Olean General Hospital

Many athletes and active individuals use nutritional supplements for performance, muscle mass, and recovery. Creatine developed popularity in the 1990s and has continued today. During high-intensity exercise, anaerobic glycolysis and the phosphocreatine shuttle provide adenosine triphosphate (ATP). In older adults, creatine supplementation with resistance training has been shown to increase muscle mass and strength in some studies. Evidence to support creatine supplementation in adolescent and pediatric patients is limited. The most common side effect is weight gain, and there do not appear to be any adverse effects on renal function in healthy athletes. In the few studies to date, the role of creatine in postoperative recovery has not been clearly established. This review summarizes the basic science of creatine, its potential role in recovery and supplementation, and its safety profile.

Terbitnya Permenhub Nomor 12 Tahun 2019 mendorong berbagai perusahaan angkutan sewa khusus roda dua (yang juga dikenal sebagai angkutan transportasi online atau ride hailing), untuk melakukan pembinaan, pengawasan, dan kepatuhan atas keselamatan lalu lintas. Artikel ini mengeksplorasi penerapan kebijakan perlindungan keselamatan pengguna angkutan sewa khusus di seluruh dunia sebagai benchmarking berdasarkan kajian literatur pada database Scopus dalam rentang tahun publikasi 2015-2023. Hasil analisis tematik mengidentifikasi lima kategorisasi isu: Keselamatan pengemudi, keselamatan penumpang, kewajiban perusahaan/penyelenggara, kebijakan angkutan, dan faktor penyebab kecelakaan. Hasil analisis menemukan bahwa faktor penyebab utama kecelakaan pada angkutan sewa khusus adalah faktor kelelahan yang disebabkan tidak adanya batas maksimal penumpang yang dapat dilayani pengemudi setiap harinya. Selain itu, pengemudi angkutan sewa khusus dianggap tidak memiliki kompetensi yang memadai karena minim pengalaman mengemudi, keterbatasan partisipasi di dalam pendidikan keselamatan lalu lintas, dan rendahnya kesadaran terhadap pendidikan dan informasi keselamatan

Heterotaxy syndrome (HS) or situs ambiguous refers to the abnormal arrangement of viscera across the body axis, and abnormalities arise depending on the isomerism of the right or left atrial appendage. The cause remains unexplained and is attributed to a combination of genetic mutations and environmental factors. It is a rare condition and may remain undiagnosed for a long time. In this report, we aim to highlight an unusual presentation and aggravation of an infection due to the underlying isomerism of the left atrial appendage. We discuss the case of a female patient who presented with symptoms of fever and cough. The patient underwent prolonged antibiotic treatment, and her recovery was slow. The presence of bilobed lungs, vertical left-bronchus, and polysplenia on CT scan explained the left-sided aspiration pneumonia. The hypofunctioning spleen (polysplenia) caused her to have a weak immunological response, necessitating prolonged antibiotic use. She was followed up over time and had a recurrence of pneumonia within a few months. The condition is associated with high morbidity and mortality, and the role of early diagnosis and reporting to prevent complications is paramount. The recurrent pneumonia observed in the patient also raises questions related to long-term antibiotic use and immunization in the case of polysplenia in this patient population.

Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and has become a major health problem worldwide. Inflammation plays a vital role in the pathophysiology of COVID-19. Systemic Immune Inflammation Index (SII) is an index obtained from calculating the platelets counts, neutrophils, and lymphocytes, which can indicate the inflammation status and immunity. This study aimed to determine the potential of SII as a predictor of SARS-CoV-2 infection in suspected COVID-19 subjects. A retrospective study was carried out by obtaining medical record data in June 2020 at Sleman General Hospital. An unpaired T-test or the Mann-Whitney test was used to determine the statistical difference. A Receiver Operating Characteristic (ROC) curve was generated and used to get the cut-off values. Bivariate analysis was performed using Chi-Square. There were 84 subjects consisting of 46 (54.8%) males and 38 (45.2%) females with a mean age of 42.4±16.356 years. There was a significant difference in the neutrophils count (p=0.045), monocytes (p=0.001), and eosinophils (p=0.037) between subjects with positive and negative SARS-CoV-2 PCR. The median SII in the positive and negative SARS-CoV-2 PCR group was 780.12 (301.21-2178.90)x103/µL and 584.14 (117.79-1933.87)x103/µL (p=0.045), respectively. Bivariate analysis showed significant results at SII > 705 x103/µL in suspected COVID-19 patients to obtain a positive SARS-CoV-2 PCR result with Odds Ratio (OR) of 4.00 (95% CI 1.580-10.127), p=0.003. Patients with suspected SARS-CoV-2 infection with high SII levels had a greater risk of a positive SARS-CoV-2 in PCR test

Endurskoðunarnefndir gegna mikilvægu hlutverki í að tryggja áreiðanleika og óhæði endurskoðunar fyrirtækja. Eitt af meginmarkmiðum með starfsemi nefndanna er að draga úr hættu á fjármálamisferli og efla traust fjárfesta á fjárhagsupplýsingum fyrirtækja og þar með fjármálamörkuðum. Í greininni eru annars vegar birtar niðurstöður rannsóknar á samsetningu endurskoðunarnefnda við einingar tengdar almannahagsmunum á Íslandi og hins vegar eru tiltekin ákvæði laga um endurskoðunarnefndir skýrð með hliðsjón af ESB-rétti. Óvissa hefur verið um túlkun ákvæða um óhæði nefndarmanna í endurskoðunarnefnd en í greininni er það skýrt að mat á óhæði þeirra er sambærilegt hefðbundnu mati á óhæði stjórnarmanna. Sér í lagi geta stjórnarmenn talist óháðir einingunni í skilningi laganna og þar með skipað meirihluta endurskoðunarnefndar. Á Íslandi er algengt að stjórn skipi einn eða fleiri nefndarmenn utan stjórnar í endurskoðunarnefnd og eru nefndarmenn utan stjórnar í 63 af 70 endurskoðunarnefndum. Ekki er gert ráð fyrir þessu fyrirkomulagi í ESB-rétti eða lögum annarra Norðurlanda. Í greininni eru færð rök fyrir því að hin íslenska framkvæmd veiki bæði sjálfstæði og umboð nefndarmanna. Æskilegt er að endurskoðunarnefnd sé eingöngu skipuð stjórnarmönnum, ef þess er kostur, en rétt er þó að innleiða í lög heimild til að hluthafafundur tilnefni nefndarmenn, eins og ESB-réttur gerir ráð fyrir. Ekki er starfandi endurskoðunarnefnd í 32 einingum tengdum almannahagsmunum. Innleiða ætti í lög, eða skýra betur, undanþáguheimildir frá starfrækslu endurskoðunarnefndar, sérstaklega að því er varðar dótturfélög, verðbréfasjóði og sveitarfélög.

Terrorism has been a serious problem for humanity. At least there were five terror incidents hitting Indonesia since May 8, 2018, killing at least 19 people, and 60 injured. On May 13, 2018 three suicide bombings at three churches in Surabaya, carried out by a family of six (father, mother, and four children) headed by Dita Oeprianto. Due to the serious impact of the terrorism, there is a question of why and how people involved as suicide bombers. Responding to this question, and as the counter-radicalism strategy, Garin Nugroho directed a film entitled “Mata Tertutup” (The Blindfold- 2011). The film is based on the research by Maarif Institute. This paper discusses “Mata Tertutup” through the questions of how the film represents the discourse of radicalism and family roles in standing against radicalism. This question addresses mainly the issue of radical group’s recruitment process, and the roles of family in countering the radicalism, constructed in the film. The study shows that radicalism is represented through the recruitment process of NII which is done through a pattern of kidnapping and brainwashing. This process radicalizes young people and to the worst, produces suicide bombers. The discourse of radicalism issue also addresses the crucial roles family in saving young people from radical groups.

E-commerce yang menawarkan banyak kemudahan terhadap konsumen belum tentu berhasil hanya dengan membuat website toko online, namun konsumen secara personal juga akan menilai dan menentukan perilaku apa yang akan diambil berdasarkan penilaian secara subyektif dari konsumen terhadap suatu situs e-commerce, apakah konsumen tersebut akan percaya dan selanjutnya dengan senang hati bertukar informasi pribadi dengan situs e-commerce, dan akhirnya mempunyai keinginan untuk bertransaksi atau tidak. Penelitian ini bermaksud menguji pengaruh 3 faktor dalam Trust Building Model (TBM) kaitannya dengan kepercayaan konsumen terhadap e-commerce toko online fashion di Indonesia. Benarkah kepercayaan konsumen di Indonesia disebabkan oleh faktor perceived site quality (kualitas situs yang dirasakan), faktor perceived vendor reputation (reputasi vendor yang dirasakan), dan structural assurance (susunan keamanan) khususnya untuk e-commerce bisnis ke konsumen. Penelitian ini menggunakan Structural Equation Modeling (SEM) untuk menganalisis masing-masing faktor tersebut dengan meneliti 200 responden yang sudah pernah bertransaksi dan belum pernah bertransaksi namun mempunyai keinginan di kemudian hari dan sudah pernah berkunjung ke situs toko online fashion. Hasil dari penelitian ini menunjukkan bahwa kepercayaan konsumen e-commerce toko online fashion di Indonesia sangat dipengaruhi oleh kualitas website dan susunan keamanan yang tersaji melalui website, sedangkan reputasi vendor melalui website tidak signifikan mempengaruhi konsumen untuk bisa lebih percaya pada suatu vendor toko online fashion.E-commerce that offers a lot of convenience to consumers uncertain of success simply by making the website an online store, but consumers will personally assess and determine what behavior that consumers will take based on consumer’s assessment of an e-commerce site, whether consumer will believe and subsequent gladly exchange personal information with an e-commerce website, and make the transaction or not. This study intends to examine the influence of three factors in the Trust Building Model (TBM) relation with consumer’s trust in e - commerce online store of fashion in Indonesia. Is it true that consumer’s trust in Indonesia is caused by those factors: perceived site quality, perceived vendor reputation, and structural assurance, especially for e-commerce business to consumer. This study used Structural Equation Modeling (SEM) to analyze each of these factors by examining the 200 respondents who had dealings and have never had trade but have willingness to trade later and had ever been to a fashion online store site. The results of this study indicate that consumer’s trust in ecommerce online store of fashion in Indonesia is strongly influenced by the quality of the website and structural assurance presented through the website, while the reputation of the vendor through the website does not significantly influence consumers to be more trust in an online fashion store vendors.

The complexities of neurological practice have increased considerably in the 21st century. There is now greater awareness of links between neurological and psychiatric disorders as the branch of neuropsychiatry has moved ahead. It is well known, for example, that patients with dementia, Parkinson's disease, multiple sclerosis, and other disorders may have various behavioral problems well before the diagnosis is confirmed. This results in an increased need for having an understanding of psychological issues that neurological patients have. Depression commonly is associated with chronic pain and medical illnesses. This chapter focuses on these issues, as well as threatened violence and aggressive behavior in patients with traumatic brain injury (TBI).