63 research outputs found

    Sistem Pemberhentian (Impeachment) Kepala Daerah di Era Demokrasi Langsung (sebuah Kajian Teoritik-Ketatanegaraan)

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    The Impeachment System implemented in Law No. 32 cm the Year 2004 still uses representative mechanism with centralistic nature. The systemis controvercial with direct democratic values. However, referendum can be used as an ideallegal mechanism imposed on the head of region impeachment

    Kejanggalan Impeachment Kepala Daerah Di Era Pemilihan Langsung

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    The focus of this research is on the conformity of head of local government impeachment mechanism regulated in Act No. 32 of 2004 and Act No. 12 of 2008 with direct democracy system and the impeachment mechanism of head of local government in Indonesia after the enactment of Act No. 32 of 2004 and Act No. 12 of 2008.This research used normative juridical approach by focusing on philosophical approach. To complete the research matters, primary, secondary and tertiary legal matters method is used. The legal materials are qualitatively analyzed.The research result concludes that impeachment of kepala daerah in direct democracy era needs to be re-designed because it is not in accordance with concept of regional autonomy and the principles of legislation formation. On top of that it is to avoid centralistic system which is contradicted with the essence of decentralist system and not in line with decentralization values in the context of unitary in impeachment system

    PERANCANGAN MODEL MINIATUR GAS COMPRESSOR AFTERCOOLER PADA STASIUN KOMPRESOR PAGARDEWA PT.PGN AOSS BERBASIS MIKROKONTROLER ATMEGA2560

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    Implementasi metode redundant pada motor AC didalam sistem Gas Compressor Aftercooler pada Stasiun Kompresor Pagardewa PT.PGN AOSS mempunyai dampak perbedaan jadwal maintenance kedua motor AC serta rentang kerja motor yang tidak spesifik. Pada penelitian ini diimplementasikan motor DC dengan metode compact sebagai sistem kerja menggunakan Kontroler Proporsional Integral Difrensial (PID) berbasis mikrokontroler ATMEGA2560. Pertimbangan penggunaan motor DC dan kontroler PID adalah dapat menyelaraskan kecepatan rotasi permenit (rpm) serta mempunyai rentang kerja yang spesifik, sehingga diharapkan akan meningkatkan efisiensi dan menyelaraskan jadwal maintenance motor DC. Berdasarkan metode root-locus dengan pole s = —2.78 didapatkan nilai parameter Kp = 14.19, Ki = 20, dan Kd = 2.59. Sistem dapat mencapai setpoint 125oF dengan settling time sebesar 140 sekon pada temperatur ambient sebesar 77oF dan 144 sekon pada temperatur ambient sebesar 95oF. Sistem dapat menjaga temperatur pada rentang 115oF hingga 135oF dengan recovery time antara 63 dan 75 sekon ketika diberi gangguan berupa peningkatan temperatur sebesar 15oF.Kata kunci— Gas Compressor Aftercooler, manifold, PWM, RPM, kontroler PID, metode root-locus

    Techno-economic analysis of production of octane booster components derived from lignin

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    In this study, a comprehensive process for production of an environmentally friendly octane booster (acetophenone) from lignin is presented, along with a detailed techno-economic analysis. Recognizing that much of the prior research on octane boosters has been confined to experimental lab-level investigations, this study develops comprehensive process design to unravel the intricacies of large-scale acetophenone production. The acetophenone production process involves catalytic hydrogenolysis, which also yields phenol as a valuable side product. Based on the process flow diagram, mass and energy balances were developed, revealing significantly improved yields and purity of acetophenone compared to industry standards, reaching 0.74 kg acetophenone per kg of lignin and 99 wt%. In the techno-economic analysis, calculations involving fixed capital investment (FCI), operating costs, and working capital were conducted based on a feed of 100 kg/h of dry lignin. The results indicate FCI at 2.72 million USD, operating costs at 1.09 million USD per year, and working capital at 0.57 million USD. Assuming a 20-year operational lifespan, the payback period is estimated at 6.09 years, as depicted by the cumulative cash flow diagram. Moreover, techno-economic analysis demonstrates a net present value (NPV) of 3.24 million USD at a 10% discount rate, an internal rate of return (IRR) of 22.73%, and a return on investment (ROI) of 34.39%. These positive outcomes underscore the robust profitability of the proposed acetophenone production plant derived from lignin. Additionally, a sensitivity analysis on the IRR indicates that increasing the production capacity could further enhance profitability, reaffirming the feasibility of the plant’s operation. Crucially, this study highlights the potential for sustainable and economically viable production of acetophenone, offering an environmentally friendly alternative to toxic octane boosters and advancing the development of sustainable fuel additives. Graphical Abstract: [Figure not available: see fulltext.

    Global economic burden of unmet surgical need for appendicitis

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    Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US 92492millionusingapproach1and92 492 million using approach 1 and 73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was 95004millionusingapproach1and95 004 million using approach 1 and 75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

    Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

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    Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

    Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

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    Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

    Mortality of emergency abdominal surgery in high-, middle- and low-income countries

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    Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)
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