Triangle Approach Research Articles

Analysis of Pre-Exposure Prophylaxis (PrEP) Program in Preventing HIV/AIDS Based on the Health Policy Triangle

Background: Pre-exposure prophylaxis (PrEP) is an action to prevent HIV transmission using antiretroviral (ARV) drugs. During 2022, the PrEP program was implemented in 21 districts/cities as a trial limited to MSM and sex worker populations. This study aims to analyze the PrEP program in preventing HIV/AIDS using a health policy triangle approach that assesses the aspects of actor, context, content, and process. Methods: The study was performed using qualitative methods from electronic document searches. Results: The results of the analysis show that the actors in the PrEP program as HIV/AIDS prevention are the President, Legislative, Ministry of Health, Ministry of Education, Ministry of Internal Affairs, health office, community health centers, hospitals, non-governmental organization (NGOs)/HIV and AIDS care groups, HIV/AIDS key populations, correctional institutions, the Indonesian Ulema Council (MUI), and the Food and Drug Monitoring Agency (BPOM). The context of PrEP implementation in the form of situational factors is high HIV transmission within at-risk populations, structural factors are legal bases, cultural factors are patriarchal culture and MSM and sex workers which are still taboo, as well as international factors in the form of WHO policy. The policy process consists of problem identification, policy analysis, policy formulation, implementation, and program monitoring and evaluation. Conclusion: PrEP content regarding the aim of PrEP, targets, types of drugs used, how to get PrEP services, how to use the drugs, and how to monitor has been explained in the Technical Guidelines for PrEP Services made by WHO and adapted by the Indonesian Ministry of Health.

Analysis the Healthy School Campaign in Indonesia: A Health Policy Triangle Approach

The School Health Program policy was initiated by the Indonesian government in 2014. However, by 2021, student health service coverage was still suboptimal. The Healthy Schools Campaign Program was introduced in 2022 as an alternative policy to revitalize the School Health Programme. The study aimed to analyze the Healthy School Campaign Program using the health policy triangle framework, which includes actors, content, process, and context. This research uses qualitative methods with secondary data sourced from electronic document searches. The main actors in this policy involve official government institutions, supported by collaboration with non-government partners. Policy selection is based on situational, structural, cultural and international contextual factors. The program content focuses on physical health, healthy nutrition, and student immunization. The conclusion is that the selection of content is influenced by how actors identify health problems in the early stages of policy preparation. Implementation of this program requires a clear collaboration system as a reference for its implementation in educational units. Teacher and parent involvement is also very important to increase the effectiveness and sustainability of the program.

A comparative study on PI-PD controller design using stability region centroid methods for unstable, integrating and resonant systems with time delay

In this paper, controller tuning methods based on stability region centroid methods reported in the literature are used to design PI-PD controllers for unstable, integrating and resonant systems with time delay. By analyzing the stability boundary locus (SBL) for the PD controller, which is utilized in the inner loop of this structure, the controller parameters are obtained using three methods which are the Weighted Geometric Center (WGC), Centroid of Convex Stability Region (CCSR), and Stability Triangle Approach (STA). These techniques were applied analytically, step by step. For the closed loop transfer function obtained in the inner loop of the controlled system, these three methods were utilized to design the PI controller in the outer loop, individually. Unit step responses of the controlled system, using PI-PD gains determined by each method, have been obtained. Furthermore, a disturbance of a certain time and amplitude was added to the systems to test the disturbance rejection behavior and the robustness performance of the methods. Perturbed responses were obtained through changing the model parameters at a certain rate. Time domain performance metrics were analyzed to compare the responses. The simulations were evaluated using settling time, rise time, and percentage overshoot as the assessment criteria. As a result of this study, the effectiveness of three methods, namely WGC, CCSR, and STA, in controller design for unstable, integrating, and resonant time-delay systems has been demonstrated. In addition, a comparison of time domain performance metrics is presented for the nominal and perturbed systems. Based on these comparisons, it is concluded that the methods outperform each other only in some time response performance measures. The presented results showed the advantages of these methods over each other in terms of some performance criteria. The contribution of this study to the literature is the comparative analysis of these three analytical methods.

Three-dimensional analysis of puncture needle path through safety triangle approach PLD and design of puncture positioning guide plate.

In this study, the three-dimensional relationship between the optimal puncture needle path and the lumbar spinous process was discussed using digital technology. Additionally, the positioning guide plate was designed and 3D printed in order to simulate the surgical puncture of specimens. This plate served as an important reference for the preoperative simulation and clinical application of percutaneous laser decompression (PLD). The CT data were imported into the Mimics program, the 3D model was rebuilt, the ideal puncture line N and the associated central axis M were developed, and the required data were measured. All of these steps were completed. A total of five adult specimens were chosen for CT scanning; the data were imported into the Mimics program; positioning guide plates were generated and 3D printed; a simulated surgical puncture of the specimens was carried out; an X-ray inspection was carried out; and an analysis of the puncture accuracy was carried out. (1) The angle between line N and line M was 42°~55°, and the angles between the line M and 3D plane were 1°~2°, 5°~12°, and 78°~84°, respectively; (2) As the level of the lumbar intervertebral disc decreases, the distance from point to line and point to surface changes regularly; (3) The positioning guide was designed with the end of the lumbar spinous process and the posterior superior iliac spine on both sides as supporting points. (4) Five specimens were punctured 40 times by using the guide to simulate surgical puncture, and the success rate was 97.5%. By analyzing the three-dimensional relationship between the optimal puncture needle path and the lumbar spinous process, the guide plate was designed to simulate surgical puncture, and the individualized safety positioning of percutaneous puncture was obtained.

Visual Rhetoric of Ultra Milk X ITZY Advertisement on Youtube Media

The advertising industry in Indonesia currently uses many brand ambassadors from South Korea. Ads that use visualizations from South Korea are effective in increasing sales of local products and the image of these products. The purpose of this study is to analyze the meaning of messages and visual images displayed by advertisements in campaigning #DontStopYourMove in collaboration with Korean idols ITZY on YouTube social media for the younger generation. This research uses a critical paradigm through descriptive qualitative research methods to identify data and analyze the visual text of advertisements with observation steps through scenes in advertisements. This research uses the rhetorical triangle approach and the AISAS Model communication flow. This research aims to interpret the meaning of the message in the advertisement and analyze the visual image and analyze the audience's activity of interest in the Ultra Milk advertisement to see the position of the advertisement and ITZY brand ambassador who promotes Ultra Milk milk products and campaigns #DontStopYourMove. The results of this study show (1) The meaning of Ultra Milk's advertising message is for young people who have a lot of activities to consume milk as a nutritional companion, becoming a generation that "Don't Stop Your Move to be Unstoppable Generation, (2) The visual image built by Ultra Milk in collaboration with ITZY is expected to make the audience like Korean idols who have unique characters, enthusiasm, different and actively moving, (3) The advertisement gets the attention of the audience through brand ambassadors, visuals and products.

Usefulness of Opening the Diaphragma Sellae Before Transecting Interclinoidal Ligament for Endoscopic Endonasal Transoculomotor Triangle Approach: Technical Nuances and Surgical Outcomes

Opening the oculomotor triangle and removing the posterior fossa lesion by endoscopic endonasal approach (EEA) is challenging for even an experienced endoscopic neurosurgeon. We summarize the treatment experience and technical nuances with EEA for resection of pituitary neuroendocrine tumors and cavernous sinus (CS) meningiomas invading through the oculomotor triangle (OT). Between 2018 and 2022, eight cases, including five pituitary neuroendocrine tumors (PitNET) including three nonfunctioning and two somatotroph tumors with elevated growth hormone, and 3 CS meningiomas were treated using an endoscopic endonasal transoculomotor triangle approach. The critical surgical technique is continuously opening the diaphragma sellae from medial to lateral towards the interclinoidal ligament (ICL) and transecting it to enlarge the OT. We evaluated preoperative tumor size, previous surgical history, preoperative symptoms, extent of tumor resection, histopathology, and postoperative complications for all patients. The GTR(gross total resection)- defined as complete removal in 3 patients (38%), near-total resection(NTR) - defined as >95% removal in 4 patients (50%), and subtotal resection (STR)- defined as up to 90 % removal in one patient (12%)and gross-total resection of tumor invading through the OT was achieved in all patients through pure EEA. Two of three patients with visual deficit in Non-Functioning-PitNET improved, and the other remained stable postoperatively. One patient showed transient oculomotor nerve palsy. The Growth Hormone level of the two patients with somatotroph tumors declined to normal. For three patients with CS meningiomas, cranial nerve palsy improved in two patients, while the other patient developed increased facial numbness after surgery. Endoscopic endonasal transoculomotor triangle approach is an efficient surgical option for the tumor with CS invasion and OT penetration.

Mengatasi Siswa Sekolah Dasar yang Kesulitan dalam Mengerjakan Soal Matematika dengan Pendekatan Segitiga Restitusi

The aim of this research is to describe a model for overcoming elementary school students who have difficulty working on mathematics problems using the restitution triangle approach. Difficulty working on math problems is part of the difficulty learning mathematics. Difficulty learning mathematics is generally defined as a condition where students are unable to learn mathematics subjects completely. The restitution triangle was originally a step towards positively disciplining students. The restitution triangle approach contains aspects of a humanist approach for students. There are three steps to the restitution triangle approach, starting from stabilizing identity. This step builds confidence in students that everyone has experienced mistakes in doing questions. So that students do not feel mentally down. The second step is Validation of Incorrect Actions. In this step, students are invited to reflect on any part of the problem they got wrong and are guided to correct it, there is a remedial learning process. The third step asks about beliefs. In this step, students' motivation is increased so that students now know the steps to work on the questions, and tomorrow they will not make any more mistakes when working on the questions. The results of a literature review found that the stages of the restitution triangle in positive discipline can be used to help overcome elementary school students who have difficulty working on mathematics problems.

Germany’s Triangular Relations with the United States and China in the Era of the Zeitenwende

ABSTRACT Russia’s invasion of Ukraine has prompted a historic turning point (Zeitenwende) in Germany. This Zeitenwende has included a caesura in Berlin’s dealings with Moscow. But what about the ripple effects on Germany’s relations with its crucial security guarantor, the United States, and its most important trading partner, China? This article investigates Germany’s triangular relations with the US and China respectively in light of the ‘Russia factor’. It does so through the theoretical lens of the so-called Strategic Triangle Approach (STA) and the notion of ‘dual triangles’. The analysis reveals that Russia’s aggression against Ukraine has triggered an amplification of previously existing trends, in that German–US ties have been further strengthened whereas the German–Chinese relationship has become fraught with additional tensions. This has led to a state of affairs whereby Germany’s long-held rationale of staying on friendly terms with both superpowers is now being put to the test like never before since the turn of the millennium. Even more importantly, however, an STA-grounded assessment of Germany’s current situation also demonstrates that even – or especially – in the era of Zeitenwende, the country may be well-advised to maintain an overall cooperative course vis-à-vis China – if indeed that is possible.

Posterior Calot's Triangle Approach First Would Be a Better Choice for Chronic Atrophic Cholecystitis: A Retrospective Controlled Study.

Objective: Compare the clinical efficacy of anterior and posterior Calot's triangle approach in laparoscopic cholecystectomy (LC) for chronic atrophic cholecystitis, to find out which approach is much safer and more reliable. Patients and Methods: From June 2020 to June 2022, 102 patients with chronic atrophic cholecystitis underwent LC in our hospital. They were divided into anterior Calot's triangle approach group and posterior Calot's triangle approach group. In addition, their clinical data, intraoperative conditions, surgical results, and postoperative recovery were analyzed. Results: LC was performed in 41 females and 28 males by the anterior Calot's triangle approach, and in 20 females and 13 males by the posterior Calot's triangle approach. There were no differences in age, gender, and body mass index between the two groups (P > .05). The probability of rupture of cystic artery between both groups was not significantly different (P = .549), and the intraoperative blood loss was more in the anterior group (P = .014). The operative time of the posterior approach appeared to be shorter (P = .013). Bile duct injury and conversion to open cholecystectomy revealed no significant difference (P > .05). The recovery time of gastrointestinal function, wound infection, white blood cell count, liver function, and postoperative hospital stay time were found to be not significantly different (P > .05). Conclusion: By the posterior Calot's triangle approach, LC is a convenient and feasible surgical procedure for chronic atrophic cholecystitis with less blood loss and can become easier without increasing the risk of surgery.

Retromolar Triangle Anesthesia Technique: A Feasible Alternative to Classic?

The present prospective study included 50 subjects that had indication of inferior molar extraction. The performed anesthesia technique for these cases was the retromolar triangle approach, and the analyzed parameters for evaluating the efficacy of this anesthesia technique were the positive nerve block of the branches involved in the area (inferior alveolar, buccal, and lingual nerves) and the duration of the anesthesia. The efficiency of the retromolar triangle anesthesia technique was positive in 64% of the cases for the inferior alveolar nerve, 46% of the cases for the lingual nerve, and 22% of the cases for the buccal nerve. The duration of the anesthesia revealed a mean value of 72.4 min, suggesting that the duration is an essential factor in its effectiveness. Retromolar triangle anesthesia can be a viable option for clinicians, offering a simple and easy approach for the management of clinical cases.

PE031 - The anterior triangle approach to preserve the neurovascular bundle during robot-assisted laparoscopic radical prostatectomy and its benefits in sexual outcomes

PE031 - The anterior triangle approach to preserve the neurovascular bundle during robot-assisted laparoscopic radical prostatectomy and its benefits in sexual outcomes

Effect of non-uniform swelling on coal multiphysics during gas injection: The triangle approach

In current dual porosity/permeability models, there exists a fundamental assumption that the adsorption-induced swelling is distributed uniformly within the representative elementary volume (REV), irrespective of its internal structures and transient processes. However, both internal structures and transient processes can lead to the non-uniform swelling. In this study, we hypothesize that the non-uniform swelling is responsible for why coal permeability in experimental measurements is not only controlled by the effective stress but also is affected by the adsorption-induced swelling. We propose a concept of the swelling triangle composed of swelling paths to characterize the evolution of the non-uniform swelling and serve as a core link in coupled multiphysics. A swelling path is determined by a dimensionless volumetric ratio and a dimensionless swelling ratio. Different swelling paths have the same start and end point, and each swelling path represents a unique swelling case. The swelling path as the diagonal of the triangle represents the case of the uniform swelling while that as the two perpendicular boundaries represents the case of the localized swelling. The paths of all intermediate cases populate inside the triangle. The corresponding relations between the swelling path and the response of coal multiphysics are established by a non-uniform swelling coefficient. We define this method as the triangle approach and corresponding models as swelling path-based ones. The proposed concept and models are verified against a long-term experimental measurement of permeability and strains under constant effective stress. Our results demonstrate that during gas injection, coal multiphysics responses have a close dependence on the swelling path, and that in both future experiments and field predictions, this dependence must be considered.

Pancreaticoduodenectomy in the Portal Annular Pancreas-Mesopancreas Triangle Approach (with Video).

Portal Annular Pancreas (PAP) is a relatively uncommon entity with 4% reported incidence. Pancreaticoduodenectomy is challenging in cases with PAP and is associated with higher postoperative pancreatic fistula rate and overall morbidity. PAP is classified according to the pattern and location of fusion around the portal vein as-supra-splenic, infra-splenic & mixed fusion type. Also, the ductal anatomy can vary as pancreatic duct present only in the ante-portal portion or only in the retro-portal portion or ducts in both ante and retro-portal portion. At present, ideal surgical strategy is not defined as per the PAP types. The case demonstrated in the video presented with a localized, large duodenal mass with type IIA PAP (supra-splenic fusion with both ante and retro-portal ducts) detected on the preoperative triphasic CT scan. To achieve a single pancreatic cut surface with a single pancreatic duct for anastomosis, an extended pancreatic resection was performed using meso-pancreas triangle approach. Patient had a smooth intraoperative course & the postoperative recovery was also uneventful. Pathology reported pT3 duodenal cancer with negative margins and uninvolved lymph nodes. A preoperative knowledge of PAP and its various types is extremely important in order to tailor intraoperative management, specially of the retro-portal portion. In patients with retro-portal duct or both ante and retro-portal ducts (as the case presented in the video), an extended resection is recommended to mitigate postoperative pancreatic fistula.

Data-Driven Futuristic Scenarios: Smart Home Service Experience Foresight Based on Social Media Data

Exploring future scenarios can consider future generations and society from a long-term perspective. A Futures Triangle is an approach used for mapping future scenarios. In general, the Futures Triangle collects weak signals using qualitative research methods. However, collecting weak signals qualitatively is limited by its small data size and manual data analysis errors. To overcome those limitations, this study proposes the data-driven futuristic scenario approach. This approach analyzes a large number of social perceptions existing in social networks as weak signals via semantic network analysis. Using our proposed data-driven approach, researchers can quantitatively collect weak signals for a Futures Triangle. To verify the applicability of the proposed method, we conducted a case study on the Chinese smart home service experience. The dataset consists of 2421 posts containing the keyword “smart home experience” on the Chinese social media platform Weibo. Three future scenarios were constructed using the proposed method. The results demonstrate the feasibility of the proposed methodology. The data-driven futuristic scenario approach has the advantage of quantitatively analyzing a large amount of stakeholder data to provide weak signals for the Futures Triangle. We suggest that the data-driven futuristic scenario approach serves as a supplementary method, combined with the traditional Futures Triangle approach, to comprehensively explore future scenarios.

The influence of circular cavity on the characteristics of dynamic crack propagation in rocks using a single notch triangle approach

We used a novel single-notch triangle (SNT) sample to conduct dynamic fracture tests and investigate the effect of a circular cavity on the dynamic fracture mechanisms that occur in fractured rock masses subjected to a single crack under dynamic loads. Dynamical loads were applied with a drop hammer weight device. A modified finite difference method code was developed to simulate the dynamic cracking behavior of SNT samples under the action of impact loading. Next, we calculated the maximum principal stress and circumferential stress around the circular cavity and investigated dynamic crack initiation toughness (DCIT) by applying both experimental and numerical approaches. We also investigated the mechanisms that occur in the circular cavity with regards to the initiation of dynamic cracking and the cracking behavior by applying numerical models. Analysis demonstrated that the circular cavity promotes cracking initiation behavior and that the most significant impact was detected at a horizontal offset distance of 15 mm. Furthermore, the crack initiation time and DCIT were used effectively to evaluate the dynamic stability of cracks. However, the DCIT is accurate parameter for investigating how a mass of fractured rock changes according to different dynamic loads. We found that the roughness of the fractured surface around the crack tip was more significant than that of the fractured surface behind the circular cavity; this demonstrated that the circular cavity enhanced the energy consumed during crack propagation.

Surgical skills and precautions of pelvic exenteration combined with pelvic wall resection

The treatment of locally advanced rectal cancer (LARC) or locally recurrent rectal cancer (LRRC) has been a difficulty and challenge in the field of advanced rectal cancer, while pelvic exenteration (PE), as an important way to potentially achieve radical treatment of LARC and LRRC, has been shown to significantly improve the long-term prognosis of patients. The implementation of PE surgery requires precise assessment of the extent of invasion of LARC or LRRC and adequate preoperative preparation through multidisciplinary consultation before surgery. The lateral pelvis involves numerous tissues, blood vessels, and nerves, and resection is most difficult, and the ureteral and Marcille triangle approaches are recommended; while the supine transabdominal approach combined with intraoperative change to the prone jacket position facilitates adequate exposure of the surgical field and enables precise overall resection of the bony pelvis and pelvic floor muscle groups invaded by the tumor. Empty pelvic syndrome has always been an major problem to be solved during PE. The application of extracellular matrix biological mesh to reconstruct pelvic floor defects and isolate the abdominopelvic cavity is expected to reduce postoperative pelvic floor related complications. Reconstruction of the urinary system and important vessels after PE is essential, and the selection of appropriate reconstruction methods helps to improve the patient's postoperative quality of life, while more new methods are also being continuously explored.

Posterior cervical triangle approach for carotid endarterectomy: Technical note and results

Carotid endarterectomy (CEA) is usually performed using the anterior cervical triangle as a surgical corridor but, when needed, the retromandibular space makes dissection of higher structures difficult in some cases. The posterior cervical triangle (PCT) can be useful in these demanding cases. We retrospectively reviewed cases from July 2013 to November 2019 in which PCT was used as an approach for CEA. The surgical technique used was explained, and the complications and evolution of the patients were analysed. We found 7 CEAs performed through this approach, of which 2 presented transient trapezius paresis. There were no cases of severe complications in this series. The PCT approach for performing CEA represents a useful and easy technique that avoids the need for mandibular mobilisation or osteotomies for lesions located in anatomically high carotid bifurcations. La endarterectomía carotídea (ECA) se suele realizar utilizando el triángulo cervical anterior como corredor quirúrgico, pero el espacio retromandibular dificulta en algunos casos la disección de estructuras de localización superior. El triángulo cervical posterior (TCP) puede ser útil en estos casos complejos. Se ha realizado un estudio retrospectivo de los casos atendidos en nuestra unidad utilizando el TCP como abordaje en ECA desde julio de 2013 hasta noviembre de 2019. Se explica la técnica quirúrgica empleada y se han revisado las complicaciones y evolución de los pacientes. Se realizaron 7 ECA a través de este abordaje. Dos pacientes presentaron paresia transitoria del trapecio. No hubo casos de complicaciones graves en esta serie. El abordaje por el TCP para la realización de ECA representa una técnica útil y técnicamente simple, que evita procedimientos de movilización mandibular para lesiones localizadas en bifurcaciones carotídeas anatómicamente altas.

Posterior cervical triangle approach for carotid endarterectomy: Technical note and results

IntroductionCarotid endarterectomy (CEA) is usually performed using the anterior cervical triangle as a surgical corridor but, when needed, the retromandibular space makes dissection of higher structures difficult in some cases. The posterior cervical triangle (PCT) can be useful in these demanding cases. MethodsWe retrospectively reviewed cases from July 2013 to November 2019 in which PCT was used as an approach for CEA. The surgical technique used was explained, and the complications and evolution of the patients were analysed. ResultsWe found 7 CEAs performed through this approach, of which 2 presented transient trapezius paresis. There were no cases of severe complications in this series. ConclusionThe PCT approach for performing CEA represents a useful and easy technique that avoids the need for mandibular mobilisation or osteotomies for lesions located in anatomically high carotid bifurcations.

Family Planning Progress in 113 Countries Using a New Composite Progress Index

This paper analyses family planning progress in 113 countries in the context of meeting the demand for family planning through a composite progress index that measures progress in three dimensions – demand for permanent methods, demand for modern spacing methods and expansion of method choice – following the progress triangle approach. This paper suggests that in more than forty per cent of countries analysed, family planning progress remains far from satisfactory in meeting the family planning demand and there is substantial inter-country variation in the progress. In some countries, progress appears to have reversed. The inter-country variation in family planning progress is primarily the result of inter-country variation in meeting the demand for permanent methods. The analysis calls for the reinvigoration of family planning efforts to meet the target set under the United Nations 2030 Sustainable Development Agenda and the FP2030 initiative.

PENGARUH FRAUD TRIANGLE TERHADAP FRAUDULENT FINANCIAL STATEMENT DENGAN CORPORATE GOVERNANCE SEBAGAI VARIABEL MODERASI

Fraudulent financial statement is a form of fraud that causes losses to stakeholders. Recently, fraudulent financial statement has been rampant in the financial and banking industry, which has caused the financial and banking industry to be the sector that suffered the most losses due to fraudulent financial statements. The purpose of this study is to examine factors that influence fraudulent financial statements using the fraud triangle approach. The object of this research is banking companies listed on Indonesia Stock Exchange in period of 2017-2019. This study used 102 samples taken using purposive sampling method. Data analysis was performed using panel data regression. The result of this study indicates that rationalization has significant effect on fraudulent financial statements, while financial target and effective monitoring have no significant effect on fraudulent financial statements. In addition, this study shows that corporate governance can weaken the influence of financial target, ineffective monitoring and rationalization of fraudulent financial statements.