bluuebunny/crossref_metadata_2025 huggingface dataset:
Performance Measurement of E-Commerce Utilization in MSMEs in Situbondo Regency
Authors: Dian Widiarti  , Salya Rater  , Zidane Aji Wijaya  , Ahmat Muniril Ihsan
Published: August 2024

The development of the digital is inseparable from the convenience factor and greater benefits that can be obtained by users. Likewise in the business, with the development of digital platforms for product marketing activities, it will also have an impact on micro and medium businesses. This study wants to find out whether it is true that the use of e-commerce can improve the performance of MSME businesses. Factors that influence such as how technology, organization and environment will impact the adoption of e-commerce itself which will ultimately affect business performance in this case the MSME business. This study is an explanatory research that explains the causal relationship (cause and effect) between variables using SEM / PLS analysis. The test results show that technology and the environment have a positive and significant effect on the adoption of e-commerce and the organization has a positive but not significant effect on the adoption of e-commerce. As an intervening variable, namely the adoption of technology, it is produced that technology and the environment affect the performance of MSMEs through the e-commerce adoption variable and the organization has a positive but not significant effect on the performance of MSMEs through the e-commerce adoption variable. The overall results can be concluded that the increase in MSME performance is significantly influenced by technological factors based on the convenience, usefulness and ability to use it. Environmental factors, especially consumer behavior in utilizing technology and trends in utilizing technology in the online shopping process, also have a significant influence on the adoption of the technology itself, thus impacting business performance.
Urban transformations and tourist impact of events. The Holy Week in Seville
Authors: Barrera-Fernández Daniel , Hernández-Escampa Marco , Balbuena-Vázquez Antonia , Lluelma-Izquierdo Antonio
Published: August 2024

Introduction: Events can have a deep and long-term impact in urban transformations, due to the effects in the urban landscape and the reinforcement of urban services. In addition, tourist perceptions of urban destinations are significantly affected by their experience of events. Methodology: The objective is to analyse the impact of the Holy Week in Seville in terms of urban presence and visitor perceptions. A mixed methodology is applied involving questionnaires to visitors, spatial analysis of reinforced urban services, routes and movement of attendees, registration of related activities, and analysis of public policy documents. Results: There is a relatively low visit to heritage sites and tourist attractions during Holy Week, mainly because most tourists repeat the visit to the event. Attendees show a great satisfaction with all aspects related to the event in general, especially those who live in the city and who come from abroad. Discussion: The key aspects to improve are mobility and the visit to other resources apart from the event. Conclusions: The Holy Week is an important event in terms of the number of visitors, economic impact, and civic pride, and improving the quality of urban services is the key to ensuring tourists and residents satisfaction.
Postoperative Pain after Laparoscopic Cholecystectomy in a Tertiary Care Center: A Descriptive Cross-sectional Study
Authors: Shrestha Binod Bade , Lakhe Gajal , Ghimire Pradeep
Published: August 2024

Introduction: Laparoscopic cholecystectomy, being minimally invasive, is widely accepted in comparison to open cholecystectomy. The major benefits are small incision, less wound pain, rapid recovery, shorter hospital stay and earlier return to activities. Although, trauma and injury are limited in laparoscopic cholecystectomy; it is not a pain free surgery. Hence, we aimed to find out the prevalence of pain at wound site after laparoscopic cholecystectomy at various time intervals in post-operative period.
Methods: The descriptive cross-sectional study was conducted among 125 American Society of Anesthesiologists grade I/II patients, with diagnosis of symptomatic gallstone disease from October 2022 to September 2023 in a tertiary care hospital after ethical approval was obtained from Institutional Research Committee (Reference number: MEMG/483/IRC). Total sampling was done in this study. The post-operative pain at wound site was measured at 12, 24, 36 and 48 hours. Data were analyzed using SPSS 21.0.
Results: At 12 hours postoperatively, 2 (1.60%) patients complained of severe pain, 120 (96%) patients reported moderate pain and 3 (2.40%) patients expressed their pain as being mild. Likewise, at 24, 36 and 48 hours postoperatively, none of the patients suffered from severe pain. At 24 hours post-operative, 105 (84%) patients reported moderate pain which gradually declined over 48 hours. At 36 and 48 hours post-operative mild pain was reported by 85 (68%) and 117 (93.60%) patients respectively. The moderate pain was complained by 40 (32%) and 8 (6.40%) patients respectively.
Conclusions: The majority of patients suffered from mild to moderate pain after laparoscopic cholecystectomy, the intensity of which decreased over 48 hours.
Measurement of Information Technology Management Capability Using COBIT 5.0 in The Facility Management Department of PT Permata Graha Nusantara
Authors: Chui Alexander Alvin , Wella Wella
Published: August 2024

IT governance is the responsibility of the board of directors and executive management of a company that ensures the company information technology supports and expands the company strategy and objectives. But IT governance that does not support departments can have a negative or detrimental impact on the department. For this reason, it is necessary to take measurements to see the level of IT governance that is currently being implemented. The Facility Management Department is a department of PT Permata Graha Nusantara which is engaged in building management services that wants to see whether the ongoing IT system provides support to operational activities and provides better services to customers. To measure the capability of IT governance, the COBIT 5.0 framework is used as a reference in this study. Domain selection is done according to COBIT 5.0 standard and on the selection of the department 5 domains are tested, namely APO05 Manage Portfolios, APO10 Manage Suppliers, APO11 Manage Quality, BAI04 Manage Availability and Capacity, and DSS03 Manage Problems. Each domain chosen to have different aims and objectives and measured using standards set by the COBIT 5.0 framework. The measurement results are Capability Level which has levels from level 0 to 5. The target expected by the Facility Management department is level 4, but the results obtained are not in line with expectations and get level 3 in each domain tested, so this department must make improvements based on recommendations made based on the COBIT 5.0 framework.
DEVELOPMENT OF SMART BOX MEDIA IPAS CLASS V MATERIAL ENVIRONMENT SO DAMAGED
Authors: Safani Lainun Afrina  , Galih Mahardika Christian Putra
Published: August 2024

This study is motivated by the fact that there are still many college students who do not understand the environmental material, which can be detrimental to the content of the IPAS subject, because the teacher has not used the media optimally, resulting in students misunderstanding the environmental material, which can be detrimental to the content of the IPAS subject. This study aims to develop a smart box media for a damaged environment and test the feasibility and effectiveness of smart box media. The research method used is the research and development method with the Borg and Gall development model. The subjects of this research were 5th grade students of SD N 2 Banteran, Banyumas Regency conducted in May 2024. The methods used in this research are interviews, observations, questionnaires, tests, and documentation. The instruments used were interview guidelines, documentation, needs and feedback questionnaires, pretest and posttest questions, and validation sheets. Data analysis was done by normality test, t-test, and n-gain test. The results of this study indicate that smart box media is feasible to use with a percentage of feasibility from material validators 87.7% and media validators 86.6%. The results of the small-scale normality test of 0.415 and large-scale of 0.155 mean that the data is normally distributed. The results of the small-scale n-gain test amounted to 0.4517, a large scale of 0.4880 including the medium category. This study concludes that smart box media is feasible and effective to use as a learning media for IPAS in the classroom.
THE EFFECT OF IMPLEMENTATION OF CANVA BASED DIGITAL HANDOUT DEVELOPMENT ON PANCASILA PHASE B EDUCATION SUBJECT USING THE RICOSRE LEARNING MODEL IN PRIMARY SCHOOL
Authors: Novitasari Maya , Susanti L.R Retno , Waty Evy Ratna Kartika , Raharjo Makmum
Published: August 2024

The covid-19 pandemic has has a major influence on obstacle in the learning process which has resulted in a decrease in learning outcome. This obstacle refers to the lack of teaching materials that support the learning process, while the learning process must be carried out online. Therefore, it is necessary to use technology that can make it easier fpr educators to present material and give students the freedom to carry out the learning process wherever and whenever. Considering that online-based technology has a high level of flexibility. The research aims to explain the effect of implementing Canva based digital handout development on Pancasila Phase B Education subject with the Reading, Identifying, Construction, Solving, Reviewing, Extending (RICOSRE) learning model in primary schools. The subjects of this research were fourth grade students at state primary school 81 Palembang. The research method used is Research and Development with reference to the Rowntree research model. Data collection techniques were carried out through observation, interviews, questionnaires and group discussion forums (FGD). The research results refer to the increase in learning outcomes shown through the pretest with an average pretest score of 61.66% and an average posttest of 90.33%, while the N-Gain results show 0.76 which is in the high category. This shows that there is an increase in learning outcome of 28.7% and is included in the very effective category. Based on the research results, it can be concluded that the implementation of Canva-based digital handout development can have an influence that refers to improving learning outcomes in Pancasila Phase B Education subject.
DO YOUTUBE SOCIAL MEDIA SHOWS AFFECT THE POLITE OF ELEMENTARY SCHOOL STUDENTS?
Authors: Burhanudin Bubun , Alpian Yayan , Dewi Sinta Maria
Published: August 2024

Along with developments in the current era of communication technology, the use of gadgets has penetrated into elementary school-age students, this has caused many concerning phenomena that have an impact on the behavior and speech that children imitate, one of the phenomena caused by content on YouTube social media is related to manners, such as following speech that is not politely spoken. The study aims to describe the influence of YouTube social media impressions that occur in elementary schools in East Karawang District, Karawang Regency using a descriptive qualitative approach research method. Data collection techniques were carried out using observation interviews with field note techniques and questionnaires. The results of this study found that students behave disrespectfully, especially in terms of speech, namely rude speech obtained from watching YouTube social media content that is not good. But on the other hand, the results of this study were found from watching positive YouTube social media, namely content that inspires students to do good such as conducting social donation activities to people in need. Thus, the influence of YouTube social media broadcasts on students' polite behavior is quite influential.
THE EFFECTIVENESS OF MATHEMATICS LEARNING THROUGH A REALISTIC MATHEMATICS EDUCATION APPROACH IN ELEMENTARY SCHOOLS
Authors: Irna Nur Rohmah  , Al Jupri
Published: August 2024

The research aims to analyze the effectiveness of mathematics learning through the realistic mathematics education approach in learning the concept of counting integers in grade VI elementary school students.  The research used a quasi-experiment with one pretest postets design. The research involved 32 grade VI students at SDN 205 Neglasari, Coblong District, Bandung City. The research instrument is in the form of a multiple-choice test that includes addition and subtraction of decimal numbers. Research shows that the RME approach is effective in producing a significant improvement in students' learning completeness in the addition and subtraction of decimal integers, as well as improving mathematical problem-solving, self-efficacy, reasoning, and mathematical literacy. RME encourages students to recognize the practical application of mathematical concepts through real-world contexts and cultural elements, as well as to cultivate creative and imaginative thinking skills so that they can be an important strategy in improving mathematics education in primary schools.
DEVELOPMENT OF QUARTET QR CODE CARD LEARNING MEDIA TO IMPROVE SOCIALSCIENCE LEARNING OUTCOMES FOR GRADE V ELEMENTARY SCHOOL
Authors: Ghonia Berlian , Christian Putra Galih Mahardika
Published: August 2024

This study uses a quantitative approach with R&D methods using the ADDIE development model. The aim of this study is to know the design, validity and effectiveness of the development of learning media of QR Code Quartet Cards. This research was conducted in the V class of SD State Wonosari 2, Semarang. The sample technique used was stratified random sampling used to select a sample with a stratured population of seven participants in a small-scale trial with details of two high-level, three middle-level and two low-level students. The data collection techniques used are nontest, which include observations, interviews, requests, qualifications and responses, as well as test techniques. The results of the media statistics test meet the eligibility aspects of 100% media expert rating (very eligible), 80.9% material expert selection. (very eligible). In addition to meeting the aspect of effectiveness proved by t-test pairs obtained a significance result of 0,00<0,05 so that H0 was rejected and Ha accepted. The N-Gain test got an average of 0.65 which belongs to the middle category and in a percentage of 65.16% so the interpretation belonging to the category is quite effective.
Developing Arabic Teaching Methods Using Google Sites for Middle School Students
Authors: A’isyatuzzuhrah A’isyatuzzuhrah , Nasution Sahkholid
Published: August 2024

Teaching Arabic in schools proceeds traditionally, where education is still from one source and through limited and different means, as is the case in the Pena Santri Middle School in Medan, where students have become less active and motivated in learning Arabic. Therefore, we were in dire need of developing an appropriate method, such as Google Sites. The aim of the research is to describe the method of developing methods for teaching the Arabic language to students at Pena Santre Middle School in Medan, and to know its specifications and effectiveness to improve students’ motivation in learning the Arabic language. This research is developmental research, as the researchers used the 4-D method, which consists of 4 stages, which are definition, design, development, and publication. All these stages later result in a product that will be tested to ensure its suitability before testing it with students.  In the introduction stage, eighth grade students at Pena Santre School need a teaching method that can increase their interest in learning the Arabic language. In the design stage, the two researchers design a product that is considered compatible with the students’ needs, which is Google Sites, which consists of three parts. After completing the design, the two researchers validated it with very valid results. The result of the research is that the educational tool Google developed websites increases students’ motivation in learning Arabic, especially for the patient clinic subject.
Does Esketamine in Cesarean Delivery Increase Postoperative Adversities and Related Diseases?
Authors: Daniel Cheryce , Coombs Kylon
Published: August 2024

Esketamine has emerged as a promising treatment option, particularly noted for its effectiveness in reducing postpartum depression, alleviating pain, and promoting faster recovery. Despite its therapeutic benefits, recent research has raised concerns regarding potential adverse effects associated with high doses of esketamine in patients. Specifically, there is growing interest in understanding the potential risks linked to the administration of esketamine during cesarean delivery, given its increasing use in obstetric anesthesia. This comprehensive review aims to investigate the potential associations between the use of esketamine during cesarean delivery and the subsequent risk of related diseases or physiological disorders. The goal is to provide clinicians and researchers with valuable insights into the safety profile of esketamine when administered during cesarean delivery, thereby informing clinical practice and guiding future research directions.
How Psychological and Nonpharmacological Treatment Modalities Reduce the Disease Burden of Amplified Musculoskeletal Pain Syndromes in Pediatrics
Authors: Narvel Aalia , Gmuca Sabrina
Published: August 2024

he prevalence of pediatric chronic musculoskeletal pain ranges from 8.5% to 40%.1 This literature review examined the treatment of amplified musculoskeletal pain syndrome (AMPS), which is a general term that represents a spectrum of pain disorders for patients who may not satisfy specific diagnostic criteria.2 Specifically, sources were analyzed to compare the efficacy of individual components in the nonpharmacological, interdisciplinary treatment of AMPS against pain medications. These components included cognitive behavioral psychotherapy (CBT), physical therapy (PT), as well as occupational therapy (OT). There is limited information that assesses these components individually, but there is ample evidence that when used in conjunction, a multidisciplinary approach to AMPS is successful. In particular, the functional disability index (FDI) is indicative of decreased disease burden found in the nonpharmacologic treatments investigated. This review demonstrates the efficacy and importance of CBT, PT, and OT in AMPS treatment.
Effects of Obesity on Patients Undergoing CardioMEMs Procedure: Retrospective Cohort Study
Authors: Elias Tony , Elmalh Mena , Brahmbhatt Priya , Girgis Kyrillos , Syed Taha , Valderrama Michael , Beshai Rafail
Published: August 2024

★ Remote hemodynamic monitoring (CardioMEMs) is becoming increasingly important for management of chronic heart failure patients. ★ There is limited data looking specifically for obese patients who undergo CardioMEMs implantation. ★ We sought to examine the national inpatient sample database to describe in-hospital outcomes for this demographic
Does Strength Training Decrease the Risk of Sports Related Knee Injury?
Authors: Noll Zachary J. , Buob Quin W.
Published: August 2024

The knee is the most common joint affected by sports-related injuries, with approximately 2.5 million cases treated annually in the US alone, alongside 2 million worldwide ACL repairs. Among athletes engaged in contact sports like football, soccer, basketball, and volleyball, ACL tears are the primary injury concern. In non-contact sports, particularly running, meniscus tears are commonly experienced. A notable 23% of college athletes encounter knee injuries to varying degrees. Many risk factors have been identified including patient sex, activity type, and body composition, justifying the need for individualized preventive measures. Various strength training protocols have demonstrated efficacy in reducing the risk of ACL tears, meniscus tears, and patellar tendinopathy pain. Enhancements in muscle activation ratios and biomechanical parameters resulting from strength training contribute to ACL injury risk reduction. Both male and female athletes have benefited in injury risk reduction from strength training, yet the optimal protocol remains undetermined. Nonetheless, diverse training methodologies yield risk reduction benefits, regardless of the onset age of strength training. While knee injuries pose a significant burden in sports, targeted strength training interventions offer promising avenues for injury prevention. Further research is warranted to find optimal training variety, frequency, and intensity and their effects across different athlete demographics.
Efficacy of Psilocybin in the Treatment of Substance and Alcohol Use Disorders
Authors: Brancaccio Hanna
Published: August 2024

Introduction: Substance use disorder (SUD) and alcohol use disorder (AUD) are major public health crises, affecting millions of Americans. Current treatment options include behavioral therapies and medications. In this review, we explored psilocybin’s efficacy in treating SUD and AUD. Methods: Key terms were used to search databases to identify articles that addressed psilocybin in the treatment of SUD. Included in the review were indexed, peer-reviewed, primary sources that were published within the last 10 years. Excluded studies were non-peer reviewed, not relevant to the thesis, and did not have an English translation. Results: The psychodynamic antidepressant effects of psilocybin mark its potential as treatment for depression and other mental health disorders. Clinical trials investigating the efficacy of psilocybin as a complement to psychotherapy for AUD reported notable an overall decrease in alcohol consumption compared to control groups. Similarly, other trials concluded that participants reported improvement of depressive symptoms. Furthermore, participants suffering from mental health disorders who experimented with microdosing reported improved focus, confidence, and relationships alongside decreased social anxiety. Animal models proved that psilocybin disrupted alcohol-related memories and alcohol-seeking behaviors; thus, psilocybin therapy may be beneficial in preventing relapse in patients with AUD. Discussion: Current studies show that psilocybin has potential as a treatment for SUD and AUD. Studies on psilocybin have various limitations, such as small sample sizes, reliance on self-reported data, and the inability to fully replicate the psychedelic experience in animal models. Despite limitations, these findings provide a strong rationale for conducting future high quality research.
Clinical Outcomes for VA-ECMO Patients Associated with Hyperlipidemia: An Analysis of the National Inpatient Sample
Authors:   Rowan University, Pastore Dakota B. , Elias Tony , Beshai Rafail , Girgis Kyrillos , Daneshvar Maziyar , Anacker Keith
Published: August 2024

Introduction: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is considered the most advanced temporary life support which provides complete hemodynamic support in addition to gas exchange. There is limited data available on the impact of hyperlipidemia (HLD) on VA-ECMO patients. We sought to examine the national inpatient sample (NIS) database to describe in-hospital outcomes among these patients. Methods: The NIS was searched for hospitalizations of adult VA-ECMO patients with and without a concomitant diagnosis of HLD for the years 2019 and 2020. The primary outcome was inpatient mortality. Results: This study included 3,885 VA-ECMO patients, of which 1,082 (27.8%) patients had HLD. VA-ECMO patients with HLD had higher prevalence of hypertension (57.3% vs. 71.4%, p <0.001), and chronic kidney disease (26.3% vs. 17.0 %, p <0.001) compared to VA-ECMO patients without HLD. In-hospital mortality was higher among those with HLD (61.5 % vs. 45.5%, p <0.001). Multivariate regression showed that VA-ECMO patients with HLD had higher inpatient mortality (OR 1.371, 95% CI 1.332-1.410, p <0.001). On secondary analysis, patients had higher odds of having ventricular arrhythmia (OR 1.472, 95% CI 1.416-1.531, p <0.001), acute kidney failure (OR 1.394, 95% CI 1.359-1.429, p <0.001), intracranial hemorrhage (OR 1.157, 95% CI 1.099-1.219, p <0.001), DVT (OR 1.252, 95% CI 1.200-1.306, p < 0.001), and sepsis (OR 1.226, 95% CI 1.195-1.257, p <0.001) compared to VA-ECMO patients without HLD. Conclusion: In this nationally representative population‐based retrospective cohort study, HLD was associated with higher mortality and worse outcomes among VA-ECMO patients.
Colorblind Racial Attitudes and Emotion Dysregulation: Impact on White People’s Ethnocultural Empathy and Feelings towards People of Color
Authors:   Rowan University, Veltre Vanessa L. , Hochman Alissa
Published: August 2024

Colorblind racial attitudes, which minimize the importance of race, have been identified as a barrier to understanding systemic racism and fostering empathy towards people of color (POC). This study aimed to examine the relationship between emotion dysregulation and White people's ethnocultural empathy and warmth towards people of color, and to explore the potential moderating role of colorblind racial attitudes. The study utilized data from 511 White participants (ages 19-50) who completed the Difficulties in Emotion Regulation Scale (DERS), Colorblind Racial Attitudes Scale (CoBRAS), Scale of Ethnocultural Empathy (SEE), and a feeling thermometer scale measuring warmth towards POC. Participants were categorized into upper, middle, and lower quartiles based on CoBRAS scores. Moderation analyses were conducted using the PROCESS macro for SPSS. Higher colorblind racial attitudes were associated with lower ethnocultural empathy (b = -0.8297, p < 0.0001) and warmth towards POC (b = -13.7, p < 0.0001). Contrary to predictions, lower attitudes demonstrated a negative correlation between emotion dysregulation and ethnocultural empathy. However, lower colorblind attitudes exhibited higher empathy and warmth compared to those with higher colorblind attitudes when emotion dysregulation was held constant. The interaction between emotion dysregulation and colorblind racial attitudes did not significantly impact ethnocultural empathy or warmth towards POC. The findings suggest that while higher emotion dysregulation did not directly impact our outcome variables, colorblind racial attitudes played a significant role in moderating these outcomes. Future research should investigate the development of anti-racism interventions targeting colorblind racial attitudes and explore behavioral responses to racism.
CVA in Patient with Systemic Sclerosis on Aspirin Therapy: A Case Report
Authors: Mahmud Rahyan , Koutsenko Bianna , Goich Kenneth , Hasan Usaid
Published: August 2024

Introduction Systemic sclerosis is an autoimmune disorder characterized by microvascular damage and multiorgan fibrosis. These patients have a higher risk of cerebrovascular events, but it is difficult to develop strategies for prevention due to limited understanding of underlying pathophysiology. Case Presentation A 76-year-old female with a history of systemic sclerosis presented to the emergency department with acute onset slurred speech, facial droop, and left arm pain with a National Institutes of Health (NIH) Stroke Scale of 1. She was outside the thrombolytic window. Other history includes hypertension and hyperlipidemia; both were well controlled. MRI confirmed right frontal lobe ischemic stroke with additional ischemic foci in the temporal and parietal lobe. CTA neck and echocardiogram were negative for emboli source, and LDL was within normal limits. She was started on dual antiplatelet therapy (DAPT). The patient’s condition improved and by day 2 the only residual symptom was facial droop. She was discharged on DAPT with plans to transition to Plavix monotherapy after 90 days. Discussion This case illustrates the risk of CVA in a patient with systemic sclerosis. The patient’s other major risks for CVA include hypertension and hyperlipidemia, both of which were well controlled. For this reason, along with negative imaging, we suspect systemic sclerosis is the most probable cause of CVA. Long-term aspirin therapy is the consensus for prevention, however there are no clear cut guidelines. Due to aspirin failure, she will be transitioned to Plavix following completion of DAPT. Conclusion Further research into pathophysiology and prevention of stroke in this population is needed.
Exploring Hypertension Prevalence Among Ill-housed individuals in Urban Environments
Authors: Goldberg Lia , Shah Sameer , Archakam Nikhila , Khikmatov Murod , Choksi Kesha , White Anddee
Published: August 2024

This study explores the interrelations of hypertension, homelessness, and access to healthcare in urban ill-housed populations. It was found that conditions such as heart disease and diabetes significantly exacerbate hypertension, which remains highly prevalent due to the population's limited access to consistent medical care. Homelessness further complicates the management of hypertension due to unstable living conditions, making adherence to treatment and follow-up with healthcare providers challenging. Additionally, factors like higher rates of substance abuse and malnutrition among homeless populations contribute to worsening hypertension, which, if untreated, can lead to severe health crises including heart attacks and strokes. The research underscores the critical public health implications of hypertension within these communities, emphasizing the role of social determinants of health in exacerbating health disparities. The study suggests that interventions such as improved housing, accessible healthcare services, and nutrition support are crucial. It also calls for policymakers to allocate resources strategically to address these disparities and support the health and well-being of homeless populations. Our findings reveal a stark connection between a lack of basic needs, as framed by Maslow's Hierarchy of Needs, and poor health outcomes, particularly in managing chronic conditions like hypertension. This study not only highlights the health inequities faced by ill-housed individuals but also outlines the next steps for public health measures and policy adjustments aimed at reducing these disparities and improving overall community health.
Evaluating the Effectiveness of a School-Based Cognitive Behavioral Youth Depression Prevention Program in Improving Life Satisfaction
Authors: Patel Roshani , Brunwasser Steven M. , Hochman Alissa
Published: August 2024

Depression is the leading cause of disability worldwide, known as the global burden of disease. Incident cases from 1990 to 2017 have increased by 49.86%. Additionally, rates have been seen to dramatically rise in adolescents aged 18-25 (17%) compared to rates in individuals aged 10-14 (1.1%). This makes it beneficial to have prevention programs for middle school aged children. The Penn Resiliency Program (PRP) is a youth depression prevention program focused on cultivating healthy thinking styles and behavioral coping skills. In our study, we used archival data from a randomized control trial of PRP to evaluate whether the program led to improvements in life satisfaction in adolescents. Life satisfaction was reported using the Satisfaction with Life Scale by Diener. We used mixed effects modeling to evaluate the data collected from the PRP clinical trial. It was found that children in PRP tended to report slightly higher levels of life satisfaction, but these differences were not statistically significant. We did not find compelling evidence that children in PRP reported higher life satisfaction levels than those who received no intervention. Residual diagnostic analyses showed minor departures from normality in our residuals at high and low ends of the distribution, but overall the statistical model assumptions appeared to be reasonable. In conclusion, the data does not show enough evidence to conclude that life satisfaction was improved. Future research should look at functional outcomes, e.g., the child’s academic and social wellbeing.
Effects of Exercise on the Cardiovascular Health of Adolescents and Young Adults With Down Syndrome
Authors: Gupta Samarth
Published: August 2024

Introduction: It is known that the incidence of Down Syndrome has increased over time and that this condition is associated with congenital heart defects, lower cardiorespiratory capacity, and increased rates of obesity and type 2 diabetes. It has been shown that individuals who have congenital heart defects but not Down Syndrome have increased cardiorespiratory function after engaging in exercise. Unfortunately, the role of exercise in improving cardiovascular health outcomes among individuals with DS is not yet fully understood. Results: Exercise has been found to improve several health outcomes among individuals with Down Syndrome. For example, moderate to vigorous treadmill exercises increased the maximum heart rates and maximal oxygen consumption of those with this condition. Participants engaged in circuit training and plyometrics also experienced increases in peak minute ventilation and aerobic capacity. Lastly, aerobic and resistance training both reduced systolic, diastolic, and mean blood pressures among individuals with Down Syndrome. Conclusions: These results show that exercise is effective at improving cardiovascular health outcomes among adolescents and young adults with Down Syndrome. However, few studies have investigated these effects, and larger sample sizes and more studies that focus on Down Syndrome patients with congenital heart defects are needed to draw more generalizable conclusions. It is imperative that we create exercise interventions that will maximize cardiovascular health outcomes among this population.
Diagnosis and Management of a Patient with Chronic Lymphocytic Leukemia and a Concurrent Plasmacytoma: An Overview of a Case Report
Authors: Thor Danielle C. , Umrani Rohan , Bergal Jack , Yang Charles , Gordon Richard
Published: August 2024

Chronic lymphocytic leukemia (CLL) typically presents as an indolent disease with a benign disposition in most patients. In select patients, CLL can progress into a more aggressive disease via its original morphology, following a Richter transformation to an alternative non-Hodgkin lymphoma, or with the concomitant development of multiple myeloma. In an extremely rare subset of individuals with CLL, an extramedullary plasmacytoma may coexist. This presentation seeks to describe the diagnosis and treatment of a patient with concurrent CLL and a plasmacytoma.
Doxazosin Immediate Release as Alternative Treatment for Nightmares in Post-Traumatic Stress Disorder: A Case Report
Authors: Khan Danyaal , Richardson Christie , Forsberg Martin
Published: August 2024

Nightmares and flashbacks are common debilitating symptoms of post-traumatic stress disorder (PTSD) that can disrupt daily functioning in patients. Prazosin, an alpha-1 adrenergic antagonist, has been commonly used off-label for the treatment of PTSD intrusion symptoms, although its short half-life is limiting. Doxazosin, another alpha-1 antagonist, is starting to be investigated in the treatment of PTSD-related nightmares due to its smaller side effect profile and longer half-life. In our case report, we present a case of a patient with PTSD-related nightmares who was successfully treated with doxazosin following relapse of symptoms after discontinuation of prazosin. The success of doxazosin immediate release for PTSD-related nightmares warrants further studies into its efficacy and use as an alternative treatment to prazosin.
Case Report: Overdrive Pacing in Refractory Ventricular Tachycardia
Authors: Baldini Alyssa A. , Patel Kishan
Published: August 2024

We report a case of a 67-year-old male who presented to the emergency department (ED) for palpitations and complaint of his automated implantable cardioverter defibrillator (AICD) firing at home who had multiple episodes of persistent ventricular tachycardia (VT) during his course of stay in the ED. Patients with pacemakers and AICDs can present an additional layer of complexity when treating these conditions. Temporary overdrive pacing (TOP) should be considered as a treatment to correct refractory ventricular tachycardia in patients with implanted pacemakers and AICDs presenting to the ED.
Effect of Exercise Intervention on Facioscapulohumeral Muscular Dystrophy (FSHD)
Authors: DesRochers John
Published: August 2024

Facioscapulohumeral Muscular Dystrophy (FSHD) is a common muscular dystrophy. The facial muscles, shoulder girdles, and upper arms are notably affected.1 A common presenting symptom is asymmetrical scapular winging and further symptoms may include but are not limited to: loss of pectoral muscles, fatigue, severe pain, pathologic spinal curvatures, and foot drop.2 It is a particularly debilitating muscular dystrophy, with 20% of people >50 y.o. requiring a wheelchair.3 With no approved therapeutics, patients are managed symptomatically.3 This review sought to determine the effect of different exercise interventions on patients with FSHD. It is hypothesized that exercise may prevent need for assistive devices and increase patient quality of life. A literature review was conducted with search across PubMed, Cochrane library, Web of Science and Embase, with 15 articles selected from the results. All three forms of training, aerobic, strength, and anaerobic, were found to have positive effects on patients with FSHD. Positive effects of aerobic and strength training interventions include reduced levels of fatigue, increased oxygen uptake, improved muscle strength, and functional improvements in fitness, walking speed, and other functional tasks.1-3,6-7 In addition, neither aerobic nor strength training resulted in any signs of further muscle damage.2-3,11 Notably less research has been conducted on the impacts of HIIT or other forms of anaerobic training on patients with FSHD. Further research should be performed to determine the specifically most optimal routine for these patients in addition to further evaluation of the effects of anaerobic exercise.
Case Report: Erysipelas Diagnosed in the Emergency Department
Authors: Nadeem Arsam , Espinosa James A. , Lucerna Alan A.
Published: August 2024

Here we present a case of erysipelas. Erysipelas is a common and potentially dangerous infection. It involves the dermal layer of the skin but may also extend to the superficial cutaneous lymphatics. It is characterized by a relatively fast onset and a well-defined border. The most common sites are lower extremities with face being second. Much feared and often fatal in the pre-antibiotic era, it responds well to antibiotics today and most people have a full recovery without complications.
Clinical Outcomes for Cardiac Ablation in Octogenarians, Nonagenarians, and Centenarians: A Retrospective Cohort Study
Authors:   Rowan University, Elias Tony , Elmalh Mena , Girgis Kyrillos , Valderrama Michael , Beshai Rafail
Published: August 2024

Background Cardiac ablation is a therapeutic intervention aimed at correcting abnormal heart rhythms by disrupting electrical pathways in the heart, using techniques such as radiofrequency or cryoablation. Despite its effectiveness, there is a scarcity of data regarding the outcomes of cardiac ablation specifically among elderly patients. Previous studies have highlighted the complexities and challenges associated with managing cardiac arrhythmias in the elderly population, emphasizing the need for further investigation into treatment outcomes in this demographic.1,2 Therefore, this study aimed to investigate in-hospital outcomes among elderly patients who underwent cardiac ablation using data from the National Inpatient Sample (NIS) Database. Methods Data from the NIS Database for the years 2019 and 2020 were utilized to identify hospitalizations of adult patients who underwent cardiac ablation based on international classification of diseases 10th revision codes. Patients were stratified into two groups: those aged 80 years or older (≥80 YO) and those younger than 80 years old. Linear regression and multivariate logistic regression were employed to adjust for confounding variables, with inpatient mortality as the primary outcome measure. Statistical analyses were conducted using SPSS software. Results The study included 25,754 patients who underwent cardiac ablation, with 3,743 (14.5%) being elderly (≥80 YO). Elderly patients had a significantly higher prevalence of hypertension (66.8% vs. 51%, P Conclusions This nationally representative population-based retrospective cohort study underscores the association between cardiac ablation and heightened mortality, as well as worse outcomes, among older patients. These findings highlight the importance of tailored approaches to cardiac arrhythmia management in the elderly population.
Case Report: Monkeypox Diagnosed in the ED
Authors: Baluyot Richard M. , Pagano Joseph , Espinosa James A. , Lucerna Alan
Published: August 2024

Rashes are one of the most common chief complaints we see as emergency medicine physicians on a day-to-day basis. Most of them tend to be self-limited and require very little workup and can be discharged home; however, it is our job to try to identify rashes that may require isolation in order to prevent an outbreak in our communities. Here we present a case of one such rash that has gained major media attention as of late, Monkeypox.
Dermoid Cyst – Presenting with LLQ Abdominal Pain
Authors: Rattu Mohammad A. , Espinosa James A.
Published: August 2024

Ovarian cysts are fluid-filled structures that may be defined as simple or complex and are often discovered incidentally on imaging. Their etiology can range from physiologically normal (such as follicular or luteal cysts) to ovarian malignancies. They are more common in the reproductive years secondary to endogenous hormonal production however may also occur at any age. Simple cysts more commonly occur among all age groups; mixed cystic and solid and completely solid ovarian lesions however have rates of increased malignancy. The most independent risk factor is age; therefore, post-menopausal women should have proper follow-up secondary to this risk. Some risk factors include infertility treatment, hypothyroidism, pregnancy, tobacco use, tubal ligation and tamoxifen. Among women of reproductive age, ovarian cysts are functional and benign. However, ovarian cysts are prone to complications, some of which include pelvic pain, cystic rupture, hemorrhage and ovarian torsion, which require prompt management.
Are you feeling comfortable? – Measuring Clinical Hormesis
Authors: Kyriazis Marios , Fontana Alessandro , Calabrese Vittorio
Published: August 2024

Hormesis is a biological phenomenon where exposure to a low dose of a stressor or toxin induces a beneficial adaptive response, whereas higher doses may have detrimental effects. The concept of hormesis is being increasingly appreciated not only in toxicology and in pharmacology, but also in nutrition, clinical medicine, and in situations involving everyday life. Hormesis is an adaptive response of cells and organisms to a moderate and intermittent stressful stimulation. Following such stimulation, the organism must respond, and it has to make a choice: either treat it as a positive ‘challenge’, adapting to it and increasing its robustness, or treat it as a negative ‘threat’ with detrimental consequences for physiology and health. In clinical and everyday situations it is usually difficult to advise patients on how to determine the strength of such stimulation, and when to decide that each new stimulation is too low (ineffective), moderate (appropriate for health), or excessive (damaging to health). In this paper we argue that it is possible to rely on the subjective feelings of ‘comfort vs discomfort’, for deciding about the strength of the stimulus: if each exposure to a stimulation is felt by the individual as a ’comfortable’ event, then it is likely that its effects are beneficial (a hormetic challenge). If it is felt as an ‘uncomfortable’ event, then it is likely that it is damaging to health (a threat). These feelings take place in the anterior insula which evaluates the state of resources for responding to an external or internal event, and are a result of the integration of signals from the amygdala, hippocampus, and the prefrontal cortex.Nutritional hormesis, and digital cognitive stimulation are mentioned as two examples.
The Relationship Between Housing Conditions and Social Vulnerabilities: A Literature Review
Authors: Abukhalaf Amer Hamad Issa
Published: August 2024

The real estate market in the US has historically been shaped by social systems that influence economic foundations, political environments, and social norms, leading to socioeconomic inequality and segregation. Social vulnerabilities, rooted in these systems, result in unequal risk distributions across communities, particularly during disasters. Many case studies have highlighted how marginalized communities suffer disproportionately due to poor housing conditions. This disparity is compounded by historical policies such as the Indian Removal Act, Jim Crow Laws, and the Home Owners’ Loan Corporation mapping system, which entrenched housing inequities. Addressing these vulnerabilities requires comprehensive housing policies, community-based initiatives, and interdisciplinary approaches that focus on equitable access to resources, improved housing quality, and resilience against natural hazards. By tackling the root causes of social inequalities, policymakers can foster more inclusive, sustainable, and healthy living environments, mitigating the impacts of disasters on vulnerable populations.
Cost-Benefit Assessment and Industrial Scale-Up Variability of Low Carbon Hydrogen Energy Production
Authors: Mittal Harshit , Yadav Vivek , S Karthika , Kushwaha Omkar Singh
Published: August 2024

In a booming global economy, through the use of a fair share of conventional energy sources, converting the current economy into a low-carbon hydrogen economy is an exigent problem. Several policies and economies have failed to implement a fully circulating hydrogen economy. This paper provides a novel policy framework from the grassroots to the global level to achieve free-flowing hydrogen production, storage, and transport. Such a policy framework is thoroughly proposed through a cost‒benefit analysis of a plant producing 1 tonne of low-carbon hydrogen per day using several mathematical and computational models. This paper showcases the operations, development and tangible and intangible benefits of the hydrogen economy through which a final cost‒benefit mechanism and a global policy framework are formulated. Along with such formulations, a varied industrial scalability is also portrayed, which significantly portrays the industrial requirements from 0.5 to 10 TPD through cost‒benefit analysis parameters.