Peluang Peningkatan Tipe Terminal di Kecamatan Banyumaik (Analisis Demand dan Supply)

Kecamatan Banyumanik merupakan kecamatan yang terus mengalami perkembangan baik dari jumlah penduduk maupun pelayanan kotanya. Kecamatan ini juga berbatasan langsung dengan kabupaten Semarang dan menjadi gerbang koridor semarang atas atau semarang bagian Selatan sehingga memiliki pergerakan yang tinggi sebagai jalur keluar masuknya kota Semarang. Pergerakan yang tinggi tersebut tidak diimbangi dengan ketersediaan fasilitas transportasi pendukung yaitu terminal. Terminal merupakan salah satu fasilitas utama yang memiliki peran penting dalam sistem transportasi. Menurut keputusan menteri nomor 35 tahun 2003 pengertian terminal adalah prasarana transportasi jalan untuk keperluan memuat dan menurunkan orang dan/atau barang serta mengatur kedatangan dan pemberangkatan kendaraan umum, yang merupakan salah satu wujud simpul jaringan transportasi. Terminal juga memiliki peran yang penting sebagai unsur tata ruang dalam kaitannya untuk meningkatkan mobilitas dan efisiensi kehidupan kota. Terminal merupakan tempat untuk mengurangi kemacetan dimana dapat mengatur lokasi pergantian moda transportasi menjadi lebih teratur. Lokasi sebuah terminal harus sesuai dengan rencana tata ruang wilayah (RTRW) dan sesuai dengan kebutuhan masyarakat Di kecamatan Banyumanik hanya memiliki sub terminal atau terminal bantu yang berfungsi sebagai tempat transit dan pergantian moda. Demand yang tinggi terhadap fasilitas transportasi tersebut tidak sebanding dengan supply fasilitas terminal yang tersedia sehingga mengakibatkan timbulnya titik-titik baru yang digunakan masyarakat untuk menunggu angkutan yaitu terminal bayangan. Terminal bayangan ini muncul karena adanya demand yang tinggi dari mayarakat banyumanik terhadap kebutuhan sarana transportasi dan efisiensi waktu. Ketidakseimbangan antara demand dan supply ini mengakibatkan berbagai dampak makro maupun mikro terhadap lalu lintas maupun jaringan angkutan di Kecamatan Banyumanik dan kota Semarang

Speech difficulties and patient health communication mediating effects on worry and health‐related quality of life in children, adolescents, and young adults with Neurofibromatosis Type 1

The objective was to investigate the serial mediating effects of speech difficulties, patient health communication, and disease‐specific worry in the relationship between neurofibromatosis (NF) symptoms (pain and skin symptoms) and total generic health‐related quality of life (HRQOL) in children, adolescents, and young adults with NF Type 1 (NF1) from the patient perspective. The Speech, Communication, Worry, Pain, Skin Itch Bother, and Skin Sensations Scales from the Pediatric Quality of Life Inventory (PedsQL) NF1 Module and the PedsQL 4.0 Generic Core Scales were completed in a multi‐site national study by 305 patients ages 5–25 years. A serial multiple mediator model analysis was conducted to test the hypothesized sequential mediating effects of speech difficulties, health communication, and worry as intervening variables in the association between NF1 symptoms and HRQOL. Symptoms predictive effects on total generic HRQOL were serially mediated by speech difficulties, patient health communication, and worry. In predictive analytics models utilizing hierarchical multiple regression analyses with age and gender demographic covariates, the pain, skin itch bother, and skin sensations multiple mediator models accounted for 61%, 59%, and 56% of the variance in generic HRQOL (p < .001), reflecting large effect sizes. Speech difficulties, patient health communication, and disease‐specific worry explain in part the mechanism of symptoms predictive effects on total generic HRQOL in pediatric patients with NF1. Identifying NF1‐specific predictors and serial mediators of total generic HRQOL in pediatric patients with NF1 from the patient perspective enables a patient‐centered comprehensive care approach for children, adolescents, and young adults with NF1

Early

Arthritis Rheum. 2004 Dec;50(12):3934-40. Early response to immunosuppressive therapy predicts good renal outcome in lupus nephritis: lessons from long-term followup of patients in the Euro-Lupus Nephritis Trial. Houssiau FA, Vasconcelos C, D'Cruz D, Sebastiani GD, de Ramon Garrido E, Danieli MG, Abramovicz D, Blockmans D, Mathieu A, Direskeneli H, Galeazzi M, Gül A, Levy Y, Petera P, Popovic R, Petrovic R, Sinico RA, Cattaneo R, Font J, Depresseux G, Cosyns JP, Cervera R. Université Catholique de Louvain, Brussels, Belgium. [email protected] Abstract OBJECTIVE: In the Euro-Lupus Nephritis Trial (ELNT), 90 patients with lupus nephritis were randomly assigned to a high-dose intravenous cyclophosphamide (IV CYC) regimen (6 monthly pulses and 2 quarterly pulses with escalating doses) or a low-dose IV CYC regimen (6 pulses of 500 mg given at intervals of 2 weeks), each of which was followed by azathioprine (AZA). After a median followup of 41 months, a difference in efficacy between the 2 regimens was not observed. The present analysis was undertaken to extend the followup and to identify prognostic factors. METHODS: Renal function was prospectively assessed quarterly in all 90 patients except 5 who were lost to followup. Survival curves were derived using the Kaplan-Meier method. RESULTS: After a median followup of 73 months, there was no significant difference in the cumulative probability of end-stage renal disease or doubling of the serum creatinine level in patients who received the low-dose IV CYC regimen versus those who received the high-dose regimen. At long-term followup, 18 patients (8 receiving low-dose and 10 receiving high-dose treatment) had developed permanent renal impairment and were classified as having poor long-term renal outcome. We demonstrated by multivariate analysis that early response to therapy at 6 months (defined as a decrease in serum creatinine level and proteinuria <1 g/24 hours) was the best predictor of good long-term renal outcome. CONCLUSION: Long-term followup of patients from the ELNT confirms that, in lupus nephritis, a remission-inducing regimen of low-dose IV CYC followed by AZA achieves clinical results comparable with those obtained with a high-dose regimen. Early response to therapy is predictive of good long-term renal outcome. PMID: 15593207 [PubMed - indexed for MEDLINE

Contemporary European practice in transcatheter aortic valve implantation:results from the 2022 European TAVI Pathway Registry

Background: A steep rise in the use of transcatheter aortic valve implantation (TAVI) for the management of symptomatic severe aortic stenosis occurred. Minimalist TAVI procedures and streamlined patient pathways within experienced Heart Valve Centres are designed to overcome the challenges of ever-increasing procedural volume. Aims: The 2022 European TAVI Pathway Survey aims to describe contemporary TAVI practice across Europe. Materials and methods: Between October and December 2022, TAVI operators from 32 European countries were invited to complete an online questionnaire regarding their current practice. Results: Responses were available from 147 TAVI centres in 26 countries. In 2021, the participating centres performed a total number of 27,223 TAVI procedures, with a mean of 185 TAVI cases per centre (median 138; IQR 77–194). Treatment strategies are usually (87%) discussed at a dedicated Heart Team meeting. Transfemoral TAVI is performed with local anaesthesia only (33%), with associated conscious sedation (60%), or under general anaesthesia (7%). Primary vascular access is percutaneous transfemoral (99%) with secondary radial access (52%). After uncomplicated TAVI, patients are transferred to a high-, medium-, or low-care unit in 28%, 52%, and 20% of cases, respectively. Time to discharge is day 1 (12%), day 2 (31%), day 3 (29%), or day 4 or more (28%). Conclusion: Reported adoption of minimalist TAVI techniques is common among European TAVI centres, but rates of next-day discharge remain low. This survey highlights the significant progress made in refining TAVI treatment and pathways in recent years and identifies possible areas for further improvement.</p