Medicine and Health Sciences Commons^™

Physical And Physiological Profiles Of Competitive Fencers: A Systematic Review And Meta-Analysis Of Strength, Power, Endurance, Agility And Asymmetry, Joanna Motowidło, Miłosz Drozd, Petr Stastny, Dariusz T. Skalski, Izabella Socha, Adam Maszczyk

Baltic Journal of Health and Physical Activity

Background: Evidence on lower-limb strength, explosive power and bilateral asymmetry in competitive fencing is fragmented, and the relative impact of general neuromuscular capacity versus targeted training interventions remains unclear. The aim of this systematic review and meta-analysis is to provide a multidimensional, evidence-based synthesis of data on strength, power, and bilateral asymmetry of the lower limbs in professional fencers. Materials and methods: Following PRISMA 2020 (PROSPERO CRD420251041007), six databases were searched by 31 January 2025. Forty studies of fencers aged ≥ 12 years met the inclusion criteria. Three domain-specific random-effects meta-analyses (DerSimonian–Laird) were conducted: (1) integrated strength and power across …

Differential Treatment Responses Among Comorbidity-Based Subgroups In Individuals With Autism Spectrum Disorder And Clinical Epilepsy, Jenna E. Franklin, Richard E. Frye Md, Phd

Cumberland Medica

Children with Autism Spectrum Disorder (ASD) have elevated rates of epilepsy, seizures, and abnormal electroencephalograms compared to the general population. Many also experience co-occurring comorbidities, which have been associated with epilepsy severity. Although various treatments have shown improvements in seizures and ASD symptomatology, there is limited research on how treatment effectiveness varies by comorbidity profiles. In this study, we characterized individuals with ASD and clinical seizures into specific patient cohorts based on comorbidities and evaluated the responses to traditional antiepileptic drugs (AEDs), non-AED seizure treatments, and non-traditional ASD interventions. Data were collected from a parent-reported, cross-sectional survey previously used to …

Perspective In Biomedical Sciences Field: Education And Career, Fitra Adi Prayogo, Mellyaning Oktaviani Sonya Kirana Sari, Isy Royhanaty, Poppy Fansisca Amelia, Heni Wijayanti, Ni Nyoman Maryaningtyas Adinatha, Dyah Wulandari, Anto Budiharjo

Chulalongkorn Medical Journal

Abstract

Background: The biomedical sciences represent a dynamic and multidisciplinary field pivotal to advancing human health through research, education, and innovation.

Objective(s): This review explores the evolving landscape of biomedical education and career pathways, driven by technological advancements, interdisciplinary integration, and global health demands.

Methods: We examine the distinctions between biomedical science, biomedicine, and biomedical engineering, highlighting their historical origins and contemporary roles. The education and career trajectories of biomedical laboratory scientists (BLS) are analysed, emphasising diverse competencies, core curricula, and the impact of regional policies on professional qualifications. Emerging trends and ethical/regulatory challenges are discussed.

Result(s): Key trends include …

Sequential Presentation Of Diabetic Ketoacidosis, Acute Ischemic Stroke, And St-Elevation Myocardial Infarction: A Case Report, Ichlasul Mahdi Fardhani, Putu Aditya Darmawan Kuntadi, Hammam Arif Shabri, Muhammad Isra Rafidin Rayyan, Zarrah Yuniar Qolbi Harris, Tristi Lukita Wening, Azham Purwandhono

Chulalongkorn Medical Journal

Cardio-cerebral infarction (CCI), the simultaneous occurrence of acute ischemic stroke (AIS) and acute myocardial infarction (AMI), is a rare and life-threatening emergency. Management becomes even more challenging when accompanied by metabolic complications like diabetic ketoacidosis (DKA). We report a case of a 45-year-old man with hypertension and a chronic smoking history, found unresponsive with right-sided hemiparesis. He was last seen well six hours before arrival. On examination, he was hypertensive, tachypneic, had a ketotic breath odor, GCS 12, and NIHSS 15. Laboratory results confirmed DKA, with a random blood glucose of 412 mg/dL and metabolic acidosis. Non-contrast brain CT revealed …

Malignant Transformation Of Giant Epidermal Cyst In The Gluteal Region - A Case Report, Xin Zen Ong Dr., Wan Mokhzani Wan Mokhter Mr., Jing Wen Loh Mr., Ruhana Amirah Abdul Halim Dr.

Chulalongkorn Medical Journal

Epidermal cyst is a very common cutaneous lesion. Giant epidermal cyst is defined by its size of more than 5 cm in diameter. Buttock is an unusual site for epidermal cyst. Malignant transformation of epidermal cyst is an exceedingly rare phenomenon. Clinicians should be vigilant of such entity especially in giant epidermal cyst despite a seemingly benign imaging finding. Long term outcome of surgery for such tumor remains an uncertainty.

Artificial Intelligence Decision Support In Automated Breast Ultrasound: Improving Diagnostic Accuracy And Reducing Unnecessary Biopsies, Chayaporn Hasdiseve, Jenjeera Prueksadee

Chulalongkorn Medical Journal

Background: Emerging roles of artificial intelligence support in breast imaging leads to improved radiologists’ performance

Objective: To assess the diagnostic performance of the artificial intelligence decision support in the evaluation of breast masses using automated breast ultrasound (ABUS).

Methods: 182 patients (415 breast masses) who received ABUS were included. Two readers, including the experienced breast radiologist (reader1) and the breast imaging fellow (reader2), separately reviewed the ABUS images and the artificial intelligence decision support according to the ACR BI-RADS 5^th edition.

Results: All of the 415 masses; 395 masses (95.2%) were benign and 20 masses …

Effect Of Music Therapy On Biophysical Profile And Oxygen Consuption In Preterm Babies In A Rural Hospital., Mahaveer Singh Lakra, Roshan Prasad, Ashwini Lakra, Amar Taksande, Revat J. Meshram, Sagar Karotkar, Mayur Wanjari

Chulalongkorn Medical Journal

Introduction: Music therapy in preterm babies helps in early weight gain, stabilization of heart and respiratory rates, and affect the biophysiological profile. It has a beneficial effect on oxygen consumption and hospital stay. Objectives: This study aimed to assess the effect of music therapy on biophysical profile and oxygen requirement in preterm babies. Methodology: The present comparative, observational study was carried out in the department of neonatology, a rural tertiary care hospital, Sawangi Meghe, Wardha, Maharashtra, India, for one year. All the relevant data was collected and analyzed using the prevalidated Performa. Results and observations: The male-to-female ratio both …

Performance And Cost Comparison Of A Rapid Diagnostic Test For Malaria And Microscopy. A Cross-Sectional Diagnostic Study, Abubakar Sunusi Ishak, Habibu U. Isgogo, Abubakar A. Lawan, Yuda Chongpison

Chulalongkorn Medical Journal

Background: The shift from traditional microscopy to rapid diagnostic tests (RDTs) for malaria diagnosis is gaining popularity, especially in resource-limited settings with unstable electricity and limited expertise. However, trust issues arise due to the inconsistent performance of different RDT kits.

Objectives: This study identified the variations in performance and cost of an RDT brand for malaria among different population demographics: pregnant women, young children, and adults, when compared with microscopy as a gold standard.

Method: The research was carried out in northwestern Nigeria and involved 360 participants stratified into 3 groups: children (5–17 years), adults (≥ 18 years), and pregnant …

Clinical Characteristics Of Cystic Biliary Atresia, Kanokrat Thaiwatcharamas, Sinobol Chusilp, Katawaetee Decharun, Pachareeporn Tanming, Nimmita Srisan, Paisarn Vejchapipat

Chulalongkorn Medical Journal

Background & Objective: Cystic biliary atresia (BA) is a unique form of BA. Our objective was to review the clinical characteristics of cystic BA in order to better understand its nature.

Methods: We retrospectively reviewed all infants diagnosed with cystic BA during January 2005 to December 2019. The diagnosis of BA was confirmed in all cases by laparotomy. Clinical data, pre-operative laboratory and imaging, intraoperative findings, and post-operative outcome were recorded. Data were expressed as mean and SD.

Results: There were 14 cystic BA patients out of the 227 BA patients (6.2%) during the studied period. The mean pre-operative ultrasound …

Superior Mediastinal Cut-Off Measurements In Chest Radiographs For Screening Of Silent Thoracic Aortic Diseases, Kantheera Leesmidt, Boonyarit Sintuvikaiwong, Apichaya Sripariwuth

Chulalongkorn Medical Journal

Objective: To determine cut-off values for superior mediastinal width and the mediastinal width-to-thoracic cage ratio from chest radiographs for the early detection of unrecognized thoracic aortic diseases. Additionally, this study aims to enhance diagnostic strategies for identifying aortic abnormalities.

Materials and Methods: This retrospective analysis included 152 subjects who underwent both computed tomography angiography (CTA) of the thoracic aorta and chest radiograph between April 2007 and January 2021. Superior mediastinal width was measured at 3 levels on chest radiographs. Thoracic CTA findings were categorized into normal and abnormal groups, the latter comprising aortic dissection, intramural hematoma, penetrating atherosclerotic …

Aircraft Wastewater Surveillance As A Tool For Monitoring Disease In The Pacific, Carla J. Eaton, Joanne R. Chapman, Brent J. Gilpin

Pacific Journal of Health

Wastewater surveillance is a powerful tool for monitoring infectious diseases within a population. However, as most wastewater surveillance relies on interconnected wastewater networks to provide samples representative of the population, many Pacific Islands have been excluded from benefiting from this tool due to their lack of reticulated sewerage systems. Many diseases of concern for the Pacific are detectable in wastewater even though individuals may be asymptomatic. We investigated whether analysis of wastewater from aircraft arriving in New Zealand from Pacific Island nations could be used as a proxy for in-country surveillance. Flights from the Pacific arrive in Auckland daily, with …

Integrating Artificial Intelligence Into Fnp/Dnp Simulation To Enhance Clinical Competency, Doris K. Gonzales

SACAD: Scholarly Activities

Abstract  

This poster presents a theoretically grounded, AI-integrated simulation program design structured across 3-4 semesters of Family Nurse Practitioner (FNP) and Doctor of Nursing Practice (DNP) education. This program is designed to support the development of clinical judgment and diagnostic reasoning among FNP students. Guided by Tanner’s Clinical Judgment Model and Roy's Adaptive Model as Theoretical Framework. The program addresses identified gaps in differential diagnosis and role transition from Registered Nurse (RN) to FNP practice. A needs assessment informed the development of a semester-sequenced curricular framework integrating AI-supported simulation across four semesters. The proposed design illustrates how progressive simulation experiences …

Faktor Risiko Perdarahan Gastrointestinal Pada Pasien Dengan Sindrom Koroner Akut: Sebuah Tinjauan Sistematis, Assyadilla Kirana Setyobudi, Amie Vidyani, Jonathan Christianto Sutadji, Lady Aqnes Kurniawati, Kevin Fernando Suhardi

Jurnal Penyakit Dalam Indonesia

Introduction. Gastrointestinal bleeding (GIB) is a serious but potentially preventable condition. Its symptoms include hematemesis, hematochezia, and melena. Risk factors for GIB include medications such as antiplatelets and anticoagulants, which are standard treatments for acute coronary syndrome (ACS). GIB is strongly associated with ACS and represents the most common bleeding complication in these patients. This study aimed to systematically review the factors contributing to GIB in patients with ACS.

Methods. Relevant articles were retrieved from PubMed, ScienceDirect, Springer, and EBSCO databases, covering studies on GIB risk factors in ACS patients published between March 31, 2003, and March 31, …

Campak: Refleksi Keberhasilan Program Vaksinasi, Erni Juwita Nelwan

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Waktu Pemulihan Saturasi Oksigen Pada Pasien Covid-19 Di Rsnd Semarang: Pengaruh Usia, Derajat Keparahan, Dan Komorbiditas, Hererapratita Aysha Hapsari, Yosef Purwoko, Edwin Basyar, Dwi Ngestiningsih

Jurnal Penyakit Dalam Indonesia

Introduction. COVID-19 may cause impaired oxygenation that affects the recovery process, making oxygen saturation an important parameter in clinical monitoring. Age, disease severity, and comorbidities are suspected to influence the duration of oxygen saturation recovery. This study aimed to analyze differences in oxygen saturation recovery time based on age, disease severity, and comorbidity status in hospitalized COVID-19 patients.

Methods. This was an observational analytic study with a retrospective cohort design using a survival analysis approach. The study was conducted at Diponegoro National Hospital (RSND) Semarang from October to November 2021 using medical records of hospitalized COVID-19 patients from …

Skoring Risiko Mortalitas Pada Pneumonia Komunitas Sedang-Berat, Ni Nyoman Indirawati Kusuma, Gurmeet Singh, Vally Wulani, Cleopas Martin Martin Rumende, Fauzar Fauzar, Telly Kamelia, Sukamto Koesnoe, Adityo Susilo, Hamzah Shatri

Jurnal Penyakit Dalam Indonesia

Introduction. Community Acquired Pneumonia (CAP) is a lung parenchyma infection acquired outside of the hospital and is significantly associated with morbidity and mortality rates. Identifying patients with moderate-severe CAP at high risk of mortality through a combination of these variables is expected to serve as a basis for prompt and appropriate intervention, ultimately improving clinical outcomes for CAP patients. This study aimed to develop a scoring system using clinical characteristics, radiological findings, and serum biomarkers to assess the mortality risk in patients with moderate-severe CAP.

Methods. This study employs a retrospective cohort design with moderate-severe CAP patients treated …

Manfaat Latihan Kekuatan Otot Terhadap Kadar Hba1c Pada Orang Dewasa Dengan Prediabetes: Laporan Kasus Berbasis Bukti, Owen Paruhum Simanjuntak, Anna Mira Lubis

Jurnal Penyakit Dalam Indonesia

Prediabetes is a metabolic condition of impaired glucose homeostasis which results in elevated blood glucose levels. Besides the higher risk of developing diabetes, prediabetes is associated with increased risk of cancer, dementia, heart failures, and coronary artery disease. The common first line treatment regimen given to this group are healthy diet and aerobic exercise. However, some conditions might prevent patients from doing aerobic exercises therefore there is a need for alternatives. This evidence-based case report aims to evaluate the benefit of resistance training on HbA1c levels compared to control group (no exercise) in prediabetic adults. Literature search was conducted across …

Koeksistensi Spondiloartritis Perifer Dan Fokal Segmental Glomerulosklerosis: Sebuah Laporan Kasus Jarang, Zakiya Zulaifah, Florentina Carolin Puspita Hapsari, Virly Nanda Muzellina

Jurnal Penyakit Dalam Indonesia

Spondyloarthritis is a group of inflammatory rheumatic diseases characterized by shared clinical features, genetic predispositions, and pathogenic mechanisms. Without appropriate management, it carries a risk of various complications. We report the case of a young male patient with a one-year history of nephrotic syndrome prior to admission, presenting with chronic polyarthritis. Initially, systemic lupus erythematosus (SLE) with renal and musculoskeletal involvement was suspected, although SLE is relatively uncommon in young males. However, based on the clinical presentation of arthritis, imaging findings of sacroiliitis, and the absence of diagnostic criteria supporting SLE, the patient was subsequently diagnosed with peripheral spondyloarthritis and …

Campak Dan Vaksinasi Campak Pada Orang Dewasa, Robert Sinto, Sukamto Koesnoe, Erni Juwita Nelwan, Alvina Widhani, Sharifah Shakinah, Adeline Pasaribu, Bernadine Gracia Duindrahajeng, Suhendro Suwarto, Leonard Nainggolan, Lie Khie Chen, Adityo Susilo, Suzy Maria, Anshari Saifuddin Hasibuan, Bramantya Wicaksana

Jurnal Penyakit Dalam Indonesia

Measles is a highly contagious viral infection that remains a significant global health problem despite the availability of an effective vaccine. Measles re-emergence is driven by gaps in immunization coverage, waning post-vaccination immunity, and increased population mobility. In adults, measles infection is associated with greater disease severity compared to children. This literature review was conducted by reviewing recent scientific publications addressing the epidemiology, pathogenesis, clinical manifestations, diagnosis, management, complications, and prevention of measles, with a focus on the adult population.  Measles is caused by an RNA virus of the Paramyxoviridae family and is transmitted through respiratory droplets and aerosols. Typical …

Prevalensi Covid-19 Derajat Berat Dan Kritis Saat Admisi Pada Pasien Penyakit Reumatik Autoimun Dan Faktor-Faktor Yang Berhubungan, Mulia Destini, Anna Ariane, Mira Yulianti, Aulia Rizka, Ikhwan Rinaldi, Arif Mansjoer, Hasan Maulahela, Syahidatul Wafa

Jurnal Penyakit Dalam Indonesia

Introduction. Patients with autoimmune rheumatic diseases are known to be more vulnerable to severe and critical infections, including COVID-19. Although it is no longer classified as a pandemic, SARS- CoV-2 infection still persists, and several surges of cases have been reported, including in Indonesia. To date, no data are available regarding the prevalence of severe and critical COVID-19 at admission in patients with autoimmune rheumatic diseases in Indonesia and the associated factors. This study aimed to determine the prevalence of severe and critical COVID-19 at admission in patients with autoimmune rheumatic diseases at Dr. Cipto Mangunkusumo National General Hospital, …

Risk Factors Of Leptospirosis Among Agricultural Workers In Southeast Asia: Literature Review, Ronggo Adi Wibowo, Wawa Najwa Nurzakia, Meirany Sasitha Kirana, Yulia Arthemisia Wijaya, Jasmine Ayumaharani Sekaryudha, Dwi Sarwani Sri Rejeki, Rosita Dwi Jayanti

Jurnal Epidemiologi Kesehatan Indonesia

The agricultural sector is the primary source of livelihood for communities in Southeast Asia; however, these activities increase the risk of exposure to zoonotic diseases, particularly leptospirosis. Southeast Asia is one of the regions with the highest incidence of leptospirosis in the world. This literature review aims to identify risk factors for leptospirosis among agricultural workers in Southeast Asia. The search for research articles utilized three databases (Google Scholar, PubMed, and ScienceDirect) using a descriptive approach based on literature review and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A total of 9,800 articles were screened for …

Factors Associated With Stunting Among Children Aged 6 – 59 Months Attending Integrated Health Post (Posyandu) In Selapajang And Kedaung Wetan Villages, Neglasari Sub-District, Tangerang City: A Matched Case-Control Study, Michael Alexander Solang, Joue Abraham Trixie, Gloria Semula, Tiona Simamora, Conny Tanjung

Jurnal Epidemiologi Kesehatan Indonesia

Stunting is a problem in Indonesia. In 2022, Kedaung Wetan and Selapajang Villages in Neglasari sub-district, Tangerang City, were identified as a priority. This study aimed to identify factors associated with stunting among children (6 – 59 months) in these villages. A matched case-control study consisting of 214 children (107 cases and 107 controls) was conducted, with individual matching based on age, sex, and prematurity at birth. Cases were children with height-for-age (H/A) measurement less than -2SD (according to WHO standard), while controls were children with H/A equal to or greater than -2SD. Conditional logistic regression was used for the …

Limb Dominance Does Not Affect Single-Leg Hop Performance In Non-Injured Young Athletes, Rawan Aldhabi

Journal of Medical Rehabilitation Science

Background: The concept of leg dominance is important in clinical settings. Single-leg hop (SLH) tests are frequently used to assess injury-risk and guide return-to-sport decision after lower-limb injury, yet the influence of limb dominance on SLH performance in non-injured young athletes remains unclear. The aim of the study was to examine the influence of limb dominance on SLH test performance in young healthy athletes, and to explore the relationships among different types of SLH tests. Methods: Forty-seven healthy collegiate athletes (mean age 21.44 ± 3.5 years; 26 males and 21 females) completed three SLH tests: single hop for distance (SHD), …

Kesintasan Hidup Satu Tahun Pasien Sirosis Hati Yang Dirawat Di Rumah Sakit Cipto Mangunkusumo Pada Periode Covid-19, Gita Aprilicia, Ichwan Baihaki, Riri Oktavani Banjarnahor, Kemal Fariz Kalista, Rino Alvani Gani

Jurnal Penyakit Dalam Indonesia

Introduction. Liver cirrhosis represents the terminal stage of chronic liver disease and is characterized by a markedly reduced survival rate. Understanding the characteristics and laboratory parameters of patients with liver cirrhosis can provide valuable insights into their prognosis and potential interventions. This study was conducted during the COVID-19 pandemic period, which may have influenced patient outcomes due to potential impact of COVID-19 infection on patients with chronic liver disease. This study aimed to evaluate the one-year survival rate of hospitalized liver cirrhosis patients at Cipto Mangunkusumo Hospital during the COVID-19 and to identify clinical and laboratory factors associated with …

Breast Cancer-Derived Extracellular Vesicle Mir-425-5p (Mir-425) Promotes Brain Metastasis Via Activating Astrocytes Through The Novel Mir-425-Znf24-Ccl8 Signaling Axis, Grace L Wong, Munazza S Khan, Sara Manore, Shivani Bindal, Ravi Singh, Hui-Wen Lo

Faculty, Staff and Student Publications

Mechanisms underlying breast cancer brain metastasis (BCBM) are still not well understood. Here, we identified that BCBM patient serum contained extracellular vesicles (EVs) with high levels of microRNAs (miRNAs)-107 and -425. Levels of miR-107 and miR-425 were elevated in brain metastases, and the elevation was associated with poor patient prognoses. Ectopic expression of miR-107 and miR-425 promoted mammospheres; however, the inhibition of miR-425, but not miR-107, suppressed breast cancer mammosphere formation. We further observed that EVs from miR-425-overexpressing breast cancer cells strongly activated astrocytes whereas their inhibitors abrogated the effect. Conditioned media from miR-425-activated astrocytes promoted mammospheres. To elucidate how …

A Systematic Review Of Implementing Iot Healthcare Systems: Technological, Organizational, And Ethical Barriers In Rural Settings, Mudzramer A. Hayudini, Angela Joy A. Jimpoy, Jonel T. Alibasa, Aisha A. Carolino, Jenden M. Julkamri, Nagdir B. Muhadja, Al Rajab H. Aming, Hamdoni K. Pangandaman, John Ed Augustus A. Escorial

Jurnal Keperawatan Indonesia

The implementation of Internet of Things (IoT) technologies holds transformative potential for healthcare delivery in rural and underserved regions. This systematic review focuses on technological, organizational, and ethical barriers. A comprehensive literature search across six major academic databases yielded eleven empirical studies published between 2015 and 2025. The review adhered to PRISMA protocols, with data synthesized using the Synthesis Without Meta- Analysis (SWiM) guidelines. Findings revealed that technological challenges—such as unreliable internet connectivity, lack of device interoperability, and power supply issues—are widespread across rural implementations. Organizational limitations included inadequate training, resistance to workflow changes, and financial constraints. Ethical concerns primarily …

Factors Affecting Older Adult Adjustment At A Health Promoting Hospital In Nakhon Phanom, Thailand, Onuma Kaewkerd, Yuttachai Chaiyasit, Phensiri Dumrongpakapakorn, Nuttiya Prommasaka Na Sakonnakhon

Jurnal Keperawatan Indonesia

Elderly adjustment influences quality of life and well-being and informs appropriate health promotion, holistic care, and health services. This study aimed to investigate the factors influencing the adaptation of older adults by focusing on a study conducted at Dong Kwang Health Promoting Hospital in Nakhon Phanom Province, Thailand. A cross-sectional design was used for the study. The sample consisted of 100 older adults and were selected for data collection from March 22, 2023, to April 20, 2023. The research instruments consisted of questionnaires assessing personal information, spiritual well-being, stress, perceived self-care abilities of older adults, quality of life, and older …

Educating Staff Nurses On Pain Reassessment, Katie Louise Pemberton

Walden Dissertations and Doctoral Studies

Pain is one of the most common reasons that patients seek medical care, and chronic pain is a major health problem. The goal of this project was to address a lack of current, evidence-based knowledge of nurses regarding pain reassessment. The context for this project was a medical-surgical area in a rural hospital. The Doctor of Nursing Practice project attempted to answer the practice focus question on whether education improved knowledge related to improving pain reassessment. The project framework utilized in the doctoral project was the analysis, design, development, implementation, and evaluation model. An education program was designed with the …

National Durc Capacity Building Program: A Novel Ipe Model For Responsible Life Science Research Education, Wael Elrayes, Ali Asy, Maha Farid

Innovations in Health Sciences Education Journal

This is an abstract from the Spotlight on Scholarship event in 2026.

Implementing Holographic Instruction In Multi-Campus Dpt Education, Stacie M.L. Christensen, Brad Dexter, Michael Hollins, Elisabeth Barrett

Innovations in Health Sciences Education Journal

Poster presented at the 2026 Spotlight on Scholarship at the University of Nebraska Medical Center, Omaha, Nebraska.

Outstanding Project: Second Place Winner