Pengaruh Komunikasi Terapeutik Perawat Terhadap Kepuasan Pasien Di Rawat Jalan RSUD Jogja

The Objective of this study is to know influence of nurse therapeutic communication to satisfaction of patients satisfaction in RSUD Yogyakarta. The study was a quantitative research methods such as surveys of descriptive inferential research with cross sectional approach. Number of samples in this research is 285 sample in inpatient and 140 in emergency room. The instrument used a questionnaire. Analysis of data using multiple linear regression. This study show that there is the influence of therapeutic communication nurse to satisfaction of outpatients and Emergency room in RSUD Yogyakarta, and orientation phase is a phase that most influence on patient satisfaction. The most influential to therapeutic communication is termination stage

Enhancing Long-Term Durability of Electrochemical Reactors Producing Formate from CO₂ and Water Designed for Integration with Solar Cells

Artificial photosynthetic cells producing organic matter from CO2 and water have been extensively studied for carbon neutrality, and the research trend is currently transitioning from proof of concept using small-sized cells to large-scale demonstrations for practical applications. We previously demonstrated a 1 m2 size cell in which an electrochemical (EC) reactor featuring a ruthenium (Ru)-complex polymer (RuCP) cathode catalyst was integrated with photovoltaic cells. In this study, we tackled the remaining issue to improve the long-term durability of cathode electrodes used in the EC reactors, demonstrating high Faradaic efficiencies exceeding 80% and around 60% electricity-to-chemical energy-conversion efficiencies of a 75 cm2 sized EC reactor after continuous operation for 3000 h under practical conditions. Introduction of a pyrrole derivative containing an amino group in the RuCP coupled with UV–ozone treatment to create carboxyl groups on the carbon supports effectively reduced the detachment of the RuCP catalyst by forming a strong amide linkage. A newly developed chemically resistant graphite adhesive prevented the carbon supports from peeling off of the conductive substrates. In addition, highly durable anodes composed of IrOx-TaOy/Pt-metal oxide/Ti were adopted. Even though the EC reactor was installed at an inclined angle of 30°, which is approximately the optimal angle for receiving more solar energy, the crossover reactions were sufficiently suppressed because the porous separator film impeded the transfer of oxygen gas bubbles from the anode to the cathode. The intermittent operation improved the energy-conversion efficiency because the accumulated bubbles were removed at night

Establishment of Mouse Model of <i>MYH9</i> Disorders: Heterozygous R702C Mutation Provokes Macrothrombocytopenia with Leukocyte Inclusion Bodies, Renal Glomerulosclerosis and Hearing Disability

<div><p>Nonmuscle myosin heavy chain IIA (NMMHCIIA) encoded by <i>MYH9</i> is associated with autosomal dominantly inherited diseases called <i>MYH9</i> disorders. <i>MYH9</i> disorders are characterized by macrothrombocytopenia and very characteristic inclusion bodies in granulocytes. <i>MYH9</i> disorders frequently cause nephritis, sensorineural hearing disability and cataracts. One of the most common and deleterious mutations causing these disorders is the R702C missense mutation.</p><p>We generated knock-in mice expressing the <i>Myh9</i> R702C mutation. R702C knock-in hetero mice (R702C+/− mice) showed macrothrombocytopenia. We studied megakaryopoiesis of cultured fetal liver cells of R702C+/− mice and found that proplatelet formation was impaired: the number of proplatelet tips was decreased, proplatelet size was increased, and proplatelet shafts were short and enlarged. Although granulocyte inclusion bodies were not visible by May–Grünwald Giemsa staining, immunofluorescence analysis indicated that NMMHCIIA proteins aggregated and accumulated in the granulocyte cytoplasm.</p><p>In other organs, R702C+/− mice displayed albuminuria which increased with age. Renal pathology examination revealed glomerulosclerosis. Sensory hearing loss was indicated by lowered auditory brainstem response.</p><p>These findings indicate that <i>Myh9</i> R702C knock-in mice mirror features of human <i>MYH9</i> disorders arising from the R702C mutation.</p></div

Auditory Brain-stem Response (ABR).

<p>ABR measurement in R702C+/− mice. Means and standard deviations of ABR thresholds (in dB SPL) in R702C+/− mice and WT mice. ABRs were measured in 10 R702C+/− mice and five WT mice aged approximately 20 weeks, as described in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0071187#s2" target="_blank">Materials and Methods</a>.</p

Percentage of glomeruli with sclerosis.

<p>Mean ratio of glomerulus with sclerosis (%): 43.4% (n = 5).</p

Myh9 R702C knock-in strategy.

<p>A) Targeting strategy for R702C knock-in mutation of the murine <i>Myh9</i> gene. The targeting vector p<i>Multi-ND1.0_Myh9^neo</i>, the wild-type <i>Myh9</i> allele and the targeted allele before (<i>Myh9^neo</i>) and after Cre-mediated excitation of the <i>loxP</i> franked <i>neo</i> cassette (<i>Myh9^mt</i>) are schematically represented. The targeting vector also contains the Diphtheria toxin fragment A <i>(DTA)</i> gene outside the flanking homologies. Black boxes in the genomic structures represent exon sequences; the asterisk on exon 16 denotes the R702C mutation; the underlined N (<i>Nde</i>I) denotes the extra diagnostic restriction site created by silent mutation. The expected restriction fragments of the genotyping PCR products are indicated with their relative size accompanied with solid lines. The black box above the wild-type gene represents the 5′ probe used for Southern blot analysis. The open arrowheads under the gene represent the primers used for long-PCR genotyping. (B, C) Confirmation at the DNA level of correct targeting of the <i>Myh9</i> gene. Correct homologous recombination as identified by an additional 4.8-kb band in Southern blot analysis of <i>Hin</i>dIII digested genomic DNA with the 5′ probe, as well as by a 3.8 kb targeted fragment in long-PCR products digested with <i>Nde</i>I (B). Correct Cre-mediated excitation of the <i>loxP</i> franked <i>neo</i> cassette as confirmed by the appearance of a 2.4 kb recombined instead of 3.8 kb targeted fragment in long-PCR products digested with <i>Nde</i>I (C).</p

Abnormal kidney function.

<p>Coomassie blue-stained SDS-PAGE gel of urine samples from 5 and 20 week old mice (A). Albuminuria was also measured at 5, 10, 15 and 20 weeks using an ELISA kit (AlbuwellM, Exocell) (n = 6) (B). These results show that, while WT mice had little albuminuria at any age, R702C+/− mice had significant albuminuria from the age of 5 weeks. This progressive albuminuria was observed in all R702C+/− mice. Pathologic confirmation of albuminuria was obtained by light and electron microscopy of renal specimens from 20-week-old R702C+/− mice and WT mice. Light microscopy samples were stained with Periodic acid-methenamin (PAM) and were observed at 100-fold magnification (C) (D) and 630-fold magnification (E) (F) (G). R702C+/− mice displayed significant glomerulosclerosis (D), primarily global glomerulosclerosis (indicated by white arrow in D and magnified on (G)) and some segmental glomerulosclerosis (indicated by black arrow in D and magnified on (F)). (C) and (E) are normal controls. Electron microscopic analysis was performed at 3000-fold magnification (H) (I). Transmission electron microscopy revealed foot process effacement (I). (H) is normal control.</p

Abnormal megakaryocytopoiesis.

<p>In hematoxylin-eosin staining, the morphology of megakaryocyte in R702C+/− mice was not different from that of WT mice (A) (B). There were no significant differences in the distribution of NMMHCIIA between R702C+/− mice and WT mice by immunostaining (C) (D). Proplatelet formation was explored by cultured fetal liver cells. In WT mice, the proplatelet shaft extends from the cell spindle, leading to the formation of proplatelet beads. R702C+/− mice had shorter and thicker shafts when compared with WT mice, and the proplatelet beads were fewer and larger than those of WT mice. MKs were stained with MGG (E) (F) or were observed using CD41 immunofluorescence (G) (H).</p

Macrothrombocytopenia and abnormal NMMHCIIA accumulation in granulocytes.

<p>R702C+/− mice exhibited decreased platelet count (mean±SD, C57BL/6j: 1212±146×10⁹/L vs. R702C+/−: 342±49×10⁹/L) (n = 10) (A). Platelet size was evaluated by measuring platelet diameter (mean±SD: C57BL/6j: 1.52±0.29 µm vs. R702C+/−: 3.65±0.56 µm) (n = 10) (B). Most R702C+/− mice had a bleed time comparable to WT mice, although several displayed prolonged bleed times (n = 10) (C). Clot retraction was not impaired in R702C+/− mice. Data are representative of three experiments (D). There were no abnormalities in granulocytes and no granulocyte inclusion bodies were visible following May–Grünwald Giemsa (MGG) staining (E) (F). Immunofluorescence analysis showed that NMMHCIIA aggregated and accumulated in the granulocyte cytoplasm of R702C+/− mice (G)(H).</p

Urine examination by urinary test strip.

<p>Hematuria: − means RBC<10/µl, Hb<0.03 mg/dl.</p><p>Proteinuria: ±:15, +:30, ++:100, +++:300 (mg/dl).</p><p>Urinal sugar: ±:50, +:100, ++:250, +++:500 (mg/dl).</p