Hospital readmissions are a key indicator of healthcare quality and have substantial implications for patient outcomes and system-level costs. Identifying individuals at high risk of experiencing 30-day all-cause readmission events is essential for implementing preventive strategies and improving resource allocation. This study aimed to develop and internally validate a simple, interpretable risk stratification index for identifying individuals at elevated risk of experiencing at least one 30-day all-cause readmission event in a community-dwelling general population using machine learning (ML)-based feature selection and logistic regression (LR)-based risk scoring. We analyzed data on adults residing in Suwon City from the 2016-2019 South Korean National Health Insurance Service-National Sample Cohort. The outcome was defined at the person level as experiencing at least one all-cause readmission within 30 days of discharge from any hospitalization during the study period. Elastic net (EN) regularization was used to select candidate predictors, and LR was used to derive a point-based scoring index. Model performance was evaluated in an internal validation dataset using the area under the receiver operating characteristic curve (AUC), calibration curves, and Brier score. Among 3,357 adults, 357 (10.6%) experienced at least one 30-day readmission event during the study period. Four of seven features selected by EN (top-quartile number of hospital admissions, length of stay, total healthcare costs, and any malignancy) were retained to construct the SUwon Population-based Readmission risk Estimation ModEl (SUPREME) Index, with scores ranging from 0 to 14. Internal validation showed good performance (AUC = 0.861; Brier score = 0.067) with adequate calibration. A cutoff score of 8 provided a balanced operating point (sensitivity 0.742; specificity 0.867) for classifying individuals as high risk. The SUPREME Index, developed using EN and LR, provides a practical and interpretable tool for person-level risk stratification using administrative claims data. Because predictors were derived from routinely available claims and screening data and were not anchored to a single uniform baseline time point, the index should be interpreted as a stratification tool rather than an event-level prediction model anchored to a specific index hospitalization. External validation and evaluation in diverse populations are warranted.
Extranumerary nasal conchae, including the supreme nasal concha (SupNC) and Zuckerkandl's concha (ZC), are uncommon variants relevant to endoscopic sinus and skull base surgery, yet their prevalence and morphometry remain poorly defined. No cadaveric study has simultaneously evaluated prevalence, detailed morphometry, and a data-driven SupNC classification using principal component analysis (PCA). This study determined SupNC prevalence in cadavers and proposed a clinically oriented classification integrating morphological and quantitative parameters. A cross-sectional cadaveric study analyzed 59 hemisections with preserved nasal conchae. Conchae were counted, and SupNCs classified according to Orhan and a new system. Morphometry was obtained using digital calipers and ImageJ. Of 59 hemisections, 37 (63%) had three conchae, 21 (35%) four, and 1 (2%) five. SupNC was present in 22/59 (37.3%) and ZC in 1/59 (1.7%), associated with SupNC. Significant differences were found between hemisections with and without extranumerary conchae in middle concha area (3.68 ± 1.07 vs. 4.45 ± 1.20 mm2), superior concha area (1.26 ± 0.40 vs. 0.94 ± 0.36 mm2), length (26.13 ± 4.19 vs. 21.93 ± 3.94 mm), and height (0.72 ± 0.24 vs. 0.45 ± 0.13 mm). Concha number strongly correlated negatively with nasal cavity height (r = -0.83). PCA identified two clusters: Straight (Type I) and Triangular (Type II) SupNCs. SupNC was relatively common, whereas ZC was rare. The proposed morphology- and morphometry-based classification may improve preoperative CT evaluation and intraoperative orientation.
To report a cluster of five concurrent cervical vascular variants identified on computed tomography angiography (CTA), including a thyroid ima artery (TIA) from a high-riding brachiocephalic trunk (BCT), a supreme intercostal artery (SIA) in thoracic vertebral artery (TVA) configuration, and associated variants, and to discuss their embryological basis and combined surgical implications. Retrospective review of an archived CTA study of a 74-year-old female patient, using the Horos DICOM workstation with multiplanar reformatting and three-dimensional volume-rendered reconstruction. All measurements were performed by a single observer, repeated on a separate session, and the mean reported. Five concurrent vascular variants and one skeletal variant were identified. (1) A common origin of the brachiocephalic trunk and left common carotid artery (the so-called bovine aortic arch). (2) A high pretracheal BCT course (calibre 1.29 cm, length 2.9 cm) with its upper margin 1.74 cm above the manubrial notch, crossing the anterior trachea from left to right. (3) A TIA arising from the BCT immediately proximal to its bifurcation and supplying both thyroid lobes. (4) An inferior mediastinal loop of the right subclavian artery (1.72 cm) with an intrathoracic origin of the right vertebral artery at 0.99 cm below the neck of the first rib. (5) A right SIA (calibre 1.1 mm) arising from the right vertebral artery at the level of the C7 transverse process in the TVA configuration, passing through the C7 transverse foramen and descending posterior to the necks of ribs 1-3. In addition, bilateral poor sternoclavicular joint articulation converted the suprasternal notch into an interclavicular space simultaneously containing the BCT, TIA, and thyroid isthmus. This combination of variants places multiple vessels in a shared pretracheal/interclavicular operative plane and appears to be undocumented as a combined pattern in the anatomical literature reviewed for this report. The embryological basis, clinical implications, and role of preoperative CTA in detection are discussed.
Homelessness is an important public health issue, and the number of individuals experiencing unsheltered homelessness has increased since 2020. On June 28, 2024, the US Supreme Court issued a 6-to-3 decision in City of Grants Pass v Johnson, which broadened the authority of local governments to prohibit public camping. The National Call Center for Homeless Veterans (NCCHV) offers a 24/7 virtual option for veterans to access services to address housing instability. The objective of this study was to assess whether expanded local enforcement authority affected inflow and characteristics of individuals contacting NCCHV after the Grants Pass decision. We used data from 418 814 contacts to NCCHV from January 1, 2023, through December 31, 2024. We conducted 3 types of analyses: (1) bivariate analysis comparing changes in contact characteristics using Wald χ2 tests, (2) direct comparisons of average weekly call volume using paired t tests, and (3) an interrupted time-series analysis using an autoregressive linear regression model. While we did not observe seasonal variations in call volume, we found a significant increase in average weekly NCCHV call volume between the pre- and post-Grants Pass periods, from 3926.6 to 4394.8 calls (mean [95% CI] change in average weekly call volume: 468.2 [216.8-719.6; P = .005). This study provides an indication of the association between the Grants Pass decision and an increase in help-seeking behavior (potentially representing increased needs) among veterans experiencing housing instability. Future work should assess on-the-ground changes in the needs of individuals experiencing housing instability and responses offered by providers of homeless services.
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Medical malpractice occurring in primary health care settings may have significant consequences for patient safety, quality of care, and the legal liability of health care professionals. This study aimed to retrospectively examine malpractice cases alleged to have occurred in primary health care institutions in Türkiye and adjudicated by the Court of Cassation, in order to describe the types of errors, case outcomes, characteristics of the judicial process, and decision patterns. Using the official decision search system of the Presidency of the Court of Cassation of the Republic of Türkiye, 22 decisions meeting the inclusion and exclusion criteria were identified and included. Data were evaluated with respect to the type of action (civil compensation vs. criminal), the profession of the defendant, the alleged type of error, the outcome of the incident, the status of the expert report, and judicial decisions. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 22.0 (IBM SPSS Corp.; Armonk, NY, USA). Of the decisions reviewed, 54.5% concerned compensation claims and 45.5% were criminal proceedings. Nurses constituted the most frequently prosecuted professional group (40.9%), and the most common malpractice allegation was incorrect injection administration (31.8%). The vast majority of incidents occurred in health centers/family health centers. In primary health care, medical malpractice allegations primarily cluster around nursing practices and injection procedures. Strengthening training, supervision, record-keeping systems, and intra-team allocation of responsibilities will play a critical role in reducing malpractice in primary care. Cite this article as: Sancı GT, Sancı A, Vural T. Evaluation of medical malpractice in primary healthcare: A 20-year retrospective analysis of supreme court decisions. Eurasian J Med. 2026, 58(3), 1360, doi: 10.5152/eurasianjmed.2026.261360.
In United States v. Skrmetti, the U.S. Supreme Court considered the constitutionality of a Tennessee law prohibiting certain medical procedures for the treatment of minors with gender dysphoria. A majority of the justices agreed that the law failed to violate the U.S. Constitution's equal protection provision. Because the law failed to distinguish among patients on the basis of sex, they said, it required only a rational basis to survive constitutional scrutiny. A lack of solid evidence on appropriate treatment for transgender minors supplied this rational basis. The Skrmetti majority strained, however, to avoid acknowledging that Tennessee's law classifies people on the basis of sex.
Eye Movement Desensitization and Reprocessing (EMDR) is a first-line psychotherapy for post-traumatic stress disorder. Despite its established clinical efficacy, concerns have been raised regarding its potential effects on autobiographical memory and testimonial reliability in judicial contexts. Given the reconstructive nature of memory, this study aimed to examine how Italian courts address EMDR when evaluating witness credibility. A targeted jurisprudential analysis was conducted using the DeJure legal database. Final decisions of the Italian Supreme Court (Corte di Cassazione) issued up to January 2026 were retrieved and screened to identify rulings in which EMDR therapy was explicitly mentioned and played a forensically relevant role in the assessment of testimonial credibility, memory reliability, or evidentiary reasoning. Eligible cases were required to constitute final, non-appealable rulings and to include substantive judicial or expert discussion of EMDR. Two researchers independently screened, selected, and analyzed the decisions according to predefined inclusion criteria, applying a qualitative case-series approach. Five Supreme Court decisions met the inclusion criteria, all involving criminal proceedings with minor victims and credibility assessment. EMDR was primarily raised by the defense as a potential source of memory alteration. The Court consistently rejected categorical assumptions of reduced testimonial reliability. Instead, it required concrete, case-specific evidence of memory distortion. Where credibility was questioned, judicial criticism focused on procedural and methodological deficiencies, particularly inadequate documentation, and insufficient separation between therapeutic and investigative roles. Italian Supreme Court jurisprudence reflects a cautious and context-sensitive approach to testimony following EMDR. The therapy is recognized as clinically legitimate and is not considered intrinsically suggestive. Judicial concerns are directed toward procedural safeguards and transparency rather than the therapeutic technique itself. These findings support a case-by-case evaluation model and highlight the importance of rigorous clinical documentation and role differentiation in forensic settings.
Dental composite dust generated during finishing procedures or mastication may adversely affect gingival epithelia. However, the mechanistic distinction between particulate and chemical (eluate) exposures and their respective signaling consequences remains insufficiently defined. Dust particles and corresponding eluates from three restorative composites, Admira Fusion, Ceram.x Spectra ST, and Filtek Supreme XTE, were evaluated under standardized high-dose in vitro exposure conditions. Human gingival keratinocytes were assessed for proliferation, adhesion, differentiation, fibronectin (FN1) remodeling, and IL-8 secretion, alongside analysis of ERK, p38, and NF-κB signaling and phosphorylation of the stress-responsive regulator SIRT1 at Ser682 (SIRT1-S682). Particulate exposure elicited more pronounced impairment of cellular adhesion, proliferation, and differentiation than eluates. Dusts derived from Ceram.x Spectra ST and Filtek Supreme XTE suppressed ERK activity, reduced FN1 abundance, and decreased nuclear SIRT1-S682, consistent with a generalized stress response. In contrast, Admira Fusion dust preserved FN1, activated ERK signaling, reduced SIRT1-S682, and induced robust IL-8 secretion. Across all materials, particulate exposure reduced nuclear SIRT1-S682 without affecting total SIRT1 levels, indicating a shared permissive stress modification. Notably, only Admira Fusion coupled this permissive state with p38 activation and sustained NF-κB p65 Ser536 phosphorylation, resulting in transcriptionally active NF-κB and elevated IL-8 production, whereas Ceram.x Spectra ST and Filtek Supreme XTE failed to activate this ERK-FN1-p38-NF-κB axis, yielding either transcriptionally inactive NF-κB or no detectable enrichment. These findings support a material-associated in vitro response pattern in which a shared SIRT1-S682 reduction is accompanied by distinct ERK/FN1, p38, NF-κB, and IL-8 readouts. SIRT1-S682 reduction alone did not define the inflammatory phenotype, because it occurred across particulate exposures, whereas IL-8 secretion was observed only under conditions that also showed p38 activation and comparatively maintained NF-κB p65 Ser536 phosphorylation. This signature arises from the convergence of a permissive SIRT1-S682 background with ERK- and p38-dependent MAPK signaling to enable NF-κB-mediated IL-8 expression, highlighting that both composite composition and particulate properties critically determine inflammatory potential and underscoring the importance of incorporating particulate fractions into cytocompatibility testing strategies.
Introduction: The goal of this study was to evaluate the influence of combined artificial aging protocols on the surface roughness and Vickers microhardness of bulk-fill resin composites, compared with a nanofilled composite used as a reference. Materials and Methods: A total of 120 cylindrical specimens were prepared from three bulk-fill composites (Tetric EvoCeram Bulk Fill, Filtek One Bulk Fill, Venus Bulk Fill) and one nanofilled composite (Filtek Supreme Ultra). Specimens were allocated into three aging conditions: mechanical wear (A), mechanical wear combined with pH-cycling (B), and mechanical wear combined with thermocycling (C). Surface roughness (Ra) and Vickers microhardness (VHN) were evaluated at two time points (T1: 120,000 cycles; T2: 240,000 cycles). Non-parametric statistical tests were applied (α = 0.05). Results: Aging protocols significantly influenced both Ra and VHN (p < 0.05). Overall, higher surface roughness and lower Vickers microhardness values were observed after cumulative aging, with material-dependent variations between T1 and T2. The greatest post-aging differences were observed under combined mechanical wear and pH-cycling (subgroup B), whereas mechanical wear alone showed the lowest changes. Filtek One Bulk Fill and Filtek Supreme Ultra showed more favorable post-aging Ra and VHN values, whereas Venus Bulk Fill showed less favorable post-aging surface properties. No significant correlation was found between Ra and VHN (rho = -0.009; p = 0.958). Conclusions: Combined aging conditions significantly affected the surface roughness and Vickers microhardness of resin composites, with the greatest post-aging differences observed under acidic challenges. Bulk-fill materials exhibit variable resistance depending on composition, emphasizing the importance of material selection for long-term clinical performance. Clinical relevance: Composite restorations exposed to combined mechanical and acidic challenges may show altered surface roughness and microhardness, highlighting the need for materials with enhanced resistance in high-risk oral environments.
This study evaluated the influence of shade, irradiance, and exposure time on the depth of cure (DoC) of a simplified bulk-fill universal composite (Tetric plus Fill) and a conventional composite (Filtek Supreme Ultra). The 80% bottom-to-top hardness ratio was used as an empirical cutoff, and 99% confidence intervals were calculated using R version 4.5.1. The DoC values were material and protocol dependent. Tetric plus Fill reached the 80% threshold to depths ranging from 3.5 to 4.5 mm, depending on shade and exposure protocol. All the Tetric plus Fill and the Filtek Supreme Ultra products reached their manufacturer's claimed DoC depth with both 3 s extra-high and 10 s high exposures from the Bluephase PowerCure. This study highlights the importance of following the manufacturers' recommendations for increment thickness and exposure time and of recognizing that shade and material formulation influence DoC.
To estimate changes in beliefs about abortion safety among a representative sample of the U.S. population assigned female at birth (AFAB) before and after the Supreme Court's 2022 Dobbs decision. We administered two serial cross-sectional surveys to English- or Spanish-speaking AFAB members of a nationally representative panel (ages 15-49), pre-Dobbs (2021-2022; n = 6943) and post-Dobbs (2023; n = 3533). Respondents indicated their agreement (vs disagree/unsure) that "it is usually safe" to end a pregnancy via 1) an in-clinic abortion procedure; and using medication abortion pills obtained 2) at a clinic/doctor's office; or 3) outside the formal healthcare system (for example, from the internet, a friend, etc.). Using adjusted weighted logistic regression models, we assessed changes in safety beliefs pre- to post-Dobbs. From pre- to post-Dobbs, agreeing that each abortion method was "usually safe" increased: in-clinic procedural abortion: 57.8-64.1% (p < 0.001); medication abortion from a clinic/doctor's office: 52.2-59.6% (p < 0.001); and medication abortion obtained outside the formal healthcare system: 7.3-9.6% (p = 0.005). Agreement that each abortion method is usually safe increased significantly among respondents identifying as Democrat, with no history of abortion, and/or who support abortion legality (p < 0.05). While abortion restrictions in the U.S. increased, so did public perceptions that procedural and medication abortion are safe. However, about 40% still had concerns about the safety of abortions within the formal healthcare system and almost all (90%) continued to disagree or were unsure whether medication abortion obtained outside the formal healthcare system is safe. Major gaps exist in the U.S. public's knowledge about abortion safety. These findings suggest that continued education about the availability and safety of medication abortion is essential, particularly as abortion bans and regulatory threats to medication abortion within the formal healthcare system remain and attempts to self-manage increase.
Silverleaf whitefly (Bemisia tabaci), silverleaf disorder (SLD), and whitefly-transmitted viruses (WTVs) are major constraints to cucurbit production in the southeastern United States. Two field trials were conducted in Tifton, Georgia, USA, during the fall of 2023 and 2024 to evaluate yellow squash and zucchini (Cucurbita pepo L.) cultivars for tolerance to SLD and WTVs. In one experiment, 10 yellow squash cultivars (8 straight neck: 'Cougar,' 'Lioness,' 'Multipik,' 'Lazor,' 'Grand Prize,' 'Gold Prize,' 'Enterprise,' and 'Fortune'; and 2 semi-crook neck: 'Gentry' and 'Gold Star') were evaluated. In another experiment, 10 zucchini cultivars: three spineless ('Spineless Perfection,' 'Spineless King,' and 'Spineless Supreme'), 2 gray types ('Hurakan,' and 'Rocio'), and 5 green types ('MGO477, 'Everglade,' 'Cardea,' 'Fortress,' and 'Renegade') were evaluated. 'Gold Star' and 'Spineless Perfection' served as susceptible controls. In yellow squash, 'Lioness' and 'Cougar' displayed the lowest SLD progression. Area under symptom progress curve (AUSPC) values for SLD were 203 in 2023 and 202 in 2024 for 'Lioness,' and 446 in 2023 and 490 in 2024 for 'Cougar.' Virus incidence was also lowest in 'Lioness' (area under disease progress curve (AUDPC) values 315 in 2023 and 403 in 2024) and 'Cougar' (AUDPC values of 548 in 2023 and 516 in 2024). Aligned rank transformed (ART) values for virus severity were smallest in 'Lioness' (7), followed by 'Enterprise' and 'Grand Prize' (27), and 'Cougar' (31). 'Cougar' and 'Lioness' cultivars produced the highest marketable yields (25,986 and 24,565 kg ha⁻¹ respectively in 2023). In zucchini, 'Rocio' and 'Hurakan' had the lowest AUSPC values (204 in 2023 and 197 in 2024 for 'Rocio' and 497 in 2023 and 427 in 2024 for 'Hurakan). 'Rocio,' 'Hurakan', and 'Renegade' recorded the lowest AUDPC values and virus severity (ART = 13). Marketable yields were highest in 'Renegade' (40,421 kg ha⁻¹), followed by 'Hurakan' and 'Rocio.' Across crops and years, cucurbit chlorotic yellows virus (CCYV) predominated over cucurbit yellow stunting disorder virus (CYSDV) and cucurbit leaf crumple virus (CuLCrV). Overall, 'Lioness', 'Cougar', 'Renegade', 'Hurakan', and 'Rocio' demonstrated superior performance with tolerance to SLD and WTVs while maintaining high yield.
Infertility presents a profound physical, emotional, and financial burden, particularly for rheumatology patients who often face substantial barriers to family building. The 2024 Alabama Supreme Court ruling in LePage v. Center for Reproductive Medicine equating embryo destruction with wrongful death introduced new legal uncertainties, sparking concerns about access to in vitro fertilization (IVF) and reproductive health services across the United States. Although Alabama's subsequent legislative action granted temporary protections for fertility providers, the broader implications of embryo personhood laws remain unresolved. For patients with rheumatic diseases, timely access to assisted reproductive technology (ART) is essential. However, barriers such as limited ART awareness, concerns about safety and success, social and religious stigma, and financial and legal restrictions disproportionately impact this population. The consequences of restrictive policies extend beyond females, affecting men and same-sex couples who rely on IVF to expand their families. Infertility is a recognized medical condition, and restricting ART access is medically and ethically indefensible. As physicians, researchers, and advocates, we must actively oppose legal decisions and policies that limit ART availability, including insurance restrictions, discriminatory practices, and embryo personhood legislation. Protecting and expanding ART access is critical-not only for rheumatology patients but for the one in eight couples and one in four physicians affected by infertility. Ensuring equitable, evidence-based reproductive care is imperative to safeguarding the right to family building for all.
From a food safety perspective, with a focus on natural fruit juices and concentrates, various types of adulteration, such as substitution with cheaper sweeteners, are increasingly recognized. In the present work, pure apple juice concentrate was adulterated with fructose syrup, glucose syrup, and date concentrate. Physicochemical properties (acidity, reducing sugars, formalin index, Brix, and total sugar), organic acid profiles (lactic acid, ascorbic acid, fumaric acid, and malic acid), and minerals (magnesium, iron, zinc, copper, sodium, and potassium) of pure and adulterated apple juice concentrate were evaluated and used to detect adulteration. For this purpose, after reducing the number of parameters determined by principal component analysis (PCA) and identifying the principal components (PCs) using linear and quadratic discriminant analyses (LDA and QDA), 15 parameters (including 4 organic acid factors, 5 physicochemical factors, and 6 mineral elements) were applied to classify the adulteration and authenticity of apple juice concentrate. Based on the results, the first four PCs that showed eigenvalues greater than 1 accounted for 84.5% of the total variance of the data set. The best classification (100%) was obtained using the values of three mineral elements, including sodium, potassium, and copper. Also, two physicochemical parameters, pH and total sugar, as well as the amounts of two organic acids, malic acid and ascorbic acid, were identified as the best parameters for classifying the type and concentration of adulterations in apple concentrate, respectively. The obtained results illustrated supreme discrimination for the type and concentration of the adulterants with a zero 2Log (likelihood) factor and 100% correct classification, which can be used for reliable detection of adulteration in apple concentrate.
This article repositions the family as a central yet overlooked institution in environmental governance by examining the Dongria Kondh of the Niyamgiri hills in India. Moving beyond dominant policy narratives that treat families as passive beneficiaries of sustainability frameworks, the paper argues that indigenous households function as sites where ecological knowledge, legal agency, and intergenerational solidarity converge to produce enduring forms of environmental stewardship. Drawing on a critical interpretive review of statutory law, constitutional jurisprudence, ethnographic accounts, and policy documents, the study develops the concept of familial ecological sovereignty to capture how kin-based institutions sustain ecological continuity through everyday practices of care, ritual, and decision-making. The analysis situates Dongria Kondh familial practices within India's plural legal landscape, particularly the Forest Rights Act, 2006, and relevant Supreme Court jurisprudence, including the landmark Niyamgiri case. It demonstrates that legal consciousness is not solely generated in courts or formal institutions but is cultivated within domestic spaces through intergenerational transmission of norms, values, and ecological understanding. At the same time, the paper critically engages with internal tensions within families, including gendered authority, migration, and intra-community inequalities, cautioning against idealized portrayals of indigenous governance. By integrating insights from legal pluralism, relational sociology, and traditional ecological knowledge, the study advances a conceptual triad linking legal agency, ecological knowledge, and intergenerational solidarity as mutually reinforcing processes. It argues that sustainability in indigenous contexts is not merely a matter of resource management but a relational practice rooted in kinship and moral obligation across generations. The paper concludes by proposing a shift in environmental governance from technocratic and centralized models toward relational frameworks that recognize families as co-governors of ecological systems. It outlines modest but actionable legal and policy reforms within existing statutory structures to better accommodate familial forms of knowledge and authority. In doing so, the study contributes to broader debates on decolonizing sustainability and foregrounds the role of intergenerational solidarity in shaping resilient ecological futures.