scholarly journals Application of the T-Test in Health Insurance Cost Analysis: Large Data Sets

ECONOMICS ◽  
2019 ◽  
Vol 7 (2) ◽  
pp. 157-167
Author(s):  
Bojan Kresojević ◽  
Milica Gajić
Keyword(s):  
Health Insurance ◽  
Statistical Tests ◽  
Bootstrap Method ◽  
T Test ◽  
Risk Level ◽  
P Value ◽  
Whitney Test ◽  
Mann Whitney Test ◽  
Insurance Cost ◽  
Two Samples

Abstract In this paper will be analyzed the application of the t-test against the nonparametric Mann - Whitney test in the analysis of health insurance benefit costs in the Republic of Srpska on large samples. This research aims to examine which method produces better results when testing statistical hypotheses. The adequacy of the statistical tests will be tested on primary health insurance cost data for 1,044,690 insureds in 2017. For two samples of size 4,000, the sampling distribution of the difference in two means has a skewness coefficient of 0.05 and a kurtosis coefficient of 3.09. Jarque - Bera test does not reject the hypothesis of normality of distribution with a p-value of 0.135. On the other hand, in the Mann - Whitney test, the real risk of the first species, when there is a difference in skewness between the samples, may be less than 0.001 compared to the nominal risk level of 0.05. Based on the results obtained, it is suggested to use the t-test instead of the Mann - Whitney test if the sample is large enough, which should be verified by the bootstrap method.

scholarly journals Pemberian Bubur Tempe terhadap Lamanya Diare Akut pada Balita di Puskesmas Puruk Cahu

2021 ◽  
Vol 7 (1) ◽  
pp. 27
Author(s):  
Happy Marthalena Simanungkalit ◽  
Muliana Muliana
Keyword(s):  
Health Center ◽  
Acute Diarrhea ◽  
Statistical Tests ◽  
Control Group ◽  
P Value ◽  
Whitney Test ◽  
Mann Whitney Test ◽  
Post Test ◽  
The Difference ◽  
Control Post

Diarrhea is currently still the third leading cause of under-five mortality after pneumonia. Diarrhea is one of the diseases that causes death and illness in toddlers every year. One result of diarrhea is nutritional disorders due to reduced food intake, vomiting, hypoglycemia, dehydration which causes metabolic balance disorders because fluid intake is not balanced with expenditure through vomiting and diarrhea. The purpose of this study was to determine the difference in the duration of diarrhea when giving tempeh porridge to toddlers at the Puruk Cahu Health Center. The design of this study is analytic research with this type of research is Quasi Experiment using the design of the Group Control Post Test Only Design. The population in this study were toddlers who had acute diarrhea in the working area of ​​Puruk Cahu Health Center, Murung Raya Regency and the sample size was 38 people (19 people as the control group and 19 experimental groups). The statistical test used in this study was the Mann Whitney test. The results of statistical tests using the Mann Whitney test found that p value = 0.002 means the value of p value < alpha (0.05), meaning that there is an effect of giving tempe porridge to the duration of diarrhea at Puruk Cahu Health Center. Diarrhea in the group that was not given tempeh porridge lasted longer than the group that was given tempeh porridge. The Conclusion is that there is a difference in the duration of acute diarrhea in the administration of tempe porridge for toddlers at the Puruk Cahu Health Center.

Effect of Outliers on the Relative Power of Parametric and Nonparametric Statistical Tests

1990 ◽  
Vol 71 (1) ◽  
pp. 339-349 ◽  
Author(s):  
Donald W. Zimmerman ◽  
Bruno D. Zumbo
Keyword(s):  
Population Distribution ◽  
Extreme Values ◽  
Statistical Tests ◽  
T Test ◽  
Standard Normal Distribution ◽  
Type I ◽  
Relative Power ◽  
Whitney Test ◽  
Mann Whitney Test ◽  
Initial Power

It is known that parametric statistical tests, such as t and F, are more powerful than their nonparametric counterparts, such as the Wilcoxon-Mann-Whitney test or the Kruskal-Wallis test, when the assumption of a normal population distribution is satisfied. However, it has been found that, for quite a few nonnormal distributions, the Wilcoxon-Mann-Whitney test ( W) is more powerful than the Student t-test ( t) both in the asymptotic limit and for small samples. The present computer-simulation study examined the role of outliers in determining the relative power of W and t. In a series of five steps, a standard normal distribution, as well as a uniform distribution, was altered so that extreme scores occurred with increasingly higher probability. It was found that the initial power advantage of t gradually diminished in favor of W. In contrast, in a series of five steps, exponential and Cauchy distributions were truncated at less and less extreme values, so that the influence of outliers was reduced, and the initial power advantage of W gradually diminished in favor of t. For all distributions, the ordinary Student t-test performed on the ranks of measures instead of the measures was affected by addition or elimination of outliers in the same way as W and yielded the same probabilities of Type I and Type II errors as W.

scholarly journals Peningkatan Kemampuan Interpretasi Electrocardiogram (ECG) Perawat Dengan Pembelajaran Pelatihan Dan Multimedia Di RSUD Dr. Soeratno Sragen

2017 ◽  
Vol 6 (1) ◽  
Author(s):  
Akhmad Rifai ◽  
Dwi Sulistyowati
Keyword(s):  
Statistical Tests ◽  
Test Group ◽  
Heart Association ◽  
Wilcoxon Test ◽  
Control Group ◽  
P Value ◽  
Whitney Test ◽  
Mann Whitney Test ◽  
Significant Difference ◽  
And Training

Abstract: Level Of Ability Of Nurses, ECG Interpretation. American Heart Association (AHA) in 2011, recorded more than 1.000.000 people have heart attacks every year, half died from the heart attack and in Europe figures reach 20,000-40,000 CHD patients than 1,000,000 population. In Indonesia in 2002 with acute myocardial infarction disease is the first cause of death with a mortality rate of 220,000 (14%). The purpose of this study to determine the level of ability to interpret ECG nurse in RSUD dr. Soeratno Gemolong Sragen. This research is an experimental approach to Pre-TestPost Test Group design. through research hypothesis testing. The study population was a nurse amounted to 50 respondents divided into two groups. 30 respondents as the treatment group and 20 respondents as the control group. Statistical tests on the group in pairs using the nonparametric Wilcoxon test and unpaired pad groups using the Mann-Whitney test. Based on the results of the Wilcoxon test can be concluded that the 30 respondents who do the training interpretation of ECG by means of training and training using the modules can be drawn the conclusion that the majority of nurses had good knowledge in terms of ability to interpret ECG with p-value 0.001, which means there are significant differences between before and after doing the training. While the results of the Mann-Whitney test the difference between training and training in how to use the module p-value 0.001, which means there is a significant difference training by way of training and training in how to use the module.

scholarly journals The Effectiveness of Clinical Learning Module on Competency Achievement of Nursing Students

2019 ◽  
Vol 3 (2) ◽  
pp. 84
Author(s):  
Arif Helmi Setiawan ◽  
Siti Nurjannah ◽  
Nur Muji Astuti
Keyword(s):  
Nursing Students ◽  
Treatment Group ◽  
Statistical Tests ◽  
Control Group ◽  
P Value ◽  
Clinical Learning ◽  
Whitney Test ◽  
Learning Module ◽  
Mann Whitney Test ◽  
Before And After

Introduction: Clinical learning is a very important component for nursing students to integrate theoritical with skills in real settings. However, the reality revealed that the achievement of student competency is still not fulfilled yet; this is due to the unstructured interaction between students and mentors. The purpose of this study was analyzed the competence of the clinical learning module on the competency achievement of nursing student. Methods: This research is a quasi-experiment with the pretest-posttesttwogroup research design. Research samples of students in two nursing school in Surabaya who met the criteria of 50 respondents as a treatment group and 50 respondents as a control group. The research instrument used questionnaires and clinical learning modules as well as competency achievement books. Data analysis used Wilcoxon sign ranks test and Mann Whitney test with α ≤ 0,05.Results: The results of statistical tests in the control group obtained P value 0.14 showed there were differences in achievement of competencies before and after, in the treatment group obtained P value 0.000 which means that there were differences in achievement of competencies before and after using the learning module, and the results of Mann Whitney Test obtained P 0.000 , means there is an influence of the clinical learning module on the achievement of the competence of nursing students.Conclusions: Nursing clinic learning requires interaction between students and mentors so that with this clinical learning module can effectively improve the achievement of the competence of nursing students.

scholarly journals Pengaruh Rangsangan Puting Susu dengan Pembukaan Serviks pada Persalinan Kala 1 Fase Aktif

2020 ◽  
Vol 10 (1) ◽  
pp. 51-55
Author(s):  
Dhita Yuniar Kristianingrum
Keyword(s):  
T Test ◽  
P Value ◽  
Whitney Test ◽  
Mann Whitney Test ◽  
Post Test ◽  
Group Post

Pendahuluan, Partus lama salah satu penyebab kematian di dunia  sebesar 8 % sedangkan di Indonesia sebesar 9 %. Dari studi pendahuluan didapatkan bahwa partus lama adalah penyebab kematian ibu terbayak yakni menduduki peringkat 5 di Indonesia. Tujuan, penelitian yaitu mengetahui pengaruh antara rangsangan puting susu dengan pembukaan serviks pada persalinan kala 1 fase aktif di Kamar Bersalin RSUD Jombang. Penelitian, ini adalah analitik pendekatan kuantitatif, metode quassy eksperiment atau eksperimen semu dengan two group post test desain. Populasi seluruh ibu bersalin Kala 1 fase aktif di Kamar Bersalin RSUD Jombang. Variabel independent yaitu rangsangan puting susu dan variabel dependent yaitu pembukaan serviks ibu bersalin kala 1 fase aktif. Uji yang digunakan yaitu uji independent T test ( Mann-Whitney test). Hasil, Berdasarkan hasil penelitian pada kelompok subjek hampir seluruh responden mengalami kemajuan persalinan dan kelompok kontrol sebagian besar responden tidak mengalami kemajuan persalinan, serta p value < α (0,015 < 0,05). Kesimpulan, ada  pengaruh antara rangsangan puting susu dengan pembukaan serviks pada persalinan kala 1 fase aktif di Kamar Bersalin RSUD Jombang. Kata kunci:  Rangsangan puting susu, pembukaan serviks, ibu bersalin kala 1

Abstract P022: Hypertriglyceridemic Waist Phenotype is Associated with Elevated Inflammatory Biomarker Levels

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Maithili Shenoy ◽  
Tushar Tuliani ◽  
Vikas Veeranna ◽  
Sandip Zalawadiya ◽  
Krunal H. Patel ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Uric Acid ◽  
Visceral Obesity ◽  
T Test ◽  
Inflammatory Biomarkers ◽  
P Value ◽  
C Peptide ◽  
Whitney Test ◽  
Mann Whitney Test ◽  
Hypertriglyceridemic Waist

Introduction: Hypertriglyceridemic waist (TGW) is an easily identifiable clinical phenotype, reflecting visceral obesity. Inflammatory markers and insulin resistance potentially serve as the genetic link between TGW, accelerated atherogenesis and cardiovascular outcomes. We describe characteristics of patients with TGW and the association between inflammatory biomarkers, insulin resistance and TGW. Methods: Our sample consisted of 3328 subjects from the National Health and Nutrition Examination Survey III (1988-1994). Subjects who did not have data regarding waist circumference (WC) or fasting serum triglycerides (TG) were excluded. TGW was defined as WC ≥ 90 cm and TG ≥ 176 mg/dl in males and WC ≥ 85 cm and TG ≥ 132 mg/dl in females. Biomarkers studied were serum ferritin, C Reactive protein (CRP), uric acid, fasting insulin and C-peptide. Stata 11 was used to perform T test (using log-transformed variables), Wilcoxon-Mann-Whitney test and logistic regression. Results: Our data consisted of 51% (1700) males, 56% (1847) Caucasians/16% (537) African Americans, 54% (1791) had hypertension, 12% (406) had diabetes, 38% (1255) had hyperlipidemia and 35% (1169) had TGW. Mean TG was 163+155mg/dl; mean WC was 99+14cm. Patients with TGW were older (61+ 12 vs. 59+13, p<0.001), male (54 vs. 48%, p 0.003), Caucasian (60 vs. 54%, p<0.001), had more hypertension (61 vs. 50%, p<0.001), hyperlipidemia (47 vs. 33%, p<0.001), diabetes (17 vs. 10%, p<0.001). T test and Wilcoxon-Mann-Whitney test revealed ferritin, CRP, uric acid, insulin and C-peptide to be higher among those who had TGW. They predicted TGW after adjustment for age, sex, race, glomerular filtration rate, hypertension, hypertension medications, hyperlipidemia, hyperlipidemia medications, diabetes, end stage renal disease and hemodialysis. (See table 1) Conclusion: Patients with TGW have worse clinical profiles. Inflammatory biomarkers and insulin resistance are associated with TGW. Genetic studies are required for further evaluation. Table 1. Biomarker Ferritin (ng/ml) CRP (mg/dl) Uric acid (mg/dl) Insulin (µU/ml) C peptide (ng/ml) Median (TGW) 115 0.33 5.6 13.3 1.02 Median (no TGW) 92 0.21 5.3 8.2 0.69 Β coefficient 0.202 0.236 0.091 0.543 1.171 95% CI 0.098-0.306 0.123-0.349 0.011-0.185 0.266-0.821 0.786-1.556 P value <0.001 <0.001 0.098 <0.001 <0.001

scholarly journals PERBEDAAN PENGARUH EFEK AKUT INSTRUMENT ASSISSTED SOFT TISSUE MOBILIZATION (IASTM) DAN SELF MYOFASCIAL RELEASE (SMFR) UNTUK MENINGKATKAN FLEKSIBILITAS OTOT HAMSTRING

2019 ◽  
Vol 3 (2) ◽  
pp. 9-23
Author(s):  
Wijianto . ◽  
Nizar Wazdi
Keyword(s):  
Soft Tissue ◽  
Range Of Motion ◽  
T Test ◽  
Myofascial Release ◽  
Whitney Test ◽  
Mann Whitney Test ◽  
Soft Tissue Mobilization ◽  
Paired T Test

Latar Belakang:  Instrumen Assisted Soft Tissue Mobilization (IASTM) merupakan prosedur terapi yang mana menggunakan instrumen untuk secara mekanik menstimulus struktur jaringan lunak untuk mengurangi nyeri otot, ketidaknyamanan, dan meningkatkan secara keseluruhan mobilitas dan fungsi Self Myofascial Release (SMFR) merupakan salah satu teknik manual terapi dengan cara memberikan tekanan pada otot dan fascia yang bertujuan untuk menambah Range of Motion (ROM), mengurangi nyeri, dan meningkatkan fungsi. Tujuan: Tujuan dari penelitian ini adalah untuk mengetahui efek akut perubahan fleksibilitas otot hamstring setelah diberikan IASTM dan SMFR, juga mengetahui adanya perbedaan efek akut antara pemberian IASTM dan SMFR pada perubahan fleksibilitas otot hamtring. Metode: Penelitian eksperimen dengan membandingan pre dan post tes dari dua kelompok yang berbeda perlakuan. Kelompok pertama diberikan perlakuan teknik IASTM, kelompok kedua diberikan perlakuan SMFR.  Data yang dikumpulkan dianalisa menggunakan paired t-test dan mann-whitney test. Hasil: Hasil penelitian menunjukkan efek akut IASTM terhadap fleksibilitas otot hamstring (p = 0,001), efek akut SMFR terhadap fleksibilitas otot hamstring  (p = 0,000), Perbedaan pengaruh antara passive dan active MFR terhadap ketegangan otot (p = 0,134). Kesimpulan: Terdapat peningkatan fleksibilitas otot hamstring pada grup 1 dan grup 2. Tidak ada beda pengaruh yang signifikan antara pemberian IASTM atau SMFR terhadap fleksibilitas otot hamstring.  Kata Kunci: Hamstring, instrumen assisted soft tissue mobilization, fleksibilitas, self  myofascial release.

scholarly journals PENGARUH MENYIKAT GIGI DENGAN SIWAK (Salvadora persica) TERHADAP pH SALIVA

2016 ◽  
Vol 4 (1) ◽  
pp. 45-54
Author(s):  
Yossy Juliarni ◽  
Gunawan Gunawan2
Keyword(s):  
T Test ◽  
Control Group ◽  
Case Group ◽  
Salvadora Persica ◽  
Control Group Design ◽  
Whitney Test ◽  
Mann Whitney Test ◽  
Significant Difference ◽  
Salivary Ph ◽  
Paired T Test

Background: Salivary pH is one of factor which involved in caries development. Decreasing of salivary pH will cause enamel demineralization. Miswak (Salvadora persica) as a toothbrush because it has mechanical and chemical effects such as essential oil and bicarbonate which can stimulate salivary secretion. Thus, it will increase the buffer capacity and salivary pH lead to enamel remineralization. Objective: This study aimed to know the effect of toothbrushing with miswak (Salvadora persica) on salivary pH. Methods: The clinical experiment study with pre-test and post-test control group design. The sample of this study is the students of Faculty of Dentistry, Andalas University, Padang. There are 34 students that divided into two groups randomly that is case and control group. Case group used miswak while control group used conventional toothbrush, respectively brushing horizontally for 2 minutes. Salivary pH was measured using digital pH meter in scale of 0.0 to 14.0 with 0.1 sensitivity from pen type pH meter. The data analyzed by Shapiro-Wilk test continued by paired t-test and Mann-Whitney test. Results: paired t-test produced significant value p=0,001 in case group and p=0,000 in control group. Mann-Whitney test produced significant value p=0.317. There was no significant difference in statistic among these groups. Conclusion: Toothbrushing with miswak has effect on salivary pH. Miswak as effective as toothbrush on salivary pH Keywords:Toothbrushing, miswak (Salvadora persica), Salivar

scholarly journals ANALISIS PERBANDINGAN KINERJA KEUANGAN BANK PEMERINTAH (BUMN) DAN BANK UMUM SWASTA NASIONAL (BUSN) DENGAN MENGGUNAKAN METODE PENDEKATAN RGEC (RISK PROFIL E,GOOD CORPORATE GOVERNANCE, EARNING AND CAPITAL)YANG TERDAFTAR DI BURSA EFEK INDONESIA TAHUN 2014-2018

2021 ◽  
Vol 9 (1) ◽  
pp. 127
Author(s):  
Debby Suciani ◽  
Yulita Triadiarti
Keyword(s):  
Corporate Governance ◽  
Risk Profile ◽  
T Test ◽  
Capital Adequacy ◽  
Return On Equity ◽  
Purposive Sampling ◽  
Whitney Test ◽  
Good Corporate Governance ◽  
Mann Whitney Test ◽  
Capital Adequacy Ratio

ABSTRAK Penelitian ini bertujuan untuk menguji apakah terdapat perbedaan kinerja keuangan yang signifikan antara bank pemerintah (BUMN) dengan Bank Umum Swasta Nasional (BUSN) di Bursa Efek Indonesia tahun 2014-2018. . Kinerja keuangan diukur dengan menggunakan metode pendekatan RGEC yaitu Risk Profile, Good Corporate Governance, Earning, and Capital. Aspek Risk Profile diukur menggunakan rasio Non Performing Loan (NPL),aspek Good Corporate Governance diukur menggunakan nilai komposit GCG, aspek Earning diukur menggunakan rasio Return on Equity (ROE), dan aspek Capital diukur menggunakan Capital Adequacy Ratio (CAR). Populasi dalam penelitian ini adalah seluruh bank yang terdaftar di Bursa Efek Indonesia (BEI) tahun 2014 - 2018. Dari 42 perbankan yang terdaftar, dipilih 4 bank pemerintah (BUMN) dan 4 Bank Umum Swasta Nasional dengan menggunakan purposive sampling. Data yang digunakan dalam penelitian ini adalah data sekunder, yang diperoleh dari situs www.idx.co.id, www.ojk.go.id, dan www.bi.go.id. Teknik analisis data yang digunakan adalah analisis deskriptif kuantitatif, uji normalitas, Independent Sample T-test dan Mann Whitney Test. Hasil penelitian menunjukkan bahwa terdapat perbedaan kinerja keuangan yang signifikan antara bank pemerintah (BUMN) dan Bank Umum Swasta Nasional (BUSN) dilihat dari aspek Earning yang diukur dengan rasio Return on Equity (ROE). Dan tidak terdapat perbedaan kinerja keuangan yang signifikan antara bank pemerintah (BUMN) dan Bank Umum Swasta Nasional (BUSN) jika dilihat dari aspek Risk Profile yang diukur dengan rasio Non Performing Loan (NPL), aspek Good Corporate Governance yang diukur dari nilai komposit GCG, dan aspek Capital yang diukur dengan Capital Adequacy Ratio (CAR). Kata Kunci : Perbandingan, Kinerja Keuangan, Non Performing Loan, Nilai Komposit GCG, Return on Equity, dan Capital Adequacy Ratio. 

scholarly journals EFEKTIVITAS POSISI TANGAN PENOLONG DALAM PENCEGAHAN RUPTUR PERINEUM PADA PERSALINAN NORMAL

2017 ◽  
Vol 9 (01) ◽  
pp. 68
Author(s):  
Mulyati Priyantini ◽  
Yuli Trisnawati
Keyword(s):  
Maternal Morbidity ◽  
P Value ◽  
Cross Sectional ◽  
Second Stage Of Labor ◽  
Whitney Test ◽  
Second Stage ◽  
Mann Whitney Test ◽  
Significant Difference ◽  
U Value ◽  
Quota Sampling

ABSTRAKFokus utama asuhan persalinan adalah pencegahan komplikasi untuk mengurangi angka kesakitan dan kematian ibu. Salah satu upaya adalah mencegah terjadinya ruptur perineum. Posisi tangan yang dipakai penolong persalinan kala II untuk mencegah ruptur perineum antara lain posisi tangan APN dan Varney. Penelitian ini bertujuan untuk mengetahui efektivitas antara posisi tangan penolong menurut APN dan menurut Varney dalam mencegah ruptur perineum spontan pada kala II persalinan di RSIA ‘Bunda arif’ Purwokerto. Penelitian ini merupakan penelitian observasional analitik, menggunakan pendekatan cross sectional dengan populasi seluruh persalinan spontan di RSIA ‘Bunda arif’ Purwokerto. Sampel yang digunakan adalah quota sampling  sebanyak 30 sampel yang memenuhi kriteria inklusi. Metode analisis data menggunakan uji U Mann-Whitney. Hasil penelitian ini adalah Kejadian ruptur perineum pada posisi tangan menurut APN sebanyak 93,3%, sedangkan menurut Varney sebanyak 86,7%. Hasil analisa statistik uji U Mann-Whitney didapatkan p value = 0,550 (p>0,005) sedangkan U value  = 33,000 (Uh < U t ), artinya tidak ada perbedaan bermakna, tetapi posisi tangan Varney lebih baik dengan selisih ruptur 6,6%. Posisi tangan penolong menurut Varney lebih efektif daripada posisi tangan menurut APN dalam pencegahan ruptur perineum spontan pada kala II persalinan, tetapi keduanya tidak memberikan perbedaan yang bermakna terhadap kejadian ruptur perineum. Penolong persalinan dapat menemukan metode yang paling tepat dalam meminimalisir kejadian ruptur perineum spontan untuk menurunkan angka kesakitan dan kematian ibu.Keyword : Posisi tangan penolong, ruptur perineumEFFECTIVENESS OF HANDLING POSITION IN PREVENTION OF PERINEUM RUPTURE IN NORMAL LABORABSTRACTMain focus of delivery care is preventing the complication to reduce the maternal morbidity and mortality. One of the efforts to prevent the occurance of perineal rupture. The position hand which is used birth attendant in the second stage of labor to prevent perineal rupture among others APN and Varney hands position. The goal of this reasearch is to know the effectiveness between APN and Varney hands position to prevent spontanoeus perineal rupture in the second stage of labor in RSIA ‘Bunda arif’ Purwokerto. This reasearch was observational analytic by approachment cross sectional with population of this reasearch was all of spontaneous delivery in RSIA ‘Bunda arif’ Purwokerto and the sample used quota sampling, it’s about 30 sample can be a inclusion criteria. The analyze method data used U Mann-Whitney test. The result of this experiment are precentage of spontaneous perineal rupture by  APN hands position is 93,3%, while by Varney is 86,7%. Result of statistic analysis used U Mann-Whitney test is p value = 0,550 (p>0.005) and U value  = 33,000 (Uh < U t). It means, not significant difference, but Varney hands position better by a margin of 6.6%. the conclusion are varney hands position is more effective than APN hands position in  prevention spontaneous perineal rupture in the second stage of labor, but both not significant for perinel rupture. Suggestion : Birth attendants can find the most appopriate method to minimize perineal ruptured to reduce maternal morbidity and mortalityKeyword : APN & Varney hands position, and perineal rupture.

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