Analisis Kebutuhan Parkir Pada Rumah Sakit Umum Kelas B Di Kota Semarang

Parking is one of the important elements of urban transportation, such, it has various long and short-term impacts on individuals, societies, and transportation systems. It affects to the transportation mode selection. People tend to drive private car when the representative parking area is available. This research is focused at the determination of the parameters that affect the use of parking area. The parameters are expected to be useful in estimating the parking area demand of the hospital class B in Semarang. There are six major parameters describing the parking slot, i.e.: accumulation, parking volume, total spaces available (capacity), parking turnover, peak time, duration of occupancy and occupancy. Three hospitals are selected as object of the study; there are RS Telogorejo, RS Elisabeth and RS dr Kariadi. The survey is carried out by direct investigation and questionnaire. Statistical analysis by using linear regression, logarithmic, quadratic, and exponential, indicated that the amount of bed used has a very high correlation with the parking demand. The next highest correlation is observed between medical specialist and parking demand. The average duration in RS Telogorejo is 15 – 30 minutes, RS Elisabeth is 30 minutes – 2 hours, and RS dr Kariadi is 15 – 30 minutes for car. For motorcycle, the average duration in RS Telogorejo is 30 minutes – 1 hour, RS Elisabeth is 30 minutes – 2 hours, and RS dr Kariadi is above 4 hours. From the study, it was found that the ratio between parking demand for vehicle and the number of bed being used is 0.89, meanwhile the ratio between parking demand for motorcycle and the number of bed being used is 1.29. Other alternative of parking facility like special parking building area is recommended to be considered for the hospital with limited area

Efficacy and safety of ixekizumab in patients with plaque psoriasis across different degrees of disease severity: results from UNCOVER-2 and UNCOVER-3

PURPOSE: To evaluate short- and long-term efficacy and safety of ixekizumab in patients according to psoriasis severity. MATERIALS AND METHODS: Data were integrated from clinical trials (UNCOVER-2, UNCOVER-3). Patients received placebo, 80-mg ixekizumab every 2 weeks (IXEQ2W), every 4 weeks (IXEQ4W), or 50-mg etanercept (ETN) biweekly for 12 weeks, then open-label IXEQ4W (UNCOVER-3). Psoriasis severity was categorized by baseline Psoriasis Area and Severity Index (PASI /=20). Efficacy was evaluated by percentage reaching PASI 75, 90, 100, and absolute PASI /=20 (vs. PASI /=20 vs. PASI <20 patients across treatments reached PASI </=5, </=2, and </=1 at Week 12. Efficacy was maintained during 156 weeks of ixekizumab treatment with no differences between groups. The IXEQ2W safety profile was similar between groups except for injection-site reactions (significantly higher in PASI <20). CONCLUSIONS: Ixekizumab demonstrated a high level of efficacy and had a consistent safety profile in patients with different baseline psoriasis severity levels

Correction to : Efficacy and Safety of Switching to Ixekizumab in Etanercept Non-Responders: A Subanalysis from Two Phase III Randomized Clinical Trials in Moderate-to-Severe Plaque Psoriasis (UNCOVER-2 and -3)

Altres ajuts: NCT01597245 and NCT01646177 and the post hoc analyses of these studies presented in this manuscript were funded by Eli Lilly and Company.Patients with psoriasis who have an inadequate response to one biologic may benefit from switching to a new biologic, such as ixekizumab, a high affinity monoclonal antibody that selectively targets interleukin (IL)-17A. Our aim was to assess the response to ixekizumab in patients with moderate-to-severe plaque psoriasis who did not respond adequately to etanercept using a post-hoc analysis in two phase III studies. For the subanalyses in two phase III trials (UNCOVER-2 and -3), non-response was defined by either failure to have a static physician global assessment (sPGA) of 0/1 in UNCOVER-2 or failure to have at least 75% improvement in psoriasis area and severity index (PASI 75) in UNCOVER-3 at Week 12 of each study. Non-responders treated with twice-weekly etanercept 50 mg in the first 12 weeks received two injections of placebo at Week 12 (4-week wash-out period), followed by ixekizumab every 4 weeks (Q4W) for Weeks 16-60. Non-responders to placebo in the first 12 weeks were administered ixekizumab 160 mg at Week 12, followed by ixekizumab Q4W for Weeks 16-60. After switching to ixekizumab Q4W, a substantial proportion of patients with moderate-to-severe psoriasis who did not respond to etanercept experienced rapid and durable improvement in all efficacy evaluations. Among sPGA 0/1 (UNCOVER-2) and PASI 75 (UNCOVER-3) non-responders to etanercept, 73.0% achieved sPGA 0/1 and 78.2% achieved PASI 75, respectively, after 12 weeks of ixekizumab treatment. Safety profiles in patients switched from etanercept to ixekizumab were similar to those in patients switched from placebo to ixekizumab. Patients who were non-responders to etanercept after 12 weeks, as defined by failure to meet sPGA 0/1 (UNCOVER-2) or PASI 75 (UNCOVER-3), achieved high levels of response 12 weeks after switching to ixekizumab. Studies are registered with ClinicalTrials.gov (NCT01597245 and NCT01646177)

Comparison of ixekizumab with ustekinumab in moderate-to-severe psoriasis: 24-week results from IXORA-S, a phase III study

Background It has been shown that the interleukin (IL)-23/IL-17 axis is critical in the pathogenesis of psoriasis. Objectives To present the primary end point (week 12) and safety and efficacy data up to week 24 from a head-to-head trial (IXORA-S) of the IL-17A inhibitor ixekizumab (IXE) vs. the IL-12/23 inhibitor ustekinumab (UST). Methods Randomized patients received IXE (160-mg starting dose, then 80 mg every 2 weeks for 12 weeks, then 80 mg every 4 weeks, n = 136) or UST (45 mg or 90 mg weight-based dosing per label, n = 166). The primary end point was the proportion of patients reaching ≥ 90% Psoriasis Area and Severity Index improvement (PASI 90). Hommel-adjusted key secondary end points at week 12 included PASI 75, PASI 100, static Physician's Global Assessment (sPGA) score of 0 or 1, sPGA score of 0, Dermatology Life Quality Index (DLQI) score of 0 or 1, ≥ 4-point reduction on the itch numerical rating scale (NRS) and changes in itch NRS and skin pain visual analogue scale. Results At week 12, IXE (n = 99, 72 8%) was superior to UST (n = 70, 42 2%) in PASI 90 response (response difference 32 1%, 97 5% confidence interval 19 8 44 5%, P < 0 001). Response rates for PASI 75, PASI 100 and sPGA (0,1) were significantly higher for IXE than for UST (adjusted P < 0 05). At week 24, IXEtreated patients had significantly higher response rates than UST-treated patients for PASI, sPGA and DLQI (unadjusted P < 0 05). No deaths were reported, and the treatments did not differ with regard to overall incidences of adverse events (P = 0 299). Conclusions The superior efficacy of IXE demonstrated at week 12 persisted up to week 24. The safety profiles were consistent with those previously reported for both treatments. peerReviewe

Association between psoas abscess and prosthetic hip infection: a case-control study

Background and purpose The relationship between prosthetic hip infection and a psoas abscess is poorly documented. We determined the frequency of prosthetic hip infections associated with psoas abscesses and identified their determinants

Gender differences in the use of cardiovascular interventions in HIV-positive persons; the D:A:D Study

Peer reviewe

Non-AIDS defining cancers in the D:A:D Study-time trends and predictors of survival : a cohort study

BACKGROUND:Non-AIDS defining cancers (NADC) are an important cause of morbidity and mortality in HIV-positive individuals. Using data from a large international cohort of HIV-positive individuals, we described the incidence of NADC from 2004-2010, and described subsequent mortality and predictors of these.METHODS:Individuals were followed from 1st January 2004/enrolment in study, until the earliest of a new NADC, 1st February 2010, death or six months after the patient's last visit. Incidence rates were estimated for each year of follow-up, overall and stratified by gender, age and mode of HIV acquisition. Cumulative risk of mortality following NADC diagnosis was summarised using Kaplan-Meier methods, with follow-up for these analyses from the date of NADC diagnosis until the patient's death, 1st February 2010 or 6 months after the patient's last visit. Factors associated with mortality following NADC diagnosis were identified using multivariable Cox proportional hazards regression.RESULTS:Over 176,775 person-years (PY), 880 (2.1%) patients developed a new NADC (incidence: 4.98/1000PY [95% confidence interval 4.65, 5.31]). Over a third of these patients (327, 37.2%) had died by 1st February 2010. Time trends for lung cancer, anal cancer and Hodgkin's lymphoma were broadly consistent. Kaplan-Meier cumulative mortality estimates at 1, 3 and 5 years after NADC diagnosis were 28.2% [95% CI 25.1-31.2], 42.0% [38.2-45.8] and 47.3% [42.4-52.2], respectively. Significant predictors of poorer survival after diagnosis of NADC were lung cancer (compared to other cancer types), male gender, non-white ethnicity, and smoking status. Later year of diagnosis and higher CD4 count at NADC diagnosis were associated with improved survival. The incidence of NADC remained stable over the period 2004-2010 in this large observational cohort.CONCLUSIONS:The prognosis after diagnosis of NADC, in particular lung cancer and disseminated cancer, is poor but has improved somewhat over time. Modifiable risk factors, such as smoking and low CD4 counts, were associated with mortality following a diagnosis of NADC

Development and Validation of a Risk Score for Chronic Kidney Disease in HIV Infection Using Prospective Cohort Data from the D:A:D Study

Ristola M. on työryhmien DAD Study Grp ; Royal Free Hosp Clin Cohort ; INSIGHT Study Grp ; SMART Study Grp ; ESPRIT Study Grp jäsen.Background Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. Methods and Findings A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with >= 3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1: 393 chance of developing CKD in the next 5 y in the low risk group (risk score = 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria. Conclusions Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.Peer reviewe

Industrialisation du management par les processus : mise en oeuvre d'ARIS, outil de modélisation des processus

In 2001, the Euriware Group, SSII, launches an approach of management by processes, it decides to endow her with a Business Process Modelling software. The approach has two purposes, to improve the performance of the company and the customer satisfaction, and to obtain the certification ISO 9001 version 2000. This project is entrusted to the Direction of the Sustainable development and Continuous Improvement to model processes in a methodical and structured way. It is realized with a software package of the market recognized in the field of process, ARIS of IDS Scheer who leans on client-server and has features of publication in the Web format. It will be integrated into the information system. This document describes why and expectations of the project, its organization, the delivered product, its realization in the respect for the practices to satisfy the users, and in what it was profitable in method, in new projects and in individual contributions. The responsibility of its development fell to my project manager's role. It allowed to implement and to define methodological approaches which participated in the innovative aspect of this project, with however, a certain disappointment not to have seen the complete outcome of the project.En 2001, le Groupe Euriware, SSII, lance une démarche de management par les processus et décide de la doter d'un outil de modélisation des processus. La démarche a deux finalités : améliorer la performance de l'entreprise et la satisfaction client et obtenir la certification ISO 9001 version 2000. Ce projet est confié à la Direction du Développement Durable et Progrès Continu afin de modéliser les processus de façon méthodique et structurée. Il est réalisé avec un progiciel du marché reconnu dans le domaine du processus, ARIS d'IDS Scheer qui s'appuie sur une architecture client serveur et possède des fonctionnalités de publication au format web. Il sera intégré au système d'information. Ce document décrit le pourquoi et les attentes du projet, son organisation, le produit livré, sa réalisation dans le respect des pratiques pour satisfaire les utilisateurs et en quoi il a été profitable en matière de méthode, de nouveaux projets et d'apports individuels. La responsabilité de sa réalisation incombait à mon rôle de chef de projet. Cela a permis de mettre en oeuvre et de définir des approches méthodologiques qui ont participé à l'aspect novateur de ce projet avec, toutefois, une certaine déception de n'avoir pas vu l'aboutissement complet du projet