bluuebunny/crossref_metadata_2025 huggingface dataset:
Innovative 3D Heterogeneous Chip Manufacturing Approach to the Problem of Approaching Physical Limits with Traditional Chip Manufacturing Technologies
Authors: Conger Muhammed , Develi İbrahim
Published: May 2023

The 3D heterogeneous chip manufacturing approach is an innovative technological approachthat has significant future potential. This innovative manufacturing process enables different semiconductormaterials to be used in a single chip. It also offers higher performance and more functionality thantraditional chips. 3D heterogeneous chip fabrication is accomplished by combining different semiconductormaterials. These materials may include semiconductors with different electronic properties. While allcomponents are made of the same semiconductor material in traditional chip manufacturing processes, amore complex and advanced structure is obtained by using different materials together in 3D heterogeneouschip production. 3D heterogeneous chip production brings many advantages thanks to the combination ofdifferent materials. Another advantage is to increase energy efficiency with 3D heterogeneous chipproduction. Using different materials together and in a single chip makes it possible to manage energy moreefficiently. Another advantage is that the more complex and dense logic circuits of 3D heterogeneous chipfabrication can be located on the same unit square and on top of each other. In this context, this studypresents the technical details and potential risks of the proposed solution method, along with end-to-endchip production, for the resolution of the mentioned problem.
IoT Technology in Smart Agriculture
Authors: Cihan Pınar
Published: May 2023

– In recent years, IoT technology has been increasingly used in the agriculture sector, making itsmarter with its usage. This study examines the application areas of IoT technology in the agriculture sector,the advantages it provides, and the necessary equipment for these applications. IoT technology providesadvantages in improving efficiency, reducing production costs, increasing product quality, ensuringsustainability, and facilitating resource management in the agriculture sector. There are various applicationsin agriculture, such as smart greenhouse systems, soil moisture and temperature sensors, automation offarming machinery, animal tracking and health monitoring, plant disease and pest monitoring, grain storagemonitoring, data analysis, and artificial intelligence. The necessary equipment for IoT applications includessensors, actuators, wireless networks, data storage and processing devices, cameras and imaging systems,and GPS devices, allowing farmers to collect real-time data on weather conditions, soil moisture levels,plant diseases, and pests in their fields. This study explains the advantages and application areas of IoTtechnologies in the agriculture sector, demonstrating to researchers and farmers how to use them to increaseefficiency and ensure sustainability in the agriculture sector. Additionally, the study identifies the necessaryresources for the implementation of these technologies, including the required equipment for IoTapplications. Therefore, this study can be beneficial in the decision-making process of researches andindustry leaders who follow innovative applications and technologies in the agriculture sector.
Muerte por amebiasis intestinal crónica en paciente inmunosuprimido
Authors: Verdugo-Barrera Janny Fernanda , Celaya-Sandoval Héctor Esteban , Cardoza-Amador Jorge Isaac
Published: May 2023

La amebiasis intestinal es una infección parasitaria gastrointestinal provocada por la ameba Entamoeba histolytica, la cual ya tiene un tratamiento específico con resultados favorables para la mayoría de los pacientes. El fallecimiento aún tras seguir el tratamiento recomendado es algo poco común y por lo cual el caso debe estudiarse con el fin de determinar la verdadera causa de muerte. En esta presentación se examina el historial de un paciente masculino de 48 años que declara toxicomanías para cristal. Ingresa por dolor abdominal tipo punzante, acompañado de evacuaciones diarreicas con moco y sangre, además de fiebre no cuantificada. Por el primer ingreso, se administra solución Hartmann, además de ciprofloxacino y tratamiento sintomático, a partir de ello se da el primer egreso del paciente, el cual declara supuesta mejoría. Siete días después, reingresa el paciente por complicaciones asociadas al padecimiento; se realiza inmediata cirugía donde se observan perforaciones de colon de hasta 1 cm de diámetro, finalmente debido a una septicemia el paciente fallece.
La visión de una nueva psiquiatría: neurotransmisores y nuevos fármacos
Authors: Peterson-Beltrán Luis David , Durazo-Durazo Diana Margarita
Published: May 2023

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Trastorno obsesivo-compulsivo: más que una obsesión
Authors: Contreras-Contreras Alejandro , Rodríguez-Contreras Marla Lourdes
Published: May 2023

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Traumatismo craneoencefálico
Authors: López-Oviedo Alejandro , Huaranga Castro Frida María
Published: May 2023

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Panel: EVC
Authors: Gámez Rosa María , Valle-Armenta Eleazar , Antillón-Valenzuela Joaquín Enrique , Espinoza-Larios Adolfo , Aguirre-Bañuelos Ramón
Published: May 2023

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Exploración sistematizada del paciente con alteración en urgencias
Authors: Gámez Rosa María , Espinoza-Luna Ana Karen
Published: May 2023

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Terapia endovascular en ENEVC
Authors: Amaya-Sánchez Luis Enrique , Gamboa-Del Castillo Laura Vianey
Published: May 2023

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Trastornos de la conducta alimentaria
Authors: Pérez-Beltrán Fernando Jesús , Tobin-De La Vara Aylin Alejandra
Published: May 2023

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Convulsiones en la infancia: generalidades de epilepsia y abordaje de las crisis febriles
Authors: Rodríguez-Treviño Karen Ivette , Durazo-Durazo Diana Margarita
Published: May 2023

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Las técnicas skimming y scanning como estrategia didáctica de lectura en el quinquenio 2019-2023
Authors: Wong Paredes Jacqueline Silvia
Published: May 2023

Este trabajo tiene como principal propósito realizar un análisis de los principales hallazgos con relación a las técnicas skimming y scanning como estrategia didáctica de lectura en el quinquenio 2019-2023. Asimismo, el estudio es de tipo revisión sistemática, puesto que localiza literatura importante que se acopla a los juicios de inclusión/exclusión anticipadamente definidos. Fueron seleccionados 40 artículos científicos de los buscadores académicos Redalyc, Dialnet, Scielo, y Google Académico, la mayor cantidad de investigaciones se localizó en Indonesia (23). En el 67.50\% de los artículos se aplicaron cuestionarios. Entre los principales aportes se consideró que esta estrategia tiene un gran impacto en la capacidad de lectura de los estudiantes. Concluyendo que la principal ventaja del skimming es el repaso ágil de textos que se han estudiado, mientras que a través del scanning se logra localizar información concreta en un texto. Se recomienda que, se emplee la técnica skimming, a causa de que es de utilidad para encontrar información general y ser utilizado en la pre-lectura, entre tanto el scanning contribuye a la identificación de términos que sirvan como guía para comprender el contenido del tópico.
Inovasi Sistem E-Kasir untuk Meningkatkan Kinerja Usaha KUD Sawit Jaya
Authors: Nasari Fina , Nofiar. Am Andri , Pribadi Antoni , Fitri  , Oktorina Fenty Kurnia , Ridwan Muhammad , Triyanto Slamet , Patitis Niken Ellani , Veronika Nina , Deli Nur Asma
Published: May 2023

The Sawit Jaya Village Unit Cooperative (KUD) in Tapung District, Kampar Regency, Riau still uses a manual cashier system in the sales transaction process, which is time-consuming and labor-intensive. Therefore, innovation is needed by building an electronic cashier system that can improve the performance of the Sawit Jaya KUD business. The aim of this community service is to improve the effectiveness and efficiency of the sales transaction process of the Sawit Jaya KUD by implementing an electronic cashier system. The methods used in this community service include discussions, data collection, system design, system development, system implementation, training, and report writing. The results of this community service show that the electronic cashier system has successfully improved the performance of the Sawit Jaya KUD business and can help in producing more accurate and efficient sales reports. Thus, the implementation of an electronic cashier system can be a solution to improve the business performance of the Sawit Jaya KUD.
Perawatan Pompa Air untuk Sarana Air Bersih Mushalla Al-Muhajirin Desa Blang Krueng Kabupaten Aceh Besar
Authors: Suhaeri  , Syukri Mahdi , Alfisyahrin  , Adria Agus , Syukriyadin  , Ali Masri , Ali Nurdin , Machmud M. Nizar , Huzaim  , Saiful
Published: May 2023

Community service activities are carried out to maintain water pumps in the Al Muhajirin Mushalla clean water facility in Blang Krueng Village, Aceh Besar District, to address the problem of the availability of clean water in the area. The project team carried out several stages during the week, including observation, problem identification, planning, implementation, and evaluation. Observations were made at clean water facilities to identify existing problems. The results showed that the water pump used in the clean water facility was damaged and not functioning properly. Therefore maintenance is needed to repair the water pump so that clean water facilities can function properly. After identifying the problem, the team plans to maintain the water pump by replacing damaged components and cleaning the contaminated parts. Clean water facilities in Mushalla Al Muhajirin can function properly after maintenance, and the availability of clean water in the area increases. Evaluation is carried out to determine the success of maintenance. The evaluation showed that the maintenance was successful in increasing the availability of clean water, and the local community felt that this improvement helped. In conclusion, the water pump maintenance project at Mushalla Al Muhajirin succeeded in increasing the availability of clean water. This community service project is expected to inspire and guide other communities in improving their clean water facilities.
Strategi Pemberdayaan Masyarakat dalam Meningkatkan Partisipasi dalam Pembangunan Desa Payakameng
Authors: Masri Mohd. Andalusia , Ibrahim Mifzal , Hadi Marta
Published: May 2023

Community service in village development aims to strengthen community participation in planning, budgeting, and evaluating the results of village development in a more participatory manner. This study used a participatory and qualitative approach with data collection techniques through focus group discussions, interviews, and field observations. This service is focused on training and skills provision for community members in planning, budgeting and evaluating village development programs. The results of the service show that through training and skills provision, community members are able to increase their participation in planning, budgeting and evaluating village development results. In addition, community service also encourages the creation of synergies between the village government and the community in strengthening community participation in more inclusive and sustainable village development. Thus, community service can be one of the solutions to strengthen community participation in more participatory and sustainable village development.
Partisipasi Masyarakat dalam Program Penyediaan Air Minum dan Sanitasi Berbasis Masyarakat (PAMSIMAS) Tahun 2022 di Desa Batu Putih Kabupaten Konawe Selatan
Authors: Ibal La , Abubakar Endang
Published: May 2023

Efforts to overcome the problem of the availability of clean water in Indonesia are by involving community participation in the planning, implementation and maintenance of clean water facilities and infrastructure in the community. This service aims to find out the form of community participation in supporting the clean water availability program in Batu Putih Village. The service uses a qualitative descriptive analysis. Forms of Community Participation in the PAMSIMAS Program in Batu Putih Village, East Kolono District, Konawe Selatan District are (1) Planning, forms of community participation appear in the planning, implementation and maintenance stages. In the planning stage, community participation in the PAMSIMAS Program is in the form of contributions; (2) Implementation, Pamsimas activities are carried out after the disbursement of funds, community participation is mutual cooperation when clearing land for the manufacture of clean water storage tanks; (3) Operational and Maintenance, community participation is to keep the Pamsimas infrastructure that has been built running well; and (4) Strengthening Sustainability, community participation is participating in bookkeeping training and training to repair damaged equipment and so on.
ՌՈՄԱՆԱԳԵՐՄԱՆԱԿԱՆ (ՄԱՅՐՑԱՄԱՔԱՅԻՆ) ԻՐԱՎԱԿԱՆ ԸՆՏԱՆԻՔԻ ԸՆԴՀԱՆՈՒՐ ԲՆՈՒԹԱԳԻՐԸ ԵՎ ԱՌԱՆՁՆԱՀԱՏԿՈՒԹՅՈՒՆՆԵՐԸ
Authors: VARDANYAN RAFAEL , SHUKURYAN ARMEN
Published: May 2023

The article thoroughly discusses and focuses on the general characteristic features of the Romance and Germanic (continental) legal family, in particular, the concept of law, its sources, codification problems and other related issues.
ԱՌԱՆՁԻՆ ՏԵՍԱԿԻ ՎԱՐՉԱԿԱՆ ՎԱՐՈՒՅԹՆԵՐԻ ԻՐԱՎԱԿԱՆՈՒԹՅԱՆ ԸՆԴՀԱՆՈՒՐ ՉԱՓՈՐՈՇԻՉՆԵՐԸ
Authors: AVAGYAN NORAYR
Published: May 2023

The article “General definitions of the legality of certain types of administrative proceedings” includes valuable opinions on important theoretical and practical issues regarding administrative proceedings. The author has emphasized that that based on the goals and problems of a different type of administrative proceeding, it can have, and even needs to have, features in order to correspond to the scope of legality of the given process, the criterion of which is the “effectiveness” principle of the constitution
ԱՐՏԱՎԱՐՈՒԹԱՅԻՆ ՓԱՍՏԱԹՂԹԵՐԻ ՎԵՐԱԾՎԵԼՈՒ ՕՊԵՐԱՏԻՎ-ՀԵՏԱԽՈՒԶԱԿԱՆ ԳՈՐԾՈՒՆԵՈՒԹՅԱՆ ԱՐԴՅՈՒՆՔՆԵՐԻ ՀԵՌԱՆԿԱՐՆԵՐԸ
Authors: BAGRATYAN AZAT
Published: May 2023

This academic article is dedicated to the characteristics of the application of the operative-search activities in the field of criminal procedures. In particular, it studies the possibilities of transforming operative-search activity results into extra-procedural documents. This article illustrates the contradictions, which exist not only between the systems, but also in the domain of the legislative regulation of operative-search activity. Certain suggestions are being made in order to exclude omissions and to create a favorable environment for the application of operative-search activity results.
Modern Technology Adoptions and the Faculty Need in Nigeria Universities
Authors:   College of Education, Open, Distance and E-Learning Kampala International University Kampala, Uganda, UZORKA Afam , ANUMAKA Blessing Ijeoma ,   College of Education, Open, Distance and E-Learning Kampala International University Kampala, Uganda
Published: May 2023

Faculty members are interested in the impact of technology on education and are supported by regulatory bodies promoting technology standards, recruiters seeking teachers with technology skills, legislated technology in the curriculum, and a demand for a technology-skilled workforce. In response to the interest in technology in education and faculty members incorporating technology in their research, this study was carried out to assess faculty needs concerning technology in the educational delivery system of Nigerian universities. The study adopted a qualitative approach to investigate the research needs of faculties concerning technology. This qualitative study randomly selected a convenience sample of 100 faculty and administrators in the faculty of education of 12 universities in Nigeria across several states. Using focus-group discussion sessions and interviews, the researchers met with 100 participants in groups of 10 to 15 for each session. Data were transcribed and entered into a database for analysis. The use of technology in research such as searching (search engines), data gathering, analysis, and publishing was discussed before explaining the needs and concerns of faculties with regard to technology. The study shows that there is a need for government and universities to adopt and institutionalize e-learning which will help to close the gap in technology
The Effectiveness and Ineffectiveness of Combating Corruption in Nigeria
Authors:   Department of Business Administration and Management, Rufus Giwa Polytechnic, Owo, Ondo State, Nigeria, AKINNIYI Alaba Joseph , OLABIMTAN Oladele Emmanuel ,   Department of Business Administration and Management, Rufus Giwa Polytechnic, Owo, Ondo State, Nigeria
Published: May 2023

Corruption is a great disaster that destroys the socio-economic development and political prosperity of any nation. The menace has caused developing countries to fall behind in terms of national and international development. This prompted both state actors and international organisations to wage war against corruption through multiple strategies. The Nigerian fourth republic follows the race in combating corruption and enhancing national development through anti-corruption institutions such as EFCC and ICPC to sanitise the political economy of the state. This paper elucidates the challenges in combating corruption with aim of offering solutions. Despite the existence of antigraft institutions, corruption is still going on due to the lack of political will by the government, political interference, lack of autonomy, paucity of funds among others. Descriptive analysis was duly adopted for this study. Secondary data collection methods were used to collect necessary data for the study. In this regard, secondary data were gathered from textbooks, journals and internet facilities. The study recommended, among other things, that only competent, experienced and morally upright persons should be appointed to leadership positions in anti-corruption agencies in the country. It was also recommended that sufficient funds should be voted for anti-corruption agencies to enable them to acquire necessary security equipment.
Exploring the Connect between Language and Literature: A Stylistic Analysis of Ademola Omobewaji Dasylva’s GOLOBA
Authors:   Department of English, Obafemi Awolowo University, Ile-Ife, Nigeria, FALOYE Yemisi Folasade , AKINKUROLERE Susan Olajoke ,   Department of Educational Foundations, Kampala International University, Uganda
Published: May 2023

It is noted that scholars of linguistics have argued and proved that stylistics is a two-faced sub-linguistic field. In essence, stylistics is relevant in the study of both linguistic and literary texts which serves as the basis for distinguishing linguistic stylistics from literary stylistics. Literary texts are usually analysed to bring to fore the essence of focusing on the language of literature but to also demonstrate the concerns of literary-stylisticians as they set definite boundaries in analysing literary texts. In this paper, a poem titled “Goloba” by Ademola Dasylva is analysed to justify the claim that linguistic stylistics is a veritable approach for analysing and interpreting literary texts, by looking into the graphological features, phonological features, lexico-syntactic features and lexico-semantic features inherent in the poem. These linguistic features are distinctive in interpreting literary texts and the distinctions between linguistic stylistics and literary stylistics have been highlighted. Thus, the paper concludes that literary texts are not only the subject of literary critics but stylisticians.
Comparison of Teaching Personnel Competence on Secondary Schools Students’ Academic Performance in Mathematics
Authors:   Department of Mathematics and Statistics, Kampala International University, Kampala, Uganda, Peter Benjamin A , Peter Ruth E ,   Faculty of Accounting and Informatics, Durban University of Technology, South Africa
Published: May 2023

This study compared the teaching personnel's competence in secondary school student’s academic performance in Mathematics. To this end, five research questions and two research hypotheses were proposed. The data was collected from twenty secondary schools in Ijebu-Ode, Ogun State. One hundred (100) students and teachers were selected to participate in this study. The instruments used were Students’ Attitude Towards Mathematics Questionnaire (SATMQ) and Teachers’ Attitude Towards Mathematics Questionnaire (TATMQ). T-test and regression statistics were used to analyse data at 0.05 level of confidence. The findings indicated that there was a statistically significant difference between the students’ attitude towards Mathematics in public and private secondary schools. Also, there was a statistically significant difference between the professional status of teachers in public and private secondary schools. This implied that there are more professional qualified teachers in public schools than their private school counterparts which could have positive influence on students’ academic performance in Mathematics. There was, however, no statistically significant influence of teachers’ competence on students’ academic performance of public and private secondary schools in Mathematics. Invariably, this implies that teaching personnel competence is not the only contributing factors on students’ academic performance in Mathematics. Therefore, there was no statistically significant influence of the students’ attitude on the academic performance of public and private secondary schools in Mathematics.
Engaging Decolonisation: Migration, Memory and Trauma in Contemporary African Literature
Authors:   Department of Languages, Rufus Giwa Polytechnic, Owo, Nigeria, AMINU Segun , OGUNMOLA Adedamola A , DAHUNSI Kayode F
Published: May 2023

The subject of decolonisation has been engaged by scholars such as Chinweizu (1987) and Ngugi (1986). However, this research centres around the contributions of contemporary African writers by interrogating the subjects of trauma, memory and migration in African literature. It analyses the transition of trauma from the colonial period till now using contemporary literary text. This discourse also examines the issues arising from migration in the writings of migrant writers. Further, the essay elucidates the issue of collective memory in African literature. It probes the effect of colonialism on the lives of Africans and their response to its trauma throughout history. It concludes by identifying the strategies employed by contemporary African writers in their works to decolonise the African mind and the inherent deficiencies.
An Analysis of Articles’ Usage among Students Studying English in Selected Universities in Sudan
Authors:   Department of Educational Foundations, Kampala International University, Uganda, AKINKUROLERE Susan O
Published: May 2023

This paper investigated how the articles are used by Sudanese university students studying the English language in Khartoum to highlight their effective mastery of “a”, “an” and “the”. Specifically, the descriptions of proper and improper use of articles by students of Khartoum State universities were done in relation to factors propelling them. The data for the study were drawn from the essays of university students in Khartoum. Through the research design, collection and analysis of first-hand information were done using qualitative approach and techniques. The findings revealed that most Sudan University students are not aware of the right usage of English articles and their application, and using English articles is considered a daunting task during language learning. In addition, most of the challenges faced by students in using articles in English require that both students and teachers pay attention to ways of overcoming them. Hence, teachers should implement academic activities to help English language learners improve their writing abilities, especially on proper usage of articles in English.
Assessment of Teachers' Knowledge and Use of Mastery Learning Strategy in the Implementation of Basic School Creative Arts Curriculum in Katsina State, Nigeria
Authors:   Department of Educational Foundations, Faculty of Education, Federal University Dutsinma, Katsina State, Nigeria, TORPEV Terver F , EZENKIRI Nwankwo J , GANA Enock
Published: May 2023

Culture is the pride of members of every society as the cultural elements of any society portray their needs, interest, aspirations and dilemmas. It is in this context that arts and design plays a significant role in creating and preserving some of the societal cultural heritage through painting, carving, molding and building. It is therefore disheartening to note that most of the roles which art as a subject was included in school curriculum to perform have been negated as a result of the inability of the teachers to effectively use strategies like mastery learning that could motivate students’ interest in the subject. The study, therefore, assessed teachers’ use of mastery learning strategy in implementation of basic school art education curriculum for reinforcement of cultural sustainability in Nigeria. The study adopted descriptive survey research design. The population comprised of all the basic school teachers in Katsina state, Nigeria. Target population was creative art teachers in basic schools. The sample was 50 creative art teachers purposely selected from five public basic schools in Dutsinma Local Government Area (LGA), Katsina State. Questionnaire tagged: ‘Assessment of Mastery Learning Strategy Questionnaire’ (AMLS) was constructed, validated and trial tested on teachers in Kurfi LGA which yielded a reliability coefficient at 0.75. In an attempt to answer the questions raised, mean, percentage and standard deviation were employed to answer the research questions while chi-square test statistics were made use of in testing the formulated hypotheses at 0.05 level of significance. The finding of the study indicated that most teachers were uninformed of the mastery learning strategy. Based on the finding, the study recommended that workshops on mastery learning should be organized to update teachers' knowledge of mastery learning and other motivating learning strategies. The study concluded that similar studies should be carried out in related subjects to ascertain the effectiveness of learning strategies used in imparting knowledge to learners.
Campbell University Student-Run Free Clinic: Osteopathic Medical Care for the Rural Underserved
Authors: Taylor Kathryn , Willis Elizabeth , Hitchens Jordan , Moses Daniel , Pennings Jeffrey , Deal Phillip , Parker Anthony , Hooper James , Lorenzini Mark , Dobson Richard , Pikman Paul
Published: May 2023

Based at the Campbell University School of Osteopathic Medicine, the Campbell University Student-Run Free Clinic (CUFC) is an interprofessional effort to address the medical needs of the rural underserved population in Harnett County of central North Carolina. Although osteopathic physicians have historically been more likely to practice primary care, particularly in rural settings, than their allopathic counterparts, osteopathic medical schools are often omitted in the current research and literature on student-run free clinics. This report details the development of the CUFC, including a basic needs assessment, staffing and recruitment, resource identification, clinic operations, electronic medical record, and quality assessment and research. The CUFC demonstrates a working model for a free clinic based at an osteopathic medical school in a rural underserved area that can potentially be replicated in other regions.
Student-Run Clinics Adapt to Emerging Changes in Healthcare and Education
Authors: Coburn Brian , Seryak Katie , Lander Jessica
Published: May 2023

Healthcare and medical education have undergone rapid evolution in the past five years. These changes highlight the flexibility and impact of student-run clinics (SRCs). From the passage of the Affordable Care Act to medical educationâ€™s increasing emphasis on healthcare delivery and experiential learning, the rise of SRCs has placed students on the front lines of progress. During this time, the Society of Student-Run Free Clinics (SSRFC) has worked diligently to help clinics adapt and prosper in this new era. In this article we reflect on the upcoming SSRFC Annual Conference and how SRCs are situated to adapt to these recent changes. We conclude by identifying specific SSRFC goals to help students and clinics continue to grow.
Formula for a Comprehensive Year Four Student-Run Free Clinic Elective
Authors: LaJeunesse Christopher , Bains Ashika , Fisher Rebecca , Chadwell Margit , Binienda Juliann
Published: May 2023

Many student-run clinics offer electives for professional students. They provide additional clinical experience and exposure to practice management. Since it began five years ago, Wayne State University School of Medicineâ€™s Robert R. Frank Student-Run Free Clinic offers its fourth-year medical students with an innovative and comprehensive elective.  Twenty-five students have completed this elective. Four pillars create the foundation of this unique learning environment: clinical care, leadership/mentorship, teaching, and scholarship. We present a blueprint for professional schools to shape their elective to become truly student-run and to give advanced students a rich capstone experience preparing them for future training.
A Chronic Disease Management Program at the Rowan School of Osteopathic Medicineâ€™s Student-Run Free Clinic
Authors: Goldwaser Eric , Bibber Bernadette , Eckert Kathryn , Paglinco Samantha , Leroy Kyley , Alaimo Danielle
Published: May 2023

In the United States, one out of every four adults is living with at least one chronic disease. Treatment of these chronic conditions accounts for 84% of healthcare spending. Successful treatment of chronic diseases involves support from family, the community, and the healthcare system. In this descriptive report, we outline the beginning steps of implementing a new program aimed at addressing a pervasive chronic disease in the population seen at our student-run clinic. The Rowan University School of Osteopathic Medicineâ€™s Camden Community Health Center in conjunction with the Camden Area Health Education Center gathered information from a community needs assessment and focus group to better direct efforts at optimizing healthcare delivery to the priorities of the community. After collecting the data, a chronic disease management pilot program targeting patients with chronic hypertension was created. The program included a course run over a six-week period, in which a peer-run educational group focused on lifestyle changes and medical management of hypertension. This plan utilized community health workers, a â€œbuddy system,â€ and family support. At the end of the program, participants were provided with a weekly blood pressure log, action plan for their disease management, and specific follow-up appointments. Furthermore, we briefly share preliminary data that allowed us to gauge success of the pilot program and form the basis for a larger, more comprehensive follow-up study.
Recommended Medical Record Practices for Student-Run Free Clinics
Authors: Smeenge David , Larson Bradley , Chadwell Margit , Binienda Juliann
Published: May 2023

Although well-intentionedÂ­Â­, free clinics may overlook details pertaining to the protection of patient information and maintenance of medical records. Providing students may not know about important regulations and practices which are currently in place to protect patients. For example, it is necessary for a business associate agreement to be signed with respective data managing providers prior to using an online cloud storage provider. This article is a summary of reasonable and prudent tips for free clinics to follow and includes: the proper handling of patient information, what to include in patient notes, who may write notes, and ensuring that notes are signed in a timely manner.
Improving Education and Care in Student-Run Clinics: A Didactic Intervention for Pre-Clinical Medical Students
Authors: Phillips Andrew , Smith Sandy G , Rossi-Foulkes Rita , Bordenave Kristine K
Published: May 2023

Background: Merging education with clinical care is essential at student-run clinics.Methods: First year medical students participated in 15-minute small-group didactic sessions monthly from January through May 2011. Topics included diabetes, hypertension, mood disorders, and back pain. After the intervention, a 10-question survey comprised of eight 7-point Likert items and two narrative response questions was made available online to all eligible students. Patient encounter times during the intervention period were recorded and compared to the year prior to intervention.Results: Fourteen of 26 students (54%) responded to the survey. All students found the intervention to offer more information about standards of practice than their courses. Of respondents, 64.3% agreed or strongly agreed they provided better patient care with the intervention. Students reported a higher probability of using standards of practice: 57.1% agreed and 21.4% strongly agreed. When accounting for confounders, mean patient encounter time was 69.9 (95%CI, -92.4 to -39.4, p<0.001) minutes shorter with the intervention.Conclusions: Decreased patient encounter time and survey responses support the interventionâ€™s educational and clinical efficacy.
Integrating Behavioral Health Services in a Student-Run Medical Clinic
Authors: Belus Jennifer M , Cohen Matthew J , Givens Matthew , Simirnova Natalia , Myerholtz Linda
Published: May 2023

Integrating behavioral health services into a student-run medical clinic serves multiple purposes. One primary goal of such an initiative is to address the mental health needs of uninsured individuals who are more at risk for mental illness and less likely to seek help than individuals with insurance. An additional objective is to create a venue to train future healthcare providers in integrated healthcare models. This article describes the process of developing and implementing a behavioral health service within a well-established student-run medical clinic. Within the article, issues related to workflow, types of behavioral health services offered, patient recruitment, and clinical supervision are described. The purpose of this article is to explore key lessons learned and to inform other individuals and institutions interested in similarly integrating behavioral health services into current student-run health clinic models.
Student-Run Free Clinic as a Source of Meaningful Ophthalmologic Care for Underserved Patients
Authors: Downie Elaine , Von Hohenberg Maximilian , Harrison Andrew , Sick Brian
Published: May 2023

Background: There are many student-run free clinics in existence, however few of them offer medical specialty care. Even fewer of these clinics offer eye care. Previous studies have demonstrated that ophthalmologic services are particularly difficult to access for patients who are un- or underinsured. The aim of this study was to assess community need for specialty care in an underserved neighborhood, and following implementation of these services, to evaluate the impact on our patients. Methods: Patients at a free clinic in Minneapolis were surveyed to assess demand for specialty care. After community needs were assessed, the clinic partnered with the University of Minnesota Department of Ophthalmology to establish a bimonthly ophthalmology night. Patients were then surveyed at each specialty night to determine health insurance status, reason for visiting the clinic, and satisfaction with various aspects of their clinic experience. Results: The most requested specialty was ophthalmology (34%). Following implementation, over the course of 5 clinic nights, 50 patients were seen. Of the patients surveyed, 59% did not have health insurance and 89% were satisfied or very satisfied with the clinic. Conclusions: Having adequate eye care is important for multiple aspects of patient health and well-being. Our study contributes further evidence that students in free clinics can offer important visual services to patients who would not otherwise have this access.
Understanding the Barriers to Optimal Nutrition in Uninsured and Underserved Adults at the CommunityCare Free Medical Clinic in Toledo, Ohio
Authors: Marino Elizabeth Bedell , Thuppal Hayavadhan , Marino Christopher , Welch Philip John
Published: May 2023

Background: Healthful eating habits are crucial for obesity prevention and are often lacking among the underserved and uninsured. The CommunityCare Free Medical Clinic (CCFMC) exists to serve the primary and preventive health care needs of uninsured and underserved residents of greater Toledo. The goal this study was to better understand the barriers to achieving optimal nutrition in the CCFMC patient population. Methods: A series of five focus groups of CCFMC patients was conducted in July and August 2015 to better understand the underlying factors resulting in poor nutrition in this population. Participants (n=50) were between ages 18 â€“ 65 and racially diverse. Focus group discussions were recorded, transcribed, and analyzed using the long-table approach. Participants responded to 8 questions pertaining to food insecurity and ranked four factors by level of influence on their food purchasing decisions: cost, taste, nutritional value, and ease of preparation.Results: Several themes emerged, such as shame and embarrassment about not being able to afford nutritious food and the reliance on television personalities for nutritional guidance. Participants shared numerous insights on how to improve nutrition-related interventions at CCFMC. The ranking activity revealed that cost and ease of preparation influenced purchasing decisions more than taste or nutritional value.Conclusions: Based on the focus group findings, we suggest student-run free clinics provide a dedicated website for announcing nutrition programs and events, include clinicians in nutrition conversations with patients, and broadcast informational videos in the clinic lobby to promote nutrition awareness and discourse.
Relationship of Volunteer Student-Run Clinic Experience with Future Primary Care and Underserved Practice
Authors: Shah Ruby P , Fancher Tonya L , Jerant Anthony , Bhe Anthony , Henderson Mark C
Published: May 2023

Background: Student-run clinics (SRCs) are increasingly common at or in partnership with medical schools, providing service-based learning to students and increasing access to care for underserved populations. Early, small studies suggest that student participation may be associated with eventual practice in primary care and in medically underserved areas, but current career outcomes are largely unknown. The purpose of this study is to determine the relationship between participation in SRCs, primary care (PC) career choice, and future practice setting.Method: For all graduates of the University of California, Davis from 2004 to 2008 (N=454), the authors determined practice specialty (family medicine, general internal medicine or pediatrics, or not) and practice setting (health professional shortage area [HPSA] or not) two to five years after residency. Multivariate analysis adjusted for level of SRC participation, age, gender, race, more than one language spoken, total dollar debt at graduation, research experience during medical school, Medical College Admission Test, and United States Medical Licensing Examination Step 1 and 2 performance.Results: Of 454 total graduates, 68% participated in a SRC. In adjusted analyses, committed SRC participation was associated with PC practice after residency (adjusted odds ratio [AOR] 2.15, 95% confidence interval [CI] 1.18-3.75) and intermittent SRC participation was not (AOR 1.13, 95% CI 0.65-1.99). The sole predictor of post-residency practice in a HPSA was more than one language spoken (AOR 1.97, 95% CI 1.20-3.25). Race was not significantly associated with practice in HPSAs.Conclusions: This study indicates that students who were committed SRC volunteers were more likely to practice in PC after residency. These findings suggest that participation in SRCs may increase graduates practicing in PC, but further studies are required to address the strength of the relationship between SRC participation and future PC practice.
Predictors of Patient Retention at a Student-Run Free Clinic
Authors: Hess Matthew C , Chung Sebastian K , Banos James H , Cockrum Richard H , Van Wagoner Nicholas , Hoesley Craig
Published: May 2023

Background: Studies of patient retention at student-run free clinics (SRFCs) are lacking. We determined variables associated with clinic retention at Equal Access Birmingham (EAB), an urban SRFC that aims to provide acute care for clients with transitory health needs and longitudinal care for patients with chronic diseases. Methods: We retrospectively analyzed EAB patient data from March 1, 2013 to July 1, 2015, including demographic, social, medical history, and clinical care variables. The primary outcome was retention in care, defined as attendance at a follow-up appointment 6 to 12 months after the initial new patient visit. Potential predictors of retention were examined using stepwise multivariate logistic regression.Results: Patient retention rate was 25.2%. Positive predictors of retention included receipt of medication at the initial visit (odds ratio [OR] 15.40, 95% confidence interval [CI] 1.56-152.82), more kept appointments within 6 months of initial visit (OR 2.00, 95% CI 1.51-2.66), and longer time to follow-up (OR 1.14, 95% CI 1.04-1.26). Negative predictors included receiving only acute care at initial visit (OR 0.10, 95% CI 0.01-0.95), any appointment no-shows (OR 0.33, 95% CI 0.13-0.86), and cancellations (OR 0.29, 95% CI 0.09-0.87) within 6 months of an initial visit.Conclusion: This study is one of the first to analyze predictors of patient retention at a SRFC. Although we analyze a relatively small sample size in a single SRFC, our results inform strategies to better retain SRFC patients who have high rates of chronic illness and are vulnerable to loss to follow-up.
A Model for Colon Cancer Screening at a Free Community Clinic
Authors: Kattih Zein , Uhlar Courtney , Perera Yohan , Atkinson Brian , Angell Erin , Ourn Felicia , Travis Tom , Slone Frederick , Roetzheim Richard , Guerra Lucy , Gonzalez Eduardo
Published: May 2023

Background: The BRIDGE Clinic began a Colon Cancer Screening Program in 2012 that has continued to provide the local underserved community with free colon cancer screening. This program allows BRIDGE Clinic to provide preventative care in accordance with the United States Preventative Services Task Force guidelines for colorectal cancer screening. The purpose of this study was to investigate the demographics of participants and the outcomes of the colorectal cancer screening program at BRIDGE Clinic and compare this information to 2015 National Health Interview Survey data.Methods: This study was a retrospective analysis of the medical records of patients eligible for routine colorectal cancer screening. Patients aged 50-75 years and who had at least one clinic visit at BRIDGE between January 2012 and December 2015 were included. Demographics, screening method, and outcome information were extracted by chart review.Results: A total of 133 uninsured patients were eligible. Of those patients who qualified for colorectal cancer screening, 64% were screened (34% with fecal immunochemical testing, 66% with colonoscopy). Among those screened with colonoscopy, one (2%) patient had rectal carcinoma in situ, 10 (18%) patients had pre-cancerous polyps, 19 (34%) patients had benign hyperplastic polyps (34%), and 26 (46%) had normal colonoscopies.Conclusions: The Colon Cancer Screening Program at the BRIDGE Clinic has facilitated a screening rate of 64%, a rate that is close to three times the national average for uninsured patients (22%) and almost at the national average for insured patients (65%). This suggests it is feasible for free clinics to achieve high colorectal cancer screening rates if strong community partnerships and a clear process are in place.
Development of Novel Cloud-Based Clinical Credentialing and Training Checklist System to Improve Volunteer On-Boarding and Certification Tracking in a Student-Run Free Clinic
Authors: Nott Rohini , Patel Nina , Hartmark-Hill Jennifer
Published: May 2023

Interprofessional, student-run free clinics oversee many volunteers of different disciplines who may participate in multiple outreach programs. Effective organizational volunteer management is crucial to achievement of mission goals and volunteer retention. Students from different organizational and educational backgrounds may be required to complete a number of unique certifications and trainings in order to volunteer in a clinical role. Clear and concise dissemination of requirements to both new and returning volunteers must be performed in a structured and replicable way to ensure organizational consistency and accuracy. The Student Health Outreach for Wellness (SHOW) Community Initiative serves vulnerable populations in a variety of clinical settings, including outreaches to people experiencing homelessness and those in treatment for substance abuse disorders. Implementation of the cloud-based clinical checklist and volunteer roster has enabled our student-run free clinic to more effectively communicate both within our volunteer management team and with clinical volunteers we oversee. This article describes how a novel volunteer management workflow strategy was employed to improve volunteer compliance and communication between clinical staff and volunteers and volunteer onboarding efficiency, as well as how other student-run free clinics can implement similar strategic workflow practices to optimize their volunteer management efficiency and efficacy.
Improving Student Cliniciansâ€™ Documentation of Lifestyle Modification
Authors: Chen Iris , Jin Donna , Rifkin Robert , Chandrasekaran Sandhya , Leader Andrew , Thomas David , Meah Yasmin
Published: May 2023

Background: Lifestyle modification is an important component of clinical encounters, particularly in student-run free clinics that provide care for uninsured patients with a high burden of chronic disease. This study aimed to evaluate the effect of two interventions on the rates of documentation of patient diet, exercise, and health goals at East Harlem Health Outreach Partnership (EHHOP), a student-run free clinic affiliated with the Icahn School of Medicine at Mount Sinai.Methods: A quasi-experimental study was performed at EHHOP over 12 weeks from September to November 2015. Rates of documentation of lifestyle modification and health goals discussions were assessed at baseline and following two periods of intervention. Intervention 1 used electronic medical record (EMR) templates for documenting discussions, and Intervention 2 used focused student teaching to prioritize discussion and documentation of lifestyle modification and health goals. Patient characteristics and documentation rates were compared between each of the three time periods.Results: A total of 161 patient visits were included. There were no significant differences in patient characteristics between Baseline (n=54), Intervention 1 (n=50), and Intervention 2 (n=57) time periods. Rates of documentation increased from 48% (Baseline) to 56% (Intervention 1) to 68% (Intervention 2) for diet, 25% to 42% to 53% for exercise, and 22% to 34% to 39% for health goals. EMR-based Intervention 1 was more effective in improving documentation rates for clinicians caring for patients without diabetes, and student teaching-based Intervention 2 was more effective in improving documentation rates for clinicians caring for patients with diabetes.Conclusions: Systemic efforts that incorporate targeted EMR templates and teaching can help promote documentation rates of lifestyle modification discussions in student clinicians.