Development of Customer Loyalty Convenience Stores in Wonokromo District Surabaya

Grocery stores are businesses that require precise strategies to develop effectively. In order for a grocery business to run well, a good management concept is needed, namely customer orientation, coordinated business effort, goal orientation. Besides that, it is necessary to increase customer satisfaction and maintain customer loyalty. This development of loyalty has developed well in minimarkets that grow around grocery stores so that the development of grocery store loyalty requires attention and in-depth understanding. This research is a qualitative descriptive study. The results of this study are from 3 Kotler formulations that cause the creation of customer loyalty is still difficult to apply by grocery stores due to the low management of information which is the basis of the database due to the traditional grocery store management

Upotreba koncentrata dušika iz krumpira u proizvodnji α-amilaze s pomoću plijesni Aspergillus oryzae

The influence of various nitrogen sources and media supplements on α-amylase (EC 3.2.1.1) formation by Aspergillus oryzae ATCC 1011 was investigated in shake flask experiments and batch fermentations. Both inorganic and organic nitrogen-containing supplements have been applied, while corn starch and ammonium sulphate were used as the major source of carbon and nitrogen, respectively. Shake flask experiments revealed that potato nitrogen concentrate (PNC) is almost equivalent to corn steep liquor (CSL) in supporting amylase formation. A pretreatment step consisting of clarification of the turbid material did not show any significant effect. The replacement of the inorganic nitrogen source by sodium nitrate led to lower enzyme yields. Other complex supplements may reduce the enzyme level formed, e.g. casein hydrolysate, or increase the amylase titre slightly, e.g. yeast extract or malt extract. Cultivations in instrumented bench top reactors on media supplemented with PNC led to higher cell growth rates and yields of α-amylase in comparison with the medium without any supplement. Replacement of PNC by CSL revealed a slightly increased enzyme level, which is in the range of 9–17 % after 100 h of cultivation. Only minor differences were revealed in the growth kinetics and enzyme formation when PNC was used as the sole nitrogen source, replacing a mixture of soybean meal, yeast extract, malt extract and casein hydrolysate in bioreactor cultivations with lactose as the carbon source. However, metabolic differences as seen from the course of dissolved oxygen tension (DOT), α-amino nitrogen concentration and the amount of acid needed to maintain a constant pH were observed.Istražen je utjecaj različitih izvora dušika i dodataka podlozi na proizvodnju α-amilaze (EC 3.2.1.1) s pomoću plijesni Aspergillus oryzae ATCC 1011 u pokusu na tresilici i šaržnim uzgojem. Primijenjeni su anorganski i organski dušikovi spojevi, a kao glavni izvori ugljika i dušika korišteni su kukuruzni škrob i amonijev sulfat. Pokusima na tresilici dokazano je da je utjecaj koncentrata dušika iz krumpira (potato nitrogen concentrate – PNC) na proizvodnju amilaze skoro jednak onom ekstrakta kukuruza (corn steep liquor – CSL). Pročišćavanjem zamućenog materijala prije obrade nije se postigao značajan učinak. Zamjenom anorganskog izvora dušika natrijevim nitratom dobiveni su manji prinosi enzima. Dodatkom drugih kompleksnih spojeva, kao što je hidrolizat kazeina, smanjio se prinos enzima, a dodatkom ekstrakta kvasca ili slada neznatno se povećao titar amilaze. Veći rast stanica i bolji prinos α-amilaze postignut je uzgojem na podlozi obogaćenoj s PNC u reaktoru na postolju nego bez tih dodataka. Zamjenom PNC sa CSL postignuto je povećanje prinosa enzima za 9-17 % nakon 100 sati uzgoja. Upotreba PNC kao jedinog izvora dušika, uz zamjenu sojine kaše, ekstrakta kvasca i slada te hidrolizata kazeina laktozom kao izvorom ugljika, dovela je do neznatnih razlika u kinetici rasta i formiranju enzima u bioreaktoru. Međutim, uočene su metaboličke razlike u zasićenosti otopljenim kisikom (dissolved oxygen tension – DOT), koncentraciji α-amino dušika i količini kiseline potrebne za održavanje konstantnog pH

PainEd VR versi 1.0

Aplikasi ini adalah program komputer berbasis Virtual Reality yang dapat digunakan untuk pembelajaran nyeri di pendidikan kedokteran. Aplikasi ini dapat digunakan dengan alat Oculus, yang mana pengguna aplikasi diminta mengikuti skenario seorang pasien yang mengalami nyeri yang datang ke layanan gawat darurat. Skenario ini dibawakan dalam bentuk video 360. Selama menjalankan aplikasi, pengguna dapat berinteraksi dengan berbagai elemen yang disediakan dan diberikan beberapa kuis yang menstimulasi pembelajaran nyeri. Salah satunya, di akhir skenario, pengguna dapat bereksperimen menentukan penanganan yang tepat bagi pasien untuk meredakan nyeri. Aplikasi ini akan lebih optimal jika penggunaannya dipadukan dalam konteks diskusi interaktif dengan sesama pengguna dan tutor

High-sensitive cardiac troponin I (hs-cTnI) concentrations in newborns diagnosed with spinal muscular atrophy

BackgroundSpinal muscular atrophy (SMA) is a genetic neurodegenerative disease leading to muscular weakness and premature death. Three therapeutic options are currently available including gene replacement therapy (GRT), which is potentially cardiotoxic. High-sensitive cardiac troponin I (hs-cTnI) is widely used to monitor potential cardiac contraindications or side effects of GRT, but reference data in healthy newborns are limited and lacking in neonates with SMA. The aim of this study is to determine the range of pre-therapeutic hs-cTnI concentrations in neonates with SMA and to provide guidance for the assessment of these values.MethodsHs-cTnI levels, genetic and clinical data of 30 newborns (age range 2–26 days) with SMA were retrospectively collected from 6 German neuromuscular centers. In addition, hs-cTnI levels were measured in 16 neonates without SMA.ResultsThe median hs-cTnI concentration in neonates with SMA was 39.5 ng/L (range: 4–1205). In 16 newborns with SMA, hs-cTnI levels were above the test-specific upper reference limit (URL). Exploratory statistical analysis revealed no relevant correlation between hs-cTnI levels and gender, gestational age, mode of delivery, SMN2 copy number, symptoms of SMA or abnormal cardiac findings.DiscussionOur results suggest higher hs-cTnI plasma levels in newborns with and without SMA compared to assay-specific reference values generated in adults. Given the wide range of hs-cTnI values in neonates with SMA, hs-cTnI levels must be determined before treatment in each patient and post-treatment elevations should be interpreted in the context of the course rather than as individual values

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions