Perancangan Tata Letak Fasilitas Ulang (Relayout) Untuk Produksi Truk Di Gedung Commercial Vehicle (CV) PT. Mercedes-benz Indonesia

Dalam suatu Perusahaan, salah satu cara untuk meningkatkan produktivitas produksi adalah dengan perbaikan susunan mesin-mesin produksi atau perbaikan tata letak fasilitas yang terdapat pada pabrik. Tata letak fasilitas berhubungan erat dengan Perubahan masukan menjadi keluaran. Berbagai macam pemborosan dapat terjadi pada proses produksi yang disebabkan oleh tata letak fasilitas yang tidak baik. Hal ini menjadi masalah dalam proses produksi untuk truk di PT. Mercedes-Benz Indonesia adalah panjangnya jarak perpindahan material antar stasiun kerja yang ada, sehingga berimbas pula bertambahnya biaya perpindahan dan jumlah output produksi yang dihasilkan. Oleh karena itu, maka diperlukan perancangan tata letak fasilitas ulang yang baru untuk mengatur ulang jalur lalu lintas material/barang yang lebih sesuai, sehingga dapat meminimalkan jarak dan ongkos material handling. Salah satu cara untuk mendapatkan usulan tata letak baru yaitu dengan Activity Relationship Diagram (ARC) dan Activity Relationship Diagram (ARD). Perhitungan jarak material handling yang digunakan yaitu jarak rectilinier. Terdapat dua alternatif usulan tata letak hasil olahan, maka dipilih alternatif pertama karena memiliki total jarak dan biaya material handling yang lebih efisien. Hasil perhitungan total jarak perpindahan untuk layout awal sebesar 591 m2/hari, alternatif pertama sebesar 565m2/hari, dan alternatif kedua sebesar 584m2/hari. Biaya material handling untuk layout awal sebsar Rp. 360.598,7/hari, alternatif pertama sebesar Rp. 344.734,8/hari, dan alternatif kedua sebesar Rp. 356.327,6/hari. Maka terjadi penurunan dari total jarak perpindahan pada alternatif pertama sebesar 26m2/hari, dan alternatif kedua sebesar 7m2/hari dari total jarak perpindahan layout awal. Serta terjadi penurunan biaya material handling pada layout alternatif pertama sebesar Rp. 15.864/hari, dan alternatif kedua sebesar Rp. 4.271,2/hari dari total biaya material handling layout awal

Pengaruh Jarak Tanam Terhadap Pertumbuhan Dan Hasil Tanaman Padi (Oryza Sativa L.) Pada Pola Jarak Tanam Yang Berbeda Dalam Sistem Tabela

The study aimed to find plant spacing for better growth and yield of wetland rice crops under direct seeded planting system. The study was arranged in a Randomized Block design with two factors i.e. two different spatial plantings and three kinds of Jajar Legowo patterns. The plant spacing of 25 cm x 25 cm with Jajar Legowo pattern of 2:1 produced highest grain yield (8.21 ton ha-1) followed by the plant spacing of 20cm x 20cm with Jajar Legowo pattern of 3:1 (7.21 ton ha-1). Jajar Legowo pattern of 3:1 resulted in better plant height (74.80cm), similarly plant spacing of 25cm x 25 cm also had same plant height, more tiller number (30.69) and panicles per clump, longer panicle length and more grain number

Grand Desain Simulasi Bencana Merapi 2014 Solusi Perencanaan Dan Pengelolaan Aspek Kesehatan Masyarakat Pengungsi

Saat terjadi bencana selalu terjadi kedaruratan disemua aspek kehidupan. Bencana menimbulkan korban jiwa manusia, kerusakan lingkungan, kerugian harta benda, dan dampak psikologis. Aspek kesehatan menjadi hal utama selama tinggal di pengungsian. Dampak yang sangat menonjol dari segi kesehatan di pengungsian bencana Merapi adalah merebaknya penyakit kulit dan batuk-batuk. Bantuan hidup dasar juga sangat dibutuhkan oleh para pengungsi. Kebutuhan air bersih, MCK, sanitasi, gizi dan bilik asmara perlu disediakan untuk para pengungsi. Untuk memperoleh jumlah perkiraan pengungsi Merapi pada tahun 2014 dan perhitungan jumlah kebutuhan dasar pengungsi yang tercetak dalam sebuah buku panduan yang disebut Grand Desain sedangkan metode yang digunakan didasarkan pada proyeksi penduduk untuk memperkirakan jumlah orang yang akan mengungsi di wilayah KRB Merapi Regional Jawa Tengah dan menghitung kebutuhan dasar pengungsi dari aspek kesehatan masyarakat pengungsi secara fisiologis. Dengan menggunakan rumus proyeksi penduduk diperoleh jumlah perkiraan pengungsi di KRB Merapi Jawa Tengah pada tahun 2014 sebanyak 319.126 jiwa. Jumlah kebutuhan dasar pengungsi yang harus dipenuhi mencakup kebutuhan air bersih, gizi, MCK, sanitasi dan persampahan, serta kebutuhan bilik asmara. Sebanyak 319.126 jiwa pengungsi membutuhkan setidaknya 6.382.520 liter air bersih per hari untuk keperluan memasak, makan, minum. Kebutuhan MCK setidaknya membutuhkan 6.383 sampai 12.764 buah MCK. Kebutuhan gizi pengungsi Merapi mencakup setidaknya 127.650 ton beras per hari dan diperkirakan pula akan dihasilkan jumlah timbulan sampah dipengungsian sebanyak 638,3 m3 per hari. Tingginya jumlah timbulan sampah membutuhkan setidaknya 80 truk pengangkut sampah per hari untuk mengangkut sampah keluar dari tempat pengungsi

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

The Application of Imprisonment to Kleptomaniacs: A Case Studies of Court Decision

This study aims to examine and analyze the Judge's application of imprisonment to kleptomaniacs based on Decision No. 574/Pid.B/2019/PN.Dps. This study uses a normative juridical research method. The data was collected using literature study techniques on primary, secondary, and tertiary legal materials. The collected legal material is then analyzed using qualitative data analysis methods with a statute approach and a case approach which will then conclude the object of the research. The results show that the Judge's application of imprisonment to the accused is based on Decision No. 574/Pid.B/2019/PN.Dps was the right decision. In this case, the problem of kleptomania currently ongoing in court should be proven with a Psychiatric Visum et Repertum. While the Letter of Statement No. 01/II.MR/RSPI/2019 cannot be the basis for the implementation of eliminating punishment. To determine that a person has kleptomania must undergo a process of examination for a minimum of two weeks to three months. Therefore, it is recommended that investigators provide the opportunity or take the initiative to prove the suspect's mental condition before being processed to the following legal proof stage. So no more accused who prove their status as kleptomaniacs using the letter of statement. The Judge is also recommended to decide by giving measures sanction to the accused if proven to have kleptomania to avoid the recurrence of the crime of theft in the future

Does manufacturers' size affect the prevalence of mycobiota and occurrence of mycotoxins in spices and spice-based products?

The present work aimed to establish the prevalence of mycobiota and occurrence of mycotoxins (aflatoxins and ochratoxin A) in spices and spice-based products, and correlate these to their manufacturers’ sizes. A total of 90 spice, sauce and paste samples were purchased; 3 manufacturer sizes (small, medium, large) × 3 types of samples (spices, sauces, pastes) × 5 brands × 2 replicates. The prevalence of mycobiota was assessed with dichloran rose bengal chloramphenicol (DRBC) and Aspergillus flavus and Aspergillus parasiticus (AFPA) medium, while the occurrence of mycotoxins was quantified with HPLC-FLD. Large-scale manufacturers were found to adopt a greater number of safety and quality certifications. Small-scale manufacturers significantly yielded the highest total fungal loads on DRBC (log 5.084±0.417 cfu/g paste, log 6.253±0.407 cfu/g sauce, log 6.662±0.222 cfu/g spice) and AFPA (log 4.461±0.451 cfu/g paste, log 5.661±0.395 cfu/g sauce, and log 6.269±0.432 cfu/g spice). Correlation analysis (Pearson’s r) revealed that manufacturers’ sizes positively influenced (DRBC r=0.781; AFPA r=0.702) the prevalence of mycobiota. Aflatoxin B1 was present in 6/30 (20%) paste samples, 1/30 sauce samples (3.33%) and 12/30 spice samples (40%). Aflatoxin B2 was only present in 2/30 sauce samples (6.67%). Aflatoxin G1 and G2 were absent from all samples. Ochratoxin A was present in 11/30 (36.67%) paste samples, 5/30 sauce samples (16.67%) and 21/30 spice samples (70%). It was found that, to a certain extent, the size of and certification adopted by manufacturers affected the prevalence of mycobiota and the occurrence of mycotoxins in spices and spice-based products analysed in the present work. Nevertheless, it is henceforth recommended that a surveillance study of this nature be extended and widened in terms of number of samples as well as type of spices, sauces and pastes to obtain a more thorough and significant profile of the products’ food safety and quality level

Association between administration of IL-6 antagonists and mortality among patients hospitalized for COVID-19 : a meta-analysis

IMPORTANCE Clinical trials assessing the efficacy of IL-6 antagonists in patients hospitalized for COVID-19 have variously reported benefit, no effect, and harm. OBJECTIVE To estimate the association between administration of IL-6 antagonists compared with usual care or placebo and 28-day all-cause mortality and other outcomes. DATA SOURCES Trials were identified through systematic searches of electronic databases between October 2020 and January 2021. Searches were not restricted by trial status or language. Additional trials were identified through contact with experts. STUDY SELECTION Eligible trials randomly assigned patients hospitalized for COVID-19 to a group in whom IL-6 antagonists were administered and to a group in whom neither IL-6 antagonists nor any other immunomodulators except corticosteroids were administered. Among 72 potentially eligible trials, 27 (37.5%) met study selection criteria. DATA EXTRACTION AND SYNTHESIS In this prospectivemeta-analysis, risk of biaswas assessed using the Cochrane Risk of Bias Assessment Tool. Inconsistency among trial results was assessed using the I-2 statistic. The primary analysis was an inverse variance-weighted fixed-effects meta-analysis of odds ratios (ORs) for 28-day all-cause mortality. MAIN OUTCOMES AND MEASURES The primary outcome measurewas all-cause mortality at 28 days after randomization. There were 9 secondary outcomes including progression to invasive mechanical ventilation or death and risk of secondary infection by 28 days. RESULTS A total of 10 930 patients (median age, 61 years [range of medians, 52-68 years]; 3560 [33%] were women) participating in 27 trials were included. By 28 days, there were 1407 deaths among 6449 patients randomized to IL-6 antagonists and 1158 deaths among 4481 patients randomized to usual care or placebo (summary OR, 0.86 [95% CI, 0.79-0.95]; P =.003 based on a fixed-effects meta-analysis). This corresponds to an absolute mortality risk of 22% for IL-6 antagonists compared with an assumed mortality risk of 25% for usual care or placebo. The corresponding summary ORs were 0.83 (95% CI, 0.74-0.92; P <.001) for tocilizumab and 1.08 (95% CI, 0.86-1.36; P =.52) for sarilumab. The summary ORs for the association with mortality compared with usual care or placebo in those receiving corticosteroids were 0.77 (95% CI, 0.68-0.87) for tocilizumab and 0.92 (95% CI, 0.61-1.38) for sarilumab. The ORs for the association with progression to invasive mechanical ventilation or death, compared with usual care or placebo, were 0.77 (95% CI, 0.70-0.85) for all IL-6 antagonists, 0.74 (95% CI, 0.66-0.82) for tocilizumab, and 1.00 (95% CI, 0.74-1.34) for sarilumab. Secondary infections by 28 days occurred in 21.9% of patients treated with IL-6 antagonists vs 17.6% of patients treated with usual care or placebo (OR accounting for trial sample sizes, 0.99; 95% CI, 0.85-1.16). CONCLUSIONS AND RELEVANCE In this prospectivemeta-analysis of clinical trials of patients hospitalized for COVID-19, administration of IL-6 antagonists, compared with usual care or placebo, was associated with lower 28-day all-cause mortality

Use of Telemedicine for Post-discharge Assessment of the Surgical Wound: International Cohort Study, and Systematic Review with Meta-analysis

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P&lt;0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval 0.63-0.84, P&lt;0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In nine eligible non-randomised studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound post-discharge is feasible, but risks underreporting of SSI. Standardised tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally