What about the caregiver? A journey into Parkinson's disease following the burden tracks.

OBJECTIVES: To investigate caregivers and patients characteristics related to different dimensions of burden in Parkinson's disease (PD). METHODS: 55 pairs of PD patients and caregivers were recruited. The burden was evaluated with the Caregiver Burden Inventory (CBI). Multivariate analysis was applied to evaluate the impact of caregivers' and patients' characteristics on the varying aspects of burden. RESULTS: ADL score was the dominant predictor for the total score and all dimensions of CBI, except for the social burden, which is strongly predicted by the motor severity of PD. As one can easily imagine, the Total CBI decreases as the ADL score increases. DISCUSSION: An increased appreciation for characteristics of caregiver burden is a fundamental aspect of the patient's global evaluation. Clinicians may need to directly probe for these factors in the caregiver as they may not be elicited routinely.

The band bending effect of LiI/NaI treated TiO2 photoanodes on the performance of dye-sensitized solar cells.

A new method has been developed for surface treatment of TiO2 photoanodes with LiI/NaI to enhance the photocurrent and, subsequently, the performance efficiency of the fabricated dye-sensitized solar cells (DSSCs). Three different concentrations (0.1, 0.25, and 0.5 mmol%) of LiI and NaI solutions were used to investigate the effect of this surface treatment on the device performance of DSSCs. A positive shift in the energy level of TiO2 has been experienced by surface treated devices, which is predominantly supported by the decrease in VOC. Furthermore, the introduction of LiI/NaI onto the TiO2 surface resulted in a reduction in the crystallite size, indicating an increase in the surface area which helps in more dye adsorption leading to higher JSC values of the devices. Besides, modification of the conduction band energy level, it also allows a fast electron injection process by shifting the density of states. Thus, this approach offers a simple but efficient route to enhance the photocurrent and efficiency of DSSCs.

MoS2 coated CoS2 nanocomposites as counter electrodes in Pt-free dye-sensitized solar cells.

Expensive Pt counter electrodes remain an obstacle for the commercialization of dye-sensitized solar cells (DSSCs). Therefore, research focusing on low-cost alternative counter electrode materials has been considered important for their commercialization. Here, the fabrication of dye-sensitized solar cells has been performed utilizing CoS2 and MoS2 coated CoS2 nanocomposite materials as the counter electrode, which are synthesized via a hydrothermal route involving low-cost precursor materials. The experimental results obtained from XRD, XPS, EDX, SEM, TEM, and Raman etc. have confirmed the successful formation of CoS2 and MoS2 coated CoS2 nanocomposites. The electrochemical characterization of these materials is performed, which suggests that the electrocatalytic activity towards the liquid iodine electrolyte of these materials is as good as that of the conventional Pt counter electrodes. So, dye-sensitized solar cell devices are fabricated by interpolating a (cis-bis(isothiocyanato)bis(2,2'-bipyridyl-4,4'-dicarboxylato)ruthenium(ii)) dye-loaded TiO2 photoanode and CoS2, MoS2 coated CoS2 and Pt counter electrodes using iodine/iodide as a liquid electrolyte. The devices fabricated with CoS2 counter electrodes have shown an open circuit voltage of 790 mV, a short circuit current of 11.9 mA cm-2, a fill factor of 0.54, and a power conversion efficiency of 6%. On the other hand, the device based on a Pt counter electrode has shown an open circuit voltage of 773 mV, a short circuit current of 13.4 mA cm-2, a fill factor of 0.54, and a power conversion efficiency of 6.6%. In addition, MoS2 coated with a CoS2 counter electrode has shown the best performance with an open circuit voltage of 763 mV, a short circuit current of 20.1 mA cm-2, a fill factor of 0.42, and a power conversion efficiency of 7.6%.

Regeneration and Long-Term Stability of a Low-Power Eco-Friendly Temperature Sensor Based on a Hydrogel Nanocomposite.

A water-processable and low-cost nanocomposite material, based on gelatin and graphene, has been used to fabricate an environmentally friendly temperature sensor. Demonstrating a temperature-dependent open-circuit voltage between 260 and 310 K, the sensor effectively detects subzero ice formation. Notably, it maintains a constant temperature sensitivity of approximately -19 mV/K over two years, showcasing long-term stability. Experimental evidence demonstrates the efficient regeneration of aged sensors by injecting a few drops of water at a temperature higher than the gelation point of the hydrogel nanocomposite. The real-time monitoring of the electrical characteristics during the hydration reveals the initiation of the regeneration process at the gelation point (~306 K), resulting in a more conductive nanocomposite. These findings, together with a fast response and low power consumption in the range of microwatts, underscore the potential of the eco-friendly sensor for diverse practical applications in temperature monitoring and environmental sensing. Furthermore, the successful regeneration process significantly enhances its sustainability and reusability, making a valuable contribution to environmentally conscious technologies.

Recent Advances and Future Directions in Syncope Management: A Comprehensive Narrative Review.

Syncope is a highly prevalent clinical condition characterized by a rapid, complete, and brief loss of consciousness, followed by full recovery caused by cerebral hypoperfusion. This symptom carries significance, as its potential underlying causes may involve the heart, blood pressure, or brain, leading to a spectrum of consequences, from sudden death to compromised quality of life. Various factors contribute to syncope, and adhering to a precise diagnostic pathway can enhance diagnostic accuracy and treatment effectiveness. A standardized initial assessment, risk stratification, and appropriate test identification facilitate determining the underlying cause in the majority of cases. New technologies, including artificial intelligence and smart devices, may have the potential to reshape syncope management into a proactive, personalized, and data-centric model, ultimately enhancing patient outcomes and quality of life. This review addresses key aspects of syncope management, including pathogenesis, current diagnostic testing options, treatments, and considerations in the geriatric population.

The role of the fracture liaison service in the prevention of atypical femoral fractures.

Osteoporosis and fragility fractures (FFs) are considered critical health problems by the World Health Organization (WHO) because of high morbidity, mortality, and healthcare costs. The occurrence of a FF raises the risk of a subsequent fracture (refracture). The hip is the most common site of fragility refracture, and its onset is associated with a further increase in patient's morbidity, mortality, and socioeconomic burden. Therefore, the prevention of refracture is essential. In this context, fracture liaison service (FLS) demonstrated to be able to reduce FF risk and also improve patients' adherence to anti-osteoporotic treatments, particularly for bisphosphonates (BPs). However, long-term and high adherence to BPs may lead to atypical femoral fractures (AFFs). These latter are tensile side stress fractures of the femur, with high rates of complications, including delayed and non-healing. An effective FLS should be able to prevent both FF and AFF. A comprehensive and interdisciplinary approach, through the involvement and education of a dedicated team of healthcare professionals (i.e. orthopedic, geriatrician, primary care physician, rehabilitation team, and bone nurse) for evaluating both FF and AFF risks might be useful to improve the standard of care.

Association between Older Age and Psychiatric Symptoms in a Population of Hospitalized Patients with COVID-19.

Increased rates of anxiety and depression have been reported for older adults during the COVID-19 pandemic. However, little is known regarding the onset of mental health morbidity during the acute phase of the disease and the role of age as potential independent risk factor for psychiatric symptoms. The cross-sectional association between older age and psychiatric symptoms has been estimated in a sample of 130 patients hospitalized for COVID-19 during the first and second wave of the pandemic. Compared to younger patients, those who were 70 years of age or older resulted at a higher risk of psychiatric symptoms measured on the Brief Psychiatric Symptoms Rating Scale (BPRS) (adjusted (adj.) odds ratio (OR) 2.36, 95% confidence interval (CI) 1.05-5.30) and delirium (adj. OR 5.24, 95% CI 1.63-16.8)). No association was found between older age and depressive symptoms or anxiety. Age was associated with psychiatric symptoms independently of gender, marital status, history of psychiatric illness, severity of disease and cardiovascular morbidity. Older adults appear at high risk of developing psychiatric symptoms related to COVID-19 disease during hospital stay. Multidisciplinary preventive and therapeutic interventions should be implemented to reduce the risk of psychiatric morbidity and related adverse health care outcomes among older hospital inpatients with COVID-19.

Low-Power and Eco-Friendly Temperature Sensor Based on Gelatin Nanocomposite.

An environmentally-friendly temperature sensor has been fabricated by using a low-cost water-processable nanocomposite material based on gelatin and graphene. The temperature dependence of the electrochemical properties has been investigated by using cyclic voltammetry, chronopotentiometry and impedance spectroscopy measurements. The simple symmetric device, composed of a sandwich structure between two metal foils and a printable graphene-gelatin blend, exhibits a dependence on the open-circuit voltage in a range between 260 and 310 K. Additionally, at subzero temperature, the device is able to detect the ice/frost formation. The thermally-induced phenomena occur at the electrode/gel interface with a bias current of a few tens of µA. The occurrence of dissociation reactions within the sensor causes limiting-current phenomena in the gelatin electrolyte. A detailed model describing the charge carrier accumulation, the faradaic charge transfer and diffusion processes within the device under the current-controlled has been proposed. In order to increase the cycle stability of the temperature sensor and reduce its voltage drift and offset of the output electrical signal, a driving circuit has been designed. The eco-friendly sensor shows a temperature sensitivity of about -19 mV/K, long-term stability, fast response and low-power consumption in the range of microwatts suitable for environmental monitoring for indoor applications.

Electrochemical Performance of Biopolymer-Based Hydrogel Electrolyte for Supercapacitors with Eco-Friendly Binders.

An environmentally friendly hydrogel based on gelatin has been investigated as a gel polymer electrolyte in a symmetric carbon-based supercapacitor. To guarantee the complete sustainability of the devices, biomaterials from renewable resources (such as chitosan, casein and carboxymethyl cellulose) and activated carbon (from coconut shells) have been used as a binder and filler within the electrode, respectively. The electrochemical properties of the devices have been compared by using cyclic voltammetry, galvanostatic charge/discharge curves and impedance spectroscopy. Compared to the liquid electrolyte, the hydrogel supercapacitors show similar energy performance with an enhancement of stability up to 12,000 cycles (e.g., chitosan as a binder). The most performant device can deliver ca. 5.2 Wh/kg of energy at a high power density of 1256 W/kg. A correlation between the electrochemical performances and charge storage mechanisms (involving faradaic and non-faradaic processes) at the interface electrode/hydrogel has been discussed.

A Comparative Evaluation of Sustainable Binders for Environmentally Friendly Carbon-Based Supercapacitors.

Environmentally friendly energy storage devices have been fabricated by using functional materials obtained from completely renewable resources. Gelatin, chitosan, casein, guar gum and carboxymethyl cellulose have been investigated as sustainable and low-cost binders within the electrode active material of water-processable symmetric carbon-based supercapacitors. Such binders are selected from natural-derived materials and industrial by-products to obtain economic and environmental benefits. The electrochemical properties of the devices based on the different binders are compared by using cyclic voltammetry, galvanostatic charge/discharge curves and impedance spectroscopy. The fabricated supercapacitors exhibit series resistance lower than a few ohms and values of the specific capacitance ranged between 30 F/g and 80 F/g. The most performant device can deliver ca. 3.6 Wh/kg of energy at a high power density of 3925 W/kg. Gelatin, casein and carboxymethyl cellulose-based devices have shown device stability up to 1000 cycles. Detailed analysis on the charge storage mechanisms (e.g., involving faradaic and non-faradaic processes) at the electrode/electrolyte interface reveals a pseudocapacitance behavior within the supercapacitors. A clear correlation between the electrochemical performances (e.g., cycle stability, capacitance retention, series resistance value, coulombic efficiency) ageing phenomena and charge storage mechanisms within the porous carbon-based electrode have been discussed.

Natural History of Scoliosis in Children with NF1: An Observation Study.

(1) Background. Scoliosis is the most common musculoskeletal manifestation of Neurofibromatosis type 1 (NF1), and it might be dystrophic (D) or non-dystrophic (ND) depending on the presence of dysplastic changes of the spine. The aim of our study was to describe the characteristics and natural history of patients with NF1 and scoliosis. (2) Methods. We retrospectively reviewed records from patients with NF1 and scoliosis. Scoliosis was classified as D if at least two dystrophic changes were documented at imaging. (3) Results. Of the 438 patients reviewed, 43 fulfilled inclusion criteria; 17 were classified in D group and 26 in ND. The groups did not differ in age and localization of scoliosis curvature. Surgery was needed more often in D group, but the between-group difference was not significant. Male-to-female ratios of 3:1 and 4:1 were reported in surgically treated NF1 patients with ND and D scoliosis, respectively. (4) Conclusions. Our data suggests independently by the presence of dysplastic changes affecting the spine that males with NF1 are more often affected by scoliosis that requires surgery.

Fractures around Trochanteric Nails: The "Vergilius Classification System".

INTRODUCTION: The fractures that occurred around trochanteric nails (perinail fractures, PNFs) are becoming a huge challenge for the orthopaedic surgeon. Although presenting some specific critical issues (i.e., patients' outcomes and treatment strategies), these fractures are commonly described within peri-implant ones and their treatment was based on periprosthetic fracture recommendations. The knowledge gap about PNFs leads us to convene a research group with the aim to propose a specific classification system to guide the orthopaedic surgeon in the management of these fractures. MATERIALS AND METHODS: A steering committee, identified by two Italian associations of orthopaedic surgeons, conducted a comprehensive literature review on PNFs to identify the unmet needs about this topic. Subsequently, a panel of experts was involved in a consensus meeting proposing a specific classification system and formulated treatment statements for PNFs. Results and Discussion. The research group considered four PNF main characteristics for the classification proposal: (1) fracture localization, (2) fracture morphology, (3) fracture fragmentation, and (3) healing status of the previous fracture. An alphanumeric code was included to identify each characteristic, allowing to describe up to 54 categories of PNFs, using a 3- to 4-digit code. The proposal of the consensus-based classification reporting the most relevant aspects for PNF treatment might be a useful tool to guide the orthopaedic surgeon in the appropriate management of these fractures.

Mitochondrial Signatures in Circulating Extracellular Vesicles of Older Adults with Parkinson's Disease: Results from the EXosomes in PArkiNson's Disease (EXPAND) Study.

Systemic inflammation and mitochondrial dysfunction are involved in neurodegeneration in Parkinson's disease (PD). Extracellular vesicle (EV) trafficking may link inflammation and mitochondrial dysfunction. In the present study, circulating small EVs (sEVs) from 16 older adults with PD and 12 non-PD controls were purified and characterized. A panel of serum inflammatory biomolecules was measured by multiplex immunoassay. Protein levels of three tetraspanins (CD9, CD63, and CD81) and selected mitochondrial markers (adenosine triphosphate 5A (ATP5A), mitochondrial cytochrome C oxidase subunit I (MTCOI), nicotinamide adenine dinucleotide reduced form (NADH):ubiquinone oxidoreductase subunit B8 (NDUFB8), NADH:ubiquinone oxidoreductase subunit S3 (NDUFS3), succinate dehydrogenase complex iron sulfur subunit B (SDHB), and ubiquinol-cytochrome C reductase core protein 2 (UQCRC2)) were quantified in purified sEVs by immunoblotting. Relative to controls, PD participants showed a greater amount of circulating sEVs. Levels of CD9 and CD63 were lower in the sEV fraction of PD participants, whereas those of CD81 were similar between groups. Lower levels of ATP5A, NDUFS3, and SDHB were detected in sEVs from PD participants. No signal was retrieved for UQCRC2, MTCOI, or NDUFB8 in either participant group. To identify a molecular signature in circulating sEVs in relationship to systemic inflammation, a low level-fused (multi-platform) partial least squares discriminant analysis was applied. The model correctly classified 94.2% ± 6.1% PD participants and 66.7% ± 5.4% controls, and identified seven biomolecules as relevant (CD9, NDUFS3, C-reactive protein, fibroblast growth factor 21, interleukin 9, macrophage inflammatory protein 1ß, and tumor necrosis factor alpha). In conclusion, a mitochondrial signature was identified in circulating sEVs from older adults with PD, in association with a specific inflammatory profile. In-depth characterization of sEV trafficking may allow identifying new biomarkers for PD and possible targets for personalized interventions.

A novel multi-marker discovery approach identifies new serum biomarkers for Parkinson's disease in older people: an EXosomes in PArkiNson Disease (EXPAND) ancillary study.

Dopaminergic nigrostriatal denervation and widespread intracellular α-synuclein accumulation are neuropathologic hallmarks of Parkinson's disease (PD). A constellation of peripheral processes, including metabolic and inflammatory changes, are thought to contribute to neurodegeneration. In the present study, we sought to obtain insight into the multifaceted pathophysiology of PD through the application of a multi-marker discovery approach. Fifty older adults aged 70+, 20 with PD and 30 age-matched controls were enrolled as part of the EXosomes in PArkiNson Disease (EXPAND) study. A panel of 68 circulating mediators of inflammation, neurogenesis and neural plasticity, and amino acid metabolism was assayed. Biomarker selection was accomplished through sequential and orthogonalized covariance selection (SO-CovSel), a multi-platform regression method developed to handle highly correlated variables organized in multi-block datasets. The SO-CovSel model with the best prediction ability using the smallest number of variables was built with seven biomolecules. The model allowed correct classification of 94.2 ± 3.1% participants with PD and 100% controls. The biomarker profile of older adults with PD was defined by higher circulating levels of interleukin (IL) 8, macrophage inflammatory protein (MIP)-1ß, phosphoethanolamine, and proline, and by lower concentrations of citrulline, IL9, and MIP-1α. Our innovative approach allowed identifying and evaluating the classification performance of a set of potential biomarkers for PD in older adults. Future studies are warranted to establish whether these biomolecules could serve as biomarkers for PD as well as unveil new targets for interventions.

Proton Radiation Hardness of Perovskite Tandem Photovoltaics.

Monolithic [Cs0.05(MA0. 17FA0. 83)0.95]Pb(I0.83Br0.17)3/Cu(In,Ga)Se2 (perovskite/CIGS) tandem solar cells promise high performance and can be processed on flexible substrates, enabling cost-efficient and ultra-lightweight space photovoltaics with power-to-weight and power-to-cost ratios surpassing those of state-of-the-art III-V semiconductor-based multijunctions. However, to become a viable space technology, the full tandem stack must withstand the harsh radiation environments in space. Here, we design tailored operando and ex situ measurements to show that perovskite/CIGS cells retain over 85% of their initial efficiency even after 68 MeV proton irradiation at a dose of 2 × 1012 p+/cm2. We use photoluminescence microscopy to show that the local quasi-Fermi-level splitting of the perovskite top cell is unaffected. We identify that the efficiency losses arise primarily from increased recombination in the CIGS bottom cell and the nickel-oxide-based recombination contact. These results are corroborated by measurements of monolithic perovskite/silicon-heterojunction cells, which severely degrade to 1% of their initial efficiency due to radiation-induced recombination centers in silicon.

The Geriatrician: The Frontline Specialist in the Treatment of COVID-19 Patients.

On February 20, 2020, a man living in the north of Italy was admitted to the emergency room with an atypical pneumonia that later proved to be COVID-19. This was the trigger of one of the most serious clusters of COVID-19 in the world, outside of China. Despite aggressive restraint and inhibition efforts, COVID-19 continues to increase, and the total number of infected patients in Italy is growing daily. After 6 weeks, the total number of patients reached 128,948 cases (April 5, 2020), with the higher case-fatality rate (15,887 deaths) dominated by old and very old patients. This sudden health emergency severely challenged the Italian Health System, in particular acute care hospitals and intensive care units. In 1 hospital, geriatric observation units were created, the experience of which can be extremely useful for European countries, the United States, and all countries that in the coming days will face a similar situation.

Circulating amino acid signature in older people with Parkinson's disease: A metabolic complement to the EXosomes in PArkiNson Disease (EXPAND) study.

BACKGROUND AND AIM: Parkinson's disease (PD) is the second most prevalent neurodegenerative disorder in old age. Neurotoxicity of dopaminergic neurons triggered by aggregation of misfolded α-synuclein is a major pathogenic trait of PD. However, growing evidence indicates that peripheral processes, including metabolic changes, may precede and contribute to neurodegeneration. The present study was undertaken to identify a metabolic signature of PD through the quantification of serum amino acids and derivatives. PARTICIPANTS AND METHODS: Twenty older adults with PD (11 men and 9 women; mean age 73.1 ±â€¯10.2 years) and 30 age-matched controls (14 men and 16 women; mean age 74.6 ±â€¯4.3 years) were enrolled. A panel of 37 serum amino acids and derivatives was assessed by ultra-performance liquid chromatography/mass spectrometry. Partial least squares - discriminant analysis (PLS-DA) followed by double cross-validation was used to characterize the relationship between amino acid profiles and PD. RESULTS: The optimal complexity of the PLS-DA model was found to be three latent variables. The proportion of correct classifications was 99.3 ±â€¯2.5% for participants with PD and 94.7 ±â€¯3.0% for non-PD controls. Higher levels of ß-amino butyric acid, cystine, ornithine, phosphoethanolamine, and proline defined the circulating amino acid profile of older people with PD. Controls were characterized by higher concentrations of 3-methyl-histidine, citrulline, and serine. CONCLUSION: Our findings indicate the existence of a distinct metabotype in older persons with PD. Future studies will have to establish whether changes in amino acid metabolism are involved in the pathogenesis of PD. This knowledge may be harnessed to identify novel disease biomarkers as well as new targets for interventions.

Correlation between Electronic Defect States Distribution and Device Performance of Perovskite Solar Cells.

In the present study, random current fluctuations measured at different temperatures and for different illumination levels are used to understand the charge carrier kinetics in methylammonium lead iodide CH3NH3PbI3-based perovskite solar cells. A model, combining trapping/detrapping, recombination mechanisms, and electron-phonon scattering, is formulated evidencing how the presence of shallow and deeper band tail states influences the solar cell recombination losses. At low temperatures, the observed cascade capture process indicates that the trapping of the charge carriers by shallow defects is phonon assisted directly followed by their recombination. By increasing the temperature, a phase modification of the CH3NH3PbI3 absorber layer occurs and for temperatures above the phase transition at about 160 K the capture of the charge carrier takes place in two steps. The electron is first captured by a shallow defect and then it can be either emitted or thermalize down to a deeper band tail state and recombines subsequently. This result reveals that in perovskite solar cells the recombination kinetics is strongly influenced by the electron-phonon interactions. A clear correlation between the morphological structure of the perovskite grains, the energy disorder of the defect states, and the device performance is demonstrated.

Radiation Hardness and Self-Healing of Perovskite Solar Cells.

The radiation hardness of CH3 NH3 PbI3 -based solar cells is evaluated from in situ measurements during high-energy proton irradiation. These organic-inorganic perovskites exhibit radiation hardness and withstand proton doses that exceed the damage threshold of crystalline silicon by almost 3 orders of magnitude. Moreover, after termination of the proton irradiation, a self-healing process of the solar cells commences.