Quality Measures Research Articles

Differences in the cost and environmental impact between the current diet in Brazil and healthy and sustainable diets: a modeling study

BackgroundWhile healthy and sustainable diets benefit human and planetary health, their monetary cost has a direct impact on consumer food choices. This study aimed to identify the cost and environmental impact of the current Brazilian diet (CBD) and compare it with healthy and sustainable diets.MethodsData from the Brazilian Household Budget Survey 2017/18 and the Footprints of Foods and Culinary Preparations Consumed in Brazil database were used for a modeling study comparing the cost of healthy and sustainable diets (based on the Brazilian Dietary Guidelines (BDG) diet and the EAT-Lancet diet) versus the CBD. The DIETCOST program generated multiple food baskets for each scenario (Montecarlo simulations). Nutritional quality, cost, and environmental impact measures (carbon footprint (CF) and water footprint (WF)) were estimated for all diets and compared by ANOVA. Simple linear regressions used standardized environmental impacts measures to estimate differentials in costs and environmental impacts among diets scenarios.ResultsWe observed significant differences in costs/1000 kcal. The BDG diet was cheaper (BRL$4.9 (95%IC:4.8;4.9) ≈ USD$1.5) than the CBD (BRL$5.6 (95%IC:5.6;5.7) ≈ USD$1.8) and the EAT-Lancet diet (BRL$6.1 (95%IC:6.0;6.1) ≈ USD$1.9). Ultra-processed foods (UPF) and red meat contributed the most to the CBD cost/1000 kcal, while fruits and vegetables made the lowest contribution to CBD. Red meat, sugary drinks, and UPF were the main contributors to the environmental impacts of the CBD. The environmental impact/1000 kcal of the CBD was nearly double (CF:3.1 kg(95%IC: 3.0;3.1); WF:2,705 L 95%IC:2,671;2,739)) the cost of the BDG diet (CF:1.4 kg (95%IC:1.4;1.4); WF:1,542 L (95%IC:1,524;1,561)) and EAT-Lancet diet (CF:1.1 kg (95%IC:1.0;1.1); WF:1,448 L (95%IC:1,428;1,469)). A one standard deviation increase in standardized CF corresponded to an increase of BRL$0.48 in the cost of the CBD, similar to standardized WF (BRL$0.56). A similar relationship between the environmental impact and the cost of the BDG (CF: BRL$0.20; WF: BRL$0.33) and EAT-Lancet (CF: BRL$0.04; WF: BRL$0.18) was found, but with a less pronounced effect.ConclusionsThe BDG diet was cost-effective, while the EAT-Lancet diet was slightly pricier than the CBD. The CBD presented almost double the CF and WF compared to the BDG and EAT-Lancet diets. The lower cost in each diet was associated with lower environmental impact, particularly for the BDG and EAT-Lancet diets. Multisectoral public policies must be applied to guide individuals and societies towards healthier and more sustainable eating patterns.

Differences in the cost and environmental impact between the current diet in Brazil and healthy and sustainable diets: a modeling study

BackgroundWhile healthy and sustainable diets benefit human and planetary health, their monetary cost has a direct impact on consumer food choices. This study aimed to identify the cost and environmental impact of the current Brazilian diet (CBD) and compare it with healthy and sustainable diets.MethodsData from the Brazilian Household Budget Survey 2017/18 and the Footprints of Foods and Culinary Preparations Consumed in Brazil database were used for a modeling study comparing the cost of healthy and sustainable diets (based on the Brazilian Dietary Guidelines (BDG) diet and the EAT-Lancet diet) versus the CBD. The DIETCOST program generated multiple food baskets for each scenario (Montecarlo simulations). Nutritional quality, cost, and environmental impact measures (carbon footprint (CF) and water footprint (WF)) were estimated for all diets and compared by ANOVA. Simple linear regressions used standardized environmental impacts measures to estimate differentials in costs and environmental impacts among diets scenarios.ResultsWe observed significant differences in costs/1000 kcal. The BDG diet was cheaper (BRL$4.9 (95%IC:4.8;4.9) ≈ USD$1.5) than the CBD (BRL$5.6 (95%IC:5.6;5.7) ≈ USD$1.8) and the EAT-Lancet diet (BRL$6.1 (95%IC:6.0;6.1) ≈ USD$1.9). Ultra-processed foods (UPF) and red meat contributed the most to the CBD cost/1000 kcal, while fruits and vegetables made the lowest contribution to CBD. Red meat, sugary drinks, and UPF were the main contributors to the environmental impacts of the CBD. The environmental impact/1000 kcal of the CBD was nearly double (CF:3.1 kg(95%IC: 3.0;3.1); WF:2,705 L 95%IC:2,671;2,739)) the cost of the BDG diet (CF:1.4 kg (95%IC:1.4;1.4); WF:1,542 L (95%IC:1,524;1,561)) and EAT-Lancet diet (CF:1.1 kg (95%IC:1.0;1.1); WF:1,448 L (95%IC:1,428;1,469)). A one standard deviation increase in standardized CF corresponded to an increase of BRL$0.48 in the cost of the CBD, similar to standardized WF (BRL$0.56). A similar relationship between the environmental impact and the cost of the BDG (CF: BRL$0.20; WF: BRL$0.33) and EAT-Lancet (CF: BRL$0.04; WF: BRL$0.18) was found, but with a less pronounced effect.ConclusionsThe BDG diet was cost-effective, while the EAT-Lancet diet was slightly pricier than the CBD. The CBD presented almost double the CF and WF compared to the BDG and EAT-Lancet diets. The lower cost in each diet was associated with lower environmental impact, particularly for the BDG and EAT-Lancet diets. Multisectoral public policies must be applied to guide individuals and societies towards healthier and more sustainable eating patterns.

Taking the natural geography book of the eleventh grade of high school under the light of the general quality measurements in the view of teachers and expert supervisors.

This research is to build a scale for evaluating the natural geography book of high school under the light of general quality criteria. Knowing theextentof having a general quality measure in the geography book of the11th grade of literary readings in the eyes of teachers and expert supervisors, according to the gender change (male and female) General quality in the booklet to achieve these goals, the researcher used the method of description and analysis as an example of the research which was made in (70) teachers and supervisors of geography in male and female gender All three educations in the east and west of Sulaimaniyah and Chamchamal education for the school year (2021-2022), which were selected in a symbolic way, research tools Which consisted of a survey form consisting of 86 sections, which was divided into (7) items, and this was the benefit of the previous research. The researcher after preparing the tool and directing it The truth and stability of using Person's partner in the rate of (0.815) then the researcher also performed it on the example of the research, after analyzing and presenting the survey to Using Person's co-ordination, appropriate center, Test (T.test) after being certain of the truth, the researcher used the(spss) statistical program. Finally, the researcher reached the goals that each (7) sections of the 11th grade natural geography book which are (objective, they were (aim, art, activity, motivation, teaching, language, subject, content) and they were not accepted.

Self-Collection for HPV Testing: Potential Issues Related to Performance Measures and Quality Improvement Among Federally Qualified Health Centers.

Most incident cases of cervical cancer in the United States are attributable to inadequate screening. Federally qualified health centers (FQHCs) serve a large proportion of women who are low-income, have no insurance, and are underserved-risk factors for insufficient cervical cancer screening. FQHCs must maintain quality measures to preserve their accreditation, address financial reimbursements, and provide quality care. Implementation of human papillomavirus (HPV) self-collection can improve cervical cancer screening coverage within FQHCs. To understand perspectives from clinical personnel on current cervical cancer screening rates at FQHCs in North Carolina and the impact of implementing HPV self-collection among underscreened patients on screening rates and performance measures. The study used focus groups and key informant interviews. Coding-based thematic analysis was applied to both focus group and interview transcripts. Emergent themes regarding perspectives on self-collection implementation were mapped onto Consolidated Framework for Implementation Research (CFIR) constructs to identify future barriers and facilitators to implementation. Two FQHCs in North Carolina and a cloud-based videoconferencing platform. Six FQHCs in North Carolina; 45 clinical and administrative staff from the 6 FQHCs; 1 chief executive officer (n = 6), 1 senior-level administrator (n = 6), 1 chief medical officer (n = 6), and 1 clinical data manager (n = 6) from each FQHC. Achievement of clinical perspectives. Societal-, practice-, and patient-level factors currently contribute to subpar cervical cancer screening rates. HPV self-collection was expected to improve screening uptake among underscreened women at FQHCs, and thus quality and performance measures, by offering an alternative screening approach for in-clinic or at-home use. Implementation barriers include financial uncertainties and HPV self-collection not yet a Food and Drug Administration-approved test. HPV self-collection has potential to improve cervical cancer screening quality and performance measures of FQHCs. For a successful implementation, multilevel factors that are currently affecting low screening uptake need to be addressed. Furthermore, the financial implications of implementation and approval of HPV self-collection as a test for cervical cancer screening quality measures need to be resolved.

A Proposed Concept for Developing School Administration in Light of Edward Deming's Quality Standards

The aim of this study was to present a proposed framework for the development and improvement of educational administration in light of the quality standards set by Edward Deming as a measure of quality. This is intended to enhance the educational level and work towards performance improvement by providing a set of strategies related to processes and organizational structures that lead to continuous improvement within educational institutions. This study relied on a descriptive approach through the presentation and analysis of concepts and key elements addressed in the analytical meta-analysis method. Finally, the researcher recommends the adoption of total quality management by educational institutions and emphasizes the support of administrative leadership for this philosophy, in order to create a new organizational culture based on standards that measure educational quality in various domains.

Alternative Payment Models and Performance in Federally Qualified Health Centers.

Several state Medicaid agencies have transitioned from traditional fee-for-service to a value-centric alternative payment model (APM) to reimburse federally qualified health centers (FQHCs). Little is known about the effects of this shift on FQHC performance. To assess the association between APMs and the clinical performance, payer mix, risk profile, and financial sustainability of FQHCs. This retrospective cohort study was performed in 684 FQHCs (representing 37 states plus the District of Columbia) that continuously operated between January 2009 and December 2021. Data on payer mix (eg, type of insurance) and risk profile (eg, proportion of patients with chronic conditions) of FQHC patients were obtained from the Uniform Data System, and clinic-level financial data (eg, revenue) were obtained from Internal Revenue Service form 990 tax documents. Data were analyzed between November 2022 and October 2023. Initial rollout of a value-based payment model (ie, an APM) for FQHCs, as offered by state Medicaid program, between January 2013 and December 2021. The main outcomes were 4 audited process measures of health care quality (cervical and colorectal cancer screening and body mass index [BMI] assessment for adults and children) and 2 intermediate health outcome measures (hypertension control and diabetes control). A difference-in-differences design was used with staggered implementation comparing FQHCs before and after the initial APM rollout vs contemporaneous changes in FQHCs in states without APMs. A total of 684 FQHCs (8892 FQHC-years) that served 17 823 959 patients in 2021 (57.3% female) were included in the study. Among FQHCs in states implementing APMs, significant differential increases in 3 of the 4 process quality measures were observed compared with FQHCs in states that did not implement an APM: colorectal cancer screening (3.24 percentage points [pp]; 95% CI, 1.40-5.08 pp), adult BMI (3.19 pp; 95% CI, 0.70-5.68 pp), and child BMI (4.50 pp; 95% CI, 1.83-7.17 pp). There were also modest differential improvements in blood pressure control for individuals with hypertension (1.02 pp; 95% CI, 0.04-2.00 pp) and blood glucose control for individuals with type 2 diabetes (1.02 pp; 95% CI, 0.02-2.02 pp) compared with FQHCs in states without an APM. There was no evidence that the APM rollout was associated with clinics selecting healthier patients (-0.01 pp; 95% CI, -0.21 to 0.19 pp) or stinting on care (-0.02 visits; 95% CI, -0.08 to 0.04 visits). In this cohort study, introduction of Medicaid APM options for FQHCs was associated with modest, statistically significant increases in quality concentrated among FQHCs with APM models that explicitly incentivized quality. This finding suggests that APMs can be both a financially viable and a health-promoting model for reimbursement in the health care safety net.

Psychiatric Morbidity Among Patients Recovered from COVID-19 Pneumonia: A Cross Sectional Telephonic Survey

Background: Mental health issues among COVID-19 survivors can have broader public health implications, including decreased quality of life, impaired functional recovery, increased healthcare utilization, and higher mortality rates. Aims and Objectives: The aim of this study was to evaluate the psychiatric morbidities among the persons treated and recovered from COVID-19. Materials and Methods: A cross sectional telephonic survey was undertaken in hundred patients infected with COVID-19 pneumonia, treated and discharged from a tertiary care centre. Depression, anxiety, PTSD symptoms were assessed using PHQ-2, GAD-2, PTSD screen for DSM-5 respectively. Sleep quality was assessed using single item sleep quality scale. Overall quality of life and health satisfaction was assessed using WHOQOL-BREF. Results: Mean age of study participants is 46.15 years and study sample included 62% of males. Admitted patients had mean CT severity score of 40% lung involvement. On the measures of sleep quality, twelve were having fair range and two participants had poor sleep quality. 24% and 31% of participants had anxiety and depressive symptoms respectively while 14% had symptoms of PTSD. Conclusion: Post covid sequelae is an important concern to be addressed, larger studies are required to assess the psychiatry morbidity accurately. Further sequential assessments would help to delineate the natural course of post covid psychiatric sequalae.

Alternative Payment Models and Performance in Federally Qualified Health Centers

ImportanceSeveral state Medicaid agencies have transitioned from traditional fee-for-service to a value-centric alternative payment model (APM) to reimburse federally qualified health centers (FQHCs). Little is known about the effects of this shift on FQHC performance.ObjectiveTo assess the association between APMs and the clinical performance, payer mix, risk profile, and financial sustainability of FQHCs.Design, Setting, and ParticipantsThis retrospective cohort study was performed in 684 FQHCs (representing 37 states plus the District of Columbia) that continuously operated between January 2009 and December 2021. Data on payer mix (eg, type of insurance) and risk profile (eg, proportion of patients with chronic conditions) of FQHC patients were obtained from the Uniform Data System, and clinic-level financial data (eg, revenue) were obtained from Internal Revenue Service form 990 tax documents. Data were analyzed between November 2022 and October 2023.ExposureInitial rollout of a value-based payment model (ie, an APM) for FQHCs, as offered by state Medicaid program, between January 2013 and December 2021.Main Outcomes and MeasuresThe main outcomes were 4 audited process measures of health care quality (cervical and colorectal cancer screening and body mass index [BMI] assessment for adults and children) and 2 intermediate health outcome measures (hypertension control and diabetes control). A difference-in-differences design was used with staggered implementation comparing FQHCs before and after the initial APM rollout vs contemporaneous changes in FQHCs in states without APMs.ResultsA total of 684 FQHCs (8892 FQHC-years) that served 17 823 959 patients in 2021 (57.3% female) were included in the study. Among FQHCs in states implementing APMs, significant differential increases in 3 of the 4 process quality measures were observed compared with FQHCs in states that did not implement an APM: colorectal cancer screening (3.24 percentage points [pp]; 95% CI, 1.40-5.08 pp), adult BMI (3.19 pp; 95% CI, 0.70-5.68 pp), and child BMI (4.50 pp; 95% CI, 1.83-7.17 pp). There were also modest differential improvements in blood pressure control for individuals with hypertension (1.02 pp; 95% CI, 0.04-2.00 pp) and blood glucose control for individuals with type 2 diabetes (1.02 pp; 95% CI, 0.02-2.02 pp) compared with FQHCs in states without an APM. There was no evidence that the APM rollout was associated with clinics selecting healthier patients (–0.01 pp; 95% CI, –0.21 to 0.19 pp) or stinting on care (–0.02 visits; 95% CI, –0.08 to 0.04 visits).Conclusions and RelevanceIn this cohort study, introduction of Medicaid APM options for FQHCs was associated with modest, statistically significant increases in quality concentrated among FQHCs with APM models that explicitly incentivized quality. This finding suggests that APMs can be both a financially viable and a health-promoting model for reimbursement in the health care safety net.

Psychiatric Morbidity Among Patients Recovered from COVID-19 Pneumonia: A Cross Sectional Telephonic Survey

Background: Mental health issues among COVID-19 survivors can have broader public health implications, including decreased quality of life, impaired functional recovery, increased healthcare utilization, and higher mortality rates. Aims and Objectives: The aim of this study was to evaluate the psychiatric morbidities among the persons treated and recovered from COVID-19. Materials and Methods: A cross sectional telephonic survey was undertaken in hundred patients infected with COVID-19 pneumonia, treated and discharged from a tertiary care centre. Depression, anxiety, PTSD symptoms were assessed using PHQ-2, GAD-2, PTSD screen for DSM-5 respectively. Sleep quality was assessed using single item sleep quality scale. Overall quality of life and health satisfaction was assessed using WHOQOL-BREF. Results: Mean age of study participants is 46.15 years and study sample included 62% of males. Admitted patients had mean CT severity score of 40% lung involvement. On the measures of sleep quality, twelve were having fair range and two participants had poor sleep quality. 24% and 31% of participants had anxiety and depressive symptoms respectively while 14% had symptoms of PTSD. Conclusion: Post covid sequelae is an important concern to be addressed, larger studies are required to assess the psychiatry morbidity accurately. Further sequential assessments would help to delineate the natural course of post covid psychiatric sequalae.

Modernizing Surgical Quality: A Novel Approach to Improving Detection of Surgical Site Infections in the Veteran Population.

Introduction: Surgical site infections (SSIs) are an important quality measure. Identifying SSIs often relies upon a time-intensive manual review of a sample of common surgical cases. In this study, we sought to develop a predictive model for SSI identification using antibiotic pharmacy data extracted from the electronic medical record (EMR). Methods: A retrospective analysis was performed on all surgeries at a Veteran Affair's Medical Center between January 9, 2020 and January 9, 2022. Patients receiving outpatient antibiotics within 30 days of their surgery were identified, and chart review was performed to detect instances of SSI as defined by VA Surgery Quality Improvement Program criteria. Binomial logistic regression was used to select variables to include in the model, which was trained using k-fold cross validation. Results: Of the 8,253 surgeries performed during the study period, patients in 793 (9.6%) cases were prescribed outpatient antibiotics within 30 days of their procedure; SSI was diagnosed in 128 (1.6%) patients. Logistic regression identified time from surgery to antibiotic prescription, ordering location of the prescription, length of prescription, type of antibiotic, and operating service as important variables to include in the model. On testing, the final model demonstrated good predictive value with c-statistic of 0.81 (confidence interval: 0.71-0.90). Hosmer-Lemeshow testing demonstrated good fit of the model with p value of 0.97. Conclusion: We propose a model that uses readily attainable data from the EMR to identify SSI occurrences. In conjunction with local case-by-case reporting, this tool can improve the accuracy and efficiency of SSI identification.

Quality Assurance of Administrative Judiciary: Perspectives from France

Objective: This study objective is necessary to understand the concepts related to quality in the administrative judiciary: perspectives from France. The current study also identifies the main requirements for achieving quality in the administrative judiciary function. Method: The study embraces the descriptive and analytical approaches in order to identify and analyze the concepts and measures of quality that are compatible with the nature and specificity of administrative cases. Results and conclusion: The study has reached some results, the most important of which are: The real measure of quality in the administrative judiciary is represented as the achievement of the strategic objective of the administrative judiciary. Another result turns out to be that the quality of the performance of the administrative judiciary, whether quantitative or qualitative, is, in fact, just a means to achieve this goal.

Exploring the Benefits of Mass Timber Construction in the Workplace: A Novel Primer for Research

Mass timber construction has recently gained popularity due to its outstanding environmental benefits and building performance, which hold revolutionary potential for the construction industry. However, its impacts from the perspective of occupants have not been thoroughly explored. This study introduces an innovative empirical approach that explores the potential benefits of mass timber construction for individuals and organizations, with an emphasis on the workplace. We review the conceptual framework regarding how visual and physical exposure to timber construction materials and finishes have a positive effect on individuals and organizations at a broad level. We propose a more holistic mixed-method behavioral approach to studying occupant behavior and well-being by integrating self-reported questionnaires, objective biomarkers (heart rate variability and hair cortisol), and indoor environmental quality (IEQ) measures. Our study offers a novel research primer on the exploration of mass timber construction impacts and benefits for both office workers and construction workers. Participants from different office settings completed pre- and post-occupancy evaluation surveys to assess their experiences, including IEQ satisfaction, productivity, and health. Office workers were located in three different offices: a controlled laboratory environment, an open-plan office, and an open-plan space with a timber interior. The construction workers worked in a timber space for three months and then moved to work in a building with a concrete structure. The analysis included descriptive statistics, t-tests, ANOVA, and linear regression to compare differences between office settings and assess the relationship between environmental variables and overall satisfaction in IEQ, comfort, productivity, and health. In office workers, in terms of building image, thermal comfort, and artificial lighting, the data analysis revealed significant differences in occupants’ satisfaction levels between office settings. However, the low number of participants affected the results, and some factors were not found significant in relation to the office setting. Among tradespeople, there was no relationship between the building environment and productivity, health, or comfort. However, the results of hair cortisol testing indicated that working in a timber space can decrease the level of cortisol (stress) and have an impact on the productivity of workers. Such occupant’s perspective research is pivotal to informing policy makers, developers, business owners, construction professionals, timber industry stakeholders, environmentalists, and researchers in their decision-making processes. Fostering the future widespread adoption and advancement of mass timber construction.

Exploring the Benefits of Mass Timber Construction in the Workplace: A Novel Primer for Research

Mass timber construction has recently gained popularity due to its outstanding environmental benefits and building performance, which hold revolutionary potential for the construction industry. However, its impacts from the perspective of occupants have not been thoroughly explored. This study introduces an innovative empirical approach that explores the potential benefits of mass timber construction for individuals and organizations, with an emphasis on the workplace. We review the conceptual framework regarding how visual and physical exposure to timber construction materials and finishes have a positive effect on individuals and organizations at a broad level. We propose a more holistic mixed-method behavioral approach to studying occupant behavior and well-being by integrating self-reported questionnaires, objective biomarkers (heart rate variability and hair cortisol), and indoor environmental quality (IEQ) measures. Our study offers a novel research primer on the exploration of mass timber construction impacts and benefits for both office workers and construction workers. Participants from different office settings completed pre- and post-occupancy evaluation surveys to assess their experiences, including IEQ satisfaction, productivity, and health. Office workers were located in three different offices: a controlled laboratory environment, an open-plan office, and an open-plan space with a timber interior. The construction workers worked in a timber space for three months and then moved to work in a building with a concrete structure. The analysis included descriptive statistics, t-tests, ANOVA, and linear regression to compare differences between office settings and assess the relationship between environmental variables and overall satisfaction in IEQ, comfort, productivity, and health. In office workers, in terms of building image, thermal comfort, and artificial lighting, the data analysis revealed significant differences in occupants’ satisfaction levels between office settings. However, the low number of participants affected the results, and some factors were not found significant in relation to the office setting. Among tradespeople, there was no relationship between the building environment and productivity, health, or comfort. However, the results of hair cortisol testing indicated that working in a timber space can decrease the level of cortisol (stress) and have an impact on the productivity of workers. Such occupant’s perspective research is pivotal to informing policy makers, developers, business owners, construction professionals, timber industry stakeholders, environmentalists, and researchers in their decision-making processes. Fostering the future widespread adoption and advancement of mass timber construction.

Psychometric Properties of the EQ-5D-5L in Patients with Alopecia Areata.

For many decision makers in Health Technology Assessment the EQ-5D-5L is the standard measure of health-related quality of life (HRQL). However, evidence has shown the limitations of the measure in certain disease areas, including dermatology. Alopecia areata (AA) is associated with a significant HRQL impact, partly due to the emotional impact of hair loss. This study explores the psychometric properties of the EQ-5D-5L in people with AA in reference to the short-form 36 version 2 (SF-36v2), the Alopecia Areata Patient Priority Outcomes (AAPPO), the Severity of Alopecia Tool (SALT) and the Patient Global Impressions of Change (PGI-C). Data from participants with AA enrolled in the ALLEGRO-2b/3 trial (NCT03732807) of ritlecitinib were analysed. Participants completed the AAPPO measure (an AA-specific measure assessing emotional symptoms and activity limitations), PGI-C, EQ-5D-5L and SF-36v2 across 48-weeks of follow up. Extent of scalp hair loss was assessed using the SALT. Ceiling effects, known groups validity, convergent validity and responsiveness were examined. Known groups were defined by SALT score and a PGI-C defined response from baseline. Exploratory factor analysis was also performed. Data were available from 612 adult participants. Ceiling effects were observed for the EQ-5D-5L (55.3-61.2%) and analyses suggested that the EQ-5D did not capture important differences between patients that the SF-36v2 did. The EQ-5D-5L very weakly correlated with SALT score, whereas the AAPPO correlated more strongly with the extent of hair loss. Compared with the EQ-5D-5L, the AAPPO was better able to discriminate between known groups defined by SALT and PGI-C. An exploratory factor analysis suggested that the EQ-5D-5L had limitations in content validity compared with the AAPPO. The EQ-5D-5L may not adequately measure the burden of AA on patients' HRQL. Insensitivity to the burden of AA suggests that the EQ-5D-5L may not measure treatment-related benefit with hair regrowth. Data from other measures could be considered if they are shown to be more relevant.

Personalized, parcel-guided non-invasive transcranial magnetic stimulation for the treatment of post-concussive syndrome: safety and proof of concept

ABSTRACT Objective To determine the safety and proof of concept of a parcel-guided, repetitive Transcranial Magnetic Stimulation (rTMS) in patients who develop a heterogeneous array of symptoms, known collectively as post-concussive syndrome (PCS), following traumatic brain injury (TBI). Methods We performed a retrospective review of off-label, individualized, parcel-guided rTMS in 19 patients from December 2020 to May 2023. Patients had at least one instance of mild, moderate, or severe TBI and developed symptoms not present prior to injury. rTMS targets were identified based on machine learning connectomic software using functional connectivity anomaly matrices compared to healthy controls. EuroQol (EQ-5D), as a measurement of quality of life, and additional questionnaires dependent on individual’s symptoms were submitted prior to, after, and during follow-up from rTMS. Results Nineteen patients showed improvement in EQ-5D and Rivermead Post Concussion Symptoms Questionnaires − 3 after treatment and follow-up. For nine patients who developed depression, five (55%) attained response and remission based on the Beck Depression Inventory after treatment. Eight of ten patients with anxiety had a clinically significant reduction in Generalized Anxiety Disorder-7 scores during follow-up. Conclusion Parcel-guided rTMS is safe and may be effective in reducing PCS symptoms following TBI and should incite further controlled studies.

Carrot strips of various origins: Impact on acrylamide formation in baked goods

The study explored the effects of varied qualities of carrot strips (Q1, Q2) with similar market specification, water addition (56.5–67.8 g/100 g flour) and carrot quantities (7.5–22.5 g/100 g flour) on AA concentrations in wheat bread crumb and crust and baking quality. Analyses included reducing sugars (HPAEC–PAD) and free asparagine (HPLC) levels in doughs as well as acrylamide (HPLC-MS/MS) in crumbs and crusts and baking quality measures. Bread crusts with Q1 reached AA levels of 142 ± 13 μg/kg and significant values in the crumbs (40.8 ± 6.7 μg/kg), whereas bread crusts with Q2 reached up to 274 ± 10 μg/kg and crumbs did not contain AA. With increasing dough water addition, a significant reduction in AA was visible in the case of carrots Q1 and a significant increase in crust AA for carrots Q2. Significant and positive correlation was observed between AA levels in crusts and the addition of carrot strips (rQ1 = 0.93, p < 0.001), whereas for the crust moisture and AA a significant and negative correlation was observed (rQ1 = −0.73, p < 0.01). The precursors in the dough were significantly influenced by the quantities and qualities of ingredients, while the AA formation depended on the quality of the carrot strips and the amount of water added.

A Blockchain-Driven Smart Broker for Data Quality Assurance of the Tagged Periodic IoT Data in Publisher-Subscriber Model

The Publisher-Subscriber model of data exchange has been a popular method for many Internet-based applications, including the Internet of Things (IoT). A traditional PS system consists of publishers, subscribers, and a broker. The publishers create new data for a registered topic, and the data broker relays the data to the corresponding subscribers. This paper introduces a blockchain-based smart broker for the publisher-subscriber (PS) framework for the IoT network. As IoT data comes from devices operating in various environments, it may suffer from multiple challenges, such as hardware failures, connectivity issues, and external vulnerabilities, thereby impacting data quality in terms of accuracy and timeliness. It is important to monitor this data and inform subscribers about its quality. The proposed smart broker is composed of multiple smart contracts that continuously monitor the quality of the topic data by assessing its relationship with other related topics and its drift or delay in publishing intervals. It assigns a reputation score to each topic computed based on its quality and drifts, and it passes both the original data and the reputation score as a measure of quality to the subscriber. Furthermore, the smart broker can suggest substitute topics to subscribers when the requested topic data are unavailable or of very poor quality. The evaluation shows that a smart broker efficiently monitors the reputation of the topic data, and its efficiency increases notably when the data quality is worse. As the broker is run inside the blockchain, it automatically inherits the advantages of the blockchain, and the quality scoring is indisputable based on immutable data.

A Blockchain-Driven Smart Broker for Data Quality Assurance of the Tagged Periodic IoT Data in Publisher-Subscriber Model

The Publisher-Subscriber model of data exchange has been a popular method for many Internet-based applications, including the Internet of Things (IoT). A traditional PS system consists of publishers, subscribers, and a broker. The publishers create new data for a registered topic, and the data broker relays the data to the corresponding subscribers. This paper introduces a blockchain-based smart broker for the publisher-subscriber (PS) framework for the IoT network. As IoT data comes from devices operating in various environments, it may suffer from multiple challenges, such as hardware failures, connectivity issues, and external vulnerabilities, thereby impacting data quality in terms of accuracy and timeliness. It is important to monitor this data and inform subscribers about its quality. The proposed smart broker is composed of multiple smart contracts that continuously monitor the quality of the topic data by assessing its relationship with other related topics and its drift or delay in publishing intervals. It assigns a reputation score to each topic computed based on its quality and drifts, and it passes both the original data and the reputation score as a measure of quality to the subscriber. Furthermore, the smart broker can suggest substitute topics to subscribers when the requested topic data are unavailable or of very poor quality. The evaluation shows that a smart broker efficiently monitors the reputation of the topic data, and its efficiency increases notably when the data quality is worse. As the broker is run inside the blockchain, it automatically inherits the advantages of the blockchain, and the quality scoring is indisputable based on immutable data.

Accelerated High-Resolution Deep Learning Reconstruction Turbo Spin Echo MRI of the Knee at 7 T.

The aim of this study was to compare the image quality of 7 T turbo spin echo (TSE) knee images acquired with varying factors of parallel-imaging acceleration reconstructed with deep learning (DL)-based and conventional algorithms. This was a prospective single-center study. Twenty-three healthy volunteers underwent 7 T knee magnetic resonance imaging. Two-, 3-, and 4-fold accelerated high-resolution fat-signal-suppressing proton density (PD-fs) and T1-weighted coronal 2D TSE acquisitions with an encoded voxel volume of 0.31 × 0.31 × 1.5 mm3 were acquired. Each set of raw data was reconstructed with a DL-based and a conventional Generalized Autocalibrating Partially Parallel Acquisition (GRAPPA) algorithm. Three readers rated image contrast, sharpness, artifacts, noise, and overall quality. Friedman analysis of variance and the Wilcoxon signed rank test were used for comparison of image quality criteria. The mean age of the participants was 32.0 ± 8.1 years (15 male, 8 female). Acquisition times at 4-fold acceleration were 4 minutes 15 seconds (PD-fs, Supplemental Video is available at http://links.lww.com/RLI/A938) and 3 minutes 9 seconds (T1, Supplemental Video available at http://links.lww.com/RLI/A939). At 4-fold acceleration, image contrast, sharpness, noise, and overall quality of images reconstructed with the DL-based algorithm were significantly better rated than the corresponding GRAPPA reconstructions (P < 0.001). Four-fold accelerated DL-reconstructed images scored significantly better than 2- to 3-fold GRAPPA-reconstructed images with regards to image contrast, sharpness, noise, and overall quality (P ≤ 0.031). Image contrast of PD-fs images at 2-fold acceleration (P = 0.087), image noise of T1-weighted images at 2-fold acceleration (P = 0.180), and image artifacts for both sequences at 2- and 3-fold acceleration (P ≥ 0.102) of GRAPPA reconstructions were not rated differently than those of 4-fold accelerated DL-reconstructed images. Furthermore, no significant difference was observed for all image quality measures among 2-fold, 3-fold, and 4-fold accelerated DL reconstructions (P ≥ 0.082). This study explored the technical potential of DL-based image reconstruction in accelerated 2D TSE acquisitions of the knee at 7 T. DL reconstruction significantly improved a variety of image quality measures of high-resolution TSE images acquired with a 4-fold parallel-imaging acceleration compared with a conventional reconstruction algorithm.

Strawberry field trial in Australia demonstrates improvements to fruit yield and quality control conformity, from application of two biostimulant complexes

ABSTRACT Strawberry (Fragaria x ananassa) is a popular fruit consumed for its desirable flavour, aroma and colour and is considered a functional food due to its antioxidant properties. Noting the need for farmers to increase productivity to meet increasing consumer demands, this study aimed to explore the potential of biostimulants to enhance strawberry cultivation. Herein, a field trial was conducted on a commercial strawberry farm, wherein 1944 strawberry plants received fertigation supplementation with either a control solution (nutrients only) or nutrients combined with one of two biostimulant complexes (BCs). Biostimulant complex 1 (BC1) was composed of molasses, Aloe vera extract and fish-hydrolysate, and biostimulant complex 2 (BC2) was composed of potassium silicate and potassium phosphite. Results indicated that BC1 maintained total yields but increased the sellable proportion and decreased the proportion of waste. In contrast, BC2 increased total yields with both sellable yields and waste increased. No significant changes were observed for indicators of consumer preference (flavour, aroma and fruit colour), however, on-average large increases were observed to indicators of fruit antioxidant properties (phenolic and flavonoid content). Accordingly, these results support the utilisation of biostimulants as a strategy to improve strawberry on-farm productivity without compromising consumer quality measures.