The Geras virtual frailty rehabilitation program to build resilience in older adults with frailty during COVID-19: a randomized feasibility trial.

BACKGROUND: The Coronavirus (COVID-19) pandemic has exacerbated the risk for poor physical and mental health outcomes among vulnerable older adults. Multicomponent interventions could potentially prevent or reduce the risk of becoming frail; however, there is limited evidence about utilizing alternative modes of delivery where access to in-person care may be challenging. This randomized feasibility trial aimed to understand how a multicomponent rehabilitation program can be delivered remotely to vulnerable older adults with frailty during the pandemic. METHODS: Participants were randomized to either a multimodal or socialization arm. Over a 12-week intervention period, the multimodal group received virtual care at home, which included twice-weekly exercise in small group physiotherapy-led live-streamed sessions, nutrition counselling and protein supplementation, medication consultation via a videoconference app, and once-weekly phone calls from student volunteers, while the socialization group received only once-weekly phone calls from the volunteers. The RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework was used to evaluate the feasibility of the program. The main clinical outcomes were change in the 5-times sit-to-stand test (5 × STS) and Depression, Anxiety and Stress Scale (DASS-21) scores. The feasibility outcomes were analyzed using descriptive statistics and expressed as frequencies and mean percent with corresponding confidence intervals (CI). Analysis of covariance (ANCOVA) was used for the effectiveness component. RESULTS: The program enrolled 33% (n = 72) of referrals to the study (n = 220), of whom 70 were randomized. Adoption rates from different referral sources were community self-referrals (60%), community organizations (33%), and healthcare providers (25%). At the provider level, implementation rates varied from 75 to 100% for different aspects of program delivery. Participant's adherence levels included virtual exercise sessions 81% (95% CI: 75-88%), home-based exercise 50% (95% CI: 38-62%), protein supplements consumption 68% (95% CI: 55-80%), and medication optimization 38% (95% CI: 21-59%). Most participants (85%) were satisfied with the program. There were no significant changes in clinical outcomes between the two arms. CONCLUSION: The GERAS virtual frailty rehabilitation study for community-dwelling older adults living with frailty was feasible in terms of reach of participants, adoption across referral settings, adherence to implementation, and participant's intention to maintain the program. This program could be feasibly delivered to improve access to socially isolated older adults where barriers to in-person participation exist. However, trials with larger samples and longer follow-up are required to demonstrate effectiveness and sustained behavior change. TRIAL REGISTRATION: ClinicalTrials.gov NCT04500366. Registered August 5, 2020, https://clinicaltrials.gov/ct2/show/NCT04500366.

Quasi-Homojunction Organic Nonfullerene Photovoltaics Featuring Fundamentals Distinct from Bulk Heterojunctions.

In contrast to classical bulk heterojunction (BHJ) in organic solar cells (OSCs), the quasi-homojunction (QHJ) with extremely low donor content (≤10 wt.%) is unusual and generally yields much lower device efficiency. Here, representative polymer donors and nonfullerene acceptors are selected to fabricate QHJ OSCs, and a complete picture for the operation mechanisms of high-efficiency QHJ devices is illustrated. PTB7-Th:Y6 QHJ devices at donor:acceptor (D:A) ratios of 1:8 or 1:20 can achieve 95% or 64% of the efficiency obtained from its BHJ counterpart at the optimal D:A ratio of 1:1.2, respectively, whereas QHJ devices with other donors or acceptors suffer from rapid roll-off of efficiency when the donors are diluted. Through device physics and photophysics analyses, it is observed that a large portion of free charges can be intrinsically generated in the neat Y6 domains rather than at the D/A interface. Y6 also serves as an ambipolar transport channel, so that hole transport as also mainly through Y6 phase. The key role of PTB7-Th is primarily to reduce charge recombination, likely assisted by enhancing quadrupolar fields within Y6 itself, rather than the previously thought principal roles of light absorption, exciton splitting, and hole transport.

Simultaneously Enhancing Exciton/Charge Transport in Organic Solar Cells by an Organoboron Additive.

Efficient exciton diffusion and charge transport play a vital role in advancing the power conversion efficiency (PCE) of organic solar cells (OSCs). Here, a facile strategy is presented to simultaneously enhance exciton/charge transport of the widely studied PM6:Y6-based OSCs by employing highly emissive trans-bis(dimesitylboron)stilbene (BBS) as a solid additive. BBS transforms the emissive sites from a more H-type aggregate into a more J-type aggregate, which benefits the resonance energy transfer for PM6 exciton diffusion and energy transfer from PM6 to Y6. Transient gated photoluminescence spectroscopy measurements indicate that addition of BBS improves the exciton diffusion coefficient of PM6 and the dissociation of PM6 excitons in the PM6:Y6:BBS film. Transient absorption spectroscopy measurements confirm faster charge generation in PM6:Y6:BBS. Moreover, BBS helps improve Y6 crystallization, and current-sensing atomic force microscopy characterization reveals an improved charge-carrier diffusion length in PM6:Y6:BBS. Owing to the enhanced exciton diffusion, exciton dissociation, charge generation, and charge transport, as well as reduced charge recombination and energy loss, a higher PCE of 17.6% with simultaneously improved open-circuit voltage, short-circuit current density, and fill factor is achieved for the PM6:Y6:BBS devices compared to the devices without BBS (16.2%).

Electrochemically Prepared Polyaniline as an Alternative to Poly(3,4-ethylenedioxythiophene)-poly(styrenesulfonate) for Inverted Perovskite Solar Cells.

The goal of this work is to substitute the conventional high-cost poly(3,4-ethylenedioxythiophene)-poly(styrenesulfonate) (PEDOT:PSS) in inverted perovskite solar cells (PSCs) with an efficient and conducting polyaniline (PANI) polymer. The reported use of PANI in PSCs involves a chemical synthesis method which is prone to contamination with impurities as it requires several materials for polymerization and adhesion improvement with substrates, contributing to low device efficiencies. This work mitigates this issue using an electrochemical method that is low cost, less time consuming, and capable of producing thin films of PANI with excellent adhesion to substrates. Results demonstrated that the power conversion efficiency of the electrochemically synthesized PANI-based PSC is 16.94% versus 15.11% for the PEDOT:PSS-based device. It was observed that the work function of PANI was lower compared to that of PEDOT:PSS which decreased V OC but enhanced hole extraction at the hole transport layer/perovskite interface, thus increasing J SC. Doping electrolyte solution with lithium bis(trifluoromethanesulfonyl)imide LiTFSI increased the work function of PANI, thus increasing V OC from 0.87 to 0.93 V. This method enables simple and scalable synthesis of PANI as a competitive hole transport material to replace rather expensive PEDOT:PSS, thus enabling an important step toward low-cost inverted perovskite photovoltaic devices.

Roles of Organic Ligands in Ambient Stability of Layered Halide Perovskites.

The combination of organic ligands and inorganic Pb-I frameworks in layered perovskites has bestowed upon them high structural tunability and stability, while their microscopic degradation mechanism remains unclear. Here, we found the key role of ligands in intrinsic structural stability and the consequent morphological evolution in layered perovskites during long-term ambient aging based on (GA)(MA)nPbnI3n+1 (GA = guanidinium, = 4) and (BDA)(MA)n-1PbnI3n+1 (BDA = 1,4-butanediammonium, < n > = 4) perovskites. The BDA-based perovskites have a low intrinsic stability due to high crystal formation energy (ΔH), which are prone to hydration during ambient aging. We overserved changed crystal orientation from perpendicular to parallel, a delayed charge populating time from <1 ps to >50 ps, an inhibited carrier transfer kinetics between quantum wells, an increase of 0.9 µs of charge carrier transport time and a decrease of 1.2 µs of charge carrier lifetime in the BDA-based film during ambient aging, which accounts for a large power-conversion efficiency (PCE) loss (14.2% vs 11.2%). By contrast, the GA ligand increases the intrinsic structural stability of perovskites, which not only yields an initial PCE as high as 20.0% but also helps retain excellent optoelectronic properties during aging. Therefore, only a slight PCE loss (20.0% vs 19.1%) was observed. Our work reveals the key role of organic-inorganic interaction affecting the intrinsic structural stability and optoelectronic properties, and provides a theoretical basis for the future design of stable and efficient optoelectronic devices.

Mitigating Interfacial Mismatch between Lithium Metal and Garnet-Type Solid Electrolyte by Depositing Metal Nitride Lithiophilic Interlayer.

Solid-state lithium batteries are generally considered as the next-generation battery technology that benefits from inherent nonflammable solid electrolytes and safe harnessing of high-capacity lithium metal. Among various solid-electrolyte candidates, cubic garnet-type Li7La3Zr2O12 ceramics hold superiority due to their high ionic conductivity (10-3 to 10-4 S cm-1) and good chemical stability against lithium metal. However, practical deployment of solid-state batteries based on such garnet-type materials has been constrained by poor interfacing between lithium and garnet that displays high impedance and uneven current distribution. Herein, we propose a facile and effective strategy to significantly reduce this interfacial mismatch by modifying the surface of such garnet-type solid electrolyte with a thin layer of silicon nitride (Si3N4). This interfacial layer ensures an intimate contact with lithium due to its lithiophilic nature and formation of an intermediate lithium-metal alloy. The interfacial resistance experiences an exponential drop from 1197 to 84.5 Ω cm2. Lithium symmetrical cells with Si3N4-modified garnet exhibited low overpotential and long-term stable plating/stripping cycles at room temperature compared to bare garnet. Furthermore, a hybrid solid-state battery with Si3N4-modified garnet sandwiched between lithium metal anode and LiFePO4 cathode was demonstrated to operate with high cycling efficiency, excellent rate capability, and good electrochemical stability. This work represents a significant advancement toward use of garnet solid electrolytes in lithium metal batteries for the next-generation energy storage devices.

Grain Boundary Defect Passivation of Triple Cation Mixed Halide Perovskite with Hydrazine-Based Aromatic Iodide for Efficiency Improvement.

Perovskites have been unprecedented with a relatively sharp rise in power conversion efficiency in the last decade. However, the polycrystalline nature of the perovskite film makes it susceptible to surface and grain boundary defects, which significantly impedes its potential performance. Passivation of these defects has been an effective approach to further improve the photovoltaic performance of the perovskite solar cells. Here, we report the use of a novel hydrazine-based aromatic iodide salt or phenyl hydrazinium iodide (PHI) for secondary post treatment to passivate surface and grain boundary defects in triple cation mixed halide perovskite films. In particular, the PHI post treatment reduced current at the grain boundaries, facilitated an electron barrier, and reduced trap state density, indicating suppression of leakage pathways and charge recombination, thus passivating the grain boundaries. As a result, a significant enhancement in power conversion efficiency to 20.6% was obtained for the PHI-treated perovskite device in comparison to a control device with 17.4%.

Assessing the Reliability of a Semiautomated Segmentation Algorithm for Quantifying Erosions in the Metacarpophalangeal Joints of Patients with Rheumatoid Arthritis.

OBJECTIVE: Assess the reliability of early erosions in rheumatoid arthritis (EERA) software for quantifying erosive damage to the metacarpophalangeal joints of patients with rheumatoid arthritis (RA). METHODS: One hundred magnetic resonance image sets from 68 patients with early referral RA were evaluated. Reliability was assessed using 95% limits of agreement and intraclass correlation coefficient (ICC) with 95% CI. RESULTS: Limits of agreement linearly depended on erosion volume: 0.44× between readers and 0.19× within readers. Interrater ICC was 0.976 (95% CI 0.965-0.984) and intrarater ICC was 0.996 (95% CI 0.994-0.997). CONCLUSION: EERA is highly reproducible for quantifying erosions in patients with early RA.

A double-blind, randomized controlled trial to compare the effect of biannual peripheral magnetic resonance imaging, radiography and standard of care disease progression monitoring on pharmacotherapeutic escalation in rheumatoid and undifferentiated inflammatory arthritis: study protocol for a randomized controlled trial.

BACKGROUND: Permanent joint damage is a major consequence of rheumatoid arthritis (RA), the most common and destructive form of inflammatory arthritis. In aggressive disease, joint damage can occur within 6 months from symptom onset. Early, intensive treatment with conventional and biologic disease-modifying anti-rheumatic drugs (DMARDs) can delay the onset and progression of joint damage. The primary objective of the study is to investigate the value of magnetic resonance imaging (MRI) or radiography (X-ray) over standard of care as tools to guide DMARD treatment decision-making by rheumatologists for the care of RA. METHODS: A double-blind, randomized controlled trial has been designed. Rheumatoid and undifferentiated inflammatory arthritis patients will undergo an MRI and X-ray assessment every 6 months. Baseline adaptive randomization will be used to allocate participants to MRI, X-ray, or sham-intervention groups on a background of standard of care. Prognostic markers, treating physician, and baseline DMARD therapy will be used as intervention allocation parameters. The outcome measures in rheumatology RA MRI score and the van der Heijde-modified Sharp score will be used to evaluate the MRI and X-ray images, respectively. Radiologists will score anonymized images for all patients regardless of intervention allocation. Disease progression will be determined based on the study-specific, inter-rater smallest detectable difference. Allocation-dependent, intervention-concealed reports of positive or negative disease progression will be reported to the treating rheumatologist. Negative reports will be delivered for the sham-intervention group. Study-based radiology clinical reports will be provided to the treating rheumatologists for extra-study X-ray requisitions to limit patient radiation exposure as part of diagnostic imaging standard of care. DMARD treatment dose escalation and therapy changes will be measured to evaluate the primary objective. A sample size of 186 (62 per group) patients will be required to determine a 36% difference in pharmacological treatment escalation between the three groups with intermediate dispersion of data with 90% power at a 5% level of significance. DISCUSSION: This study will determine if monitoring RA and undifferentiated inflammatory arthritis patients using MRI and X-ray every 6 months over 2 years provides incremental evidence over standard of care to influence pharmacotherapeutic decision-making and ultimately hinder disease progression. TRIAL REGISTRATION: This trial has been registered at ClinicalTrials.gov: NCT00808496 (registered on 12 December 2008).

The protective effect of antimalarial drugs on thrombovascular events in systemic lupus erythematosus.

OBJECTIVE: The antimalarial medication hydroxychloroquine has been proposed as a thromboprotective agent in systemic lupus erythematosus (SLE), but studies thus far have been limited by the possibility of confounding by indication. This study was conducted to assess whether exposure to antimalarial drugs is associated with a decrease in thrombovascular events (TEs) in patients with SLE. METHODS: The study was designed as a nested case-control study embedded in an inception cohort of patients with SLE, which allowed adjustments for possible confounding by calendar year, duration of disease, duration of observation, and severity of lupus. After controlling for the possible confounding variables in conditional logistic regression models, the use of antimalarial drugs was assessed for its effects on the development of TEs in lupus patients. RESULTS: Fifty-four cases of TE were identified, and these were matched with 108 control subjects (lupus patients without TEs). Univariate analyses identified older age (odds ratio [OR] 1.04, 95% confidence interval [95%CI] 1.01-1.07) or being older than age 50 years (OR 3.5, 95% CI 1.4-8.6) and ever having hypertension (OR 2.5, 95% CI 1.0-5.8) as being associated with an increased risk of TEs, whereas use of antimalarial drugs (OR 0.31, 95% CI 0.13-0.71) was associated with a decreased risk of TEs. Separate analyses were done for arterial and venous TEs, which yielded similar results. In multivariate analyses, use of antimalarial drugs (OR 0.32, 95% CI 0.14-0.74) and older age (OR 1.04, 95% CI 1.01-1.07) were the only 2 variables that remained significant. CONCLUSION: The results from this nested case-control study demonstrate that, after accounting for the effects of disease severity, disease duration, and calendar year, antimalarial drugs were found to be thromboprotective, being associated with a 68% reduction in the risk of all TEs, with a range of risk reduction of at least 26% up to as high as 86%.

Validation of the GALS musculoskeletal screening exam for use in primary care: a pilot study.

BACKGROUND: As the proportion of the Canadian population > or =65 grows, so too does the prevalence of musculoskeletal (MSK) conditions. Approximately 20% of visits to family physicians occur as a result of MSK complaints. The GALS (Gait, Arms, Legs, and Spine) screening examination was developed to assist in the detection of MSK abnormalities. Although MSK exams are primarily performed by rheumatologists or other MSK specialists, expanding their use in primary health care may improve the detection of MSK conditions allowing for earlier treatment. The primary goal of this study was to evaluate the use of the GALS locomotor screen in primary care by comparing the results of assessments of family physicians with those of rheumatologists. The secondary goal was to examine the incidence of MSK disorders and assess the frequency with which new diagnoses not previously documented in patients' charts were identified. METHODS: Patients > or =65 years old recruited from an academic family health centre were examined by a rheumatologist and a family physician who recorded the appearance of each participant's gait and the appearance and movement of the arms, legs and spine by deeming them normal or abnormal. GALS scores were compared between physicians with the proportion of observed (Pobs), positive (Ppos) and negative (Pneg) agreement being the primary outcomes. Kappa statistics were also calculated. Descriptive statistics were used to describe the number of "new" diagnoses by comparing rheumatologists' findings with each patient's family practice chart. RESULTS: A total of 99 patients consented to participate (92 with previously diagnosed MSK conditions). Results showed reasonable agreement between family physicians and rheumatologists; Pobs = 0.698, Ppos = 0.614 and Pneg = 0.752. The coefficient of agreement (estimated Kappa) was 0.3675 for the composite GALS score. For individual components of the GALS exam, the highest agreement between family physicians and rheumatologists was in the assessment of gait and arm movement. CONCLUSION: Previously reported increases in undiagnosed signs and symptoms of musculoskeletal conditions have highlighted the need for a simple yet sensitive screening exam for the identification of musculoskeletal abnormalities. Results of this study suggest that family physicians can efficiently use the GALS examination in the assessment of populations with a high proportion of musculoskeletal issues.

Review of the safety and efficacy of risedronate for the treatment of male osteoporosis.

Osteoporosis in men is an increasingly recognized problem with associated fracture morbidity and mortality. Treatment is limited, with the bisphosphonates being the mainstay of therapy. Risedronate has demonstrated fracture efficacy in women and efficacy has been recently been investigated in men. In men, risedronate either maintains or increases bone mineral density. In placebo controlled trials it has been shown to be safe and effective in preventing fractures.

Biochemical measurement of muscle injury created by lumbar surgery.

PURPOSES: 1. To determine whether lumbar disc surgery (LS) provides a sufficiently detectable rise in serum creatine kinase (CK) concentration to serve as a model to study biochemical measurement of muscle injury, and 2. To use the model to examine the consistency of the time course of CK concentration changes. METHOD: The study used a repeated measures design. Six women and six men scheduled for LS were recruited. Blood samples were taken in the pre-operative waiting areas, immediately after surgery, at 6 hour intervals until discharge, and at 2, 4, and 6 to 7 days following surgery. Total serum CK was quantified using the Roche Modular to detect enzyme concentration. RESULTS: Following LS, mean Total CK increased from a baseline 50 U/L (SD = 53) to a peak 114 U/L (SD = 32) in women (P < 0.001) and from 183 U/L (SD = 69) to a peak 454 U/L (SD = 173) in men (P < 0.05). Baseline to peak changes in CK exceeded subjects' own baseline fluctuations in all 6 women and all 6 men, and amounted to a mean 6 fold (SD = 4) increase in women and 16 fold (SD = 31) increase in men. While CK concentrations returned to baseline over the observation period in all subjects, time to peak ranged between 9 to 47 hours. CONCLUSIONS: The LS model produced a consistently detectable CK response in both genders. Time to peak is variable indicating a need for multiple serial measures to capture this biochemical injury response.

A review of the sapporo and revised Sapporo criteria for the classification of antiphospholipid syndrome. Where do the revised sapporo criteria add value?

OBJECTIVE: The preliminary classification criteria for antiphospholipid syndrome (APS), or the Sapporo criteria, are widely used for the inclusion of patients with APS into clinical studies. Revised Sapporo criteria have been proposed as an improved criteria set. Whether these criteria sets fulfill the current standards of measurement science are unknown. The purpose of this study was (1) to evaluate the developmental methodology and measurement properties of the Sapporo and the revised Sapporo criteria for use in clinical trials; and (2) to evaluate if the revised Sapporo criteria provide added value over the Sapporo criteria. METHODS: A computer search for articles describing use of the Sapporo and the revised Sapporo criteria was performed. Item generation, item reduction, sensibility, validity, and reliability of the criteria were evaluated. RESULTS: The Sapporo criteria set has incremental face and content validity over its predecessors. However, through separation of anti-ss2-glycoprotein I antibodies as a sub-item, the specification of a wider time interval between serologic testing, the specification of a time interval between serology and clinical manifestations, and specification of definitions for clinical manifestations and laboratory titer thresholds, the revised Sapporo criteria set has incremental face and content validity over the Sapporo criteria. The complexity of the criteria, diagnostic tests, and immunologic tests limits their feasibility. The reliability of each criterion is unknown. The discriminative capacity of the Sapporo criteria is good, with sensitivity, specificity, and positive and negative predictive values of 0.71, 0.98, 0.95, and 0.88, respectively, compared to patients with systemic lupus erythematosus. The discriminative capacity of the revised Sapporo criteria is unknown. CONCLUSION: The revised Sapporo criteria set has incremental face and content validity compared its predecessors. Reliability testing of each criterion is needed before these criteria can be confidently used in multicenter APS trials. Discriminatory testing of the revised Sapporo criteria is required.

Tolerability of different dosing regimens of bisphosphonates for the treatment of osteoporosis and malignant bone disease.

Bisphosphonates are the primary pharmacological agents used for the management of osteoporosis and hypercalcaemia of malignant bone disease. The efficacy of these agents in these two conditions has been demonstrated in many well designed trials published over the past 2 decades. The variety of bisphosphonates currently available to us provides a wide range of tolerability and dosing profiles thus necessitating a thorough comparison of the most recent oral and intravenous bisphosphonates to differentiate the clinical context in which they should be used. Despite the fact that bisphosphonates are generally well accepted, their tolerability is dependent on complications which encompass gastrointestinal (GI) and renal toxicity. Other adverse events include osteonecrosis of the jaw, arthralgias, flu-like symptoms and uveitis. Studies have shown that various dosing regimens are able to modulate these rates of toxicity. To maximise tolerability, the direction of future therapy will likely fall into a pattern of decreasing the frequency of administration of bisphosphonates, whether it is oral or intravenous formulations, thus improving patient adherence. To review the literature on different dosing regimens of various bisphosphonates and their associated tolerability, we searched MEDLINE for articles from 1975 to 2006. Oral bisphosphonates, in particular alendronate and risedronate, have been systematically evaluated with regards to GI toxicity. Overall tolerability with these oral formulations has found GI toxicity to be the primary adverse event of interest. Both alendronate and risedronate have been found to have similar rates of GI toxicity when compared with placebo. Mounting evidence has developed validating the use of intravenous ibandronate and zoledronic acid for the purpose of treating hypercalcaemia secondary to malignancy. Unique to all other bisphosphonates, ibandronate also has an oral form which has a similar GI-toxicity profile to placebo. In addition, no significant differences in renal toxicity have been observed between those receiving intravenous ibandronate compared with placebo. Because of its potency and mode of administration, zoledronic acid has been widely accepted for the treatment of hypercalcaemia secondary to malignancy. However, a decrease in renal function, albeit rare, remains a significant complication of zoledronic acid; therefore, regular renal monitoring is recommended.