IDENTIFIKASI BAHAYA PEKERJAAN PERBAIKAN AERATOR MENGGUNAKAN METODE HIRADC DI PERUSAHAAN LUBRICANT REFINERY

Perusahaan Lubricant Refinery merupakan perusahaan yang bergerak dalam bidang produksi refinery oil yang ada di Indonesia. Dalam mengelola produknya perusahaan ini memiliki 3 macam proses produksi yaitu refinery, utility, dan waste. Pada proses pengolahan limbah (waste) di perusahaan ini, terdapat pengolahan limbah menggunakan (biologi treatment) di dalam kolam aerator. Kerusakan terjadi pada pipa bagian dalam dan bocornya dinding tangki aerator yang mengharuskan dilakukanya perbaikan. Dimana pada proses pekerjaan perbaikan tangki terdapat beberapa tahapan pekerjaan, pekerjaan tersebut memiliki potensi bahaya yaitu faktor manusia, peralatan atau mesin, dan lingkungan. Oleh karena itu penulis akan mengidentifikasi bahaya dengan menggunakan metode HIRADC. Dari hasil penelitian menggunakan metode HIRADC ditemukan 0 high risk, 17 medium, 42 low, dan 4 residual risk. Untuk pemberian solusi alternatif terhadap bahaya residual risk dengan cara membuat jadwal maintenance rutin, melaksanakan pekerjaan sesuai dengan prosedur bekerja dengan aman, serta menyediakan dan memakai Alat Pelindung diri (APD) yang layak. Kata Kunci: Aerator, HIRADC, Residual ris

Genital ulcers associated with systemic lupus erythematosus – what are the possible causes? A Case Report

Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease that affects many organs. In this report, we discuss the case of a patient with SLE who presented to an out-hospital clinic, complaining of fever and pain with genital ulcers. Negative evaluations for other causes of genital ulcers, indicated these ulcers as related to SLE. This case highlights the importance of including SLE ulcers in the differential diagnosis of genital ulcers

Severe headache in primary Sjögren’s syndrome responded to rituximab

Introduction: Primary Sjögren syndrome (pSS) is an immune systemic disease, that may affect the central nervous system. A severe headache unresponsive to treatment is the headache which is persistently nonresponsive to narcotic analgesics. Case presentation: A 48-year-old woman with a 10-year history of pSS was seen in January 2021, complaining of a headache one week previously. The headache was characterised by a dull persistent pressing intensity and was not responding to paracetamol, NSAIDs or codeine. She had no previous history, nor family history. Physical examination revealed bilateral parotid glands enlargement. Laboratory tests showed anaemia, and elevated levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), with positive anti-La and anti-Ro antibodies. She was given topical treatment and different doses of Predlone, in addition to methotrexate10 mg/week. She had received three pulses of methylprednisolone and was started on azathioprine with a mild response to the headaches, so she received two initial IV doses of rituximab 375 mg/m2, then every 2 weeks, with a clinical and laboratory response. Two years later, she had no headache. Discussion: Headache that may presented in pSS are tension headaches, migraines and cluster headaches. The therapy is disease-modifying antirheumatic drugs, hydroxychloroquine, glucocorticoids and biotherapeutics. Rituximab is used in the treatment of some patients with pSS, especially where it can affect systemic symptoms. Conclusion: Rituximab treatment may be an option for severe headache in patients with pSS. The mechanism is unknown but may be due to depletion of brain auto-reactive B cells. Further research is needed

Proposed New Business Model on Virtual Reality Tour Based on Customer Segmentation (Case Study of PT Telkom Indonesia)

A virtual reality tour or VR tour is one of the current tourist industry trends. Virtual tours have become widely known since the pandemic, and virtual tours are an alternative to entertainment while at home. Nevertheless, the use of VR in Indonesia itself is still relatively minimal. Seeing the opportunities in the development of VR in Indonesia, PT Telkom has the initiative to develop VR tours with the theme of ten new Balis as a collaboration with the ministry of tourism to promote tourist destinations. However, due to the lack of use of VR in Indonesia, PT Telkom is still unable to determine the right target market for the development of this virtual tour business. The target market is the first step to determine the business model that Telkom wants to develop. In developing a virtual tour that is in accordance with the wishes of consumers, this research conducted a survey of customers. The survey was conducted using an open-ended survey to gain insight from customers on virtual tours. Based on the survey results, the root of the problem lies in the lack of experience they get when using virtual tours because the content such as images and videos received is unclear. From this problem, a solution is made in a business model to develop a virtual tour tailored to the customer's needs using lean business model. In implementing the implementation plan, the author recommends using pirate metrics starting from the awareness of potential customers to how potential customers can invite other potential customers to use this virtual tour.Keyword: Customer Segment, Lean Business Model, VR, Virtual Tou

Proposed New Business Model on Virtual Reality Tour Based on Customer Segmentation (Case Study of PT Telkom Indonesia)

A virtual reality tour or VR tour is one of the current tourist industry trends. Virtual tours have become widely known since the pandemic, and virtual tours are an alternative to entertainment while at home. Nevertheless, the use of VR in Indonesia itself is still relatively minimal. Seeing the opportunities in the development of VR in Indonesia, PT Telkom has the initiative to develop VR tours with the theme of ten new Balis as a collaboration with the ministry of tourism to promote tourist destinations. However, due to the lack of use of VR in Indonesia, PT Telkom is still unable to determine the right target market for the development of this virtual tour business. The target market is the first step to determine the business model that Telkom wants to develop. In developing a virtual tour that is in accordance with the wishes of consumers, this research conducted a survey of customers. The survey was conducted using an open-ended survey to gain insight from customers on virtual tours. Based on the survey results, the root of the problem lies in the lack of experience they get when using virtual tours because the content such as images and videos received is unclear. From this problem, a solution is made in a business model to develop a virtual tour tailored to the customer's needs using lean business model. In implementing the implementation plan, the author recommends using pirate metrics starting from the awareness of potential customers to how potential customers can invite other potential customers to use this virtual tour.Keyword: Customer Segment, Lean Business Model, VR, Virtual Tou

Prone versus Supine FDG PET/CT in the Staging of Breast Cancer

Supine [18F]Fluorodeoxyglucose (FDG) positron emission technology/computed tomography (PET/CT) is a commonly used modality for the initial staging of breast cancer, and several previous studies have shown superior sensitivity and specificity of prone FDG PET/CT in comparison to its supine counterpart. This retrospective study included 25 females with breast cancer referred for staging. They underwent supine FDG PET/CT followed by prone FDG PET/CT. The outcomes were: number of primary breast lesions, anatomical site of FDG-avid lymph nodes (LNs), and number and type of bone lesions, with SUVmax of all corresponding parameters. Performance was superior in prone acquisition compared to supine acquisition, with the respective results: 29 vs. 22 breast tumor lesions detected, 62 vs. 27 FDG-avid axillary LNs detected, sensitivity of 68% vs. 57%, specificity of 64% vs. 53%. The detection rate of axillary LNs in the prone position was significantly higher (p = 0.001). SUVmax for breast tumor lesions (p = 0.000) and number of detected axillary LNs (p = 0.002) were significantly higher in prone acquisition. Five patients were upstaged after experts read the prone acquisition. Prone FDG PET/CT acquisition is a promising technique in detecting primary breast lesions and metastatic LNs possibly missed in supine acquisition, which may lead to change in patient staging and management

Prone versus Supine FDG PET/CT in the Staging of Breast Cancer

Supine [18F]Fluorodeoxyglucose (FDG) positron emission technology/computed tomography (PET/CT) is a commonly used modality for the initial staging of breast cancer, and several previous studies have shown superior sensitivity and specificity of prone FDG PET/CT in comparison to its supine counterpart. This retrospective study included 25 females with breast cancer referred for staging. They underwent supine FDG PET/CT followed by prone FDG PET/CT. The outcomes were: number of primary breast lesions, anatomical site of FDG-avid lymph nodes (LNs), and number and type of bone lesions, with SUVmax of all corresponding parameters. Performance was superior in prone acquisition compared to supine acquisition, with the respective results: 29 vs. 22 breast tumor lesions detected, 62 vs. 27 FDG-avid axillary LNs detected, sensitivity of 68% vs. 57%, specificity of 64% vs. 53%. The detection rate of axillary LNs in the prone position was significantly higher (p = 0.001). SUVmax for breast tumor lesions (p = 0.000) and number of detected axillary LNs (p = 0.002) were significantly higher in prone acquisition. Five patients were upstaged after experts read the prone acquisition. Prone FDG PET/CT acquisition is a promising technique in detecting primary breast lesions and metastatic LNs possibly missed in supine acquisition, which may lead to change in patient staging and management

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially