Prospects for the convergence of polyphenols with pharmaceutical drugs in Type 2 Diabetes: challenges, risks, and strategies.

Type 2 diabetes mellitus (T2DM) is a complex disease that can lead to a variety of life-threatening secondary health conditions. Current treatment strategies primarily revolve around tight glucose control that is difficult to achieve and often turns out to be dangerous due to possible hypoglycemic events. Numerous long-term studies have demonstrated that complex pathways, including low-grade inflammation due to fluctuating glucose levels, are involved in the progression of the disease and the development of secondary health conditions. Growing clinical evidence supports the effectiveness of using multiple medications, possibly in combination with insulin, to effectively manage T2DM. On the other hand, despite the huge, largely untapped potential therapeutic benefit of 'polyphenols', there remains a general skepticism of the practice. However, for any evidence-based clinical intervention, the balance of benefits and risks takes center stage and is governed by biopharmaceutics principles. In this article, we outline the current clinical perspectives on pharmaceutical drug combinations, rationale for early initiation of insulin, and the advantages of novel dosage forms to meet the pathophysiological changes of T2DM, emphasizing the need for further clinical studies to substantiate these approaches. We also make the case for traditional medicines and their combinations with pharmaceutical drugs and outline the inherent challenges in doing so, while also providing recommendations for future research and clinical practice. Significance Statement Type 2 diabetes is associated with life-threatening secondary health conditions that are often difficult to treat. This review provides an in-depth account of preventing/delaying secondary health conditions through combination therapies and emphasizes the role of effective delivery strategies in realizing the translation of such combinations. We will build the case for the importance of polyphenols in diabetes, determine the reasons for skepticism, and potential combinations with pharmaceutical drugs.

Site-selective measurement of coupled spin pairs in an organic semiconductor.

From organic electronics to biological systems, understanding the role of intermolecular interactions between spin pairs is a key challenge. Here we show how such pairs can be selectively addressed with combined spin and optical sensitivity. We demonstrate this for bound pairs of spin-triplet excitations formed by singlet fission, with direct applicability across a wide range of synthetic and biological systems. We show that the site sensitivity of exchange coupling allows distinct triplet pairs to be resonantly addressed at different magnetic fields, tuning them between optically bright singlet ([Formula: see text]) and dark triplet quintet ([Formula: see text]) configurations: This induces narrow holes in a broad optical emission spectrum, uncovering exchange-specific luminescence. Using fields up to 60 T, we identify three distinct triplet-pair sites, with exchange couplings varying over an order of magnitude (0.3-5 meV), each with its own luminescence spectrum, coexisting in a single material. Our results reveal how site selectivity can be achieved for organic spin pairs in a broad range of systems.

Low-temperature transport properties of photogenerated charges in organic materials.

We report a new experimental method to measure the localization length of photogenerated carriers in an organic donor-acceptor photovoltaic blend by comparing their dielectric and electron spin-resonance susceptibilities, which are simultaneously measured by monitoring the resonance frequency of a superconducting resonator. We show that at cryogenic temperatures excitons are dissociated into long lived states, but that these are confined within a separation of around 4 nm. We determine the Debye and recombination times, showing the coexistence of a fast electrical response corresponding to delocalized motion, with glasslike recombination kinetics.

Blue-phase templated fabrication of three-dimensional nanostructures for photonic applications.

A promising approach to the fabrication of materials with nanoscale features is the transfer of liquid-crystalline structure to polymers. However, this has not been achieved in systems with full three-dimensional periodicity. Here we demonstrate the fabrication of self-assembled three-dimensional nanostructures by polymer templating blue phase I, a chiral liquid crystal with cubic symmetry. Blue phase I was photopolymerized and the remaining liquid crystal removed to create a porous free-standing cast, which retains the chiral three-dimensional structure of the blue phase, yet contains no chiral additive molecules. The cast may in turn be used as a hard template for the fabrication of new materials. By refilling the cast with an achiral nematic liquid crystal, we created templated blue phases that have unprecedented thermal stability in the range -125 to 125 °C, and that act as both mirrorless lasers and switchable electro-optic devices. Blue-phase templated materials will facilitate advances in device architectures for photonics applications in particular.

A new low-dimensional metal, Cs[Pd(S2C2(CN)2)2]·0.5 H2O.

The discovery of a low-temperature superconducting state in organic compounds of the type (TMTSF)2CIO4 (Tc = 1.2 K) and (BEDT-TTF)2AuI2 (TC = 4 K) (where TMTSF is tetramethyltetraselenafulvalene, BEDT-TTF is bis(ethylenedithiolo)tetrathiafalvalene and Tc is the superconducting transition temperature) has stimulated the search for new materials that may show higher values of Tc (refs 1-3). The general problem encountered in molecular charge-transfer salts of this type, which have conduction bands formed by intermolecular overlap of π-electron systems, is that conduction is usually quasi-one-dimensional, with good conduction along the stacking direction. Metals with this one-dimensional character are unstable, and undergo a Peierls transition4 to a semiconducting state at low temperatures. The relatively few exceptions (mentioned above), which remain metallic down to low temperatures, are considered to do so because they show stronger interstack interactions. We report here a new material with inherently two-dimensional interactions between the molecular π-electron systems and which we are able to stabilize as a metal down to low temperatures (1.4 K) under hydrostatic pressure (12 kbar).

High-resolution inkjet printing of all-polymer transistor circuits.

Direct printing of functional electronic materials may provide a new route to low-cost fabrication of integrated circuits. However, to be useful it must allow continuous manufacturing of all circuit components by successive solution deposition and printing steps in the same environment. We demonstrate direct inkjet printing of complete transistor circuits, including via-hole interconnections based on solution-processed polymer conductors, insulators, and self-organizing semiconductors. We show that the use of substrate surface energy patterning to direct the flow of water-based conducting polymer inkjet droplets enables high-resolution definition of practical channel lengths of 5 micrometers. High mobilities of 0.02 square centimeters per volt second and on-off current switching ratios of 10(5) were achieved.

Self-organized discotic liquid crystals for high-efficiency organic photovoltaics.

Self-organization of liquid crystalline and crystalline-conjugated materials has been used to create, directly from solution, thin films with structures optimized for use in photodiodes. The discotic liquid crystal hexa-peri-hexabenzocoronene was used in combination with a perylene dye to produce thin films with vertically segregated perylene and hexabenzocoronene, with large interfacial surface area. When incorporated into diode structures, these films show photovoltaic response with external quantum efficiencies of more than 34 percent near 490 nanometers. These efficiencies result from efficient photoinduced charge transfer between the hexabenzocoronene and perylene, as well as from effective transport of charges through vertically segregated perylene and hexabenzocoronene pi systems. This development demonstrates that complex structures can be engineered from novel materials by means of simple solution-processing steps and may enable inexpensive, high-performance, thin-film photovoltaic technology.

Room temperature magneto-optic effect in silicon light-emitting diodes.

In weakly spin-orbit coupled materials, the spin-selective nature of recombination can give rise to large magnetic-field effects, e.g. on the electro-luminescence of molecular semiconductors. Although silicon has weak spin-orbit coupling, observing spin-dependent recombination through magneto-electroluminescence is challenging: silicon's indirect band-gap causes an inefficient emission and it is difficult to separate spin-dependent phenomena from classical magneto-resistance effects. Here we overcome these challenges and measure magneto-electroluminescence in silicon light-emitting diodes fabricated via gas immersion laser doping. These devices allow us to achieve efficient emission while retaining a well-defined geometry, thus suppressing classical magnetoresistance effects to a few percent. We find that electroluminescence can be enhanced by up to 300% near room temperature in a seven Tesla magnetic field, showing that the control of the spin degree of freedom can have a strong impact on the efficiency of silicon LEDs.

Excitation migration along oligophenylenevinylene-based chiral stacks: delocalization effects on transport dynamics.

Atomistic models based on quantum-chemical calculations are combined with time-resolved spectroscopic investigations to explore the migration of electronic excitations along oligophenylenevinylene-based chiral stacks. It is found that the usual Pauli master equation (PME) approach relying on uncoherent transport between individual chromophores underestimates the excitation diffusion dynamics, monitored here by the time decay of the transient polarization anisotropy. A better agreement to experiment is achieved when accounting for excitation delocalization among acceptor molecules, as implemented in a modified version of the PME model. The same models are applied to study light harvesting and trapping in guest-host systems built from oligomers of different lengths.

Poly(distyrylbenzene-block-sexi(ethylene oxide)), a highly luminescent processable derivative of PPV.

A block copolymer of distyrylbenzene with sexi(ethylene oxide) spacers displays high solid state photoluminescence efficiency (34%). Single layer light-emitting diodes with calcium or aluminium cathodes exhibit luminances over 2000 cd m-2 and efficiencies of 0.5 cd A-1.

Improving adjustment to chronic illness through strategic self-presentation: an experimental study on a renal dialysis unit.

Laboratory studies show that strategic self-presentations strongly influence private self-evaluations. The present study experimentally manipulated self-presentations of dialysis patients' coping skills in order to influence their adjustment. In all, 42 renal dialysis patients matched for diabetes, gender, and dialysis years were randomly assigned to 3 conditions; adjustment was assessed at baseline, post-intervention, and 1 month follow-up. Patients in a self-presentation condition selectively presented themselves as successful copers in a videotaped interview, ostensibly as part of a training program for new patients. Patients in a problem disclosure condition discussed problems with managing their illness. Control group patients viewed a medical videotape about adjusting to dialysis. Patients in the self-presentation condition reported better adjustment, fewer physical symptoms, and more coping skills 1 month later, compared with patients in the other 2 conditions. In addition, coping skills were shown to mediate the relationship between strategic self-presentation and adjustment.

Fluid noncompliance and symptomatology in end-stage renal disease: cognitive and emotional variables.

Fluid noncompliance in patients with end-stage renal disease (ESRD) is a widespread problem with severe consequences for health. In addition, ESRD patients report considerable stress in relation to their illness and dialysis treatment. The present study examined the role of cognitive and emotional variables in fluid noncompliance, symptomatology, and stress. Fifty hemodialysis patients were assessed (a) on the cognitive variables of locus of control, self-evaluations of their past compliance, and self-efficacy to resist fluid intake and (b) on the emotional variables of depression, anger, and anxiety. Results showed that cognitive variables accounted for fluid noncompliance and predicted future adherence. Patients high in negative emotions complied equally as well as patients low in negative emotions but were found to report substantially more symptomatology and distress associated with their treatment. The implications of these findings for treatment of ESRD patients and future research are discussed.

Burden of self-care in seriously ill patients: impact on adjustment.

Perceived, but not actual, control over the treatment has been consistently related to better adjustment in chronic illness. This study examined the relationship between actual control over treatment and severity of illness and their influence on depression in a chronically ill population of end-stage renal disease (ESRD) patients. The authors hypothesized that as severity of illness increases, the burden of control over treatment would increase depression. Severity of illness and depression were assessed for 98 ESRD patients. Control over treatment was represented by whether dialysis patients were self-administering treatment (high control) or were receiving treatment from the medical staff (low control). Results indicated that for the most severely ill patients, high control over treatment resulted in poorer adjustment. Furthermore, this effect was due in part to how illness interferes with social relationships in seriously ill, self-care patients.

Reducing denial and sexual risk behaviors in college students: a comparison of a cognitive and a motivational approach.

This study compared two interventions designed to decrease denial of sexually transmitted disease (STD)/human immunodeficiency virus (HIV) risk, to increase purchase of and intent to use condoms, and to decrease sexual risk behaviors. One hundred and fifty sexually active male and female undergraduates were assessed at baseline for denial of STD/HIV risk, knowledge of sexual risk behaviors, and self-reports of sexual behavior and were randomly assigned to either a motivational or cognitive intervention or a control condition. After the intervention, subjects were offered the opportunity to purchase condoms and were assessed for denial and intent to use condoms. Two months later, sexual risk behaviors and denial were measured. The motivational approach was most effective in reducing denial and in increasing intent to use condoms immediately following the intervention and in reducing sexual risk behaviors 2 months later.

Interpersonal expectations, social support, and adjustment to chronic illness.

Chronic illness places considerable burdens on patients and their interpersonal relations with families. In this study, patients' perceptions of family and medical staff expectations regarding responsibility for care and routine functions were examined. The authors hypothesized that a patient's perceived inability to meet others' expectations about coping with illness would lead to poorer adjustment. Forty-two chronically ill patients were assessed prospectively for perceptions of others' expectations, social support, and psychological adjustment. Findings confirmed that expectations predicted subsequent decreases in psychological adjustment over a 3-month period, even when social support was controlled. A test of the reverse hypothesis showed that poorly adjusted patients did not misperceive others' expectations. Theoretical interpretations of the findings and their relation to social support research are discussed.

Weight reduction and fluid intake in an obese and fluid noncompliant ESRD patient.

This case study describes the application of a behavioral weight reduction program to an obese ESRD patient who was also fluid noncompliant. The major purpose of the study was to determine whether the behavioral weight reduction program could be successfully applied to a hemodialysis patient, and if so, what effect reduced caloric intake would have on fluid intake. Based on animal and human studies showing a strong relation between eating and drinking, it was expected that body weight reduction would be accompanied by reduced fluid intake. On the other hand, an alternative psychological hypothesis suggested that increased fluid intake might be substituted for reduced food intake. The results of the weight reduction program indicated that a successful weight reduction of 42 lbs was maintained over an 18-month follow-up period. However, fluid intake increased during periods when caloric intake was reduced. Overall, the results indicated that behavioral weight reduction programs can be successfully applied to weight reduction in obese hemodialysis patients but that ways to avoid increased fluid intake need to be carefully addressed by such programs.

Accuracy or bias in nurses' ratings of patient compliance: a comparison of treatment modality.

OBJECTIVE: The study examined the accuracy of nurses' assessments of patient compliance and identified factors influencing these assessments, including possible biases. DESIGN: Nurses' assessments of compliance, lab serum levels of dietary compliance, and interdialytic weight gain (IWG) were collected and compared to each other. End-stage renal disease (ESRD) patients on peritoneal dialysis (PD) and hemodialysis (HD) were compared on these measures and their compliance. SETTING: The study was conducted at the tertiary care university hospital at Stony Brook. PATIENTS: Data were collected for 62 ESRD patients (38 male, 24 female; mean age 54 years). The sample consisted of 26 HD and 36 PD patients. INTERVENTIONS: Nurses rated patients' compliance with fluid restrictions (HD patients only) and overall dietary compliance, as well as individual indicators of compliance including protein, potassium, and phosphorus compliance on a 7-point rating scale. Interdialytic weight gain, dietary (serum BUN and K levels), and medication compliance were recorded from charts for a 3-month period for each patient. MAIN OUTCOME MEASURES: The main outcome measures were the correlations between nurses' ratings of compliance and medical compliance data and the regression coefficients, which indicate the relative importance of each of the factors that nurses use to make their compliance ratings. RESULTS: Nurses' ratings for patients in both treatment modalities were highly correlated with the medical data for measures of fluid (r = 0.66, p < 0.001), potassium (r = 0.36, p < 0.01), and phosphorus (r = 0.36, p < 0.01). A regression analysis indicates that potassium (beta = 0.48, p < 0.001), phosphorus (beta = 0.19, p < 0.05), and protein (beta = 0.31, p < 0.01) all significantly contributed to nurses' assessments of patients' overall compliance. However, nurses' ratings of education levels for patients in both treatment modalities were not associated with phosphorus (r = 0.07, p < 0.61), protein (r = 0.18, p < 0.23), or potassium (r = 0.03, p < 0.85) measures. Finally, regressions revealed that nurses used personal knowledge of the patients when rating noncompliant patients (beta = 0.49, p < 0.05) but not when rating compliant patients (beta = 0.05, p < 0.75). CONCLUSIONS: Nurses rely heavily on medical records to rate patients' compliance and to make accurate assessments. Nurses also use several individual indicators (lab values and IWG) to rate overall dietary compliance, suggesting a thorough assessment. While assessments are not biased by personal factors such as nurses' perceptions of patients' education levels, nurses do rely on personal knowledge when rating noncompliant patients.

The working through of patients' suicides by four therapists.

In 1976 four psychotherapists in training at one institution had patients who committed suicide. The therapists met as a group over a one-year period. This paper presents brief case summaries, explores the reactions of each therapist, presents conclusions regarding the mourning process following patients' suicides, and puts forth implications and suggestions for training programs. The authors conclude that it is necessary for therapists, supervisors, and training programs to recognize the inevitability of crises and tragedies when working with disturbed persons and that, though the process of mourning must be worked through individually, training settings can permit therapists to experience the pain and loneliness while providing opportunities for mastery and growth.

Serum albumin and depression in end-stage renal disease.

The purpose of our study was to determine whether albumin influenced patients' depression or whether depression influenced patients' albumin. Patients from a tertiary care university medical hospital were assessed for both serum albumin and depression [Beck Depression Inventory (BDI)] at two time points separated by 6 months. Data were collected for 72 patients (43 male, 29 female; mean age 54 years). The sample consisted of 32 hemodialysis and 40 peritoneal dialysis patients. The outcome measures were changes in depression and albumin over time. Regression analysis indicated that all three Time 1 measures of BDI, BDICOG (BDI cognitive), and BDISOM (BDI somatic) significantly predicted decreases in albumin from Time 1 to Time 2 (beta = -0.22, p < 0.002; beta = -0.17, p < 0.015; beta = -0.23, p < 0.002, respectively). However, Time 1 measures of albumin did not predict changes in BDI, BDICOG, or BDISOM (beta = -0.04, p < 0.738; beta = -0.08, p < 0.375; beta = -0.07, p < 0.618, respectively). Thus depression at Time 1 predicted decreases in albumin from Time 1 to Time 2. The reverse effect that albumin influences depression from Time 1 to Time 2 was not found. In conclusion, this study suggests that depression influences the nutritional status indicated by albumin levels. Thus poor nutritional status may mediate the relation between depression and mortality in end-stage renal disease (ESRD).

Comparison of quality of life in hemodialysis and peritoneal dialysis patients.

This study was designed to compare severity of illness and quality of life variables in chronic peritoneal dialysis (PD) and hemodialysis (HD) patients. The patient sample consisted of 63 PD patients (38 male, 25 female; mean age 54.5 years) and 35 HD patients (23 male, 12 female; mean age 54.9 years). Disease severity was greater in in-center HD patients than in PD patients (p < 0.008), although there were no significant differences in functional status as measured by the Karnofsky Index between HD patients (68.6 +/- 2.3) and PD patients (71.9 +/- 1.7). While both patient groups reported the same number of overall physical symptoms. HD patients reported significantly greater overall discomfort from symptoms than PD patients (p < 0.008). In terms of psychological adjustment, analyses revealed that 22 PD patients (36.7%) and 9 HD patients (25.7%) were classified as clinically depressed. PD patients reported higher anxiety scores than HD patients (p < 0.02) and lower positive mood scores (p < 0.021). HD patients were more severely ill and appeared to suffer from physical symptomatology to a greater degree than PD patients, although they were not more impaired in terms of functional status. Moreover, HD patients showed better psychological adjustment along several dimensions when compared to PD patients. One reason for this finding may be that PD patients experience greater distress, and isolation due to a lack of social support from similar others and medical staff in comparison to in-center HD patients.