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Acinetobacter baumannii: Role in Blood Stream Infection in Neonatal Unit, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Enty Tjoa,Lucky Hartati Moehario,Andriansjah Rukmana,Rinawati Rohsiswatmo
International Journal of Microbiology , 2013, DOI: 10.1155/2013/180763
Abstract: Acinetobacter baumannii (A. baumannii) is Gram-negative coccobacilli that has emerged as a nosocomial pathogen. Several reports in Indonesia showed the continuous presence of A. baumannii. This study aimed to determine the incidence of A. baumannii bacteremia in neonates in the Neonatal Unit Dr. Cipto Mangunkusumo Hospital (RSCM), Jakarta, Indonesia, and assess its role in blood stream infection using antibiogram and genotyping by pulsed-field gel electrophoresis (PFGE). Subjects were neonates with clinical sepsis. Blood specimens from the neonates and samples of suspected environment within the Neonatal Unit were cultivated. Antimicrobial resistance profiles were classified for analysis purpose. A. baumannii isolates were genotyped by PFGE to determine their similarity. A total of 24 A. baumannii were isolated from 80 neonates and the environment during this period of study. Seven isolates from the neonates showed multiple antimicrobial resistance (MDR), and 82% ( ) of the environment isolates were also MDR. Antibiotype “d” seemed to be predominant (62.5%). PFGE analysis showed a very close genetic relationship between the patients and environment isolates (Dice coefficient 0.8–1.0). We concluded that a mode of transmission of environmental microbes to patients was present in the Neonatal Unit of RSCM and thus needed to be overcome. 1. Introduction Acinetobacter spp. are ubiquitous in the environment, that is, soil and water, and occasionally isolated from mucous membrane, secretion, and skin of hospitalized patients, also on surfaces of hospital environment [1]. This aerobic Gram-negative coccobacilli has emerged as important nosocomial pathogen. Clinical sepsis (CSEP) is included in the blood stream infections (BSI) category and restricted only for infant less than 1 year old [2]. However, in protocols of CDC/NHSN 2013, CSEP criteria are not in the list of BSI group but laboratory-confirmed BSI type 1, 2, and 3 [3]. Multidrug resistance of A. baumannii has caused morbidity, mortality, and increased patients’ length of stay in hospital in many countries [4–6]. Mortality of patient with Acinetobacter sp. infection reached 17%–46% [4, 5]. The continuous presence of this environment microorganism from clinical specimens in Jakarta, Indonesia, has been reported [7, 8]. Since Acinetobacter sp. is frequently established as part of skin and respiratory flora of hospitalized patients especially with prolonged periods, assessment of A. baumannii as etiology of disease or colonization is a particular challenge [9]. Bacterial typing either fenotype or genotype
Personal endotoxin exposure in a panel study of school children with asthma
Ralph J Delfino, Norbert Staimer, Thomas Tjoa
Environmental Health , 2011, DOI: 10.1186/1476-069x-10-69
Abstract: We characterized personal endotoxin exposures in 45 school children with asthma ages 9-18 years using 376 repeated measurements from a PM2.5 active personal exposure monitor. We also assayed endotoxin in PM2.5 samples collected from ambient regional sites (N = 97 days) and from a subset of 12 indoor and outdoor subject home sites (N = 109 and 111 days, respectively) in Riverside and Whittier, California. Endotoxin was measured using the Limulus Amoebocyte Lysate kinetic chromogenic assay. At the same time, we measured personal, home and ambient exposure to PM2.5 mass, elemental carbon (EC), and organic carbon (OC). To assess exposure relations we used both rank correlations and mixed linear regression models, adjusted for personal temperature and relative humidity.We found small positive correlations of personal endotoxin with personal PM2.5 EC and OC, but not personal PM2.5 mass or stationary site air pollutant measurements. Outdoor home, indoor home and ambient endotoxin were moderately to strongly correlated with each other. However, in mixed models, personal endotoxin was not associated with indoor home or outdoor home endotoxin, but was associated with ambient endotoxin. Dog and cat ownership were significantly associated with increased personal but not indoor endotoxin.Daily fixed site measurements of endotoxin in the home environment may not predict daily personal exposure, although a larger sample size may be needed to assess this. This conclusion is relevant to short-term exposures involved in the acute exacerbation of asthma.Endotoxin is a cell wall component of the outer membrane of gram negative bacteria. Sources include animals and agricultural activities. In its purified form, it is known as lipopolysaccharide, which is both toxic and immunogenic [1]. A small and variable mass fraction of fine (respirable) particles < 2.5 μm in diameter (PM2.5) may contain endotoxin. Experimental inhalation of endotoxin in humans leads to airway inflammation, character
Feature extraction for the analysis of colon status from the endoscopic images
Marta P Tjoa, Shankar M Krishnan
BioMedical Engineering OnLine , 2003, DOI: 10.1186/1475-925x-2-9
Abstract: Endoscopic images contain rich texture and color information. Novel schemes are developed to extract new texture features from the texture spectra in the chromatic and achromatic domains, and color features for a selected region of interest from each color component histogram of the colonoscopic images. These features are reduced in size using Principal Component Analysis (PCA) and are evaluated using Backpropagation Neural Network (BPNN).Features extracted from endoscopic images were tested to classify the colon status as either normal or abnormal. The classification results obtained show the features' capability for classifying the colon's status. The average classification accuracy, which is using hybrid of the texture and color features with PCA (τ = 1%), is 97.72%. It is higher than the average classification accuracy using only texture (96.96%, τ = 1%) or color (90.52%, τ = 1%) features.In conclusion, novel methods for extracting new texture- and color-based features from the colonoscopic images to classify the colon status have been proposed. A new approach using PCA in conjunction with BPNN for evaluating the features has also been proposed. The preliminary test results support the feasibility of the proposed method.In the case of colorectal cancer, abnormal cell growth takes place in the large intestine resulting in the formation of tumors. The detection of any abnormal growth in the colon at an early stage will increase the patient's chance of survival. A few methods, such as sigmoidoscopy, barium x-ray, etc., are available for examination of the colon, but colonoscopy is considered to be the best procedure at present for the detection of abnormalities in the colon [1]. Despite the usefulness of colonoscopic methods, an expert endoscopist is needed to detect colorectal cancer. The endoscopist uses a colonoscope to detect the presence of abnormalities in the colon. The analysis of the endoscopic images is usually performed visually and qualitatively. Conseq
Yulia Yulia,Liliana Liliana,Tjoa Freddy
Jurnal Informatika , 2009,
Abstract: CV. X is a garment company which has 55 employees. Every end of the month the company doing payroll calculations and every year make an annual tax report (Notice Letter / SPT). Currently the calculation of salaries and the making of SPT are still done manually and thus require a long time and the large possibility of miscalculation. In this research, we have designed a payroll information system and SPT reporting, including employee attendance system, payroll calculation system and the various attribute such as overtime, furlough, deductions and so forth automatically. This system is able to do the calculation and reporting of annual tax returns and tax correction automatically. Besides, the system is also able to create various reports such as salary statements, tax cuts statements, the report to the director of such employee data report, employee history report, and payroll report. From the test results of payroll information systems and SPT report, can be seen that the system is able to perform the calculation of salaries and annual tax returns correctly. Abstract in Bahasa Indonesia: CV. X merupakan sebuah perusahaan koveksi dengan total karyawan sekitar 55 orang. Setiap akhir bulan perusahaan melakukan penghitungan gaji karyawan dan tiap tahun melakukan pembuatan laporan pajak tahunan (Surat Pemberitahuan/SPT). Saat ini penghitungan gaji dan pembuatan SPT ini masih dilakukan secara manual sehingga membutuhkan waktu yang lama serta besar kemungkinan terjadinya kesalahan perhitungan. Pada penelitian ini, dirancang sebuah sistem informasi penggajian dan pembuatan laporan SPT, antara lain meliputi sistem absensi karyawan, sistem penghitungan gaji dan berbagai attributnya seperti lembur, cuti, potongan dan sebagainya secara terotomatisasi. Sistem ini juga mampu melakukan penghitungan dan pembuatan laporan SPT tahunan serta koreksi pajak secara terotomatisasi. Selain itu sistem juga mampu membuat berbagai laporan baik yang ditujukan untuk karyawan seperti slip gaji, laporan potongan pajak ataupun laporan yang ditujukan untuk direktur seperti laporan data karyawan, laporan histori karyawan, dan laporan gaji karyawan secara terotomatisasi. Dari hasil pengujian sistem informasi penggajian dan laporan SPT tahunan, dapat dilihat bahwa sistem mampu melakukan penghitungan gaji dan SPT tahunan dengan tepat. Kata kunci: pajak, sistem informasi penggajian, SPT
The megalithic complex of highland Jambi: An archaeological perspective
Dominik Bonatz,John David Neidel,Mai Lin Tjoa-Bonatz
Bijdragen tot de Taal-, Land- en Volkenkunde , 2008,
Abstract: The highlands of Sumatra remain one of the most neglected regions of insular Southeast Asia in terms of history and archaeology. No comprehensive research program incorporating both a survey and excavations within a defined geographical or environmental zone has been carried out there since Van der Hoop (1932) conducted his study of the megaliths on the Pasemah plateau in the 1930s. Meanwhile, Van der Hoop’s investigations and several other archaeological research activities at places such as northwest Lampung (McKinnon 1993), Pasemah (Sukendar and Sukidjo 1983-84; Caldwell 1997; Kusumawati and Sukendar 2000), Kerinci (Laporan 1995a, 1996a), and the Minangkabau heartland (Miksic 1986, 1987, 2004) have placed special emphasis on the megalithic remains. As a result, the megaliths are by far the bestknown archaeological attraction of the Sumatran highlands.
Modeling personal particle-bound polycyclic aromatic hydrocarbon (pb-pah) exposure in human subjects in Southern California
Jun Wu, Thomas Tjoa, Lianfa Li, Guillermo Jaimes, Ralph J Delfino
Environmental Health , 2012, DOI: 10.1186/1476-069x-11-47
Abstract: We conducted real-time (1-min interval) personal PB-PAH exposure sampling coupled with GPS tracking in 28 non-smoking women for one to three sessions and one to nine days each session from August 2009 to November 2010 in Los Angeles and Orange Counties, California. Each subject filled out a baseline questionnaire and environmental and behavior questionnaires on their typical activities in the previous three months. A validated model was used to classify major time-activity patterns (indoor, in-vehicle, and other) based on the raw GPS data. Multiple-linear regression and mixed effect models were developed to estimate averaged daily and subject-level PB-PAH exposures. The covariates we examined included day of week and time of day, GPS-based time-activity and GPS speed, traffic- and roadway-related parameters, meteorological variables (i.e. temperature, wind speed, relative humidity), and socio-demographic variables and occupational exposures from the questionnaire.We measured personal PB-PAH exposures for 180?days with more than 6 h of valid data on each day. The adjusted R2 of the model was 0.58 for personal daily exposures, 0.61 for subject-level personal exposures, and 0.75 for subject-level micro-environmental exposures. The amount of time in vehicle (averaging 4.5% of total sampling time) explained 48% of the variance in daily personal PB-PAH exposure and 39% of the variance in subject-level exposure. The other major predictors of PB-PAH exposures included length-weighted traffic count, work-related exposures, and percent of weekday time.We successfully developed regression models to estimate PB-PAH exposures based on GPS-tracking data, traffic data, and simple questionnaire information. Time in vehicle was the most important determinant of personal PB-PAH exposure in this population. We demonstrated the importance of coupling real-time exposure measures with GPS time-activity tracking in personal air pollution exposure assessment.Airborne polycyclic aromatic hy
Meeting human resources for health staffing goals by 2018: a quantitative analysis of policy options in Zambia
Aaron Tjoa, Margaret Kapihya, Miriam Libetwa, Kate Schroder, Callie Scott, Joanne Lee, Elizabeth McCarthy
Human Resources for Health , 2010, DOI: 10.1186/1478-4491-8-15
Abstract: We developed a model to forecast the size of the public sector health workforce in Zambia over the next ten years to identify a combination of interventions that would expand the workforce to meet staffing targets. The key forecasting variables are training enrolment, graduation rates, public sector entry rates for graduates, and attrition of workforce staff. We model, using Excel (Office, Microsoft; 2007), the effects of changes in these variables on the projected number of doctors, clinical officers, nurses and midwives in the public sector workforce in 2018.With no changes to current training, hiring, and attrition conditions, the total number of doctors, clinical officers, nurses, and midwives will increase from 44% to 59% of the minimum necessary staff by 2018. No combination of changes in staff retention, graduation rates, and public sector entry rates of graduates by 2010, without including training expansion, is sufficient to meet staffing targets by 2018 for any cadre except midwives. Training enrolment needs to increase by a factor of between three and thirteen for doctors, three and four for clinical officers, two and three for nurses, and one and two for midwives by 2010 to reach staffing targets by 2018. Necessary enrolment increases can be held to a minimum if the rates of retention, graduation, and public sector entry increase to 100% by 2010, but will need to increase if these rates remain at 2008 levels.Meeting the minimum need for health workers in Zambia this decade will require an increase in health training school enrolment. Supplemental interventions targeting attrition, graduation and public sector entry rates can help close the gap. HRH modelling can help MOH policy makers determine the relative priority and level of investment needed to expand Zambia's workforce to target staffing levels.The human resources for health (HRH) shortage is estimated at more than 4 million workers globally [1]. The shortage of health workers is particularly acute
Doubling the number of health graduates in Zambia: estimating feasibility and costs
Aaron Tjoa, Margaret Kapihya, Miriam Libetwa, Joanne Lee, Charmaine Pattinson, Elizabeth McCarthy, Kate Schroder
Human Resources for Health , 2010, DOI: 10.1186/1478-4491-8-22
Abstract: We determined the feasibility and costs of doubling training institution output through an individual school assessment framework. Assessment teams, comprised of four staff from the MoH and Clinton Health Access Initiative, visited all of Zambia's 39 public and private health training institutions from 17 April to 19 June 2008. Teams consulted with faculty and managers at each training institution to determine if student enrollment could double within five years; an operational planning exercise carried out with school staff determined the investments and additional operating costs necessary to achieve expansion. Cost assumptions were developed using historical cost data.The individual school assessments affirmed the MoH's ability to double the graduate output of Zambia's public health training institutions. Lack of infrastructure was determined as a key bottleneck in achieving this increase while meeting national training quality standards. A total investment of US$ 58.8 million is required to meet expansion infrastructure needs, with US$ 35.0 million (59.5%) allocated to expanding student accommodation and US$ 23.8 million (40.5%) allocated to expanding teaching, studying, office, and dining space. The national number of teaching staff must increase by 363 (111% increase) over the next five years. The additional recurring costs, which include salaries for additional teachers and operating expenses for new students, are estimated at US$ 58.0 million over the five-year scale-up period. Total cost of expansion is estimated at US$ 116.8 million over five years.Historic underinvestment in training institutions has crippled Zambia's ability to meet expansion ambitions. There must be significant investments in infrastructure and faculty to meet quality standards while expanding training enrollment. Bottom-up planning can be used to translate national targets into costed implementation plans for expansion at each school.Many resource-limited countries are facing the chall
3A Study of the Significance of Apoptosis and its Association with Abnormalities in Expression of BCL-2 Proto-Oncogene in Benign Nodular Hyperplasia of Prostate
Srikumar Chakravarthi,Linda Tjoa Husin,P.M. Thani,Nadeem Irfan Bukhari
Research Journal of Biological Sciences , 2012,
Abstract: Benign Prostatic Hyperplasia (BPH) is an enlargement of the prostate gland caused by an increase in the number of glandular units. Apoptosis is a programmed cell death necessary for the regulation of the size of organs in adult life. Disruption of apoptotic pathways has been suggested as an important regulatory mechanism in BPH. A high level of the BCL-2 protein suppresses apoptosis by preventing the activation of the enzymes that carry out the process. In this study, an attempt was made to observe the abnormal expression of BCL-2 protein in BPH tissues in paraffin sections and to demonstrate the disruption of apoptotic pathways in BPH. Prostatic tissue from 30 patients with BPH and no prior prostatic carcinoma were obtained by transurethral resection of prostate procedure. Apoptotic index was compared in the H and E sections. Expression of BCL-2 was analyzed by immunohistochemistry and evaluated. Apoptotic index in BPH tissues was found to be twice lower than that of normal tissues. Wilcoxon signed rank test was employed and the p-value proved that the results were highly significant (p<0.01). This data supported the research hypothesis that apoptotic index is decreased in benign prostatic hyperplasia. Out of 30 tissue samples, 20 (67%) shown positivity for BCL-2 expression. Kendall’s Tau-B test was applied and the result showed negative correlation between the intensity of BCL-2 expression and apoptosis, however not significantly. This proves, the theory that BCL-2 regulates individual cell death up to a certain extent.
Identifying and Incorporating Affective States and Learning Styles in Web-based Learning Management Systems
Farman Ali Khan,Sabine Graf,Edgar R. Weippl,A Min Tjoa
Interaction Design and Architecture(s) , 2010,
Abstract: Learning styles and affective states influence students’ learning. The purpose of this study is to develop a conceptual framework for identifying and integrating learning styles and affective states of a learner into web-based learning management systems and therefore provide learners with adaptive courses and additional individualized pedagogical guidance that is tailored to their learning styles and affective states. The study was carried out in three phases, the first of which was the investigation and determination of learning styles and affective states which are important for learning. Phase two consisted of the development of an approach for the identification of learning styles and affective states as well as the development of a mechanism to calculate them from the students’ learning interactions within web-based learning management systems. The third phase was to develop a learning strategy that is more personalized and adaptive in nature and tailored to learners’ needs and current situation through considering learners’ learning styles and affective states, aiming to lead to better learning outcomes and progress.
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