Strict Protocol Research Articles

The Evolving Role of Nurses in Patient-Centered Care

As the healthcare landscape continues to evolve, so too does the role of nurses in providing patient-centered care. Gone are the days when nurses were solely seen as assistants to physicians. Today, nurses play a vital and dynamic role in shaping healthcare outcomes, making significant contributions to the overall patient experience. With their holistic approach, empathetic nature, and clinical expertise, nurses have become key drivers in delivering personalized care that puts patients at the center. The evolving role of nurses in patient-centered care is characterized by their increased autonomy and decision-making authority. Nurses are no longer confined to following strict protocols but are actively involved in care planning, assessment, and coordination. This expanded scope of practice empowers nurses to develop personalized care plans that address the unique needs and preferences of individual patients, fostering a stronger therapeutic alliance.
 Furthermore, nurses have become integral members of interdisciplinary healthcare teams. Their ability to collaborate and communicate effectively with other healthcare professionals ensures seamless coordination of care and promotes continuity across different settings. Nurses act as advocates for patients, facilitating dialogue and ensuring that their voices are heard in the decision-making process. This collaborative approach fosters a culture of patient-centeredness and enhances the overall quality of care delivered. Another significant aspect of the evolving role of nurses is the integration of technology in patient-centered care. Nurses are now proficient in using various digital tools, electronic health records, and telehealth platforms. These technological advancements enable nurses to collect and analyze patient data more efficiently, monitor vital signs remotely, and provide timely interventions. By leveraging technology, nurses can deliver care that is both personalized and evidence-based, optimizing patient outcomes.
 The evolving role of nurses in patient-centered care marks a paradigm shift in healthcare delivery. With their expanded scope of practice, interdisciplinary collaboration, and integration of technology, nurses have emerged as leaders in shaping the patient experience. By placing patients at the center of care and tailoring interventions to their unique needs, nurses ensure that healthcare remains truly patient-centered. As the healthcare landscape continues to evolve, it is imperative that we recognize and support the pivotal role nurses play in championing patient-centered care for better health outcomes.

Features of technological regulation for cardiac bioimplants

Patients with congenital heart defects and cardiovascular diseases are required new approaches to surgical intervention. The use of biological cardiac implants, which are made from the extracellular matrix, is a promising trend in modern regenerative medicine. These bioimplants can completely replace defective tissue or organs, and when manufactured with strict protocols and quality control measures, can be safe and effective for therapeutic applications. The process of manufacturing bioimplants involves various risks that need to be assessed and mitigated with ongoing monitoring and evaluation necessary to ensure the highest standards of quality. Overall, this study was successfully evaluated the requirements for introducing a new medical device into practice and created a technical file that meets all necessary documentation for certification.

GAMBARAN PERILAKU MASYARAKAT DALAM PELAKSANAAN PROTOKOL KESEHATAN SEBAGAI UPAYA PENCEGAHAN COVID-19 DI WILAYAH KERJA PUSKESMAS WAJO

Efforts prevent spread Covid-19 can be carried out with strict health protocols and carried out by all levels society. Data from Wajo Health Center showed many as 202 cases Covid-19 and there are 2 cases death in 2021. Increase in cases Covid-19 is caused not complying with health protocols recommended by government. Purpose study was to find out description behavior in form washing hands, wearing masks, maintaining distance, staying away from crowds, and reducing mobility in implementation health protocols effort to prevent Covid-19. Type of research used is descriptive observational. Research population is entire community totaling 18,532, sample amounting to 391 and side method used is cluster sampling. Research data collection consisted primary data obtained by questionnaire and secondary data obtained from report notes Wajo Health Center. Data processing is done computerized using SPSS program. Analysis used is univariate analysis, namely to see appearance frequency distribution each variable studied. Results univariate analysis showed that 59.6% had poor hand washing behavior, 59.6% had less mask wearing behavior, 55.8% had less social distancing behavior, 55.5% avoided crowd behavior who are lacking, and 57.5% have behavior of reducing mobility that is lacking in implementation health protocols as an effort to prevent Covid-19. Conclusion shows that there is still a lack community behavior in implementing health protocols effort to prevent Covid-19 in work area Wajo Health Center, Baubau City. Suggestions for need to increase awareness, willingness and behavior from the community to implement health protocols effort to prevent Covid-19.

Strategi Ladokgi TNI AL R.E. Martadinata dalam Pencegahan Penularan Covid-19 Guna Mendukung Tugas TNI Angkatan Laut

Dental and oral health services at Indonesian Navy Dental Institution R.E Martadinata might continue during the COVID-19 pandemic so as not to interfere with the duties of Indonesian Navy soldiers. For this reason, the implementation of dental and oral treatment might implement the procedures to prevent COVID-19 transmission. This study aimed to analyze transmission prevention procedures and strategies to prevent transmission of COVID-19. This study used a qualitative method with a descriptive design. The results showed that: 1) the procedure for preventing the transmission of COVID-19 in Indonesian Navy Dental Institution R.E Martadinata was carried out by applying strict health protocols and testing; 2) The strategy carried out is to provide initial training such as Basic Life Support, COVID-19 screening training, and PCR examinations, and increase the capacity of health workers by installing air purifiers in every room, equipping dental units with High Volume Evacuators (HVE). The conclusion in the study was that the procedure for preventing the transmission of COVID-19 and the strategy carried out by Indonesian Navy Dental Institution R.E Martadinata were good for preventing the transmission of COVID-19. Thus, dental and oral treatment services can continue to run properly without neglecting the safety of health workers and patients.

"Selametan Tolak Bala" as Coping Strategy During the Covid-19 Pandemic

<em>Selametan tolak bala</em> is a ritual that Javanese people usually do during the pagebluk period. During the current Covid-19 pandemic, some people still carry out this ritual. This study seeks to examine from a psychological point of view why the ritual is still carried amid restrictions on community activities. This research was conducted by literature review method using sources from books, previous research, articles from mass media and website pages, aiming to collect theories and pieces of information relevant to the topics studied in this research. The results of this research are <em>selametan tolak bala</em> could be a form of problem-focused coping if the practitioners believed that this ritual could stop the outbreak. It could be a form of emotional-focused coping if the practitioners believed that this ritual is done to eliminate the anxiety. As Javanese local wisdom, whatever the meaning coping strategies, <em>selametan tolak bala</em> could be one of the efforts in dealing with the Covid-19 pandemic, especially in reducing anxiety levels. Therefore it had to be done by enforcing strict health protocols to avoid the possibility of increasing positive cases of Covid-19 after the ritual implementation, which thwarts the ritual’s purpose.

Internship Report on Static Test Pad Design for Solid Rocket Motor at STAR – Space Technology and Aeronautical Rocketry

This paper outlines the process and considerations involved in designing a static test pad dedicated to rocket motor testing. The static test pad serves as a crucial facility to assess the performance, stability, and safety of rocket motors before actual flight applications. The paper discusses the key aspects of the design, including safety protocols, instrumentation, data acquisition systems, and infrastructure requirements. This study emphasizes the importance of safety in static testing, highlighting the implementation of strict protocols to protect personnel and equipment during the test. Furthermore, the abstract delves into the selection and installation of suitable instrumentation and data acquisition systems to capture essential parameters during the test, such as thrust, chamber pressure, burn time, and exhaust plume characteristics. The integration of reliable sensors and advanced data acquisition technology ensures accurate and real-time data collection, enabling engineers to make informed decisions and refine the rocket motor's design

Analysis of School Management Readiness to Face-to-Face Learning at SMA Negeri 1 Kayuagung OKI Regency

This study aims to describe and find out the Analysis of School Management Readiness, Constraints, and Solutions to Face Face-to-Face Learning at SMA Negeri 1 Kayuagung, OKI Regency. Data collection tools using interviews, documentation, observation and literature review. Data analysis used descriptive qualitative analysis with research stages referring to Miles and Huberman’s theory, namely data collection, data reduction, data presentation, drawing conclusions. The results of the study stated that school management facing face-to-face learning at Kayuagung 1 Public High School was carried out through 1) planning face-to-face learning preparation after online learning; 2) organizing school resources to carry out face-to-face learning after online learning; 3) carrying out face-to-face learning; 4) supervise the implementation of face-to-face learning at SMA Negeri 1 Kayuagung. The obstacles faced are 1) Compliance with health protocols; 2) The number of students exceeds the capacity of the classroom; 3) Availability of resources and equipment; 4) Uncertainty of the pandemic situation; 5) Adjustment of teaching methods; 6) Limited internet access The solutions taken include 1) Providing training and education to students, teachers, staff and parents regarding the importance of complying with health protocols; 2) Carry out regular monitoring and evaluation of the implementation of face-to-face learning; 3) Maintain strict health protocols.

Evaluation of PaCO<sub>2</sub> trend in COVID-19 patients undergoing helmet CPAP in the emergency department

The use of continuous positive airway pressure (CPAP) in COVID-19 hypoxemic respiratory failure (h-ARF) under a strict protocol has been described to be highly efficient. However, early prediction of failure is crucial to avoid delayed intubation. Lower PaCO2 values may represent a higher inspiratory effort and, therefore, may help identify patients at greatest risk of CPAP failure. Aim of this study was to observe the PaCO2 trend of COVID-19 patients with h-ARF before and after the initial treatment with helmet-CPAP. A case series study was conducted from November 2020 to March 2021. All adult patients with h-ARF secondary to COVID-19 treated with helmet-CPAP and eligible for endotracheal intubation were observed. Of a total of 54 patients, 32 (59.3%) underwent intubation. Seven (12.9%) patients died in the ETI group, and none in the non-ETI group. Median PaO2/FiO2 ratio on admission was 91mmHg [IQR 68-185] vs. 104mmHg [IQR 85-215] (p=0.137) in the ETI e non-ETI group, respectively. No differences were found either for PaCO2 values on admission (31.5mmHg [IQR 27-35] vs. 29.3mmHg [IQR 27.7-40]) and for PaCO2 variations after 120 minutes of CPAP (+2.38mmHg ± 3.65 vs. +2.73mmHg ± 3.96). Changes in PaCO2 values were observed during an initial helmet-CPAP trial, but no differences were found in those undergoing endotracheal intubation as compared to the others.

SOSIALISASI UPAYA PREVENTIF PENYEBARAN CORONAVIRUS DISEASE 2019 (COVID-19) di SMAN 15 MUARO JAMBI

Coronavirus Disease 2019 (COVID-19) is still a global public health problem. However, Indonesia has decided to conduct Face-to-face Learning in the learning process. Schools need to implement strict health protocols to prevent the spread of COVID-19 in the school. Schools (teachers and education personnel) have an essential role in monitoring and ensuring the implementation of health protocols. Therefore, socialization about preventing the spread of Coronavirus Disease 2019 (COVID-19) must be done at SMAN 15 Muaro Jambi Regency. The target of the socialization was teachers and education staff at SMAN 15 Muaro Jambi Regency. The Pondok Meja Health Center and the community service team delivered the socialization material using lecture and discussion methods. This activity also measures knowledge before and after socialization. Data were analyzed univariate and bivariate using the Wilcoxon test. Seventeen teachers and education staff attended the socialization activity. The results showed that respondents' average level of knowledge before socialization was 7.94, with a standard deviation of 0.899, and after socialization was 8.35, with a standard deviation of 1.455. The Wilcoxon test showed no difference in the respondents' knowledge before and after socialization. However, there was an increase in the average level of knowledge before and after, from 7.94 to 8.35. Through this socialization, it is hoped that schools can improve the implementation of COVID-19 prevention efforts in schools during face-to-face learning.

Assessing the impact of the COVID‑19 pandemic health protocols on the hygiene status of swimming pools of hotel units.

With the onset of the coronavirus disease 2019 (COVID-19) pandemic, numerous countries imposed strict lockdown measures and travel bans, resulting in the closure of hotels. Over time, the opening of hotel units was gradually allowed, and new strict regulations and protocols were issued to ensure the hygiene and safety of swimming pools in the era of COVID-19. The present study aimed to evaluate the implementation of strict health COVID-19-related protocols in hotel units during the 2020 summer tourist season concerning microbiological hygiene and physicochemical parameters of water, and to compare the data with those from the 2019 tourist season. For this reason, 591 water samples from 62 swimming pools were analyzed, of which 381 samples were for the 2019 tourist season and 210 samples were for the 2020 tourist season. To examine the presence of Legionella spp, 132 additional samples were taken from 14 pools, of which 49 in 2019 and 83 in 2020. In 2019, 2.89% (11/381) of the samples were out of legislative limits (0/250 mg/l) regarding the presence of Escherichia coli (E. coli), 9.45% (36/381) were out of acceptable limits (0/250 mg/l) regarding the presence of Pseudomonas aeruginosa (P. aeruginosa) and 8.92% (34/381) had residual chlorine levels <0.4 mg/l. In 2020, 1.43% (3/210) of the samples were out of the legislative limits as regards the presence of E. coli, 7.14% (15/210) were out of acceptable limits regarding the presence of P. aeruginosa and 3.33% (7/210) of the samples measured residual chlorine levels <0.4 mg/l. The risk ratio (RR) in relation to the presence of E. coli due to incorrect compliance with the requirements for residual chlorine was calculated for 2019 at 8.50, while in 2020 it was calculated at 14.50 (P=0.008). The RR of the presence of P. aeruginosa due to inappropriate residual chlorine requirements was calculated in 2019 at 2.04 (P=0.0814), while in 2020 it was calculated at 2.07 (P=0.44). According to the microbiological hygiene and physicochemical parameters of the water samples studied, there was a significant improvement due to the strict protocols for the swimming pools in the summer season of 2020 compared to the tourist season of 2019, namely 72.72% (E. coli), 58.33% (P. aeruginosa), 79.41% (of residual chlorine <0.4 mg/l) in the three main parameters studied. Finally, an increased colonization by Legionella spp. detected in the internal networks of the hotels due to the non-operation of the hotels during the lockdown, the improper disinfection and stagnant water in the internal water supply networks. Specifically, in 2019, 95.92% (47/49) of the samples tested negative and 4.08% (2/49) tested positive (≥50 CFU/l) for Legionella spp., compared to 2020 where 91.57% (76/83) of the samples tested negative and 8.43% (7/83) tested positive.

Evaluating the theoretical performance of aircraft wastewater monitoring as a tool for SARS-CoV-2 surveillance.

Air travel plays an important role in the cross-border spread of infectious diseases. During the SARS-CoV-2 pandemic many countries introduced strict border testing protocols to monitor the incursion of the virus. However, high implementation costs and significant inconvenience to passengers have led public health authorities to consider alternative methods of disease surveillance at borders. Aircraft wastewater monitoring has been proposed as one such alternative. In this paper we assess the theoretical limits of aircraft wastewater monitoring and compare its performance to post-arrival border screening approaches. Using an infectious disease model, we simulate an unmitigated SARS-CoV-2 epidemic originating in a seed country and spreading to the United Kingdom (UK) through daily flights. We use a probabilistic approach to estimate the time of first detection in the UK in aircraft wastewater and respiratory swab screening. Across a broad range of model parameters, our analysis indicates that the median time between the first incursion and detection in wastewater would be approximately 17 days (IQR: 7-28 days), resulting in a median of 25 cumulative cases (IQR: 6-84 cases) in the UK at the point of detection. Comparisons to respiratory swab screening suggest that aircraft wastewater monitoring is as effective as random screening of 20% of passengers at the border, using a test with 95% sensitivity. For testing regimes with sensitivity of 85% or less, the required coverage to outperform wastewater monitoring increases to 30%. Analysis of other model parameters suggests that wastewater monitoring is most effective when used on long-haul flights where probability of defecation is above 30%, and when the target pathogen has high faecal shedding rates and reasonable detectability in wastewater. These results demonstrate the potential use cases of aircraft wastewater monitoring and its utility in a wider system of public health surveillance.

Use of Hybrid Methods in Improving Community Healthy Lifestyle Behavior during the COVID-19 Pandemic in Indonesia: Opportunities and Challenges

BACKGROUND: The COVID 19 pandemic is a challenge for public health services in Indonesia because various priority health services for diabetes prevention in the community have not been implemented. Diabetes risk factors such as obesity, lack of physical exercise, and eating fewer vegetables and/or fruit also increased. The SESAMA (Segitiga Kerjasama/Triangle of cooperation) model is a Diabetes control model whose implementation is carried out directly in the community but during the COVID-19 pandemic, it could not be fully implemented so the hybrid method became a modification of the implemented strategy. This study aims to find out whether the SESAMA model can be implemented using the hybrid method.&#x0D; &#x0D; METHODS: The study was conducted by a survey to all people aged &amp;gt; 18 years in 4 target villages, who participated in fasting blood glucose screening and body weight measurements. The survey produced a number of respondents who met the criteria for obesity with or without prediabetes and were given the SESAMA model of intervention. &amp;nbsp;&#x0D; &#x0D; RESULTS: There was a decrease in the number of people with prediabetes from 148 people to 105 people (29.05%). Prediabetes with obesity also experienced a reduction. From 108 people with prediabetes with grade 3 obesity, 14 people were reduced to 3 people (78.57%); for grade 2 as many as 12 people were reduced to 9 people (25%) and for grade 1 as many as 82 people increased to 83 people and normal weight increased from 40 people to 53 people.&#x0D; &#x0D; CONCLUSIONS: Implementation of the SESAMA Model for people with Prediabetes during the COVID-19 Pandemic which was carried out using the hybrid method showed a decrease in the proportion of people with prediabetes. The proportion of obesity in people with prediabetes has also decreased. The SESAMA model during a pandemic can be implemented using the hybrid method, by maintaining the application of strict health protocols and optimizing cooperation with various stakeholders in the community.

Implementation of neonatal phototherapy with the BiliCocoon Bag® device in the maternity ward and impact on mother–infant separation

BackgroundFree bilirubin jaundice is a frequent pathology in the neonatal period. The major complication is neurological toxicity, the most severe form of which is kernicterus. Overall, 5%–10% of jaundiced neonates require treatment. The first-line treatment is phototherapy, with intensive phototherapy being the gold standard. Other equipment is also available, including the BiliCocoon Bag®. It is a safe and controlled therapy that can be performed in the mother's room in the maternity ward, thereby avoiding separation and allowing for breast- or bottle-feeding during treatment. It is easy to install and does not require protective glasses, thus no scope or hospitalization. In our maternity ward, all neonates requiring intensive phototherapy are hospitalized in the neonatology ward. ObjectiveThe objective of our study was to evaluate the number of avoided hospitalizations in neonatology for free bilirubin jaundice since the introduction, according to a strict protocol, of the BiliCocoon Bag® device. Material and MethodThis was a single-center retrospective cohort study using data of newborns usually collected as part of standard care. Children born in our maternity ward during an 18-month period (August 1, 2020 to January 31, 2022) were included. Causes of jaundice, age at the beginning and mode of treatment, number of sessions for each device, and length of stay were compared. Results are presented as number and percentage with median (25th–75th) or mean (extremes) values for categorical and continuous variables, respectively. A t-test was used to compare the means of the independent groups. ResultsA total of 316 newborns were included. Physiological jaundice was the main cause of jaundice. The median age for the first phototherapy treatment was 54.5 h (30–68). The 316 neonates needed 438 phototherapy sessions: 235 (74%) neonates required only one phototherapy session, 85 (36%) of them were treated with the BiliCocoon Bag®. For the 81 children who needed two or more phototherapy sessions, 19 children (23.5%) were treated by tunnel phototherapy and then the BiliCocoon Bag®, and eight children (10%) by BiliCocoon Bag® alone. The BiliCocoon Bag® enabled a relative reduction in the hospitalization rate of 38% and avoided hospitalization for approximately one third of the newborns treated. The BiliCocoon Bag® failure rate was 3.6% and the average length of stay was comparable between the two types of treatment. ConclusionFollowing a strict protocol of use, the BiliCocoon Bag® is a reliable method and a good alternative to intensive phototherapy for newborns in the maternity ward, as it avoids hospitalization and mother–infant separation.

Development of Protocol for Ventriculoperitoneal Shunt Surgery in Paediatric Patients to Reduce Shunt Infection

Background: Ventriculoperitoneal shunt (VPS) is the most common treatment modality for hydrocephalus. However, VPS infection is acommon and serious complication with high rates of mortality and morbidity and there is some emerging evidence suggesting that adherence to a strict protocol may be important in reducing the rate of shunt infection. Objectives: To develop a protocol for initial ventriculoperitoneal shunt surgery and assess the efficacy of this protocol in reducing ventriculoperitoneal shunt infection rate. Materials and Methods: This study was a comparative study was carried out in the Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka from December 2021 to March 2023. Total 100 patients were included in this study. Patients &lt; 18 years of age undergoing initial ventriculoperitoneal shunt surgery for hydrocephalus due to various etiologies in the Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University. Data collection sheet was used to collect the necessary information. Voluntary written informed consent was taken from the patients and/or the legal guardian/responsible family members after completely explaining to them the procedure and the purpose of the study. Using simple random sampling by lottery method, the patients were divided into a study group and a control group. Patients in the study group underwent ventriculoperitoneal shunt surgery as per the proposed surgery protocol and strict adherence to the protocol by the operating surgeon was ensured. Patients in the control group underwent ventriculoperitoneal shunt surgery as per the current standard practice. Post-operative care of the patient was carried out as per the standard practice in both the groups. Follow-up of the patients were done on an outpatient department basis at 1 month and at 3 months postoperatively, where they were examined thoroughly for signs and symptoms of shunt infection. Patients not showing up at the outpatient department were ...

Post-cardiac arrest intensive care in Sweden: A survey of current clinical practice.

European guidelines recommend targeted temperature management (TTM) in post-cardiac arrest care. A large multicentre clinical trial, however, showed no difference in mortality and neurological outcome when comparing hypothermia to normothermia with early treatment of fever. The study results were valid given a strict protocol for the assessment of prognosis using defined neurological examinations. With the current range of recommended TTM temperatures, and applicable neurological examinations, procedures may differ between hospitals and the variation of clinical practice in Sweden is not known. The aim of this study was to investigate current practice in post-resuscitation care after cardiac arrest as to temperature targets and assessment of neurological prognosis in Swedish intensive care units (ICUs). A structured survey was conducted by telephone or e-mail in all Levels 2 and 3 (= 53) Swedish ICUs during the spring of 2022 with a secondary survey in April 2023. Five units were not providing post-cardiac arrest care and were excluded. The response rate was 43/48 (90%) of the eligible units. Among the responding ICUs, normothermia (36-37.7°C) was applied in all centres (2023). There was a detailed routine for the assessment of neurological prognosis in 38/43 (88%) ICUs. Neurological assessment was applied 72-96 h after return of spontaneous circulation in 32/38 (84%) units. Electroencephalogram and computed tomography and/or magnetic resonance imaging were the most common technical methods available. Swedish ICUs use normothermia including early treatment of fever in post-resuscitation care after cardiac arrest and almost all apply a detailed routine for the assessment of neurological prognosis. However, available methods for prognostic evaluation varies between hospitals.

Pelatihan Pembuatan Sabun Lembaran Berbahan Aktif Kulit Buah Naga di Panti Asuhan Izzati Jannah

In recent years, the world has been shocked by the emergence of a disease caused by a virus, namely the corona virus or better known as COVID-19. The rapid spread of Covid-19 requires precautions to prevent transmission to break the chain of the COVID-19 pandemic and be able to face the new normal era. One of the preventive measures is to carry out the movement of washing hands with soap. Sheet soap is used as disposable hand soap and is perfect for use when traveling or doing activities outside the home. Currently, the community has started to carry out offline school and lecture activities. This activity aims to demand awareness to increase activities that are able to prevent the spread of Covid-19. So bringing antiseptic products, both in the form of liquids and sheet soap, is highly recommended to provide comfort in dealing with the new normal conditions after the Covid-19 pandemic. Activity method: This activity is planned to be carried out at the izzati jannah orphanage where the orphanage students have carried out learning activities offline. Activities are carried out following strict health protocols. The counseling activity was attended by 30 orphanage children. Based on the results of the post test, it was obtained a value of 92% of students being able to understand the training material provided. So that the results of the activity show that there is an increase in the knowledge of the orphans about processing dragon fruit peel powder into sheet soap that is easy to use and carry.

Recurrence Rate of High-altitude Pulmonary Edema in Lowlanders Inducted Temporarily to High-altitude Areas

Abstract Background: Some section of the Indian population resides in high-altitude areas of the mighty Himalayas. In addition to the residents who inhabit mountainous areas, there is also a group of lowlanders who occasionally visit these regions temporarily for work-related purposes or vacations. These individuals are prone to high-altitude illnesses, including acute mountain sickness and high-altitude pulmonary edema (HAPE). This cohort study was undertaken, among acclimatized and nonacclimatized lowlanders based on 3 years of data at a tertiary care hospital, to study the recurrence rate of HAPE in lowlanders. Materials and Methods: The inception cohort consisted of consecutive cases of HAPE among lowlanders, temporarily posted to these high-altitude regions, over 3 years. This cohort was followed up for at least 1 year. The recurrence rate of HAPE in terms of incidence density in person-months and cumulative incidence was calculated, and variables, including clinical features, altitudes at which the symptoms occurred, mode of induction to the high-altitude area, and time of onset of HAPE episodes postinduction altitudes, were studied. Results: The study revealed the recurrence of HAPE as an incidence density of 88.7 per 1000 person-months (95% confidence limit 66.1–115.9 per 1000 person-months). The cumulative incidence was 125 per 1000, over an average follow-up of 22.54 months (95% confidence limit 26–323 per 1000). The study revealed that the recurrence was found to occur at similar altitudes as the previous episode even after following strict acclimatization protocols and slow induction to the high-altitude area by road route with the onset of symptoms within 72 h of entry into the high-altitude area. Conclusion: This study brought out that there is a risk of recurrence of HAPE in lowlanders temporarily inducted to high-altitude areas, with previous episodes of HAPE at similar altitudes as previous episodes, even when acclimatization protocols are followed.

Implementation of Health Protocol Social Distancing on Children Educational Toy

&lt;p&gt;Nearing the end of 2019 a virus broke out causing the world to be in the state of a pandemic. With the virus spreading easily through droplets, the government of Indonesia issued the people to wear masks and keep a distance minimum of 1 meter. Public places such as schools, restaurants and religious places are to be closed and to operate through online media. Through 2 years of the pandemic the virus spreading decreased and the government allowed for public places to open again with a strict health protocol. Schools also begin the education onsite but this raises a new problem for the schools and children to face, especially children of 4-6 years old. These ages are where children begin to socialize with their peers. With the limitations of online meeting, children can not interact with their peers resulting in their social skills not developing optimally. Even when schools started onsite again the interaction period is limited by the health protocol such as wearing masks and social distancing. The method used in this study is a mixed method, combining both qualitative and quantitative to gather data both descriptive and number in order to produce the design. The design process uses SCAMPER (Substitute, Combine, Adapt, Modify, Put to Other Use, Eliminate, Reverse) method to adapt and combine two toys into a new one. This study hopes to design educational toys which encourage the interaction of children while abiding the health protocol. &lt;/p&gt;

Worship in the Mosque during the Pandemic: A Study of Islamic Law

The Covid-19 pandemic has affected almost every aspect of Indonesian life, including religious aspects such as the ban on congregational prayers in mosques. The measures taken by the government are certainly controversial among the public. The purpose of this study was to find out the practice of holding congregational prayers during the Covid-19 pandemic in Medan City based on the contemporary Ulama Ijtihad method and Islamic law. The method used in this study is a qualitative research method. The results of the study show that congregations in Medan City can still perform congregational prayer at the mosque, but by implementing strict health protocols such as applying a distance of at least 1 metre for prayer, mandatory wearing of masks, using their prayer mats, performing ablution (wudu) at home respectively, congregations are not allowed to gather at the same time as well as not allowed to bring such children to the mosque.Highlights:&#x0D; &#x0D; Congregational prayers are allowed, with strict health protocols.&#x0D; Measures include maintaining 1-meter distance, wearing masks, and using personal prayer mats.&#x0D; Other precautions involve performing ablution at home, staggering arrival times, and prohibiting children in mosques.&#x0D; &#x0D; Keywords: Congregational Prayer, Ijtihad method, contemporary ulama, Covid-19&#x0D;

Factors Affecting Water Quality and Sustainability in Dental Practices in Greece

Good water quality, achieved with environmentally friendly means, is essential in ensuring the safe operation of a dental practice. Our aim was to evaluate procedures and protocols used by dentists for water quality and sustainability. Greek dentists (n = 206) participated in this questionnaire-based study. Statistically significant results (p &lt; 0.05) have shown that (a) female dentists were more interested in additional information about water quality (87.5% vs. 71.8%), had water supply directly from the public network to the dental unit (68.8% vs. 73.8%), were more likely to disinfect surfaces between two appointments (97.7% vs. 88.0%) and were more likely to perform annual maintenance to the dental unit (66.3% vs. 57.9%). (b) More experienced dentists were also more likely to clean the waterline network of the unit with a large amount of fluid once a day (39.3–48.3%), had newer equipment, had more handpieces, and spent more time cleaning and disinfecting the unit (χ2 = 26.21). (c) Dentists who have studied abroad were more likely to perform less strict antiseptic protocols while believing that their practices are environmentally friendly (χ2 = 10.93). Dentists with some postgraduate education were more likely to have an assistant, know the active substance of the antiseptic, supply antiseptic to the handpieces automatically and maintain the dental unit annually (χ2 = 7.24). (d) Dentists who practiced general dentistry were less likely to have an assistant and performed less strict protocols while they cleaned suctions with a large amount of fluid less often (χ2 = 11.64). Dentists who practiced in a clinic (with employees) were more likely to have newer equipment, have an assistant and perform stricter water sustainability protocols. (e) Dentists with a higher annual income were also more likely to have an assistant, perform microbiological tests for the quality of the water of the unit, have a continuous water supply system and perform stricter protocols for water quality of the unit. Overall, less experienced (and younger) dentists are more informed about water quality legislation (27.6%) compared to more experienced and older dentists (13.2–17.5%). Gender, work experience, level of education and dental office characteristics are important factors determining water sustainability, waterlines, and equipment maintenance in dental practice. Dental associations should raise awareness regarding water quality and sustainability, investing in lifelong learning, while implementing protocols and green strategies.