Implementasi Model Pengendalian Persediaan Eoq Multi Item dengan Mempertimbangkan Masa Deathstock pada Non-konstan Demand (Studi Kasus : Rumah Sakit X Tangerang)

The hospital is a community service facilities provided by the government . The hospital has a service goal is to provide medicines at the right time and in the dosage and how to use the right . Medication management process in hospitals include planning , procurement , storage and distribution . These four stages are interrelated and have a considerable impact on the availability of drugs in the hospital so it must be well coordinated . Disease and drug demand is unpredictable . Therefore , the management of inventory is crucial in dealing with cases of non- constant demand as demand for drugs . Each year , the number increases every year deathstock thereby increasing the cost of the warehouse store . This is because reservations are not scheduled drugs , causing a buildup of the drug ( deathstock ) warehouse and cause drug becomes outdated. Hence the importance of inventory control in the hospital . Controlling inventory in this study using Multi- Item EOQ model by considering deathstock conditions and expiry dates so that hospitals have the right medication ordering schedule is 0,406 in every year or once order for 149 days and resulting in lower total cost savings of Rp 10,274,584.52 per cycle

Usulan Model Persediaan dengan Metode Hadley-Within dan Chiu Approximation dengan Mempertimbangkan Pengembalian pada Produk Farmasi di RSUD Kardinah

Keberadaan persediaan bagi suatu instansi merupakan hal yang penting dan tidak dapat dihindari, namun keberadaannya sering dianggap sebagai pemborosan. Oleh karena itu, pengendalian persediaan adalah hal yang penting untuk dilakukan agar kebutuhan akan suatu produk dapat terpenuhi secara optimal. Unit farmasi adalah instalasi pendukung bagi Rumah Sakit sebagai sarana penyedia obat. Obat merupakan salah satu produk yang memiliki masa kadaluwarsa. Pada kondisi manajemen unit logistik farmasi di RSUD Kardinah saat ini terdapat obat yang tidak mengalami penjualan selama 3 bulan berturut-turut atau deathstock akibat obat mengalami slow moving stock sehingga obat-obat tersebut menumpuk terlalu lama digudang dan menyebabkan biaya persediaan yang besar akibat biaya simpan yang besar. Obat-obat yang akan kadaluwarsa harus di lakukan return ke supplier dengan lead time rata-rata 5 bulan, hal ini menimbulkan resiko stockout dan opportunity lost yang tinggi atas penjualan obat-obat tersebut. Maka perlu dilakukan pengendalian persediaan dengan mempertimbangkan demand yang probabilistik, masa kadaluwarsa dan pengembalian produk agar total biaya persediaan minimum. Tujuan dari penelitian ini adalah menentukan kuantitas pemesanan obat yang optimal dan meminimalkan kuantitas obat kadaluwarsa yang di return. Dari hasil perhitungan numerik dapat disimpulkan bahwa metode yang digunakan dapat menyelesaikan masalah dari unit farmasi pada RSUD Kardinah yang memiliki suatu sistem persediaan dengan faktor demand probabilistik, kadaluwarsa dan pengembalian produk

Differences in potassium forms between cutans and adjacent soil matrix in a Grey Clay Soil

International audienceCutans are common fabric features in soil and represent foci of chemical and biological reactions. The influence of cutans on potassium forms and their transformations were investigated for a Western Australian grey clay soil. Cutans and matrix soil had similar clay mineral associations with kaolinite, smectite and illite being present, but had different chemical properties. The organic carbon content of cutans was higher than for matrix soil, while pH values and oxalate extractable/dithionate extractable iron (Feo/Fed) ratios were lower. Numerous SEM-EDS single point analyses of cutans and the plasma phase of the matrix soil indicated that the mean value of K concentration in cutans is greater than in matrix soil, and that the K concentration decreased with distance from cutan to matrix. Chemical extractions showed mean values of total K and latent exchangeable K were higher for cutans than for matrix soil, but both fixed K and exchangeable K values were the same for cutans and matrix soil. In a K adsorption/desorption experiment, 35% of K adsorbed by matrix soil could not be desorbed by 1 M NH4Ac. These results indicate that cutans are relatively enriched in K and may play an important role in determining available K and latent exchangeable K due to the special physical and chemical environments they provide in the soil

Noise Effects on the Complex Patterns of Abnormal Heartbeats

Patients at high risk for sudden death often exhibit complex heart rhythms in which abnormal heartbeats are interspersed with normal heartbeats. We analyze such a complex rhythm in a single patient over a 12-hour period and show that the rhythm can be described by a theoretical model consisting of two interacting oscillators with stochastic elements. By varying the magnitude of the noise, we show that for an intermediate level of noise, the model gives best agreement with key statistical features of the dynamics.Comment: 4 pages, 4 figures, RevTe

Predicting species and community responses to global change using structured expert judgement : an Australian mountain ecosystems case study

Conservation managers are under increasing pressure to make decisions about the allocation of finite resources to protect biodiversity under a changing climate. However, the impacts of climate and global change drivers on species are outpacing our capacity to collect the empirical data necessary to inform these decisions. This is particularly the case in the Australian Alps which has already undergone recent changes in climate and experienced more frequent large-scale bushfires. In lieu of empirical data, we used a structured expert elicitation method (the IDEA protocol) to estimate the abundance and distribution of nine vegetation groups and 89 Australian alpine and subalpine species by the year 2050. Experts predicted that most alpine vegetation communities would decline in extent by 2050; only woodlands and heathlands are predicted to increase in extent. Predicted species-level responses for alpine plants and animals were highly variable and uncertain. In general, alpine plants spanned the range of possible responses, with some expected to increase, decrease or not change in cover. By contrast, almost all animal species are predicted to decline or not change in abundance or elevation range; more species with water-centric life-cycles are expected to decline in abundance than other species. While long-term ecological data will always be the gold-standard in informing the future of biodiversity, the method and outcomes outlined here provide a pragmatic and coherent basis upon which to start informing conservation policy and management in the face of rapid change and paucity of data

A theory led narrative review of one-to-one health interventions:the influence of attachment style and client-provider relationship on client adherence

A theory-led narrative approach was used to unpack the complexities of the factors that enable successful client adherence following one-to-one health interventions. Understanding this could prepare the provider to anticipate different adherence behaviours by clients, allowing them to tailor their interventions to increase the likelihood of adherence. The review was done in two stages. A theoretical formulation was proposed to explore factors which influence the effectiveness of one-to-one interventions to result in client adherence. The second stage tested this theory using a narrative synthesis approach. Eleven studies across the health care arena were included in the synthesis and explored the interplay between client attachment style, client–provider interaction and client adherence with health interventions. It emerged that adherence results substantially because of the relationship that the client has with the provider, which is amplified or diminished by the client’s own attachment style. This occurs because the client’s attachment style shapes how they perceive and behave in relationships with the health-care providers, who become the ‘secure base’ from which the client accepts, assimilates and adheres with the recommended health intervention. The pathway from one-to-one interventions to adherence is explained using moderated mediation and mediated moderation models

A next-generation sequencing method for overcoming the multiple gene copy problem in polyploid phylogenetics, applied to Poa grasses

<p>Abstract</p> <p>Background</p> <p>Polyploidy is important from a phylogenetic perspective because of its immense past impact on evolution and its potential future impact on diversification, survival and adaptation, especially in plants. Molecular population genetics studies of polyploid organisms have been difficult because of problems in sequencing multiple-copy nuclear genes using Sanger sequencing. This paper describes a method for sequencing a barcoded mixture of targeted gene regions using next-generation sequencing methods to overcome these problems.</p> <p>Results</p> <p>Using 64 3-bp barcodes, we successfully sequenced three chloroplast and two nuclear gene regions (each of which contained two gene copies with up to two alleles per individual) in a total of 60 individuals across 11 species of Australian <it>Poa </it>grasses. This method had high replicability, a low sequencing error rate (after appropriate quality control) and a low rate of missing data. Eighty-eight percent of the 320 gene/individual combinations produced sequence reads, and >80% of individuals produced sufficient reads to detect all four possible nuclear alleles of the homeologous nuclear loci with 95% probability.</p> <p>We applied this method to a group of sympatric Australian alpine <it>Poa </it>species, which we discovered to share an allopolyploid ancestor with a group of American <it>Poa </it>species. All markers revealed extensive allele sharing among the Australian species and so we recommend that the current taxonomy be re-examined. We also detected hypermutation in the <it>trn</it>H-<it>psb</it>A marker, suggesting it should not be used as a land plant barcode region. Some markers indicated differentiation between Tasmanian and mainland samples. Significant positive spatial genetic structure was detected at <100 km with chloroplast but not nuclear markers, which may be a result of restricted seed flow and long-distance pollen flow in this wind-pollinated group.</p> <p>Conclusions</p> <p>Our results demonstrate that 454 sequencing of barcoded amplicon mixtures can be used to reliably sample all alleles of homeologous loci in polyploid species and successfully investigate phylogenetic relationships among species, as well as to investigate phylogeographic hypotheses. This next-generation sequencing method is more affordable than and at least as reliable as bacterial cloning. It could be applied to any experiment involving sequencing of amplicon mixtures.</p