COLLABORATIVE GOVERNANCE IN MANAGING MARINE ECOTOURISMS: A CASE STUDY AT KLAYAR BEACH, PACITAN REGENCY, INDONESIA

This study aims to analyze the collaborative governance process in ecotourism development at Klayar Beach, Pacitan. This study implies that the sustainability of the role of collaboration between the government and non-government must be carried out by looking at the aspects of building trust, and commitment, as well as understanding and mutual agreement with the sustainability goal of marine ecotourism being able to be carried out optimally. This study uses a qualitative method with a case study approach. The results showed that the dynamics of tourists visiting the Klayar Beach ecotourism destination continued to increase every year, even though there had been a decline due to the disaster. However, the government through a collaboration scheme has succeeded in rebuilding the tourism aspect through trust and commitment to development. Looking at future projections, local governments must prepare further strategies in the context of common understanding. In addition, today's progress, which has shown a positive local socio-economic impact with nature conservation that has been implemented, must be able to be maintained and continuously improved along with opportunities for increasing tourists in the future. The conclusion shows that collaboration by local government in Pacitan Regency and non-government in general has shown a positive impact, but it is necessary to pay attention to mutual understanding and agreement within the scope of harmony between implementing parties, considering challenges faced in multi-actor development. It is very complex and has the potential to become an obstacle in the process of development of Klayar Beach Ecotourism

Public Services, Public Acceptance, and Satisfaction: Macro Evaluation of Government Services in Sigi Regency

The background of this research is the justification of findings in the form of public services in Indonesia in general, which are not good and not satisfactory. The objectives of this research are; 1) testing the level of public satisfaction with the implementation of basic service programs in Sigi Regency (14 indicators), and; 2) testing the level of public acceptance of the implementation of development programs in Sigi Regency (9 indicators). We use a mix-method approach in analyzing the results of public satisfaction and public acceptance to obtain the depth of data and field results. The results showed that the index of public acceptance of public services in Sigi Regency was 3.92, which means that the majority of Sigi Regency people received local government programs simultaneously. Partially, there are three dimensions in the form of program effectiveness, program efficiency, and dimensions of trust concerning the index of public acceptance of public services in Sigi Regency which is below the average score. However, this dimension does not simultaneously affect the level of public trust in public services in Sigi Regency with a total increase of 76.02%. The implication of this research is the existence of alternative strategies for improvement to improve public acceptance (IPM) and public satisfaction (IKM), including efficiency and public trust in the public acceptance index (IPM) framework, as well as safety and comfort within the public satisfaction index framework (IKM).Keywords: public service; public acceptance index; public satisfaction index; Sigi Regency

Embrio Destinasi Wisata Religi Baru: Identifikasi Komponen 3A Berbasis Wisata Ziarah Desa Balun, Lamongan

This study aims to examine the readiness and feasibility of supporting components in the midst of the designation of the Balun Village as the Pancasila Village and the Religious Tourism District of Lamongan Regency. Cultural attractions offered are the Mbah Alun Graveyard Site and the value of pluralism of religious community life in Balun Village. The study used a qualitative method with a descriptive analytic and participatory rural appraisal (PRA) approach. Data collection techniques in the form of narratives sourced from several informants, secondary statistical data, and field documentation. The results of the study indicate that the readiness represented in component 3A, namely: Attractions, in the form of cultural attractions either physical or tangible (pilgrimage sites) and non-physical or intangible (values of pluralism of society / diversity and religious festivals) have been owned and run for decades; Accessibility in the form of distance to Balun Village from strategic points relatively close (2-5 km) and road infrastructure conditions, as well as; Amenities and additional supporting elements in the form of services and other supporting services available such as accommodation for tourists, restaurants and culinary centers, souvenir centers, transportation points and access close to the main road. Another development that needs to be done is improvement in terms of accessibility considering the opportunity of arrival at the Balun Village Pilgrimage Site jumped dramatically on certain religious holidays

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Kuluttajabarometri maakunnittain 2000, 2. neljännes

Suomen virallinen tilasto (SVT

Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries: a 7-day cohort study of elective surgery

This was an investigator-initiated study funded by Nestle Health Sciences through an unrestricted research grant and by a National Institute for Health Research (UK) Professorship held by R.P. The study was sponsored by Queen Mary University of London

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine