Definition of patient complexity in adults: A narrative review.

Background: Better identification of complex patients could help to improve their care. However, the definition of patient complexity itself is far from obvious. We conducted a narrative review to identify, describe, and synthesize the definitions of patient complexity used in the last 25 years. Methods: We searched PubMed for articles published in English between January 1995 and September 2020, defining patient complexity. We extended the search to the references of the included articles. We assessed the domains presented in the definitions, and classified the definitions as based on (1) medical aspects (e.g., number of conditions) or (2) medical and/or non-medical aspects (e.g., socio-economic status). We assessed whether the definition was based on a tool (e.g., index) or conceptual model. Results: Among 83 articles, there was marked heterogeneity in the patient complexity definitions. Domains contributing to complexity included health, demographics, behavior, socio-economic factors, healthcare system, medical decisionmaking, and environment. Patient complexity was defined according to medical aspects in 30 (36.1%) articles, and to medical and/or non-medical aspects in 53 (63.9%) articles. A tool was used in 36 (43.4%) articles, and a conceptual model in seven (8.4%) articles. Conclusion: A consensus concerning the definition of patient complexity was lacking. Most definitions incorporated nonmedical factors in the definition, underlining the importance of accounting not only for medical but also for non-medical aspects, as well as for their interrelationship

Analisis Kualitas Pelayananan Izin Mendirikan Bangunan Di Kota Malang Tahun 2017

Sebagai negara yang sedang berkembang, Indonesia merupakan salah satu negara yang mempunyai tingkat pembangunan yang cukup tinggi. Dalam setiap pembangunan khususnya bangunan gedung, tentunya diperlukan suatu peraturan yang berfungsi sebagai sarana pengendali untuk menjamin bahwa bangunan yang akan dibangun dapat menjamin keselamatan orang-orang yang akan tinggal di dalam gedung tersebut serta orang-orang di sekitar gedung tersebut. Untuk itulah, Izin Mendirikan Bangunan sebagai sarana perizinan dalam rangka mendirikan/merubah bangunan dapat digunakan sebagai standar penyesuaian bangunan yang dapat melindungi keamanan masyarakat serta lingkungan sekitarnya. Selain itu, Izin Mendirikan Bangunan juga dapat digunakan sebagai jaminan hukum yang sah kepada masyarakat terhadap kepemilikan gedung Izin Mendirikan Bangunan tentunya sangat diperlukan khusunya di Kota Malang sebagai daerah rawan pemungutan liar. Untuk itulah, karena Izin Mendirikan Bangunan menjadi hal yang penting hal-hal seperti lambannya birokrasi, ketidakjelasan informasi, lamanya pemrosesan perizinan diharapkan tidak lagi menjadi kendala yang dapat menjadi penghambat bagi masyarakat yang ingin mengurus IMB di Kota Malang. Dinas Penanaman Modal dan Pelayanan Terpadu Satu Pintu yang merupakan bentuk kebijakan Pelayanan Terpadu Satu Pintu (PTSP) adalah salah satu usaha pemerintah untuk memberikan pelayanan yang optimal kepada masyarakat serta agar pelayanan publik itu sendiri lebih efektif. Tujuan dari penelitian ini adalah untuk melihat bagaimana kualitas pelayanan Izin Mendirikan Bangunan (IMB) pada Kota Malang. Dinas Penanaman Modal dan Pelayananan Terpadu Satu Pintu serta untuk mengetahui kendala-kendala yang dihadapi dalam penerbitan IMB. Untuk melihat apakah suatu proses pelayanan sudah berjalan dengan efektif atau tidak, maka digunakan suatu standar penilaian. Penelitian ini menggunakan metode penelitian deskriptif dengan pendekatan kualitatif. Kesimpulan yang diperoleh dari penelitian iniadalah bahwa kualitas penerbitan Izin Mendirikan Bangunan (IMB) pada Dinas Penanamanan Modal dan Pelayananan Terpadu Satu Pintu sudah lumayan berjalan efektif bila dilihat dari sisi organisasi, interpretasi serta pelaksanaaan. Kemudian, keterbatasan sumber daya manusia dan fasilitas fisik yang dimiliki, tidak terlaksananya fungsi pengawasan di lapangan terhadap bangunan yang tidak memiliki IMB, serta masih adanya masyarakat yang mengurus IMB setelah bangunannya selesai didirikan menjadi kendala yang dihadapi dalam penerbitan Izin Mendirikan Bangunan. Untuk itulah, ada baiknya dengan keterbatasan sumber daya manusia yang dimiliki organisasi tersebut dapat melakukan pelimpahan wewenang, serta perlunya diadakan sosialisasi mengenai IMB kepada masyarakat agar masyarakat memahami tata cara mengurus IMB

A Multi-Year Photopolarimetric Study of the Semi-Regular Variable V CVn and Identification of Analogue Sources

The semi-regular variable star V Canum Venaticorum (V CVn) is well-known for its unusual linear polarization position angle (PA). Decades of observing V CVn reveal a nearly constant PA spanning hundreds of pulsation cycles. This phenomenon has persisted through variability that has ranged by 2 magnitudes in optical brightness and through variability in the polarization amplitude over 0.3% and 6.9%. Additionally, the polarization fraction of V CVn varies inversely with brightness. This paper presents polarization measurements obtained over three pulsation cycles. We find that the polarization maximum does not always occur precisely at the same time as the brightness minimum. Instead, we observe a small lead or lag in relation to the brightness minimum, spanning a period of a few days up to three weeks. Furthermore, the PA sometimes exhibits a non-negligible rotation, especially at lower polarization levels. To elucidate the unusual optical behavior of V CVn, we present a list of literature sources that also exhibit polarization variability with a roughly fixed PA. We find this correlation occurs in stars with high tangential space velocities, i.e., "runaway" stars, suggesting that the long-term constant PA is related to how the circumstellar gas is shaped by the star's high-speed motion through the interstellar medium.Comment: 9 pages + appendices, 7 figures, accepted for publication in A&

An accurate determination of the Avogadro constant by counting the atoms in a 28Si crystal

The Avogadro constant links the atomic and the macroscopic properties of matter. Since the molar Planck constant is well known via the measurement of the Rydberg constant, it is also closely related to the Planck constant. In addition, its accurate determination is of paramount importance for a definition of the kilogram in terms of a fundamental constant. We describe a new approach for its determination by "counting" the atoms in 1 kg single-crystal spheres, which are highly enriched with the 28Si isotope. It enabled isotope dilution mass spectroscopy to determine the molar mass of the silicon crystal with unprecedented accuracy. The value obtained, 6.02214084(18) x 10^23 mol^-1, is the most accurate input datum for a new definition of the kilogram.Comment: 4 pages, 5 figures, 3 table

Indonesia Governance Index 2012: Towards a Well-informed Society and Responsive Government

Regional autonomy aims not only to increase welfare through provision of quality public services, but also to allow regions to determine their own development priorities. As a result, there is a range of different capacities and standards between local administrations and other stakeholders, leading to widening gaps in development between regions. Efforts to improve are limited by the analytical capacity and the quality of governance in each location. Because of this we need an objective assessment of governance and Kemitraan has adressed this need with the Indonesia Governance Index (IGI). This book examines the national findings of the 2012 IGI research, and offers concrete suggestions to solve current problems. It also elaborates on the results in key areas like gender, investment friendliness, and environmental management

Organic matter composition and heterotrophic bacterial activity at declining summer sea ice in the central Arctic Ocean

The Arctic Ocean is highly susceptible to climate change as evidenced by rapid warming and the drastic loss of sea ice during summer. The consequences of these environmental changes for the microbial cycling of organic matter are largely unexplored. Here, we investigated the distribution and composition of dissolved organic matter (DOM) along with heterotrophic bacterial activity in seawater and sea ice of the Eurasian Basin at the time of the record ice minimum in 2012. Bacteria in seawater were highly responsive to fresh organic matter and remineralized on average 55% of primary production in the upper mixed layer. Correlation analysis showed that the accumulation of dissolved combined carbohydrates (DCCHO) and dissolved amino acids (DAA), two major components of fresh organic matter, was related to the drawdown of nitrate. Nitrate‐depleted surface waters at stations adjacent to the Laptev Sea showed about 25% higher concentrations of DAA than stations adjacent to the Barents Sea and in the central Arctic basin. Carbohydrate concentration was the best predictor of heterotrophic bacterial activity in sea ice. In contrast, variability in sea‐ice bacterial biomass was largely driven by differences in ice thickness. This decoupling of bacterial biomass and activity may mitigate the negative effects of biomass loss due to ice melting on heterotrophic bacterial functions. Overall, our results reveal that changes in DOM production and inventories induced by sea‐ice loss have a high potential to enhance the bacterial remineralization of organic matter in seawater and sea ice of the Arctic Ocean

Lattice dynamics and correlated atomic motion from the atomic pair distribution function

The mean-square relative displacements (MSRD) of atomic pair motions in crystals are studied as a function of pair distance and temperature using the atomic pair distribution function (PDF). The effects of the lattice vibrations on the PDF peak widths are modelled using both a multi-parameter Born von-Karman (BvK) force model and a single-parameter Debye model. These results are compared to experimentally determined PDFs. We find that the near-neighbor atomic motions are strongly correlated, and that the extent of this correlation depends both on the interatomic interactions and crystal structure. These results suggest that proper account of the lattice vibrational effects on the PDF peak width is important in extracting information on static disorder in a disordered system such as an alloy. Good agreement is obtained between the BvK model calculations of PDF peak widths and the experimentally determined peak widths. The Debye model successfully explains the average, though not detailed, natures of the MSRD of atomic pair motion with just one parameter. Also the temperature dependence of the Debye model largely agrees with the BvK model predictions. Therefore, the Debye model provides a simple description of the effects of lattice vibrations on the PDF peak widths.Comment: 9 pages, 11 figure

Adaptive individual variation in phenological responses to perceived predation levels

The adaptive evolution of timing of breeding (a component of phenology) in response to environmental change requires individual variation in phenotypic plasticity for selection to act upon. A major question is what processes generate this variation. Here we apply multi-year manipulations of perceived predation levels (PPL) in an avian predator-prey system, identifying phenotypic plasticity in phenology as a key component of alternative behavioral strategies with equal fitness payoffs. We show that under low-PPL, faster (versus slower) exploring birds breed late (versus early);the pattern is reversed under high-PPL, with breeding synchrony decreasing in conjunction. Timing of breeding affects reproductive success, yet behavioral types have equal fitness. The existence of alternative behavioral strategies thus explains variation in phenology and plasticity in reproductive behavior, which has implications for evolution in response to anthropogenic change