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The aims of this study are to: (1) Describe the institutional of plantation extension in RokanHilir; (2) analyze the performance of plantation extension services in RokanHilir based onextensionworkers and farmers perception. This study was conducted in RokanHilir, the reason for taking this research is because RokanHilir is one of the regency that do not have a special institution to deal with extension activities. The method used to determine the sample in this research was purposive sampling, census, and Yaname Taro formula. Descriptive analysis is used to answer the first question and Likert Scale's Summated Rating (SLR) analysis was used to answer the second aim.The results showed: (1); The field of extension is a field that is responsible for extension activities that have 8 plantationextension, themembers who work in plantation offices are not appropriate with their background , while for the program areas of extension is not running well.(2) the perception of the extension workersperformance extension is in high category as can be seen fromthe responsiveness, responsibility, accountability and quality of service. Meanwhile, according to farmers' perception, the extension workersperformance is in the low category that can be seen from indicators of responsiveness, responsibility, accountability and quality of service

Impact of Inflation and Exchange Rate Rupiah Toward Poverty and Unemployment in Indonesia (Case Study: Small Industry in the Tourist Area of Lombok)

The purpose of this research are: (1). Evaluate the impact of inflation and the weakening of the rupiah against US $ against unemployment, poverty. (2). Obtain some alternative ways to overcome inflation and weakening of rupiah exchange rate against US dollar in maintaining stability of welfare of SMEs in Lombok region. (3) To evaluate the marketing system used by MSMEs (4) To know the obstacles faced by MSMEs (5) To know the related sectors in supporting the success of UMKM. Method of research used descriptive and qualitative method, with literary study approach, Data Collection, using participant observation and in-depth interviews. Data Validity, with triangulation method of source, method and time. The results show that the SME sector has contributed to the economic and development of Indonesia. There are several factors that challenge the development of SMEs

Measuring patient experience with patient care coordinators during decongestion of outpatient department of an apex tertiary care referral public hospital in India

Background: Specialized hospitals are faced with overcrowding in OPDs, improper behaviour of staff and navigation difficulties. In an apex tertiary care referral public hospital of India, Patient care coordinators (PCCs) were introduced to help patients navigate as a part of an OPD decongestion project. A novel concept involving patient interaction, called for measuring patient experience, to provide a baseline measurement, further improvements needed and benchmarking. For this, the model for decongestion also needed to be studied.Methods: A descriptive and cross-sectional study was conducted. Direct observations were conducted to study decongestion model and expectations from PCCs. Patient experience was measured from 400 patients using a 27-item questionnaire designed by researcher. A 5-point Likert’s scale was used for their availability, politeness, promptness, guidance, information accuracy, emotional support, etc. Dichotomous scale was also used to measure competence of PCCs.Results: A patient reception centre with three different zones was created based on status of appointments, unique hospital identification number (UHID) and new or re-visit patients. Waiting areas were created and crowd distributed based on handling capacities of sub-waiting areas dynamically adjusting to service time of doctors. PCCs facilitated navigation to right destinations. Patients had positive experience irrespective of age, gender and educational status. It related positively with a confident next visit.Conclusions: Introduction of PCCs is an effective way for assisting patient navigation. The study contributes by providing a measure of experience and benchmarking. It succinctly describes a model for decongesting OPD that may be adopted in similar settings

Resource optimization through process re-engineering of inhalational therapy unit at a tertiary care public hospital

Background: Salaries, supplies and machinery account for bulk of public funding necessitating efficient utilisation. Studies suggest that process re-engineering helps improve cost, quality, service, and speed. Disbanded once and re-commissioned, a centralized Inhalational Therapy Unit (ITU) banked and provided portable mechanical ventilators to the inpatient wards. A demand for new ventilators from ITU led to the present study involving its critical review and cost analysis.Methods: An interventional study was conducted at a large tertiary care public hospital in India from April 2015 to June 2015. Critical review of process of providing portable ventilators and cost analysis were conducted. Review of records of and interview with ITU personnel and nursing staff were carried out. Fundamental rethinking and radical redesign of the process was done with attention to human resource, costs, space and actual medical equipment utilization. Two fundamental questions of process re-engineering were deliberated upon: “Why do we do what we do?” “And why do we do it the way we do?” Fundamental rethinking for new process was organized around the outcome.Results: Average utilization coefficient was 6.2% (3.3% to 12.1%). Ventilators utilized per day were 1.43. Expenditure on salaries was INR 315000 per month and INR 10500 per day. Low utilization offered low value for expenses incurred. All activities in ITU focused on “provision of ventilators” (outcome) and the old rule was, “If one needed a ventilator one must contact ITU”. Since nurses were using the “outcome” and performed activities of arranging, they were handed-over the ventilators (based on utilisation patterns). ITU was disbanded, human resource and space were re-allocated to various hospital areas (costs tied were done away with) with no adverse effect on hospital functioning.Conclusions: Process re-engineering led to improved healthcare delivery, curtailed delays in hospital processes, optimised costs involved in human resources and medical equipment

Does designation as a UNESCO World Heritage Site influence tourist evaluation of a local destination?

The purpose of this study is to explore whether the UNESCO World Heritage Site (WHS) designation affects tourists’ evaluation of the local destination hosting the site, building on a large sample of about 0.8 million tourists who visited Italy over the period 1997-2015. We find that the inscription onto the UNESCO World Heritage List exerts surprisingly a negative effect on the overall evaluation of the destination and also on the evaluation of its artistic assets though the magnitude of the latter is lower. The effect is heterogeneous across visitors, depending on evaluation levels, as well as origin/destinations and demographics. Nonetheless, the presence of multiple WHSs in the same destination tends to increase evaluation suggesting that destination stakeholders with previous experience in dealing with WHS designations are better equipped to manage the complicated relationship between tourism and preservation. Managerial and policy-making implications are discussed

Birthing practices of traditional birth attendants in South Asia in the context of training programmes

Traditional Birth Attendants (TBA) training has been an important component of public health policy interventions to improve maternal and child health in developing countries since the 1970s. More recently, since the 1990s, the TBA training strategy has been increasingly seen as irrelevant, ineffective or, on the whole, a failure due to evidence that the maternal mortality rate (MMR) in developing countries had not reduced. Although, worldwide data show that, by choice or out of necessity, 47 percent of births in the developing world are assisted by TBAs and/or family members, funding for TBA training has been reduced and moved to providing skilled birth attendants for all births. Any shift in policy needs to be supported by appropriate evidence on TBA roles in providing maternal and infant health care service and effectiveness of the training programmes. This article reviews literature on the characteristics and role of TBAs in South Asia with an emphasis on India. The aim was to assess the contribution of TBAs in providing maternal and infant health care service at different stages of pregnancy and after-delivery and birthing practices adopted in home births. The review of role revealed that apart from TBAs, there are various other people in the community also involved in making decisions about the welfare and health of the birthing mother and new born baby. However, TBAs have changing, localised but nonetheless significant roles in delivery, postnatal and infant care in India. Certain traditional birthing practices such as bathing babies immediately after birth, not weighing babies after birth and not feeding with colostrum are adopted in home births as well as health institutions in India. There is therefore a thin precarious balance between the application of biomedical and traditional knowledge. Customary rituals and perceptions essentially affect practices in home and institutional births and hence training of TBAs need to be implemented in conjunction with community awareness programmes

Infection control in delivery care units, Gujarat state, India: A needs assessment

Peer reviewedPublisher PD

Stress and psychological health: testing the mediating role of cognitive appraisal

This study tested the mediating role of primary (e.g., threat and challenge perceptions) and secondary (e.g., coping potential and control perception) cognitive appraisal in the relationship between occupational stress and psychological health. This mediation was tested using a cross-sectional study based on self-reported measures. The total sample consisted of 2,302 nurses, 1,895 females (82.3%) and 407 males (17.7%), who completed an evaluation protocol with measures of occupational stress, cognitive appraisal, and psychological health. To test the mediating role of cognitive appraisal in the relationship between cognitive appraisal and psychological health, we used Structural Equation Modeling (SEM). The results confirmed that primary and secondary cognitive appraisals partially mediated the relationship between occupational stress and psychological health; however, the direct effects of stress on psychological health cannot be ignored. The findings indicated that cognitive appraisal is an important underlying mechanism in explaining adaptation at work.This study was conducted at Psychology Research Centre (UID/PSI/01662/2013), University of MInho, and supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education through national funds and co-financed by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653)

Does an extensive diagnostic workup for upfront resectable pancreatic cancer result in a delay which affects survival? Results from an international multicentre study

Backgrounds/Aims: Pancreatoduodenectomy (PD) is recommended in fit patients with a carcinoma (PDAC) of the pancreatic head, and a delayed resection may affect survival. This study aimed to correlate the time from staging to PD with long-term survival, and study the impact of preoperative investigations (if any) on the timing of surgery. // Methods: Data were extracted from the Recurrence After Whipple’s (RAW) study, a multicentre retrospective study of PD outcomes. Only PDAC patients who underwent an upfront resection were included. Patients who received neoadjuvant chemo-/radiotherapy were excluded. Group A (PD within 28 days of most recent preoperative computed tomography [CT]) was compared to group B (> 28 days). // Results: A total of 595 patents were included. Compared to group A (median CT-PD time: 12.5 days, interquartile range: 6–21), group B (49 days, 39–64.5) had similar one-year survival (73% vs. 75%, p = 0.6), five-year survival (23% vs. 21%, p = 0.6) and median time-todeath (17 vs. 18 months, p = 0.8). Staging laparoscopy (43 vs. 29.5 days, p = 0.009) and preoperative biliary stenting (39 vs. 20 days, p 0.99) and endoscopic ultrasonography (28 vs. 32 days, p > 0.99) were not. // Conclusions: Although a treatment delay may give rise to patient anxiety, our findings would suggest this does not correlate with worse survival. A delay may be necessary to obtain further information and minimize the number of PD patients diagnosed with early disease recurrence