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.
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.
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.
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.
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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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.
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.
The Bayley is widely used for developmental assessment of young children. Reports suggest that Bayley-III overestimates scores and underidentifies developmental delay. Hypothesis: Using preterm cohort data, Bayley-4 scores will be lower than Bayley-III, with higher rates of developmental delay. Data are from the SuPreme Study, a prospective observational cohort of 1601 very preterm infants born 2013-2020. Follow-up included assessment at 24 months corrected age using the Bayley edition in routine use at the time, Bayley-III or Bayley-4 (Bayley-4A&NZ version). Of 1509 surviving SuPreme study participants, 96.6% were followed up. Bayley scores were obtained on a subgroup of 1034 (68.5%): 525 Bayley-III and 509 Bayley-4. Baseline characteristics and corrected age at assessment were similar. Adjusted mean difference estimates between standard scores on Bayley-4A&NZ vs Bayley-III were cognitive -10.3 (95% CI [-11.9 to -8.8]; P < .001), language -5.9 (95% CI [-7.6 to -4.1]; P < .001), motor -3.7 (95% CI [-5.2 to -2.2]; P < .001. Cognitive scores more than 2 standard deviations below the mean occurred in 12.8% of Bayley-4A&NZ group vs 4% of the Bayley-III group. Bayley-4A&NZ standard scores are lower than Bayley-III scores. Adjusted mean differences between scores are large. The findings apply across a broad range of developmental functioning. The clinical corollary is a higher proportion of children are identified with developmental delay using Bayley-4, particularly moderate/severe cognitive delay-adjusted relative risk ratio 4.0. More children will meet access criteria for early support services. Further implications are that research/audit data using different editions cannot be directly compared. Studies of other Edition-4 versions are warranted.
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.
Policy Points State policies and programs play an outsized role in shaping availability and access to sexual and reproductive health services across the nation. This has a major impact on women's access to contraception, abortion, and maternity services. In particular, state decisions about health care Medicaid coverage and payment, professional credentialing, reproductive rights, and regulatory policy all affect whether access to sexual and reproductive health services is broadened or constrained and ultimately whether low-income women will be able to access the broad range of services they need. Beyond coverage and payment, examples of recent state policies impacting reproductive health care include telehealth provision of abortion, pharmacists' prescribing authority, and efforts related to maternal health care quality improvement and oversight. Access to sexual and reproductive health care varies widely by geography, and state-level policies play a major role in establishing the contours that govern the coverage, provision, availability, and costs of services. The role of state-level policies has been amplified in the wake of the 2022 Supreme Court ruling in Dobbs v. Jackson Women's Health Organization, which eliminated the federal right to abortion care allowing states to set their own policies to ban or protect abortion. Additionally, states play a major role in shaping Medicaid policies that affect access to contraception and maternity care. This Perspective examines the many ways that state policy choices affects access to three interrelated areas of reproductive health care: contraception, abortion, and maternity care. State policy actions and decisions are at the core of reproductive health coverage and access. They are shaped by funding decisions, eligibility, and coverage polices established by the legislative and administrative bodies. This includes state policies related to contraceptive coverage and rights, Medicaid eligibility, telehealth and pharmacy access, scope of Medicaid and private insurance coverage, and efforts related to quality improvement and oversight. Affordability, availability, and coverage are still barriers to sexual and reproductive health services in many parts of the nation. Several states have intentionally erected barriers to abortion care, but structural challenges also affect contraception and maternity care access. Financing and regulatory policies treat contraception, abortion, and maternity care as distinct domains, but they are inextricably linked and many women often seek these services from the same clinicians. State level policies related to health coverage, reimbursement levels, workforce supply, and quality of care all overlap and affect the care that women receive and their experiences with the health care system. State policymakers play an outsize role in developing and implementing approaches to address their resident's reproductive health needs. The implementation of Medicaid work requirements and other federal cuts to health spending in the next several years is expected to lead to a major increase in people becoming uninsured at the same time that the reproductive health care safety-net faces financial uncertainty. States that take a coordinated, systems-level approach to health care can strengthen access, improve care delivery, and better meet patients' reproductive health care needs.
This paper examines how linguistic meaning interacts with legal interpretation for the statutory term child, focusing on the 2013 Alabama Supreme Court case Ex parte Ankrom. In that case, the court held that child includes unborn individuals under chemical endangerment laws, a decision that raises important questions about how ordinary meaning is established. Using a triangulated, corpus-based framework grounded in linguistic theory, this study analyzes the term child across three corpora representing national, regional, and informal U.S. English. The methodology integrates semantic coding, grammatical context analysis, and lexical alternation to assess whether unborn individuals fall within the prototypical meaning of child in ordinary usage. The findings reveal a strong preference for interpreting child as referring to born individuals, with linguistic evidence supporting its extension to fetuses only in marked contexts. This tension between the court's interpretation and the linguistic evidence highlights the challenges of aligning legal definitions with everyday language use. In emphasizing the role of empirical linguistic data, the study contributes to ongoing debates in legal corpus linguistics around frequency, representativeness, and contextual meaning. Ultimately, this analysis offers insight into how corpus linguistics can support statutory interpretation and reduce interpretive ambiguity without overstepping the boundaries between linguistic and legal expertise.
This Viewpoint discusses the US Supreme Court’s decision in Chiles v Salazar and offers suggestions for state professional regulation that protect patient safety and autonomy while respecting constitutional boundaries.
President Trump and his administration have repeatedly threatened to invoke insurrection powers and unleash US military and National Guard members in American cities in response to civil uprisings and alleged interferences with immigration officials' actions. In so doing, they raise a specter of significant constitutional clashes over the use of these antiquated emergency authorities. To the extent Congress is unwilling to constrain presidential discretion, the US Supreme Court may be called on to clarify the scope and limits of Insurrection Act powers.