COVID-19 infection prevention and control for hospital workers in Indonesia

Introduction

The outbreak of SARS-CoV-2 in 2019 led to a global pandemic, posing unprecedented challenges to healthcare systems, particularly in hospitals.

Purpose

This study explores the intricacies of strategies employed for preventing and controlling COVID-19 in Indonesian hospitals, with a particular focus on the protocols, challenges, and solutions faced by healthcare professionals.

Methods

Using a cross-sectional analysis, we examined 27 hospitals and uncovered disparities in their preparedness levels. During our investigation, we observed the robust implementation of infection prevention measures, which encompassed stringent protocols, adequate ventilation, and proper use of personal protective equipment. However, shortcomings were identified in areas such as surveillance, mental health support, and patient management.

Discussion

This study underscores the importance of addressing these gaps, suggesting tailored interventions, and continuous training for healthcare staff. Effective leadership, positive team dynamics, and adherence to comprehensive policies emerge as pivotal factors. Hospitals should strengthen weak areas, ensure the ethical execution of emergency protocols, and integrate technology for tracking and improving standard operating procedures. By enhancing the knowledge and skills of healthcare workers and maintaining strong management practices, hospitals can optimize their efforts in COVID-19 prevention and control, thereby safeguarding the wellbeing of professionals, patients, and communities.

Hospital preparedness for COVID-19 in Indonesia

Introduction

As a disaster-prone country, hospital preparedness in dealing with disasters in Indonesia is essential. This research, therefore, focuses specifically on hospital preparedness for COVID-19 in Indonesia, which is important given the indication that the pandemic will last for the foreseeable future.

Methods

During March to September 2022, a cross-sectional approach and a quantitative study was conducted in accordance with the research objective to assess hospital preparedness for the COVID-19 pandemic. This research shows the level of readiness based on the 12 components of the rapid hospital readiness checklist for COVID-19 published by the World Health Organization (WHO). Evaluators from 11 hospitals in four provinces in Indonesia (Capital Special Region of Jakarta, West Java, Special Region of Yogyakarta, and North Sumatra) filled out the form in the COVID-19 Hospital Preparedness Information system, which was developed to assess the level of hospital readiness.

Results

The results show that hospitals in Capital Special Region of Jakarta and Special Region of Yogyakarta have adequate level (≥ 80%). Meanwhile, the readiness level of hospitals in West Java and North Sumatra varies from adequate level (≥ 80%), moderate level (50% - 79%), to not ready level (≤ 50%).

Conclusion

The findings and the methods adopted in this research are valuable for policymakers and health professionals to have a holistic view of hospital preparedness for COVID-19 in Indonesia so that resources can be allocated more effectively to improve readiness.

Factors Associated with Psychosocial Symptoms Experienced by Students in Response to COVID-19 Pandemic: A Multivariate Analysis

The COVID-19 pandemic has significantly impacted many sectors, including the education sector. After in-person school activities were suspended due to the pandemic, a number of educational institutions in Indonesia reported concerns in implementing online learning due to the institutions' unpreparedness. This issue may potentially induce mental health disorders among students and triggers long-term stress. This study aimed to examine factors linked to the psychosocial symptoms of anxiety, stress, and depression in response to the early stage of the COVID-19 pandemic. An online cross-sectional study in Indonesia was conducted with 433 undergraduate and senior high school students aged 15 to 26 years old, both female and male. The self-reported symptoms were analyzed using both bivariate and multivariate linear regression methods. It was found that the percentage of participants with depression symptoms was 66%, while 61% and 43% participants experienced stress and anxiety respectively. The bivariate analysis presented strong correlations between anxiety and gender, learning duration and use of gadgets, internet expenses, and highly-interrupted learning. Furthermore, the multivariate regression revealed that only anxiety was significantly linked to internet expenses. This study indicates that many students are affected by COVID-19, the impacts of which manifest in psychosocial issues in the form of anxiety. We suggest that creating a supportive and positive family environment would help to alleviate some of these issues.

Peningkatan Produktivitas Minyak Atsiri bagi Petani Nilam di Desa Sausu Torono

Usaha produksi minyak nilam dipilih sebagai salah satu mata pencaharian masyarakat di Desa Sausu Torono, Kecamatan Sausu, Kabupaten Parigi Moutong Sulawesi Tengah. Dengan permintaan yang terus meningkat menjadi penting untuk dilakukan pelatihan dalam bentuk pendampingan kepada petani nilam untuk meningkatkan produktivitas minyak nilam. Target khusus yang ingin dicapai pada program pelatihan ini adalah meningkatnya pendapatan kelompok usaha tani nilam yang berdampak pada perbaikan perekonomian masyarakat ditengah pandemi Covid-19. Kegiatan pengabdian dilaksanakan dengan metode Participatory Action Learning System (PALS) yang berdampak pada peningkatan pengetahuan dan ketrampilan masyarakat mitra mulai dari pengolahan hingga pemasaran. Hasil kegiatan pelatihan dan pendampingan menunjukkan bahwa kegiatan pelatihan mendapat respon yang positif dibuktikan dengan antusias warga untuk hadir dan aktif dalam diskusi tanya jawab pada kegiatan. Petani sangat terbantu dengan edukasi yang diberikan dan akan mempraktekkan dalam usaha mereka. Sebagai saran penelitian selanjutnya perlu dilakukan pengembangan usaha pertanian lain yang memiliki prospek tinggi dan disesuaikan dengan kondisi lahan dan SDM di Desa Sausu Torono.

Time-dependent prediction of mortality and cytomegalovirus reactivation after allogeneic hematopoietic cell transplantation using machine learning

Allogeneic hematopoietic cell transplantation (HCT) effectively treats high-risk hematologic diseases but can entail HCT-specific complications, which may be minimized by appropriate patient management, supported by accurate, individual risk estimation. However, almost all HCT risk scores are limited to a single risk assessment before HCT without incorporation of additional data. We developed machine learning models that integrate both baseline patient data and time-dependent laboratory measurements to individually predict mortality and cytomegalovirus (CMV) reactivation after HCT at multiple time points per patient. These gradient boosting machine models provide well-calibrated, time-dependent risk predictions and achieved areas under the receiver-operating characteristic of 0.92 and 0.83 and areas under the precision-recall curve of 0.58 and 0.62 for prediction of mortality and CMV reactivation, respectively, in a 21-day time window. Both models were successfully validated in a prospective, non-interventional study and performed on par with expert hematologists in a pilot comparison.

Berberine Ameliorate Haloperidol and 3-Nitropropionic Acid-Induced Neurotoxicity in Rats

Berberine due to its antioxidant properties, has been used around the globe significantly to treat several brain disorders. Also, oxidative stress is a pathological hallmark in neurodegenerative diseases like Huntington's disease (HD) and Tardive dyskinesia (TD). Berberine an alkaloid from plants has been reported to have neuroprotective potential in several animal models of neurodegenerative diseases. Hence, this study aims to evaluate the neuroprotective effect of berberine in the animal model of 3-nitropropionic acid (3-NP) induced HD and haloperidol induced tardive dyskinesia with special emphasis on its antioxidant property. The study protocol was divided into 2 phases, first phase involved the administration of 3-NP and berberine at the dose of (25, 50, and 100 mg/kg) intraperitoneally (i.p) and orally (p.o.) respectively for 21 days, and the following parameters (rotarod, narrow beam walk and photoactometer) as a measure of motor activity and striatal and cortical levels of (LPO, GSH, SOD, catalase, and nitrate) evaluated as a measure of oxidative stress were assessed for HD. Similarly in the second phase, TD was induced by using haloperidol, for 21 days and berberine at the dose of (25, 50, and 100 mg/kg) was administered, and both physical and biochemical parameters were assessed as mentioned for the HD study. The resultant data indicated that berberine attenuate 3-NP and haloperidol-induced behavioral changes and improved the antioxidant capcity in rodents. Hence berberine might be a novel therapeutic candidate to manage TD & HD.

Identification of Depression Among Elderly During COVID-19

Elderly population is increasing, while the world has been facing the novel coronavirus (COVID-19), which causes a greater adverse impact among older population in various aspects of their lives, such as depression, daily routine disruption, illness, and social and emotional issues. The purpose of this study was to assess the elderly’s depression during the COVID-19 pandemic, and the risk factors including socio-demographic, physical and psychosocial conditions, as well as family support. The method used was cross-sectional design, with a total sampling of 457 participants. The measuring instruments used were ADL (Activities of Daily Living Scale) and IADL (Lowton and Brody Instrumental Activities of Daily Living Scale) for physical activities assessment, APGAR (Adaptability, Participation, Growth, Affection, Resolution) for family support function assessment, and Geriatric Depression Scale (GDS) for depression level measurement, with additional questions for psychosocial assessment. 212 elderlies (46.4%) were found with no depression tendency, 183 elderlies (40%) had a tendency of depression, and 62 elderlies (13.6%) had depression. These depression issues were significantly linked to retirement and income among elderly, dependency, fitness and health status, family and social support, and sources of funds. In the presence of depression, control measures for social, health, and psychosocial support must be implemented in order to minimize its impact among the elderly.

Participation Action Research on Daily Health Literacy Using Voice Recognition Application for the Visual Impairment in Indonesia: A Research Protocol

Visually impaired people are often associated with various complex problems because they are considered unproductive even for daily health, so that daily health literacy is needed. The most needed aspects for visually impaired people are balanced nutrition, covid-19, and information on the nearest health service. The location of the difference in health literacy between people who see and people with visual impairment is accessibility. The purpose of this study is to describe the Participation Action Research (PAR) Protocol on Daily Health Literacy Using Voice Recognition Applications for visually impaired people in Indonesia. We will conduct a study using the Mixed Exploratory method, which is a method that in the early stages of research uses qualitative methods and the next stage uses quantitative methods. The mixing of the data of the two methods is connecting between the results of the first and subsequent studies. This exploratory type is a sequential model (sequence). The research stages are divided into three starting from pre-intervention by conducting systematic reviews, preliminary studies, and qualitative studies, as well as application design, the second stage is intervention through two groups, namely, the intervention group carried out health literacy using voice recognition applications and the control group carried out intervention using e-mail. -book reader, the intervention is continued with assistance for the blind by partners for 30 days, the third stage is post-intervention by monitoring and evaluating behavior, and evaluating applications for evolution and publication of applications to the play store for use by visually impaired people in Indonesia.

Analysis of Bio-Risk Management System Implementation in Indonesian Higher Education Laboratory

Developing countries face various challenges in implementing bio-risk management systems in the laboratory. In addition, educational settings are considered as workplaces with biohazard risks. Every activity in a laboratory facility carries many potential hazards that can impact human health and the environment and may cause laboratory incidents, including Laboratory Acquired Infections (LAIs). In an effort to minimize the impact and occurrence of these incidents, it is necessary to evaluate the implementation of a bio-risk management system in every activity that involves handling biological agents. This study was conducted in an Indonesian higher-education institution, herein coded as University Y. This is a descriptive, semi-quantitative study aimed at analysing and evaluating the implementation of the bio-risk management systems used in laboratories by analysing the achievements obtained by each laboratory. The study used primary data that were collected using a checklist which referred to ISO 35001:2019 on Laboratory Bio-risk Management. The checklist consisted of 202 items forming seven main elements. In addition, secondary data obtained from literature and document review were also used. The results show that out of 11 laboratories examined, only 2 laboratories met 50% of the requirements, which were Laboratory A and B, achieving good performance. Regarding the clauses of standards, a gap analysis identified leadership, performance evaluation, and support as elements with the lowest achievement. Therefore, corrective action should be developed by enhancing the commitment from management as well as improving documentation, policy, education and training.

Numerical study of nano-biofilm stagnation flow from a nonlinear stretching/shrinking surface with variable nanofluid and bioconvection transport properties

A mathematical model is developed for stagnation point flow toward a stretching or shrinking sheet of liquid nano-biofilm containing spherical nano-particles and bioconvecting gyrotactic micro-organisms. Variable transport properties of the liquid (viscosity, thermal conductivity, nano-particle species diffusivity) and micro-organisms (species diffusivity) are considered. Buongiorno's two-component nanoscale model is deployed and spherical nanoparticles in a dilute nanofluid considered. Using a similarity transformation, the nonlinear systems of partial differential equations is converted into nonlinear ordinary differential equations. These resulting equations are solved numerically using a central space finite difference method in the CodeBlocks Fortran platform. Graphical plots for the distribution of reduced skin friction coefficient, reduced Nusselt number, reduced Sherwood number and the reduced local density of the motile microorganisms as well as the velocity, temperature, nanoparticle volume fraction and the density of motile microorganisms are presented for the influence of wall velocity power-law index (m), viscosity parameter [Formula: see text], thermal conductivity parameter (c4), nano-particle mass diffusivity (c6), micro-organism species diffusivity (c8), thermophoresis parameter [Formula: see text], Brownian motion parameter [Formula: see text], Lewis number [Formula: see text], bioconvection Schmidt number [Formula: see text], bioconvection constant (σ) and bioconvection Péclet number [Formula: see text]. Validation of the solutions via comparison related to previous simpler models is included. Further verification of the general model is conducted with the Adomian decomposition method (ADM). Extensive interpretation of the physics is included. Skin friction is elevated with viscosity parameter ([Formula: see text] whereas it is suppressed with greater Lewis number and thermophoresis parameter. Temperatures are elevated with increasing thermal conductivity parameter ([Formula: see text] whereas Nusselt numbers are reduced. Nano-particle volume fraction (concentration) is enhanced with increasing nano-particle mass diffusivity parameter ([Formula: see text]) whereas it is markedly reduced with greater Lewis number (Le) and Brownian motion parameter (Nb). With increasing stretching/shrinking velocity power-law exponent ([Formula: see text] skin friction is decreased whereas Nusselt number and Sherwood number are both elevated. Motile microorganism density is boosted strongly with increasing micro-organism diffusivity parameter ([Formula: see text]) and Brownian motion parameter (Nb) but reduced considerably with greater bioconvection Schmidt number (Sc) and bioconvection Péclet number (Pe). The simulations find applications in deposition processes in nano-bio-coating manufacturing processes.

Colistimethate Sodium Dosing and Nephrotoxicity among in-Patients at Tertiary Care Hospital Karachi, Pakistan

Introduction: Colistimethate sodium (CMS) is a polymyxin group of antibiotics which were throw out for many years, due to their potential adverse reaction neurotoxicity and nephrotoxicity. The different guidelines were reported regarding CMS dosing some based on Creatinine clearance (CrCl) and some on weight and CrCl. There are many discrepancies in the prevalence of nephrotoxicity that has been reported which included various definitions of acute renal injury and many CMS doses used in a variety of literature. In EMA guideline they suggested the dose as 9 MIU which is equivalent to 300 mg of CBA given as a maintenance dose with normal renal function patients.  In FDA standard dosing of CMS remains 5 mg/kg CBA per day used and also dose is dependent on patient weight. The aim of this study was to evaluate the dosing criteria of colistimethate sodium associated with nephrotoxicity. Methodology: A prospective observational study was conducted in private sector tertiary care hospital in Karachi, Pakistan, for duration of six months from July 2020 to December 2020. Sample size was comprised of 157 patients, calculated at 35% prevalence, 95% Confidence Interval and 7% margin of error. Patient included were ≥ 18 years of age, who have received intravenous CMS therapy for greater than 48 hours. Patients having an acute kidney injury or on dialysis (at start of therapy) were excluded. Loading dose and daily dose of CMS was calculated by using actual body weight and Creatinine clearance (CrCl). Cockcroft and Gault equation was used to estimate CrCl before and after the therapy. Nephrotoxicity was assessed by using the RIFLE criteria. SPSS-20 was used for frequency distribution and percentage calculation to show categorical variable. Results: Among 157 enrolled patients, 101 (64.3%) were male and 56(35.7%) were female (Table 1). Table 2. represents that 68(43.3%) patients were admitted in intensive care unit (ICU) and 89(56.7%) were in medicinal ward; 22.9% patients were in between the age range 60-70 years (Table 3). Among all patients 63(40.1%) patients were at risk of nephrotoxicity, 27(17.2%) patients were developing injury and 14(8.9%) patients were diagnosed to kidney failure and 53(33.8%) patients were found not to developed nephrotoxicity (Table 4). Table 5 exhibits that 48.4% of the patients were receiving dose of CMS using EMA guideline while 51.6% patients were receiving dose of CMS 2.5-5 mgCBA/kg/day according to FDA. Nephrotoxicity was high among FDA regimen (44.5%). Conclusion: It was concluded that CMS dosing criteria have a significant impact on nephrotoxicity. Close monitoring of renal function, particularly the first week of CMS therapy should be considered to evaluate the renal toxicity of CMS.

Environmental sustainability assessment due to stone quarrying and crushing activities in Jaflong, Sylhet

Quarrying and crushing activities constitute a major threat to the environment and occupational health of the workers in Jaflong, Sylhet. This study aims to determine the environmental sustainability of stone quarrying and crushing activities considering four dominant environmental components, viz. physicochemical parameters of water, PM_2.5 and PM₁₀, sound, and land use land cover (LULC). Water quality was measured in a seasonal variation, and air and sound data were collected in an 8-h period of every weekday of 2 months while LULC data were also collected from 1999 to 2019 with 5 years of interval. Water quality index (WQI) and cluster analysis were applied to classify the pollution sources while inverse distance weighting (IDW) and weighted overlay were used to show the vulnerable zone. All the parameters were considered with the established limit of WHO. WQI detects that the sampling stations located near the quarrying site were responsible for the deterioration of the water quality. Cluster analysis identified that the S8 and S10 sites were heavily susceptible to air and sound pollution. IDW and WO ranked the south-western lower stream and tribal village located at the north-western side as moderately to highly polluted. Correlation analysis illustrated that the values of air and sound parameters were concentrated above the permissible limit. Besides, LULC change revealed the significant lowering trend of vegetation and water bodies whereas it shows the upward trend of barren land and settlement. Finally, the extensive quarrying and crushing activities without any safety measure lead to breaking the environmental sustainability as well as workers and nearby dwellers were exposed to several respiratory diseases.

Attenuation of cisplatin-induced acute kidney injury by N-(2-Hydroxyphenyl) acetamide and its gold conjugated nano-formulations in mice

The attenuation of cisplatin-induced acute kidney injury (AKI) in mice by N-(2-hydroxyphenyl) acetamide (NA-2) and NA-2-conjugated gold nanoparticles (NA2-AuNPs) was investigated. Male BALB/c mice (n = 54) were divided into nine groups having six animals in each group. Animals in groups 3-9 were pre-treated for 5 days with test compounds, whereas, animals in group 1 and 2 received normal saline. On day 4, animals in groups 2, 3, 4, 5, 6 and 9 were given single intra-peritoneal injection of CP at the dose of 5 mg/kg. After 72 hours of CP injection, all animals were sacrificed. Blood was collected for serum urea and creatinine estimation, and kidneys were harvested for histo-pathological examinations and qPCR studies for nuclear factor-κB p50, (NFκB) ; inducible nitric oxide synthase (iNOS); hemeoxygenase-1 (HO-1); and interleukin-6 (IL-6).NA-2 and NA2-AuNPs was observed to decrease the serum urea and creatinine levels. Both the test compounds reduced kidney injury damage score and improved histological architecture in the treated animals in dose dependent manner. Furthermore, the mRNA expressions of NFkB p50, iNOS and IL-6 genes were down-regulated, and HO-1 gene was up-regulated in the animals treated with the test compounds. It is concluded that NA-2 and NA2-AuNPs attenuates CP-induced AKI in mice models through anti-inflammatory and anti-oxidant mechanisms.

Modeling magnetic nanopolymer flow with induction and nanoparticle solid volume fraction effects: Solar magnetic nanopolymer fabrication simulation

A mathematical model is presented for the nonlinear steady, forced convection, hydromagnetic flow of electro-conductive magnetic nanopolymer with magnetic induction effects included. The transformed two-parameter, non-dimensional governing partial differential equations for mass, momentum, magnetic induction and heat conservation are solved with the local non-similarity method subject to appropriate boundary conditions. Keller’s implicit finite difference “box” method is used to validate solutions. Computations for four different nanoparticles and three different base fluids are included. Silver nanoparticles in combination with various base fluids enhance temperatures and induced magnetic field and accelerate the flow. An elevation in magnetic body force number decelerates the flow, whereas an increase in magnetic Prandtl number elevates the magnetic induction. Furthermore, increasing nanoparticle solid volume fraction is found to substantially boost temperatures. Applications of the study arise in advanced magnetic solar nanomaterials (fluids) processing technologies.

Stratification of Integrated Cancer Center in Indonesia to Improve the Access to Care

Background and context: Indonesia as one of the low- and middle-income countries has not had a classification of cancer services yet. This classification will be very important for standardization and equalization of cancer services for all Indonesian people to access the cancer services provided. Based on Social Security Administering Agency of Health report, advanced stage of cancer have absorbed ∼17% national health budget (the third largest in financing National Health Insurance) but the outcome of the services still not good enough. Dharmais National Cancer Center (NCC) has the task of establishing cancer services system in stages throughout Indonesia by arrange the cancer services strata in Indonesia and develop its roadmap of achievement to improve the access to care. Aim: To build the stratification of integrated cancer center (ICC) in Indonesia by Health Ministerial Decree to improve access to care as a part of cancer control planning. Strategy/Tactics: 1. Build the concept of integrated cancer center stratification in Indonesia by assess the instrument of Director General of Health Services, Ministry of Health that conduct a comprehensive stratification of cancer services especially for diagnostic radiology services, nuclear medicine and radiotherapy to support the cancer services development plan in Indonesia. Currently, internal audit of radiology quality management has been developed by adopt the International Atomic Energy Agency (IAEA) standards issue with 3 instruments used to assess the radiology quality management, namely: a. Quality Assurance Audit for Diagnostic Radiology Improvement and Learning (QUAADRIL). b. Quality Management Audits in Nuclear Medicine Practices (QUANUM). c. Quality Assurance Team of Radiation Oncology (QUATRO). 2. Conducted an audience with Minister of Health to present the concept of integrated cancer center stratification in Indonesia and to initiate Ministry of Health decree as a regulation. The decree will be follow up by disseminate to all national, provincial and regional referral hospitals so they will have internal audit by IAEA to be mapping. Program/Policy process: 1. Dharmais NCC offer a model of cancer referral networking capabilities as a part of integrated national referral systems that includes preventive, promotive, curative and rehabilitative services for various levels of health care facilities with level strata as ICC strata 1, strata 2, strata 3 and NCC. 2. Encouraging the immediate issuance of Ministry of Health policy in the form of decree or regulation as the legal aspects of implementation. Outcomes: The Minister of Health agree with the proposed stratification of integrated cancer center and process the ministerial decree. What was learned: The stratification of integrated cancer center in Indonesia is very important needed to promote the NCCP especially in access to care so the cancer cases will find and treat in early stage due to closer access.

Site-Specific Lung Cancer to Support National Cancer Control Programs in Indonesia

Background: Lung cancer surely increased particularly in developing country that has double burden of disease because of epidemiologic transition effected high incidence in productive age and premature death. Indonesia as a developing country has better life expectancy but there aren't national cancer control yet. National cancer registry as one of pivotal tools in priority setting of national cancer control. Aim: Epidemiology pattern of lung cancer based on National Cancer Registry to determine national cancer control programs. Methods: In 2016 Ministry of Health assigned 14 provinces (26 cities/districts) in Indonesia to enforce population-based cancer registry and Dharmais as a National Cancer Centre. All health facilities sent data to the National Referral Hospitals in each provinces which Canreg5 were used, year 2008-2012. Data from 14 National Referral Hospitals sent to Dharmais NCC for analysis. Results: Lung cancer posed in the first rank for male and the sixth rank for female by comparison 2:1. Peak incidence occurs in age group of 55 years for male meanwhile 50 years for female. However escalation of cases began in age group of 35 years for both sexes. Three provinces which have high incidence for lung cancer were Bali, South Sumatera and DKI Jakarta as capital city of Indonesia. Adenocarcinoma as the most common histology type. Despite most valid percentage and coverage from each province still quite low. Conclusion: Lung cancer become the first priority for cancer control program in male foremost three provinces. This issue highlighted and need further analysis to assess risk factor.

Epidemiology of Childhood Cancer in Indonesia: Study of 14 Population Based Cancer Registries

Background: Childhood cancer was about 3%-5% cases of all cases. Dharmais National Cancer Hospital was pointed out by Ministry of Health as National Quality Control of Cancer Burden Data in 2016. To provide national cancer burden data, Ministry of Health established 14 population based cancer registries in 2016, located in 14 provinces in Indonesia. The coverage area was 26 districts/municipalities in each selected provinces with total coverage number of population was 14% of Indonesia. Aim: This study was to describe quality data of 14 population based cancer registries in Indonesia and to describe the epidemiology of childhood cancer during 2008-2012. Methods: We used 14 population based cancer registries data that collected in Office of National Quality Control of Cancer Burden Data, Dharmais National Cancer Center, within age 0-19 years old during 2008-2012. We analyzed quality data of 14 population based cancer registries data based on WHO-IARC rules for cancer registry data. Results: There were 4156 cases. The average of percentage microscopic verification was 59%, 7 out of 7 provinces had lower percentage of microscopic verification. The highest was South Sulawesi (98%) followed by Central Java (92.9%), and East Borneo (79.4%). Most of them had over 25% of DCO. DKI Jakarta had the highest incidence age-standardized rate (7.1) followed by Bali (4.9) and North Sulawesi (4.8). The most frequent childhood cancer cases were in male (57%), between 10-14 years old. Both in male and female had similar rank of the most frequent cases, other malignant epithelial (22.4%: 17.2%), leukemia (19.3%: 14.3%), and other and unspecified malignant tumor (9.4%: 8.4%). Conclusion: The coverage and quality data of childhood cancer in 14 population based cancer registries data were low. Each population based cancer registries should improve the process of cancer registration.

Profile of Colorectal Cancer in 14 Provinces in Indonesia

Background: In Indonesia, the incidence of colorectal cancer was separated in colon and rectum cancer. The incidence of rectum cancer ranked number five in male and number eight in female. The incidence of colon cancer ranked number seven in male and number nine in female. Aim: The aim of this study is to know the profile of colorectal cancer in Indonesia. Methods: Using data collected from population based cancer registry in 14 provinces (26 cities/districts) in Indonesia which was developed into a site specific cancer registry. All of the data diagnosed from 2008-2012. The classification of cases is used WHO criteria, ICD-O-3 (C18-C20). There were 3453 patients included in this study. CanReg5 was used as the software for entry and analyze the data. All primary health care and hospitals sent the data to the 14 National Referral Hospitals which located in each provinces. Finally, the 14 National Referral Hospitals sent the data to Dharmais National Cancer Center. Results: Incidence of colorectal cancer was higher in male (54%) than female (46%). Peak cancer cases occurred in the age of 50-54 years. DKI Jakarta, Central Java, DIY Yogyakarta as the three provinces which have highest incidence for colorectal cancer. The highest microscopic verification was in Papua, Central Java, and South Sulawesi. The highest percentage location was in the colon. The type of morphology was adenocarcinoma. Conclusion: The incidence of colon cancer entered in the top ten most common cancers in Indonesia. The quality of data still needed to be improved.

Epidemiology of Female Breast Cancer in West Jakarta, Indonesia

Background: Breast cancer was the most common cancer in the world. GLOBOCAN 2012 estimated the incidence of female breast cancer in Indonesia was 40.3 per 100,000 and the mortality rate was 16.6 per 100,000. In 2016, Dharmais National Cancer Center was appointed as Regional Population Based Cancer Registry in West Jakarta. West Jakarta was a municipality with 2,281,945 populations, being the 2nd largest population in DKI Jakarta Province. Aim: This study was to evaluate the quality of population based cancer registry data and to describe the epidemiology of female breast cancer in West Jakarta, Indonesia during 2008-2012 and to compare with GLOBOCAN 2012 . Methods: We used population based cancer registry data with ICD - O code C50.0-C50.9 in female who live in West Jakarta. The population based cancer registry data were collected in Dharmais National Cancer Center. We evaluated the quality of population based cancer registry data based on WHO-IARC rules for cancer registry data. Results: The quality of population based cancer registry data were microscopic verification (70%); DCO percentage (20.8%), and unknown age (0%). The trend of female breast cancer was increasing during 2008-2012. Age-standardized rate incidence was 19.3 per 100,000. The most of frequent were in 45-49 years old, not other specific location subtopography (81.5%), the histopathology type was ductal and lobular neoplasm (51.8%), in stage III (44%), and with metastases to bone (34%). The average of length of duration was 29.1 months, most of them were unknown of last status contact (84%). Conclusion: The coverage and quality data of West Jakarta population based cancer registry need to be increased and establish a follow-up system to decrease the unknown last contact status of patients.

Increase Coverage Cancer Registry by Strengthening and Improving the Reporting of Breast Cancer Screening Program in Jakarta as One of Data Source

Background and context: Breast cancer screening programs by mobile mammography have been done since 2005 for Jakarta and around by collaboration of Dharmais National Cancer Center with The Indonesia Breast Cancer Foundation and Jakarta Health Department. Every activity, mobile mammography has been examined 50 persons for 60-80 times yearly. For 2015 there were 3493 examinations with 529 cases (15.1%) were abnormal which 43 from that cases (8.1%) are suspect malignancy. All that data were compile with early detection and cancer registry data to know the real cancer, but there were no malignancy and only 15 benign cases had come to follow-up to Dharmais NCC. The result is no malignancy. To compile the mobile mammography data with detection unit and cancer registry data were difficult because of the difference terms of the variables. National Cancer Registry of Indonesia has been announced by Ministry of Health since 2016. The coverage of cancer that diagnosed in 2008-2012 in Jakarta just 30.7%. One of the sources of data are screening data. In Indonesia, screening programs for breast and cervix cancer have been done sporadically, including at Jakarta. Unfortunately for 2008-2012 diagnose year, there were no data can compile to cancer registry because there were no address data and name. So we collaborate to improve the data variables for cancer registration system. Aim: To conduct the mobile mammography screening data as one of the sources data for cancer registration to improve the coverage in Jakarta and to prepare the breast specific cancer registry system. Strategy/Tactics: Cancer Registry, Early Detection, Radiology and Pathology Unit was collaborating with The Indonesia Breast Cancer Foundation to improve the variables. Program/Policy process: We to improve the variables and their operational definition especially for name, address and birth date include risk factors and physical examinations variables. The palpations of breast was conduct by midwives or doctors before the examination with mammography. Cancer registration variables definition is the standard, so the name variable is the name that written in the National Identity Card, include the birth date and address. Information system department in Dharmais NCC has made the program to this data system and have been take place since July 2017. Outcomes: There were 1462 data that have been in hospital data based for mobile mammography with 237 cases (16.2%) were abnormal which 14 cases (5.9%) are suspect malignancy. Only 5 suspect malignancy cases had more examination in Dharmais NCC and all of them were diagnosed breast malignancy. What was learned: Standardization of variable definitions is very important for cancer registry data source to improve the coverage especially for early stage finding cases. But to know the standard diagnose and to follow the cases real conditions, we have to make a good and clear referral system networking.

The Evaluation of Serum Il-6 Changes as Proliferative Cytokines in Patients With Nasopharyngeal Carcinoma Before and After the Ionizing Radiotherapy

BACKGROUND: Nasopharyngeal carcinoma is a squamous cell malignancy derived from the nasopharyngeal epithelial layer. This study aimed to calculate the IL-6 levels in patients with nasopharyngeal carcinoma before and after radiotherapy, in the week I and week 3 during the radiotherapy, and 2 weeks after the radiotherapy.METHODS: The study was conducted in a prospective cohort on 16 people suffering from nasopharyngeal carcinoma and undergoing radiotherapy, i.e. 9 patients were in stage I of nasopharyngeal carcinoma and 7 people were in stage II of nasopharyngeal carcinoma. Each sample underwent the examination of IL-6 before the week I and week 3 during the radiotherapy, and 2 weeks after the radio¬therapy.RESULTS: The more they received the treatment with radiotherapy the greater was the decrease of serum IL-6. The percentages of the decrease of the levels of serum IL-6 was greater in those receiving the 3-week duration of radiotherapy (24.59%) compared to those who just received 1-week duration of radiotherapy (6.44%). The decrease of serum IL-6 would continue, although radio-therapy had ended; 2 weeks after the radio-therapy, the percentage of serum IL-6 decreased to 42.43% from the level of serum IL-6 before the radio-therapy.CONCLUSIONS: The research results indicated that there happened a significant decrease of serum IL-6 (p<0.05) after the treatment with the radio-therapy

Unsteady electromagnetic radiative nanofluid stagnation-point flow from a stretching sheet with chemically reactive nanoparticles, Stefan blowing effect and entropy generation

This article investigates the combined influence of nonlinear radiation, Stefan blowing and chemical reactions on unsteady electro-magneto-hydrodynamic stagnation-point flow of a nanofluid from a horizontal stretching sheet. Both electrical and magnetic body forces are considered. In addition, the effects of velocity slip, thermal slip and mass slip are considered at the boundaries. An analytical method named as homotopy analysis method is applied to solve the non-dimensional system of nonlinear partial differential equations which are obtained by applying similarity transformations on governing equations. The effects of emerging parameters such as Stefan blowing parameter, electric parameter and magnetic parameter on the important physical quantities are presented graphically. In addition, an entropy generation analysis is provided in this article for thermal optimization. The flow is observed to be accelerated both with increasing magnetic field and electrical field. Entropy generation number is markedly enhanced with greater magnetic field, electrical field and Reynolds number, whereas it is reduced with increasing chemical reaction parameter.

Migrant children's health problems, care needs, and inequalities: European primary care paediatricians' perspective

BACKGROUND

Primary care paediatricians' perception of migrant children's health in Europe has not been explored before. Our aim was to examine European paediatricians' knowledge on migrant children's health problems, needs, inequalities, and barriers to access health care.

METHODS

European primary care paediatricians were invited by the European Academy of Paediatrics Research in Ambulatory Setting Network country coordinators to complete a web-based survey concerning health care of migrant children. A descriptive analysis of all variables was performed.

RESULTS

The survey was completed by 492 paediatricians. Sixty-three per cent of the respondents reported that the general health of migrant children is worse than that of nonmigrants, chronic diseases cited by 66% of the respondents as the most frequent health problem. Sixty-six per cent of the paediatricians reported that migrant children have different health needs compared to nonmigrant children, proper oral health care mentioned by 86% of the respondents. Cultural/linguistic factors have been reported as the most frequent barrier (90%).to access health care. However, only 37% of providers have access to professional interpreters and cultural mediators. Fifty-two per cent and 32% do not know whether one or more of the family members are undocumented and whether they are refugees/asylum seekers, respectively. Updated guidelines for care of migrant children are available for only 35% of respondents, and 80% of them have not received specific training on migrant children's care.

CONCLUSIONS

European primary care paediatricians recognize migrant children as a population at risk with more frequent and specific health problems and needs, but they are often unaware of their legal state. Lack of interpreters augments the existing language barriers to access proper care and should be solved. Widespread lack of guidelines and specific providers' training should be addressed to optimize health care delivery to migrant children.

Implementation of an in-patient pediatric mortality reduction intervention, Gondar University Hospital, Ethiopia

SETTING

Gondar University Hospital (GUH) is a resource-limited tertiary care hospital in northern Ethiopia.

OBJECTIVE

To evaluate the aggregate effect of care standardization, institutional guidelines, and simulation-based training on pediatric mortality at a resource-limited hospital.

DESIGN

Uncontrolled pre-post study. GUH in-patients aged from 30 days to 14 years were included in the program evaluation (baseline 11 September-18 November 2010; intervention 19 September-9 December 2011). Interns attached to the GUH pediatrics department from 6 September to 9 December 2011 were included in the training evaluation. Institution-specific management guidelines were prepared for choking, respiratory distress, dehydration, sepsis, congestive heart failure, coma, and seizure. Approval for the protocols was obtained from each pediatric faculty member. Interns received a 3.5 h simulation-based training in triage, procedural skills, and protocol usage. Primary outcome was overall deaths (%); secondary outcomes were deaths within 24 h of admission (%) and median pre/post-training emergency management test scores (%).

RESULTS

No difference in mortality (OR 0.72, 95%CI 0.40-1.29, P = 0.265) or first 24 h mortality (crude OR 0.97, 95%CI 0.37-2.55) was observed. Trainee examination scores improved from 33% to 74% (P < 0.001).

CONCLUSION

Combining care standardization, management protocols, and simulation-based training did not reduce mortality among pediatric in-patients. Focused, simulation-based training improved short-term test scores among interns.

PET imaging of the in vivo brain acetylcholinesterase activity and nicotine binding in galantamine-treated patients with AD

The effect of galantamine treatment on cortical acetylcholinesterase (AChE) activity and nicotinic receptor binding was investigated by positron emission tomography (PET) in 18 patients with mild Alzheimer's disease (AD) in relation to galantamine concentration and the patients' cognitive performances. The first 3 months of the study was of a randomized double-blind placebo-controlled design, during which 12 patients received galantamine (16-24mg/day) and 6 patients the placebo, and this was followed by 9 months' galantamine treatment in all patients. The patients underwent PET examinations to measure cortical AChE activity ((11)C-PMP) and (11)C-nicotine binding. Neuropsychological tests were performed throughout the study. Inhibition (30-40%) of cortical AChE activity was observed after 3 weeks to 12 months of galantamine treatment. No significant change in mean cortical (11)C-nicotine binding was observed during the study. (11)C-Nicotine binding, however, positively correlated with plasma galantamine concentration. Both the changes of AChE activity and (11)C-nicotine binding correlated positively with the results of a cognitive test of attention. In conclusion, galantamine caused sustained AChE inhibition for up to 12 months. At the individual level, the in vivo cortical AChE inhibition and (11)C-nicotine binding were associated with changes in the attention domain of cognition rather than episodic memory.

Publication bias in abstracts presented to the annual meeting of the American Academy of Orthopaedic Surgeons

PURPOSE

To examine possible causes of publication bias in the orthopaedic literature so as to avoid inappropriate clinical decisions based on reviews of the literature.

METHODS

Two reviewers independently reviewed abstracts presented to the 1999 American Academy of Orthopaedic Surgeons annual meeting. Data pertaining to sample size, statistical significance, study setting, country of origin, outcome, study type, and sponsorship were extracted from each abstract. The publication rate was measured after 5 years, by electronic searching and author contact. Predictors of publication were identified using logistic regression analysis.

RESULTS

Of the 318 abstracts listed in the proceedings, 175 (55%) were published within 5 years. Publication was associated with positive rather than neutral outcomes (odds ratio, 1.62; 95% confidence interval, 1.01-2.59; p<0.05) and with the reporting of statistical significance (odds ratio, 2.05; 95% confidence interval 1.24-3.39; p=0.005). Sponsorship, country of origin, sample size, study setting, and study type did not significantly influence the publication rate.

CONCLUSION

Evidence of publication bias exists in abstracts presented at the 1999 American Academy of Orthopaedic Surgeons annual meeting. Clinical decisions based on the literature may be biased due to an over-representation of studies with positive outcomes.

Inhibition of acetylcholinesterase in CSF versus brain assessed by 11C-PMP PET in AD patients treated with galantamine

The relationship between acetylcholinesterase (AChE) activity in the CSF and brain of patients with Alzheimer's disease (AD) was investigated in 18 mild AD patients following galantamine treatment. The first 3 months of the study had a randomized double-blind placebo-controlled design, during which 12 patients received galantamine (16-24 mg/day) and six patients placebo. This was followed by 9 months galantamine treatment in all patients. Activities and protein levels of both the "read-through" AChE (AChE-R) and the synaptic (AChE-S) variants in CSF were assessed in parallel together with the regional brain AChE activity by (11)C-PMP and PET. The AChE-S inhibition was 30-36% in CSF, which correlated well with the in vivo AChE inhibition in the brain. No significant AChE inhibition was observed in the placebo group. The increased level of the AChE-R protein was 16% higher than that of AChE-S. Both the AChE inhibition and the increased level of AChE-R protein positively correlated with the patient's performance in cognitive tests associated with visuospatial ability and attention. In conclusion, AChE levels in CSF closely mirror in vivo brain AChE levels prior to and after treatment with the cholinesterase inhibitors. A positive cognitive response seems to dependent on the AChE inhibition level, which is balanced by an increased protein level of the AChE-R variant in the patients.

Differential CSF butyrylcholinesterase levels in Alzheimer's disease patients with the ApoE epsilon4 allele, in relation to cognitive function and cerebral glucose metabolism

Butyrylcholinesterase (BuChE) is increased in the cerebral cortex of Alzheimer's disease (AD) patients, particularly those carrying epsilon4 allele of the apolipoprotein E gene (ApoE) and certain BuChE variants that predict increased AD risk and poor response to anticholinesterase therapy. We measured BuChE activity and protein level in CSF of eighty mild AD patients in relation to age, gender, ApoE epsilon4 genotype, cognition and cerebral glucose metabolism (CMRglc). BuChE activity was 23% higher in men than women (p<0.03) and 40-60% higher in ApoE epsilon4 negative patients than in those carrying one or two epsilon4 alleles (p<0.0004). CSF BuChE level correlated with cortical CMRglc. Patients with high to moderate CSF BuChE showed better cognitive function scores than others. We hypothesize that CSF BuChE varies inversely with BuChE in cortical amyloid plaques. Thus, low BuChE in a patient's CSF may predict extensive incorporation in neuritic plaques, increased neurotoxicity and greater central neurodegeneration.

Prevalence of the mitochondrial DNA A1555G mutation in sensorineural deafness patients in island Southeast Asia

A mtDNA A1555G base substitution in a highly conserved region of the 12S rRNA gene has been reported to be the main cause of aminoglycoside induced deafness. This mutation is found in approximately 3% of Japanese and 0.5-2.4% of European sensorineural deafness patients. We report a high prevalence (5.3%) of the A1555G mutation in sensorineural deafness patients in Sulawesi (Indonesia). Our result confirms the importance of determining the prevalence of the mtDNA A1555G mutation in different populations, and the need for mutation detection before the administration of aminoglycoside antibiotics.

In vivo responses to antimalarials by Plasmodium falciparum and Plasmodium vivax from isolated Gag Island off northwest Irian Jaya, Indonesia

There is renewed interest in the rich nickel and cobalt deposits of Pulau Gag, an isolated but malarious island off the northwest coast of Irian Jaya. In preparation for an expanded workforce, an environmental assessment of malaria risk was made, focusing upon malaria prevalence in the small indigenous population, and the in vivo sensitivity of Plasmodium falciparum and P. vivax to chloroquine (CQ) and sulfadoxine/pyrimethamine (S/P), the respective first- and second-line drugs for uncomplicated malaria in Indonesia. During April-June 1997, mildly symptomatic or asymptomatic malaria infections were found in 24% of 456 native residents. Infections by P. falciparum accounted for 60% of the cases. Respective day 28 cure rates for CQ (10 mg base/kg on days 0 and 1; 5 mg/kg on day 2) in children and adults were 14% and 55% (P < 0.005). Type RII and RIII resistance characterized only 5% of the CQ failures. Re-treatment of 36 P. falciparum CQ treatment failures with S/P (25 mg/kg and 1.25 mg/kg, respectively) demonstrated rapid clearance and complete sensitivity during the 28-day follow-up period. More than 97% of the P. vivax malaria cases treated with CQ cleared parasitemia within 48 hr. Three cases of P. vivax malaria recurred between days 21 and 28, but against low drug levels in the blood. The low frequency of RII and RIII P. falciparum resistance to CQ, the complete sensitivity of this species to S/P, and the absence of CQ resistance by P. vivax are in contrast to in vivo and in vitro test results from sites on mainland Irian Jaya.

Conduction velocity versus amplitude analysis: evidence for demyelination in diabetic neuropathy

Motor conduction velocities (CVs) were correlated with distal compound muscle action potential (CMAP) amplitudes for tibial, peroneal, and median nerves in patients with biopsy-proven chronic inflammatory demyelinating polyneuropathy (CIDP), diabetic neuropathy, and amyotrophic lateral sclerosis. Only in the diabetic patients did CV significantly correlate with CMAP amplitude. The data show that diabetic neuropathy produces conduction velocity slowing that cannot be explained by axon loss alone, and that differentiation between diabetic neuropathy and CIDP in an individual nerve is difficult.

Direct Influence of Temperature on the Semicircular Canal Receptor

Effect of thermal stimulus on the vestibular receptor was studied using the isolated frog semicircular canal. The posterior (PSC) and lateral semicircular canals (LSC) were placed in the horizontal plane in frog Ringer's solution. The ampullary nerve was sucked into a glass suction electrode to record compound potentials. The steel thermal probe was positioned next to the ampullary surface to give thermal stimuli. When the PSC ampulla was cooled, the spontaneous discharge markedly increased. When the PSC ampulla was warmed, the discharge decreased. When the LSC ampulla was cooled, the discharge increased in the same manner as in the PSC. Also, warming of the LSC decreased the discharge in the same manner as in the PSC. The cupula was removed from the crista in order to eliminate the effect of volume change of the endolymph. The results were comparable to those with intact cupula in both the PSC and LSC. Cooling increased, while warming decreased the discharge. These responses are possibly due to a mechanism other than mechanical volume change, because the PSC and LSC yielded the same type of responses. Direct temperature reaction of the vestibular hair cell was suggested.

Direct influence of temperature on the semicircular canal receptor

Effect of thermal stimulus on the vestibular receptor was studied using the isolated frog semicircular canal. The posterior (PSC) and lateral semicircular canals (LSC) were placed in the horizontal plane in frog Ringer's solution. The ampullary nerve was sucked into a glass suction electrode to record compound potentials. The steel thermal probe was positioned next to the ampullary surface to give thermal stimuli. When the PSC ampulla was cooled, the spontaneous discharge markedly increased. When the PSC ampulla was warmed, the discharge decreased. When the LSC ampulla was cooled, the discharge increased in the same manner as in the PSC. Also, warming of the LSC decreased the discharge in the same manner as in the PSC. The cupula was removed from the crista in order to eliminate the effect of volume change of the endolymph. The results were comparable to those with intact cupula in both the PSC and LSC. Cooling increased, while warming decreased the discharge. These responses are possibly due to a mechanism other than mechanical volume change, because the PSC and LSC yielded the same type of responses. Direct temperature reaction of the vestibular hair cell was suggested.

Effect of streptomycin intoxication on vestibular nerve regeneration and posture recovery

The action of streptomycin sulfate (SM) on the regenerative process of the vestibular nerve and posture recovery was studied, using bull frogs. The vestibular nerve was sectioned in various conditions with intact endorgan or with SM intoxication. When the nerve was sectioned with the hair cells left intact, the nerve regenerated well and body balance recovered to normal. However, when neural regeneration was blocked, recovery was incomplete. SM intoxication resulted in various degrees of hair cell damage. Degree of posture recovery correlated well with the number of hair cells. When the nerve was sectioned after damaging the hair cell, the nerve failed to regenerate and posture recovery was incomplete. These results suggest that the degree of posture recovery depends on hair cell function and neural regeneration. Furthermore, neural regeneration is strongly influenced by hair cell function.

A study on temperature dependent vestibular potential: effect of long lasting thermal stimulus and aminoglycoside agent

Effect of temperature changes on the vestibular receptor was studied using isolated posterior semicircular canals (PSC) of bull frogs. Cupula was removed from the crista. PSC was placed in the inner compartment of the double chamber. Warm or cool water was filled in the outer compartment to change the temperature of the inner compartment. Changes of the spontaneous discharge were recorded from the ampullary nerve. When cooled, the discharge temporarily increased, followed by a gradual decrease. When warmed, it temporarily decreased and then increased, forming response curves of a mirror image. After addition of streptomycin, the temperature dependent response disappeared. These results suggest that the semicircular canal receptor is activated by direct temperature effects.

Phenylbutazone pharmacokinetics and bioavailability in the dromedary camel (Camelus dromedarius)

Phenylbutazone was administered intravenously and intramuscularly at a dosage rate of 4.4 mg/kg to a group of 6 female camels in a two-period crossover study. After intravenous (i.v.) administration, disposition was characterised by a two-compartment open model, with a low volume of distribution (0.174 l.kg-1), and distribution and elimination half-lives of 0.43 and 12.51 h, respectively. After intramuscular (i.m.) dosing absorption was relatively rapid with absorption half-time and time of maximal concentration values of 1.14 and 3.95 h, respectively. Plateau concentrations of phenylbutazone in plasma were obtained between 2 and 12 h and mean bioavailability was 97%, although this was subject to wide inter-animal differences. Plasma concentrations of the phenylbutazone metabolite, oxyphenbutazone, were low after iv dosing and generally undetectable after im administration, indicating that it is unlikely to contribute significantly to the pharmacological effects produced by phenylbutazone administration. An indication was obtained that phenylbutazone inhibited the ex vivo synthesis of serum thromboxane B2 (TxB2) for 24h after i.v. dosing, but this finding requires confirmation.

The origin of thermally evoked vestibular potential

The origin of the thermally evoked ampullary nerve action potential was searched using isolated frog posterior semicircular canal (PSC). The PSC was placed in the dish with 2 chambers separating endo- and perilymphatic fluid. Cooling stimulus was given by approximating the iced bar to the ampulla, and induced action potential (CAP) was recorded. When only the endolymph contained Ca2+, no CAP was evoked, while, the perilymph contained Ca2+, CAP was observed. These findings were comparable between with and without cupula. When only the endolymph contained tobramycin (TOB), the spike count did not change. However, when TOB was added into the perilymph, the spike count decreased according to concentration of TOB. When TOB was washed out, the spike count recovered. These findings were also comparable between with and without cupula. The above results indicate that thermally evoked vestibular potentials possibly originate in the hair cell.