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Background: Polypharmacy and the resulting problems lead to considerable consequences for those affected. There are also considerable problems with the medication management., Objective: Which interventions and programs for optimizing the supply of medication are available for nursing homes and which implementation problems can be expected?, Material and Method: A literature search was carried out for interventional studies in nursing homes in Germany, with a focus on improving medication safety., Results: A total of six programs were identified for which evaluation results are available. Despite a mostly multimodal approach with several pillars of intervention (e.g., medication reviews, further education and training, development of aids), the results are largely disappointing. The effects on the number of prescriptions in general, specific medication groups or outcome parameters such as hospital admissions could only be shown in one study, whereby, selection bias could also be at least partly responsible for this. Interdisciplinary collaboration and the implementation of medication recommendations formulated in reviews by the responsible physicians are the main problem areas. At the same time, too little attention is paid to the central role of nurses in the entire process and they are not actively promoted enough. This could be one of the reasons for the difficulties in implementation in practice., Conclusion: There are nearly no significant changes as a result of the interventions implemented in the studies reviewed. In particular, interprofessional cooperation, especially the skills of nurses and the reluctance on the part of physicians, should probably be given more attention., (© 2024. The Author(s).)

Background: Head tremor is common in dystonia syndromes and difficult to treat. Deep brain stimulation (DBS) is a therapeutic option in medically-refractory cases. In most DBS-centers, the globus pallidus internus (GPi) is targeted in patients with predominant dystonia and the ventrointermediate nucleus of the thalamus (Vim) in predominant tremor. The aim of the study was to evaluate the effect of GPi- versus Vim-DBS in dystonic or essential head tremor., Methods: All patients with dystonia or essential tremor (ET) (n = 381) who underwent DBS surgery at our institution between 1999 and 2020 were screened for head tremor in our database according to predefined selection criteria. Of the 33 patients meeting inclusion criteria tremor and dystonia severity were assessed at baseline, short- (mean 10 months) and long-term follow-up (41 months) by two blinded video-raters., Results: Twenty-two patients with dystonic head tremor received either GPi- (n = 12) or Vim-stimulation (n = 10), according to the prevailing clinical phenotype. These two groups were compared with 11 patients with ET, treated with Vim-stimulation. The reduction in head tremor from baseline to short- and long-term follow-up was 60-70% and did not differ significantly between the three groups., Conclusions: GPi-DBS effectively and sustainably reduced head tremor in idiopathic dystonia. The effect was comparable to the effect of Vim-DBS on head tremor in dystonia patients with predominant limb tremor and to the effect of Vim-DBS on head tremor in ET., (© 2024 The Authors. Movement Disorders Clinical Practice published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.)

Essential tremor (ET) amplitude is modulated by visual feedback during target driven movements and in a grip force task. It has not been examined yet whether visual feedback exclusively modulates target force tremor amplitude or if other afferent inputs like auditory sensation has a modulatory effect on tremor amplitude as well. Also, it is unknown whether the enhanced sensory feedback causes an increase of arousal in persons with ET (p-ET). We hypothesized that (1) amplitude of tremor is modulated by variation of auditory feedback in the absence of visual feedback in a force tremor paradigm; (2) increase of tremor amplitude coincides with pupillary size as a measure of arousal. 14 p-ET and 14 matched healthy controls (HC) conducted a computer-based experiment in which they were asked to match a target force on a force sensor using their thumb and index finger. The force-induced movement was fed back to the participant visually, auditory or by a combination of both. Results showed a comparable deviation from the target force (RMSE) during the experiment during all three sensory feedback modalities. The ANOVA revealed an effect of the high vs. low feedback condition on the tremor severity (Power 4-12 Hz) for the visual- and also for the auditory feedback condition in p-ET. Pupillometry showed a significantly increased pupil diameter during the auditory involved high feedback conditions compared to the low feedback conditions in p-ET. Our findings suggest that action tremor in ET is firstly modulated not only by visual feedback but also by auditory feedback in a comparable manner. Therefore, tremor modulation seems to be modality independent. Secondly, high feedback was associated with a significant pupil dilation, possibly mirroring an increased arousal/perceived effort., (© 2024. The Author(s).)

Simulating the ozone variability at regional scales using chemistry transport models (CTMs) remains a challenge. We designed a multi-model intercomparison to evaluate, for the first time, four regional CTMs on a national scale for Germany. Simulations were conducted with LOTOS-EUROS, REM-CALGRID, COSMO-MUSCAT and WRF-Chem for January 1 st to December 31 st , 2019, using prescribed emission information. In general, all models show good performance in the operational evaluation with average temporal correlations of MDA8 O 3 in the range of 0.77-0.87 and RMSE values between 16.3 μg m -3 and 20.6 μg m -3 . On average, better models' skill has been observed for rural background stations than for the urban background stations as well as for springtime compared to summertime. Our study confirms that the ensemble mean provides a better model-measurement agreement than individual models. All models capture the larger local photochemical production in summer compared to springtime and observed differences between the urban and the rural background. We introduce a new indicator to evaluate the dynamic response of ozone to temperature. During summertime a large ensemble spread in the ozone sensitivities to temperature is found with (on average) an underestimation of the ozone sensitivity to temperature, which can be linked to a systematic underestimation of mid-level ozone concentrations. During springtime we observed an ozone episode that is not covered by the models which is likely due to deficiencies in the representation of background ozone in the models. We recommend to focus on a diagnostic evaluation aimed at the model descriptions for biogenic emissions and dry deposition as a follow up and to repeat the operational and dynamic analysis for longer timeframes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Polypharmacy and drug-related problems are major challenges in the care and treatment of nursing home residents. Many interventional studies showed disappointing results, which lead to the question if this could also be due to the selection of the target parameters of these studies., Material and Methods: A routine data set from six long-term care facilities was retrospectively analyzed. The question is if the recently validated medication risk score (MERIS) is suitable for carrying out a risk assessment in a population of nursing home residents. Associations between MERIS and the dependent variables hospital admissions and falls over 12 months and a weight loss of ≥ 5% over 3 months were examined., Results: Out of 495 residents 38.6% (n = 191) have a high risk of drug-related problems according to MERIS. A univariate regression analysis showed a significantly increased risk of hospital admissions (OR 2.2; p < 0.001) and weight loss of ≥ 5% (OR 1.95; p = 0.041) with high MERIS, but no significant association with falls. In the multivariate regression the risk of hospitalization was increased by diabetes mellitus (OR 1.88; p = 0.004), falls in the same period (OR 1.91; p = 0.001), positive MERIS (OR 1.75; p = 0.006) and decreased with stable weight (OR 0.88; p = 0.004)., Conclusion: The results indicate the potential of the score for future research projects and individual risk assessment; however, due to the limitations of retrospective secondary analyses further studies are required., (© 2022. The Author(s).)

Background: Postural abnormalities involving the trunk are referred to as axial postural abnormalities and can be observed in over 20% of patients with Parkinson's disease (PD) and in atypical parkinsonism. These symptoms are highly disabling and frequently associated with back pain and a worse quality of life in PD. Despite their frequency, little is known about the pathophysiology of these symptoms and scant data are reported about their clinical predictors, making it difficult to prompt prevention strategies., Objectives: We conducted a scoping literature review of clinical predictors and pathophysiology of axial postural abnormalities in patients with parkinsonism to identify key concepts, theories and evidence on this topic., Methods: We applied a systematic approach to identify studies, appraise quality of evidence, summarize main findings, and highlight knowledge gaps., Results: Ninety-two articles were reviewed: 25% reported on clinical predictors and 75% on pathophysiology. Most studies identified advanced disease stage and greater motor symptoms severity as independent clinical predictors in both PD and multiple system atrophy. Discrepant pathophysiology data suggested different potential central and peripheral pathogenic mechanisms., Conclusions: The recognition of clinical predictors and pathophysiology of axial postural abnormalities in parkinsonism is far from being elucidated due to literature bias, encompassing different inclusion criteria and measurement tools and heterogeneity of patient samples. Most studies identified advanced disease stage and higher burden of motor symptoms as possible clinical predictors. Pathophysiology data point toward many different (possibly non-mutually exclusive) mechanisms, including dystonia, rigidity, proprioceptive and vestibular impairment, and higher cognitive deficits., (© 2023 The Authors. Movement Disorders Clinical Practice published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.)

Background: Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an effective and evidence-based treatment for idiopathic Parkinson's disease (iPD). A minority of patients does not sufficiently benefit from STN-DBS., Objective: The predictive validity of the levodopa challenge for individual patients is analyzed., Methods: Data from patients assessed with a preoperative Levodopa-test and a follow-up examination (mean ± standard deviation: 9.15 months ±3.39) from Kiel (n = 253), Berlin (n = 78) and Toronto (n = 98) were studied. Insufficient DBS outcome was defined as an overall UPDRS-III reduction <33% compared to UPDRS-III in med-off at baseline or alternatively if the minimal clinically important improvement of 5 points was not reached. Single UPDRS-items and sub-scores were dichotomized. Following exploratory analysis, we trained supervised regression- and classification models for outcome prediction., Results: Data analysis confirmed significant correlation between the absolute UPDRS-III reduction during Levodopa challenge and after stimulation. But individual improvement was inaccurately predicted with a large range of up to 30 UPDRS III points. Further analysis identified preoperative UPDRS-III/med-off-scores and preoperative Levodopa-improvement as most influential factors. The models for UPDRS-III and sub-scores improvement achieved comparably low accuracy., Conclusions: With large prediction intervals, the Levodopa challenge use for patient counseling is limited, though remains important for excluding non-responders to Levodopa. Despite these deficiencies, the current practice of patient selection is highly successful and builds not only on the Levodopa challenge. However, more specific motor tasks and further paraclinical tools for prediction need to be developed., (© 2023 The Authors. Movement Disorders Clinical Practice published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.)

Background: Questionable signs of dystonia are a common finding in patients with essential tremor (ET). Brain structural alterations in ET patients plus dystonic soft signs (ET + ds) in comparison to ET patients without dystonic soft signs (ET-ds) or patients with tremor associated with manifest dystonia (TAWD) have not been examined yet. Therefore, our study aims to explore alterations of brain grey matter in patients with ET + ds., Methods: A total of 68 elderly patients with ET-ds (n = 32), ET + ds (n = 20) or idiopathic cervical dystonia with dystonia associated action tremor of the upper limbs (TAWD, n = 16) and 42 age-matched healthy controls underwent a clinical and electrophysiological assessment and 3T MRI. For grey matter alterations T1 MRI images were analysed by voxel-based morphometry. Additionally, regression analyses with clinical parameters (tremor frequency, severity and disease duration) were performed., Results: VBM showed a significant increase of grey matter in the right lentiform nucleus in ET + ds and TAWD compared to HC and ET-ds. Further, an increase of cortical grey matter in the middle frontal gyrus in ET + ds was shown. The hypertrophy of the lentiform nucleus in ET + ds was correlated with disease severity and duration., Conclusion: Patients with ET + ds showed grey matter brain structural alterations similar to TAWD. Our findings suggest an involvement of the basal ganglia-cortical loop in ET + ds which may indicate a pathophysiological similarity with TAWD rather than ET., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Aerosols' influences on Earth's climate have been documented by several authors. This ranges from scattering and reflecting of shortwave radiation (direct effect) which is also regarded as the "Whitehouse Effect," to the ability to act as condensation nuclei (indirect effect) which results in cloud droplet formation. This broad summary of aerosol's effect on earth's climate has in turn affected some other weather variables either positively or negatively depending on people's perspectives. This work was done in a view to ascertaining some of these claims by determining the statistical significance of some certain aerosol's relationships with some selected weather variables. This was done over six (6) stations across the West African region to represent the climatic zones from the rainforest around the coasts to the desert of the Sahel. Data used consist of aerosol types (biomass burning, carbonaceous, dust, and PM 2.5 ) and climatic types (convective precipitation, wind speed, and water vapor) over a period of 30 years, with the python and ferret programs explicitly used for the graphical analyses. Climatologically, locations close to the point source seem to record more of the presence of the pollutants than the farthest ones. Results indicated that aerosols were more pronounced in the dry months of NDJF over the rainforest region depending on the latitudinal position of the location. The relationship result showed a negative correlation between convective precipitation and aerosols, except carbonaceous. But the strongest relationship can be found between water vapor and the selected aerosol types., (© 2023. The Author(s).)

Background: Three-dimensional (3D) human body estimation from common photographs is an evolving method in the field of computer vision. It has not yet been evaluated on postural disorders. We generated 3D models from 2-dimensional pictures of camptocormia patients to measure the bending angle of the trunk according to recommendations in the literature., Methods: We used the Part Attention Regressor algorithm to generate 3D models from photographs of camptocormia patients' posture and validated the resulting angles against the gold standard. A total of 2 virtual human models with camptocormia were generated to evaluate the performance depending on the camera angle., Results: The bending angle assessment using the 3D mesh correlated highly with the gold standard ( R  = 0.97, P  < 0.05) and is robust to deviations of the camera angle., Conclusions: The generation of 3D models offers a new method for assessing postural disorders. It is automated and robust to nonperfect pictures, and the result offers a comprehensive analysis beyond the bending angle., (© 2022 The Authors. Movement Disorders Clinical Practice published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.)

Background: Camptocormia (CC) is the forward-bending of the spine of more than 30 degrees that can be found in Parkinson's disease (PD) as a disabling complication. Detection of changes in paraspinal lumbar musculature in CC is of value for choosing treatment strategies., Objective: To investigate whether these changes can be detected using muscle ultrasonography (mUSG)., Methods: Age and sex-matched groups comprised 17 PD patients with CC (seven acute, PD-aCC; 10 chronic PD-cCC), 19 PD patients with no CC, and 18 healthy controls (HC). Lumbar paravertebral muscles (LPM) on both sides were assessed using mUSG by two different raters blinded to the group assignment. Groups were compared with regard to the linear measurements of the muscle thickness as well as semi-quantitative and quantitative (grayscale) analyses of muscle echogenicity using a univariate general linear model., Results: All assessments showed substantial interrater reliability. The PD-cCC group had significantly thinner LPM compared to groups with no CC (PD and HC). Groups of PD-aCC and PD-cCC differed from the groups of no CC in quantitative and semi-quantitative analyses of LPM echogenicity, respectively., Conclusion: Assessment of LPM in PD patients with CC can be reliably performed using mUSG. Also, mUSG may be used as a screening tool to detect CC-related changes in thickness and echogenicity of the LPM in patients with PD.

The camptocormia angle has been established as a strong indicator for evaluating the progress of Parkinson's disease and the efficacy of therapeutical approaches. A wearable setup is proposed to measure the camptocormia angle with the perpendicular method using five inertial sensors. This study identifies suitable inertial measurement unit sensors for mobile long-term measurement. Moreover, a machine-learning approach is presented for segmenting the recorded data into periods with different dominant activities. An artificial neural network was the better classifier compared to a support vector machine to recognize certain common activities in patients with camptocormia. The artificial neural network's accuracy, sensitivity, and F1-score were 92.4 %, 82.9 %, and 82.1 %, respectively. Clinical Relevance- The presented approach is expected to lead to a wearable system for long-term monitoring of the progress of camptocormia, yielding improved parameters compared to the conventional static photo method.

DBS Think Tank IX was held on August 25-27, 2021 in Orlando FL with US based participants largely in person and overseas participants joining by video conferencing technology. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers and researchers (from industry and academia) can freely discuss current and emerging deep brain stimulation (DBS) technologies as well as the logistical and ethical issues facing the field. The consensus among the DBS Think Tank IX speakers was that DBS expanded in its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. After collectively sharing our experiences, it was estimated that globally more than 230,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. As such, this year's meeting was focused on advances in the following areas: neuromodulation in Europe, Asia and Australia; cutting-edge technologies, neuroethics, interventional psychiatry, adaptive DBS, neuromodulation for pain, network neuromodulation for epilepsy and neuromodulation for traumatic brain injury., Competing Interests: RR was employed by Medtronic, Inc. HBo was employed by Boston Scientific Neuromodulation Corporation. DG was employed by the NeuroPace, Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Wong, Deuschl, Wolke, Bergman, Muthuraman, Groppa, Sheth, Bronte-Stewart, Wilkins, Petrucci, Lambert, Kehnemouyi, Starr, Little, Anso, Gilron, Poree, Kalamangalam, Worrell, Miller, Schiff, Butson, Henderson, Judy, Ramirez-Zamora, Foote, Silburn, Li, Oyama, Kamo, Sekimoto, Hattori, Giordano, DiEuliis, Shook, Doughtery, Widge, Mayberg, Cha, Choi, Heisig, Obatusin, Opri, Kaufman, Shirvalkar, Rozell, Alagapan, Raike, Bokil, Green and Okun.)

Background: Malnutrition is a major challenge in routine clinical practice and is associated with increased mortality., Objectives: In the research project Prevention and treatment of malnutrition in geriatric patients in hospital funded by the Federal Ministry of Education and Research (BMBF), routine data were analyzed. The aim was to uncover the causes of malnutrition risks acquired in hospital., Material and Methods: Anonymized data from nursing home residents with at least a 3-day hospital stay were analyzed. The study included a total of 2058 residents from 19 nursing homes. The malnutrition risk was assessed by the combined MUST/PEMU (Malnutrition Universal Screening Tool/Nursing Measurement of Malnutrition and its Causes) screening and malnutrition by ESPEN (European Society for Clinical Nutrition and Metabolism) criteria., Results: Of the residents 36.2% (n = 744) had an initial risk of malnutrition and 12.7% (n = 262) were already malnourished. The proportions increased to 48.6% (n = 881) and 14.3% (n = 259) at discharge, respectively. The logistic regression analysis showed a significantly increasing probability of developing a malnutrition risk during the hospital stay with the diagnoses diseases of the respiratory system (OR 2.686; CI 95 1.111-4.575), chondropathy and osteopathy (OR 1.892; CI 95 1.149-3.115) and a higher BMI (OR 0.108; CI 95 1.038-1.181), more positive weight changes 6 months before hospital (OR 1.055; CI 95 1.017-1.094) and an increasing hospital stay (OR 1.048; CI 95 1.029-1.067)., Conclusion: The identification of an initial malnutrition and the prevention of developing a malnutrition risk represent major challenges in clinical practise. Both are equally necessary., (© 2021. The Author(s).)

(1) Background: Malnutrition in hospitalized patients is prevalent worldwide, but the severity of the issue is often underestimated by practitioners. The purpose of this study is to investigate the prevalence of malnutrition and inadequate eating behaviour in a geriatric sample. (2) Methods: Two hospitals participated with six wards on nutritionDay in 2017, 2018 and 2019. Nutritional status, food intake, and nutritional interventions were analyzed for all patients ≥ 65 years ( n = 156), using the official nutritionDay questionnaires. Malnutrition risk is identified by Malnutrition Universal Screening Tool (MUST), malnutrition by the ESPEN criteria (European Society of Clinical Nutrition and Metabolism). (3) Results: According to MUST ( n = 136) 16.9% ( n = 23) were at medium risk of malnutrition, 33.8% ( n = 46) at high risk of malnutrition, 28.1% ( n = 38) were malnourished. Overall, 62.8% ( n = 98) showed an inadequate eating behaviour during hospital stay. Moreover, patients with inadequate nutrition had significantly worse self-reported health statuses ( p = 0.001; r = -0.276), were less able to walk on nutritionDay ( p = 0.002; r = -0.255), had eaten little in the week before admission to hospital ( p < 0.001; r = -0.313), and had an increased length of stay ( p = 0.036; r = -0.174). (4) Conclusion: To identify malnourished patients is a significant barrier for practitioners seeking to administer specific, tailored interventions. Malnutrition screening protocols must be improved, just as nutrition monitoring in general.

We present in this technical note the research protocol for phase 4 of the Air Quality Model Evaluation International Initiative (AQMEII4). This research initiative is divided into two activities, collectively having three goals: (i) to define the current state of the science with respect to representations of wet and especially dry deposition in regional models, (ii) to quantify the extent to which different dry deposition parameterizations influence retrospective air pollutant concentration and flux predictions, and (iii) to identify, through the use of a common set of detailed diagnostics, sensitivity simulations, model evaluation, and reduction of input uncertainty, the specific causes for the current range of these predictions. Activity 1 is dedicated to the diagnostic evaluation of wet and dry deposition processes in regional air quality models (described in this paper), and Activity 2 to the evaluation of dry deposition point models against ozone flux measurements at multiple towers with multiyear observations (to be described in future submissions as part of the special issue on AQMEII4). The scope of this paper is to present the scientific protocols for Activity 1, as well as to summarize the technical information associated with the different dry deposition approaches used by the participating research groups of AQMEII4. In addition to describing all common aspects and data used for this multi-model evaluation activity, most importantly, we present the strategy devised to allow a common process-level comparison of dry deposition obtained from models using sometimes very different dry deposition schemes. The strategy is based on adding detailed diagnostics to the algorithms used in the dry deposition modules of existing regional air quality models, in particular archiving diagnostics specific to land use-land cover (LULC) and creating standardized LULC categories to facilitate cross-comparison of LULC-specific dry deposition parameters and processes, as well as archiving effective conductance and effective flux as means for comparing the relative influence of different pathways towards the net or total dry deposition. This new approach, along with an analysis of precipitation and wet deposition fields, will provide an unprecedented process-oriented comparison of deposition in regional air quality models. Examples of how specific dry deposition schemes used in participating models have been reduced to the common set of comparable diagnostics defined for AQMEII4 are also presented., Competing Interests: Competing interests. The authors declare that they have no conflict of interest.

Background: Malnutrition remains a challenging problem in hospitals, especially among geriatric patients. The background and causes are actually well known but still underestimated in clinical practice., Aim and Methods: This study evaluated possible differences in rates of malnutrition risk and malnutrition in geriatric patients living at home and geriatric patients living in residential nursing homes. For this purpose, data from a total of 4 surveys (3 times nutritionDay plus 1 additional survey) were combined and evaluated. In this secondary analysis, 258 patients 65 years and older are included. Malnutrition risk is determined by the malnutrition universal screening tool (MUST) and malnutrition by the ESPEN criteria., Results: Of the patients 86.0% ( n  = 222) live at home and 14.0% ( n  = 36) in residential nursing homes. The patients living in nursing homes have a higher morbidity and need of care. Indicators for the increased morbidity are a larger number of nights spent in the clinic in the last 12 months (mdn 10.0 vs. 5; p  0.007), higher number of daily drug intake (mdn 9.0 vs. 7.0; p  0.002) and greater limitations in walking abilities (mdn 3.0 vs. 1.0; p  < 0.001). They are significant older (median 86.0 vs. 78.0; p  < 0.001) and show a higher percentage of manifest malnutrition (35.7%; n  = 10 vs. 20.1%; n  = 40; p  0.062)., Conclusion: Geriatric patients living at home and in residential nursing homes show high rates of malnutrition. A malnutrition screening at the beginning and during hospital stay is urgently required in every case as this is the only way to identify those affected. In addition, regular screening in outpatient departments as well as in nursing homes is also necessary., (© The Author(s) 2021.)

Background: Urinary incontinence is a widespread health-related problem predominately occurring in older adults. The aim of the study was to evaluate the effectiveness of the management of urinary incontinence in routine care in a geriatric rehabilitation clinic., Methods: A prospective observational study without a control group was conducted between 7 February 2018 and 7 June 2018. All patients included in the study (N = 32) received individualized guideline-conform measures to improve the symptoms of incontinence during the rehabilitation period. To assess the change in symptoms, the International Consultation on Incontinence Modular Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) was used at admission (T0) and discharge (T1). Assessment of patient satisfaction was conducted at T1 using the benefit, satisfaction, and willingness to continue treatment questionnaire (BSW)., Results: The total score of the ICIQ-UI SF improved by an average of 3.4 points (p = 0.004) due to a decrease in the frequency of incontinence episodes and in a reduction in the urine volume lost. Furthermore, there was a decrease in the number of patients who lost a large amount of urine from 9.4% at T0 to 3.1% at T1. The proportion of patients with incontinence several times a day, decreased from 68.6% to 31.3% during the intervention. Of the patients 80% received a guideline-conform treatment during the time of rehabilitation and 64% of the patients were satisfied with the treatment., Conclusion: The guideline-conform treatment of urinary incontinence in geriatric patients led to an improvement in the symptoms. A large number of patients benefited from the management of urinary incontinence during the rehabilitation period.

Introduction: A stooped posture is a main clinical feature of Parkinson's disease (PD). The assessment of posture is important to measure treatment effects. The aim of this study was to investigate the reliability of a standardized postural rating tool, to calculate minimal detectable change scores and to assess the role of gender and age., Methods: Two independent raters assessed total camptocormia (TCC), upper camptocormia (UCC) and Pisa angles of 192 PD patients and 78 healthy controls (HC) with the free NeuroPostureApp©(http://www.neuroimaging.uni-kiel.de/NeuroPostureApp). Reliabilities and linear models were calculated for different effects. Three subgroups were defined based on two thresholds (mean+2SD of HC and PD): A) normal, B) presumed stooped/lateral bended posture and C) postural disorder., Results: Intraclass correlation coefficients ranged between 0.71 and 0.95 for the interrater and test-retest reliability of the three angles. The minimal detectable change values in the PD patients were 3.7°, 6.7° and 2.1° for the TCC, UCC and Pisa angles, respectively. Men had a more stooped posture than women (p < 0.05). Patients with PD had a worse posture than HC (p < 0.001) in all three angles. For the TCC angle, 39.1% of the patients had a normal posture (<17.4°), 47.9% a presumed stooped posture (>17.4°, <30.2°) and 6.3° had camptocormia (>30.2°)., Conclusions: The NeuroPostureApp© is reliable. Our results confirmed gender differences and the progression of postural deviation in PD patients with age and empirically support the ≥30° TCC angle as a defining criterium for camptocormia. Diagnostic criteria for UCC and Pisa syndrome should be further explored in future studies., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Introduction: Postural abnormalities are common in Parkinson's disease (PD) and increasing with disease progression. While many studies focus on balance and gait, postural alignment is only infrequently studied. Purpose: The aim of the present study was to examine the immediate and long-term effects of medication and deep brain stimulation (DBS) in the subthalamic nucleus on postural alignment in PD. Materials and Methods: PD patients ( n = 192) in an advanced stage of disease were videotaped during a standardized l-dopa trial before and after DBS. The patients were tested with and without medication pre-surgical and retested post-surgical (6-24 months) in all treatment combinations of medication and DBS regarding the on and off conditions. The forward bending as total camptocormia (TCC) and upper camptocormia (UCC) angles and lateral bending as Pisa angle were assessed with the free downloadable NeuroPostureApp (http://www.neuroimaging.uni-kiel.de/NeuroPostureApp/). Three subgroups were defined according to normative values of healthy controls and according to clinical criteria: patients with normal posture, with stooped posture, and with postural disorders. Results: A stooped posture was found in 82% of the patients with regard to the TCC angle and in 54% for the UCC angle. Sixty-two percent had an abnormal Pisa angle. Camptocormia was diagnosed in ~7% and a Pisa syndrome in 1% of the patients. Medication and DBS both significantly improved postural alignment in the entire cohort. Female and male patients benefit similarly by medication and stimulation. Subgroup analyses revealed that the effects were also significant for patients with stooped posture, and the effects were strongest for patients with camptocormia: they led to angles below the diagnostical criterion for camptocormia for 13 of 14 patients with TCC and 11 of 26 patients with UCC. DBS had an additional effect to medication over time for the Pisa angle. Conclusion: Medication and DBS both improved postural alignment in PD patients, but effects were small for the entire cohort. Patients with camptocormia according to the TCC angle benefit strongest. The large differences of the treatment effects may indicate distinct pathological mechanisms for stooped posture and postural disorders. The TCC angle was shown to be sensitive to change. The UCC angle was less sensitive but may be a useful assessment tool for a subgroup., (Copyright © 2019 Schlenstedt, Gavriliuc, Boße, Wolke, Granert, Deuschl and Margraf.)

Assessing the flexion of the trunk of patients with camptocormia is a key factor in developing therapies for camptocormia and monitoring their success. Currently used methods to measure this camptocormia angle are based on photographs or short videos. Both methods are not able to take the ability of patients into account to compensate their symptoms for short amounts of time. We propose a simple two sensor measurement setup based on two accelerometers to measure the angle in accordance with the established perpendicular measurement method [1]. We show that our method yields an average deviation of -1.74° with a maximum deviation of +2° and -6° compared to visual assessment with a motion capturing system.

Detailed multiphase chemistry box model studies are carried out, investigating halogen radical activation at polluted coastal areas. Simulations are performed for a nonpermanent cloud and a cloud-free scenario and reveal that ClNO 2 photolysis and ICl photolysis are crucial for gas-phase Cl atom activation. In the cloud scenario, the integrated ClNO 2 and ICl photolysis rates are 3.7 × 10 7 and 3.1 × 10 7 molecules cm -3 s -1 . In the cloud-free scenario, the integrated ClNO 2 and ICl photolysis rates are 8.1 × 10 7 and 3.6 × 10 7 molecules cm -3 s -1 . The simulations show larger contributions of ClNO 2 photolysis in the morning and higher ones of ICl photolysis during afternoon. Throughout the simulation, average contributions to Cl atom activation in the cloud and cloud-free scenarios by ClNO 2 photolysis are 42% and 62% and by ICl photolysis 35% and 28%, respectively. ICl is formed through an aqueous-phase reaction of HOI with chloride. Two thirds of the formed ICl is released into the gas phase. The residual third reacts with bromide, creating IBr. Overall, the simulations emphasize the crucial role of INO 3 hydrolysis for Cl and Br atom activation in polluted coastal areas. Therefore, it needs to be considered in chemical transport models to improve air quality predictions.

Introduction: Camptocormia is characterized by a pathological forward flexion of the trunk, which is reversible when lying and worsened by standing and walking. So far there is no consensus on how to measure the angle of flexion, and studies therefore give differing results. Harmonization is needed for both research and clinical practice. Orthopedic measures are not useful for this purpose., Methods: Two expert raters independently analyzed the photographs of 39 Parkinson patients with camptocormia while standing. They used four different methods to determine the camptocormia angle. The results were compared statistically. An international Consensus Group reviewed the results and drafted recommendations., Results: The four methods yielded camptocormia angles that differed by up to 50% in the same patient. Inter-rater reliability and test-retest reliability also differed, but were satisfactory to excellent., Conclusion: This Consensus Group concluded that two of the methods qualified as reliable measures of the trunk angles in standing patients based on their clinimetric properties. They propose that the 'total camptocomia angle' be the angle between the line from the lateral malleolus to the L5 spinous process and the line between the L5 spinous process and the spinous process of C7. They also propose that the 'upper camptocormia angle' be the angle of the lines between the vertebral fulcrum to the spinous processes of L5 and C7, respectively. An app is provided on the web for these measurements (http://www.neurologie.uni-kiel.de/de/axial-posturale-stoerungen/camptoapp)., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Monocyclic aromatic compounds are ubiquitous in the polluted troposphere and contribute to the formation of tropospheric ozone and anthropogenic secondary organic aerosol, including brown carbon. Currently available physico-chemical data including aqueous-phase kinetic and mechanistic data, as well as phase-transfer parameters have been compiled and reviewed, to construct a novel aqueous-phase oxidation mechanism for monocyclic aromatic compounds. The performed chemical mechanism development results in a comprehensive aqueous-phase oxidation mechanism (addressed as CAPRAM-AM1.0), which includes 292 processes considering the oxidation of different aromatic compounds. Detailed numerical simulations with the air parcel model SPACCIM are carried out for different urban environmental and seasonal conditions. Results show that the aqueous-phase chemistry of aromatic compounds, particularly in clouds, increases the organic aerosol mass by up to 10% in total. The absolute contribution to aqSOA in summertime is modelled to be 260 ng m-3 and 1.2 μg m-3 under moderate and strongly polluted conditions, respectively. Aqueous-phase oxidations of aromatic compounds are important not only for the degradation, but also for the formation of nitrated aromatic compounds. In-cloud chemistry contributes up to 54% to the nitrocatechol oxidation and up to 37% to its formation under polluted tropospheric conditions. Besides, nitrated aromatic compounds contribute up to 5.4 μg m-3 to modelled brown carbon concentration in cloud droplets and 140 ng m-3 in aerosol particles. Further, the model simulations indicate that besides OH radical oxidations, aromatic compounds with two hydroxyl groups are also strongly oxidised by O3 and HO2. O3 contributes with 49% to 68% and HO2 with 19% to 22% to the aqueous-phase oxidation of catechol under moderate and strong polluted environmental conditions studied.

Oceans dominate emissions of dimethyl sulfide (DMS), the major natural sulfur source. DMS is important for the formation of non-sea salt sulfate (nss-SO 4 2- ) aerosols and secondary particulate matter over oceans and thus, significantly influence global climate. The mechanism of DMS oxidation has accordingly been investigated in several different model studies in the past. However, these studies had restricted oxidation mechanisms that mostly underrepresented important aqueous-phase chemical processes. These neglected but highly effective processes strongly impact direct product yields of DMS oxidation, thereby affecting the climatic influence of aerosols. To address these shortfalls, an extensive multiphase DMS chemistry mechanism, the Chemical Aqueous Phase Radical Mechanism DMS Module 1.0, was developed and used in detailed model investigations of multiphase DMS chemistry in the marine boundary layer. The performed model studies confirmed the importance of aqueous-phase chemistry for the fate of DMS and its oxidation products. Aqueous-phase processes significantly reduce the yield of sulfur dioxide and increase that of methyl sulfonic acid (MSA), which is needed to close the gap between modeled and measured MSA concentrations. Finally, the simulations imply that multiphase DMS oxidation produces equal amounts of MSA and sulfate, a result that has significant implications for nss-SO 4 2- aerosol formation, cloud condensation nuclei concentration, and cloud albedo over oceans. Our findings show the deficiencies of parameterizations currently used in higher-scale models, which only treat gas-phase chemistry. Overall, this study shows that treatment of DMS chemistry in both gas and aqueous phases is essential to improve the accuracy of model predictions., Competing Interests: The authors declare no conflict of interest.

By developing evidence-based, national Expert Standards, agreed-upon by an association of nursing professionals, the German Care Science participates in the international discussion. Up to now, five National Expert Standards on relevant care-related topics have been developed and have been widely implemented in Care Practice. However, sufficient evaluations of these Expert Standards are still required, especially from an economic perspective. The following paper addresses this topic by performing a cost-benefit analysis for the National Expert Standard Prophylaxis of Pressure Ulcers. The authors demonstrate which costs are caused by the implementation of this National Expert Standard for a residential care agency providing services. The benefit of the implementation of the Expert Standard is then being compared to its cost for a period of three years. The evaluation concludes that, in consideration of opportunity costs, the introduction of the National Expert Standard Prophylaxis of Pressure Ulcers appears economically viable for the residential care agency only if the rate of pressure ulcers in the reference agency can be lowered at least by 26.48%. In this case, when exclusively considering direct benefits and direct costs, a positive impact of the implementation will be achieved.

An in vitro phagocytosis assay was developed for hybrid striped bass (Morone saxatilis x Morone chrysops), using cells collected from the peritoneal cavity of this fish. The findings indicated that: (1) 10 days following a single intraperitoneal injection (1 ml) of Freund's incomplete adjuvant (FIA) was an appropriate time for collecting suitable working concentrations (5.3+/-4.0 x 10(7) cells ml(-1)) of peritoneal phagocytes (83.7+/-1.5% macrophages) from these hybrids held at 23 degrees C; (2) these cells phagocytosed latex beads (polystyrene microspheres 3.12 microm in diameter) after 30 min of in vitro incubation at room temperature (25+/-1 degrees C). The phagocytic ability and phagocytic capacity in a washed adherent layer exposure system were 67.2+/-2.76% and 4.14+/-0.35 beads phagocyte(-1), respectively. These results strongly suggest that a simple methodology, including baseline data serving as guidelines, is now available for conducting in vitro phagocytosis assays in this hybrid.

In the USA a small proportion of fishery products are contaminated with appreciable amounts of potentially hazardous contaminants. However, risks to consumers are not generally high. Inorganic contaminants with the greatest potential for toxicity are antimony, arsenic, cadmium, lead, mercury, selenium and sulfites. Among organic compounds, polychlorinated biphenyls, dioxins, several chlorinated hydrocarbon insecticides, certain processing-related and aquaculture-related contaminants pose potential risks for consumers. Log-normal distributions appear to provide good descriptions of the pattern of variation of contaminant concentrations among different geographic areas, and some contaminants (mostly organic) appear to be much more variable than others. This variability offers a solution for reduction of exposure through restricting the harvest of aquatic organisms from specific sites, and by excluding certain species. It is recommended that: (i) existing State and Federal regulations and environmental monitoring be strengthened and enforced to minimize contamination of the aquatic environment; (ii) a program of shared responsibility be instituted, where Federal agencies develop a set of monitoring and inspection practices and state agencies assume responsibility for primary control, site closures and advisories issue; (iii) research and public education by government agencies and health professionals be expanded to determine actual risks and approaches to manage them; (iv) mandatory labeling be considered for specific contaminants; (v) a better system requiring international agreements be developed in order to minimize the differences among various national regulatory approaches.

The kinetics of piscine liver, spleen, and kidney macrophage aggregate formation was studied in Carassius auratus using the sequential interperitoneal injection of fluorescent green and yellow microspheres. This study indicates that 1. macrophages migrating to or forming new aggregates move randomly throughout the aggregate mass and do not simply increase aggregate size by a laminating process (layer upon layer), 2. macrophages apparently form new aggregates and migrate to existing aggregates simultaneously, and 3. macrophage aggregates form in greater number and more rapidly in the spleen and kidney than in the liver.

The bioavailability of lysine in Maillard browned protein was investigated by plasma lysine response in rainbow trout (Salmo gairdneri). The concentrations of free lysine in the plasma were measured after feeding control and browned protein diets supplemented with graded levels of lysine. Bioavailability of lysine was estimated based on the amounts of supplemental lysine in the diets that resulted in rapid increases in plasma lysine. An approximately 80% loss in bioavailable lysine content was determined by this method in a fish protein isolate subjected to the Maillard browning reaction under mild conditions (40 d incubation at 37 degrees C). The nutritional damage to lysine determined by plasma lysine response was similar to that estimated in vitro by enzymatic hydrolysis and fluorodinitrobenzene reagent, but was underestimated by acid hydrolysis and trinitrobenzene sulfonic acid reagent. Rainbow trout are similar to other animals in their inability to utilize the deoxyketosyl (Amadori) compound of lysine formed in early Maillard reaction, and in their plasma response to dietary levels of essential amino acids.

Loggerhead sea turtles (Caretta caretta) from the Atlantic seaboard (Florida to Massachusetts) were examined at the Marine Pathology Laboratory, University of Rhode Island, from March through December, 1980. Three genera of blood flukes (spirorchids) were found in 14 (33%) of the 43 turtles. Gross signs in heavily infected animals included cachexia, anemia and enteritis. Histopathological lesions were similar to those present in homeotherms with schistosomiasis. Granulomatous gastritis, enteritis, hepatitis, pneumonitis, and nephritis were present. Acute and chronic vasculitis accompanied metastasis of eggs. Infected animals had severe hepatic hemosiderosis, indicative of the anemia observed grossly. Evidence is presented that spirorchidiasis is prevelent in sub-adult loggerhead sea turtles, is responsible for extensive lesions and may be responsible for significant debilitation and mortality.

The cellular immune response of rainbow trout, Salmo gairdneri, to sheep erythrocytes was investigated. Both the primary and secondary responses were measured using the migration inhibition factor (MIF), antigen-binding (ABC), and plaque-forming cell (PFC) assays. These immune function assays provide measures of both T and B cell activity. The kinetics of these three responses at 16 degrees C were determined by sampling fish over an 18 day period for the primary response and a ten day period for the secondary response. The peak MIF response occurred two days after injection, while the primary peak PFC response was observed 14 days post-injection. Two ABC peaks were observed in the primary response, one at four days and one at ten days after injection. In the secondary response the peak ABC response was observed four days and the peak PFC response six days post-inoculation. The possible interrelationships of the various cell populations are discussed.

The toxicity of the plant flavonol, quercetin, to rainbow trout (Salmo gairdneri) was investigated. Quercetin, which had been confirmed to be mutagenic in the Ames Salmonella/mammalian microsome test, was fed to trout at levels of 1 or 5% in the diet for 8 months. Survival, growth and feed conversion efficiency, selected haematological parameters and the relative weights of heart, liver and spleen were unaffected by the ingestion of quercetin, and there were no histopathological changes in any of the tissues examined.

The effect of the Maillard browning reaction in the diet of rainbow trout (Salmo gairdneri) on growth and amino acid availability was investigated. Chemical and enzymatic hydrolysis methods were applied for the detection of the losses of amino acids in a model protein browning system. Arginine and lysine exhibited the greatest losses in the mixture of fish protein isolate and glucose stored for 40 d at 37 degrees C. The apparent digestibility and absorption of individual amino acids, particularly lysine, was lower in trout fed browned protein than in those fed the control protein. Plasma lysine levels were significantly depressed, while the plasma levels of glucose and most other amino acids were elevated in relation to the loss in nutritive value of dietary protein after browning. The early Maillard reaction derivative of lysine, epsilon-deoxy-fructosyl-lysine, was recovered from browned protein (by using the in vitro enzymatic hydrolysis procedure) and from the plasma of trout fed browned protein. Analysis of plasma free amino acids provided an indication of lysine bioavailability and identified lysine as the first-limiting amino acid in the diets containing browned protein.

Neoplasia was a prevalent disease of the soft-shell clam and was found in widely geographically distinct sites in New England. Two types of neoplasms were recognized. Most were of hematopoietic origin, except in clams from Maine, which also had gonadal neoplasms. Both types were apparently malignant neoplasms, based on their characteristic anaplastic appearance, invasiveness, metastasis, mitotic activity, associated tissue necrosis, and mortality. Diagnosis of neoplasia in the living mollusk was achieved rapidly and accurately by cytologic examination of circulating blood. The etiology of the neoplasms was not identified. In general, nonneoplastic lesions, such as epithelial hyperplasia and accumulations of a orange-brown bodies, were more common in clams from polluted areas.