Translation, cultural adaptation and validation of the revised patients' attitudes towards deprescribing (rPATD) questionnaire in Romanian older adults

BACKGROUND

Deprescribing is part of ensuring appropriate medication use and may reduce medication-related harm. Capturing the beliefs and attitudes of patients towards deprescribing by using a validated tool may support optimizing medication use in practice.

OBJECTIVES

To translate, culturally adapt and validate the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire in Romanian and to investigate the attitudes and beliefs of older adults towards deprescribing.

METHODS

The rPATD questionnaire was translated using forward-backward translation into Romanian and culturally adapted. The psychometric properties were evaluated in older adults ≥65 years of age. Structural validity was assessed by item load on factors using an exploratory factor analysis (EFA) which was compared to the original English version and the internal consistency by Cronbach's alpha. Construct validity was evaluated by calculating the Spearman's rank correlation coefficients between the factor scores obtained using the revised version of the Romanian rPATD and scores on the Beliefs about Medicines Questionnaire (BMQ) Specific Concerns Romanian version. Floor and ceiling effect were also examined.

RESULTS

We translated the questionnaire and administered it to 224 participants (median age 72 years [interquartile range: 68.0; 77.0]). In the EFA individual items loaded onto 4 factors, grouped similarly to the English version (Involvement, Burden, Appropriateness, Concerns about Stopping factors). Two items from each of the Involvement and Appropriateness factors were removed to improve factor loading and avoid cross-loading. The Cronbach's alpha values for the 4 factors ranged between 0.522 and 0.773. The scores for Burden and Concerns about Stopping factors were found to be positively correlated with BMQ Specific Concerns score. We identified a ceiling effect for one of the four factors (Involvement) and no floor effects.

CONCLUSIONS

The Romanian rPATD was validated in 4 factor structure similar to the original English questionnaire. The Romanian version of the questionnaire may support the health care professionals in Romania to initiate and support patient-centered deprescribing.

Synthesis, Properties and Adsorption Kinetic Study of New Cross-Linked Composite Materials Based on Polyethylene Glycol Polyrotaxane and Polyisoprene/Semi-Rotaxane

New composite materials were prepared via cross-linking of polyethylene glycol/2-hydroxypropyl-β-cyclodextrins polyrotaxane (PEG/HPβCD) and polyisoprene/HPβCD semi-polyrotaxane (PI/HPβCD SR) with 1,6-hexamethylene diizocyanate (HMDI). Advanced instrumental methods (such WAXS (wide angle X-ray scattering), AFM (atomic force microscopy), SEM (scanning electron microscopy), and thermal and dynamic vapor sorption) were employed for the structural, morphological and thermal characterization of the resulting composite materials. The roughness parameters calculated using AFM indicate a smoother surface for the composite material with 10 wt% of PI/HPβCD SR, denoting that a homogeneous film was obtained. SEM analysis reveals porous morphologies for both composite materials and the pore sizes increase with the increasing concentration of PI/HPβCD SR in the matrix. Dynamic vapor sorption/desorption measurements and type IV isotherms confirmed the hydrophilic and porous materials, which are in agreement with SEM analysis. The composite with a higher PI/HPβCD SR concentration in the matrix showed increased thermal stability than that of the pure cross-linked material. This material was further tested as a sorbent for methylene blue (MB) dye removal from an aqueous solution. The adsorption capacity of the composite film was found to be 2.58 mg g-1 at 25 °C.

Novel Insight into the Photophysical Properties and 2D Supramolecular Organization of Poly(3,4-ethylenedioxythiophene)/Permodified Cyclodextrins Polyrotaxanes at the Air-Water Interface

Two poly(3,4-ethylenedioxythiophene) polyrotaxanes (PEDOT∙TMe-βCD and PEDOT∙TMe-γCD) end-capped by pyrene (Py) were synthesized by oxidative polymerization of EDOT encapsulated into TMe-βCD or TMe-γCD cavities with iron (III) chloride (FeCl₃) in water and chemically characterized. The effect of TMe-βCD or TMe-γCD encapsulation of PEDOT backbones on the molecular weight, thermal stability, and solubility were investigated in depth. UV-vis absorption, fluorescence (F_L), phosphorescence (P_H), quantum efficiencies, and lifetimes in water and acetonitrile were also explored, together with their surface morphology and electrical properties. Furthermore, dynamic light scattering was used to study the hydrodynamic diameter (DH) and z-potential (ZP-ζ) of the water soluble fractions of PEDOT∙TMe-βCD and PEDOT∙TMe-γCD. PEDOT∙TMe-βCD and PEDOT∙TMe-γCD exhibited a sharp monodisperse peak with a DH of 55 ± 15 nm and 122 ± 32 nm, respectively. The ZP-ζ value decreased from -31.23 mV for PEDOT∙TMe-βCD to -20.38 mV for PEDOT∙TMe-γCD, indicating that a negatively charged layer covers their surfaces. Surface pressure-area isotherms and Brewster angle microscopy (BAM) studies revealed the capability of the investigated compounds to organize into sizeable and homogeneous 2D supramolecular assemblies at the air-water interface. The control of the 2D monolayer organization through the thermodynamic parameters of PEDOT∙TMe-βCD and PEDOT∙TMe-γCD suggests potential for a wide range of optoelectronic applications.

Inclusion Complexes of 3,4-Ethylenedioxythiophene with Per-Modified β- and γ-Cyclodextrins

Herein, we report the synthesis of inclusion complexes (ICs) based on 3,4-ethylenedioxythiophene (EDOT) with permethylated β-cyclodextrins (TMe-βCD) and permethylated γ-cyclodextrins (TMe-γCD) host molecules. To prove the synthesis of such ICs, molecular docking simulation, UV-vis titrations in water, ¹H-NMR, and H-H ROESY, as well as matrix-assisted laser desorption ionization mass spectroscopy (MALDI TOF MS) and thermogravimetric analysis (TGA) were carried out on each of the EDOT∙TMe-βCD and EDOT∙TMe-γCD samples. The results of computational investigations reveal the occurrence of hydrophobic interactions, which contribute to the insertion of the EDOT guest inside the macrocyclic cavities and a better binding of the neutral EDOT to TMe-βCD. The H-H ROESY spectra show correlation peaks between H-3 and H-5 of hosts and the protons of the guest EDOT, suggesting that the EDOT molecule is included inside the cavities. The MALDI TOF MS analysis of the EDOT∙TMe-βCD solutions clearly reveals the presence of MS peaks corresponding to sodium adducts of the species associated with the complex formation. The IC preparation shows remarkable improvements in the physical properties of EDOT, rendering it a plausible alternative to increasing its aqueous solubility and thermal stability.

Multi-site validation of shipping noise maps using field measurements

Underwater radiated noise from shipping is globally pervasive and can cause deleterious effects on marine life, ranging from behavioural responses to physiological effects. Acoustic modelling makes it possible to map this noise over large areas and long timescales, and to test mitigation scenarios such as ship speed reduction or spatial restrictions. However, such maps must be validated against measurements to ensure confidence in their predictions. This study carried out a multi-site validation of the monthly and annual shipping noise maps for 2019 produced as part of the Joint Monitoring of Ambient Noise in the North Sea (JOMOPANS) programme. Spectral, spatial, and temporal differences between predictions and measurements were analysed, with differences linked to uncertainty in model input data and additional sources of anthropogenic noise in the measurements. Validating shipping noise models in this way ensures they can be applied with confidence in future management decisions to address shipping noise pollution.

Synthesis, Photophysics, and Langmuir Films of Polyfluorene/Permodified Cyclodextrin Polyrotaxanes

In the present study, we investigated the effect of permodified 2,3,6-tri-O-trimethylsilyl β- and γ-cyclodextrin (TMS·β-CD, TMS·γ-CD) encapsulation on the optical, electrochemical, morphological, and supramolecular arrangements of a poly[2,7'-(9,9-dioctylfluorene-alt-2',7-fluorene)] PF copolymer. For this purpose, the photophysical properties and Langmuir monolayer formation of PF·TMS·β-CD and PF·TMS·γ-CD polyrotaxanes were investigated and compared with those of the reference PF. Surface pressure-area isotherms and Brewster angle microscopy studies indicated the capability of both polyrotaxanes to organize into larger and homogeneous 2D supramolecular assemblies at the air-water interface. The obtained results suggest that the presence of the surrounding TMS·β-CD and TMS·γ-CD macrocycles on the PF backbones leads to changes in the conformation and hydrophobicity of the film surfaces. Our investigation offers a method to assess the impact of TMS-CD encapsulation on the control of 2D monolayer formation, with particular attention on the generation of stable PF monolayers for organic electronic devices.

Synthesis and Characterization of a Fully Aromatic Polyazomethine with Main Chain Rotaxane Architecture

A new aromatic polyazomethine with rotaxane architecture containing a blocking group in every structural unit has been synthesized by polycondensation of 3,6-diformyl-9-butyl carbazole with p,p′-diaminobiphenyl (benzidine)/β-cyclodextrin adduct. As compared with polymers obtained in the absence of β-cyclodextrin, this polymer is more hygroscopic and soluble in polar solvents such as DMF and DMSO. The IR, 1H-NMR, GPC and DSC data support the presence of β-cyclodextrin in the polymer chain. Measurements made by gel permeation chromatography of the DMF soluble main-chain polyrotaxane show high molecular weight. This polymer is a light-yellow coloured product and its electrical conductivity is as high as 10−9 S cm−1. Doping with iodine markedly increased the conductivity of the orange-brown coloured semiconductive polyazomethine with a maximum conductivity of 10−6 S cm−1.

Poly(Azomethine)s with Rotaxane Architecture Containing a Blocking Group in Every Structural Unit: Synthesis and Characterization

Poly(azomethine)s with rotaxane architecture containing a blocking group in every structural unit of the polymer chain have been synthesized by polycondensation of 3,6-diformyl-9-butyl carbazole with 1,6-hexamethylenediamine/α-or β-cyclodextrin adducts. As compared with the polymers obtained in the absence of cyclodextrins, these polymers are more hygroscopic and soluble in polar solvents such as dimethylformamide and dimethyl sulfoxide. The infrared, proton nuclear magnetic resonance, gel permeation chromatography and differential scanning calorimetry data support the presence of cyclodextrins in every structural unit of the polymer chain.

Synthesis and photophysical characteristics of polyfluorene polyrotaxanes

Two alternating polyfluorene polyrotaxanes (3·TM-βCD and 3·TM-γCD) have been synthesized by the coupling of 2,7-dibromofluorene encapsulated into 2,3,6-tri-O-methyl-β- or γ-cyclodextrin (TM-βCD, TM-γCD) cavities with 9,9-dioctylfluorene-2,7-diboronic acid bis(1,3-propanediol) ester. Their optical, electrochemical and morphological properties have been evaluated and compared to those of the non-rotaxane counterpart 3. The influence of TM-βCD or TM-γCD encapsulation on the thermal stability, solubility in common organic solvents, film forming ability was also investigated. Polyrotaxane 3·TM-βCD exhibits a hypsochromic shift, while 3·TM-γCD displays a bathochromic with respect to the non-rotaxane 3 counterpart. For the diluted CHCl₃ solutions the fluorescence lifetimes of all compounds follow a mono-exponential decay with a time constant of ≈0.6 ns. At higher concentration the fluorescence decay remains mono-exponential for 3·TM-βCD and polymers 3, with a lifetime τ = 0.7 ns and 0.8 ns, whereas the 3·TM-γCD polyrotaxane shows a bi-exponential decay consisting of a main component (with a weight of 98% of the total luminescence) with a relatively short decay constant of τ₁ = 0.7 ns and a minor component with a longer lifetime of τ₂ = 5.4 ns (2%). The electrochemical band gap (ΔE_g) of 3·TM-βCD polyrotaxane is smaller than that of 3·TM-γCD and 3, respectively. The lower ΔE_g value for 3·TM-βCD suggests that the encapsulation has a greater effect on the reduction process, which affects the LUMO energy level value. Based on AFM analysis, 3·TM-βCD and 3·TM-γCD polyrotaxane compounds exhibit a granular morphology with lower dispersity and smaller roughness exponent of the film surfaces in comparison with those of the neat copolymer 3.

An investigation of the concomitant use of angiotensin-converting enzyme inhibitors, non-steroidal anti-inflammatory drugs and diuretics

OBJECTIVE

To determine in retrospective data the prevalence at hospital discharge of co-prescribing angiotensin-converting enzyme inhibitors (ACE-I) and non-steroidal anti-inflammatory drugs (NSAIDs) and ACE-I/NSAIDs and diuretics and to identify factors associated with the co-prescription. Secondary, we evaluated the extent of serum creatinine and potassium monitoring in patients treated with ACE-I and these associations and determined the prevalence of values above the upper normal limit (UNL) in monitored patients.

PATIENTS AND METHODS

Hospitalized patients with ACE-I in their therapy at discharge were included in 3 groups as follows: ACE-I, DT (double therapy with ACE-I and NSAIDs) and TT (triple therapy with ACE-I, NSAIDs and diuretics) groups. We evaluated differences on demographic characteristics, co-morbidities, medications, laboratory monitoring and quantified the patients with serum creatinine and potassium levels above the UNL using descriptive statistics. Logistic regression analysis with backward elimination was performed to identify significant predictors of combination therapy.

RESULTS

Of 9960 admitted patients, 1214 were prescribed ACE-I, 40 were prescribed ACE-I/NSAIDs and 22 were prescribed ACE-I/NSAIDs/diuretics (3.13% and 1.72%, respectively, of the patients prescribed with ACE-I). Serum creatinine and potassium were monitored for the great majority of patients from all groups. The highest percentage of hyperkalemia was found in the DT group (10% of the patients) and of serum creatinine above UNL in the TT group (45.45%). The logistic regression final model showed that younger patients and monitoring for potassium were significantly associated with combination therapy.

CONCLUSIONS

The prevalence of patients receiving DT/TT was relatively low and their monitoring during hospitalization was high. Factors associated with the combinations were younger patients and patients not tested for serum potassium.

The effect of permodified cyclodextrins encapsulation on the photophysical properties of a polyfluorene with randomly distributed electron-donor and rotaxane electron-acceptor units

We report on the synthesis as well as the optical, electrochemical and morphological properties of two polyrotaxanes (4a and 4b), which consist of electron-accepting 9,9-dicyanomethylenefluorene 1 as an inclusion complex in persilylated β- or γ-cyclodextrin (TMS-β-CD, TMS-γ-CD) (1a, 1b) and methyltriphenylamine as an electron-donating molecule. They are statistically distributed into the conjugated chains of 9,9-dioctylfluorene 3 and compared with those of the corresponding non-rotaxane 4 counterpart. Rotaxane formation results in improvements of the solubility, the thermal stability, and the photophysical properties. Polyrotaxanes 4a and 4b exhibited slightly red-shifted absorption bands with respect to the non-rotaxane 4 counterpart. The fluorescence lifetimes of polyrotaxanes follow a mono-exponential decay with a value of τ = 1.14 ns compared with the non-rotaxane, where a bi-exponential decay composed of a main component with a relative short time of τ₁ = 0.88 (57.08%) and a minor component with a longer lifetime of τ₂ = 1.56 ns (42.92%) were determined. The optical and electrochemical band gaps (ΔE_g) as well as the ionization potential and electronic affinity characterized by smaller values compared to the values of any of the constituents. AFM reveals that the film surface of 4a and 4b displays a granular morphology with a lower dispersity supported by a smaller roughness exponent compared with the non-rotaxane counterpart.

Anionic ring-opening polymerization of ethylene oxide in DMF with cyclodextrin derivatives as new initiators

Anionic polymerization initiated by cyclodextrins suffers from a poor solubility of those derivatives in standard polymerization solvents. The possibility to perform ethylene oxide polymerization initiated by monofunctional initiators (allyl alcohol, 2-methoxyethanol) by living ring opening polymerization in DMF, a good solvent for any CD derivative, was demonstrated by SEC, (1)H and (13)C NMR analyses. The study was extended to the use of native CD as initiator, leading to the synthesis of ill-defined structures, explained by the reactivity scale of the various hydroxyl functions. Two selectively modified CD derivatives are then used to synthesize a new family of star-shaped poly(ethylene oxide) polymers with CD core, having 14 or 21 arms. The polymerization was found to be living and DOSY experiments confirmed the well-defined structures for the synthesized star-polymers.

Synthesis and characterization of low-molecular-weight π-conjugated polymers covered by persilylated β-cyclodextrin

The paper reports the preparation of a poly[2,7-(9,9-dioctylfluorene)-alt-5,5'-bithiophene/PS-βCD] (PDOF-BTc) polyrotaxane copolymer, through a Suzuki coupling reaction between the 5,5^'-dibromo-2,2'-bithiophene (BT) inclusion complex with persilylated β-cyclodextrin (PS-βCD), and 9,9-dioctylfluorene-2,7-bis(trimethylene borate) (DOF) as the blocking group. The chemical structure and the thermal and morphological properties of the resulting polyrotaxane were investigated by using NMR and FT-IR spectroscopy, TGA, DSC and AFM analysis. The encapsulation of BT inside the PS-βCD cavity results in improvements in the solubility, as well as in different surface morphology and thermal properties of the PDOF-BTc rotaxane copolymer compared to its noncomplexed PDOF-BT homologue. In contrast, the number-average molecular weight (M_n) of PDOF-BTc rotaxane copolymer indicated lower values suggesting that the condensation reaction is subjected to steric effects of the bulkier silylated groups, affecting the ability of the diborate groups from the DOF molecule to partially penetrate the PS-βCD cavity.

Synthesis and Characterization of Polyrotaxanes based on Cyclodextrins and Viologen-modified Polydimethylsiloxanes

β-Cyclodextrin ( 1 -CD) and 2 -cyclodextrin ( 2 -CD) (hosts) formed inclusion complexes with 4,41-bipyridinium dication derivatives with long chains (guests), in which the substituents on the bipyridinium nitrogen atoms are 1,3-bis(chloromethylphenethyl)-1,1,3,3-tetramethyldisiloxane. The number of 2 -CD molecules threaded onto the polymer chain increases with the length of the guest chain. In contrast, the number of β-CD molecules threaded onto the polymer is approximately 4 corresponding to each molecular chain, due to the repulsive interaction between β-CD and the quaternary bipyridinium units. The complexes were isolated in high yield and characterized by 1H NMR, 13C NMR, X-ray diffraction, thermal and scanning electron micrographs studies. As proven by X-ray analysis, the synthesized polyrotaxanes are crystalline materials with crystalline patterns significantly different from that of native cyclic oligosaccharide. The thermal stabilities of polyrotaxanes are higher than that of the physical mixture between cyclodextrin and the alternating copolymer, denoting the formation of the inclusion complexes. Scanning electron micrographs of polyrotaxanes reveal cubic and linear shapes without a well formed shape. Shape regularity and geometrical regularities in the agglomerating forms can be observed.

Polyrotaxanes composed of β-cyclodextrin and polydimethylsiloxanes: synthesis, morphology and thermal behavior

Epoxy-terminated polydimethylsiloxanes (E-PDMSs) of different molecular weight Mn were proved to undergo inclusion complexation into the inner cavity of β-cyclodextrin (β-CD), resulting in polyrotaxanes (PRots). The dethreading of the macrocycle was prevented by blocking the siloxane chain with a bulky substituent derived from 4-aminophenyltriphenyl methane (APhTPhM). As revealed by thermogravimetric analysis, differential scanning calorimetry, scanning electron microscopy (SEM), wide-angle X-ray diffraction and statistical analysis of SEM images, the thermal properties and the morphology of polyrotoxanes are dependent upon Mn, β-CD/E-PDMS molar ratio and the presence of free β-CD in the complexes.

Synthesis and characterization of new phenanthrolinetriether copolymers with rotaxane architecture

This paper is devoted to the preparation and characterization of new phenanthroline-triether copolymers with rotaxane architecture by reaction of complexes of α- or β- cyclodextrin and tri(ethylene glycol) ditosylate with 2,9-di(4-hydroxyphenyl)-1,10- phenanthroline, which is large enough to prevent dethreading of cyclodextrin molecules. Comparative 1H-NMR analysis of tri(ethylene glycol) ditosylate complexes and of rotaxane copolymers evidenced the lower cyclodextrin content in rotaxane copolymers as compared to the calculated values. The rotaxane copolymers present bimodal molecular weight distributions attributed to the separation of the fractions with different content of cyclodextrin threaded on the copolymer chain. As evidenced by thermogravimetric analysis, the rotaxane copolymers show higher thermal stability than its non-complexed homologue.

Cerebrospinal fluid and serum immunoglobulins and C3 in Creutzfeldt-Jakob disease

We determined the concentrations of IgA, IgG, and C3 in spinal fluid and IgA, IgG, IgM, and C3 in serum from seven patients with histologically revified Creutzfeldt-Jakob disease. The mean total protein content in spinal fluid was significantly higher than in controls. The increased mean concentrations of IgA, IgG, and C3 in spinal fluid, and their respective mean percentages in spinal fluid, suggest a passage of IgG and C3 from blood into spinal fluid, and a possible production of IgA within the central nervous system.

The concentration of alpha-1-antitrypsin in cerebrospinal fluid and serum in a series of 40 intracranial tumors

Forty patients with histologically proved intracranial tumors were submitted to preoperative lumbar and venous punctures. The concentration of alpha-1-antitrypsin in the serum and in cerebrospinal fluid was determined by radial immunodiffusion technique. In the series, both serum and cerebrospinal fluid alpha-1-antitrypsin concentrations are significantly higher than the mean normal values. No statistical differences are observed in serum alpha-1-antitrypsin levels between benign and malignant tumors, but cerebrospinal fluid alpha-1-antitrypsin is significantly increased in the group of malignant tumors if cases undergoing steroid treatment are excluded. The diagnostic value of alpha-1-antitrypsin determinations in groups of patients with intracranial tumors is suggested.