The urgency of the process aproach in the management of the enterprise

Today in the conditions of the strict dynamics of the external surroundings the transfer is necessary from the accumulation of the volumes of output to the diversification of the economic activities and the maximum satisfaction of the customers is in the basis. Thus, the application of the process approach to the management is actual. The balanced scorecard by D. Kaplan and R. Norton gives to create the system of the indexes of the management of the process which are directed on the satisfaction of the requirements of the clients

Peningkatan Hasil Belajar Biologi dengan Model Discovery Learning

The research aim was to find out the improvement of biology achievement of the tenth grade students of science class at SMA Negeri 3 Lubuklinggau. The research method used was Classroom Action Research. The population was all of the tenth grade students of science class. The sampling technique was purposive sampling technique with 32 students as the samples. The instruments of data collection were observation sheets and tests. The data were analyzed both through quantitative and qualitative descriptive method. The results showed that the students achievement was improved indicated by initial percentage 37%, cycle I 43,75 % to 59,37 % in cycle II. The data of students learning activities were collected from some parameters such as students' activities, response, cooperation, responsibilities, tolerances, and diligence with the average score in cycle I only 62,03 and it was improved in cycle II to 79,53. In conclusion, discovery learning model could improve students' learning achievements and students' learning activities. Keywords: students achievement, model discovery learnin

Survey Pemanfaatan Pangan Lokal Untuk Mencegah Anemia Pada Ibu Hamil Di Puskesmas Alak Wilayah Kerja Kota Kupang

Anemia is the decrease of red blood cells (erythrocyte) in blood circulation or in hemoglobin mass resulting in blood’s inability to fulfill its function as oxygen carrier to tissues in the body. During pregnancy, women need adequate nutrition such as carbohydrate, protein, fat, vitamins e.g. Vitamin C, folic acid, and iron. Local foods are foods that are native to and originally harvested from a certain area and can be directly used for consumption. In this context, foods that are regarded local are corn, cassavas, nuts, vegetables, and fruits. This research aims to identify how those foods are utilized in the effort of preventing anemia in pregnant women in the working area of Alak Public Health Centre of Kupang City. This research is descriptive in nature with survey design. 95 respondents were chosen through consecutive sampling technique. Instruments used in this research were questionnaires. Based on the data, it was concluded that most pregnant woman make use of local foods to prevent anemia. Among the local foods that are mostly used are corn, beans (green beans, red beans, and other beans), cassavas, and varieties of yams.   Keywords: Local Foods And AnemiaAnemia adalah berkurangnya sel darah merah (eritrosit) dalam sirkulasi darah atau masa hemoglobin sehingga tidak mampu memenuhi fungsinya sebagai pembawa oksigen ke seluruh jaringan. Selama kehamilan ibu hamil membutuhkan nutrisi yang cukup seperti karbohidrat, protein, lemak, vitamin seperti vit.c, asam folat dan zat besi. Pangan local adalah pangan yang diproduksi oleh suatu wilayah untuk tujuan konsumsi. Yang termasuk dalam pangan lokal adalah jagung, umbi-umbian, kacangkacangan, sayuran dan buah. Penelitian ini bertujuan untuk mengidentifikasi pemanfaatan pangan lokal untuk mencegah anemia pada ibu hamil di Puskesmas Alak. Penelitian ini menggunakan desain penelitian deskriptif dengan menggunakan rancangan penelitian survey. Total responden sebanyak 95 orang. Pengambilan sampel menggunakan consecutive sampling. Instrument yang digunakan dalam penelitian ini adalah kuesioner. Kesimpulan dari penelitian tersebut bahwa sebagian besar ibu memanfaatkan ketersedian pangan lokal, memanfaatkan jenis pangan lokal dan memanfaatkan atau mengkonsumsi pangan lokal seperti jagung, kacang-kacangan (kacang hijau, kacang merah dan kacang lain) dan umbi- umbian seperti ubi jalar, ubi ubi talas ubi kayu untuk mencegah anemia pada ibu hamil.   Kata Kunci: Pangan Lokal Dan Anemi

Nonlinear Vibration of Ladle Crane due to a Moving Trolley

The structural vibration of the main beam of a crane causes fatigue damage and discomfort to the driver. The swing of the payload has an effect on positioning precision, especially for a ladle crane, and this directly affects production safety. To study the influence of system parameters on the vibration of a crane’s main beam and the angle of the payload, a system consisting of the main beam, trolley, payload, and cabin was constructed. A rigid-flexible coupling dynamic model of a moving trolley with a hanging payload that moves on the flexible main beam with a concentrated cabin mass is established, and the direct integration method is used to solve the nonlinear differential equations of system vibration, which are obtained through Lagrange’s equation. Then, the time domain responses of the flexible main beam, payload angle, and cabin vibration are obtained. The influences of the trolley running speed, quality of the payload, and quality and position of the cabin on the vibration of the main beam and payload angle are analyzed. The results indicate that the amplitude of the main beam is directly proportional to the quality of the trolley, payload, and cab; the position of the cabin is closer to the mid-span; the amplitude of the main beam is larger; the structural damping has some influence on the vibration of the main beam; and the swing angle of the payload is related to the maximum running speed of the trolley, acceleration time, and length of the wire rope. In order to reduce the vibration of the main beam and cabin, the connection stiffness of the cabin should be ensured during installation

Angiogenic potential of circulating blood neutrophils in endometrial cancer

Neutrophils play an important role in carcinogenesis, mediating inflammation, immunosuppression and metastasis. A dual role of neutrophils in regulation of angiogenesis has been shown. Endometrial cancer is the most common malignant neoplasm of the female reproductive system. To assess the cellular angiogenic potential, we determined the levels of inflammatory and angiogenic cytokines (VEGF-A, IL-17A, IL-1β, IL-6) in cell lysate of peripheral blood neutrophils in the patients with endometrial cancer, and with uterine myoma (comparison group). Expression of the nuclear factor-kB was determined. In nuclear fraction of neutrophils. The neutrophil-to-lymphocyte ratio (NLR) was assessed in the studied groups. Statistical processing of the obtained data was carried out using Statistica 10 software. We have not found any significant changes in NLR in endometrial cancer, compared with controls and the uterine myoma groups. Expression of NF-kB and VEGF was increased as compared to the control for all the studied stages of endometrial cancer and in uterine myoma. There was a change in NF-kB level in neutrophils, depending on the tumor differentiation grade. A regression relationship was found between the content of VEGF and NF-kB in neutrophils. We have found increased IL-1β and IL-6 levels in neutrophils of the uterine myoma patients, and at different stages of endometrial cancer compared with control. The IL-1β level was higher in neutrophils of the patients with intermediate and high tumor grade, compared to low-grade cases. IL-17A expression in the neutrophil lysate was significantly reduced in uterine myoma and at different stages of endometrial cancer, as compared with controls. There was a moderate inverse correlation between the contents of VEGF and IL-6 in neutrophils (r = -0.426, p = 0.001); a remarkable inverse relationship between VEGF and IL-17A (r = -0.615, p < 0.001). The combination of IL-6 and IL-17A levels in the neutrophils lysate (according to the results of multivariate analysis) may be used for the differential diagnosis of endometrial cancer and uterine myoma. Thus, the differences in the expression of inflammatory and angiogenic cytokines included in NF-kB-dependent signaling, may point to acquisition of pro-tumor functions by neutrophils during the endometrial cancer progression

Management of bleeding complications during thymectomy by subxiphoid approach with double elevation of the sternum: a case report.

Thymoma is the most common tumor of the anterior mediastinum and surgical resection for thymoma has been recommended as the principal treatment. Bleeding control remains as a challenging task under minimally invasive approach. Subxiphoid approach with double elevated of sternum was a novel method which might provide good surgical view and space for operating. In this study we reported a case of bleeding control with this approach after unexpected damage to innominate vein to address the advantage of bleeding control using this specific surgical approach. The case was a 66-year-old female patient with an anterior mediastinal mass incidentally detected during physical examination and was diagnosed with thymoma with a diameter of 5 cm. Injury to the joint of innominate vein and the vena cava occurred during a subxiphoid approach with double elevation of the sternum. It was well managed by controlling the bleeding site with Alice forceps and suture under thoracoscope view without conversion to median sternotomy. A 4-0 PROLENE line was used with an elbow needle holder under the thoracoscope to suture continuously. Intraoperative blood loss was 350 mL. The drainage tubes were removed on postoperative day (POD) 2, and the patient was discharged on POD 3. This case indicated that thymectomy by subxiphoid approach with double elevation of the sternum has more advantages when there is an emergency for bleeding during the operation compared with traditional intercostal approach or subxiphoid approach with carbon dioxide inflation

Subxiphoid thymectomy with a double sternum retractor: a pilot study.

Background: Our study aims to describe the experience of a single team in terms of the potential and benefits of subxiphoid thymectomy using a double sternum hook retractor. Methods: From November 2016 to July 2018, 34 patients have been undergone subxiphoid thymectomy at our Department. Twenty patients were diagnosed with Masaoka Stage I–III thymomas, 12 with thymic hyperplasia or cysts of the thymus, 2 with thymic tumors. All patients underwent a chest computed tomography (CT) with enhancement. 18-Fludeoxyglucose positron emission tomography (18FDG-PET) was performed when recurrence was suspected. Neurological examinations were set. Patients underwent video-assisted thoracoscopic surgery (VATS) subxiphoid thymectomy with a double sternum retractor. A retrospective analysis of clinical, perioperative data, and follow-up was performed. Incidence rates for death or recurrence were calculated. Average pain score (NRS scale), average mental health, and physical health scores (SF-12) were analyzed. Results: Thirty-four patients (mean age 54; 12 men and 22 women) with thymic neoformation (from 1.0 cm × 1.0 cm × 1.0 cm to 14.0 cm × 9.0 cm × 4.5 cm) were enrolled. All patients underwent subxiphoid thymectomy. No mortality or recurrence was observed. Median follow-up time was 17.9 months (range, 2.2–23.3 months). The morbidity rate was 9.7 events per 100 person-years. Average pain scores after surgery and after follow-up were 1.7±0.4 and 0.1±0.4, respectively; average mental health and physical health scores on the SF-12 scale were 45.6±2.4 and 33.6±2.4, respectively. Conclusions: Subxiphoid thymectomy is a high satisfaction approach with positive aesthetic outcomes and low pain. Double sternum retractors are especially useful for creating space during thymectomy. However, the qualified experience is needed

A novel drainage strategy using chest tube plus pleural catheter in uniportal upper lobectomy: A randomized controlled trial.

Background In this study we explored whether one pleural catheter plus single chest tube drainage could achieve a noninferior drainage effect when compared with the traditional two chest tubes in uniportal video-assisted thoracoscopic surgery (VATS) for an upper pulmonary lobectomy. Methods Patients that underwent an upper pulmonary lobectomy from January to November 2020 were enrolled in this single-center, randomized, open-label, noninferiority trial. Prior to closure, patients were randomized to an intervention group who received an improved drainage strategy involving one pleural catheter with one chest tube (24 Fr), while traditional double chest tube drainage was applied for the control group. Results A total of 390 patients entered the study, although 190 were excluded for changing nonuniportal surgical approaches or opting for nonlobectomy resections. Finally, 200 patients were randomized (100 in the intervention group and 100 in the control group). The baseline demographic and clinical characteristics were comparable between the groups. The incidence of pneumothorax in the intervention and control groups was similar on postoperative Day 1 (noninferiority, 10% vs. 13%, p = 0.658). In addition, there were no significant differences in secondary outcomes such as incidence of pneumothorax by Day 30, postoperative chest tube/pleural catheter removal time, amount of drainage on Day 1, total amount of drainage after operation, or postoperative hospitalization. A significantly lower pain score was observed in the intervention group (3.33 ± 0.68 vs. 3.68 ± 0.94, p = 0.003). Conclusions The new strategy is noninferior to double chest tube drainage after an upper pulmonary lobectomy offers superior pain control, and is recommended for an upper lobectomy by uniportal VATS