Desain Self-propelled Car Barge Untuk Distribusi Mobil Baru Rute Cikarang Bekasi Laut (Cbl) – Tanjung Perak

Berbagai upaya telah dilakukan Pemerintah untuk dapat mengurangi kemacetan jalur Pantura. Mulai dari pemberian jalur alternatif, pelebaran jalan, hingga pembuatan jalan tol baru. Segala upaya tersebut tidak sebanding dengan jumlah kendaraan yang terus meningkat melewati jalur Pantura, khususnya kendaraan-kendaraan barang seperti truk dan kontainer. Hal ini tidak terlepas dari geliat perekonomian yang terus tumbuh. Kawasan industri otomotif di sekitar Cikarang dan Bekasi salah satu contohnya. Jumlah produksi mobil domestik dan permintaan yang terus meningkat ini membutuhkan sarana yang baik dan cepat dalam mendistribusikan mobil baru ke berbagai daerah. Dalam beberapa tahun ini, Jawa Timur merupakan provinsi dengan tingkat permintaan mobil yang cukup tinggi di Indonesia. Oleh karena itu, salah satu solusi yang ditawarkan untuk dapat mengurangi kemacetan di jalur darat adalah berupa pengalihan transportasi darat ke sungai atau laut. Berdasarkan solusi tersebut, maka dibutuhkan alat transportasi pengangkut barang, dalam hal ini mobil, yang dapat melewati sungai dan laut. Self-propelled car barge diharapkan mampu menjadi inovasi yang cukup baik dalam mendistribusikan barang melalui rute Sungai Cikarang Bekasi Laut (CBL) menuju ke Pelabuhan Tanjung Perak. Untuk mendapatkan ukuran utama yang optimum digunakan metode optimation design approach dengan bantuan fitur solver pada program Microsoft Excel dengan menjadikan biaya pembangunan paling minimum sebagai fungsi objektif, serta adanya batasan-batasan dari persyaratan teknis dan regulasi yang ada. Dari proses optimisasi, didapatkan ukuran utama optimum Self-Propelled Car Barge adalah L=53.10 m, B=15.17 m, TFW=3.09 m, TSW=3.02 m, dan H=4.66 m, dengan estimasi biaya pembangunan sebesar $1.435.270,56 atau setara Rp.19.281.424.757,10

Continuity of cancer care: Where do primary care practitioners fit in?

Cancer is the leading cause of illness in Australia and is a national health priority. Primary care in Australia is well positioned to support individuals diagnosed with cancer and their family/caretakers. However, obstacles exist that impact on the quality and continuity of care that primary care providers and community health professionals can provide. A rapid review of the research available revealed that the knowledge, attitudes and beliefs held by health professionals and patients can impact engagement in early detection, treatment and follow-up care. Health professionals have limited knowledge of evidence-based practices, while cancer literacy among minority groups, including Aboriginal Australians, is lower than the population overall. In this paper, we provide a summary of the rapid review of the literature and provide some recommendations based on our research

Do patients with long-term side effects of cancer treatment benefit from general practitioner support? A literature review

Background: Alongside specialist cancer clinics, general practitioners have an important role in cancer patients’ follow-up care, yet no literature summarises the nature, extent and impact of their involvement. This paper addresses this issue through a review of the literature. Methods: Studies were sourced from six academic databases - AustHealth (n = 202), CINAHL (n = 500), the Cochrane Library (reviews and trials; n = 200), Embase (n = 368), PHCRIS (n = 132) and PubMed/Medline (n = 410). Studies that focused on interventions designed for patients receiving follow-up care and reported cancer care provided by a general practitioner delivered alongside specialist care were reviewed. Results: A total of 19 papers were identified as relevant for this review (3 randomised control trials; 4 cross-sectional, 5 cohort and 3 qualitative studies, and 3 systematic reviews). The reviewed studies indicated that providing general practitioner-led supportive interventions for post-treatment care of cancer patients is feasible and acceptable to patients. General practitioner involvement resulted in improved physical and psychosocial well-being of patients and continuity of care, especially for patients with concomitant health conditions. Conclusion: Involving general practitioners in post-treatment cancer care is beneficial to patients. However, proactive initiatives that encourage and facilitate patients to consult their general practitioner about their needs or symptoms of recurrence should be considered

Pengaruh Implementasi Pembelajaran Tematik terhadap Prestasi Belajar Ditinjau dari Motivasi Belajar pada Siswa Kelas IV Gugus Empat di Kecamatan Gianyar

This study aimed to determine (1) the difference between the academic achievement of students who take thematic learning compared to students who take conventional learning, (2) the effect of the interaction between learning strategies with students' motivation to learning achievement, (3) differences in academic achievement between students who following thematic learning compared to students who take conventional learning on students who have high motivation to learn, and (4) differences in academic achievement between students who take the thematic learning compared to students who take conventional learning on students with low learning motivation. Data were analyzed by analysis of variance with two lanes F-test. The results show that: (1) there are differences in student achievement between students who take the thematic learning and students who take conventional learning (FA = 5.008 with p <0.05), (2) There is an interaction effect between learning strategies and motivation toward achievement learning (FAB = 36.762 with p <0.05), (3) In the students who have high motivation to learn, there are differences in student achievement between students who take the thematic learning and students who take conventional learning (t-test = 5.870> t-table = 1.960), and (4) At the student who has a low learning motivation, there is a difference in student achievement between students who take the thematic learning and students who take conventional learning (t-test = 2.705> t-table = 1.960)

Developing and testing a strategy to enhance a palliative approach and care continuity for people who have dementia: Study overview and protocol

Background: Typically, dementia involves progressive cognitive and functional deterioration, leading to death. A palliative approach recognizes the inevitable health decline, focusing on quality of life. The approach is holistic, proactive, supports the client and the family, and can be provided by the client’s usual care team. In the last months of life, distressing symptoms, support needs, and care transitions may escalate. This project trialed a strategy intended to support a consistent, high quality, palliative approach for people with dementia drawing close to death. The strategy was to implement two communities of practice, drawn primarily from service provider organizations across care sectors, supporting them to address practice change. Communities comprised practitioners and other health professionals with a passionate commitment to dementia palliative care and the capacity to drive practice enhancement within partnering organizations. Project aims were to document: (i) changes driven by the communities of practice; (ii) changes in staff/practitioner characteristics during the study (knowledge of a palliative approach and dementia; confidence delivering palliative care; views on death and dying, palliative care, and a palliative approach for dementia); (iii) outcomes from perspectives of family carers, care providers, and community of practice members; (iv) the extent to which changes enhanced practice and care continuity; and (v) barriers to and facilitators of successful community of practice implementation. Methods/design: This action research project was implemented over 14 months in 2010/11 in metropolitan Perth, Western Australia and regional Launceston, Tasmania. Each state based community of practice worked with the researchers to scope existing practice and its outcomes. The research team compiled a report of existing practice recommendations and resources. Findings of these two steps informed community of practice action plans and development of additional resources. Change implementation was recorded and explored in interviews, comparisons being made with practice recommendations. Changes in staff/practitioner characteristics were evaluated using survey data. Findings from semi structured interviews and survey administration established outcomes from perspectives of family carers, care providers, and community of practice members. Consideration of processes and outcomes, across the two state based settings, informed identification of barriers and facilitators. Community of practice reflections also informed study recommendations

Implementing telephone triage in general practice: a process evaluation of a cluster randomised controlled trial

Background: Telephone triage represents one strategy to manage demand for face-to-face GP appointments in primary care. However, limited evidence exists of the challenges GP practices face in implementing telephone triage. We conducted a qualitative process evaluation alongside a UK-based cluster randomised trial (ESTEEM) which compared the impact of GP-led and nurse-led telephone triage with usual care on primary care workload, cost, patient experience, and safety for patients requesting a same-day GP consultation. The aim of the process study was to provide insights into the observed effects of the ESTEEM trial from the perspectives of staff and patients, and to specify the circumstances under which triage is likely to be successfully implemented. Here we report perspectives of staff. Methods: The intervention comprised implementation of either GP-led or nurse-led telephone triage for a period of 2-3 months. A qualitative evaluation was conducted using staff interviews recruited from eight general practices (4 GP triage, 4 Nurse triage) in the UK, implementing triage as part of the ESTEEM trial. Qualitative interviews were undertaken with 44 staff members in GP triage and nurse triage practices (16 GPs, 8 nurses, 7 practice managers, 13 administrative staff). Results: Staff reported diverse experiences and perceptions regarding the implementation of telephone triage, its effects on workload, and on the benefits of triage. Such diversity were explained by the different ways triage was organised, the staffing models used to support triage, how the introduction of triage was communicated across practice staff, and by how staff roles were reconfigured as a result of implementing triage. Conclusion: The findings from the process evaluation offer insight into the range of ways GP practices participating in ESTEEM implemented telephone triage, and the circumstances under which telephone triage can be successfully implemented beyond the context of a clinical trial. Staff experiences and perceptions of telephone triage are shaped by the way practices communicate with staff, prepare for and sustain the changes required to implement triage effectively, as well as by existing practice culture, and staff and patient behaviour arising in response to the changes made. Trial registration: Current Controlled Trials ISRCTN20687662. Registered 28 May 2009

Presence of Epstein-Barr virus latency type III at the single cell level in post- transplantation lymphoproliferative disorders and AIDS related lymphomas

AIMS: To investigate the expression pattern of Epstein-Barr virus (EBV) latent genes at the single cell level in post-transplantation lymphoproliferative disorders and acquired immunodefiency syndrome (AIDS) related lymphomas, in relation to cellular morphology. METHODS: Nine post-transplantation lymphoproliferative disorders and three AIDS related lymphomas were subjected to immunohistochemistry using monoclonal antibodies specific for EBV nuclear antigen 1 (EBNA1) (2H4), EBNA2 (PE2 and the new rat anti-EBNA2 monoclonal antibodies 1E6, R3, and 3E9), and LMP1 (CS1-4 and S12). Double staining was performed combining R3 or 3E9 with S12. RESULTS: R3 and 3E9 anti-EBNA2 monoclonal antibodies were more sensitive than PE2, enabling the detection of more EBNA2 positive lymphoma cells. Both in post-transplantation lymphoproliferative disorders and AIDS related lymphomas, different expression patterns were detected at the single cell level. Smaller neoplastic cells were positive for EBNA2 but negative for LMP1. Larger and more blastic neoplastic cells, sometimes resembling Reed-Sternberg cells, were LMP1 positive but EBNA2 negative (EBV latency type II). Morphologically intermediate neoplastic cells coexpressing EBNA2 and LMP1 (EBV latency type III), were detected using R3 and 3E9, and formed a considerable part of the neoplastic population in four of nine post-transplantation lymphoproliferative disorders and two of three AIDS related lymphomas. All samples contained a subpopulation of small tumour cells positive exclusively for Epstein-Barr early RNA and EBNA1. The relation between cellular morphology and EBV expression patterns in this study was less pronounced in AIDS related lymphomas than in post-transplantation lymphoproliferative disorders, because the AIDS related lymphomas were less polymorphic than the post-transplantation lymphoproliferative disorders. CONCLUSIONS: In post-transplantation lymphoproliferative disorders and AIDS related lymphomas, EBV latency type III can be detected by immunohistochemistry in a subpopulation of tumour cells using sensitive monoclonal antibodies R3 and 3E9. Our data suggest that EBV infected tumour cells in these lymphomas undergo gradual changes in the expression of EBV latent genes, and that these changes are associated with changes in cellular morphology

Options for early breast cancer follow-up in primary and secondary care : a systematic review

Background Both incidence of breast cancer and survival have increased in recent years and there is a need to review follow up strategies. This study aims to assess the evidence for benefits of follow-up in different settings for women who have had treatment for early breast cancer. Method A systematic review to identify key criteria for follow up and then address research questions. Key criteria were: 1) Risk of second breast cancer over time - incidence compared to general population. 2) Incidence and method of detection of local recurrence and second ipsi and contra-lateral breast cancer. 3) Level 1–4 evidence of the benefits of hospital or alternative setting follow-up for survival and well-being. Data sources to identify criteria were MEDLINE, EMBASE, AMED, CINAHL, PSYCHINFO, ZETOC, Health Management Information Consortium, Science Direct. For the systematic review to address research questions searches were performed using MEDLINE (2011). Studies included were population studies using cancer registry data for incidence of new cancers, cohort studies with long term follow up for recurrence and detection of new primaries and RCTs not restricted to special populations for trials of alternative follow up and lifestyle interventions. Results Women who have had breast cancer have an increased risk of a second primary breast cancer for at least 20 years compared to the general population. Mammographically detected local recurrences or those detected by women themselves gave better survival than those detected by clinical examination. Follow up in alternative settings to the specialist clinic is acceptable to women but trials are underpowered for survival. Conclusions Long term support, surveillance mammography and fast access to medical treatment at point of need may be better than hospital based surveillance limited to five years but further large, randomised controlled trials are needed

Addenda to Secondary Sources in Ismāʿīlī Studies: The Case of the Omissions

This bibliographic study identifies over 600 secondary sources published up to and including 2003 that have been omitted in previous bibliographies in Ismaili studies, namely, Farhad Daftary’s "Ismaili Literature: A Bibliography of Sources and Studies" (London, 2004) and Nagib Tajdin’s "A Bibliography of Ismailism" (Delmar, 1985). It encompasses all aspects of Ismaili thought and history, including the Fatimid and Alamut periods, as well as studies on modern Ismaili communities. The study consists of: an introduction that describes the research methods utilized, the omissions arranged in author-alphabetical order, and a subject index