Objective: To study the role of IgM enriched IVIg in reducing mortality in neonatal sepsis. Method: It is a prospective randomized study conducted in Special Newborn Care Unit(SNCU) of CNMCH, Kolkata over a period of two years (June 2016 – May 2018).Two groups of 248 newborn each (matched for gestational age, sex, weight and other variables) were randomly allocated to receive either antibiotics alone (control group) and antibiotics plus IgM enriched IVIg intravenously (5ml/kg/day) for 4 days(Immunotherapy Group). Result: Mortality from sepsis in control group was 88/248 (35.5%) of which death from culture proven sepsis was 70/182 (38.5%) and culture negative sepsis was 18/66 (27.3%).In immunotherapy group overall mortality was 40/248(16.1%) of which death from culture proven sepsis was 32/192 (16.7 %) and culture negative sepsis was 8/56(14.2%).Conclusion: We conclude that IgM enriched IVIg therapy in conjuction with antibiotic significantly reduces mortality in neontal sepsis,particularly in culture positive cases.

Programmed cell death 1 (PD-1), and its ligand programmed cell death-ligand 1 (PD-L1), is important for tumor-immune escape. Expression PD-L1 was observed in various solid tumors, including breast cancer (BC). The aim of this study is to examine the expression of PD-1 in tumor infiltrating lymphocytes (TILs) and PD-L1 in tumor cells (TC) in BC cases, to analyze the association between PD-1 and PD-L1 expression and clinicopathological features, as well as to correlate their expression with overall survival (OS). This is a retrospective study that was conducted on 110 cases of BC. Immunohistochemistry was performed to evaluate PD-1 and PD-L1 expression in TILs and TC respectively. There was no significant association between PD-1expression in TILs and clinicopathological variables. The presence of PD-1+ TIL was positively associated with PDL-1 expression in tumor cells; however, this association was not statistically significant (p = 0.062). On the other hand, PD-L1 expression in TC was significantly associated with lymph node involvement (P <0.0001), advanced stage (P = 0.035), high grade (P <0.0001), high TIL (P = 0.009), and negative ER (P = 0.01). BC cases with PD-L1 expression had a significantly worse OS (HR = 0.201; 95% CI [0.048 - 0.112], p <0.000). PD-L1 expression was an independent prognostic factor in multivariate analysis (HR = 0.195; 95% CI [0.058 - 0.655], p =0.008). In conclusion, PD-L1 expression is associated with advanced tumor stage, aggressive subtypes of BC, lymphatic infiltration, and poor OS in BC.

An earthquake is the result of a sudden release of stored energy n the Earth’s crust that creates seismic waves. In term of the earthquake, this study aimed to cluster which areas were the most affected by earthquake occured in Java Province in 2017. The algorithm used in this study was Self Organizing Maps algorithm (SOMs) with Cohonen as a type of Artificial Neural Networks (ANN) that is trained using unsupervised learning in decision making. In addition, the clustering results through its algoritm are functioned as a base of determining the eartquake pattern criteria and which areas often occurred in order to be able to mitigate earthquake that causes fatal impacts.

Primary lymphoma of breast is an uncommon tumour that constitutes 0.04% to 0.5% of malignant breast neoplasms [1]. Here, we present an interesting case of a 28 years old lady who presented with ascites alongwith past history of lumpectomy breast. Her ascitic fluid cytology showed monomorphic malignant tumour cells of poorly preserved morphology. Being suspicious of tumour type, we reviewed the clinical details and past histopathology records of the patient.

Background: Spleen is an essential organ due to its significant role in immunological and haematological functions of the body. Splenic notches on various borders establish the lobulation of the spleen in early life. Aim: To study the morphological and morphometric parameters of the spleen in aborted foetuses Materials and Methods: 30 foetal spleen specimens (Male-14; Female-16) of both sexes from 12-40 weeks of gestational age were obtained from the Department of Anatomy, Santhiram Medical College, Nandyal. The morphometric parameters like length, width, thickness and weight of the foetal spleen were measured and recorded Results: The incidence of wedge shape was 23 (76.66%), the pyramidal shape was 6(20%), and leaf-shaped was 1(3.33%). The incidence of the single notch was observed in 19 (63.33%), two notches in 9(30%), and three notches in 2(6.66%) specimens were found in the present study. The parameters like length, width, thickness, and weight of the fetal spleen were increased in relation to the gestational age in the present study. Conclusion: The present study acknowledges the anatomical and morphological basis of the spleen may be helpful for the surgeons while doing partial splenectomy in the removal of the affected segment by ligating the segmental branch of the splenic artery.

Introduction: Bronchoscopy is a valuable diagnostic tool and has a significant clinical impact on the management of pneumonia, especially ventilator-associated pneumonia in ICU patients who fail to respond to standard, guideline-based therapy. The investigation of bronchial alveolar lavage (BAL) specimens involves an extensive laboratory work. Currently, there are very few published studies evaluating the diagnostic benefit of collecting multiple BAL specimens during bronchoscopy. These redundant specimens result in a significant workload increase for the diagnostic microbiology laboratory. Objective: To investigate the optimal number of specimens for bacteriology, virology, mycology, Pneumocystis jirovecii (PJP) and Legionella penumophila specimens in order to optimize the utility of BAL specimens with the aim of minimizing harm to the patient and optimizing resource utilization for the laboratory. Method: BAL specimens collected at an academic institution in Southern Ontario were reviewed retrospectively over a 15 month period for bacteriology, 16 months for virology, one year for mycology, and three years for L. pneumophila and P. jirovecii. Results: One thousand sixty-three BAL specimens were ordered for bacterial culture, yielding positive results in 45.5%. Among them, a concordance rate of 97.1% was found between two or more specimens acquired from different lung lobes. The concordance rate of multiple virology samples was 98.6% among patients in whom 2 specimens were collected per procedure, and 100% among those with 3 specimens per procedure. To study whether one specimen is sufficient for the detection of filamentous fungi, we reviewed 43 BAL samples which grew Aspergillus fumigatus between. A concordance rate of only 60% was found between two specimens obtained from different lung lobes. A concordance rate of 100% was found among multiple specimens ordered for L. pneumophila and P. jirovecii with positivity rates of 0.14% and 0.92% respectively. Conclusion: We recommend a single specimen per BAL be sent from the most purulent lung segment for bacteriology and viral PCR. Single specimens may also be appropriate for L. pneumophila and P. jirovecii, however further study is needed. Multiple specimens should be submitted for mycology investigations. By eliminating duplicate specimens laboratory utilization can be optimized and patient morbidity may be decreased.

Interior Design (ID) development and growth is being appreciated by many people today than it was in the past. This paper discusses the findings of a study that sought to investigate the training needs of the Kenyan Interior Design Diploma Graduates (KIDDGs). Employing a descriptive survey research design, the study was conducted in Nairobi County, Kenya. The target population was KIDDGs who graduated within the last ten years and were practicing in the Interior Design Industry. Snowball sampling was used to select 120 KIDDGs. Self-administered questionnaires, interviews, and observation were the methods of data collection. Data was coded according to emerging patterns, analyzed using Statistical Packages for Social Sciences (SPSS version 25) and presented using tables and histograms as well as written reports. This paper demonstrates that most of the KIDDGs reported of their inability to positively perform in areas such as analyzing their clients’ needs, goals, and life and safety requirements, inadequacy in the formulation of the preliminary design concepts, and lack of knowledge to collaborate with other licensed design practitioners in the technical areas. This forces them to retrain on areas such as lighting and lighting designs, visual language of design and properties of colour and colour psychology for them to be effective in the IDI. Other training needs are working out costs, preparing estimates and how to advise client on the use of fittings, furniture, fabrics, and wall and floor coverings. The paper recommends that to address this dire scenario, the government and the public technical institutions need to expand the contribution of interior design to society through the exchange and development of knowledge and experience in education and practice. In addition, Institutions offering ID Programs need to equip their computer labs and workshops with essential modern equipment, sufficient and effective training personnel and provision of adequate supplier of instructional materials. Technical institutions should focus on education that gives designers access to internships and regular industrial visits to interact with other designers with real-world experience.

Introduction: Candida is a genus of yeast which is the most common cause of fungal infection. Candida albicans is most important fungal opportunistic pathogen. The candiduria refers to the presence of yeast in urine either by the microscope observation of budding pseudohyphae, or by the growth of fungi in culture. Aim: To find the prevalence of candiduria in tertiary care Centre. Materials and Method: This was a study conducted at Saveetha medical college from January 2018 to December 2018, the total number of urine sample collected were 10194 out of which 2500 showed various microbial growth, out of which 50 Candida strains were isolated. Speciation was done according to standard protocol. Result: The prevalence of candiduria caused by Candida non-albicans species (1.24%) is more than that caused by Candida albicans species (0.76%). The prevalence is more in female (66%) than male (34%). Among the age group the prevalence is more in the age group between 21-30 years (50%). Candiduria cases are common among the NON-ICU cases with 92%. Candiduria is prevalent among the non-diabetic patients with 92%. Conclusion: Urinary tract candidiasis is known as the most frequent nosocomial fungal infection worldwide. Candida albicans is the most common cause of nosocomial fungal urinary tract infections; however, a rapid change in the distribution of Candida species is undergoing. Simultaneously, the increase of urinary tract candidiasis has led to the appearance of antifungal resistant Candida species.

Aim: This article assesses the student’s insight about simulation base skills learning. Back Ground: Simulation is a teaching style which is appropriate for professional skills learning because it is parallel to real situation. In nursing education it is being used in many ways to train learner in professional skills. In 1960 first health-care simulation manikins were presented (Jeffries et al., 2015). A study reveals that students expressed that simulation is helpfulness, comfort and a Clinical simulation is important approach for professional skill learning programed (Padilha, Machado, Ribeiro, & Ramos, 2018). Method: A cross-sectional descriptive study design was used. This study evaluates the student’s insight about simulation base skills learning in nursing education. 133 participants filled the Simulation Evaluation Survey (SES) form. A study setting was a private sector university. In this study random sampling technique was used. Results: Study results revealed that this approach enhances learner knowledge and skill performance. Quantitative Survey data facts regarding simulation experience revealed the students feedback that simulated body approach can Amplified knowledge about relevant content for practice, which have been utilized (96.9%). During the debriefing session of practice, participant felt that the faculty involve in this approach was Knowledgeable (98.5 %). After simulation session students’ knowledge Increased about content discussed, (97%). Survey data facts explore that students feel better prepared for real patient care after simulation practice (94%). Conclusions: This study concluded that through simulation base learning, students get improvement in different aspects, like enhancement in knowledge, confidence, and performance. This study reveals that students feel confident, skillful and can give better performance in real clinical setting.

Trisigma Inti Solusi, PT is a company engaged in Landscape Engineering & Architectural Product. Where the company is committed to continuously provide technical goods that provide solutions to the needs associated with the design and construction, in particular modern recharge wells (sigmatank) with the concept of "Green Building Solution". More than 100 Project that has been handled by Trisigma Inti Solusi, PT since its establishment in 1995, with more than 15 years. Over a period of 5 years (2014 to 2018) sales of modern recharge wells (sigmatank) fluctuated or up and down, in the last 2 years (2017-2018) has decreased. Besides, the increasing number of competitors or new players are popping up, as well as a decrease in prices in accordance with market and product quality. Researchers conducted a survey to the respondent or client ever transaction or purchase of modern recharge wells (sigmatank), with the aim of increasing sales as targeted by the management company. Thus, it will be able to improve product quality, appropriate price reduction amount of the purchase, sale given as expected. The aim of the research is influencing purchasing decisions with quality products, pricing and promotions on purchasing decisions that impact customer satisfaction. Total population owned 450 and 180 samples with the SEM technique recommended the case Between 100 - 200. The analytical methods used are quantitative analysis. Mechanical analysis with SEM, the software used SmartPLS3.2.8. The results of this study are product, price, promotion affects purchasing decisions, the impact is customer satisfaction.

This study is entitled Comparison Analysis of Stock Price Before and After Announcement of Business Index 27. The target population is 27 companies, operational variables taken is the stock price 20 days before and after the announcement of business index 27. Processing data is done using SPSS Version 22 Program, the results show there is no difference in stock prices before and after announcements of business index 27 means that the announcement does not affect stock prices, but the relationship between stock prices before and after is very strong.

This paper is an attempt to examine the needs for ethical consideration in testing and evaluation. It argues that all in all, there are basically three areas of ethical consideration which pervade the literature; (i) Fairness of test-based decisions; (ii) The utility of tests for evaluating education and (iii) The implications of using test scores as labels for categorising individuals. The paper also examines in some detail some other critical ethical issues like freedom from coercion, informed consent; limited deception; adequate debriefing; confidentiality and protection of privacy. It ends up by advocating monitoring of the use of these tools for testing and evaluation in order to avoid their abuse and misuse.

This study aims to comparative analyze between before (2016) and after (2017) the implementation of the Financial Services Authority's circular letter number 14 / SEOJK.03 / 2017 concerning the health level of PT Bank Mega Tbk. The method used in this study is paired sample t-test. The results are not difference significant between Performance Ratio of Bank Mega in 2016 (before the implementation of the Financial Services Authority's circular letter number 14 / SEOJK.03 / 2017) and Performance Ratio of Bank Mega in 2017 (after the implementation of the Financial Services Authority's circular letter number 14 / SEOJK.03 / 2017).

Government institutions such as the National Police of the Republic of Indonesia have given attention to the process of implementing public information disclosure by issuing several regulations. Regulations concerning public information services were issued by the agency since 2010, which were later, renewed in the regulation of the Head of the National Police of the Republic of Indonesia number 24 of 2011. Changes to the new regulation are the result of revision of regulation number 16 of 2010 concerning the public information service in the police force of the Republic of Indonesia. Public perceptions related to the quality of service of government institutions that are considered complicated, slow and too many procedures are a challenge for the Indonesian Police Agency. The process of achieving good performance as an indication of the success in the implementation of good governance. According to a survey conducted by the Partnership Governance Index (PGI) regarding the quality of the principles of good governance in Indonesia, data were obtained that based on the dimensions of the principle of good governance related to the level of government information disclosure, showed a tendency towards poor assessment on aspects of transparency. It is an indication that the public considers the level of transparency of the government and Indonesian bureaucracy needs to be improved and improved. Through the qualitative analysis method, this research is expected to produce a mapping of communication and changes in the development of good governance in the Indonesian National Police. Communication and changes in realizing good governance at the police institution are carried out through POLRI Bureaucratic Reform (RBP) as stated in Map the third wave of the National Police Bureaucracy Reform 2016-2019, which is nothing but the actualization of 8 areas of change in the Apparatus, Supervision, Accountability, Mental fields. Institutional, Management, Human Resources Apparatus, Legislation and Public Services, which confirms the importance of implementing clean government and good governance that are universally believed to be the principal needed to provide excellent service to the community, with the main program being carried out by the government to build state apparatus through the application of bureaucratic reform.

The dictionary meaning of the term ‘Education’ is the process of teaching or learning especially in a school or college or knowledge gained from a source of study. This being the case accepted and accredited learning centers around the world have formatted their own curriculum structures and methodologies to impart learning. However the most important question that needs to be answered here is whether or not this learning that students achieve in the learning centers are truly contributing effectively to them being placed in suitable positions. More often than not it has been noted that this is not the case. In a country like Oman where the process of education has of a sure certainty picked up its pace, the actual placement levels of the Omani graduates in suitable placements has not been really up-to the mark. This is because the gap between education and employability which is a continuing problem in Oman. This study aims at trying to find reasons why this is the case and what measures or methods need to be adopted to try change the existing scenario.