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Due to its effect on the caliber of generations to come, iron deficiency anemia in teenage females is one of Indonesia's most pressing reproductive health concerns. Adolescents' awareness to autonomously adopt preventative actions is shaped mostly by their knowledge. The purpose of this research is to determine whether there is a correlation between the prevalence of anemia among teenage females in Boyolali Regency and their degree of education. Using a cross-sectional design, this study employs quantitative correlational analytic methods. An accidental sampling approach was used to obtain a sample size of 80 respondents from the population of seventh grade female pupils. A digital POCT device was utilized to quantify the incidence of anemia variables based on hemoglobin (Hb) levels, while a structured questionnaire instrument was employed to gather data for knowledge variables. The Chi-Square test was used to assess the bivariate data analysis. According to the univariate analysis, 62.5% of the participants (50 respondents) had a decent level of knowledge, and 73.8% of the participants (59 respondents) did not suffer from anemia (Hb > 12 g/dL). With a p-value of 0.000 (p < 0.05), the results of the bivariate test were generated. Anemia is more common among female students at MTs Al Ihsan Doglo who have a higher degree of expertise, according to this study. School districts should keep an eye on students' iron pill use and improve their nutrition education programs.

Diesel engines are widely used in the transportation and industrial sectors due to their high thermal efficiency and good operational durability. However, increased fuel consumption due to inefficiency of the injection system remains a common problem. Injector characteristics, particularly nozzle diameter and injection pressure, are important factors that affect the quality of fuel atomization, air-fuel mixing, and combustion efficiency. An inappropriate combination of parameters can cause suboptimal combustion and increase fuel consumption. This study aims to analyze the effect of variations in nozzle diameter and injection pressure on fuel consumption efficiency in diesel engines. The method used is an experiment with variations in nozzle diameter of 0.150 mm, 0.152 mm, and 0.154 mm and injection pressures of 400 bar, 420 bar, and 440 bar. Tests were conducted at engine speeds of 500 rpm, 1000 rpm, and 1500 rpm with a fuel consumption measurement time of one minute for each parameter combination. Fuel consumption was measured using the volumetric method and analyzed through the fuel volumetric flow rate, fuel mass flow rate, Brake Power (BP), and Brake Specific Fuel Consumption (BSFC). The results showed that the combination of a nozzle diameter of 0.150 mm and an injection pressure of 400 bar produced the lowest BSFC value, thus providing the best fuel consumption efficiency. Meanwhile, the combination of a nozzle diameter of 0.152 mm and an injection pressure of 420 bar showed the closest condition to optimal because it was able to provide a balance between atomization quality and the amount of fuel injected, resulting in efficient and stable combustion. Thus, the efficiency of a diesel engine is influenced by the balance of nozzle size and injection pressure, not solely by the lowest fuel consumption.

Bacterial infections are diseases that can be transmitted by bacteria from sufferers to others, either directly or indirectly. Cases of bacterial infections are more common among children. The use of antibiotics is needed to treat life-threatening conditions caused by bacteria by killing bacteria or making it difficult for bacteria to grow and reproduce. Antibiotics are a type of drug given to prevent bacterial infections, or are drugs given to high-risk patients. This research method is a descriptive study by collecting medical record data to find out the description of bacterial infections and the use of antibiotics in pediatric inpatients at RSU Cut Meutia Aceh Utara in 2022. This research technique used purposive sampling with a sample size of 183 samples. The results of this study showed that 183 children suffered from bacterial infections and received injection antibiotic therapy, the majority were boys, namely 106 children (57%), the age group with the most number of sufferers, namely aged 0‒5 years, totaling 76 children (41%), the percentage of bacterial infections most commonly found in pediatric inpatient wards at RSU Cut Meutia Aceh Utara in 2022, namely typhoid fever as much as 33%, the class of antibiotics most commonly used at RSU Cut Meutia is cephalosporins (93%).

The Fréchet distribution is one of the commonly used Extreme Value Distributions (EVDs) in statistical modeling and heavy-tailed data analysis, where it plays an important role in describing product lifetimes as well as climatic and financial phenomena. The estimation of its two parameters, namely the shape parameter and the scale parameter, is traditionally based on the Maximum Likelihood Estimation (MLE) method. However, maximizing the likelihood function for this distribution involves numerical difficulties, which necessitates the use of numerical optimization methods. In this study, we propose the use of the Aquila Optimizer (AO), a recent metaheuristic algorithm inspired by the hunting behavior of eagles, as an efficient numerical tool for maximizing the likelihood function of the Fréchet distribution. The objective function was formulated as the negative log-likelihood function (-LogL), and the Aquila Optimizer was employed to obtain the optimal estimates of the distribution parameters. Several simulation experiments with different sample sizes were conducted to compare the performance of the proposed method with a conventional approach represented by the Nelder–Mead method, using the Mean Squared Error (MSE) criterion. The simulation results demonstrated that the Aquila Optimizer outperformed the Nelder–Mead algorithm in many cases, although the superiority was slight. The results also showed that both algorithms were consistent, as their MSE values decreased with increasing sample size. In addition, a practical application was carried out using real data, and the results of the survival function estimation indicated a good fit.

State finances rely heavily on tax revenues, yet tax avoidance remains a persistent obstacle that can reduce government income. This practice is commonly associated with internal corporate conditions. Therefore, this research examines how profitability, leverage, firm size, and capital intensity relate to tax avoidance behavior. Employing a descriptive design with a Systematic Literature Review (SLR), the study evaluates ten empirical articles published between 2021 and 2025 in Sinta and Scopus indexed journals. The analysis indicates that the influence of these internal factors varies across studies. Profitability and leverage demonstrate contradictory effects, as strong earnings and higher debt may stimulate aggressive tax planning through tax shields, but may also restrain avoidance to preserve corporate image. Firm size likewise presents inconsistent results due to regulatory and public attention. In contrast, capital intensity generally shows minimal influence because investments in fixed assets are directed toward operational efficiency. These findings provide valuable considerations for policymakers to strengthen tax deduction regulations and encourage responsible corporate tax compliance.

This research try to examine how investment choices in property and real estate sector businesses listed on IDX (2020-2024) are impacted by the cost of debt and equity.For the accuracy of the analysis, this study also uses firm size and profitability as controler. Purposive sampling was used in the sampling process, which produced seven qualifying organizations with a total of 35 observations over a five-year period. Panel data regression was used for data analysis, and the Common Effect Model was shown to be the best estimation model. The findings show that investment decisions are significantly influenced by firm size, profitability, cost of debt, and cost of equity all at the same time. Nonetheless, investment choices are not much impacted by the cost of debt. Similarly, it has been demonstrated that the cost of equity has no appreciable effect on the capital expenditures of the businesses. Firm size has a favorable and substantial impact, making it the main motivator for investment activity in the real estate industry. During the study period, investment decisions were not significantly impacted by profitability. These results show that, especially in the post-pandemic economic recovery era, asset capacity and economies of scale are more important for the viability of real investment projects for property firms on the IDX than yearly variations in capital costs.

The integration of Artificial Intelligence (AI) into precision agriculture has significantly improved plant disease recognition; however, many existing deep learning models remain computationally expensive and feature-redundant, limiting their deployment on low-power and edge devices. To address these limitations, this study proposes a lightweight framework for maize leaf disease recognition based on serial deep feature extraction, dimensionality reduction, and machine-learning–based classification. A pre-trained MobileNetV2 network is employed as a fixed feature extractor to obtain discriminative visual representations, while Principal Component Analysis (PCA) is applied to reduce feature dimensionality by approximately 76%, retaining 95% of the original variance and improving computational efficiency. The compressed features are subsequently classified using a Radial Basis Function Support Vector Machine (RBF-SVM), optimized via grid search and cross-validation. Experiments conducted on a four-class maize leaf disease dataset (Northern Leaf Blight, Common Rust, Gray Leaf Spot, and Healthy), with class imbalance handled during training, demonstrate that the proposed MobileNetV2–PCA–SVM pipeline achieves 97.58% accuracy, 96.60% precision, 96.59% recall, and 96.59% F1-score, outperforming the DenseNet201 + Bayesian-optimized SVM baseline (94.60%, 94.40%, 94.40%, and 94.40%, respectively). This improvement corresponds to a 2.98% accuracy gain, a 55% reduction in error rate, an 86% reduction in model parameters (20.31M to 2.75M), and an 85% reduction in model size (81 MB to 12 MB). These results indicate that the proposed framework provides a compact and efficient solution with strong potential for deployment in resource-constrained agricultural environments.

Private vehicles are a frequently used mode of transportation because they are considered more practical. However, using private vehicles carries several risks, such as traffic accidents due to drivers losing focus on the road due to other activities, such as making calls on smartphones, drinking, or operating the radio. Approximately 90% of accidents are caused by human error. Convolutional Neural Network (CNN) is a type of neural network commonly used on image data. CNN is often used for image classification due to its high performance and accuracy. Therefore, this study aims to analyze the performance of CNN for the classification of distracted driving activities. The results show that the CNN model is able to effectively classify images of distracted driving activities, with an accuracy of approximately 99% across all datasets and across all input image size variations. Furthermore, the results of this study also show that differences in right-hand and left-hand drive datasets do not significantly affect model accuracy. Variations in input image size also do not significantly affect model accuracy, but do affect the training duration.

Background: Dysmenorrhea is commonly experienced by female adolescents and may interfere with daily activities and academic concentration. Non-pharmacological interventions such as listening to the murottal of Surah Ar-Rahman and the use of lemon aromatherapy have been reported to provide relaxation and analgesic effects. However, evidence regarding the effectiveness of their combined use remains limited. Therefore, this study aimed to evaluate the effect of combined therapy using Murottal Surah Ar-Rahman and lemon aromatherapy on dysmenorrhea pain levels among female adolescents at SMA Negeri 10 Semarang. Method: This study was conducted at SMA Negeri 10 Semarang using a Quasi-Experimental design with a Pretest–Posttest Group approach. The population consisted of 188 students who met the inclusion criteria. The sample size was determined using the Slovin formula, resulting in 40 respondents selected through purposive sampling. A normality test was performed prior to analysis, and the bivariate analysis utilized the Wilcoxon Signed Rank Test. Result: The Wilcoxon Signed Rank Test showed a p-value of 0.000 (p < 0.05), indicating a significant difference between pain levels before and after the intervention. These findings demonstrate that the combination of Murottal Surah Ar-Rahman and lemon aromatherapy is effective in reducing dysmenorrhea pain among female adolescents at SMA Negeri 10 Semarang. Conclusion: The combined therapy of Murottal Surah Ar-Rahman and lemon aromatherapy is effective in reducing dysmenorrhea pain levels among female adolescents.  

Prolactinoma is the most common functional pituitary adenoma, particularly in adolescent females, and is typically characterized by amenorrhea and galactorrhea resulting from hyperprolactinemia. However, in certain cases, serum prolactin levels may appear normal due to the hook effect, an immunoassay measurement error caused by extremely high prolactin concentrations that interfere with antigen–antibody complex formation. We report the case of a 17-year-old female presenting with a five-month history of galactorrhea, accompanied by breast pain, headache, and primary amenorrhea. Brain MRI revealed a pituitary mass measuring 1.4 × 0.8 × 0.5 cm, suspicious for prolactinoma, while serum prolactin was within the normal range (17.33 ng/mL). The discrepancy between clinical manifestations, lesion size, and laboratory findings raised suspicion of the hook effect. The patient was treated with dopamine agonists, bromocriptine and cabergoline, and referred for multidisciplinary management involving endocrinology, neurosurgery, and obstetrics–gynecology. Despite the absence of prolactin dilution testing, MRI findings supported the diagnosis of prolactinoma, and the patient demonstrated a favorable clinical response to therapy. This case highlights the importance of recognizing laboratory variability, performing comprehensive hormonal evaluation, and considering prolactin dilution assays when clinical and laboratory findings are discordant, particularly in adolescent patients with suggestive symptoms.

Hemangioma is the most common benign vascular tumor in infancy and is generally characterized by a proliferative phase followed by spontaneous involution. Although most cases resolve without intervention, treatment is required when hemangiomas cause functional impairment, ulceration, or life-threatening complications. Lingual hemangioma is a rare presentation and may result in significant feeding difficulties and airway compromise, requiring prompt and multidisciplinary management. This study aims to report the comprehensive management of a refractory lingual hemangioma in an infant, emphasizing diagnostic evaluation, therapeutic strategy, and nutritional support. A six-month-old female infant presented with a lingual hemangioma associated with progressive feeding difficulties. Prior to initiating therapy, a thorough diagnostic workup was performed, including echocardiography to assess cardiac function, magnetic resonance imaging (MRI) to evaluate lesion extent, and computed tomography angiography (CT-angiography) to delineate vascular anatomy. The patient initially received oral propranolol as first-line therapy; however, due to an inadequate response, combination chemotherapy with Bleomycin–Vincristine (BV) was initiated. To minimize the risk of toxicity, a 50% dose reduction was applied. Clinical evaluation demonstrated a favorable therapeutic response, with a reduction in lesion size and improvement in feeding ability after 10 weeks of treatment. No severe adverse effects were observed during the treatment period. To ensure adequate nutritional intake and support growth, enteral nutrition via a nasogastric tube (NGT) was provided throughout the course of therapy. This case highlights the importance of comprehensive diagnostic assessment, individualized treatment planning, and close monitoring in refractory hemangioma. In addition, optimal nutritional support plays a crucial role in overall patient outcomes. A multidisciplinary approach is essential for the successful management of complex infantile hemangiomas with functional complications.

Chronic Kidney Disease (CKD) is a global health problem with a continuously increasing prevalence and mortality rate. Global data indicates that kidney disorders have affected more than 850 million people, with CKD being one of the leading causes of death. North Sulawesi is recorded as one of the provinces with the highest prevalence of CKD. Blood creatinine is used as the primary marker of kidney function, while hypertension is a comorbidity commonly found in CKD patients and can act as both a cause and a consequence of impaired kidney function. Several studies have reported varying results regarding the relationship between creatinine levels and blood pressure. Purpose to analyze the association between serum creatinine levels and blood pressure in chronic kidney disease patients with hypertension at ODSK Hospital, North Sulawesi Province. Methods the research design used an observational analytic cross-sectional design. This study used an observational analytic cross-sectional design. It was a retrospective study utilizing secondary data from medical records for the period of June 2022 to August 2025. Total sampling method was employed with a sample size of 65 patients who met the inclusion criteria. Based on the Spearman correlation test results, the significance values between creatinine and systolic pressure was 0.685, and between creatinine and diastolic pressure was 0.787 (p-value >0.05). There is no significant correlation between serum creatinine levels and blood pressure in chronic kidney disease patients with hypertension at ODSK Hospital, North Sulawesi Province.

Private vehicles are a frequently used mode of transportation because they are considered more practical. However, using private vehicles carries several risks, such as traffic accidents due to drivers losing focus on the road due to other activities, such as making calls on smartphones, drinking, or operating the radio. Approximately 90% of accidents are caused by human error. Convolutional Neural Network (CNN) is a type of neural network commonly used on image data. CNN is often used for image classification due to its high performance and accuracy. Therefore, this study aims to analyze the performance of CNN for the classification of distracted driving activities. The results show that the CNN model is able to effectively classify images of distracted driving activities, with an accuracy of approximately 99% across all datasets and across all input image size variations. Furthermore, the results of this study also show that differences in right-hand and left-hand drive datasets do not significantly affect model accuracy. Variations in input image size also do not significantly affect model accuracy, but do affect the training duration.

Overview: Back pain during pregnancy is a common problem experienced by approximately 50–70% of pregnant women. Back pain during pregnancy is caused by an imbalance between the muscle activity in the lumbar region. Several maternal factors are known to play a role in the onset of back pain during pregnancy, including maternal age, body mass index (BMI), number of pregnancies (gravida), and physical activity. Research Method: This is a quantitative analytical study with a cross-sectional approach. The sample size was 33 pregnant women in their third trimester. The sampling technique used purposive sampling, and data analysis used the Chi-square test. Research Results: There was a relationship between BMI and back pain (p-value: 0.015), and there was no relationship between maternal age (p-value: 0.715), gravida (p-value: 0.442), and physical activity (p-value: 0.156) and back pain in pregnant women in their third trimester. Conclusion: There was a significant relationship between BMI and back pain in pregnant women in their third trimester, and there was no significant relationship between maternal age, gravida, and physical activity and back pain in pregnant women in their third trimester.

This study employs the Systematic Literature Review (SLR) method following the PRISMA 2020 Statement guidelines to identify the main models and indicators used in measuring the performance of Micro, Small, and Medium Enterprises (MSMEs). The literature selection process includes the stages of identification, screening, eligibility assessment, and inclusion, resulting in ten articles from reputable Q1 international journals. The analysis reveals that the most frequently used performance measurement models are integrated performance models such as the Balanced Scorecard, Performance Prism, and models based on resource capability, customer, internal process, and financial perspectives. Commonly used indicators include sales growth, profitability, market share, customer satisfaction, process flexibility, technology adoption, and business sustainability. The study concludes that although financial measures remain dominant, non-financial dimensions—such as digital capability, stakeholder engagement, and internal process effectiveness—are increasingly important for MSMEs operating in the context of global market dynamics and digital transformation. The implications of this study provide theoretical contributions to the development of MSME performance measurement frameworks and offer practical guidance for MSME managers in selecting indicators that align with the characteristics of small and medium-sized enterprises.

Recurrent aphthous stomatitis (RAS) is a common inflammatory condition of the oral mucosa characterized by round or oval ulcers with well-defined reddish borders and a shallow base covered by a grayish or yellowish fibrinous pseudomembrane. RAS is generally classified into three clinical types—minor, major, and herpetiform based on the size, number, and duration of the lesions. Several factors contribute to its occurrence, including bacterial infections such as Streptococcus sanguis, immune system dysfunctions, and nutritional deficiencies involving iron, vitamin B12, and folic acid. Other potential triggers include local trauma, hormonal or endocrine imbalances, psychological stress, and allergic reactions. Among these, anemia due to deficiencies in iron, folate, or vitamin B12 is considered an important etiopathogenic factor, although its exact role has not been fully clarified. The management of RAS primarily focuses on symptom relief, promoting faster ulcer healing, and preventing recurrence through both topical and systemic approaches. Effective treatment often includes improving nutritional intake, maintaining oral hygiene, and addressing underlying systemic or psychological conditions. Understanding the multifactorial causes of RAS is crucial in developing comprehensive strategies for prevention and long-term management of this recurrent oral lesion.

Canine dwarfism is a growth disorder resulting from physiological dysfunction within the endocrine system, primarily due to growth hormone (GH) deficiency commonly caused by abnormal pituitary development. GH and Insulin-like Growth Factor 1 (IGF-1) play essential roles in regulating the growth of bones, muscles, skin, and internal organs through the hypothalamic–pituitary–liver axis. Under normal conditions, the hypothalamus controls GH secretion, which subsequently stimulates the liver to produce IGF-1 as the main mediator of growth. Genetic abnormalities such as LHX3 mutations can impair somatotroph cell differentiation and reduce GH production, ultimately leading to decreased IGF-1 levels. The deficiency of these hormones disrupts chondrocyte proliferation in the epiphyseal plates, decreases muscle protein synthesis, and negatively affects the development of tissues such as skin, hair, and reproductive organs. This study was conducted using a literature review method by searching scientific databases and selecting relevant publications addressing the physiological, clinical, and pathophysiological aspects of canine dwarfism. Literature analysis indicates that GH deficiency leads to clinical manifestations such as stunted body size, thin and easily shedding hair, dry and infection-prone skin, reduced muscle mass, metabolic disturbances, and delayed reproductive maturation. Diagnosis is established through clinical evaluation, IGF-1 measurement as an indicator of GH activity, and radiographic assessment of epiphyseal plate development. Overall, a comprehensive understanding of the relationship between physiological abnormalities and clinical signs is crucial for early detection and appropriate management of dwarfism, providing a strong scientific foundation for understanding the hormonal mechanisms disrupted in this condition.

Exclusive breastfeeding (ASI) is the provision of only breast milk to infants for the first six months without additional food or drink, including water. Breast milk has important benefits in improving infant health, growth, and survival. However, the coverage of exclusive breastfeeding in Indonesia, including in the Pasar Health Center in Prabumulih City, has not yet reached the national target of 80%. One factor influencing the success of exclusive breastfeeding is husband's support. The purpose of this study was to determine the correlation between husband's support and exclusive breastfeeding. The study used a quantitative approach with a cross-sectional design. The sample size was 49 mothers with infants aged 7–12 months. The study was conducted in the Pasar Health Center in May 2025. The results showed that 28 infants (57.1%) received exclusive breastfeeding, and 30 mothers (61.2%) reported receiving support from their husbands. Statistical tests using the chi-square test showed a significant relationship between husband's support and exclusive breastfeeding (p = 0.000). These findings indicate that husband's support plays an important role in successful breastfeeding. This research suggests that involving husbands in breastfeeding education and support is highly recommended to increase the coverage of exclusive breastfeeding in the community.

Antibiotic resistance has emerged as a significant global health challenge, prompting the exploration of alternative antimicrobial agents. This study focuses on the synthesis and antibacterial potential of plant-based nanoparticles, specifically silver nanoparticles AgNPs, synthesized using neem leaf extract Azadirachta indica. The research aims to assess the effectiveness of these green-synthesized nanoparticles against Escherichia coli E. coli), a common pathogen responsible for numerous infections, including those resistant to conventional antibiotics. The synthesis of AgNPs was performed using neem leaf extract as a reducing and stabilizing agent, following a green synthesis approach that is environmentally friendly and avoids harmful chemicals. The synthesized nanoparticles were characterized using UV-Vis spectroscopy, Transmission Electron Microscopy TEM, and X-ray Diffraction XRD, ensuring the particles’ size, shape, and crystalline structure were in the desired range. Antibacterial activity was assessed using the agar diffusion method, comparing the inhibition zones formed by the nanoparticles with those of traditional antibiotics. The findings revealed that the silver nanoparticles displayed significant antibacterial activity against E. coli, with inhibition zones comparable to conventional antibiotics, indicating their potential as an effective alternative in combating antibiotic-resistant bacteria. Moreover, these nanoparticles exhibited high stability and biocompatibility, making them a promising candidate for further biomedical applications. The results suggest that neem-based AgNPs could serve as an eco-friendly solution for addressing antibiotic resistance. Future research is recommended to explore the broad-spectrum activity of these nanoparticles against other bacterial pathogens and to assess their safety and efficacy in clinical settings.

Inguinal hernia is one of the most common abdominal wall disorders, accounting for approximately 75% of all hernia cases, with 50% classified as lateral inguinal hernias, and it occurs more frequently in older adults. We report a 57-year-old male patient who was admitted to the hospital with a complaint of a lower abdominal mass. The mass initially appeared in the right inguinal region one year prior and subsequently developed in the left inguinal region two months later. The swelling progressively increased in size. Intermittent pain, predominantly on the left side, had been present for the past month without associated nausea, vomiting, or fever. Physical examination revealed a moderately ill general condition, stable vital signs, and a soft, tender mass in both inguinal regions. Based on the clinical history, physical examination, and supporting investigations, the patient was diagnosed with bilateral irreducible lateral inguinal hernia. The patient received intravenous Ringer’s lactate and intravenous ketorolac, followed by an elective herniorrhaphy using Lichtenstein Tension-Free Repair Technique under spinal anesthesia. The operation was completed successfully without intraoperative complications.