Pengaruh Strategi Kompetitif, Aliansi Stratejik, Informasi Sistem Akuntansi Manajemen, dan Budaya Tri Hita Karana terhadap Sustainability Balanced Scorecard

Penelitian ini bertujuan untuk menguji pengaruh strategi kompetitif, aliansi stratejik, informasi SAM terhadap Sustainability Balanced Scorecard (SBSC). Penelitian ini membentuk konsep baru dalam peningkatan SBSC. Unit analisis penelitian ini adalah manajer umum hotel berbintang 3, 4 dan 5 di Provinsi Bali. Data primer diperoleh melalui survei. Pengujian hipotesis dilakukan dengan metode struktural. Hasil pengujian menunjukkan penelitian ini telah berhasil mengembangkan model baru, yang menunjukkan bahwa strategi kompetitif, aliansi stratejik, dan informasi SAM telah meningkatkan SBSC. Aliansi stratejik meningkatkan penggunaan informasi SAM. Temuan lain, pada hotel berbintang 3, informasi SAM bermanfaat dalam penerapan strategi kompetitif untuk meningkatkan SBSC. Pada hotel berbintang 4 dan 5, strategi kompetitif tidak harus dilakukan melalui pelaksanaan aliansi stratejik untuk meningkatkan SBSC. Temuan berikutnya, budaya Tri Hita Karana telah berhasil dibuktikan memiliki peranan untuk memperkuat penerapan strategi kompetitif agar SBSC meningkat. Kondisi ini memberikan makna bahwa untuk meningkatkan SBSC, diperlukan strategi yang menginternalisasi penerapan nilai-nilai budaya yang mengedepankan keharmonisan antar sesama manusia, lingkungan, dan Tuhan. Temuan terakhir, terdapat kepekaan kinerja keuangan pada saat terjadinya perubahan strategi kompetitif yang diambil oleh korporasi. Pada saat low season, korporasi “fit” menerapkan strategi low cost, sedangkan strategi diferensiasi “fit” diterapkan pada saat high season. Strategi diferensiasi akan menghasilkan kinerja keuangan yang lebih tinggi, jika dibandingkan dengan strategi low cost

Nuclear anomalies in the buccal cells of calcite factory workers

The micronucleus (MN) assay on exfoliated buccal cells is a useful and minimally invasive method for monitoring genetic damage in humans. To determine the genotoxic effects of calcite dust that forms during processing, MN assay was carried out in exfoliated buccal cells of 50 (25 smokers and 25 non-smokers) calcite factory workers and 50 (25 smokers and 25 non-smokers) age- and sex-matched control subjects. Frequencies of nuclear abnormalities (NA) other than micronuclei, such as binucleates, karyorrhexis, karyolysis and ‘broken eggs', were also evaluated. Micronuclei and the other aforementioned anomalies were analysed by two way analysis of covariance. The linear correlations between the types of micronucleus and nuclear abnormalities were determined by Spearman's Rho. There was a positive correlation between micronuclei and other types of nuclear abnormalities in accordance with the Spearman's Rho test. Results showed statistically significant difference between calcite fabric workers and control groups. MN and NA frequencies in calcite fabric workers were significantly higher than those in control groups (p < 0.05). The results of this study indicate that calcite fabric workers are under risk of significant cytogenetic damage

Unmappable ventricular tachycardia after an old myocardial infarction. Long-term results of substrate modification in patients with an implantable cardioverter defibrillator

Purpose The frequent occurrence of ventricular tachycardia can create a serious problem in patients with an implantable cardioverter defibrillator. We assessed the long-term efficacy of catheter-based substrate modification using the voltage mapping technique of infarct-related ventricular tachycardia and recurrent device therapy. Methods The study population consisted of 27 consecutive patients (age 68 +/- 8 years, 25 men, mean left ventricular ejection fraction 31 +/- 9%) with an old myocardial infarction and multiple and/or hemodynamically not tolerated ventricular tachycardia necessitating repeated device therapy. A total of 31 substrate modification procedures were performed using the three-dimensional electroanatomical mapping system. Patients were followed up for a median of 23.5 (interquartile range 6.5-53.2) months before and 37.8 (interquartile range 11.7-71.8) months after ablation. Antiarrhythmic drugs were not changed after the procedure, and were stopped 6 to 9 months after the procedure in patients who did not show ventricular tachycardia recurrence. Results Median ventricular tachycardias were 1.6 (interquartile range 0.7-6.7) per month before and 0.2 (interquartile range 0.00-1.3) per month after ablation (P = 0.006). Nine ventricular fibrillation episodes were registered in seven patients before and two after ablation (P = 0.025). Median antitachycardia pacing decreased from 1.6 (interquartile range 0.01-5.5) per month before to 0.18 (interquartile range 0.00-1.6) per month after ablation (P = 0.069). Median number of shocks decreased from 0.19 (interquartile range 0.04-0.81) per month before to 0.00 (interquartile range 0.00-0.09) per month after ablation (P = 0.001). One patient had a transient ischemic attack during the procedure, and another developed pericarditis. Nine patients died during follow-up, eight patients due to heart failure and one patient during valve surgery. Conclusion Catheter-based substrate modification using voltage mapping results in a long-lasting reduction of cardioverter defibrillator therapy in patients with multiple and/or hemodynamically not tolerated infarct-related ventricular tachyarrhythmia

Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis

BACKGROUND:Cesarean birth rates continue to rise worldwide with recent (2016) reported rates of 24.5% in Western Europe, 32% in North America, and 41% in South America. The objective of this systematic review is to describe the long-term risks and benefits of cesarean delivery for mother, baby, and subsequent pregnancies. The primary maternal outcome was pelvic floor dysfunction, the primary baby outcome was asthma, and the primary subsequent pregnancy outcome was perinatal death. METHODS AND FINDINGS:Medline, Embase, Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were systematically searched for published studies in human subjects (last search 25 May 2017), supplemented by manual searches. Included studies were randomized controlled trials (RCTs) and large (more than 1,000 participants) prospective cohort studies with greater than or equal to one-year follow-up comparing outcomes of women delivering by cesarean delivery and by vaginal delivery. Two assessors screened 30,327 abstracts. Studies were graded for risk of bias by two assessors using the Scottish Intercollegiate Guideline Network (SIGN) Methodology Checklist and the Risk of Bias Assessment tool for Non-Randomized Studies. Results were pooled in fixed effects meta-analyses or in random effects models when significant heterogeneity was present (I2 ≥ 40%). One RCT and 79 cohort studies (all from high income countries) were included, involving 29,928,274 participants. Compared to vaginal delivery, cesarean delivery was associated with decreased risk of urinary incontinence, odds ratio (OR) 0.56 (95% CI 0.47 to 0.66; n = 58,900; 8 studies) and pelvic organ prolapse (OR 0.29, 0.17 to 0.51; n = 39,208; 2 studies). Children delivered by cesarean delivery had increased risk of asthma up to the age of 12 years (OR 1.21, 1.11 to 1.32; n = 887,960; 13 studies) and obesity up to the age of 5 years (OR 1.59, 1.33 to 1.90; n = 64,113; 6 studies). Pregnancy after cesarean delivery was associated with increased risk of miscarriage (OR 1.17, 1.03 to 1.32; n = 151,412; 4 studies) and stillbirth (OR 1.27, 1.15 to 1.40; n = 703,562; 8 studies), but not perinatal mortality (OR 1.11, 0.89 to 1.39; n = 91,429; 2 studies). Pregnancy following cesarean delivery was associated with increased risk of placenta previa (OR 1.74, 1.62 to 1.87; n = 7,101,692; 10 studies), placenta accreta (OR 2.95, 1.32 to 6.60; n = 705,108; 3 studies), and placental abruption (OR 1.38, 1.27 to 1.49; n = 5,667,160; 6 studies). This is a comprehensive review adhering to a registered protocol, and guidelines for the Meta-analysis of Observational Studies in Epidemiology were followed, but it is based on predominantly observational data, and in some meta-analyses, between-study heterogeneity is high; therefore, causation cannot be inferred and the results should be interpreted with caution. CONCLUSIONS:When compared with vaginal delivery, cesarean delivery is associated with a reduced rate of urinary incontinence and pelvic organ prolapse, but this should be weighed against the association with increased risks for fertility, future pregnancy, and long-term childhood outcomes. This information could be valuable in counselling women on mode of delivery

Ferromagnetism at 19 K in a bimetallic compound based on 1,2-propanediamine ligand

We report the synthesis, magnetic characteristics and electron paramagnetic resonance (EPR) data on the new hexacyanometallate-based bimetallic molecular compound [Ni(pn)(2)](3).[Fe(CN)(6)](2). 12H(2)O, where pn = 1,2-propanediamine, which shows bulk ferromagnetic order below 19 K. It is a soft magnet exhibiting a rather weak hysteresis. The EPR spectra show a fine structure, characteristic of an S = 3/2 state, in a very narrow temperature region just above Te that is suggestive of the formation and ordering of S = 3/2 ferromagnetically coupled states of state of Ni2+ (S = 1) and Fe-III (S = 1/2) ions