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Background – Health facilities and hospitals are government facilities in serving the community in the health sector, BPJS is one of the media used by the government in carrying out these services. PT. Zaps Teknologi is a company engaged in technology and information with the product of Dokter Tunggu (DOKU). This application was created to improve BPJS services in Hospitals and Health Facilities. The application has innovations in BPJS services where this application has features that are able to accommodate BPJS services. Online referrals, real time conditions from the Referral Hospital are some of the features embedded in this application, besides that in the next few years PT. Zaps Teknologi will improve services by adding features to this application. The addition of features requires detailed financial analysis and precise investment calculations Method - Investment analysis using NPV, ROI, PP and IRR. Result – This analysis shows the investment value for investors in making investment decisions. Keywords: Investment, BPJS, Financial Analysis.

Lipoma is a benign soft tissue tumor that is mostly found in the trunk, however, lipomas of the thumb are rarely reported, around 1% of cases. We report a case of a Saudi male aged 32-year-old who presented with a progressive left thumb swelling for a long time. The aim is to add more cases to the literature and to consider it as a differential.

By following the evolution of situated practices and concepts of educational leadership, the transformation of the Regional Centers for the Professions of Education and Training in Morocco, from a local management mode to a regional management mode, has inspired us to characterize the new style of leadership practiced within these centers. For this, we took a sample of the Center of the Casablanca-Settat Region as a megalopolis. The eleven other centers in Morocco have the same institutional framework and the same regional operating logic. To collect data characterizing the leadership practiced in terms of building the center’s commitments on a vision and values, we targeted the management and teachers, as the main actors of this leadership, through an online questionnaire. To validate certain information, we used the center’s database. In terms of our work, we ended up with a form of leadership, which we called “satellite leadership”, allowing each annex or provincial branch—of a Regional Centers for the Professions of Education and Training—to develop its local leadership while evolving with the changing orbit of regional leadership. This new configuration allows us to conclude on the possibility of carrying this style of educational leadership, at the national or international level, on any educational structure bringing together sub-structures grouped.

This study aims to examine the key factors that drive the success of Fraser & Neave (F&N). The data collection was by referring to the company’s official website and other related websites. Identified key success factors are innovation, consumer’s health and safety, creating value for society, talent management, and sustainable sourcing. These empirical findings provide new insights for the management of F&N about the antecedents of governing talent development. This study also provides a breakdown of F&N's strategic pillars and factors affecting those strategies, which can be utilized by management for future decision making to achieve their goals.

Introduction: Knee Osteoarthritis is a condition that frequently occurs in elderly which has a major impact on the elderly’s disability. As a degenerative disease, knee osteoarthritis occurs due to cartilage damage which is then accompanied by inflammation, pain, stiff joints and muscles thereby limiting the range of motion. This research aims to compare the effect of Kinesio taping and a combination of myofascial release and Kinesio taping intervention on ROM improvement in elderly with knee osteoarthritis.Methods: This study applies a quasi-experimental design with a non-equivalent group approach. Goniometer is applied as a measurement instrument. 25 people participated in this study who were recruited through purposive sampling. The sample was then divided into 2 groups which were given treatment 3 times a week in one month. The control group with Kinesio Taping treatment consisted of 14 samples and the case group with a combination treatment of myofacial release and Kinesio taping consisted of 11 samples. Furthermore, data analysis was performed with the Shapiro Wilk test, Wilcoxon rank test, and the Mann-Whitney test using SPSS version 25.Results: The comparison test results show that the significance value of p yields 0.6> 0.05, therefore H1 is rejected, and H0 is accepted. The interpretation of these results is that there is no significant difference between the effects of Kinesio taping and the combination of myofacial release and Kinesio taping on increasing ROM in the elderly with the risk of knee osteoarthritis.Conclusion: This study shows that there is no significant difference in the effect of the treatment of Kinesio taping and the combination of myofacial release and Kinesio taping in increasing ROM in the elderly with osteoarthritis.

Background Postoperative pulmonary complications (PPCs) often occur after cardiac operations and are a leading cause of morbidity, inhibit oxygenation, and increase hospital length of stay and mortality. Although clinical evidence for PPCs prevention is often unclear and crucial, measures occur to reduce PPCs. One device usually used for this reason is incentive spirometry (IS). The aim of the study is to evaluate the effect of preoperative incentive spirometry to prevent postoperative pulmonary complications, improve postoperative oxygenation, and decrease hospital stay following coronary artery bypass graft (CABG) surgery patients. Methods This was a clinical randomized prospective study. A total of 80 patients were selected as candidates for CABG at An-Najah National University Hospital, Nablus-Palestine. Patients had been randomly assigned into two groups: incentive spirometry group (IS), SI performed before surgery (study group) and control group, preoperative spirometry was not performed. The 40 patients in each group received the same protocol of anesthesia and ventilation in the operating room. Result The study findings showed a significant difference between the IS and control groups in the incidence of postoperative atelectasis. There were 8 patients (20.0%) in IS group and 17 patients (42.5%) in the control group (p = 0.03). Mechanical ventilation duration was significantly less in IS group. The median was four hours versus six hours in the control group (p p p Conclusion Preoperative incentive spirometry for two days along with the exercise of deep breathing, encouraged coughing, and early ambulation following CABG are in connection with prevention and decreased incidence of atelectasis, hospital stay, mechanical ventilation duration and improved postoperative oxygenation with better pain control. A difference that can be considered both significant and clinically relevant. Trial registration Thai Clinical Trials Registry: TCTR20201020005. Registered 17 October 2020—retrospectively registered.

In the growth of information technology that is very fast, it brings the era to be completely digital or so-called digital age. This phenomenon leads an institution or organization to involve an information technology that can help increase efficiency in carrying out activities and achieving business goals. The use of an information technology does not only have a positive impact. The higher utilization of information technology, the higher the gaps in security incidents and the potential for cybercrimes, so that cybersecurity becomes an important factor to minimize this issue. On the business processes of financial institutions that focus on economic stability and the role of IT as an enabler, however, workforce management that focuses on cybersecurity must be managed properly. This study attempts to assess cybersecurity maturity within the scope of Workforce Management in a case study in Bank Indonesia. The framework used in conducting this assessment is C2M2 Framework which focuses on the Workforce Management Domain. The results of this study indicate that cybersecurity in the workforce management domain at Bank Indonesia has not reached MIL 3. The results of the assessment will serve as a reference for improving cybersecurity in the field of workforce management at Bank Indonesia.

Introduction Complications following Cardiopulmonary resuscitation (CPR) are rare and usually follows a vigorous CPR or in special cases like pregnancy are due to lack of knowledge and clinical practice of how to preform CPR in pregnancy. One of this complication is diaphragmatic rupture with herniation of abdominal organs. Surgical intervention needs to be planned carefully in multidisciplinary team approach and requires fine surgical techniques for better outcome. There are few reported cases of diaphragmatic rupture after Cardiopulmonary resuscitation but none in pregnant woman. Case presentation We report a rare case of diaphragmatic rupture in a 29-year-old pregnant patient who experienced a full-blown diaphragmatic defect and herniation of the abdominal organs into the thoracic cavity, as a complication of CPR. Following careful assessment and diagnosis, the patient underwent urgent laparotomy with reduction of the contents and primary closure of the defect. One year follow up was satisfactory. To the best of our knowledge, this is the first reported case of diaphragmatic rupture with herniation of the abdominal organs following CPR in a pregnant woman in the literature. Conclusion The application of external cardiac massage through CPR is a life-saving procedure for the management of cardiac arrest. Common complications related to CPR include rib fractures, sternal fractures and haemothorax. Diaphragmatic rupture with herniation of the abdominal organs is a rare complication, having been reported only once in the literature (Sabzi F, Faraji R, Tanaffos 16:170–172, 2017); however, it represents a serious and life-threating event. Thus, careful evaluation of the patient by a multidisciplinary team and prompt intervention is recommended in order to improve outcomes.

Compared to coal, few studies were performed on biomass pyrolysis at elevated pressures, high heating rates, and moderate temperatures, the conditions usually prevailing in commercial fluidized bed gasifiers. In this work, Miscanthus is selected as one of the most promising biomass energy crops which is characterized by high annual yield and energy ratio. The effect of pressure on the product yields, gas composition, and char structure for pyrolysis of pulverized raw and torrefied Miscanthus was investigated in a drop tube reactor. Torrefaction was carried out at 250 °C for 30 min, while pyrolysis of raw and torrefied Miscanthus was performed at 800 °C in a pressure range of 1–30 bar. The gases were analyzed using a micro-GC, while the chars were characterized using proximate and ultimate analysis, porosity and BET surface area measurements, and Scanning Electron Microscopy (SEM). It was found that the pyrolysis pressure significantly affects the yields and properties of products, and that torrefaction significantly changes properties and pyrolysis behavior of Miscanthus. The torrefied Miscanthus was found to have higher char yields and char porosities at all the investigated pressures, while the raw Miscanthus was found to have higher gas yields, and higher liquid yields at high pressures. The char yield of both raw and torrefied Miscanthus increases till 10 bar and did not show any further changes at higher pyrolysis pressures. The yield of CO 2 increased with pyrolysis pressure for both raw and torrefied Miscanthus, while the yield of the high molecular weight gases like C 2 H 4 and C 2 H 6 decrease with increasing pyrolysis pressure and totally disappear at 30 bar. Hydrogen represented the major difference in the gas yield trend for raw and torrefied Miscanthus. A non-monotonous trend with pressure was observed for the liquid product yield of raw Miscanthus, while a decreasing trend with asymptote-like nature took place for torrefied Miscanthus. The different pyrolysis behavior of raw and torrefied Miscanthus evidenced in the liquid product yield trend, char porosity and SEM images might be attributed to the force balance on the particles’ structure which led to extensive fragmentation occurrence in the 10–15 bar range for raw Miscanthus chars, and its absence in the whole pressure range for torrefied Miscanthus chars, a hypothesis that is to be confirmed in future research work. The results obtained in this study are important inputs for modeling industrial fluidized bed gasifiers working on Miscanthus.

Background Idiopathic pulmonary artery aneurysm is a rare anomaly with only a handful reports in the literature. It is often asymptomatic, while the first presentation could be severe hemoptysis or death. Surgical intervention needs to be planned carefully with a multidisciplinary team approach to secure optimal outcome. We hope to spread our experience with such cases and to encourage other surgeons worldwide to deal surgically with these cases when its indicated. Case presentation A 47 years old man presented to our institution after three episodes of hemoptysis, echo demonstrated good left ventricle (LV) systolic function, normal right ventricle (RV) size and function, Chest computed tomography (CT) revealed aneurysmal dilatation with pending rupture of the pulmonary artery trunk (4.5 cm), the left pulmonary artery (6 cm) and the right pulmonary artery (2.3 cm). The patient successfully underwent replacement of Pulmonary artery trunk, left pulmonary artery and right pulmonary artery by Wovex Prosthetic graft (28 mm). The patient discharged home on the eight postoperative day in good clinical condition . Conclusion With this case report we wish to emphasize the need for a careful multidisciplinary approach given the complex and rare nature of the reported pathology. Electronic supplementary material The online version of this article (10.1186/s13019-018-0791-9) contains supplementary material, which is available to authorized users.

BackgroundAlthough there is a recommendation that toddlers be screened for Autism spectrum disorder (ASD) during their 18- and 24-month well-care child visits, diagnosis often occurs well after the child turns 4 years old. Such delayed diagnosis hinders the implementation of early intervention thus worsens the long-term prognosis of ASD.ObjectivesThe current community-based study in its stage I aimed at early screening of Egyptian toddlers for ASD using an Arabic validated version of Modified Checklist for Autism in Toddlers (M-CHAT).MethodologyA cross-sectional community-based descriptive study was carried out enrolling 5546 Egyptian toddlers. They were randomly recruited from those attending Primary Health Care Units in six Egyptian governorates with a fair representation of the urban, semi-urban, and rural Egyptian populations. An Arabic validated version of M-CHAT was used as a screening tool for ASD.ResultsThe current study revealed failure of M-CHAT (suspected to have ASD and needs further evaluation) in 1320 out of the enrolled 5546 Egyptian toddlers (23.8%).ConclusionsM-CHAT as a screening tool for ASD has flagged a considerable percent of the enrolled toddlers that necessitates referral for further evaluation (stage II) to settle the diagnosis of ASD in the true positive cases. Perfecting the delicate balance between sensitivity and specificity for ASD screening tools is crucial in order not to miss early detection of ASD cases and at the same time, to avoid over-diagnosis with subsequent abuse of the limited healthcare resources in developing countries.

Diesel fuel shortage is one of the main energy crisis components in Egypt as it is heavily employed in the electricity and transportation sectors. CtL (Coal to Liquids) and CBtL (combined Coal and Biomass to Liquids) are promising routes which can be currently applied for diesel production in Egypt. This paper will propose a novel methodology to drive the CBtL/CtL routes forward in Egypt. The methodology is based on using Miscanthus as biomass material and utilizing the Egyptian “Maghara” coal. It recommends some measures to improve project economics and simultaneously provide solutions to other strategic national problems including the poor sewage infrastructure and the unutilized desert areas. Eight scenarios were studied; four for each route with variable production capacities (450, 900, 1,350, 1,800 t diesel /d). To evaluate the scenarios, the diesel price was fixed at $50 below its current import price, and the corresponding discount rate and payback period were calculated. At high capacities, both routes are economically feasible (discounted interest rate of about 17%) and less sensitive to the price variation of equipment, raw materials and byproducts. Implementing the CBtL route can be regarded as a strategic project as besides being economically feasible, it offers crucial social and environmental benefits.

Antegrade cannulation of peripheral veins is the usual practice. Blood stasis between a catheter and the wall of the vein or at its tip in addition to catheter-induced phlebitis may initiate a thrombosis. The use of retrograde ventriculojugular shunts against the direction of the blood flow with resultant decrease in the incidence of venous thrombosis encouraged us to compare retrograde versus conventional antegrade peripheral venous cannulation.Monocentric, nonblinded, prospective observational cohort of 40 intensive care unit patients receiving 2 peripheral venous catheters in upper limbs, 1 inserted in the direction of blood flow (antegrade cannula) and the other inserted in an opposite direction to blood flow (retrograde cannula). Daily ultrasound assessment of the angle between the catheter and the vascular wall was done to detect onset and progression of thrombus formation.The study included 40 patients, aged 46.7 ± 10.132 years. The incidence of thrombus formation was 100% in both techniques. The onset time of thrombus formation between the catheter and the wall of a vein was significantly longer with the retrograde catheters than with the antegrade catheters with median time (interquartile range [range]) 6 days (5-6.75 [4-8]) with 95% confidence interval (CI), 5.58-6.42 vs 3 days (3-4 [2-5]) with 95% CI (2.76-3.24), respectively, with a P value.001. The time needed by the recently detected thrombus to reach the catheter tip determined by ultrasound with or without catheter failure was significantly longer in the retrograde catheters than in the antegrade catheter with median time (interquartile range [range]) 9 days (8-9 [7-10]) with 95% CI, 8.76-9.24 vs 4 days (4-5 [3-6]) with 95% CI, 3.76-4.24, respectively, with a P value.001.Retrograde cannulation did not decrease the incidence of thrombus formation, but significantly increased the onset time until thrombus formation and prolonged the time needed by the newly formed thrombus to reach the catheter tip compared with conventional antegrade cannulation.

This is the first time the concept of total quality management in burn injuries is proposed. This is a prospective study done in 1997-2003. All burn admissions to King Fahd Hospital of the University, Division of Plastic Surgery, were included. Total number of cases is 240. Male patients constituted 141 (59.2%); female patients, 97 (40.8%), and 2 cases were not specified in forms. There were 114 children (0-18 years, 50.2%) and 113 adults (19-99 years, 49.8%). The source of admission was mainly emergency room (197, 82%) followed by outpatient department (27, 11.3%), and other hospitals in 16 (6.7%). The type of burn was mainly scald (16.3%), then flame (6.98%), electrical (6.5%), chemical (2.8%), friction (0.47%), and not specified in 33% of recorded cases. The most encountered body percentage burn was 1% to 10% and 11% to 20% in 36.7% and 25.9% of cases, respectively. Sixty-six cases (28.2%) were operated on. The reason for nonoperation was not indicated in 78.5% and refusal in 1.8%. The most frequent operation was split-thickness skin grafting followed by tangential excision + split-thickness skin grafting. Operations took mostly about 2 hours (53.8%). The region operated on was mainly upper limbs (42.6%), then head and neck (27.7%). The affected body part in electrical burns was upper limb, then the head. Preoperative photography was done in 17% and post operatively in 9.4% of recorded cases. Consultations were needed in 39.4% and responded to in 48 hours in 98.2% of them. Discharge was home in 80.9%, against medical advice in 7.5%, died in 7%, transferred in 4%, and other ward in 0.5%. No significant difference was observed between pediatric age groups and adults (>18 years old), also for electrical versus nonelectrical burns in relation to total hospital stay. Similar observations were made among various age groups with respect to total hospital stay. The clinicopathologic typing relation to age groups, nationality, and sex was found significant. Recommendations and the newly proposed zone of practice and concept of total quality management in burn injuries are included. Language: en

Background: The primary goal of cardiac surgery is not just a minimally acceptable outcome where the patient survives without life threatening complications, but a healthy productive long term survivor. There is no universally accepted technique for anesthesia management during cardiac surgery,Anesthetic protocols in cardiac surgery are investigated and analyzed in terms of their effect on post-operative mortality and incidence of myocardial infarction following cardiac surgery, needs for inotropic support, time to extubation, time on mechanical ventilation, and hospital length of stay. Fast–track tracheal extubation (within 6 hours after the surgery) after cardiac surgery has become a methods which is believed to facilitate this must be validated. One of these methods, is the use of intra-operative monitoring Modalities, such as (BIS) which is a value derived from electroencephalogram, and had been used as a measure of anesthesia effect. We performed this study in An-najah National University Hospital / Palestine to investigate the role of BIS monitoring on time to extubate and CCU length of stay after cardiopulmonary bypass surgery. Methods: In a randomized control study we used the bispectral index monitoring during cardiopulmonary bypass between 40-50 and in the CCU between 60-70 until extubation. 100 patients between the age of 30 and 75 years undergoing elective cardiopulmonary bypass surgery and patients undergoing elective valve replacement or repair, from 01/10/2015 to 01/04/2016 were assigned for this study, randomized to 50 patients each in the BIS group and the conventional group. Results: Extubation time data were available for 100 patients. The median time to extubate (320) minutes in the BIS group and (365) minutes in conventional group. The median CCU length of stay (24.1) hours in BIS group and (24.3) hours in conventional group. Regarding hospital length of stay, there was no difference in between the two groups, with median time of (5 days) in both groups. Conclusions: Data from this study suggested that the use of the BIS monitor during cardio pulmonary bypass does not confer an advantage in reducing time to extubation, CCU length of stay, or overall hospital length of stay.

We present a series of 40 cases who underwent reconstructive procedures using rectus abdominis myocutaneous units. The transplanted tissue comprised superior pedicle (26 cases), inferior pedicle (11 cases), and as free muscle flap (3 cases). The application fell into three groups i.e.; 1. breast and chest wall reconstruction; 2. groin, genital, and trochanteric area; and 3. leg and heel ulcer. The results show that surgical dissection of flaps is relatively easy and has a wide range of applications that can be used for different surgical reconstructive problems. Surgical dissection has a low incidence of complication for flap viability as well as for donor site.