the training showed that the models were able to give better performance compared to the model built using conventional clustering methods. The test results show that those three models have comparable performance compared to their counterpart. Software validation shows that the it gives 94.00% succeed for training data and up to 100% for testing data. This application is not intended to replace the role of a doctor, but to help diagnose the patient's condition earlier.

A rise and/or fall in troponin level is an indication of type 1 or 2 myocardial infarct. A 62-year-old male physician presented to emergency room with chest discomfort followed by thought to be normal electrocardiogram (ECG) and normal echocardiography results. His serial hs-troponin test showed remarkable escalation three hours from the initial (107 ng/l into 4.978 ng/l), suggesting a high-risk non-ST-segment myocardial infarction (NSTEMI). An early invasive procedure was performed, showing acute total occlusion (TO) in the obtuse marginal 1 branch. We retrospectively reviewed our examination to diagnose better the presence of TO in NSTEMI patients presented with non-diagnostic examination. Our evaluation showed a minor change in the form of an ‘N-wave’ pattern on the ECG, which was not yet an established guideline criterion for prompt angiography. Although ECG pattern is often normal in LCx occlusion, recent study shows the presence of ‘N-wave’ ECG pattern in 10% of NSTEMI cases following TO at LCx.

Introduction Patients with COVID‐19 frequently exhibit a hypercoagulable state with high thrombotic risk, particularly those admitted to intensive care units (ICU). Thromboprophylaxis is mandatory in these patients; nevertheless, thrombosis still occurs in many cases. Thus, the problem of assessing an adequate level of anticoagulation in ICU patients becomes evident during the COVID‐19 pandemic. The aim of this study was to evaluate the heparin resistance and the efficacy of heparin monitoring using an anti‐Xa activity assay. Methods Thirty‐seven heparin‐treated patients admitted to ICU for SARS‐CoV‐2 pneumonia were retrospectively studied for antifactor Xa activity (anti‐Xa), activated partial thromboplastin time (APTT), Antithrombin, Fibrinogen, D‐Dimer, Factor VIII, von Willebrand Factor, and the total daily amount of heparin administered. The correlation between APTT and anti‐Xa was evaluated for unfractionated heparins (UFH). The correlations between the daily dose of UFH or the dosage expressed as IU/kg b.w. for low molecular weight heparin (LMWH) and anti‐Xa were also evaluated. Results Twenty‐one patients received calcium heparin, 8 sodium heparin, and 8 LMWH. A moderate correlation was found between APTT and anti‐Xa for UFH. APTT did not correlate with coagulation parameters. 62% of UFH and 75% of LMWH treated patients were under the therapeutic range. About 75% of patients could be considered resistant to heparin. Conclusions SARS‐COV2 pneumonia patients in ICU have frequently heparin resistance. Anti‐Xa seems a more reliable method to monitor heparin treatment than APTT in acute patients, also because the assay is insensitive to the increased levels of fibrinogen, FVIII, and LAC that are common during the COVID‐19 inflammatory state.

Background: It is important and challenging to distinguish between acute myocardial infarction and Wellens syndrome due to its time to intervention. Difficulties in differentiating between subtypes could mean the patients are overtreated or receive undertreatment. Case report: A 57-year-old man was referred to our emergency ward with acute onset of chest pain. Electrocardiographic (ECG) changes were suggestive of Wellens syndrome type A. Nitroglycerin was administrated, the patient's chest pain disappeared, and we planned an early invasive strategy. He had a previous documented ECG before he went for catheterization and based on the second ECG changes were suggestive of an ST elevation. As the result of the invasive strategy, it was found that there was single-vessel disease, near total occlusion in the middle of the left anterior descending artery (LAD) with collateral from the right coronary artery. After two days of observation in the Intensive Cardiovascular Care Unit (ICCU), the patient improved and was transferred to the Low Care Unit. Conclusions: The case highlights Wellens syndrome in acute total occlusion with collateral artery.

Background Venous thromboembolism (VTE) encompasses pulmonary embolism (PE), and deep vein thrombosis (DVT) is a common complication of cancer. Cancer manifestation in cardiac often secondary from the metastatic process, mostly in the pericardium. These concomitant findings of PE, DVT, and hemorrhagic cardiac tamponade as the first signs of cancer in a young patient is rare. Case Summary A 39-years-old man was referred to the emergency department from secondary hospital with the main complaint of dyspnea that onset abruptly two days before admission and swollen of the entire right leg since one week before. We report concomitant finding of hemorrhagic cardiac tamponade, deep vein thrombosis, and acute pulmonary embolism as initial presentations of occult malignancy. Starting anticoagulant in the hemorrhagic state and finding the primary cancer were problematic and challenging. Discussion The challenge in management, posed by hemorrhagic versus thrombosis state in cancer, prompted us to cautiously deliver the treatment with consideration of benefit over the risk. Primary cancer is not always easy to identify. Comprehensive (re-)evaluation is mandatory.

Videos and movies can be categorized as one of mass media in conveying messages to society. One of the important processes in video or film making is the editing process.The community service reported in this paper aimed to provide a training on film and video editing for literacy activists at the Kali Atas Community House of Reading, Cicalengka. Based on the analysis of the conditions faced by the participants, it was decided that the community service program should not only focus on increasing people's reading interest, but should also include activities that support the creativity of the community. The specific target expected from the training was to increase the participants’ creativity demonstrated by their ability to create video content that can attract people's reading interest. The film and video editing training was implemented for 3 weeks, starting from surveys, interviews, activities, evaluations, to final report. As a result of this activity, literacy activists who belonged to the Kali Atas Community House of Reading, Cicalengka, showed that they were able to produce a video that contained useful information for literacy promotion activities and this video was later uploaded on social media such as YouTube, Facebook, and Iinstagram. We recommend that this activity be continued to support literacy activities in Cicalengka such as discussion on media literacy, mural painting as well as more advanced training on film/video editing.

The purpose of learning in SMK (Junior High School) is to pproduce students who have the skills and knowledge that qualified. Skills and knowledge are gained significantly from the learning outcomes with the project model. This study aims to improve the ability of individuals to improve the skills of work and skills required and network updates and the need for time and place during school studies. Web-enhanced instructional model of project-based teaching can be an existing solution. The development design is a development model of Lee and Owen (2004). This development product produces a learning design packaged in web technology. Abstrak: Tujuan pembelajaran di SMK (Sekolah Menengah Kejuruhan) adalah mencetak siswa mempunyai keterampilan dan pengetahuan yang mumpuni. Keterampilan dan pengetahuan didapat secara nyata dari hasil pembelajaran dengan model proyek. Penelitian ini bertujuan merancang desain pembelajaran yang mampu memenuhi kebutuhan siswa secara personal untuk meningkatkan ketrampilan bekerja dan keahlian dibidang perencanaan dan pemutakhiran jaringan serta kebutuhan akan waktu dan tempat selama belajar di sekolah. Desain pembelajaran model project-based teaching practices berbantuan web bisa menjadi solusi permasalahan yang ada. Pengembangan menggunakan model Lee dan Owen (2004). Produk pengembangan ini menghasilkan desain pembelajaran yang dikemas dalam teknologi web.

The association between angiotensin-converting enzyme insertion/deletion (ACE I/D) polymorphisms and plasma ACE levels may allow for the optimization of a preventive intervention to reduce cardiovascular morbidity and mortality in the chronic kidney disease (CKD) population. In this study, we aimed to analyze the association between ACE I/D polymorphism and cardiovascular mortality risk among non-hemodialyzed chronic kidney disease patients. This cross-sectional study examined 70 patients of Javanese ethnic origin with stable CKD who did not receive hemodialysis. ACE I/D polymorphisms, plasma ACE levels, atherosclerotic cardiovascular disease (ASCVD) risk, and cardiovascular mortality risk were investigated. As per our findings, the I allele was found to be more frequent (78.6) than the D allele (21.4), and the DD genotype was less frequent than the II genotype (4.3 vs. 61.4). The ACE I/D polymorphism had a significant direct positive effect on plasma ACE levels (path coefficient = 0.302, p = 0.021). Similarly, plasma ACE levels had a direct and significant positive effect on the risk of atherosclerotic cardiovascular disease (path coefficient = 0.410, p = 0.000). Moreover, atherosclerotic cardiovascular disease risk had a significant positive effect on cardiovascular mortality risk (path coefficient = 0.918, p = 0.000). The ACE I/D polymorphism had no direct effect on ASCVD and cardiovascular mortality risk. However, our findings show that the indirect effects of high plasma ACE levels may be a factor in the increased risk of ASCVD and cardiovascular mortality in Javanese CKD patients.

Chronic kidney disease (CKD) is progressive disease that closely related to the chronic inflammatory process.Angiotensin-Converting Enzyme Inhibitor (ACE-I)/Angiotensin Receptor Blockers (ARBs) is the main therapy in the management of CKD, based on the recent sudies stated that this drug have pleiotropic effects as anti-inflammation.The aim of this study is tosee the interaction of hs-CRP and HDL-Cholesterol to prove the role of ACE-I/ARBs as an anti-inflammatory treatment for CKD patient. In this study we compared hs CRP, HDL Cholesterol and HDL Cholesterol /hs-CRP ratio levels in CKD patients who consumeand do not consumeACE-I/ARBs. Forty eight samples of CKD patients were taken randomly and then separated into two group based on their consumption of ACE-I/ARBs, each group have 24 samples.There were significantly different of mean of hs-CRP, HDL Cholesterol, and HDL Cholesterol/hs-CRP ratio between group, the mean concentration of hs-CRP in the ACE-I/ARBs group was significantly lower than in non-ACE-I/ARBs group (1,48±0,81 vs 4,19±4,02; P= 0.038),the mean of HDL (48,95±13,05vs 41,50±12,31; P= 0,048).There were negative correlation between HDL Cholesterol and hs-CRP, positive correlation between HDL Cholesterol/hs-CRP ratio and eGFR.This result indicate that hs-CRP and HDL-Cholesterol monitoring very important in CKD patient.