Formulating A Competitive Advantage Model for Tourism Destinations in Indonesia

LESMANA, Henky,SUGIARTO, Sugiarto Korea Distribution Science Association 2021 The Journal of Asian Finance, Economics and Busine Vol.8 No.3

Indonesia has successfully increased its ranking to 40th place in the 2019 Travel & Tourism Competitiveness Index. While tourism has become the country's second largest foreign exchange contributor, there is no existing competitive advantage model for Indonesian tourist destinations. The purpose and novelty of this study is to develop and formulate a competitive advantage model for Indonesia's tourism industry. The model will be based on the supply-side perception analysis of competitiveness indicators from Bali and five designated super-priority destinations in Indonesia. This model is expected to become a guideline for policymakers to design an effective and focused strategy. Data were obtained from in-depth interviews with, and questionnaires given to, 62 qualified industry players from the public and private sectors. This data-driven approach builds a relationship between competitiveness indicators and competitive advantages using a combination of importance-performance analysis and confirmatory factor analysis, thereby leveraging these advantages to generate a strategic model to compete in the international tourism industry. This would also be the first study to use this method in defining the competitive advantage of a destination. Using structural equation modeling, the study found that there are 54 indicators representing twelve dimensions of competitive advantages with good fit criteria.

Efficacy of Mouthwash Containing Curcuma xanthorrhiza on Lactoperoxidase System Activity and Halitosis Risk

Stella Lesmana,Risqa Rina Darwita,Anton Rahardjo 대한예방치과학회 2013 International Journal of Clinical Preventive Denti Vol.9 No.4

Objective: The use of mouthwash may increase the activity of lactoperoxidase system in saliva and may reduce the risk of halitosis. The research was conducted to determine the effect of mouthwash containing Curcuma xanthorrhiza on lactoperoxidase system activity in relation to halitosis risk. Methods: The research design was a before after clinical trial, the 5 ml saliva samples were taken from 10 subjects age 20-23 years oldat 22.00 WIB at night and at 04.00 WIB in the morning. Lactoperoxidase enzyme activity was measured using the method of Chance and Maehly while the concentration of thiocyanate ion was measured using Thomas and Aune method. Results: The mean±SD of the baseline lactoperoxidase activity absorbance in the evening 0.2463333±0.126053 and then decreased in the morning to 0.1994999±0.059258 and the mean±SD baseline thiocyanate ion from 1.9328±0.187181 in the night decreased in the morning to 1.819±0.510573. After intervention with mouthwash containing Curcuma xanthorrhiza, theincreasing of average value of baseline Lactoperoxidase activity absorbances was indicated from 0.2121±0.107991 in the evening becomes 0.240233±0.091862 in the morning, while the average of thiocyanate ion from 1.0531±0.108838 in the evening becomes 1.090267±0.285835 in the morning. There were no significant differences between the activity of lactoperoxidaseenzyme and thiocyanate ion concentrations in both treatments (p>0.05). Conclusion: The use of mouthwash containing Curcuma xanthorrhiza has the potential to raise the lactoperoxidase system activity.

Design for Walking Rehabilitation of a Lower Limb Exoskeleton Based on Interaction Torque

Agus Lesmana,Kai-Tai Song 제어로봇시스템학회 2017 제어로봇시스템학회 국제학술대회 논문집 Vol.2017 No.10

In this research, an adaptive lower limb exoskeleton (AEXO) has been designed and constructed as a rehabilitation device. It is important during the rehabilitation that a user obtains assistance from the exoskeleton in an adaptive manner, as the user may improve his/her walking during rehabilitation. The assistance from the machine will be less or more according to the current situation of the user during the use of the exoskeleton. The question then arises as to how the exoskeleton can provide adaptive adjustment. It was decided that a tangible design was to measure the user status such as the user interaction force during walking. In this design, force sensors are installed on each link of exoskeleton to record the user walking effort during walking. By measuring this force, the control computer of the exoskeleton will understand for each cycle what the status of the user is and predict an adaptive torque according to measured force. In order to generate a suitable torque, the compliant motion control, which is a combination of impedance and admittance control is used. Walking experiments of a healthy person to wear the AEXO have been carried out in the lab. The first experiment verified the propose algorithm by using a predefined reference trajectory for the user and giving an adjustment to the reference trajectory based on the interaction torque. The second experiment verified that even without the predefined gait trajectory to the user, the exoskeleton can move in compliance to the user under various walking speeds. For the future development, the method will be expanded and tested for people who suffer from stroke or other walking impairment.

On the importance of the bullet jacket during the penetration process: Reversed-ballistic experimental and numerical study

Denny Lesmana,Faizal Arifurrahman,Amer Hameed,G. J. Appleby-Thomas,Sigit P. Santosa 대한기계학회 2020 JOURNAL OF MECHANICAL SCIENCE AND TECHNOLOGY Vol.34 No.5

The behaviour of exposed and copper-jacketed 12.7 mm En8 steel cores impacting against 5 and 9 mm Armox Advance plates was investigated to determine the significance of the jacket during the penetration. The target plates were accelerated into stationary projectiles (a reversed-ballistic configuration) and the impact was monitored using a multichannel flash X-ray system to gain insight into the interaction of the core target. Numerical simulations were also carried out to compare result with the experimental testing. Explicit numerical software LS-DYNA was used to model the behaviour of the target and the projectile during the impact collision. Fragments of the core and target plate were collected post-shot for analysis. A similar penetration behaviour was observed for both plates, although the post-shot core was shorter after impacting against the 9 mm plate, consistent with enhanced erosion behaviour. The copper jacket protected the core, resulting in greater surface defeat and dwell compared to the unjacketed core. Numerical studies agreed on the cases of projectile impacting the 5 mm and 9 mm target. However, the target fracture cannot be captured. This could be caused by the input of material data and strain rate parameter modelling in LS-DYNA was limited, while the impact phenomenon was high velocity impact that the material exhibits a highstrain rate effect. Overall, the ductile jacket appeared to serve two functions: (1) Absorbing reflected energy during impact, hence cushioning the impact and thereby preserving the core, and (2) constraining or confining the core. In this study, the steel core design and copper jacket has a more complex geometry compared to the simplified steel core designs often applied in several earlier ballistic studies. The captured flash X-rays revealed significantly less erosion in the jacketed cores, agreeing with the post-impact core length measurements.

Current Status of HBV in Asia : Epidemiology of Hepatitis B Virus in Indonesia

( Laurentius A. Lesmana ) 대한간학회 2004 Clinical and Molecular Hepatology(대한간학회지) Vol.10 No.1(S)

Detection Rate of Colorectal Adenoma or Cancer in Unselected Colonoscopy Patients: Indonesian Experience in a Private Hospital

Sudoyo, Aru W.,Lesmana, C. Rinaldi A.,Krisnuhoni, Ening,Pakasi, Levina S.,Cahyadinata, Lidwina,Lesmana, Laurentius A. Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.22

Background: Colorectal cancer is currently the third most common cancer in Indonesia, yet colonoscopy - the most accepted mode of screening to date - is not done routinely and national data are still lacking. Objective: To determine the detection rate of colorectal cancers and adenomas in unselected patients undergoing colonoscopy for various large bowel symptoms at the Digestive Disease and GI Oncology Centre, Medistra Hospital in Jakarta, Indonesia. Materials and Methods: Colonoscopy data from January 2009 to December 2012 were reviewed. New patients referred for colonoscopy were included. Data collected were patient demographic and significant colonoscopy findings such as the presence of hemorrhoids, colonic polyps, colonic diverticula, inflammation, and tumor mass. Histopathological data were obtained for specimens taken by biopsy. Associations between categorical variables were analyzed using chi-square test, while mean differences were tested using the t-test. Results: A total of, 1659 cases were included in this study, 889 (53.6%) of them being men. Polyps or masses were found in 495 (29.8%) patients while malignancy was confirmed in 74 (4.5%). Patients with a polyp or mass were significantly older (60.2 vs 50.8 years; p<0.001; t-test) and their presence was significantly associated with male gender (35.0% vs 23.9%; prevalent ratio [PR] 1.71; 95% confidence interval [CI] 1.38-2.12; p<0.001) and age >50 years (39.6% vs 16.6%; PR 3.29; 95% CI 2.59-4.12; p<0.001). Neoplastic lesions was found in 257 (16.1%), comprising 180 (11.3%) adenomas, 10 (0.6%) in situ carcinomas, and 67 (4.2%) carcinomas. Conclusions: Polyps or masses were found in 30% of colonoscopy patients and malignancies in 16.1%. These figures do not represent the nation-wide demographic status of colorectal cancer, but may reflect a potentially increasing major health problem with colorectal cancer in Indonesia.

Managing liver cirrhotic complications: Overview of esophageal and gastric varices

Cosmas Rinaldi Adithya Lesmana,Monica Raharjo,Rino A. Gani 대한간학회 2020 Clinical and Molecular Hepatology(대한간학회지) Vol.26 No.4

Managing liver cirrhosis in clinical practice is still a challenging problem as its progression is associated with serious complications, such as variceal bleeding that may increase mortality. Portal hypertension (PH) is the main key for the development of liver cirrhosis complications. Portal pressure above 10 mmHg, termed as clinically significant portal hypertension, is associated with formation of varices; meanwhile, portal pressure above 12 mmHg is associated with variceal bleeding. Hepatic vein pressure gradient measurement and esophagogastroduodenoscopy remain the gold standard for assessing portal pressure and detecting varices. Recently, non-invasive methods have been studied for evaluation of portal pressure and varices detection in liver cirrhotic patients. Various guidelines have been published for clinicians’ guidance in the management of esophagogastric varices which aims to prevent development of varices, acute variceal bleeding, and variceal rebleeding. This writing provides a comprehensive review on development of PH and varices in liver cirrhosis patients and its management based on current international guidelines and real experience in Indonesia.

Role of endoscopy in gastroesophageal reflux disease

Daniel Martin Simadibrata,Elvira Lesmana,Ronnie Fass 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.6

In general, gastroesophageal reflux disease (GERD) is diagnosed clinically based on typical symptoms and/or response to proton pumpinhibitor treatment. Upper gastrointestinal endoscopy is reserved for patients presenting with alarm symptoms, such as dysphagia,odynophagia, significant weight loss, gastrointestinal bleeding, or anorexia; those who meet the criteria for Barrett’s esophagus screen-ing; those who report a lack or partial response to proton pump inhibitor treatment; and those with prior endoscopic or surgical an-ti-reflux interventions. Newer endoscopic techniques are primarily used to increase diagnostic yield and provide an alternative to med-ical or surgical treatment for GERD. The available endoscopic modalities for the diagnosis of GERD include conventional endoscopywith white-light imaging, high-resolution and high-magnification endoscopy, chromoendoscopy, image-enhanced endoscopy (nar-row-band imaging, I- SCAN, flexible spectral imaging color enhancement, blue laser imaging, and linked color imaging), and confocallaser endomicroscopy. Endoscopic techniques for treating GERD include esophageal radiofrequency energy delivery/Stretta procedure,transoral incisionless fundoplication, and endoscopic full-thickness plication. Other novel techniques include anti-reflux mucosecto-my, peroral endoscopic cardiac constriction, endoscopic submucosal dissection, and endoscopic band ligation. Currently, many of thenew endoscopic techniques are not widely available, and their use is limited to centers of excellence.

Hepatocellular Carcinoma in a Tertiary Referral Hospital in Indonesia: Lack of Improvement of One-Year Survival Rates between 1998-1999 and 2013-2014

Loho, Imelda M,Hasan, Irsan,Lesmana, C Rinaldi A,Dewiasty, Esthika,Gani, Rino A Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.4

Background: The survival of hepatocellular carcinoma (HCC) patients is usually low due to late diagnosis. Cipto Mangunkusumo Hospital as the largest tertiary referral hospital in Indonesia, has recently improved its modalities for advanced HCC management, but there has not been any evaluation on any improvement in HCC patient survival. Materials and Methods: A retrospective analysis on 114 HCC patients in 2013-2014 were conducted and compared with the database for 77 HCC patients in 1998-1999. Clinical characteristics and treatment received were recorded and the survival of both groups was analyzed using the Kaplan-Meier method and compared using the log-rank test. Results: The percentage of HBV positive patients had increased after fifteen years from 32.5% to 67.5%. Only two patients (1.8%) in 2013-2014 were diagnosed with HCC during surveillance program. Proportions of Barcelona Clinic Liver Cancer A, B, C, and D in 2013-2014 were 1.8%, 42%, 28.1%, and 28.1%, respectively. There was an increase in the use of potentially curative treatment, such as surgical resection or combination of loco-regional therapies. The one-year survival rate increased from 24.1% in 1998-1999 to 29.4% in 2013-2014, while the median survival decreased from 146 days to 138 days, but the difference was not statistically significant (p=0.913). Conclusions: There was no improvement in the median survival of HCC patients after fifteen years because most continued to present at late stages. There is an urgent need for a nationwide implementation of a hepatitis screening program and HCC surveillance education.

Cleft lip and palate surgery during COVID-19 pandemic in Indonesia: a 36-month experience at the Bandung Cleft Lip and Palate Center

Ali Sundoro,Dany Hilmanto,Hardisiswo Soedjana,Ronny Lesmana,Kevin Leonard Suryadinata Korean Cleft Palate-Craniofacial Association 2023 Archives of Craniofacial Surgery Vol.24 No.3

Background: In Indonesia, the prevalence of cleft lip and palate increased from 0.08% to 0.12% between 2013 and 2018. Children with cleft deformities typically undergo staged surgery. However, the coronavirus disease 2019 (COVID-19) pandemic has had negative impacts on the healthcare sector, including the suspension of elective procedures; this has raised concerns about the safety of performing surgery and the functional consequences of delaying treatment, the latter of which is associated with poor prognosis. The purpose of this study was to report the characteristics of clefts treated by the Bandung Cleft Lip and Palate Center team during the pandemic period. Methods: This brief comparative study based on a chart review was conducted at the Bandung Cleft Lip and Palate Center. We statistically evaluated data from all patients treated between September 2018 and August 2021. Frequency analysis was performed to analyze the average number of each procedure by age before and during the COVID-19 pandemic. Results: Data from 18-month periods before (n= 460) and during (n= 423) the pandemic were compared. Cheiloplasty procedures were examined (pre-pandemic, n= 230; pandemic, n= 248); before the pandemic, 86.1% were performed according to the treatment protocol (patient < 1 year old), and this proportion non-significantly dropped to 80.6% during the pandemic (p= 0.904). Palatoplasty procedures were also compared (pre-pandemic, n= 160; pandemic, n= 139); the treatment protocol (patient 0.5-2 years old) was followed for 65.5% of procedures before the pandemic and 75.5% during the pandemic (p= 0.509). Additionally, 70 (mean age, 7.94 years) revision and other procedures were performed before the pandemic and 36 (mean age, 8.52 years) during the pandemic. Conclusion: The cleft procedures performed at the Bandung Cleft Lip and Palate Center did not significantly change during the COVID-19 pandemic.