KEWENANGAN PENCATATAN NIKAH MELALUI PENGHULU DAN KEPALA KUA DALAM PERSPEKTIF PERATURAN MENTERI AGAMA DENGAN PERATURAN PENDAYAGUNAAN APARATUR NEGARA

Marriage registration for Muslims is carried out by Marriage Registration Officer (PPN). Minister Religion Regulation (PMA) Number 11 2007 concerning Marriage Registration Article 2 Paragraph (1) mentions Head of KUA as PPN. Meanwhile, Ministe State Apparatus Empowerment Regulation Number: Per/62/M. PAN/6/2005 concerning Functional Position Penghulu Article 1 Paragraph (1) states that Penghulu also PPN. Serious problems related to authority Penghulu caused by mention Penghulu and Head of KUA as PPN, this makes authority Penghulu as functional give Prealable authority which authority to carry out decisions taken without asking for prior approval from agency or individual, which this can have an impact on validity marriage book by penghulu or head of KUA. This research uses empirical juridical research and uses a qualitative approach. Results analysis, that in practice registering marriages at KUA of Sukun Subdistrict, Malang City, conclusions: First, functions and authorities role Penghulu as PPN to carry out munakahat legal fatwas, mu’amalah guidance, as advisory supervision and marriage consultation or reconciliation. role Head of KUA as PPN supervise implementation duties Penghulu and Assistant PPN, reporting marriage registration to Regency/City Ministry of Religion, as guardian adlol or guardian judge and signing examination, agreements and events marriage certificates, divorce, and reconciliation. Second,implementation, namely: mandate Head of KUA to Penghulu responsibility and accountability Head of KUA, Head of KUA can give mandate to Penghulu carry out tasks in some of his working areas, and role of Penghulu as form representative Head of KUA when unable to attend meeting. wedding ceremony. Third, supporting factors include: understanding importance registering marriages, Penghulu at District KUA fulfills human resources and role Head of KUA in management and coaching. Inhibiting factors: level of understanding regulations not optimal, human resources KUA employees still lacking, clash mentioning Penghulu and Head of KUA as PPN, and lack supervision from BIMAS Islam.

Evaluation of Analgesic Effect of Unani Pharmacopoeial Formulation Habb-E-Suranjan and Raughan-E-Suranjan in Wajaul Mafasil (Joints Pain) Patients: An Open Prospective Clinical Trial

Wajaul Mafasil (joint pain) is the most prevalent and common cause of morbidity and disability not only in India but also throughout the world. In spite of various scientific developments in conventional medicine, there is no specific therapy or cure available for joints pain particularly when the disease has progressed to chronic stage. Therefore, it is the need of the hour to explore new formulations from herbal sources which are safe and effective. The present trial was undertaken to scientifically validate the Unani pharmacopoeial compound formulations of Habb-e-Suranjan and Raughan-e-Suranjan for its safety and efficacy in patients with joints pain. Patients with joint pain, who gave written informed consent, were recruited in the study from general OPD of RRIUM, Chennai with the prior approval of the Institutional Ethics Committee. 97 patients completed the study treatment. The treatment protocol was followed for 14 days and the clinical evaluation was done on seventh and fourteenth day of the treatment. At the end of fourteenth day intensity of individual parameters like joints pain, swelling, tenderness and restriction of movement showed statistically significant improvement (p<0.05). Overall therapeutic response of the treatment observed in this study was 100%. It was observed that 47.4% cases were completely relieved; 51.4% cases were relieved while 1.2% cases showed partial relief after the treatment. The laboratory investigations showed that the drugs used in the study were safe as evident by its maintenance. It may be concluded that Habb-e-Suranjan in combination with Raughan-e-Suranjan possesses significant analgesic property and may be a better option for the patients of joint pain. Keywords: Arthritis, Joints pain, Wajaul Mafasil, Habb-e-Suranjan, Raughan-e-Suranjan

Acceptability and effectiveness of antimicrobial stewardship implementation strategies on fluoroquinolone prescribing

Objective: To assess the effectiveness and acceptability of antimicrobial stewardship-focused implementation strategies on inpatient fluoroquinolones. Methods: Stewardship champions at 15 hospitals were surveyed regarding the use and acceptability of strategies to improve fluoroquinolone prescribing. Antibiotic days of therapy (DOT) per 1,000 days present (DP) for sites with and without prospective audit and feedback (PAF) and/or prior approval were compared. Results: Among all of the sites, 60% had PAF or prior approval implemented for fluoroquinolones. Compared to sites using neither strategy (64.2 ± 34.4 DOT/DP), fluoroquinolone prescribing rates were lower for sites that employed PAF and/or prior approval (35.5 ± 9.8; P = .03) and decreased from 2017 to 2018 (P < .001). This decrease occurred without an increase in advanced-generation cephalosporins. Total antibiotic rates were 13% lower for sites with PAF and/or prior approval, but this difference did not reach statistical significance (P = .20). Sites reporting that PAF and/or prior approval were “completely” accepted had lower fluoroquinolone rates than sites where it was “moderately” accepted (34.2 ± 5.7 vs 48.7 ± 4.5; P < .01). Sites reported that clinical pathways and/or local guidelines (93%), prior approval (93%), and order forms (80%) “would” or “may” be effective in improving fluoroquinolone use. Although most sites (73%) indicated that requiring infectious disease consults would or may be effective in improving fluoroquinolones, 87% perceived implementation to be difficult. Conclusions: PAF and prior approval implementation strategies focused on fluoroquinolones were associated with significantly lower fluoroquinolone prescribing rates and nonsignificant decreases in total antibiotic use, suggesting limited evidence for class substitution. The association of acceptability of strategies with lower rates highlights the importance of culture. These results may indicate increased acceptability of implementation strategies and/or sensitivity to FDA warnings.

Evaluating Criteria-Based Thresholds in Cataract Commissioning and Their Contribution to Variable Access to Surgery – an Observational Study

ObjectivesPrevious work has suggested wide variation in policies for cataract surgery across different Commissioning Groups, but did not evaluate the potential impact of that variation on access.This study characterises the variation in rates of cataract surgery across England, reviews threshold policies against NICE guidance, and explores whether stringency of policy has a significant effect on access, to determine whether threshold policies are contributing to unequal access to surgery. It examines the effect of social deprivation and the impact of prior approval processes, where these are in place.MethodsInformation on number of surgeries undertaken and threshold policy were provided from 127 Clinical Commissioning Groups (“CCGs”) through Freedom of Information request. The results were grouped by threshold stringency and analysed on an age group-corrected basis. ANOVA testing was performed to assess effect of policy stringency on regional rates of cataract surgery.ResultsIn the population over 60 years old, rates of cataract surgery vary across CCGs, from 1,980 to 6,427 per 100,000 population with a standard deviation (784.76) of 22% of the mean value, 3,598.There is variability in threshold policies for cataract surgery between CCGs: 33 had no policy, 45 utilised NICE-compliant policies, accessible on the basis of Quality of Life (“QoL”) impact, and 39 required that Visual Acuity (“VA”) threshold be exceeded, against current NICE guidance. Increasing restrictiveness of policy is associated with decreasing rates of cataract surgery (p<0.01) and accounts for 18% of the total variation seen. Variation in deprivation across CCGs contributes to 11% of the total deviation (p<0.01).There is little evidential basis to many policies, with 40% of policies not citing any supporting evidence. Prior approval processes represent 7.3% of total cataract activity but are not significantly associated with a reduced rate of cataract surgery (p=0.56).ConclusionOver two-thirds of CCGs continue to use threshold-based policies for access to cataract surgery, with increasing stringency of policy associated with decreasing cataract activity. A third of CCGs control access solely on the basis of visual acuity requirements, despite NICE guidance to the contrary. There is a need for consistency in policy across CCGs, and introduction of validated quality of life impact assessment tool to reduce variability of access.

Google shopping queries for vaping products, JUUL and IQOS during the E-cigarette, or Vaping, product use Associated Lung Injury (EVALI) outbreak

ObjectivesTo assess whether the late 2019 US outbreak of pulmonary disease linked to vaping (‘E-cigarette, or Vaping, product use Associated Lung Injury’ (EVALI)) impacted online shopping queries for vaping products and the Philip Morris ‘IQO’ brand of heated tobacco.MethodsWe tracked online shopping queries for vape(s), JUUL and IQOS by analysing rates of Google queries indicative of shopping (eg, buy IQOS) after news of the outbreak was first reported (the week of 29 July 2019) until hospitalisations ceased (the week of 16 February 2020). We compared observed rates of shopping during the outbreak to counterfactual expected rates that were predicted using an autoregressive iterative moving average model fit to queries from 1 January 2014 to the week of 21 July 2019.ResultsDuring the outbreak, vape shopping queries were 34% (95% CI 30% to 38%) lower than expected and JUUL shopping queries were 39% (95% CI 34% to 45%) lower than expected, translating into about 7.2 and 1.0 million fewer searches. IQOS shopping queries were 58% (95% prediction interval (PI): 34–87) higher than expected, translating into 35 000 more searches. Moreover, IQOS shopping queries reached a historic high the week they were discussed as a potentially safe alternative to vaping (the week of 29 September 2019), when they were 382% (95% PI: 219–881) above expected rates for the week.ConclusionsThese results suggest that unplanned events, such as the EVALI outbreak, can provoke changes in the epidemiology of product usage. Tobacco companies should be prohibited from using events such as disease outbreaks to position their products as less harmful without prior approval.

Legal Action for Pre-Project Selling Based Buyers Whose Apartment Specification Have Changed Without Prior Approval

One of the alternatives that can be used as a residence is an apartment. This study aims to know and analyze how the apartment buyers' dispute settlement is experiencing changes in the apartment location without prior notification and approval. This is normative legal research that will explore the legislation's contents. Based on the study results, the sale and purchase of apartments done by ordering then made a Sale and Purchase Agreement (PPJB) that ensures the apartment will not be sold to others and delivered according to the time specified. Besides, it also regulated in Law Number 8 the Year 1999 concerning Consumer Protection and Law Number 20 the Year 2011 on Flats. Therefore, in case of misuse in the sale and purchase of an apartment, the consumer may initiate legal action based on the existing PPJB and Consumer Protection Law.Keywords: PPJB, Apartment, Consumer

Drug utilization pattern of antidiabetic drugs among indoor diabetic patients in a tertiary care teaching hospital, Jorhat

Introduction and Aim: Diabetes is an opportunistic killer. Approximately 77 million people in India suffer from diabetes. A person develops diabetes due to genetic predisposition, family history, obesity, lack of physical activity, diet low in fruits and vegetables. Modification of life style and pharmacotherapy of diabetes are often indicated to control diabetes and emergence of complications. Therefore, the present study was undertaken to evaluate the prescription pattern of antidiabetic drugs among indoor patient with adherence to WHO core prescribing indicator. Materials and Methods: A retrospective observational study was conducted for a period of six months and 140 case sheets of indoor diabetic patients admitted in Medicine department were collected from MRD office after prior approval from IEC. The data were analysed using descriptive statistics. Results: The study showed male preponderance of 75.71% in comparison to female 24.29%. The pattern of antidiabetic prescribed showed highest prescription rate of various preparations of insulin (68.57%) with regular insulin most commonly prescribed preparation (64.58%). Among oral antidiabetic drugs metformin (42.86%) was most commonly used. The percentage of drug prescribed in generic name was 36.36% and the percentage of drugs prescribed from National List of Essential Medicines (NLEM) was found to be 69.7%. Conclusion: The study provided substantial information about the prescribing practices of physicians and also paved a way to formulate prescribing policies at our institution.

Impact of an antimicrobial stewardship programme on reducing broad-spectrum antibiotic use and its effect on carbapenem-resistant Acinetobacter baumannii (CRAb) in hospitals in Jordan

Objectives To evaluate the impact of an antimicrobial stewardship programme (ASP) on reducing broad-spectrum antibiotic use and its effect on carbapenem-resistant Acinetobacter baumannii (CRAb) in hospitalized patients. Methods The study was a retrospective, ecological assessment in a tertiary teaching hospital over 6 years (January 2014 to December 2019). The intervention involved the implementation of an ASP in February 2018, which remains in effect today. This ASP consists of several components, including education, antibiotic guidelines, antibiotic restriction policy with prior approval, audit of compliance to the restriction policy and feedback. Restricted antibiotics were imipenem/cilastatin, ertapenem, meropenem, vancomycin, teicoplanin, tigecycline, colistin, amikacin, piperacillin/tazobactam, levofloxacin and ciprofloxacin. The intervention was evaluated by time-series methods. Results Statistically significant decreases in the level of antibiotic use, after the introduction of the ASP, were observed for the following antibiotics: imipenem/cilastatin (P = 0.0008), all carbapenems (P = 0.0001), vancomycin (P = 0.0006), colistin (P = 0.0016) and third-generation cephalosporins (P = 0.0004). A statistically significant decrease in the slope, after the introduction of the ASP, for ertapenem (P = 0.0044) and ciprofloxacin (P = 0.0117) was observed. For piperacillin/tazobactam, there was a significant increasing trend (P = 0.0208) before the introduction of the ASP. However, this increased trend was halted post-introduction of the ASP (P = 0.4574). The introduction of the ASP was associated with a significant impact on reducing the levels of CRAb (P = 0.0237). Conclusions The introduced antimicrobial stewardship interventions contributed to a reduction in the use of several broad-spectrum antibiotics, reversed the trends of increasing use of other antibiotics and were associated with a significant reduction in CRAb.

The Study of Ethnobotanical Uses by Local Healers in Taktse Chiwog from Central Bhutan

Aim: To document the ethnobotanical uses in Taktse Chiwog (Village blocks) by local healers. Study Design: Semi-structured interview and direct interview was conducted with the prior approval from the Chiwog official. Two local healers/informants were contacted for interview before field visits based on their popularity and experience of using medicinal plants in their locality. Place and Duration of Study: The study was conducted at Taktse Chiwog, Trongsa Dzongkhag, Bhutan between July and October 2019. Methodology: Two local healers were identified based on their experience on ethno medical practice. Multiple approaches were taken such as botanical inventories, collection of plant specimens, semi-structured and direct interviews with local healers including free listing (FL) and preference ranking (PR) to collect the information on medicinal use/s using questionnaires. Results: Eighty Two plant species from forty nine families were recorded with their ethno medicinal uses by the local healers against various ailments and diseases. Conclusion: This study suggests that most of the medicinal plants available within locality are commonly used by the healers for the treating different diseases, dislocation and fracture of musculoskeletal system.

Policy, toxicology and physicochemical considerations on the inhalation of high concentrations of food flavour

Food flavour ingredients are required by law to obtain prior approval from regulatory bodies, such as the U.S. Food and Drug Administration (FDA) or the European Food Safety Authority (EFSA) in terms of toxicological data and intended use levels. However, there are no regulations for labelling the type and concentration of flavour additives on the product, primarily due to their low concentration in food and generally recognised as safe (GRAS) status determined by the flavour and extract manufacturers’ association (FEMA). Their status for use in e-cigarettes and other vaping products challenges these fundamental assumptions, because their concentration can be over ten-thousand times higher than in food, and the method of administration is through inhalation, which is currently not evaluated by the FEMA expert panel. This work provides a review of some common flavour ingredients used in food and vaping products, their product concentrations, inhalation toxicity and aroma interactions reported with different biological substrates. We have identified several studies, which suggest that the high concentrations of flavour through inhalation may pose a serious health threat, especially in terms of their cytotoxicity. As a result of the wide range of possible protein-aroma interactions reported in our diet and metabolism, including links to several non-communicable diseases, we suggest that it is instrumental to update current flavour- labelling regulations, and support new strategies of understanding the effects of flavour uptake on the digestive and respiratory systems, in order to prevent the onset of future non-communicable diseases.