Academic literature on the topic 'Samuel Marsden'

Moore College Library has successfully applied for four Community Heritage Grants from the National Library of Australia between 2009 and 2019. This report outlines the grant process and describes the conservation projects which have been undertaken on significant collections within Moore College's Samuel Marsden Archives.

Remarkably little is recorded to suggest that lunacy was regarded as a problem in the transports, by the reported suicides or the reactions to starvation, privation and cruelty in the early years of settlement [1]. Nevertheless, in 1787, Phillip, the first Governor of New South Wales, was specifically directed to exercise powers regarding the insane. Part of these orders were: “Wee have thought fit to entrust you with the care and commitment of the said ideots and lunaticks and their estates” [2]. From then onwards nothing is heard of “the lunaticks” until after Samuel Marsden was given official duties in this field.

In 1846, in his serialized novel Woman’s Love: A Romance of Smiles and Tears!, G. Herbert Rodwell (1800–52) introduced a Pākehā Māori character, ‘the wandering Missionary, Tang-goo’. Although Jules Sébastien César Dumont d’Urville (1790–1842) had included a Pākehā Māori in his earlier novel, Les Zélandais: Histoire Australienne, written in 1824–25, this remained unpublished, and therefore Rodwell’s Tang-goo appears to be the first such character in a published novel. Tang-goo is a richly imaginative conception drawing on various sources, including the Pākehā Māori who had come to London, a ‘White Father’ character in G. P. R. novel, The Gipsy, the Native American category of ‘medicine men’, the experiences of missionaries in New Zealand, especially Samuel Marsden’s 1820 travels, and the Biblical John the Baptist. For much of Rodwell’s novel, Tang-goo is taken to be authentically Māori and as such seems to be a fantastical representation of Britain’s civilizing influence in New Zealand. The novel’s late revelation that Tang-goo was born an English nobleman explodes such a fantasy and also subverts the stereotyped negative portrayals of Pākehā Māori in missionary literature. Tang-goo knows himself to be a unique figure; his creation of a Māori identity is complete only once he is dead.

MS Glow For Men merupakan brand skincare pria yang melakukan pendekatan komunikasi melalui penggunaan brand ambassador Babecabita dan Marshel Widianto dan tagline #SemuaJugaBisa. Penelitian ini dilakukan untuk menguji dan menganalisis adanya dan seberapa besar Pengaruh Brand Ambassador dan Tagline Terhadap Respon Khalayak Pada Brand MS Glow For Men baik secara parsial maupun simultan. Untuk melihat efek yang ditimbulkan brand ambassador dan tagline terhadap respon khalayak pada penelitian ini maka akan diukur melalui teori hierarchy of effect model yang terdiri dari 3 tahap yaitu cognitive stage, affective stage, dan behaviour stage. Metode penelitian yang digunakan adalah metode kuantitatif dengan menggunakan teknik analisis regresi linier berganda dan korelasi parsial. Teknik penentuan sampel menggunakan non probability sampling melalui pendekatan purposive sampling yang diujikan pada 100 responden. Hasil penelitian ini adalah ditemukan adanya pengaruh brand ambassador dan tagline secara parsial, dimana keduanya memiliki thitung > t tabel dan nilai signifikansi < 0,05. Kemudian brand ambassador memiliki pengaruh kuat sebesar 57,3049% terhadap respon khalayak dan tagline memiliki pengaruh kuat sebesar 38,1924% terhadap respon khalayak. Ditemukan bahwa adanya pengaruh signifikan dan positif brand ambassador dan tagline terhadap respon khalayak. Hal ini dibuktikan dengan Fhitung 84,139 > Ftabel 3,09 dan nilai signifikansi 0,000 < 0,5. Berdasarkan hasil koefisien determinasi didapatkan bahwa brand ambassador dan tagline berpengaruh terhadap respon khalayak sebesar 63,4% sedangkan 36,6% dipengaruhi oleh faktor lain diluar penelitian.

FAKTOR-FAKTOR YANG MEMPENGARUHI MORTALITAS PADA PASIEN DENGAN FRAKTUR COSTA: Literature Review Anna Tri Wahyuni1), Masfuri2), Liya Arista3)1,2,3 Fakultas Ilmu Keperawatan Universitas Indonesia ABSTRAK Cedera paling umum yang terjadi pada trauma tumpul adalah fraktur costa (patah tulang iga/rusuk) dimana mekanisme cedera berpotensi mengancam jiwa. Pasien fraktur costa yang menunjukkan tingkat keparahan trauma lebih dari 90% melibatkan kepala, perut dan ekstremitas. Nyeri yang dirasakan akibat dari fraktur costa berkontribusi pada gangguan pernafasan, peningkatan resiko pneumonia dan gagal nafas yang meningkatkan angka morbiditas dan mortalitas. Pedoman penanganan fraktur costa sangat dibutuhkan untuk terjadinya komplikasi. Studi literature ini bertujuan menganalisis faktor-faktor yang mempengaruhi mortalitas pada pasien fraktur costa. Metode penulisan artikel ini menggunakan literature review yang didapat melalui 5 online database yaitu Sage Publishing, Science Direct, SpringerLink, Pub Med dan Google Scholar. Kriteria inklusi jurnal terkait meliputi: free fulltext, berbahasa Indonesia atau Bahasa asing lainnya, metode penelitian prospective, retrospective, case-control, cohort dan terbit antara tahun 2004-2021. Kata kunci yang yang digunakan dalam pencarian adalah “Respiratory depression OR Respiratory failure AND fraktur ribs AND Mortality”. Dari pencarian artikel diperoleh hasil akhir sebanyak 7 artikel yang relevan dan dilakukan proses review. Artikel tersebut menunjukkan hasil bahwa angka mortalitas dipengaruhi oleh faktor usia, skor keparahan cedera, jumlah patah tulang rusuk, dan implementasi penanganan infeksi. Faktor usia, tingkat keparahan cedera dan jumlah tulang rusuk yang patah menentukan tinggi rendahnya angka mortalitas pasien fraktur costa. Penanganan yang tepat dan manajemen nyeri yang sesuai dapat mempengaruhi penurunan angka morbiditas dan mortalitas pasien dengan fraktur costa. Pengembangan intervensi perawatan pasien fraktur costa terkait manajemen nyeri dan kontrol infeksi menjadi penelitian menarik selanjutnya.Kata kunci : Depresi pernafasan, gagal nafas, fraktur iga, angka kematian, angka kesakitanABSTRACT The most common injury in blunt trauma is a rib fracture, where the mechanism of injury is potentially life-threatening. Patients with rib fracture whose severity of the injury is greater than 90% are associated with damage to the head, abdomen, and extremities. Pain from rib fractures contributes to respiratory failure, increasing the risk of pneumonia and respiratory failure, which increases morbidity and mortality. Recommendations are needed for the treatment of complicated rib fractures. This literature study aims to analyze the factors that influence mortality in rib fracture patients. The method of writing this article uses a literature review sourced from 5 online databases, namely Sage Publishing, Science Direct, SpringerLink, Pub Med, and Google Scholar. The inclusion criteria for related journals included: free full text, in Bahasa or another foreign language, prospective, retrospective, case-control, cohort study method, and published between 2004 and 2021. Keywords used in the search were: "respiratory depression OR respiratory failure AND rib fractures AND death." From the article search results, we obtained 7 relevant articles which are the final results and a review process is carried out. The article showed that mortality was influenced by age, injury severity score, number of rib fractures, and infection control practices. The mortality rate of patient with rib fracture is determined by Factors such as age, severity of injury, and number of rib fractures. Appropriate care and adequate pain management can help reduce morbidity and mortality in patients with rib fractures. Another interesting research is the development of interventions in the treatment of rib fracture patients related to pain management and infection control.Key words: respiratory depression; respiratory failure; rib fracture; mortality; morbidity. Alamat korespondensi: RSUD Dr.Kanujoso Djatiwibowo Jalan MT.Haryono No 656 Ringroad BalikpapanEmail: annazahra30@gmail.com PENDAHULUAN Fraktur costa adalah cedera pada dada karena trauma tumpul, tajam atau kondisi patologis angka morbiditas dan mortilitas. Berdasarkan Western Trauma Association (WTA) sekitar 10% kematian pada orang dewasa muda disebabkan oleh cedera patah tulang rusuk yang melibatkan kepala, perut dan ekstremitas. Sebaliknya, pasien lanjut usia dengan patah tulang rusuk memiliki setidaknya 20% kematian yang secara langsung menyebabkan gagal napas progresif dan pneumonia (Brasel et al., 2017). Risiko pneumonia meningkat sebesar 27%, dan kematian meningkat sebesar 19% untuk setiap fraktur costa lebih dari 2 pada kelompok lanjut usia (Wanek & Mayberry, 2004). Pasien dengan trauma dada atau fraktur costa harusnya dilakukan pemantauan ketat sejak masuk rumah sakit, 24 jam pertama merupakan identifikasi awal adanya komplikasi yang menyebabkan depresi pernafasan. Menurut penelitian Coary, et.al (2020) fraktur costa adalah cedera paling serius pada 55% pasien berusia di atas 60 tahun yang menyebabkan kematian karena 90% dari patah tulang rusuk menunjukkan cedera tambahan pada pemeriksaan sistemik. Trauma langsung dan hipoventilasi yang diinduksi nyeri menyebabkan komplikasi pernafasan sehingga menjadi beban morbiditas dan mortalitas. Komplikasi yang sering terjadi adalah pneumotoraks diikuti hemothoraks, kontusio paru dan flail chest.Nyeri adalah suatu pengalaman sensorik yang multidimensional dengan fenomena yang berbeda dalam intensitas (ringan,sedang, berat), kualitas (tumpul, seperti terbakar, tajam), durasi (transien, intermiten,persisten), dan penyebaran (superfisial atau dalam, terlokalisir atau difus) (Bahrudin, 2018). Induksi nyeri pada pasien dengan fraktur costa menyebabkan pasien kesulitan bernafas dimana keparahan memar paru yang mendasarinya signifikan dengan terjadinya hipoksemia atau gangguan pernafasan. Hal ini menyebabkan pasien cenderung membatasi pergerakan dan menjadi tirah baring lama. Kondisi tirah baring lama menyebabkan tubuh mengalami penurunan berbagai fungsi secara sistematis, yang disebut dengan sindroma dekondisi dan rentan terjadinya infeksi (Hashem, Nelliot, & Needham, 2016; Hunter, Johnson, & Coustasse, 2014; Phelan, Lin, Mitchell, & Chaboyer, 2018 dalam Ananta & Fitri, 2020).Fraktur costa atau patah tulang rusuk secara klinis penting disebabkan tiga hal yaitu: sebagai penanda penyakit serius cedera intrathoraks dan perut, sebagai sumber rasa sakit yang signifikan, dan sebagai prediktor untuk kerusakan paru, terutama pada pasien usia lanjut. Organ perut yang paling sering terluka adalah hati dan limpa. Pasien dengan patah tulang rusuk kanan, memiliki 19% hingga 56% kemungkinan cedera hati, sedangkan patah tulang sisi kiri memiliki 22% hingga 28% kemungkinan cedera limpa (Wanek & Mayberry, 2004). Kematian pada orang dewasa dan lansia cenderung terjadi kemudian (≥72 jam setelah masuk) dan biasanya sebagai akibat dari kegagalan multi-organ yang dipicu oleh insufisiensi pernapasan dan pneumonia sehingga tingkat kematian secara keseluruhan, tanpa memandang usia, diperkirakan antara 10 dan 12% (Wanek & Mayberry, 2004). Tingkat mortalitas untuk pasien trauma usia lanjut yang mengalami patah tulang rusuk lebih besar daripada mereka yang tidak mengalami cedera toraks (Coary, et.al, 2020). Penelitian yang dilakukan Marini, et.al, (2021) menyatakan indikator penyebab kematian pada pasien fraktur costa dengan atau tanpa trauma kepala dan cedera organ adalah usia, jenis kelamin, ISS (Injury Severe Score), dan GCS (Glasglow Coma Scale).Berdasarkan uraian diatas maka peneliti ingin menganalisis faktor-faktor yang mempengaruhi angka morbiditas dan mortalitas pada pasien dengan fraktur costa untuk meningkatkan pemahaman tentang penanganan fraktur costa serta mengidentifikasi dari beberapa artikel terkini dalam mengurangi mortalitas. METODE PENELITIAN Metode penulisan artikel ini menggunakan literature review yaitu studi yang berfokus pada hasil penulisan yang berkaitan dengan topik, tema atau variabel penulisan.dan dipakai untuk menghimpun data atau sebuah sintesa sumber-sumber yang berhubungan dengan topik penelitian (Nursalam, 2017). Didapatkan 5 database yang dilakukan melalui pencarian elektronik dari yaitu Sage Publishing, Science Direct, SpringerLink, Pub Med dan Google Scholar. Kriteria inklusi telaah jurnal ini adalah free fulltext, berbahasa Indonesia atau bahasa asing lainnya, dengan metode penelitian prospective, retrospective, case-control, cohort dan terbit tahun 2004-2021. Kata kunci yang yang digunakan dalam pencarian adalah “Respiratory depression OR Respiratory failure AND fraktur ribs AND Mortality”. HASIL DAN PEMBAHASAN Berdasarkan hasil studi literature terdapat banyak faktor yang mempengaruhi terjadinya depresi pernafasan pada pasien fraktur costa yang dapat menyebabkan kematian. Terdapat 17.500 artikel yang muncul setelah dilakukan telusur berdasarkan kata kunci dalam google scholar, 10.000 artikel tidak masuk kriteria inklusi, 350 artikel duplikat dengan database yang lain. Kemudian sisanya disaring kembali berdasarkan hasil abstrak, metode dan hasil temuan sesuai topik peneliti yang diinginkan dan diperoleh 7 artikel yang relevan dan tersedia dalam bentuk fulltext. Beberapa penelitian terkait pencegahan depresi pernafasan pada fraktur costa berfokus pada manajemen nyeri baik secara farmakologis maupun non farmakologis. Penanganan dan pemantauan yang ketat dapat mengurangi komplikasi yang menyebabkan terjadinya depresi pernafasan. Berikut faktor-faktor yang mempengaruhi angka morbiditas dan mortalitas pada fraktur costa menurut Coary, et.al (2020) yaitu: (1) Usia, pasien berusia > 65 tahun memiliki kematian 2-5 kali lebih tinggi dibandingkan usia dibawahnya pada kondisi fraktur costa lebih dari dua. Pasien dengan komorbid sering menjadi faktor penyulit ditambah dengan kondisi paru-paru yang buruk (misal: perokok). Faktor pemulihan menjadi terhambat disebabkan osteoporosis, sistem pernafasan yang buruk, gangguan pertukaran gas dan tergambar dari lama rawat inap. (2) Jumlah patah tulang, dari beberapa penelitian meta-analisis diperoleh hasil jumlah absolut fraktur tulang rusuk yang berjumlah >2 maka dua kali lebih mungkin meninggal dunia dibandingkan pasien dengan 1-2 patah tulang rusuk. (3) Posisi anatomi patah tulang, Fraktur costa bilateral memiliki resiko kematian lebih tinggi dimana segmen flail chest menghasilkan gerak paradox yang menyebabkan pergerakan dinding dada mengarah kedalam saat inspirasi sedangkan tulang rusuk yang sehat bergerak keluar sehingga ventilasi tidak adekuat dan terjadi depresi pernafasan dan kematian. Berbeda dengan penelitian yang dilakukan Brasel et al., (2006) faktor yang paling mempengaruhi kematian adalah faktor usia ditandai dengan Injury Severity Score (ISS) jika dikaitkan dengan peningkatan terjadinya pneumonia. Analisis yang menyatakan komorbiditas mempengaruhi kematian hal ini disertai dengan faktor usia bukan karena faktor komorbiditas murni. Komorbiditas yang biasanya menyertai fraktur costa menurut penelitian adalah komorbiditas yang spesifik seperti gagal jantung kongestif, aritmia, gagal ginjal, penyakit hati, kanker metastatik dan penyakit neurologis.Pada penelitian Bulger et al dalam Wanek & Mayberry, (2004), membandingkan pasien yang berusia minimal 65 tahun keatas dengan usia 18-64 tahun dengan metode cohort pada kasus fraktur costa pada kelompok >65 tahun memiliki dua kali mortalitas dan morbiditas yang tinggi. Risiko pneumonia meningkat sebesar 27%, dan kematian meningkat sebesar 19% untuk setiap fraktur tulang rusuk tambahan pada kelompok lanjut usia.Nyeri adalah keluhan yang paling dirasakan oleh pasien dengan fraktur costa. Oleh sebab itu penanganan manajemen nyeri untuk mengontrol nyeri terus-menerus dan mencegah depresi pernafasan harus diberikan terapi yang agresif dengan pendekatan multimodalitas. Penelitian yang dilakukan oleh Peek, et.al, (2019) dengan membandingkan pemberian analgesik dengan 4 metode yaitu analgesia epidural, analgesia intravena, blok paravertebral dan blok intercostal, diperoleh hasil berdasarkan systematic review dan meta-analysis analgesia epidural signifikan mengurangi rasa sakit dibandingkan intervensi yang lain. Intervensi keperawatan sendiri menekankan pada terapi non farmakologis untuk kontrol nyeri pada pasien fraktur. Terapi nonfarmakologis dengan guided imagery dapat mengurangi intensitas dan skala nyeri pada pasien fraktur. Guided imagery mempengaruhi hampir semua fisiologis sistem kontrol tubuh yaitu pernapasan, denyut jantung, tekanan darah, tingkat metabolisme dalam sel, mobilitas dan sekresi gastrointestinal, fungsi seksual, dan bahkan respon imun (Rossman, 2000). Intervensi ini juga dapat mempercepat penyembuhan pasien dan mengurangi hari rawat inap (Forward et.al, 2015) Gambar 1. Algorithma fraktur costa (Brasel K.J, et.al, 2016).Western Trauma Association (WTA) menyatakan algorithma penanganan fraktur costa sebagai suatu observasi atau pemantauan ketat pada fraktur costa lebih dari 2 patah tulang (Brasel et.al, 2017). Berdasarkan algoritma diatas maka pasien dengan patah tulang rusuk >2 dengan usia lebih dari 65 tahun jika pada observasi kurang dari 24 jam menunjukkan peningkatan pada depresi pernafasan maka segera pindahkan ke ICU dan pertimbangkan penggunaan ventilator dan operasi rib fixaxion. Penggunaan terapi analgesia epidural digunakan untuk kontrol nyeri dilanjutkan batuk efektif, tehnik relaksasi nafas dalam dan mobilisasi dini (Brasel et.al, 2017). Analisis terkait studi literatur untuk memperkuat hasil analisis terdapat pada masing-masing artikel dibawah ini. Tabel 1. Artikel terkait faktor-faktor yang mempengaruhi terjadinya depresi pernafasan pada pasien dengan fraktur costa.Study citationMetode penelitian Desain PenelitianSampel dan Jumlah sampelHasil temuanA multidisciplinary clinical pathway decreases rib fracture–associated infectious morbidity and mortality in high-risk trauma patientsTodd,et.al,(2006)prospective cohort study Non eksperimental150 pasien dari Februari 2002-Oktober 2004 dengan > 45 tahun dan>4 patah tulang rusuk.Diperoleh hasil usia, skor keparahan cedera, dan jumlah patah tulang rusuk, jalur klinis menurunkan mekanisme hari tergantung ventilator, lama rawat inap, morbiditas infeksi, dan mortalitas dengan (interval kepercayaan 95% [CI] P<0.01).Predicting outcome of patients with chest wall injuryPressley, et.al, (2012)retrospectively reviewedNon eksperimental649 pasien (Juni 2008 hingga Februari 2010) termasuk usia, jumlah patah tulang, cedera bilateral, adanya kontusio paru, klasifikasi memar, LOS, masuk ICU, ventilasi mekanikSebuah sistem penilaian sederhana memprediksi kemungkinan bahwa pasien akan memerlukan ventilasi mekanik dan perawatan yang berkepanjangan. Skor 7 atau 8 memprediksi peningkatan risiko kematian, penerimaanke ICU, dan intubasi. Skor 5 memprediksi lama tinggal yang lebih lama dan periode ventilasi yang lebih lama. Factors Affecting Pneumonia Occurring to Patients with Multiple Rib FracturesByun & Kim., (2013).retrospectively reviewedNon eksperimentalData rekam medis 327 pasien laki-laki rata-rata usia 53 tahun dengan fraktur costa akibat kecelakaan dari Januari 2002- Desember 2008.Faktor yang mempengaruhi pneumonia pada pasien dengan fraktur tulang rusuk multipel dalam analisis multivariat termasuk usia (p=0,004), ISS (p＜0,001), dan skor tulang rusuk(p=0,038). Penggunaan antibiotik tidak berhubungan dengan kejadian pneumonia (p=0,28).Determinants of Mortality in Chest Trauma PatientsEkpe & Eyo, (2014)Retrospective and prospective Non eksperimental149 pasien dengan trauma thoraks 121 laki-laki, 28 perempuan dari Januari 2007-Desember 2011Variabel bebas, umur, jenis kelamin dan jenis cedera dada tidak terbukti berkorelasi dengan mortalitas dengan nilai P >0,05. Namun adanya cedera organ ekstra toraks terkait, skor MEWS saat masuk tinggi> 9, cedera pada interval presentasi lebih dari 24 jam, dan cedera dada yang parah ditandai dengan keterlibatan dada bilateral yang berkorelasi positif dengan mortalitas dengan nilai P <0,05.The number of displaced rib fractures is more predictive for complications in chest trauma patientsChien et.al, (2017)retrospectively reviewedNon eksperimentalJanuari 2013 -Mei 2015 diperoleh data di rumah sakit dengan total pasien 3151. Pasien yang dirawat dengan trauma dada dan patah tulang rusuk, termasuk cedera otak, limpa, panggul atau hatiJumlah patah tulang rusuk yang bergeser bisa menjadi prediktor kuat untuk berkembangnya penyakit paru-paru komplikasi. Untuk pasien dengan kurang dari tiga patah tulang rusuk tanpa perpindahan tulang rusuk dan paru-paru awal atau cedera organ lainnya, manajemen rawat jalan bisa aman dan efisien.Is the number of rib fractures a risk factor for delayed complications? Flores-Funes, et.al, (2020)Retrospective case–control studyNon eksperimentalPasien yang dirawat dengan diagnosis patah tulang rusuk antara 2010 dan 2014, diperoleh 141 pasien.Tidak ada perbedaan dalam karakteristik dasar pasien (usia, jenis kelamin dan Indeks Komorbiditas Charlson) antara kedua kelompok. Perbedaan ditemukan pada jumlah fraktur pada kelompok tanpa komplikasi p>0,05 (tidak signifikan) pada kelompok dengan komplikasi, (p=0,05) dan pada penurunan kadar hemoglobin (p=0,01). Hari rawat inap bervariasi pada setiap kelompok tetapi tanpa signifikansi statistik (p=0,11). Kesimpulan: Jumlah fraktur iga yang paling baik memprediksi munculnya komplikasi (delayed pleuro-pulmonary) dan perdarahan yang lebih besar) adalah patah tulang rusuk 3 atau lebihPredictors of mortality in patients with rib fracturesMarini, et.al, (2021) Retrospective review Non eksperimental1188 pasien patah tulang rusuk dan cedera tambahan yang dirawat selama Januari 2013-Desember 2014; 800 laki-laki dan 388 perempuan Usia, GCS, jenis kelamin laki-laki, dan Injury Severity Score (ISS) tetapi tidak jumlah patah tulang rusuk dan/atau Pulmonary contusion merupakan prediksi kematian. Peningkatan mortalitas pada pasien patah tulang rusuk dimulai pada usia 65-80 tahun tanpa peningkatan lebih lanjut. Jumlah patah tulang rusuk bukan faktor independen peningkatan mortalitas terlepas dari usia. Severe traumatic brain injury adalah penyebab kematian paling umum pada pasien usia 16-65 tahun, dibandingkan dengan komplikasi pernapasan pada pasien berusia 80 tahun atau lebih. Banyak penelitian yang telah dilakukan untuk menentukan faktor prediktor kematian pada pasien fraktur costa. Dari 7 artikel di atas terdapat berbagai bukti yang mempengaruhi kematian akibat fraktur costa dengan metode penelitian yang berbeda.Penelitian Chien, et.al, (2017) dan Flores-Funes, et.al, (2020) menunjukkan hasil yang hampir sama dimana jumlah fraktur costa yang >2 akan meningkatkan angka morbiditas dan mortalitas dikarenakan faktor komplikasi pada paru. Berbeda dengan penelitian yang dilakukan Marini, et.al, (2021) yang menyatakan jumlah dari fraktur costa tidak memprediksi peningkatan mortalitas terlepas dari usia. Menurut peneliti faktor usia menjadi prediktor utama dalam menentukan angka mortalitas pada pasien dengan fraktur costa, dimana peningkatan mortalitas pada pasien patah tulang rusuk dimulai pada usia 65-80 tahun ke atas.Penelitian yang dilakukan Todd et.al,(2006) menghasilkan hipotesa bahwa usia, skor keparahan cedera, dan jumlah patah tulang rusuk, dan implementasi jalur klinis signifikan dengan penurunan lama perawatan di unit perawatan intensif, lama rawat inap di rumah sakit, infeksi pneumonia, dan mortalitas. Maka semakin lanjut usia, tingkat keparahan yang tinggi dan jumlah patah tulang rusuk bilateral atau >2 dapat meningkatkan angka morbiditas dan mortalitas pasien dengan fraktur costa.Penelitian Pressley et.al, (2012) dilakukan dengan melakukan analisis dengan menggunakan trauma dada scoring system dimana skor >7 memprediksi peningkatan risiko kematian, penerimaan ke ICU, dan intubasi. Penilaian scoring system ini dapat digunakan untuk memprediksi kemungkinan pasien akan memerlukan ventilasi mekanik dan perawatan yang berkepanjangan sehingga dapat memperparah penyakit, menimbulkan infeksi oportunistik dan menyebabkan resiko mortalitas.Penelitian Ekpe & Eyo, (2014) menggunakan system MEWS (modified early warning signs) untuk menganalis faktor prognosis pada pasien dengan trauma dada. Sebagai variabel bebas, umur, jenis kelamin dan jenis cedera dada tidak terbukti berkorelasi dengan mortalitas dengan nilai P >0,05. Namun adanya cedera organ ekstra toraks terkait, skor MEWS saat masuk tinggi> 9, dimana interval presentasi lebih dari 24 jam dengan cedera dada yang parah ditandai dengan keterlibatan dada bilateral, berkorelasi positif pada mortalitas. Berbeda dengan penelitian sebelumnya Byun & Kim., (2013) dimana faktor umur berpengaruh pada terjadinya infeksi pneumonia dan meningkatkan angka mortilitas dengan atau tanpa diikuti tingkat keparahan pada trauma dada.Berdasarkan analisis diatas terdapat persamaan hasil penelitian dimana rata-rata metode penelitian yang dilakukan dengan menggunakan retrospective review non eksperimental. Peneliti mengamati data rekam medis dari beberapa rentang waktu dengan kriteria inklusi menderita patah tulang rusuk lebih dari dua. Namun, terdapat kriteria yang berbeda-beda pula dimana peneliti memasukkan trauma tambahan seperti brain injury dan cedera pada organ yang lain. Jumlah sampel antara penelitian satu dengan yang lain juga berbeda dari ratusan hingga ribuan data yang dianalisis. Hal ini menyebabkan hasil penelitian yang diperoleh sedikit berbeda antara satu dengan yang lain.Manajemen fraktur costa berfokus pada manajemen nyeri yang adekuat, batuk efektif, relaksasi nafas dalam dan mobilisasi dini (Brasel et al., 2017). Berdasarkan beberapa penelitian manajemen nyeri pada pasien orthopedic terutama pasca operasi adalah dengan guided imagery. The American Holistic Nurses Association menyatakan guided imagery adalah modalitas holistik yang membantu klien dalam menghubungkan pengetahuan batin mereka pada pemikiran, perasaan, dan tingkat penginderaan, mempromosikan penyembuhan bawaan mereka dengan kemampuan bersama-sama memandu klien mengatasi stres; resolusi konflik; masalah pemberdayaan diri; dan persiapan medis-bedah (Integrative & Review, 2016). Oleh sebab itu, guided imagery tepat jika digunakan pada managemen nyeri non farmakologis yang diterapkan dalam intervensi keperawatan.Dalam teori keperawatan Jean Watson tentang Transpersonal Caring mendefinisikan hubungan manusia yang bersifat caring, bersatu dengan orang lain dengan menghargai klien seutuhnya termasuk keberadaannya di dunia (Alligood, 2014). Watson menyatakan kepedulian transpersonal caring adalah dasar dari teori kepedulian manusia dimana fokus dari kepedulian transpersonal adalah pada peduli, penyembuhan, dan keutuhan, bukan pada penyakit, sakit dan patologi yang mencakup 10 faktor karatif dalam konsep utamanya (Integrative & Review, 2016). Sesuai dengan teori Watson, Guided Imagery (GI) menggabungkan kedua sains (melalui praktik berbasis bukti) dan seni (melalui aplikasi untuk berlatih) untuk mengobati rasa sakit pasien menggunakan imaginasi terbimbing dan teknik relaksasi nafas dalam. Kombinasi dengan terapi obat, GI menyediakan rezim pengobatan holistik untuk manajemen nyeri untuk menenangkan pikiran dan merilekskan tubuh mereka, memberikan kesempatan bagi klien untuk menciptakan lingkungan penyembuhan internalnya sendiri (Integrative & Review, 2016).Intervensi keperawatan untuk batuk efektif dan mobilisasi dini termasuk poin penting dalam manajemen perawatan pasien fraktur costa. Batuk efektif adalah suatu metode batuk dengan benar dan pasien dapat mengeluarkan dahak secara maksimal untuk mengeluarkan sekret dari saluran pernapasan bawah (Potter dan Perry, 2006). Mobilisasi sendiri dapat menghasilkan outcome yang baik bagi pasien seperti meningkatkan pertukaran gas, mengurangi angka Ventilator Associated Pneumoia (VAP), mengurangi durasi penggunaan ventilator, dan meningkatkan kemampuan fungsional jangka panjang (Green, Marzano, Leditschke, Mitchell, & Bissett, 2016 dalam Ananta & Fitri, 2020). Oleh sebab itu, kedua intervensi ini perlu diteliti lebih lanjut guna mengembangkan riset terkait manajemen pasien fraktur costa. SIMPULAN Pasien dengan usia lanjut dengan patah tulang rusuk atau fraktur costa biasanya menunjukkan tingkat kelemahan, multi-morbiditas, dan kompleksitas medis yang tinggi (Coary, et.al, 2020). Hal ini tentu menjadi penghambat dalam faktor penyembuhan tulang dan dapat meningkatkan angka mortalitas. Pemaparan hasil analisis menggambarkan faktor usia, cedera tulang rusuk atau costa bilateral lebih dari 2, terjadinya komplikasi dan cedera pada organ lain menyebabkan pasien harus dirawat di ruang ICU lebih lama karena resiko infeksi dan komplikasi yang dapat meningkatkan angka morbiditas dan mortalitas.Terlepas dari faktor usia, tingkat keparahan cedera dan jumlah tulang rusuk yang patah menentukan haluaran pasien yang lebih baik. Penanganan fraktur costa yang tepat yang berfokus pada kontrol kerusakan, manajemen nyeri, fiksasi seleksi, dan kualitas hidup mempengaruhi penurunan angka morbiditas dan mortalitas pasien dengan fraktur costa. Kedudukan dan peran perawat spesialis dalam tugas mengatur asuhan klien dengan kompleksitas tinggi menjadi sangat penting (Masfuri, et.all, 2019) SARAN Penelitian klinis terkait implementasi keperawatan berbasis kasus masih jarang dilakukan. Implementasi keperawatan pada pasien dengan fraktur costa terkait manajemen nyeri dan kontrol infeksi menjadi penelitian yang menarik untuk dilakukan karena hal ini menjadi indikator faktor yang mempengaruhi angka mortalitas pasien dengan fraktur costa. DAFTAR PUSTAKA Alligood Raile Martha,2014, Nursing Theorits and their Work, 8th edition, by Mosby, an imprint of Elsevier IncAnanta Tanujiarso, B., & Fitri Ayu Lestari, D. (2020). Mobilisasi Dini Pada Pasien Kritis Di Intensive Care Unit (Icu): Case Study. 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This thesis examines the transmission of Protestantism to Australia by the early British colonists and its consequences for their engagement with the land between 1788 and 1850. It explores the ways in which colonists gave religious meaning to their surrounds, particularly their use of exile and exodus narratives to describe journeying to the colony and their sense of their destination as a site of banishment, a wilderness or a Promised Land. The potency of these scriptural images for colonising Europeans has been recognised in North America and elsewhere: this study establishes and details their significance in early colonial Australia. This thesis also considers the ways in which colonists’ Protestant values mediated their engagement with their surrounds and informed their behaviour towards the land and its indigenous inhabitants. It demonstrates that leading Protestants asserted and acted upon their particular values for industry, order, mission and biblicism in ways that contributed to the transformation of Aboriginal land. From the physical changes wrought by industrious agricultural labour through to the spiritual transformations achieved by rites of consecration, their specifically Protestant values enabled Britons to inhabit the land on familiar material and cultural terms. The structural basis for this study is provided by thematic biographies of five prominent colonial Protestants: Richard Johnson, Samuel Marsden, William Grant Broughton, John Wollaston and John Dunmore Lang. The private and public writings of these men are examined in light of the wider literature on religion and colonialism and environmental history. By delineating the significance of Protestantism to individual colonists’ responses to the land, this thesis confirms the trend of much recent British and Australian historiography towards a more religious understanding of the eighteenth and early nineteenth centuries. Its overarching argument is that Protestantism helped lay the foundation for colonial society by encouraging the transformation of the environment according to the colonists’ values and needs, and by providing ideological support for the British use and occupation of the territory. Prominent Protestants applied their religious ideas to Australia in ways that tended to assist, legitimate or even necessitate the colonisation of the land.

Doctor of Philosophy
This thesis examines the transmission of Protestantism to Australia by the early British colonists and its consequences for their engagement with the land between 1788 and 1850. It explores the ways in which colonists gave religious meaning to their surrounds, particularly their use of exile and exodus narratives to describe journeying to the colony and their sense of their destination as a site of banishment, a wilderness or a Promised Land. The potency of these scriptural images for colonising Europeans has been recognised in North America and elsewhere: this study establishes and details their significance in early colonial Australia. This thesis also considers the ways in which colonists’ Protestant values mediated their engagement with their surrounds and informed their behaviour towards the land and its indigenous inhabitants. It demonstrates that leading Protestants asserted and acted upon their particular values for industry, order, mission and biblicism in ways that contributed to the transformation of Aboriginal land. From the physical changes wrought by industrious agricultural labour through to the spiritual transformations achieved by rites of consecration, their specifically Protestant values enabled Britons to inhabit the land on familiar material and cultural terms. The structural basis for this study is provided by thematic biographies of five prominent colonial Protestants: Richard Johnson, Samuel Marsden, William Grant Broughton, John Wollaston and John Dunmore Lang. The private and public writings of these men are examined in light of the wider literature on religion and colonialism and environmental history. By delineating the significance of Protestantism to individual colonists’ responses to the land, this thesis confirms the trend of much recent British and Australian historiography towards a more religious understanding of the eighteenth and early nineteenth centuries. Its overarching argument is that Protestantism helped lay the foundation for colonial society by encouraging the transformation of the environment according to the colonists’ values and needs, and by providing ideological support for the British use and occupation of the territory. Prominent Protestants applied their religious ideas to Australia in ways that tended to assist, legitimate or even necessitate the colonisation of the land.

In 1518, Martin Luther is reputed to have nailed his 95 theses to the door of the Castle Church at Wittenberg, an act that sparked the Protestant Reformation. Luther sought change in the Catholic Church: a return to an unmediated relationship with God based on a closer understanding of the Word. Since then, Protestant evangelism has been a force for social change: and this is particularly true in New Zealand, where evangelism has gone hand in hand with the colonisation of the country. This thesis proposes that it is not, in fact, the literal understanding of the Word that gives these services meaning, and that such an understanding is problematic and perhaps even impossible: the Word is always a translation. Instead, it is through what is not said - the performative aspects of evangelistic services, including the use of space, the actions of the evangelist, and pre-existing cultural “horizons of expectation” - that meanings are produced. Taking as material Samuel Marsden’s first service in New Zealand in 1814, in which the Word was preached in English to a congregation who primarily spoke only Maori, the more contemporary example of televangelist Benny Hinn, who performs miracles to television cameras, and the religious and political performances of Destiny Church’s Brian Tamaki, this thesis uses the tools of performance studies to undertake an ethnographic study of evangelistic services. This brings into focus the ways in which evangelists may create congregations and produce meanings in their services through different modes of performance and the ways in which these ulterior meanings impact, and have impacted, on New Zealand society.

The first Evangelical minister whom I ever met, once asked me to preach in St Peter's Church Hobart. It was part of a very novel decision to involve laymen and so the minister thought that for a six weeks' trial period he would have lay people delivering the sermons. I knew nothing about Evangelicalism and I was to be the first of the six speakers. I and two of my colleagues had just had a long, tiresome but victorious struggle for equal pay for women teachers, so I chose as my text Hebrews 11:1 "Now faith is the substance of things hoped for, the evidence of things not seen," and my sermon was to be about a better and more equal deal for women in the church. The novel decision was cancelled immediately and I learned quite an amount about Evangicalism, especially that it is not given to a woman to be the bringer of good tidings. In cases where it does happen, it is customary to shoot the messenger. I wish to thank the late Reverend Herbert Condon, Archdeacon Lou Daniels, Dr Richard Ely and Joanne Webb for their considerable help and interest in this project.

Wetlands, marshes, and swamps have great natural importance. They have a number of important environmental functions, supporting the water balance of the area and ensuring its high biodiversity. This is reflected in the wide range of ecosystem services provided within this area. At the same time, they are one of the most vulnerable ecosystems on the planet. The study of the carbon cycle, emissions, and absorption in the current climate change and conditions and anthropogenic pressures are important and urgent tasks in terms of refining the climate models and more accurate determination of climate impacts to the environment and society. This study proposes a methodological approach based on the classification methods of remote sensing data to identify different types of land cover. This chapter is focused on the CO2 adsorption by wetlands with the GOSAT satellite data usage. During the 2010-2020 years, the changes in CO2 concentration were estimated.

The Isle of Sheppey lies in the mouth of the Thames tucked up along the northern coastline of Kent, south-eastern England. Known to the Romans as insula orivum, and accessible for centuries only by ferry, the small Isle waited until 1860 for the construction of its first permanent bridge, over the River Swale to the mainland. It contains an uneasy mixture of lowland agricultural farmland, tourism, and commercial shipping activities, all divided by a diagonal east-to-west line of low hills. Elmley Marshes, situated on the southern side of the Isle, attract thousands of ducks, geese, and wading birds in the winter. Further to the east lies the Swale National Nature Reserve, a mosaic of grazing land and salt marshes that is home to short-eared owls and hen harriers. Fine beaches dotted along the northern coastline near to the traditional seaside town of Leysdown-on-Sea draw tourists whose spending boosts the local economy. Discovery of a deep-water channel off the north-west coast saw the construction of a Royal Navy dockyard at Sheerness in 1669. The new dockyard was replaced 290 years later by the commercially successful Port of Sheerness, which benefits from the capacity to accommodate large modern ships regardless of the tides. Geology and the sea have combined to shape the cultural and economic aspects of the Isle from its earliest days. In the early part of the nineteenth century, pyrite—iron sulfide—collected from the beaches and foreshore provided a source of green vitriol dye for the tanning and textiles industries. At around the same time, a small industry flourished excavating cement stones (septaria) for the manufacture of Parker’s (or Roman) cement. But the supply of septarian nodules on the beaches was soon exhausted and, with the emergence of more economic means of producing cement, the industry collapsed. The fleeting septaria industry mirrors the fleeting existence of Sheppey, for the Isle is shrinking fast as wave action erodes metres of its cliffs each year. Ultimately, in no more than a geological instant, the Isle of Sheppey and its inhabitants will be gone.

Unusually heavy rains in the winter of 1969 transformed California’s normally dry Owens Valley, causing an explosion of grasses and reeds along the edge of the Owens River. Lying in the eastern rain shadow of the Sierra Nevada, not far from Death Valley, the river flows south down the valley before disappearing into a dry lake bed. By summer the heavy vegetation along the river and its adjacent spring-fed marshes was sucking up moisture and releasing it into the hot, dry air. At the same time, the flow from one of these springs suddenly and mysteriously dropped, and parts of a wetland called Fish Slough began to dry up fast. The disappearance of the small pools that make up Fish Slough would have gone unnoticed in a world not reshaped by human hands. Desert springs and marshes can be verdant one year, parched the next. Human activity, however, had made Fish Slough a vital place. The need for water to support Los Angeles and other cities has led to all manner of water projects, including dams, reservoirs, canals, and aqueducts. One of those projects, the Los Angeles Aqueduct, diverted nearly all the water from the Owens River beginning in 1913, greatly reducing the flows that once created seasonally flooded shallows along the river’s edge. Those shallow, warm waters provided ideal habitat for a unique species offish, the Owens pupfish (Cyprinodon radiosus). The loss of habitat, along with the introduction of exotic species like largemouth bass, gradually eliminated the pupfish from most of its relatively limited range, until the species remained only in Fish Slough. If the marsh disappeared, so would the Owens pupfish. Alerted to the potential disaster, Phil Pister, a fishery biologist working nearby with the California Department of Fish and Game, and two colleagues grabbed nets, buckets, and aerators and raced for the pond (Pister 1993). They removed the last 800 of the two-inch-long pupfish to wire mesh cages in the main channel of the slough. As his colleagues drove off, thinking the pupfish at least temporarily secure, Pister realized that the cages were in eddies out of the main current and that the water in the eddies was not carrying enough dissolved oxygen.

There is ample evidence that a progressive change in the intensity of an important environmental factor leads to the formation of zones or belt-like communities in which the plant species reflect a fairly distinct range of tolerance for that factor (Daubenmire 1968). Zonation has been defined as a sequence of vegetation in space and succession as a sequence of vegetation in time (McIntosh 1980). A zone is an area occupied by a plant community that is distinctly different from other zones and can be readily recognized by a change in dominant vegetation. Striking examples of zonation are found in salt marshes, mountain slopes and ponds because of soil salinity in salt marshes, decrease in temperature on mountain slopes and increase in water depth in ponds (Daubenmire 1968; Chapman 1976; Partridge and Wilson 1988). Similarly, it has long been known (Beck 1819) that sand dunes along sea coasts exhibit a zonation pattern extending from the beach to inland dunes. The zones are discrete and occur in parallel series with distinctly different species composition that is related to the ability of plant species to withstand the environmental factors prevailing in that zone (Doing 1985). Many later studies using transects from the shoreline to the inland dunes have confirmed that the taxa are not randomly distributed; they peak at definite distances from the beach (Oosting and Billings 1942; Boyce 1954; Martin 1959; Barbour 1978; Barbour et al. 1985). Succession in coastal dunes is an example of primary succession because the sandy material deposited on the shoreline by waves is inert. The term is generally used to denote a directional change in species composition and physiognomy of vegetation at the same site over time (Drury and Nisbet 1973). However, only the very early stages of dune succession can be observed during the life time of a plant ecologist and the later stages are usually inferred from plant communities represented on older sand dunes. It is hypothesized that the autogenic influence of early colonizers alters environmental conditions in the habitat and facilitates the establishment of new species better adapted to live in the altered habitat.

This chapter discusses three families of theoretical mechanisms—homophily, proximity (physical and electronic), and social support—that have been identified by social scientists as important motivations for why we create, maintain, dissolve, and reconstitute our communication networks. While much of this research is conducted in nonorganizational settings, this chapter focuses on the theory and research that we consider to be most germane to communication and other organizational networks. Several researchers have attempted to explain communication networks on the basis of homophily, that is, the selection of others who are similar. Brass (1995a, p. 51) notes that “similarity is thought to ease communication, increase predictability of behavior, and foster trust and reciprocity.” Homophily has been studied on the basis of similarity in age, gender, education, prestige, social class, tenure, and occupation (Carley, 1991; Coleman, 1957; Ibarra, 1993b, 1995; Laumann, 1966; Marsden, 1988; McPherson & Smith-Lovin, 1987). Several lines of reasoning provide support for the homophily hypothesis. These fall into two general categories: the similarity-attraction hypothesis (Byrne, 1971) and the theory of self-categorization (Turner, 1987). The similarity-attraction hypothesis is exemplified in the work of Heider (1958) who posited that homophily reduces the psychological discomfort that may arise from cognitive or emotional inconsistency. Similarly, Sherif (1958) suggested that individuals were more likely to select similar others because by doing so they reduce the potential areas of conflict in the relationship. The theory of self-categorization (Turner & Oakes, 1986) suggests that individuals define their social identity through a process of self-categorization during which they classify themselves and others using categories such as age, race, gender. Schachter (1959) argued that similarity provided individuals with a basis for legitimizing their own social identity. The manner in which individuals categorize themselves influences the extent to which they associate with others who are seen as falling into the same category. It is easy to see that the theoretical mechanism by which homophily influences the likelihood of a communication relation is based on the similarity among specific attributes of the actors.

English is a subtle language with many words that offer fine shades of meaning, but it also can be blunt and unequivocal. Dictionaries were not made for words such as hairdo, ballpark, or pigpen. The law, however, as practiced by Americans, can mutate the meaning of even the humblest word. If the law concerns itself with pigpens, then we must know whether a pigpen still exists when the pigs are removed and, if so, for how long. We must know if a pen originally built for cattle can become a pigpen if occupied by pigs and if pigpens are the same in all parts of the nation. In short, we must have federal guidance, regional interpretations, legal specialists, and technical authorities on pigpens. So it is with wetlands. The chapters of this book will show how troublesome the definition of wetlands has become since the federal government began regulating them. In the meantime, it will suffice to define wetlands informally as those portions of a landscape that are not permanently inundated under deep water, but are still too wet most years to be used for the cultivation of upland crops such as corn or soybeans. Wetlands, in other words, coincide pretty well with the common conception of swamps, marshes, and bogs. Government has had its hand in wetlands for about 150 years. Between the 1850s and 1970s, the federal government was intent on eliminating wetlands. Since then, it has been equally intent on preserving them. An individual who behaved in this manner would seem at least irresponsible. Many critics of federal wetland policy have in fact given the government a sound thrashing for its inconsistency, but the shift from elimination to protection of wetlands has continued nevertheless. Blaming government is the duty of a free people, and also good sport. Even so, the obvious truth about wetland regulation is that government has merely reflected a change in public attitude toward wetlands. Most Americans now believe that wetlands should be saved throughout the nation, except possibly on their own property. Americans did not always feel this way. Most European colonists of North America came from homelands that were essentially tame.

Louisiana coast experiences significant erosion due to wave actions. The loss of beaches in some coastal areas in Louisiana is severe. There are wetlands and marshes located in the coastal areas. Wetland loss is a major threat to the coast areas. 3D numerical simulations of wave-levee interactions were conducted, and the results were analyzed to determine the flow characteristics and surface shear distributions. The simulation setup is exactly the same as an experiment conducted in a wave tank facility. The velocity histories on different locations near the test levee surface were compared, and the agreement is very good, therefore the simulation is validated. A test levee system was also constructed on a test Gulf beach site, approximately 4.6 miles west of Holly Beach in Cameron Parish, Louisiana. Long term observation of erosion was conducted, and survey data showing the change of the test levee were produced. From the observations, the loss of this portion of Gulf beach is significant during the 2-year research period. Real-time images were recorded to show this significant change in topography. The losses of the levee materials during the entire project period were quantified based on the survey data. The history of the loss was plotted. It indicates some major storm event contributed to significant losses and erosion of the test structure. It can be seen from the results that the real-time erosion pattern on the test site agrees reasonably with the surface shear patterns from the simulations. In the numerical simulation, commercial package ANSYS-FLUENT was used. A free-surface flow model is adopted with open channel wave boundary conditions. A grid-independence study was performed to determine to appropriate grid resolution to be used in the simulation. Parallel computing was conducted due to the expensive cost of this 3D simulation with relatively fine grid resolutions.

Buried steel pipelines are one of the most efficient means of transporting oil and gas from their resource deposits to their markets. The pipeline industry is experiencing an increased demand for larger diameter pipelines along with the implementation of thinner walls and higher operating pressures. In these cases, the external pipeline loads have significant effect on the pipeline stresses and deformations, thus influencing wall thickness and associated cost effectiveness. The external loads are made up of the weight of the backfill material combined with live and impact loads due to traffic. For the designs of buried pipelines, API RP1102, CSA Z662, American Lifelines Alliance (ALA) “Guidelines for the Design of Buried Pipelines”, ASCE “Design and Installation of Buried Pipes” and AWWA Manual M11 are commonly used to calculate external loads on buried pipelines. For the calculation of backfill loads, these methods are based mainly on the same theory, i.e., Marston load theory, while the calculation of live load, due to traffic loads, is based on different approaches. Depending on the design methodology selected, there is a large variation in the calculated external loads due to both backfill and live loads. In this paper, the experimental results of a field monitoring program will be compared with the calculated results from the various methods. An alternative approach for calculating external loads is presented and verified to field studies. In addition, for the design of onshore pipelines the industry uses design criteria which are based on allowable stress and ovalization deformation limits. Pipe stresses and deformations resulting from the external loads are commonly based on the Spangler stress and the Iowa equations. The parameters in the formulas include pipe and soil properties, pipe-soil stiffness and the geometric relation of a pipe section during deformation. As pipe materials, pipe sizes, operating means and pipe coating techniques change over time, the allowable design criteria shall be re-examined, especially for the ovalization deformation limits. In this paper the allowable strain and the corresponding ovalization deformation limits are re-examined by reviewing experimental results and industrial requirements.