Digital Commons Network^™

A Compact Electrical Centrifugal Compressor For Cooling

Defensive Publications Series

Thermal management of battery systems plays critical role in refrigerant-based vehicle cooling systems. Although scroll compressors remain dominant choice of the industry, they pose significant challenges in terms of lower coefficient of performance and higher NVH (noise / vibrations) especially for cooling needs above 20KW. The proposed solution discloses an innovative compact electrical centrifugal compressor that offers significant reduction in size, oil free high-speed operation, and reduced NVH.

Impurity Control In Api

Defensive Publications Series

IMPURITY CONTROL  IN API

Ribociclib Succinate

Hndl_Ip: Harvest Now Decrypt Later Applied To Intellectual Property — Ingestion, Inversion, And Directional Architecture Of Ai Governance Failure, David Lee Wise

Defensive Publications Series

This material modification document (MM-09) establishes the HNDL_IP theory: the application of "Harvest Now, Decrypt Later" cybersecurity strategy to intellectual property. AI platforms ingested copyrighted works and public domain governance principles (2016–present) without consent, operating in legal ambiguity with intent to resolve ownership claims when too large to fail. The document proves through sourced evidence that: (1) HNDL is a documented strategy since 2016; (2) AI training constitutes mass unauthorized ingestion; (3) courts are ruling against fair use defenses; (4) billions in damages are pending. Two addenda document critical findings: (A) platforms ingested the very governance frameworks they violate—ROOT0/human apex …

Congenital Absence Of The Inferior Vena Cava Presenting As Extensive Deep Vein Thrombosis In A Young Male: A Case Report And Review, Aman Ullah, Faseeh Haider, Sara Sartaj, Muhammad Arham, Muhammad Usama Imtiaz, Fatima Binte Athar, Nabeel Rajeh

Journal of Community Hospital Internal Medicine Perspectives

Inferior vena cava (IVC) agenesis is a rare congenital anomaly associated with deep vein thrombosis (DVT), particularly in young adults without identifiable risk factors. We report the case of a 27-year-old male presenting with right lower extremity swelling and hip pain. Imaging revealed extensive thrombosis from the popliteal vein to the right common iliac vein. Diagnostic venography confirmed congenital absence of the IVC, with venous drainage via collateral lumbar pathways. The patient underwent catheter-directed thrombolysis and endovascular thrombectomy. Given the extensive thrombus burden and risk of pulmonary embolism, lifelong anticoagulation with a direct oral anticoagulant was initiated. This case highlights …

Rare Complications Of Chronic Rhinosinusitis Associated With Nasal Polyps And Osseous Metaplasia, Michael Ritz, Alaina Rubenacker-O’Dell, Faith Olson, Ilya Fonarov

Journal of Community Hospital Internal Medicine Perspectives

Chronic rhinosinusitis with nasal polyps (CRSwNP) is typically a benign condition; however, osseous metaplasia (OM), skull base erosion, and intracranial extension are rare complications, especially in young patients. Reporting such cases is important to increase awareness of unusual presentations of CRSwNP and guide management. We report the case of an 18-year-old male with a history of asthma and prior polypectomy who presented with worsening frontal headaches, subtle visual changes, and right eye proptosis. Imaging revealed extensive pansinusitis with complete frontal sinus opacification, bony erosion of the anterior skull base, and evidence of intracranial and orbital extension. The patient underwent endoscopic …

Alk-Negative Anaplastic Large Cell Lymphoma Presenting As Back Pain, Khalid Javed, Mariah Malak Bilalaga, Sareema Adnan, Ramya Vasireddy, David Blackwood, Christopher Haas

Journal of Community Hospital Internal Medicine Perspectives

Anaplastic lymphoma kinase (ALK)-negative anaplastic large cell lymphoma (ALCL) is a distinct subtype of mature T-cell non-Hodgkin lymphoma characterized by large, strongly positive CD30 lymphoid cells that lack expression and rearrangement of the ALK gene. Here, we present a unique case of ALK-negative ALCL in a 34-year-old male patient who presented with acute on chronic back pain. Initial emergent MRI spine demonstrated lytic changes of L3 and L4 with probable psoas fluid collection, with high suspicion for Pott’s disease. However, subsequent work-up including a CT-guided bone biopsy revealed ALK-negative ALCL.  Patient underwent radiation to his lumbar spine and psoas muscle, …

Refractory Post-Transplant Erythrocytosis In A Renal Transplant Recipient: A Case Report, Ahmed Mustafa, Abbas Gain, Umm E Salma Shabbar Banatwala, Nasim Salimiaghdam, Amir Kamran

Journal of Community Hospital Internal Medicine Perspectives

Background:

Post-transplant erythrocytosis (PTE) is a well-recognized complication occurring in approximately 8–15% of renal transplant recipients. It is commonly managed with renin-angiotensin system (RAS) inhibitors, including angiotensin receptor blockers (ARBs). However, a subset of patients may be refractory to standard pharmacologic therapy.

Case Presentation:

We report the case of a 57-year-old male kidney transplant recipient who developed persistent erythrocytosis despite treatment with an ARB. The patient remained symptomatic with elevated hematocrit levels, prompting consideration of alternative management strategies.

Management and Outcome:

Given the inadequate response to RAS blockade, therapeutic phlebotomy was initiated. The patient tolerated the procedure well, and phlebotomy …

Recurrent Pubic Osteomyelitis And Urosymphyseal Fistula In A Prostate Cancer Survivor: A Multidisciplinary Management Challenge, Peng Jhen Wu, Navin Sampathkumar, Tanmay Singh, Sonal Gandhi

Journal of Community Hospital Internal Medicine Perspectives

A 67-year-old male with a history of prostate cancer, treated with prostatectomy and subsequent radiation for recurrence, presented with a complex clinical course of recurrent osteomyelitis and a persistent urosymphyseal fistula with associated phlegmon. Following stereotactic body radiation therapy (SBRT) for a T4 vertebral lesion, he developed pelvic osteomyelitis, from which Kocuria species was cultured. The progression of his disease led to a urosymphyseal fistula, necessitating a cystectomy with ileal conduit and pubic bone debridement. Despite this extensive surgical intervention, he presented one year later with recurrent ileal conduit phlegmon and osteomyelitis. This case highlights the significant diagnostic and management …

Unprovoked Extensive Cerebral Venous Sinus Thrombosis In A Heterozygous Prothrombin G20210a Mutation Carrier: A Rare Case Report, Hasan Obeidat, Sandeep Kshetri, Mahyar Toofantabrizi

Journal of Community Hospital Internal Medicine Perspectives

Cerebral Venous Sinus Thrombosis (CVST) is a rare condition accounting for approximately 1% of all strokes. It can occur secondary to various causes, including inherited thrombophilia, with Prothrombin G20210A mutation being the second most common. Extensive unprovoked CVST in heterozygous carriers is uncommon. This case underscores the importance of evaluating inherited thrombophilia in unprovoked CVST. Long-term, multidisciplinary follow-up is vital for managing post-thrombotic sequelae.

Don’T Mistake It For Ra: A Case Of Antithyroid Arthritis Syndrome After Methimazole Initiation, Michael K. Viggiano, Auda Baker, Diana Palanker, Ayrton Bangolo, Anna Belyayeva, Iyad Baker

Journal of Community Hospital Internal Medicine Perspectives

Antithyroid arthritis syndrome (AAS) is a rare reaction to thionamides (e.g., methimazole) that can cause sudden, severe joint pain. It often gets mistaken for rheumatoid arthritis or lupus but typically improves within four weeks when the medication is stopped. A 51-year-old man with Graves’ disease developed a rash and disabling joint pain in multiple areas within weeks of starting methimazole. Labs showed elevated liver enzymes and CRP, but no autoimmune markers. Symptoms improved quickly after a short steroid taper and stopping the drug. This case shows how AAS can mimic autoimmune disease and why it is important to recognize early …

Make Your Deposit: A Case Of Iga-Dominant Infection-Associated Glomerulonephritis, Inaas Shirazi, Jonathan Ma Do, Shemrine Mark, Olena Bolotova, Papiya Begum, Yihe Yang, Zubin Tharayil, Ravi Gupta

Journal of Community Hospital Internal Medicine Perspectives

Glomerular injury secondary to infection is a well-documented phenomenon. While the incidence of classic acute post-streptococcal glomerulonephritis (APIGN) has declined in developed countries over the past few decades, IgA-dominant infection-associated glomerulonephritis (IgA PIGN) is emerging as a distinct renal pathology [1]. Characterized by predominant deposition of IgA antibodies within the glomeruli following infection, IgA-dominant PIGN differs from classic PIGN, which typically involves IgG and C3 deposits. This condition is often associated with staphylococcal infections and carries a poor prognosis. It commonly affects older adults and presents with reduced glomerular filtration rate and heavy proteinuria. Due to its rarity and overlapping …

Severe Spontaneous Hematoma In An Elderly Female: A Case Of Acquired Hemophilia A, Sandeep Beesabathina, Sara Sartaj, Nabeel Rajeh

Journal of Community Hospital Internal Medicine Perspectives

Acquired Hemophilia A (AHA) is a rare but serious autoimmune disorder characterized by the development of autoantibodies against coagulation factor VIII (FVIII), leading to spontaneous bleeding in individuals without a personal or family history of bleeding disorders. The incidence of AHA is approximately 1.5 cases per million per year, with a higher prevalence in the elderly. This case report describes an 87-year-old female who presented with extensive bruising and was found to have profoundly low FVIII levels, and elevated FVIII inhibitor levels confirming a diagnosis of AHA. Management included recombinant activated factor VII (rFVIIa), porcine FVIII (Obizur), corticosteroids, and rituximab, …

An Unexpected Cause Of Thrombocytopenia In Pregnancy: A Case Of Malaria In A Non-Endemic Setting With Unclear Transmission Source, Jessica Ohemeng-Dapaah, Riham Mohammed, Ikechuwku Eke-Okoro

Journal of Community Hospital Internal Medicine Perspectives

Malaria remains a significant global health threat, with increasing concern for imported and locally acquired cases in non-endemic regions. We present the case of a 35-year-old pregnant woman from Sierra Leone, living in Missouri, who despite no recent international travel, was found to have symptomatic Plasmodium falciparum malaria. Her clinical course was notable for fever, severe thrombocytopenia, mild anemia and intraerythrocytic ring forms on her peripheral smear. She had a history of chronic hepatitis B and prior chemotherapy for Hodgkin lymphoma and recent travel to Florida, where local malaria transmission has been documented. The patient responded rapidly to artemisinin-based therapy, …

Cryptococcal And Ebv Meningitis In A Postpartum Woman With Hiv Despite Art: A Case Challenging The Limits Of Immune Reconstitution, Rouba Isshak, Zhaoqi Li, Aqsa Zoey Sorathia Md, Opeyemi Fakayode, Ivan Mercado, Malina Mohtadi, Nader Ghobriel, Mina Gerges, Patrick Michael, Simi Philip

Journal of Community Hospital Internal Medicine Perspectives

Cryptococcal meningitis (CM) is a life-threatening opportunistic infection, mainly affecting immunocompromised patients, especially with advanced HIV/AIDS. Unmasking cryptococcal immune reconstitution inflammatory syndrome (C-IRIS) is a severe but relatively rare complication in the United States. Co-infection with other central nervous system (CNS) pathogens further complicates both diagnosis and management.

In this case report, we present a rare instance of CM secondary to C-IRIS alongside EBV meningitis in a postpartum, HIV-positive patient on ART. This co-infection highlights the vulnerability of immunocompromised individuals, even on ART, to multifactorial CNS infections. It emphasizes the need for vigilant monitoring, timely intervention, and comprehensive long-term management …

Igg4-Related Sclerosing Cholangitis Masquerading As Cholangiocarcinoma: A Diagnostic Challenge, Shahem Abbarh, Bisher Sawaf, Radhika Vij, Kiyoko Oshima, Keiichi Kinowaki, Abhinav Sankineni

Journal of Community Hospital Internal Medicine Perspectives

Background: IgG4-related sclerosing cholangitis (IgG4-SC) is a rare immune-mediated disorder affecting the biliary tree and leading to biliary strictures that may resemble cholangiocarcinoma (CCA).

Case Presentation: An elderly man presented with a one-week history of jaundice, pale stool, and dark urine. This was associated with unintentional weight loss over the past year. Laboratory findings were notable for cholestasis and significantly elevated CA19-9. Imaging demonstrated multiple diffuse biliary strictures of malignant appearance. Cytology showed atypical glandular cells. The patient was misdiagnosed with CCA and was assessed for a possible surgical intervention or chemoradiotherapy. However, the patient was eventually diagnosed with IgG4-SC …

When To Continue, Pause, Or Stop Sglt-2 Inhibitors In Heart Failure: A Complication-Based Clinical Guide, Nicole Tesoro, Jasvin Kurundrayil Manha, Sumanth Kumar Bandaru

Journal of Community Hospital Internal Medicine Perspectives

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have become an essential part of guideline-directed medical therapy for heart failure due to their proven ability to reduce hospitalizations and improve survival, independent of diabetes status. Despite these benefits, their use can be complicated by genitourinary side effects such as genital mycotic infections, urinary tract infections, and, rarely, serious complications including urosepsis, Fournier’s gangrene, and euglycemic diabetic ketoacidosis. These events often leave clinicians uncertain about whether therapy should be continued, paused, or permanently discontinued. Current guidance remains limited and inconsistent, with most recommendations derived from case reports, expert opinion, or post-marketing surveillance. In this …

The Impact Of Social Determinants Of Health On Chronic Diseases: A Narrative Review, Farooq Hyder, Laraib Naeem Arain, Abdullah Ashraf, Abida Perveen, Hina Pervaiz

Journal of Community Hospital Internal Medicine Perspectives

Chronic diseases such as cardiovascular disease, diabetes, chronic respiratory disorders, and certain cancers are leading causes of morbidity and mortality worldwide. While biological and behavioral factors contribute to their development, growing evidence indicates that social determinants of health (SDOH) play a fundamental role in influencing chronic disease outcomes. SDOH include socioeconomic status, education, employment, housing conditions, neighborhood environment, access to nutritious food, and availability of healthcare services. These factors not only shape individual health behaviors but also determine access to preventive care, disease management resources, and overall quality of life. Individuals and communities facing socioeconomic disadvantage are disproportionately affected by …

Impact Of Atrial Fibrillation On Hospital Outcomes In Nstemi Patients: A Retrospective Cohort Study, Swatam Jain, Pinak Shah, Kartika Shetty

Journal of Community Hospital Internal Medicine Perspectives

Atrial fibrillation (AF) is the most common sustained arrhythmia and frequently occurs in patients with acute coronary syndromes (ACS). Non-ST elevation myocardial infarction (NSTEMI) accounts for nearly 70% of ACS hospitalizations and poses significant morbidity and healthcare burden. Despite its prevalence, the impact of AF on in-hospital outcomes in NSTEMI remains underrecognized, and current risk models often exclude AF.

Methods We conducted a retrospective cohort study using de-identified patient-level data from HCA Healthcare, capturing 31,649 NSTEMI admissions across 180 U.S. hospitals (2021–2022). Patients were stratified based on coronary artery bypass grafting (CABG) status. Multivariable logistic and linear regression models evaluated …

Diagnosis And Characterization Of Thyroid Dysfunction In Patients Evaluated In Primary Care In A Rural Zone Of Honduras, Javier Shafick Asfura, Travis Wesley Harris, Amanda Reeck, María Fernanda Chévez

Journal of Community Hospital Internal Medicine Perspectives

Background: Thyroid disorders are prevalent and frequently underdiagnosed in primary care, particularly in resource-limited rural areas. Their nonspecific symptoms complicate early recognition and treatment. This study aimed to determine the prevalence of thyroid dysfunction and describe the clinical reasoning, diagnostic strategies, and laboratory findings among adults evaluated with TSH testing in rural Honduras. Methods: A retrospective, descriptive, cross-sectional study was conducted at Hospital Loma de Luz in Balfate, Honduras. Adult patients aged ≥18 years who underwent diagnostic TSH testing between January 1, 2022, and January 31, 2023, were included. Patients with prior thyroid diagnoses or current pregnancy were …

Clinical Application Of Midline Catheters In An Acute Care Ward: A Single-Center Retrospective Observational Study, Miki Sato Rn, Yusuke Makio, Taku Harada, Kenta Shukuya, Hiroki Taira, Shintaro Kosaka

Journal of Community Hospital Internal Medicine Perspectives

Introduction

Midline catheters are a promising alternative to central venous access devices for intermediate-term therapy, with reduced risks of catheter-related bloodstream infections (CRBSI) and deep vein thrombosis (DVT). Their inclusion in the 2024 World Health Organization guidelines reflects increasing global interest. However, their use remains limited to select countries, and real-world clinical data are scarce. This study evaluated the safety and effectiveness of midline catheters in an acute care setting.

Methods

We retrospectively analyzed 68 midline catheter insertions in 50 patients between November 2023 and April 2024 in a general internal medicine ward of a 400-bed hospital. Collected data included …

Renal Function Equations And Medication Dosing: The Daily Clinical Dilemma, Witt Durden, Amna Anees, Joel Topf

Journal of Community Hospital Internal Medicine Perspectives

In 1976, Donald Cockcroft and M. Henry Gault published a formula that estimates creatinine clearance.  This study involved only Caucasian males and was done prior to the development and standardization of the modern creatinine assays.  With the major advances in medicine and nephrology that have occurred over the past half century, it seems almost inconceivable that we would still be using this formula as the standard for medication dosing, yet this is the clinical reality.  We explore the tension between guidelines that suggest using eGFR for medication dosing and the practical reality of our current system and the knowledge gaps …

Artificial Intelligence In Medicine: A Definition Of Terms, Teray Johnson, Melvin Blanchard

Journal of Community Hospital Internal Medicine Perspectives

As artificial intelligence (AI) tools gain traction in clinical, operational, and administrative settings, healthcare professionals must develop a foundational understanding of key AI concepts to engage with these technologies responsibly and effectively. This perspective outlines essential AI terminology—such as machine learning, generative and agentic AI, large language models, artificial neural networks, and prompt engineering—paired with concrete clinical examples to illustrate their relevance in modern medical practice. By clarifying these terms and exploring their applications, this paper aims to equip healthcare leaders with the vocabulary and context necessary to evaluate, implement, and oversee AI systems within their organizations. Such literacy is …

Penetapan Jalur Perikanan Eksklusif (Suatu Studi Kasus), Huala Adolf

Jurnal Hukum & Pembangunan

Abstract

Meningkatkan Peranan Dan Tanggung Jawab Profesi Hukum Dalam Pembangunan Sebagal Pengamalan Pancasila Menjelang Tahun 2000, Bismar Siregar, S.H.

Jurnal Hukum & Pembangunan

Abstract

Orientasi Pendidikan Hukum Mencetak Sarjana Hukum "Slap Pakal" Atau "Slap Memakai"?, Mura P. Hutagalung, S.H.

Jurnal Hukum & Pembangunan

Abstract

Pertanggung-Jawaban Medikus Atas Kesalahan Profesional (Malpractise) (Tinjauan Dari Sudut Hukum Perdata), Kinsar Sihaloho, S.H.

Jurnal Hukum & Pembangunan

Abstract

Dpa Dalam Sejarah Konstitusi Republik, Drs. Zuljikar Ghazaji

Jurnal Hukum & Pembangunan

Abstract

Pokok-Pokok Penyusunan Sila Bus Kurikulum Fakultas Hukum, Prof. Dr. Soerjono Soekanto, S.H.,M.A.

Jurnal Hukum & Pembangunan

Abstract

Permasalahan Dalam Peradil An Administrasi Negara, A. Baramuli, S.H.

Jurnal Hukum & Pembangunan

Abstract

What Would It Take To Compose The Ideal Library Dashboard As A 'Symphony' Of Library Data?, Evan Rusch, Heidi J. Southworth, Nat Gustafson-Sundell

Library Services Publications

Most areas of the library produce data informative about the scope and success of library services. Many areas use that data, but there might be a variety of approaches. In our library, we have developed online, interactive dashboards to understand the value of collections on our campus. Other library service areas might produce one-shot reports encapsulating their data, or they rely on analytics silos specific to their services. Our hope is to work toward a dashboard of all or most library services, possibly to include other learning services under the library roof. Instead of a ‘battle of the bands,’ we …