Search

Background: Overactive bladder (OAB) is a common non-motor symptom of Parkinson disease (PD), often treated with antimuscarinics or beta-3 agonists. There is lack of evidence to guide OAB management in PD., Objectives: To assess the comparative safety of antimuscarinics versus beta-3 agonists for OAB treatment in PD., Methods: We employed a new-user, active-comparator cohort study design. We included Medicare beneficiaries age ≥65 years with PD who were new users of either antimuscarinic or beta-3 agonist. The primary outcome was any acute care encounter (i.e., non-elective hospitalization or emergency department visit) within 90 days of OAB drug initiation. The main secondary outcome was a composite measure of acute care encounters for anticholinergic related adverse events (AEs). Matching on high-dimensional propensity score (hdPS) was used to address potential confounding. We used Cox proportional hazards models to examine the association between OAB drug category and outcomes. We repeated analyses for 30- and 180-day follow-up periods., Results: We identified 27,091 individuals meeting inclusion criteria (mean age: 77.8 years). After hdPS matching, antimuscarinic users had increased risks for any acute care encounter (hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.12-1.37) and encounters for anticholinergic related AEs (HR 1.18, 95% CI 1.04-1.34) compared to beta-3 agonist users. Similar associations were observed for sensitivity analyses., Conclusions: Among persons with PD, anticholinergic initiation was associated with a higher risk of acute care encounters compared with beta-3 agonist initiation. The long-term safety of anticholinergic vs. beta-3 agonist therapy in the PD population should be evaluated in a prospective study., Competing Interests: Declaration of competing interest Dr. Abraham received financial compensation from the Parkinson's Foundation. Dr. Pham Nguyen is a member of the 2022–2023 Junior Investigator Intensive Program of the U.S. Deprescribing Research Network, which is funded by the National Institute on Aging [Grant #R24AG064025] and receives support from the National Institutes of Health [Grants #R01NS099129, #R01AG02515215, #R01AG06458903] and Acadia Pharmaceuticals Inc. Dr. Hennessy directs the University of Pennsylvania's Center for Real-world Effectiveness and Safety of Therapeutics (CREST), which receives funds from Pfizer and Sanofi to support pharmacoepidemiology education and has received grants from Pfizer, and Johnson and Johnson during the conduct of the study, consulted for Novo Nordisk, Arbor Pharmaceuticals, the Medullary Thyroid Cancer Consortium (Novo Nordisk, AstraZeneca, GlaxoSmithKline and Eli Lilly), Biogen, Intercept Pharmaceuticals, Provention Bio, bluebird bio, and Amylyx Pharmaceuticals, and is a special government employee of the U.S. Food and Drug Administration. Dr. Leonard is an Executive Committee Member of the University of Pennsylvania's CREST and recently received honoraria from the American College of Clinical Pharmacy Foundation, the Consortium for Medical Marijuana Clinical Outcomes Research, the University of Florida, the University of Massachusetts, and the Scientific and Data Coordinating Center for the NIDDK-funded Chronic Renal Insufficiency Cohort Study; he is a Special Government Employee of the United States (US) Food and Drug Administration and consults for their Reagan-Udall Foundation and receives travel support from John Wiley & Sons. Dr. Leonard consults for TriNetX and Novo Nordisk. Dr. Leonard's spouse is an employee of Merck; neither Dr. Leonard nor his spouse owns stock in the company. Dr. Weintraub receives support from the National Institutes of Health [Grant #R01NS099129] and has also received research funding or support from Michael J. Fox Foundation for Parkinson's Research, Alzheimer's Therapeutic Research Initiative (ATRI), Alzheimer's Disease Cooperative Study (ADCS), the International Parkinson and Movement Disorder Society (IPMDS); honoraria for consultancy from Acadia Pharmaceuticals Inc., Aptinyx, Biogen, Bracket, CHDI Foundation, Clintrex LLC, Enterin, F. Hoffmann-La Roche Ltd, Ferring, Promentis, Sunovion, and Takeda; and license fee payments from the University of Pennsylvania for the QUIP and QUIP-RS. Dr. Willis receives financial support from National Institutes of Health [Grants #R01NS099129, #K24AG075234, #P30AG059302], the Parkinson's Foundation, Acadia Pharmaceuticals Inc., and the University of Pennsylvania. All other authors declared no competing interests for this work., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Direct methanol fuel cell (DMFC) technology has grabbed much attention from researchers worldwide in the realm of green and renewable energy-generating technologies. Practical applications of DMFCs are marked by the development of highly active, efficient, economical, and long-lasting anode catalysts. Layered double hydroxide (LDH) nanohybrids are found to be efficient electrode materials for methanol oxidation. In this study, we synthesized NiCu-LDH/MXene nanocomposites (NCMs) and investigated their electrochemical performance for methanol oxidation. The formation of NCM was verified through field emission scanning electron microscopy (FE-SEM), energy-dispersive X-ray spectroscopy (EDX), X-ray diffraction (XRD), Fourier transform infrared (FTIR) spectroscopy, Brunauer-Emmett-Teller (BET), and X-ray photoemission spectroscopy (XPS) analyses. The cyclic voltammetry, chronoamperometry, and electron impedance spectroscopy techniques were carried out to assess the electrocatalytic ability of the methanol oxidation reaction. The incorporation of MXene enhanced the methanol oxidation 2-fold times higher than NiCu-LDH. NCM-45 exhibited high peak current density (86.9 mA cm -2 ), enhanced electrochemical active surface area (7.625 cm 2 ), and long-term stability (77.8% retention after 500 cycles). The superior performance of NCM can be attributed to the synergistic effect between Ni and Cu and, further, the electronic coupling between LDH and MXene. Based on the results, NCM nanocomposite is an efficient anodic material for the electrocatalytic oxidation of methanol. This study will open the door for the development of various LDH/MXene nanocomposite electrode materials for the application of direct methanol fuel cells.

This study aimed to examine differential prescribing due to channeling and propensity score non-overlap over time in new versus established treatments for common neurological conditions. We conducted cross-sectional analyses on a national sample of US commercially insured adults using 2005-2019 data. We compared new users of recently approved versus established medications for management of diabetic peripheral neuropathy (pregabalin versus gabapentin), Parkinson disease psychosis (pimavanserin versus quetiapine), and epilepsy (brivaracetam versus levetiracetam). Within these drug pairs, we compared demographic, clinical, and healthcare utilization characteristics of recipients of each drug. In addition, we fit yearly propensity score models for each condition and assessed propensity score non-overlap over time. For all three drug pairs, users of the more recently approved medications more frequently had prior treatment (pregabalin = 73.9%, gabapentin = 38.7%; pimavanserin = 41.1%, quetiapine = 14.0%; brivaracetam = 93.4%, levetiracetam = 32.1%). Propensity score non-overlap and its resulting sample loss after trimming were the greatest in the first year that the more recently approved medication was available (diabetic peripheral neuropathy, 12.4% non-overlap; Parkinson disease psychosis, 6.1%; epilepsy, 43.2%) and subsequently improved. Newer neuropsychiatric therapies appear to be channeled to individuals with refractory disease or intolerance to other treatments, leading to potential confounding and biased comparative effectiveness and safety study findings when compared to established treatments. Propensity score non-overlap should be reported in comparative studies that include newer medications. When studies comparing newer and established treatments are critically needed as soon as new treatments enter the market, investigators should recognize the potential for channeling bias and implement methodological approaches like those demonstrated in this study to understand and improve this issue in such studies., (© 2023. The American Society for Experimental Neurotherapeutics, Inc.)

Background: Hip fractures are a public health problem among older adults, but most research on recovery after hip fracture has been limited to females. With growing numbers of hip fractures among males, it is important to determine how recovery outcomes may differ between the sexes., Methods: 168 males and 171 females were enrolled within 15 days of hospitalization with follow-up visits at 2, 6, and 12 months postadmission to assess changes in disability, physical performance, cognition, depressive symptoms, body composition, and strength, and all-cause mortality. Generalized estimating equations examined whether males and females followed identical outcome recovery assessed by the change in each outcome., Results: The mean age at fracture was similar for males (80.4) and females (81.4), and males had more comorbidities (2.5 vs 1.6) than females. Males were significantly more likely to die over 12 months (hazard ratio 2.89, 95% confidence interval: 1.56-5.34). Changes in outcomes were significantly different between males and females for disability, gait speed, and depressive symptoms (p < .05). Both sexes improved from baseline to 6 months for these measures, but only males continued to improve between 6 and 12 months. There were baseline differences for most body composition measures and strength; however, there were no significant differences in change by sex., Conclusions: Findings confirm that males have higher mortality but suggest that male survivors have continued functional recovery over the 12 months compared to females. Research is needed to determine the underlying causes of these sex differences for developing future prognostic information and rehabilitative interventions., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The American Academy of Neurology Parkinson Disease (PD) quality measures include an annual diagnostic review., Objective: To investigate the frequency and pattern of changes in diagnoses between PD and other causes of parkinsonism., Methods: This prospective longitudinal cohort study included consented patients diagnosed with PD at least once and a minimum of two times at the Movement Disorders Center between 2002 and 2017. Movement disorder specialists confirmed and documented diagnoses at every visit. Longitudinal changes in diagnoses were identified across visits., Results: Of 1567 patients with parkinsonism, 174 had non-PD parkinsonism with no change over time. Of 1393 patients diagnosed with PD at least once, 94% ( N  = 1308) had no change of diagnosis over time and 6% ( N  = 85) had a change of diagnosis including PD ⟷ drug-induced parkinsonism (DIP) (27.1%), PD ⟷ multiple system atrophy (MSA) (20.0%), PD ⟷ progressive supranuclear palsy (PSP) (18.8%), PD ⟷ Lewy body dementia (DLB) (16.5%), PD⟷ vascular parkinsonism (9.4%), more than two diagnoses (4.7%), and PD ⟷ corticobasal syndrome (CBS) (3.5%). The direction of diagnostic switches was as follows: PD ⟶ other parkinsonism diseases (36.5%), other parkinsonism diseases ⟶ PD (31.8%), and 31.8% of multiple switches. There were no significant differences in duration of follow-up, age at first visit, gender, race, marital status, education, income, cognition, or employment between the stable and unstable groups. Diagnostic change was associated with greater PD severity and greater medical comorbidity., Conclusion: Over a 15-year period, movement disorder specialists changed their clinical diagnosis of PD in 6% of patients. The most common diagnostic switches, to or from PD, were DIP, MSA, PSP, and DLB. This study describes routine clinical diagnostic patterns in the absence of pathologic confirmation. The presence of diverse diagnostic changes over time underscores the value of confirming PD diagnosis., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Marzieh Keshtkarjahromi et al.)

Background: Frailty is a geriatric syndrome with negative health impacts not captured by comorbidity and disability alone. The prevalence of frailty in Parkinson's disease (PD) has been described, but data on frailty-associated outcomes are limited., Objective: To describe the level of frailty and investigate the association between frailty and outcomes in a Medicare sample of persons diagnosed with PD., Methods: We used the claims-based frailty index to assess frailty in a cohort of Medicare beneficiaries with PD in 2013. Frailty was categorized as non-frail/pre-frail, mildly frail, moderately frail, and severely frail. Adjusted logistic regression models examined the relationship between frailty and mortality, hospitalization, emergency department visits, and fall-related injuries through 2014., Results: Of 62,786 beneficiaries with PD in 2013, 55.3% were frail. Frail individuals were more likely to be female, older, Black, metropolitan dwelling, without neurologist care, nursing facility residents, or multimorbid. The average daily levodopa equivalent dose initially increased, then decreased from the pre-frail to the severely frail groups. Compared to non-frail/pre-frail persons, severely frail persons had higher adjusted odds of 1-year mortality (AOR 2.74, 95% CI 1.98, 3.78), hospitalization (AOR 2.34, 95% CI 1.74, 3.14), emergency department visits (AOR 2.97, 95% CI 2.14, 4.13), and fall-related injury (AOR 1.43, 95% CI 0.90, 2.26)., Conclusions: Frailty is common and differentially distributed among older adults with PD. Frailty in PD is associated with adverse health outcomes and death. Observational study analyses may benefit from adjustment for frailty; claims-based frailty surveillance may identify vulnerable PD patients in health system, registry, or administrative data. © 2021 International Parkinson and Movement Disorder Society., (© 2021 International Parkinson and Movement Disorder Society.)

Background: Antipsychotics are used in Parkinson disease (PD) to treat psychosis, mood, and behavioral disturbances. Commonly used antipsychotics differ substantially in their potential to worsen motor symptoms through dopaminergic receptor blockade. Recent real-world data on the use and continuation of antipsychotic therapy in PD are lacking. The objectives of this study are to (1) examine the continuation of overall and initial antipsychotic therapy in individuals with PD and (2) determine whether continuation varies by drug dopamine receptor blocking activity., Methods: We conducted a retrospective cohort study using U.S. commercially insured individuals in Optum 2001-2019. Adults aged 40 years or older with PD initiating antipsychotic therapy, with continuous insurance coverage for at least 6 months following drug initiation, were included. Exposure to pimavanserin, quetiapine, clozapine, aripiprazole, risperidone, or olanzapine was identified based on pharmacy claims. Six-month continuation of overall and initial antipsychotic therapy was estimated by time to complete discontinuation or switching to a different antipsychotic. Cox proportional hazards models evaluated factors associated with discontinuation., Results: Overall, 38.6% of 3566 PD patients in our sample discontinued antipsychotic therapy after the first prescription, 61.4% continued with overall treatment within 6 months of initiation. Clozapine use was too rare to include in statistical analyses. Overall therapy discontinuation was more likely for those who initiated medications with known dopamine-receptor blocking activity (adjusted hazard ratios 1.76 [95% confidence interval 1.40-2.20] for quetiapine, 2.15 [1.61-2.86] for aripiprazole, 2.12 [1.66-2.72] for risperidone, and 2.07 [1.60-2.67] for olanzapine), compared with serotonin receptor-specific pimavanserin. Initial antipsychotic therapy discontinuation also associated with greater dopamine-receptor blocking activity medication use - adjusted hazard ratios 1.57 (1.28-1.94), 1.88 (1.43-2.46), 2.00 (1.59-2.52) and 2.03 (1.60-2.58) for quetiapine, aripiprazole, risperidone, and olanzapine, respectively, compared with pimavanserin. Similar results were observed in sensitivity analyses., Conclusions: Over one-third of individuals with PD discontinued antipsychotic therapy, especially if the initial drug has greater dopamine-receptor blocking activity. Understanding the drivers of antipsychotic discontinuation, including ineffectiveness, potentially inappropriate use, clinician inertia, patient adherence and adverse effects, is needed to inform clinical management of psychosis in PD and appropriate antipsychotic use in this population.

Objective: To examine the national prevalence of pharmacological treatment of affective disorders in older adults with Parkinson's disease (PD), and determine the prevalence and risk factors for receipt of an American Geriatrics Society Beers Criteria® defined potentially inappropriate medication (PIM) for affective disorder treatment., Design: Cross-sectional analysis of 2014 Medicare data., Setting: Research Identifiable File data from the Centers for Medicare and Medicaid Services., Participants: Individuals ≥65 years of age with PD whose inpatient, outpatient, and prescription care is administered through the U.S. Medicare Program., Measurements: The 2014 prevalence of affective (i.e., depressive and anxiety) disorders was calculated. We assessed prescription fills for affective disorder treatment and classified prescriptions according to PIM status. Patient and clinician factors associated with PIM prescriptions were determined., Results: Of 84,323 beneficiaries with PD, 15.1% had prevalent depression only, 7.5% had anxiety only, and 8.5% had comorbid depression and anxiety. Among those with depression only, 80.7% were treated in 2014 (12.8% of treated received at least one PIM). The annual treatment prevalence was 62.9% (75.9% PIM) and 93.1% (63.9% PIM) in the anxiety only and comorbid group, respectively. In most groups, PIM use was less likely among men and those with dementia; geriatricians were less likely to prescribe PIMs., Conclusion: Treatment of affective disorders in persons diagnosed with PD is high. PIM use is also common, particularly in persons with anxiety. Future research will quantify the potential effects of these PIMs on clinical and patient outcomes., (Copyright © 2020 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background: Visual impairment is associated with hip fracture, depression, anxiety, and dementia in the general population, and many causes of visual impairment are preventable or treatable with early detection. However, the prevalence, outcomes, and healthcare utilization patterns associated with visual impairment have not been examined in Parkinson's disease (PD)., Methods: We performed a cross-sectional analysis of all Medicare beneficiaries with complete data in 2014 and longitudinal analysis of beneficiaries with PD from 2010 to 2014. We used diagnosis and procedure codes to identify PD, visual impairment, eye exams, hip fracture, and neuropsychiatric disorders. We compared the prevalence of visual impairment using logistic regression and used Cox proportional hazards regression to examine visual impairment and incident hip fracture, depression, anxiety, dementia, and death. We also examined the frequency of eye exams in PD using repeated-measures logistic regression., Results: Among 26,209,997 Medicare beneficiaries in 2014, visual impairment was significantly more prevalent in PD (1.7%) than non-PD (0.71%) (adjusted odds ratio, 1.60; 95% confidence interval [CI], 1.56-1.65). In a longitudinal cohort of 542,224 Medicare beneficiaries with PD, less than 60% had a yearly eye exam. Visual impairment associated with increased hazard of depression (hazard ratio [HR], 1.23; 95% CI, 1.14-1.32), anxiety (HR, 1.34; 95% CI, 1.24-1.43), dementia (HR, 1.28; 95% CI, 1.21-1.36), and death (HR, 1.49; 95% CI, 1.44-1.55)., Conclusion: Visual impairment is more common in PD than the general population and is associated with negative PD-related outcomes. Understanding the mechanisms for these relationships is important for guiding future interventions to improve health outcomes in PD. © 2020 International Parkinson and Movement Disorder Society., (© 2020 International Parkinson and Movement Disorder Society.)

Background: impairments in neurotransmitter pathways put Parkinson's disease (PD) patients at risk for drug-disease interactions and adverse medication events., Objective: to determine the prevalence and risk factors for potentially inappropriate medication (PIM) prescriptions, as defined by the 2015 Beers List, in PD., Methods: cross-sectional analysis was conducted on 2014 Medicare beneficiaries with PD who had parts A, B and D coverage. The prevalence of PIM prescriptions for older adults was determined overall, and specifically for medications that can exacerbate motor symptoms or cognitive impairment in PD. Logistic regression models were constructed to determine the association between age, sex, race, geography and poverty with PIM prescriptions., Results: the final sample included 458,086 beneficiaries. In 2014, 35.8% of beneficiaries with PD filled a prescription for at least one PIM for older adults. In total, 8.7% of beneficiaries received a PIM that could exacerbate motor symptoms and 29.0% received a PIM that could worsen cognitive impairment. After adjustment, in all models, beneficiaries who were younger, female, white, urban-dwelling and eligible for Medicaid benefits were more likely to receive a PIM., Conclusion: PIM prescriptions are not uncommon in PD, particularly for medications that can exacerbate cognitive impairment. Future research will examine underlying drivers of sex and other disparities in PIM prescribing. Additional studies are needed to understand the impact of PIMs on disease symptoms, healthcare utilisation and patient outcomes., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Our objectives were to (1) characterize patient and clinical characteristics of adults hospitalized with meningitis; (2) describe meningitis hospitalization outcomes, including 30- and 90-day readmissions; and (3) determine whether clinical, patient, or index hospitalization characteristics are associated with readmission and readmission outcomes., Methods: This retrospective study of the 2014 National Readmissions Database extracted data on hospitalized adults with a principal diagnosis of meningitis and examined hospitalization outcomes using descriptive statistics. Logistic regression models were built to determine whether characteristics were associated with 30- or 90-day readmissions., Results: For the 30-day readmission analyses, 18,883 adults qualified. Meningitis hospitalizations commonly involved adults 25 to 54 years of age who were insured by private carriers. The readmission rates were 7.0% at 30 days and 11.4% at 90 days. Readmission was associated with greater comorbidity burden (2 conditions: adjusted odds ratio [AOR] = 1.60, range 1.24-2.08; 3 conditions: AOR = 1.92, range 1.43-2.58; 4+ conditions: AOR = 2.68, range 2.04-3.51 vs 0 or 1 condition), public insurance (Medicare: AOR = 1.85, range 1.30-2.62; Medicaid: AOR = 1.48, range 1.16-1.90 vs private insurance), and medical error (AOR = 1.43, range 1.07-1.91). Readmissions were most often for meningitis, septicemia, or medical complications., Conclusions: Readmission after hospitalization for meningitis is associated with both fixed and modifiable factors. More research is needed to determine which post-meningitis readmissions are preventable., (Copyright © 2019 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Objectives: While sarcopenia is prevalent after hip fracture in the acute postfracture period, little is known about the prevalence after discharge. This study assessed longitudinal trends in sarcopenia prevalence over 12 months after hip fracture using three different operational definitions., Design: Prospective observational study., Setting: Baltimore Hip Studies seventh cohort., Participants: A total of 82 men and 78 women, aged 65 years and older, with surgical repair of a nonpathological hip fracture., Measurements: Baseline assessment included a dual-energy X-ray absorptiometry scan and interview. Follow-up assessments, which additionally included performance measures, occurred 2, 6, and 12 months after admission. Using these measures, three sarcopenia definitions were assessed over the year following hip fracture: European Working Group on Sarcopenia in Older Persons (EWGSOP), International Working Group on Sarcopenia (IWGS), and Foundation for the National Institutes of Health (FNIH)., Results: EWGSOP and IWGS provided the highest prevalence of sarcopenia (62%-69% in men, 42%-62% in women), while prevalence by FNIH was much lower for men (15%-19%) and women (5%-12%). For both men and women, the agreement between EWGSOP and IWGS definitions was excellent, and FNIH showed poor agreement with them, supported by various statistical measures across first-year follow-up. Prevalence was stable over time in men by all definitions, while the prevalence in women by FNIH was lowest at 2 months, significantly increased at 6 months (P = .03), and remained higher at 12 months. Whether sarcopenia prevalence differed significantly by sex varied by time point and definition; however, when different, men had a higher prevalence than women (P < .05). While some participants recovered from sarcopenia over time, some also became newly sarcopenic., Conclusion: The prevalence of sarcopenia after fracture differed greatly for EWGSOP and IWGS compared to FNIH. Overall, there appeared to be no reduction in sarcopenia over the year after hip fracture, regardless of definition. Future research should examine the relationship between sarcopenia prevalence and functional recovery. J Am Geriatr Soc 68:1537-1544, 2020., (Published 2020. This article is a U.S. Government work and is in the public domain in the USA.)

Introduction: Deep brain stimulation (DBS) surgery is an efficacious, underutilized treatment for Parkinson's disease (PD). Studies of DBS post-operative outcomes are often restricted to data from a single center and consider DBS in isolation. National estimates of DBS readmission and post-operative outcomes are needed, as are comparisons to commonly performed surgeries., Methods: This study used datasets from the 2013 and 2014 Nationwide Readmissions Database (NRD). Our sample was restricted to PD patients discharged alive after hospitalization for DBS surgery. Descriptive analyses examined patient, clinical, hospital and index hospitalization characteristics. The all-cause, non-elective 30-day readmission rate after DBS was calculated, and logistic regression models were built to examine factors associated with readmission. Readmission rates for the most common surgical procedures were calculated and compared to DBS., Results: There were 6058 DBS surgeries for PD in our sample, most often involving a male aged 65 and older, who lived in a high socioeconomic status zip code. DBS patients had an average of four comorbidities. With respect to outcomes, the majority of patients were discharged home (95.3%). Non-elective readmission was rare (4.9%), and was associated with socioeconomic status, comorbidity burden, and teaching hospital status. Much higher acute, non-elective readmission rates were observed for common procedures such as upper gastrointestinal endoscopy (16.2%), colonoscopy (14.0%), and cardiac defibrillator and pacemaker procedures (11.1%)., Conclusion: Short-term hospitalization outcomes after DBS are generally favorable. Socioeconomic disparities in DBS use persist. Additional efforts may be needed to improve provider referrals for and patient access to DBS., Competing Interests: Declaration of competing interest RBS: Has no conflicts of interest relevant to this work but reports grant support from the National Institute of Neurological Disorders and Stroke, Biohaven Pharmaceuticals, CHDI Foundation, Teva Pharmaceuticals, Pfizer, Nuredis Inc., The Michael J. Fox Foundation, and the Canadian Institute of Health Research as well as financial support from the Parkinson's Foundation. JJ-S: Reports research support from Medtronic and St. Jude Medical/Abbott as well as consulting agreements with Medtronic, St. Jude Medical/Abbott, and Boston Scientific relevant to this work. Also reports research support from Teva and Lilly; consulting agreements with Bracket and Nuvelution; and grant support from the National Institute of Neurological Disorders and Stroke, the Michael J. Fox Foundation, and the Simons Foundation. DSA: Has no conflicts of interest relevant to this work but reports research support from the National Institutes of Health and financial support from the Parkinson's Foundation. DPT: None. SM: None. MF: Has no conflicts of interest relevant to this work but reports active research funding from the American Academy of Neurology, American Brain Foundation, and the Parkinson's Foundation. MAB: Has no conflicts of interest relevant to this work but reports active research funding from the Parkinson's Foundation. KLC: Has no conflicts of interest relevant to this work but reports active research funds from the National Institutes of Health and the Parkinson Study Group, consulting agreements with Sunovion Pharmaceuticals, and royalties from UpToDate and Springer. MS: Has no conflicts of interest relevant to this work but reports active research funding from Abbvie, USWorldMeds, Sanofi, Lundbeck, and Abbott. WJJ: None. P-FD: Has no conflicts of interest relevant to this work but reports service as an Officer of Neurotargeting LLC. MKY: Has no conflicts of interest relevant to this work but reports personal compensation for consultant, Steering Committee, and Data Safety Monitoring Board service from the Michael J. Fox Foundation and Boston Scientific. JCK: None. JMS: Has no conflicts of interest relevant to this work but reports research grants from Medtronic, service as a consultant for Guidant, LLC, and salary support from Blue Cross Blue Shield of Michigan. AJE: Has no conflicts of interest relevant to this work but reports grant support from the National Institutes of Health, Great Lakes Neurotechnologies, and the Michael J Fox Foundation; personal compensation as a consultant/scientific advisory board member for Abbvie, Neuroderm, TEVA, Impax, Acadia, Acorda, Cynapsus/Sunovion, Lundbeck, Osmotica Pharmaceutical, and USWorldMeds; publishing royalties from Lippincott Williams & Wilkins, Cambridge University Press, and Springer; and honoraria from Abbvie, UCB, USWorldMeds, Lundbeck, Acadia, the American Academy of Neurology, and the Movement Disorders Society. LCS: Has no conflicts of interest relevant to this work but reports employment with Biogen, Inc. DKS: Has no conflicts of interest relevant to this work but reports research funding from BioElectron Technology, Lysosomal Therapeutics, Mission Therapeutics, Voyager Therapeutics, the Weston Brain Institute, and the National Institutes of Health as well as honorarium for Steering Committee service from the Michael J. Fox Foundation and Biogen. CH: None. JAGC: Has no conflicts of interest relevant to this work but reports research support from the Northern Ontario Academic Medicine Association. AWW: Has no conflicts of interest relevant to this work but reports research funding from the National Institutes of Health and the Parkinson's Foundation., (Copyright © 2019. Published by Elsevier Ltd.)

Introduction: Females have a reduced risk of Parkinson's disease (PD). However, it is unclear if sex is a prognostic factor. We aimed to examine differences in presentation, physician- and patient-reported PD outcomes, and progression by sex in a large clinical cohort., Methods: This study was a secondary analysis of a cohort of PD patients seen at a tertiary care center. Sociodemographic and clinical characteristics, treatment, care timing, and outcomes were examined by sex. Sex differences in progression of impairment, disability, and health-related quality of life (HRQoL) were tested with five-year piecewise linear mixed-effects models. A mediation analysis assessed drivers of sex differences., Results: The study included 914 males and 549 females. Females had significantly less social support, more psychological distress, and worse self-reported (but not physician-reported) disability and HRQoL at initial PD care visits, compared to males. Addressing anxiety symptoms may attenuate this difference. PD progression sex differences were minimal., Conclusion: PD progression does not differ by sex, yet patient-reported measures of disease severity are worse in females than males. To attenuate this sex difference in disease experience, psychological distress screening and management, particularly targeting females, should be implemented as part of PD clinical care., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Purpose: To compare the amount of phacoemulsification ultrasound energy used between eyes undergoing femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification., Methods: One eye of consecutive patients undergoing routine non-complicated phacoemulsification from January 2014 to December of 2015 was included in the analysis. FLACS was performed using the Alcon LenSx. Linear regression was used for analysis with type of surgery (FLACS versus conventional phacoemulsification) as the exposure and cumulative dispersed energy (CDE) as the outcome variable. Age, surgeon, eye side, and eye sequence (first versus second eye) were covariates., Results: A total of 1159 surgeries met inclusion criteria. The average age of the cohort was 70.6 (SD 8.6) years, 590 cases (51%) were performed by surgeon 1, and 582 cases (50%) were right eyes. Overall, FLACS resulted in significantly lower CDE as compared to conventional phacoemulsification (β = 0.89, 95% CI 0.83, 0.95). When stratified by eye side and surgeon, FLACS performed on left eyes operated on by surgeon 1 resulted in lower CDE as compared to conventional phacoemulsification (β = 0.76, 95% CI 0.66, 0.87), but not for right eyes operated on by surgeon 1 (β = 0.92, 95% CI 0.79, 1.07) or for eyes operated on by surgeons 2 or 3., Conclusions: The use of FLACS on the Alcon LenSx platform results in a small decrease in phacoemulsification energy as compared to conventional phacoemulsification in certain cases. Further study assessing optimal laser settings and surgical technique is necessary.

Objective: To examine trends in 12-month postfracture residual disability, nursing home placement, and mortality among patients with a hip fracture between 1990 and 2011., Design: Secondary analysis of 12-month outcomes from 3 cohort studies and control arms of 2 randomized controlled trials., Setting: Original studies were conducted as part of the Baltimore Hip Studies (BHS)., Participants: Community-dwelling patients ≥65 years of age hospitalized for surgical repair of a nonpathologic hip fracture (N=988)., Main Outcome Measures: Twelve-month residual disability, mortality, and nursing home residency were examined in case-mix adjusted models by sex and study. Residual disability was calculated by subtracting prefracture scores of Lower Extremity Physical Activities of Daily Living from scores at 12 months postfracture. We also examined the proportion of individuals with a 12-month score higher than their prefracture score (residual disability>0)., Results: Only small improvements were seen in residual disability between 1990 and 2011. No significant differences were seen for men between BHS2 (enrollment 1990-1991; mean residual disability=3.1 activities; 95% confidence interval [CI], 2.16-4.10) and BHS7 (enrollment 2006-2011; mean=3.1 activities; 95% CI, 2.41-3.82). In women, residual disability significantly improved from BHS2 (mean=3.5 activities; 95% CI, 2.95-3.99) to BHS3 (enrollment 1992-1995; mean=2.7 activities; 95% CI, 2.01-3.30) with no significant improvements in later studies. After adjustment, a substantial proportion (91% of men and 79% of women) had a negative outcome (residual disability, died, or nursing home residence at 12 months) in the most recently completed study (BHS7)., Conclusions: Over 2 decades, patients undergoing usual care post-hip fracture still had substantial residual disability. Additional clinical and research efforts are needed to determine how to improve hip fracture treatment, rehabilitation, and subsequent outcomes., (Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: Angiotensin converting enzyme inhibitors are commonly prescribed medications after the Norwood procedure. There are little data that can be used to determine if angiotensin converting enzyme inhibitors improve interstage outcomes in children with single ventricle defects. The objective of this study was to investigate the relationship between angiotensin converting enzyme inhibitors and interstage failure among infants born with hypoplastic left heart syndrome., Methods: We conducted a retrospective cohort study using data from the National Pediatric Cardiology Quality Improvement Collaborative database (collected between 2008 and 2015). We used logistic regression models to assess the exposure-outcome associations and propensity score matching to account for differences in baseline patient characteristics associated with use of angiotensin converting enzyme inhibitors., Results: A total of 1 487 neonates participated in the study. Thirty-nine percent of patients were prescribed angiotensin converting enzyme inhibitors after the Norwood procedure; 11% experienced interstage failure (death, heart transplantation, and not being a candidate for the second-stage surgery). Before propensity score matching, patients receiving angiotensin converting enzyme inhibitors were significantly more likely to experience interstage failure, compared to patients not on angiotensin converting enzyme inhibitors (OR = 1.44; 95% CI: 1.04, 1.99; P = 0.03). Although there was an increased odds of interstage failure among patients receiving angiotensin converting enzyme inhibitors compared to patients not receiving angiotensin converting enzyme inhibitors in the propensity score-matched cohort, this association was not significantly different (adjusted OR = 1.29; 95% CI: 0.88, 1.95; P = 0.18)., Conclusion: Angiotensin converting enzyme inhibitor therapy did not demonstrate a beneficial effect on interstage failure among infants with hypoplastic left heart syndrome, even when patient characteristics associated with the use of angiotensin converting enzyme inhibitors were considered., (© 2018 Wiley Periodicals, Inc.)

Background: Low birth and operative weight have been identified as risk factors for death after first-stage single-ventricle palliation. We hypothesize that weight gain after the first-stage operation is associated with transplant-free interstage survival to admission for the second-stage operation., Methods: We used historical data from the National Pediatric Cardiology Quality Improvement Collaborative database to conduct a longitudinal study to assess the association between weight gain and transplant-free interstage survival. The primary predictor was weight gain. The primary outcome was transplant-free survival. We constructed a repeated-measures logistic regression model using the general estimating equation method to examine the association between weight gain and transplant-free interstage survival., Results: The study population included 1,501 infants who were discharged alive from the first-stage single-ventricle palliation between June 2008 and January 2015. Patients who underwent a hybrid operation (n = 132) or were lost to follow-up (n = 11) were excluded. Transplant-free interstage survival was 90% (1,228 of 1,358). The mean weight gain was 2.5 (SD, 1.0) kg. Adjusted for age at the time of each measurement, the number of measurements, age at discharge from the first-stage operation, sex, diagnosis, postoperative arrhythmia, postoperative complications, and discharge antibiotic therapy, each 100-g increase in weight was associated with an odds ratio of transplant-free interstage survival of 1.03 (95% confidence limit, 1.01, 1.05)., Conclusions: After first-stage single-ventricle palliation, interstage weight gain is significantly associated with transplant-free interstage survival., (Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Objectives: To evaluate the efficacy and safety of lorazepam in reducing psychological distress and chemotherapy-induced nausea and vomiting., Methodology: It was a prospective interventional study with seventy patients for a period of 1 year. In which, patients' anxiety, distress and status of nausea, and vomiting were assessed in the first four chemotherapy cycles before drug intervention. During the subsequent chemotherapy cycles, the outcomes of the intervention were reassessed along with patient's quality of life (QOL)., Results: Out of seventy patients, 62 showed improvement in their distress level after the drug intervention and patient counseling. Lorazepam along with other antiemetic drugs reduced chemotherapy-induced delayed nausea and vomiting. During the course of the study, 15 patients experienced drowsiness as an adverse reaction to lorazepam. The overall QOL of the population was also improved with lorazepam., Conclusion: Lorazepam along with patient counseling can improve patient's psychological distress and thus their QOL. The off-labeled use of lorazepam can be utilized for controlling chemotherapy-induced nausea vomiting., Competing Interests: There are no conflicts of interest.

Objective: Psychological distress is common among Parkinson disease (PD) patients. Screening tools, such as the Brief Symptom Inventory-18 (BSI-18), help clinicians to identify and manage PD patients with psychiatric symptoms. The objective of this study is to test the factor structure of the BSI-18 in PD patients., Methods: Analysis was conducted on PD patients who had initial visits at a movement disorders center from 2004 to 2015. Univariate analysis was used to describe the distribution of socio-demographic and clinical characteristics. The BSI-18 was used to determine the prevalence of clinically significant psychological distress. Confirmatory factor analyses (CFA) treating BSI-18 items as ordered categorical data were conducted. Five competing models were tested. Multiple fit indices, parsimony, and past theory were used to select the final model., Results: In the study sample (n=1067), 18.7%, 22.5%, 15.4%, and 15.0% of patients had BSI-18 T-scores indicative of clinically significant global psychological distress, somatization, depression, and anxiety, respectively. Of the competing models, the final model chosen was the second-order three-factor structure with somatization, depression, and anxiety loaded on psychological distress., Conclusion: The original proposed factor structure of the BSI-18 was validated in this patient population. Consequently, this study confirms the construct validity of the BSI-18 for screening of psychological distress in PD patients. Findings highlight somatization as a particularly important component of psychological distress in PD patients., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Hospital readmissions are common and costly. Our goal was to determine the association between depressive symptoms and readmission within 30 days following hospital discharge in older adults., Methods: We analyzed data from a study of 789 persons aged 65 years or older admitted to a 20-bed acute care for elders (ACE) hospital unit from May 2009 to July 2011. Depressive symptoms were recorded within 24-hours of admission to the hospital unit, using the Center for Epidemiologic Studies -Depression (CES-D) Scale. The primary outcome was readmission to hospital within 30 days of discharge., Results: The mean age was 77 years; 66% were female, 72% were White, and 59% were unmarried. On average, older patients reported 2.6 comorbid conditions. Sixteen percent were classified with high depressive symptoms (CES-D ≥ 16). The readmission rate within 30 days was 15%. Older patients with high depressive symptoms had more than 1.6 times the odds (OR 1.66; 95% CI: 1.01-2.74) of being readmitted within 30-days, as compared to those with low depressive symptoms (CES-D < 16), after adjustment for age, race/ethnicity, sex, marital status and comorbid conditions., Conclusion: High depressive symptoms increased the risk of hospital readmission within 30 days of discharge after adjusting for relevant covariates. In-hospital screening for depressive symptoms may identify older persons at risk for recurrent hospital admissions.

Introduction: This study aimed to compare the prevalence of potentially inappropriately prescribed drugs in hemodialysis patients and patients with chronic kidney disease who did not require renal replacement therapy, as well as to identify risk factors associated with potentially inappropriate prescribing. Methods: The study was designed as a cross‐sectional study conducted at the Department of Nephrology, Clinical Center in Nis, Serbia. The patients were divided into two groups: (1) patients on hemodialysis treatment and (2) patients with various degrees of chronic kidney disease without renal replacement therapy. The presence or absence of potentially inappropriate prescribing was determined using the 2015 AGS Beers criteria. Findings: The study included a total of 218 patients aged 65 years and over. The number of patients with potentially inappropriate prescribed drugs did not differ significantly (chi‐square = 0.000, p = 1.000) between patients on hemodialysis (27 of 83, i.e., 32.5%) and patients with various degrees of chronic kidney disease without renal replacement therapy (44 of 135, i.e., 32.6%). Factors associated with potentially inappropriate prescribing in hemodialysis patients were the number of drugs (hazard ratio [HR] = 1.919, 95% confidence interval [CI]: 1.325–2.780) and number of comorbidities (HR = 1.743, 95% CI: 1.109–2.740). The number of drugs (HR = 1.438, 95% CI: 1.191–1.736) was the only independent factor associated with increased risk of potentially inappropriate prescribing in patients without renal replacement therapy. Discussion: Our study showed that potentially inappropriate prescribing is a relatively frequent phenomenon present in about a third of patients in both study groups. The number of prescribed drugs was the main factor associated with the increased risk of potentially inappropriate prescribing in both groups. [ABSTRACT FROM AUTHOR]

Background: Pain after total hip arthroplasty (THA) for femoral neck fracture (FNF) can be severe, potentially leading to serious complications. PENG block has become an optional local analgesic strategy in hip fracture surgery, but it cannot provide effective pain relief for the posterior capsule of the hip joint. Therefore, we modified the traditional sacral plexus nerve block and named it Posterior Hip Pericapsule Block (PHPB) to complement the blockade of the relevant nerves innervating the posterior hip capsule region. Thereby, we detail the analgesic effect of PHPB combined with PENG block on five hip fracture patients and the effect on their hip motor function. Methods: This case series was conducted from December 2023 to February 2024. We performed ultrasound-guided PHPB combined with PENG block on five patients with hip fractures. Numerical Rating Scale (NRS) pain scores at rest and maximum NRS pain scores during limb movement of the five patients were recorded within 48 h after surgery. Their hip flexion, abduction, adduction, keen flexion and quadriceps muscle strength were also recorded. Serious postoperative complications, including wound infection, hematoma formation, or nerve injury, were recorded. Results: They experienced effective pain control within 48 h postoperatively, with NRS pain scores at rest decreasing from 3.0 (3.0, 4.5) to 0.0 (0.0, 1.0) and maximum NRS pain scores during limb movement from 8.0 (7.5, 8.5) to 1.0 (0.5, 2.0). They can autonomously perform hip flexion, abduction, adduction, and knee flexion within 48 h postoperatively without any signs of movement disorders or quadriceps muscle weakness. No severe postoperative complications, such as wound infections, hematoma formation or nerve damage, were observed in any of the patients. Conclusions: Ultrasound-guided PENG block combined with PHPB provided effective analgesia for hip fracture patients in the perioperative period. It maintained hip joint motor function and quadriceps muscle strength within 24 h after THA. [ABSTRACT FROM AUTHOR]

This paper introduces a novel design for a universal DC-DC and DC-AC converter tailored for DC/AC microgrid applications using Approximate Dynamic Programming and Artificial Neural Networks (ADP-ANN). The proposed converter is engineered to operate efficiently with both low-power battery and single-phase AC supply, utilizing identical side terminals and switches for both chopper and inverter configurations. This innovation reduces component redundancy and enhances operational versatility. The converter's design emphasizes minimal switch usage while ensuring efficient conversion to meet diverse load requirements from battery or AC sources. A conceptual example illustrates the design's principles, and comprehensive analyses compare the converter's performance across various operational modes. A test bench model, rated at 3000W, demonstrates the converter's efficacy in all five operational modes with AC/DC inputs. Experimental results confirm the system's robustness and adaptability, leveraging ADP-ANN for optimal performance. The paper concludes by outlining potential applications, including microgrids, electric vehicles, and renewable energy systems, highlighting the converter's key advantages such as reduced complexity, increased efficiency, and broad applicability. [ABSTRACT FROM AUTHOR]

Background: Deprescribing of potentially inappropriate medications is recommended for older adults and may improve health outcomes and quality of life in persons living with Parkinson disease (PD). Patient attitudes, beliefs, and preferences play a crucial role in the success of deprescribing interventions. We aimed to examine the attitudes and beliefs about medication burden and deprescribing among persons living with PD. Methods: We administered a survey to participants of Fox Insight, a prospective longitudinal study of persons living with PD. The survey included the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire and additional questions about adverse drug effects. We used logistic regression models to explore potential predictors of treatment dissatisfaction and willingness to deprescribe. Results: Of the 4945 rPATD respondents, 31.6% were dissatisfied with their current medications, and 87.1% would be willing to deprescribe medications. Male sex was associated with a greater willingness to deprescribe (adjusted odds ratio [aOR] 1.62, 95% confidence interval [CI] 1.37–1.93). A greater belief that the medication burden was high or that some medications were inappropriate was associated with treatment dissatisfaction (aORs 3.74, 95% CI 3.26–4.29 and 5.61, 95% CI 4.85–6.50), and more willingness to deprescribe (aORs 1.74, 95% CI 1.47–2.06 and 2.87, 95% CI 2.41–3.42). Cognitive impairment was the adverse drug effect participants were most concerned about when prescribed new medications to treat nonmotor symptoms. Conclusions: Persons with PD are often dissatisfied with their overall medication load and are open to deprescribing. Medications that are associated with cognitive impairment might be prioritized targets for deprescribing interventions in this population. [ABSTRACT FROM AUTHOR]

This paper discusses potential new metrics for criticality assessments testing them on lithium supply chain. In the midst of the US-China technological competition, it is essential to fine-tune the methodology according to the new international context. First, to understand more in depth the structure and complexity of critical minerals supply chain, as countries are not fully aware of the intricate webs of cross-ownership or firm-to-firm relations that determine ultimate control from mining to downstream activities. To this end, I propose and discuss the concept of source of control (SOC). Second, I take as a case study the geography of production of lithium, from a country and company perspective, to show the complexity of two-level interconnections among entities involved. Criticality is a social-constructed feature that can inform policymaking in raw materials' supply chains and it should consider not only where those critical minerals come from but also who controls their production. In order to test the plausibility of these improvements, I show how the US Inflation Reduction Act (IRA) is intended to redraw the lithium-ion battery supply chain through a top-down approach. Generally, criticality studies have been primarily concerned about dependency risks while not considering the role of positive/negative externalities. Once these are clearly recognized, policy interventions should be tailored according to supply chain dynamics in industries or technological assets that States judge to be strategic. [ABSTRACT FROM AUTHOR]

The growing integration of renewable energy sources into grid-connected microgrids has created new challenges in power generation forecasting and energy management. This paper explores the use of advanced machine learning algorithms, specifically Support Vector Regression (SVR), to enhance the efficiency and reliability of these systems. The proposed SVR algorithm leverages comprehensive historical energy production data, detailed weather patterns, and dynamic grid conditions to accurately forecast power generation. Our model demonstrated significantly lower error metrics compared to traditional linear regression models, achieving a Mean Squared Error of 2.002 for solar PV and 3.059 for wind power forecasting. The Mean Absolute Error was reduced to 0.547 for solar PV and 0.825 for wind scenarios, and the Root Mean Squared Error (RMSE) was 1.415 for solar PV and 1.749 for wind power, showcasing the model's superior accuracy. Enhanced predictive accuracy directly contributes to optimized resource allocation, enabling more precise control of energy generation schedules and reducing the reliance on external power sources. The application of our SVR model resulted in an 8.4% reduction in overall operating costs, highlighting its effectiveness in improving energy management efficiency. Furthermore, the system's ability to predict fluctuations in energy output allowed for adaptive real-time energy management, reducing grid stress and enhancing system stability. This approach led to a 10% improvement in the balance between supply and demand, a 15% reduction in peak load demand, and a 12% increase in the utilization of renewable energy sources. Our approach enhances grid stability by better balancing supply and demand, mitigating the variability and intermittency of renewable energy sources. These advancements promote a more sustainable integration of renewable energy into the microgrid, contributing to a cleaner, more resilient, and efficient energy infrastructure. The findings of this research provide valuable insights into the development of intelligent energy systems capable of adapting to changing conditions, paving the way for future innovations in energy management. Additionally, this work underscores the potential of machine learning to revolutionize energy management practices by providing more accurate, reliable, and cost-effective solutions for integrating renewable energy into existing grid infrastructures. [ABSTRACT FROM AUTHOR]

Background: Potentially inappropriate prescribing (PIP) refers to the prescription of medications that carry a higher risk of adverse outcomes, such as drug interactions, falls, and cognitive impairment. PIP is of particular concern in older adults, and is associated with increased morbidity, mortality, and healthcare costs. Socioeconomic deprivation has been identified as a potential risk factor for PIP. However, the extent of this relationship remains unclear. This review aimed to synthesize the current literature on the association between PIP and socioeconomic status (SES) in older adults. Methods: A literature search was conducted using the databases Medline, Embase and CINAHL. A search strategy was developed to capture papers examining three key concepts: PIP, socioeconomic deprivation and older/elderly populations. Peer-reviewed quantitative research published between 1/1/2000 and 31/12/2022 was eligible for inclusion. Results: Twenty articles from 3,966 hits met the inclusion criteria. The sample size of included studies ranged from 668 to 16.5million individuals, with the majority from Europe (n = 8) and North America (n = 8). Most defined older patients as being 65 or over (n = 12) and used income (n = 7) or subsidy eligibility (n = 5) to assess SES. In all, twelve studies reported a statistically significant association between socioeconomic deprivation and an increased likelihood of experiencing PIP. Several of these reported some association after adjusting for number of drugs taken, or the presence of polypharmacy. The underlying reasons for the association are unclear, although one study found that the association between deprivation and higher PIP prevalence could not be explained by poorer access to healthcare facilities or practitioners. Conclusion: The findings suggest some association between an older person's SES and their likelihood of being exposed to PIP. SES appears to be one of several factors that act independently and in concert to influence an older person's likelihood of experiencing PIP. This review highlights that prioritising older people living in socioeconomically-deprived circumstances may be an efficient strategy when carrying out medication reviews. [ABSTRACT FROM AUTHOR]

Many countries are moving to electric vehicles for daily transportation due to the scarcity of fossil fuels and the pollution emissions from internal combustion engines. The most promising technique to manage environmental pollution and energy security is the employment of electric vehicles. The electric bicycle is gaining an abundance of attention due to the various advantages of electric vehicles. Recently, people started using electric bicycles on a regular basis, and it is a suitable option for shorter daily rides. The present study was conducted using the Scopus database, which included an analysis of all papers pertaining to the content of electric bicycles up until the year 2023. The literature review delves into the profound impact and numerous benefits of electric bicycles, highlighting their potential for revolutionizing transportation. This exploration is informed by advancements in design and construction, offering insights into optimal electric bicycle development. One promising avenue for sustainability involves integrating solar technology into these vehicles, reducing reliance on conventional energy sources, and addressing environmental concerns. Discussions encompassed diverse aspects, including operation principles, throttle variations, commutation systems, self-charging mechanisms, health advantages, and solar-powered electric bicycles. To address this, the goal is to create universally acceptable electric bicycles to broaden their appeal and dispel misconceptions. In order to provide scientists and researchers with beneficial information to further optimize electric bicycles, the research fields pertaining to electric bicycles are reviewed in accordance with previous studies. [ABSTRACT FROM AUTHOR]

Parkinson's disease is a progressive neurodegenerative disorder characterized by motor and non-motor symptoms, including hallucinations. The use of antipsychotic medications is a common strategy to manage hallucinations associated with Parkinson's disease psychosis (PDP). However, careful consideration is necessary when selecting the most appropriate drug due to the potential risks associated with the available treatment options. Atypical antipsychotics (AAPs), such as Pimavanserin and Clozapine, have effectively controlled PDP symptoms. On the contrary, the support for utilizing quetiapine is not as substantial as other antipsychotics because research studies specifically investigating its application are still emerging and relatively recent. The broad mechanisms of action of AAPs, involving dopamine and serotonin receptors, provide improved outcomes and fewer side effects than typical antipsychotics. Conversely, other antipsychotics, including risperidone, olanzapine, aripiprazole, ziprasidone, and lurasidone, have been found to worsen motor symptoms and are generally not recommended for PDP. While AAPs offer favorable benefits, they are associated with specific adverse effects. Extrapyramidal symptoms, somnolence, hypotension, constipation, and cognitive impairment are commonly observed with AAP use. Clozapine, in particular, carries a risk of agranulocytosis, necessitating close monitoring of blood counts. Pimavanserin, a selective serotonin inverse agonist, avoids receptor-related side effects but has been linked to corrected QT (QTc) interval prolongation, while quetiapine has been reported to be associated with an increased risk of mortality. This review aims to analyze the benefits, risks, and mechanisms of action of antipsychotic medications to assist clinicians in making informed decisions and enhance patient care. [ABSTRACT FROM AUTHOR]

Electricity generation in Islanded Urban Microgrids (IUMG) now relies heavily on a diverse range of Renewable Energy Sources (RES). However, the dependable utilization of these sources hinges upon efficient Electrical Energy Storage Systems (EESs). As the intermittent nature of RES output and the low inertia of IUMGs often lead to significant frequency fluctuations, the role of EESs becomes pivotal. While these storage systems effectively mitigate frequency deviations, their high costs and elevated power density requirements necessitate alternative strategies to balance power supply and demand. In recent years, substantial attention has turned towards harnessing Electric Vehicle (EV) batteries as Mobile EV Energy Storage (MEVES) units to counteract frequency variations in IUMGs. Integrating MEVES into the IUMG infrastructure introduces complexity and demands a robust control mechanism for optimal operation. Therefore, this paper introduces a robust, high-order degree of freedom cascade controller known as the 1PD-3DOF-PID (1 + Proportional + Derivative—Three Degrees Of Freedom Proportional-Integral-Derivative) controller for Load Frequency Control (LFC) in IUMGs integrated with MEVES. The controller's parameters are meticulously optimized using the Coati Optimization Algorithm (COA) which mimics coati behavior in nature, marking its debut in LFC of IUMG applications. Comparative evaluations against classical controllers and algorithms, such as 3DOF-PID, PID, Reptile Search Algorithm, and White Shark Optimizer, are conducted under diverse IUMG operating scenarios. The testbed comprises various renewable energy sources, including wind turbines, photovoltaics, Diesel Engine Generators (DEGs), Fuel Cells (FCs), and both Mobile and Fixed energy storage units. Managing power balance in this entirely renewable environment presents a formidable challenge, prompting an examination of the influence of MEVES, DEG, and FC as controllable units to mitigate active power imbalances. Metaheuristic algorithms in MATLAB-SIMULINK platforms are employed to identify the controller's gains across all case studies, ensuring the maintenance of IUMG system frequency within predefined limits. Simulation results convincingly establish the superiority of the proposed controller over other counterparts. Furthermore, the controller's robustness is rigorously tested under ± 25% variations in specific IUMG parameters, affirming its resilience. Statistical analyses reinforce the robust performance of the COA-based 1PD-3DOF-PID control method. This work highlights the potential of the COA Technique-optimized 1PD-3DOF-PID controller for IUMG control, marking its debut application in the LFC domain for IUMGs. This comprehensive study contributes valuable insights into enhancing the reliability and stability of Islanded Urban Microgrids while integrating Mobile EV Energy Storage, marking a significant advancement in the field of Load-Frequency Control. [ABSTRACT FROM AUTHOR]

Economic and military power have rested on the possession of metallic minerals for many centuries; far longer than has been the case with hydrocarbons. Since minerals are unevenly distributed around the world, there have been many instances in history where countries have sought to bolster or extend their power by the acquisition of minerals from others through trade or through territorial expansion (empire-building). This article explores the interplay of mining, metals and power, through case studies of Ancient Rome, Spain during its colonisation of South and Central America, Britain's maritime empire, and the Soviet Union's belated and rapid industrialisation during the twentieth century. These case studies serve to make the point that current concerns in the USA, Europe, Japan and China about the vulnerability of their economies and military capabilities to the disruption of mineral supplies from overseas are nothing new, although the range of minerals now used, the complexity of modern supply chains and prevailing geopolitical norms suggest that there may not be too much in the historical record to assist these countries and regions address their concerns. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Oncology is the property of Chinese Journal of Oncology / Zhonghua Zhongliu Zazhi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The yeast Mcm1 protein is a member of the MADS box family of transcription factors that interacts with several cofactors to differentially regulate genes involved in cell-type determination, mating, cell cycle control and arginine metabolism. Residues 18 to 96 of the protein, which form the core DNA-binding domain of Mcm1, are sufficient to carry out many Mcm1-dependent functions. However, deletion of residues 2 to 17, which form the nonessential N-terminal (NT) arm, confers a salt-sensitive phenotype, suggesting that the NT arm is required for the activation of salt response genes. We used a strategy that combined information from the mutational analysis of the Mcm1-binding site with microarray expression data under salt stress conditions to identify a new subset of Mcm1-regulated genes. Northern blot analysis showed that the transcript levels of several genes encoding associated with the cell wall, especially YGP1, decrease significantly upon deletion of the Mcm1 NT arm. Deletion of the Mcm1 NT arm results in a calcofluor white-sensitive phenotype, which is often associated with defects in transcription of cell wall genes. In addition, the deletion makes cells sensitive to CaCl2 and alkaline pH. We found that the defect caused by removal of the NT arm is not due to changes in Mcm1 protein level, stability, DNA-binding affinity, or DNA bending. This suggests that residues 2 to 17 of Mcm1 may be involved in recruiting a cofactor to the promoters of these genes to activate transcription.

This comprehensive review extensively explores the potential applications of MXenes as versatile materials in the realm of photocatalysis, with a specific focus on their efficacy in mitigating hazardous dyes and CO2 to less harmful and friendly by-products. The review systematically investigates the unique properties that render MXenes well-suited for photocatalytic purposes and provides a thorough examination of their current state of research. It meticulously summarizes the successes and breakthroughs achieved thus far, offering insights into the advancements that have propelled these materials into the spotlight of photocatalytic research. In addition to highlighting achievements, the review critically addresses the challenges and hurdles that impede the full realization of the potential inherent in MXenes. Here, we have also highlighted the stability problem of MXenes and how to overcome this problem for efficient photocatalysis. The mechanism of photocatalysis was also the main theme of this review article and how to overcome the recombination of photogenerated charges. By identifying these challenges, the review serves as a valuable resource for researchers, providing a roadmap for future endeavours to unlock the untapped capabilities of these materials. It serves as a beacon for environmental researchers, offering valuable insights into the pivotal role these materials can play in creating a more environmentally friendly and safe world. Ultimately, this review contributes significantly to the collective knowledge base and will prove instrumental for researchers and professionals dedicated to environmental protection and sustainable living. Highlights: Hazardous effect of pollutants on environment. Properties and synthesis of MXenes. MXenes promising materials for dyes degradation and CO2 reduction. Mechanism of Photocatalysis for dyes degradation and CO2 reduction. [ABSTRACT FROM AUTHOR]

In response to escalating environmental concerns driven by greenhouse gas emissions, Pakistan, amid accelerated climate change and deteriorating air quality, struggles with power crisis. Our purpose of this research was to develop a pivotal strategy to address the power crisis and provide clean transportation facilities by involving power transitioning from fossil fuel vehicles to electric vehicles (EVs). We aimed to establish EV charging stations powered by renewable sources like solar and wind energy using grid to vehicle (V2G) mechanism. Utilizing MATLAB Simulink, an optimal electric vehicle charging system with a Level 2 fast charging mechanism was designed, aiming to significantly reduce greenhouse gas emissions from both the transportation and energy sectors. This framework aligned with global trends in climate change mitigation, providing developing countries like Pakistan with a practical solution. The results indicated a 10-kW, AC power output at 240 V coupled with an ideal 50 kWh EV battery rating, which was achieved for EV charging. The output parameters, including current voltage and power output of solar PV, micro wind, and battery levels, were used before and after the incorporation of a boost converter. Consequently, the application of a boost converter and proportional integral (PI) controller resulted in low overshoot and steady state output parameters of the proposed system. Also, the battery backup helped to optimize the power output for load driven EVs. [ABSTRACT FROM AUTHOR]

Rapid placement of electric vehicle charging stations (EVCSs) is essential for the transportation industry in response to the growing electric vehicle (EV) fleet. The widespread usage of EVs is an essential strategy for reducing greenhouse gas emissions from traditional vehicles. The focus of this study is the challenge of smoothly integrating Plug-in EV Charging Stations (PEVCS) into distribution networks, especially when distributed photovoltaic (PV) systems are involved. A hybrid Genetic Algorithm and Simulated Annealing method (GA-SAA) are used in the research to strategically find the optimal locations for PEVCS in order to overcome this integration difficulty. This paper investigates PV system situations, presenting the problem as a multicriteria task with two primary objectives: reducing power losses and maintaining acceptable voltage levels. By optimizing the placement of EVCS and balancing their integration with distributed generation, this approach enhances the sustainability and reliability of distribution networks. [ABSTRACT FROM AUTHOR]

Purpose: Older adults with Alzheimer's disease are less likely to be offered cataract surgery than the general population, but these disparities have not been examined in the context of other neurodegenerative disorders such as Parkinson's disease (PD). Methods: Using data from the English Longitudinal Study on Ageing (ELSA), an ongoing, longitudinal population-based survey of older adults in England, we examined the relationship between PD and cataract surgery among adults 50 and older. We used logistic regression to measure the association between PD and history of cataract surgery at baseline. In longitudinal analyses of subjects with no history of cataract surgery at time of enrollment, we used semiparametric, discrete-time proportional hazards models to model the incidence of cataract surgery as a function of PD and other time-dependent covariates. Models were adjusted for demographic variables, self-reported comorbidities, and measures of daily activity limitation. Results: We included data from 19,241 eligible ELSA respondents, of whom 231 (1.2%) reported a diagnosis of PD. PD was positively associated with a history of self-reported cataract surgery at baseline (OR 3.66, 95% CI: 2.55–5.26), but this did not remain significant after adjusting for confounders (OR 1.22, 95% CI: 0.75–1.98). Among subjects with no history of cataract surgery at baseline, PD was also not associated with incident cataract surgery (adjusted HR 1.32, 95% CI: 0.86–2.02). Conclusion: Unlike Alzheimer's disease, people with PD were no less likely to receive cataract surgery compared to those without PD. [ABSTRACT FROM AUTHOR]

Ag nanoparticles (Ag NPs) were synthesized using Clitoria ternatea plant extract and confined onto mesoporous SBA-15, functionalized with 3-glycidoxypropyl trimethoxysilane followed by tris (2-amino ethyl) amine (SBA-15/GPTMS-TAEA). The sequential grafting of TAEA, GPTMS, and confinement of Ag NPs on the mesoporous SBA-15 was verified by various spectroscopic and microscopic techniques such as FT-IR, SEM, TEM-EDX, XRD, SAXRD, BET, TGA, 29Si NMR, and 13C MAS NMR analysis. HR-TEM analysis revealed that the mean diameter of green synthesized Ag NPs is 6–8 nm and the successful confinement of Ag NPs inside the pores of SBA-15/GPTMS-TAEA. The synthesized SBA-15/GPTMS-TAEA-Ag was used are a carrier for binding ciprofloxacin and the controlled drug release of ciprofloxacin was monitored on a UV–Vis spectrophotometer. In Vitro, the loading and release of Ciprofloxacin were found to be 19.8% and 98.14% of the loaded Ciprofloxacin. The kinetic models deducted from the release study demonstrated that SBA-15/GPTMS-TAEA-Ag is a potential carrier for the controlled release of Ciprofloxacin. [ABSTRACT FROM AUTHOR]