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"A curve stream is the part of river if compared to a straight stream with more problems. Problems always accurring are the scouring at the outer bend of curve and sedimentation at inner bend of curve...."

"ABSTRAKLatar Belakang: Studi ini bertujuan untuk mengamati dampak aplikasi Tumescent ONEPERMIL dan segi keamanannya pada skin flap yang telah mampu pulih hidup dari cedera iskhemia sebelumnya. Metode: Studi eksperimental dengan kontrol dan randomisasi dilakukan pada 40 groin flap dari 20 ekor Rattus novergicus strain Wistar yang sehat berbobot 220-270 gram. Infiltrasi Tumescent ONEPERMIL, infiltrasi salin normal dan grup kontrol dilakukan pada flap yang berhasil pulih vital 100% dari cedera iskhemia yang dikondisikan melalui pemasangan klem selama 15 menit pada pedikelnya. Perfusi flap dimonitor melalui pengukuran tekanan oksigen transkutaneous (TcPO2), sebelum dan sesudah infiltrasi dilakukan. Vitalitas flap dinilai secara klinis maupun menggunakan Analyzing Digital Images® di hari ke 7 paska prosedur infiltrasi dan resetting flap pada tempatnya. Analisa statistik dilakukan dengan test Chi-square (p<0,05).Hasil: Penilaian akhir menunjukkan kepulihan hidup seluruh groin flap tanpa ditemukan tanda nekrosis. Pengukuran TcPO2 pada flap sebelum dan sesudah prosedur infiltrasi menunjukkan perbedaan yang signifikan (p<0,0001) namun masih berada dalam batasan prediksi flap akan pulih hidup.Kesimpulan: Aplikasi Tumescent ONEPERMIL pada groin flap yang telah pulih hidup dari cedera iskhemia sebelumnya, tidak menimbulkan dampak nekrosis pada flap.

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ABSTRACTBackground: To observe the effect of One-per-mil tumescent injection on viable skin flaps that previously had suffered from an ischemic insult, so as to ascertain One-per-mil tumescent safety application in the related theme. Methods: 40 groin flaps from 20 healthy Wistar strained-Rattus novergicus weighing 220-270 grams were conditioned to acute ischemia by clamping the pedicle for 15 minutes. Merely totally survived and viable flaps on the seventh postoperative day were randomly divided into: One-per-mil tumescent infiltration group(A), normal saline infiltration group(B), and control group(C). Before and after the infiltration, transcutaneous oxygen tension (TcPO2) measurement was performed, and the changes values were calculated by statistical analysis using ANOVA and Paired T-Test. Viability of flaps was assessed clinically and by using AnalyzingDigitalImages® 7 days later.Results: TcPO2 readings yielded a decreasing value significantly (p<0.001) following both One-per-mil tumescent and normal saline infiltration. However, all groin flaps survived with no signs of tissue necrosis. Conclusion: One-per-mil tumescent injection into viable skin flaps is safe even though the flaps had previously suffered from an ischemic condition."

"Resiko pelaksanaan proyek konstruksi pada tahap III dari Project Life Cycle, yaitu tahap Produksi atau Pelaksanaan konstruksi fisik perlu mendapat perhatian manajemen sejak tender sampai proses pengakhiran proyek. Manajemen resiko meliputi Identifikasi, Kuantifikasi, Pengembangan respon dan Kontrol. Dari analisa tersebut diketahui faktor resiko yang dominan. Dengan mengelola faktor-faktor resiko yang dominan diharapkan bisa mengantarkan proyek kepada pencapaian sasarannya. Proyek yang karena perubahan design menjadi bermasalah dalam pencapaian target laba kotor yaitu dari rencana Rp. 9,651 milyard menjadi Rp. 5,383 milyard atau berkurang sebesar Rp. 4,467 milyard. Setelah dilakukan kegiatan respon terhadap resiko yang dominan, diprediksikan bisa kembali mencapai target labanya, bahkan dimungkinkan bisa dicapai laba kotor sebesar Rp. 14,577 milyard atau 151 % dari target rencana aslinya. Mengejar target perusabaan bersamaan dengan usaha pemenuhan kebutuhan para stake holder akan lebih memperbesar kemungkinan tercapainya target tersebut.. Dan penggunaan teknik-teknik analisa yang sesuai dengan permasalahannya terbukti menghasilkan peneiitian yang berakurasi tinggi.

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Construction Risk at the 3r phase of Project Life Cycle ( production, fabrication, installation) should have the adequate concern from the tendering up to the closing of the project. Risk Management consist of Identification, Quantification, Risk Response development and Control. These processes define the dominant risk factor. Concentrating on these dominant risk factors management will reach the project objectives. The Project when facing the design change meet the crucial condition to achieve the gross profit target from Rp. 9,652 billion to Rp. 5,383 billion or decreasing Rp. 4,269 billion. By the dominant risk response action, the gross profit predicted to rise over the targeted gross profit. Even possible to reach Rp. 14,577 billion or 151 % from the original of profit target. Simultaneously attaining internal corporate objectives and provided stakeholders needs make the greater probability to overcome the targets. And utilization of adequate techniques of analyses to the problem solving represent the high accuracy research finding."

"ABSTRACTPurpose: Up to 6-7% of patients who have undergone laparoscopic groin hernia repair suffer from chronic pain, depending on various factors; however, the long-term course is unclear. The purpose of this study was to assess the prevalence of chronic pain 1-5 years after laparoscopic groin hernia repair.Methods: The subjects of this nationwide cross-sectional questionnaire study were adults who underwent laparoscopic mesh repair of an inguinal or a femoral hernia. The patients were identified from the Danish Hernia Database, which has a follow-up rate of almost 100%. The prevalence of chronic pain was assessed 1-5 years postoperatively by the validated inguinal pain questionnaire (IPQ).Results: A total of 1383 groins were included in this study, based on a 66% response rate to the questionnaire. The prevalence of pain decreased, especially 3.5 years postoperatively. There were no statistically significant differences when each postoperative year was compared with the second postoperative year. However, the prevalence of chronic pain 3.5-5 years postoperatively was significantly lower (4.4%) than that 1-3.5 years postoperatively (8.1%) (p = 0.014). The prevalence of pain that could not be ignored was still 5-6% in the fifth postoperative year.Conclusions: The prevalence of chronic pain seems to decline 1-5 years after laparoscopic groin hernia repair, with a distinct decrease 3.5 years postoperatively."