Pasar Tunggal ASEAN 2015: Diplomasi Indonesia dan Penguatan Kapasitas Tenaga Kerja Terdidik

This paper argues that in order to prepare ASEAN Economic Community 2015, Indonesia should improve their competence in service sector through skilled labourempowerment. Within five priorities in service sector; health, e-commerce, tourism, flight service and logistics, the role of skilled labourplays an essential factor for the achievement of Indonesian national interest. In order to discuss this issue, the explanation about ‘top-down approach’ and ‘bottom-up approach’ of Indonesian policy toward ASEAN Single Market 2015, should be perceived. National Interest which has been formulated in the national level should be feasible to be implemented in the local level. Meanwhile, the society ought to plays their role as activator network to support Indonesian diplomacy. Indonesia can use their mechanism of diplomacy to empower the worker. Further, this paper will also try to elaborate the role of society as an important variable for Indonesian diplomacy

Risk-minimal routes for emergency cars

The computation of an optimal route for given start and destination in a static transportation network is used in many applications of private route planning. In this work we focus on route planning for emergency cars, such as for example police, fire brigade and ambulance. In case of private route planning typical quantities to be minimized are travel time or route length. However, the idea of this paper is to minimize the risk of a travel time exceeding a certain limit. This is inspired by the fact that the emergency cars have to reach the destination within a legal time. We consider mainly two approaches. The first approach takes into account relevant information to determine the weight, i.e. the desirability of certain edges of a graph during the minimization procedure. One possible risk factor to be aware of would be a suddenly jammed single-lane road on which the emergency car has no chance to make use of the benefits of the siren for instance. The same holds for full-closure situations and railroad crossings. We present a catalogue of risk factors along with an appropriate algorithm for practical route planning in emergency situations. The second one takes into account a weekly updated set of probe-vehicle data for each minute of the week along with data of current travel times. Comparing those travel-time data allows calculation of the associated risk for traveling certain edges of a route in a road network. We expect our algorithm to be a major advancement especially for destinations that lie outside the typical region travelled weekdays. In this case the automatic route planning naturally goes along with an additional gain of time

Event traffic forecast for metropolitan areas based on microscopic simulation

It is shown that a traditional travel demand forecast combined with a simulationbased approach can serve as a short-term forecast for the traffic situation. The approach presented was developed and tested during the Soccer World Cup 2006 in the city of Cologne as a service for the action forces to react as fast as possible to developing aberrations. This paper discusses the merits and the short-comings of the approach

Multidisciplinary management of acromegaly: A consensus.

The 13th Acromegaly Consensus Conference was held in November 2019 in Fort Lauderdale, Florida, and comprised acromegaly experts including endocrinologists and neurosurgeons who considered optimal approaches for multidisciplinary acromegaly management. Focused discussions reviewed techniques, results, and side effects of surgery, radiotherapy, and medical therapy, and how advances in technology and novel techniques have changed the way these modalities are used alone or in combination. Effects of treatment on patient outcomes were considered, along with strategies for optimizing and personalizing therapeutic approaches. Expert consensus recommendations emphasize how best to implement available treatment options as part of a multidisciplinary approach at Pituitary Tumor Centers of Excellence

Long-term treatment of acromegaly with pegvisomant, a growth hormone receptor antagonist

"Background Pegvisomant is a new growth hormone receptor antagonist that improves symptoms and normalises insulin-like growth factor-1 (IGF-1) in a high proportion of patients with acromegaly treated for up to 12 weeks. We assessed the effects of pegvisomant in 160 patients with acromegaly treated for an average of 425 days. Methods Treatment efficacy was assessed by measuring changes in tumour volume by magnetic resonance imaging, and serum growth hormone and IGF-1 concentrations in 152 patients who received pegvisomant by daily subcutaneous injection for up to 18 months. The safety analysis included 160 patients some of whom received weekly injections and are excluded from the efficacy analysis. Findings Mean serum IGF-1 concentrations fell by at least 50%: 467 μg/L (SE 24), 526 μg/L (29), and 523 μg/L (40) in patients treated for 6, 12 and 18 months, respectively (p less than 0·001), whereas growth hormone increased by 12·5 μg/L (2·1), 12·5 μg/L (3·0), and 14·2 μg/L (5·7) (p less than 0·001). Of the patients treated for 12 months or more, 87 of 90 (97%) achieved a normal serum IGF-1 concentration. In patients withdrawn from pegvisomant (n=45), serum growth hormone concentrations were 8·0 μg/L (2·5) at baseline, rose to 15·2 μg/L (2·4) on drug, and fell back within 30 days of withdrawal to 8·3 μg/L (2·7). Antibodies to growth hormone were detected in 27 (16·9%) of patients, but no tachyphylaxis was seen. Serum insulin and glucose concentrations were significantly decreased (p less than 0·05). Two patients experienced progressive growth of their pituitary tumours, and two other patients had increased alanine and asparate aminotransferase concentrations requiring withdrawal from treatment. Mean pituitary tumour volume in 131 patients followed for a mean of 11·46 months (0·70) decreased by 0·033 cm3(0·057; p=0·353). Interpretation Pegvisomant is an effective medical treatment for acromegaly.

Management of acromegaly in Latin America: expert panel recommendations

Although there are international guidelines orienting physicians on how to manage patients with acromegaly, such guidelines should be adapted for use in distinct regions of the world. A panel of neuroendocrinologists convened in Mexico City in August of 2007 to discuss specific considerations in Latin America. Of major discussion was the laboratory evaluation of acromegaly, which requires the use of appropriate tests and the adoption of local institutional standards. As a general rule to ensure diagnosis, the patient’s GH level during an oral glucose tolerance test and IGF-1 level should be evaluated. Furthermore, to guide treatment decisions, both GH and IGF-1 assessments are required. The treatment of patients with acromegaly in Latin America is influenced by local issues of cost, availability and expertise of pituitary neurosurgeons, which should dictate therapeutic choices. Such treatment has undergone profound changes because of the introduction of effective medical interventions that may be used after surgical debulking or as first-line medical therapy in selected cases. Surgical resection remains the mainstay of therapy for small pituitary adenomas (microadenomas), potentially resectable macroadenomas and invasive adenomas causing visual defects. Radiotherapy may be indicated in selected cases when no disease control is achieved despite optimal surgical debulking and medical therapy, when there is no access to somatostatin analogues, or when local issues of cost preclude other therapies. Since not all the diagnostic tools and treatment options are available in all Latin American countries, physicians need to adapt their clinical management decisions to the available local resources and therapeutic options

Event traffic forecast for metropolitan areas based on microscopic simulation

It is shown that a traditional travel demand forecast combined with a simulationbased approach can serve as a short-term forecast for the traffic situation. The approach presented was developed and tested during the Soccer World Cup 2006 in the city of Cologne as a service for the action forces to react as fast as possible to developing aberrations. This paper discusses the merits and the short-comings of the approach