bluuebunny/crossref_metadata_2025 huggingface dataset:
Difficult Airway Response Team Outcomes in an Academic Emergency Department: A Prospective, Multidisciplinary Airway Management Cohort Study
Authors: Saheed Mustapha O , Varghese John , Truong Dang , Hillel Alexander T , Haut Elliott R , Berkow Lauren C , Kirsch Thomas , Brenner Michael J , Pandian Vinciya
Published: January 2025

Background

Successful first-attempt intubation minimizes the risk of hypoxemia, hypoventilation, and hypoperfusion. However, few data exist on outcomes of team-based difficult airway management in the Emergency Department (ED) for patients with deteriorating respiratory status.

Objective

To investigate the outcomes of an ED Difficult Airway Response Team (DART) program.

Methods

A prospective observational cohort study of DART implementation was conducted in the ED of an academic, tertiary care institution over a five-year period. An activation protocol was established, and the DART team included emergency physicians, other physicians (anesthesiologists, otolaryngologists, and trauma surgeons), respiratory therapists, nurses, and staff. Patients 18 years or older managed by the DART in the ED were included. Outcome measures included first-attempt intubation success, intubation techniques, and need for surgical airway.

Results

Across 98 DART activations, 73 patients were managed in ED, nine patients were transported directly to the operating room, and 16 were transported to the operating room after an unsuccessful attempt at airway securement. Advanced airway techniques (fiberoptic bronchoscopy or videolaryngoscopy) accounted for 76% of first-attempt success with airway securement versus 24% for direct laryngoscopy (p<.01). Difficulty with bag-mask ventilation, need for cardiopulmonary resuscitation, and underlying illness predicted lower first attempt success rates (all p <.01). Surgical interventions were required in 17 patients, and 6 patients underwent cricothyroidotomy. There were no airway-related mortalities. Airway anatomy, difficult airway history, and context were associated with equipment selection, transport to operating room, and need for surgical airway.

Conclusion

In this DART implementation, the first attempt intubation success was associated with use of advanced airway techniques and favorable patient characteristics.
Healthcare Policy and Equity in Tracheostomy Care: Navigating Access, Advocacy, and Reform
Authors: Brenner Michael J. , Pandian Vinciya
Published: January 2025

The evolving U.S. healthcare landscape poses significant challenges for individuals requiring tracheostomy care, their families, and healthcare teams. These patients, their care partners, and health professionals face significant medical and social challenges, necessitating coordinated, long-term support to maintain health, prevent complications, and enhance quality of life. While policies like the Affordable Care Act (ACA) and Medicaid expansion have reduced uninsured rates and improved access to critical services, sustaining these gains relies on the renewal of subsidies that broaden coverage. Systemic barriers—including coverage gaps, inequities, and administrative inefficiencies—persist. This commentary explores how healthcare reforms, including Medicaid expansion, enhanced ACA subsidies, and Medicare policy adjustments, can address these barriers. It also highlights the disproportionate burden on low-income and minority populations, as well as the strain on healthcare teams managing complex care needs. Advocacy efforts should focus on expanding coverage, reducing costs, and addressing social determinants of health to promote equitable, high-quality care for all patients.
Outcomes of Patients with Tendinous Mallet Finger Injury Managed with DIPJ Extension Splinting vs Axial Pinning
Authors: Rabino Roel Gabriel , Sibonga Raymar
Published: January 2025

Background: Mallet finger, a common finger injury, results from damage to the distal extensor tendon, causing a flexion deformity at the distal interphalangeal joint. While conservative treatment with splinting is often effective, surgical intervention using Kirschner wire fixation may be necessary for complex cases or non-compliant patients. Objective: This study compared the outcomes of two treatments for tendinous mallet finger: splinting and pinning. Researchers analyzed patient demographics, distal interphalangeal joint range of motion, clinical outcomes, and complication rates between the two groups.
Methodology: We retrospectively reviewed patients diagnosed with tendinous mallet finger injury managed conservatively or surgically from 2018 to 2022 in a tertiary hospital.
Result: Both surgical and conservative treatments were effective, as shown by the excellent total active motion scores and satisfactory qDASH (Disabilities of the Arm, Shoulder, and Hand) outcomes in both groups. However, when comparing the Miller and Crawford criteria, the surgical group consistently showed slightly better functional outcomes.
Conclusion: Both treatments yielded similar results for range of motion, extension lag, and flexion loss, making them equally effective. However, axial pinning may result in better subjective improvement and satisfaction.
ESTAÇÃO DE TRATAMENTO DE RESÍDUOS POLIMÉRICOS PARA A PRODUÇÃO DE FILAMENTOS DE IMPRESSÃO 3D
Authors: Borges Fonseca Nathália Aparecida , Oliveira Santos Vitor Fernando , Kabayama Alfred Makoto
Published: January 2025

Este trabalho aborda o desperdício de resíduos poliméricos na indústria, causado pela reciclagem inadequada. O objetivo geral é demonstrar a viabilidade de implementar uma estação de tratamento dentro da empresa para transformar esses resíduos em filamentos para impressão 3D, ajudando a empresa a se inserir na Indústria 4.0. A metodologia inclui a análise dos fluxos de resíduos e produção, bem como a avaliação dos benefícios e desafios dessa implementação. Os resultados indicam que a reciclagem interna dos polímeros pode reduzir significativamente o volume de resíduos descartados e gerar novos produtos a partir de materiais reciclados. Conclui-se que essa prática, além de promover a sustentabilidade, pode aumentar a eficiência produtiva da empresa, embora existam obstáculos a serem superados, como os custos iniciais e a adaptação dos processos produtivos.
Development Trends in the Clinical Test of Multiple Myeloma from 2000 to 2023: A Bibliometric Study
Authors:   ,   School of Pharmacy and Pharmaceutical Sciences (Institute of Pharmaceutical Sciences), Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan 250117, China, Wu Hongcheng , Sun Haomiao , Wang Yichen , Lv Zehui , Li Yingshuo , Su Fangzheng , Liu Chiyi , Chen Yuxin , Shi Kun , Zhao Pengyu , Wu Xinyu ,   School of Pharmacy and Pharmaceutical Sciences (Institute of Pharmaceutical Sciences), Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan 250117, China
Published: January 2025

Objective: This study investigates the development trends and research hotspots in clinical testing for multiple myeloma from 2000 to 2023, using bibliometric techniques.
Method: Search for relevant literature on clinical testing of multiple myeloma published in the Web of Science Core Collection (WoSCC) from 2000 to 2023, and use CiteSpace 6.2.R4 software to draw a visual knowledge map of authors, research institutions, national and regional cooperation networks, journals, and keywords, and conduct bibliometric analysis.
Results: The study found an upward trend in publications over the specified period, with significant growth noted from 2012 onwards. The majority of research originates from the United States, with significant contributions from institutions like the Mayo Clinic and MD Anderson Cancer Center. Analysis of author collaboration networks indicated relatively low centrality, suggesting minimal collaboration among researchers. Bibliometric mapping highlighted several hotspots in the field including therapeutic strategies involving proteasome inhibitors and immunomodulatory drugs, the role of stem cell transplantation, and the importance of achieving and monitoring minimal residual disease.
Conclusion: The field of clinical testing for multiple myeloma is characterized by a growing body of research, with significant contributions from the United States. Despite the increasing volume of research, there is a need for enhanced collaboration among researchers and institutions to consolidate findings and advance clinical practice.
Impacto económico del megapuerto de Chancay en las pymes
Authors: Tencco Cordova Victoria Magali Ivonne , Arapa Palacios Nicole Jasmine , Quispe Quichua Gabriela Jasmin , Delgado Huanca Maria Silvia
Published: January 2025

El megapuerto de Chancay se erige como un catalizador del crecimiento económico peruano especialmente para las pequeñas y medianas empresas (pymes). Debido a la modernización logística y el acceso directo hacia los proveedores internacionales, principalmente asiáticos, abren un sinfín de posibilidades para que las pequeñas y medianas empresas se expandan y desarrollen. Este artículo explora el impacto económico que tiene este Megapuerto en las pymes, considerando aprovechar al máximo las nuevas oportunidades que se presentan; sin embargo, tendrán que adaptarse y sobrevivir ante nuevos desafíos como los estándares de calidad y eficiencia que exigen los mercados internacionales. La investigación gira en torno a los posibles obstáculos de las pymes, esto implica inversiones en tecnología, capacitación del personal y la falta de apoyo del Estado. Asimismo, es fundamental que las pymes establezcan alianzas estratégicas con otras empresas y organizaciones para fortalecer sus capacidades y mejorar su competitividad ante las empresas grandes.
La escritura alfabética y su rol de memoria artificial
Authors: Contreras Advincula Angely Naomi , Esteban Meza Juan Diego , Reyes Pacheco Lesly Pamela , Guevara Ruiz Agustín Esmaro
Published: January 2025

Con la aparición de los sistemas de escritura, particularmente, la alfabética, los repositorios de información externos al ser humano se convirtieron en los principales medios para almacenar y difundir una amplia gama de información, actuando como una forma de memoria artificial; estos medios artificiales, como tablillas de arcilla, papiros y posteriormente libros, facilitaron el intercambio de ideas entre diferentes culturas y generaciones. Es por ello que en la presente investigación nos proponemos explicar que, con el pasar del tiempo, la escritura se convirtió en una memoria artificial creada por el ser humano, al servicio de este, pues la escritura alfabética fue un medio artificial más, junto a muchos otros, tales como el fuego, la flecha, la rueda, la agricultura, etc. Desde el punto de vista del uso de la metodología, la presente investigación gira en torno a la hipótesis, la misma que sostiene que los sistemas de registro cumplen el rol de una memoria artificial, es decir se trata de un medio depositario de información externa a la naturaleza física del ser humano.
Auditoría De Calidad Para El Mejoramiento Del Proceso Productivo En Plantas Compactas
Authors: Veliz Caicedo Dayanna Dennys , Morán Quimí Johnny Alonso , Santos Carvajal Jonathan Daniel , Perero Reyes William Joel , Sosa Bueno Graciela Celedonia
Published: January 2025

En esta investigación, la auditoría de calidad de las plantas compactas de Aguapen EP, se evaluó el cumplimiento de los estándares y requerimientos bajo la norma ISO 9001:2015 en los procesos productivos. El análisis reveló que, aunque las plantas cumplen en cierta medida con los procedimientos establecidos, persisten algunas áreas con no conformidades, especialmente en la consistencia y control de los procesos, evidenciando un 50,20% de no conformidades y un 49,80% de conformidades en los requerimientos y puntos a evaluar de la norma ISO 9001:2015. A través de la auditoría se evidenciaron los hallazgos más destacados se identificaron deficiencias en la documentación y en el cumplimiento de ciertos procedimientos, lo que genera la necesidad de implementar acciones correctivas. Se identificaron las áreas de oportunidad de mejora y así mismo, la auditoría subraya la importancia de fortalecer la capacitación del personal y fomentar una cultura de calidad y comunicación más sólida dentro de la organización. Esto permitirá reducir la recurrencia de no conformidades y mejorar la efectividad de los procesos. Se concluye que, con las acciones correctivas y preventivas recomendadas para los procesos productivos, Aguapen EP puede optimizar sus procesos, incrementar su eficiencia y asegurar un mayor cumplimiento de los estándares de calidad, beneficiando tanto a la empresa como a sus clientes.
Cacao fino de aroma: Comercio interno en el Ecuador
Authors: Córdova Durán Edmundo Guillermo
Published: January 2025

La investigación examina el comercio interno del cacao fino de aroma en Ecuador, subrayando su impacto en los productores y empresas. Mediante el método de investigación combinado, tanto con técnicas cualitativas y cuantitativas, se examinó elementos primordiales de la cadena de valor del cacao y su avance en la mejora de una economía sostenible en la nación. Los descubrimientos evidencian la relevancia de elementos como la calidad del grano, las acciones sustentables y el enlace emocional que los consumidores tienen con el cacao del país. Se resalta la manera en que las estrategias y la administración impulsan la demanda y aportan al sector agrícola. Este estudio ofrece una perspectiva para comprender el comportamiento del mercado interno del cacao y su importancia a nivel local como en el marco del comercio equitativo y el desarrollo sostenible.
Medidas constitucionais de restauração da ordem pública: reflexões sobre a intervenção federal e os estados de defesa e de sítio
Authors: Gonçalves Francysco Pablo Feitosa
Published: January 2025

O estudo apresenta algumas considerações sobre as medidas constitucionais de restauração da ordem pública, tema que costuma gerar algumas dificuldades entre os que estudam o Direito Constitucional. Para isso, primeiramente avalia em que consiste a ordem pública, suas manifestações em diversos ramos do Direito, sua relação com as instituições, a crise constitucional e a crise constituinte; em seguida, apresenta a ideia de estado de exceção, com base nas obras de Reinach, Schmitt e Agamben, para num terceiro momento analisar o regramento das medidas constitucionais de restauração da ordem – a intervenção federal, o estado de defesa e o estado de sítio –, bem como ponderar se tais medidas consistem em estados de exceção. O estudo dialoga com autores clássicos sobre o tema, estabelecendo uma interface com os fatos políticos e sociais
A abordagem das capacitações (capabilities) e o exercício das liberdades: referências em Aristóteles e Amartya Sen
Authors: Zambam Neuro José , Cenci Ângelo Vitório
Published: January 2025

O objetivo deste artigo é investigar as condições de justiça na abordagem das capacitações (capabilities) ao resgatar a herança de Aristóteles como matriz do pensamento de Sen. O ponto de partida é o vínculo estabelecido por Aristóteles entre ética, economia e justiça. Os conceitos de potência e capacitação subjacentes a ele representam as necessárias condições para a avaliação do sentimento de justiça existente (ou não) no cotidiano. A centralidade do ser humano, a relativização dos mercados e a necessária vitalidade da democracia indicam o vigor desses gigantes da justiça à sobrevivência humana e as condições reais de superação das graves injustiças que ameaçam a equidade política, econômica, ambiental e cultural. Os gigantes, seja da tradição, seja da atualidade, são faróis entre a opulência e a barbárie, assim como uma centelha em direção ao futuro
Tessitura culinária regional brasileira: uma análise das iniciativas de fomento e suas implicações na promoção da saúde e desenvolvimento sustentável
Authors: Martins Natália , Santos Vitor , Sei Alícia , Bezerra José Arimatea , Benevides Selene , Carvalho Diana , Lima Francisca Elisângela , Sousa Paulo Henrique Machado
Published: January 2025

As culinárias regionais têm sido alvo de estudos mundiais. Elas valorizam ingredientes locais, promovem a integração sustentável entre o homem e o meio ambiente, gerando renda e empregos para grupos rurais. Dessa forma, a presença de políticas públicas é crucial para garantir e estimular o regionalismo e as tradições culinárias brasileiras. Assim, tem-se como objetivo verificar as iniciativas de fomento às culinárias regionais brasileiras desenvolvidas no âmbito da Gestão Federal. Trata-se de uma pesquisa documental realizada nos portais do Governo Federal Brasileiro, com levantamento e análise crítica das iniciativas e ações de fomento às culinárias regionais do país. Constataram-se diversas produções dos Ministérios da Educação e da Cidadania, destacando-se a publicação do novo Guia Alimentar para População Brasileira e o Programa Nacional de Alimentação Escolar. Este estudo evidenciou a dimensão e complexidade da culinária regional, tendo em vista a existência de políticas públicas com abordagens na perspectiva da promoção da saúde, da educação em alimentação e nutrição, do turismo gastronômico e do desenvolvimento sustentável.
Receitas autênticas: gastronomias locais e reconhecimento patrimonial
Authors: Cunha Luís
Published: January 2025

Com base no universo das confrarias gastronómicas portuguesas, propomo-nos discutir alguns dos processos de constituição e afirmação de gastronomias locais. Ocupar-nos-emos dos discursos que as três confrarias que escolhemos analisar produzem sobre elas próprias e sobre aquilo que fazem, definindo como pano de fundo os debates sobre património. A retórica patrimonialista, que serviu a consolidação dos nacionalismos oitocentistas e que serve hoje os mecanismos de integração da diversidade em narrativas globais, tem na gastronomia uma expressão exponenciada desses processos. Esta constitui-se afirmando singularidades, que alguns agentes, como os que integram as confrarias, procuram proteger. Por outro lado, a gastronomia, ao revitalizar-se pela permanente incorporação de novos produtos, saberes e sabores, sem deixar de dar resposta ao que a torna património, busca um reconhecimento tão vasto quanto possível. Será sobre estas diferentes camadas narrativas, geradas no balanceamento entre a defesa de gastronomias locais e nacionais e a incorporação do valor patrimonial consagrado no plano global, que nos ocuparemos neste texto.
Antes de “Comer com os Olhos”: a experiência de um curso de processos de criação e empratamento para Gastronomia
Authors: Borges Rangel Carraro Toledo , Lima Paula Garcia , Gandra Tatiane Kuka Valente
Published: January 2025

Este artigo tem como objetivo discorrer acerca de um curso de processos de criação e empratamento intitulado “Laboratório de Criação em Gastronomia”, ocorrido no  Curso Superior de Tecnologia em Gastronomia da Universidade Federal de Pelotas, entre os meses de agosto e novembro de 2023. Utilizando uma abordagem qualitativa de pesquisa-ação, abordaram-se temas como teoria das cores, fotografia, criatividade, food styling, dentre outros. Os resultados indicaram que a experiência proporcionou aos participantes um desenvolvimento significativo de suas habilidades criativas, o que permitiu criar pratos autorais e aprimorar suas técnicas de apresentação. A partir do retorno dos participantes foi possível sugerir uma metodologia para criação de pratos e menus degustação na gastronomia, a ser utilizada em sala de aula. As conclusões apontam que o curso pode se tornar uma ferramenta valiosa para a formação de gastrônomos, podendo se tornar uma disciplina para o Curso Superior em Gastronomia, desde que sejam adicionadas algumas temáticas importantes para um melhor aproveitamento da ação.
The Role of Vietnamese Mourning Culture in Grief Symptomatology – A Study Protocol
Authors: Le Huy Hoang , Piccolo Mayron , Killikelly Clare
Published: January 2025

Losing a loved one is a universal and inevitable part of life; however, the way that bereaved individuals grieve and cope with loss varies between cultures. Culturally bound symptoms of disordered grief often go unnoticed when assessed with Western-developed diagnostic tools. Additionally, culturally significant funerals and rituals to be carried out during the mourning period may serve an important role in defining the expression and presentation of grief. Funeral and mourning activities following the death of a family member in Viet Nam span over one year, consisting of rituals to be carried out forty-nine days, one hundred days, and one-year post-loss. No previous study has assessed the course of grief symptoms of Vietnamese bereaved throughout the mourning period using a culturally adapted scale. This paper describes the protocol for the research that aims to examine the possible protective and supportive role of traditions, rituals, and other ceremonies for bereaved individuals. The results are expected to reveal that participating in ritual activities predicts a better grief trajectory. These results would suggest the consideration of cultural contexts in the assessment and treatment of pathological grief. The project would not only contribute to the cross-cultural understanding of grief but also highlight the importance of local cultural practices in grief recovery.
Scaling for Success: Organizing for Rapid Growth
Authors: Westover Jonathan
Published: January 2025

The article examines the critical elements leaders must address to successfully scale a startup company without losing control or efficiency. As a startup grows rapidly, it must evolve its organizational structure, processes, and culture to support expansion. The article outlines key strategies, including departmentalization to gain focus and specialization, implementing strong communication channels to prevent silos, aligning hiring with strategic goals, streamlining the hiring process, and cultivating a values-driven culture that is maintained through rapid growth. It also emphasizes the need to continually refine the organization, such as iterating department models and enabling internal mobility, to sustain strategic alignment and agility. Drawing on research and industry examples, the article provides a comprehensive framework for how startups can structure their operations to maximize the opportunities of scaling while mitigating the risks of uncontrolled growth.
MODERATE EXERCISE AND ANTIOXIDANT DYNAMICS: UNRAVELLING THE INFLUENCE OF FAMILY HISTORY IN PREDIABETES
Authors: Shah Zubia , Shah Inayat , Malik Muhammad Omar , Fayyaz Fatima
Published: January 2025

Objectives: This study investigates the effects of moderate-intensity physical activity on glycemic control and antioxidant capacity in prediabetics, regardless of whether they have a family history of diabetes.
Methods: It was conducted at the Physiology Department of the Institute of Basic Medical Sciences in Peshawar, Pakistan. The study included a cohort of 50 adult participants who were diagnosed with prediabetes. Out of the total, 25 individuals had a positive family history of diabetes (PFHG), and the other 25 had a negative family history (NFHG). The group consisted of 22 females and 28 males, whose ages ranged from 18 to 35 years. The diagnosis of prediabetes was made based on glycated hemoglobin values falling between 5.7-6.4% and impaired fasting glucose levels ranging from 100-125 mg/dL. Anthropometric measurements and biochemical testing were conducted before and after the exercise session. The Participants engaged in moderate exercise for 30 minutes, with a maximum heart rate of 70% ± 5%, five days a week for eight weeks. Their exercise was tracked using a pedometer. An enzyme-linked immunosorbent test (ELISA) was conducted to measure both individual and total antioxidants.
Results: Anthropometric measurements, fasting blood glucose (P<0.001), and glycated hemoglobin (P<0.001) showed significant changes at post-intervention. A slight rise in uric acid levels (P<0.005) and a substantial increase in total antioxidant concentration (P<0.001) was observed. Peroxidase, vitamin C, and nitric oxide significantly dropped (P<0.001).
Conclusion: Engaging in moderate physical activity for 8 weeks, there was a notable decrease in the levels of individual antioxidants. Additionally, there was a slight increase in overall antioxidant capacity and uric acid. Both groups experienced an apparent fall in their anthropometric measurements and diabetes profile.
LOW SERUM ADIPONECTIN AND HIGH SERUM LEPTIN LEVELS FOUND IN WOMEN WITH HYPERTENSIVE DISEASES OF PREGNANCY COMPARED TO NORMOTENSIVE PREGNANT WOMEN
Authors: Gul Shabnam , Muhammad Gul , Khan Muhammad Salman , Mariyum Sara , Hashmi Hijab , Tirimzi Syed Soban Ahmed
Published: January 2025

Objective: The study aimed to compare serum leptin and adiponectin levels between women with hypertensive diseases of pregnancy (HDP) and normotensive pregnant women and to evaluate their associations with Body Mass Index and blood pressure.
Methodology:  A cross-sectional study was conducted at the outpatient department of Hayatabad Medical Complex, Peshawar, from 12thAugust 2024 to12th November 2024. A total of 125 participants were divided into two groups: women with hypertensive diseases of pregnancy (HDP; n = 62) and normotensive pregnant women (n = 63). Serum levels of leptin and adiponectin were measured using enzyme-linked immunosorbent assays (ELISA). Body Mass Index (BMI) and blood pressure were recorded and classified. Data were analyzed using descriptive and inferential statistics in SPSS
Results: Women with HDP had significantly elevated serum leptin levels (45.2 ± 9.6 ng/mL) and decreased adiponectin levels (3.8 ± 0.9 µg/mL) compared to the normotensive group (leptin: 27.8 ± 7.1 ng/mL; adiponectin: 5.6 ± 1.2 µg/mL). Correlation analysis revealed a positive association between leptin levels, Body Mass Index (BMI), and blood pressure (systolic and diastolic). Conversely, adiponectin levels showed a negative association with BMI and blood pressure. These findings highlight the potential role of these biomarkers in the pathophysiology of hypertension during pregnancy.
Conclusion: In conclusion, Elevated levels of leptin and reduced adiponectin are associated with hypertensive diseases during pregnancy. These biomarkers could serve as likely indicators for early detection and management of HDP.
EXPLORING THE SILENCE: BARRIERS TO MEDICAL ERROR REPORTING IN UROLOGY
Authors: Ullah Rizwan , Asim Nowshad , Khan Naveed Afzal , Jamil Brekhna , Ali Syed Muhammad Shabbir , Wajid Summaya
Published: January 2025

Objective: To explore barriers to medical error reporting among urology healthcare professionals at tertiary care hospitals in Peshawar.
Methodology: This qualitative study utilized a case study approach. Maximum variation purposive sampling was employed to select faculty of Urology (assistant professor and above) with at least two years of experience, resulting in five interviews using a structured interview guide. The interviews were recorded, transcribed, and analyzed through thematic inductive analysis. Data collection and analysis were done concurrently.
Results: Four main themes precipitated from the data. Understanding the medical error landscape focuses on what constitutes a medical error. Reporting Roadblocks identified the barriers to reporting medical errors. Institutional Bottlenecks originate from the hurdles in the healthcare system to report medical errors. The last theme, pathways to progress, shows how to improve the process of reporting medical errors.
Conclusion: The study highlights the complex systemic, organizational, and human factors contributing to the underreporting and mismanagement of medical errors in urology units. Addressing these challenges is essential for advancing patient safety and fostering a culture of accountability in healthcare.
EXPLORING THE RESEARCH JOURNEY: BARRIERS AND FACILITATORS FOR POSTGRADUATE MAXILLOFACIAL TRAINEES
Authors: Fahimuddin  , Khan Naveed Afzal , Khan Muslim , Kayani Harmain , Durrani Mushyyada , Zakariya Muhammad
Published: January 2025

Objective: To explore the Barriers and Facilitators for research in Postgraduate Maxillofacial Trainees.
Methodology: Exploratory Qualitative study design (Case study) was adopted. A ten-question questionnaire was developed and piloted to identify the different perceptions of maxillofacial Trainees. Purposive Sampling was used to conduct eight semi-structured interviews. Thematic analysis was undertaken with Triangulation of transcripts.
Results: Five main themes emerged from the data analyses. Research as a Path to Innovation showed research as a means of pushing boundaries and advancing knowledge. Motivation to Make a Difference outlined that the motivation for conducting research stems from personal passion and external pressures. Hurdles on the Research Path portrays the barriers in the research journey. Fueling Research Success highlights the facilitators in this journey. Nurturing Research Skills for Tomorrow shows the path to improve research skills among trainees.
Conclusion: Maxillofacial surgery residents face significant barriers in their research journey. Despite these obstacles, their intrinsic motivation and the requirement for academic publishing drive their research efforts. To improve research outcomes, early exposure to research, continuous training, and institutional support are essential.
STUDY OF THE EFFECTIVENESS OF MOTIVATIONAL INTERVENTIONS IN THE TREATMENT OF PANIC DISORDER: CLINICAL FEATURES
Authors:   Dagestan State Medical University, Ismailova A.S. , Bigishiev G.K. ,   Dagestan State Medical University
Published: January 2025

The aim of the study is to evaluate the effectiveness of motivational and individualized interventions in treating patients with panic disorder at the primary health care level. Materials and methods. The study was conducted from March 1, 2023 to July 1, 2024. This randomized, parallel-design trial was conducted to minimize physician impact. Participants were screened using OASIS and PHQ, and participation was confirmed through diagnostic interviews and MKB-10 checklists. The intervention group received specific CBT-based training and accompaniment. Assessment was performed at 6 and 12 months using BAI and PHQ-9. Results. The study found that the use of individualized and motivational approaches significantly increased patient adherence in the intervention group, increasing it to 80%. This indicates a more active participation of patients in the process of therapy and an increase in their motivation. In addition, there was a significant decrease in depression: PHQ-9 scores decreased from 9 to 6 at 12 months, indicating an improvement in the psycho-emotional state of the participants. These results highlight the effectiveness of implemented strategies in improving the condition of patients with panic disorder and comorbid depression. Conclusions. The effectiveness of individualized and motivational interventions was confirmed: they improved treatment adherence and reduced the severity of symptoms. Long-term observations confirmed the robustness of the effect, suggesting the importance of a comprehensive approach to panic disorder therapy at the primary health care level.
REMOVAL OF BROKEN INSTRUMENTS FROM ROOT CANALS: ULTRASONIC ANALYSIS AND ITS EFFECTIVENESS
Authors: Golova V.L.
Published: January 2025

The goal is to evaluate the effectiveness of methods for extracting broken files from root canals and their impact on tooth strength. Materials and methods. The study used 25 chlorhexidine-treated double-rooted maxillary premolars. Samples were divided into experimental and control groups. The experimental group underwent complex procedures for extracting damaged instruments with various localizations, the results of which were analyzed using statistical methods. Results. In the experimental group, 80% of broken instruments were successfully extracted, especially effectively in the middle part of the root. Although the control group required slightly more effort to break down the root, no significant differences in strength were noted between the groups. Conclusions. The ultrasonic extraction method is effective for removing broken instruments, minimally affecting tooth strength. Careful planning of procedures, taking into account the configuration of the channels, significantly increases the chances of successful deletion.
Security Infrastructure Service and Information Security Management Capability Audit to Improve System Security in Preventing Cyber Attacks using COBIT 2019
Authors: Salim Salim , Muhammad Alva Hendi
Published: January 2025

Cyber-attacks have become a serious concern in recent years, as hackers can attack systems, databases, and even steal personal data from a particular organization's database and sell it on the dark web. The individual identity data will be used to carry out various financially profitable activities such as online fraud, selling data containing detailed account information, and asking for ransom from data owners. The failure of an organization to protect data assets from cyber-attacks stems from several internal factors such as the vulnerability of the information security system it has, the less than optimal awareness of users in the organization of the importance of maintaining safe behavior in cyberspace, and routine processes related to information security that are missed. COBIT 2019 can be used as an audit framework to assess the level of maturity of the governance. Network infrastructure services in an organization can be measured in terms of the level of capability in terms of the application of technology assets and their configuration using the DSS05 and APO13 domains. This study aims to provide guidelines in assessing system security infrastructure in IT governance by assessing areas that are still not comply with the framework used, and providing recommendations for improving these inconsistencies so that the level of infrastructure capability will be maximized then.
Born Healers, Not Leaders: The Hidden Weakness of Medical Education
Authors: Bennett Steven , Kelly Brendan , Messmer Madison , Shepard Samuel , Scott Gavin , McDermott Michael , Bamberger Brent
Published: January 2025

Background
Leadership is a critical element in achieving both personal and professional success, particularly in healthcare where team collaboration is essential. A strong leader who can effectively communicate, assign roles, and delegate responsibilities is often the driving force behind a successful team. However, leadership skills are notably lacking among frontline physicians, largely due to the insufficient emphasis on leadership development in medical training.  Some programs have begun incorporating leadership training for their residents and students, finding it valuable, recommending other programs to adopt similar initiatives. 

Purpose
To standardize leadership training in medical education, we first must distinguish leadership from management. With this in mind, the purpose of this study is to define leadership in the clinical setting, and assess how medical trainees perceive it and its potential integration into their training. 

Methods
A survey was sent to residents of a community-based training hospital. The de-identified survey consisted of 10 multiple-choice and multiple-answer questions defining leadership, interest in leadership training, confidence in personal leadership, and perceived necessity for formal leadership training. Demographics such as year in training, specialty, and gender were also collected for analysis. Data was collected and analyzed through SurveyMonkey. 

Results
Twenty-one (21) responses were received, consisting of eleven (11) male and ten (10) female participants. The respondents ranged from first postgraduate year (PGY-1) residents to those finishing their residency (PGY-5), with the largest number of respondents in postgraduate year 3.  The specialties with the highest number of responses were Family Medicine and Orthopedic Surgery , each accounting for 19% of total respondents. 100% (21/21) of respondents stated some attending physicians were better leaders than others, with 66.7% (14/21) stating the most important characteristic of these leaders is the ability to communicate effectively, listen actively, and build strong relationships with others. 24% (5/21)  of respondents stated they did not believe medical school and residency alone prepared them to be adequate leaders with 43% (9/21) stating leadership training should be incorporated into residency programs and 24% (5/21) stating leadership training should be incorporated into all phases of medical training, including as attending physicians. 

Conclusions
Nearly all respondents agreed that leadership training should be a part of medical education, with over half emphasizing its value in improving networking and mentoring in their roles as physicians.  Respondents highlighted communication and relationship-building as key leadership traits, and noted their medical education lacked direct preparation in these areas.  Leadership skills are vital for success in healthcare, and should be prioritized in medical training.
Maintaining a Cement Spacer for the Treatment of Bony Voids in Complicated Fracture Nonunions
Authors: McDermott Michael , Rebic Ante , DiPasquale Luke , Steimle Jerrod
Published: January 2025

Background
Fracture nonunion is a rare but devastating outcome that can result in significantly increased morbidity and a lengthy recovery for the patient. In the cases of septic nonunion, treatment options include IV antibiotics and debridement of all nonviable bone. While this approach is often successful at clearing infection, it can result in a substantial bony void. To combat these defects, many surgeons have implemented multi-stage procedures such as the Masquelet technique (MT). MT is a well-studied concept that consists of debridement and the placement of an antibiotic cement spacer. After the infection has cleared, the second procedure removes the spacer and fills the void with bone graft. While successful, this multi-stage procedure can be associated with significant patient burden, a long, non-weight-bearing period, and an overall lengthy recovery. This case series highlights a variation of the standard MT technique, utilizing concepts of cement augmentation for fracture treatment while reducing the need for the second stage of the procedure.

 Case Series
In this retrospective series, four consecutive patients with complicated fracture nonunions were subjected to a first-stage MT procedure with placement of an antibiotic polymethylmethacrylate cement spacer and definitive hardware placement. These nonunions included two distal femur fractures, a spiral humeral shaft fracture and a clavicle fracture. These four patients demonstrated good bone healing and quickly returned to their baseline activity levels. In each case, elective permanent retention of the cement spacer was discussed, and exchange for bone graft was only performed on an as-needed basis. All patients went on to develop bridging bone around the spacer with full healing of the adjacent cortices. 

Conclusions
Maintaining the cement spacer allowed these patients to regain function quickly and return to their daily living activities while eliminating the risks associated with a second procedure.
La pesca pirata
Authors: Carril Vázquez Xosé Manuel
Published: January 2025

La definición jurídica de pesca pirata no hace referencia a condiciones de trabajo y de protección social. Al margen de la paradoja que supone hablar de actividades de pesca lícita cuando hay verdaderos déficits de trabajo decente en su realización, lo cierto es que —desde un punto de vista jurídico— puede resultar inútil insistir en que existan unas buenas condiciones de trabajo en los buques de pesca pirata por causa de que es la propia ilegalidad de la actividad pesquera la que ampara y ocasiona la inexistencia tanto de un trabajo decente como de una mínima protección social. Por ello, se defiende la necesidad de incluir en la delimitación jurídica de pesca pirata aquella que se realiza en condiciones de trabajo y de protección social que son inaceptables de acuerdo con el derecho internacional del trabajo y de la seguridad social e incompatibles con los convenios de la Organización Internacional del Trabajo (señaladamente, su Convenio número 188, que ha sido incorporado al Derecho de la Unión Europea a través de la Directiva 2017/159), en la medida en que, además de garantizar un trabajo decente, esta inclusión de normas mínimas de trabajo permitiría descubrir prácticas de pesca pirata. Y también por ello, se propone vincular la realización de la actividad pesquera al respeto de las normas mínimas de trabajo que figuran en citado Convenio número 188, mediante su incorporación en el contenido de los acuerdos internacionales de pesca, a modo de «cláusula social» (al igual que en los Acuerdos de Libre Comercio).

Esta «cláusula social» operaría —desde un punto de vista jurídico-social— como medio de protección laboral, pero también —desde un punto de vista económico— como medio para acabar con la competencia desleal de quienes, incumpliendo tales normas laborales, alteran la competencia con la práctica del dumping social, en la medida en que su neutralización podría conseguirse empleando los mismos medios adoptados contra las prácticas que son desleales y que, en este caso, además de sanciones económicas, podrían suponer la inmovilización del buque, la suspensión inmediata de la licencia de pesca o su denegación posterior.
Nuevos retos en la salud laboral de la mujer
Authors: Romero Coronado Mª Ángeles
Published: January 2025

El presente estudio encuentra justificación en la complejidad y amplitud de la situación actual de la protección de la salud de las mujeres en el puesto de trabajo, desde una perspectiva no discriminatoria y promotora de la igualdad, que plantea constantemente nuevos interrogantes (retos) acerca de la regulación legal.

Esta situación viene motivada por el conjunto de bienes jurídicos protegidos de la normativa constitucional y preventiva, referidos no solo a la protección de la integridad física de las trabajadoras, sino también a un fuerte componente de tutela antidiscriminatoria de esta regulación.

Con esta monografía se pretende no solo poner de relieve los problemas técnico-jurídicos y sociales de la salud laboral de la mujer en la actualidad, sino dar respuesta mediante una visión global e integradora de los diversos intereses en juego mediante la propuesta de algunas acciones específicas que pueden ser de gran utilidad.
Las integraciones económicas: Concepto, taxonomía y efectos
Authors: Sevilla Duro Miguel Ángel
Published: January 2025

Este libro busca desarrollar una teoría general sobre las integraciones económicas, ofreciendo un enfoque integral y sistemático frente al análisis tradicional, a menudo casuístico y eurocéntrico. En un contexto donde todos los Estados participan en procesos orientados a la armonización o unificación económica, esta obra aborda la falta de un marco teórico básico que explique de manera inductiva y holística su configuración, estructura, evolución y finalidad.La monografía comienza explorando el contexto general de las integraciones, marcado por la globalización, y analiza estas construcciones interestatales desde siete perspectivas complementarias: metodológica, conceptual, histórica, tipológica y estructural, funcional y teleológica, sociopolítica y empírica. Además, incorpora un innovador análisis económico que examina los factores que condicionan la evolución del flujo comercial en todas las integraciones económicas vigentes.Este estudio constituye un aporte único al campo, al ofrecer una visión multidimensional y operativa sobre los procesos de integración económica, sentando las bases para una comprensión más profunda y global de estos fenómenos.
Analysis of the Influence of Technological Development on Traditional Market Activities
Authors: Ziahh Fau , Hartono Rudi , Heryadi Adie
Published: January 2025

Purpose of the research This is to see how the influence of technological developments impacts conventional market activities. This research focuses on interactions between traders and consumers, operational efficiency, and competitiveness with contemporary markets. 
Research methods This is a qualitative descriptive, and case study conducted in several traditional markets that have used technology such as electronic payment systems and digital marketing applications. Apart from interviews and direct observations with traders and consumers, data was collected through research into related literature.Research result shows that technology impacts traditional markets in a dual way: it increases transaction efficiency and opens markets to traders who are able to adapt. However, some traders face difficulties understanding and implementing new technology. Apart from that, pressure from modern markets to adapt to faster technology also affects the sustainability of traditional markets.
In order for traditional market traders to remain competitive in the face of change, this research recommends that they need technology training programs and policy support from the government to support technology integration in traditional markets so that they can compete fairly in the digital era.
DEVELOPMENT OF WORDWALL EDUCATIONAL GAME-BASED EVALUATION INSTRUMENTS IN MATHEMATICS SUBJECTS IN CLASS IV SDN LALADON 02 BOGOR REGENCY FY 20232024
Authors: Fadillah Farid , Arief Zainal Abidin , Raini Yeni
Published: January 2025

The learning process has been transformed into a form of learning that uses technology, especially the internet. With advances in technological tools in the education sector, researchers are developing existing evaluation tools by utilizing websites Wordwall. The results of the needs questionnaire show that teachers have not used evaluation tools to determine student grades. In the assessment process, teachers still apply traditional methods such as paper exams. Therefore, there is a need for evaluation tools that can expand students' ways of thinking when learning. The aim of this research is to determine the feasibility of an educational game-based evaluation instrument Wordwall in Mathematics subjects in class IV SDN Laladon 02 Bogor Regency. This research method uses R&D using the Borg and Gall model using the Borg and Gall model development procedure adapted by Sugiyono, however this research only uses 8 stages out of 10 research stages because it is limited by researchers according to research needs and ongoing developments. The subjects of this research were fourth grade students at SDN Laladon 02, Bogor Regency. This research creates an educational game-based evaluation tool Wordwall using interview, observation and questionnaire data collection methods. The data analysis technique used is product feasibility testing. The research results showed that the feasibility test by media expert validation was 71% (feasible), language experts were 72% (feasible), learning design experts were 89.3% (very feasible), and material experts were 92% (very feasible). Furthermore, the results of individual trials were 81.6% (very feasible), and small group trials were 80.4 (feasible). The research results show that the evaluation tool is based on educational games Wordwall mathematics for class IV is considered suitable for use in the learning assessment process.