Medicaid, which provides health insurance to low-income Americans, is a joint federal-state partnership that manifests as 50 unique state programs. States have policy flexibility to design programs within federal parameters. However, Medicaid also requires funding flexibility to encourage states to maintain services during times of crisis when more people need Medicaid. Currently, Medicaid’s funding formula, the Federal Medical Assistance Percentage (FMAP), adjusts federal spending by state levels of economic development but fails to adjust for nationwide recessions. During economic contractions, the federal government should use its ability to run budget deficits to reimburse states at higher rates in exchange for maintaining services. In turn, during economic expansions, states should shoulder relatively more costs of Medicaid. Although the current FMAP boost provided under the Families First Coronavirus Response Act has reduced strain on state Medicaid programs, it does not account for the severity of state-specific downturns and is limited to the current emergency. Instead of ad hoc, across-the-board FMAP boosts to respond to each crisis, Congress should pass legislation making automatic adjustments based on changes in state unemployment rates.

Evidence is limited as to whether the introduction of the Affordable Care Act (ACA)’s Medicaid expansions was associated with improvements in cardiovascular risk factors at the population level.

To examine the association between the ACA Medicaid expansions and changes in cardiovascular risk factors among low-income individuals during the first 3years of the implementation of the ACA Medicaid expansions at the national level.

A quasi-experimental difference-in-differences (DID) analysis to compare outcomes before (2005-2012) and after (2015-2016) the implementation of the ACA Medicaid expansions between individuals in states that expanded Medicaid and individuals in non-expansion states.

A nationally representative sample of individuals aged 19-64years with family incomes below 138% of the federal poverty level from the 2005-2016 National Health and Nutrition Examination Survey (NHANES).

ACA Medicaid expansions.

Cardiovascular risk factors included (1) systolic and diastolic blood pressure, (2) he representative data of individuals who were affected by the ACA, we found that the ACA Medicaid expansions were associated with a modest improvement in cardiovascular risk factors related to hypertension and diabetes during the first 3 years of implementation.

The study sought to assess the prognostic impact of chronic kidney disease (CKD) in patients with electrical storm (ES). ES represents a life-threatening heart rhythm disorder. In particular, CKD patients are at risk of suffering from ES. However, data regarding the prognostic impact of CKD on long-term mortality in ES patients is limited.

All consecutive ES patients with an implantable cardioverter-defibrillator (ICD) were included retrospectively from 2002 to 2016. Patients with CKD (MDRD-GFR < 60 ml/min/1.73 m

) were compared topatients without CKD. The primary endpoint was all-cause mortality at 3 years. Secondary endpoints were in-hospital mortality, cardiac rehospitalization, recurrences of electrical storm (ES-R), and major adverse cardiac events (MACE) at 3 years.

A total of 70 consecutive ES patients were included. CKD was present in 43% of ES patients with a median glomerular filtration rate (GFR) of 43.3 ml/min/1.73 m

. CKD was associated with increased all-cause mortality at 3 years (63% vs. 20%; p = 0.001; HR = 4.293; 95% CI 1.874-9.836; p = 0.001) and MACE (57% vs. 30%; p = 0.025; HR = 3.597; 95% CI 1.679-7.708; p = 0.001). Crizotinib In contrast, first cardiac rehospitalization (43% vs. 45%; log-rank p = 0.889) and ES-R (30% vs. 20%; log-rank p = 0.334) were not affected by CKD. Even after multivariable adjustment, CKD was still associated withincreased long-term mortality (HR = 2.397; 95% CI 1.012-5.697; p = 0.047), as well aswith the secondary endpoint MACE (HR = 2.520; 95% CI 1.109-5.727; p = 0.027).

In patients with ES,the presence of CKD was associated with increased long-term mortality and MACE.

In patients with ES, the presence of CKD was associated with increased long-term mortality and MACE.The acaricidal activity of Azadirachta indica (neem) aqueous fruit extracts was evaluated against Sarcoptes scabiei var. suis (mange mites) in an on-farm trial using grower pigs. Aqueous neem fruit extracts of three concentrations 5%, 10%, and 25% w/v and a commercial acaricide, 12.5% amitraz-based Triatix spray (positive control), were compared with pigs that received no treatment (negative control). Thirty grower pigs of the Dalland breed were allocated to the five treatments in a completely randomized experiment. Each experimental animal was sprayed on day 0 and again on day 7. Counts of mange mites, scoring of lesion index, and calculation of rubbing index were done weekly. Topical application of 25% aqueous neem fruit extract had a higher efficacy ratio (p less then  0.05) than the other fruit extract concentrations, and performed similarly to an amitraz-based acaricide, suggesting a dose-dependent response. Amitraz (positive control) cured clinical mange on grower pigs after 5 weeks and 25% aqueous neem fruit extract 6 weeks post-treatment. The results indicated that aqueous neem fruit extracts have acaricidal effects against mange mites and can provide a cheaper, safer, and more eco-friendly alternative for the control of Sarcoptes mange in pigs.

To develop a radiomics model based on dynamic contrast-enhanced ultrasound (CEUS) to predict early and late recurrence in patients with a single HCC lesion ≤ 5cm in diameter after thermal ablation.

We enrolled patients who underwent thermal ablation for HCC in our hospital from April 2004 to April 2017. Radiomics based on two branch convolution recurrent network was utilized to analyze preoperative dynamic CEUS image of HCC lesions to establish CEUS model, in comparison to the conventional ultrasound (US), clinical, and combined models. Clinical follow-up of HCC recurrence after ablation were taken as reference standard to evaluate the predicted performance of CEUS model and other models.

We finally analyzed 318 patients (training cohort test cohort = 25563). The combined model showed better performance for early recurrence than CUES (in training cohort, AUC, 0.89 vs. 0.84, P < 0.001; in test cohort, AUC, 0.84 vs. 0.83, P = 0.272), US (P < 0.001), or clinical model (P < 0.001). For late recurrence prediction, the combined model showed the best performance than the CEUS (C-index, in training cohort, 0.