Analysis of Service Gaps in Outpatient Polyclinic Using Customer Window

Patient complaints toward service at Undaan Eyes Hospital in 2015 amounted to 9 complaints, and has not yet reached target set by the hospital which was equal to 0 complaints. Therefore, the purpose of this research is to analyze gaps in expected service and perceived service of responsiveness, reliability and emphatyat UndaanEyes Hospital. This research was an analytic observational survey and to be analyzed by customer window. Sample were in equal to 98 people and collected by systematic random sampling. The result showed from the analysis of the customer windowwas that some aspects in service are in quadrant A or Attention, which patient expected service higher than perceived service. Some aspects that were in Attention quadrant, are: waiting time > 30 minutes, speed of service delivery was slow and lack information. It can be concluded that some of the things that are in quadrant A or Attention is a strategic issue that must consider and resolve byUndaan Eyes Hospital to meet the expectations of patients

Studi Tentang Pengelolaan Obat di Puskesmas Buranga Kabupaten Wakatobi Tahun 2016

Pengelolaan obat di puskesmas merupakan hal yang sangat penting yang perlu di perhatikan,mengingat dengan pengelolaan yang tidak sesuai dengan prosedur yang tepat akan terjadi masalahtumpang tindih anggaran dan pemakaian yang tidak tepat guna. Penelitian ini bertujuan untukmengetahui pengelolaan obat di puskesmas Buranga Kabupaten Wakatobi tahun 2016. Jenispenelitian yang digunakan dalam penelitian ini adalah penelitian kualitatif dengan pendekatanfenomenologi. Pengumpulan data dilakukan melalui teknik wawancara mendalam dan observasilangsung. Untuk menjamin keabsahan data yang dikumpulkan, digunakan teknik metode triangulasiyaitu triangulasi sumber, triangulasi metode, dan triangulasi teori. Hasil penelitian terkaitpengelolaan obat di Puskesmas Buranga menunjukkan bahwa perencanaan obat di puskesmasberdasarkan persediaan obat tanpa melihat pola penyakit yang terjadi di puskesmas. Pengadaan obatdilakukan setiap tiga bulan dengan membuat Laporan Pemakaian dan Lembar Permintaan Obat(LPLPO). Penyimpanan obat belum masuk standar penyimpanan obat yang baik, dimanapenyimpanan obat tidak berdasarkan abjad melainkan berdasarkan kebiasaan. Pendistribusian obatke unit-unit pelayanan kesehatan dengan sistem amprah. Pencatatan dan pelaporan obat dipuskesmas dilakukan setiap hari dalam kartu stok obat kemudian diregister bulanan. Kesimpulan daripenelitian ini, terkait pendistribusian serta pencatatan dan pelaporan sudah sesuai standarpengelolaan obat di Puskesmas. Tetapi perencanaan, pengadaan, dan penyimpanan obat belum sesuai dengan pedoman pengelolaan obat yang ada

Endoscopy-assisted tracheal reconstruction of post-traumatic obstruction in a cat: A case report

A domestic shorthair cat was referred with a history of dyspnoea and lethargy that had arisen gradually within the last few days. The cat had been hit by an automobile 10 days earlier. A thoracic radiograph suggested stenosis of the intrathoracic trachea, proximal to the tracheal bifurcation. Endoscopic examination confirmed a narrowing of the tracheal lumen due to the presence of a fibrotic ring, with remaining patent lumen of about 2 mm. A surgical treatment with a right lateral thoracotomy approach and resection of the narrowed portion of the trachea (a length of about 1 cm) was performed under endoscopic vision. The procedure was unsuccessful because of the size of the tissue removed and the laxity of the remaining tracheal tissue that caused dehiscence of sutures between the tracheal stump and tracheal bifurcation. After consultation with the cat\u2019s owners, an intraoperative euthanasia was performed

An SK3 Channel/nWASP/Abi-1 Complex Is Involved in Early Neurogenesis

BACKGROUND: The stabilization or regulated reorganization of the actin cytoskeleton is essential for cellular structure and function. Recently, we could show that the activation of the SK3-channel that represents the predominant SK-channel in neural stem cells, leads to a rapid local outgrowth of long filopodial processes. This observation indicates that the rearrangement of the actin based cytoskeleton via membrane bound SK3-channels might selectively be controlled in defined micro compartments of the cell. PRINCIPAL FINDINGS: We found two important proteins for cytoskeletal rearrangement, the Abelson interacting protein 1, Abi-1 and the neural Wiskott Aldrich Syndrome Protein, nWASP, to be in complex with SK3- channels in neural stem cells (NSCs). Moreover, this interaction is also found in spines and postsynaptic compartments of developing primary hippocampal neurons and regulates neurite outgrowth during early phases of differentiation. Overexpression of the proteins or pharmacological activation of SK3 channels induces obvious structural changes in NSCs and hippocampal neurons. In both neuronal cell systems SK3 channels and nWASP act synergistic by strongly inducing filopodial outgrowth while Abi-1 behaves antagonistic to its interaction partners. CONCLUSIONS: Our results give good evidence for a functional interplay of a trimeric complex that transforms incoming signals via SK3-channel activation into the local rearrangement of the cytoskeleton in early steps of neuronal differentiation involving nWASP and Abi-1 actin binding proteins

The Politics of (and Behind) the UNFCCC’s Loss and Damage Mechanism

Despite being one of the most controversial issues to be recently treated within climate negotiations, Loss and Damage (L&D) has attracted little attention among scholars of International Relations (IR). In this chapter we take the “structuralist paradox” in L&D negotiations as our starting point, considering how IR theories can help to explain the somewhat surprising capacity of weak parties to achieve results while negotiating with stronger parties. We adopt a multi-faceted notion of power, drawing from the neorealist, liberal and constructivist schools of thought, in order to explain how L&D milestones were reached. Our analysis shows that the IR discipline can greatly contribute to the debate, not only by enhancing understanding of the negotiation process and related outcomes but also by offering insights on how the issue could be fruitfully moved forward. In particular, we note the key importance that discursive power had in the attainment of L&D milestones: Framing L&D in ethical and legal terms appealed to standards relevant beyond the UNFCCC context, including basic moral norms linked to island states’ narratives of survival and the reference to international customary law. These broader standards are in principle recognised by both contending parties and this broader framing of L&D has helped to prove the need for action on L&D. However, we find that a change of narrative may be needed to avoid turning the issue into a win-lose negotiation game. Instead, a stronger emphasis on mutual gains through adaptation and action on L&D for both developed and developing countries is needed as well as clarity on the limits of these strategies. Examples of such mutual gains are more resilient global supply chains, reduction of climate-induced migration and enhanced security. As a result, acting on L&D would not feel as a unilateral concession developed countries make to vulnerable ones: it would rather be about elaborating patterns of collective action on an issue of common concern

Rasa Tentrem Sajrone Cerbung Nrima Ing Pandum Anggitane Sutarmanto (Tintingan Psikologi Humanistik Abraham Maslow)

  Cerbung Nrima ing Pandum anggitane Sutarmanto nggambarake ngenani kabutuhan rasa tentrem para paragane. Kabutuhan rasa tentrem kang durung kacukupan bisa nuwuhake pirang-pirang problem. Saliyane anane problem kang tuwuh uga ana pirang-pirang upaya kanggo nyukupi kabutuhan rasa tentrem. Bab rasa tentrem minangka unsur kang onjo sajrone cerbung Nrima ing Pandum kasebut, mula panliten iki nliti babagan kabutuhan rasa tentrem para paragane kanthi nggunakake teori psikologi humanistik hirarki kabutuhane Abraham Maslow mligine babagan kabutuhan rasa tentrem. Underane panliten iki yaiku 1) Kepriye gambaran kabutuhan rasa tentrem sajrone cerbung Nrima Ing Pandum Anggitane Sutarmanto, 2) Kepriye problem saka kabutuhan rasa tentrem sajrone cerbung kasebut, 3) Kepriye upayane paraga kanggo nyukupi kabutuhan rasa tentrem sajrone cerbung kasebut. Slaras karo undere panliten dingerteni tujuwan saka panliten iki yaiku 1) ngandharake gegambaran kabutuhan rasa tentrem sajrone cerbung Nrima Ing Pandum Anggitane Sutarmanto, 2) ngandharake problem saka kabutuhan rasa tentrem sajrone cerbung kasebut, 3) ngandharake upayane paraga kanggo nyukupi kabutuhan rasa tentrem paraga sajrone cerbung kasebut. Metodhe kang digunakake sajrone panliten yaiku metodhe dheskriptif kualitatif. Sumber dhatane panliten arupa cerbung sajrone kalawarti Nrima ing Pandum. Dhatane panliten yaiku tembung, frase lan ukara sajrone cerbung Nrima Ing Pandum taun 2015. Panglumpuke dhata kasebut nggunakake teknik waca pilih cathet lan kapustakan. Kanggo ngandharake lan njlentrehake dhata nggunakake metodhe dheskriptif analisis kanthi tintingan psikologi sastra Abraham Maslow. Asile panliten iki bisa diperang dadi telu. Perangan sepisan ngenani gambaran kabutuhan rasa tentreme paraga kaperang dadi wolu, yaiku 1) Kabutuhan rasa tentrem saka rasa tagihan utang, 2) Kabutuhan rasa tentrem saka mungsuh, 3) Kabutuhan rasa tentrem saka bebaya, 4) Kabutuhan rasa tentrem saka idheologi tartamtu, 5) Kabutuhan rasa tentrem saka inciman, 6) Kabutuhan rasa tentrem saka pangenyek, 7) Kabutuhan rasa tentrem saka lara, lan 8) Kabutuhan rasa tentrem saka rasa sumelang. Perangan kapindho, problem kang tuwuh saka  kabutuhan rasa tentreme paraga  diperang dadi telu yaiku 1) pikiran mbruwet 2) rasa rikuh, lan 3) wedi srawung. Perangan katelu upaya kanggo nyukupi kabutuhan rasa tentreme paraga diperang dadi enem yaiku 1) Gelem diwelasi,  2) Nyilih dhuwit, 3) Ndhewe, 4) Menging wong liya, 5) Pasrah marang Gusti, lan 6) Donga marang Gusti

Major Tegument Protein pp65 of Human Cytomegalovirus Is Required for the Incorporation of pUL69 and pUL97 into the Virus Particle and for Viral Growth in Macrophages▿

The tegument protein pp65 of human cytomegalovirus (HCMV) represents the major component of mature virus particles. Nevertheless, deletion of pp65 has been shown to have no effects on virus replication and morphogenesis in fibroblasts in vitro. We have studied the HCMV virion composition in the absence of pp65 and viral growth of a pp65 stop mutant in different cell types, including monocyte-derived macrophages. Two stop codons at amino acids 11 and 12 of pp65 were introduced by bacterial artificial chromosome mutagenesis into the endotheliotropic strain TB40/E. Clear changes of the tegument composition could be observed in purified mutant virus particles, where the amount of tegument protein pUL25 was drastically reduced. In addition, pUL69 and the virally encoded protein kinase UL97 were undetectable in the pp65 stop mutant. Expression of pUL69 in infected cells was unaltered while pUL25 accumulated in the absence of pp65, thus demonstrating that only incorporation into virus particles is dependent on pp65. Coimmunoprecipitation experiments using lysates of infected cells revealed an interaction between pUL69 and pp65. This interaction was verified in pull-down experiments using transfected cells, which showed that pp65 and pUL69 do not require the presence of other viral proteins for their interaction. We conclude that pp65 is required for the incorporation of other viral proteins into the virus particle and thus is involved in the protein-protein interaction network leading to normal tegument formation. When studying growth kinetics of the pp65 stop mutant in different cell types, we found a severe impairment of viral growth in monocyte-derived macrophages, showing for the first time a strong cell-specific role of pp65 in viral growth

Hybrid neuroelectronics: towards a solution-centric way of thinking about complexproblems in neurostimulation tools

Responsive neuromodulation is increasingly being used to treat patients withneuropsychiatric diseases. Yet, inefficient bridges between traditional and newmaterials and technological innovations impede advancements inneurostimulation tools. Signaling in the brain is accomplished predominantlyby ionflux rather than the movement of electrons. However, thestatusquofor the acquisition of neural signals is using materials, such as noble metals, thatcan only interact with electrons. As a result, ions accumulate at the biotic/abioticinterface, creating a double-layer capacitance that increases impedance andnegatively impacts the efficiency of neural interrogation. Alternative materials,such as conducting polymers, allow ion penetration in the matrix, creating avolumetric capacitor (two orders of magnitude larger than an area-dependentcapacitor) that lowers the impedance and increases the spatiotemporal resolutionof the recording/stimulation. On the other hand, the increased development andintegration capabilities of CMOS-based back-end electronics have enabled thecreation of increasingly powerful and energy-efficient microchips. These includestimulation and recording systems-on-a-chip (SoCs) with up to tens of thousandsof channels, fully integrated circuitry for stimulation, signal conditioning,digitation, wireless power and data telemetry, and on-chip signal processing.Here, we aim to compile information on the best component for each buildingblock and try to strengthen the vision that bridges the gap among various materialsand technologies in an effort to advance neurostimulation tools and promote asolution-centric way of considering their complex problem

Use of contrast\u2010enhanced ultrasonography for the characterization of tumor thrombi in seven dogs

Tumors of adrenal and thyroid glands have been associated with vascular invasions\u2014socalled tumor thrombi, both in humans and dogs. The detection and characterization of venous thrombi is an important diagnostic step in patients with primary tumors for both surgical planning and prognosis. The aim of this study was to describe the use of contrast\u2010enhanced ultrasonography (CEUS) for the characterization of tumor thrombi. Dogs with tumor thrombus who underwent bidimensional ultrasound (B\u2010mode US) and CEUS were included. Seven dogs were enrolled in this retrospective case series. On B\u2010mode US, all thrombi were visualized, and vascular distension and thrombus\u2010tumor continuity were seen in three and two cases, respectively. On color Doppler examination, all thrombi were identified, seemed non\u2010occlusive and only two presented vascularity. On CEUS, arterial\u2010phase enhancement and washout in the venous phase were observed in all cases. Non\u2010enhancing areas were identified in the tumor thrombi most likely representing nonvascularized tissue that could potentially be embolized in the lungs after fragmentation of the tumor thrombi. On the basis of these preliminary study, CEUS appeared to be useful for the characterization of malignant intravascular invasion