bluuebunny/crossref_metadata_2025 huggingface dataset:
1500 év Tárnok múltjából
Authors: Kemsei Zoltán
Published: February 2021

Rövid merítés egy Budapest közeli (hajdan Fejér, ma Pest megyei) község múltjából a legendák homályába vesző tárnokvölgyi csatától a modernizáció, az iparosodás kezdetéig. Ez a hajdan magyar, majd rövid ideig szerb, később szlovák falu az ország jelentős történelmi eseményeiben nem vett részt, szem elé is csak a 20. század elejétől, agglomerációs településsé válásától került. Tárnok élő emlékezete körülbelül negyed évezredre tekinthet vissza, köszönhetően az identitását, nyelvét, szokásait sokáig megőrző szlovák nemzetiségnek. A fennmaradó 1250 évet a krónikák, oklevelek, történettudományi munkák őrzik. Tárnok története talán tipikus is lehet: egy középkori község, amely a török időkben lakosságát elvesztvén kiürül, majd a 18. században települ újjá, gyökeresen megváltozott jelleggel, nemzetiségi összetétellel, a régi hagyományok helyett új szokásokkal.
Veszprém dualizmuskori városi fejlődése
Authors: Rácz Nóra
Published: February 2021

A tanulmány Veszprém dualizmuskori városi fejlődését foglalja össze. A bevezetés után betekintést nyújt a városiasodás folyamatának meghatározó tényezőbe. Ismerteti Veszprém 19. századi helyzetét, társadalmi, gazdasági jellemzőit, oktatásban betöltött szerepét. A továbbiakban röviden kitér a fontosabb korabeli építkezésekre (pl. a zsinagóga) és átépítésekre (pl. a Tűztorony). Említésre kerülnek a millennium évében végbemenő városfejlesztési munkálatok és annak előzményei egy korabeli újságcikk alapján. Megvizsgálja azt a kérdést, hogy a vasúti hálózat kiépítése hogyan befolyolta a város fejlődését. A város fejlődésének vizsgálata során elkerülhetetlen a társadalom és a népességi adatok vizsgálata. Végezetül pedig egy, a polgárosodás kezdetén élt borbélymester történetének összefoglalása alapján kaphatunk képet a város és a kor társadalmi problémáiról, fejlődésének menetéről.
Kontrasto figūrų galia Rolando Pavilionio kalbose
Authors: Koženiauskienė Regina
Published: February 2021

Straipsnyje analizuojamos Rolando Pavilionio kalbos (pasakytos ir parašytos 2000–2006 m. laikotarpiu) peržengus, jo žodžiais, per amžinybės paženklinto Vilniaus universiteto slenkstį į visai kitą – žemišką politinio gyvenimo – erdvę, kurios nesutaikomas kritikas jis buvo iki tolei. Dėmesys sutelktas į vieną svarbų retorinį aspektą – kontrastą, kuris yra nuolatinė intelektualaus oratoriaus gyvenimo būsena, mąstymo pagrindas ir kalbėjimo būdas. Pirmą kartą aptariamas išskirtinis R. Pavilionio gebėjimas pasinaudoti visa apimančiomis retorinėmis kontrasto figūromis – antiteze, oksimoronu, paradoksu, antimetabole, antifraze, padėjusiomis jam pasiekti užsibrėžtų tikslų. Parodomas didelis šių figūrų psichologinis poveikis klausytojams. R. Pavilionio, lyderio iš prigimties, mintys, išsakytos nesuderinamais ir kartu paradoksaliai suderinamais žodžiais ir pasakymais, įsirėžia į klausytojų atmintį, verčia mąstyti, paryškina emocinį aptariamų dalykų santykį, patraukia paskui save tiesos ir naujumo link, įtikina ir įteigia, nes turi retorinio argumentavimo galią.
Penerapan Sistem Akuaponik (Budidaya Ikan Dalam Ember) untuk Pemenuhan Gizi Dalam Mencegah Stunting di Desa Gending Kabupaten Probolinggo
Authors: Perwitasari Dyah Ayu , Amani Tatik
Published: February 2021

Gending Village is a village located in Gending District, Probolinggo Regency, consisting of 4 Hamlets, 4 RWs, 13 RT. RT 09 area. Buyut Hamlet is one of the areas in the village of Gending, Gending District. The majority of RT 9 residents have livelihoods as farmers. The area of ​​Buyut Hamlet was once a center for catfish farming in the village of Gending, but is now beginning to be abandoned because of the existence of a small amount of feed. The adoption of the budikdamber as the development of the aquaponics system is expected to be able to foster community interest in conducting fish and vegetable cultivation in one place, so that the yields obtained are also abundant and meet the nutritional needs derived from fish and vegetables. One effort to redevelop the local potential in the form of catfish farming, needs to be done an action in the form of socialization. The socialization was carried out by conveying material about hydroponics and buddhambers, which was followed by housewives of RT 9 with the aim to be able to fill spare time and develop the ability of catfish culture that had previously been nurturing, but also as a form of utilization of house yards or narrow land to be efficient and profitable. The practice was carried out by demonstrating the buddhamber accompanied by lecturers and student teams, and handing over the assemblies of the buddambers along with vegetables and fish to one of the residents as a pilot. The results obtained from this program are an increase in knowledge and skills of partners about fish farming in a bucket (Budikdamber) as well as an increase in family food independence by utilizing home yards through the cultivation of vegetables and fish in one place.

Keywords: Gending, Aquaponics, Budikdamber, Nutrition, Stunting
Pemanfaatkan Potensi Lokal Melalui Pembuatan Susu Jagung Guna Mencegah Stunting Pada Desa Gejugan
Authors: Setiyono Agus Edi , Ngatimun Ngatimun , Musriati Titik
Published: February 2021

Gejugan Village is one of the villages in Probolinggo district on the north coast. Gejugan Village is in the west bordering Klaseman Village and Karangpranti Village, Pajarakan District. Gejugan village has local potential that can be developed from their agricultural produce, namely corn. Corn is an alternative food source that contains many nutrients. But the people here still don't have the knowledge to be able to use it. The Socialization Activity for Making SUJU (Corn Milk) to Prevent Stunting and Utilizing Local Potential is expected to provide more knowledge to the Gejugan community in utilizing existing local potential, especially processing corn into corn milk. Besides having good nutrition, corn milk also has more value in the economy. If it is processed properly and properly, this product can be sold in the market. The socialization of making corn milk was attended by 25 residents of Gejugan Village. Material for making corn milk was given by providing materials and hands-on practice during the event. Participants in the socialization of making corn milk enthusiastically listened to and practiced directly making corn milk during the socialization process. From the results of the socialization, the practiced corn milk resulted in 6 bottles of corn milk measuring 360 ml. Participants listened well and the material presented was well received by all participants present.

Keywords: Local Potential, Corn Milk, Stunting
Liderazgo en la innovación
Authors: Ávila Díaz William Darío
Published: February 2021

El objetivo de este documento es mostrar la importancia del “Liderazgo de la Innovación” dentro del contexto organizacional, ya sea social, empresarial o personal, en los tiempos difíciles en los que se encuentra nuestro planeta. Con respecto a la metodología que se siguió, lo primero fue definir algunos términos como innovación, creatividad, capacidades y su aplicabilidad en las organizaciones mencionadas para dimensionar la importancia del liderazgo en la innovación, ya que la vida no será igual, a como se había estado desarrollando antes de la llegada de la pandemia (causada o natural), hacia el mes de diciembre de 2019 desde Wuhan (China).
Los resultados obtenidos fueron: comprender la situación del liderazgo de las organizaciones antes y durante la pandemia de COVID-19 y cómo, de ese liderazgo, las organizaciones procederán con nuevas estrategias en tiempos posteriores a la pandemia.
En tiempos de epidemia, las estructuras como tales, tuvieron que sufrir cambios radicales en su comportamiento, tratando de reinventarse para sobrevivir en la problemática situacional, económica y social que atraviesa la humanidad.
El hombre 2020. Medio rostro
Authors: Rincón Rueda Alberto Isaac
Published: February 2021

El año 2020 llegó al mundo con la pandemia del COVID-19 que está atacando al hombre y a la sociedad, y cambiando el estilo de vida de todas las personas. El virus, está causando la muerte de individuos sin ninguna distinción de raza o sexo; edad o situación económica. Y la única forma de protegerse, es hacerse responsable de sí mismo y de los demás, observando estrictamente las normas de autocuidado, dado que “la muerte es el acontecimiento más dramático y más decisivo de la vida de una persona” (Valverde, 1994, p. 248) Esta certeza no implica, en modo alguno, que el ser humano no tenga la posibilidad de prevenir situaciones que se presentan y que puedan terminar con la vida y, en el caso del COVID-19, las posibilidades de contagio de la enfermedad, que es potencialmente mortal.
Hubungan Pemanfaatan Posyandu Prakonsepsi dengan Status Gizi Wanita Prakonsepsi di Desa Lokus Stunting Kabupaten Banggai
Authors: Balebu Dwi Wahyu , Labuan Arsiyanti , Tongko Mirawati , Sattu Marselina
Published: February 2021

Posyandu prakonsepsi adalah pelayanan wanita usia subur reproduksi sebelum kehamilan pertama untuk memastikan bahwa kondisi dan perilaku ibu pada saat hamil dapat menimbulkan resiko bagi ibu dan bayi dapat diidentifikasi. Penelitian ini bertujuan untuk mengetahui hubungan pemanfaatan posyandu prakonsepsi dengan status gizi wanita prakonsepsi. Jenis Penelitian ini adalah analitik dengan rancangan penelitian cross sectional dengan total 316 sampel. Status Gizi di tandai dengan Status Anemi, Lingkar Lengan Atas (LILA) dan Indeks Masa Tubuh (IMT). Analisis data dilakukan secara univariate dan bivariate. Hasil penelitian menunjukkan ada hubungan yang signifikan antara pemanfaatan posyandu prakonsepsi dengan status anemi wanita prakonsepsi (ρ = 0,021  X²= 5,361 ), tidak ada hubungan yang signifikan antara pemanfaatan posyandu prakonsepsi dengan status KEK wanita prakonsepsi  (ρ=0,447 X²= 0,578), dan ada hubungan yang signifikan antara pemanfaatan posyandu prakonsepsi dengan status IMT wanita prakonsepsi (ρ = 0,003  X²=9,016 ). Berdasarkan hasil tersebut perlu motivasi dan dorongan kepada wanita prakonsepsi untuk memanfaatkan posyandu prakonsepsi serta mengoptimalkan posyandu prakonsepsi yang sudah ada di masyarakat, serta mengintegrasikan upaya promotive dan edukasi gizi kedalam program posyandu prakonsepsi.
Preconception Posyandu is a service for women of reproductive age before first pregnancy to ensure that maternal conditions and behavior during pregnancy can pose risks for both mother and baby can be identified. This study aims to determine the relationship between the use of preconception posyandu and preconception female nutrition status. This type of research is analytic with a cross sectional study design with a total of 316 samples. Nutritional Status is marked with Anemia Status, Upper Arm Circumference (MUAC) and Body Mass Index (BMI). Data analysis was carried out univariate and bivariate. The results showed a significant relationship between the use of preconception posyandu with preconception female anemic status (ρ = 0.021 X² = 5.361), there was no significant relationship between the use of preconception posyandu with preconception SEZ status of women (ρ = 0.447 X² = 0.578), and there was no significant relationship between the use of preconception posyandu with preconception SEZ status of women (ρ = 0.447 X² = 0.578), a significant relationship between the use of preconception posyandu with preconception female BMI status (ρ = 0.003 X² = 9.016). Based on these results, motivation and encouragement to preconception women need to use preconception posyandu and optimize preconception posyandu that already exists in the community, as well as integrating promotive and nutritional education efforts into the preconception posyandu program
Gambaran Pengetahuan dan Sikap Ladies Cafe tentang Pencegahan Hiv/Aids Daerah Pandanwangi Toili Barat
Authors: Tongko Mirawati , Amir Zahrawati , Derthan Derthan , Balebu Dwi Wahyu
Published: February 2021

Salah satu penyakit menular yang mendapat perhatian dunia karena insidensi dan penyebarannya yang semakin meningkat adalah penyakit HIV/AIDS. Tujuan dilakukan penelitian ini agar memperoleh gambaran tentang bagaimana pengetahuan dan sikap ladies cafe terhadap pecegahan HIV/AIDS dalam rangka identifikasi faktor risiko penularan penyakit menular seksual di kalangan masyarakat. Jenis penelitian ini adalah penelitian deskripif dengan teknik pengumpulan data melalui kuisioner. Populasi dalam penelitian ini adalah seluruh Ladies Cafe yang bekerja di Cafe Pandanwangi Kecamatan Toili Barat Kabupaten Banggai. Teknik sampel menggunakan total sampling atau keseluruhan jumlah populasi. Data dianalisis deskriptif univariat. Hasil Penelitian didapatkan bahwa sebanyak 64% Ladies Cafe memliki pengetahuan Cukup tentang Pencegahan HIV/AIDS sedangkan sebanyak 96% Ladies Cafe memiliki sikap Positif terhadap pencegahan HIV/AIDS. Tingkat pengetahuan merupakan domain untuk melakukan tindakan hingga taraf memahami ditunjukkan melalui penginterpretasian materi secara benar hingga selanjutnya pengaplikasian secara real, yang berarti responden mampu membaca kondisi bahaya HIV/AIDS dan cara mencegahnya sehingga ia dapat melakukan pencegahan. 
One of the infectious diseases that received worldwide attention because of its increasing incidence and spread is HIV / AIDS.  The purpose of this study was to obtain a picture of how the knowledge and attitudes of women cafes against HIV / AIDS prevention in the context of identifying risk factors for sexually transmitted diseases in the community. This type of research is descriptive research with questionnaire data collection techniques. The population in this study were all ladies cafes who worked in Pandanwangi café, West Toili Sub-District, Banggai Regency. The sampling technique uses total sampling or the total population. Data were analyzed univariate descriptive. The results of the study found that as many as 64% of the Ladies Cafe have Sufficient knowledge about HIV / AIDS Prevention, while 96% of the Ladies Café have a positive attitude towards HIV / AIDS prevention. The level of knowledge is a domain for someone to carry out an act of someone's level of understanding is shown through the interpretation of material correctly until the subsequent applicated , which means the respondent able to read the dangerous condition of HIV / AIDS and how to prevent it so that he can do prevention.
Faktor yang Berhubungan dengan Kejadian Dehidrasi pada Pekerja Tempe di Kelurahan Rajawali Kota Jambi
Authors: Sari Novitri , Mirsiyanto Eko
Published: February 2021

Dehidrasi merupakan kekurangan cairan tubuh karena jumlah cairan yang keluar lebih banyak dari pada jumlah cairan yang masuk. Salah satu pekerjaan yang beresiko mengalami dehidrasi adalah pada perebusan pembuatan tempe dimana menggunakan lingkungan yang cukup panas sehingga banyak mengeluarkan keringat dan mebutuhkan asupan cairan yang lebih. Tujuan penelitian adalah untuk mengetahui faktor-faktor yang berhubungan dengan kejadian dehidrasi pada pekerja pengrajin tempe. Penelitian ini merupakan penelitian deskriptif analitik dengan pendekatan cross sectional. Populasi dalam penelitian ini adalah seluruh jumlah pengrajin tempe. Sampel berjumlah 30 responden. Teknik pengambilan sampel dengan cara total sampling. Analisis data dalam penelitian ini secara univariat dan bivariat dengan uji chi square. Hasil penelitian ada hubungan konsumsi cairan (0,004) dan beban kerja (0,007) dengan kejadian dehidrasi pada pekerja pengrajin tempe. Tidak ada hubungan berat badan dengan kejadian dehidrasi pada pekerja pengrajin tempe (p=0,875). Diharapkan pemilik usaha pengrajin tempe untuk dapat selalu menyediakan air minum yang cukup bagi pekerjanya saat pekerja membutuhkan sehingga kejadian dehidrasi dan dampaknya dapat diminimalisir.
Dehydration is a lack of body fluids because the amount of fluid that comes out is more than the amount of fluid that is entered. One of the jobs that are at risk of dehydration is in boiling the manufacture of tempeh which uses a hot enough environment so that you sweat a lot and require more fluid intake. The research objective was to determine the factors associated with the incidence of dehydration in tempe craftsmen. This research is a descriptive analytic study with a cross sectional approach. The population in this study were all of the tempe craftsmen. The sample is 30 respondents. The sampling technique was total sampling. Data analysis in this study was univariate and bivariate with the chi square test. The results showed a relationship between fluid consumption (0.004) and workload (0.007) with the incidence of dehydration among workers of tempe craftsmen. There is no correlation between body weight and dehydration in tempe craftsmen workers (p = 0.875). It is expected that the tempe craftsman business owners can always provide sufficient drinking water for their workers when they need them so that the incidence of dehydration and its impact can be minimized.
Persepsi Remaja Putri tentang Anemia di Sekolah Menengah Kejuruan (SMK) Negeri 5 Luwuk Timur
Authors: Yulita Nadya , Lanyumba Fitrianty Sutadi , Balebu Dwi Wahyu , Ramli Ramli
Published: February 2021

Anemia adalah suatu kondisi dimana jumlah sel darah merah atau hemoglobin berada di bawah normal. Tujuan dalam penelitian ini yaitu untuk memperoleh gambaran Persepsi Remaja Putri tentang Anemia di SMK Negeri 5 Luwuk Timur. Jenis penelitian ini yaitu kualitatif dengan menggunakan teknik purposive sampling dengan kriteria bahwa, pernah mendapatkan tablet tambah darah (Fe) dan penyuluhan dari petugas kesehatan tentang anemia. Informan dalam penelitian ini adalah remaja putri SMK 5 Luwuk Timur dengan kriteria bahwa, pernah mendapatkan tablet tambah darah (Fe) dan penyuluhan dari petugas kesehatan tentang anemia dan informan kunci yaitu petugas kesehatan di Puskesmas Hunduhon. Penelitian ini menggunakan teknik analisis data menurut Milles dan Huberman (1984) yaitu Reduction, Display, Conclusion. Hasil penelitian menunjukkan bahwa sebagian besar remaja putri mempersepsikan anemia sebagai keadaan kurang darah dan mengatakan bahwa gejala anemia adalah pusing, sakit kepala, lemah, letih, lesu, lemas, dan loyo. Sebagian besar remaja putri belum memahami penyebab anemia. Remaja putri mengatakan bahwa begadang dan kurang tidur sebagai penyebab dari anemia. Remaja putri yang belum memahami akibat atau dampak menganggap bahwa sakit badan dan kepala adalah akibat atau dampak dari anemia. Perlu adanya perhatian untuk memberikan penyuluhan dalam kegiatan posyandu remaja dan disarankan kepada remaja putri lebih meningkatkan pengetahuan dan pemahaman tentang anemia. 
Anemia is a condition in which the number of red blood cells or hemoglobin is below normal. The purpose of this study was to obtain a description of the perception of young women about anemia at SMK Negeri 5 Luwuk Timur. This type of research is qualitative by using purposive sampling technique with the criteria that, have ever received a blood supplement (Fe) tablet and counseling from health workers about anemia. The informants in this study were young women of SMK 5 Luwuk Timur with the criteria that they had received blood added tablets (Fe) and counseling from health workers about anemia and key informants were health workers at the Hunduhon Health Center. This study uses data analysis techniques according to Milles and Huberman (1987), namely Reduction, Display, Conclusion. The results showed that most of the young women perceived anemia as a lack of blood and said that the symptoms of anemia were dizziness, headache, weakness, fatigue, lethargy, weakness, and weakness. Most of the young women do not understand the causes of anemia. Young women say that staying up late and lack of sleep are the causes of anemia. Young women who do not understand the consequences or effects think that body and headaches are the result or impact of anemia. Attention is needed to provide counseling in youth posyandu activities and it is recommended that young women increase their knowledge and understanding of anemia.
Pelayanan Kesehatan Ibu, Anak, dan Keluarga Berencana di Puskesmas Cirimekar, Bogor
Authors: Tunggal Mutika Winnie , Doria Magda , Putri Mita Meliani , Sari Ninda , Anggriani Yohana , Renwarin Zainah Azan , Ambariani Ambariani
Published: February 2021

Pusat Kesehatan Masyarakat (Puskesmas) adalah organisasi fungsional yang menyelenggarakan upaya kesehatan yang bersifat menyeluruh, terpadu, merata, dapat diterima, terjangkau oleh masyarakat, dengan peran serta aktif masyarakat dan menggunakan hasil pengembangan ilmu pengetahuan dan teknologi tepat guna, dengan biaya yang dapat dipikul oleh pemerintah dan masyarakat. Salah satu tugas dan fungsi puskesmas adalah melaksanakan enam upaya kesehatan wajib diantaranya adalah upaya pelayanan kesehatan ibu, anak, dan keluarga berencana. Penelitian dengan menggunakan pendekatan deskriptif (explanatory research). Pengumpulan data dilakukan melalui observasi serta wawancara kepada tenaga kesehatan dan pasien khususnya yang menerima pelayanan kesehatan ibu, anak, dan keluarga berencana di Puskesmas Cirimekar. Instrumen yang digunakan adalah panduan wawancara evaluasi pelayanan dari tim praktik klinik Program Studi Kebidanan Universitas Gunadarma. Hasil wawancara dan observasi dibuat dalam bentuk narasi sehingga dapat diberikan ke lahan praktik untuk meningkatkan pelayanan Puskesmas Cirimekar. Hasil pelayanan kesehatan ibu, anak, dan keluarga berencana menunjukkan prosedur pelayanan, waktu pelayanan, sarana dan prasarana yang terdapat di puskesmas sudah cukup baik.Keterbatasan sumber daya manusia yaitu petugas kesehatan yang ada di Puskesmas Cirimekar menyebabkan waktu tunggu lebih lama yang ditunjukkan adanya antrian pasien KIA dan KB sehingga pelayanan yang diberikan dirasa kurang optimal. 
 
Public health center (Puskesmas) is a functional organization who held comprehensive, integrated, and acceptable health efforts to society with active role from society and using  science and technology, with cost comes from the government and society. Puskesmas duty is doing six health efforts obligatory in society, one of the obligatory is mother, child, and family planning health services. This research is using explanatory research. Data was collected through observation and interviews with health workers and patients, especially those who received maternal, child and family planning health services in Puskesmas Cirimekar. The instrument used was service evaluation interview guide from the clinical practice team of the Program Study of Universitas Gunadarma. The results of interviews and observations were made in narrative form so that they could be given to practice fields to improve Puskesmas Cirimekar services.Result from interview and observation processed using descriptive analysis. The result shows that health service for mother, child and family planning health services in Puskesmas Cirimekar is pretty good based on procedure, time and facilities. But, the limited of human resources (health workers) in Puskesmas Cirimekar sometimes make a long queue for services at mother health, child health and also family planning, and it makes the services not optimal.
Determinan Kejadian Bayi Berat Badan Lahir Rendah (Bblr) di Gorontalo
Authors: Ramadhani Firdausi , Hano Yanti Hz.
Published: February 2021

Penelitian ini bertujuan untuk mengetahui beberapa faktor yang berhubungan dengan kejadian bayi Bayi Berat Badan Lahir Rendah (BBLR) di Wilayah Kerja Puskesmas Limboto Kabupaten Gorontalo. Metode yang digunakan adalah  Observasional Analitik dengan pendekatan cross sectional study. Populasi adalah seluruh ibu yang melahirkan berjumlah 853 responden, dengan Sampel yaitu sebanyak 202 responden. Teknik pengambilan sampel menggunakan tekhnik Purposive Sampling. Analisis data menggunakan uji Chi Square. Hasil penelitian menunjukkan proporsi bayi Berat Badan Lahir Rendah (BBLR) 34 responden (16,8%) dan bayi Berat Badan Lahir Normal (BBLN) 168 responden (83,2%). Hasil bivariat didapatkan bahwa ada hubungan pengetahuan (p-value 0,044), pendapatan keluarga (p-value 0,029) dengan kejadian bayi Berat Badan Lahir Rendah (BBLR). Sedangkan, jumlah paritas (p value 0,523),  jarak kehamilan (p-value 0,659), dan Kekurangan Energi Kronik (KEK) (p-value 0,637) tidak memiliki hubungan yang bermakna secara statisti dengan kejadian bayi Berat Badan Lahir Rendah (BBLR). 
 
This study aims to determine several factors associated with the incidence of low birth weight babies (LBW) in the Limboto Health Center, Gorontalo District. The method used is analytic observational with a cross sectional study approach. The population was all mothers who gave birth totaling 853 respondents, with a sample of 202 respondents. The sampling technique used purposive sampling technique. The results showed that the proportion of Low Birth Weight (LBW) babies was 34 respondents (16.8%) and Normal Birth Weight (BBLN) babies were 168 respondents (83.2%). The bivariate results showed that there was a relationship between knowledge (p value 0.044), family income (p value 0.029) with the incidence of low birth weight babies (LBW). Meanwhile, the parity (p value 0.523), pregnancy distance (p-value 0.659), and Chronic Energy Deficiency (P-value 0.637) did not have a statistically significant relationship with the incidence of Low Birth Weight (LBW).
Penilaian Pelaksanaan Trias UKS di SMP Negeri 1 Giri Banyuwangi Berdasarkan Pedoman Pelaksanaan UKS
Authors: Putri Fika Ardiana , Rahayu Intan Putri , Febriawan Wahyu , Yuliandari Inriza
Published: February 2021

Pembinaan dan pengembangan Usaha Kesehatan Sekolah (UKS) merupakan salah satu upaya pemeliharaan dan peningkatan kesehatan yang ditujukan kepada peserta didik (usia sekolah), hal ini penting untuk meningkatkan kualitas fisik mereka. Metode penelitian ini merupakan penelitian deskriptif menggunakan pendekatan kualitatif. Sumber informasi penelitian ini adalah data primer berupa observasi lapangan, wawancara kepada informan atau narasumber yaitu guru pembina UKS, siswa anggota PMR dan siswa bukan anggota PMR serta warga sekolah, sedangkan untuk data sekunder berupa dokumen pedoman pelaksanaan UKS di sekolah. Penelitian ini berfokus pada TRIAS UKS yang meliputi pendidikan kesehatan, pelayanan kesehatan dan pembinaan lingkungan sekolah sehat. Hasil pelaksanaan promosi kesehatan di institusi pendidikan “SMP Negeri 1 Giri Banyuwangi Tahun 2018” pada aspek organisasi tim pembina dan tim pelaksana UKS didapatkan skor 50%, aspek pendidikan kesehatan didapatkan skor 56,8%, aspek pelayanan kesehatan didapatkan skor 38,6% sehingga ketiganya dalam kategori cukup, dan aspek pembinaan lingkungan sekolah sehat didapatkan skor 65% sehingga dalam kategori baik. Secara kumulatif pelaksanaan promosi kesehatan di institusi pendidikan “SMP Negeri 1 Giri Banyuwangi Tahun 2018” berada pada skor 54 %. Skor tersebut berada pada tingkatan kategori cukup. Kesimpulan penelitian ini adalah pelaksanaan Trias UKS di SMP Negeri 1 Giri Banyuwangi belum sesuai dengan Pedoman Pelaksanaan UKS di Sekolah Tahun 2014.
School Health Unit (UKS) is one of the efforts to maintain and improve the health goals of students (school age), this is important to improve their physical quality. This research method is a descriptive study using a qualitative approach. The source of information for this research is primary data in the form of field observations, interviews with informants or interviewees, which is the UKS’ supervisor teacher, students of PMR members and students who don't belong members of the PMR and school citizens, while for secondary data is the guidelines for implementing UKS in schools. This research focuses on TRIAS UKS which includes health education, health services and fostering a healthy school environment. The educational institution "1 Giri Junior High School, Banyuwangi in 2018" on the organizational aspects of the UKS training team obtained by a score of 50%, the aspects of health services obtained a score of 38.6% so that the three categories were insufficient category, and the aspect of fostering a healthy school environment got a score of 65% so that it was in the good category. The implementation of health promotion at the educational institution "1 Giri Junior High School, Banyuwangi in 2018" was at a score of 54%. The score is at the sufficient category level. This research report is the implementation of the Trias UKS in 1 Giri Junior High School, Banyuwangi not in accordance with the UKS Implementation Guidelines in 2014.
Straw vs Cup Use in Patients with Symptoms of Oropharyngeal Dysphagia
Authors: Pang Bo , Cox Paul , Codino Julianna , Collum Austin , Sims Jake , Rubin Adam
Published: February 2021

CONTEXT

This study aims to determine whether straw or cup use is superior for the control of a single thin liquid bolus in patients with symptoms of oropharyngeal dysphagia to liquids.

METHODS

This is a prospective, randomized, single-blinded study. Patients were studied at a Professional Voice and Swallowing Center by a laryngologist between April 2017 and April 2018. Twenty-five patients, 18 years of age or older, who presented with symptoms of oropharyngeal dysphagia the clinic were included in the study. Each patient complained of difficulty with choking on liquids. Informed consent was obtained from each patient. Patients that were unable to follow one to two step commands and patients with dysphagia that lack oral strength or respiratory strength to facilitate straw or cup usage were not included. Patients with dysphagia that are tracheostomy tube dependent were also not included.

RESULTS

The average PAS for straw versus cup drinking at 10mL was 1.08 and 1.04 respectively with a p-value of 0.33. For straw versus cup at 20mL, the PAS was 1.04 and 1.26 respectively with a p-value of 0.13. For 30mL, the PAS was 1.0 and 1.4 for straw and cup use respectively with a p-value of 0.16. And for 40mL, the PAS was 1.0 and 1.09 with a p-value of 0.27.

CONCLUSIONS

No statistical significant difference was demonstrated in risk of penetration or aspiration of thin liquids between cup and straw usage in patients with mild oropharyngeal dysphagia.
Provider Driven Follow-Up in a Chest Pain Accelerated Diagnostic Protocol: Round Two of the PDSA Cycle in a Multidisciplinary Quality Improvement Patient Safety Project
Authors: Troiano Isaac , Mitchell Mary , Schury Mark , Butki Nikolai
Published: February 2021

CONTEXT

In 2016, the McLaren Oakland Department of Emergency Medicine developed and implemented a Chest Pain Accelerated Diagnostic Protocol (CP-ADP) to identify patients presenting to the emergency department (ED) with chest pain who were at low risk for acute coronary syndrome (ACS) and appropriate for outpatient follow-up. The evaluation of the QI/PS project demonstrated that only 47% of the patients discharged from the ED under the CP-ADP received outpatient follow-up. In response, a second round of the PDSA cycle modified the CP-ADP to add a multidisciplinary provider driven follow-up.

METHODS

After ED discharge, patients in the CP-ADP with provider driven follow-up were contacted by a primary care physician to schedule a follow-up appointment. The premise was that this provider driven follow-up would alleviate navigation of the health care system as a barrier to follow-up.

RESULTS

The evaluation of the modified CP-ADP with provider driven follow-up demonstrated that 9 of the 30 patients discharged from the ED were able to be contacted. 21 of the patients were unable to be reached by the phone number they provided. Only 3 patients discharged with provider driven follow-up showed up to follow up appointments.

CONCLUSIONS

There were some internal process failures identified that contributed to the low numbers of patients that were successfully contacted. External factors such as patient access to phones and means of communication were also discussed as factors that were originally not considered.
Ancillary Findings on CT Pulmonary Angiograms that are Negative for Pulmonary Embolism
Authors: Stein Paul , Matta Fadi , Gerstner Brett J. , Kakish Edward J. , Hughes Patrick G. , Lata Julie , Trigger Christopher C. , Jutzy Kevin A. , Doyle Michael Q. , Warpinski Mathew A. , Corser William D. , Long Jerome P. , Fakhouri Nasheed S. , Jones Corion L. , Owen Kristen N. , Lyons Casey , Carracedo Damien , Skinner Ian P. , Warner Laura A. , Saffer Ethan R. , Deming Brody A. , Cronovich Keith D. , Hughes Mary J.
Published: February 2021

CONTEXT

One advantage of computed tomographic pulmonary angiograms (CTPA) is that they often show pathology in patients in whom pulmonary embolism (PE) has been excluded. In this investigation, we identified the ancillary findings on CTPAs that were negative for PE to obtain an impression of the type of findings shown.

METHODS

This was a retrospective analysis of findings on CTPAs that were negative for PE obtained in nine emergency departments between January 2016 - February 2018. Ancillary findings were assessed by review of the radiographic reports.

RESULTS

Ancillary findings were identified in N=338 (40.9%) of 825 patients with CTPAs that were negative for PE. Most ancillary findings, 254 (75.1%) of 338 were pulmonary or pleural abnormalities. Liver, gall bladder, kidney, or pancreatic abnormalities were shown in 26 (7.7%) cases, and abnormalities of the heart or great vessels were shown in 23 (6.8%) of cases. Abnormalities of the esophagus or intestine were shown in 12 (3.6%), abnormalities of the thyroid in 10 (3.0%) and abnormalities of bone or soft tissue lesions were shown in three (0.9%) cases. Inferential statistical procedures demonstrated that the occurrence of ancillary findings in patients with negative CTPAs was proportionately greater in patients who were 50 years and older (p < 0.001), although not between genders (p = 0.145).

CONCLUSIONS

Ancillary findings on CTPAs that were negative for PE were frequently reported. Future studies might focus of the extent to which ancillary findings on CTPA assisted physicians in management of the patient.
Incidence of Heterotopic Ossification in Direct Anterior Approach to Total Hip Arthroplasty with use of Aspirin as Thromboembolic Prophylaxis
Authors: Knapp Paul , Doehrmann Ross , Yokhana Sanar , Rizvi Syed , Boura Judith , Knesek David
Published: February 2021

CONTEXT

Heterotopic ossification (H.O.) is a common occurrence after total hip arthroplasty (THA) with significant potential clinical ramifications. Controversy still exists regarding the exact etiology of the disorder, including possible risk factors. Surgical technique, surgical approach, postoperative medication protocols and even thromboembolic prophylaxis have been implicated in the formation of H.O. Our study looked at one institution with a single surgeon performing direct anterior THA (DAA THA) in patients who received aspirin (ASA) as monotherapy for thromboembolic prophylaxis.

METHODS

Patients at a single institution who underwent DAA THA between 2015 and 2019 were identified by CPT code. 45 patients ultimately met inclusion criteria. Postoperative radiographs were analyzed retrospectively for H.O. according to the Brooker classification. Several patient characteristics and comorbidities were statistically analyzed using Chi-square tests, Fisher Exact tests, Wilcox rank sum tests, and Pearson correlation.

RESULTS

12 patients (26.7%) were found to have heterotopic ossification (67% Class 1, 8% Class 2, 25% Class 3, and 0% Class 4); with a median follow up of 35 weeks (range: 12-96). 25% of these patients received ASA 325mg BID while 75% received ASA 81 BID. No statistical differences in development of H.O. were detected among age, gender, BMI, sex, race, diabetes, or NSAID use in the post-operative interval. There were significantly more smokers in the H.O. group (50% vs. 9%, p<0.006).

CONCLUSIONS

Our analysis aimed to quantify the incidence of H.O. with consistency in surgical approach and post-operative protocol. There have been few studies on this topic, and we believe it is very relevant with the increasing use of aspirin in the post-operative protocol for thromboembolic prophylaxis. Our retrospective analysis identified H.O. at rates similar to previous studies in DAA.
Congenital Pharyngeal Web in an Adult: Treatment of a Rare Clinical Anomaly by Coblation
Authors: Minutello Katrina , Pinther Steven , Stachler Robert
Published: February 2021

INTRODUCTION TO THE TOPIC

Previous reports of congenital pharyngeal webs, although rare, have been described in children. Clinical presentation varies, ranging from aspiration to intermittent airway obstruction, and most commonly, dysphagia. In this case report, the authors describe an unusual finding of a hypopharyngeal web in an adult patient. This patient had no prior history of chemoradiotherapy, malignancy, or total laryngectomy, all of which have been associated with acquired pharyngeal stenosis, supporting that this finding was of congenital origin. After a review of the possible embryological developmental abnormalities, the hypothesis is that of gut recanalization failure during development.

CASE PRESENTATION

We present a case of a woman in her mid-40’s with a history of solid food dysphagia resulting in a 20 kg weight loss over three months. The patient denied dysphagia progressing to liquids, pain with swallowing, and a history of alcohol or tobacco use. Upon examination of the larynx via laryngoscope, a congenital hypopharyngeal web was identified. Successful excision of the web via coblation restored proper drainage of the pyriform sinus into the esophagus and resulted in markedly improved swallowing function and weight gain.

CONCLUSIONS

Pharyngeal webs are rare findings, particularly in adult patients. These congenital anomalies can be safely and effectively treated endoscopically via coblation.
Approach to Formalized Ultrasound Credentialing in a Community Hospital Health System with both Academic and Non-Academic Clinical Settings
Authors: Long Jeremy , Meyering Stefan , Scheel Timothy
Published: February 2021

INTRODUCTION

In the US, ultrasound in Emergency Medicine (EM) is widely considered the standard of care in clinical practice amongst most Emergency Department providers. At the authors’ institution and affiliates, there were a variety of health care providers utilizing ultrasound for clinical practice, and their skill levels varied, dependent on training and exposure. As an attempt to standardize credentialing practice and determine need for additional training thresholds, the authors endeavored to perform a skills assessment utilizing both written and clinical based practical assessments.

METHODS

A 7 point questionnaire was administered to a convenience sample of providers requesting formal training information, number of ultrasounds performed, and self-assessed competency. A 10 point written assessment with ultrasound knowledge and clinical application questions was also administered. A subsequent clinical assessment on live humans and models was then performed with multiple stations assessing 15 different instrumentation skills and technique, as well as image interpretation and evaluation.

RESULTS

A total of 23 attending EM board-certified physicians, and four advanced practice providers (PA and NP) took the credentialing assessments scoring an average of 7.3 out of 10 (SD 0.83) for the written assessment. Twenty (71%) of the 28 tested passed the clinical evaluation on their initial attempt. Five (17%) passed on a first remediation. Three (10%) required more than one initial revision attempt. All those who did remediate were able to complete the revision with a passing score.

CONCLUSIONS

Overall, the testing was considered a successful process. This program appears to have offered a level of standardization that was appealing to the credentialing body at our institution. We were able to assess to a level of competence considered standard of care by national credentialing bodies.
All’s Not Well(ens) that Ends Well: Case Study of Significant Thebesian Veins Mimicking Wellens Syndrome
Authors: Frank Keith
Published: February 2021

Thebeisan veins are microfistulous connections between a coronary arterial branch directly to a ventricular or atrial chamber. Extensive thebesian veins that empty into the left ventricle can cause typical chest pain symptoms, troponin elevation, and ischemic EKG changes from coronary steal leading to acute coronary syndrome in extreme cases. Literature review exposed a consistent pattern of EKG findings among patients with extensive thebesian veins involving all three major coronary arteries. We present a case study as an example of this rare anatomic finding of extensive thebesian veins draining into the left ventricle causing acute coronary syndrome in a symptomatic patient with elevated troponin and ischemic changes on EKG. This same EKG pattern that is present in our patient was discovered to be consistent among available case studies reviewed that had included an EKG tracing in their report. A newly proposed association between the ischemic changes on EKG due to extensive thebeisan veins and those of a severe proximal left anterior descending coronary artery stenotic lesion was discovered. The newly discovered consistency in the EKG pattern with acute coronary syndrome caused by extensive thebesian veins is the same pattern as that seen in Wellens Syndrome.
Management of Lateral Thigh Pain following Cephalomedullary Nail: A Technical Note
Authors: Rosen Michael , Kasik Connor , Swords Michael
Published: February 2021

Peritrochanteric hip fractures are most commonly treated with proximal femoral fixation devices, such as a cephalomedullary nail or sliding hip screw. As usage rates increase for these fixation devices, complications from their insertion are becoming more prevalent. Lateral hip pain from proximal locking device insertion and prominence continues to be one of the most frequent complaints regarding hardware irritation following this surgical procedure. Conservative treatment options for this complaint include local corticosteroid injection and physical therapy, although once these treatments have been exhausted, surgical intervention may be recommended. This has generally been managed previously with implant removal, although studies have shown associated femoral neck fractures after removal even with the prescribed protected postoperative weight bearing. Additionally, in certain situations (e.g., when the nail is placed for prophylactic treatment), its removal is contraindicated. The purpose of this manuscript is to describe an alternative treatment option that would limit morbidity, and the need for proximal locking device or implant removal by excising the portion of the iliotibial band causing hip irritation at the level of the proximal locking device, while leaving the retained implant in place. This surgical option would allow most patients to return to their pre-operative weight-bearing status immediately following surgery without the need for additional postoperative precautions.
Discovering Pathologies in the Anatomy Lab: The Case of Brachial Plexopathy Mimicking Neurological Thoracic Outlet Syndrome
Authors: Mancine Ryley , Kowalski Paul , McMillan William , Geske Nicole , Kujjo Loro
Published: February 2021

CONTEXT

Well-established human anatomy labs with access to expert faculty are exceedingly valuable tools to medical student education. In this manuscript, we detail an infero-lateral subclavicular lipoma which was discovered as a result of the utilization of both those labs and expert faculty. This lipoma may have caused brachial plexopathy or may serve as an unusual cause of neurologic thoracic outlet syndrome (NTOS) due to the location of the mass.

EDUCATIONAL CASE PRESENTATION

During prosection of a donor in the human anatomy lab, a mass was discovered by a medical student. This medical student utilized the human anatomy lab faculty members and resources to identify the mass as a lipoma. The lipoma compressed the lateral cord of the brachial plexus and the suprascapular nerve, but no diagnosis of NTOS or brachial plexopathy was made during the life of the donor, nor was any surgical intervention indicated. Removal of the lipoma immediately relieved stress upon the nerves. Histochemical analysis confirmed the diagnosis of a lipoma and demonstrated almost only mature adipocytes.

CONCLUSION

The authors concluded that the lipoma of this patient was not identifiable with computerized tomography imaging modalities, despite ultrasound demonstrating a hyperechoic outline of the mass in the cadaver of the patient. It is very likely that this lipoma had not been diagnosed previously due to the atypical location of the tumor. Equally, typical surgical methods associated with brachial plexopathy or NTOS treatment would be difficult or more complicated, due to the lateral and inferior location of the lipoma. Physicians treating thoracic outlet syndrome-type symptoms without resolution should consider potential non-malignant obstruction located outside the thoracic outlet, toward the extremity. Deep palpatory methods and physical therapy should be considered until diagnosis is certain, as ultrasound would be difficult and typical transaxillary surgical methods would be nonhelpful. Medical students and early-career residents and physicians should be aware of the resources provided to them via campus human anatomy laboratories which they may utilize to further their understanding and knowledge of specific pathologies.
Evaluation of a COVID-influenced Curriculum to Address Food Insecurity in a Detroit Family Medicine Residency Clinic
Authors: Ghouse Amrien , Gunther William , Sebastian Matthew
Published: February 2021

CONTEXT

To date, numerous projects have demonstrated that an ongoing limited access to nutritionally dense food (i.e., “food insecurity”) plays a key role in the overall health and wellbeing of lower income at-risk populations.

METHODS

For this 2019-2020 pilot project, the resident physician authors first created and administered a simple five-item questionnaire screening process to systematically identify food insecure patients in their metropolitan Detroit residency clinic. A sample of patients who had been identified as food insecure and pre-diabetic were then provided improved access to healthy foods, supplemented by a six-week program of nutritional education classes using a nationally recognized “Cooking Matters’’ six-week long curriculum with a licensed chef and nutrition educator

RESULTS

After institutional review board approval, the authors enrolled a sample of 10 adults. The authors successfully measured both pre- and post-program Hemoglobin A1c (HbA1C) levels for all participants who completed the required course and subsequent clinic follow up visits. Using a series of initial non-parametric Wilcoxon Signed Rank matched pair tests, post-program follow-up at three months revealed statistically significant reductions in documented HbA1c levels from baseline for six enrolled patients (W=1, Z = - 2.226, p = 0.026) and six-month follow up (i.e., more than four months after completion of the program) (W = 1, Z = - 2.060, p = 0.039). In post-program surveys, each respondent indicated that they found the class content to be generally beneficial to increase their nutritional knowledge.

CONCLUSIONS

In the authors’ setting, this food insecurity program has subsequently led to a more formal screening process to evaluate and identify food insecure patients. The authors discuss the scheduling difficulties they experienced from the COVID-19 pandemic for their sample patients. However, these pilot results suggest that prolonged benefits may require ongoing “virtual” teaching sessions with pre-diabetic patients to address the complex factors influencing food insecurity levels identified in similar inner-city settings.