Administration of oral of morphine for pain management to adult cancer patients has remained a great challenge. Nurses working in medical wards of Kenyatta National hospital have been faced with challenges of inadequate knowledge and attitudes of oral morphine administration to adult cancer patients. Oral morphine would provide relieve of pain in adult patients suffering from moderate or severe pain resulting from cancer. The main objective of the study was to establish nurses’ knowledge, and attitudes on administration of oral morphine for pain management to adult cancer patient in medical wards, Kenyatta National Hospital. A descriptive study was carried out and a total of 34 nurses participated in the study. Data was collected using structured, open-ended questionnaires for respondents. Data was analysed using the Scientific Package for Social Sciences (SPSS) software version twenty-one. Majority of the respondents 71.2% (n=24) received training on administration of oral morphine through on job training, (48.1%) respondents were undecided on administering oral morphine. Majority at (76.9%) nurses underestimated patients’ pain and all nurses agreed their reluctant to administer oral morphine because of respiratory depression. The study concludes that adult cancer patients with pain are not adequately relieved of pain and majority of nurses have inadequate knowledge and attitudes on administration of oral morphine. This study recommends continuing education programs on administration of oral morphine to adult cancer patient for nurses to facilitate acquisition of skills of oral morphine administration to relieve pain to adult cancer patients.

The potentiality of yoga to improve V̇O2max is often questioned because of its low exercise stimulus. Considering the positive effects of Yoga Breathing Maneuvers (YBM) on cardio-respiratory systems, its effect on V̇O2max needs to be studied. So, possible role of YBM in improvement in V̇O2max in yoga training was observed.32 healthy male students of 19 to 21 years of age were divided into two equal groups of 16 each. One group (YG) practiced yoga (Yogasanas, YBM and meditation) for 40 minutes every day for 6 days per week for 3 months. YBM were progressively inducted by increasing practice duration throughout training. Other group (CG) did not practice Yoga. Their basal heart rate (HR) and respiratory rate (RR) were recorded in the morning in bed. Predicted V̇O2max was measured on them by Queen’s college step test. HR was recorded before, during and after exercise manually and with Polar sports tester. All the parameters were recorded at baseline, 6th and 12th week end of yoga training.In YG, V̇O2max improved from baseline (47.5±3.7 ml/kg/min) to 6th week (49.4±3.3 ml/kg/min, P<0.001) and 12th week end (53.03±3.3ml/kg/min, P<0.0001). YG showed significant reduction in basal RR, HR and resting HR at 6th and 12th week end compared to their respective base line values. CG did not show such changes. V̇O2max was correlated to basal RR(r= – 0.463, p=0.0009), HR (r= -0.235, p=0.107) and resting HR (r= -0.414, p=0.003). YBM facilitated the improvement in V̇O2max possibly by its effects on cardiovascular and respiratory systems.

Generalized lymphadenopathy is a common cause of concern for both patients and clinicians. Causes for kikuchi fujimoto’s are infections and malignancies. Kikuchi Fujimoto disease (KFD) presents with fever, lymphadenopathy it also presents with systemic involvement. We report the cases of a 5 patients who presented with generalized lymphadenopathy, high fever, skin vasculitis and polyserositis. The lymph-node biopsy shows histiocytotic necrotizing lymphadenitis, suggestive of Kikuchi’s disease.

Microplastics come from various types of materials in the form of pieces, fibres, fragments, granules, slabs, or tiny flakes between 0.1-5000 µm. It is very resistant to degradation and is insoluble in water. Microplastics are widely distributed in the oceans, sediments, land, and consumed by marine organisms such as fish and shellfish. This study aims to describe the presence of microplastics in the faeces of pregnant women. This type of research is an analytic observation with a cross-sectional design. The sample in this study amounted to thirty pregnant women. Data obtained through interviews using a questionnaire and examination of faeces samples. The results showed that all stool samples contained microplastics. The number of microplastics found ranged from 5 to 21 microplastics with the types of fiber, fragments, and films. The length of the microplastics ranges from 0.2 - 4.9 mm. It is concluded that ingested microplastics are disposed of through feces but the residue will accumulate in the body and can pose health risks in the long term. Encouraging the role of the government through education and regulation so that the community obeys and does not throw garbage anywhere.

The risk of international trade transactions occurs because of the risk of fluctuations in foreign currency exchange rates. Hedging derivatives is a part of risk management carried out by companies to overcome significant impacts on unexpected changes in the value of foreign currencies. The purpose of this study was to determine the effect of leverage, company size, growth opportunity and financial difficulties on hedging decisions. This research was conducted at manufacturing companies listed on the Indonesia Stock Exchange for the 2016-2018 period. This study has a total population of 420 and is calculated by purposive sampling in accordance with the criteria for a sample of 216 out of 140 companies observed. The results of this study indicate that there is no effect of leverage, growth opportunity and financial difficulties on hedging decisions, while firm size has an effect on hedging decisions.

Aim: To study the correlation of varying degrees of iron deficiency anemia with reactive thrombocytosis. Introduction: Iron deficiency anemia is a very common entity in women belonging to reproductive age group of 15-49 years. Iron deficiency anemia is also a causative factor for reactive thrombocytosis in most cases. The relationship of thrombocytosis in iron deficiency anemia is not yet understood properly. This study was undertaken to correlate the various degrees of thrombocytosis in association with various degrees of anemia. Materials and methods: A total number of 500 female patients belonging to the reproductive age group of 15-49 years, attending the out-patient and in- patient departments, who were identified to have iron deficiency anemia and thrombocytosis which was confirmed with relevant hematological studies including peripheral smear studies done in Sree Balaji Medical College and Hospital, Chennai were included in the study during the period of November 2018 to May 2019. Results: The current study helps in correlation and evaluation of varying degrees of iron deficiency anemia and reactive thromocytosis, which can be used to determine the treatment approach.

Neurodegenerative diseases (NDD) are a major global public health concern and a leading cause of disability-adjusted life-years, moreover, therapeutic options are limited. Brain targeting has always been challenging due to the presence of various physiological barriers, of which one of the most robust barriers is Blood Brain Barrier (BBB). The BBB consists of endothelial cells which are the tight layers surrounded by astrocyte foot processes, and these anatomic features together constitute a significant barrier that hampers the delivery of drugs to the central nervous system (CNS). In the past few decades, the nose-to-brain targeted delivery has received a great deal of attention because of factors like the rapid onset of action, increased bioavailability, manageable surface area and avoids the first-pass metabolism, thus considering it as a non-invasive, convenient and reliable approach that may overcome the challenges associated with nose-to-brain targeted delivery. However, this strategy still possesses significant limitations, which led to the development of nanotechnological approaches like solid lipid nanoparticles, polymeric nanoparticles, nanoemulsions, liposomes and polymeric micelles, thus circumventing these barriers. The present review article highlights a complete understanding of every aspect related to nose-to-brain delivery: mechanism involved in the transport of drugs from nose-to-brain via BBB by complex pathways, strategies to overcome the barrier-BBB, recent examples, and applications of nose-to-brain targeted delivery using nanotechnologies for brain gliomas and other neurological disorders.

According to the three-layer airport runway, based on spherical cavity-expansion theory and considering interface effect of concrete-macadam-soil by analyzing kinetic energy projectile penetrating layered target of concrete-macadam-soil, penetration models of concrete cratering, concrete pore-forming, macadam pore-forming and soil pore-forming are established. In addition, numerical solution of control equations is carried out by using Runge-Kutta method. And the Time-history curve of residual velocity is obtained. The theoretical analysis shows that because of the interface effect, the penetration resistance of projectile suffered on concrete layer and macadam layer when moving , is related not only to penetration velocity, mass, projectile shape and medium character, but also to penetration depth, which is the biggest difference compared with penetrating into single layer. Finally, by means of finite element simulation, the process of oblique penetrating into multilayered medium of airport runway is simulated by three dimensional numerical analysis. Thus, the influence of the penetration velocity and the boundary of the runway on the penetration process were studied. The results show that the presence of the multi-layer media interface of the runway accelerates the attitude of the projectile body; the smaller the penetration rate is, the more obvious the phenomenon is. At the same time, the overload response of projectile body is changed. The research results have laid a foundation for the further research on the technology of the composite medium penetration into the airport runway. They also have reference value for the research on the failure of civil engineering materials under the action of dynamic loads.

Sphingomonas are ubiquitous bacteria, widely distributed in the nature, soil and water including the water sources in the hospital environment, contains at least more than 30 species, which of only paucimobilis is an occasional pathogen.1 It is one of the non-fermenting Gram-negative bacilli that is emerging as an opportunistic pathogen [7]. S.paucimobilis is considered to be the organism of low virulence likely owing to absence of endotoxin and typical polysaccharide and thus responsible for less mortality and morbidity but sometimes can lead to septic shock. To support this, retrospective study conducted at our hospital on total 1580 inpatient (IP) blood samples for culture yielding positivity of 0.44% for the growth of S.paucimobilis, did favour the survival of the all the patients. All the blood isolates produced distinct white or off-white coloured colonies on blood and chocolate agar hence referred as “Bleached Sphingomonas paucimobilis.”

This study aims to determine the diversity of fish at various water levels in Batu Bumbun Reservat, as input material to formulate management activities that must be done to save the reserve. Research was carried out by survey method, in the dry season (April-June) and rainy season (November-December) 2016. Parameters measured, water quality (DO, pH, temperature, TSS, TDS, alkalinity and brightness), fish community structure diversity, uniformity, relative abundance, diversity and dominance), water levels, and sedimentation. The fish community data obtained were analyzed by the Shannon-Wiener index. The results showed that: (1) Changes in water level resulted in the Batu Bumbun Reservus ecosystem having experienced severe degradation, characterized by fluctuations in water level during two extreme seasons. When the rainy season occurs extreme floods, while the dry season, there is siltation to dry. (2) Community of fish caught in Batu Bumbun Reservus ecosystem of 29 species, consisting of 23 genus and 16 families. When the rainy season is dominantly caught fish community (white fish), with fish density 7.015.000 head / km2, while the dominant season is dominant caught is a community of swamp (black fish), with density of 2,334,000 fish / km2. Based on the analysis of fish community, the value of diversity index (H ') ranged from 1,188-0,825 means low-moderate species diversity, dominance index (C) around 0.0827-0.2147 means no dominant species and uniformity index (E) , 8295-0.6710 means that in a balanced state, there is no competition. It is concluded that the Batu Bumbun Reservus ecosystem has experienced severe degradation, with indicator of fish community change. It is recommended that the management must be done to save the Batu Bumbun Reservus ecosystem is, Dredging, Weed cleaning, Local Fish Restocking, illegal fishing Prevention, Increase of reservat security facility.

In this investigation, exact displacement functions were used to analyze thick anisotropic rectangular plates of two boundary conditions; simply supported on all edges (SSSS) and clamped on all edges (CCCC). Third order shear deformation model was employed in the formulation of the total potential energy functional for thick anisotropic rectangular plate. This total potential energy functional was reduced to the governing equation and compatibility equations for thick anisotropic plate. The governing equation and compatibility equations were solved to obtain the general displacement functions. By satisfying the boundary conditions for SSSS and CCCC plates their distinct displacement functions were obtained. These displacement functions were used to obtain the stiffness coefficients (k-values) for the plates. Minimizing the total potential energy functional with respect to the coefficients of the displacement functions gives the formulas for calculating the values of the coefficients. At this point, the displacements and stresses of the plates were calculated at various angles fiber orientations (0^0, 〖15〗^0, 〖30〗^0, 〖45〗^0, 〖60〗^0, 〖75〗^0 and 〖90〗^0) and various span-to-thickness ratios, α (5, 10, 20, 30, 40, 50, 60, 70, 80, 90 and 100). The results obtained were close to the results of other scholars.

This work concentrated on the analysis of thick anisotropic rectangular plate through exact approach using third order shear deformation theory. Refined plate theory assumptions were relied upon to formulate the total potential energy functional. Displacement field, kinematic relations, constitutive relations and stress displacement relations were also obtained from the assumptions. Kinematic relations and Stress-displacement relations were substituted into the universal strain energy equation to formulate the strain energy equation. Total potential energy functional for the analysis of thick anisotropic rectangular plate was obtained by adding the external work and strain energy equation together. The total potential energy functional was differentiated with respect to the out plane deflection (w), shear deformation rotation in x direction (_x) and shear deformation rotation in y direction (_y). This yielded the governing equation and two compatibility equations of thick anisotropic rectangular plate. Third order polynomial shear deformation function which was derived by Ibearugbulem et al. was relied upon to obtain the displacement functions. From these displacement functions, the unique displacement functions for the SSSS plate boundary condition were determined. Also the stiffness coefficients were calculated for the SSSS plate boundary condition. The formulas for calculating the coefficients of the displacements were combined with elastic equations to determine the novel formulas which were used in calculating for displacements (u, v and w) and stresses (σ_RR,σ_QQ,τ_RQ,τ_RS and τ_QS) at various angle fiber orientation (0^0, 〖15〗^0, 〖30〗^0, 〖45〗^0, 〖60〗^0, 〖75〗^0 and 〖90〗^0) and various span to thickness ratio, α (5, 10, 20, 30, 40, 50, 60, 70, 80, 90 and 100). These formula were used to analyze typical anisotropic rectangular thick plates. The results obtained were shown on Tables 1, 2, 3, 4 and 5. These numerical results obtained showed some level of agreement with previous works by other scholars. Hence the developed method is recommended for analyzing thick rectangular anisotropic plates.

The problem discussed in this study involves is that there is yet to be a law protection for Multiple or Separate-Editor in case if company is declared bankrupt and is unable to pay its debts as a whole that could reflect Justice Value. The method of research used in this research is juridical-empirical where the research type is qualitative research with a sociological juridical approach (Socio-Legal Approach). The results of this study indicate that the position of the separate-creditors in the company bankruptcy currently has a priority in obtaining repayment of their accounts. Manpower legal protection in the event of a debtor who has been declared bankrupt before and after the Constitutional Court decision No. 67 / PUU-XI / 2013 are as follows: prior to the Constitutional Court decision it was assumed that labor wages remained under separate-creditors, taxes, auction fees, and curator fees and were deemed not to contradict Article 28D paragraph (1) and paragraph (2) of the Indonesian Constitution Law Year 1945. After the Constitutional Court decision, the position of workers' wages according to the Bankruptcy Law and the Civil Code takes precedence. The reconstruction of the position of the separate-creditor as offered by the author is by reconstructing the decision of the Constitutional Court No. 67 / PUU-XI / 2013 to better reflect the value of justice.

The problem of juvenile dealing with the law is one of the problems surfaced in the effort to protect and to fulfill juvenile's rights in Indonesia. Currently, the problem is handled with Law No. 11 of 2012 concerning the Juvenile Criminal Justice System (SPPA) which regulates the judicial process for juvenile in conflict with the law, including juvenile in conflict with the law, especially regarding their assistance in the court. The existing problems show that the SPPA Law does not reflect the value of justice on the legitimacy of legal acts of juvenile in conflict with the law. This study uses a socio-legal research approach with data sources, namely primary data obtained in the field and relevant literature as a secondary data. The data analysis used was a descriptive-analytical method. The results the author's research shows that the protection of the legitimacy of juvenile's legal acts in conflict with the law in the juvenile criminal justice system in Indonesia has not shown the value of justice optimally because not all juvenile who undergo a judicial process in child criminal cases receive assistance from their parents or biological parents them, it is not uncommon for many parents to feel embarrassed to accompany the criminal justice process for their juvenile. From this, efforts are needed to reconstruct the legality of legal acts of juvenile, namely reconstructing and adding new constructs of Article 1 point 18 with new constructions and adding one new construction as point 18a.

The implementation of the termination of investigations by the Indonesia's Commission of the Eradication of Corruption (KPK) in Indonesia has not been able to provide justice due to the unclear regulatory factors in Law Number 19 of 2019 concerning the Amendment of the KPK Law. Based on this, the problem raised by the writer in this study is what are the obstacles that arise in in the process of investigation by the KPK in realizing the principles of fast, cheap, and simple Investigation and how to reconstruct the termination of an investigation by the KPK from the perspective of Law Number 19 of 2019. The research method used in this research is normative juridical using secondary legal materials and a qualitative analysis. The results showed that in its development, the investigation policy for suspects who died had changed since the second amendment to Law no. 30 of 2002. Several considerations behind the change in the policy of stopping KPK investigations are to provide protection for the rights of suspects. To deal with this, a reconstruction of the policy to stop investigations in the criminal justice system for corruption cases under the authority of the Corruption Eradication Commission requires reconstruction in Article 40 paragraph (1) of Law no. 30 of 2002, by adding to the provision that the KPK can stop investigating and prosecuting corruption cases where the investigation and prosecution are not completed within a maximum period of 2 (two) years or if there is not enough evidence, not a criminal act and for the sake of the law.