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.].

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.

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.

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.

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.

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.

Intra- and Inter-Physician Agreement in Therapeutic Decision for Sleep Apnea Syndrome / Concordancia intra e inter-médico en la decisión terapéutica para el síndrome de apnea del sueño

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 AHÍ < 40 events/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 AHÍ < 15 events/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

Introducción: La gran variedad de procedimientos diagnósticos y recomendaciones de tratamiento puede dificultar el manejo del síndrome de apnea obstructiva del sueño (SAHS), y del mismo modo comprometer la correcta interpretación de los resultados de ensayos clínicos multicéntricos, especialmente en pacientes con SAHS no grave. El objetivo de este estudio fue analizar la decisión terapéutica de distintos médicos expertos en sueño en pacientes con el índice de apnea hipopnea < 40 eventos/h. Métodos: Se pidió a seis especialistas con amplia experiencia en sueño de diferentes centros de España que tomaran una decisión terapéutica (terapia de presión positiva continua en las vías respiratorias o CPAP) basada en datos anónimos de los pacientes con sospecha de SAHS en los que previamente se había llevado a cabo un estudio del sueño. Los datos clínicos procedían de una base de datos online e incluían características antropométricas, cuestionarios clínicos, comorbilidades, examen físico y resultados del estudio del sueño. La concordancia intra- e interobservador de la toma de decisiones se analizó mediante el estadístico Fleiss' Kappa (Kappa). Resultados: Se analizaron un total de 720 decisiones médicas para evaluar el consenso entre profesionales del sueño. De manera global, la fiabilidad de la evaluación intraobservador fue casi perfecta (Kappa = 0,83; 95% CI; 0,75 a 0,90, p < 0,001). Sin embargo, la concordancia global interobservador disminuyó hasta alcanzar un grado moderado de consenso (Kappa = 0,46; 95% CI; 0,42 a 0,51, p < 0,001), que fue especialmente bajo cuando se tuvo en cuenta un índice de apnea hipopnea < 15 eventos/h. Conclusiones: Este estudio demuestra una buena concordancia intraobservador en la toma de decisiones terapéuticas de distintos médicos expertos en sueño que tratan a pacientes con SAHS leve o moderado. Sin embargo, los resultados relativos al acuerdo interobservador fueron notablemente peores. Estos hallazgos señalan la importancia de desarrollar mejores protocolos consensuados de manejo

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.

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.

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.

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.

Using moxibustion in primary healthcare to correct non-vertex presentation: a multicentre randomised controlled trial.

OBJECTIVE: To compare the effectiveness of additional moxibustion at point BL67 with moxibustion at a non-specific acupuncture point and with usual care alone to correct non-vertex presentation. METHODS: This was a multicentre randomised controlled trial in which 406 low-risk pregnant women with a fetus in ultrasound breech presentation, with a gestational age of 33-35 weeks, were assigned to (1) true moxibustion at point BL67 plus usual care; (2) moxibustion at SP1, a non-specific acupuncture point (sham moxibustion) plus usual care; or (3) usual care alone. The primary outcome was cephalic presentation at birth. Women were recruited at health centres in primary healthcare. RESULTS: In the true moxibustion group, 58.1% of the full-term presentations were cephalic compared with 43.4% in the sham moxibustion group (RR 1.34, 95% CI 1.05 to 1.70) and 44.8% of those in the usual care group (RR 1.29, 95% CI 1.02 to 1.64). The reduction in RR of the primary outcome in women allocated to the true moxibustion group compared with the usual care group was 29.7% (95% CI 3.1% to 55.2%) and the number needed to treat was 8 (95% CI 4 to 72). There were no severe adverse effects during the treatment. CONCLUSIONS: Moxibustion at acupuncture point BL67 is effective and safe to correct non-vertex presentation when used between 33 and 35 weeks of gestation. We believe that moxibustion represents a treatment option that should be considered to achieve version of the non-vertex fetus. TRIAL REGISTRATION: Current Controlled Trials ISRCTN10634508.

Spectroscopic study of the ground and excited state prototropic equilibria of 4-azaindole.

The ground and singlet excited state prototropism of 4-azaindole, 4AI, in acid and basic aqueous solutions, inside and outside the pH range, has been systematically studied by using absorption and fluorescence spectroscopic techniques. These studies have thrown light on some interesting aspects on the nature and the photophysics of the 4-AI prototropic species. Thus, the changes of the 4AI absorption spectra reveal the existence of four ground state species; the pyridinic protonated cation, C (pK(a)(C)=7.5±0.1), the neutral molecule, N (pK(a)(N)=15.5±0.5), the pyrrolic deprotonated anion, A, and a previously unnoticed dication, DC (pK(a)(DC)=-4.6±0.4). Besides the emissions of these species, a new fluorescence profile appears in alkaline solutions at around 500nm. This extra band has been ascribed to the neutral phototautomer, NT. What is more relevant to this study is the fact that the position and the intensity of the emission band assigned to the monoprotonated cation are very different from those observed for the normal cation of the 7-azaindole, 7-AI. This together with the fact that for the formation of the DC species a cationic precursor with a quinoid structure must be invoked, have prompted us to assign this cationic emission to the isomeric CI cations. Finally, the excited-state pK(a)s of the prototropic species of 4AI have been theoretically 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.

A photophysical study of the α-carboline (1-azacarbazole) aggregation process.

This paper reports a comprehensive photophysical study of the aggregation process of 1-azacarbazole, or α-carboline (9H-pyrido[2,3-b]indole), AC, in low polar aprotic solvents by using absorption, steady state and time-resolved fluorescence spectroscopic techniques. To ascertain the characteristics of the aggregation process we have studied the changes produced by the increase of the AC concentration and the decrease of the temperature on the absorption and fluorescence spectra of the AC monomer. Previously, to aid the interpretation of these results, the hydrogen bonding interactions of the AC monomer with pyridine, PY, and indole, IND, have been also analyzed. The results obtained from these studies reveal that, under our experimental conditions, AC does not form doubly hydrogen bonded cyclic dimers, (AC)(2), but singly hydrogen bonded open dimers, AC-AC, and open higher aggregates, (-AC-)(n). The formation of these species shifts to the red the absorption spectrum of the AC monomer and quenches its fluorescence.

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.

Electronic spectra and photophysics of the α-carboline (1-azacarbazole) monomer.

The UV-vis electronic absorption and emission spectra of α-carboline or 1-azacarbazole, 9H-pyrido[2,3-b]indole, AC, have been investigated in aprotic solvents. Radiative, k(r), non-radiative, k(nr), rate constants and natural lifetimes, τ(N), of the AC monomer in hexane and acetonitrile, obtained from the experimentally determined fluorescence quantum yields and fluorescence lifetimes, have been compared with those theoretically estimated. The closeness between these experimental and theoretical data, the small Stokes shifts, the mirror image relationship between the absorption and fluorescence spectra and the close correspondence between the absorption and fluorescence excitation spectra, provide good evidences that the emission of AC monomer occurs directly from its lowest singlet excited state. The mono- and multi-parametric analyses of the AC solvatochromism indicate that the polarity-polarizability, the hydrogen bond donor and the hydrogen bond acceptor properties of the solvent preferentially stabilize the singlet excited over the ground state. These analyses also reveal that photoexcitation reinforces the hydrogen bond donor and acceptor properties of the AC, becoming the pyridinic nitrogen atom more basic and the pyrrolic group more acid.

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.

Modified BODE indexes: Agreement between multidimensional prognostic systems based on oxygen uptake.

AIM: It has been recently shown that the original BODE index has a high degree of correlation with two modified BODE indexes using maximal oxygen uptake expressed either as mL/min/kg (mBODE) or as the percentage predicted (mBODE%). In this study we investigated the agreement between the two modified BODE indexes (mBODE and mBODE%) in patients with stable chronic obstructive pulmonary disease (COPD). METHODS: A total of 169 patients with stable COPD were enrolled in this cross-sectional study. Differences between the two mBODE indexes were assessed using kappa coefficients and Bland-Altman plots. One out of every three patients underwent the six-minute walking test to investigate the agreement with the original BODE index. RESULTS: Correlations between the two mBODE indexes with each other (r = 0.96, P < 0.001) and with the original BODE index (mBODE r = 0.88, P < 0.001; mBODE% r = 0.93, P < 0.001) were excellent. However, the two mBODE indexes were significantly different from each other (mBODE 5.27 +/- 2.3 versus mBODE% 4.31 +/- 2.5; P < 0.001). The kappa coefficients were significantly lower (entire study group k = 0.5, P < 0.001) for every GOLD stage. The mean difference between the two mBODE indexes was 0.8 +/- 0.6 units. Differences with the original BODE were higher for the mBODE (1.8 +/- 0.9) than for the mBODE% (0.6 +/- 0.8). CONCLUSIONS: The new mBODE indexes are highly correlated but significantly different from each other. The differences between the novel indexes deserve further scrutiny.