Standardized Process Research Articles

The Effect of Different Obturation Techniques on the Sealing Ability of Root Canal Filling Materials

ABSTRACT Background: The performance of root canal filling materials in sealing is crucial for the effectiveness of endodontic procedures as it prevents the escape of microorganisms and guarantees the durability of the treatment. Materials and Methods: The present in vitro investigation included the preparation of 90 human single-rooted teeth using a standardized process. These teeth were then randomly separated into three groups (n = 30) according to the obturation technique: Group A (Lateral Compaction), Group B (Thermafil), and Group C (Continuous Wave of Condensation). Furthermore, each group was separated into two subgroups based on the specific kind of root canal filling material employed: Subgroup 1 (Gutta-Percha) and Subgroup 2 (Resilon). The sealing capacity was evaluated using a dye penetration technique, with measurements conducted at three specific time intervals: 24 hours, 1 week, and 4 weeks after the obturation process. Statistical analysis of the data was conducted using analysis of variance and post hoc tests to identify significant differences across groups. Results: The findings showed that the Continuous Wave of Condensation method (Group C) had the lowest dye penetration, with an average depth of penetration of 1.2 mm. The Thermafil technique (Group B) followed closely with a penetration depth of 1.8 mm, while the Lateral Compaction technique (Group A) achieved a penetration depth of 2.5 mm. In terms of sealing ability, Gutta-Percha demonstrated superior performance compared to Resilon, achieving average penetration depths of 1.5 mm and 2.0 mm, respectively. Statistical analysis showed statistically significant differences between the groups (P < 0.05), with the Continuous Wave of Condensation approach utilizing Gutta-Percha showing the highest level of sealing effectiveness. Conclusion: In conclusion, the Continuous Wave of Condensation approach showed a substantial improvement in the sealing efficacy of root canal fillings when compared to the Lateral Compaction and Thermafil procedures.

Development of the implementability assessment tool for clinical practice guidelines based on the COSMIN framework and factorial experiment: a study protocol.

Clinical practice guidelines are essential tools for standardizing medical practices and improving healthcare quality. However, current guideline implementation is unsatisfactory. Barriers to guideline implementation include external environmental factors (e.g., medical personnel, medical institutions, local policies) and intrinsic characteristics (e.g., context, format, language etc.), with the latter being addressable by optimizing the guidelines themselves. This study aims to develop an appraisal tool to promote effective guideline implementation. Existing guideline implementability appraisal tools lack a clear theoretical basis, evidence of reliability and validity, and/or empirically-based guidance for effective implementation, all of which will be addressed in this study. The research is divided into four phases: (1) Generating a theoretical framework for guideline implementability (i.e., scoping review and concept analysis method); (2) Conducting a factorial experiment (i.e., guideline users simulate the use of different guideline versions to examine the relationship between constructs in the framework and implementability), and removing constructs with weak relationships to form the final implementability theoretical framework; (3) Generating dimensions and items for the guideline implementability appraisal tool based on the constructs in the theoretical framework, conducting comprehensive reliability and validity testing, usability testing, and iterative optimization according to the COSMIN guidelines; (4) Integrating the validated tool with the STAR guideline rating system for guideline appraisal and feedback to promote guideline implementability. STRENGTHS AND LIMITATIONS: (1) Our research will follow a standardized and rigorous process for developing measurement scales, ensuring that the resulting evaluation scale for the implementability of CPGs is theoretically grounded, internally consistent between theory and practice, and reliable and valid. (2) The theoretical framework developed in our study will strengthen the validity and rationality of constructs in the real world. (3) In the confirmatory factor analysis, this study will determine the dimensions and items' weight through factor loadings, allowing for the quantification of the implementability of CPGs and providing users of the guidelines with objective evaluative results. In addition, the clinical practice guideline implementability evaluation tool developed in this study can assist guideline developers in enhancing implementability before, during, and after guideline formulation.

Real-Time Data Governance and Compliance in Cloud-Native Robotics Systems

This study investigates the frameworks and challenges of real-time data governance and compliance in cloud-native robotics systems, focusing on data integrity, cloud security, regulatory adherence, and cybersecurity risks. Using extensive datasets from the Amazon AWS Open Data Registry, the EU GDPR Enforcement Tracker, and Kaggle’s IoT dataset, the analysis explores cloud-native systems' data accuracy, security, and governance. Data were extracted through a standardized process: performance metrics, including latency and error rates, were gathered from Amazon AWS to assess system efficiency, GDPR violation records were analyzed from the EU Enforcement Tracker to understand compliance trends, and data volume and governance metrics from Kaggle’s IoT dataset were correlated to identify governance challenges. Together, these data sources provide comprehensive insights into how cloud-native systems can be optimized for real-time operations. The study highlights the cloud security benefits and governance advantages inherent to cloud-native frameworks, such as real-time monitoring, automated threat detection, and data encryption, which collectively reduce unauthorized access risks while supporting operational efficiency. Findings indicate high data accuracy (0.51% error rate) and low latency (mean of 48.96 ms) across systems; however, processing time variability (standard deviation of 28.61 ms) signals a need for further optimization in time-sensitive environments. The regression analysis of GDPR violations reveals a substantial penalty increase of €53,789.41 per violation, emphasizing the financial risks of non-compliance. Correlation analysis (r = 0.083 for data volume and governance failures) suggests that external cybersecurity threats have a greater impact on governance than internal metrics, underscoring the importance of adaptive governance frameworks that support both data integrity and regulatory compliance in cloud-native robotics systems.

Managing Eating Disorders Within Medicaid-Funded Health Care Systems in California.

This study describes the current management of patients with eating disorders (EDs) served by publicly-funded Medicaid behavioral health systems. Behavioral health leaders across nine counties in California met on a quarterly basis to share experiences, challenges, and lessons in the management of EDs within publicly-funded service systems. Detailed notes were taken, and a qualitative content analysis was undertaken to identify key themes. County leadership noted insufficient outpatient capacity and difficulty building capacity for ED treatment, in addition to extraordinary challenges when facilitating admission to out-of-network higher level of care programs, at significant expense. Several challenges were identified in building an internal ED workforce, including the fact that many providers weren't eager to treat EDs due to training burden, patient complexity, and high levels of clinician burnout. When a higher level of care was required due to lack of outpatient resources or patient symptom severity or complexity, leaders dedicated significant resources to identify and contract with an appropriate program and secure the necessary funds. Our study supports the need for specialized ED treatment and case management, as well as standardized processes and centralized resources, in Medicaid-managed care. Findings also indicate the importance of protecting against clinician burnout, possibly through reduced caseload expectations, financial incentives, or increased support. Future policy change could reduce administrative burden and clinician burnout by facilitating admission to and reimbursement for higher levels of care.

Shared decision making in primary malignant bone tumour surgery around the knee in children and young adults: protocol for a prospective study

BackgroundChildren and young adults needing surgery for a primary malignant bone tumour around the knee face a difficult, life-changing decision. A previous study showed that this population wants to be involved more in the decision-making process and that more involvement leads to less decisional stress and regret. Therefore, a well-designed and standardized decision-making process based on the principles of shared decision-making needs to be designed, implemented, and evaluated.MethodsWe developed a shared decision-making (SDM) model for this patient population, including an online decision aid (DA). This model has been implemented in the standard care of patients with a primary malignant bone tumour around the knee. Following implementation, we will analyse its effect on the decision-making process and the impact on patient experiences using questionnaires and interviews. Moreover, potential areas for improvement will be identified.DiscussionGiven the importance of involving patients and parents in surgical decision-making, particularly in life-changing surgery such as malignant bone tumour surgery, and given the lack of SDM models applicable for this purpose, we want to share our model with the international community, including our study protocol for evaluating and optimising the model. This study will generate valuable knowledge to facilitate the optimisation of current patient care for local treatment. The sharing of our implementation and study protocol can serve as an example for other centres interested in implementing SDM methods in an era characterized by more empowered patients and parents who desire autonomy and reliable and realistic information.

The 24-Hour Urinary Cortisol/Urinary Creatinine Ratio Helps Differentiate Cushing's Syndrome from Simple Obesity

BackgroundCushing's syndrome (CS) is a condition caused by an increase in blood cortisol levels, leading to elevated blood sugar, osteoporosis, neuropsychiatric disorders, and weight gain and abnormal fat distribution. Its diagnostic process is cumbersome, and the process of clinical confirmation is influenced by many factors. ObjectivesIn this study, we investigated the relationship between the 24-hour urinary cortisol/urinary creatinine ratio (24hUCor/Cr) and other relevant biological markers associated with CS in an attempt to find novel ways to diagnose the disease. MethodsThis cross-sectional study included 395 hospitalized patients. Urinary cortisol and creatinine were measured by retaining a 24-hour urine sample. Multivariate binary logistic regression analysis was used to test the correlation between the 24hUCor/Cr and CS. All patients diagnosed with CS underwent a standardized diagnostic process. ResultsOf the 395 subjects, 94 (23.8%) were diagnosed with CS. In the unadjusted model, the likelihood of subjects having CS increased with increasing 24hUCor/Cr (odds ratio: 2.05, 95% confidence interval: 1.56–2.71; P<0.001). In the fully adjusted model, the risk of patients developing CS increased by 74% for each standard deviation increase in the 24hUCor/Cr (95% confidence interval: 1.02–2.97; P<0.05). Based on the subject working characteristic curve analysis and Youden’s index, the sensitivity and specificity of the 24hUCor/Cr for predicting CS were 88.3% and 91.7%, respectively, in all subjects (cutoff value: 52.3554, AUC: 0.942; P<0.001) ConclusionA higher 24hUCor/Cr helped to identify CS with an optimal cutoff value of 52.3554.

Application of artificial intelligence in career development of women in STEM field: Counseling, network construction and recruitment

With the rapid development of science and technology, the application of artificial intelligence (AI) in STEM (science, technology, engineering and mathematics) is increasingly extensive, which provides a new idea for solving the challenges of women's career development in STEM. This paper deeply discusses the application of AI in counseling, network construction and recruitment of women's STEM career development, aiming at promoting gender equality and women's career growth. In career counseling, AI technology provides customized career advice and development path for women through deep learning and big data analysis. According to personal education background, skill level, hobbies and career goals, the system intelligently recommends suitable career directions, and updates industry trends and job market data in real time to help women make more informed career choices. The AI tutoring system also enhances women's professional self-confidence through functions such as simulated interviews and career planning exercises. In terms of network construction, AI helps women to expand their professional networks more effectively through intelligent recommendation system. Based on user behavior data and preferences, AI accurately recommends industry seminars, technical exchange activities and online communities to promote women to establish contacts with like-minded professionals. AI also assists women in managing and maintaining network relationships, ensures the continuity of network interaction through intelligent reminding functions, and identifies key nodes and influential people to enhance network quality. In the recruitment process, AI technology reduces gender bias and improves the fairness and transparency of recruitment through automatic resume screening, standardized interview process and competency-based evaluation model. AI system can analyze a large amount of data, accurately match the skills and job requirements of female candidates, and improve the employment rate of women in STEM field. At the same time, through transparent algorithm decision-making process and fairness check, the potential gender bias problem in AI algorithm is overcome. The research in this paper provides theoretical support and practical guidance for using AI technology to promote women's career development in STEM field, and helps to build a more equal and inclusive scientific and technological working environment.

Medical futility at the end of life: the first qualitative study of ethical decision-making methods among Turkish doctors

BackgroundThe swift advancement of intensive care medicine, coupled with technological possibilities, has prompted numerous ethical inquiries regarding decision-making processes concerning the withholding or withdrawal of treatment due to medical futility. This study seeks to delineate the decision-making approaches employed by intensive care physicians in Türkiye when faced with medical futility at the end of life, along with an ethical evaluation of these practices.MethodsGrounded theory, a qualitative analysis method was employed, conducting semi-structured, in-depth interviews with eleven intensive care physicians in Türkiye. The subsequent text analysis was carried out using MAXQDA software.ResultsParticipants assert that the decisions made by Turkish physicians determine whether treatment is futile, rely on medical consensus, and lack a standardized decision-making process. The decisions are influenced by legal and social pressures, resource constraints, and occasional conflicts of interest. The significance of professional hierarchy is notable, with limited consideration given to the opinions of nurses and other staff. The unstructured medical consensus processes are shaped by normative concepts such as benefit, age, justice, and conscience. Furthermore, it was observed that the conscientious opinions of physicians carry more weight than adherence to ethical principles and guidelines.ConclusionTo create optimal conditions for doctors to make ethically justifiable decisions, the dynamics within the treatment team should be improved, emphasizing the minimization of hierarchy, and ensuring the active participation of all team members in the decision-making process. Additionally, efforts should be directed toward narrowing the gap between the conscience of the individual doctor and established ethical principles. A potential solution lies in the nationwide implementation of clinical ethics committees and the establishing of clinical ethics guidelines, aiming to address, and overcome the identified challenges.

Optimizing vaccination to reduce waste and boost coverage in Primary Health Care Units

Abstract Background In immunization, vaccine consumption typically exceeds the number of recipients. The number of doses per vial influences wastage and vaccination coverage goals. In Brazil, 48% of the National Immunization Program’s vaccines are multidose, with 4 having limited shelf-life post-opening. Strategies to reduce wastage aim to optimize dose utilization, enhance process quality, and broaden coverage effectiveness. The objective was to outline strategies for reducing wastage and expanding coverage for children under 5 in 14 São Paulo city Primary Health Care Units (PHCUs). Methods The Lean Six Sigma approach guided the stages. A group conducted contextual analysis to identify PHCU barriers. Data on wasted doses and vaccination were gathered. Weekly meetings for data analysis began in May 2023, following DMAIC phases: Define, Measure, Analyze, Improve, Control. An action plan stemmed from these phases for PHCU implementation. Results Data analysis, from January 2022 to June 2023, revealed a significant vaccine wastage trend, reaching 59% from January to December 2022 and increasing to 63% from January to June 2023. This wastage incurs an average annual cost of R$614,416.26, due to lost doses from expiration after vial opening and expiration of shelf life. The vaccines analyzed were BCG, Oral Polio Vaccine (OPV), Measles, Mumps, and Rubella (MMR), and Yellow Fever. At the project start in May 2023, vaccination coverage was 90%, increasing to 93% afterward. This rise resulted from actions taken and improved data monitoring. Post-project, vaccine wastage reduced by 7 percentage points (from 62% to 56%). Conclusions Addressing vaccine wastage and expanding vaccination coverage for children under 5 are critical in healthcare. Utilizing Lean Six Sigma, key issues in PHCUs were identified, leading to an action plan that reduced wastage, increased coverage, and standardized processes. Key messages • Vaccines are valuable resources and wasting them means reducing financial resources in health. • Vaccination coverage is crucial to protect the population’s health, prevent disease outbreaks, and maintain the country’s economic health, reducing costs for treating preventable diseases.

Signal detection and assessment supporting syndromic surveillance during the UEFA EURO 2024

Abstract Background Mass gatherings like the UEFA European Football Championship in Germany pose a challenge for public health, elevating the risk of infectious disease outbreaks. The Robert Koch Institute (RKI) is performing intensified surveillance during this event, including data from emergency departments (ED). So far, no standardised process for signal detection, their assessment and communication exists for ED surveillance. Methods We reviewed the literature to identify an appropriate signal detection method for ED surveillance. We tested different aggregation levels of the ED data, to ensure sufficient quality with sparse categories. After consulting with international experts, we defined a standardized process for signal assessment. We developed an interactive dashboard to investigate anomalies by further analysing the ED data. Results We used the Farrington Flexible algorithm, but expanded its functionality to perform daily instead of weekly monitoring. Aggregating to federal state level or in five age categories provided enough daily data for the algorithm. During the assessment, identified signals will be automatically scored based on pre-defined criteria (e.g. excess number of cases, reoccurrence in previous days). Signals with a high score will be forwarded to an epidemiological assessment, where they are manually evaluated based on standardised questions (e.g. expected seasonality, disease severity). Surveillance experts at RKI discuss them further and decide the course of communication and possible further measures. We developed an interactive dashboard in which signal detection and assessment is visualized. Conclusions Syndromic surveillance using ED data is used as an information source for early warning during a mass sporting event in Germany. Signal detection enables the identification of potential outbreaks, while the standardized assessment process ensures an efficient way to prioritize and steer communication efforts across public health services. Key messages • Syndromic surveillance using signal detection has previously proven valuable to detect potential outbreaks of infectious diseases during mass gatherings. • A standardised signal assessment process including an automatic and manual component ensures a sustainable and efficient way to prioritize possible incidents and steer public health communication.

Proses Asuhan Gizi Terstandar pada Pasien dengan Autoimun dan Sirosis Hepatis

Liver cirrhosis is a pathological condition of the liver that defines the end stage of hepatic fibrosis. Liver cell damage will lead to disruption of the liver structure and increased vascularization, causing enlargement of blood vessels in the gastric and esophageal areas. Liver cirrhosis is often caused by history of infection with hepatitis B virus or hepatitis C virus. Other causes include a family history of liver disease, excessive alcohol consumption, and a history of autoimmune disease. Providing a liver diet as one of the standardized Nutrition Care Process (NCP) for this disease aims to achieve and maintain optimal nutritional status without burdening liver function. The purpose of the case study is to find out the process of standardized nutritional care process for patients with autoimmune and liver cirrhosis through providing a liver diet. The case study was conducted in September 2023 at patients in Hospital X Surabaya. After monitoring and evaluation, the patient’s energy, protein, fat, and carbohydrates intake domains increased even though they had not yet reached the fulfillment target (&lt;80%), the patient’s biochemistry domain was not received because the monitoring time was short, the patient’s physical/clinical condition continued to improve until the third day. The progress of the patient’s recovery over three days always increases. Starting with the stabilized appetite, the food intake received by patient increases so the patient’s physical and clinical condition continues to improve.

Patients with Diabetes Mellitus and Comorbid Mental Disorders - Is there a Psychotherapeutic Undertreatment? - Results of the DiMPS Study

Diabetes mellitus is associated with an increased likelihood of mental disorders, especially depression. Despite a frequently postulated underprovision, the actual need for psychotherapeutic treatment in this patient group has hardly been investigated. The aim of this study is to analyze the care situation of diabetes patients with mental comorbidities in Germany. 240 consecutively treated patients with type 1 or type 2 diabetes were examined cross-sectionally and longitudinally in a tertiary diabetological center. After a screening and diagnostic examination, 94 patients with comorbid mental disorders were included in the study. Patients then decided on the treatment of their mental disorder according to a standardized shared decision-making process. At the 6-month follow-up, 77 of the 94 patients (81.9%) provided information about the realization of their treatment decision and the obstacles they encountered. 39.2% of patients with diabetes had a mental disorder. Of these, 44.2% were already receiving psychotherapy or medication. After six months, 46.8% were able to implement their treatment decision. Only 7.1% did not receive any treatment despite their efforts. The 6-month follow-up showed a significant reduction in diabetes-related distress (PAID; p<0.05) and an increase in psychological well-being in all subgroups, regardless of treatment initiation (WHO-5; p<0.05). Contrary to the widespread notion of a lack of access to psychotherapy for people with diabetes and mental disorders in Germany, this assumption could not be confirmed in this study. Equating the frequency of mental disorders with the need for psychotherapeutic and/or psychopharmacological treatment without considering the specific treatment needs and preferences of patients may lead to an overestimation of the need for care.

Coffee and Cases (C&C) - Enhancing Knowledge Creation and Sharing for Organizational Learning From Clinical Debriefs in a Helicopter Emergency Medical Service: A Quality Improvement Study

Objectives The objective of this quality improvement (QI) study was to improve organizational learning from clinical debriefs known as “Coffee and Cases” (C&C) in a helicopter emergency medical service (HEMS) by increasing weekly learning summaries (LS) and documented learning points (DLP) as well as the dissemination thereof by at least 50% from baseline. Methods The problem analysis for sub-optimal organizational learning from C&C identified several factors, including lack of responsibility, poor documentation quality, and limited sharing of learning points. Using the Model for Improvement (MFI), interventions enhanced the learning environment, and improved documentation and dissemination. Changes included dedicated computers, introducing standardized processes, a newsletter, and a searchable DLP database. Statistical process control (SPC) charts were used to assess the effectiveness of interventions. Results Prior to interventions (August 2022 to January 2023), baseline mean counts of weekly DLPs, LSs, DLPs internally disseminated, and DLPs openly disseminated were 3.18, 2.67, 3.18, and 2.96, respectively. Plan-Do-Study-Act (PDSA) cycles included declaring C&C as a non-clinical portfolio, redesigning documentation processes, initiating monthly newsletters, developing a DLP repository, and designing a C&C visual brand. Signals of special cause variation showed improvements, with mean counts increasing. Weekly DLPs increased to 14.92, LSs to 5.2, internally disseminated C&C Snippets to 11.88, and openly disseminated C&C Snippets to 8.64. Conclusions Recognizing barriers to effective knowledge creation and sharing, our QI study aimed to increase weekly DLPs and LSs by 50% from baseline. It aligned with the relationship between knowledge management and organizational learning, emphasizing the importance of utilizing knowledge for improved performance. Our interventions enhanced the learning environment, ensured robust capturing of learning points and effective communication thereof, ultimately contributing toward improving organizational dissemination of learning from clinical debriefs. Our QI study demonstrates how enhanced knowledge creation and sharing can widen the benefits of learning from clinical team debriefs.

Improved Production Process Map and Safety of Millet‐Based Fermented Beverage

ABSTRACTThe present study aimed to develop a standardized process map to produce a microbiologically safe and consumer‐acceptable Brukina beverage. Field interactions and observations were employed for the baseline data, while an improved production process was developed and utilized to produce a Brukina beverage. The microbial safety of the new approach was assessed by determining the total coliform, yeast and mold, as well as Staphylococcus aureus. A consumer preference test was conducted to validate the contribution of the improved and hygienic steps to the overall acceptability. The existing production processes for manufacturing Brukina beverage did not embrace Good Manufacturing Practices (GMPs) and as such, the resultant beverage was contaminated with coliforms and S. aureus. Moreover, the sensory characteristics including taste, mouthfeel, viscosity and overall acceptability, were negatively affected. The inclusion of food safety management practices and efficient production steps has a greater tendency of producing microbiologically safe and market‐acceptable fermented millet‐based beverages while safeguarding consumers’ health and satisfaction.

Automated Car Damage Assessment Using Computer Vision: Insurance Company Use Case

Automated car damage detection using computer vision techniques has been studied using several datasets, but real cases for insurance companies are usually dependent on private methods and datasets. Furthermore, there are no metrics or standardized processes that describe the situation in which the company analyzes the customer’s images, the models used for the inference, and the results. We perform extensive experiments to show that our proposal, an ensemble of 10 deep learning detectors based on YOLOv5, improves the state-of-the-art not only in terms of typical metrics but also in terms of inference speed, allowing scalability to thousands of instances per minute. A comparison with YOLOv8 is carried out, showing the differences between both ensembles. Furthermore, a dataset called TartesiaDS, labeled under the supervision of professional appraisers from insurance companies, is available to the community for evaluation of future proposals.

A value chain modeling approach for upscaling the production of fine flavor cocoa in Arauca (Colombia)

AbstractThe fine flavor cocoa (FFC) market offers additional income for small farmers. Despite the potential of several Latin American countries to produce FFC, their lack of standardized postharvest processes hinders compliance with high‐quality standards demanded by the FFC market, as these processes have a direct impact on cocoa's organoleptic characteristics. This work supports the design of a collective postharvest transformation model that coordinates the main steps in the cocoa agri‐food chain: transport of the cocoa harvest, classification, fermentation, drying, storage, and commercialization. Our methodology includes a modeling scheme combining optimization and simulation models, considering variability in the processes, and covering operational (transport and resource allocation), tactical (design and sizing of the processing plant), and strategic (sales dynamics) decisions across the cocoa value chain. We illustrate this methodology in a case study in Arauca, Colombia. Our findings emphasize the importance of combining these operational and strategic models since their inputs and outputs are interconnected influencing the decision‐making within the cocoa value chain. Our study also identifies key determinants for the postharvest design, highlighting the postharvest center capacity, FFC prices, and the market selling mode (export or local).

Food retailer actions toward the National Strategy on Hunger, Nutrition, and Health to promote nutrition security: Applicability of the Business Impact Assessment-Obesity as a monitoring tool.

The White House National Strategy on Hunger, Nutrition, and Health (National Strategy) encourages actions across government and society to promote nutrition security. Nutrition security includes adequate food, diet quality, and equity, and food retail settings can promote these major concepts. Of all National Strategy whole-of-society calls to action, food retailers can contribute to 15 calls as key actors. However, there is currently no standardized monitoring tool to track food retailers' commitments and actions toward the National Strategy to promote nutrition security. The Business Impact Assessment-Obesity and population-level nutrition (BIA-Obesity), a tool originally developed for corporate accountability monitoring, can be tailored for the National Strategy and nutrition security, given its standardized indicators and process to assess food company policies and commitments across six domains. We discuss the fit of the BIA-Obesity indicators for tracking food retailers' commitments and actions across four pillars of the National Strategy. Existing indicators are appropriate to monitor components of Pillar 1: Improve Food Access and Affordability; Pillar 2: Integrate Nutrition and Health; Pillar 3: Empower All Consumers to Make and Have Access to Healthy Choices; and Pillar 5: Enhance Nutrition and Food Security Research. We suggest expanding current indicators to include equity, local foods, the digital food environment, and food waste reduction to improve alignment of the BIA-Obesity with the National Strategy. Application of the BIA-Obesity as an existing tool can facilitate data cohesion and more rapid assessment of the food retailer landscape to mutually meet nutrition security goals by 2030.

Nursing process performance measurement tool based on bloom’s revised taxonomy: A validity and reliability analysis

AimThis study aimed to develop a measurement tool that could evaluate educational approaches by integrating the cognitive dimensions required at each stage of the nursing process and strengthening the connection between education and clinical practice. BackgroundThe nursing process is a core component of nursing practice and supports nurses and nursing students in systematically performing the problem-solving process necessary for patient health management. DesignCross-sectional, methodological study. MethodsA nursing process performance measurement tool that could measure the cognitive dimensions required at each stage of the nursing process was developed based on Anderson’s and Bloom’s revised taxonomy. The data for this study were collected from July to August 2023 at four universities in South Korea. The reliability and validity of the measurement tool were evaluated through a survey conducted on 406 nursing students. Participants were third- and fourth-year nursing students with clinical practice experience, recruited through purposive sampling. ResultsThe developed tool was designed to systematically measure and evaluate each step of the nursing process. This tool consisted of 28 questions, each of which was divided into five assessment questions, six diagnosis questions, six planning questions, five implementation questions and six evaluation questions. Items were rated on a 5-point Likert scale, ranging from 1 (“not at all”) to 5 (“very much”). The measurement score ranged from 28 to 140 points, with higher scores indicating better nursing process performance. The cumulative variance contribution rate of the tool was 68.1 % and the Cronbach’s α value was 0.85 for all items. ConclusionsThis study provides a basis for evaluating educational approaches in nursing curricula by integrating the cognitive dimensions required at each stage of the nursing process. This approach can strengthen the connection between education and clinical practice and can be used not only as a tool to systematically evaluate the learning outcomes of nursing students but also as a standardized nursing process guide.

Impact of sleep deprivation on aperiodic activity: a resting-state EEG study.

Sleep deprivation (SD) has been shown to have a negative impact on alertness, as evidenced by behavioral and electroencephalographic studies. Nevertheless, conventional fixed-bandwidth spectral analysis confused the aperiodic and periodic components, and ignored some important periodic parameters (i.e., center frequency, bandwidth). Here, based on a large open access dataset of SD, we employed a standardized process for multiple electrode analysis and group inference. We found that, compared to SC, the aperiodic offset shifted overall after SD, primarily in the occipital region. And this shift was associated with a reduction in subjective alertness. For periodic component, we did not found any power change in alpha rhythm, but there is an increase in bandwidth of alpha. And the increased regions distributed in the occipital and temporal lobes. These findings highlight the potential significance and value of aperiodic parameters in behavioral and electrophysiological researches.

Standardizing Identification of Cognitive Impairment in the Acute Hospital Setting: Toward a Common Language.

Although many hospitals universally screen their patients for functional mobility and activity impairment, there is no common method to do this for cognitive impairment. Establishing an interdisciplinary and standardized process to screen for cognitive impairment is essential for early identification of impairments, optimization of patients' function, and safe discharge planning. Previously, the reliability and validity of the Activity Measure for Post-Acute Care Applied Cognitive Inpatient Short Form "6-Clicks" (AM-PAC ACISF) were measured among occupational therapy practitioners and speech-language pathologists; however, its reliability among other team members, specifically nurses, is unknown. This study reports the interprofessional interrater reliability of the AM-PAC ACISF in the acute care hospital setting. To examine the nursing-therapist interrater reliability of the AM-PAC ACISF in the acute care hospital setting. A prospective study using a convenience sample. Acute care hospital. Fifty adult patients, six nurses, five occupational therapy practitioners, and one speech-language pathologist. Interrater reliability for the AM-PAC ACISF among therapists and nurses. Interrater reliability was good among nurses and therapists, with an intraclass correlation coefficient of .88 (95% confidence interval [.79, .93]) for the AM-PAC ACISF. Findings suggest that the AM-PAC ACISF is reliable for use among interdisciplinary teams, helps to establish a common language for early identification of cognitive impairment, and can be used for guiding clinical discussions around patient cognition in the acute care setting. Plain-Language Summary: Having an interdisciplinary and standardized process to screen patients early for cognitive impairment is essential for identifying impairments, optimizing patients' function, and facilitating safe discharge planning in the acute care setting. Early identification of cognitive impairment by the interdisciplinary team can also allow for timely occupational therapy and other rehabilitation service interventions. The findings of this study suggest that the Activity Measure for Post-Acute Care Applied Cognitive Inpatient Short Form "6-Clicks" (AM-PAC ACISF) can reliably be used by interdisciplinary teams, establishes a common language for early identification of cognitive impairment, and can be used for guiding clinical discussions around patient cognition in the acute care setting.