Power-law distribution of degree-degree distance: A better representation of the scale-free property of complex networks.

Whether real-world complex networks are scale free or not has long been controversial. Recently, in Broido and Clauset [A. D. Broido, A. Clauset, Nat. Commun. 10, 1017 (2019)], it was claimed that the degree distributions of real-world networks are rarely power law under statistical tests. Here, we attempt to address this issue by defining a fundamental property possessed by each link, the degree-degree distance, the distribution of which also shows signs of being power law by our empirical study. Surprisingly, although full-range statistical tests show that degree distributions are not often power law in real-world networks, we find that in more than half of the cases the degree-degree distance distributions can still be described by power laws. To explain these findings, we introduce a bidirectional preferential selection model where the link configuration is a randomly weighted, two-way selection process. The model does not always produce solid power-law distributions but predicts that the degree-degree distance distribution exhibits stronger power-law behavior than the degree distribution of a finite-size network, especially when the network is dense. We test the strength of our model and its predictive power by examining how real-world networks evolve into an overly dense stage and how the corresponding distributions change. We propose that being scale free is a property of a complex network that should be determined by its underlying mechanism (e.g., preferential attachment) rather than by apparent distribution statistics of finite size. We thus conclude that the degree-degree distance distribution better represents the scale-free property of a complex network.

Multifunctional Novel Nanoplatform for Effective Synergistic Chemo-Photodynamic Therapy of Breast Cancer by Enhancing DNA Damage and Disruptions of Its Reparation.

Photodynamic therapy (PDT) is an effective noninvasive therapeutic strategy that has been widely used for anti-tumor therapy by the generation of excessive highly cytotoxic ROS. However, the poor water solubility of the photosensitizer, reactive oxygen species (ROS) depleting by high concentrations of glutathione (GSH) in the tumor microenvironment and the activation of DNA repair pathways to combat the oxidative damage, will significantly limit the therapeutic effect of PDT. Herein, we developed a photosensitizer prodrug (CSP) by conjugating the photosensitizer pyropheophorbide a (PPa) and the DNA-damaging agent Chlorambucil (Cb) with a GSH-responsive disulfide linkage and demonstrated a multifunctional co-delivery nanoplatform (CSP/Ola nanoparticles (NPs)) together with DSPE-PEG2000 and PARP inhibitor Olaparib (Ola). The CSP/Ola NPs features excellent physiological stability, efficient loading capacity, much better cellular uptake behavior and photodynamic performance. Specifically, the nanoplatform could induce elevated intracellular ROS levels upon the in situ generation of ROS during PDT, and decrease ROS consumption by reducing intracellular GSH level. Moreover, the CSP/Ola NPs could amplify DNA damage by released Cb and inhibit the activation of Poly(ADP-ribose) polymerase (PARP), promote the upregulation of γ-H2AX, thereby blocking the DNA repair pathway to sensitize tumor cells for PDT. In vitro investigations revealed that CSP/Ola NPs showed excellent phototoxicity and the IC50 values of CSP/Ola NPs against MDA-MB-231 breast cancer cells were as low as 0.05-01 µM after PDT. As a consequence, the co-delivery nanoplatform greatly promotes the tumor cell apoptosis and shows a high antitumor performance with combinational chemotherapy and PDT. Overall, this work provides a potential alternative to improve the therapeutic efficiency of triple negative breast cancer cell (TNBC) treatment by synergistically enhancing DNA damage and disrupting DNA damage repair.

Percolation Theories for Quantum Networks.

Quantum networks have experienced rapid advancements in both theoretical and experimental domains over the last decade, making it increasingly important to understand their large-scale features from the viewpoint of statistical physics. This review paper discusses a fundamental question: how can entanglement be effectively and indirectly (e.g., through intermediate nodes) distributed between distant nodes in an imperfect quantum network, where the connections are only partially entangled and subject to quantum noise? We survey recent studies addressing this issue by drawing exact or approximate mappings to percolation theory, a branch of statistical physics centered on network connectivity. Notably, we show that the classical percolation frameworks do not uniquely define the network's indirect connectivity. This realization leads to the emergence of an alternative theory called "concurrence percolation", which uncovers a previously unrecognized quantum advantage that emerges at large scales, suggesting that quantum networks are more resilient than initially assumed within classical percolation contexts, offering refreshing insights into future quantum network design.

MERLIN: Phase 3a, Multicenter, Randomized, Double-Masked Trial of Brolucizumab in Participants with Neovascular Age-Related Macular Degeneration and Persistent Retinal Fluid.

PURPOSE: To assess the 52-week efficacy and safety of brolucizumab 6 mg administered every 4 weeks compared with aflibercept 2 mg dosed every 4 weeks in eyes with neovascular age-related macular degeneration (nAMD) and persistent retinal fluid. DESIGN: Multicenter, randomized, double-masked phase 3a study. PARTICIPANTS: Participants with recalcitrant nAMD (persistent residual retinal fluid despite previous frequent anti-vascular endothelial growth factor treatment). METHODS: Eyes were randomized (2:1) to intravitreal brolucizumab 6 mg or aflibercept 2 mg every 4 weeks up to and including week 100. MAIN OUTCOME MEASURES: The primary end point was analysis of noninferiority in mean best-corrected visual acuity (BCVA) change from baseline to week 52 (margin, 4 letters). Other key end points included change in central subfield thickness (CST) from baseline to week 52, fluid-free status (no intraretinal fluid and no subretinal fluid), and safety. RESULTS: At week 52, brolucizumab was noninferior to aflibercept in BCVA change from baseline (least squares mean difference, -0.6 Early Treatment Diabetic Retinopathy Study letters; 95% confidence interval [CI], -2.1 to 0.9; P < 0.001). A total of 4.8% and 1.7% of participants reported a 15-letter or more BCVA loss from baseline at week 52 in the brolucizumab and aflibercept groups, respectively. In eyes treated with brolucizumab compared with those treated with aflibercept, the CST was reduced significantly (P < 0.001), and a significantly greater proportion of eyes were fluid free at week 52 (40.4% brolucizumab vs. 19.0% aflibercept; 95% CI, 13.9-29.0; P < 0.001). Incidence of intraocular inflammation (IOI), including retinal vasculitis and retinal vascular occlusion, were 9.3% (0.8% and 2.0%) for brolucizumab versus 4.5% (0% and 0%) for aflibercept, respectively. CONCLUSIONS: Visual acuity outcomes in previously treated participants with nAMD and persistent retinal fluid receiving brolucizumab 6 mg dosed every 4 weeks were noninferior to aflibercept 2 mg dosed every 4 weeks, with superior anatomic outcomes. However, incidences of IOI, including retinal vasculitis and retinal vascular occlusion, also were higher, leading to study termination.

Diffusion interactions between crossing fibers of the brain.

PURPOSE: Recent observations of several preferred orientations of diffusion in deep white matter may indicate either (a) that axons in different directions are independently bundled in thick sheets and function noninteractively, or more interestingly, (b) that the axons are closely interwoven and would exhibit branching and sharp turns. This study aims to investigate whether the dependence of dMRI Q-ball signal on the interpulse time Δ can decode the smaller-than-voxel-size brain structure, in particular, to distinguish scenarios (a) and (b). METHODS: High-resolution Q-ball images of a healthy brain taken with b=8000  s/mm2 for 3 different values of Δ were analyzed. The exchange of water molecules between crossing fibers was characterized by the fourth Fourier coefficient f4(Δ) of the signal profile in the plane of crossing. To interpret the empirical results, a model consisting of differently oriented parallel sheets of cylinders was developed. Diffusion of water molecules inside and outside cylinders was simulated by the Monte Carlo method. RESULTS: Simulations predict that f4(Δ) , agreeing with the empirical results, must increase with Δ for large b-values, but may peak at a typical Δ that depends on the thickness of the cylinder sheets for intermediate b-values. Thus, the thickness of axon layers in voxels with 2 predominant orientations can be detected from empirical f4(Δ) taken at smaller b-values. CONCLUSION: Based on the simulation results, recommendations are made on how to design a dMRI experiment with optimal b-value and range of Δ in order to measure the thickness of axon sheets in the white matter, hence to distinguish (a) and (b).

Concurrence Percolation in Quantum Networks.

Establishing long-distance quantum entanglement, i.e., entanglement transmission, in quantum networks (QN) is a key and timely challenge for developing efficient quantum communication. Traditional comprehension based on classical percolation assumes a necessary condition for successful entanglement transmission between any two infinitely distant nodes: they must be connected by at least a path of perfectly entangled states (singlets). Here, we relax this condition by explicitly showing that one can focus not on optimally converting singlets but on establishing concurrence-a key measure of bipartite entanglement. We thereby introduce a new statistical theory, concurrence percolation theory (ConPT), remotely analogous to classical percolation but fundamentally different, built by generalizing bond percolation in terms of "sponge-crossing" paths instead of clusters. Inspired by resistance network analysis, we determine the path connectivity by series and parallel rules and approximate higher-order rules via star-mesh transforms. Interestingly, we find that the entanglement transmission threshold predicted by ConPT is lower than the known classical-percolation-based results and is readily achievable on any series-parallel networks such as the Bethe lattice. ConPT promotes our understanding of how well quantum communication can be further systematically improved versus classical statistical predictions under the limitation of QN locality-a "quantum advantage" that is more general and efficient than expected. ConPT also shows a percolationlike universal critical behavior derived by finite-size analysis on the Bethe lattice and regular two-dimensional lattices, offering new perspectives for a theory of criticality in entanglement statistics.

Patient reported outcomes and performance metrics at diagnosis of secondary progressive multiple sclerosis.

BACKGROUND: Relapsing-remitting multiple sclerosis (RRMS) usually evolves into secondary progressive multiple sclerosis (SPMS). Recognition of SPMS is important because of prognostic and treatment implications. OBJECTIVE: The objective of this study is to determine distributions of patient-reported outcomes (PROs) and the Timed 25-Foot Walk (T25FW) at SPMS diagnosis and describe the evolution of these metrics in patients with SPMS. METHODS: A tertiary MS center clinical database was queried to identify patients with RRMS and SPMS. PRO data including performance scales (PS), Patient Health Questionnaire-9 (PHQ-9), European Quality of Life-5-Dimensions (EQ-5D), and the T25FW were extracted. Descriptive statistics were calculated at SPMS diagnosis, and score trajectories were modeled. Cox proportional hazards modeling was used to estimate hazard ratios for time to SPMS diagnosis. RESULTS: Among 5,558 patients identified, 164 were diagnosed with SPMS between January 2008 and June 2016. At SPMS diagnosis, the mean outcome values were T25FW = 12.5 seconds (standard deviation, SD = 10.7), PS = 15.6 (SD = 6.5), PHQ-9 = 6.8 (SD = 4.2), and EQ-5D = 0.63 (SD = 0.20). Distinct patterns were observed in the measures leading up to SPMS diagnosis. Higher age, male gender, longer disease duration, and greater disability were associated with an increased hazard of SPMS diagnosis. CONCLUSION: Longitudinal monitoring of PROs and performance metrics may help identify those at higher risk of near-term SPMS.

Joint Feature-Space and Sample-Space Based Heterogeneous Feature Transfer Method for Object Recognition Using Remote Sensing Images with Different Spatial Resolutions.

To improve the classification results of high-resolution remote sensing images (RSIs), it is necessary to use feature transfer methods to mine the relevant information between high-resolution RSIs and low-resolution RSIs to train the classifiers together. Most of the existing feature transfer methods can only handle homogeneous data (i.e., data with the same dimension) and are susceptible to the quality of the RSIs, while RSIs with different resolutions present different feature dimensions and samples obtained from illumination conditions. To obtain effective classification results, unlike existing methods that focus only on the projection transformation in feature space, a joint feature-space and sample-space heterogeneous feature transfer (JFSSS-HFT) method is proposed to simultaneously process heterogeneous multi-resolution images in feature space using projection matrices of different dimensions and reduce the impact of outliers by adaptive weight factors in the sample space simultaneously to reduce the occurrence of negative transfer. Moreover, the maximum interclass variance term is embedded to improve the discriminant ability of the transferred features. To solve the optimization problem of JFSSS-HFT, the alternating-direction method of multipliers (ADMM) is introduced to alternatively optimize the parameters of JFSSS-HFT. Using different types of ship patches and airplane patches with different resolutions, the experimental results show that the proposed JFSSS-HFT obtains better classification results than the typical feature transferred methods.

Entanglement-Structured LSTM Boosts Chaotic Time Series Forecasting.

Traditional machine-learning methods are inefficient in capturing chaos in nonlinear dynamical systems, especially when the time difference Δt between consecutive steps is so large that the extracted time series looks apparently random. Here, we introduce a new long-short-term-memory (LSTM)-based recurrent architecture by tensorizing the cell-state-to-state propagation therein, maintaining the long-term memory feature of LSTM, while simultaneously enhancing the learning of short-term nonlinear complexity. We stress that the global minima of training can be most efficiently reached by our tensor structure where all nonlinear terms, up to some polynomial order, are treated explicitly and weighted equally. The efficiency and generality of our architecture are systematically investigated and tested through theoretical analysis and experimental examinations. In our design, we have explicitly used two different many-body entanglement structures-matrix product states (MPS) and the multiscale entanglement renormalization ansatz (MERA)-as physics-inspired tensor decomposition techniques, from which we find that MERA generally performs better than MPS, hence conjecturing that the learnability of chaos is determined not only by the number of free parameters but also the tensor complexity-recognized as how entanglement entropy scales with varying matricization of the tensor.

24-Hour Intraocular Pressure Control with Fixed-dose Combination Brinzolamide 1%/Brimonidine 0.2%: A Multicenter, Randomized Trial.

PURPOSE: To determine the intraocular pressure (IOP)-lowering effect of fixed-combination brinzolamide 1%/brimonidine 0.2% (BBFC) over a 24-hour period. DESIGN: Prospective, multicenter, double-masked, parallel-group clinical trial conducted at 16 academic and nonacademic sites in the United States. PARTICIPANTS: Subjects with open-angle glaucoma (OAG) or ocular hypertension (OHT) aged ≥18 years with mean baseline IOP measurements in at least 1 eye of ≥21 and <28 mmHg. METHODS: Duplicate mean pneumatonometer IOP measurements were collected every 2 hours over a 24-hour period in controlled light conditions in overnight facilities. Daytime (8 am-8 pm) and nocturnal (10 pm-6 am) IOP measurements were collected in a sitting or supine position, respectively. Baseline 24-hour IOP was measured in untreated subjects after a washout (up to 4 weeks) and eligibility phase. After the baseline visit, participants were randomized 1:1 to receive masked BBFC or vehicle, 1 drop 3 times daily (8 am, 3 pm, and 10 pm) for 4 weeks. At week 4, IOP measurements were repeated in both groups under the same conditions. MAIN OUTCOME MEASURE: Mean change from baseline in 24-hour IOP at week 4. RESULTS: Of 125 participants randomized, 123 (98%; BBFC, n = 62; vehicle, n = 61) completed the study. No subjects randomized to BBFC discontinued the study. At week 4, BBFC-treated eyes had significantly reduced mean 24-hour IOP vs. vehicle (least squares mean difference [95% confidence interval]: -2.5 [-3.3, -1.7]; P < 0.001); daytime (-3.4 [-4.3, -2.6]; P < 0.001) and nocturnal (-1.2 [-2.3, 0.0]; P = 0.053) reductions were observed. Mean change from baseline was significantly different between BBFC- and vehicle-treated eyes at all daytime points and 3 of 5 nocturnal time points (10 pm, 12 am, and 6 am; secondary end point). The frequency of adverse events was similar between treatment groups; in the BBFC arm, ocular hyperemia, corneal abrasion, and dysgeusia were the most frequently reported, consistent with events described in the drug label. CONCLUSIONS: This large, multicenter study of 24-hour IOP control with BBFC met its primary end point; BBFC demonstrated significantly superior 24-hour IOP-lowering efficacy versus vehicle after 4 weeks of 3-times-daily treatment in subjects with OAG or OHT.

Correction to: Analysis of cardiac monitoring and safety data in patients initiating fingolimod treatment in the home or in clinic.

Following publication of the original article [1], the authors reported a mistake regarding the year found in the paragraph of the Background section.

Analysis of cardiac monitoring and safety data in patients initiating fingolimod treatment in the home or in clinic.

BACKGROUND: Fingolimod (Gilenya®) is approved for relapsing forms of multiple sclerosis in the USA. Owing to transient heart-rate effects when initiating fingolimod, eligible patients undergo precautionary baseline assessment and first-dose observation (FDO) for ≥6 h. Prior to 2014, FDO was undertaken only in clinics. As the FDO period is short, and fingolimod has accumulated evidence of a positive benefit:risk ratio, an in-home treatment-initiation program, Gilenya@Home, was developed to offer a convenient alternative. METHODS: Cardiac parameters and adverse events (AEs) were recorded by healthcare professionals performing fingolimod FDOs in the US Gilenya@Home program or in US Gilenya Assessment Network clinics. Anonymized data were collated retrospectively from the first 34 months in the home setting and from 78 months in clinics; data are reported descriptively. Satisfaction with Gilenya@Home was rated by patients using a 7-item questionnaire that considered aspects such as ease of scheduling, courtesy, and competency. RESULTS: Data were captured as part of standard care from 5573 patients initiating fingolimod in-home (October 2014 to July 2017) and from 15,025 patients initiating in-clinic (July 2010 to December 2016). In the Gilenya@Home questionnaire, 91.7% of 1848 respondents rated their overall satisfaction as "very good," and 7.6% rated their satisfaction as "good." AEs were reported for 30.7 and 32.6% of in-home and in-clinic patients, respectively. In total, 557 in-home (10.0%) and 398 in-clinic (2.6%) patients were monitored for > 6 h; 15 (0.3%) in-home and 129 (0.9%) in-clinic patients were transferred to an emergency room for overnight monitoring. The mean (standard deviation) heart rate (HR; bpm) pre-FDO was 74.8 (12.2) in-home and 74.2 (11.3) in-clinic; reduction in HR at 6 h postdose was 10.6 (12.0) and 6.3 (9.6), respectively. New-onset first-degree atrioventricular block was experienced by 132 (2.4%) in-home and 74 (0.5%) in-clinic patients, and Wenckebach (Mobitz type I) second-degree atrioventricular block by four (0.07%) and nine (0.1%) patients, with no cases of third-degree atrioventricular block. CONCLUSIONS: A substantial number of patients have initiated fingolimod at home, reporting very high levels of satisfaction. Gilenya@Home was as rigorous as the clinic setting in detecting cardiovascular events. Overall, FDO safety outcomes were similar with Gilenya@Home and in-clinic.

Exploration of the Product of the 5-Point Investigator's Global Assessment and Body Surface Area (IGA × BSA) as a Practical Minimal Disease Activity Goal in Patients with Moderate-to-Severe Psoriasis.

BACKGROUND/AIMS: In the treat-to-target era, psoriasis disease activity measures that can be easily performed in routine clinical practice are needed. This retrospective pooled analysis explored cutoff values of the product of the 5-point Investigator's Global Assessment and percentage of affected body surface area (IGA × BSA) correlating with achievement of minimal disease activity (MDA). METHODS: Post hoc analysis of the phase 3 clinical trials ERASURE, FIXTURE, FEATURE, and JUNCTURE was conducted to determine associations between IGA × BSA and 2 MDA definitions (Psoriasis Area and Severity Index [PASI] 90 and Dermatology Life Quality Index [DLQI] 0/1, or PASI score ≤1 or BSA <3%) in patients with moderate-to-severe psoriasis receiving secukinumab 300 mg. For each definition of MDA, a range of possible cutoff values of IGA × BSA was examined at each time point. The optimal cutoff value was determined using Youden index (YI), calculated as (sensitivity + specificity - 1). RESULTS: For MDA defined as PASI 90 and DLQI 0/1, optimal IGA × BSA cutoffs were 2.10 at week 12 (YI, 0.60; sensitivity, 0.78; specificity, 0.82), 1.02 at week 24 (YI, 0.55; sensitivity, 0.73; specificity, 0.82), and 1.00 at week 52 (YI, 0.65; sensitivity, 0.79; specificity, 0.86). For MDA defined as PASI score ≤1 or BSA <3%, optimal IGA × BSA cutoffs were 2.98 at week 12 (YI, 0.91; sensitivity, 0.99; specificity, 0.92), 2.80 at week 24 (YI, 0.94; sensitivity, 0.99; specificity, 0.95), and 3.00 at week 52 (YI, 0.96; sensitivity, 1.00; specificity, 0.96). CONCLUSION: IGA × BSA could be a valid measure highly associated with achievement of MDA.

Effect of operating parameters on milling quality and energy consumption of brown rice.

The objective of this study was to evaluate the effect of operating parameters including milling weight (MW; 10, 95, 220, 345, 430 g), filling ratio (FR; 1, 1.4, 2, 2.6, 3) and milling duration (MD; 6, 30, 65, 100, 124 s) on head rice yield (HRY), whiteness index (WI) and specific energy consumption (Es). The experiments were conducted based on a vertical circulation mill employing a 5 level, 3 parameters CCD design and operating parameters were optimized using response surface methodology. During the processing, MW and MD had significant negative effects on HRY. On the contrary, they both had significant positive effects on WI. All the three parameters had a significant effect on Es Taking HRY, WI, Es as the evaluative index and degree of milling, temperature rise of milled rice as the restrictive index, the best combination of operating parameters was obtained, namely MW of 345 g, FR of 2.6 and MD of 30 s. The Pearson correlation coefficients between all the milling qualities were analyzed. Results showed that the temperature rise as an easy measurement index was highly correlated with the other qualities. The regression models between temperature rise and the other milling quality indices can assist in evaluating the quality of milled rice quickly and quantifiably.

Three-Bladed Rylene Propellers with Three-Dimensional Network Assembly for Organic Electronics.

Two kinds of conjugated C3-symmetric perylene dyes, namely, triperylene hexaimides (TPH) and selenium-annulated triperylene hexaimides (TPH-Se), are efficiently synthesized. Both TPH and TPH-Se have broad and strong absorption in the region 300-600 nm together with suitable LUMO levels of about -3.8 eV. Single-crystal X-ray diffraction studies show that TPH displays an extremely twisted three-bladed propeller configuration and a unique 3D network assembly in which three PBI subunits in one TPH molecule have strong π-π intermolecular interactions with PBI subunits in neighboring molecules. The integration of selenophene to TPH endows TPH-Se with a more distorted propeller configuration and a more compact 3D network assembly due to the Se···O interactions. A single-crystal transistor confirms that both TPH and TPH-Se possess good electron-transport ability. TPH and TPH-Se acceptor-based solar cells show high power conversion efficiency of 8.28% and 9.28%, respectively, which mainly results from the combined properties of broad and strong absorption ability, appropriate LUMO level, desirable aggregation, high electron mobility, and good film morphology with the polymer donor.

High Performance All-Polymer Solar Cells by Synergistic Effects of Fine-Tuned Crystallinity and Solvent Annealing.

Growing interests have been devoted to the design of polymer acceptors as potential replacement for fullerene derivatives for high-performance all polymer solar cells (all-PSCs). One key factor that is limiting the efficiency of all-PSCs is the low fill factor (FF) (normally <0.65), which is strongly correlated with the mobility and film morphology of polymer:polymer blends. In this work, we find a facile method to modulate the crystallinity of the well-known naphthalene diimide (NDI) based polymer N2200, by replacing a certain amount of bithiophene (2T) units in the N2200 backbone by single thiophene (T) units and synthesizing a series of random polymers PNDI-Tx, where x is the percentage of the single T. The acceptor PNDI-T10 is properly miscible with the low band gap donor polymer PTB7-Th, and the nanostructured blend promotes efficient exciton dissociation and charge transport. Solvent annealing (SA) enables higher hole and electron mobilities, and further suppresses the bimolecular recombination. As expected, the PTB7-Th:PNDI-T10 solar cells attain a high PCE of 7.6%, which is a 2-fold increase compared to that of PTB7-Th:N2200 solar cells. The FF of 0.71 reaches the highest value among all-PSCs to date. Our work demonstrates a rational design for fine-tuned crystallinity of polymer acceptors, and reveals the high potential of all-PSCs through structure and morphology engineering of semicrystalline polymer:polymer blends.

A 24-Week, Open-Label Extension Study to Investigate the Long-term Safety, Tolerability, and Efficacy of 13.3 mg/24 h Rivastigmine Patch in Patients With Severe Alzheimer Disease.

The long-term safety, tolerability, and efficacy of high-dose 13.3 mg/24 h rivastigmine patch in severe Alzheimer disease was evaluated in a 24-week, open-label extension to the double-blind ACTION study. Safety and tolerability, and efficacy on the Alzheimer's Disease Cooperative Study-Activities of Daily Living scale-Severe Impairment Version (ADCS-ADL-SIV), Severe Impairment Battery (SIB), and ADCS-Clinical Global Impression of Change (ADCS-CGIC) were assessed. Overall, 197 patients continued on 13.3 mg/24 h patch; 199 uptitrated from 4.6 mg/24 h to 13.3 mg/24 h patch. The incidence of adverse events (AEs), serious AEs and discontinuations due to AEs was similar in patients who continued on, and patients who uptitrated to, 13.3 mg/24 h patch (AEs: 57.9% and 59.8%; serious AEs: 16.2% and 16.1%; discontinuations: 11.2% and 12.1%, respectively). Larger mean changes from double-blind baseline were observed in patients uptitrated on the ADCS-ADL-SIV (-4.6; SD=8.7) and SIB (-7.0; SD=16.6), than those who continued on 13.3 mg/24 h patch (-3.9; SD=8.0 and -4.7; SD=16.8, respectively). ADCS-CGIC scores were comparable. There were no clinically relevant between-group differences in safety and tolerability. Greater decline was observed in patients with delayed uptitration to high-dose 13.3 mg/24 h patch than patients who continued on high-dose patch.

Efficacy of higher-dose 13.3 mg/24 h (15 cm2) rivastigmine patch on the Alzheimer's Disease Assessment Scale-cognitive subscale: domain and individual item analysis.

OBJECTIVE: Rivastigmine displays dose-dependent efficacy on cognition in patients with Alzheimer's disease (AD), as measured by the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog). Subanalysis of the OPTIMA (OPtimising Transdermal Exelon In Mild-to-moderate Alzheimer's disease) study aimed to define ADAS-cog domains by factor analysis of individual items. Efficacy of 13.3 mg/24 h versus 9.5 mg/24 h rivastigmine patch on individual items and newly derived domains was assessed. METHODS: OPTIMA was a 48-week, double-blind (DB) study in patients with mild-to-moderate AD. Patients meeting pre-defined decline criteria during open-label treatment with 9.5 mg/24 h patch were randomized in the DB phase to 13.3 mg/24 h (n = 280) or 9.5 mg/24 h (n = 287) patch. ADAS-cog change from baseline was a co-primary outcome measure. Factor analysis categorized ADAS-cog items into newly derived domains. Change from DB-baseline was calculated for domains and individual items. RESULTS: Numerically, less decline was displayed with 13.3 mg/24 h versus 9.5 mg/24 h patch in the total ADAS-cog score at all time points (significant at Week 24, p = 0.027). Factor analysis identified two domains: memory and language. Significantly, less decline was observed on the memory domain with 13.3 mg/24 h versus 9.5 mg/24 h patch at Weeks 12, 24, and 48 (p < 0.05; observed cases). Three items (following commands, orientation, and word recognition) displayed numerically less decline with 13.3 mg/24 h versus 9.5 mg/24 h patch at all time points. No significant between-group differences were observed on the language domain. CONCLUSION: Results suggest that the greater cognitive efficacy of 13.3 mg/24 h versus 9.5 mg/24 h rivastigmine patch is driven primarily by effects on memory, particularly in the areas of following commands, orientation, and word recognition.

Hidden citations obscure true impact in science.

References, the mechanism scientists rely on to signal previous knowledge, lately have turned into widely used and misused measures of scientific impact. Yet, when a discovery becomes common knowledge, citations suffer from obliteration by incorporation. This leads to the concept of hidden citation, representing a clear textual credit to a discovery without a reference to the publication embodying it. Here, we rely on unsupervised interpretable machine learning applied to the full text of each paper to systematically identify hidden citations. We find that for influential discoveries hidden citations outnumber citation counts, emerging regardless of publishing venue and discipline. We show that the prevalence of hidden citations is not driven by citation counts, but rather by the degree of the discourse on the topic within the text of the manuscripts, indicating that the more discussed is a discovery, the less visible it is to standard bibliometric analysis. Hidden citations indicate that bibliometric measures offer a limited perspective on quantifying the true impact of a discovery, raising the need to extract knowledge from the full text of the scientific corpus.