Quality Measures Research Articles

Treatment outcomes in the inpatient management of severe functional neurological disorder: a retrospective cohort study

BackgroundFunctional neurological disorder (FND) is a heterogeneous condition; severe forms can be disabling. Multidisciplinary treatment and rehabilitation are recommended for severe FND, but there remains a lack of evidence for...

Associations between pain, function and quality of life after total hip arthroplasty

ObjectivesThis study investigated patient reported outcomes, and associations with improvement in quality of life 12-months after total hip arthroplasty (THA). Materials and MethodsParticipants were adults (n = 433) undergoing THA for osteoarthritis between January 2017 and October 2020 in a large publicly funded tertiary hospital in [country]. Participants completed patient reported outcome measures of pain, function and quality of life (QOL) preoperatively, 6- and 12-months following THA. ResultsClinically significant changes in domains of pain and function were associated with improved QOL, even when pre-operation scores were controlled for. The largest gains in all three domains occurred in the pre- to 6-month post-operation period. Baseline demographic variables such as gender and comorbidities were not associated with change in QOL pre- to post-operation. However, although modest, age at surgery was negatively correlated with change in QOL. ConclusionsTHA contributes to substantial improvements in QOL, pain and function outcomes, and although possibly tempered by age, these relationships are likely to be inter-related and mutually reinforcing. Future QOL outcomes research should also consider the impacts on QOL improvement of other aspects of functioning such as psychological and social wellbeing.

Identifying the fate of dissolved organic matter in wastewater treatment plant effluent-dominated urban river based on fluorescence fingerprinting and flux budget approach

Effluent organic matter from wastewater treatment plants (WWTPs) is an important source of dissolved organic matter (DOM) in urban rivers worldwide and is an important water quality factor. Identifying the fate of DOM in urban river is crucial for water quality management. To address this concern, a fluorescent flux budget approach was conducted to probe the fate of DOM in WWTP effluent-dominated urban river, in combination with field measurement and fluorescence fingerprinting. An urban river receiving two WWTP effluents in Hefei City, China was chosen as the study site, where longitudinal measurements of river hydrology and water quality were performed. The fluorescence fingerprinting revealed the presence of two humic-like components (C1, C4), one fulvic-like component (C2) and one protein-like component (C3) in this investigated river, among which C2 and C4 were indicative of anthropogenic influences, closely associated with treated effluents. For each fluorescent component, the WWTP effluent contributed over 80 % of the total fluorescent dissolved organic matter (FDOM) input in this river. Using the developed FDOM flux budget model, it was found that the C1 and C3 were almost conserved within the waterbody, while the C2 and C4 experienced losses due to biogeochemical reactions. The decay rates of C2 and C4 were estimated to be 0.109–0.174 d−1 and 0.096–0.320 d−1, respectively. Spatial heterogeneity of decay rates for C2 and C4 were associated with the varied chemistries of the lateral input sources including two treated effluents and one tributary flow. Our study highlights that after treated effluent is released into the receiving waterbody, the FDOM would undergo loss from the waters particularly for anthropogenic fulvic-like substance C2 and humic-like substance C4. Additionally, the quantified FDOM decay rate in actual urban water environment provides insights for river water quality management, especially when using DOM as the surrogate indicator of organic pollutants.

On the ability of the SF-6D to capture the consequences of chronic illnesses on subjective well-being: Evidence from France

Using cross-sectional data from a representative sample of the French population (the 2008 Disability Health survey), this paper examines whether the SF-6D, a widely used preference-based measure of health-related quality of life in economic evaluations, fully captures the variation in subjective well-being (SWB) due to chronic illnesses. We conduct a mediation analysis to disentangle the direct and indirect, through the SF-6D, effects of various chronic conditions on SWB (happiness). Our results show that the SF-6D reflects changes in happiness due to most illnesses except mental illness. Changes in SWB mediated by the SF-6D account for 74% of the total effect. The variation unexplained by the SF-6D is significant and increases substantially in the presence of multimorbidity, when a chronic illness is combined with anxiety or depression. Overall, our results suggest that the SF-6D incompletely captures the subjective experience of chronically ill patients especially, those with comorbid conditions.

Relationship Between Sleep Quality and Quality of Life: Analysis of Hepatocellular Carcinoma Survivors.

We analyzed the correlation between the Pittsburgh Sleep Quality Index (PSQI) subcategories (sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, sleep medications, and daytime dysfunction) and a comprehensive measure of quality of life (QOL), the 36-Item Short Form Survey (SF-36) items, in patients with hepatocellular carcinoma (HCC) to determine the components that require intervention to improve QOL. A total of 75 patients with recurrent HCC admitted to our hospital between May 2021 and May 2023 were included in this study. The QOL score was used for the SF-36 items, and the sleep disorder score was used for PSQI questionnaires. Correlations were found between sleep quality, sleep disturbance, and SF-36 for all QOL items and between sleep onset time and SF-36 for six QOL items: bodily pain, mental health, physical functioning, role-emotional, role-physical, and vitality. Correlations between daytime dysfunction and SF-36 were found for all QOL items, except for physical functioning. No correlation was found between sleep duration, sleep efficiency, sleep medications, and SF-36 for any QOL item. Sleep duration, sleep efficiency, and sleep medications may not contribute to QOL improvement in patients with HCC and sleep disturbances. Factors that improve sleep quality and sleep difficulty may contribute to QOL improvement. Therapeutic interventions aimed at improving general health and social functioning for sleep latency and physical functioning for daytime arousal difficulty are required.

Using ChatGPT for Kidney Transplantation: Perceived Information Quality by Race and Education Levels.

Kidney transplantation is a complex process requiring extensive preparation and ongoing monitoring. Artificial intelligence (AI)-powered chatbots hold potential for providing accessible health information, but our understanding of their role in offering health advice for kidney transplantation and how individuals assess such advice remains limited. This study investigates how individuals evaluate ChatGPT's responses to kidney transplantation questions in terms of information quality and empathy, focusing on potential differences across race/ethnicity and educational backgrounds. We collected Reddit posts (N=4624) regarding kidney transplantation and selected 86 questions to represent typical clinician inquiries. These questions were used as input prompts for ChatGPT. A total of 565 participants assessed ChatGPT's responses through online surveys, rating information quality and empathy using Likert scales. Multilevel analyses (N=2825) show that there is a significant interaction between race/ethnicity and education levels in various measures related to perceived information quality, but not perceived empathy of ChatGPT's responses: accuracy (p<0.05); authenticity (p<0.01); believability (p<0.05); informativeness (p=0.053); usefulness (p<0.05); recognizing users' feelings (p=0.70) and understanding feelings and situations (p=0.65). Among non-White individuals, higher education levels predicted higher perceived quality of ChatGPT's responses across all information quality measures. Notably, this trend was reversed for White individuals, where higher education levels led to lower perceived information quality. Our results highlight the importance of developing AI tools sensitive to diverse communication styles and information needs.

Malnutrition management and the application of medical nutrition therapy in hospitalized patients at the end of life

Objectives(1) To determine the prevalence of malnutrition risk in hospitalized patients at the end of life (EOL), (2) to evaluate which nutritional interventions are administered in hospitalized end-of-life patients with malnutrition risk and (3) to assess the association of end-of-life care and the administration of medical nutrition therapy in patients with malnutrition risk. DesignCross-sectional multi-center study SettingHospital ParticipantsHospitalized adult patients MeasurementsBased on the valid and reliable questionnaire of the Nursing Quality Measurement 2.0 (LPZ), the parameters of demographic data, medical diagnoses, end-of-life phase, care dependency, malnutrition risk according to the Malnutrition Universal Screening Tool (MUST) and nutritional interventions conducted in patients at risk of malnutrition were assessed. Descriptive statistics and statistical tests were conducted. Logistic regression models were established to identify odds ratios (OR) and confidence intervals (CI) for the association of end-of-life care and the provision of medical nutrition therapy. This was done separately for oral nutritional supplements (ONS), enteral nutrition and parenteral nutrition as the respective dependent variables. ResultsOf all 12,947 participants, 706 (5.5%) were in an end-of-life phase. The prevalence of malnutrition risk in end-of-life patients was 41.1% compared to 24.7% in other patients (p < 0.001). End-of-life patients with malnutrition risk received more nutritional interventions than other patients with malnutrition risk. The regression models showed that being at the end of life (CI 1.30, 2.63; p < 0.001), being treated by a dietitian (OR 6.02; CI 4.86, 7.45; p < 0.001), suffering from dementia (OR 1.85; CI 1.10, 3.12; p = 0.02) or cancer (OR 1.56; CI 1.25, 1.96; p < 0.001) increased the chance of receiving oral nutritional supplements. For receiving parenteral nutrition, being at the end of life (OR 1.68; CI 1.04, 2.71; p = 0.04), being treated by a dietitian (OR 5.80; CI 4.07, 8.25; p < 0.001), surgery within the previous two weeks (OR 1.58; CI 1.09, 2.30; p = 0.02), younger age (OR 0.99; CI 0.98, 1.00; p = 0.04), care dependency (OR 0.97; CI 0.96, 0.98; p < 0.001), suffering from a disease of the digestive system (OR 2.92; CI 2.07, 4.11; p < 0.001) or cancer (OR 2.44; CI 1.71, 3.49; p < 0.001) were independent predictors. Being at the end of life did not influence the application of enteral nutrition. ConclusionThis study showed that nutritional interventions are often applied in end-of-life patients admitted to general hospitals. Being at the end of life was positively associated with the application of oral nutritional supplementation and parenteral nutrition. This data does not allow a conclusion about the appropriateness of using medical nutrition therapy in this study sample. Judging the appropriateness of medical nutrition therapy at the end of life is challenging because of the high variability of prognostication as well as the wishes and needs of the specific patients and their relatives that influences the appraisal of adequate interventions. Every decision about nutrition and hydration in end-of-life patients should be a shared decision and be based on advanced care planning principles.

Back-propagation ANN to Predict Cleanliness and Quality of Cotton Spinning Preparatory Output: A Comprehensive Research

Background: Modern spinning preparatory has undergone drastic technological changes, but still, individual’s expertise-based decisions govern the complex and non-linear multivariant relationships prevailing amongst raw material (cotton) variables, machine variables, process variables (waste), and product (card sliver) quality. The scientifically precise prediction regarding the cleanliness and quality of card sliver and waste control for the given inputted cotton variables processed on the state-of-the-art machinery setup without waiting for the production and testing of card sliver is still impossible. Methods: The present work describes the use of Aritificial Neural Networks (ANN) for ruling out these limitations on scientific grounds. A complex system targeted at ANN was developed using the "newff" function on the mill's five-year database. Single-group ANN was initially designed to determine the influence of inherent variations in raw cotton fibre properties and trash content on blow room and card performance. A multi-group approach of ANN was developed at a later stage to define the influence of complex interactions amongst various fibre properties on three main quality measures considered at blow room and carding, viz., i) influence of blow room and card on fibre length properties, ii) fibre damage at blow room or improvement at card, and iii) degree of cleanliness of the output material. Results: Reverse modelling for both groups was also successfully designed to demarcate feed cotton quality and cleanliness requirements for targeted blow room or card cleaning performance. Conclusion: A high level of positive endurance was observed for all ANNs. Multigroup networking has proven to be more precise than single group networking.

Subtrochanteric Femur Fractures: The Association Between Obesity and Perioperative, Clinical, and Radiographic Outcomes.

To evaluate the association between obesity and treatment approaches, perioperative factors, and clinical and radiographic outcomes following subtrochanteric fracture fixation. Retrospective Cohort. Academic Medical Center. Patients operatively treated for an AO/OTA 32Axa, 32Bxa, or 32Cxa subtrochanteric femur fracture. Injury characteristics, perioperative parameters, fixation information, postoperative complications, and clinical and radiographic outcomes. Univariate analyses were conducted between the obese (BMI ≥30 kg/m2) and the nonobese (BMI <30 kg/m2) cohorts. Regression analyses were performed to assess BMI as a continuous variable. Of 230 operatively treated subtrochanteric fracture patients identified, 49 (21%) were obese and 181 (79%) were nonobese. The average age of the obese cohort was 69.6 ± 17.2 years, with 16 (33%) male and 33 (77%) female. The average age of the nonobese cohort was 71.8 ± 19.2 years, with 60 (33%) male and 121 (77%) female. Aside from BMI, there were no significant differences in demographics between the obese and nonobese (age [P = 0.465], sex [P = 0.948], American Society of Anesthesiology Score [P = 0.739]). Both cohorts demonstrated similar injury characteristics including mechanism of injury, atypical fracture type, and AO/OTA fracture pattern (32A, 32B, 32C). Obese patients underwent more open reduction procedures (59% open obese, 11% open nonobese, P < 0.001), a finding further quantified by a 24% increased likelihood of open reduction for every 1 unit increase in BMI (OR: 1.2, 95% CI, 1.2-1.3, P < 0.001). There was no difference in average nail diameter, 1 versus 2-screw nail design, or number of locking screws placed. The obese cohort was operated more frequently on a fracture table (P < 0.001) when compared with the nonobese cohort that was operated more frequently on a flat table (P < 0.001). There were no significant differences (P > 0.050) in postoperative complications, mortality/readmission rates, hospital quality measures, fixation failure, or time to bone healing. The treatment of subtrochanteric fractures in obese patients is associated with a higher likelihood of surgeons opting for open fracture reduction and the use of different operating room table types, but no difference was observed in postoperative complications, mortality or readmission rates, or healing timeline when compared with nonobese patients. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Design of a Frequency Controller System for UHF Radio Wave Receiver Device

Design of a Frequency Controller System for UHF Radio Wave Receiver Device

The role of accelerometer-derived sleep traits on glycated haemoglobin and glucose levels: a Mendelian randomization study

Self-reported shorter/longer sleep duration, insomnia, and evening preference are associated with hyperglycaemia in observational analyses, with similar observations in small studies using accelerometer-derived sleep traits. Mendelian randomization (MR) studies support an effect of self-reported insomnia, but not others, on glycated haemoglobin (HbA1c). To explore potential effects, we used MR methods to assess effects of accelerometer-derived sleep traits (duration, mid-point least active 5-h, mid-point most active 10-h, sleep fragmentation, and efficiency) on HbA1c/glucose in European adults from the UK Biobank (UKB) (n = 73,797) and the MAGIC consortium (n = 146,806). Cross-trait linkage disequilibrium score regression was applied to determine genetic correlations across accelerometer-derived, self-reported sleep traits, and HbA1c/glucose. We found no causal effect of any accelerometer-derived sleep trait on HbA1c or glucose. Similar MR results for self-reported sleep traits in the UKB sub-sample with accelerometer-derived measures suggested our results were not explained by selection bias. Phenotypic and genetic correlation analyses suggested complex relationships between self-reported and accelerometer-derived traits indicating that they may reflect different types of exposure. These findings suggested accelerometer-derived sleep traits do not affect HbA1c. Accelerometer-derived measures of sleep duration and quality might not simply be ‘objective’ measures of self-reported sleep duration and insomnia, but rather captured different sleep characteristics.

600 years of wine must quality and April to August temperatures in western Europe 1420–2019

Abstract. This study investigates the validity of wine must quality as an April-to-August temperature proxy between 1420 and 2019 based on expert ratings and quality measurements from Germany, Luxembourg, eastern France, and the Swiss Plateau. This is highly relevant as uncertainties remain on past climate variations during this period. The evidence was reviewed according to the best practice of historical climatology. Expert ratings tended to agree with Oechsle density measurements that gradually replaced them from the 1840s. A statistical model calibrated to predict wine must quality from climate data explains 75 % of the variance, underlining the potential value of wine must quality as a climate proxy. Premium crops were collected in years of early harvest involving high insolation during maturation, while poor crops resulted from very late harvests in cold and wet summers. An analysis of daily weather types for high- and low-quality years after 1763 shows marked differences. On a decadal timescale, the average quality was highest from 1470 to 1479, from 1536 to 1545, and from 1945 to 1954. Poor crops were collected in periods with prevailing cold and wet summers such as 1453 to 1466, 1485 to 1494, 1585 to 1614, 1685 to 1703, 1812 to 1821, and 1876 to 1936. In the period of enhanced warming after 1990, high quality became the rule.

Studi Kualitas Fisis Air Sungai Leang Lonrong Kawasan Karst Pangkep Taman Nasional Bantimurung Bulusaraung

This research is an experimental research with a survey type aimed to analyse water quality of the Leang Lonrong River reviewed from smell, taste, Total Dissolved Solid (TDS), turbidity, temperature, color, clarity, and UV index, as well as to describe community activities as factors that influence the water quality of the Leang Lonrong River in its utilization. This study was carried out in the Region Tour Leang Lonrong in the Panaikang Village, Minasatene District, Pangkep Regency, which is one of part Pangkep Karst Area Bantimurung Bulusaraung National Park. In the study, the measurement of water quality for sanitary hygiene needs and public bath reviewed its physical parameters by Regulation Minister Health No. 32 of 2017. Obtained results study that physical parameters water of Leang Lonrong River for sanitary hygiene needs own quality that meets requirement, because the water no smells, no taste, has an average TDS of 6.44 mg/L, an average turbidity of 1.71 NTU, an average temperature of 24.14 °C, and average color 0 TCU. The water of Leang Lonrong River for necessity public bath is no fulfill appropriate water quality standard raw quality. This caused some parameters not to fulfill the standard, namely the parameter of clarity is an average of 0.136 meters deep and UV index parameters more than 3 on at 11:00 a.m and 1:00 p.m in Central Indonesia Time (WITA).

Information for Authors

The objective of this study was to examine a complex service environment-hospitals-to suggest how service quality could be reframed and measured for multiple-encounter service situations more effectively. In this cross-sectional study, a sample of 371 patients completed the survey instrument. Service quality measures were guided by the literature but allowed to flow from the respondents at the preliminary stage. Confirmatory factor analysis, along with structural equation modeling, was used to test the hypothesized relationships among key actors' performance metrics (KAPMs). Patient satisfaction is significantly influenced by perceived service quality based on KAPMs. For multiple-encounter services, service quality dimensions and measures ought to be tied to KAPMs. Primary actors-ie, doctors-need knowledge and skills about patient psychology, negotiation, handling difficult patients, and, importantly, "putting the customer first." Sensitivity training on such matters should be provided. The secondary actors are the nurses who have more frequent contact with the patients. Nurses need to be perceived as "patient advocates." Effective advocacy begins with prompt and caring services to build trust. The tertiary actors in their support role also ought to be integrated into becoming vital part of the service provided.

Correlation of Sperm DNA Fragmentation Index With Semen Parameters, Lifestyle and Clinical Pregnancy Outcome After Intracytoplasmic Injection.

This study aimed to measure the correlation of sperm DNA fragmentation with semen parameters, lifestyle, and fertility outcomes after intracytoplasmic injection (ICSI). The partners who were candidates for ICSI with a history of one In vitro fertilization (IVF) failure or male factor were recruited in the study. Semen parameters including sperm count, motility, and morphology as well as DNA fragmentation index (DFI) (that were divided into 2 groups as high (>15%), and low (≤15%) fragmentation scales) were evaluated either. The correlation of DFI with semen parameters, lifestyle, and clinical pregnancy after ICSI were compared between groups. In 120 included couples, 59 men (49.2%) had DFIs ≤ 15% and 61 (50.8%) cases had DFIs >15%. In the group with higher DFI, abnormal morphology (p=0.010) was higher whereas, progressive motility (p=0.001), total motility (p<0.001), and total count (p<0.001) of sperm were significantly lower. In addition, the DFI was significantly higher in the subgroup of male infertility (0.012). Logistic regression showed that a lower risk of DFI>15% was associated with higher values of progressive motility (OR=0.97, p=0.001), total motility (OR=0.96, p=<0.001), count (OR=0.96, p=<0.001) and even clinical pregnancy (OR=0.27, p=0.011). However, a history of testicular surgery was associated with a higher risk of DFI>15% (OR=3.37, p=0.046). Although no correlation was found between male age and lifestyle components with DFI, the number of embryos was lower in DFI≥15% (p<0.001). DFI provide a clinically important measurement of sperm quality and have an impact on IVF outcomes; however, lifestyle components may not correlate with DFI.

Habitat quality or quantity? Niche marginality across 21 plants and animals suggests differential responses between highland and lowland species to past climatic changes

Climatic changes can affect species distributions, population abundance, and evolution. Such organismal responses could be determined by the amount and quality of available habitats, which can vary independently. In this study, we assessed changes in habitat quantity and quality independently to generate explicit predictions of the species' responses to climatic changes between Last Glacial Maximum (LGM) and present day. We built ecological niche models for genetic groups within 21 reptile, mammal, and plant taxa from the Baja California peninsula inhabiting lowland or highland environments. Significant niche divergence was detected for all clades within species, along with significant differences in the niche breadth and area of distribution between northern and southern clades. We quantified habitat quantity from the distribution models, and most clades showed a reduction in distribution area towards LGM. Further, niche marginality (used as a measure of habitat quality) was higher during LGM for most clades, except for northern highland species. Our results suggest that changes in habitat quantity and quality can affect organismal responses independently. This allows the prediction of genomic signatures associated with changes in effective population size and selection pressure that could be explicitly tested from our models.

Risk factors for 30-day hospital readmission in patients with diabetic foot

IntroductionDiabetic foot (DF) is part of the natural history of diabetes mellitus, ulceration being a severe complication with a prevalence of approximately 6.3 %, which confers a significant economic burden. Hospital readmission in the first thirty (30) days is considered a measure of quality of healthcare and it's been identified that the most preventable causes are the ones that occur in this period. This study seeks to identify the risk factors associated with readmission of patients with DF. MethodsA case-control study was done by performing a secondary analysis of a database. Descriptive statistics were used for all variables of interest, bivariate analysis to identify statistically significant variables, and a logistic regression model for multivariate analysis. Results575 cases were analyzed (113 cases, 462 controls). A 20 % incidence rate of 30-day readmission was identified. Statistically significant differences were found in relation to the institution of attention (Hospital Universitario de la Samaritana: OR 1.9, p value < 0.01, 95 % CI 1.2–3.0; Hospital Universitario San Ignacio: OR 0.5, p value < 0.01, 95 % CI 0.3–0.8) and the reasons for readmission before 30 days, especially due to surgical site infection (SSI) (OR 7.1, p value < 0.01, 95 % CI 4.1–12.4), sepsis (OR 8.4, p value 0.02, 95 % CI 1.2–94.0), dehiscence in amputation stump (OR 16.4, p value < 0.01, 95 % CI 4.2–93.1) and decompensation of other pathologies (OR 3.5, p value < 0.01, 95 % CI 2.1–5.7). ConclusionThe hospital readmission rate before 30 days for our population compares to current literature. Our results were consistent with exacerbation of chronic pathologies, but other relevant variables not mentioned in other studies were the hospital in which patients were taken care of, the presence of SSI, sepsis, and dehiscence of the amputation stump. We consider thoughtful and close screening of patients at risk in an outpatient setting might identify possible readmissions.

Assessment of cone-beam CT technical image quality indicators and radiation dose for optimal STL model used in visual surgical planning.

The aim of this study was to identify cone-beam computed tomography (CBCT) protocols that offer an optimal balance between effective dose and 3D model for orthognathic virtual surgery planning, using CT as a reference, and to assess whether such protocols can be defined based on technical image quality metrics. Eleven CBCT (VISO G7, Planmeca Oy, Helsinki, Finland) scan protocols were selected out of 32 candidate protocols, based on effective dose and technical image quality measurements. Next, an anthropomorphic RANDO SK150 phantom was scanned using these 11 CBCT protocols and 2 CT scanners for bone quantity assessments. The resulting DICOM files were converted into STL models that were used for bone volume and area measurements in the predefined orbital region to assess the validity of each CBCT protocol for VSP. The highest CBCT bone volume and area of the STL models were obtained using normal dose protocol (F2) and ULD protocol (J13) which resulted in 48% and 96% of the mean STL bone volume and 48% and 95% of the bone area measured on CT scanners, respectively. The optimal normal dose CBCT protocol" F2" offered optimal bone area and volume balance for STL. The optimal CBCT protocol can be defined exhibited similar using CNR and MTF values that were similar with of those of the reference CT scanners'. CBCT scanner with selected protocols can offer a viable alternative to CT scanners for acquiring STL models for VSP at a lower effective dose.

Spatial quality measurement of commercial streets in old cities of medium-sized cities in China

ABSTRACT Chinese urban development has entered the stage of stock planning, and as an important part of urban public space, the construction of street space has a direct impact on urban development. High-quality street space contributes to sustainable urban development.High-quality street spaces are highly important for constructing vibrant and sustainable cities. Taking Jiaozuo city, a medium-sized city, as an example, this article establishes an evaluation index system for commercial street space quality from the aspects of external characterization and objective material space and uses the Pearson correlation coefficient to explore the influencing factors of urban commercial street space quality. This study finds that (1) crowd activities on commercial streets have different temporal and spatial patterns on weekdays and days off; (2) the external characterization of urban street space quality has a significant positive correlation with objective material spatial elements such as the density of public transportation stops, functional density, functional mixing, interface continuity, and spatial green visibility rate; (3) the enhancement of street accessibility and fine-tuning of functions are key to improving the spatial quality of commercial streets.This study provides theoretical basis and ideas for improving the spatial quality of commercial streets in medium-sized cities in China and promoting sustainable urban development.

Prevalence and early surgical outcome of congenital diaphragmatic hernia in the Netherlands: a population-based cohort study from the European Pediatric Surgical Audit

BackgroundCongenital diaphragmatic hernia (CDH) is a rare birth defect with substantial mortality. This study aims to generate a population-based overview of CDH care and outcomes in the Netherlands. Moreover, it...