Analisis Faktor Determinan Yang Mempengaruhi Pelaksanaan Budaya Keselamatan Pasien di Rumah Sakit Umum Daerah Mgr. Gabriel Manek, Svd Atambua

Budaya keselamatan pasien merupakan produk dari nilai, sikap, kompetensi dan pola perilaku individu dan kelompok yang menentukan komitmen dan kemampuan suatu budaya organisasi pelayanan kesehatan terhadap program keselamatan pasien. Dampak dari budaya keselamatan pasien yang kurang di rumah sakit adalah menurunnya tingkat kepercayaan masyarakat terhadap pelayanan kesehatan. Organisasi kesehatan dunia mengestimasi bahwa di Asia orang menerima lebih dari 5 kali injeksi/tahun dan 50% dari tindakan injeksi tersebut tidak aman. Sekitar 4% pasien mengalami adverse event selama dirawat di rumah sakit, 70% berakhir dengan kecacatan sementara, sedangkan 14% berkahir dengan kematian. Sedangkan Institute of Medicine mencatat sebanyak 44.000-98.000 orang meninggal per tahunnya di Amerika Serikat yang disebabkan oleh kesalahan medis. Dan untuk Indonesia dalam rentang waktu 2006-2011 Komite Keselamatan Pasien Rumah sakit melaporkan adanya sejumlah 877 insiden terkait keselamatan pasien. WHO mengembangkan empat kategori faktor yang sangat berhubungan dengan penyebab insiden keselamatan pasien yaitu : kategori faktor budaya organisasi, kategori faktor kerja tim, kategori faktor individu, dan kategori faktor lingkungan kerja. Tujuan dari penelitian ini adalah untuk mengetahui faktor determinan yang mempengaruhi pelaksanaan budaya keselamatan pasien di Rumah sakit Umum Daerah Mgr. Gabriel Manek SVD Atambua. Penelitian ini merupakan rancangan penelitian kuantitatif mengunakan desain cross sectional yang dianalisis dengan regresi linear berganda. Responden pada penelitian ini sebanyak 127 responden. Hasil penelitian, pada univariat di dapatka hasil distribusi frekwensi budaya organisasi, tim kerja, individu, lingkungan kerja dan budaya keselamatan pasien berada pada kategori baik, ini menggambakan semakin tinggi budaya organisasi, kerja tim, individu dan lingkungan kerja maka akan semakin baik budaya keselamatan pasien di Rumah sakit. Uji pearson corelation diperoleh hasil hubungan budaya organisasi dengan budaya keselamatan pasien p=0,000 dan memiliki hubungan yang kuat dengan nilai corelation coefision 0,829. Hubungan kerja tim dengan budaya keselamatan pasien p=0,000 dan memiliki hubungan yang kuat dengan nilai corelation coefision 0,868. Hubungan Individu dengan budaya keselamatan pasien p=0,000 dan memiliki hubungan yang kuat dengan nilai correlation coefficient 0,856. Hubungan lingkungan kerja dengan budaya keselamatan pasien p=0,000 dan memiliki hubungan yang kuat dengan nilai correlation coefficient 0,863. Ini menjelaskan bahwa budaya keselamatan pasien merupakan upaya untuk meningkatkan ketepatan identifikasi pasien, peningkatan komunikasi yang efektif, peningkatan keamanan obat, tepat lokasi prosedur operasi, pengurangan risiko infeksi terkait pelayanan kesehatan dan pengurangan risiko pasien jatuh melalui budaya organisasi, kerja tim, individu dan lingkungan kerja baik. Sedangkan analisis multivariat menggunakan uji regresi linear berganda didapatkan persamaan Y = 40,842 + 1,007(Faktor Kerja tim) + 1,042 (Faktor Lingkungan kerja). Nilai constanta positif menunjukkanviii pengaruh positif variabel independen yaitu variabel kerja tim dan variabel lingkungan kerja. 1,007 merupakan nilai koefisien regresi variabel kerja tim terhadap budaya keselamatan pasien, yang artinya jika variabel kerja tim mengalai kenaikan satu satuan maka budaya keselamatan pasien akan mengalami peningkatan 1,007. Dan 1,042 merupakan nilai koefisien regresi variabel lingkungan kerja terhadap budaya keselamatan pasien, yang artinya jika variabel lingkungan kerja mengalai kenaikan satu satuan maka budaya keselamatan pasien akan mengalami peningkatan 1,042. Terdapat hubungan yang signifikan antara faktor budaya organisasi, kerja tim, individu dan lingkungan kerja terhadap budaya keselamatan dan faktor yang paling dominan mempengaruhi budaya keselamatan pasien di Rumah sakit Mgr. Gabriel Manek, SVD Atambua berdasarkan pemodelan regresi linear adalah tim kerja. Kerja tim akan menjadi penentu lancar tidaknya suatu organisasi. Interaksi dalam tim berpengaruh terhadap prilaku anggota dalam berkomunikasi dan terbuka dalam mengungkapkan kesalahan yang terjad

New distance measures for classifying X-ray astronomy data into stellar classes

The classification of the X-ray sources into classes (such as extragalactic sources, background stars, ...) is an essential task in astronomy. Typically, one of the classes corresponds to extragalactic radiation, whose photon emission behaviour is well characterized by a homogeneous Poisson process. We propose to use normalized versions of the Wasserstein and Zolotarev distances to quantify the deviation of the distribution of photon interarrival times from the exponential class. Our main motivation is the analysis of a massive dataset from X-ray astronomy obtained by the Chandra Orion Ultradeep Project (COUP). This project yielded a large catalog of 1616 X-ray cosmic sources in the Orion Nebula region, with their series of photon arrival times and associated energies. We consider the plug-in estimators of these metrics, determine their asymptotic distributions, and illustrate their finite-sample performance with a Monte Carlo study. We estimate these metrics for each COUP source from three different classes. We conclude that our proposal provides a striking amount of information on the nature of the photon emitting sources. Further, these variables have the ability to identify X-ray sources wrongly catalogued before. As an appealing conclusion, we show that some sources, previously classified as extragalactic emissions, have a much higher probability of being young stars in Orion Nebula.Comment: 29 page

Back from a Predicted Climatic Extinction of an Island Endemic: A Future for the Corsican Nuthatch

The Corsican Nuthatch (Sitta whiteheadi) is red-listed as vulnerable to extinction by the IUCN because of its endemism, reduced population size, and recent decline. A further cause is the fragmentation and loss of its spatially-restricted favourite habitat, the Corsican pine (Pinus nigra laricio) forest. In this study, we aimed at estimating the potential impact of climate change on the distribution of the Corsican Nuthatch using species distribution models. Because this species has a strong trophic association with the Corsican and Maritime pines (P. nigra laricio and P. pinaster), we first modelled the current and future potential distribution of both pine species in order to use them as habitat variables when modelling the nuthatch distribution. However, the Corsican pine has suffered large distribution losses in the past centuries due to the development of anthropogenic activities, and is now restricted to mountainous woodland. As a consequence, its realized niche is likely significantly smaller than its fundamental niche, so that a projection of the current distribution under future climatic conditions would produce misleading results. To obtain a predicted pine distribution at closest to the geographic projection of the fundamental niche, we used available information on the current pine distribution associated to information on the persistence of isolated natural pine coppices. While common thresholds (maximizing the sum of sensitivity and specificity) predicted a potential large loss of the Corsican Nuthatch distribution by 2100, the use of more appropriate thresholds aiming at getting closer to the fundamental distribution of the Corsican pine predicted that 98% of the current presence points should remain potentially suitable for the nuthatch and its range could be 10% larger in the future. The habitat of the endemic Corsican Nuthatch is therefore more likely threatened by an increasing frequency and intensity of wildfires or anthropogenic activities than by climate change

Silencing of Aphid Genes by dsRNA Feeding from Plants

RNA interference (RNAi) is a valuable reverse genetics tool to study gene function in various organisms, including hemipteran insects such as aphids. Previous work has shown that RNAi-mediated knockdown of pea aphid (Acyrthosiphon pisum) genes can be achieved through direct injection of double-stranded RNA (dsRNA) or small-interfering RNAs (siRNA) into the pea aphid hemolymph or by feeding these insects on artificial diets containing the small RNAs.In this study, we have developed the plant-mediated RNAi technology for aphids to allow for gene silencing in the aphid natural environment and minimize handling of these insects during experiments. The green peach aphid M. persicae was selected because it has a broad plant host range that includes the model plants Nicotiana benthamiana and Arabidopsis thaliana for which transgenic materials can relatively quickly be generated. We targeted M. persicae Rack1, which is predominantly expressed in the gut, and M. persicae C002 (MpC002), which is predominantly expressed in the salivary glands. The aphids were fed on N. benthamiana leaf disks transiently producing dsRNA corresponding to these genes and on A. thaliana plants stably producing the dsRNAs. MpC002 and Rack-1 expression were knocked down by up to 60% on transgenic N. benthamiana and A. thaliana. Moreover, silenced M. persicae produced less progeny consistent with these genes having essential functions.Similar levels of gene silencing were achieved in our plant-mediated RNAi approach and published silencing methods for aphids. Furthermore, the N. benthamiana leaf disk assay can be developed into a screen to assess which genes are essential for aphid survival on plants. Our results also demonstrate the feasibility of the plant-mediated RNAi approach for aphid control

Search for new phenomena in final states with an energetic jet and large missing transverse momentum in pp collisions at √ s = 8 TeV with the ATLAS detector

Results of a search for new phenomena in final states with an energetic jet and large missing transverse momentum are reported. The search uses 20.3 fb−1 of √ s = 8 TeV data collected in 2012 with the ATLAS detector at the LHC. Events are required to have at least one jet with pT > 120 GeV and no leptons. Nine signal regions are considered with increasing missing transverse momentum requirements between Emiss T > 150 GeV and Emiss T > 700 GeV. Good agreement is observed between the number of events in data and Standard Model expectations. The results are translated into exclusion limits on models with either large extra spatial dimensions, pair production of weakly interacting dark matter candidates, or production of very light gravitinos in a gauge-mediated supersymmetric model. In addition, limits on the production of an invisibly decaying Higgs-like boson leading to similar topologies in the final state are presente

The Tyrosine Kinase Inhibitor Dasatinib Induces a Marked Adipogenic Differentiation of Human Multipotent Mesenchymal Stromal Cells

BACKGROUND: The introduction of specific BCR-ABL inhibitors in chronic myelogenous leukemia therapy has entirely mutated the prognosis of this hematologic cancer from being a fatal disorder to becoming a chronic disease. Due to the probable long lasting treatment with tyrosine-kinase inhibitors (TKIs), the knowledge of their effects on normal cells is of pivotal importance. DESIGN AND METHODS: We investigated the effects of dasatinib treatment on human bone marrow-derived mesenchymal stromal cells (MSCs). RESULTS: Our findings demonstrate, for the first time, that dasatinib induces MSCs adipocytic differentiation. Particularly, when the TKI is added to the medium inducing osteogenic differentiation, a high MSCs percentage acquires adipocytic morphology and overexpresses adipocytic specific genes, including PPARγ, CEBPα, LPL and SREBP1c. Dasatinib also inhibits the activity of alkaline phosphatase, an osteogenic marker, and remarkably reduces matrix mineralization. The increase of PPARγ is also confirmed at protein level. The component of osteogenic medium required for dasatinib-induced adipogenesis is dexamethasone. Intriguingly, the increase of adipocytic markers is also observed in MSCs treated with dasatinib alone. The TKI effect is phenotype-specific, since fibroblasts do not undergo adipocytic differentiation or PPARγ increase. CONCLUSIONS: Our data demonstrate that dasatinib treatment affects bone marrow MSCs commitment and suggest that TKIs therapy might modify normal phenotypes with potential significant negative consequences

Second-Generation Sequencing Supply an Effective Way to Screen RNAi Targets in Large Scale for Potential Application in Pest Insect Control

The key of RNAi approach success for potential insect pest control is mainly dependent on careful target selection and a convenient delivery system. We adopted second-generation sequencing technology to screen RNAi targets. Illumina's RNA-seq and digital gene expression tag profile (DGE-tag) technologies were used to screen optimal RNAi targets from Ostrinia furnalalis. Total 14690 stage specific genes were obtained which can be considered as potential targets, and 47 were confirmed by qRT-PCR. Ten larval stage specific expression genes were selected for RNAi test. When 50 ng/µl dsRNAs of the genes DS10 and DS28 were directly sprayed on the newly hatched larvae which placed on the filter paper, the larval mortalities were around 40∼50%, while the dsRNAs of ten genes were sprayed on the larvae along with artificial diet, the mortalities reached 73% to 100% at 5 d after treatment. The qRT-PCR analysis verified the correlation between larval mortality and the down-regulation of the target gene expression. Topically applied fluorescent dsRNA confirmed that dsRNA did penetrate the body wall and circulate in the body cavity. It seems likely that the combination of DGE-tag with RNA-seq is a rapid, high-throughput, cost less and an easy way to select the candidate target genes for RNAi. More importantly, it demonstrated that dsRNAs are able to penetrate the integument and cause larval developmental stunt and/or death in a lepidopteron insect. This finding largely broadens the target selection for RNAi from just gut-specific genes to the targets in whole insects and may lead to new strategies for designing RNAi-based technology against insect damage

The Distribution of Toxoplasma gondii Cysts in the Brain of a Mouse with Latent Toxoplasmosis: Implications for the Behavioral Manipulation Hypothesis

reportedly manipulates rodent behavior to enhance the likelihood of transmission to its definitive cat host. The proximate mechanisms underlying this adaptive manipulation remain largely unclear, though a growing body of evidence suggests that the parasite-entrained dysregulation of dopamine metabolism plays a central role. Paradoxically, the distribution of the parasite in the brain has received only scant attention. at six months of age and examined 18 weeks later. The cysts were distributed throughout the brain and selective tropism of the parasite toward a particular functional system was not observed. Importantly, the cysts were not preferentially associated with the dopaminergic system and absent from the hypothalamic defensive system. The striking interindividual differences in the total parasite load and cyst distribution indicate a probabilistic nature of brain infestation. Still, some brain regions were consistently more infected than others. These included the olfactory bulb, the entorhinal, somatosensory, motor and orbital, frontal association and visual cortices, and, importantly, the hippocampus and the amygdala. By contrast, a consistently low incidence of tissue cysts was recorded in the cerebellum, the pontine nuclei, the caudate putamen and virtually all compact masses of myelinated axons. Numerous perivascular and leptomeningeal infiltrations of inflammatory cells were observed, but they were not associated with intracellular cysts. distribution stems from uneven brain colonization during acute infection and explains numerous behavioral abnormalities observed in the chronically infected rodents. Thus, the parasite can effectively change behavioral phenotype of infected hosts despite the absence of well targeted tropism