Intelligent monitoring of coastal outfalls via multi-source remote sensing image fusion.

Dual Frontiers Cancer and Palliative Care.

Factors Affecting Textbook Outcomes for Colectomy for Diverticular Disease.

Integrated CPR coach and compressor training improves CPR quality in a pediatric emergency department.

Blood pressure (BP) control is a core quality metric in value-based care (VBC). The Healthcare Effectiveness Data and Information Set (HEDIS) Controlling High Blood Pressure (CBP) measure uses the final BP reading of the calendar year, a method that overlooks well-documented seasonal variation-BP declines in summer and rises in winter. We evaluated the impact of this pattern on measured performance in a large health system. We conducted a retrospective analysis of monthly BP control rates (July 2019 to December 2025) across the Jefferson Health-Lehigh ambulatory network, totaling 78 months and approximately 7.6 million patient-months. Summer (June to August) and winter (December to February) rates were compared using paired t-tests and ordinary least square regression with seasonal adjustment. Year-end performance was assessed using both the HEDIS final-reading (December rate) and a rolling Q4 average (October to December mean). Standard VBC quality improvement initiatives with Q4 intensification were in place. BP control rates were significantly higher in summer (75.2%; 95% confidence interval [CI]: 73.5%-77.0%) than winter (73.1%; 95% CI: 71.2%-75.1%), a 2.1-percentage-point difference (paired t = 5.13, P = 0.002). This pattern was consistent across all 7 years. Within-year peak-to-trough amplitude averaged 2.8 percentage points in nonpandemic years. The rolling Q4 average exceeded the December-only rate in all years, with differences of 0.06-0.59 percentage points, reclassifying 60-520 additional patients as controlled annually. Seasonal BP variation is robust and inadequately addressed by current quality measures. Multi-reading or seasonally adjusted methods would improve measurement accuracy and fairness. Engagement with NCQA and CMS to pilot redesigned measures is recommended.

The submental artery pedicled flap for peri-auricular and parotid reconstruction: a comparative cohort.

Paganin's method for image reconstruction in propagation-based phase-contrast X-ray imaging and tomography has enjoyed broad acceptance in recent years, with over one thousand publications citing its use. The present paper discusses approaches to optimisation of the method with respect to simple image quality metrics, such as signal-to-noise ratio and spatial resolution, as well as a reference-based metric corresponding to the relative mean squared difference between the reconstructed image and the 'ground truth' image that would be obtained in a setup with perfect spatial resolution and no noise. The problem of optimisation of the intrinsic regularisation parameter of Paganin's method with respect to spatial resolution in the reconstructed image is studied in detail. It is also demonstrated that a combination of Paganin's method with a Tikhonov-regularised deconvolution of the point-spread function of the imaging system can provide significantly higher image quality compared to the standard version of the method. Analytical expressions for some relevant image quality metrics are obtained and compared with results of numerical simulations. Advantages and shortcomings of optimisation approaches using a number of different image quality metrics are discussed. The results of this study are expected to be useful in practical X-ray imaging and in training of machine learning models for image denoising and segmentation.

In-hospital stroke is associated with delayed recognition and worse outcomes compared with community-onset stroke. Contemporary national data in the mechanical thrombectomy (MT) era are limited. We performed a retrospective cohort study of adult ischemic stroke admissions in the Get With The Guidelines-Stroke registry from January 2016 to December 2023 (the MT era). In-hospital stroke was compared with community-onset stroke as the primary analysis. A secondary descriptive analysis comparing in-hospital patients with stroke from January 2006 to April 2012 and January 2016 to December 2023 was also performed. Primary outcomes were in-hospital mortality, discharge home, and independent ambulation at discharge. Multivariable logistic regression with generalized estimating equations accounted for within-hospital clustering and adjusted for demographics, vascular risk factors/comorbidities, and hospital characteristics. Temporal trends in MT use were assessed with the Cochran-Armitage trend test. Among 4 996 392 ischemic stroke admissions from 2016 to 2023, 191 355 (3.8%) were in-hospital, and 4 805 037 (96.2%) were community onset. In-hospital patients presented with greater severity (National Institutes of Health Stroke Scale score >20: 14.5% versus 7.9%; National Institutes of Health Stroke Scale score, 0-4: 43.3% versus 60.4%) had worse outcomes including higher in-hospital mortality (adjusted odds ratio, 2.27 [95% CI, 2.18-2.36]; P<0.001), lower likelihood of discharge home (adjusted odds ratio, 0.46 [95% CI, 0.45-0.48]; P<0.001), and lower independent ambulation at discharge (adjusted odds ratio, 0.52 [95% CI, 0.50-0.53]; P<0.001). Recognition-to-computed tomography time was longer for in-hospital (median 51 [interquartile range, 16-269] versus 18 [10-39] minutes; P<0.001). MT rates increased significantly from 2016 to 2023 in both in-hospital and community-onset patients (4.47%-9.54% and 2.35%-5.55%, respectively; P<0.001). Quality metrics and outcomes significantly improved in the MT era, independent of treatment modality. In patients with in-hospital stroke, MT rates increased over time, and improvements in quality metrics were observed regardless of treatment modality. A higher level of stroke severity and worse outcomes persists.

Three unbiased anisotropic diffusion filtering models with optimized parameters for Rician noise removing in MR images.

The temporal dynamics of shot quality in elite football remain poorly understood, despite well-documented declines in physical and technical performance during matches. This study aimed to analyze the evolution of advanced shot metrics across match halves and 15 min intervals in elite men’s and women’s international competitions. A total of 4074 shots from the UEFA European Championships were examined. To ensure methodological consistency among the three advanced shooting metrics (expected goals, xG; expected shot impact timing, xSIT; and expected goals on target, xGOT), analyses were restricted to shots on target (men: 775; women: 554), as xGOT can only be calculated for on-target attempts. Shot quality was assessed using xG, xSIT and xGOT. Differences between halves were evaluated using the Mann–Whitney U test, while temporal trends were analyzed through linear mixed-effects models. Results showed no significant differences between halves in shot distribution or quality metrics in either competition (all p &gt; 0.05). Likewise, no significant temporal variations were found across the six match intervals for any metric. Women’s football exhibited a largely stable quality of shots on target throughout the match. In men’s competitions, although a significant difference in xG was observed (p = 0.04, effect sizes were trivial (d = −0.17), and no consistent patterns emerged in xSIT or xGOT. No sex-related differences were observed. Overall, shot quality remained stable despite match progression, suggesting that changes in goal frequency are not driven by variations in the intrinsic quality of shooting opportunities. Therefore, these findings suggest that optimizing the contextual conditions that facilitate the creation of shooting opportunities may be as important as, or more important than, focusing solely on shooting execution.

High-fidelity three-dimensional reconstruction of musculoskeletal tissues via diffusion based ultrasonic computed tomography.

The Special Programme for Research and Training in Tropical Diseases (TDR), co-sponsored by WorldHealthOrganization, United Nations Children's Fund, United Nations Development Programme, and the World Bank, launched the Clinical Research and Development Fellowship (CRDF) in 1999 to strengthen clinical research capacity in low- and middle-income countries (LMICs). Despite sustained investment, evidence on the longer-term scientific outcomes of such programmes remains limited. This study evaluated the scientific outcomes of the CRDF programme (1999-2021) using bibliometric analysis of fellows' peer-reviewed publications before and after their fellowship. A retrospective bibliometric analysis was conducted on peer-reviewed publications authored by CRDF fellows from 1999 through 2021. Publication data were retrieved from Open Researcher and Contributor ID profiles and verified using PubMed, Google search, and Google scholar. A retrospective bibliometric analysis was conducted using descriptive and comparative statistical methods to evaluate publication productivity, authorship position, journal quality metrics, collaboration patterns, disease focus, and research themes before and after fellowship participation. Analyses were conducted using R statistical software. Scientific outcome of the fellowship was judged based on the evolution of collaboration network, journal metrics, and seniority in authorship. Among 128 fellows, 76 had verifiable publications, contributing a total of 1821 peer-reviewed articles. Publications were predominantly produced after fellowship participation (1309; 71.9%), compared with 512 pre-fellowship publications. Median publications per fellow increased from 5 [interquartile range (IQR): 2-10] before the fellowship to 14 (IQR: 8-28). The proportion of first-author publications declined (30.7-19.2%), while last-author publications increased (8.0-11.0%), suggesting progression toward senior research roles. Journal quality improved, with publications in Q1 journals increasing from 66.6 to 71.3%, and the median impact factor rising from 2.8 (IQR: 1.9-3.9) to 3.4 (IQR: 2.6-4.9). North-South collaborations increased substantially after the fellowship, while South-South collaborations grew modestly. Participation in the CRDF programme was associated with a visible increase in research productivity, publication quality, and international collaboration among fellows. Research output aligned closely with infectious diseases of poverty and evolving global health priorities. While the collaboration network expanded, leadership as gauged by the evolution of authorship position remained constrained, highlighting the need for continued investment in research leadership development. Bibliometric analysis offers a useful approach for examining longer-term scientific outcomes of capacity-strengthening initiatives, while recognizing its limitations in capturing broader policy and societal impacts.

Preeclampsia information on social media: A cross-sectional analysis of content, quality, and reliability.

Inverse planning is often used for Gamma Knife radiosurgery, allowing clinicians to mathematically specify desired clinical objectives and dose limits. The objectives are controlled by weights that are manually tuned to find the desired trade-off, which varies from case to case. Automation of this process can reduce clinical workload and improve consistency in plan quality. To train a deep reinforcement learning agent using a reward function that incorporates the clinical metrics from past plans into its scoring criteria. The metric trade-off from the clinical plan is scored higher than all others, guiding the agent to produce plans with similar trade-offs. An agent was trained to adjust the two priority weights (i.e., digital slider bars) in the clinical inverse planner. The agent consists of a neural network that receives the metrics and dose distribution of the current plan and the target and organ-at-risk masks as inputs. These methods were demonstrated on a dataset of 204 single-target metastases and a dataset of 71 acoustic neuroma cases. The cases were split into training, validation, and testing sets of size 123/41/40 and 42/14/15 for the metastases and acoustic neuromas, respectively. On the metastases test dataset, the agent achieved a significantly higher (p=0.0136) average plan score (3.925±0.130) compared to the default slider plans (3.874±0.147). On the acoustic neuromas test dataset, the agent achieved a higher (p=0.4493) average plan score (4.035±0.177) compared to the default slider plans (3.995±0.365). The higher plan scores are reflected in the four plan quality metrics: the agent's plans, on average, had metrics more similar to the clinical plans, compared to the default slider plans, for both test datasets. The proposed reward function enabled the agent to learn to find plans that aligned with historical planning decisions. Future work will investigate providing the agent with additional inputs that can explain the variability in planning decisions, which would further improve its performance.

To assess whether improvements in transurethral resection of bladder tumour (TURBT) quality achieved during the RESECT international study (ClinicalTrials.gov identifier: NCT05154084) were sustained over time following completion of the programme at our institution and to investigate their effect on disease recurrence. We conducted a prospective, observational monocentric cohort study at a tertiary university hospital. A total of 128 consecutive patients undergoing TURBT between March 2023 and June 2025 and meeting RESECT eligibility criteria were analysed. Four pre-defined surgical quality indicators-detrusor muscle sampling, completeness of resection, accuracy of operative documentation, and administration of single immediate intravesical chemotherapy (SI-IVC)-were compared across three institutional phases: pre-audit, prospective audit and post-audit RESECT periods. Recurrence-free survival (RFS) at follow-up was evaluated by cystoscopy and histological confirmation with TURBT. Detrusor muscle presence improved from 61.9% in the pre-audit phase to 70.7% during the prospective audit and 85.9% post-audit (P < 0.001). Completeness of resection documentation increased from 88.4% to 96.3% and 97.6%, respectively (P < 0.001), while documentation accuracy remained high across all phases (93.2%, 96.3%, and 96.1%). SI-IVC use rose from 0% in the first two phases to 25% after audit closure. Despite these improvements, RFS did not differ significantly between phases. Participation in a service-wide audit and feedback programme resulted in sustained improvements in TURBT surgical quality indicators after programme completion. This did not yield a detectable reduction in recurrence, highlighting the multifactorial nature of oncological outcomes in non-muscle-invasive bladder cancer. Further studies are required to identify which quality metrics most strongly influence long-term prognosis.

A substantial proportion of esophageal adenocarcinoma (EAC) and high-grade dysplasia (HGD) cases in Barrett's esophagus (BE) are diagnosed after a dysplasia-negative endoscopy before the next recommended surveillance interval. These are classified as postendoscopy esophageal carcinoma (PEEC) or postendoscopy esophageal neoplasia (PEEN) and represent critical failures of BE surveillance. This review summarizes current definitions, epidemiology, potential etiologies, and evolving strategies to reduce PEEC/PEEN and improve the quality of BE surveillance. High-quality endoscopic examination using high-definition white-light endoscopy (HD-WLE) and virtual chromoendoscopy (CE), adherence to the Seattle biopsy protocol, adequate inspection time, and training in the recognition of visible lesions harboring prevalent dysplasia/EAC, are critical in reducing PEEC/PEEN. Initial data on the use of adjunctive tools (wide-area transepithelial sampling) and molecular biomarkers (p53, DNA methylation panels, and Tissue Systems Pathology tests) demonstrate promising results for detecting prevalent dysplasia and for reducing PEEC and PEEN. BE surveillance quality metrics, such as cancer and neoplasia detection rates, have been shown to be inversely associated with PEEN. PEEC and PEEN reflect critical gaps in the effectiveness of BE surveillance. Improving the quality of endoscopic surveillance is essential, including meticulous mucosal inspection, appropriate use of advanced imaging techniques, and adherence to systematic biopsy protocols, to minimize missed neoplasia.

Defining failure to rescue in emergency general surgery on the Eve of Centers for Medicare and Medicaid Services adoption: A scoping review.

Beyond the Ventilator: Risk Factors for "Trauma-Associated" Pneumonia in the Trauma Intensive Care Unit.

ABSTRACT Background Patients who leave the emergency department (ED) without being seen (LWBS) represent a critical quality and safety metric. Although most LWBS cases involve low-acuity presentations, some may have time-sensitive conditions, leading to delayed diagnoses, adverse outcomes, and increased healthcare utilization. To determine the prevalence, characteristics, and predictors of LWBS over a multi-year period in a high-volume tertiary ED in Türkiye. Methods This retrospective case–control study included all adult ED visits between 1 January 2020, and 30 June 2025, at Taksim Training and Research Hospital. LWBS cases were identified from electronic medical records and compared with controls presenting during the same timeframes. Demographic, triage, temporal, and operational factors were analyzed, and binary logistic regression identified independent predictors. Results From a total of 1,058,817 adult emergency department (ED) visits during the study period, 9,737 LWBS cases were identified, corresponding to an overall LWBS incidence of 1.0%. Annual LWBS counts ranged from 1,447 (14.9%) in 2020 to a peak of 2,995 (30.8%) in 2022, before declining to 450 (4.6%) in 2024. Patients who left without being seen were younger (mean 36.1 ± 15.0 years) and predominantly male (61.6%).The highest frequency of LWBS occurred during the evening shift (16:00–00:00) and among green-triage patients, with multivariable analysis confirming increased odds in these groups (evening shift OR = 4.99; 95% CI, 3.18–8.09). Night-shift presentations were associated with reduced LWBS risk (OR = 0.54; p < 0.001). Conclusion Younger age, evening presentation, and triage category were associated with LWBS in this high-volume tertiary emergency department. However, the predictive performance of the regression model was modest (AUC = 0.584), suggesting that additional patient-related, behavioral, and system-level factors may contribute to LWBS. Further studies are needed to better understand the determinants of this phenomenon.

Federally qualified health centers (FQHCs) use core quality measures to guide care and secure funding. One core measure is "Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antiplatelet." A pilot program at an FQHC utilized the clinical pharmacy team to improve appropriate aspirin prescribing. Clinical pharmacy technicians identified eligible patients through a best practice advisory (BPA) in the electronic health record and contacted individuals with IVD not prescribed aspirin to schedule a clinical pharmacist appointment. Pharmacists then conducted medication reconciliations and ordered aspirin when indicated. This study evaluated the impact of incorporating pharmacy technicians into the clinical pharmacy workflow on the IVD quality measure. This retrospective chart review compared aspirin prescriptions ordered from June to November 2023 between patients contacted by pharmacy technicians and those who were not. Demographics, outreach attempts, aspirin orders, and diagnosis codes were collected. Descriptive statistics and Fisher's exact test were used for analysis. Pharmacy technicians attempted to contact 65 eligible patients, with 49 successfully reached. Aspirin was prescribed for 3.1% of control patients vs 30.6% in patients successfully contacted by the pharmacy team (P < .001). Resolved BPAs increased to 53.8% in the intervention group. A clinical pharmacy team significantly increased aspirin therapy among eligible patients with IVD, demonstrating the value of pharmacy team involvement on quality metrics. Future research should explore expanded integration of clinical pharmacy team services to enhance patient care.