bluuebunny/crossref_metadata_2025 huggingface dataset:
Kolon Kanserinde EGF Sitokininin İnsan Karbonik Anhidraz III (CAIII) Geninin mRNA Ekspresyon Seviyesine Etkisi
Authors: Okuyan Derya
Published: May 2023

Karbonik anhidraz enzim ailesinin üyeleri karbondioksitin bikarbonat iyonuna geri dönüşümlü hidratasyonunu katalizleyerek dokulardaki CO2 taşınımını, pH dengesini, solunum reaksiyonlarını, iyon dengesini, biyolojik reaksiyonları ve kemik oluşumu gibi birçok önemli süreci katalizleyen ailenin kasa spesifik üyesi olan Karbonik Anhidraz III (CAIII)’ün kolon kanser modeli HT-29 hücre hattında EGF etkili mRNA düzeyindeki ekspresyon seviyesi analiz edilmiştir. Özellikle hücrenin hayatta kalması, büyümesi, invazyonu ve proliferasyonu gibi önemli mekanizmaları regüle eden EGF sitokininin CAIII mRNA seviyesini düşürdüğü bu çalışma ile belirlenmiştir.
İklim Değişikliği ve Hymenoptera (Insecta) Taksonlarına Etkileri Üzerine İnceleme
Authors: Kekillioğlu Aysel , Bostan Ömer Eren
Published: May 2023

İklim değişikliği tüm dünyanın en önemli ekolojik sorunlarının başında gelmektedir. Küreselısınmanın başta etken olduğu iklim değişimine bağlı olarak ekosistemlerin büyük bölümünde bozulmalarve biyolojik türlerde değişmeler gözlenmektedir. Böcekler yeryüzünde bulunan canlı türlerinin büyük birçoğunluğunu oluşturması nedeniyle küresel iklim değişikliklerinden en fazla etkilenmesi beklenen canlıgruplarının başında gelmektedir. İklim değişimlerinden dolayı Atmosferden yeryüzüne yansıyan veBiyosferin genelini etkilemesi öngörülen, sıcaklık artışının hayvan ve bitkilerin yaşam ortamlarındadoğrudan ve dolaylı biçimde ve ağırlıklı olarak olumsuz değişiklikler yaratacağı varsayılmaktadır. Doğalolarak bu durumdan en fazla etkilenecek organizmalar; gerek ekolojik yaşam ortamları gerekse biyolojikaktivite ve davranışları tehdit altında olan canlılar olarak hassas böcekler arasında yer alan Hymenopterataksonu olacaktır. Bu nedenle, çalışmamız kapsamında; Hymenoptera takımı içerisinde yer alan taksonlarıniklim değişiminden etkilenme süreçleri mevcut durum ve gelecekteki riskler ve öngörüler bağlamındaanaliz edilmesi amaçlanmaktadır.
CONDITION ASSESSMENT OF BUILDING CONCRETE STRUCTURES USING NDTs – CASE STUDY
Authors: Herki Bengin A , Khatib Jamal , Ramadhan Zina , Hamadameen Banaz
Published: May 2023

The quality of concrete and serviceability for three old buildings utilizing non-destructive testing(NDT) method of rebound hammer (RH) and ultrasonic pulse velocity (UPV) was assessed in the presentstudy. Identification, classification and evaluation of in-situ concrete have helped us to decide whether thesethree buildings need to be repaired and in result extent their service life or it is not acceptable for its intendedusage and they need to be demolished. To evaluate the level of deterioration in historical and fire-damagedbuildings or infrastructures, non-destructive testing (NDT) methods can be used. In fact, NDT methodemploys inspection techniques to evaluate engineering properties to see if it is acceptable for its intendedusage that does not need specimens to be crushed like the destructive testing method. The NDT method ofrebound hammer (RH) and ultrasonic pulse velocity (UPV) in combination with conventional methods suchas internal and external visual inspection and concrete color change to locate deterioration was used toevaluate the quality of concrete structures for three old buildings. According to the results obtained the RHand UPV can be used as reliable tools to predict the mechanical properties of concrete structures subjectedto fire and/or weathering deterioration. In addition, combining the two NDTs decreased inaccuracies causedby utilizing one method alone to evaluate concrete quality.
A Review on the Ignition Characteristics of Dimethyl Ether in Diesel Engines
Authors: Şahin Yiğit Serkan
Published: May 2023

This review study was gathered from the results of various papers performed on the use ofdimethyl ether as a fuel or fuel additive in diesel engines. Several methods are applied for the reduction ofthe polluting emissions emitted from diesel engines. The first method for the reducing of hazardousemissions is improved the combustion by the modification of engine design and fuel injection system, butthis is expensive and time consuming process. The second method is the using of various exhaust gasdevices i.e. catalytic converters and diesel particulate filters. However, it is determined that the use of thesedevices affects diesel engine performance conversely. The last method to reduce the polluting emissionsand also improve the diesel engine performance is the using of renewable alternative fuels or various fueladditives. Among the various alternative fuels, dimethyl ether (DME) is the pioneer by reason of itsattractive fuel properties such as high cetane number and oxygen content. On the other hand, the physicaland chemical properties of the used fuel play the important role on the injection, ignition and combustioncharacteristics of internal combustion engines (ICEs). Moreover, outputs of ICEs i.e. performance, fuelconsumption and emissions are affected extensively from the ignition, injection and combustioncharacteristics. Therefore, it is essential that the results of studies performed on dimethyl ether are evaluatedtogether to support future researches and practice applications. Especially, this review study investigatesthe effects of using DME on the ignition characteristics.
Characteristics of the spatial distribution of pollutants in the Shkumbin River, using the Inverse Distance Weighting Method
Authors: Çomo Elvin , Hasimi Albana , Tako Edlira , Murtaj Bledar , Nuro Aurel
Published: May 2023

The Shkumbin River is one of the largest in the country, with a length of 181 km, a catchmentarea of 2444 km2, and an average height of its sources of 753 m. For the specificity of the ShkumbinRiver and the importance of the use of its waters, it is necessary to continuously study the level of waterquality and the level of pollution, especially in its lower reaches, where agricultural and urban activitiesare concentrated and industrial.The study was carried out in the period 2021–2022, in the Shkumbin River watershed, and eight stationswere selected as representative points of the main stream of the Shkumbin River. In the context ofindustrial and urban development, the preservation of the natural environment takes on specialimportance. The solution to this problem requires the hydrochemical study of water sources, which isnecessary for the control of their condition, and the study of compounds and polluting phenomena. Inorder to study the distribution of organic pollutants and heavy metals and obtain pollutant distributionpictures using the ArcGIS system, the Inverse Distance Weighting Method was used.
Propolis and its therapeutic potential on wound healing
Authors: Yeşilkent Esra Nur , Ceylan Hamid
Published: May 2023

Propolis is a resinous mixture collected by honey bees from tree buds or other plant sources.Propolis compounds have been the focus of many studies due to their anti-microbial, anti-cancer, and antiinflammatory effects. In addition, propolis is also recognized to have regenerative properties. It has beenfound to regulate a number of cellular and molecular processes such as wound repair and regeneration,hemostasis, inflammation, cell proliferation, and tissue remodeling. Many in vivo studies on wound modelsshow that propolis has beneficial roles in wound healing. These beneficial roles have also been confirmedby clinical research studies. However, more research is needed on the dose, side effects, and clinicalefficacy of propolis on wounds. In conclusion, research with different experimental models is promising asa potential therapeutic strategy in wound healing.
Smart Interior Designing Application Using VR
Authors: Siddiqui Aneeta , Siddiqui Rizwan Alam , Noor Shaheena , Saleem Muhammad Imran
Published: May 2023

This research project aims to design and develop a 3D interior designing application to provide a virtual experience to users in which they can visualize a standard home (sample space) and do interior designing. Users can interact with four main interior design modules i.e., Furniture, Tiles, Paints and Customization (Mix and Match). Users will be able to experience it on two different platforms, which are the desktop and the VR version. Its primary purpose is to display interior design products with complete context, unlike stores where small samples are displayed. This will help customers to make a better buying decision when it comes to design and decorate their homes.
Panel: Actualizaciones del trastorno de ansiedad generalizada
Authors: Ávila-Gámez Luis Daniel , Fierros-Greenhouse Enrique , Peterson-Beltrán Luis David , Acuña-Montaño Carmen Daniela
Published: May 2023

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Trastorno por estrés postraumático
Authors: Orozco-Ibarra Jaime , León-Duarte Alesandra
Published: May 2023

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Trastornos del neurodesarrollo en niños y adolescentes con énfasis en el síndrome autista
Authors: López-Gómez Marcos , Leverda-González Diana Judith
Published: May 2023

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Diagnóstico por imagen y tratamiento endovascular del ictus cerebral agudo
Authors: Antillón-Valenzuela Joaquín Enrique , Campa-Navarro Ana Bolena
Published: May 2023

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Intervención neuropsicológica y terapia cognitivo-conductual de tercera generación en salud mental
Authors: Rodríguez-Maldonado Denisse , Vazquez-Medina Oswaldo Humberto
Published: May 2023

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Clasificación y diagnóstico de epilepsia
Authors: Martínez-Leyva Octavio , Huaranga-Castro Frida María
Published: May 2023

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Meningitis: de lo global a lo local
Authors: Boroel Cervantes Carlos , Rivera-Rosas Cristian Noé
Published: May 2023

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Strategi UMKM Desa Sungai Luar untuk Meningkatkan Perekonomian Pasca Pandemi Covid 19
Authors: Wardah Siti , Julianti Rini , Febrianto Rio , Ibrahim Izhar Alan , Wiranda Wahyu
Published: May 2023

The Covid-19 pandemic has had a profound impact on all people on Earth. The development of Covid-19 has not shown a significant decrease, and the public is urged to always be cautious in their activities, both at home and outside. The purpose of this community service is to provide efforts to develop UMKM strategies through sports and policies. The method used is through interviews and direct discussions with UMKM communities. The result of this community service is that almost all of the people in the Sungai Luar village, especially UMKM players, maintain good habits by living clean and healthy lives to optimize their health. In the UMKM group of Sungai Luar village, Batang Tuaka district, this community service activity is carried out as an effort of attention, concern, and health support to contribute to the community's economic growth. The activities carried out are to popularize sports and government policies as a support system for the community, especially UMKM players. The essence of the effort to popularize sports during the pandemic is to create social change for physical activity in the community during the recovery from Covid-19. Through socialization and education to popularize, and providing support for facility improvements, residents can better understand the concept of popularizing sports and government policies as a supporting system for the health of UMKM players in the Sungai Luar village in entrepreneurship, with the hope of helping to restore the economic cycle in the village.
Pemberdayaan Industri Pengerajin Bambu di Dusun Gunung Mijil untuk Meningkatkan Penjualan melalui Pemasaran Digital
Authors: Nugroho Wawan Sadtyo , Wicaksonando Abizart , Hanan Vikri Putra Nur , Kurniawan Naufal Rizky , Kurniawan Agil Zamzam
Published: May 2023

The purpose of this service is to provide new understanding and insight to Bamboo Craftsmen that digitalized marketing and good branding will be able to expand consumers of handicraft products being sold and also retain existing consumers. The method used to achieve this goal is to carry out five stages of service activities, namely socialization, training, practice, mentoring and evaluation. The results achieved are additional insight, understanding and knowledge of bamboo craftsmen in operating social media as a means of digital marketing to sell their products. In addition, this digitalized marketing is expected to have an economic impact on bamboo craftsmen in Gunung Mijil Hamlet, Kebonsari Village.
High consistency between recommendations by a pulmonary specialist and ChatGPT for the management of a patient with non-resolving pneumonia
Authors: Chirino Alejandro , Wiemken Timothy , Furmanek Stephen , Mattingly William , Chandler Thomas , Cabral Guillermo , Cavallazzi Rodrigo , Carrico Ruth , Ramirez Julio
Published: May 2023

The use of artificial intelligence in healthcare is rapidly growing, with great potential to assist medical professionals in diagnosis and treatment of complex medical conditions. In this case report, the recommendations of a pulmonary consultation are compared to the recommendations from a large language model (LLM), ChatGPT, in regards to a case of non-resolving pneumonia. The recommendations by ChatGPT were found to be consistent with the pulmonary consultation, and no recommendations given were inappropriate. As shown in this case report, early generations of LLM such as ChatGPT were able to provide appropriate recommendations for the management of a patient with a complex medical condition.
ПРОБЛЕМЫ ОБРАЩЕНИЯ ВЗЫСКАНИЯ НА ЗАЛОЖЕННЫЕ ИСКЛЮЧИТЕЛЬНЫЕ ПРАВА ДОЛЖНИКА ПРИ ПРОЦЕДУРЕ БАНКРОТСТВА В РА И РФ
Authors: TADEVOSYAN LUSINE
Published: May 2023

The article studies the mechanism of foreclosure on such an intangible asset of the debtor as objects of exclusive rights. The features of the realization of the rights to exclusive rights in the bankruptcy of the debtor, the procedure for foreclosure, ways to include such a right in the bankruptcy estate are considered. The article also discusses the problems of valuation of such property
ԴԱՏԱԿԱՆ ՔՆՆՈՒԹՅԱՆ ԺԱՄԿԵՏՆԵՐԸ ՊԱՏՎԻ, ԱՐԺԱՆԱՊԱՏՎՈՒԹՅԱՆ ԵՎ ԳՈՐԾԱՐԱՐ ՀԱՄԲԱՎԻ ՊԱՇՏՊԱՆՈՒԹՅԱՆ ԳՈՐԾԵՐՈՎ
Authors: ZOHRABYAN ARA
Published: May 2023

The present article is dedicated to the peculiarities of the examination of cases on the protection of honor, dignity and business reputation and, in particular, the necessity to set short deadlines for dispute resolution. Within the scope of the article the law formed by the ECHR decisions, doctrinal approaches, and the experience of foreign countries are presented. Within the scope of the article, it is proposed to establish a three-month period for the examination cases of protection of honor, dignity and business reputation in the first instance court, allowing the court in extremely exceptional cases to extend that period for another three months. Time limit, procedural time limit, time limit for cases regarding the honor and dignity, time limit for examination of cases, the business reputation honor, and dignity.
ՄԻ ՔԱՆԻ ՆԿԱՏԱՌՈՒՄՆԵՐ՝ ՀՀ ԻՐԱՎԱԿԱՆ ՀԱՄԱԿԱՐԳ ՆԵՐԴՐՎԱԾ ԻՐԱՎԱԲԱՆԱԿԱՆ ԱՆՁԱՆՑ ՔՐԵԱԿԱՆ ՊԱՏԱՍԽԱՆԱՏՎՈՒԹՅԱՆ ԻՆՍՏԻՏՈՒՏԻ ՎԵՐԱԲԵՐՅԱԼ
Authors: SMBATYAN KARAPET
Published: May 2023

Taking into account the fact that new clauses of Criminal Code of the Republic of Armenia on criminal liability of legal bodies have been entered into force, we consider it contemporary to refer to this institution, to some of it’s upcoming usage problems, to show some ways of overcoming that problems and prevent possible defects.
An object of the work is to demonstrate in detail the essence of the legal bodies liability institution, reasons of its investing, some opinions of prominent people on it, international experience and some defects of the Armenian version.
The work is introduced in principles of comparative analyses as well as showing contemporary problems and international experience.
Longevity of E-learning Towards Quality and Effective Delivery in Educational Institutions
Authors:   College of Education, Open, Distance and E-learning Kampala International University, UZORKA Afam , OLANIYAN Ademola Olatide ,   School of Natural and Applied Sciences Kampala International University
Published: May 2023

There is an urgent need for stakeholders to find ways to improve the modes of education delivery, especially based on the experiences and innovations that emerged as positives from the pandemic era. Looking beyond the present situations and challenges that came with the pandemic as it relates to the delivery of quality e-learning, to the post-pandemic and the emergence of the new normal in teaching, learning and research. There is, therefore, a need to carry out this study to enhance a better understanding of e-learning for quality and effective use and delivery of knowledge in our educational system. This study addresses four issues of e-learning: development, accessibility, emerging technologies that bring a new dimension, and cost-effectiveness. The study concludes with the need for Administrators and stakeholders to review institution mandates if accessibility to quality education for sustainable development is to be an achievable goal through e-learning in our institutions.
Nigeria 2015 Presidential Election: A Multimodal Discourse Interpretations of Selected Cartoons of TELL’s News-Magazine
Authors:   Department of Languages, Rufus Giwa Polytechnic, Owo, Nigeria, Olowu Ayodeji
Published: May 2023

This paper analysed some selected cartoons from TELL news-magazines. The purpose was to describe the visual components and communicative devices employed by the cartoonist to send his message to the viewer/readers. The cartoons essentially were used to satirise represented phenomenon that arose through intrigues that characterised Nigeria 2015 Presidential elections. Data for the study were drawn from both primary and secondary sources. The main data for the study comprised 3 colour cartoons purposively selected from different editions of TELL news-magazines published in 2015. The selection of the cartoons was predicated upon the subject under consideration. Analysis of the data is based on multimodal discourse analysis as explicated by Gunter Kress and Theo Van Leeuwen (2001). The result showed that semiotic resources such as colour, image, symbols and icons, gaze and posture enhance the semantic quality of the cartoons. This study revealed very strongly and established the potentials of visual images to convey meaning beyond the verbal language in any human society
Experiences, Challenges and Prospect of e-Learning in Higher Education in Uganda
Authors:   College of Education, Open & Distance learning, Kampala International University, Uganda, ANUMAKA Ijeoma B
Published: May 2023

E-¬Learning has helped higher education scale through the huddles that interrupted process had posed during the COVID-19 total lockdown period in 2020. Due to the challenges of online instruction using available e-learning models, many higher educational institutions fail to handle the continuation of the educational process during the lockdown. This paper, using a document review of already done research, moved beyond diagnosis to describe students and institutional experiences, challenges and the prospects of e-learning for higher institutions in Uganda. In developing essence, the study found that higher education in Uganda has forged ahead with its role of teaching, research, community development and storage of knowledge, despite all the challenges. In contribution to the ongoing conversation, these findings x-ray the need for higher institutions to embrace the new normal, to increase access to higher education in Uganda. This paradigm shift has not, in any way, changed the role of higher education in Sub-Saharan Africa, and in Uganda in particular.
Hypertension Outcomes at a Student-Run Clinic for the Uninsured
Authors: Taylor Jessica , Thomas David , Tornheim Jeffrey , Meah Yasmin
Published: May 2023

Background: Hypertension is a potent risk factor for cardiovascular disease in the uninsured. Medical student-run free clinics are increasingly managing chronic conditions like hypertension, but there are limited data addressing the quality of care such clinics provide. This study evaluates hypertension outcomes at the East Harlem Health Outreach Partnership (EHHOP), a student-run clinic affiliated with Mount Sinai School of Medicine, in comparison to publicly and privately insured populations.Methods: A retrospective cohort analysis of EHHOP patients with hypertension (N=65) was performed. Results were compared to New York State Medicaid (N=10,117) and commercial insurance patients (N=7,669) with hypertension. The primary outcome measure was percent of patients controlled <140/90 mmHg. Secondary analyses in the EHHOP sample evaluated control below individual JNC 7 (Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) goal, blood pressure trends, and factors associated with control.Results: At their most recent visits, 57% of EHHOP, 58% of Medicaid, and 59% of commercial insurance patients were controlled <140/90 mmHg. In the EHHOP sample, 47.7% (31/65) of patients met their individual goal, including 35.7% (10/28) of diabetics. The mean change in blood pressure at EHHOP was -12.3 mmHg systolic (95% CI 5.7-18.9; p<0.01) and -6.8 mmHg diastolic (95% CI 2.9-10.5; p<0.01) over a mean follow-up of 16.2 months.Conclusions: Though limited by small sample size, results suggest that hypertension control at EHHOP is equivalent to other care settings. Results also demonstrate that EHHOP patients with hypertension experience clinically meaningful reductions in blood pressure. The study supports student-run free clinics as a model for delivering quality healthcare to vulnerable populations.
Accelerating Progress: The Journal of Student-Run Clinics
Authors: Kruger Jessica , Chen Kevin
Published: May 2023

The second issue of the Journal of Student-Run Clinics features a perspective article, an original research article, and two descriptive reports. The perspective article explores the contemporary progress of student-run clinics as narrated by current and past leaders of the Society of Student-Run Free Clinics (SSRFC) in context of the upcoming SSRFC Annual Conference. The original study investigates why faculty members volunteer at student-run clinics and gives insights as to how to improve faculty involvement. The descriptive reports outline an urban eye health initiative and how one osteopathic clinic cares for the rural underserved. Members of twenty-six institutions and five health disciplines have participated in the journal as of the second issue. Nine articles were reviewed for this issue, and four were published.
Measuring Clinical Reasoning and Interprofessional Attitudes
Authors: Johnson Emily , Seif Gretchen , Coker-Bolt Patty , Kraft Sara
Published: May 2023

Background: Interprofessional learning, collaboration and clinical reasoning are vital in medical education and medical care in order to best meet the needs of todayâ€™s patients.  Student-run free clinics are a type of learning experience that can foster interprofessionalism and develop clinical reasoning skills.  Ongoing evaluation of student attitudes, behaviors, and knowledge related to interprofessionalism and clinical reasoning are beneficial in order to continually improve education and curricula and maximize student learning outcomes. While numerous tools exist to measure student attitudes toward interprofessionalism and clinical reasoning skills, there is a lack of high quality measurement tools in this field. Methods: This study completed an exploratory factor analysis of the Self-Assessment of Clinical Reflection and Reasoning (SACRR) and the Interprofessional Education Scale (IEPS) to develop a new shortened interprofessional and clinical reasoning evaluation tool to measure student perceptions of interprofessionalism and clinical reasoning skills. Results: Factor analysis of SACRR yielded 4 factors, and RIPLS yielded 3 factors. In an overall exploratory factor analysis of SACRR and IEPS together, 11 significant factors emerged, with 5 of the factors having questions that loaded to them. Thirteen total questions loaded to each of the factors, forming the basis for a new survey tool.Conclusions: This new shortened survey tool can be beneficial to measuring interprofessional student learning outcomes and enhancing medical education, thereby improving the overall quality of health care delivery.
iRefer: A Novel Application for Making Referrals at a Student-Run Free Clinic
Authors: Goel Alexander N , Michel Joaquin , Sathianathan Shyama , Youssef Neveen
Published: May 2023

Background: Referring patients to specialty care providers is an important function of a student-run free clinic. Selecting the appropriate referral site is a complex problem, as the criteria for eligibility are often very specific and frequently change. Mobile Clinic Project, a free clinic at University of California, Los Angeles, previously managed referral decisions by training a â€œreferrals committee.â€ This committee maintained paper documentation on 140+ referral sites that was used to make on-site referral decisions. This approach was time consuming and subject to error. Our team aimed to build a web app to streamline the process of searching for the optimal referral site. Methods: A web app was created, and pilot testing was conducted to determine its efficacy in the hands of referrals committee members versus untrained clinic volunteers. After pilot testing, the app was released for use in the clinic, and a Likert survey was done at three months to assess its utility and usability. Results: The app, iRefer, allows users to electronically search information about referral sites and provides recommendations for the most appropriate sites based on patient information. Patient feedback about their visits to off-site providers can be incorporated into iRefer so that well-reviewed sites will be more highly recommended in future patient encounters. Additional features include the ability to print directions to the site directly from a volunteerâ€™s phone and to track the number of times a particular referral site is recommended. Pilot testing of the app demonstrated that it allows users to make appropriate referral decisions with little training time required. Users viewed iRefer as an effective tool to improve the quality and efficiency of referrals at Mobile Clinic. Conclusions: A web app may be a technology-enabled tool for facilitating referrals at a student-run free clinic.
The Impact of the Case Management Model at MedZou Community Health Clinic
Authors: Lesko David , Day Jesse , Honig Rachel , Howenstine Debra , Lindbloom Erik
Published: May 2023

MedZou Community Health Clinic is the University of Missouriâ€™s student-run clinic (SRC) that serves the uninsured of central Missouri. While successful, MedZou has faced barriers to delivering continuity and coordination of care, spurring the creation of the Case Management Model (CMM) in 2013. This innovative model consists of medical students serving as case managers, case management directors, and MedZou clinic directors, supported by physician advisors. At its foundation, a case manager is paired with a patient who has a chronic, complex medical history along with multifactorial psychosocial issues. The case manager assesses each patientâ€™s health needs, helps them navigate medical resources, and coordinates their medical care with the help of a physician advisor. This report describes two cases that demonstrate how the CMM has led to improvements in coordination and continuity of health care. Case 1 involves a patient with severe psoriasis who obtained mandatory lab testing before starting HumiraÂ® (adalimumab) and received Humira free of charge. Case 2 involves a patient who received timely treatment for a myocardial infarction, as well as help with Family and Medical Leave Act paperwork, medication coverage, and accessing social services post-hospitalization. In each case, the CMM led to greatly improved health outcomes and quality of life for patients and provided case managers with valuable educational experiences. We believe that this simple model can be easily implemented at other SRCs and we urge its adoption to better serve communities abroad.
Increasing HPV Education and Vaccination of Preteens in a Medically Underserved Neighborhood
Authors: Pyland Derek , Martin Elissabeth , Neill Kathryn , White Lanita
Published: May 2023

The United States of America is failing to achieve widespread human papillomavirus (HPV) vaccination coverage despite evidence that shows the vaccine can prevent HPV related disease, including greater than 80 percent of cervical cancers. Internationally, school based vaccination programs have proven to lead to the highest vaccination rates. In an effort to increase rates in one of Arkansasâ€™s most underserved communities, the University of Arkansas for Medical Sciences 12th Street Health and Wellness Center formed a partnership with the Little Rock School District to provide the Gardasil 9 vaccination series to 11-12-year-old students free of charge in their middle school. Student-run free health clinics can help increase local HPV vaccination rates by utilizing existing government resources to provide free vaccines to medically underserved children. Our goal in publishing this report is to provide the steps necessary to design and implement similar school-based vaccination programs to replicate this partnership across the nation.
Prevalence of Diabetes Mellitus, Hypertension, and Dyslipidemia in Student-Run Screening Clinics for Rural Communities in the Sierra Norte of Puebla, Mexico
Authors: Navin Sean , Tomaszewski Daniel
Published: May 2023

Background: The growing prevalence of hypertension (HTN), diabetes mellitus (DM), and dyslipidemia in Mexico highlights the need for preventative health care services. Rural communities worldwide lack access to such services. The purpose of this study was to describe the prevalence of HTN, DM, and dyslipidemia in student-run screening clinics in rural communities of the Sierra Norte of Puebla, Mexico to better understand the role the clinics play for the patients served.Methods: Data were collected from patients from rural, Mexican towns participating in free pharmacy student-run screening clinics. Patients consented to have their de-identified information pooled for research. Screenings included blood pressure readings, blood glucose levels, hemoglobin A1C values, and cholesterol levels.Results: Records from 483 patients were used from a total of 12 clinics. The prevalence of HTN was 38.3%, DM was 20.3%, and dyslipidemia was 45%. The median total cholesterol was 169 mg/dL, triglycerides were 180.5 mg/dL, HDL was 38 mg/dL, and LDL was 88 mg/dL. The most frequent lipid panel abnormality was hypertriglyceridemia with a prevalence of 66.3% followed by low HDL with a prevalence of 55.8%, and hypercholesterolemia was 24.4%.Conclusions: There was a high prevalence of DM, HTN, and dyslipidemia in pharmacy student-run screening clinics in rural communities of the Sierra Norte of Puebla, Mexico. Future studies should evaluate patient access to primary care and health insurance coverage in order to better understand the value of these student-run clinics in the context of local resources.
Identifying the Underserved: An Analysis of a Free Eye Clinicâ€™s Demographics
Authors: Nizamuddin Imran , Hussain Ahsan , Gummi Ravali , Solanki Birju
Published: May 2023

Background: The Kansas City Free Eye Clinic (KCFEC) is a student-run free clinic dedicated to providing comprehensive eye exams and treatment to the underserved populations of the Kansas City metropolitan area. Since the clinicâ€™s inception, volunteers have observed firsthand the great need for eye care and the impact of poor vision on health, employment, and education. As a result, services provided continue to expand, with the goal of incorporating novel communities into the treatment network. The purpose of this study was to review patient demographics in order to identify possible barriers to care and shortcomings in outreach efforts. Methods: Medical records for patients seen at the KCFEC between December 2014 and July 2016 were reviewed for demographics including age, gender, ethnicity, housing status, and insurance status. Results: Analysis of 334 patient records indicated that the average patient at KCFEC was a 45-year-old African American male who is uninsured and homeless. Certain groups, including females, individuals below 40 years of age, individuals above 65 years of age, and patients belonging to other minority groups, were not as prevalent at KCFEC. Conclusions: Further investigation of potential barriers to care disproportionately experienced by these groups will be the next step in efforts to increase the clinicâ€™s impact. With the aid of periodic retrospective review of patient demographics, KCFEC aims to be a source of accessible and quality healthcare to a diverse group of patients in Kansas City.
Training Health Professional Students as Lay Counselors to Treat Depression in a Student-Run Free Clinic
Authors: Rodriguez Guzman Juan , Ramos Marco A , Silva Michelle , Mata Douglas A , Raila Hanna , Rohrbaugh Robert , Barkil-Oteo Andres
Published: May 2023

Background: Global initiatives to train lay counselors in mental health care delivery have been effective with depressed patients in low-income countries. However, lay-counselor models have not been employed to address mental health disparities in high-income countries (HICs). This article presents a lay-counselor program for providing mental health interventions to uninsured, undocumented immigrants in a low-resource setting in the United States.Methods: Mental health professionals trained students as lay counselors to deliver psychoeducation, reduction of psychosocial stressors, and behavioral activation interventions to Spanish-speaking, undocumented immigrants with symptomatic depression. Changes in depressive symptoms prior to and after participation in the program were assessed with the Patient Health Questionnaire-9 (PHQ-9). The educational component of the program was examined administering a survey to the lay counselors.Results: Twenty-five patients enrolled in the program, 68% female, mean age 39 years (standard deviation [SD] = 12). Eighteen patients completed the program. PHQ-9 data were available from 15 individuals, among whom the mean baseline score was 11.7 (SD = 6.2) and mean final score was 4.6 (SD = 4.2; p < 0.001). The survey showed that students had increased interest in both underserved populations and mental health after participation in the program.Conclusions: Lack of access to psychiatrists and psychologists is a growing problem for uninsured people suffering from depression in the United States. Lay counselor approaches may help to address mental health disparities in low-resource settings in HICs and may also be used to help recruit health professional students into the psychiatric profession.
A Student-Run Free Mobile Veterinary Clinic in the Phoenix Metropolitan Area
Authors: Wozniak Molly , Stablein Cortney , Zuk Nikalette , Kreisler Rachael
Published: May 2023

For many individuals who are housing insecure or homeless, dealing with the emotional toll of these stressors is made more bearable by the companionship of a pet. However, access to veterinary care is limited for these and other underserved populations. To ensure veterinary care is made available for all pets, the Midwestern University College of Veterinary Medicineâ€™s mobile veterinary clinic provides free veterinary services. Additional goals of our student-run free mobile veterinary clinic are to provide clinical and interprofessional opportunities for students, including education in the One Health initiative, and to expose students to the challenges associated with providing veterinary care to underserved populations. This article describes the clinic operations, impact, and future directions of the Midwestern University College of Veterinary Medicineâ€™s mobile veterinary clinic.
Establishment of an Interprofessional, Student-Led, Community-Based, Free Clinic
Authors: White Lanita , Franks Amy , Ragland Denise
Published: May 2023

This report describes an innovative, team-based model for the development of an interprofessional, student-led, community-based, free clinic. The 12th Street Health and Wellness Centerâ€™s creation was a direct collaboration of university administration, faculty from the various university colleges, students, and the community for the purpose of providing basic healthcare for the neighboring medically underserved population. Inclusion of the target community in the planning and implementation processes allowed for easy identification of neighborhood needs while providing community stakeholders a leadership role in creation and operations. Challenges in establishing the clinic are discussed including financial support, volunteer recruitment, and scheduling. Primary care services are provided by student teams from five colleges and a graduate school in a model that engages all students in interprofessional interactions throughout the patient visit. Each student team presents their assessment and plan to an interprofessional preceptor team who oversees and facilitates discussions regarding refining the diagnosis, identifying further assessment needed, and outlining the most appropriate plan. This model of patient care is embraced by students, preceptors, and patients while providing the opportunity for interprofessional education as healthcare students from several professions learn from, about, and with each other.
Development and Evaluation of a Student-Led Mental Health Promotion Workshop to Address Community Needs for Marginalized Populations in Urban Northern Ontario, Canada
Authors: Eton Vic , Semalulu Teresa , Desruisseaux Tiffany , Kuehner Zachary , Leinonen Esa , McCann Jessica , Petrick Carmen , Hoy Jennifer T , Lagadouro Dyane , Young Athena , McPhail Jennifer
Published: May 2023

Background: Compass North is a student-led health outreach initiative in Thunder Bay, Ontario, Canada. A current unmet need in Thunder Bay identified in a previously published community needs assessment is mental health services. Women, youth, senior, Indigenous, and LGBT2-SQ populations were disproportionately affected. In response to these perceived gaps in services, a subcommittee of Compass North developed, delivered, and evaluated mental health workshops.Methods: Affiliations with Shelter House Thunder Bay (SH) and Anishnawbe Mushkiki Thunder Bay Aboriginal Health Access Centre (AM) were established. Six interactive workshops were developed and delivered over eight months. Likert scale-based evaluation surveys gauging workshop participant and presenter satisfaction with content were used. Attendance and return attendance were additional markers of success.  Results: A total of 36 participant surveys were completed between both sites. Response rates were 74% and 84% at SH and AM, respectively. Workshop content was well-received by participants and helped address some unmet health education needs. Attendance increased with time at SH.Conclusions: These interactive workshops are one way of addressing unmet community needs in Thunder Bay while maintaining a community presence prior to establishing a fully functional student-run clinic (SRC). They comprise a potentially valuable stage in development of a SRC.
Intervention to Improve Mammography Screening at a Student-Run Free Clinic
Authors: DiLorenzo Madeline A , Osterbur Badhey Marika L , Roth Lauren , Cohen-Levy Wayne B , Badhey Arvind K , Lin Juan , Jordan William B , Nosal Sarah C , Cortijo Amarilys , Schoenbaum Ellie
Published: May 2023

Background: Most late-stage breast cancer occurs in those who have never been screened. Uninsured women have lower screening rates than insured women. Student-run free clinics (SRFCs) caring for uninsured women can test interventions that attempt to increase screening rates.Methods: The United States Preventive Task Force guidelines were used to determine patient eligibility for screening mammography in a SRFC. Medical students began receiving education on screening mammography on May 31, 2013 while a simultaneous intervention to streamline workflow related to mammography referrals was implemented. We assessed the change in counseling and referral rates pre- and post-intervention as well as the impact of race/ethnicity, chronic disease status, and preferred language on the likelihood of getting counseled and referred for screening mammography. We also investigated the impact of the intervention on screening mammography attendance rates.Results: We collected data from the medical records of 106 women (171 patient visits) pre-intervention and 113 women (193 patient visits) post-intervention. The intervention significantly improved the rate of mammography counseling (from 54.4% to 81.9%) and mammography screening referrals (from 37.7% to 70.6%). Preferred language, race/ethnicity, and chronic disease status were not associated with counseling and referral rates. The intervention did not improve mammography attendance.Conclusions: An education and workflow intervention in a SRFC that improved counseling and referral rates did not improve mammography attendance. Further studies are needed to investigate patient-level barriers that may be affecting mammography appointment attendance.
Comparison of the Health Status of Uninsured Diabetic Patients Presenting for an Initial Visit to an Urban Free Clinic to Diabetic Patients from the National Health and Nutrition Examination Survey
Authors: Dalrymple Nathan , Hidalgo Michael , Desai Anjali
Published: May 2023

Background: We compare the health status of uninsured diabetic patients presenting for their initial visit at the Cooper Rowan Clinic (CRC) to insured and uninsured diabetic respondents of the National Health and Nutrition Examination Survey (NHANES). By establishing a baseline health status of CRC patients and comparing to NHANES respondents, we aim to identify how insurance status may be associated with health outcomes of this at-risk population.

Methods: CRC patients with diabetes and insured and uninsured NHANES respondents with diabetes were compared based on health indicator goals established by the American Diabetes Association (ADA). Specifically, we used chi-squared tests to compare the proportion of individuals in each group that met ADA health indicator goals for hemoglobin A1c (HbA1c), blood pressure, low-density lipoprotein (LDL), and high-density lipoprotein (HDL). Then, we used post hoc one-way ANOVA to identify significant differences in the mean measurements of each of the health indicators.

Results: CRC patients presenting at their initial visit have higher mean HbA1c than insured NHANES respondents (p<0.001) but similar mean HbA1c to uninsured NHANES respondents. CRC patients at their initial visit have higher blood pressures compared to insured and uninsured NHANES respondents (p<0.001). There were no significant differences in HDL and LDL between groups.

Conclusions: This study adds to the literature describing the health status of uninsured diabetics. We show a positive association between insurance status and the control of HbA1c and blood pressure but no effect on HDL or LDL. CRC patients at their initial visit are less likely to be at blood pressure goal than both insured and uninsured NHANES respondents.
Is Stability Sufficient? Challenging the Status Quo via Needs Assessment in a 22-Year-Old Student-Run Free Clinic
Authors: Rizzo Gabriella , Elkhatib Safwan , Geske Jenenne , Menning Melanie , Christiansen Hannah
Published: May 2023

Background: An increase in the utilization of student-run free clinics (SRFCs) as an adjunct to early healthcare student training begs the question of whether SRFCs are meeting expectations of stakeholders, particularly students, faculty, and staff. The objective of our study was to perform a needs assessment of clinic stakeholders to assess whether their expectations regarding clinic purpose and performance were being met.

Methods: Clinical leadership at an interdisciplinary SRFC affiliated with an academic medical center in Omaha, Nebraska sent a needs assessment survey to all students, faculty, and staff at the affiliated academic medical center. The responses were coded and analyzed via descriptive statistics.

Results: The survey demonstrated that the clinics met key stakeholder priorities in patient care and education and identified some anticipated areas for improvement. It also illuminated several previously unknown and unmet stakeholder expectations, including needs for higher visibility, desire for expanded volunteer roles, discovery of an untapped pool of potential volunteers, and desire for significant improvements to the interdisciplinary process.

Conclusions: The needs assessment survey identified specific areas of unmet needs that have implications for the ability of the SRFC to operate and serve patients with quality and efficiency.
Addressing Dermatologic Health Disparities: Characterization of a Free Dermatology Clinic for an Uninsured Population
Authors: O'Connell Katie , Bartholomew Erin , Villanueva Andrew
Published: May 2023

Background: Barriers to accessing dermatologic care are important to address for individuals without health insurance. This report aims to highlight dermatologic health disparities facing the uninsured population, to demonstrate the invaluable impact a monthly student-run free clinic can have on this population, and to encourage the implementation of dermatologic free clinics at other institutions.

Methods: Data was collected using the electronic medical record â€œChart Reportsâ€ tool to create a query for total dermatology visits from 2012-2019. Records were reviewed and descriptive data was collected on diagnoses, medications, procedures,  and follow-up rates of a student-run dermatology free clinic from 2012-2019.

Results: Over this period, dermatologic care was provided to 215 patients and a total of 321 diagnoses were made. The most common diagnoses included atopic dermatitis (26), seborrheic keratosis (21), and acne (17).  Twenty-three skin cancer diagnoses were made, including 13 basal cell carcinomas, 8 squamous cell carcinomas, one case of melanoma, and one case of nonmelanoma skin cancer, unspecified. 

Conclusion: A higher prevalence of atopic dermatitis, melanoma, and non-melanoma skin cancer has been reported in ethnic minorities and people of low socioeconomic status. This aligns with our results and these findings highlight the significant need for improved access to dermatologic screening and follow-up for individuals without health insurance. This report also shows the unique opportunity free clinics have to address dermatologic health disparities in the local community.
Findings from a Qualitative Needs Assessment of Equal Access Birmingham, a Student-Run Free Clinic in the Southern United States
Authors: Chilukuri Pranaya , Williams Collier , Dowla Shima , Paul Shejuti , Sheets Lindsay , Zinski Anne , Van Wagoner Nicholas
Published: May 2023

Background: Student-run free clinics (SRFCs) are becoming increasingly common across the United States. To better understand clientele and improve these organizations, it is important to assess patient feedback about SRFC services. This study is based on Equal Access Birmingham (EAB), a SRFC that aims to provide and improve quality healthcare for underserved populations in central Alabama. A qualitative needs assessment of patients receiving care at EAB has not yet been performed. The purpose of this study was to identify and explore EAB clientsâ€™ perceived health needs, health-related behaviors, and access to healthcare.

Methods: Clients were recruited to participate in semi-structured qualitative interviews at EAB. Major themes included barriers to healthcare, primary health concerns, individual health behaviors, and patterns of clinic utilization.

Results: The study analyzed 16 patient interviews. Participants stated that cost, transportation, and housing were barriers to healthcare. Their main health concerns were hypertension (cited by 21% of participants), diabetes (21%), pain (21%), and mental health management (21%). Ninety-four percent of study participants reported relying on EAB to obtain medication refills. Respondents also reported accessing the clinic for mental health issues, and many used EAB as their primary care provider.   

Conclusions: Despite numerous barriers, EAB was the source of primary healthcare and medications for many respondents. This qualitative investigation identified specific concerns and noteworthy strengths that may extend to other SRFCs.