Analisis Customer Relationship Management terhadap Kepuasan Pasien Pusat Jantung Nasional Harapan Kita

The research tries to find out how big the influence of Customer Relationship Management of Heart Centre Patient Harapan Kita concerning the patient satisfaction. The Customer Relationship Management divide into three main functions which is Acquisition, Enhance, and Retain. The conclusion is, if there is increased in Customer Relationship Management of Heart Centre Patient Harapan Kita, it will increased the patient satisfaction also

Cohomological BRST aspects of the massless tensor field with the mixed symmetry (k,k)

The main BRST cohomological properties of a free, massless tensor field that transforms in an irreducible representation of GL(D,R), corresponding to a rectangular, two-column Young diagram with k>2 rows are studied in detail. In particular, it is shown that any non-trivial co-cycle from the local BRST cohomology group H(s|d) can be taken to stop either at antighost number (k+1) or k, its last component belonging to the cohomology of the exterior longitudinal derivative H(gamma) and containing non-trivial elements from the (invariant) characteristic cohomology H^{inv}(delta|d).Comment: Latex, 50 pages, uses amssym

BRST cohomological results on the massless tensor field with the mixed symmetry of the Riemann tensor

The basic BRST cohomological properties of a free, massless tensor field with the mixed symmetry of the Riemann tensor are studied in detail. It is shown that any non-trivial co-cycle from the local BRST cohomology group can be taken to stop at antighost number three, its last component belonging to the cohomology of the exterior longitudinal derivative and containing non-trivial elements from the (invariant) characteristic cohomology.Comment: 39 page

Consistent interactions of dual linearized gravity in D=5: couplings with a topological BF model

Under some plausible assumptions, we find that the dual formulation of linearized gravity in D=5 can be nontrivially coupled to the topological BF model in such a way that the interacting theory exhibits a deformed gauge algebra and some deformed, on-shell reducibility relations. Moreover, the tensor field with the mixed symmetry (2,1) gains some shift gauge transformations with parameters from the BF sector.Comment: 63 pages, accepted for publication in Eur. Phys. J.

Geographical drivers and climate-linked dynamics of Lassa fever in Nigeria

Lassa fever is a longstanding public health concern in West Africa. Recent molecular studies have confirmed the fundamental role of the rodent host (Mastomys natalensis) in driving human infections, but control and prevention efforts remain hampered by a limited baseline understanding of the disease's true incidence, geographical distribution and underlying drivers. Here, we show that Lassa fever occurrence and incidence is influenced by climate, poverty, agriculture and urbanisation factors. However, heterogeneous reporting processes and diagnostic laboratory access also appear to be important drivers of the patchy distribution of observed disease incidence. Using spatiotemporal predictive models we show that including climatic variability added retrospective predictive value over a baseline model (11% decrease in out-of-sample predictive error). However, predictions for 2020 show that a climate-driven model performs similarly overall to the baseline model. Overall, with ongoing improvements in surveillance there may be potential for forecasting Lassa fever incidence to inform health planning

Nigeria’s Relations with Her Neighbors and the Fight against Terrorism: An Analysis of the Multinational Joint Task Force

This chapter examines Nigeria’s relationship with her immediate neighboring countries in the fight against terrorism. It probed the challenges of national security following the internationalization of Boko Haram terrorist threats, particularly around the Lake Chad basin, and the responses of countries such as Cameroon, Chad, and Niger. These countries, like Nigeria, share borders around the Lake Chad and are the core contributors to the Multinational Joint Task Force (MNJTF). Nigeria is an English-speaking country (former British colony), while these other neighbors are historically French colonial territories. Hence, their political, cultural, military, and economic affinities are with France. The varying backgrounds have accounted for the challenges in the subregion including the Boko Haram insurgency and the efforts at military cooperation in tackling it. Consequently, these questions are examined: what factors led to the formation of MNJTF and what role has it played in the counterterrorism strategies of the country? In what ways has the nature of Nigeria’s relations with these countries impacted on the operation of the body? What are the roles of external powers such as France with her domineering influence on these countries in the war against terrorism and how has it promoted Nigeria’s national security interest? The chapter relies on documented materials to interrogate the questions and proffer necessary policy recommendations premised on the findings

Reactivation of M. tuberculosis Infection in Trans-Membrane Tumour Necrosis Factor Mice

Of those individuals who are infected with M. tuberculosis, 90% do not develop active disease and represents a large reservoir of M. tuberculosis with the potential for reactivation of infection. Sustained TNF expression is required for containment of persistent infection and TNF neutralization leads to tuberculosis reactivation. In this study, we investigated the contribution of soluble TNF (solTNF) and transmembrane TNF (Tm-TNF) in immune responses generated against reactivating tuberculosis. In a chemotherapy induced tuberculosis reactivation model, mice were challenged by aerosol inhalation infection with low dose M. tuberculosis for three weeks to establish infection followed chemotherapeutic treatment for six weeks, after which therapy was terminated and tuberculosis reactivation investigated. We demonstrate that complete absence of TNF results in host susceptibility to M. tuberculosis reactivation in the presence of established mycobacteria-specific adaptive immunity with mice displaying unrestricted bacilli growth and diffused granuloma structures compared to WT control mice. Interestingly, bacterial re-emergence is contained in Tm-TNF mice during the initial phases of tuberculosis reactivation, indicating that Tm-TNF sustains immune pressure as in WT mice. However, Tm-TNF mice show susceptibility to long term M. tuberculosis reactivation associated with uncontrolled influx of leukocytes in the lungs and reduced IL-12p70, IFNγ and IL-10, enlarged granuloma structures, and failure to contain mycobacterial replication relative to WT mice. In conclusion, we demonstrate that both solTNF and Tm-TNF are required for maintaining immune pressure to contain reactivating M. tuberculosis bacilli even after mycobacteria-specific immunity has been established

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes