Diponegoro University

Abstract Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities 1,2 . This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity 3–6 . Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017—and more than 80% in some low- and middle-income regions—was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing—and in some countries reversal—of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.

Abstract Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders affecting cortisol biosynthesis. Reduced activity of an enzyme required for cortisol production leads to chronic overstimulation of the adrenal cortex and accumulation of precursors proximal to the blocked enzymatic step. The most common form of CAH is caused by steroid 21-hydroxylase deficiency due to mutations in CYP21A2. Since the last publication summarizing CAH in Endocrine Reviews in 2000, there have been numerous new developments. These include more detailed understanding of steroidogenic pathways, refinements in neonatal screening, improved diagnostic measurements utilizing chromatography and mass spectrometry coupled with steroid profiling, and improved genotyping methods. Clinical trials of alternative medications and modes of delivery have been recently completed or are under way. Genetic and cell-based treatments are being explored. A large body of data concerning long-term outcomes in patients affected by CAH, including psychosexual well-being, has been enhanced by the establishment of disease registries. This review provides the reader with current insights in CAH with special attention to these new developments.

Permasalahan hukum semakin hari semakin berkembang, hal ini sejalan dengan perkembangan teknologi informasi. Diperlukan adanya suatu metode penelitian hukum sebagai instrumen untuk menjelaskan dan meneliti permasalahan hukum yang semakin hari semakin berkembang tersebut. Penelitian ini akan menjelaskan berbagai metode penelitian dalam melakukan penelitian hukum guna mengurai permasalahan hukum kontemporer. Penelitian ini dilakukan dengan penelusuran bahan-bahan kepustakaan untuk selanjutnya digunakan sebagai landasan dalam menganalisis permasalahan yang diteliti. Hasil penelitian menunjukan ada 3 (tiga) jenis metode penelitian hukum yaitu Metode penelitian hukum normatif, metode penelitian hukum empiris, dan metode penelitian socio legal. Masing-masing jenis metode penelitian inilah yang bisa digunakan sebagai instrumen dalam mengurai permasalahan hukum kontemporer, tentu disesuaikan dengan kecocokan permasalahan hukum dan karakteristik masing-masing metodologi penelitian hukum yang digunakan.

This paper presents an empirical study of feature extraction methods for the application of low-speed slew bearing condition monitoring. The aim of the study is to find the proper features that represent the degradation condition of slew bearing rotating at very low speed (≈ 1 r/min) with naturally defect. The literature study of existing research, related to feature extraction methods or algorithms in a wide range of applications such as vibration analysis, time series analysis and bio-medical signal processing, is discussed. Some features are applied in vibration slew bearing data acquired from laboratory tests. The selected features such as impulse factor, margin factor, approximate entropy and largest Lyapunov exponent (LLE) show obvious changes in bearing condition from normal condition to final failure.

BACKGROUND: Disorders of sex development (DSD) are congenital conditions in which chromosomal, gonadal, or phenotypic sex is atypical. Clinical management of DSD is often difficult and currently only 13% of patients receive an accurate clinical genetic diagnosis. To address this we have developed a massively parallel sequencing targeted DSD gene panel which allows us to sequence all 64 known diagnostic DSD genes and candidate genes simultaneously. RESULTS: We analyzed DNA from the largest reported international cohort of patients with DSD (278 patients with 46,XY DSD and 48 with 46,XX DSD). Our targeted gene panel compares favorably with other sequencing platforms. We found a total of 28 diagnostic genes that are implicated in DSD, highlighting the genetic spectrum of this disorder. Sequencing revealed 93 previously unreported DSD gene variants. Overall, we identified a likely genetic diagnosis in 43% of patients with 46,XY DSD. In patients with 46,XY disorders of androgen synthesis and action the genetic diagnosis rate reached 60%. Surprisingly, little difference in diagnostic rate was observed between singletons and trios. In many cases our findings are informative as to the likely cause of the DSD, which will facilitate clinical management. CONCLUSIONS: Our massively parallel sequencing targeted DSD gene panel represents an economical means of improving the genetic diagnostic capability for patients affected by DSD. Implementation of this panel in a large cohort of patients has expanded our understanding of the underlying genetic etiology of DSD. The inclusion of research candidate genes also provides an invaluable resource for future identification of novel genes.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs.

Abstract High blood cholesterol is typically considered a feature of wealthy western countries 1,2 . However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world 3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health 4,5 . However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol—which is a marker of cardiovascular risk—changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million–4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.

The gut is a fundamental organ system which makes up two equally important functions, i.e., the digestion and host defence. To elicit the well-functioning and healthy gut, the dynamic balance of gut ecosystem is of importance. A wide range of factors related to diets and infectious disease agents seem to affect this balance, and subsequently affect the health status and production performance of the chicken. With the ban and/or reduction of the use of antibiotic growth promoters (AGPs) in poultry production, the alternatives to AGP are needed especially to preserve the balance of gut microbiota in chicken. This review provides a summary of the potentials and possible mechanisms of action of some alternatives to AGP (referred as nutraceuticals) in improving the gut microbial ecosystem and immune system as well as growth performance of poultry.

PURPOSE: To evaluate the results of the prophylactic use of mitomycin-C to inhibit haze formation after excimer laser photorefractive keratectomy (PRK) for medium and high myopia in eyes that were not good candidates for laser in situ keratomileusis (LASIK). SETTING: Carones Ophthalmology Center, Milan, Italy. METHODS: This prospective randomized masked study comprised 60 consecutive eyes (60 patients). The inclusion criteria were a spherical equivalent correction between -6.00 and -10.00 diopters (D) and inadequate corneal thickness to allow a LASIK procedure with a residual stromal thickness of more than 250 microm. The eyes were divided into 2 groups according to the randomization protocol. After PRK, the study group eyes were treated with a single intraoperative dose of mitomycin-C (0.2 mg/mL), applied topically with a soaked microsponge placed over the ablated area and maintained for 2 minutes. The control eyes did not receive this treatment. Refraction, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and slitlamp evidence of corneal opacity (haze) or other visible complications were evaluated. RESULTS: No toxic or side effects were encountered postoperatively. No study group eye had a haze rate higher than 1 during the 6-month follow-up; 19 eyes (63%) in the control group did (P =.01). At 6 months, the between-group difference in the refractive outcome was statistically significant (P =.05), with 26 study group eyes (87%) and 14 control eyes (47%) within +/-0.50 D of the attempted correction. No study group eye had a BCVA loss during the follow-up; 7 control eyes had lost 1 to 3 lines at 6 months (P =.0006). CONCLUSIONS: The prophylactic use of a diluted mitomycin-C 0.02% solution applied intraoperatively in a single dose after PRK produced lower haze rates, better UCVA and BCVA results, and more accurate refractive outcomes than those achieved in the control group.

OBJECTIVE: Minocycline rescued synaptic abnormalities and improved behavior in the fragile X mouse model. Previous open-label human studies demonstrated benefits in individuals with fragile X syndrome (FXS); however, its efficacy in patients with FXS has not been assessed in a controlled trial. METHOD: Randomized, double-blind, placebo-controlled, crossover trial in individuals with FXS, aged 3.5 years to 16 years (n = 55, mean age 9.2 [SD, 3.6] years). Participants were randomized to minocycline or placebo for 3 months and then switched to the other treatment. RESULTS: Sixty-nine subjects were screened and 66 were randomized. Fifty-five subjects (83.3%) completed at least the first period and 48 (72.7%) completed the full trial. Intention-to-treat analysis demonstrated significantly greater improvements in one primary outcome, Clinical Global Impression Scale-Improvement after minocycline compared with placebo (2.49 ± 0.13 and 2.97 ± 0.13, respectively, p = .0173) and greater improvement in ad hoc analysis of anxiety and mood-related behaviors on the Visual Analog Scale (minocycline: 5.26 cm ± 0.46 cm, placebo: 4.05 cm ± 0.46 cm; p = .0488). Side effects were not significantly different during the minocycline and placebo treatments. No serious adverse events occurred on minocycline. Results may be potentially biased by study design weaknesses, including unblinding of subjects when they completed the study, drug-related side effects unblinding, and preliminary efficacy analysis results known to investigators. CONCLUSIONS: Minocycline treatment for 3 months in children with FXS resulted in greater global improvement than placebo. Treatment for 3 months appears safe; however, longer trials are indicated to further assess benefits, side effects, and factors associated with a clinical response to minocycline.

Extreme concentration of marine biodiversity and exploitation of marine resources in the Coral Triangle pose challenges to biogeographers and resource managers. Comparative phylogeography provides a powerful tool to test biogeographic hypotheses evoked to explain species richness in the Coral Triangle. It can also be used to delineate management units for marine resources. After about a decade of phylogeographical studies, patterns for the Coral Triangle are emerging. Broad connectivity in some species support the notion that larvae have maintained gene flow among distant populations for long periods. Other phylogeographic patterns suggest vicariant events resulting from Pleistocene sea level fluctuations, which have, at least occasionally, resulted in speciation. Divergence dates ranging back to the Miocene suggest that changing land configurations may have precipitated an explosion of species diversification. A synthesis of the marine phylogeographic studies reveals repeated patterns that corroborate hypothesized biogeographic processes and suggest improved management schemes for marine resources.

With growing insight into the harmful impact of the lifestyles practiced in modern societies on the environment, pro-environment behavioral change has become a central focus of not only environmental policy but also applied environmental psychology. An established theoretical framework is needed to understand the development of environmentally friendly behaviors. The objective of this study was to propose a social-cognitive theory perspective as one of the psychology theories that can be applied to explain pro-environmental behavior. Understanding pro-environmental behavior is crucial as it will contribute to theory development related to the pro-environmental behavior management and to inform the policy maker when devising intervention to encourage pro-environmental behavior. Previous studies have used theory of planned behavior, norm activation theory, and values-beliefs-norms theory to explain pro-environmental behavior. However, the use of social-cognitive theory to explain pro-environmental behavior is lacking. We summarize previous studies which have been using social-cognitive constructs and describe a social-cognitive theory perspective for understanding a variety of routes to promote pro-environmental behavior. The theory highlights personal agency as the capacity of individuals to intentionally choose, execute, and manage their own actions to actualize expected outcomes. When applied in the environmental psychology area, the theory argues that individuals with favorable contextual condition and high environmental self-efficacy judgments will have more outcome expectations and will set more challenging goals, and also will engage more in pro-environmental behavior than individuals with a lower perception of their efficacy to perform such acts.

Asas kepastian hukum merupakan suatu asas yang menurut Gustav Radbruch termasuk ke dalam nilai dasar hukum. Asas ini pada pokoknya mengharapkan dan mewajibkan hukum dibuat secara pasti dalam bentuk yang tertulis. Keberadaan asas ini menjadi penting karena akan menjamin kejelasan dari suatu produk hukum positif yang ada. Makna penting dari asas ini pun memiliki suatu kesamaan (similarity) dengan gagasan utama yang ada pada konstruksi penalaran positivisme hukum, yakni kejelasan (certainty). Oleh karena itu, pada tulisan ini hendak dicapai pemahaman mengenai asas kepastian hukum dengan menggunakan konstruksi penalaran positivisme hukum.

As a research method, case studies are often used in qualitative research, but there is no agreement on research procedures. Case studies have been widely used in psychology, which is not only used in the context of research but it has different meanings. The purpose of this article is to provide a description of the case study as a research method, by providing an overview of the procedures for conducting research which includes when case studies can be used, research design, data collection, data validity, and data analysis. This article seeks to help emerging researchers in the field of psychology with several views from Robert Yin and Robert Stake. This article helps researchers to familiarize themselves with the procedures of qualitative research using case studies. A case study approach that is applied correctly can be a valuable method for conducting research, especially in the field of psychology as a means of developing theory, evaluating programs, developing interventions.

This study aimed to examine the role of environmental commitment, environmental consciousness, green lifestyle, and green self-efficacy in influencing pro-environmental behaviour. Data were obtained through a survey of 72 students at one of the training centers in Malaysia. The hypothesized relationships were tested using partial least squares (PLS) methodology. Results showed that environmental commitment, environmental consciousness, green lifestyle, and green self-efficacy positively influenced pro-environmental behaviour, thereby providing new insights to existing literature on environmental sustainability. The results may be used by educational institutions, the government, and private agencies to strengthen students’ knowledge, attitude, and behaviour that support environment-based education. The scope of the study was limited to students at a training center, so the results may not be generalizable to different settings. Another limitation was that the study used limited contextual elements. The novelty of this study is that it examined the role of environmental commitment, environmental consciousness, green lifestyle, and green self-efficacy as determinants of pro-environmental behaviour among students in an educational setting in Malaysia.

Artikel ini berjudul Thematic Analysis sebagai Metode untuk menganalisa Data untuk Penelitian Kualitatif. Tulisan ini bertujuan untuk mendeskripsikan tentang apakah itu thematic analysis sekaligus mengilustrasikan bagaimana metode ini digunakan pada salah satu penelitian kualitatif. Thematic analysis Thematic analysis merupakan salah satu cara untuk menganalisa data dengan tujuan untuk mengidentifikasi pola dan menemukan tema melalui data yang telah dikumpulkan oleh peneliti. Thematic analysis telah digunakan pada beberapa penelitian ilmu-ilmu sosial, termasuk ilmu perpustakaan dan informasi. Artikel ini juga menunjukkan bagaimana thematic analisis ini secara teknis diimplementasikan dalam menganalisa sebuah penelitian yang bertujuan untuk memahami literasi informasi peneliti saat menggunakan open access. Penelitian tersebut menemukan empat tema, yaitu pemahaman tentang open access, institutional repository, publikasi dan diseminasi, dan penelusuran informasi. Selain itu, penelitian ini juga berhasil menemukan hubungan antar masing-masing tema.

PURPOSE: The purpose of the study was to define the histological origin of gonadoblastomas, allowing the identification of high-risk patients. EXPERIMENTAL DESIGN: Sixty paraffin-embedded gonadectomy or gonadal biopsy samples of 43 patients with gonadal dysgenesis were selected from our archives. We studied the morphology and immunohistochemical properties of the germ cells in 40 samples without neoplastic transformation and compared these findings with the morphological and immunohistochemical characteristics of 20 samples containing gonadoblastoma/dysgerminoma. RESULTS: The overall incidence of germ cell tumors in our patient series was 35%. In dysgenetic gonads without germ cell neoplasia, besides the presence of areas with testicular and/or ovarian differentiation, areas of undifferentiated gonadal tissue were identified in 13 of 40 samples (32.5%). A subpopulation of germ cells within these undifferentiated areas stained positive for octamer binding transcription factor (OCT)3/4, the stem cell factor receptor, placental-like alkaline phosphatase, and testis-specific protein-Y encoded. Gonadoblastoma germ cells display identical staining results. Moreover, in gonads containing gonadoblastoma, adjacent to this lesion, areas of undifferentiated gonadal tissue with identical immunohistochemical characteristics were identified in 10 of 20 samples (50%). No adjacent tissue was available in five cases, whereas in the five remaining cases, it consisted of streak tissue. In three cases, an accumulation of OCT3/4-positive germ cells in the proximity of the malignant lesions was found, suggesting clonal expansion and final organization into gonadoblastoma nests. CONCLUSIONS: Based on these observations, we hypothesize that gonadoblastomas originate from surviving OCT3/4-positive germ cells in areas of undifferentiated gonadal tissue within the dysgenetic gonad. Supportive evidence was obtained that carcinoma in situ arises in regions with testicular differentiation.

Previously, fermentation has been associated with methods that improve the nutritional value of unconventional feed ingredients for broilers. In recent decades, the fermentation process has been employed to produce functional feeds that have the potential to improve broiler gastrointestinal tract microecology, health and production performance. Some of the functional ingredients found in fermented feed include lactic acid bacteria (LAB), lactic acid and other organic acids, and appear to play major roles in determining the beneficial effects of fermented feed on broiler gut health and performance. Unlike the pig, the available literature on broiler fermented feed is still rather limited. This review describes recent advances in the use of fermented feed (on the basis of conventional and unconventional feed ingredients) in broilers. Similarly, this review also shows that additional research is necessary to exploit fermented feed as a viable food source in broiler nutrition.

The association between helminth infection and cognitive and motor function was investigated in school-age children in Java, Indonesia. 432 children from 42 primary schools participated in the study. Children were stratified by age and sex into two age groups, 8-9 years and 11-13 years. Children infected with hookworm performed significantly worse than children without hookworm infection in 6 of the 14 cognitive or motor tests. After controlling for school (as a random effect) plus age, socio-economic status and parental education, sex, stunting (height-for-age < - 2sd), body mass index, haemoglobin concentration and the presence of A. lumbricoides and T. trichiura infections, infection with hookworm explained significantly lower scores on tests of Fluency (P < 0.01), Digit-Span Forwards (P < 0.01), Number Choice (P < 0.01), Picture Search (P < 0.03), Stroop Colour Word (P < 0.02) and Mazes (P < 0.001). In 4 of the 6-tests (Fluency, Number Choice, Picture Search and Mazes), there was a significant interaction between hookworm infection and age (P < 0.03), indicating that the association between hookworm and lower test scores increased with age. No associations were observed between hookworm infection and scores in tests of Digit-Span Backwards, Corsi-Block, Stroop Colour, Stroop Interference, Free Recall, Verbal Analogies, Bead Threading or the Pegboard (P > 0.05). Tests associated with helminths represented various functions of working memory. No significant associations between helminth infection and motor function were observed that could not be explained by chance. The results suggest that hookworm infection can have a significant adverse effect on children's working memory which may have consequences for a child's reasoning ability and reading comprehension. Although the results are only associational, the fact that differences in cognition were observed at baseline imply that preventing infection with helminths in school-age children could be of benefit.

Certain patients with disorders of sex development (DSD), who bear Y chromosome material in their karyotype, are at increased risk for the development of type II germ cell tumors (GCT), which arise from early fetal germ cells. DSD gonads frequently harbor immature germ cells which express early fetal germ cell markers. Some of them (e.g. OCT3/4 and NANOG) seem to be of pathogenetic relevance in GCT development providing cells with the ability of pluripotency, proliferation and apoptosis suppression. Also TSPY (testis-specific protein Y-encoded), the main candidate for the so-called gonadoblastoma locus on Y chromosome, is overexpressed in germ cells of DSD patients and possibly contributes to their survival and proliferation. Nowadays, the use of immunohistochemical methods is highly relevant in identifying DSD gonads at risk. The risk for GCT development varies. While the prevalence of GCT is 15% in patients with partial androgen insensitivity, it may reach more than 30% in patients with gonadal dysgenesis. Patients with complete androgen insensitivity and ovotesticular DSD develop malignancies in 0.8% and 2.6% of cases, respectively. However, these data may be biased for various reasons. To better estimate the risk in individual groups of DSD, further investigations on large patient series are needed.