ANALISIS DINDING MECHANICALLY STABILIZED EARTH (MSE) (STUDI KASUS: RUAS JALAN TOL MANADO BITUNG STA 6+475)

Pada ruas jalan Tol Manado Bitung akan dibuat jalan diatas permukaan tanah yang miring sehingga perlu penimbunan tanah agar elevasi tanah sesuai perencanaan. Hal tersebut dapat menyebabkan kelongsoran apabila tidak diberi pengaman lereng pada area tanah timbunan. Pada penelitian ini dilakukan analisis pengaplikasian dinding Mechanically Stabilized Earth (MSE) yang direncanakan mulai dari kestabilan ekternal, internal dan global dengan variasi panjang perkuatan 0,3 He; 0,4 He; 0,5 He; 0,6 He; 0,7 He; 0,8 He; 0,9 He (He = Tinggi dinding MSE), jarak vertikal perkuatan 1 m; 1,2 m; 1,5 m; 2 m; 3 m dan jenis geogrid UX 1100, UX 1400, UX 1500, UX 1600, UX 1700, dan UX 1800.Hasil penelitian menunjukkan bahwa lereng eksisting pada ruas jalan Tol Manado Bitung STA 6+475 memiliki faktor keamanan lebih dari 1 sehingga dapat dikategorikan aman. Dalam mengaplikasikan dinding MSE pada lokasi studi kasus dengan dimensi yang direncanakan untuk panjang perkuatan 0,6 He dan 0,5 He memenuhi syarat kestabilan eksternal namun tidak memenuhi syarat kestabilan internal. Stabilitas global dengan menggunakan kohesi tanah 20 kPa sebagai facing sudah memenuhi persyaratan stabilitas global yakni diatas 1,3 sehingga lereng dengan perkuatan dinding MSE yang direncanakan dapat digunakan. Kata kunci: “Dinding MSE”,” Lereng”, “Geogrid”.

PENGARUH PENAMBAHAN ZEOLITE TERHADAP KUAT GESER PADA TANAH BERLEMPUNG

Permasalahan dalam pembangunan suatu konstruksi diantaranya kondisi tanah yang tidak mendukung. Diperlukan metode perbaikan tanah untuk mengatasi permasalahan seperti itu. Stabilisasi kimiawi merupakan salah satu alternatif untuk memperbaiki kondisi tanah tersebut. Penelitian ini menggunakan zeolite sebagai bahan stabilisasi, yaitu mencampur zeolite dengan tanah yang digunakan, dengan variasi campuran 5%, 10%, 15%  dan 20% zeolite terhadap berat contoh tanah. Tujuannnya untuk meningkatkan kuat geser pada tanah yang diteliti. Berdasarkan hasil penelitian, penambahan zeolite memberikan pengaruh yang signifikan terhadap kuat geser. Kuat geser mula-mula 0,128 kg/cm2 berubah menjadi 0,546 kg/cm2 dengan variasi campuran 20% zeolite. Variasi penambahan 20% zeolite memberikan hasil yang paling besar dibandingkan 5%, 10% dan 15% zeolite. Semakin besar jumlah zeolite yang digunakan semakin besar pula pengaruh yang diberikan. Kata kunci: Kuat Geser, Stabilisasi kimiawi, Zeolit

Orthodontics in the era of big data analytics

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149344/1/ocr12279_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149344/2/ocr12279.pd

Selecting effective incentive structures in health care: A decision framework to support health care purchasers in finding the right incentives to drive performance

<p>Abstract</p> <p>Background</p> <p>The Ontario health care system is devolving planning and funding authority to community based organizations and moving from steering through rules and regulations to steering on performance. As part of this transformation, the Ontario Ministry of Health and Long-Term Care (MOHLTC) are interested in using incentives as a strategy to ensure alignment – that is, health service providers' goals are in accord with the goals of the health system. The objective of the study was to develop a decision framework to assist policymakers in choosing and designing effective incentive systems.</p> <p>Methods</p> <p>The first part of the study was an extensive review of the literature to identify incentives models that are used in the various health care systems and their effectiveness. The second part was the development of policy principles to ensure that the used incentive models are congruent with the values of the Ontario health care system. The principles were developed by reviewing the Ontario policy documents and through discussions with policymakers. The validation of the principles and the suggested incentive models for use in Ontario took place at two meetings. The first meeting was with experts from the research and policy community, the second with senior policymakers from the MOHLTC. Based on the outcome of those two meetings, the researchers built a decision framework for incentives. The framework was send to the participants of both meetings and four additional experts for validation.</p> <p>Results</p> <p>We identified several models that have proven, with a varying degree of evidence, to be effective in changing or enabling a health provider's performance. Overall, the literature suggests that there is no single best approach to create incentives yet and the ability of financial and non-financial incentives to achieve results depends on a number of contextual elements. After assessing the initial set of incentive models on their congruence with the four policy principles we defined nine incentive models to be appropriate for use in Ontario and potentially other health care systems that want to introduce incentives to improve performance. Subsequently, the models were incorporated in the resulting decision framework.</p> <p>Conclusion</p> <p>The design of an incentive must reflect the values and goals of the health care system, be well matched to the performance objectives and reflect a range of contextual factors that can influence the effectiveness of even well-designed incentives. As a consequence, a single policy recommendation around incentives is inappropriate. The decision framework provides health care policymakers and purchasers with a tool to support the selection of an incentive model that is the most appropriate to improve the targeted performance.</p

A Survey of Bayesian Statistical Approaches for Big Data

The modern era is characterised as an era of information or Big Data. This has motivated a huge literature on new methods for extracting information and insights from these data. A natural question is how these approaches differ from those that were available prior to the advent of Big Data. We present a review of published studies that present Bayesian statistical approaches specifically for Big Data and discuss the reported and perceived benefits of these approaches. We conclude by addressing the question of whether focusing only on improving computational algorithms and infrastructure will be enough to face the challenges of Big Data

Systematic review: Effects, design choices, and context of pay-for-performance in health care

<p>Abstract</p> <p>Background</p> <p>Pay-for-performance (P4P) is one of the primary tools used to support healthcare delivery reform. Substantial heterogeneity exists in the development and implementation of P4P in health care and its effects. This paper summarizes evidence, obtained from studies published between January 1990 and July 2009, concerning P4P effects, as well as evidence on the impact of design choices and contextual mediators on these effects. Effect domains include clinical effectiveness, access and equity, coordination and continuity, patient-centeredness, and cost-effectiveness.</p> <p>Methods</p> <p>The systematic review made use of electronic database searching, reference screening, forward citation tracking and expert consultation. The following databases were searched: Cochrane Library, EconLit, Embase, Medline, PsychINFO, and Web of Science. Studies that evaluate P4P effects in primary care or acute hospital care medicine were included. Papers concerning other target groups or settings, having no empirical evaluation design or not complying with the P4P definition were excluded. According to study design nine validated quality appraisal tools and reporting statements were applied. Data were extracted and summarized into evidence tables independently by two reviewers.</p> <p>Results</p> <p>One hundred twenty-eight evaluation studies provide a large body of evidence -to be interpreted with caution- concerning the effects of P4P on clinical effectiveness and equity of care. However, less evidence on the impact on coordination, continuity, patient-centeredness and cost-effectiveness was found. P4P effects can be judged to be encouraging or disappointing, depending on the primary mission of the P4P program: supporting minimal quality standards and/or boosting quality improvement. Moreover, the effects of P4P interventions varied according to design choices and characteristics of the context in which it was introduced.</p> <p>Future P4P programs should (1) select and define P4P targets on the basis of baseline room for improvement, (2) make use of process and (intermediary) outcome indicators as target measures, (3) involve stakeholders and communicate information about the programs thoroughly and directly, (4) implement a uniform P4P design across payers, (5) focus on both quality improvement and achievement, and (6) distribute incentives to the individual and/or team level.</p> <p>Conclusions</p> <p>P4P programs result in the full spectrum of possible effects for specific targets, from absent or negligible to strongly beneficial. Based on the evidence the review has provided further indications on how effect findings are likely to relate to P4P design choices and context. The provided best practice hypotheses should be tested in future research.</p

Prevalence of mental disorders from adolescence through early adulthood in American Indian and First Nations communities

Indigenous communities lack representation in psychiatric epidemiology despite disproportionate exposure to risk factors. We document the cumulative and 12-month prevalence of psychiatric disorders across the early life course among a sample of Indigenous young adults and compare prospective and retrospective reporting of lifetime mental disorders. This community-based participatory research includes data from 735 Indigenous people from 8 reservations/reserves. Personal interviews were conducted between 2002–2010 and 2017–2018 totaling 9 waves; diagnostic assessments of DSM-IV-TR alcohol abuse/dependence, marijuana use/dependence, other substance abuse/dependence, generalized anxiety disorder, major depressive disorder, dysthymic disorder, and attention deficit/hyperactivity disorder occurred at waves 1 (mean age = 11.1 years), 4 (mean age = 14.3 years), 6 (mean age = 16.2 years), 8 (mean age = 18.3 years), and 9 (mean age = 26.3 years). Cumulative lifetime psychiatric disorders reached 77.3% and lifetime comorbidity 56.4% by wave 9. Past-year prevalence and comorbidity at wave 9 were 28.7% and 6.7%, respectively. Substance use disorders (SUDs) were most common with peak past-year prevalence observed when participants were on average 16.3 years old then declining thereafter. Trends in early life course psychiatric disorders in this study with Indigenous participants highlight cultural variations in psychiatric epidemiology including surprisingly low rates of internalizing disorders in the face of risk factors, disproportionately high rates of early-onset and lifetime SUD, and lower rates of past-year SUD in early adulthood compared with prior research.Peer reviewedSociolog