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Background: Extended platelet-rich fibrin (e-PRF) membranes are a novel 100% autologous biomaterial with a longer resorption time (4–6 months) than traditional solid-PRF membranes (two weeks). In part 1 of this 2-part publication series, four clinical variations for using these novel e-PRF membranes for socket preservation were introduced. In this randomized clinical trial (RCT), all four iterations of e-PRF membranes were compared to traditional collagen membranes in alveolar ridge preservation for hard and soft tissue dimensional changes and early wound healing outcomes. Methods: A single-center RCT was conducted, including 55 patients requiring the extraction of a single tooth with planned implant placement. All sockets were grafted with a “sticky bone” (bone allograft mixed with PRF) and secured with either a collagen membrane (control) or e-PRF membranes utilizing the four variations present in Part 1 (both formed extra-orally or intra-orally, each with or without an overlying solid PRF membrane). The time of fabrication and application of each e-PRF iteration was recorded. Cone beam computed tomography was utilized to evaluate horizontal and vertical ridge dimensions at baseline and 3 months post-operatively, and soft tissue thickness was also measured at both time intervals utilizing an endodontic reamer. Early wound healing was recorded at 2 weeks, utilizing the Landry, Turnbull, and Howley Index by three blinded clinicians. Results: The results demonstrated that, at 3 months, the e-PRF membranes fabricated utilizing all 4 treatment variations demonstrated equal improvements in horizontal and vertical ridge dimensions and soft tissue thickness when compared to collagen membranes. Additionally, the membrane (p = 0.029) and membrane w/solid (p = 0.021) groups demonstrated statistically significant superior early wound healing compared to the collagen membrane group. Notably, the Bio-Filler groups demonstrated statistically significant reduction in fabrication/application time compared to the membrane groups. Conclusions: Within the limitations of this RCT, all e-PRF iterations performed comparably to collagen membranes in maintaining both hard and soft tissue ridge dimensions when combined with sticky bone, while also significantly improving soft tissue wound healing. Future RCTs with alternative grafting materials, direct wound-margin assessment, and evaluation of patient-reported outcomes are necessary to clarify the advantages of each membrane type.

BackgroundCardiovascular (CV) readmissions after heart failure (HF) hospitalization represent a significant source of morbidity and healthcare burden. Although hypertension (HTN) is a key precursor of HF, its impact on CV-specific readmissions after discharge is less well characterized.MethodsWe conducted a retrospective cohort study using the Nationwide Readmissions Database, spanning 2016 to 2022. Adult patients hospitalized with a primary diagnosis of HF were included. CV-specific readmissions within 30 days and one year were identified using ICD-10 codes for HTN, HF, myocardial infarction, arrhythmias, stroke, and thromboembolic conditions. Demographic, clinical, and hospital-level variables were evaluated to identify factors associated with readmission risk. ResultsAmong 31,886,859 weighted hospitalizations for HF, HTN, or HTN crisis, HTN crisis was the most frequent cause of CV-specific readmissions, comprising 64.80% (N=20,662,685) of 30-day and 65.10% (N=20,758,345) of one-year events. All comparisons vs. HTN were highly significant (p<0.001) with large effect sizes (phi-coefficients=0.53-0.69).ConclusionHTN is the most frequent diagnosis leading to CV-specific readmissions after HF discharge. These findings underscore the need for prioritized BP management to prevent recurrent admissions and improve outcomes.

Abstract Introduction In 2023, our center implemented a novel clinical decision support system (CDSS) for burn resuscitation. Initial education was provided to staff and performance was monitored in real-time. It was found that burn nursing staff (RN) were struggling with the components of CDSS documentation despite ongoing education. Recognizing that RNs lacked understanding, confidence and comfort with the system, the team revamped the CDSS education. A quality improvement (QI) project was initiated using a multi-pronged educational approach. The purpose of this study was to evaluate the efficacy of the project in improving nurse-reported levels of comfort and confidence. Methods The Burn Educator and Burn Nurse Specialist worked to expand the existing education mediums which included nursing huddles and instructional handouts. Complementary resources were developed, namely classroom training, an enhanced step-by-step guide, and initiation checklist. Learners were given pre- and post-education surveys to ascertain comfort and confidence in CDSS initiation, ongoing management, troubleshooting, location of resources and serving as a resource for colleagues. A post-education test was administered with a minimum score of 100% required to pass. Results A total of 33 RNs completed the training. The greatest improvement in comfort and confidence was seen in the management of resuscitation in the operating room (pre 30.3%, post 78.8%), followed by initiation and troubleshooting (pre 48.5%, post 93.9%), supporting colleagues with CDSS use (pre 48.5%, post 72.7%), and ability locating resources (pre 69.7%, post 97%). Ultimately, all RNs passed the post-test with the required 100% score. Conclusions The most notable improvements were seen in comfort initiating CDSS-guided fluid resuscitation and continuing resuscitation off-unit. These measures of amplified comfort and confidence, combined with increased levels of understanding ultimately impact nursing competency. All burn ICU and ED RNs are required to complete and pass the education prior to caring for a patient during fluid resuscitation in our center. The education is required annually and routine monitoring of performance is incorporated into our formal QI program. Applicability of Research to Practice This project highlights the importance of expanding education to mediate fluctuating levels of RN comfort, confidence and understanding. Funding for the Study N/A

In the UK, place-based food initiatives, herein “food hubs,” offer a range of economic, social, and/or environmental benefits via the programs, activities and support they offer. Examples of food hubs include food banks, food pantries, social supermarkets, community farms and gardens, and community cafes. Identifying, monitoring, and communicating the benefits of and areas of improvement for food hubs are important in ena­bling these organizations to access funding, scale up and/or out, and support their ambitions to enhance community development and promote community-based circular food systems (C-B CFS). However, due to constraints in time, funding, and resources, evaluation of the work of food hubs across the UK is limited to date and does not cap­ture the multidimensional benefits they provide or the impacts they have to achieve a C-B CFS. This paper presents the co-production and application of an impact evaluation tool aiming to support food hubs to capture evidence of the benefits they provide, and areas where additional benefits can be achieved across four domains: (a) sustainability and resilience; (b) health and wellbeing; (c) access and demand for healthy, local food; and (d) food secu­rity and economy. The tool, available freely online, was implemented at 10 diverse food hubs in Leeds, UK, to capture their activities and impact. Partici­pating food hubs agreed that the tool offers a comprehensive yet practical method of evidencing the impact of their activities. The evidence cap­tured using the tool could strengthen both indivi­dual PBFIs and the wider community food sector. By demonstrating their contributions to national and global priorities in health, food security, and sustainability, this evidence supports advocacy for greater policy recognition and funding. After assessing the implementation of the too across multiple PBFIs, we found how structured impact monitoring could enhance operational resilience, inform strategic planning, and reinforce the case for systemic support of C-B CFS.

Abstract Circuit languages like Circom and Gnark have become essential tools for programmable zero-knowledge cryptography, allowing developers to build privacy-preserving applications. These domain-specific languages (DSLs) encode both the computation to be verified (as a witness generator) and the corresponding arithmetic circuits, from which the prover and verifier can be automatically generated. However, for these programs to be correct, the witness generator and the arithmetic circuit need to be mutually consistent in a certain technical sense, and inconsistencies can result in security vulnerabilities. This paper formalizes the consistency requirement for circuit DSLs and proposes the first automated technique for verifying it. We evaluate the method on hundreds of real-world circuits, demonstrating its utility for both automated verification and uncovering errors that existing tools are unable to detect.

Abstract Purpose A significant proportion of many populations remain uninsured. The aim of the study was to assess differences in breast cancer outcomes before and after the implementation of an innovative approach to the multidisciplinary treatment of uninsured breast cancer patients. Methods Retrospective review was performed of patients seen at a safety net hospital from January 2000 to December 2020. Beginning July 2006 an innovative approach was implemented to lower patient costs to facilitate care of uninsured patients. Results The study included 1,797 patients, 661 patients before the changes (BCS), 1,136 patients after implementation of the new cost saving approach (ACS). The mean age was 53 years. The majority were uninsured (56%) or insured by Medicaid (31%). Only 18% underwent screening mammography. The ACS group had a higher rate of breast conservation (75% vs 47%, p &lt; 0.001). A higher percentage of the ACS group received adjuvant therapy: Chemotherapy (91% vs 70%, p &lt; 0.001), Radiation therapy (91% vs 70%, p &lt; 0.001), and initiated endocrine therapy (87% vs 67%, p &lt; 0.001). After follow up of 8 years, these changes resulted in lower ipsilateral breast tumor recurrence (2% vs 16%, p &lt; 0.001) and chest wall recurrence (5% versus 8%) and improvement in overall survival (90% vs 81%, p &lt; 0.001). Conclusion Peer reviewed literature is replete of studies documenting disparities in breast cancer treatment. The current study describes a successful cost limiting method which takes advantage of existing financial assistance programs to improve care in uninsured patients.