bluuebunny/crossref_metadata_2025 huggingface dataset:
Critical success factors in the implementation of cloud ERP in SMEs: A case study in Brazilian organizations
Authors: Barbieri Leonardo Moro , Sott Michele Kremer
Published: December 2024

Objective: This study aims to identify and discuss the Critical Success Factors (CSFs) that impact the implementation of Cloud ERP in Small and Medium-sized Enterprises (SMEs). Method: A multiple case study was conducted in Brazilian SMEs to identify how Critical Success Factors (CSFs) impacted the Cloud ERP implementation process. Qualitative data were obtained through semi-structured interviews. The NVivo software was used for interview coding, and content analysis was performed based on the coded data. Originality/Relevance: This study identifies and compiles CSFs that impact the implementation of Cloud ERP in SMEs. Additionally, it analyzes the impact of each CSF through real cases of SMEs. Results: Sixteen CSFs impacting Cloud ERP implementation in SMEs were identified. The CSFs were classified according to the TOE framework (organizational, environmental, and technological factors). Among the highlighted CSFs are competitiveness, knowledge in information systems, accessibility flexibility, relative advantage, and security. Additionally, two new CSFs were identified: best practices and process definition. Theoretical/Methodological Contributions: This study contributes to the literature by identifying two new CSFs impacting Cloud ERP implementation in SMEs. Social/Management Contributions: The results aim to assist SMEs in identifying CSFs in Cloud ERP implementation. They also provide assistance to Cloud ERP providers facing various challenges in delivering a system efficiently and effectively to their clients.
Japan Approves Datopotamab Deruxtecan for the Treatment of Adult Patients with HR positive, HER2 negative Unresectable/Recurrent Breast Cancer after Prior Chemotherapy
Authors:   Sunvalley Communication, LLC / ADC Review, Hofland Peter , Garcia Danielle ,   Sunvalley Communication, LLC / ADC Review
Published: December 2024

Datopotamab deruxtecan (Datroway®; Daiichi Sankyo, previously known as DS-1062 and TROP2 ADC, see ADC Drug Map) an antibody-drug conjugate or ADC, being jointly developed and commercialized globally by Daiichi Sankyo and AstraZeneca, has been approved in Japan for the treatment of adult patients with hormone receptor (HR) positive, HER2 negative (IHC 0, IHC 1+ or IHC 2+/ISH-) unresectable or recurrent breast cancer after prior chemotherapy.
Radiographic Characteristics of Caudal Segment in Multilevel Anterior Cervical Discectomy and Fusion: The Bony Buttress Formation
Authors: Ham Chang Hwa , Kim Joo Han , Park Youn-Kwan , Kwon Woo-Keun , Moon Hong Joo
Published: December 2024

Objective: Anterior cervical discectomy and fusion (ACDF) with anterior plating is a commonly performed procedure for cervical disc diseases. While the clinical outcomes of most reported multilevel ACDF cases are excellent, symptomatic pseudarthrosis remains a challenge, often requiring revision surgeries. This study aims to present the radiological characteristics of multilevel ACDF constructs, which can be considered during intraoperative management to prevent pseudarthrosis.Methods: This retrospective cohort study included patients who underwent multilevel (3 or 4 levels) ACDF with anterior plating between June 2010 and August 2022. Patients were regularly followed at 4 months, 12 months, and then annually postoperation. Fusion rates and characteristic radiological patterns, such as the formation of bony buttresses underneath the anterior plate, were graded and evaluated.Results: A total of 163 patients were included in the study. Overall fusion rates were 26.38%, 64.34%, and 81.58% at 4-month, 1-year, and the final follow-up, respectively. Nonunions at 4-month follow-up with tightly engaged anterior plate with bony buttress formation were more likely to fuse in the later period (Buttress grade 0 vs. 1; p=0.01, odds ratio [OR], 5.70, Buttress grade 1 vs. >2; p<0.01, OR, 12.00).Conclusion: This study emphasizes the significance of pseudarthrosis following multilevel ACDF. Pseudarthrosis predominantly occurs in the caudal-most segment of the construct, particularly when it terminates at C7. Constructs that are not tightly engaged and lack bony buttress formation in the caudal part of multilevel ACDF are more likely to develop pseudarthrosis.
Application of Transverse Process Hooks at Distal Thoracic Vertebrae in Uppermost Vertebral Instrumentation for Adult Spinal Deformity Surgery: Special Focus on Delayed-Onset Neurologic Deficits
Authors: Yoo Sun-Joon , Jang Hyun-Jun , Moon Bong Ju , Park Jeong-Yoon , Kuh Sung Uk , Chin Dong-Kyu , Kim Keun-Su , Shin Jun Jae , Ha Yoon , Kim Kyung-Hyun
Published: December 2024

Objective: We aimed to investigate the incidence of delayed-onset neurological deficits (DONDs), DOND-related reoperation rates following adult spinal deformity (ASD) surgery, and efficacy of transverse process hooks (TPHs) at the uppermost instrumented vertebra (UIV) compared to pedicle screws (PSs).Methods: We included 90 consecutive patients who underwent instrumented fusion from the sacrum to the distal thoracic spine for ASD, with a minimum follow-up of 24 months. Clinical and radiological outcomes were compared between 33 patients in the TPH group and 57 patients in the PS group, using the Scoliosis Research Society-22 Outcomes questionnaire (SRS-22), Medical Outcomes Study Questionnaire Short-Form 36 (SF-36), and various spinal sagittal parameters.Results: While absent in the TPH group, myelopathy occurred in 15.8% of the PS group, wherein 15 patients underwent reoperation. The change in the proximal junctional angle, from the pre- to postoperative assessment, was lower in the TPH group than in the PS group (0.2 vs. 6.6, p=0.002). Postoperative facet degeneration in the PS group progressed more significantly than in the TPH group (0.5 vs. 0.1, p=0.002). Surgical outcomes were comparable for both groups, except for the back visual analogue scale (3.5 vs. 4.1, p=0.010) and SRS-22 domains, including pain and satisfaction (3.3 vs. 2.9, p=0.033; 3.7 vs. 3.3, p=0.041). No intergroup difference was observed in SF-36.Conclusion: Using TPHs at the UIV level can prevent DOND, and thereby prevent postoperative myelopathy that necessitates reoperation; thus, TPHs is preferable over PSs in ASD surgery.
C7–T1 Full-Endoscopic Posterior Foraminotomy and Sequestrectomy Using Navigation
Authors: Saravanan Soubach , Fournier Jean Yves , Simonin Alexandre
Published: December 2024

The main objective of this case and video is to demonstrate the surgical technique of navigated full-endoscopic decompression and sequestrectomy at the C7–T1 level to alleviate C8 nerve root compression and manage cervicobrachialgia. Cervicobrachialgia resulting from C7–T1 disc herniation is a quite rare yet painful condition that can significantly impair motor function in the upper limb. Traditionally, open surgeries can be invasive, with prolonged recovery times and/or fusion of the level with adjacent segment disease. Posterior full-endoscopic approach offers a minimally invasive alternative that allows for quicker recovery, less postoperative pain, and improved outcomes. By preserving motion, it also prevents adjacent segment disease. A 72-year-old female presented with sudden-onset cervicobrachial pain radiating to the ulnar side of the right arm, coupled with paresthesia and weakness of the flexors/interosseous muscles (Medical Research Council=M3). Magnetic resonance imaging confirmed a large right-sided C7–T1 disc herniation compressing the C8 nerve root. A full-endoscopic C7–T1 posterior foraminotomy and sequestrectomy was performed with navigation. The patient experienced immediate relief from pain and improved motor function in the right hand postoperatively. Posterior full-endoscopic foraminotomy and sequestrectomy of the C7–T1 disc herniation is effective for treating cervicobrachialgia due to C8 nerve compression. The minimally invasive approach demonstrated in this video highlights the technique and stresses the advantage of navigation in the lower cervical spine.
Uniportal Full Endoscopic 270° Decompression for Thoracic 1–2 Hard Disc Herniation With Ossification of the Ligamentum Flavum
Authors: Ma Hyun-Jin , Lee Sang Ho , Park Chan Hong
Published: December 2024

This article aims to demonstrate the uniportal full endoscopic surgery for treating complex anterior and posterior spinal pathology at the T1–2 level, offering a invasive, accessible, stable, and versatile approach to challenging anatomical situations. Uniportal full endoscopic surgery is one of the most minimally invasive spinal surgeries, utilizing slim, elongated, and compact instruments that provide access to lesions from any angle and distance. This characteristic makes the technique especially suitable for hard, such as the T1–2 level, where traditional approaches may be limited or difficult. We present the case of a 39-year-old male patient (height, 187 cm; weight, 130 kg) who developed myelopathy due to a hard disc herniation and ossification of the ligamentum flavum at the T1–2 leading to paraparesis, which was more severe on the left side. An anterior approach was challenging due to the anatomical constraints at the T1–2 level, as well as the patient’s body size. A posterior access via the interlaminar approach facilitated the removal of the ossified ligamentum flavum. However, to the anterior lesion remained problematic without spinal cord retraction. Using the uniportal full endoscope, we were able to approach both anterior and posterior lesions through an incision 8 cm lateral to the midline, allowing for the treatment of the entire 270° arc of the pathology. The slim and elongated nature of the full endoscope enabled effective decompression without exerting pressure on the spinal cord, providing access from any angle and distance. This technique can be applied to a variety of cases involving difficult-to-access spinal.
The Edward Blank YIVO Vilna Online Collections Project: A Case Study
Authors: Halpern Stefanie
Published: December 2024

In January 2022, the YIVO Institute for Jewish Research completed the Edward Blank YIVO Vilna Online Collections Project, a major international initiative to virtually reunite YIVO’s prewar collection held by YIVO in New York and three Lithuanian institutions: the Lithuanian Central State Archives, the Martynas Mažvydas National Library of Lithuania, and the Wroblewski Library of the Lithuanian Academy of Sciences. This project, which took seven years to complete and had a budget of nearly 7 million dollars, was the largest and most comprehensive digitization initiative YIVO had ever embarked on. This article chronicles the initiation, planning, and implementation of this major undertaking. It focuses on the success, setbacks, and lessons learned by the project team and how the procedures and workflows develop throughout the project now form the framework of YIVO’s subsequent digitization efforts.
Jewish Immigrant Booksellers from Germany and Central Europe in Palestine, 1933–1939
Authors: Barsky Zvi
Published: December 2024

This essay is an abridged, translated version of Zvi Barsky's 2019 Hebrew book, Making a Mark: Booksellers in Palestine, 1870–1948. The study is based on the author's collection of rare booksellers’ labels, his thorough scan of period newspapers, and interviews with dozens of people.
Práticas Pedagógicas para a Igualdade Racial na Educação Infantil
Authors: Silva Inayanne Regina de Oliveira e , Oliveira Débora Benício Alves , Alves Francisca Ivoneide Benício Malaquias , Bringel Maricélia Felix Andrade
Published: December 2024

A infância é a etapa onde a criança começa a aprender e a entender o respeito ao próximo e, mediante construções de práticas pedagógicas, fica mais abrangente a promoção da igualdade racial. Esta pesquisa visou as relações étnico-raciais na infância, mais especificamente, na Educação Infantil, como objetivo geral intensificar na construção da identidade. A justificativa para a elaboração do estudo consiste no garantir uma educação que supere o racismo e as desigualdades, além de promover os esforços para a construção da identidade das crianças. A metodologia aplicada na realização da presente pesquisa é de caráter qualitativo e bibliográfico, diante de observações e análises sobre o tema. Os resultados demonstram que os professores e as famílias, ao continuarem realizando momentos em que abordem mais sobre as práticas pedagógicas para a igualdade racial na educação infantil poderá minimizar a problemática dentro da sala de aula, onde entende-se que ainda prevalece a predominação eurocêntrica, mais popularmente conhecida como “homem branco”. Conclui-se que o ensino étnico racial em sala de aula desde a primeira etapa de ensino é de suma importância para prática do respeito e igualdade na formação social do aluno.
Increased Medication Utilization Precedes Incidentally Diagnosed Inflammatory Bowel Disease: A Multicenter, Case-Control Study
Authors: Rodríguez-Lago Iago , Aguirre Urko , Cabriada Jose Luis , Ungaro Ryan C. , Colombel Jean-Frédéric , Barreiro-de Acosta Manuel ,   on behalf of the Preclinical Basque Inflammatory Bowel Disease (PREBIBD) Study Group
Published: December 2024

This study investigates whether subclinical inflammation in asymptomatic patients with inflammatory bowel disease (IBD) leads to increased medication use. In a multicenter, retrospective analysis of patients diagnosed with incidental ulcerative colitis or Crohn's disease during colorectal cancer screening (2010–2021), medication use was compared with symptomatic patients and healthy non-IBD controls. Asymptomatic patients showed a higher use of cardiovascular, antiparasitic, musculoskeletal, respiratory, and sensory organ medications up to 5 years before diagnosis. This trend suggests that a systemic inflammatory process occurs years before clinical onset of IBD, suggesting the potential for earlier diagnosis and intervention.
Extended trochanteric osteotomy for extraction of well-fixed fractured femoral stem after total hip replacement in a dog: a case report
Authors: Cho Soyoung , Kim Gyumin , Kim Daehyun , Jeong Seong Mok , Lee Haebeom , Jeong Jaemin
Published: December 2024

A 5-year-old, 28 kg castrated male Border Collie was referred for surgical intervention following complications from a prior total hip replacement. A physical examination revealed reduced weight-bearing and metallic crepitus on the affected limb. A radiographic assessment confirmed a fractured femoral stem. Extended trochanteric osteotomy (ETO) was performed to extract the well-fixed stem, followed by the removal of the acetabular cup. ETO stabilization was achieved with cerclage wires and a locking plate. Six months postoperatively, the radiographs indicated successful bone healing, and the dog exhibited improved limb function. The ETO technique can provide enhanced surgical access to extract well-fixed implants.
Innovative use of Biomagic-Enzyme complex for pig farm odor reduction, harmful bacteria inhibition, and immune enhancement
Authors: Akram Abdul Wahab , Cho Hae-Yeon , Saba Evelyn , Lee Ga-Yeong , Park Seung-Chun , Kim Sung Dae , Han Yong Gu , Rhee Man Hee
Published: December 2024

The global increase in livestock production has correspondingly intensified farm odors due to harmful bacteria, reduced immunity, and disease progression. In this study, we treated feces with Biomagic-Enzyme complex for 4 months to understand the relationship between farm odor, immunity against common viral diseases, immune cytokines, and changes in the microbiota. A gas meter (MultiRAE) was used to measure ammonia (NH3) and hydrogen sulfide (H2S) while odor intensity and offensiveness were characterized by the non-objective scaling method. A complete blood count was performed and plasma was obtained after blood centrifugation at 3,000 rpm for 20 minutes. The cytokine profile was evaluated using commercial kits. Microbial DNA was extracted and purified from fecal samples to analyze the microbiota. Microbial DNA and viral RNA/DNA were obtained from fecal samples and amplified to determine the expression of transmissible gastroenteritis virus (TGEV), porcine reproductive and respiratory syndrome (PRRS), and porcine circovirus type 2 (PCV2). Our results indicated that Biomagic reduced odor nuisance by decreasing ammonia levels, resulting in faint and fairly offensive odor intensity. After the enzyme treatment, Escherichia coli populations significantly reduced across all 3 farms. In contrast, beneficial Lactobacillus spp. levels remained stable, indicating the enzyme selectively targeted harmful bacteria while preserving beneficial ones. The beneficial Lachnospiraceae, Spirochaetaceae, and Bacteroidaceae were found to be higher in the third month of treatment. TGEV was not detected, while PRRS and non-pathogenic PCV2 showed a positive infection rate. In conclusion, Biomagic reduced ammonia, prevented viral infection from pig farms, and improved gut-beneficial bacteria and microbiota.
Soil Sampling Procedure for Management and Analysis of Legacy Sites in the Korean Peninsula
Authors: Kim Yongmin , Park Suhui , Han Jiyoung , Park Jewan
Published: December 2024

Background: The Korean Peninsula is split between the South Korea and Democratic People’s Republic of Korea (DPRK, North Korea), with North Korea possessing nuclear weapons. There are rising concerns over legacy sites, areas contaminated primarily by nuclear activities. In North Korea, these sites lack regulatory oversight and are likely neglected even if inactive. Hence, it is vital to devise strategies to manage and assess these sites. Yongbyon, a prominent nuclear site in North Korea, has been proposed for environmental sampling to gauge contamination levels. The goal is to determine contamination by suggesting sample collection points in Yongbyon.Materials and Methods: Using recent data and satellite imagery from the International Atomic Energy Agency’s periodic Safety Measures Report, we selected legacy sites to assess their contamination levels with recent data and satellite imagery. We identified sampling locations using the Visual Sample Plan (VSP) to check nuclear contamination. From these results, we devised a scenario evaluating accessibility and the local environment.Results and Discussion: For Yongbyon in North Korea, this study created two sampling scenarios based on interior access feasibility. Given North Korea’s constraints, we finalized the scenario without interior access. The sampling areas include two steam lines, four vehicle paths, and five green zones outside the facility.Conclusion: Nuclear facility operations worldwide are concerning. When halted, these become legacy sites requiring contamination management. Despite North Korea’s limited recordkeeping and challenges in determining contamination, we devised a sampling scenario using VSP software, factoring in accessibility and movement paths.
Epidemiología y daños causados por un nuevo complejo viral de batata en la Pcia. de Córdoba
Authors: Vilanova Perez Antonella , Flamarique Sofía Solange , López Colomba Eliana , Rodríguez Pardina Patricia , Di Feo Liliana del Valle
Published: December 2024

Se realizaron estudios de prospección, epidemiología y daños en lotes de batata de Colonia Caroya con síntomas de un complejo viral, durante tres campañas sucesivas. Fueron detectados sweet potato feathery mottle virus (SPFMV), sweet potato virus G (SPVG), sweet potato chlorotic stunt virus (SPCSV) y sweet potato leaf curl virus (SPLCV). Al comparar plantas con síntomas severos vs. plantas con síntomas suaves, los daños en componentes de rendimiento fueron inferiores a los registrados en plantas con síntomas severos respecto a plantas asintomáticas (mermas en peso fresco y número de raíces comerciales de 44 y 45% y 94 y 86%, respectivamente).  Incidencia y prevalencia de los diferentes virus se incrementaron en campañas sucesivas. La mayor severidad de síntomas sucedió en infecciones dobles, triples y cuádruples en las que participaron SPCSV y SPFMV. Los daños provocados por el complejo viral fueron corroborados en dos ensayos comparativos de rendimiento en lotes experimentales del IPAVE.  El primer ensayo incluía plantas infectadas con complejo viral vs. plantas con sanidad controlada y el segundo, plantas infectadas con complejo viral vs. plantas asintomáticas procedentes del primer ensayo. Los daños fueron significativos tanto en lotes comerciales como en ensayos experimentales, lo cual indicaría que la forma de control más eficiente es el empleo de propágulos con sanidad controlada. La presencia de los virus responsables del complejo en plantines de diversa procedencia indica que el empleo de semilla foránea conlleva su dispersión.
Pragmática y gramática: modalidad enunciativa y adverbios de oración
Authors: Zimmermann Liliana
Published: December 2024

El carácter multifacético de los estudios lingüísticos deriva directamente de la complejidad del fenómeno sobre el cual cada escuela lingüística define su objeto de estudio (Lavandera, 1984). La pertinencia de conocimientos de pragmática y gramática se asienta en la idea de que la lingüística se hamaca entre una fase humanística y un enfoque lógico–matemático: para muchos autores pragmática y gramática no pueden reunirse y tienen desempeños independientes (Verschueren, 2002; Fuentes Rodríguez, 2013); para otros, se trata de disciplinas complementarias y se auxilian en situaciones de descripción y explicación lingüística (Escandell Vidal, 1996).Consideramos que la cooperación de conocimientos entre pragmática y gramática se constata en el discurso, donde los hablantes modalizan sus enunciados y expresan las posibles actitudes del hablante (modus) hacia lo dicho (dictum) (Bally, 1932; Ridruejo, 2000). En este trabajo indagaremos relaciones entre estas disciplinas con base en ejemplos de empleos de modalizadores, descriptos como adverbios oracionales desde la morfosintaxis y la periferia izquierda, para valorar efectivamente el alcance sobre la construcción de significado/s en enunciados discursivos.
Rafael Barrett entre la ciencia y la subversión. Exploraciones en torno a las ideas sobre el lenguaje de un anarquista peculiar
Authors: Ternavasio Federico
Published: December 2024

Este artículo aborda las ideas sobre el lenguaje del escritor anarquista Rafael Barrett (1876–1910), en el contexto de las primeras décadas del siglo XX en Paraguay, a partir del análisis interpretativo de un corpus de tres textos: «La Regla», publicado en la revista Los sucesos en 1906; «Guaraní», publicado en el semanario Rojo y Azul en 1907; y «Esperanto», publicado en el periódico La Razón (1909). A partir de la noción de «ideologías lingüísticas», el análisis permite observar cómo se reformulan los problemas lingüísticos que interesaban a la prensa y el pensamiento del momento, incorporando preocupaciones sociales vinculadas al ideario anarquista sin abandonar una adscripción al pensamiento científico de la época, y con él, a un sesgo eurocéntrico.
publicidad política desde la semiótica. Anuncio “Tres historias” (MORENA) de la campaña electoral presidencial mexicana 2018
Authors: Santibáñez Alquicira Rosa Emilia
Published: December 2024

El presente trabajo se basa en la aplicación teórica de la semiótica, principalmente, para el análisis de uno de los anuncios políticos audiovisuales del cierre de campaña del partido político MORENA en las elecciones presidenciales en México del 2018. El objeto es visto como un texto y desde ahí parte el análisis. Los trabajos de Umberto Eco, Roland Barthes, Jacques Aumont, y Mark L. Knapp fueron la base del estudios realizado. Se pudo concluir que, la publicidad política es un instrumento comunicacional inmerso de signos y significados para posicionar un partido político y a sus candidatos, trasladado a las estrategias de la publicidad comercial. Por medio de una ingeniería codicial se crea un mensaje interesado que pretende influir en la sociedad, en su perspectiva de mundo y en la generación de una acción (voto). Se detectó, además, un enfoque en las emociones y el cansancio de los ciudadanos mexicanos a causa de los gobiernos anteriores. Con la investigación de sus códigos y la expresión cinematográfica, se identificaron huellas ideológicas sobre el mundo social y cultural a través de  este tipo de contenidos.
Halal Certification and Implications for MSMEs: A Systematic Literature Review
Authors: M. Topit Hidayat  , Sri Rahma Witta
Published: December 2024

Research Aims: This study explores the role of halal certification in fostering business growth within the Micro, Small, and Medium Enterprises (MSMEs) sector. Addressing a gap in the literature on the impact of halal certification on MSME performance, it examines its influence on competitiveness, profitability, and market expansion.
Methodology: The research employs a Systematic Literature Review (SLR) methodology, gathering relevant articles published between 2019 to 2024 from the Google Scholar database. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) model is utilized to guide the collected studies’ identification, selection, and filtration processes.
Research Findings: The findings indicate that halal certification significantly supports MSME operations and enhances product continuity. Consumers are more likely to purchase halal-certified MSME products, positively impacting revenue and sales growth. However, price remains a dominant factor in consumer purchasing decisions, even though halal certification is crucial for meeting Muslim consumer standards.
Theoretical Contribution: This study contributes to the literature by shifting the focus from large corporations to MSMEs. It emphasizes halal certification’s economic and operational implications, highlighting its role in attracting Muslim consumers, enhancing market confidence, and fostering MSME growth and sustainability in the global halal market.
Research Limitation and Implication: The research is limited to Google Scholar studies within a specific timeframe, possibly excluding relevant findings from other sources. It emphasizes the importance of integrating halal certification into MSME strategies to meet sharia standards, enhance market performance, and provide valuable insights for policymakers and halal industry practitioners.
Erasing the Line between Students and Instructors: The Influence of Classrooms and Online Learning Spaces on Student Engagement
Authors: Parsons Caroline S.
Published: December 2024

This study investigated the influence of physical and virtual learning spaces on student engagement in a modern university setting. Qualitative analysis of an active learning classroom that employed the use of roundtables was conducted. Interview and focus group data from students and faculty, along with classroom observations, resulted in the finding that the circular arrangement of this active learning classroom positively influenced student engagement by promoting immediate exchange of feedback, agency, and a system of accountability. This study also resulted in the finding that virtual learning spaces influence student engagement and the amount of engagement is heavily moderated by instructor efforts to facilitate interpersonal immediacy. Both physical and virtual learning spaces influenced student engagement and the level of engagement was heavily moderated by students’ desire for engagement. Recommendations and suggestions for future research are provided.
Evidence-Based Pedagogy for Values Outcomes in Capstone Experiences
Authors: Vale Julie , Kirkscey Russell , Weiss James , Hill Jenny
Published: December 2024

Undergraduate programs that focus on disciplinary knowledge and skills can reinforce pre-existing mindsets or ideologies that can lead to insufficient questioning of certain types of information (e.g., empirical data or model results) or insufficient valuing of certain types of information (e.g., Indigenous knowledge).  One way to address this challenge is to include values-based learning and assessment strategies that empower students to better understand and engage with their complex and changing worlds.  General Education (GenEd) Capstone Experiences (CE) often seek to instill such values, but scholarly analysis of the pedagogies and their effectiveness is limited, as is discussion on the inclusion of similar pedagogies in discipline-focused courses. This study addresses this research disparity by using a mixed methods approach to investigate student and faculty perceptions of the values integrated by a GenEd CE program and the pedagogies used to integrate those values.  Results demonstrate that the integration of reflection and discussion pedagogies has the potential to influence a variety of values-based outcomes, including thoughtfulness, openness, and responsibility.  Institutional leaders and CE instructors may integrate these pedagogies into their CEs, with mindful attention to the associated values that they seek to instill.
From plague to the promise: The journey of Bacille Calmette–Guérin
Authors: Kluemper Anthony , Morris Kosta , J. Mellon Matthew
Published: December 2024

Background: Intravesical Bacille Calmette–Guérin (BCG) therapy is a widely adopted treatment for non-muscle-invasive bladder cancer (NMIBC). Despite its extensive use, the historical origins of BCG therapy remain under-appreciated by many practitioners. Initially developed as a tuberculosis vaccine by Albert Calmette and Camille Guérin in the early 20th century, BCG’s immunomodulatory potential was later harnessed for cancer treatment. The unintended discovery of its attenuated virulence, combined with extensive subsequent research, laid the foundation for its clinical application in bladder cancer. Currently, BCG is a cornerstone treatment for NMIBC, particularly in high-risk cases, and has significantly influenced the evolution of modern immunotherapies, including checkpoint inhibitors. Objective: This paper was written with the intent of exploring the origins of BCG and historically significant research that led to it’s use and acceptance as a treatment for NMIBC while highlighting it’s impact on the development of immunotherapy as a whole. Conclusion: The BCG vaccine’s journey from a tuberculosis preventive to a groundbreaking cancer treatment underscores the interconnected nature of scientific discovery and its enduring impact on modern medicine.
Reappraisal of the fundamental mechanisms of the sHA14-1 molecule as a Bcl-2/Bcl-XL ligand in the context of anticancer therapy: A cell biological study
Authors: Moustapha Aoula , Andreu Pauline , Gonzalvez François , Fradin Delphine , Tissier Jean-Pierre , Diolez Phillippe , Petit Patrice Xavier
Published: December 2024

Background: HA14-1 is a small-molecule, stable B-cell lymphoma 2 (Bcl-2) antagonist that promotes apoptosis in malignant cells through an incompletely-defined mechanism of action. Bcl-2 and related anti-apoptotic proteins, such as B-cell lymphoma-extra-large [Bcl-XL]), are predominantly localized to the outer mitochondrial membrane, where they regulate cell death pathways. However, the notably short half-life of HA14-1 in vitro limits its potential therapeutic application. To address this limitation, a more stable analog, ethyl-2-amino-6-phenyl-4-(2-ethoxy-2-oxoethyl)-4H-chromene-3-carboxylate (sHA14-1), was developed. Objective: This study investigated the relationship between sHA14-1 and Bcl-2/Bcl-XL. The sHA14-1 molecule acts as a hormetic substance. Therefore, it is crucial to determine whether the hormetic zone corresponds to a putative therapeutic window, that is, the optimal concentration at which sHA14-1 selectively kills cancer cells overexpressing Bcl-2 or Bcl-XL while causing minimal damage to normal cells. Methods: Using classical cell biology and flow cytometry, we examined the main signaling pathways involving Bcl-2 or Bcl-XL, and their modification in the presence of sHA14-1. Results: We showed that sHA14-1 exerted a dual effect on mitochondria: (i) it sensitized cells to increased permeability, and (ii) it inhibited adenosine diphosphate-stimulated respiration and uncoupled respiration. At relatively low concentrations, sHA14-1 induced mitochondrial swelling, reminiscent of “pore opening” but with distinct characteristics. Over 30 μM, sHA14-1 caused mitochondrial transition depolarization independent of permeability transition and cell death that resembled secondary necrosis (i.e., occurring after maximal mitochondrial permeability) rather than apoptosis. The balance between apoptotic and necrotic cell death induced by sHA14-1 was also evaluated. Conclusion: Our results suggested that sHA14-1 plays a multifunctional role, involving both mitochondria and the endoplasmic reticulum. Its actions are more complex than its originally intended role in targeting anti-apoptotic Bcl-2 family members, which may complicate its potential application as an anticancer therapy.
TANTANGAN INTEROPERABILITAS REKAM MEDIS : STUDI KASUS DI RUMAH SAKIT SINGAPARNA MEDIKA CITRAUTAMA
Authors: Wahyuni Ida , Heryawan Lukman , Sanjaya Guardian Yoki , Prabowo Tony
Published: December 2024

Background: Health transformation in Indonesia is aimed at achieving one health data. Health data interoperability is the key to comprehensive health services. Integration can be done if a sistem is interoperable. This case study was conducted at a local government hospital in West Java Province. Concerning the vision of national interoperability, it is important to assess interoperability readiness.Objective: To explore the interoperability challenges of medical records in RSUD SMC Tasikmalaya.Method: A qualitative research design through in-depth interviews with 11 participants to explore the interoperability of medical records based on the framework of interoperability maturity aspects.Results: The interoperability of medical records at RSUD SMC is in the preparation phase. Device standardization as a sistem compatibility requirement has been implemented. Currently, hospitals are faced with technical interoperability challenges, both compliance with medical record data variables, sistem quality challenges, and medical record information quality, as well as data security in hospitals. For this reason, maturity support is needed in aspects of information technology leadership and governance to strengthen digital investment and vendor cooperation. The functionality of human resources in the implementation of information sistems through the support of human resource capacity building for front and back-end developers, medical record experts, and data engineers is in line with the strengthening of technology infrastructure. Conclusion: To improving  quality of the RME interoperability, management of the three aspects of leadership and governance, HR, and technology in hospitals is urgently needed for further strategies for organizational interoperability.
THE RELATIONSHIP BETWEEN PATIENT EXPERIENCE AND PATIENT LOYALTY MEDIATED BY TRUSTWORTHINESS AND OUTCOME QUALITY IN HEALTHCARE SERVICES: A CASE AT PRIVATE CLINIC IN BATAM
Authors: Renaldo Doddy , Antonio Ferdi
Published: December 2024

This study explores how patient experience influences patient loyalty, with trustworthiness and outcome quality as mediators. In Indonesia, health clinics have been segmented since introducing the national health insurance scheme called BPJS. While universal healthcare was achieved, some patients are willing to pay a premium for better care experiences. Understanding patient loyalty and its antecedents is crucial for maintaining a competitive advantage in private clinics. The study was conducted at a private clinic in Batam, involving 117 patients who visited between October and December 2023. Data were collected using a modified version of the GS-PEQ (Generic Short-Patient Experience Questionnaire) and further analyzed with Partial Least Squares Structural Equation Modeling (PLS-SEM) via SmartPLS4® software. Ten hypotheses were tested to explore the relationships between patient experience, trustworthiness, outcome quality, and patient loyalty. The findings reveal that patient experience positively impacts patient loyalty, which is mediated by trustworthiness. Outcome quality mediates the relationship between patient experience and trustworthiness but does not significantly mediate the relationship between patient experience and patient loyalty. This study highlights the importance of patient experience and trustworthiness in private clinics and suggests the use of GS-PEQ to measure patient experience and achieve competitive advantage.
QUALITY OF CARE AND TREATMENT ON EMERGENT THREATS FOR MATERNAL AND NEWBORN
Authors: Iwamizu Yuko , Dewi Bella Rossana , Lisnawati Naintina , Sriatmi Ayun
Published: December 2024

Pregnant women and newborns are particularly vulnerable during public health emergencies in Indonesia, where there is a lack of specific guidance to support these groups when emergent threats (ET) arise. Health workers, crucial in delivering maternal and newborn health (MNH) services, often fail to anticipate and address the needs of these vulnerable populations adequately.A literature review analyzing 24 articles from PubMed, Dimension, and Web of Science published between 2016 and 2024 focused on emerging infectious diseases, maternal and newborn health, quality of care, referral systems, and small vulnerable newborns. The review identified substantial gaps in the skills and competencies needed to provide high-quality MNH services globally and in Indonesia. Key issues include non-compliance with existing guidelines, inefficient referral coordination, insufficient monitoring of sick mothers, and a lack of preparedness for emergent threats, all contributing to suboptimal MNH outcomes.These gaps could be addressed by adopting improved training and referral systems, as proposed in the new SVN conceptual framework. Essential actions to enhance MNH outcomes include improving guideline compliance, enhancing referral systems, and ensuring comprehensive training for healthcare providers. Developing an integrated tool tailored to Indonesia's needs that includes SVN, sick mothers, infrastructure, referral systems, and infectious disease management is vital. Implementing these strategies can significantly reduce adverse outcomes and enhance care quality for women and newborns during public health crises.
ANALISIS SITUASI DAN KONDISI FASILITAS KESEHATAN MITRA BPJS KESEHATAN SETELAH ENAM TAHUIMPLEMENTASI JAMINAN KESEHATAN NASIONAL
Authors: Suryawati Chriswardani
Published: December 2024

In the sixth year, the implementation of JKN has resulted in achievements, especially community access to treatment at health facilities, but there are still many problems, especially in hospitals. This research is an observational study with qualitative methods. The informants are two government hospital directors and three private hospital directors, a triangulation of BPJSK officials. Hospitals have adaptively made adjustments, especially regarding the increase in the number of BPJSK participating patients, preparation of facilities and facilities, socialization of JPSBK regulations, and improvement of services to maintain the quality of services and to increase BPJSK patient satisfaction. Medical staff workload has increased but has yet to be accompanied by increased medical incentives, restrictions on medical authority, especially in administering drugs according to the BPJSK formulary and limiting medical support services and patient care days. This was all done to control costs due to reduced hospital income due to Ina-CBG payments from BPJSK. Hospitals must be innovative and creative in managing finances and generating revenue. The problem of late payments (claim pending) needs to be resolved immediately. Likewise, the satisfaction of internal hospital staff needs to be considered.
PENDIDIKAN DAN PELATIHAN PEGAWAI SEBAGAI FAKTOR KUNCI KEBERHASILAN PENERAPAN TOTAL QUALITY MANAGEMENT (TQM) DALAM PENCAPAIAN INDIKATOR NASIONAL MUTU (INM) DI RSGMP X
Authors: Wigati Putri Asmita , Fatmasari Eka Yunila
Published: December 2024

National Quality Indicators (INM) at RSGMP X in Semarang haves not reached the target in the aspect of 6-step handwashing compliance and the use of personal protective equipment among doctors, nurses and young dentists. Other research has found that education and training for employees is important in improving their technical skills and professional expertise. This study aims to determine the relationship between education and training as one of the elements of TQM and the achievement of INM at RSGMP X in Semarang City. This study is an observational quantitative study with a cross sectional approach. Data collection using a questionnaire by google form with a total sample of 75 of employee. Data analysis was performed bivariately with chi square. There is a relationship between perceptions of education and training aspects and the achievement of INM at RSGMP X in Semarang City. In addition, respondents who have good perceptions of education and training aspects tend to support the achievement of good INM (57.3%) compared to those who are not good (25.3%). Respondents with unfavorable perceptions of education and training tended to be less supportive of INM achievement (12%) compared to those who were supportive of INM achievement (5.4%). Most of the study respondents had good perceptions on education and training aspects (82.6%). In improving the achievement of National Quality Indicators, hospitals need to emphasize education and training efforts.Keywords : TQM, National Quality Indicators, Indikator Nasional Mutu, Education, Training
SEA SURFACE SALINITY AND PRECIPITATION PATTERNS AS INDICATORS OF CLIMATE CHANGE-INDUCED HEALTH RISKS IN INDONESIAN COASTAL VILLAGES: A DATA ENVELOPMENT ANALYSIS APPROACH
Authors: Wati Dyah Retno
Published: December 2024

Coastal communities in Indonesia face interconnected challenges from climate change and public health vulnerabilities, yet the relationships between these factors remain poorly understood. We investigated these connections across eight Indonesian provinces by analyzing marine dependency, disease susceptibility, and flood risk projections using Data Envelopment Analysis (DEA) and multiple datasets. Our analysis revealed that South Kalimantan's coastal communities are particularly vulnerable, demonstrating the highest dependency on marine resources while simultaneously facing significant health and environmental challenges. This heightened vulnerability is evidenced by elevated Marine Capture Fisheries Households (RTPT) scores and fish capture data, indicating substantial economic reliance on marine resources. The challenges are further intensified by projected flood risks expected to impact these areas within six years, alongside varying health vulnerabilities including tuberculosis, HIV, dengue fever, and COVID-19 cases. Through our DEA estimation, which incorporated six output and four input variables along with demographic information, we found that South Kalimantan's marine resource dependency significantly exceeds that of other provinces. These findings provide crucial insights for policymakers and health administrators, establishing a data-driven foundation for developing targeted interventions and resource allocation strategies. Our study underscores the necessity of implementing integrated approaches that simultaneously address environmental and public health concerns in coastal communities.
WORKFORCE ECOSYSTEM DEVELOPMENT AT HOSPITAL X SURABAYA
Authors: Putri Errytrina Kurnia , Setianto Budhi , Adriansyah Agus Aan
Published: December 2024

X Hospital is one of the hospitals in Surabaya that continues to improve its medical services following several negative reviews found on Google Business between January and April 2024. These reviews suggest that human resource performance, particularly in patient care, needs improvement. In response, the hospital is focusing on internal development by cultivating a workforce ecosystem that includes organic employees, non-organic employees, and interns. This study aims to analyze the development of the workforce ecosystem at Manyar Hospital by evluating employee performance, skill training, and on-the-job training among 116 organic employees, 88 non-organic employees, and 20 interns, with a sample size of 65 participants. Descriptive statistical analysis was employed, with samples selected through convenience sampling. The results indicated that, for employee performance, the highest mean value was found in supervisor social support, while the lowest was found in empowerment. For skill training, the highest mean value was found in the ability to ask, while the lowest was found in self-control. For on-the-job training, the highest mean value was found in the effect on the job, employee training, and deductive and inductive on-the-job training strategies, while the lowest mean was found in structured on-the-job training in developing nations.
DETERMINANTS OF DIABETES MELLITUS PREVALENCE IN INDONESIA: A MULTIPLE LINEAR REGRESSION MODEL IN AN ECOLOGICAL ANALYSIS OF ADULTS AGED 15 YEARS AND OLDER
Authors: Nuridzin Dion Zein , Aghram Nauval , Mawarni Atik , Retnowati Retnowati
Published: December 2024

Indonesia faces a double burden of disease, with an increasing prevalence of non-communicable diseases (NCDs), such as diabetes mellitus (DM), alongside communicable diseases. This study investigates the determinants of DM prevalence among individuals aged 15 years and older in Indonesia. An ecological design was employed using secondary data from the 2018 Basic Health Research Report, 2018 Welfare Statistics Report, and the 2019 Provincial in Figures Report, encompassing 514 districts across 34 provinces. Data analysis included univariate descriptive statistics, Pearson correlation for bivariate analysis, and multiple linear regression with a backward method to identify significant predictors. The results revealed significant associations between DM prevalence and hypertension (p < 0.001), obesity (p < 0.001), routine blood sugar testing (p < 0.001), good nutrition (p = 0.016), the ratio of general hospitals (p < 0.001), public health centers (p < 0.001), and physicians (p < 0.001), as well as the interaction between hospital and physician ratios (p < 0.001). The model explained 61.5% of the variance in DM prevalence (R² = 0.615), meeting all multiple linear regression assumptions. Prevalence of hypertension, obesity, and higher ratios of general hospitals and physicians were positively correlated with DM prevalence, while good nutrition and greater availability of public health centers exhibited protective effects. The positive association of routine blood sugar testing likely reflects increased screening in high-DM areas. These findings highlight the need for targeted public health interventions, emphasizing obesity reduction, nutritional improvements, and equitable healthcare distribution to mitigate DM prevalence in Indonesia.