Evaluasi Penerapan Indikator Mutu Pelayanan Unit Gawat Darurat Rumah Sakit PKU Muhammadiyah Karanganyar

This study aims to determine: 1) evaluation of the implementation of quality service indicators of emergency unit established by the Ministry of Health of the Republic of Indonesia in PKU Muhammadiyah Hospital Karanganyar; 2) influence of response time to quality of service in Emergency Unit of PKU Muhammadiyah Hospital Karanganyar; 3) the influence of perception between doctor-patient communication on the quality of service in Emergency Unit of PKU Muhammadiyah Hospital Karanganyar. The sample in this research is patient of PKU Muhammadiyah Hospital Karanganyar in last one month which amounted to 140 people. The research instrument used observation sheet and questionnaire. The analysis technique used is regression analysis (multiple regression). Based on the results of analysis: 1) there is a significant influence of response time (X1) and perception between doctor-patient communication (X2) on the quality of service (Y); 2) there is influence of response time (X1) on the quality of service (Y); 3) there is a significant influence perceptions between doctor-patient communication (X2) on the quality of service (Y). Conclusions: 1) The response time of the patients in the Emergency Room of PKU Muhammadiyah Hospital Karanganyar majority is relatively fast; 2) Perception about communicates the doctor - patient in Emergency Room PKU Muhammadiyah Hospital Karanganyar majority classified as less good; 3) The quality of service in Emergency Room PKU Muhammadiyah Hospital Karanganyar mostly classified as quite good; 4) There is influence of response time and perception of communication between doctor - patient to the quality of service at Emergency Room of PKU Muhammadiyah Hospital Karanganyar; 5) perception variable about doctor-patient communication is the most dominant factor influence on the quality of service in Emergency Room of PKU Muhammadiyah Hospital Karanganyar. Penelitian ini bertujuan untuk mengetahui: 1) evaluasi penerapan indikator mutu pelayanan unit gawat darurat yang ditetapkan oleh Kementerian Kesehatan RI di RS PKU Muhammadiyah Karanganyar; 2) pengaruh waktu tanggap terhadap mutu pelayanan di Unit Gawat Darurat RS PKU Muhammadiyah Karanganyar; 3) pengaruh persepsi tentang komunikasi dokter – pasien terhadap mutu pelayanan di Unit Gawat Darurat RS PKU Muhammadiyah Karanganyar. Sampel dalam penelitian ini adalah pasien RS PKU Muhammadiyah Karanganyar pada satu bulan terakhir yang berjumlah 140 orang. Instrumen penelitian menggunakan lembar observasi dan kuesioner. Teknik analisis yang digunakan adalah analisis regresi (multiple regression). Berdasarkan hasil analisis diketahui: 1)terdapat pengaruh yang signifikan waktu tanggap (X1) dan persepsi tentang komunikasi dokter-pasien (X2) terhadap mutu pelayanan (Y); 2) terdapat pengaruh waktu tanggap (X1) terhadap mutu pelayanan (Y); 3) terdapat pengaruh yang signifikan persepsi tentang komunikasi dokter-pasien (X2) terhadap mutu pelayanan (Y). Kesimpulan: 1) Waktu tanggap pasien di UGD RS PKU Muhammadiyah Karanganyar mayoritas tergolong cepat; 2) Persepsi tentang komuniksi dokter – pasien di UGD RS PKU Muhammadiyah Karanganyar mayoritas tergolong kurang baik; 3) Mutu pelayanan di UGD RS PKU Muhammadiyah Karanganyar mayoritas tergolong cukup baik; 4) Terdapat pengaruh waktu tanggap dan persepsi tentang komunikasi dokter – pasien terhadap mutu pelayanan di UGD RS PKU Muhammadiyah Karanganyar; 5) variabel persepsi tentang komunikasi dokter-pasien merupakan faktor yang paling dominan pengaruhnya terhadap mutu pelayanan di UGD RS PKU Muhammadiyah Karanganyar

Chronology protection in stationary three-dimensional spacetimes

We study chronology protection in stationary, rotationally symmetric spacetimes in 2+1 dimensional gravity, focusing especially on the case of negative cosmological constant. We show that in such spacetimes closed timelike curves must either exist all the way to the boundary or, alternatively, the matter stress tensor must violate the null energy condition in the bulk. We also show that the matter in the closed timelike curve region gives a negative contribution to the conformal weight from the point of view of the dual conformal field theory. We illustrate these properties in a class of examples involving rotating dust in anti-de Sitter space, and comment on the use of the AdS/CFT correspondence to study chronology protection.Comment: 20 pages. V2: minor corrections, Outlook expanded, references added, published versio

Initial intramuscular perfusion pressure predicts early skeletal muscle function following isolated tibial fractures

<p>Abstract</p> <p>Background</p> <p>The severity of associated soft tissue trauma in complex injuries of the extremities guides fracture treatment and decisively determines patient's prognosis. Trauma-induced microvascular dysfunction and increased tissue pressure is known to trigger secondary soft tissue damage and seems to adversely affect skeletal muscle function.</p> <p>Methods</p> <p>20 patients with isolated tibial fractures were included. Blood pressure and compartment pressure (anterior and deep posterior compartment) were measured continuously up to 24 hours. Corresponding perfusion pressure was calculated. After 4 and 12 weeks isokinetic muscle peak torque and mean power of the ankle joint in dorsal and plantar flexion were measured using a Biodex dynamometer.</p> <p>Results</p> <p>A significant inverse correlation between the anterior perfusion pressure at 24 hours and deficit in dorsiflexion at 4 weeks was found for both, the peak torque (R = -0.83; p < 0.01) and the mean power (R = -0.84; p < 0.01). The posterior perfusion pressure at 24 h and the plantar flexion after 4 weeks in both, peak torque (R = -0.73, p =< 0.05) and mean power (R = -0.7, p =< 0.05) displayed a significant correlation.</p> <p>Conclusion</p> <p>The functional relationship between the decrease in intramuscular perfusion pressures and muscle performance in the early rehabilitation period indicate a causative and prognostic role of early posttraumatic microcirculatory derangements and skeletal muscle function. Therapeutic concepts aimed at effective muscle recovery, early rehabilitation, and decreased secondary tissue damage, should consider the maintenance of an adequate intramuscular perfusion pressure.</p

Degradation of 4-fluorophenol by Arthrobacter sp. strain IF1

A Gram-positive bacterial strain capable of aerobic biodegradation of 4-fluorophenol (4-FP) as the sole source of carbon and energy was isolated by selective enrichment from soil samples collected near an industrial site. The organism, designated strain IF1, was identified as a member of the genus Arthrobacter on the basis of 16S ribosomal RNA gene sequence analysis. Arthrobacter strain IF1 was able to mineralize 4-FP up to concentrations of 5 mM in batch culture. Stoichiometric release of fluoride ions was observed, suggesting that there is no formation of halogenated dead-end products during 4-FP metabolism. The degradative pathway of 4-FP was investigated using enzyme assays and identification of intermediates by gas chromatography (GC), GC–mass spectrometry (MS), high-performance liquid chromatography, and liquid chromatography–MS. Cell-free extracts of 4-FP-grown cells contained no activity for catechol 1,2-dioxygenase or catechol 2,3-dioxygenase, which indicates that the pathway does not proceed through a catechol intermediate. Cells grown on 4-FP oxidized 4-FP, hydroquinone, and hydroxyquinol but not 4-fluorocatechol. During 4-FP metabolism, hydroquinone accumulated as a product. Hydroquinone could be converted to hydroxyquinol, which was further transformed into maleylacetic acid and β-ketoadipic acid. These results indicate that the biodegradation of 4-FP starts with a 4-FP monooxygenase reaction that yields benzoquinone, which is reduced to hydroquinone and further metabolized via the β-ketoadipic acid pathway

Abnormal Changes in NKT Cells, the IGF-1 Axis, and Liver Pathology in an Animal Model of ALS

Amyotrophic lateral sclerosis (ALS) is a rapidly progressing fatal neurodegenerative disorder characterized by the selective death of motor neurons (MN) in the spinal cord, and is associated with local neuroinflammation. Circulating CD4+ T cells are required for controlling the local detrimental inflammation in neurodegenerative diseases, and for supporting neuronal survival, including that of MN. T-cell deficiency increases neuronal loss, while boosting T cell levels reduces it. Here, we show that in the mutant superoxide dismutase 1 G93A (mSOD1) mouse model of ALS, the levels of natural killer T (NKT) cells increased dramatically, and T-cell distribution was altered both in lymphoid organs and in the spinal cord relative to wild-type mice. The most significant elevation of NKT cells was observed in the liver, concomitant with organ atrophy. Hepatic expression levels of insulin-like growth factor (IGF)-1 decreased, while the expression of IGF binding protein (IGFBP)-1 was augmented by more than 20-fold in mSOD1 mice relative to wild-type animals. Moreover, hepatic lymphocytes of pre-symptomatic mSOD1 mice were found to secrete significantly higher levels of cytokines when stimulated with an NKT ligand, ex-vivo. Immunomodulation of NKT cells using an analogue of α-galactosyl ceramide (α-GalCer), in a specific regimen, diminished the number of these cells in the periphery, and induced recruitment of T cells into the affected spinal cord, leading to a modest but significant prolongation of life span of mSOD1 mice. These results identify NKT cells as potential players in ALS, and the liver as an additional site of major pathology in this disease, thereby emphasizing that ALS is not only a non-cell autonomous, but a non-tissue autonomous disease, as well. Moreover, the results suggest potential new therapeutic targets such as the liver for immunomodulatory intervention for modifying the disease, in addition to MN-based neuroprotection and systemic treatments aimed at reducing oxidative stress

Hemispheric Asymmetry in White Matter Connectivity of the Temporoparietal Junction with the Insula and Prefrontal Cortex

The temporoparietal junction (TPJ) is a key node in the brain's ventral attention network (VAN) that is involved in spatial awareness and detection of salient sensory stimuli, including pain. The anatomical basis of this network's right-lateralized organization is poorly understood. Here we used diffusion-weighted MRI and probabilistic tractography to compare the strength of white matter connections emanating from the right versus left TPJ to target regions in both hemispheres. Symmetry of structural connectivity was evaluated for connections between TPJ and target regions that are key cortical nodes in the right VAN (insula and inferior frontal gyrus) as well as target regions that are involved in salience and/or pain (putamen, cingulate cortex, thalamus). We found a rightward asymmetry in connectivity strength between the TPJ and insula in healthy human subjects who were scanned with two different sets of diffusion-weighted MRI acquisition parameters. This rightward asymmetry in TPJ-insula connectivity was stronger in females than in males. There was also a leftward asymmetry in connectivity strength between the TPJ and inferior frontal gyrus, consistent with previously described lateralization of language pathways. The rightward lateralization of the pathway between the TPJ and insula supports previous findings on the roles of these regions in stimulus-driven attention, sensory awareness, interoception and pain. The findings also have implications for our understanding of acute and chronic pains and stroke-induced spatial hemineglect

Low-dose retinoic acid enhances in vitro invasiveness of human oral squamous-cell-carcinoma cell lines

Retinoids inhibit the proliferation of several types of tumour cells, and are used for patients with several malignant tumours. In this study, we examined the effect of retinoic acids (RAs) on the invasive potentials of the oral squamous cell carcinoma (SCC) cells, BHY and HNt. BHY cells expressed all of retinoid nuclear receptors (RARα, β, γ, and RXRα) and cytoplasmic retinoic acid binding proteins (CRABP1 and CRABP2). HNt cells lacked the expression of RARβ, but expressed other nuclear receptors and CRABPs. All-trans retinoic acid (ATRA) and 13-cis retinoic acid (13-cisRA) (10−6and 10−7M) inhibited the growth of the cells, but low-dose ATRA and 13-cisRA (10−8M) marginally affected the growth of the cells. Surprisingly, low-dose RAs enhanced the activity of tissue-type plasminogen activator (tPA), and activated pro-matrix metalloproteinases (proMMP2 and proMMP9). Activation of proMMP2 and proMMP9 was inhibited by aprotinin, a serine-proteinase, tPA inhibitor. Furthermore, low-dose RAs enhanced the in vitro invasiveness of BHY cells. These results indicate that low-dose RAs enhances the in vitro invasiveness of oral SCC cells via an activation of proMMP2 and proMMP9 probably mediated by the induction of tPA. © 2001 Cancer Research Campaign http://www.bjcancer.co

Expression of cell cycle proteins in male breast carcinoma

<p>Abstract</p> <p>Introduction</p> <p>Male breast cancer (MBC) is a rare, yet potentially aggressive disease. Although literature regarding female breast cancer (FBC) is extensive, little is known about the etiopathogenesis of male breast cancer. Studies from our laboratory show that MBCs have a distinct immunophenotypic profile, suggesting that the etiopathogenesis of MBC is different from FBCs. The aim of this study was to evaluate and correlate the immunohistochemical expression of cell cycle proteins in male breast carcinoma to significant clinico-biological endpoints.</p> <p>Methods</p> <p>75 cases of MBC were identified using the records of the Saskatchewan Cancer Agency over 26 years (1970-1996). Cases were reviewed and analyzed for the immunohistochemical expression of PCNA, Ki67, p27, p16, p57, p21, cyclin-D1 and c-myc and correlated to clinico-biological endpoints of tumor size, node status, stage of the disease, and disease free survival (DFS).</p> <p>Results</p> <p>Decreased DFS was observed in the majority of tumors that overexpressed PCNA (98%, p = 0.004). The overexpression of PCNA was inversely correlated to the expression of Ki67 which was predominantly negative (78.3%). Cyclin D1 was overexpressed in 83.7% of cases. Cyclin D1 positive tumors were smaller than 2 cm (55.6%, p = 0.005), had a low incidence of lymph node metastasis (38.2%, p = 0.04) and were associated with increased DFS of >150 months (p = 0.04). Overexpression of c-myc (90%) was linked with a higher incidence of node negativity (58.3%, p = 0.006) and increased DFS (p = 0.04). p27 over expression was associated with decreased lymph node metastasis (p = 0.04). P21 and p57 positive tumors were related to decreased DFS (p = 0.04). Though p16 was overexpressed in 76.6%, this did not reach statistical significance with DFS (p = 0.06) or nodal status (p = 0.07).</p> <p>Conclusion</p> <p>Aberrant cell cycle protein expression supports our view that these are important pathways involved in the etiopathogenesis of MBC. Tumors with overexpression of Cyclin D1 and c-myc had better outcomes, in contrast to tumors with overexpression of p21, p57, and PCNA with significantly worse outcomes. P27 appears to be a predictive marker for lymph nodal status. Such observation strongly suggests that dysregulation of cell cycle proteins may play a unique role in the initiation and progression of disease in male breast cancer. Such findings open up new avenues for the treatment of MBC as a suitable candidate for novel CDK-based anticancer therapies in the future.</p