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The use of potentially inappropriate medication (PIMs) is frequent in nursing homes (NHs), and leads to worsened health outcomes for their residents. Numerous initiatives to curb their use have been launched. Most studies of PIMs use in NHs, however, focused on their prevalence, and provide few insights on the evolution of their use.

The objective of this analysis is to measure the evolution of PIMs use in the nursing NHs of western Switzerland taking part in an integrated pharmacy service (IPS).

Drug consumption data from 166 NHs were collected for 2014 to 2018, through the monitoring of the IPS. Selleck Retinoic acid These data were cross-referenced with validated PIMs lists (Beers’ list and Norwegian General Practice-Nursing Home, NORGEP-NH) to compute the number of potentially inappropriate defined daily doses per average resident (DDD/res) in each NH. Linear mixed-effects models were used to assess the evolution of PIMs use over time, following the NORGEP-NH classification of PIMs and the drug classes involved.

In 201interventions and implementation strategies need to be developed to help clinicians further reduce their use in NHs.Front-of-pack nutrition labels (FOP-NL) are efficient tools for increasing consumers’ awareness of the nutritional quality of food products, prompting healthier food choices. The main goal of this study was to evaluate the impact of four FOP-NL schemes – Traffic Light label (TL), Guideline Daily Amounts (%GDA), Nutri-Score (NS) and Health Star Rating (HSR) – on consumers’ selection of food products according to perceived nutritional quality. A cross-sectional open-label crossover randomized controlled study was carried out among Portuguese consumers. A web-based questionnaire was used to assess participants’ a) preferences regarding FOP-NLs and b) capacity to select healthy products in a food selection task using the information from FOP-NL schemes. When performing the selection task, participants had the option to indicate that they could not decide simply based on the presented FOP-NL (requiring more information). Overall, 357 adults participated in the study. Regarding consumers’ preferences, TL received the most favorable responses, while NS received the fewest. All FOP-NLs performed better than the no-nutritional label control condition in the food selection task. The highest proportion of correct choices was obtained for TL (72.3%), followed by HSR (70.9%), %GDA (70.0%) and NS (62.2%), though no significant differences were found among FOP-NLs. Percentages of respondents indicating not being able to answer due to lack of information affected the proportion of correct choices, with 10.3% for TL, 12.9% for %GDA, 14.6% for HSR, and 25.8% for NS, indicating they were unable to choose without additional information. Although no particular FOP-NL system stood out as the most significantly effective, TL was the most preferred by Portuguese adults. Long-term real-world evidence is necessary to assess the impact of FOP-NL systems on individuals’ food choices.Acute type A aortic dissection is a clinical emergency and is associated with significant morbidity and mortality rates if not managed promptly in specialised and high-volume centres. The mortality rate is increased by 1% for each hour delay in management; however, with advancement in clinical practice, diagnostic imaging and clinician awareness, this has been dramatically reduced to below 30% in most international centres. Not only timing of recognition of the pathology, but also other factors can significantly affect outcomes of such critical pathology. This includes, but is not limited to, age, extent of the pathology, existence of connective tissue disorders, hypertension, diabetes mellitus and surgeon experience. This narrative review will focus on current clinical practice and the evidence behind optimising each factor to minimise adverse outcomes in such high-risk cohort.

To measure the degrees of conversion (DC), conversion kinetics, and the effect of post-irradiation time on rapid photo-polymerized bulk-fill resin composites under conditions equivalent to clinical depths of 1 and 4mm.

36 specimens (n=3), based on two resin composites incorporating PowerCure rapid-polymerization technology in two consistencies (PFill; PFlow) and two comparators with matching consistencies (Eceram; EFlow), were investigated from the same manufacturer (Ivoclar AG, Liechtenstein). Specimens were prepared within 4mm diameter cylindrical molds, of either 1mm or 4mm depths respectively, to simulate near-surface and deep locations in a bulk-fill restoration. The independent variables in this study were materials, thickness and time. Two high irradiance polymerization protocols were utilized for PowerCure materials 2000 and 3050mW/cm

for 5 and 3s, respectively. A standard (1200mW/cm

) polymerization protocol was used with control materials. FTIR was utilized to measure DC in real-time for 24h and PFlow materials produced an overall comparable conversion at 5min and 24h post-irradiation, despite the ultra-short irradiation times, throughout the 4mm specimen thickness.

Polymerization kinetics and RPmax were influenced by specimen thickness and material viscosity. PFill and PFlow materials produced an overall comparable conversion at 5min and 24h post-irradiation, despite the ultra-short irradiation times, throughout the 4mm specimen thickness.This paper addresses a missile-target interception guidance process considering acceleration saturation and target maneuver as a constrained nonlinear tracking issue. A dynamic auxiliary system is designed for compensating the effects of constrained input, and external disturbances are counteracted through designing a nonlinear disturbance observer (NDO). The feedforward+feedback composite architecture is built in which a feedforward backstepping control and a feedback optimal control is presented recurrently. Furthermore, the parameter adaptive updating laws are derived to estimate the unknown functions online. Subsequently, the boundedness of the closed-loop signals are guaranteed. The predefined cost function is also ensured to be minimized. Furthermore, the control input is prevented violating its boundary. The contrastive simulation results demonstrate that the robustness of the proposed method is more superior to the nonsingular terminal sliding mode (NTSM) and the proportional navigation (PN) methods.