Tocilizumab Initiation based on Indicator in Patients Infected by Coronavirus-19 to Prevent Intubation

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has created severe medical and economic consequences worldwide since 2019. Tocilizumab is one of the therapies considered capable of improving the condition of patients with COVID-19. However, there is not much information about the best time to give tocilizumab. METHOD(S): This was an analytical study with a retrospective cohort design, using the data of 125 patients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with signs of acute respiratory distress syndrome in Dr. Moewardi Hospital, Surakarta, from March to August 2020. We analyzed various available clinical data to see which factors into clinical improvement with tocilizumab therapy. RESULT(S): Most patients showed clinical improvement after administration of tocilizumab. During the follow-up period, 21 patients died despite tocilizumab therapy. Significant risk factors associated with the need for intubation were heart rate, neutrophil, lymphocyte, pH, PaCO2, and PO2. The most influential variable on the need for intubation without being associated with other risk factors was PaO2 (p = 0.003, Confidence Intervals 95%). CONCLUSION(S): Tocilizumab has a role in treating patients infected by SARS-CoV-2, preventing the need for intubation when given to patients in good saturation condition with oxygen supplementation without positive pressure (PaO2 >65mmHg;SpO2 >93%).Copyright © 2023 Septian Adi Permana, Adhrie Sugiarto, Sidharta Kusuma Manggala, Muhammad Husni Thamrin, Purwoko Purwoko, Handayu Ganitafuri.

Adopting the Enhanced Crafting Strategy to Predict Hotel Resilience: Acces la Success

The tourism and hospitality sectors all over the world have been somewhat decimated by the COVID-19 pandemic. However, there are still many hotels operating today despite the calamity. Given the complexity and unpredictability of the hotel industry environment, this study enhanced the Crafting Strategy (CS) notion by adding the experimenting dimension and provides empirical support for the enhanced CS capability to predict hotel resilience, which are the novelties of this study. This study explained the relationship between CS, planned resilience (PR), reactive resilience (RR), and resilience outcomes (RO). A mixed methods analysis was used to analyze data from 150 hotel senior managers in Bali Island, the hardest hit tourist destination in Indonesia. The result revealed that experimenting is indeed a strong contributor to CS. Furthermore, CS shows a positive and significant impact to PR and RR. PR also has a strong influence on RR and the relationship between PR and RO (recoverability, adaptation, and innovation) is mediated by RR. Positive impacts of recoverability and adaptation on financial performance were also shown. In conclusion, hotels need to build and strengthen both their PR, and RR as they are equally important for the RO that is crucial for sustainability.

Organizational climate and quality of work-life in the creativity of teachers

This study analyzed the effect of organizational climate and quality of work-life on teachers' creativity throughout state vocational high schools in Serang, Indonesia during the COVID-19 pandemic. This work involved 164 civil servant teachers in state vocational high schools in Serang, Indonesia as the sample. As the major analysis tool, we used a multiple linear regression model. The hypothesis test used the t-test and f-test. The study revealed that: i) Organizational climate positively and significantly influenced the civil servant teachers' creativity amid the COVID-19 pandemic with a significance value of.000 (α<.005);ii) The quality of work-life also had a positive and significant effect on the teachers' creativity during this difficult situation has significance value of.000 (α<.005);and iii) The quality of their work influenced both organizational climate and the creativity of state vocational high school teachers living in Serang, Indonesia, with a determination coefficient of.861 or 86.1% during the pandemic. © 2023, Institute of Advanced Engineering and Science. All rights reserved.

Hemoperfusion techniques using Jafron HA330 cartridge combined with BBraun Dialog+ dialysis machine in patient with coronavirus disease 2019 pneumonia and septic shock: a case report.

BACKGROUND: The use of hemoperfusion for cytokine removal and inflammatory mediators is increasingly intense, especially in coronavirus disease 2019 patients who are already known to the general public for having cytokine storms. However, we have known about these cytokine storms for a long time in the critical care world. One of the modalities to remove cytokines is to use filtration and adsorption techniques with continuous renal replacement therapy. The use of continuous renal replacement therapy is usually constrained by its very high cost compared with standard care, especially in Indonesia, where health costs are covered by national health insurance. In this case, we use hemodialysis and hemoperfusion, using a dialysis machine, which is more cost-effective and easy to use. CASE PRESENTATION: We used the Jafron HA330 cartridge, modified for the BBraun Dialog+ dialysis machine. This case report presents an 84-year-old Asian man with septic shock due to pneumonia, congestive heart failure, and acute chronic kidney disease accompanied by fluid overload. After undergoing hemodialysis and hemoperfusion separately, there was a gradual and significant clinical improvement. Clinical indicators, including the vasopressor inotropic score and infection markers, should all be considered when deciding whether to begin hemodialysis and hemoperfusion. CONCLUSION: In general, using hemoperfusion to treat septic shock patients can reduce the length of stay in the intensive care unit, and morbidity and mortality.

Solid-state Thermal Transformation of Methylammonium Monomolybdate to Polyoxomolybdates and their Applications as Staining Reagents for Transmission Electron Microscopy Observations of Viruses

The solid-state heating of methylammonium monomolybdate, (CH3NH3)2[MoO4] (prepared by dissolving MoO3 in an aqueous methylamine solution), in air released methylamine and water to produce (CH3NH3)6[Mo7O24] and followed by (CH3NH3)8[Mo10O34] before transformation to MoO3. We report the first single-crystal X-ray structural analysis of (CH3NH3)2- [MoO4] and (CH3NH3)6[Mo7O24] and demonstrate that the decamolybdate structure is different from that obtained from ammonium molybdates. Furthermore, (CH3NH3)6[Mo7O24] is a good negative staining reagent for transmission electron microscopy observations of viruses, such as SARS-CoV-2 and influenza virus. © 2023 The Chemical Society of Japan.

Hemoperfusion that was popular during the COVID-19 pandemic: A case series

The medical world has been seeking solutions in solving the Coronavirus disease 2019 (COVID-19) outbreak since 2019. Amongst several alter-natives, hemoperfusion therapy has been reported to be beneficial for alleviating symptoms and reducing mortality in severely ill COVID-19 patients. Hemoperfusion is a process of filtering blood to eliminate toxins and inflammatory factors from the body. This case series aims to high-light the unexpected adverse clinical and labora-tory outcomes in the majority of COVID-19 patients treated with hemoperfusion in our hospi-tal. We included fifteen patients admitted to the Intensive Care Unit (ICU) with moderate-to-se-vere COVID-19 between August and December 2020 and were all given two to four sessions of hemoperfusion using the MG150 cartridge. All ten men and five women showed no improve-ment in their neutrophil-lymphocyte ratio (NLR), ferritin, D-dimer, and C-reactive protein (CRP) values after the hemoperfusion regiments, both survivors and non-survivors. In addition, eleven out of twelve patients with respiratory failure who were then intubated resulted in death. Based on our findings and previous evi-dence, we recommended only performing hemoperfusion for investigational instead of therapeutic purposes due to its poorly under-stood pathophysiology in COVID-19. We also recommended further research regarding the us-age of hemoperfusion in COVID-19 patients, es-pecially in the matter of determining the best time to start the therapy.Copyright © 2023, The Indonesian Foundation of Critical Care Medicine. All rights reserved.

The Influence of Operational Risk Management on Intention to Revisit and Intention to Recommend by Using Satisfaction as a Mediating Variable: A Study of Homestay Users in Dieng Plateau, Central Java, Indonesia

In the new normal era of the COVID-19 pandemic, homestay users are very concerned about security and safety. Risk management, especially operational risk management, plays an important role in mitigating the risk of homestay users. In this research, we determine the effect of operational risk management on the intention to revisit and the intention to recommend homestay users by using satisfaction as a mediating variable. The study was conducted using 198 respondents who have had repeated overnight experiences in homestays operating in the Dieng Plateau, Wonosobo, Central Java, Indonesia. Samples were taken using a multistage sampling technique. The research was carried out using an explanatory sequential design of mixed methods research. Data analysis was performed using Structural Equation Model with Smart PLS 3.0. The results state that operational risk management has a significant positive impact on homestay user satisfaction. Satisfaction has a significant positive impact on the intention to revisit and on the intention to recommend of homestay users. Furthermore, we also show that satisfaction has a significant positive role as a mediating variable from operational risk management on intention to revisit and intention to recommend of homestay users.

Airborne Microbial Quality Assessment in the Educational Buildings during the COVID-19 Pandemic

Rooms with pollutants have a poor impact of 2-5 times greater than outdoors. The lecture hall had the potential to experience a decrease in air quality. This study was conducted to assess microbiological air quality in the general lecture building I Institut Teknologi Sumatra, Lampung, Indonesia, during the COVID-19 pandemic and its relationship with environmental conditions. This study was conducted using a settling sampling technique to count the number of bacteria and fungi in the air. Samples were collected twice daily for five working days. The results showed that the highest concentrations of bacteria and fungi were found at the wifi corner location, at 36.7–1237.2 CFU/m3 and 225.4–1431.2 CFU/m3, respectively. The highest average concentrations of bacteria and fungi at the wifi corner location were found in the afternoon at 479.1 ± 438.1 CFU/m3 and 800 ± 548.4 CFU/m3, respectively. The three locations did not meet the standards of room suitability for humans with immunodeficiencies based on the ACGIH. The location of the wifi corner did not meet the standards of the Minister of Manpower of the Republic of Indonesia No. 5 of 2018 and the WHO regarding microbial standards in the room. The highest value of the Global Microbial Contamination Index (GIMC/m3) was found in the wifi corner (G4: ≥2000 – ≤4000), which is closely related to population density and ventilation. Environmental factors influence the density of bacteria and fungi at the sampling sites. The relative humidity strongly influenced the concentration of fungi. In addition to relative humidity, bacterial density is also affected by light intensity and the number of people. This indicates that despite restrictions on activities during the COVID-19 pandemic, the room at GKU 1 did not meet the eligibility requirements for students with immune disorders. © 2023 by the authors.

Mortality Rate of COVID‐19 Patients in Intensive Care Unit: A Multicentre Retrospective Observational Study

The case of Coronavirus Disease 2019 (COVID-19) is growing rapidly worldwide. More than 6 million people in Indonesia were confirmed to be infected as of March 2022. This disease caused an increase in the demand of respiratory assistance and intensive care services back in 2021. Unfortunately, the report about COVID-19 case in Intensive Care Unit (ICU) of Indonesia is very scarce although it is very crucial to evaluate the treatment approach and the prognosis of the patients. This study aimed to determine the characteristics, therapy, and outcomes of critically ill COVID-19 patients treated in the ICU. This was a multicentre retrospective study conducted in 12 hospitals in Indonesia from April 2020 to March 2021. All data regarding the characteristics, therapy, and outcomes of COVID-19 patients admitted to ICU were recorded and analysed. 1,502 patients were included in this study. Inpatient mortality occurred in 44.67% patients. The highest morbidity is attributed to stroke (83.4%). We found a significantly longer duration of mechanical ventilation use in non-survivors group (5.57 vs. 1.74 hours). Furthermore, the results of this study showed a significant difference in all type of treatment (excluding antifungal) between two groups. The mortality of COVID-19 patients in ICU is considerably high. Hypothyroidism and DMIІ patients showed a high serum asprosin, which linked with poor glycemic and lipid management. It is a biomarker for diabetes and thyroid issues. © 2023 by SPC (Sami Publishing Company)

A mannequin based comparative study of quality of chest compression with or without personal protective equipment (PPE)

Background & Objective: The use of Personal Protective Equipment (PPE) is highly recommended during chest compression in COVID-19 patients, as it can generate aerosols. It was thought that quality of chest compression might be affected by the use of PPE. We compared the quality of chest compression with or without PPE using a mannequin to formulate practical recommendations. Methodology: This observational analytical study used randomised crossover design, and was carried out in Cipto Mangunkusumo National General Hospital from December 2020 to July 2021. After a thorough assessment, a total of 92 samples fulfilled the inclusion and exclusion criteria. The chosen participants were postgraduate residents, and they were asked to do chest compression on a mannequin with (Group-I) and without PPE (Group-II) and with breaks in between. The quality of CPR was measured using feedback tool CPR R Series® Monitor (Zoll Inc., USA). After a break the groups were crossed over and re-evaluated. Results: Sixty-five (35.3%) non-PPE participants did quality compression, but only 16 (8.7%) did quality compression when using PPE (P < 0.001). Effective compression was done by 80 (43.5%) of the non-PPE participants, compared to 61 (33.2%) participants doing the compression effectively when using PPE (P = 0.002). Eighty-two (44.6%) non- PPE participants did adequate compressions compared to 61 (33.2%) participants when using PPE (P < 0.001). Meanwhile, the post-compression fatigue level was 7 (6.00-9.00) when using PPE compared to 5 (3.00-7.00) when not using PPE (P < 0.001). Conclusion: The use of PPE during chest compressions can reduce the quality of compression and increase the level of post-compression fatigue compared to performing chest compressions without PPE. PPE use was also associated with low levels of effectiveness, and adequacy of the chest compression. Abbreviations: PPE - Personal Protective Equipment;CPR – Cardiopulmonary resuscitation;AHA - American Heart Association;ERC - European Resuscitation Council [ FROM AUTHOR] Copyright of Anaesthesia, Pain & Intensive Care is the property of Department of Anaesthesia, Pain & Intensive Care and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Choice model and influencing factors of the travel mode for motorcycle and BRT-lite in Banda Aceh, Indonesia

The City of Banda Aceh continues to experience rapid development both in terms of economy, infrastructure, and transportation which has resulted in increased autos mobilities. This increased mobility has an impact on the increasing tendency to use motorcycles which harm the environment for instances traffic congestion, air pollution, noise, and accidents. The Government of Aceh has implemented a policy called Bus Trans Koetaradja with the concept of Bus Rapid Transit-Lite (BRT-lite), but due to inaccuracy and lack of exclusive lanes, it has caused people to be reluctant to shift from private mode to the urban Bus. Therefore, this aiming at investigates the determinants of shifting travel mode choice from motorcycle to BRT-lite based travel survey conducted in Banda Aceh using the contexts of Stated Preference. Due to pandemic Covid-19, the data was collected using online-based questionnaire survey using Google form. A total of 400 data is valid and used for the analysis of travel mode choice using Binary Logistic approach. The results of the binary logistic regression analysis reveal that determinants of selecting motorcycle as a representative daily mode used is the distance to make a trip, travel time within origin-destination, and vehicle operating costs. The probability of selecting travel modes is 70% and 30% for motorcycle and BRT-lite, respectively. © 2022 Author(s).

Thermal Structure Transformation of Methylammonium Vanadate and it's Application as a Negative Staining Reagent for Observing SARS‐CoV‐2

The solid‐state thermal structure transformation of methylammonium vanadate, (CH3NH3)VO3, from −150 °C to 350 °C is reported. Variable‐temperature X‐ray single‐crystal structure analysis at 23, 0, −50, −100, and −150 °C reveal (CH3NH3)VO3 comprises of methylammonium cations and “snake‐like” ([VO3]−)n anion chains propagating along the c‐direction in the Pna21 space group. In between −150 and −100 °C, we observe a reversible structural transformation due to the re‐orientation of the methylammonium cations in the crystal packing, which is also confirmed by the reversible profiles observed in differential scanning calorimetry. The methylammonium vanadate is stable until at ca. 100 °C and further heating releases methylamine and water and V2O5 is formed at ca. 275 °C . Furthermore, we show that the methylammonium vanadate can be used as a negative staining reagent for visualizing SARS‐CoV‐2, allowing us to discern the spike proteins from the body of the virus using transmission electron microscopy. Methylammonium vanadate, [(CH3NH3)VO3]n, shows a reversible structure transformation due to change of methylammonium cation orientation between −100 and −150 °C. In contrast, heating causes decomposition to form V2O5. The methylammonium vanadate can be used as a negative staining reagent for visualizing SARS‐CoV‐2 using transmission electron microscopy.

Sustainable indigenous cattle production in Brebes Regency, Indonesia: opportunities and threats during pandemic

This study assesses the sustainability of indigenous cattle production (Jabres Cattle) during the COVID 19 pandemic in Brebes Regency, Indonesia. The sustainability of Jabres cattle production is considered from the aspects of production, socio-economic, and environmental aspects. The study was conducted on 64 Jabres farmers in 5 sub-districts (Ketanggungan, Bantarkawung, Banjarharjo, Larangan, and Salem). Respondents were taken using a simple random sampling method and data was taken using online questionnaires. The collected data were analyzed using descriptive statistics. The indigenous cattle farmers in Brebes Regency have a long experience as beef cattle farmers (10.7 years on average) with an average ownership scale of 7 heads. During the pandemic, there was an increase of 54.7 percent of farmers who felt it was difficult to get cattle breeds compared to before the pandemic. The number of farmers who found it difficult to get forage also showed an increase of 36 percent compared to before the pandemic. Likewise, an increase in the number of farmers (75 percent) felt that it was increasingly difficult to sell beef cattle, which resulted in not making it easy for profits. However, the COVID 19 pandemic can encourage all farmers to pay more attention to the cleanliness of cowshed and the cage environment. Most of the indigenous cattle farmers (89 percent) remain committed to continuing their business despite difficulties in obtaining calves, feed, and selling cattle. Farmers still have confidence that the difficult situation will pass, and demand slaughter cattle will recover.

Factor Related the Use of Respiratory Supports among COVID-19 Patients in Sardjito Hospital Yogyakarta: A Cross-sectional Study

BACKGROUND: In patients with coronavirus disease-19 (COVID-19), respiratory failure is a serious condition that requires immediate respiratory supports. Various clinical conditions can be determinant factors to the need for used of ventilators. AIM: The aim of the study was to determine factor related to the used of ventilators among COVID-19 patients transferred to intensive care unit Sardjito Hospital. METHODS: Using a cross-sectional design, a total of 171 of 300 medical records selected in accordance to the inclusion criteria. Association of each clinical characteristics and outcome variable used contingency coefficient and Spearman rank tests, while multivariate logistic regression model was performed for hypothesis testing. The area under curve (AUC) was test to determine model fit of the logistic approach. RESULTS: There was a significant correlation between age (p = 0.004), blood sugar levels (p < 0.001), and oxygen saturation (p < 0.001), and the used of ventilator. Patients with hypoxia and severe hypoxia had odds of using ventilation supports 5 times and 114 times (OR = 5.623) and (OR = 114.3). The AUC test indicated that null hypothesis was rejected. CONCLUSION: The clinical characteristics were associated with age, blood sugar levels, and oxygen saturation. Patients with COVID-19 who admitted to hospital with hypoxia and severe hypoxia increased the odds of the use ventilators.

Development of Real-time Handwashing Assessment using Video Analysis

The world communities have suffered from the COVID-19 pandemic for the last two years. Even though many countries have started to normalise the situation, the COVID-19 still becomes a severe threat in the future. Healthy habits, such as complete and frequent handwashing, still need to be practised. These habits can minimise the transmission risks. The paper proposed a single-board computer system that aims to assess the handwashing steps. The standardised handwashing procedure is used to validate the acquired video of hand movement. The system is installed in a Raspberry Pi and receives video data from the connected mini camera. The deep learning model is implemented to provide classification capabilities. The assessment result is summarised according to the movement completeness and total duration. The testing stages found that the proposed system can provide accuracy and F1-score values of 82.55% and 86.66%, respectively. © 2021 ACM.

Microbial Pattern and Antibiotic Resistance of Severe Pneumonia in A National Referral Hospital in Indonesia (preprint)

Background: Patients hospitalized in the intensive care unit (ICU) have a higher susceptibility to infections. Respiratory infections are the most common nosocomial infections. Rising antibiotic resistance due to indiscriminate use of antibiotics and poor adherence to standard precaution in healthcare facilities compounds the problem. The main aim of this study is to assess microbial patterns and antibiotic resistance from bronchoalveolar lavage specimens in severe pneumonia patients. Methods: This retrospective study was conducted in an Indonesian tertiary care hospital from January 2016-December 2020. Written and verbal informed consent was obtained prior to bronchoscopy procedures. Patients were enrolled if they had severe community-acquired pneumonia (CAP) according to American Thoracic Society (ATS)/Infectious Disease Society of America (IDSA) criteria, had high-risk hospital-acquired pneumonia (HAP), late-onset ventilator-associated pneumonia (VAP), or pneumonia caused by Coronavirus disease (COVID-19). Respiratory specimens via bronchoscopy were inoculated on general semi-sloid thioglycolate media. Testing for antibiotic susceptibility was done using the disk diffusion method. Results: Two hundred and one patients’ data were analyzed. The majority of patients were males (65,17%) and above 60 years of age. The most common type of pneumonia was CAP (39,3%). Neurologic/cerebrovascular disease was the most common comorbidity (35,32%). Acinetobacter baumannii was the most frequently isolated microorganism. Ampicillin/sulbactam and amikacin were found to yield lower microbial resistance. Conclusion: Combination of ampicillin/sulbactam and amikacin appeared effective as initial empirical therapy in severe pneumonia patients. Further studies are needed to evaluate the feasibility and effectiveness of this combined therapy.

In situ simulation training for a better interprofessional team performance in transferring critically ill patients with COVID-19: a prospective randomised control trial.

BACKGROUND: Transferring critically ill patients with COVID-19 is a challenging task; therefore, well-trained medical team is needed. This study aimed to determine the role of in situ simulation training during pandemic by using high-fidelity manikin to improve interprofessional communication, skills and teamwork in transferring critically ill patients with COVID-19. METHODS: This single-blinded randomised control trial included 40 subjects allocated into standard low-fidelity simulator (LFS) and high-fidelity simulator (HFS) groups. Subjects, who were not members of multiprofessional team taking care of patients with COVID-19, in each group were assigned into small groups and joined an online interactive lecture session, two sessions of in-situ simulation and a debriefing session with strict health protocols. The first simulation aimed to teach participants the skills and steps needed. The second simulation aimed to assess transfer skills, communication and teamwork performance, that participants had learnt using a validated, comprehensive assessment tool. Data were analysed using unpaired t test or Mann-Whitney test. RESULTS: The HFS group showed significantly better overall transfer and communication skills than LFS group (89.70±4.65 vs 77.19±3.6, <0.05 and 100 vs 88.34 (63.33-100), p=0.022, respectively). The HFS group also demonstrated significantly better teamwork performance than the standard LFS group (90 (80-900) vs 80 (70-90), p=0.028). CONCLUSION: In situ simulation training using HFS significantly showed better performance than the standard training using LFS in regards to overall transfer and communication skills as well as teamwork performance. The training using HFS may provide a valuable adjunct to improve interprofessional skills, communication and teamwork performance in transferring critically ill patients with COVID-19.Trial registration numberNCT05113823.

Dampak positif pembelajaran online dalam sistem pendidikan keperawatan pasca pandemi COVID-19

Lonjakan perubahan metode pembelajaran terjadi cukup signifikan pada pandemi COVID-19. Setelah masuknya COVID-19 di Indonesia, pemerintah mengeluarkan kebijakan untuk menghilangkan pembelajaran tatap muka sementara. Pandemi COVID-19 telah menciptakan tantangan berikutnya dalam pendidikan keperawatan. Mahasiswa keperawatan, dilarang berpartisipasi dalam kesempatan belajar tatap muka dan pengalaman klinis "langsung". Dunia pendidikan keperawatan meresponnya dengan melakukan proses pembelajaran online melalui elearning (pembelajaran elektronik) yang dikembangkan oleh perguruan tinggi masing-masing dan sumber belajar online lainnya yang tersedia di dunia maya. Untuk mengakomodasi mahasiswa keperawatan yang dalam bahaya tidak maju dalam studi akademis mereka dan untuk menyelesaikan gelar. Kajian pustaka bertujuan untuk mengetahui gambaran metode pembelajaran selama pandemi. Pencarian literatur menggunakan database pubMed dan google scholar dengan kata kunci: pembelajaran online dan pendidikan keperawatan. Hasilnya adalah 5 jurnal periode 2016-2019 yang memenuhi kriteria inklusi. Hasil dari 5 jurnal yang dilihat secara lengkap melalui studi pustaka ini diperoleh 5 jurnal. Kesimpulan dari tinjauan pustaka ini adalah bahwa inovasi dan pengembangan serta penerapan dalam proses pembelajaran merupakan lompatan yang signifikan dalam budaya pembelajaran online: implementasi dari filosofi Merdeka Belajar-Kampus Merdeka. The Surge in learning method changes occurred quite significantly in the COVID-19 pandemic. After the inclusion of COVID-19 in Indonesia, the government issued a policy of eliminating temporary face-to-face learning. The COVID-19 pandemic has created the next challenges to nursing education. Nursing students, restricted from participation in face-to-face learning opportunities and "hands on" clinical experiences. The world of nursing education responds by conducting an online learning process through elearning (electronic learning) developed by their respective tertiary institutions and other online learning resources available in cyberspace. To accommodate nursing students that are in danger of not progressing in their academic studies and to degree completion. The literature review aims to find an overview of learning methods during the pandemic. Literature search used pubMed and Google Scholar databases with keywords: online learning AND nursing education. The results were 5 journals from the 2016-2019 timeframe that match the inclusion criteria. The results of 5 journals that were viewed in full through this literature review were obtained from 5 journals. The conclusion from this literature review is that innovation and development and application in the learning process are a significant leap in the culture of online learning: an implementation of the philosophy of Merdeka Belajar-Kampus Merdeka.

New normal sebagai momentum kebangkitan ekowisata: Sebuah kajian awal tentang daya dukung lingkungan pascapandemi COVID-19

Pandemi COVID-19 telah mengubah banyak hal dalam kehidupan. Salah satu yang cukup menonjol adalah perubahan perilaku. Istilah new normal kemudian menjadi sangat populer. Padanan terhadap istilah ini dalam bahasa Indonesia kemudian bermunculan antara lain kenormalan baru, normal baru, tatanan kehidupan baru, dan masih banyak lagi yang semua mengacu kepada keadaan normal yang baru. Keadaan normal baru ini antara lain (1) memakai masker ketika harus keluar rumah atau berinteraksi dengan orang lain yang tidak diketahui status kesehatannya;(2) mencuci tangan menggunakan sabun dengan air mengalir atau menggunakan cairan antiseptik berbasis alkohol/hand sanitizer;(3) menjaga jarak minimal satu meter dengan orang lain serta menghindari kerumunan keramaian dan berdesakan;serta (4) meningkatkan daya tahan tubuh dengan menerapkan perilaku hidup bersih dan sehat. Dalam konteks menjaga jarak minimal satu meter dengan orang lain serta menghindari kerumunan keramaian dan berdesakan inilah pembahasan tentang daya dukung lingkungan di bidang pariwisata dibahas dalam artikel ini. Dengan demikian tujuan penulisan artikel ini adalah untuk memberikan sebuah perspektif terhadap penerapan konsep daya dukung lingkungan di destinasi pariwisata pasca pandemi COVID-19. Metode pengumpulan data yang digunakan adalah studi literatur terhadap dokumen yang membahas tentang new normal dan ekowisata dikaitkan dengan kondisi kekinian. Berdasarkan hasil kajian terhadap berbagai literatur tersebut penulis menyimpulkan bahwa new normal merupakan sebuah kondisi yang bisa dijadikan sebagai momentum kebangkitan ekowisata khususnya terkait dengan penerapan konsep daya dukung lingkungan di destinasi pariwisata.