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Muscle-invasive bladder cancer (MIBC) is an aggressive malignancy associated with high morbidity, reduced survival, and impaired quality of life. Radiotherapy (RT) has been widely used as a bladder-preserving strategy, particularly for patients unsuitable for surgery or systemic chemotherapy. RT may also enhance tumor immunogenicity through programmed death-ligand 1 (PD-L1) upregulation, providing a rationale for combination therapy with immunotherapy. This study aimed to evaluate the effectiveness of combining immunotherapy and radiotherapy in MIBC treatment. A systematic review was conducted following PRISMA 2020 guidelines using the PICO framework. Literature searches were performed in PubMed, Embase, Cochrane, ClinicalTrials.gov, Web of Science, and Scopus databases for studies published between 2016 and 2025. Risk of bias was assessed using the Cochrane Risk of Bias Tool and ROBINS-I. Of 105 identified studies, five met the inclusion criteria and were included in the final analysis. Only one Phase II randomized controlled trial demonstrated low risk of bias in randomization and allocation concealment. ROBINS-I assessment indicated moderate to serious risk in confounding and participant selection domains. Clinical findings showed promising outcomes, with complete response rates ranging from 35%–50% and partial response rates from 25%–40%. Median overall survival ranged from 24–30 months, with favorable disease-free and progression-free survival outcomes. Combined immunotherapy and radiotherapy demonstrate potential to improve survival and disease control in MIBC; however, further rigorous clinical studies are needed to optimize patient-centered treatment strategies.  

Risk factors for melasma have been identified at several points such as the use of birth control pills, cosmetics, sun exposure, estrogen therapy, decreased thyroid and ovarian function, ovarian tumors, nutrition, drugs that are classified as phototoxic or photoallergic, and epilepsy drugs. This article aims to determine the incidence of melasma and its risk factors. This study uses articles collected from the Google Scholar database. The data collection step uses the keyword "Risk Factor Melasma" according to the title and keyword criteria. The articles used are publications in the 2018-2023 year range. The stages of analysis are carried out using VOSviewer software for visualization and trend analysis in the form of bibliometric maps. The bibliometric approach was applied to identify publication patterns, research developments, and relationships among topics related to melasma risk factors. Based on the visualization results, 100 selected documents were published within 5 years, from 2018 to 2023. The findings provide an overview of the main research trends and contribute to a better understanding of the incidence of melasma and the factors associated with its occurrence

Balanced nutrition intake is an important factor in supporting the performance of young athletes, especially during the growth period that requires optimal nutrition for intense physical activity. However, the lack of nutritional knowledge among parents of young athletes often leads to nutritional imbalances that have a negative impact on athlete health and performance. This study aims to measure the effect of balanced nutrition education on improving the knowledge and attitudes of parents of athletes at the Kancil Mas Football School (SSB), Karawang. The method used was a quasi-experiment with a pre-test and post-test design involving 20 respondents who were parents of U-13 athletes. Education was provided in the form of direct counseling sessions and group discussions, which were supplemented with supporting materials such as leaflets. The Wilcoxon signed rank test was used to analyze changes in parental knowledge and attitude scores before and after the intervention. The results of the analysis showed a significant increase in parents' understanding and positive attitudes towards balanced nutrition after education (p < 0.05). The results showed a significant increase in the level of parents' understanding and positive attitudes towards nutrition after the education intervention. These findings highlight the importance of active parental involvement in ensuring that young athletes' nutritional needs are met, as well as providing a basis for developing nutrition education programs in other sports schools.

Background: Adenoid hypertrophy is a condition characterized by enlargement of the adenoid tissue which can cause nasopharyngeal obstruction and potentially affect the function of the Eustachian tube. Dysfunction of the Eustachian tube may disrupt middle ear ventilation and increase the risk of otitis media. The degree of adenoid hypertrophy can be objectively assessed using a lateral nasopharyngeal radiograph by calculating the adenoid–nasopharyngeal ratio (A/N ratio). Objective: This study aimed to determine the relationship between adenoid hypertrophy based on the adenoid–nasopharyngeal ratio and the incidence of otitis media. Methods: This study was a quantitative research with an analytic observational design using a cross-sectional approach. Data were obtained from the medical records of patients with adenoid hypertrophy who underwent lateral nasopharyngeal radiographic examination at RSI Purwokerto from 2022 to 2025. The sample consisted of 31 patients who met the inclusion and exclusion criteria. Data analysis was performed using the Spearman correlation test because the data were not normally distributed based on the Shapiro–Wilk test. Results: The results showed that most of the subjects were male (17 subjects, 54.8%) and female (14 subjects, 45.2%). The median age of the subjects was 7 years with an age range of 4–9 years. The median adenoid–nasopharyngeal ratio was 0.90 with a range of 0.68–0.99. Otitis media was found in 11 subjects (35,5%), while 20 subjects (64,5%) did not experience otitis media. The Spearman correlation test showed a correlation coefficient of r = 0.015 with a p-value of 0.936 (p > 0.05), indicating that there was no significant relationship between the adenoid–nasopharyngeal ratio and the incidence of otitis media. Conclusion: There was no statistically significant relationship between adenoid hypertrophy based on the adenoid–nasopharyngeal ratio and the incidence of otitis media.

Diabetes Mellitus is a non-communicable disease with an increasing prevalence and has become a major public health concern globally and nationally. The incidence of diabetes mellitus is influenced by various individual and environmental factors. This study aimed to analyze the relationship between age, gender, and residential proximity to landfill areas and the incidence of diabetes mellitus in Bendosari District. A quantitative analytic observational design with a cross-sectional approach was employed. The study population consisted of 1,890 patient visit records recorded in the Management Information System of Bendosari Public Health Center in 2025. A total of 363 respondents were selected using proportionate stratified random sampling. Data were analyzed through univariate analysis, bivariate analysis using the Chi-Square test, and multivariate analysis using multiple logistic regression. The findings showed that age was significantly associated with diabetes mellitus incidence (p=0.000; OR=79.790; 95% CI=53.511–118.974). Gender was also significantly related to diabetes mellitus incidence (p=0.000; OR=0.298; 95% CI=0.203–0.435), indicating that females had a higher risk than males. In contrast, residential proximity to landfill areas was not significantly associated with diabetes mellitus incidence (p=0.308; OR=1.247; 95% CI=0.439–3.540). Multivariate analysis revealed that age and gender were the dominant factors influencing diabetes mellitus incidence, with the model explaining 56.1% of the variation. The study concludes that age and gender are significant determinants of diabetes mellitus incidence, whereas residential proximity to landfill areas has not been proven to significantly affect its occurrence.

Amidst rising global pressure regarding sustainability and cross-border trade, customs agencies are no longer viewed merely as gatekeepers but as strategic actors in global environmental governance through the Green Customs Initiative (GCI). This research aims to uncover the evolutionary patterns of GCI research within the context of adaptive policy, map its intellectual structure, and identify future thematic directions. The methodology employs a bibliometric analysis of documents sourced from the Web of Science database, utilizing VOSviewer software to perform co-authorship, bibliographic coupling, and co-word analysis.The results demonstrate that the dominance of scientific actors in this field is determined more by the strength of collaboration networks than by the mere volume of publications. The findings identify that the primary intellectual foundations of GCI research rest upon the critical relationship between environmental regulation, international trade, market responses, and eco-innovation. Furthermore, country-level analysis highlights the central roles of China, the United States, and the United Kingdom in shaping the knowledge structure of this domain. Overall, these findings underscore that the GCI has evolved into a multidisciplinary field that requires an adaptive policy framework to respond to the dynamics of ecological risks and global trade demands through institutional flexibility and cross-actor collaboration. By integrating environmental protection into border management and risk assessment, this study provides a strategic reference for customs authorities to move toward a more responsive and knowledge-based green customs administration.

The acceleration of digitalization in recent years has shaped a new socio-economic landscape in Indonesia. Access to app-based financial services and online entertainment has increased rapidly, but at the same time, illegal online lending and digital gambling, targeting adolescents, have flourished. This paper explores a Community Service intervention model that combines preventative digital literacy and artificial intelligence (AI) optimization within the La Tansa Islamic Boarding School in Palembang. The research was conducted using a qualitative approach with participant observation, in-depth interviews, focus group discussions, and written reflection analysis. Findings indicate that strengthening digital literacy based on critical awareness not only improves risk understanding but also deepens self-control integrated with religious values. AI training for educators also encourages changes in learning practices to be more adaptive and reflective of the dynamics of the digital era. This model offers a digital resilience approach that can be replicated in other educational institutions with similar characteristics.

Instagram social media addiction has become an increasingly common phenomenon among university students. Excessive use of Instagram can negatively affect mental, social, and academic well-being, and may increase the risk of social anxiety. Students who experience Instagram addiction tend to have reduced direct social interaction, and fear of negative evaluation from others, which are key factors contributing to social anxiety. This study aims to determine the relationship between Instagram social media addiction and social anxiety among students. This study used a quantitative approach with a cross-sectional design. The sample consisted of 105 respondents selected using purposive sampling. The instruments used were the Instagram Addiction Scale (TIAS) and the Social Anxiety Scale for Social Media Users (SAS-SMU). Data analysis was conducted using the Chi-Square test. The results showed that most respondents had a moderate level of Instagram addiction (56.2%) and a moderate level of social anxiety (68.6%). The Chi-Square test indicated a significant relationship between Instagram addiction and social anxiety, with a p-value < 0.001 (p < 0.05). There is a significant relationship between Instagram addiction and social anxiety among students. However, the relationship is not always linear, as higher levels of addiction do not necessarily correspond to higher levels of social anxiety.

Instagram social media addiction has become an increasingly common phenomenon among university students. Excessive use of Instagram can negatively affect mental, social, and academic well-being, and may increase the risk of social anxiety. Students who experience Instagram addiction tend to have reduced direct social interaction, and fear of negative evaluation from others, which are key factors contributing to social anxiety. This study aims to determine the relationship between Instagram social media addiction and social anxiety among students. This study used a quantitative approach with a cross-sectional design. The sample consisted of 105 respondents selected using purposive sampling. The instruments used were the Instagram Addiction Scale (TIAS) and the Social Anxiety Scale for Social Media Users (SAS-SMU). Data analysis was conducted using the Chi-Square test. The results showed that most respondents had a moderate level of Instagram addiction (56.2%) and a moderate level of social anxiety (68.6%). The Chi-Square test indicated a significant relationship between Instagram addiction and social anxiety, with a p-value < 0.001 (p < 0.05). There is a significant relationship between Instagram addiction and social anxiety among students. However, the relationship is not always linear, as higher levels of addiction do not necessarily correspond to higher levels of social anxiety.

This study aims to examine the position of Pancasila as a grundnorm within the Indonesian constitutional system and the role of Islamic Religious Education as an ethical foundation in strengthening constitutional principles from the perspective of Islamic sociological legal theory. The methodology employed is a qualitative approach using library research, involving the analysis of various relevant literature sources. The findings indicate that Pancasila plays a fundamental role in the Indonesian legal system, serving as the highest norm in the hierarchy of laws, while also functioning as an ethical guideline in the life of the nation and the state. Islamic Religious Education plays a significant role in shaping the moral constitution through the understanding of values such as honesty, justice, responsibility, and trustworthiness, in line with the principles of Pancasila. The integration of Pancasila values and Islamic teachings, viewed through the lens of sociological law, demonstrates that effective law is not merely normative but also responsive to social realities. Therefore, Islamic sociological legal theory can strengthen the Indonesian constitutional system through the integration of normative, moral, and sociological values, resulting in a more responsive, just, and contextually relevant legal system.

This study explores the acceptance of the Free Nutritious Meal Program (MBG) at SD Inpres Gere through William of Ockham's negative rights framework, focusing on freedom from external interference. As a positive rights policy (the right to services), the MBG has the potential to conflict with the principles of individual subjective rights (negative rights). Ockham emphasized that every individual has a personal sovereignty that must be free from interference from external authorities. Using qualitative research methods through literature studies and interviews, this article analyzes the risk of standardizing consumption that can reduce individual autonomy in determining their private needs. The analysis shows that although the MBG has a noble aim to fulfill the right to life, its implementation risks becoming a form of state paternalism that harms citizens' negative freedoms if not accompanied by strict limits on power. This paper concludes that to align with Ockham's principle of individual subjective rights, the MBG program must continue to respect the private space and diversity of individual choices without creating dependency that erodes the sovereignty of legal subjects.

This study aims to examine the effect of Employee Digital Wellness (EDW) on Work Engagement (WE) among administration and digital marketing employees in startup companies implementing hybrid working, and to explore the moderating role of Organizational Support for Wellbeing (OSW). Using a quantitative approach, data were collected through a 5-point Likert scale questionnaire from 160 purposive-sampled respondents. Data analysis was conducted using Partial Least Squares Structural Equation Modeling (PLS-SEM) via SmartPLS 4.1.1.7. The findings indicate that EDW positively and significantly affects WE (β=0.621; t=8.943; p<0.001), confirming that employees who manage digital technology usage effectively tend to be more energetic, dedicated, and fully engaged in their work. In addition, OSW also positively influences WE (β=0.412; t=5.672; p<0.001), demonstrating that tangible organizational support in the form of wellbeing policies, flexible work arrangements, and mental health programs enhances work engagement. Moreover, OSW moderates the EDW → WE relationship (β=0.173; t=2.713; p=0.007), indicating that the positive effect of digital wellness on engagement is stronger when organizational support is sufficient. These findings highlight the importance of both personal management of digital wellness and consistent organizational wellbeing policies. Practically, organizations are advised to provide digital wellbeing programs, flexible working arrangements, and managerial support to maximize employee engagement, particularly in hybrid working contexts.

This study investigates the effect of total risk on firm performance and sustained growth among consumer non-cyclicals manufacturing companies listed on the Indonesia Stock Exchange (IDX) over the period 2019–2023. Total risk is operationalized through the systematic risk proxy (Beta/β), estimated via the Capital Asset Pricing Model (CAPM) framework as the covariance between individual stock returns and the market return divided by the variance of market returns, using the Jakarta Composite Index (JCI) as the market benchmark. Firm performance is measured through Return on Assets (ROA), Return on Equity (ROE), and Tobin’s Q, while sustained growth is operationalized following Gerson et al. (2025) as SG = b × ROE, where b denotes the earnings retention ratio. Panel data regression analysis is applied to 225 firm-year observations drawn from 45 companies, with model selection guided by the Chow and Hausman specification tests. The Fixed Effect Model (FEM) is adopted for ROA, ROE, and SG, while the Random Effect Model (REM) is applied for Tobin’s Q. Results indicate that systematic risk exerts a significant negative effect on ROA (β = −0.312; p < 0.01) and ROE (β = −0.278; p < 0.01), but is statistically non-significant for Tobin’s Q, suggesting that capital market pricing in Indonesia does not fully incorporate systematic risk information. Critically, systematic risk exerts the largest and most significant negative effect on sustained growth (β = −0.347; p < 0.01), revealing a dual transmission mechanism through which risk suppresses ROE while simultaneously inducing more conservative dividend policies, both of which constrain long-run growth sustainability. These findings carry important implications for corporate risk management strategy and empirically enrich the literature on risk, performance, and growth in emerging capital markets.

Antibiotic resistance is a global health problem that requires international efforts to prevent the ineffectiveness of existing antibiotics and support the development of new antimicrobial agents. The increasing use of antibiotics in the community must be accompanied by proper understanding regarding rational antibiotic use to minimize the risk of resistance. This community service activity aimed to provide education on rational antibiotic use and the dangers of antibiotic resistance to undergraduate nutrition students at STIKes Adila, Bandar Lampung. The activity was conducted through educational sessions using flyers, presentation slides, and interactive discussions to encourage active participation and improve understanding of the topic. Evaluation was carried out using pre-test and post-test assessments to measure changes in participants’ knowledge levels. Descriptive analysis showed an improvement in participants’ knowledge, with the high knowledge category increasing from 0% during the pre-test to 85% in the post-test, while the low knowledge category decreased from 35.5% to 0% after the intervention. These findings indicate that educational interventions can effectively enhance awareness and understanding of rational antibiotic use and the prevention of antibiotic resistance. Therefore, continuous educational programs are important to promote responsible antibiotic use and support public health efforts in combating antibiotic resistance.

Antibiotic resistance is a global health problem that requires international efforts to prevent the ineffectiveness of existing antibiotics and support the development of new antimicrobial agents. The increasing use of antibiotics in the community must be accompanied by proper understanding regarding rational antibiotic use to minimize the risk of resistance. This community service activity aimed to provide education on rational antibiotic use and the dangers of antibiotic resistance to undergraduate nutrition students at STIKes Adila, Bandar Lampung. The activity was conducted through educational sessions using flyers, presentation slides, and interactive discussions to encourage active participation and improve understanding of the topic. Evaluation was carried out using pre-test and post-test assessments to measure changes in participants’ knowledge levels. Descriptive analysis showed an improvement in participants’ knowledge, with the high knowledge category increasing from 0% during the pre-test to 85% in the post-test, while the low knowledge category decreased from 35.5% to 0% after the intervention. These findings indicate that educational interventions can effectively enhance awareness and understanding of rational antibiotic use and the prevention of antibiotic resistance. Therefore, continuous educational programs are important to promote responsible antibiotic use and support public health efforts in combating antibiotic resistance.

The rapid development of Artificial Intelligence (AI) has transformed various sectors of human life, including church ministry and religious organizational management. This study aims to analyze Christian leadership ethics in the use of AI within modern church ministry. The research employs a qualitative descriptive method through theological literature review and analysis of recent studies concerning digital technology and pastoral ministry. The findings indicate that AI provides significant benefits for church administration, digital communication, congregational data management, and online evangelism. Nevertheless, ethical challenges also emerge, such as the weakening of pastoral relationships, data privacy concerns, algorithmic bias, and the risk of dehumanization in ministry practices. From a Christian theological perspective, ministry is fundamentally relational and incarnational, reflecting the example of Jesus Christ who ministered through personal presence, compassion, and direct interaction with people. Therefore, AI should be understood as a supportive instrument rather than a substitute for spiritual authority and pastoral presence. Christian leadership in the digital age must be grounded in integrity, transparency, spiritual discernment, and respect for human dignity as the image of God (imago Dei). This study contributes to the development of ethical guidelines for churches in utilizing AI responsibly while maintaining theological integrity and Christian spiritual values.

This study examines the urgency of foreign nationals' (WNA) legal status and visa compliance in the vehicle rental business in Bali, as well as its impact on business disputes involving local entrepreneurs. The increasing number of international tourists visiting Bali has spurred the growth of vehicle rental services, yet it has also given rise to illegal practices by foreign nationals such as misuse of tourist visas for commercial purposes, tax evasion, and unfair business competition. This research adopts a normative juridical method using statute, conceptual, and case approaches, referring to key legal documents including Law No. 6 of 2011 on Immigration, Law No. 6 of 2023 on Manpower, Ministerial Regulation No. 21 of 2016, and Bali Regional Regulation No. 5 of 2016 on Tour Guiding. The findings highlight the vulnerability of rental contracts under Article 1548 of the Indonesian Civil Code, risks of breach of contract, and widespread violations of the Electronic Traffic Law Enforcement (ETLE) system, the penalties of which are imposed on rental owners. Nationality disparities and weak immigration oversight further undermine the effectiveness of law enforcement. This study concludes that legal protection for local business actors relies heavily on the legal clarity of WNA status, the appropriateness of 1 visa categories, and strong inter-agency coordination. The novelty of this research lies in integrating legal analysis of WNA legitimacy with a dispute resolution framework specific to the vehicle rental sector in Bali’s tourism landscape a perspective that has been largely overlooked in prior studies. The recommendations include strengthening rental contracts, enhancing coordinated supervisory mechanisms, and harmonizing civil and criminal law to establish a stronger deterrent effect.

Stunting remains a significant nutritional issue because it can impact a child's long-term growth and development. A history of low birth weight (LBW) is suspected to play a role, reflecting the condition of fetal growth during pregnancy. This study aimed to determine the relationship between a history of LBW and the incidence of stunting in children aged 2–5 years at the Bandarharjo Community Health Center in Semarang in 2025. This study used an analytical design with a case-control approach. The study sample consisted of 203 toddlers selected using consecutive sampling. Data were obtained from the KIA book and height measurements based on WHO standards. Analysis was performed using the Chi-Square test and Odds Ratio (OR) calculation. The proportion of LBW was 10.8% and stunting was 31.0%. There was a significant relationship between a history of LBW and the incidence of stunting (p = 0.012). Toddlers with a history of LBW had approximately a threefold greater risk of experiencing stunting compared to toddlers born with normal weight (OR = 3.059). There is a relationship between a history of low LBW and the incidence of stunting in toddlers aged 2-5 years at the Bandarharjo Community Health Center, Semarang in 2025.

 The rapid adoption of smartphones among Indonesian digital natives has increased reliance on biometric authentication systems. However, empirical evidence regarding the relationship between user satisfaction and security risk awareness remains limited, particularly in developing-country contexts. This study investigates the behavioral dynamics of biometric security perception among 266 respondents, consisting of 221 high school students and 45 university students in Indonesia. A Python-based computational pipeline incorporating Akaike Information Criterion (AIC) validation and 1,000-iteration stochastic bootstrapping was employed to evaluate nonlinear behavioral patterns using Polynomial Regression and Ordinary Least Squares (OLS) multivariate analysis. The results confirm the existence of a nonlinear Security Paradox. While the overall population demonstrates a positive quadratic trajectory, the university student group exhibits a concave-down parabolic relationship (a=−0.0460), indicating a decline in perceived utility beyond a specific security threshold. The identified behavioral breaking point occurs at X≈5.45 (95% CI: 2.99–20.77), suggesting that excessive security hardening may reduce perceived usability and increase cognitive friction. Furthermore, the ablation analysis reveals that security risk awareness (p<0.001) is the strongest predictor of user satisfaction, exceeding the influence of daily usage intensity. Segment-level analysis further demonstrates behavioral divergence between respondent groups. High school students exhibit relatively uniform satisfaction toward biometric systems, whereas university students display greater variability and more critical perceptions regarding authentication friction. These findings indicate that highly rigid security configurations may become less effective for users with higher digital literacy and risk awareness. This study contributes a computationally validated behavioral framework for understanding security–utility trade-offs and provides a conceptual foundation for developing adaptive, user-centric, and friction-aware biometric authentication systems.

The Legal Unit plays a crucial role in ensuring compliance with banking regulations, particularly in managing customer documents related to data protection and legal risk reduction. This study aims to explore the role and performance of the Legal Unit in managing customer files at Bank Sumsel Babel, Kapten A. Rivai Main Branch, and to identify obstacles and possible solutions. The method chosen in this study is qualitative with a descriptive approach. Data were obtained through observation, interviews, and document analysis, which were then analyzed using the interactive model of Miles and Huberman. The research findings indicate that the Legal Unit is responsible for ensuring that document management is carried out regularly, securely, and in accordance with applicable banking regulations. The implementation of Standard Operating Procedures (SOPs), internal supervision, and the use of digital archives contribute to legal compliance and minimize the risk of document loss and information leakage. Problems encountered include limitations in human resources and incompatibility with digital systems. Therefore, improvements in document management technology, training for human resources, and periodic SOP evaluation are needed to improve the effectiveness of the Legal Unit's work and maintain customer trust.