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• RSM was used for inactivation efficiency against two fungal species of tomatoes. • EO, UV and their combination were used and compared for tomatoes conservation. • The combined EO and UVC showed the best antifungal activity than other treatments. • Photosensitization of tomatoes preserved their quality attributes during 7 days. This study aims to investigate the antifungal activities of thyme essential oils mediated photosensitization for extending the shelf life and preserving the quality of fresh tomatoes. Contrary to Alternaria alternata and Botrytis cinerea , photosynthetization was proven to display the best antifungal activity, with a survival percentage of about 12 and 17% respectively. However, UV-C showed the least effectiveness, with survival rates of 33 and 32%, respectively, after 20 min of irradiation time. In addition, a central composite design (CCD) was employed, incorporating five levels and two independent variables: irradiation time and TEO concentration. This design aimed to assess the survival percentage of two fungal species, Alternaria. Alternata and Botrytis Cinerea. The obtained results indicated that the irradiation time significantly influenced the survival percentage of both tested fungal species. Interestingly, fresh tomato fruits were stored at 22 °°C with a relative humidity of 65 ± 5 % for 7 days and subsequently divided into four lots: control tomatoes, tomatoes treated only with UV-C irradiation at 10 min, tomatoes treated only with TEO at 55 µg/mL and photosynthesized tomatoes treated with both TEO and UV-C irradiations. The changes in the chemical properties of tomato, including pH, titratableacidity (TA), total soluble solids (TSS), texture and color, were analyzed, along with sensory evaluations. Chemical quality indicators like total soluble solids were significantly affected by storage time. Notably, in tomatoes treated with photosensitization, the TSS was lower (5 ± 0.05) compared to control tomatoes (5.6 ± 0.01) stored at 22 °C. Besides, the test of TEO based- photosensitization on tomatoes artificially inoculated with B. cinerea and A. alternata showed statistically significant delay in lesion diameter (1.5 cm ± 0.115) compared to the untreated group (3.5 cm ±0.15) at (p < 0.05). Subsequently, the combination of UV and TEO exhibited antifungal efficacy in tomato fruits, suggesting their potential as natural preservatives. [ABSTRACT FROM AUTHOR]

• Four methods with different cooling rates were applied to the tilapia freezing. • Volatile bases (TBV-N), thiobarbituric acid (TBARS), microstructure were analyzed. • TBV-N, colors parameters and TBARS were statistically significant in all treatments. • Air blast and combined method altered less the texture of fillets after storage time. • Cryogenic freezing showed thermal stress, cracking and tissue quality damaged. The Nile tilapia (Oreochromis niloticus) fillets were frozen with static air (SA) at -20 °C, air blast freezing (AF) at -25 °C, combined method (CM - immersion in liquid nitrogen followed by AF) and cryogenic freezing (CF - immersion in liquid nitrogen). The effects of different freezing methods and of storage time at -18 °C (0, 30, 60 and 90 days) on fillet quality were evaluated. The temperature records were obtained, and the freezing times were determined by monitoring the temperatures of the geometric centers of the fillets. For CF, CM, AF and SA, the freezing times were 5.32, 127, 146 and 268 min, respectively. The quality of the frozen fillets was evaluated by measuring pH, volatile nitrogenous bases (TBV-N), thiobarbituric acid reactive substances (TBARS), and fatty acids and by obtaining a texture profile and performing scanning electron microscopy (SEM). The samples frozen by CF, after storage, had the highest levels of TBV-N because the high freezing rate produced superficial cracks that negatively affected the quality of the fillets. Freezing the samples with SA produced the worst quality indices and the microstructure was visibly damaged, with greater spaces between the fibers left by ice crystals. For all parameters evaluated, freezing with AF and CM resulted in fast freezing rates and better-quality tilapia fillets for 90 days of storage. [Display omitted] [ABSTRACT FROM AUTHOR]

• LNF exhibited a high freezing rate and contributed to small ice crystal forming. • LNF maintained WHC and shear force of Monopterus albus. • LNF alleviated myofibrillar protein denaturation of Monopterus albus. • LNF at −110 °C is more suitable for Monopterus albus than LNF at −50 °C and −80 °C. Monopterus albus is highly susceptible to spoilage due to high protein and moisture contents while frozen storage can effectively prolong the shelf-life. To study the effect of liquid nitrogen freezing (LNF) on quality, microstructure of ice crystal and muscle fiber, and physicochemical properties of proteins, Monopterus albus was frozen at -20 °C by refrigerator (RF, control), -50 °C, -80 °C, and -110 °C by LNF, respectively. The -110 °C LNF exhibited the highest freezing rate among four groups, contributing to the formation of small ice crystals with more uniform distribution and alleviating the damage to muscle fiber. In -110 °C LNF group, protein secondary structure changed relatively subtle, resulting in high protein solubility, Ca2+-ATPase activity, and total sulfhydryl content, as well as low surface hydrophobicity and disulfide bond content. LNF retarded the rise of TVB-N value, prevented the loss of immobilized and free water, and maintained water holding capacity and shear force. In conclusion, -110 °C LNF was recommended a promising freezing process for frozen Monopterus albus due to less alteration of quality and alleviation of protein denaturation. [Display omitted] [ABSTRACT FROM AUTHOR]

• After exposed to ammonia environment below 1000 mL m−3 for 6 days, well-packaged boxed non-daily creams showed no ammonia residue. • Boxed non-daily creams with well packaging exposed to ammonia environment below 1000 mL m−3 for 6 days showed no color, odor, sensory evaluation, pH value, peroxide value, and benzo (α) pyren difference compared with the CK group at the same period. • After exposed to ammonia environment below 1000 mL m−3 for 6 days, well-packaged boxed non-daily creams had no food safety risk. Ammonia leakage in food cold storage have adverse impact on the quality of food, which may be related to ammonia concentration and exposure time, but there is a lack of data support. In this paper, the quality of boxed non-dairy cream exposed to ammonia environment (0 (CK), 100, 500, and 1000 mL m −³) at −18 °C for 6 day were evaluated. Results showed that no ammonia residue was detected in the boxed non-dairy cream exposed for 6 days. There were no significant differences (P > 0.05) in the color value, odor, pH value, and sensory score of the non-dairy cream under the four ammonia groups during the same exposure time. And peroxide values was far below the standards limit, and benzo (α) pyrene content of all the cream groups were not detected The results indicated that all the boxed non-dairy cream in this experiment had no quality deterioration and food safety risk. [ABSTRACT FROM AUTHOR]

• This paper provides a new choice of freezing method by using 20 % ethanol, 20 % propylene glycol, 10 % glycerol, and 10 % sodium chloride aqueous solution as immersion freezing medium. • The freezing rate of IF was 2.66 cm/h, which was 6.33 times higher than that in AF groups. • Compared with AF and BF, the ice crystals were smaller and more uniformly shaped, with properties of lower water migration and less texture softening after cryogenic liquid freezing of IF and LNF group aquatic products. • Immersion freezing showed the same superiority in maintaining the freshness of fish fillets and retaining the protein structure as liquid nitrogen storage. The freezing of aquatic products without causing significant changes in quality is recently attracting much attention. In this study, the effects of air freezing (AF, -20 °C), blast freezing (BF, -35 °C), liquid nitrogen freezing (LNF), and immersion freezing (IF, -35 °C) by 20 % ethanol, 20 % propylene glycol, 10 % glycerol, and 10 % sodium chloride aqueous solutions, respectively, on muscle qualities and myofibrillar protein properties of the red drum were investigated. The results indicated that the freezing rate of IF was 2.66 cm/h, which was 6.33 times higher than that in AF groups. Compared with AF and BF, the ice crystals were smaller and more uniformly shaped, with properties of lower water migration and less texture softening after cryogenic liquid freezing of IF and LNF group aquatic products. Immersion freezing showed the same superiority in maintaining the freshness of fish fillets and retaining the protein structure as liquid nitrogen storage. Overall, IF has similar effects to LNF in maintaining muscle qualities and myofibrillar protein properties. This study describes a new freezing method that uses 20 % ethanol, 20 % propylene glycol, 10 % glycerol, and 10 % sodium chloride aqueous solutions as immersion freezing medium. The multi-compound freezing medium has the potential to be used for the freezing of aquatic products. [ABSTRACT FROM AUTHOR]

Mohs Micrographic Surgery (MMS) for treatment of melanoma offers several advantages over wide local excision (WLE), including complete histologic margin evaluation, same-day resection and closure, and sparing of healthy tissue in critical anatomic sites. Recently, a large volume of clinical data demonstrating efficacy in MMS treatment of melanoma was published, leading to emerging patient safety considerations of incurred treatment costs, risk of tumor upstaging, and failure of care coordination for sentinel lymph node biopsy (SLNB). MMS offers a safe, effective, and value-based treatment for both melanoma in situ (MIS) and invasive melanoma (IM), particularly with immunohistochemistry use on frozen sections. Compared to wide local excision, MMS treatment demonstrates similar or improved outcomes for local tumor recurrence, melanoma-specific survival, and overall survival at long-term follow-up. Tumor upstaging risk is low, and if present, alteration to clinical management is minimal. Discussion of SLNB for eligible head and neck IM cases should be done prior to MMS. Though challenging, successful multidisciplinary coordination of SLNB with MMS has been demonstrated. Herein, we provide a detailed clinical review of evidence for MMS treatment of cutaneous melanoma and offer recommendations to address current controversies surrounding the evolving paradigm of surgical management for both MIS and invasive melanoma (IM). [ABSTRACT FROM AUTHOR]

A questionnaire-based study was jointly organised by European Board and College of Obstetrics and Gynaecology and European Society of Contraception to evaluate the current status as regards access and quality of care regarding contraception, abortion care, and pre-conceptional counselling and care among the 26 European countries. There are considerable variations among these countries as regards the provision of contraceptive services and abortion care. There is ample room for improvement through European training and education programs. However, the most important difference is the absence of a comprehensive network of healthcare providers in various countries to deliver these services at different points of access. There is notable absence of educational programs and instructional materials tailored specifically for nurses and midwives in several countries. This deficiency impedes the professional development and skills enhancement of these healthcare professionals, potentially compromising the quality of healthcare services provided to women in these countries. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the quality and reliability of YouTube videos focusing on unilateral biportal endoscopic spine surgery, a novel technique for spinal decompression in degenerative spinal disease. This cross-sectional study, conducted in February 2023, involved an online search on YouTube using the term "unilateral biportal endoscopic spine surgery". Video popularity was assessed using the Video Power Index. Video reliability and quality were measured using the Global Quality Scale, the Journal of the American Medical Association benchmark criteria, and the modified DISCERN instrument. Ninety-three videos were included for evaluation. Uploader profiles were categorized by continent, with 61.3% from Asia, 35.5% from the United States, 2.2% from Africa, and 1.1% from Australia. When comparing 3 groups as South Korea, United States, and other countries, no significant differences were observed in the technical characteristics of the videos. However, the educational quality and reliability of the videos were higher in those uploaded from South Korea (P < 0.001).When the videos were divided into 2 groups according to their educational quality, significant difference were noted in video duration, loading time, video quality, and reliability (P < 0.001). The YouTube videos on unilateral biportal endoscopic spine surgery showed high quality and reliability. However, videos from South Korea were found to have higher educational quality and reliability, while other specifications were similar for all videos. Furthermore, it was determined that videos uploaded more recently and with longer duration were of higher quality. [ABSTRACT FROM AUTHOR]

Hospitalized children's satisfaction with the care they receive is the main indicator for evaluating the way nurses should provide services and the quality of these services. The current study aimed to examine school-aged children's perceptions of nursing care quality. In this cross-sectional study, 144 children aged 7–11 years were selected through a convenience sampling method. The data collection tool included The Child Care Quality at Hospital Questionnaire, and the personal- and family-related and disease-related factors questionnaire. Independent t -test, one-way analysis of variance, Pearson's correlation coefficient and multiple linear regression test were used for data analysis. Based on the findings, the highest score of nursing care quality was related to characteristics domain (13 ± 1.7). In addition, the children's age, father's education and history of hospitalization were related to nurses' characteristics domain; mother's education and length of hospital stay were related to nursing activities domain; and mother's education, father's occupation and length of hospital stay were related to nursing environment domain. The results of the present study showed that children's nurses can provide better quality care to children by paying attention to nurses' characteristics and then the scope of activities and care environment. Considering the factors affecting the nursing care quality, a conscious step should also be taken for strategic planning of care. • The quality of nursing care from the perspective of school-age children is different from that of their parents. • The use of special tools can show the quality of nursing care from the perspective of hospitalized children. • School-age children consider the personality of the nurse to be the most important issue in a quality care. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) causes significant morbidity and mortality in pediatric patients and care is highly variable. Standardized mortality ratio (SMR) summarizes the mortality rate of a specific center relative to the expected rates across all centers, adjusted for case-mix. This study aimed to evaluate variations in SMRs among pediatric trauma centers for TBI. Patients aged 1–18 diagnosed with TBI within the National Trauma Data Bank (NTDB) from 2017 to 2019 were included. Center-specific SMRs and 95% confidence intervals identified centers with mortality rates significantly better or worse than the median SMR for all centers. 316 centers with 10,598 patients were included. SMRs were risk-adjusted for patient risk factors. Unadjusted mortality ranged from 16.5 to 29.5%. Three centers (1.5%) had significantly better SMR (SMR <1) and three centers (1.5%) had significantly worse SMR (SMR >1). Significantly better centers had a lower proportion of neurosurgical intervention (2.4% vs. 11.8%, p < 0.001), a higher proportion of supplemental oxygen administration (93.7% vs. 83.5%, p = 0.004) and venous thromboembolism prophylaxis (53.2% vs. 40.6%, p < 0.001) compared to significantly worse centers. This study identified centers that have significantly higher and lower mortality rates for pediatric TBI patients relative to the overall median rate. These data provide a benchmark for pediatric TBI outcomes and institutional quality improvement. Level III. Retrospective Comparative Study What is currently known about this topic? • Children with traumatic brain injury are treated at a variety of centers, and care is not standardized among these centers. What new information is contained in this article? • This is the first analysis that evaluated SMRs specific to TBI in the pediatric trauma population using NTBD data. [ABSTRACT FROM AUTHOR]

To investigate the feasibility and accuracy of radiologists categorizing the method of detection (MOD) when performing image-guided breast biopsies. This retrospective, observational study was conducted across a health care enterprise that provides breast imaging services at 18 imaging sites across four US states. Radiologists used standardized templates to categorize the MOD, defined as the first test, sign, or symptom that triggered the subsequent workup and recommendation for biopsy. All image-guided breast biopsies since the implementation of the MOD-inclusive standardized template—from October 31, 2017 to July 6, 2023—were extracted. A random sample of biopsy reports was manually reviewed to evaluate the accuracy of MOD categorization. A total of 29,999 biopsies were analyzed. MOD was reported in 29,423 biopsies (98.1%) at a sustained rate that improved over time. The 10 MOD categories in this study included the following: 15,184 mammograms (51.6%); 4,561 MRIs (15.5%); 3,473 ultrasounds (11.8%); 2,382 self-examinations (8.1%); 2,073 tomosynthesis studies (7.0%); 432 clinical examinations (1.5%); 421 molecular breast imaging studies (1.4%); 357 other studies (1.2%); 338 contrast-enhanced digital mammograms (1.1%); and 202 PET studies (0.7%). Original assignments of the MOD agreed with author assignments in 87% of manually reviewed biopsies (n = 100, 95% confidence interval: [80.4%, 93.6%]). This study demonstrates that US radiologists can consistently and accurately categorize the MOD over an extended time across a health care enterprise. [ABSTRACT FROM AUTHOR]

Cranial electrotherapy stimulation (CES) is beneficial in reducing anxiety in psychiatric patients. However, no studies have reported on elderly patients with generalized anxiety disorders (GAD). This study aimed to determine the efficacy and safety of a 6-week CES intervention for late-life GAD. This single-arm pilot study assessed 6-week CES treatment (Alpha-Stim AID) for late-life GAD and 4-week follow-up post intervention. The Hamilton Rating Scale for Anxiety (HAMA) and Beck Anxiety Inventory (BAI) were used as baseline and outcome measures at weeks 4, 6, and 10, respectively. Treatment response was defined as 50 % or more reduction of the HAMA score and remission was defined as a of score ≤7 on the HAMA. Other measures included depression, sleep quality, and quality of life assessment. We included participants (n = 27) aged 68.0 ± 5.0 years, 81.5 % of whom were female. Fifteen (55.6 %), 18 (66.7 %), and 15 (55.6 %) patients were concurrently treated with antidepressants, BZDs, and antipsychotics, respectively. Intention-to-treat (ITT) analysis revealed a significant decrease in HAMA scores from baseline (20.96 ± 3.30) to week 6 (12.26 ± 7.09) and one-month (12.85 ± 7.08) follow-up at W10 (all p < 0.001). The response and remission rates were 33.3 %, 40.7 %, and 48.1 % and 25.9 %, 29.6 %, and 25.9 % at W4, W6, and W10, respectively. The CES improved depression and sleep conditions as measured by the Beck Depression Inventory-II and Pittsburgh Sleep Quality Index. CES clinically reduces symptoms of anxiety and depression and may improve sleep quality in late-life GAD. Future randomized controlled study is needed. [ABSTRACT FROM AUTHOR]

Efficacy and safety of sugammadex for the reversal of neuromuscular blocking agents (NMBAs) in patients with neuromuscular diseases remains unclear. We summarised the available evidence and evaluated the quality of data reporting and the validity of published reports. We searched for reports (any design) on the usage of sugammadex (any regimen) for the reversal of an NMBA in patients (any age) with any neuromuscular disease. We used a modified CARE checklist (maximum score 23) to assess the quality of data reporting and an original specific validity checklist (maximum score 41) that was developed through a Delphi process. We retrieved 126 observational reports (386 patients). Most dealt with myasthenia gravis patients receiving rocuronium. The train-of-four ratio returned to ≥0.9 in 258 of 265 (97.4%) patients in whom neuromonitoring was used. Adverse events occurred in 14 of 332 (4.2%) patients in whom adverse events were reported as present or absent. In 90 case reports, the median score of the 23-point CARE checklist was 13.5 (inter-quartile range [IQR] 11–16). In all 126 reports, the median score of the 41-point validity checklist was 23 (IQR 20–27). Scores were positively correlated. These uncontrolled observations (of mainly low to moderate quality and validity) do not allow confident assessment of the efficacy and safety of sugammadex for the reversal of NMBAs in patients with neuromuscular diseases. Reporting of observational data should follow established guidelines, include specific information to ensure validity, and emphasise what the new data add to current knowledge. PROSPERO 2019 (CRD42019119924). [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the quality of plain yogurt made from cow milk (n = 10) and its plant-based analog made from coconut flesh extract (n = 14). Coconut yogurt alternatives were divided into 2 experimental groups based on differences in their color, which were noted after the packages had been opened. The first group included products with a typical white color (n = 8), and the second group comprised products with a grayish pink color (n = 6) that developed as a result of oxidative processes. In comparison with its plant-based analog, plain yogurt was characterized by higher values of lightness (L*), yellowness (b*) and chroma (C*), higher titratable acidity, a higher content of retinol and α-tocopherol, higher nutritional value of fat, and lower values of water-holding capacity (WHC) and redness (a*). Plain yogurt had lower volatile acidity than its plant-based analog with a grayish pink color. A comparison of yogurt analogs with different colors revealed that the product with a grayish pink color was characterized by a lower value of L*, and higher values of a*, b*, C*, and pH. An analysis of its fatty acid profile demonstrated that it also had a higher proportion of C14:0 and C18:1 cis -9; higher total monounsaturated fatty acids content; a lower proportion of C10:0, C12:0, and C18:2; a lower total content of polyunsaturated fatty acids (PUFA) and essential fatty acids; and a lower ratio of PUFA to saturated fatty acids. The yogurt analog with a grayish pink color had a lower total content of tocopherol isoforms than the remaining products. The yogurt analog with a white color had the highest WHC and γ-tocopherol content. Consumers should be aware of the fact that coconut yogurt alternatives may have nonstandard quality attributes. The differences between such products and yogurt made from cow milk should be explicitly communicated to consumers so that they could make informed purchasing decisions. [ABSTRACT FROM AUTHOR]

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The aim of this study is to analyze the quality, reliability, comprehensibility, and the mentioned medical concepts of traumatic brain injury (TBI) related videos on YouTube. "Traumatic brain injury (TBI)" and Google Trends related queries were used, and 328 videos were included. Categorization, quality assessment via a 5-point Global Quality Scale, reliability evaluation using a modified DISCERN scale, comprehensibility assessment using Flesch–Kincaid Reading Ease and Flesch–Kincaid Grade Level, and consensus-based classification for usefulness were performed. Target audience categorization was content-based. Text mining techniques were used to identify biomedical terms in video transcripts. Most of the videos were intended for nonhealthcare professionals and deemed useful. The videos had intermediate quality and a moderate level of reliability. The comprehensibility of the videos exceeded the recommended levels. Videos predominantly covered TBI symptoms, the severity of the condition, its impact on individuals, and possibly strategies related to diagnosis and treatment. Results suggest the requirement for higher quality and reliability in YouTube content about TBI. Emphasis should be placed on clear and accurate language to promote comprehensibility. Continued research, guidelines, education, and platform oversight can enhance the spread of reliable health information on social media, benefiting creators, and consumers in this field. [ABSTRACT FROM AUTHOR]

Medicare's legacy quality reporting programs were consolidated into the Merit-Based Incentive Payment System (MIPS) in 2015. The DataDerm registry of the American Academy of Dermatology was examined to understand the potential for and subsequent rate of improvement across 23 performance measures. We examined the level of performance across 23 performance measures with at least 20 clinicians reporting on at least 50 patients' experience. We calculated the following values: the aggregate performance rate for each measure and the overall aggregate performance rate. The aggregate performance rate for each measure ranged from 20.4% for AAD 1 (Psoriasis: Assessment of Disease Activity), to 99.9% for measure ACMS 1 (Avoidance of Opioid Prescriptions for Reconstruction After Skin Resection). Three of 23 measures had an aggregate performance over 95%. The overall aggregate performance rate across all 23 measures was 81.2%, indicating an aggregate potential for improvement of 18.8% across the 23 measures. Nine performance measures reported across the first five years of DataDerm's existence were tracked through time to understand trends in performance through time. The performance across the nine performance measures meeting the inclusion criteria consistently improved in the initial years (2016 through 2018) of DataDerm participation and showed some variation in 2019 and 2020. These data provide evidence that the very act of participation in a multi-institutional registry and tracking compliance with performance measures can lead to improvements in compliance with the performance measures and therefore improvements in quality of care. [ABSTRACT FROM AUTHOR]

This paper aims to contribute to both theory and practice by describing current problem-solving practices, proposed by various authors, as part of the quality management process of companies in the automotive industry. The paper, based on proposals from different authors, also includes a set of quality tools that can be used in the different steps of the problem-solving process. The results show that there is general agreement on best problem-solving practices, emphasizing root-cause analysis and the development and implementation of corrective actions, which are included in all the proposals analyzed. The analysis also shows that many quality tools can be used in the different steps of this process. In addition, the paper proposes an initial framework developed by the authors that can be used by organizations to improve their problem-solving practices. [ABSTRACT FROM AUTHOR]

• With modifications, the Mini Markers can be used to efficiently assess the personality of educators. • Structural quality indicators were associated with educator personality. • Educator personality was also associated with the responsivity provided to children. • Majority of educators were identified as having a resilient personality profile, with some having ordinary personality profiles. Given the significant time that children aged zero to six spend in early childhood education and care (ECEC) settings, it is imperative that we understand the drivers of ECEC quality. The role of educator personality in the quality of ECEC settings has received little attention from researchers. Using a sample of 595 educators from 240 infant and toddler classrooms, the present study examined (1) the role that educator personality plays on key quality indicators in Canadian ECEC settings, (2) the factor validity of the Mini Markers, a commonly used measure of personality, and (3) whether there are subgroups of educators based on personality characteristics, using a latent profile analysis (LPA). Results showed an acceptable factor structure of the Mini Markers measure of personality with early childhood educators. Furthermore, personality was positively related to both structural and process quality indicators. Specifically, the structural indicators of income and years in the classroom were positively and significantly related to Agreeableness and Extraversion (small and medium effects, respectively). In terms of process quality, educators' level of Extraversion had a positive and significant relationship with the quality of responsive interactions they provide to children (small effect). Finally, the LPA revealed diverse educator personality types with no significant variation at the classroom level. This study highlights the need for ongoing research to explore the connection between educators' personalities and quality in ECEC, with implications discussed for practical application. [ABSTRACT FROM AUTHOR]

• Whole-population analysis of access to high-quality ECE using a national standard. • Inequities of access associated with geographic and socio-economic disadvantage. • Recent immigrants over-represented in poor quality services. • Calls for interrogation and identification of effective thresholds of quality. The United Nations Sustainable Development Goal (4.2) calls for all children to have access to high quality Early Childhood Education (ECE), recognising the potential of ECE to promote children's development and ongoing national prosperity. Yet, in marketized systems both structural features (availability and affordability of services) and social factors (family knowledge and social connection) can drive inequitable access to the highest quality provision. In the current study, we analyse data for N =77,113 children in Australia's new whole-population integrated database to ask: Who accesses high-quality ECE services? Australia's national quality rating of ECE services provided whole-of-country standard measurement of ECE quality. We find that, although Australia provides an income-scaled subsidy to families to enable ECE attendance, inequalities are seen in the quality of service accessed. Families experiencing socio-economic disadvantage and those living in regional and remote locations are under-represented in services rated high-quality. Recent immigrants, regardless of their economic status, are most likely to attend poorer quality services. These findings highlight the need to identify and remediate mechanisms preventing those most likely to benefit from the highest quality ECE from access. Such actions are critical to deliver on the promise of ECE to disrupt intergenerational disadvantage and enable sustainable national development. [ABSTRACT FROM AUTHOR]

A manufacturing process includes inspecting the product to verify it meets its quality standards. Such steps, however, are time-consuming and, depending on the means, prone to errors. If not identified in time, defects occurring at an early step of a manufacturing process may result in significant waste, especially if the product is not easy to re-work. Today, however, the combination of AI with computer vision technologies can enable manufacturers to transform quality inspection by automating the detection of defects. This study discusses the use of products' 3D shape for inline surface defect detection, facilitating the adoption of proactive control strategies facilitating the reduction of waste. The product's 3D shape, represented by a point cloud is acquired by two fixed laser triangulation sensors orthogonally arranged. The K-means method is adopted for the point cloud data analysis, while Voxel Grid filters are used for downsampling to reduce computational time. The proposed approach has been evaluated in a use case related to the production of steel parts, with the findings supporting that an in-line implementation can facilitate the detection of surface or geometry defects, which, in turn, may facilitate the reduction of waste, by avoiding further processing of the defective product. [ABSTRACT FROM AUTHOR]

Enhanced Recovery After Surgery (ERAS) guidelines are bundled evidence-informed recommendations implemented to improve quality and safety of perioperative care. This study aims to determine feasibility of NICU implementation of an ERAS Guideline for Intestinal Resection, describing clinical outcomes and adherence to recommendations following light-touch implementation. Infants <28 days undergoing laparotomy for intestinal resection in a closed-NICU were prospectively enrolled. Exclusion criteria included prematurity (<32wks), instability, or major comorbidity. Clinical data reflecting 13 ERAS recommendations were collected through chart review. Descriptive statistics are presented as median [interquartile range]. Thirty-day post-discharge outcomes include NICU and hospital length of stay (LOS), ventilator days, surgical site infection (SSI), re-intubation, readmission, reoperation, and mortality. Adherence was calculated as the percentage of patients eligible for each recommendation whose care was adherent. Ten infant-parent dyads were enrolled (five females; GA 37 weeks [35, 38.8]; birthweight 2.97 kg [2.02, 3.69]). Surgical diagnoses included intestinal atresia/web (n = 6), anorectal malformation (n = 3), and segmental volvulus (n = 1). NICU LOS was 16 days [11, 21], hospital LOS 20 days [18, 30], and 2.5 ventilator days/patient [2, 3]. There was reduced opioid use, no SSIs, one re-intubation, three readmissions, three reoperations, and no mortalities. Adherence to ERAS recommendations ranged 0–100 % with a pooled adherence rate of 73 %. It is feasible to introduce ERAS to the NICU with acceptable overall adherence. Assessing adherence was challenging for some measures. There were promising early clinical findings including a reduction in opioid use. This implementation trial will inform development of an ERAS protocol for surgical NICUs. IV (Cohort Study). [ABSTRACT FROM AUTHOR]

Emotion AI deals with the sentiments of human beings at various domains. It is named emotion AI as using the capabilities of AI the emotions of humans would be interpreted and analysed. The objective of this paper is to learn from the experience of patients towards the healthcare facilities by studying and analysing the sentiments of the patients using machine learning. This paper focus on training the machine for reading the reviews given by patients who have used various healthcare facilities. The machine will be trained to understand the polarity for each healthcare facility in terms of cleanliness, availability of doctors, interaction of doctors with patients etc. The code is implemented in python with various libraries required for machine Learning. The code is able to extract the polarity and is able to handle the emotions of the patients for questions answered in the dataset by patients. The paper would contribute and help the patients decides which healthcare facility they shall choose based on the experiences of various other patients. For this the goodness score for every healthcare facility is calculated and implemented using Machine learning. It's the contribution of artificial Intelligence and machine learning for healthcare Domain. [ABSTRACT FROM AUTHOR]

Hospital-acquired infections (HAIs) pose a significant risk to patients, and are a major focus of infection prevention and control policies (IPC). One under-recognized reason for the generally poor compliance with IPC is that it is burdensome for healthcare workers (HCWs). To identify the burdens of IPC for HCWs. PubMed and CINAHL were searched for studies published in English since 2000 regarding compliance with IPC and the burdens associated with compliance. After screening 1018 initial results, 25 articles were included in the final review. Evidence was found for burdens including dermatological complications, headaches, sensory symptoms and time pressure. Tools designed to measure compliance with IPC have limitations, and rarely assess the burdens of compliance. A strong safety culture predicted positive compliance, while knowledge of the underlying rationale for IPC had a non-linear relationship with compliance. Future research should clarify IPC-related burdens and how these may be minimized to achieve better compliance. [ABSTRACT FROM AUTHOR]

The objective of this article is to describe the effects of patient demographics and examination factors on patient-reported experience in outpatient MRI examinations. This institutional review board–waived, HIPPA-compliant quality improvement study evaluated outpatient MRI appointments from March 2021 to January 2022 using a postappointment survey consisting of a 5-point emoji scale and text-based feedback. Patient demographics and examination information were extracted from electronic medical records. Ratings ≤ 3 were categorized as negative, and ratings ≥ 4 were categorized as positive. Continuous variables were analyzed using the Kruskal-Wallis test, and categorical variables were analyzed using the Fisher's exact test. A P value less than.05 was considered significant. A natural language processing algorithm was trained and validated to categorize patient feedback. A total of 3,636 patients responded to the survey. Positive ratings had a higher proportion of male respondents compared with negative ratings (47.9% versus 37.0%, P =.004). Examination characteristics were also grouped by positive or negative rating. Patients who endured longer examination time (median 54.0 min versus 44.0 min, P <.001) and longer wait time after check-in (median 61.6 min versus 46.2 min, P <.001) were more likely to give negative ratings. The most common themes of free text feedback included excellent service (84.3%), on-time service (8.4%), and comfortable intravenous line placement (0.4%). Most common negative feedback included long wait times (10.5%), poor communication (8.4%), and physical discomfort during the examination (4.2%). Male gender, short examination duration, and on-time start were associated with positive patient ratings. [ABSTRACT FROM AUTHOR]

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While some countries collect burn clinical data as part of nonspecific trauma datasets, others have developed burn registries allowing for benchmarking of outcome and quality-of-care data. The objectives of this project are to characterize the current state of burn clinical data collection and analysis in Canada, and to explore the interest of Canadian burn centers in contributing to a nation-wide burn registry. A 23-item mixed methods survey was created and delivered via REDCap® to burn directors of 22 burn centers across Canada. Quantitative items were analyzed by means of descriptive statistics, and thematic analysis was used to explore qualitative data. Sixteen (72 %) complete survey responses were received. All respondent units collect burn clinical data. Data are largely collected for quality improvement (69 %) and clinical research (50 %) purposes. Half of the institutions did not analyze their data, and a majority (67 %) did not benchmark their data against other datasets. The majority of respondents (93 %) demonstrated interest in contributing to a Canada-wide burn registry. Although all respondent units are currently collecting burn clinical data, there is an opportunity to improve data analysis, benchmarking, and knowledge translation. Most centers demonstrated interest in contributing to a novel Canadian burn registry. • All respondent Canadian burn units collect burn clinical data; • Data is mostly collected for quality improvement and clinical research purposes; • Half of respondent units declared their data are not currently analyzed; • A majority of units has never benchmarked their data; • Most respondent units were interested in participating in a Canadian burn registry. [ABSTRACT FROM AUTHOR]

La norme ISO 15189 évolue. Comme toute évolution elle s'accompagne de nombreux changements autant sur la forme que sur le fond. Certains sont profonds et remettent en cause des modes d'organisation, d'autres sont plus du registre de l'adaptation. Néanmoins une nouvelle approche est proposée pour la gestion des risques. Celle-ci doit remettre au cœur des préoccupations le patient et la qualité du soin. Elle va permettre aux laboratoires d'établir eux même leur politique qualité en intégrant leur particularité et en mettant en place des solutions leurs convenant spécifiquement (plus de liberté dans les solutions). Cependant cette transition va demander un effort à tous tant d'un point de vue de la charge de travail que de l'adaptation à cette approche. Les laboratoires ayant déjà fait face à de nombreux défis par le passé devraient pouvoir relever celui-ci. On peut être optimiste, d'autant que la phase de transition est longue. The ISO 15189 standard is evolving - and like any evolution, this will bring about a number of changes both in form and substance. Some of these changes are structural and thus challenge current organizational models, while others will merely require a measure of adaptation. Nevertheless, a new approach is being proposed, that of risk management. Its core objective is to place the patient and the quality of care at the heart of the procedural framework again. It will enable laboratories to establish their own quality assurance policy by molding it to their specificities and thereby implementing solutions tailored to their needs (allowing for more freedom in the solutions implemented). However, this transition can only move forward with a significant effort from everyone, both in terms of workload and of adaptation to this new approach. Laboratories that have overcome challenges in the past should also be able to overcome this one. Optimism is warranted, especially considering that the transition phase we are faced with will be a lengthy one. [ABSTRACT FROM AUTHOR]

Industry 4.0 (I4.0) is a transformative industrial paradigm that encompasses a set of technologies and principles that are increasingly essential for companies operating in the automotive sector. By embracing the principles and implementing the associated I4.0 technologies, automotive companies have the potential to improve their overall business performance, foster greater collaboration within the supply chain (SC) ecosystem and thereby strengthen their competitive edge. These technologies drive innovation, enabling the development of sustainable solutions and the alignment of products with ever-evolving customer demands. Therefore, this study explores the complex interplay between I4.0 technologies and business performance by providing insights from a multi-case study in the automotive sector. As the exploratory nature of this research is driven by the exploration of pathways, topics such as the implementation of I4.0 technologies, their impact on business performance and current important industry issues such as reshoring and the circular economy (CE) were also discussed. A research protocol was developed and semi-structured interviews were conducted with senior managers from six leading European automotive suppliers. The results show how significant improvements in business performance can be achieved by implementing advanced I4.0 technologies aimed at automating processes and making production lines more flexible. This led to improvements in productivity and product quality, while reducing production costs through the strategic use of available data. Furthermore, European automotive suppliers are engaging in collaborative initiatives with other SC actors to stay abreast of emerging innovation trends, to meet customer needs and to help share knowledge and resources. Overall, the implementation of I4.0 technologies leads directly and indirectly to more sustainable production and efficient resource management, as I4.0 technologies are designed to be energy efficient and reduce emissions. [ABSTRACT FROM AUTHOR]

Chest radiographs are the most performed radiographic procedure, but suboptimal technical factors can impact clinical interpretation. A deep learning model was developed to assess technical and inspiratory adequacy of anteroposterior chest radiographs. Adult anteroposterior chest radiographs (n = 2375) were assessed for technical adequacy, and if otherwise technically adequate, for adequacy of inspiration. Images were labelled by an experienced radiologist with one of three ground truth labels: inadequate technique (n = 605, 25.5 %), adequate inspiration (n = 900, 37.9 %), and inadequate inspiration (n = 870, 36.6 %). A convolutional neural network was then iteratively trained to predict these labels and evaluated using recall, precision, F1 and micro-F1, and Gradient-weighted Class Activation Mapping analysis on a hold-out test set. Impact of kyphosis on model accuracy was assessed. The model performed best for radiographs with adequate technique, and worst for images with inadequate technique. Recall was highest (89 %) for radiographs with both adequate technique and inspiration, with recall of 81 % for images with adequate technique and inadequate inspiration, and 60 % for images with inadequate technique, although precision was highest (85 %) for this category. Per-class F1 was 80 %, 81 % and 70 % for adequate inspiration, inadequate inspiration, and inadequate technique respectively. Weighted F1 and Micro F1 scores were 78 %. Presence or absence of kyphosis had no significant impact on model accuracy in images with adequate technique. This study explores the promising performance of a machine learning algorithm for assessment of inspiratory adequacy and overall technical adequacy for anteroposterior chest radiograph acquisition. With further refinement, machine learning can contribute to education and quality improvement in radiology departments. [ABSTRACT FROM AUTHOR]

The American Academy of Dermatology (AAD) launched DataDerm in 2016 as the clinical data registry platform of AAD. DataDerm has evolved to be the largest database containing information about dermatology patients in the world. As of December 31, 2021, DataDerm contained data from 13.2 million unique patients and 47.0 million unique patient visits, with 403 practices representing 1670 clinicians actively participating in DataDerm in 2021. Of the 1670 clinicians participating in DataDerm in 2021, the majority were dermatologists (978) followed by physician assistants (375) and nurse practitioners (163) who are employed by AAD members and meet the AAD definition of the AAD DermCare team. Furthermore, in 2021, 834 clinicians submitted data via DataDerm to the Merit-based Incentive Payment System of the Centers for Medicare & Medicaid Services. This article is the third annual report about the status of DataDerm. This year's 2022 annual report presents the progress DataDerm has made over the past year in conjunction with OM1, the data analytics partner of DataDerm, as well as the current status and future plans of DataDerm. [ABSTRACT FROM AUTHOR]

Most antibiotics prescribed to children are provided in the outpatient and emergency department (ED) settings, yet these prescribers are seldom engaged by antibiotic stewardship programs. We reviewed ED antibiotic prescriptions for three common infections to describe current prescribing practices. Prescription data between 2018 and 2021 were extracted from the electronic records of children discharged from the Children's Hospital of Eastern Ontario ED with urinary tract infection (UTI), community acquired pneumonia (CAP), and acute otitis media ≥2 years of age (AOM). Antibiotic choice, duration, as well as the provider's time in practice and training background were collected. Antibiotic durations were compared with Canadian guideline recommendations to assess concordance. Provider-level prescribing practices were analyzed using k-means cluster analysis. 10,609 prescriptions were included: 2868 for UTI, 2958 for CAP, and 4783 for AOM. Guideline-concordant durations prescribed was generally high (UTI 84.9%, CAP 94.0%, AOM 52.8%), a large proportion of antibiotic-days prescribed were in excess of the minimally recommended duration for each infection (UTI 16.8%, 19.3%, AOM 25.5%). Cluster analysis yielded two clusters of prescribers, with those in one cluster more commonly prescribing durations at the lower end of recommended interval, and the others more commonly prescribing longer durations for all three infections reviewed. No statistically significant differences were found between clusters by career stage or training background. While guideline-concordant antibiotic prescribing was generally high, auditing antibiotic prescriptions identified shifting prescribing towards the minimally recommended duration as a potential opportunity to reduce antibiotic use among children for these infections. [ABSTRACT FROM AUTHOR]

Single-crystalline diamond (SCD) tools are widely used in machining ultraprecision molds made of nonferrous metallic materials. However, the quality of natural and synthetic SCDs varies from higher to lower, and the tool life varies from longer to shorter. Therefore, in this study, the qualities of natural and synthetic SCDs were measured and analyzed crystal-optically and quantitatively by measuring the birefringence of the SCD. In the experiment, the electroless Ni P molds were single-point turned using each SCD tool to clarify the effects of the SCD crystalline quality on the tool wear resistance and surface roughness of the workpieces. [ABSTRACT FROM AUTHOR]

This paper proposes a new robust scheme to provide copy protection services to Deep Nural Network (DNN) models using digital watermarks. The rationale of the proposed technique is that robustness can be achieved by embedding a large watermark that can span the whole watermark. If an adversary attempts to destroy the watermark, he will end up destroying the DNN model. However, maximizing the embedding capacity will strongly degrade the performance of the DNN model. To control the performance-capacity-robustness trade-of, the proposed scheme utilizes the Discrete Cosine Transform (DCT) due to its strong compaction property, which becomes even stronger when applied to correlated segments of data. Therefore, the proposed technique extracts the DNN weights and groups them within correlated segments before applying the DCT. The experimental results have proven the effectiveness of the proposed DNN watermarking scheme as it was able to embed 1.73 Mb of data with only a 1.4% drop in the classification accuracy of a standard Residual Neural Network with 21 Convolutional layers. [ABSTRACT FROM AUTHOR]

Effort has been made to minimize the burden of non-interpretive tasks (NITs), in particular by hiring and training non-radiologist support staff as reading room coordinators (RRCs). Our medical center recruited and trained senior medical students from our affiliated school of medicine to work alongside on-call radiology residents as RRCs. A 12-month Malpractice Carrier monetary grant was acquired to fund medical students at with the aim to reduce malpractice risk. After the first year, residents were surveyed regarding the impact of the RRCs on perceived on-call efficiency and morale. Furthermore, report turnaround times (TAT) on call shifts that were and were not accompanied by a RRC were compared. 89 % of residents strongly agreed that the RRC improved workflow efficiency, decreased distractions, and felt less stressed during the call shift when the RRC was on duty. 78 % strongly agreed to be more likely to contact a referring clinician when the RRC was able to help coordinate. The mean TAT in the presence of a RRC was 36.8 min, and the mean TAT in the absence of a RRC was 36.9 min After hiring medical students to assist on-call radiology residents with noninterpretive tasks, residents reported subjective indicators of program success, but average report turnaround time was unaffected. Nevertheless, we predict that this type of program will continue to grow among academic radiology departments, though additional research is required to evaluate national trends and impacts on radiologist productivity and well-being. [ABSTRACT FROM AUTHOR]

To evaluate differences in quantitative features between poorly versus highly rated patient ratings of radiology reports. A HIPAA-compliant, IRB-waived study was performed from October 2019 to June 2021. Patients completed an optional 2-question survey ("How helpful was the report?" with a 5-star scale and an open text box) embedded into the patient portal, and reports were assessed for readability and brevity. Quantitative analyses were performed between poorly (≤3 stars) and highly rated (>3 stars) CT and MRI reports, including the use of structured reporting, number of words, words per sentence, Flesch Reading Ease, and Flesh-Kincaid Grade level within the findings and impression sections of the radiology reports. A two-tailed nonparametric Mann U Whitney test was performed for continuous variables and Chi2 for categorical variables. Of the 490 responses, all 135 evaluating CT or MR were included (27%). 106/135 (78%) of the patients gave high ratings (score of 4 or 5). 46/135 (34%), the radiology reports were in a structured format. The proportion of highly rated reports were significantly higher for structured than freeform reports (93.5 vs. 70.8%, p = 0.002). In the findings section, highly rated reports had a lower Flesch Reading Ease score than poorly rated reports (19.6 vs. 28.9, p <0.01). No significant differences were observed between number of words (p=0.27), words per sentence (p=0.94), and Flesh-Kincaid Grade level (p=0.09) in the findings section. In the impression section, no differences were observed between highly vs. poorly rated reports among the measured parameters. Patients preferred highly rated reports that were structured and had lower Flesch Reading Ease scores in the findings section. [ABSTRACT FROM AUTHOR]

In this study we hypothesized that the relations between the bovine colostrum (BC) microbiota, biogenic amine (BA) as well as volatile compound (VC) profiles can lead to new deeper insights concerning the BC changes during the biological preservation. To implement such an aim, BC samples were collected from 5 farms located in Lithuania and fermented with Lactiplantibacillus plantarum and Lacticaseibacillus paracasei strains. Nonfermented and fermented BC were subjected to microbiological [lactic acid bacteria (LAB), Escherichia coli , and total bacteria (TBC), total Enterobacteriaceae (TEC) and total mold and yeast (M-Y) viable counts] and physicochemical (pH, color coordinates, BA content and VC profile) parameters evaluation, and the relationship between the tested parameters were also further analyzed. In comparison pH and dry matter (DM) of nonfermented samples, significant differences were not found, and pH of BC was, on average, 6.30, and DM, on average, 27.5%. The pH of fermented samples decreased, on average, until 4.40 in Lp. plantarum fermented group, and, on average, until 4.37 in Lc. paracasei fermented group. Comparing color characteristics among nonfermented BC groups, significant differences between lightness (L*) and yellowness (b*) were not detected, however, the origin (i.e., agricultural company), LAB strain used for fermentation and the interaction between these factors were statistically significant on BC redness (a*) coordinate. The microbial contamination among all the tested BC groups was similar. However, different LAB strains used for BC fermentation showed different effects toward the microbial contamination reduction, and specifically Lc. paracasei was more effective than Lp. plantarum strain. Predominant BA in BC were putrescine and cadaverine. The main VC in nonfermented and fermented BC were decane, 2-ethyl-1-hexanol, dodecane, 1,3-di-tert-butylbenzene, 3,6-dimethyldecane and tetradecane. Moreover, this study showed worrying trends with respect to the frozen colostrum storage, because most of the dominant VC in BC were contaminants from the packaging material. Additionally, significant correlations between separate VC and microbial contamination were obtained. Finally, these experimental results showed that the separate VC in BC can be an important marker for biological as well as chemical contamination of BC. Also, it should be pointed out that despite the fermentation with LAB is usually described as a safe and natural process with many advantages, control of BA in the end product is necessary. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Medical Imaging & Radiation Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

While quality measures are integral to the maintenance of a high standard of patient care, high-quality care remains a complicated concept to define in the context of acute care. In this article we explore how quality can be measured in the intensive care unit. Standard outcome metrics such as mortality are tangible comparators, but do not offer a comprehensive assessment of quality for the complex heterogeneity of the intensive care population. We explore the Donabedian model as a means to describe the importance of outcomes, processes, structure and environment to inform the measurement of quality. These concepts can be more abstract and difficult to measure but can provide significant insight into the culture of a unit and the resulting performance, and thus provide a more comprehensive measure of quality. [ABSTRACT FROM AUTHOR]

To assess the impact of radial percentage k-space filling and signal averaging on lung MRI image quality in 3D radial ultrashort echo-time (UTE) acquisition. In this IRB approved prospective study, 25 patients (10-30 years) referred for MRI examination for indications other than related to lungs were enrolled from January 2021 to November 2021. All the patients underwent lung MRI, using three different UTE sequence parameters with radial (R) percentage of 100 or 200 and number of signal averages (NSA) of one or two. Two radiologists independently assessed the images for the outline of pleural and mediastinal surface, visibility of lung parenchyma, major bronchi, and segmental bronchi. The quality of the images was assessed based on the degree of motion artifacts. For objective assessment, signal-to-noise ratio, contrast-to-noise ratio, and contrast ratio were calculated. The outline of pleural and mediastinal surface, lung parenchyma, and segmental bronchi were best demonstrated on R100_NSA2 sequence. The major bronchi were best demonstrated on R100_NSA2 and R100_NSA1 sequences. The intersequence difference was statistically significant for evaluating the pleural and mediastinal surface and segmental bronchi only (p < 0.05). Overall, the best image quality with least artifacts was seen with R100_NSA2 sequence. The objective assessment showed no statistically significant difference between the three sequences (p > 0.05). Interobserver agreement for different findings was substantial to almost perfect for R100_NSA2 and R200_NSA1 sequences. R100_NSA2 UTE sequence performed best for the evaluation of the different findings and showed the best image quality. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Taibah University Medical Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Care for children who are hospitalized can be optimized if the pharmacist, in conjunction with the multidisciplinary team, promotes the rational use of medicines. In this sense, the evaluation of the quality of these clinical services through indicators is important in the planning, decision making of pharmacists and managers of these services. To characterize which health indicators were influenced by the pharmaceutical clinical services for the care of children in hospitals. A systematic review was performed. The search for data was made on the bases: Cochrane, Embase, Lilacs, Pubmed and Web of Science. Then, the search included studies in which evaluated the impact of pharmaceutical clinical services on clinical, economic and humanistic outcomes. The search resulted in 11 included studies. In this review, four pharmaceutical clinical services were found: pharmacotherapy review, multiprofessional team interventions, antimicrobial stewardship program and pharmaceutical services at discharge hospital. The most influenced outcome indicators were length of hospital stay, with average time in the group that received the pharmacotherapy review service, and interventions multiprofessional team with a 6.45-day vs. 10.83 days in the control group; hospital readmissions with a significant reduction of non-scheduled readmission of 30 days in the ntimicrobial stewardship program; reduction of hospital costs and caregiver satisfaction. In this study, we can highlight that pharmacotherapy review, multiprofessional team interventions and Antimicrobial Stewardship Program that significantly reduced the clinical results of length of hospital stay and hospital readmission, as well as a significant reduction of hospital costs. • Clinical pharmacy services are related to quality indicators. • These services are related wiht the significant reduction of the length of hospital stay. • These services are related wiht the significant reduction in hospital costs. • Knowing the influencers of these outcomes is essential. [ABSTRACT FROM AUTHOR]

Registries are important in rare disease research. The Anorectal Malformation Network (ARM-Net) registry is a well-established European patient registry collecting demographic, clinical, and functional outcome data. We assessed the quality of this registry through review of the structure, data elements, collected data, and user experience. Design and data elements were assessed for completeness, consistency, usefulness, accuracy, validity, and comparability. An intra- and inter-user variability study was conducted through monitoring and re-registration of patients. User experience was assessed via a questionnaire on registration, design of registry, and satisfaction. We evaluated 119 data elements, of which 107 were utilized and comprised 42 string and 65 numeric elements. A minority (37.0%) of the 2278 included records had complete data, though this improved to 83.5% when follow-up elements were excluded. Intra-observer variability demonstrated 11.7% incongruence, while inter-observer variability was 14.7%. Users were predominantly pediatric surgeons and typically registered patients within 11–30 min. Users did not experience any significant difficulties with data entry and were generally satisfied with the registry, but preferred more longitudinal data and patient-reported outcomes. The ARM-Net registry presents one of the largest ARM cohorts. Although its collected data are valuable, they are susceptible to error and user variability. Continuous evaluations are required to maintain relevant and high-quality data and to achieve long-term sustainability. With the recommendations resulting from this study, we call for rare disease patient registries to take example and aim to continuously improve their data quality to enhance the small, but impactful, field of rare disease research. V. • What is currently known about this topic? • The Anorectal Malformations Network patient registry is a well-established European rare disease patient registry that collects demographic, clinical, and functional outcome data. • What new information is contained in this article? • Periodical critical evaluation is key to continuously improving data quality in the aspiration for a registry to be sustainable and remain relevant for future research and clinical care. [ABSTRACT FROM AUTHOR]

Qualitative research has gained popularity in pediatric urology due to rich data and insights about quantitative results. To date, there has been no study evaluating the comprehensiveness of the reporting of these studies based on established guidelines. The objective of this study is to perform a scoping review of the quality of reporting in recent qualitative studies in pediatric urology based on a predominant checklist, the 21-item Standards of Reporting Qualitative Research (SRQR) and identify areas for improvement. In accordance with the Preferred Reported Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews, we performed a systematic literature search to identify qualitative studies on pediatric urology topics published from 2015 to 2021. We used clustering technology to eliminate articles with unrelated keywords. Articles not in English and those published prior to 2015 were excluded. Two reviewers performed title/abstract screening and full text review and resolved discrepancies by consensus. We reported the median and interquartile range of total SRQR scores (maximum: 21). SRQR-reported items were summarized; overall proportion of reported items for each article was estimated. Bivariate analyses examined the association between study characteristics and SRQR tertile. Simple linear regression was performed to examine the relationship between year and SRQR score. Of the 2562 titles/abstracts screened, 26 studies were included. The most common topics were hypospadias and congenital adrenal hyperplasia (Summary Figure). The median total score was 18.0 of 21 possible items (interquartile range: 3). All studies reported an abstract, problem formulation, purpose/context of the study, data collection methods, integration with prior work, limitations, and ethics review board approval. Most (25/26; 96.2%) reported sampling strategy, data analysis, synthesis/interpretation of findings and links to empirical data. Less fulfilled items included: a title identifying the study as qualitative (11/26, 42.3%), qualitative approach & research paradigm (11/26, 42.3%) and researcher characteristics & reflexivity (9/26, 34.6%). There was no association between study characteristics and SRQR score. There was a statistically significant increase in the SRQR score during the study period (β = 1.0, p < 0.0001). Studies fulfilled most SRQR checklist items. There was significant improvement in quality during the study period. Limitations include possible recency bias and exclusion of articles due to inconsistent categorizations in Pub Med. The quality and trajectory of qualitative study reporting in pediatric urology is encouraging. SRQR standards should be implemented by journals to continue improving the robustness and transparency of future qualitative manuscripts in pediatric urology. [ABSTRACT FROM AUTHOR]

The prediction of mortality, bleeding, and acute kidney injury (AKI) after percutaneous coronary intervention (PCI) traditionally relied on race-based estimates of the glomerular filtration rate (GFR). Recently, race agnostic equations were developed to advance equity. The authors aimed to compare the accuracy and implications of various GFR equations when used to predict AKI after PCI. Using the National Cardiovascular Data Registry (NCDR) CathPCI data set, we identified patients undergoing PCI in 2020 and calculated their AKI risk using the 2014 NCDR AKI risk model. We created 4 AKI models per patient for each estimate of baseline renal function: the traditional GFR equation with a race term, 2 GFR equations without a race term, and serum creatinine alone. We then compared each model's performance predicting AKI. Among 455,806 PCI encounters, the median age was 67 years, 32.2% were women, and 8.5% were Black. In Black patients, risk models without a race term were better calibrated than models incorporating an equation with a race term (intercept: −0.01 vs 0.15). Race-agnostic models reclassified 6% of Black patients into higher-risk categories, potentially prompting appropriate mitigation efforts. However, even with a race-agnostic model, AKI occurred in Black patients 18% more often than expected, which was not explained by captured patient or procedural characteristics. Incorporating a GFR estimate without a Black race term into the NCDR AKI risk prediction model yielded more accurate prediction of AKI risk for Black patients, which has important implications for reducing disparities and benchmarking. [Display omitted] [ABSTRACT FROM AUTHOR]

Off-pump coronary artery bypass grafting (OPCAB) has been used to mitigate the negative systemic effects of cardiopulmonary bypass. Recent consortium and single-institution studies suggest an association between operator experience and long-term survival. We thus aimed to ascertain the relationship between institutional OPCAB volume and outcomes using a contemporary nationwide all-payer database. Adult admissions for elective isolated OPCAB were identified from the 2016–2019 Nationwide Readmissions Database. The primary outcome was major adverse events (MAE), defined as a composite of mortality, reoperation, prolonged mechanical ventilation, acute kidney injury requiring dialysis, or perioperative stroke during the index hospitalisation. Secondary outcomes included temporal trends, postoperative length of stay (pLOS), hospitalisation costs, non-home discharge, and 30-day readmission rate. High-volume hospitals (HVH) were defined to have annual caseloads >35 based on cubic spline analysis. Of an estimated 41,154 patients, 59.9% were treated at HVH. The proportion of coronary artery bypass grafting operations that were OPCAB significantly decreased from 21.1% in 2016 to 18.3% in 2019. After adjustment, HVH status was associated with lower adjusted odds of MAE (adjusted odds ratio [AOR] 0.78, 95% confidence interval [CI] 0.70–0.88), compared to others. HVH were also associated with shorter pLOS (β -0.10, 95% -0.13, -0.07), reduced costs (β -US$4,900, - US$6,300, - US$3,600), non-home discharge (AOR 0.54, 95% CI 0.45–0.64), and 30-day readmission (AOR 0.86, 95% CI 0.77–0.96). Our results suggest that OPCAB requires a distinct set of surgical expertise and institutional aptitude. As a result, centralisation of care to centres of excellence should be considered. [ABSTRACT FROM AUTHOR]

In this study, the main execution activities associated with global roadways construction projects (RCPs) were identified and categorized into five main activities of RCPs as follows: (A) Preliminary Preparations; (B) Earthworks (cut/fill); (C) Implementing of sub-base and base layers; (D) Implementing of bituminous layers and (E) Traffic safety and road furniture. A field survey was conducted, and a comprehensive practical risk checklist consisting of 39 crucial risk factors affecting RCPs activities in Egypt was introduced as a case study. The probability of occurrence and the impacts on RCPs objectives (time, cost, and quality) and the risk severity were determined while the key risk factors were highlighted. The correlations between the risk factors indices were measured, and the strongest relationship was found between time and cost severities. The weights of time and cost percentages of each activity were identified, as well as the expected percentages of time and cost overruns. Activity (B) had the highest percentages of execution time and associated cost among the whole activities, i.e., 31% for time and 29% for cost. While the average overall time and cost overruns were found (at 15–20) % and (10–15) %, respectively. The effect on the quality of each activity and the overall effect on the project's final quality were also evaluated. The results indicated a high effect on the quality of activities (A), (B), and (D) and a moderate effect on activities (C) and (E). Furthermore, the influence on the overall quality of the entire project was found with a high effect. [ABSTRACT FROM AUTHOR]

• Obesity in US nursing home residents is increasing. • Certain nursing home characteristics are associated with falls among residents with obesity. • Nursing homes can adopt changes to lower risk of falls for residents with obesity. Background: Obesity among United States nursing home (NH) residents is increasing. These residents have special care needs, which increases their risk for falls and falls with injuries. NH are responsible for ensuring the health of their residents, including minimizing falls. However, given the special care needs of residents with obesity, different factors may be important for developing programs to minimize falls among this group. Aim: We aimed to identify NH characteristics associated with falls and falls with injuries among residents with obesity. Method: We used resident assessment data and logistic regression analysis. Results: We found that rates of falls and falls with injuries among residents with obesity varied significantly based on for-profit status, size, acuity index, obesity rate among residents, and registered nurse hours per patient day. Conclusion: Recommendations are made as to how NH may be able to lower risk for falls and falls with injuries among their residents with obesity. [ABSTRACT FROM AUTHOR]

The integration of the Nursing Quality and Safety Education (QSEN) competencies into American Association of College of Nursing - The Essentials: Core Competencies for Professional Nursing Education warrants continued assessment of the new nurses' QSEN competencies preparedness. The purpose of this study was to analyze quality and safety education needs of nurses who graduated in 2016, 2017, and 2018 and have responded to the most recent National Sample Survey of Registered Nurses. This is a retrospective correlational design study using analysis of publicly available data from the 2018 National Sample Survey of Registered Nurses. A logistic regression model was used to assess correlations between 21 quality and safety education variables and nursing degree type. When adjusting for differences in demographic and work characteristics, there were no significant differences in quality and safety training needs by the nursing degree type. New nurses, regardless of the nursing degree type reported additional training needs in patient-centered care (50%), evidence-based practice and team-based care (40%), quality improvement (30%). This study provides new, national data on new nurses' quality and safety education preparedness and provides evidence for the need for continued investment and integration of QSEN competencies in all nursing degree programs. • New nurses in the U.S. report significant quality and safety education needs. • Most wanted more education in patient-centered care and evidence-based practice. • Team-based care and quality improvement were additional educational priorities. • Bachelor's and associate's degree graduates reported the same education needs. • Results necessitate continued investment in quality and safety education. [ABSTRACT FROM AUTHOR]