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This study identifies wide variability in caregiver support acrossstate-basedMedicaid waivers. Future research should evaluate effectiveness of the waiver programs in supporting caregivers and inform evidence-based policy advocacy for supporting caregivers.

This study identifies wide variability in caregiver support across state-based Medicaid waivers. Future research should evaluate effectiveness of the waiver programs in supporting caregivers and inform evidence-based policy advocacy for supporting caregivers.Racism has been a part of nursing since its inception and has influenced its models, practices, selection of ascribed leaders, and problem framing. Reducing health disparities by effectively addressing how racism influences institutional practices is both necessary and relevant to the discipline of nursing. Using concepts from systems theory and business operations management this paper provides an important perspective for the discipline to begin to effectively address institutional racism and build nursing knowledge.

Ewing sarcoma, a malignancy originating from the bone or soft tissues most commonly diagnosed in adolescents, requires multimodality therapy. Although both surgical resection and radiation therapy are effective local control modalities, there are limited data comparing outcomes in patients treated with surgery versus radiation. We sought to determine whether there were differences in 5-year local failure-free survival, event-free survival, and overall survival based on the modality used for local control.

Patients treated for Ewing sarcoma at a single tertiary pediatric hospital between 2010 and 2020 were included for retrospective analysis. Patient and tumor demographics, treatment information, and patient response to therapies were collected from the medical record. Outcome measures were local failure-free survival, event-free survival, and overall survival at 5 years from diagnosis.

Sixty-one patients met inclusion criteria. All patients received chemotherapy, and 68.9% of patients presented with lociation, regardless of whether or not R0 resection was achieved. Future directions include a multi-institutional study to allow for further subgroup analysis and increased sample size.

A prefabricated glass fiber post provides esthetic and biomechanical benefits for severely damaged endodontically treated teeth; however, failures in post retention remain a challenge.

The purpose of this systematic review was to compare the fracture resistance and bond strength of prefabricated glass fiber posts to those made with computer-aided design and computer-aided manufacturing (CAD-CAM).

This review was entered into PROSPERO (CRD42020213668) and was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic systematic searches of PubMed/MEDLINE, Embase, and the Cochrane Library were conducted for published articles until October 2020. Studies that compared prefabricated glass fiber posts with CAD-CAM-fabricated glass fiber posts were selected, and studies that had not been published in English or in the previous 10 years were excluded. The fracture resistance (N) and bond strength (MPa) were the primary outcomes.

After reviewing the title, abstract, and the entire text of 227 articles, 8 studies were selected. Four studies were omitted. Four of the 8 studies were retained for qualitative analyses, with 1 having a high risk of bias and 3 having a medium risk of bias. Only 1 study found significantly higher fracture resistance in the CAD-CAM group than in the prefabricated group. The bond strength study reported a significant difference, with the CAD-CAM group having greater bond strength than the prefabricated group.

Despite the high heterogeneity and the few included articles, a tendency was found for the CAD-CAM-fabricated glass fiber post to improve fracture resistance and bond strength. However, the available literature is insufficient to draw definitive conclusions.

Despite the high heterogeneity and the few included articles, a tendency was found for the CAD-CAM-fabricated glass fiber post to improve fracture resistance and bond strength. However, the available literature is insufficient to draw definitive conclusions.

Additive manufacturing by selective laser melting (SLM) has been claimed to be less challenging than conventional casting of cobalt-chromium (Co-Cr) removable partial dentures (RPDs), providing significant improvements. However, how the physicomechanical properties of Co-Cr RPDs fabricated by SLM compare with those fabricated by conventional casting is unclear.

The purpose of this invitro study was to evaluate the physicomechanical properties of Co-Cr RPD palatal major connectors fabricated by SLM compared with those fabricated by conventional casting.

A master die simulating a maxillary arch of Kennedy class III modification 1 was scanned to create a virtual 3-dimensional (3D) cast. Two groups of 5 Co-Cr RPD major connectors were fabricated. In the 3D printing group, the Co-Cr major connector was virtually designed and exported for direct SLM 3D printing. For the conventional group, Co-Cr major connectors were constructed conventionally. The Co-Cr major connectors were virtually superimposed with the melative densities.

Compared with the conventional casting technique, SLM 3D printing enabled the fabrication of Co-Cr RPD major connectors with higher microhardness and fine homogenous microstructure. However, the surface adaptation and surface roughness of SLM 3D printing Co-Cr connectors were worse than those produced conventionally. Both techniques showed similar relative densities.

The association between preoperative cognitive impairment, postoperative pain, and postoperative delirium in older patients after noncardiac surgery is not known.

This was a secondary analysis of datasets from three previous studies. Patients aged ≥55 yr who underwent elective noncardiac surgery were enrolled. Preoperative cognitive impairment was defined as Mini-Mental State Examination <27. Pain intensity with movement was assessed using an 11-point numeric rating scale at 12-h intervals during the first 72 h after surgery; time-weighted average (TWA) pain score was calculated. Primary outcome was the occurrence of delirium within the first 5 postoperative days. Mediation analysis was used to investigate the relationships between cognitive impairment, pain score, and delirium.

A total of 1497 patients were included. Prevalence of preoperative cognitive impairment was 40.3% (603/1497). Patients with cognitive impairment suffered higher TWA pain score within 72 h (4 [3-5] vs 3 [2-5], P=0.004) and moration.In this paper, we design a proportional integral observe for a nonlinear synchronous reluctance motor described by a Takagi-Sugeno multi-model. In this design, both states and unknown inputs are estimated simultaneously. First, the mathematical nonlinear model of the synchronous reluctance motor is established, then it transformed into a Takagi-Sugeno exact form by a simple polytopic transformation. In The second step, the proposed observer is designed to the obtained fuzzy system. learn more Convergence conditions are expressed under a linear matrix inequality formulation using the second Lyapunov theorem, which guarantee a bounded error. Observer gains are obtained by solving a sum of constraints. For validation purposes, a hardware-in-the-loop implementation were carried out leading to results that clearly demonstrate the performance and effectiveness of the proposed technique.

Pathological reports have shown that plaque erosion (PE), a common cause of acute coronary syndrome (ACS), can form in both fibrous plaque and lipid-rich plaque (LRP). In plaque rupture (PR), which is the main cause of ACS, the underlying plaque is LRP with a thin fibrous cap. In this study, we aimed to investigate the clinical features and lipid profiles of PE with or without LRP in comparison with those of PR.

A total of 166 patients with ACS, who underwent percutaneous coronary intervention using optical coherence tomography (OCT) and met the criteria for PR or PE, were included. LRP was defined as plaque with a maximal lipid arc (>180°). Culprit lesions were categorized into PR and PE with/without LRP [PE

or PE

].

The prevalence of PR, PE

, and PE

was 104 (62.7%), 43 (25.9%), and 19(11.4%), respectively. The patients with PR and PE

had a significantly higher peak creatine kinase level (1338 and 1584U/L, respectively, p<0.01) and prevalence of ST-elevation myocardial infarction (71.2% and 79.1%, respectively, p<0.01) than those with PE

(214U/L and 21.1%, respectively). The various lipid profiles were mostly comparable between the patients with PE

and PR, but different in those with PE

. The levels of small dense low-density lipoprotein cholesterol were significantly higher in the patients with PR and PE

than in those with PE

(39.0, 35.3, and 25.7mg/dL, respectively, p=0.02).

The clinical features and lipid profiles are substantially different between PE

and PE

, but are somewhat similar between PE

and PR.

The clinical features and lipid profiles are substantially different between PE(Lipid) and PE(Fibrous), but are somewhat similar between PE(Lipid) and PR.

Sleep health (SH) is considered a key determinant of human physiological and psychological well-being. In line with this, previous studies have found that poor sleep is associated with various psychiatric disorders, in particular, with anxiety and depression. Although little is known about the neural mechanisms underlying these associations, recent findings suggest that essential dimensions of SH are associated with altered amygdala reactivity (AR); however, evidence to date is inconsistent and reliant on small sample sizes.

To address this problem, the current preregistered study investigated associations between SH and AR to negative facial expressions in the UK Biobank cohort (25,758 participants). Drawing on a large sample size and consistent data acquisition, 5 dimensions of SH (insomnia symptoms, sleep duration, daytime sleepiness, chronotype, and sleep medication) were examined.

Exploratory analyses revealed that short sleep duration was associated with decreased AR. The remaining SH dimensions and a composite measure of all SH dimensions were not associated with AR.

To our knowledge, this is the largest study to test associations between SH and AR. Habitual short sleep duration may be associated with decreased AR, possibly indicating compensation for impaired prefrontal processes and hampered emotion regulation.

To our knowledge, this is the largest study to test associations between SH and AR. Habitual short sleep duration may be associated with decreased AR, possibly indicating compensation for impaired prefrontal processes and hampered emotion regulation.

Attention-deficit/hyperactivity disorder (ADHD) is highly heritable, but little is known about the relative effects of transmitted (i.e., direct) and nontransmitted (i.e., indirect) common variant risks. Using parent-offspring trios, we tested whether polygenic liability for neurodevelopmental and psychiatric disorders and lower cognitive ability is overtransmitted to ADHD probands. We also tested for indirect or genetic nurture effects by examining whether nontransmitted ADHD polygenic liability is elevated. Finally, we examined whether complete trios are representative of the clinical ADHD population.

Polygenic risk scores (PRSs) for ADHD, anxiety, autism, bipolar disorder, depression, obsessive-compulsive disorder, schizophrenia, Tourette syndrome, and cognitive ability were calculated in UK control subjects (n= 5081), UK probands with ADHD (n= 857), their biological parents (n= 328 trios), and also a replication sample of 844 ADHD trios.

ADHD PRSs were overtransmitted and cognitive ability and obsessive-compulsive disorder PRSs were undertransmitted.