Hubungan Karakteristik Dokter Dengan Kelengkapan Catatan Laporan Operasi Di RSU Queen Latifa Yogyakarta Tahun 2016

Medical records were good and should the quality indicatos of the completeness, accuracy, timely and have the legal aspects. Objectives Knowing Relationship Characteristics of doctors by Gender, Age and Lenght of working Work with Reports Completeness of Operations In RSU Queen Latifa. This research method using observational analytic design with cross sectional approach. The study population was all file statements of operations in 2015. The samples was 166 medical record file by using purposive sampling method. Statistic test using Chi Square (X2). The results is there is a relationship between characteristics doctor by Gender (p-value 0.02) age (p value 0.02) and length of working (p value 0.00) with the completeness of operation report. There is a relationship between the characteristics of doctor with a complete statements of operations with a value of p (0.00). The count of complete report operations by doctor who have characteristics female, aged 25-45 years old and > length of working 3 years more than doctors who have characteristics male, aged 46-65 years old and length of working 1-3 years Keywords: Characteristics of Doctors, Completeness, Operation repor

Quasispecies Spatial Models for RNA Viruses with Different Replication Modes and Infection Strategies

Empirical observations and theoretical studies suggest that viruses may use different replication strategies to amplify their genomes, which impact the dynamics of mutation accumulation in viral populations and therefore, their fitness and virulence. Similarly, during natural infections, viruses replicate and infect cells that are rarely in suspension but spatially organized. Surprisingly, most quasispecies models of virus replication have ignored these two phenomena. In order to study these two viral characteristics, we have developed stochastic cellular automata models that simulate two different modes of replication (geometric vs stamping machine) for quasispecies replicating and spreading on a two-dimensional space. Furthermore, we explored these two replication models considering epistatic fitness landscapes (antagonistic vs synergistic) and different scenarios for cell-to-cell spread, one with free superinfection and another with superinfection inhibition. We found that the master sequences for populations replicating geometrically and with antagonistic fitness effects vanished at low critical mutation rates. By contrast, the highest critical mutation rate was observed for populations replicating geometrically but with a synergistic fitness landscape. Our simulations also showed that for stamping machine replication and antagonistic epistasis, a combination that appears to be common among plant viruses, populations further increased their robustness by inhibiting superinfection. We have also shown that the mode of replication strongly influenced the linkage between viral loci, which rapidly reached linkage equilibrium at increasing mutations for geometric replication. We also found that the strategy that minimized the time required to spread over the whole space was the stamping machine with antagonistic epistasis among mutations. Finally, our simulations revealed that the multiplicity of infection fluctuated but generically increased along time

Laparoscopic ileocolic resection versus infliximab treatment of distal ileitis in Crohn's disease: a randomized multicenter trial (LIR!C-trial)

Contains fulltext : 69534.pdf (publisher's version ) (Open Access)BACKGROUND: With the availability of infliximab, nowadays recurrent Crohn's disease, defined as disease refractory to immunomodulatory agents that has been treated with steroids, is generally treated with infliximab. Infliximab is an effective but expensive treatment and once started it is unclear when therapy can be discontinued. Surgical resection has been the golden standard in recurrent Crohn's disease. Laparoscopic ileocolic resection proved to be safe and is characterized by a quick symptom reduction.The objective of this study is to compare infliximab treatment with laparoscopic ileocolic resection in patients with recurrent Crohn's disease of the distal ileum with respect to quality of life and costs. METHODS/DESIGN: The study is designed as a multicenter randomized clinical trial including patients with Crohn's disease located in the terminal ileum that require infliximab treatment following recent consensus statements on inflammatory bowel disease treatment: moderate to severe disease activity in patients that fail to respond to steroid therapy or immunomodulatory therapy. Patients will be randomized to receive either infliximab or undergo a laparoscopic ileocolic resection. Primary outcomes are quality of life and costs. Secondary outcomes are hospital stay, early and late morbidity, sick leave and surgical recurrence. In order to detect an effect size of 0.5 on the Inflammatory Bowel Disease Questionnaire at a 5% two sided significance level with a power of 80%, a sample size of 65 patients per treatment group can be calculated. An economic evaluation will be performed by assessing the marginal direct medical, non-medical and time costs and the costs per Quality Adjusted Life Year (QALY) will be calculated. For both treatment strategies a cost-utility ratio will be calculated. Patients will be included from December 2007. DISCUSSION: The LIR!C-trial is a randomized multicenter trial that will provide evidence whether infliximab treatment or surgery is the best treatment for recurrent distal ileitis in Crohn's disease. TRIAL REGISTRATION: Nederlands Trial Register NTR1150

Analisis Pengaruh Kualitas Breakfast Terhadap Kepuasan Tamu Panderman Coffeeshop di Hotel Aria Gajayana

Penelitian ini berawal dari kendala yang dialami Hotel Aria Gajayana di mana tingkat hunian Hotel Aria Gajayana tidak setinggi rata-rata tingkat hunian di Kota Malang yang diduga karena adanya komplain dari tamu. Tujuan dari penelitian ini untuk menganalisis pengaruh dari kualitas pelayanan yang terbagi atas 5 dimensi yaitu tangible, reliability, responsiveness, assurance, dan empathy. Metode penelitian yang digunakan dalam penelitian ini adalah kuantitatif. Populasi dari penelitian ini adalah seluruh tamu yang menikmati layanan breakfast di Hotel Aria Gajayana dengan jumlah yang fluktuatif setiap harinya, sedangkan sampel yang diambil dari penelitian ini adalah hasil dari 10 kali jumlah variabel dependen yang menikmati breakfast atau menjadi populasi. Teknik analisis data yang digunakan yaitu penggunaaan aplikasi SPSS for Windows versi 25 untuk menghitung validitas, reliabilitas, pengaruh parsial dan pengaruh kelima variabel secara simultan kepuasan tamu. Hasil dari penelitian ini menunjukkan bahwa dari kelima variabel memiliki pengaruh tersendiri terhadap kepuasan tamu di Hotel Aria Gajayana Malang secara parsial. Indikator variabel tangible, reliability, responsiveness, dan empathy secara parsial memiliki pengaruh terhadap kepuasan tamu dan untuk di segi assurance tidak memiliki pengaruh yang signifikan terhadap kepuasan tamu. Sebaliknya jika indikator kelima variabel berjalan bersama maka ini secara simultan memiliki pengaruh yang signifikan sebesar terhadap kepuasan tamu. Hasilnya kualitas pelayanan berpengaruh 55,7% terhadap kepuasan tamu. Dapat disimpulkan bahwa tidak semua dari 5 variabel berpengaruh signifikan. Dapat dilihat variable assurance berpengaruh tidak signifikan yang diduga karena system buffet yang membuat tamu dan pramusaji tidak terlalu berintraksi

Pengaruh Pelatihan dan Kompensasi Terhadap Loyalitas Karyawan Atria Hotel Malang

Atria Hotel Malang merupakan salah satu hotel bintang 4 yang terletak di pusat Kota Malang, dan juga merupakan salah satu hotel yang ikut bersaing dalam perkembangan bisnis pariwisata khususnya di Kota Malang. Berkaitan dengan situasi persaingan bisnis perhotelan di Kota Malang yang ketat pasca covid-19, perusahaan harus memastikan kesetiaan karyawan, dengan karyawan yang memiliki sifat loyal terhadap perusahaan, perusahaan akan mampu menekan angka kesalahan kerja, menekan angka pengeluaran perusahaan dan tidak harus merekrut karyawan baru. Metode yang digunakan dalam penelitian ini adalah kuantitatif. Populasi yang digunakan adalah seluruh karyawan tetap Atria Hotel Malang tidak termasuk head of department dengan jumlah 50 orang dari seluruh departemen yang ada. Teknik pengambilan sample pada penelitian ini adalah probabilitas atau probability sampling. Dalam penelitian ini Penentuan pengambilan jumlah sample menggunakan Teknik Sampling Jenuh dalam pengambilan datanya dan untuk teknik analisis data menggunakan aplikasi IBM SPSS Statistic 25 untuk mengetahui semua pengujian. Hasil dari penelitian menjelaskan bahwa pelatihan dan kompensasai memiliki pengaruh positif dan signifikan terhadap loyalitas karyawan Atria Hotel Malang, kedua variabel tersebut berpengaruh 80,6% terhadap loyalitas dan 19,4% di pengaruhi oleh variabel diluar penelitian. Kesimpulan dari penelitian ini adalah hasil pengujian hipotesis telah membuktikan terdapat pengaruh antara pelatihan terhadap loyalitas karyawan Atria Hotel Malang, Hasil pengujian hipotesis telah membuktikan terdapat pengaruh antara kompensasi dengan loyalitas karyawan Atria Hotel Malang dan berdasarkan hasil penelitian Pelatihan dan Kompensasi secara Bersama-sama berpengaruh positif dan signifikan. Kata Kunci

All-cause mortality risk associated with long-term exposure to ambient PM2·5 in China: a cohort study

Summary: Background: Evidence from cohort studies in North America and Europe indicates that long-term exposure to fine particulate matter (PM2·5) is associated with an increased mortality risk. However, this association has rarely been quantified at higher ambient concentrations. We estimated the hazard ratio (HR) for all-cause mortality from long-term exposure to PM2·5 in a well established Chinese cohort of older adults. Methods: The Chinese Longitudinal Healthy Longevity Survey (CLHLS) is a prospective cohort study of men and women aged 65 years and older enrolled in 2008 and followed up through 2014 for mortality events. We studied individuals for whom residential locations were available in 2008 for linkage to 1 km grids of PM2·5 concentrations, derived from satellite remote sensing. Cox proportional hazards models were used to estimate the effect of long-term exposure to PM2·5 on all-cause mortality, controlling for age, sex, smoking status, drinking status, physical activity, body-mass index, household income, marital status, and education. We then used our results to estimate premature mortality related to PM2·5 exposure in the population aged 65 years and older in China in 2010. Findings: 13 344 individuals in the CLHLS cohort had data for all timepoints, yielding follow-up data for 49 440 person-years. In a 3-year window, these individuals were exposed to a median PM2·5 concentration of 50·7 μg/m3 (range 6·7–113·3). The overall HR for a 10 μg/m3 increase in this value was 1·08 (95% CI 1·06–1·09). In stratified analyses, HRs were higher in rural than in urban locations, in southern versus northern regions, and with exposure to lower versus higher PM2·5 concentrations. Based on the overall HR, we estimated that 1 765 820 people aged 65 years and older in China in 2010 had premature mortality related to PM2·5 exposure. Interpretation: Long-term exposure to PM2·5 is associated with an increased risk of all-cause mortality among adults aged 65 years and older in China, but the magnitude of the risk declines as the concentration of PM2·5 increases. Funding: National Natural Science Foundation of China, National High-Level Talents Special Support Plan of China for Young Talents, US National Aeronautics and Space Administration, and the Columbia University Global Policy Initiative

Time for More Support? Stakeholder Engagement for a Long-Term Care Planning Dementia Decision Aid Prototype

Clinical decision aids around long-term care can help support persons living with dementia (PLWD), family care partners, and healthcare providers navigate current and future care decisions. This study describes the iterative development of a long-term care planning dementia decision aid and explores care partner and geriatric providers’ insights regarding its acceptability and usability. Using a convergent parallel mixed methods design, we gathered surveys and completed interviews with 11 care partners and 11 providers. The quantitative and qualitative data were then converged, resulting in four findings: (1) helpfulness of the decision aid in supporting future care planning; (2) versatility of the decision aid in practice; (3) preferences for structure and content of the decision aid; and (4) perceived shortcomings of the decision aid in decision making. Future work should continue to refine the decision aid, pilot implementation, and evaluate potential effects on decision making as part of dementia care

The Variation Between Unilateral and Bilateral Weight Bearing in Hindfoot Alignment Evaluation. Part I: A Prospective In Vivo Radiographic Study

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: When weight bearing radiographs are taken, the patient is frequently asked to stand on the foot being examined with the other foot lifted off the floor. We have found however that alignments of the hind and midfoot change when bearing weight switches from bilateral to unilateral standing. This study investigated the possible differences in hindfoot alignments between unilateral and bilateral weight bearing using radiographical evaluation. Methods: Eight flexible feet without symptoms symptoms, nor significant trauma & surgical history in their lower limbs were recruited for this study. A portable fluoroscopy machine (Smart C, Turner Imaging, Salt Lake City, USA) was used to take weightbearing lateral views. The patient first stood on both feet with the non-examined foot standing outside of the collimator but bearing weight evenly (Figure 1), and then lifted the non-examined foot off the floor when the lateral XR image was taken for the examined foot. Hindfoot alignment in both positions was reflected by measuring the angle between the long axes of the proximal and distal portions of the Achilles tendon on the skin using the subtalar joint line as the intersection. On lateral XRs, various parameters were measured to reflect the subtalar joint alignment, the position of the calcaneus with inversion and eversion of the hindfoot, and the lateral and medial arch heights. Results: From bearing weight on two feet (bilaterally) to one foot (unilaterally), the Hindfoot Alignment Angle (Achilles) increased (6.23 to 11.21 degrees), the Calcaneal Pitch Angle decreased (22.06 to 19.22 degrees), the Middle vs Posterior Facets Angle decreased (166.46 to 160.74 degrees), and the 5th metatarsal/cuboid height decreased (0.73 to 0.67) all significant changes (p < 0.05). All of these represented a pronation movement in the mid and hindfoot, ie, valgus tilt/eversion of the calcaneus, decreased sinus tarsi opening, and reduced lateral arch height. In this small cohort, these differences were more obvious in the feet that were either slightly flat or cavus shaped (Figure 1, Table 1, and 2) than in feet with a more neutral alignment. Conclusion: The hindfoot and midfoot are more pronated in unilateral weightbearing than in bilateral weightbearing which may mask the severity of the deformity in a flexible cavovarus foot, but increase that in a flexible flatfoot. Modification of the traditionally used unilateral weightbearing position in obtaining clinical radiographs should be considered. Bilateral WBCT scans may be a better alternative, taking advantage of allowing both feet to stand in the most natural position without one foot blocking the other during the radiographic imaging