QUIT EMR trial: a prospective, observational, multicentre study to evaluate quality and 24†hours post-transport morbidity of interhospital transportation of critically ill patients: study protocol.

INTRODUCTION: It is widely accepted that transportation of critically ill patients is high risk. Unfortunately, however, there are currently no evidence-based criteria with which to determine the quality of various interhospital transport systems and their impact on the outcomes for patients. We aim to rectify this by assessing 2 scores which were developed in our hospital in a prospective, observational study. Primarily, we will be examining the Quality of interhospital critical care transportation in the Euregion Meuse-Rhine (QUIT EMR) score, which focuses on the quality of the transport system, and secondarily the SEMROS (Simplified EMR outcome score) which detects changes in the patient's clinical condition in the 24 hours following their transportation. METHODS AND ANALYSIS: A web-based application will be used to document around 150 pretransport, intratransport and post-transport items of each patient case.To be included, patients must be at least 18-years of age and should have been supervised by a physician during an interhospital transport which was started in the study region.The quality of the QUIT EMR score will be assessed by comparing 3 predefined levels of transport facilities: the high, medium and low standards. Subsequently, SEMROS will be used to determine the effect of transport quality on the morbidity 24 hours after transportation.It is estimated that there will be roughly 3000 appropriate cases suitable for inclusion in this study per year. Cases shall be collected from 1 April 2015 until 31 December 2017. ETHICS AND DISSEMINATION: This trial was approved by the Ethics committees of the university hospitals of Maastricht (Netherlands) and Aachen (Germany). The study results will be published in a peer reviewed journal. Results of this study will determine if a prospective randomised trial involving patients of various categories being randomly assigned to different levels of transportation system shall be conducted. TRIAL REGISTRATION NUMBER: NTR4937.

Helical aromatic oligoamide foldamers as organizational scaffolds for photoinduced charge transfer.

Here we report the synthesis and characterization of four quinoline-derived foldamers with increasing oligomeric length; dimer O2P, tetramer O4P, pentamer O5P, and nonamer O9P functionalized with on one end an oligo(p-phenylene vinylene) (OPV) and on the other end a perylene bisimide (PB) chromophore. (1)H NMR confirms the formation of the expected folded structures in both toluene and chloroform solution. The structural predictability and rigidity of the oligomeric series enabled us to investigate the effect of a helical bridge and chromophore position on the photoinduced processes in the electron OPV-PB donor-acceptor pair in chloroform and toluene. The helical properties of the bridge ensured that the chromophore separation distance through space is different from the separation distance through the bridge. For all foldamer-solvent combinations studied, excitation of either OPV or PB results in nearly quantitative quenching of the fluorescence indicating a fast charge separation reaction between the OPV and PB. Femtosecond photoinduced absorption measurements confirmed the fast formation of a charge-separated state. The recombination reaction involves a combination of direct decay to the ground state and the formation of an intermediate triplet state, with their balance depending on the foldamer-solvent combination. Molecular orbital calculations rationalize the fast photoinduced charge separation, by revealing that the bridging foldamer mediates the charge transfer from donor to acceptor via the superexchange mechanism. Remarkably low attenuation factors (beta(CS) approximately 10(-2) A(-1)) were obtained using either through space or through bridge separation distance. However, in these calculations only three of the four foldamers show the expected linear behavior between the logarithm of the charge separation rate constant and the distance between the chromophores. The combined results show when a helical bridge is separating the charge transfer couple, hampering the usefulness of a uniform description of the charge-separation phenomena.

PbSe nanocrystal network formation during pyridine ligand displacement.

Solution-phase pyridine treatment displaced oleic acid capping ligands from the surface of PbSe nanocrystals. During ligand displacement the nanostructure morphology dramatically changed from well-stabilized, individual nanocrystals to form crystallographically connected nanocrystal networks. The network morphology was governed by the diameter of the constituent nanocrystals. Larger nanocrystals showed dipolar alignment but maintained individual nanocrystal character, while smaller nanocrystals crystallographically fused along the <100> axis. Optical studies of nanocrystal thin films showed that pyridine ligand displacement quenches the nanocrystal photoluminescence. Blends of nanocrystals and conjugated polymer showed photoluminescence quenching of the polymer with increasing nanocrystal content. The extent of photoluminescence quenching was only weakly dependent on the nanocrystal size or surface chemistry, suggesting that the interaction between nanocrystal and polymer is mostly in the form of energy transfer rather than charge transfer.

Molecular recognition in bisurea thermoplastic elastomers studied with pyrene-based fluorescent probes and atomic force microscopy.

Fluorescence spectroscopy and atomic force microscopy (AFM) measurements using bisurea-pyrene probes show that they are randomly dispersed in the hard blocks of thermoplastic elastomers with matching bisurea groups, whereas they phase separate from polymers with non-matching or no bisurea groups.

Enhanced intersystem crossing via a high energy charge transfer state in a perylenediimide-perylenemonoimide dyad.

The electronic relaxation processes of a photoexcited linear perylenediimide-perylenemonoimide (PDI-PMI) acceptor-donor dyad were studied. PDI-PMI serves as a model compound for donor-acceptor systems in photovoltaic devices and has been designed to have a high-energy PDI (-*)-PMI (+*) charge transfer (CT) state. Our study focuses on the minimal Gibbs free energy (Delta G ET) required to achieve quantitative CT and on establishing the role of charge recombination to a triplet state. We used time-resolved photoluminescence and picosecond photoinduced absorption (PIA) to investigate excited singlet (S 1) and CT states and complemented these experiments with singlet oxygen ( (1)Delta g) luminescence and PIA measurements on longer timescales to study the population of triplet excited states (T 1). In an apolar solvent like cyclohexene (CHX), photoinduced electron transfer does not occur, but in more polar solvents such as toluene (TOL) and chlorobenzene (CB), photoexcitation is followed by a fast electron transfer, populating the PDI (-*)-PMI (+*) CT state. We extract rate constants for electron transfer (ET; S 1-->CT), back electron transfer (BET; S 1<--CT), and charge recombination (CR) to lower-energy states (CT-->S 0 and CT-->T 1). Temperature-dependent measurements yield the barriers for the transfer reactions. For ET and BET, these correspond to predictions from Marcus-Jortner theory and show that efficient, near quantitative electron transfer ( k ET/ k BET >or= 100) can be obtained when Delta G ET approximately -120 meV. With respect to triplet state formation, we find a relatively low triplet quantum yield (Phi T < 25%) in CHX but much higher values (Phi T = 30-98%) in TOL and CB. We identify the PDI (-*)-PMI (+*) state as a precursor to the T 1 state. Recombination to T 1, rather than to the ground-state S 0, is required to rationalize the experimental barrier for CR. Finally, we discuss the relevance of these results for electron donor-acceptor films in photovoltaic devices.

Triplet formation involving a polar transition state in a well-defined intramolecular perylenediimide dimeric aggregate.

A cofacially stacked perylenediimide (PDI) dimer with a xanthene linker was studied under a variety of conditions (solvent, temperature) and serves as a model for the molecular interactions occurring in solid films. Intrinsically, the PDI units have a fluorescence quantum yield (Phi F) close to unity, but Phi F is lowered by a factor of 6-50 at room temperature when two PDI moieties are held in a cofacial arrangement, while the decay time of the most emissive state is increased significantly (tau F = 27 ns in toluene) compared to a monomeric PDI molecule (tau F = 4 ns). Fluorescence measurements show a strong solvent and temperature dependence of the characteristics of the emissive excited state. In a glassy matrix of toluene (TOL) or 2-methyltetrahydrofuran (2-MeTHF), Phi F is high, and the decay time is long (tau F = approximately 50 ns). At higher temperature, both Phi F and tau F are reduced. Interestingly, at room temperature, Phi F and tau F are also reduced with increasing solvent polarity, revealing the presence of a polar transition state. Photoinduced absorption of the stacked molecules from the picosecond to the microsecond time scale shows that after photoexcitation reorganization occurs in the first nanoseconds, followed by intersystem crossing (ISC), producing the triplet excited state. Using singlet oxygen ( (1)Delta g) luminescence as a probe, a triplet quantum yield (Phi T) greater than 50% was obtained in air-saturated 2-Me-THF. Triplet formation is exceptional for PDI chromophores, and the enhanced ISC is explained by a decay involving a highly polar transition state.

Compositional and electric field dependence of the dissociation of charge transfer excitons in alternating polyfluorene copolymer/fullerene blends.

The electro-optical properties of thin films of electron donor-acceptor blends of a fluorene copolymer (PF10TBT) and a fullerene derivative (PCBM) were studied. Transmission electron microscopy shows that in these films nanocrystalline PCBM clusters are formed at high PCBM content. For all concentrations, a charge transfer (CT) transition is observed with absorption spectroscopy, photoluminescence, and electroluminescence. The CT emission is used as a probe to investigate the dissociation of CT excited states at the donor-acceptor interface in photovoltaic devices, as a function of an applied external electric field and PCBM concentration. We find that the maximum of the CT emission shifts to lower energy and decreases in intensity with higher PCBM content. We explain the red shift of the emission and the lowering of the open-circuit voltage (V(OC)) of photovoltaic devices prepared from these blends with the higher relative permittivity of PCBM (epsilon(r) = 4.0) compared to that of the polymer (epsilon(r) = 3.4), stabilizing the energy (E(CT)) of CT states and of the free charge carriers in blends with higher PCBM concentration. We show that the CT state has a short decay time (tau = ca. 4 ns) that is reduced by the application of an external electric field or with increasing PCBM content. The field-induced quenching can be explained quantitatively with the Onsager-Braun model for the dissociation of the CT states when including a high electron mobility in nanocrystalline PCBM clusters. Furthermore, photoinduced absorption spectroscopy shows that increasing the PCBM concentration reduces the yield of neutral triplet excitons forming via electron-hole recombination, and increases the lifetime of radical cations. The presence of nanocrystalline domains with high local carrier mobility of at least one of the two components in an organic heterojunction may explain efficient dissociation of CT states into free charge carriers.

Synthesis and photophysical properties of conjugated polymers with pendant 9,10-anthraquinone units.

We have synthesized and investigated the photophysical properties of a series of electron-donor conjugated copolymers with pendant electron-acceptor units. The copolymers consist of diethynyl-1,4-phenylene, fluorene, or phenylene rings alternating with a phenylene unit bearing a pendant 9,10-anthraquinone moiety. The pendant donor-acceptor polymers were designed to have different optical pi-pi* band gaps, while the oxidation potential of the polymer backbone remains approximately constant in the series. The reduction potential of the donor-acceptor polymers is associated with the pendant acceptor units. This leads to the special situation that the electrochemical gap between oxidation and reduction potentials is constant, while the optical band gap decreases, going from PPP, via PPF, to PPE. This design is used to study the effect of the optical gap on the photoinduced electron-transfer reaction that occurs between the main chain electron donor and the pendant acceptor, while the same polymer architecture and energy of the charge separated state are maintained. Fluorescence and photoinduced absorption spectroscopy are used to study the electron transfer following photoexcitation in relation to solvent polarity and in thin solid films. For the fluorene-phenylene alternating copolymer, intramolecular photoinduced electron transfer occurs in the Marcus optimal region.

Tetrafullerene conjugates for all-organic photovoltaics.

The synthesis of two new tetrafullerene nanoconjugates in which four C60 units are covalently connected through different pi-conjugated oligomers (oligo(p-phenylene ethynylene) and oligo(p-phenylene vinylene)) is described. The photovoltaic (PV) response of these C60-based conjugates was evaluated by using them as the only active material in organic solar cells, showing a low PV performance. Photophysical studies in solution demonstrated a very fast ( approximately 10 ps) deactivation of the singlet excited state of the central core unit to produce both charge-separated species (i.e., C60*--oligomer+*-(C60)3 and C60 centered singlet excited states). The charge-separated state recombines partly to the C60 centered singlet state that undergoes subsequent intersystem crossing. Photophysical studies carried out in films support these data, exhibiting long-lived triplet excited states. For both tetrafullerene arrays, the low yield of long-lived charge carriers in thin films accounts for the limited PV response. On the contrary, utilizing the oligo(p-phenylene vinylene) centered precursor aldehyde as an electron donor and antennae unit and mixing with the well-known C60 derivative PCBM, the photophysical studies in films show the formation of long-lived charges. The PV devices constructed from these mixtures showed a relatively high photocurrent of 2 mA cm(-2). The sharp contrast between the nanoconjugates and the physical blends tentatively was attributed to improved charge dissociation and the collection of more favorable energy levels in the blends as a result of partial aggregation of both of the components.

Effect of forced-air heaters on perfusion and temperature distribution during and after open-heart surgery.

OBJECTIVES: After cardiopulmonary bypass, patients often show redistribution hypothermia, also called afterdrop. Forced-air blankets help to reduce afterdrop. This study explores the effect of forced-air blankets on temperature distribution and peripheral perfusion. The blood perfusion data is used to explain the observed temperature effects and the reduction of the afterdrop. METHODS: Fifteen patients were enrolled in a randomised study. In the test group (n=8), forced-air warmers were used. In the control group (n=7), only passive insulation was used. Core and skin temperatures and thigh temperatures at 0, 8, 18 and 38 mm depth were measured. Laser Doppler flowmetry (LDF) was used to record skin perfusion from the big toe. Blood flow through the femoral artery was determined with ultrasound. RESULTS: Afterdrop in the test group was smaller than in the control group (1.2+/-0.2 degrees C vs 1.8+/-0.7 degrees C: P=0.04) whilst no significant difference in mean tissue thigh temperature was found between the groups. Local skin temperature was 2.5-3.0 degrees C higher when using forced-air heaters. However, skin perfusion was unaffected. Ultrasound measurements revealed that leg blood flow during the first hours after surgery was reduced to approximately 70% of pre- and peri-operative values. CONCLUSIONS: Forced-air blankets reduce afterdrop. However, they do not lead to clinical relevant changes in deep thigh temperature. LDF measurements show that forced-air heating does not improve toe perfusion. The extra heat especially favours core temperature. This is underlined by the decrease in postoperative leg blood flow, suggesting that the majority of the warmed blood leaving the heart flows to core organs and not to the periphery.

Charge transfer absorption for pi-conjugated polymers and oligomers mixed with electron acceptors.

Pi-conjugated polymers and oligomers show charge transfer (CT) absorption bands when mixed with electron acceptors in chloroform solution. This is attributed to the formation of (ground state) donor-acceptor complexes in solution. By varying the concentration of the donor and acceptor, the extinction coefficient for the CT absorption and the association constant of donor and acceptor are estimated. The spectral position of the CT bands correlates with the electrochemical oxidation potential of the pi-conjugated donor and the reduction potential of the acceptor.

Side chain mediated electronic contact between a tetrahydro-4H-thiopyran-4-ylidene-appended polythiophene and CdTe quantum dots.

The properties of a mixed CdTe quantum dot/tetrahydro-4H-thiopyran-4-ylidene-functionalized polythiophene system are reported. This system was prepared by exposing trioctylphosphine (TOP)-capped CdTe quantum dots to the polythiophene in solution. Strong fluorescence emission quenching and shortening of the fluorescence emission lifetimes of both the polythiophene and the quantum dots occur when they are mixed, indicating the occurrence of photoinduced charge separation. Photoinduced absorption spectroscopy reveals a considerable decrease in the population of the polythiophene triplet excited state in the mixed system. These results demonstrate that between the quantum dots and the polythiophene there is both physical and electronic contact, which is mediated by the tetrahydro-4H-thiopyran-4-ylidene side chains.