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Heart failure is a clinical syndrome characterized by shortness of breath and fatigue resulting from structural or functional abnormalities of the heart.  Acute Decompensated Heart Failure (ADHF), also known as decompensated heart failure, is a condition of worsening chronic heart failure that can occur acutely, subacutely, or insidiously, with symptoms progressively worsening over several days or weeks. A 1-year-old male patient presented to the Dermatology Clinic at Cut Meutia General Hospital with the chief complaint of A 60-year-old female patient was brought to the Cut Meutia Emergency Department with the complaint of shortness of breath that had worsened 1 day prior to admission; the shortness of breath worsened during light activity and when the patient was lying down. She also complained of swelling in both legs for one week prior to admission, which had progressively worsened. On examination, skin turgor was slow to return in the left and right lower extremities; palpation of the neck revealed jugular vein distension. Inspection showed a normal chest contour; auscultation of the lungs revealed rhonchi. Cardiac percussion revealed enlargement of the upper, left, and right borders of the heart, as well as the cardiac border at the level of the waist. Auscultation revealed a murmur at the fourth intercostal space on the left side. Examination of the lower extremities revealed pitting edema on both the left and right sides.  Supportive X-ray examination revealed severe cardiomegaly. An ECG revealed sinus rhythm, an irregular rate of 80 beats per minute, LAD axis, P wave not identifiable, PR interval 0.20 seconds, QRS complex 0.6 seconds, inverted T waves in I and AVL, LVH (+), RVH (-), PVCs, AF, and lateral ischemia. Echocardiography revealed severe aortic stenosis due to RHD and an LVEF of 21%. The patient has been prescribed furosemide, warfarin, bisoprolol, and spironolactone.

Introduction: Bronchopneumonia is an inflammatory lung condition involving one or more lobes, characterized by patchy infiltrates commonly caused by Streptococcus pneumoniae (30–50% of cases), followed by Staphylococcus aureus and Klebsiella pneumoniae in more severe infections. Clinical manifestations include high fever, restlessness, dyspnea, rapid and shallow breathing accompanied by rales, vomiting, and either dry or productive cough. Respiratory infections may trigger inflammatory responses that increase excessive mucus production. Case Illustration: A 1-year-5-month-old girl weighing 7.9 kg presented to RSUD Ir. Soekarno Sukoharjo with shortness of breath and intermittent fever for six days, accompanied by vomiting, decreased appetite and fluid intake, cough, weakness, runny nose, and oral sores. Physical examination revealed a weak general condition, compos mentis consciousness, dyspnea, wheezing, and fine wet rales in both lung bases. Dysmorphic facial features consistent with Down syndrome were observed. Laboratory findings showed leukopenia, eosinopenia, and elevated RDW-CV, while chest radiography indicated bilateral bronchopneumonia. Management included intravenous fluids, antibiotics, antipyretics, antiemetics, and bronchodilators. The patient was diagnosed with sixth-day fever due to bronchopneumonia, mild-to-moderate dehydration, recurrent nausea and vomiting, atrial septal defect, and Down syndrome.

Project scheduling is an important element for shipyard companies to gain more profit. The most frequently used analysis is the Critical Path Method (CPM). However, in reality, planning using the CPM method is considered less efficient because it does not consider the productivity of each job in it and adds safety time which causes the project duration to become longer. In accordance with the above problems, a new method for planning project schedules is now being developed, namely Critical Chain Project Management (CCPM). CCPM is a project planning method that emphasizes the resources needed to carry out existing tasks in the project. This method is carried out by eliminating multitasking, student syndrome, Parkinson's law and providing a buffer at the end of the project. In this final project, a comparison of the duration of the results of applying the CCPM method with the Critical Path Method (CPM) method is carried out in a case study of ship repairs at PT. Galangan Kapal Madura. The initial project scheduling uses the traditional method in the form of a Gantt chart which is then broken down in more detail and completely with the relationship between activities in the form of CPM, and then will be compared with the duration of the results of CCPM scheduling which has eliminated multitasking, eliminated Safety time for each activity and provided a buffer in the work.

Down Syndrome (DS) is a genetic disorder characterized by trisomy of chromosome 21 and is inherently associated with clinical manifestations such as hypotonia, joint laxity, and neuromuscular deficits, all of which collectively contribute to impaired postural control and balance. These balance impairments significantly affect the attainment of motor milestones, performance of daily activities, and increase the risk of falls. This study aims to analyze the effectiveness of core stability training in improving balance among children with DS. A narrative review approach was employed by conducting a literature search across electronic databases including PubMed, Scopus, Google Scholar, and ResearchGate. Inclusion criteria consisted of primary studies (RCTs, quasi-experimental designs) published within the last ten years (2015–2025) that examined core stability interventions targeting balance or postural control in children with DS. A review of 10 relevant studies demonstrated that core stability training, either as a standalone intervention or combined with other modalities (e.g., treadmill training or balance training), resulted in significant improvements in both static and dynamic balance. These improvements are facilitated through the strengthening of deep trunk muscles (such as the multifidus, transversus abdominis, and rectus abdominis), which play a crucial role in proximal stabilization and force transfer to the extremities. In conclusion, core stability training is an effective and recommended intervention modality within physiotherapy rehabilitation programs to enhance the quality of life and motor independence of children with Down Syndrome.  

This research was motivated by the condition of a subject who frequently displayed deviant sexual behaviors at school. The main objective of this study is to determine the effectiveness of the aversive procedure technique in reducing the frequency of sexual behavior deviations in a student with Down syndrome. The subject of this study was a tenth-grade student with Down syndrome at SKh Negeri 01 Kota Serang who exhibited deviant behaviors such as touching private parts of their body in public, hugging classmates without permission, and imitating sexual movements. The method used in this research was an experimental approach with a Single Subject Research (SSR) design of the A-B-A type, consisting of three phases: baseline-1 (A1), intervention (B), and baseline-2 (A2). The aversive procedure technique was applied by giving an unpleasant stimulus every time the deviant behavior appeared, aiming to create a deterrent effect and reduce the frequency of the behavior. The results of the study showed a significant decrease in the frequency of deviant sexual behavior after the intervention. This indicates that the aversive procedure technique is effective in reducing the frequency of deviant sexual behavior in students with down syndrome when implemented in a structured manner and adapted to the individual's psychological condition.

Sexual violence against children is a highly complex issue with profound negative impacts on both the victims and their social environment. Children with disabilities, particularly those with Down Syndrome, are among the most vulnerable to such abuse due to their physical and cognitive limitations. Given this context, the role of non-governmental organizations (NGOs) such as the Child Protection Agency (LPA) becomes crucial. LPA plays a vital role in providing support, advocacy, and assistance to child victims of sexual violence, especially those with disabilities. This study aims to examine the protective role of LPA in assisting children with Down Syndrome who have become victims of sexual violence in Deli Serdang Regency. Using a qualitative method with a phenomenological approach, the research explores and interprets the lived experiences of informants involved in the cases. The study also highlights the implementation of the four child protection principles as applied by the LPA. The findings show that LPA fulfills its protective role by providing legal assistance, psychosocial support, and ensuring the safety of the victims. The organization successfully implemented the four child protection principles, resulting in a 12-year prison sentence for the perpetrator and justice for the victim. The study recommends increasing LPA staff capacity to enhance the quality of services provided.

Syndrome is a serious problem in children's health because it has a major impact on growth and development, especially in terms of intelligence and daily activities. Down Syndrome, as one of the most well-known chromosomal disorders, is often the main cause of intellectual developmental disorders, hypotonia, facial dysmorphism, early onset of Alzheimer's disease, and various behavioral disorders. Diagnosing syndrome diseases in children is often difficult due to complex and varied symptoms, requiring lengthy, costly, and time-consuming medical evaluations. This study aims to design a Case-Based Reasoning (CBR)-based expert system for diagnosing syndromes in children, which is expected to help accelerate the disease identification process and provide more effective and efficient solutions. The method used is the development of an expert system with a CBR approach, in which the system performs calculations and matching based on the symptoms selected by the user against the available case base. The results of the study show that from symptom inputs such as wide hands with short fingers, short stature, small head, stunted growth, small lower jaw, abnormal body appearance, and weak joints, the system was able to diagnose Klinefelter syndrome with a percentage of 43.58%. This system can be an alternative for patients or families who have limited time and funds to obtain medical consultations, so that diagnosis and follow-up can be carried out more quickly and efficiently.

This study aims to examine the implementation of the selapanan tradition among Javanese postpartum women in Limau Manis Village, and to understand the meaning and community perceptions of this practice in the context of modern life. The selapanan tradition is part of local wisdom that has been passed down from generation to generation and has important value in postpartum maternal care. This study uses a qualitative method with an ethnographic approach, which allows researchers to understand cultural practices in depth through direct interaction with the community. Data collection techniques include participant observation, in-depth interviews with mothers who practice the tradition, community leaders, and traditional birth attendants, as well as documentation and field notes. The results show that selapanan is still preserved and practiced by the people of Limau Manis Village, although it has undergone several forms of adaptation to modern developments and modern medical guidelines. In its implementation, this tradition uses various natural ingredients such as parem (traditional body scrub), pilis (forehead concoction to refresh the eyes and mind), bengkungan (cloth to wrap the stomach), gerita (a kind of stagen or body binder), and the consumption of herbal medicine as part of physical care and body recovery. In addition to its physical aspects, selapanan also has a psychological dimension, providing emotional comfort and social support to postpartum mothers, thereby helping to prevent psychological disorders such as baby blues syndrome. This tradition serves not only as a form of traditional healthcare but also as a symbol of social solidarity and respect for local cultural values. Amidst the tide of modernization, preserving selapanan is crucial as a cultural identity that remains relevant. This study concludes that despite adjustments to medical developments, the selapanan tradition continues to play a significant role in maintaining maternal well-being and strengthening Javanese cultural values in the modern era.

Students with Down syndrome have developmental characteristics that differ from typical students. In such cases, the educational approach should not only focus on academic aspects but also on life skills education. In teaching life skills, teachers must adapt to each child's individual abilities. However, in practice, teachers often face various challenges. This study aims to describe the challenges faced by teachers at Terra Athena Special Needs School (SLB) in providing life skills education for students with Down syndrome, as well as the strategies used to overcome these challenges. This research uses a qualitative case study approach with data collection techniques including interviews, observations, and documentation. Data analysis was conducted using triangulation techniques to enhance data validity. The results show that teachers face several challenges such as the wide range of student abilities, students' tendencies to be absorbed in their own world, limited facilities, and the need for more time to carry out each activity. The strategies implemented include positive reinforcement and individualized approaches, the use of visual media and concrete tools, collaboration with therapists and parents, and a boarding program for students.

This community service project aims to enhance the fine motor skills of children with special needs (CWSN) at SLB C YPALB Perwari Kuningan through a beading-based art therapy approach. The program was conducted using a participatory and enjoyable educational method. A descriptive qualitative method was employed, with data collected through direct observation, informal interviews, and documentation of students' creative outputs. The results showed a significant improvement in hand-eye coordination, concentration, and perseverance among the participants. Children with intellectual disabilities, hearing impairments, autism, and Down syndrome successfully created rings and bracelets, both independently and with guidance. This activity not only contributed to fine motor development but also enhanced social interaction and self-expression. With its inclusive and adaptive approach, beading as a form of art therapy proved effective in supporting the learning process and holistic development of children with special needs in special education settings.

This community service project aims to enhance the fine motor skills of children with special needs (CWSN) at SLB C YPALB Perwari Kuningan through a beading-based art therapy approach. The program was conducted using a participatory and enjoyable educational method. A descriptive qualitative method was employed, with data collected through direct observation, informal interviews, and documentation of students' creative outputs. The results showed a significant improvement in hand-eye coordination, concentration, and perseverance among the participants. Children with intellectual disabilities, hearing impairments, autism, and Down syndrome successfully created rings and bracelets, both independently and with guidance. This activity not only contributed to fine motor development but also enhanced social interaction and self-expression. With its inclusive and adaptive approach, beading as a form of art therapy proved effective in supporting the learning process and holistic development of children with special needs in special education settings.

Mother as an individual has the right to feel happiness in herself and her life even if she has a child with special needs. There is a process that a mother who has a child with special needs goes through to finally achieve happiness in her life. This study aims to describe the happiness of mothers who have children with special needs, including disabilities, autism, and down syndrome at UPT Resource Center Gresik. This study used a qualitative approach with a case study research type and used data collection techniques in the form of interviews, observation and documentation. Data analysis techniques use the Miles and Huberman models. The data credibility technique uses triangulation techniques and member checks.  Based on the results of the research conducted by the researchers, it was shown that the three subjects were happy with their condition as mothers who have children with special needs including disabilities, autism, and down syndrome. The three subjects can establish relationships with the surrounding environment, be fully involved in their children's activities, find meaning in life, be optimistic about their children's future, and be resilient or be able to rise from the problems they face.

Down Syndrome is a fairly common genetic disorder, this is one of the diseases caused by the emergence of an extra chromosome from 21 pairs of chromosomes or known as trisomy 21. This study aims to determine the provision of Occupational Therapy in Down Syndrome Children at the Liliput Clinic. Occupational Therapy in Improving Fine Motor Skills in Down Syndrome Children and supporting and inhibiting factors. This study uses a Qualitative Method, the informant sampling technique uses the Purposive Sampling Technique. And data collection is obtained from the results of Interviews, Observations, and Documentation. Data analysis is carried out through the stages of Data Reduction, Data Presentation, and Conclusion Drawing. The location of this study is at the Liliput Clinic, Jl. Cipete IV No. 06, Rt. 02 Rw 03, South Cipete, Cilandak District. The results of the study showed that the provision of Occupational Therapy for Down Syndrome Children, namely, Down syndrome children still tend to be limp, such as when doing activities they get tired more easily, then Down syndrome children have not been able to regulate their emotions stably. In improving fine motor skills in Down syndrome children, therapists train and instruct children how to hold objects properly such as pencils, pens and small scissors. Then the child is instructed how to write correctly. Supporting factors in Occupational Therapy for Down Syndrome Children are an experienced therapy background, supporting infrastructure, and support from parents of Down syndrome children. And the inhibiting factors are Down syndrome children who have high emotional levels and physical problems in Down syndrome children.

Down syndrome (DS) is a physical disorder caused by an excess of the third chromosome in the 21st pair of chromosomes which causes the number of chromosomes to become 47. One of the symptoms of Down syndrome is muscle weakness which can affect the baby's reflexes. To assess the effect of baby massage intervention on the reflex development of babies with Down syndrome in the NICU. The method used in this research is a case study with baby massage intervention for Down syndrome patients in the NICU. The intervention was carried out for 3 days. Baby massage intervention is carried out once a day with a duration of 10 -15 minutes. The results of this case study show that after baby massage there were changes in the palmar grasp reflex and Babinski reflex. Baby massage can improve babies’ reflexes particularly palmar and Babinski reflexes on babies with Down syndrome in the NICU.

Down syndrome is one of the children with special needs, where the child has an intellectual level that is low or below average. This study aims to find out, provide an overview, and explain about the forms of social interaction carried out by a child with special needs with Down syndrome with teachers and friends in school. This is done in order to provide a true view and picture of the social behavior that appears from children with Down syndrome, where it has not been widely known by educators and the public. This research is a qualitative research with case study method, this research uses purposive sampling technique. This study uses one subject with certain characteristics. Data collection techniques used are: non-participant observation, interviews, questionnaires, and documentation. Data analysis techniques include: (1) data reduction (2) data presentation, and (3) conclusion drawing. The results of data collection conducted from March 2024, found that there are four forms of behavior that appear classified in social behavior and forms of behavior classified as asocial behavior. The intended social behaviors are friendly behavior, sympathetic behavior, cooperative behavior, and competitive behavior. Existing asocial behaviors consist of resistance behavior and attack behavior.    

Down syndrome is a common disorder. In Indonesia, cases of Down syndrome tend to increase every year. Down syndrome is a genetic disorder that causes children to have low cognitive and physical differences. One of the differences owned by down syndrome children is their language development. Therefore, this article was prepared to find out how language development in down syndrome children.  This article was prepared using the systematic literature review (SLR) method, which contains how language development in children with Down syndrome, factors that affect language development in children with Down syndrome, and efforts that can be made to develop language skills in children with Down syndrome.  This article explains that some Down syndrome children experience language delays, which are caused by genetic abnormalities and physical conditions such as a mouth cavity that is too narrow, a short palate, weak speech muscles and many more. To overcome language development in children with Down syndrome, several efforts can be made such as conducting speech and language therapy, and using the PECS method which has been proven effective in efforts to develop language in children with Down syndrome.

Parents who have children with Down syndrome experience various dynamics and problems to be able to accept the circumstances that occur. Parents' self-acceptance is an important aspect in caring for, educating, and raising the baby. This study aims to determine the effect of self-acceptance on coping strategies of parents who have children with Down syndrome. Research using quantitative methods with a sample of 287 parents, who are members of the Down Syndrome Parents Association Foundation (POTADS). there are 46 statement items on the coping strategy scale (r = 0.873) and 16 items on the self-acceptance scale (r = 0.714) on a Likert model scale. The results of data analysis using simple linear regression tests show that there is a significant effect of self-acceptance on coping strategies with a sig value. <0.05. through the regression equation Ŷ= 77.608 + 1.090X. The correlation coefficient value is 0.489 and the coefficient of determination (R Square = 0.239). 23.9% self-acceptance influences the coping strategy of parents at the POTADS Foundation.

This study aims to determine the prevalence of refractive errors in children with Down Syndrome in eye examination activities carried out during Down Syndrome Awareness Month 2023 by the East Java Association of Parents of Children with Down Syndrome (PIK POTADS). A total of 30 children with Down Syndrome underwent eye examinations, and the results showed that 18 children (72%) had myopia, 7 children (28%) had astigmatism, and 5 children were indicated to require further referral to a pediatric ophthalmologist. These results indicate that children with Down Syndrome have a high risk of experiencing refractive errors, so regular eye examinations and medical follow-up are needed.

This study aims to determine the prevalence of refractive errors in children with Down Syndrome in eye examination activities carried out during Down Syndrome Awareness Month 2023 by the East Java Association of Parents of Children with Down Syndrome (PIK POTADS). A total of 30 children with Down Syndrome underwent eye examinations, and the results showed that 18 children (72%) had myopia, 7 children (28%) had astigmatism, and 5 children were indicated to require further referral to a pediatric ophthalmologist. These results indicate that children with Down Syndrome have a high risk of experiencing refractive errors, so regular eye examinations and medical follow-up are needed.

Down syndrome refers to intelligence disability due to neural development disorders, These problems lead to interrupted social, academic, and occupational problems. Objective: This research describes the resilience and gratefulness of caregivers of children suffering from Down syndrome in Semarang. Method: This research is quantitative. Sample: the samples were 30 respondents taken with total sampling. The applied test was a statistic descriptive test. Research results: The applied statistic test found 22 caregivers had very high resilience while 18 caregivers had high resilience in the children suffering from Down syndrome. Thirty caregivers had high gratefulness for children suffering from Down syndrome in Semarang regency. Suggestion: the researcher expects future researchers to develop resilience and gratefulness of caregivers for children suffering from Down syndrome.