2,013 research outputs found

    Use of Antipsychotic Medications and Cholinesterase Inhibitors and the Risk of Falls and Fractures: self-controlled case series

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    Objective: To evaluate the association between the use of antipsychotic medications and cholinesterase inhibitors, and the risk of falls and fractures in elderly patients with major neurocognitive disorders. / Design: Self-controlled case series / Setting: Taiwan’s National Health Insurance Database / Participants: 15,278 patients who were aged 65 or older, were newly prescribed antipsychotic medications and cholinesterase inhibitors, and suffered an incident fall or fracture between 2006 and 2017. Prescription records of cholinesterase inhibitors were used to confirm the diagnosis of major neurocognitive disorders since all use of cholinesterase inhibitors was subject to review by experts based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and patients’ scores of Mini-Mental State Examination. We excluded those with schizophrenia and bipolar disorder before the first prescription of cholinesterase inhibitors to ensure that antipsychotic medications were used for neuropsychiatric symptoms of major neurocognitive disorders. / Main outcome measures: We used conditional Poisson regression to derive the incidence rate ratio and the 95% confidence interval for evaluating the association between the risk of falls and fractures and different exposure periods, including cholinesterase inhibitors alone, antipsychotic medications alone, and combination, as compared with the non-exposure period for the same individual. Moreover, we defined a 14-day pre-exposure period before study drug initiation over concerns about confounding by indication. / Results: Compared with the non-exposure period (incidence rate per 100 person-years; 95% confidence interval: 8.30; 8.14 to 8.46), the highest risk of falls and fractures occurred during the pre-exposure period (52.35; 48.46 to 56.47), followed by combination (10.55; 9.98 to 11.14), antipsychotic medications alone (10.34; 9.80 to 10.89), and cholinesterase inhibitors alone (9.41; 8.98 to 9.86). Conclusions: The incidence of falls and fractures was especially high in the pre-exposure period, suggesting that factors other than the study medications, such as underlying diseases, should be taken into consideration when evaluating the association between the risk of falls and fractures, and the use of cholinesterase inhibitors and antipsychotic medications. The exposure periods were also associated with a higher risk of falls and fractures, compared with the non-exposure period, although the magnitude was much lower than during the pre-exposure period. Prevention strategies and close monitoring of the risk of falls are still necessary until there is evidence that patients have regained a steady status

    Dynamics of one-dimensional tight-binding models with arbitrary time-dependent external homogeneous fields

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    The exact propagators of two one-dimensional systems with time-dependent external fields are presented by following the path-integral method. It is shown that the Bloch acceleration theorem can be generalized to the impulse-momentum theorem in quantum version. We demonstrate that an evolved Gaussian wave packet always keeps its shape in an arbitrary time-dependent homogeneous driven field. Moreover, that stopping and accelerating of a wave packet can be achieved by the pulsed field in a diabatic way.Comment: 8 pages, 6 figure

    Simulations of events for the LUX-ZEPLIN (LZ) dark matter experiment

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    The LUX-ZEPLIN dark matter search aims to achieve a sensitivity to the WIMP-nucleon spin-independent cross-section down to (1–2)×10−12 pb at a WIMP mass of 40 GeV/c2. This paper describes the simulations framework that, along with radioactivity measurements, was used to support this projection, and also to provide mock data for validating reconstruction and analysis software. Of particular note are the event generators, which allow us to model the background radiation, and the detector response physics used in the production of raw signals, which can be converted into digitized waveforms similar to data from the operational detector. Inclusion of the detector response allows us to process simulated data using the same analysis routines as developed to process the experimental data

    The five dimensions of B cell tolerance

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    B cell tolerance has been generally understood to be an acquired property of the immune system that governs antibody specificity in ways that avoid auto‐toxicity. As useful as this understanding has proved, it fails to fully explain the existence of auto‐reactive specificities in healthy individuals and contribution these may have to health. Mechanisms underlying B cell tolerance are considered to select a clonal repertoire that generates a collection of antibodies that do not bind self, ie tolerance operates more or less in three dimensions that largely spare autologous cells and antigens. Yet, most B lymphocytes in humans and probably in other vertebrates are auto‐reactive and absence of these auto‐reactive B cells is associated with disease. We suggest that auto‐reactivity can be embodied by extending the concept of tolerance by two further dimensions, one of time and circumstance and one that allows healthy cells to actively resist injury. In this novel concept, macromolecular recognition by the B cell receptor leading to deletion, anergy, receptor editing or B cell activation is extended by taking account of the time of development of normal immune responses (4th dimension) and the accommodation (or tolerance) of normal cells to bound antibody, activation of complement, and interaction with inflammatory cells (fifth dimension). We discuss how these dimensions contribute to understanding B cell biology in health or disease.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153034/1/imr12813.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153034/2/imr12813_am.pd
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