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The premium healthcare industry in urban areas is experiencing increasing competition along with the increase in healthcare facilities and the increasing public demand for fast, comfortable, and quality medical services. In this context, Columbia Asia Pulomas Hospital is implementing an expansion strategy by increasing facility capacity, modernizing services, and adding a Center of Excellence (COE) as a service differentiation. This study aims to analyze customer retention strategies within the Balanced Scorecard (BSC) framework, focusing on the relationship between customer perspectives, internal processes, learning and growth, and their application to the financial perspective. The research method uses a document-based policy and strategy analysis approach, field findings, and a synthesis of Balanced Scorecard theory and patient experience.The analysis shows that customer retention during the expansion phase is influenced not only by clinical quality, but also by the assurance of doctor time in practice, speed of service, physical comfort, and digitization of queues and administration. The addition of a COE has been shown to increase the perception of service value and expand market share through service specialist differentiation. Within the BSC framework, the customer perspective serves as a leading indicator for achieving the financial perspective, where increased patient retention contributes to increased revenue, ROI growth, and long-term financial expectations. The research implications emphasize that strategies for strengthening human resources, modernizing internal processes, and service innovation are important foundations in ensuring successful hospital expansion and enhancing competitive advantage.

Uterine myoma is a benign smooth muscle tumor of the uterus commonly found in women of reproductive age and may cause symptoms related to mass effect and hematologic disturbances. We report the case of a 41-year-old woman presenting with progressive vaginal pain for 3 months, accompanied by low back pain and impaired daily activities, without vaginal bleeding, vaginal discharge, fever, or urinary or defecatory symptoms. Laboratory examination revealed severe microcytic hypochromic anemia with a hemoglobin level of 4.7 g/dL, while ultrasonography demonstrated a 9.93 × 10.32 cm mass described as symmetric, well circumscribed, and hyperechoic, leading to a working diagnosis of uterine myoma with anemia. The patient was managed with general condition monitoring, intravenous fluids, analgesics, transfusion of four units of packed red cells, and laparotomy as definitive intervention. Following transfusion and surgery, the hemoglobin level increased to 9.4 g/dL and subsequently to 11.0 g/dL, accompanied by improvement in postoperative symptoms and clinical condition. This case demonstrates that a large uterine myoma may present predominantly with pelvic pain and functional impairment in the absence of vaginal bleeding. A comprehensive approach involving systematic evaluation, preoperative correction of anemia, appropriate surgical intervention, and postoperative monitoring is essential to improve safety and clinical outcomes in patients with symptomatic pelvic masses.

The study of Islamic manuscripts contributes to understanding the development of thought, values, and social practices in Muslim communities, especially when texts are viewed as cultural artifacts. This research examines the Eid al-Adha sermon manuscript from the private collection of Mgs. Muhammad Jufri using a philological approach combined with value and da'wah analysis. The method is qualitative, applying philological stages such as inventory, description, transliteration, and textual criticism to produce a reliable text edition close to the original form. The analysis is strengthened by hermeneutics and da'wah studies to interpret meanings, values, and messages contextually. The findings show that the manuscript has a structured sermon format consisting of opening, main content, and closing, with strong rhetorical and religious functions. The text contains core values such as tawhid, obedience, sacrifice, social solidarity, and morality, as well as da'wah messages emphasizing piety, qurban practice, ukhuwah, and social awareness. Although limited by the absence of data regarding authorship and transcription time, the manuscript remains relevant as a source of Islamic values. This study shows that combining philology with interpretive approaches can enrich textual meaning and support Islamic studies development in contemporary society and strengthening cultural understanding among modern Muslim communities today worldwide context.

Air quality in the Special Capital Region of Jakarta has shown a concerning decline in recent years, largely due to high emissions from motor vehicles as the main source of pollution in urban areas. The Provincial Government of DKI Jakarta issued Governor Regulation Number 66 of 2020 concerning Exhaust Emission Testing for Motor Vehicles as a public policy instrument aimed at controlling air pollution. This study aims to analyze the implementation of the regulation from a public policy perspective and to identify supporting and inhibiting factors in its execution. The research employs a normative juridical method with statutory and conceptual approaches, supported by qualitative analysis of policy documents and reports on the implementation of emission testing. The results reveal that the implementation of the regulation has not been optimal due to limited emission testing infrastructure, low levels of public awareness and socialization, and inconsistent enforcement of administrative sanctions. Nevertheless, there are opportunities to improve policy effectiveness through strengthened inter-agency coordination, digitalization of monitoring systems, and increased environmental literacy among the public. Therefore, the success of emission control policy implementation is highly dependent on resource support, regulatory consistency, and community awareness, necessitating a comprehensive and continuous multi-stakeholder improvement strategy and stronger commitment.

The need for housing is increasingly pressing with population growth and urbanization, while affordability remains a challenge for single-income households. The purpose of this investigation is to assess the impact of price also location on home purchase decisions using a literature review. This approach involves reviewing, analyzing, and synthesizing various relevant literature sources, such as scientific journals, books, undergraduate theses, also previous investigation reports that discuss factors influencing home purchase decisions. The study concludes that price plays a positive also significant role in home purchase decisions, as consumers prefer homes with prices commensurate with their purchasing power and the quality offered. Location has also been shown to influence decisions, particularly when housing is conveniently situated at a key location  and the availability of public facilities. However, certain studies indicate that price and location are not always the primary determinants of decision-making, as other variables such as promotion, brand image, product quality, and lifestyle also play a role.

This study aims to explore the role of pet attachment among cat owners in Palembang, focusing on how emotional bonds are formed, interpreted, and influence psychological well-being. A qualitative approach was employed using purposive sampling to select two main participants who had high interaction intensity with their cats, along with additional informants from family members and neighbors. Data were collected through in-depth interviews, observations, and documentation, then analyzed thematically with source triangulation to ensure validity. The findings reveal that pet attachment develops through daily interactions such as feeding, cleaning, playing, and monitoring the cat’s health. Cats are perceived not only as domestic animals but also as companions that provide psychological comfort, emotional support, and stress reduction. Factors shaping attachment include emotional needs, intensity of daily interaction, empathy toward the pet’s condition, long-term caregiving commitment, and the perception of cats as significant companions. The duration of ownership strengthens attachment quality, while the loss of a pet triggers profound grief comparable to losing a family member. Moreover, pet attachment influences family dynamics and social identity, portraying owners as caring and empathetic individuals. In conclusion, pet attachment among cat owners in Palembang is a complex psychological phenomenon involving emotional, social, and behavioral dimensions. The relationship between humans and cats extends beyond utilitarian functions, evolving into deep affective bonds that serve as coping mechanisms and psychosocial support in urban life. These findings enrich the literature on human-animal relationships and highlight the therapeutic and emotional value of pets in modern society.

Urban waste management has become a complex challenge due to population growth, urbanization, and economic activities contributing to higher waste generation. Effective waste management systems are required to reduce waste disposed at final disposal sites. This study aims to evaluate the effectiveness of waste management at the TPS 3R Pedalangan Bersinar facility in Semarang City by examining waste separation from the source. The research applied a quantitative approach using mass balance analysis to assess the balance between incoming waste, processed waste, and residual waste in the system. Primary data were collected through field observations, interviews, and operational monitoring for six consecutive days, while secondary data were obtained from the Semarang Environmental Agency. Results show community-based waste banks in Pedalangan demonstrate a high level of effectiveness with a recovery factor reaching 100%, indicating optimal recycling performance and strong community participation. Meanwhile, the TPS 3R facility processes an average waste volume of 16.61 m³/day with reduction of 10.32 m³/day and residual waste of 6.29 m³/day, resulting in a recovery factor of approximately 0.62 categorized as moderate effectiveness. Therefore, strengthening household waste separation, improving operational management, and increasing community participation are recommended to enhance waste reduction and support sustainable urban waste management systems.

The problem of urban flooding is a growing issue due to high population density, increasing volumes of plastic waste, and the reduction of water absorption areas. The use of conventional paving blocks, which are impermeable, further exacerbates flooding conditions because they do not allow water to infiltrate into the soil. This study aims to develop an innovative plastic waste-based paving block incorporating rice straw and sugarcane bagasse, along with the integration of phytoremediation concepts as a solution for urban flood mitigation. The method employed was an experimental approach involving the following stages: material preparation, plastic incineration, material mixing, molding, and testing of water absorption capacity and compressive strength. The results showed that paving blocks with a combination of plastic waste, rice straw, and sugarcane bagasse had the highest water absorption rate of 34% and compressive strength of 21 kg/cm², meeting SNI standards. The addition of natural materials containing silica was proven to enhance the material’s porosity and strength. Additionally, the application of phytoremediation using water hyacinth has the potential to improve the quality of water seeping into the soil. Thus, this phytoremediation-based paving block innovation can serve as an effective alternative solution to reduce flood risks while supporting sustainable waste management and environmental stewardship.

Ventricular septal defect (VSD) is a congenital heart defect characterized by a gap in the interventricular septum, with a prevalence of 20–30% of all cases of congenital heart disease. Based on their location, VSD is divided into perimembrane, muscular, and subarterial. This case report discusses a patient who came to the emergency room of Cut Meutia Hospital with good consciousness (GCS E4M6V5) and complained of shortness of breath, cough, nausea, and chest pain spreading to the neck and hands. The anamnesis showed chronic symptoms in the form of coughing up phlegm for two weeks, accompanied by throbbing headaches, dizziness, flatulence, and sleep disturbances. Physical examination showed vital signs of TD 140/90 mmHg, HR 86 x/min, RR 23 x/min, SpO₂ 37%, and temperature 37°C.  Supporting examinations in the form of chest X-rays showed cardiomegaly of the pulmonary segment, while ECG showed rhythmic sinuses with LAD axis, T-inverted in AVL, V1, V2, RsR' in V2, positive Cornell criteria, anterolateral myocardial infarction, RBBB, and LVH. Echocardiography shows the presence of a bidirectional shunt with a dominant right-to-left shunt. This case confirms the importance of comprehensive diagnosis through clinical and supporting examinations to determine optimal management in patients with VSD, as well as prevent further complications.

Diabetes mellitus type 2 is a chronic metabolic disorder that frequently affects elderly patients and is often accompanied by multiple comorbidities. The increasing prevalence of diabetes in the aging population contributes to higher morbidity and mortality, especially when complicated by geriatric syndromes, electrolyte imbalances, and infections such as pneumonia. This study aims to present a case of type 2 diabetes mellitus in an elderly patient with associated geriatric problems, electrolyte disturbances, and pneumonia. The method used is a descriptive case report based on clinical findings, laboratory examinations, and radiological assessment. A 76-year-old male presented with generalized weakness, weight loss, decreased appetite, respiratory symptoms, and functional decline. Physical examination and laboratory findings revealed uncontrolled diabetes, electrolyte imbalance, hypoalbuminemia, and signs of infection. Chest radiography confirmed pneumonia. Management included pharmacological therapy such as antibiotics, fluid and electrolyte correction, and supportive care, along with non-pharmacological interventions including dietary regulation and monitoring. The findings highlight the complexity of managing elderly patients with multiple comorbid conditions, emphasizing the need for a comprehensive and multidisciplinary approach. Early detection and appropriate management are essential to improve clinical outcomes and prevent further complications in geriatric patients with diabetes mellitus.

This study was conducted to determine the best log-linear model describing the relationship between gender, sleep duration, extracurricular activities, and student learning outcomes at SMAN 1 Kualuh Hulu. A log-linear analysis approach was used to identify interaction patterns among the variables and evaluate their contribution to student academic performance. The findings showed that the selected model adequately explained the structure of the observed data. A significant three-way interaction was identified between learning outcomes, sleep duration, and gender. The results indicated that insufficient sleep duration had a negative impact on student learning outcomes, and this effect varied by gender. Female students were found to be more vulnerable to decreased academic performance caused by sleep disturbances compared to male students. Meanwhile, extracurricular activities did not demonstrate a significant direct interaction with learning outcomes. This suggests that participation in extracurricular activities was not a major factor influencing differences in academic achievement among students at SMAN 1 Kualuh Hulu.

This study is motivated by the growing public demand for reliable and high-quality public transportation services such as the Trans Solo Bus on corridor 4. The purpose of this research is to analyze the influence of Facilities, Innovation, and Service Quality on User Interest, both partially and simultaneously. This study employs a quantitative method with a sample of 100 respondents who are users of the Trans Solo Bus on corridor 4. Data were collected through questionnaires and analyzed using IBM SPSS Statistics through several tests, including validity, reliability, normality, multicollinearity, heteroscedasticity, multiple linear regression, t-test, F-test, and coefficient of determination (R²). The results revealed that Facilities, Innovation, and Service Quality significantly influence User Interest, either individually or simultaneously. These findings imply that improving facilities, implementing continuous innovation, and ensuring high service quality can increase public interest in using Trans Solo Bus services, thus supporting the development of sustainable urban transportation.

A faith-based marriage strengthening program is essential for building family resilience in urban congregations facing high divorce rates and declining marital quality. This community service activity aimed to revitalize the marital bonds of 22 couples in the Pria Sejati Bandung community and GPPS Agape Bandung congregation through the "Reborn Marriage" program. Using a participatory action research approach, a team of 12 facilitators implemented three main stages: initial coordination to identify needs and plan together with the community; an intensive one-day intervention consisting of teachings on grace, agape love, and divine purpose of marriage, along with testimony sharing, footwashing ritual, and gift giving; and a marriage commitment renewal ceremony. The results showed 100% attendance rate of all registered couples, active participation in every coaching session, and qualitative findings from focus group discussions including renewed spiritual intimacy, mutual forgiveness between spouses, and alignment of marital visions based on divine values. A total of 86% of couples expressed willingness to participate in regular follow-up mentoring, and local leaders emerged among participants who are ready to facilitate small groups after the program. Discussions confirmed that combining biblical teachings on agape love with experiential symbolic rituals can holistically transform marital relationships. This community-based intervention proves replicable in other local communities and churches in urban settings, especially those seeking to strengthen family resilience through integrated pastoral care and participatory action.

In the face of Indonesia’s escalating family crises amid rapid digital disruption and post-pandemic social recovery, this study proposes a novel “Dual-Ethos Synergy Model” that integrates the Fruits of the Spirit (Galatians 5:22–23) with the second principle of Pancasila, namely “Just and Civilized Humanity.” The study is grounded in qualitative fieldwork conducted at Gereja Bethel Indonesia Pemulihan Keluarga Allah (GBI PKA). The findings demonstrate that the integration of Christian spiritual values and civic ethics fosters restorative character formation within families and church communities. This synergy produces practical outcomes, including stronger empathy in community service, improved interpersonal relationships, and more constructive conflict resolution practices. Using data gathered through nine in-depth interviews, participant observations, and document analysis, the study addresses existing gaps in urban church discipleship by combining spiritual transformation with social responsibility and civic engagement. The proposed model also offers implications for scalable digital-hybrid ministry programs focused on family restoration and contributes to the development of contextual theological praxis within pluralistic and multicultural societies. Limitations of the study and recommendations for future research are also discussed.

The smart city concept has emerged as a primary solution to address various global urbanization challenges. However, its implementation in developing countries frequently encounters unique obstacles, such as limited infrastructure, constrained budgets, and varying levels of community readiness. This study aims to identify and analyze the critical success factors for smart city implementation in developing nations using a literature review approach. The research employs a Systematic Literature Review (SLR) method, adapting the PRISMA guidelines. Data collection was conducted by screening scientific articles from leading academic databases published over the last five years. The review results indicate that the success of a smart city in developing contexts does not rely solely on technological advancement. There are four primary dimensions acting as determinants: (1) the governance dimension, encompassing regulatory support and bureaucratic transparency; (2) the technological infrastructure dimension, involving equitable internet access and centralized data integration; (3) the human resources dimension, focusing on the digital literacy of citizens and government apparatus; and (4) the financial dimension, which includes innovative financing models and public-private partnerships. The conclusion of this review emphasizes that cross-sector collaboration and strong leadership commitment remain the most crucial foundations. These findings are expected to provide a strategic reference framework for local governments in designing more sustainable and targeted smart city roadmaps.

Hypertension is one of the most common chronic diseases among the elderly and is often accompanied by insomnia. This condition can increase anxiety and reduce quality of life. Progressive Muscle Relaxation (PMR) is an effective non-pharmacological therapy to lower blood pressure and improve sleep quality. This paper describes nursing care for elderly patients with hypertension and insomnia through PMR application at RSUD Embung Fatimah Batam City in 2025. A case study approach was used through the nursing process, including assessment, nursing diagnosis, intervention, implementation, and evaluation. The main nursing diagnosis was sleep pattern disturbance related to physical discomfort and anxiety. Interventions included education and PMR exercises for six consecutive days. Results showed blood pressure decreased from 180/100 mmHg to 130/80 mmHg, sleep quality improved from difficulty sleeping to 6–7 hours per night, and anxiety levels reduced. Progressive muscle relaxation therapy proved effective as an independent nursing intervention to reduce blood pressure and improve sleep quality in elderly patients with hypertension and insomnia. Nurses should use this therapy as a routine non-pharmacological intervention in gerontological nursing practice.

Background: Carpal Tunnel Syndrome (CTS) is a condition caused by compression of the median nerve at the wrist, resulting in pain, paresthesia, and decreased hand function. This condition is commonly experienced by individuals who perform repetitive wrist activities. Objective: To determine the effectiveness of a combination of neural mobilization exercises and electrotherapy modalities in improving hand function, increasing muscle strength, and reducing pain in a patient with Carpal Tunnel Syndrome. Methods: This study used a case report design involving a 57-year-old female patient (Mrs. Q) who presented with pain and sensory disturbances in the right hand. The intervention was administered for four weeks and consisted of ultrasound therapy, Transcutaneous Electrical Nerve Stimulation (TENS), grip strengthening exercises, and nerve gliding exercises. Outcome measures included pain intensity assessed using the Numeric Rating Scale (NRS), muscle strength evaluated using Manual Muscle Testing (MMT), and functional ability measured using the Wrist Hand Disability Index (WHDI). Results: The evaluation showed a reduction in pain intensity, with resting pain at 0/10, tenderness at 4/10, and movement pain at 4/10. Muscle strength improved from grade 3 to grade 4 based on MMT. Functional ability also improved, as indicated by a 20% reduction in the WHDI score. The combination of these interventions proved effective as a conservative management approach for Carpal Tunnel Syndrome. Conclusion: The administration of ultrasound, TENS, grip strengthening exercises, and nerve gliding exercises over four therapy sessions in Mrs. Q resulted in decreased pain, increased muscle strength, and improved hand functional ability.

Online games are one of the digital entertainment activities widely favored by adolescents; however, high-intensity use can lead to psychological impacts, one of which is anxiety. Anxiety in adolescents is characterized by feelings of restlessness, irritability, difficulty concentrating, and sleep disturbances, especially when they are unable to play online games or when they experience defeat in the game. This study aimed to determine the relationship between the intensity of online game use and the level of anxiety among adolescents. This study used a quantitative design with a cross-sectional approach, involving 113 respondents selected using a cluster sampling technique. The research instruments used were the DASS questionnaire and an online game usage intensity questionnaire, and the data were analyzed using univariate and bivariate analysis. The respondents in this study were adolescents from SMAN 1 Wanadadi, most of whom were 16 years old (49.6%) and predominantly female (61.9%). The intensity of online game use was mostly in the moderate category (55.8%), while the level of anxiety was mostly in the mild category (89.0%). The results showed that most respondents had a moderate level of online game usage intensity and a mild level of anxiety. Bivariate analysis indicated that there was no significant relationship between the intensity of online game use and the level of anxiety among adolescents, with a p-value of 0.425 and a contingency coefficient value of 0.076. Therefore, it can be concluded that there is no relationship between the intensity of online game use and the level of anxiety among adolescents.

Urban development has resulted in an increase in impermeable surfaces, increasing the risk of runoff inundating the road network. This situation occurs in the drainage system on Jl. Letjend S. Parman, Jl. Emo Kurniaatmaja, and Jl. Pulau Banda, Pasirkareumbi Village, Subang Regency. This study aims to evaluate the hydraulic performance of existing channels and develop redesign guidelines to reduce the risk of local flooding. The methods used include hydrological analysis of daily maximum rainfall data from the Subang rainfall station, rainfall frequency analysis using the Generalized Extreme Value (GEV) distribution, Intensity-Duration-Frequency (IDF) curves, and hydrological and hydraulic simulations using the Storm Water Management Model (SWMM). Model parameters include sub catchment area, rainfall intensity, time of concentration, infiltration using the Curve Number method, channel dimensions, cross-sectional shape, channel material, and the Manning coefficient. The results indicate that the GEV distribution provides a good fit for determining design rainfall. Based on the typology of a metropolitan city and a catchment area of ​​26.04 ha, the modeling period is 2 to 5 years. The SWMM simulation results indicate that some channel segments have very high flow velocities, potentially causing scour, while other segments have very low velocities, potentially causing sedimentation. This confirms the need for evaluation and restructuring of channel dimensions and slopes to improve the hydraulic performance of road drainage and reduce localized flooding.

Slum upgrading is a strategic step in improving the quality of life of urban communities, where its success is largely determined by the active involvement of local residents. This study aims to analyze the level of community involvement in the implementation of slum upgrading in Mantuil Village, South Banjarmasin District. Using a descriptive quantitative approach, data were collected through a structured questionnaire from 98 respondents selected using a purposive sampling technique. Data analysis was conducted descriptively to measure the level of participation in four stages of the activity. The results show that community involvement is in the good category, but has an uneven distribution. The highest average scores were found in the utilization stage (30.44) and maintenance stages (30.23), indicating that community participation is driven by the principle of direct benefit from the infrastructure being built. Conversely, participation in the planning and implementation stages tends to be lower due to structural barriers such as time constraints and respondents' economic burdens. These findings confirm that sustainable settlement upgrading requires synergy between community social capital and government policies that are adaptive to the geographic characteristics of the region, particularly related to tidal flooding vulnerability in riverbank areas.