Factors that Influence Treatment Delay for Patients with Breast Cancer.

INTRODUCTION: The diagnosis or treatment of breast cancer is sometimes delayed. A lengthy delay may have a negative psychological impact on patients. The aim of our study was to evaluate the sociodemographic, clinical and pathological factors associated with delay in the provision of surgical treatment for localised breast cancer, in a prospective cohort of patients. METHODS: This observational, prospective, multicentre study was conducted in ten hospitals belonging to the Spanish national public health system, located in four Autonomous Communities (regions). The study included 1236 patients, diagnosed through a screening programme or found to be symptomatic, between April 2013 and May 2015. The study variables analysed included each patient's personal history, care situation, tumour history and data on the surgical intervention, pathological anatomy, hospital admission and follow-up. Treatment delay was defined as more than 30 days elapsed between biopsy and surgery. RESULTS: Over half of the study population experienced surgical treatment delay. This delay was greater for patients with no formal education and among widows, persons not requiring assistance for usual activities, those experiencing anxiety or depression, those who had a high BMI or an above-average number of comorbidities, those who were symptomatic, who did not receive NMR spectroscopy, who presented a histology other than infiltrating ductal carcinoma or who had poorly differentiated carcinomas. CONCLUSIONS: Certain sociodemographic and clinical variables are associated with surgical treatment delay. This study identifies factors that influence surgical delays, highlighting the importance of preventing these factors and of raising awareness among the population at risk and among health personnel.

Acculturation and adjustment as a function of perceived and objective value congruence.

Culture fit has been studied in numerous ways conceptually and methodologically, yielding conflicting results. This study explored it in terms of perceived and objective value congruence in relation to both acculturation and socio-cultural adjustment among 187 international students (or internationals, compared to 138 domestic students or locals) in the USA. First, for 9 out of 10 values, internationals' perceptions of U.S. values significantly differed from locals' actual values. Second, locals perceived greater stimulation and self-direction value congruence (i.e., when personal values are consistent with respondents' perceptions of U.S. values), but weaker benevolence, power, and universalism value congruence than internationals. Third, marginalised and/or separated internationals perceived incongruence on benevolence and/or tradition values. Moreover, objective value incongruence (i.e., when personal values are inconsistent with U.S. respondents' actual reported values) on power, tradition, conformity, and security values related with marginalisation. Finally, for internationals, perceived value congruence related to socio-cultural adjustment, and the correlations are opposite from expectations for locals' perceived value congruence.

Obstructive sleep apnoea in the elderly: role of continuous positive airway pressure treatment.

Almost all the information about the effect of continuous positive airway pressure (CPAP) in patients with obstructive sleep apnoea (OSA) comes from clinical trials involving only middle-aged patients. The objective of this study was to assess the effect of CPAP treatment in elderly patients with severe OSA on clinical, quality-of-life and neurocognitive spheres. We performed an open-label, randomised, multicentre clinical trial in a consecutive clinical cohort of 224 elderly (≥70 years old) patients with confirmed severe OSA (apnoea-hypopnea index ≥30) randomised to receive CPAP (n=115) or no CPAP (n=109) for 3 months. A sleep study was performed by either full polysomnography or respiratory polygraphy. CPAP titration was performed by an autoCPAP device. The primary endpoint was quality of life (Quebec Sleep Questionnaire) and secondary endpoints included sleep-related symptoms, presence of anxiety/depression, office-based blood pressure and some neurocognitive tests. The mean±sd age was 75.5±3.9 years. The CPAP group achieved a greater improvement in all quality-of-life domains (p<0.001; effect size: 0.41-0.98), sleep-related symptoms (p<0.001; effect size 0.31-0.91) as well as anxiety (p=0.016; effect size 0.51) and depression (p<0.001; effect size: 0.28) indexes and some neurocognitive tests (digit symbol test (p=0.047; effect size: 0.20) and Trail Making Test A (p=0.029; effect size: 0.44)) in an intention-to-treat analysis. In conclusion, CPAP treatment resulted in an improvement in quality of life, sleep-related symptoms, anxiety and depression indexes and some neurocognitive aspects in elderly people with severe OSA.

New insights on the 7-azaindole photophysics: the overlooked role of its non phototautomerizable hydrogen bonded complexes.

In this paper we explore the formation and the photophysical properties of the scarcely studied open hydrogen bonded aggregates of 7-Azaindole, 7AI. Thus, we have analyzed the influence that the increase of the 7AI concentration and the decrease of the temperature have on the 7AI photophysics. To help the interpretation of the results, the 7AI-Pyridine system has been used as the model for the analysis of the photophysical properties attributable to the open N(pyrrolic) - H · · · N(pyridinic) hydrogen bonded aggregates. Also, the hydrogen bond interactions have been studied by means of the atom in molecule approach from the Bader theory. Experimental and theoretical results support that the formation of open hydrogen bonded aggregates, (-7AI-)n with n ≥ 2 can efficiently compete with that of the profusely studied centro-symmetric cyclic dimer (7AI)2. Moreover, these aggregates suffer a proton-driven electron transfer process that strongly quenches their room temperature fluorescence and, therefore, masks their presence in the 7AI solutions. Therefore, because most of the studies on the 7AI photophysics have been interpreted without considering the existence of such aggregates and, more important, ignoring its quenching process, many conclusions obtained from these studies should be carefully revised.

Simulations of Multifocal Vision in Patients With Previous Monofocal Intraocular Lens Implantation.

PURPOSE: To evaluate the effectiveness and patient acceptance of multifocal vision simulation in patients with previous monofocal intraocular lens (IOL) implantation, and to explore their willingness-to-pay (WTP) and willingness-to-accept (WTA) based on the perceived advantages and disadvantages of multifocal vision. METHODS: Seventeen patients with previous monofocal IOL implantation participated in this cross-sectional study. The SimVis Gekko device (2EyesVision SL) was used to simulate monofocal (Evaluation B) and multifocal (Evaluation C) visual experiences, compared to their existing vision (Evaluation A). Visual acuity at three distances and defocus curves were measured. Patients responded to inquiries about visual quality in each evaluation, bothersomeness of photic phenomena, probability to select the visual experience, and the monetary value they associated with enhanced WTP or diminished WTA visual quality. RESULTS: The simulations underestimated the visual acuity reported for the IOL in existing literature by one or two lines, depending on the testing distance. This underestimation was more pronounced in defocus curves. However, 70.6% of patients were likely or very likely to opt for multifocal vision, indicating they perceived the benefits of multifocality. The WTP for multifocal vision was twice that of monofocal vision, and the WTP/WTA ratio exceeded 1, suggesting the perceived vision benefits outweighed potential drawbacks. CONCLUSIONS: Despite underestimating the expected postoperative visual performance, the multifocal simulation enabled patients to perceive the benefits of multifocal vision to some extent. This system could be beneficial in avoiding potential postoperative complaints, but the possible rise in false-positive results should be considered and evaluated in future research. [J Refract Surg. 2023;39(12):831-839.].

Spectral and photophysical properties of α-carboline (1-azacarbazole) in aqueous solutions.

The absorption and fluorescence spectra of α-carboline, 9H-pyrido[2,3-b]indole, AC, in organic aprotic solvents containing different water proportions and in acid/base aqueous solutions inside and outside the pH range have been examined. In the organic aprotic solvents, the addition of increasing concentrations of water sequentially quenches and shifts to the red the fluorescence spectra of AC. These spectral changes have been rationalized assuming the formation, at the lower water concentrations, of a discrete ground state non-cyclic weakly fluorescent AC hydrate emitting at 376 nm that, upon increasing the water concentrations, evolves to a higher order AC poly hydrate emitting at 397 nm. The changes of the AC absorption spectra in aqueous acid/basic solutions indicate the existence of three ground state prototropic species; the pyridinic protonated cation, C (pK(a) = 4.10 ± 0.05), the neutral, N (pK(a) = 14.5 ± 0.2), and the pyrrolic deprotonated anion, A. Conversely, the changes of the AC fluorescence spectra in these media indicate the existence of four excited state species emitting at 376 nm, 397 nm, 460 nm and 465 nm. Since the emissions at 376 nm and 397 nm satisfactorily match those of the hydrates observed in the organic-water mixtures, they were consistently assigned to two differently hydrated ground state N species. The remaining emissions at 460 nm and 465 nm have been assigned without ambiguity, on the basis of their excitation spectra, to the C and A species, respectively. The excited-state pK(a)s of the prototropic species of AC have been estimated by using the Förster-Weller cycle.

Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructive sleep apnea: a randomized controlled trial.

CONTEXT: Continuous positive airway pressure (CPAP) is the first-line treatment for patients with symptomatic obstructive sleep apnea (OSA). However, its indication for all patients with sleep-disordered breathing, regardless of daytime symptoms, is unclear. OBJECTIVE: To evaluate the effect of CPAP treatment on the incidence of hypertension or cardiovascular events in a cohort of nonsleepy patients with OSA. DESIGN, SETTING, AND PATIENTS: Multicenter, parallel-group, randomized controlled trial in 14 teaching hospitals in Spain. Between May 2004 and May 2006, 725 consecutive patients were enrolled who had an apnea-hypopnea index of 20 h(-1) or greater and an Epworth Sleepiness Scale score of 10 or less (scores range from 0-24, with values <10 suggesting no daytime sleepiness). Exclusion criteria were previous cardiovascular event, physical or psychological incapacity, chronic disease, or drug or alcohol addiction. Follow-up ended in May 2009. INTERVENTION: Patients were allocated to receive CPAP treatment or no active intervention. All participants received dietary counseling and sleep hygiene advice. MAIN OUTCOME MEASURES: Incidence of either systemic hypertension (taking antihypertensive medication or blood pressure greater than 140/90 mm Hg) or cardiovascular event (nonfatal myocardial infarction, nonfatal stroke, transient ischemic attack, hospitalization for unstable angina or arrhythmia, heart failure, or cardiovascular death). RESULTS: Seven hundred twenty-three patients underwent follow-up for a median of 4 (interquartile range, 2.7-4.4) years (1 patient from each group did not receive allocated treatment); 357 in the CPAP group and 366 in the control group were included in the analysis. In the CPAP group there were 68 patients with new hypertension and 28 cardiovascular events (17 unstable angina or arrhythmia, 3 nonfatal stroke, 3 heart failure, 2 nonfatal myocardial infarction, 2 transient ischemic attack, 1 cardiovascular death). In the control group there were 79 patients with new hypertension and 31 cardiovascular events (11 unstable angina or arrhythmia, 8 nonfatal myocardial infarction, 5 transient ischemic attack, 5 heart failure, 2 nonfatal stroke). The hypertension or cardiovascular event incidence density rate was 9.20 per 100 person-years (95% CI, 7.36-11.04) in the CPAP group and 11.02 per 100 person-years (95% CI, 8.96-13.08) in the control group. The incidence density ratio was 0.83 (95% CI, 0.63-1.1; P = .20). CONCLUSIONS: In patients with OSA without daytime sleepiness, the prescription of CPAP compared with usual care did not result in a statistically significant reduction in the incidence of hypertension or cardiovascular events. However, the study may have had limited power to detect a significant difference. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00127348.

Social media use, social identification and cross-cultural adaptation of international students: A longitudinal examination.

The mobility experience is an important life event for international students, and achieving successful psychological and sociocultural adaptation is crucial for this experience to be positive. Through a three-wave longitudinal study among international students enrolled at universities in Spain, Portugal, and Poland (n = 233), we examined the relationships between social media use, social identification, and (sociocultural and psychological) adaptation across time. Results of cross lagged panel modeling (CLPM) showed that social media contact with home nationals predicted greater identification with this group. Social media contact with host country nationals predicted poorer adaptation. Social media contact with other international students did not show any effects, while identification with this group predicted better adaptation. Our results point to the dynamic nature of the adaptation process, showing that the role of social media use and identification targeted at different social groups may play different roles than was previously found in cross-sectional research.

Visual analogical well-being scale for sleep apnea patients: validity and responsiveness : a test for clinical practice.

INTRODUCTION: Health-related quality-of-life (HRQL) tests used in sleep apnea-hypopnea syndrome (SAHS) are time-consuming, complicating their application in clinical practice. The objective was to examine the validity and responsiveness of a simple visual analogical well-being scale (VAWS) for the clinical use. METHOD: The subjects proceed from a cohort of SAHS patients treated with CPAP for 12 weeks. We correlated the VAWS with other HRQL tests, related clinical and polysomnographic measures to concurrent and construct validities. Responsiveness by: (1) comparison of HRQL tests between before and after treatment and effect size. (2) Association of the change with treatment between VAWS with other HRQL tests and between VAWS with clinical parameters. RESULTS: At baseline, VAWS correlated with all HRQL tests but better with functional outcomes in sleep questionnaires (FOSQ) and European quality-of-life questionnaire (EuroQol) thermometer. VAWS and FOSQ correlated better with clinical variables than other HRQL tests. VAWS captures the magnitude change with treatment similarly to FOSQ but better than other HRQL tests. CONCLUSION: VAWS is a very simple test which measures HRQL in SAHS. It could be a useful tool in clinical practice, primarily for the responsiveness of treatment.

Singlet excited state pyridinic deprotonation of the N9-methylbetacarboline cations in aqueous sodium hydroxide solutions.

The singlet excited state pyridinic deprotonation of the 9-methyl-9H-pyrido[3,4-b]indole, MBC, cations has been studied in aqueous NaOH solutions by absorption, steady state and time resolved fluorescence measurements. This excited state reaction proceeds through a stepwise mechanism involving different ground and excited state hydrogen bonded MBC-(water)n complexes. Thus, in aqueous NaOH solutions of MBC above pH 8, two ground state hydrogen bonded MBC-water adducts, namely PC and PTC, coexist in equilibrium. Upon excitation, the PC behaves as an independent fluorophore, whereas the PTC reacts with water molecules during its excited state lifetime to give the intermediate CL*. This exciplex is the precursor of the excited state cation, C*. In almost all the pH range, C* is practically the only existing species in the singlet excited state of MBC. In concentrated NaOH solutions beyond the pH range, C* deprotonates giving CL* and PTC* species.

A theoretical study of the hydrogen bond donor capability and co-operative effects in the hydrogen bond complexes of the diaza-aromatic betacarbolines.

In this work, we present a quantum mechanical investigation on the hydrogen bond interactions of N(9)-methyl-9H-pyrido[3,4-b]indole, MBC, and N(2)-methyl-9H-pyrido[3,4-b]indole, BCA, with different hydrogen bond donors. Thus, it has been analysed the influence that the hydrogen bond donor strength and the co-operative effect of the increasing number of donor molecules have on the shape of the potential energy surfaces versus the N···H distances, r(N­H). To rationalize the nature of the interactions, the Bader theory has been applied and the characteristics of the bond critical points analysed. The results show that two different hydrogen bond complexes can be formed depending on the donor capabilities or the number of donor molecules included in the calculations. The topological parameters from the Bader theory are used to justify the statement that the analysed interactions can be classified as weak or partially covalent hydrogen bond interactions, respectively. As experimentally observed, weak hydrogen bond donors form weak hydrogen bond complexes, called HBC. Upon the increase of the donor strength the N···H proton is shifted nearest to the nitrogen atom giving rise to the observation of a stronger hydrogen bond complex, the proton transfer complex, PTC. The most outstanding result of these studies is the fact that the formation of the PTC can also be managed just by changing the number of donor molecules, that is, by a co-operative effect of the hydrogen bonds.

Analysis of the evolution of those operated on with minimal access surgery in our hospital. Does it present better results than the conventional one? / Análisis de la evolución de los operados mediante cirugía de mínimo acceso en nuestro hospital. ¿Presenta mejores resultados que la convencional?

Symptomatic severe aortic stenosis is the most prevalent surgical pathology in cardiac surgery, and its isolated replacement has historically been performed by means of complete middle sternotomy. However, a great revolution has recently taken place, especially after the arrival of sutureless aortic prostheses that, together with a new impulse by cardiac surgery towards a less invasive course, has caused the replacement of said valve to be carried out more and more frequently due to these prostheses and minor access incisions. For this reason, we carried out a review of the cases operated on in our service from the beginning of the minimum access surgery program, comparing them with the results of the cases operated at the same time using conventional surgery.

La estenosis aórtica severa sintomática es la patología quirúrgica más prevalente en cirugía cardiaca y su sustitución aislada se ha realizado históricamente mediante esternotomía media completa. Sin embargo, se ha producido recientemente una gran revolución, especialmente tras la llegada de las prótesis aórticas sin suturas que, unido a un nuevo impulso por la cirugía cardiaca hacia un rumbo menos invasivo, ha provocado que el reemplazo de dicha válvula se lleve a cabo cada vez más frecuentemente por dichas prótesis y por incisiones de mínimo acceso. Por ello, realizamos una revisión de los casos intervenidos en nuestro servicio desde el inicio del programa de cirugía de mínimo acceso comparándolos con los resultados de los casos intervenidos en la misma época mediante cirugía convencional.

Intra- and Inter-Physician Agreement in Therapeutic Decision for Sleep Apnea Syndrome.

BACKGROUND: Large variation in diagnostic procedures and treatment recommendations may hinder the management of obstructive sleep apnea (OSA) and also compromise correct interpretation of the results of multicenter clinical trials, especially in subjects with non-severe OSA. The aim of this study was to analyze the therapeutic decision-making between different sleep physicians in patients with AHI<40events/h. METHODS: Six experienced senior sleep specialists from different sleep centers of Spain were asked to make a therapeutic decision (CPAP treatment) based on anonymized recordings of patients with suspected OSA that has previously performed a sleep study. The clinical data was shown in an online database and included anthropometric features, clinical questionnaires, comorbidities, physical examination and sleep study results. Intra- and inter-observer decision-making were analyzed by the Fleiss' Kappa statistics (Kappa). RESULTS: A total of 720 medical decisions were taken to analyze the agreement between sleep professionals. Overall intra-observer evaluation reliability was almost perfect (Kappa=0.83, 95% CI, 0.75-0.90, p<0.001). However, overall inter-observer concordance decreased to moderate agreement (Kappa=0.46, 95% CI, 0.42-0.51, p<0.001). Nevertheless, it was especially low when considering AHI<15events/h. CONCLUSIONS: This study demonstrates a good intra-observer concordance in the therapeutic decision-making of different sleep physicians treating patients with low/moderate OSA. However, when analyzing inter-observer agreement the results were considerably worse. These findings underline the importance of developing improved consensus management protocols.

The Breast Size Satisfaction Survey (BSSS): Breast size dissatisfaction and its antecedents and outcomes in women from 40 nations.

The Breast Size Satisfaction Survey (BSSS) was established to assess women's breast size dissatisfaction and breasted experiences from a cross-national perspective. A total of 18,541 women were recruited from 61 research sites across 40 nations and completed measures of current-ideal breast size discrepancy, as well as measures of theorised antecedents (personality, Western and local media exposure, and proxies of socioeconomic status) and outcomes (weight and appearance dissatisfaction, breast awareness, and psychological well-being). In the total dataset, 47.5 % of women wanted larger breasts than they currently had, 23.2 % wanted smaller breasts, and 29.3 % were satisfied with their current breast size. There were significant cross-national differences in mean ideal breast size and absolute breast size dissatisfaction, but effect sizes were small (η2 = .02-.03). The results of multilevel modelling showed that greater Neuroticism, lower Conscientiousness, lower Western media exposure, greater local media exposure, lower financial security, and younger age were associated with greater breast size dissatisfaction across nations. In addition, greater absolute breast size dissatisfaction was associated with greater weight and appearance dissatisfaction, poorer breast awareness, and poorer psychological well-being across nations. These results indicate that breast size dissatisfaction is a global public health concern linked to women's psychological and physical well-being.

Ground and singlet excited state pyridinic protonation of N9-methylbetacarboline in water-N,N-dimethylformamide mixtures.

The ground and the singlet excited state pyridinic protonation of 9-methyl-9H-pyrido[3,4-b]indole, MBC, in water-N,N-dimethylformamide mixtures has been studied by absorption, steady state and time resolved fluorescence measurements. These proton transfer reactions elapse by a stepwise mechanism modulated by different hydrogen bonded adducts and exciplexes formed by water molecules and the pyridinic nitrogen atom of the MBC. Based in the present and previous studies, a general mechanistic Scheme for the ground and the singlet excited state MBC pyridinic protonation has been proposed. Accordingly, in the ground state, upon increasing the water proportion of the water-N,N-dimethylformamide mixtures, a hydrogen bonded complex, HBC, its hydrogen bonded proton transfer complex, PTC, a pre-cationic complex, PC, and the cation, C, are progressively formed. In the excited state, MBC, HBC and PC behave as independent fluorophores. Excited state cations, C*, are mainly formed by direct excitation of the ground state cations and, in minor proportion, by the excited state reaction of the PTC* through the CL* exciplex.

Family functioning of out-of-treatment cocaine base paste and cocaine hydrochloride users.

UNLABELLED: Knowledge of family structure and behavioral dynamics of out-of-treatment drug users under poverty becomes relevant, because of the role that the family plays in drug use and rehabilitation. HYPOTHESES: 1. The perception of drug users about their family functioning reveals a dysfunctional organization and communication-connection problems with their families; and 2. the family system of cocaine base paste (CBP) users presents greater dysfunctionality than cocaine hydrochloride (CH) users. METHOD: Cross-sectional descriptive design of primary users of CH (n=236) and primary users of CBP (n=231) during the last month, out-of-substance abuse treatment during the last 6 months. INSTRUMENTS: Risk Behavior Questionnaire and How-Is-Your-Family Questionnaire. RESULTS: The total sample presented 72.9% of families with risk functioning; CBP users registered a more deteriorated family structure and communication-connection than CH users. CONCLUSIONS: CBP and CH users, who are hidden from health treatment services, do indeed present a high degree of family dysfunction; and the CBP group, compared to the CH group, presented various indicators of greater risk in their family dysfunction.

Análisis de la evolución de los operados mediante cirugía de mínimo acceso en nuestro hospital. ¿Presenta mejores resultados que la convencional? / Analysis of the evolution of those operated on with minimal access surgery in our hospital. Does it present better results than the conventional one?

Resumen La estenosis aórtica severa sintomática es la patología quirúrgica más prevalente en cirugía cardiaca y su sustitución aislada se ha realizado históricamente mediante esternotomía media completa. Sin embargo, se ha producido recientemente una gran revolución, especialmente tras la llegada de las prótesis aórticas sin suturas que, unido a un nuevo impulso por la cirugía cardiaca hacia un rumbo menos invasivo, ha provocado que el reemplazo de dicha válvula se lleve a cabo cada vez más frecuentemente por dichas prótesis y por incisiones de mínimo acceso. Por ello, realizamos una revisión de los casos intervenidos en nuestro servicio desde el inicio del programa de cirugía de mínimo acceso comparándolos con los resultados de los casos intervenidos en la misma época mediante cirugía convencional.

Abstract Symptomatic severe aortic stenosis is the most prevalent surgical pathology in cardiac surgery, and its isolated replacement has historically been performed by means of complete middle sternotomy. However, a great revolution has recently taken place, especially after the arrival of sutureless aortic prostheses that, together with a new impulse by cardiac surgery towards a less invasive course, has caused the replacement of said valve to be carried out more and more frequently due to these prostheses and minor access incisions. For this reason, we carried out a review of the cases operated on in our service from the beginning of the minimum access surgery program, comparing them with the results of the cases operated at the same time using conventional surgery.

Effect of snoring and obstructive respiratory events on sleep architecture in adolescents.

OBJECTIVE: To evaluate the effect of snoring and obstructive respiratory events on the distribution of sleep stages and arousals in a nonselected group of adolescents from the general population. DESIGN: Cross-sectional study. SETTING: Randomly selected secondary schools in Seville, Spain. Patients A general population sample of 43 adolescents (mean [SD] age, 13.6 [1.77] years). INTERVENTIONS: A questionnaire for the investigation of sleep-related breathing disorders was administered. Symptoms were evaluated according to a 4-point frequency scale. Snorers answered "sometimes" or "often" to the question about snoring, and nonsnorers answered "never" or "rarely." All subjects underwent standard polysomnography at the sleep laboratory. RESULTS: Twenty-eight subjects were snorers; 15 were nonsnorers. No statistically significant differences were noted between both groups in the percentages of sleep stages, arousal index, awakenings, or wakefulness during sleep. Snorers showed a significantly higher number of respiratory arousals than nonsnorers (mean [SD], 1.14 [1.5] vs 0.33 [0.6], P<.05). However, neither the apnea-hypopnea index (AHI) nor the oxygen desaturation index correlated with the arousal index. Twelve snorers (27.5%) had an AHI of 2 or more; 13 nonsnorers (30.2%) had an AHI of less than 2. Snorers with some obstructive respiratory events had a significantly higher number of awakenings, a lower percentage of stage 4 sleep, and a higher number of respiratory events compared with nonsnorers. However, the total number of arousals and the arousal index were similar for both groups. Wakefulness during sleep tended to be longer in snorers than in nonsnorers although differences were not significant. The percentage of respiratory events that terminated with an arousal was greater in snorers who had an AHI of 2 or more than in nonsnorers who had an AHI of less than 2 (mean [SD], 8.4% [9.5%] vs 4.9% [11.53%], P<.05). CONCLUSIONS: These data indicate normal sleep architecture in the adolescents. Although snorers as well as adolescents with some polysomnographic abnormality showed a higher number of respiratory arousals than control subjects, most obstructive events did not terminate with a cortical arousal, which may suggest that adolescents share with younger children this mechanism for preserving sleep architecture.

Dynamic study of excited state hydrogen-bonded complexes of harmane in cyclohexane-toluene mixtures.

Photoinduced proton transfer reactions of harmane or 1-methyl-9H-pyrido[3,4-b]indole (HN) in the presence of the proton donor hexafluoroisopropanol (HFIP) in cyclohexane-toluene mixtures (CY-TL; 10% vol/vol of TL) have been studied. Three excited state species have been identified: a 1:2 hydrogen-bonded proton transfer complex (PTC), between the pyridinic nitrogen of the substrate and the proton donor, a hydrogen-bonded cation-like exciplex (CL*) with a stoichiometry of at least 1:3 and a zwitterionic exciplex (Z*). Time-resolved fluorescence measurements evidence that upon excitation of ground state PTC, an excited state equilibrium is established between PTC* and the cationlike exciplex, CL*, lambdaem approximately/= 390 nm. This excited state reaction is assisted by another proton donor molecule. Further reaction of CL* with an additional HFIP molecule produces the zwitterionic species, Z*, lambda(em) approximately/= 500 nm. From the analysis of the multiexponential decays, measured at different emission wavelengths and as a function of HFIP concentration, the mechanism of these excited state reactions has been established. Thus, three rate constants and three reciprocal lifetimes have been determined. The simultaneous study of 1,9-dimethyl-9H-pyrido[3,4-b]indole (MHN) under the same experimental conditions has helped to understand the excited state kinetics of these processes.

Are virtues national, supranational, or universal?

Many studies investigated cultural differences in values, most notably by Hofstede and Schwarz. Relatively few have focused on virtues, a related and important concept in contemporary social science. The present paper examines the similarities and differences between nations, or blocks of - culturally related - nations on the perceived importance of virtues. Adults (N = 2.809 students) from 14 countries were asked to freely mention which virtues they found important to practice in daily life, and next to rate a list of 15 virtues, which reflect the most frequently mentioned categories in The Netherlands, as found in a previous study. The 14 nations included the United States, Mexico, nine European and three Asian nations. For the free-listed virtues, we compared the top-ten lists of most frequently mentioned virtues across the nations. We used a correspondence analysis on the frequency table to assess the relationships between the virtues and nations. For the 15 virtues ratings, a MANOVA, and follow-up ANOVA's were used to examine effects of nation, age, gender and religion. We found strong evidence for relationships between nations and blocks of culturally related nations and the importance attached to various virtues. There appear to be some country specific virtues, such as generosity in France, but also some relatively universal virtues, most notably honesty, respect, and kindness.