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PENINGKATAN BUDAYA KESELAMATAN PASIEN DI RSUD AHMAD RIPIN KABUPATEN MUARO JAMBI Guspianto Guspianto; Ismi Nurwaqiah Ibnu; Rizalia Wardiah
Medical Dedication (medic) : Jurnal Pengabdian kepada Masyarakat FKIK UNJA Vol. 5 No. 1 (2022): MEDIC. Medical dedication
Publisher : Universitas Jambi

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ABSTRACT The implementation of hospital patient safety culture in Jambi province has not been running optimally as evidenced by poor and not up-to-date incident reporting so that the incident seems to be kept secret.This activity aims to disseminate information about the implementation of patient safety culture at the Ahmad Ripin Hospital, Muaro Jambi Regency, with the form of activities covering dissemination, providing education and discussion, as well as evaluation.The results of the evaluation showed an increase in the knowledge and attitudes of respondents towards the implementation of patient safety culture in hospital.It is suggested that the hospital can increase the capacity and capability of supervisors in implementing patient safety efforts at the unit and hospital level through education and training, motivate and encourage the willingness of all staff to reporting any incidents occur by creating an environment free from blame and punishment. Keywords: dissemination, patient safety culture, hospital ABSTRAK Implementasi budaya keselamatan pasien rumah sakit di provinsi Jambi belum berjalan optimal dibuktikan dari pelaporan insiden yang burukdan tidak up to date sehingga insiden terkesan dirahasiakan. Kegiatan ini bertujuan untuk melakukan diseminasi informasi tentang implementasi budaya keselamatan pasien yang dilakukan di RSUD Ahmad Ripin Kabupaten Muaro Jambi, dengan bentuk kegiatan meliputi diseminasi, pemberian edukasi dan diskusi, serta evaluasi. Hasil evaluasi menunjukkan adanya peningkatan pengetahuan dan sikap responden terhadap implementasi budaya keselamatan pasien di rumah sakit. Disarankan agar pihak rumah sakit dapat meningkatkan kapasitas dan kapabilitas supervisor dalam pelaksanaan upaya keselamatan pasien di tingkat unit dan rumah sakit melalui pendidikan dan pelatihan, memberi motivasi dan mendorong kemauan seluruh staf untuk melaporkan setiap insiden yang terjadi dengan menciptakan lingkungan yang bebas dari menyalahkan dan menghukum. Kata Kunci: diseminasi, budaya keselamatan pasien, rumah sakit
HUBUNGAN FOKUS PROSES DENGAN MUTU PELAYANAN DI PUSKESMAS X TAHUN 2020 Muhammad Iqbal Hasyimi; Renny Listiawaty; Guspianto
Jurnal Ilmiah Manusia Dan Kesehatan Vol 3 No 2 (2020): Jurnal Ilmiah Manusia Dan Kesehatan
Publisher : FAKULTAS ILMU KESEHATAN UNIVERSITAS MUHAMMADIYAH PAREPARE

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31850/makes.v3i2.522

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Fokus proses ini menekankan pada pencapaian efisiensi dan efektivitas dalam proses organisasi. Sistem kerja pada puskesmas merupakan satu kesatuan pelayanan dari berbagai kegiatan program pelayanan kesehatan dasar yang saling berinteraksi dan bekerja sama, saling tergantung, masing-masing mempunyai fungsi spesifik, mendukung fungsi lainya dan berbegerak mencapai tujuan Puskesmas. Penelitian ini bertujuan untuk mengetahui hubungan fokus proses dengan mutu pelayanan di Puskesmas Koni Kota Jambi Tahun 2020. Jenis penelitian yang digunakan adalah penelitian analitik kuantitatif dengan pendekatan cross sectional. Penelitian ini dilaksanakan pada tanggal 3 - 5 Februari 2020. Teknik pengambilan sampel yang digunakan adalah Total Sampling. Sampel yang diambil adalah sebanyak 39 orang. Teknik pengambilan data melalui wawancara menggunakan kuesioner. Teknik analisis menggunakan analisis univariat dan bivariat. Hasil dari penelitian ini dianalisa dengan uji chi-square diperoleh nilai p-value = 0,036 (p < 0,05). Uji ini menunjukkan bahwa ada hubungan yang bermakna antara fokus proses dengan mutu pelayanan. Hipotesis adanya hubungan yang berarti antara fokus proses dengan mutu pelayanan di Puskesmas Koni Kota Jambi Tahun 2020 dapat diterima. Untuk meningkatkan mutu pelayanan dan kinerja di Puskesmas Koni Kota Jambi, sebaiknya Puskesmas dapat mempertahankan penerapan fokus proses yang baik.
Environmental Health Risk Analysis of Dust Exposure on Employees in PT. Cassia Co-op Indonesia in Jambi Guspianto Guspianto; Intan Tri Thursina; Fitria Eka Putri
Media Kesehatan Masyarakat Indonesia Vol. 17 No. 4: DECEMBER 2021
Publisher : Faculty of Public Health, Hasanuddin University, Makassar

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (439.251 KB) | DOI: 10.30597/mkmi.v17i4.14858

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The dust has a negative impact that can affect workers’ health. This study aimed to analyze the environmental health risks of dust exposure on workers at PT. Cassia Co-op Indonesia in Jambi. Descriptive quantitative research was conducted using an Analisis Risiko Kesehatan Lingkungan (ARKL) approach, including analysis of hazard identification, dose-response, exposure assessment, and risk characteristics. 61 respondents from the production division were selected as samples with a disproportionate stratified random technique. Data was collected using a questionnaire and Total Suspended Particulate (TSP) concentration from company’s secondary data. The results of measuring dust levels at 2 (two) points obtained a concentration value that was still below the threshold, but 77% of respondents experienced health problems related to TSP dust. The real-time intake value of TSP exposure of workers was not at risk of health problems (RQ<1) at both measurement points, and the intake lifespan value of TSP exposure was at risk of health problems (RQ>1) for all workers in the 15th year at point 1. It is recommended for companies to conduct regular health checks on workers, provide PPE and apply the standard use of PPE, make rules that prohibit smoking while working, and increase the location and frequency of testing for TSP dust levels in the company.
Does It Still Show a Deficit? Arguing Post-COVID-19 Health Financing System in Bogor, Indonesia Meita Veruswati; Al Asyary; Rony Darmawansyah Alnur; La Ode Hasnuddin S Sagala; Guspianto Guspianto; Maria Holly Herawati
Jurnal Kesehatan Masyarakat Nasional Volume 17, Special Issue No 1, 2022
Publisher : Faculty of Public Health Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (266.24 KB) | DOI: 10.21109/kesmas.v17isp1.6056

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Before the COVID-19 pandemic, the Bogor City Government regulated to cover the health financing claim during the Indonesian National Health Insurance (NHI) integration period due to the lower amount of health care claim per episode in regional hospitals compared to ones that NHI paid. This study aimed to address post-COVID-19 health financing at two hospitals in Bogor City, West Java Province, Indonesia. Descriptive analysis using the aggregate statistical summaries was taken to explore the medical care episodes of the data series at two hospitals for the last two years. Of the 890 checked medical records data, the deficit occurred in 197 (22.1%) medical care episodes, while five (0.6%) exceeded the hospitals' tariffs. The remaining 688 (77.3%) medical care episodes had suits with the Indonesian Case Based Groups. Almost a quarter of medical care episodes in aggregate experienced a deficit in the two years before the pandemic. This study is the first to provide new insight into the discussion on medical care financing in a developing country's post-pandemic era in a newly-implemented NHI system.
Manajemen Perubahan dalam Penanganan Dbd pada Masa Pandemi Covid-19 di Kota Jambi Anisa Raudatul Ulfa; Rumita Ena Sari; Arnild Augina Mekarisce; guspianto guspianto; Budi Aswin
Malahayati Nursing Journal Vol 4, No 10 (2022): Volume 4 Nomor 10 2022
Publisher : Universitas Malahayati Lampung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/mnj.v4i10.6982

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ABSTRACT The current Covid-19 pandemic has caused public health centers (Puskesmas) to face fluctuating environmental changes, one of which is the handling Dengue Hemorrhagic Fever (DHF). To analyze the management of change in the handling of DHF during the Covid-19 pandemic in Jambi City. This research was qualitative study. The research sites were the Jambi City Health Office and the Kenali Besar Health Center. Research informants totaled 7 people were determined using the snowball sampling. Data was collected on March 14, 2022 – March 29, 2022. Data collected with in-depth interviews, document review, and observation. Data analyzed with thematic analysis dan triangulation. There was no change in the flow of implementation of the handling of DHF during the Covid-19 pandemic, but there was a change in the health protocol where officers were required to wear masks and keep their distance when they went down the field, there was a reduction in the budget for handling DHF which was shifted to handling Covid-19, there was no change in the flow the implementation of G1R1J as the main focus in handling DHF, and there was no change in the team regarding the handling of DHF during the Covid-19 pandemic in Jambi City. There was no change management in handling DHF during the Covid-19 pandemic in Jambi City Keywords: Organizational Agility, Change Management, DHF, Public Health Center ABSTRAK Pandemi Covid-19 yang terjadi saat ini menyebabkan pusat kesehatan masyarakat (Puskesmas) menghadapi perubahan lingkungan yang fluktuatif, salah satunya dalam penanganan Demam Berdarah Dengue (DBD). Untuk menganalisis manajemen perubahan dalam penanganan DBD pada masa pandemi Covid-19 di Kota Jambi. Jenis penelitian yang digunakan adalah penelitian kualitatif dengan pendekatan studi kasus (case study). Tempat penelitian di Dinas Kesehatan Kota Jambi dan Puskesmas Kenali Besar. Informan penelitian berjumlah 7 orang ditentukan dengan menggunakan teknik snowball. Pengumpulan data pada 14 Maret 2022 – 29 Maret 2022. Teknik pengumpulan data dengan wawancara mendalam, telaah dokumen, dan dokumentasi. Teknik analisis data yaitu thematic analysis dan triangulasi. Tidak terjadi perubahan alur pelaksanaan penanganan DBD pada masa pandemi Covid-19, tetapi terjadi perubahan pada protokol kesehatan dimana petugas diwajibkan menggunakan masker dan menjaga jarak pada saat turun lapangan, terjadi pengurangan anggaran penanganan DBD yang dialihkan ke penanganan Covid-19, tidak terjadi perubahan alur pelaksanaan G1R1J sebagai fokus utama dalam penanganan DBD, serta tidak terjadi perubahan tim terkait penanganan DBD pada masa pandmei Covid-19 di Kota Jambi. Tidak terlaksana manajemen perubahan dalam penanganan DBD pada masa pandmei Covid-19 di Kota Jambi Kata Kunci: Agilitas Organisasi, Manajemen Perubahan, DBD, Puskesmas
Determinants of Santri Behavior in the Formation of Healthy Santri in Islamic Boarding Schools in Batanghari Regency Puspita Sari; Guspianto .; La Ode Reskiaddin; Solihin Sayuti
JURNAL KEPERAWATAN DAN FISIOTERAPI (JKF) Vol. 5 No. 1 (2022): Jurnal Keperawatan dan Fisioterapi (JKF)
Publisher : Fakultas Keperawatan dan Fisioterapi Institut Kesehatan Medistra Lubuk Pakam

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35451/jkf.v5i1.1392

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Islamic boarding schools are known as the oldest Islamic educational institutions in Indonesia. The Iarge number of Islamic boarding schooIs in Batanghari Regency, as well as the large number of students in each pesantren make this institution a major contribution to deveIopment. The roIe of the poskestren is a form of community-based health efforts (UKBM) in the boarding schooI environment, with the principle of, by and for the boarding school residents. This study aims to determine the behavioral determinants of students in the formation of heaIthy students in Islamic boarding schooIs in Batanghari Regency. This study is a quantitative study with a cross-sectional design. This study invoIved 98 respondents who were seIected by the Proportional Random Sampling technique to be interviewed. Data anaIysis was univariate, bivariate with Chi square and muItivariate with logistic regression. The results showed that 46.9% of respondents had poor student behavior in impIementing poskestren. There is a reIationship between perceived barriers (p-vaue: 0.011) perceptions of self-efficacy (p-value: 0.047), the infIuence of teachers/ustadz (p-vaIue: 0.007), the infIuence of heaIth workers (p-vaIue: 0.020) and the behavior of students. Perceived benefits (p-vaIue: 0.210) did not have a significant reIationship with the behavior of students. The factor that had a strong infIuence on the behavior of students was the influence of teachers/ustadz with an Odds Ratio (OR= 0.323. 95% CI 0.143–0.822). There is a need fr management training and the formation of HeaIthy Santri.
Profile Analysis of COVID-19 Patients in Jambi Province Titin Agustin Nengsih; Hafifatul Auliya Rahmy; Guspianto Guspianto; Ummi Kalsum; Hendra Dhermawan Sitanggang; Amirah Saeed Alharthi
Disease Prevention and Public Health Journal Vol. 16 No. 2 (2022): Disease Prevention and Public Health Journal
Publisher : Universitas Ahmad Dahlan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.12928/dpphj.v16i2.5292

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Background: The potential for COVID-19 transmission has increased sharply, so the government must implement various strategies to control the spread, especially in Jambi Province. The number of positive confirmed cases of COVID-19 in Jambi Province until August 26, 2021, was 27,422 people, with a case fatality rate is 2.37%. This condition illustrates that the spread of COVID-19 is increasing every day, so the government has set a lockdown at Level 4. Method: This research aims to analyze the profile of COVID-19 patients in Jambi Province (secondary data analysis) with a cross-sectional study design. Data analysis includes univariate analysis with the mean difference test and Chi-Square test. Result: The results show that the age of COVID-19 patients is significantly different between men and women. Furthermore, based on the Chi-Square test, it shows a significant relationship between age and gender and between region and age with a p-value <0.05. Conclusion: Indeed, the risk of COVID-19 cases increases with age and differs for each gender with a high level of mobility.
Analisis Sistem Pengolahan Limbah Medis Padat Puskesmas Di Kecamatan Bayung Lencir, Musi Banyuasin Desi Andrayani; Hutwan Syarifuddin; Guspianto Guspianto
Jurnal Pembangunan Berkelanjutan Vol. 5 No. 2 (2022): Jurnal Pembangunan Berkelanjutan
Publisher : Universitas Jambi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22437/jpb.v5i1.21196

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Operasional Puskesmas akan menimbulkan limbah, yang berpotensi menimbulkan dampak terhadap masyarakat dan lingkungan hidup. Tujuan penelitian ini menganalisis sistem pengolahan limbah medis padat (pemilahan, pewadahan, pengangkutan, penyimpanan, dan pengolahan) sesuai dengan Permen LHK No. 56/Menlhk/2015 pada puskesmas yang ada di Kecamatan Bayung Lencir, Kabupaten Musi Banyuasin. Metode penelitian kualitatif dengan pendekatan deskriptif, pelaksanaan penelitian pada bulan desember 2021 sampai Mei 2022. Sumber informasi dalam penelitian ini yaitu Kepala puskesmas sebagai informasi kunci (key informan) dokter, perawat, bidan, apoteker, analis, sanitarian, dan Cleaning service. Kecamatan Bayung Lencir memiliki dua puskesmas yaitu puskesmas Bayung Lencir dan puskesmas Suka Jaya, puskesmas memiliki proses pengolahan limbah medis padat dengan tahap yang sama yaitu pemilahan, pewadahan, pengangkutan, penyimpanan dan pengolahan. Berdasarkan permen LHK Nomor P.56/menLHK-setjen/2015 dan Permen LHK no.P12 tahun 2020 belum terpenuhi dan belum dilaksanakan dengan baik. Pemilahan belum dilakukan secara optimal masih terjadinya pencampuran antara limbah medis padat dengan limbah non medis dan limbah benda tajam, sanitarian melakukan pemilahan kembali yang akan berisiko keselamatan dan kesehatan kerja. Telah tersedia tempat sampah medis dan non medis tetapi masih ditemukan sampah bercampur. Pengangkutan tidak memiliki jalur khusus dan pengangkutan masih manual langsung diambil dari tempat penampungan limbah medis padat sehingga berisiko menjadi penularan, kapasitas tempat penyimpanan sampah sementara (TPS) tidak mencukupi serta belum memiliki izin. Pengolahan limbah medis padat
PENGARUH KUALITAS LINGKUNGAN FISIK UDARA TERHADAP ANGKA KUMAN DI RUMAH SAKIT Susilawati, Susilawati; Ilham, Ilham; Guspianto, Guspianto
JAMBI MEDICAL JOURNAL "Jurnal Kedokteran dan Kesehatan" Vol. 9 No. 3 (2021): JAMBI MEDICAL JOURNAL Jurnal Kedokteran Dan Kesehatan
Publisher : FAKULTAS KEDOKTERAN DAN ILMU KESEHATAN UNIVERSITAS JAMBI

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (150.185 KB) | DOI: 10.22437/jmj.v9i3.13349

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ABSTRACT Around 9% or 1.4 million inpatients in hospitals in the world experience nosocomial infections due to germ exposure related with the hospital's physical environment condition. This study aims to analyze the effect of the air physical environment in the in-patient room at HAMBA Hospital, Muara Bulian, Jambi. A quantitative study has been conducted with a cross sectional design with 30 samples of in-patient rooms. Data collected by measuring directly includes microbial density rate, temperature, humidity, lighting and dust, and analyzed using the Kendall-Tau correlation test. The results showed that all the air physical environmental factors had effect on microba rate, including temperature (p = 0.020), humidity (p = 0.000), lighting (p = 0.004) and dust (p = 0.001). It is especially recommended for hospitals to pay attention to the condition of inpatient rooms in order to minimize the growth of micro-organisms that cause nosocomial infections by opening windows every morning, cleaning the air conditioner at least every 6 months, changing curtains with bright colors, cleaning the room regularly, and making standard operating procedure (SOP) for in-patient room maintenance. Keywords: Air physical environment, microba rate, hospital
FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN KEJADIAN LOW BACK PAIN PADA DOSEN SELAMA MASA PANDEMI COVID-19 DI LINGKUNGAN UNIVERSITAS JAMBI TAHUN 2021 Samuella P.B.S, Covamima; Guspianto, Guspianto; Kusmawan, David
JAMBI MEDICAL JOURNAL "Jurnal Kedokteran dan Kesehatan" Vol. 10 No. 2 (2022): Special Issues: Jambi Medical And Health Sciences International Conference (JA
Publisher : FAKULTAS KEDOKTERAN DAN ILMU KESEHATAN UNIVERSITAS JAMBI

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ABSTRACT Background: Low Back Pain (LBP) is a feeling of pain in the waist area that can spread to the limbs or feet. During the pandemic covid-19, students, teachers, and lecturers were required to sit in front of a laptop every day for hours on end with a position that is not comfortable for learning or working. This repetitive activities certainly trigger the occurrence of LBP. The purpose of this study was to determine the factors associated with the incidence of low back pain on the lecturer during the pandemic covid-19 in Universitas Jambi. Methods: This study used a cross sectional design with the number of respondents 60 lecturers. The sampling technique used multi stage random sampling. The instrument in this study used a questionnaire. Data analysis used univariate and bivariate analysis. Bivariate analysis using Chi-Square method in SPSS 16. Result: The results of this study indicate that there was a significant relationship between age (p-value=0.020 and PR=9.308), and length of working (p-value=0.000 and PR=20.741) with the incidence of low back pain and there was no significant relationship between work time (p-value=0.164 and PR = 2.461), body mass index (p-value=0,122 and OR=0.427) with the incidence of low back pain. Conclusion: There was a relationship between age and length of working with the incidence of low back pain. Therefore, it is hoped that the lecturers maintain a healthy lifestyle, if work require a long time to sit then make sure that the knees are parallel with the thigh. Stand up once in a while or do some stretching while work to change position periodically. Keywords : Age, BMI, LBP, Length of Working, Work Time ABSTRAK Pendahuluan: Low Back Pain merupakan rasa nyeri pada area pinggang bawah yang dapat menjalar sampai ke tungkai atau kaki. Selama masa pandemik covid-19 siswa, mahasiswa, guru, serta dosen diharuskan duduk di depan laptop setiap harinya selama berjam-jam dengan posisi yang tidak nyaman untuk melakukan pembelajaran atau pekerjaan. Kegiatan berulang-ulang seperti ini tentunya memicu terjadinya LBP. Tujuan penelitian ini adalah untuk mengetahui faktor-faktor yang berhubungan dengan kejadian low back pain pada dosen selama masa pandemik covid-19 di lingkungan Universitas .Jambi. Metode: Penelitian ini menggunakan desain Cross Sectional dengan jumlah sampel sebanyak 60 orang. Teknik pengambilan sampel menggunakan multistage random sampling. Instrumen pada penelitian ini menggunakan kuisioner Oswestry Disability Index. Analisis data menggunakan analisis univariat dan analisis bivariat. Analisis bivariate pada penelitian ini memakai uji Chi-Square menggunakan SPSS 16. Hasil: Hasil penelitian menunjukkan bahwa ada hubungan signifikan antara usia (p- value=0.020 dan PR=9.308), dan masa kerja (p-value=0.000 dan PR=20.741) dengan kejadian low back pain, serta tidak ada hubungan signifikan antara lama kerja (p-value=0.164 dan PR=2.461) dan status gizi/indeks masa tubuh (p-value=0,122 dan OR=0.427) dengan kejadian low back pain. Kesimpulan: Ada hubungan antara umur dan masa kerja dengan kejadian low back pain. Oleh karena itu, diharapkan kepada dosen menjaga pola hidup sehat, jika memerlukan waktu yang lama untuk duduk saat bekerja maka pastikan bahwa lutut sejajar dengan paha, dan jika memang harus berdiri terlalu lama, letakkanlah salah satu kaki pada bantalan kaki secara bergantian. Beranjaklah sejenak dan lakukan peregangan di sela waktu bekerja untuk mengubah posisi secara periodik. Kata Kunci: Umur, BMI, LBP, Masa Kerja, Lama Kerja
Co-Authors Adelina Fitri Adila Solida Al Asyary Amirah Saeed Alharthi Ana Sandra Pidah Andy Amir Anisa Raudatul Ulfa Armaidi Darmawan Arnild Augina Mekarisce Arvida Bar Asparian Atikah Rahmah Bayu Rosadi Budi Aswin David Kusmawan Desi Andrayani Dessy Pramudiani Diah Tri Utami Diyank Shabira Ekawati Yun Nina Erny Kusdiyah Esra Sianipar Evi Nurchafifah Evy Wisudariani Faisal Faisal Fajar Akbar Feby Irwanti Friska Indriani Hafifatul Auliya Rahmy Hendra Dhermawan Sitanggang Hubaybah, Hubaybah Humaryanto Hutwan Syarifuddin Ilham Ilham Ilhami Mohamad Ima Maria Intan Tri Thursina Ismi Nurwaqiah Ibnu Jodion Siburian Kaimuddin Kaimuddin La Ode Hasnuddin S. Sagala Listiawaty, Renny Livia Yunita M. Ridwan M. Ridwan Maria Holly Herawati Maya Erni Lobat Meita Veruswati Muhammad Iqbal Hasyimi Muhammad Syarifuddin Muhammad Syukri Mursalin Mursalin Mutmainnah, Muthia Nasution, Helmi Suryani Nazrina Safitri Nia Riski Putri Nurchafifah, Evi Nuriyah Nuriyah Nuriyah Nuriyah Nuriyah Nursafira Rianita Nutriani Rahma Baitilla Oka Lesmana Puspita Sari Puspita Sari Puspita Sari Puspita Sari Putri, Fitria Eka Raden Muhammad Ifwazan Darusman Rd. Halim Renny Listiawaty Reskiaddin, La Ode Rianita, Nursafira Ridwan M Riska Amalya Nasution Rizaliah Wardiah Rony Darmawansyah Alnur Rumita Ena Sari Samuella P.B.S, Covamima Solihin Sayuti Sri Astuti Siregar Susilawati, Susilawati Sutrisno Sutrisno Tia Wida Ekaputri Titin Agustin Nengsih Ummi Kalsum Usi Lanita Vinna Rahayu Ningsih Vinna Rahayu Ningsih Wahyu Indah Dewi Aurora Windi Septania Zafira Nadwa Zalra Muhammad Taqwin