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Abstract Background This qualitative study aims to assess perspectives of clinicians and clinic staff on mail-order pharmacy dispensing for medication abortion. Methods Participants included clinicians and staff involved in implementing a mail-order dispensing model for medication abortion at eleven clinics in seven states as part of a prospective cohort study, which began in January 2020 (before the FDA removed the in-person dispensing requirement for mifepristone). From June 2021 to July 2022, we invited participants at the participating clinics, including six primary care and five abortion clinics, to complete a semi-structured video interview about their experiences. We then conducted qualitative thematic analysis of interview data, summarizing themes related to perceived benefits and concerns about the mail-order model, perceived patient interest, and potential barriers to larger-scale implementation. Results We conducted 24 interviews in total with clinicians (13 physicians and one nurse practitioner) and clinic staff (n = 10). Participants highlighted perceived benefits of the mail-order model, including its potential to expand abortion services into primary care, increase patient autonomy and privacy, and to normalize abortion services. They also highlighted key logistical, clinical, and feasibility concerns about the mail-order model, and specific challenges related to integrating abortion into primary care. Conclusion Clinicians and clinic staff working in primary care and abortion clinics were optimistic that mail-order dispensing of medication abortion can improve the ability of some providers to provide abortion and enable more patients to access services. The feasibility of mail-order pharmacy dispensing of medication abortion following the Supreme Court Dobbs decision is to be determined. Trial registration Registry: Clinicaltrials.gov. Trial registration number: NCT03913104. Date of registration: first submitted on April 3, 2019 and first posted on April 12, 2019.

Graduates who are superior, competitive, and ready to work are the goals of vocational education. The purpose of this research is to determine the impact of Teaching Factory (TEFA) implementation with the Context, Input, Process, and Product (CIPP) evaluation model and student work readiness on the Occupational Future Time Perspective (OFTP). Indeed, nowadays, professional/vocational graduates must be ready to enter the industrial world after graduation. This research involved 456 respondents of Vocational High School (VHS) students in South Sulawesi, Indonesia, who were determined using a proportional random sampling technique. This type of research is descriptive quantitative with data analysis using SEM AMOS. The results showed that there was a significant influence between the implementation of TEFA and the level of work readiness up to 57%, while the actual contribution of teaching and work readiness factors to future employment time was 80.7%. Overall, the results show that the implementation of TEFA has successfully helped students become more independent and ready to face the competitive world of work. Although 19.3 factors still influence work readiness and prospects, the research results do not change much. Therefore, the application of a teaching factory in the learning process is highly recommended for teachers and students in vocational schools. The implementation can be adjusted to the learning conditions and resources available in VHS. This research contributes as a source of reference in future studies related to improving practical learning and developing students' entrepreneurial skills.

Abstrak. Sistem pembayaran premi asuransi kendaraan terdiri dari beberapa state. Pembagian state ini didasari oleh banyaknya pemegang polis yang mengajukan klaim setiap tahunnya. Pola perubahan yang terjadi pada state akan mengakibatkan pencarian kondisi steady state yakni kondisi yang sudah mencapai stabil, tidak mengalami perubahan terhadap parameter waktu. Sistem Bonus-Malus Swiss (BMS) memiliki 22 state dengan distribusi dari banyaknya yang mengajukan klaim adalah Binomial Negatif-Lindley (r,?).Metode yang digunakan untuk mendapatkan distribusi stasioner adalah metode rekursif. Hasil yang diperoleh melalui simulasi numerik, untuk nilai parameter r yang kecil dan ? yang besar maka pemegang polis cenderung ke state 0 yaitu (super bonus). Kata Kunci: Steady state, BMS, Binomial Negatif-Lindley

Cancer is a disease that is still difficult to identify up to today. One of the causes of cancer is genetic modification that because of mutations in p53 gene. Healthy cells have a p53 wild type protein (normal) that is able to manage DNA separation. If DNA mutates, it will be difficult to detect cancer because the composition of the protein has changed. Bioinformatics is a combination of biology and information engineering (TI) that is utilized to manage data. One of the applications of data mining in bioinformatics is the development of pharmaceutical and medical industries. Data mining classification can use variety of methods including K-Nearest Neighbor (KNN), C45, ID3, and several other methods. One of the most reliable data classification methods is KNN. In this study, the development used two algorithms. The first was with the modification of the k-fold method, which divided two data into training data and test data, in which test-1 data and test-2 data were made into slices. The second was by a method for selecting an itemset sequence pattern that had the largest Gain Information, either 2 itemsets, 3 itemsets, and so on (Deep Miden). The best accuracy result of 96.00% was obtained through the process of computation testing in the server based on variations in terms of the number of patterns of Deep Miden itemset sequences and several k values on KNN classification method.

Key ecological features (KEFs) are elements of Australia’s Commonwealth marine environment considered to be important for biodiversity or ecosystem function, yet many KEFs are poorly researched, which can impede effective decision-making about future development and conservation. This study investigates a KEF positioned over the Last Glacial Maximum (LGM) shoreline on the northwest shelf of Australia (known as the ‘Ancient Coastline at ~125m depth contour’; AC125). Seafloor bathymetry, sedimentology and benthic habitats were characterised within five study areas using multibeam sonar, sediment samples and towed video imagery. Direct evidence for the existence of a palaeoshoreline formed during the LGM was not found, however candidate areas to find palaeoshoreline material at or just below the modern seabed were discovered. Approximately 98% of the seabed surveyed was comprised of unconsolidated soft sediment habitat (mud/sand/silt) supporting negligible epibenthic biota. The prevalence of soft sediment suggests that post-glacial sediments have infilled parts of the palaeoshoreline, with cross-shelf, probably tidal currents in the northern section of the study area responsible for some of the sediment mobilisation and southern study areas more influenced by oceanic conditions. Within study areas, total biotic cover ranged from 0.02% to 1.07%. Of the biota encountered, most comprised filter feeder organisms (including gorgonians, sponges, and whip corals) whose distribution was associated with pockets of consolidated hard substrate. Benthic community composition varied with both study area and position in relation to the predicted AC125. In general, consolidated substrate was proportionally higher in water shallower than the AC125 compared to on the AC125 or deeper than the AC125. Spatially continuous maps of predicted benthic habitat classes (pre-determined benthic communities) in each study area were developed to characterise biodiversity. Spatial modelling corroborated depth and large-scale structural complexity of the seafloor as surrogates for predicting likely habitat class. This study provides an important assessment of the AC125 and shows that if a distinct coastline exists in the areas we surveyed, it is now largely buried and as such does not provide a unique hard substrate habitat. However, much work remains to fully locate and map the ancient coastline within the vast region of the AC125 and additional surveys in shallow waters adjacent to the AC125 may identify whether some sections lie outside the currently defined KEF.

Nehad M Ayoub,1 Mona Fares,1 Raya Marji,2 Samir M Al Bashir,2 Rami J Yaghan3 1Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology (JUST), Irbid, 22110, Jordan; 2Department of Pathology and Microbiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan; 3Department of Surgery, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, BahrainCorrespondence: Nehad M AyoubDepartment of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology (JUST), Irbid, 22110, JordanTel +962-2-7201000 Ext. 23809Fax +962-2-7095123Email nmayoub@just.edu.joPurpose: Tumor expression of programmed death-ligand 1 (PD-L1) is associated with evasion of immune response in several types of malignancies and such expression may render patients eligible for PD-L1 inhibitors. The use of immune checkpoint blockade therapy has been recently approved for the treatment of breast cancer. However, PD-L1 expression data are lacking among Jordanian breast cancer patients. In this study, the tumor PD-L1 expression was characterized in breast cancer patients to assess their eligibility for immune checkpoint blockade therapy. The study also aimed to explore the association between tumoral PD-L1 expression and the clinicopathologic characteristics and the prognostic factors in patients with breast cancer.Patients and Methods: Tissue samples were available from 153 female patients with primary invasive breast cancer. Immunohistochemistry was performed on paraffin-embedded tumor sections that were stained with a PD-L1 antibody. Expression of tumor PD-L1 was correlated with demographics, clinicopathologic characteristics, and prognosis.Results: The mean age at diagnosis was 54.2± 12.8 years (median 52, interquartile range 45– 65). The percentage of PD-L1-positive tumors was 26.1%. PD-L1 expression on tumor cells significantly and positively correlated with tumor size (rho=0.174, p=0.032). PD-L1 positivity was significantly associated with the grade of carcinoma (p=0.001), HER2-positivity (p=0.015), and lymphovascular invasion (p=0.036). PD-L1 intensity was significantly associated with tumor stage (p=0.046). No significant associations were observed for the PD-L1 expression status or intensity with patient menopausal status, hormone receptor expression, and molecular subtypes. PD-L1 expression significantly correlated with a worse prognosis of breast cancer patients at the time of diagnosis (rho=0.230, p=0.005).Conclusion: Tumor PD-L1 expression was associated with advanced clinicopathologic features and worse prognosis in this cohort of Jordanian breast cancer patients. Future studies are needed to better understand the impact of PD-L1 blockade therapy on treatment outcomes in eligible breast cancer patients in Jordan.Keywords: breast cancer, PD-L1, immunohistochemistry, clinicopathologic, prognosis

Abstract Tropical cyclones generate large waves that physically damage coral communities and are commonly cited as a worsening threat to coral reefs under climate change. However, beyond projections of ocean basin‐scale changes in cyclone intensity, the other determinants of future coral reef damage such as cyclone size and duration remain uncertain. Here, we determine the extent to which downscaled cyclones represent observed cyclone characteristics that influence wave damage to Australian coral reef regions. We then investigate mid‐century (2040–2060) and end of century (2080–2100) downscaled tracks to assess whether cyclone characteristics will change with future warming under a high‐emissions scenario. We find that spatial uncertainties in downscaled cyclogenesis and track positions limit estimates of reef damage for individual coral reefs and regions. Further, the models are unable to reproduce the most reef damaging cyclones for any of the regions. The downscaled tracks capture observed cyclone characteristics, such as size, impacting the Great Barrier Reef well, but perform poorly for the Northern Territory, with mixed performance for the Coral Sea and Western Australia. We find no clear evidence that cyclones will cause more damage to Australian coral reef regions in the future, at least based on the climate models and downscaling approach examined here. There is increasing interest in using tropical cyclone projections to assess future coral reef exposure to damaging waves. We recommend caution when interpreting such projections due to large uncertainty in the mechanisms that influence reef damaging tropical cyclone characteristics and how these will change with future warming.

In the US and beyond, a paradigm shift is underway toward community-based care, motivated by changes in policies, payment models and social norms. A significant aspect of this shift for disability activists and policy makers is ensuring participation in community life for individuals with disabilities living in residential homes. Despite a U.S. government ruling that encourages community participation and provides federal and state funding to realize it, little progress has been made. This study builds on and integrates the expanded model of value creation with relational coordination theory by investigating how the resources and relationships between care providers, adults with disabilities, family members, and community members can be leveraged to create value for residents through meaningful community participation. The purpose of our community case study was to assess and improve the quality of relationships between stakeholder groups, including direct care staff and managers, residents, family members, and the community through an action research intervention. This study took place in a residential group home in a Northeastern US community serving adults with disabilities from acquired brain injury. A pre-test post-test design was used and quantitative assessments of relational coordination were collected through electronic surveys, administered at baseline, and post-intervention. Direct care staff, supervisors, the house manager, and nursing staff completed the survey. Qualitative data were collected through focus groups, change team meetings, and key informant interviews. Direct care staff formed a change team to reflect on their baseline relational coordination data and identified the weak ties between direct care staff, family members, and the community as an area of concern. Staff chose to hold a community-wide open house to provide an opportunity to foster greater understanding among staff, residents, family, and community members. The change team and other staff members coordinated with local schools, business owners, town officials, churches, and neighbors. The event was attended by 50 people, about two-thirds from the community. Following the intervention, there was an increase in staff relational coordination with the community. While statistical significance could not be assessed, the change in staff RC with the community was considered qualitatively significant in that real connections were made with members of the community both directly and afterwards. Despite a small sample size, a residential setting where management was favorable to initiating staff-led interventions, and no comparison or control group, our small pilot study provides tentative evidence that engaging direct care staff in efforts to improve relational coordination with community members may succeed in building relationships that are essential to realizing the goal of greater participation in community life.

The silver-lipped pearl oyster, Pinctada maxima, is the primary species used for the culture of pearls in the Indo-Pacific region. The Western Australian fishery relies on wild-caught animals, and as such, knowledge of the status and distribution of P. maxima underpins sustainable management of the fishery. Eighty Mile Beach, in tropical Western Australia, is the key harvest area for P. maxima, with oysters collected by divers to depths of ∼35 m, although there are anecdotal accounts of oysters beyond diving depths. Image-based, and acoustic methods were used to elucidate distribution patterns of P. maxima off Eighty Mile Beach, including data from 862 km2 of multibeam survey and 119 towed video transects spanning an area from the 20 to 100 m contour lines. We quantified habitat characters including depth, substrate, and benthic community composition associated with pearl oyster distribution. Multibeam sonar data was also coupled with towed video data to produce predictive statistical models of P. maxima habitat. We found P. maxima to depths of 76 m, although more than 90% of individuals occurred shallower than 40 m and less than 2% were found deeper than 50 m. Oysters occupied flat, sandy habitats with neighbouring benthic communities of filter feeders (>98% of observations). These results show P. maxima predominantly occurs in depths

Abstract: The purposes of the research is to determine: 1) the differences in learning outcomes of body electricity between groups using safety-based circuit racks (RRBS) and conventional circuit racks (RRK), 2) the differences in learning outcomes in body electrical between groups of students who have low, medium and high self-confidence. Data analysis used Two Ways ANOVA. The sample of this research is class XI TKR 1 & 4. The results of this study are 1) there is a significant difference in the learning outcomes of body electricity between the groups using RRBS and RRK. 2) there is a significant difference in the learning outcomes of body electricity between groups of students who have low, medium and high self confidence. Abstrak: Penelitian ini bertujuan untuk (1) mengetahui perbedaan hasil belajar kelistrikan bodi antara kelompok yang menggunakan rak rangkaian berbasis safety (RRBS) dengan rak rangkaian konvensional (RRK); (2) mengetahui perbedaan hasil belajar kelistrikan bodi antara kelompok siswa yang mempunyai low, medium and high self confidence. Analisis data menggunakan Anova 2 jalur. Sampel penelitian ini adalah kelas XI TKR 1 dan 4. Hasil dari penelitian ini adalah (1) ada perbedaan yang signifikan hasil belajar kelistrikan bodi antara kelompok yang menggunakan RRBS dengan RRK. (2) ada perbedaan yang signifikan hasil belajar kelistrikan bodi antara kelompok siswa yang mempunyai low, medium and high self confidence.

BACKGROUND: This qualitative study aims to assess perspectives of clinicians and clinic staff on mail-order pharmacy dispensing for medication abortion. METHODS: Participants included clinicians and staff involved in implementing a mail-order dispensing model for medication abortion at eleven clinics in seven states as part of a prospective cohort study, which began in January 2020 (before the FDA removed the in-person dispensing requirement for mifepristone). From June 2021 to July 2022, we invited participants at the participating clinics, including six primary care and five abortion clinics, to complete a semi-structured video interview about their experiences. We then conducted qualitative thematic analysis of interview data, summarizing themes related to perceived benefits and concerns about the mail-order model, perceived patient interest, and potential barriers to larger-scale implementation. RESULTS: We conducted 24 interviews in total with clinicians (13 physicians and one nurse practitioner) and clinic staff (n = 10). Participants highlighted perceived benefits of the mail-order model, including its potential to expand abortion services into primary care, increase patient autonomy and privacy, and to normalize abortion services. They also highlighted key logistical, clinical, and feasibility concerns about the mail-order model, and specific challenges related to integrating abortion into primary care. CONCLUSION: Clinicians and clinic staff working in primary care and abortion clinics were optimistic that mail-order dispensing of medication abortion can improve the ability of some providers to provide abortion and enable more patients to access services. The feasibility of mail-order pharmacy dispensing of medication abortion following the Supreme Court Dobbs decision is to be determined. TRIAL REGISTRATION: Registry: Clinicaltrials.gov. TRIAL REGISTRATION NUMBER: NCT03913104. Date of registration: first submitted on April 3, 2019 and first posted on April 12, 2019.

Coral bleaching, cyclones, outbreaks of crown-of-thorns seastar, and reduced water quality (WQ) threaten the health and resilience of coral reefs. The cumulative impacts from multiple acute and chronic stressors on “reef State” (i.e., total coral cover) and “reef Performance” (i.e., the deviation from expected rate of total coral cover increase) have rarely been assessed simultaneously, despite their management relevance. We evaluated the dynamics of coral cover (total and per morphological groups) in the Central and Southern Great Barrier Reef over 25 years, and identified and compared the main environmental drivers of State and Performance at the reef level (i.e. based on total coral cover) and per coral group. Using a combination of 25 environmental metrics that consider both the frequency and magnitude of impacts and their lagged effects, we find that the stressors that correlate with State differed from those correlating with Performance. Importantly, we demonstrate that WQ metrics better predict Performance than State. Further, inter-annual dynamics in WQ (here available for a subset of the data) improved the explanatory power of WQ metrics on Performance over long-term WQ averages. The lagged effects of cumulative acute stressors, and to a lesser extent poor water quality, correlated negatively with the Performance of some but not all coral groups. Tabular Acropora and branching non-Acropora were the most affected by water quality demonstrating that group-specific approaches aid in the interpretation of monitoring data and can be crucial for the detection of the impact of chronic pressures. We highlight the complexity of coral reef dynamics and the need of evaluating Performance metrics in order to prioritise local management interventions.

Abstract: Work discipline is a fundamental thing that must exist in every work environment. Vocational students in the learning period are trained to be accustomed to discipline so that they can easily adjust to the work environment later. The awareness of students in controlling soft skills is still lower than their mastery in the field of hard skills. Meanwhile, the industrial world considers soft skills to be the main thing in recruiting prospective employees. Work discipline affect on work readiness. Awareness of work discipline for students is very important to support self-quality so that students can become graduates who are ready to work. Abstrak: Disiplin kerja merupakan hal mendasar yang pasti ada dalam setiap lingkungan kerja. Peserta didik SMK dalam masa pembelajaran dilatih untuk terbiasa disiplin agar mudah menyesuaikan diri di lingkungan kerja nantinya. Kesadaran peserta didik dalam pengendalian softskill masih lebih rendah dibandingkan dengan penguasaan mereka dalam bidang hardskill, sedangkan dunia industri menganggap bahwa softskill merupakan hal utama dalam merekrut calon karyawan. Hasil penelitian menunjukkan adanya pengaruh disiplin kerja peserta didik terhadapt kesiapan kerja. Kesadaran akan disiplin kerja untuk peserta didik sangat penting untuk menunjang kualitas diri sehingga peserta didik dapat menjadi lulusan yang siap kerja.

ImportanceBefore 2021, the US Food and Drug Administration required mifepristone to be dispensed in person, limiting access to medication abortion.ObjectiveTo estimate the effectiveness, acceptability, and feasibility of dispensing mifepristone for medication abortion using a mail-order pharmacy.Design, setting, and participantsThis prospective cohort study was conducted from January 2020 to May 2022 and included 11 clinics in 7 states (5 abortion clinics and 6 primary care sites, 4 of which were new to abortion provision). Eligible participants were seeking medication abortion at 63 or fewer days' gestation, spoke English or Spanish, were age 15 years or older, and were willing to take misoprostol buccally. After assessing eligibility for medication abortion through an in-person screening, mifepristone and misoprostol were prescribed using a mail-order pharmacy. Patients had standard follow-up care with the clinic. Clinical information was collected from medical records. Consenting participants completed online surveys about their experiences 3 and 14 days after enrolling. A total of 540 participants were enrolled; 10 withdrew or did not take medication. Data were analyzed from August 2022 to December 2023.InterventionMifepristone, 200 mg, and misoprostol, 800 µg, prescribed to a mail-order pharmacy and mailed to participants instead of dispensed in person.Main outcomes and measuresProportion of patients with a complete abortion with medications only, reporting satisfaction with the medication abortion, and reporting timely delivery of medications.ResultsClinical outcome information was obtained and analyzed for 510 abortions (96.2%) among 506 participants (median [IQR] age, 27 [23-31] years; 506 [100%] female; 194 [38.3%] Black, 88 [17.4%] Hispanic, 141 [27.9%] White, and 45 [8.9%] multiracial/other individuals). Of these, 436 participants (85.5%; 95% CI, 82.2%-88.4%) received medications within 3 days. Complete abortion occurred after medication use in 499 cases (97.8%; 95% CI, 96.2%-98.9%). There were 24 adverse events (4.7%) for which care was sought for medication abortion symptoms; 3 patients (0.6%; 95% CI, 0.1%-1.7%) experienced serious adverse events requiring hospitalization (1 with blood transfusion); however, no adverse events were associated with mail-order dispensing. Of 477 participants, 431 (90.4%; 95% CI, 87.3%-92.9%) indicated that they would use mail-order dispensing again for abortion care, and 435 participants (91.2%; 95% CI, 88.3%-93.6%) reported satisfaction with the medication abortion. Findings were similar to those of other published studies of medication abortion with in-person dispensing.Conclusions and relevanceThe findings of this cohort study indicate that mail-order pharmacy dispensing of mifepristone for medication abortion was effective, acceptable to patients, and feasible, with a low prevalence of serious adverse events. This care model should be expanded to improve access to medication abortion services.

The aim of this paper is to highlight the socio-demographic differences regarding the main determinants of employee satisfaction in Jordanian hospitals using a sample of 325 employees from six different hospitals in 2015. Therefore, it has been used Warr-Cook-Wall scale in order to assess job satisfaction according to four dimensions: extrinsic job satisfaction, intrinsic job satisfaction, working conditions satisfaction, employee relations satisfaction. The socio-demographic differences on the job satisfaction factors were analyzed using t-test, Anova test and correlation coefficients. The empirical results pointed out that young and older employees express higher degrees of satisfaction comparative with other age group regarding the extrinsic satisfaction and employee relations and that administrative staff, helpers and doctors are more satisfied intrinsic satisfaction, extrinsic satisfaction, working conditions, employee relations and also on the overall level of satisfaction. Also individuals from horizontal structure exhibit higher levels of satisfaction regarding the job satisfaction factors than the ones from vertical structure.

This month the Social Medicine Journal of-fers readers the text of the Annual Harold Wise Memorial Lecture held on June 13, 2017 at the Department of Family and Social Medicine at Montefiore Medical Center. Harold Wise was the founder of the Residency Program in Social Medicine and the award recognizes a faculty member who best represents the values of the Residency Program.

Abstract: This aims of the research to examine the effect of industry support to the success of students performing in teaching factory. Teaching factory is a production-based on learning that brings the industry atmosphere into learning. This learning is expected to make students ready to work, so that unemployment SMK graduates can be reduced. Data analysis in this research use descriptive and regression analysis. The results showed that industry support influenced to the successful implementation of teaching factory with 39.2% of effective contribution. Abstrak: Penelitian ini bertujuan untuk menguji pengaruh dukungan industri terhadap keberhasilan siswa melaksanakan teaching factory. Teaching factory merupakan pembelajaran berbasis produksi yang membawa suasana industri ke dalam pembelajaran. Pembelajaran ini diharapkan akan dapat membuat siswa siap bekerja dan memiliki jiwa enterpreneurship, sehingga pengangguran lulusan SMK dapat berkurang. Penelitian ini menggunakan analisis deskriptif dan regresi. Hasil penelitian menunjukkan bahwa dukungan industri berpengaruh terhadap keberhasilan pelaksanaan teaching factory dengan sumbangan efektif sebesar 39,2%.

No abstract

The paper aims to identify the main determinants of job satisfaction in Jordanian hospitals using a sample of 325 employees from six hospitals at the level of the year 2015. In order to do that, we used Warr-Cook-Wall scale to assess job satisfaction based on four dimensions: extrinsic job satisfaction, and intrinsic job satisfaction, working conditions satisfaction, employee relations satisfaction applying the multivariate regression analysis to highlight the predictors of job satisfaction. The empirical results revealed that the main determinants of job satisfaction among Jordanian employees are related to the intrinsic job satisfaction and employee relations satisfaction and the wage have a relatively small impact on this. The findings revealed that the financial incentives have their significance but they are not fundamental, the non-financial incentives being really important in enhancing motivation among health employees. So, in order to improve the overall degree of retention, the managers need to reinforce the importance of non-financial factors like the freedom to choose the working methods, the recognition for a good work, the responsibility, the chance for promotion, the opportunity to use the abilities, the attention paid to the suggestions and the level of variety in the job.

Clonality is common in many aquatic plant species, including seagrasses, where populations are maintained through a combination of asexual and sexual reproduction. One common measure used to describe the clonal structure of populations is clonal richness. Clonal richness is strongly dependent on the biological characteristics of the species, and how these interact with the environment but can also reflect evolutionary scale processes especially at the edge of species ranges. However, little is known about the spatial patterns and drivers of clonal richness in tropical seagrasses. This study assessed the spatial patterns of clonal richness in meadows of three tropical seagrass species, Thalassia hemprichii, Halodule uninervis, and Halophila ovalis, spanning a range of life-history strategies and spatial scales (2.5–4,711 km) in Indonesia and NW Australia. We further investigated the drivers of clonal richness using general additive mixed models for two of the species, H. uninervis and H. ovalis, over 8° latitude. No significant patterns were observed in clonal richness with latitude, yet disturbance combined with sea surface temperature strongly predicted spatial patterns of clonal richness. Sites with a high probability of cyclone disturbance had low clonal richness, whereas an intermediate probability of cyclone disturbance and the presence of dugong grazing combined with higher sea surface temperatures resulted in higher levels of clonal richness. We propose potential mechanisms for these patterns related to the recruitment and mortality rates of individuals as well as reproductive effort. Under a changing climate, increased severity of tropical cyclones and the decline in populations of mega-grazers have the potential to reduce clonal richness leading to less genetically diverse populations.

Many vocational graduates are not absorbed in the world of work so that it will increase the number of unemployed. Mechanical aptitude tests should be held before students go to prakerin, in order to place students on a department that they like. Besides other factors that may affect job readiness is a prakerin. Prakerin with adequate facilities, is expected to vocational students would be able to develop science and technology. This study uses a quantitative approach to the type of cross-sectional research ex-post facto. The population in this study were students of SMK Lightweight Vehicle Engineering Expertise in Malang academic year 2015/2016 which has been carrying out prakerin is class XI. The number of population, namely (1) SMK Negeri 6 Malang; (2) SMK Negeri 10 Malang; (3) SMK Negeri 11 Malang; and (4) SMK Negeri 12 Malang as many as 406 students and 200 students obtained by calculation Slovin. The results of the simultaneous contribution is 10.9%. While the calculation of the partial between mechanical aptitude towards work readiness of 1.9% and a qualifying place prakerin against 8.3% job readiness. Lulusan SMK banyak yang tidak terserap pada dunia kerja sehingga akan menambah jumlah pengangguran. Hendaknya dilakukan tes bakat mekanik sebelum siswa penempatan di dunia industri supaya siswa prakerin di bidang yang ia sukai. Selain itu faktor lain yang dapat memengaruhi kesiapan kerja yaitu tempat prakerin. Dengan fasilitas prakerin yang memadai, diharapkan siswa SMK akan mampu mengembangkan ilmu pengetahuan dan teknologi. Penelitian ini menggunakan pendekatan kuantitatif, dengan jenis penelitian cross sectional ex-post facto. Populasi pada penelitian ini adalah siswa SMK Paket Keahlian Teknik Kendaraan Ringan di Kota Malang tahun ajaran 2015/2016 yang telah melaksanakan prakerin yaitu kelas XI. Adapun jumlah populasi yaitu: (1) SMK Negeri 6 Malang; (2) SMK Negeri 10 Malang; (3) SMK Negeri 11 Malang; dan (4) SMK Negeri 12 Malang sebanyak 406 siswa dan diperoleh 200 siswa denganperhitungan Slovin. Hasil kontribusi simultan yaitu 10,9 %. Sedangkan dariperhitungan parsial antara bakat mekanik terhadap kesiapan kerja yaitu 1,9% dan kualifikasi tempat prakerin terhadap kesiapan kerja 8,3%.

Penyusunan buku teks harus menyesuaikan kurikulum yang ber­laku yaitu ku­rikulum 2013. Realita menunjukkan tidak semua bu­ku memiliki kualitas isi dan ke­se­suaian isi seperti KI dan KD dalam kurikulum. Ba­nyak buku teks yang disusun ti­dak menyesuaikan pendekatan scientific yang berlaku di kurikulum 2013. Kondisi ter­sebut bertentangan denganfungsi buku teks dibuat yaitu untuk menunjang proses bel­ajar sesuai materi KI dan KD yang tercantum dalam kurikulum 2013. Hal tersebut be­lumdipenuhi secara ideal ada beberapa buku teks perlu dikaji ulang.Peningkatan kua­­­litas buku teks, salah satunyabuku Mekanika dan Elemen Mesin SMK Kelas X, per­lu adanya kajian terkait kesesuaian isi buku yang dapat menunjang pem­bel­ajaran de­ngan pendekatan scientific sesuai dengan kurikulum 2013 serta bagaimana se­­­­­­­ha­rus­nya buku disusun dengan menggunakan pendekatan scientific.

Tujuan penelitian ini untuk mendeskripsikan analisis pelaksanaan prakerin. Jenis penelitian deskriptif dengan pendekatan kuantitatif. Populasi dalam penelitian ini adalah siswa SMK program keahlian Tata Busana di Malang Raya kelas XII se-jumlah 329 siswa. Teknik sampling yang digunakan sampling jenuh, sedangkan tek-nik analisis menggunakan analisis deskriptif (kategorikal). Hasil penelitian menun-jukkan: sarpras dalam kategori relevan menurut 161 siswa (48,94%), pembimbingan cukup relevan 166 (50,64%), kompetensi cukup relevan 147 (44,64%) dan peran sis-wa relevan 184 (55,93%). Hal ini masih kurang dari yang diharapkan. Saran: (1) in-dustri agar berperan aktif dalam hal pembimbingan dan memberikan kesempatan ke-pada siswa SMK program keahlian Tata Busana untuk memperoleh kompetensi se-suai standar kebutuhan tenaga kerja; dan (2) pihak sekolah menjalin kerjasama de-ngan Du/Di yang diimplementasikan dalam pelaksanaan prakerin.

OBJECTIVE: Given the substantial barriers to abortion access in the United States, many clinics now mail patients abortion medications. We examined whether dispensing the medications by mail prolonged time to medication use. STUDY DESIGN: We analyzed data from no-test medication abortions with medication provided either by mail or in a clinic from 11 United States clinics from February 2020 to January 2021. We examined mean number of days from patients first contact with the clinic to mifepristone ingestion, its two-component intervals (first contact to medication dispensing and dispensing to mifepristone ingestion), and pregnancy duration at mifepristone ingestion. We used Poisson regression to compare mean outcomes across three dispensing methods: in-person, mailed from the clinic, and mailed from a mail-order pharmacy. RESULTS: Among the 2600 records, patients took mifepristone on average at 49 days of gestation (95% CI, 47-51) and 7 days (95% CI, 4-10) after first contact. Mean time from first contact to mifepristone ingestion was 6 days when medications were dispensed in-person and 9 days when mailed (p = 0.38). While time from first contact to dispensing was similar across methods (6 days in-person, 5 days mailed, p = 0.77), more time elapsed from dispensing to mifepristone ingestion when medications were mailed (4 days from clinic, 5 days from mail-order pharmacy) versus dispensed in-person (0.3 days, p

This study aimed to assess the safety and efficacy of iron sucrose in hemodialysis (HD) patients with documented hypersensitivity reactions to iron dextran. Of 205 HD patients who received low molecular weight iron dextran, 15 (7.3%) patients developed documented hypersensitivity reactions. The patients were treated with iron sucrose (100 mg administered as an intravenous push over 5-10 minutes once a week) for 8 weeks. Complete blood count, serum iron, serum ferritin, and parathyroid hormone were measured at the beginning and at the end of the study (except parathyroid hormone). All patients received subcutaneous erythropoietin at a constant dose of 5000 IU twice weekly unless a change was required. All the patients completed the study period and none of them developed hypersensitivity reactions to iron sucrose. The mean hematocrit increased from 23.8% to 32.27% (p < 0.0001), the mean serum ferritin from 185 ng/mL to 599 ng/mL (p < 0.0001), and the mean serum iron from 29.3 ng/dL to 76.8 ng/dL (p = 0.01). We conclude that iron sucrose is safe and effective in HD patients with documented hypersensitivity reactions to low molecular weight iron dextran.

Abstract: This research sets out to acquire the overall description of noise caused by the engine stand, which is made of pipe and bamboo, and the rate of its reduction. The object for this research is two premium engines located in the State University of Malang. The selected engine stand is mounted by an outtake made of pipe and bamboo before it is ignited. The analysis method used is descriptive approach complemented by Anova technique. The result shows that the noise range of engine stand are: 72 dBA to 78 dBA in rotation of 800 rpm, 78 dBA to 79 dBA in rotation of 1500 rpm, and 88 dBA to 89 dBA in rotation of 2500 rpm before the pipe outtake is mounted; meanwhile, after the pipe outtake is mounted the result shows the range of 69 dBA to 71 dBA at 800 rpm, 75 dBA to 76 dBA at 1500 rpm, and 85 dBA to 87 dBA at 2500 rpm. For the bamboo outtake, the result shows the range of 68 dBA to 69 dBA at 800 rpm, 72 dBA to 75 dBA at 1500 rpm, and 86 dBA to 88 dBA at 2500 rpm. This overall result shows significant difference with P = 0,000 for each rotation (rpm); the usage of pipe and bamboo outtake can reduce the noise.

Abstract: The addition of deceleration system as reducer of CO emission in gasoline-motor vehicle. This research is aimed to investigate the impact of addition of deceleration system on the CO reduction emitted from gasoline-motor vehicle. It uses experimental research by comparing CO emission both before and after using deceleration system. The experiment was conducted in Automotive Laboratory, the State University of Malang. The descriptive analysis is used for picturing the overall comparison, and t-test is used for describing the differences. The result shows that there is sharp CO reduction from 4.615% of average to 1.883%, following the t-test result that shows significant difference at p = 0.000. It can be concluded that the addition of deceleration system can reduce the CO emission from gasolinemotor vehicle

Peneitian ini bertujuan untuk menentukan efektivitas instalasi saluran gas buang untuk mereduksi kadar racun karboksihemoglobin dalam darah akibat paparan gas buang CO yang ditimbulkan oleh engine stand. Sebagai sampel diambil 40 mahasiswa yang terdiri dari 20 kelompok perlakuan dan 20 kelompok kontrol. Metode yang digunakan adalah eksperimental dengan acak lengkap. Hasil penelitian menunjukkan bahwa ada perbedaan yang signifikan (p = 0,0000) kadar racun karboksihemoglobin dalam darah praktikan sebelum dan sesudah praktikum menggunakan instalasi standar. Setelah diberi instalasi saluran gas buang yang dimodifikasi sebelum dan sesudah praktikum menunjukkan tidak ada perbedaan yang signifikan (p = 0,169) berarti tidak ada kenaikan yang berarti. Perbandingan penggunaan instalasi saluran gas buang (modifikasi) dengan saluran standar (tanpa instalasi) diperoleh perbedaan yang signifikan (p = 0,0480). Dengan demikian dapat disimpulkan bahwa penggunaan instalasi saluran gas buang dapat mereduksi kadar racun karboksihemoglobin dalam darah yang efektif.

Penelitian ini bertujuan untuk memperoleh gambaran menyeluruh data dari kebisingan yang diakibatkan engine stand, dan seberapa besar reduksi kebisingannya jika pada saluran gas buang ditambah saluran dari bambu. Objek penelitian adalah engine stand yang ada di laboratorium UM. Hasil rentang kebisingan yang ditimbulkan pada saat engine stand belum menggunakan saluran bambu kebisingan yang paling rendah 72 dBA dan paling tinggi 77 dBA pada putaran 800 rpm. Kemudian disusul 78 dan 79 dBA pada putaran 1500 rpm serta 88 dan 89 dBA pada putaran 2500 rpm. Setelah menggunakan saluran bambu, tingkat kebisingan yang paling rendah 68 dBA dan paling tinggi 69 dBA pada putaran 800 rpm, 72 dan 75 dBA pada putaran 1500 rpm serta 86 dan 88 dBA pada putaran 2500 rpm. Hasil tersebut menunjukkan perbedaan yang sangat signifikan dengan hasil, P = 0,000, 0,000, dan 0,000 pada putaran 800, 1500, dan 2500 rpm. Kesimpulannya penggunaan saluran bambu dapat mereduksi tingkat kebisingan.