Online KidClot education for patients and families initiating warfarin therapy: The eKITE study.

Anticoagulation with Vitamin K antagonists (VKA) has always posed challenges in terms of monitoring requirements. These challenges were further exacerbated in the setting of the COVID-19 pandemic, with limited access to and/or avoidance of laboratory testing. The importance of utilizing point of care (POC) health technology for individualized patient management is salient. The foundation of effective home INR monitoring is establishing patient knowledge about their therapy and INR testing proficiency. The eKITE series was developed to support patients in establishing foundational knowledge required for VKA (warfarin) management and INR monitoring. The primary objectives were to evaluate eKITE, a patient-oriented innovative online education program for warfarin therapy, participant learning stress, and patient preference for online learning. This multi-center prospective study provided patients access to warfarin online education. Participants were required to complete written quizzes assessing warfarin knowledge of key concepts proficiency and identifying knowledge deficits. Patient preference, evaluating calm (lack of anxiety) while learning, and an INR on a home meter was completed. Participants performed INR tests at home and reported INRs by telephone. The analysis included 144 children and caregivers enrolled at five US and CDN sites. Most indications for anticoagulation were cardiac (congenital or acquired heart disease) with varied INR target ranges. Mean knowledge scores for warfarin and INR self-testing modules were 97%, with low anxiety with TTR of 84%. Patient preferred online learning. eKITE is an effective teaching modality for warfarin/home INR monitoring with safe INR testing and warfarin management that is appropriate for pediatrics and adults alike. PROLOGUE: The whir in the hallways is deafening. Lights bright, alarms are ringing in a chorus of unsynchronized beeps and screeches. It has been more than a week since I have slept. Snuggled beside me is my precious child, whining and equally irritated with the asynchronous symphony, further compounded by anxiety, procedures, and pain. The sun has broken. The staff smiles are welcoming and incessant, as one after one, they approach hurried, urgent, assiduous, their need to coach me for our upcoming departure to the warmth of home. Each provides essential information that I will require to keep my child, my treasure, safe and healthy. Yet, my eyes are heavy, blurred, and my brain foggy, trapped in a dark heavy cloud. How am I to follow? Comprehend? and retain anything? As they instruct, my precious child yearns for loving arms, compassion and love, whining, crying in disquiet. Overwhelmed does not adequately describe my ineffable exhaustion. Amidst this, how am I to learn about warfarin? Such a challenging medication, with so much to know. Concentrate, I tell myself, focus; now is my only opportunity to learn. I must be alert. It seems to be nonsensical.

Temperature Dependence of Tryptophan Fluorescence Lifetime as an Indicator of Its Microenvironment Dynamics.

The spectral-kinetic characteristics of the fluorescence of the tryptophan molecule in an aqueous solution and in the composition of a protein (albumin) were studied in the temperature range from -170 to 25°C. To explain the observed changes in the spectra and the tryptophan fluorescence lifetime with temperature, a model of transitions between the excited and ground states involving a charge-transfer state was used, which takes into account the nonlinear nature of the dynamics of these transitions. In these processes, an important role is played by the interaction of tryptophan molecules with its microenvironment, as well as rearrangements in the system of hydrogen bonds of the water-protein matrix surrounding the tryptophan molecule.

Use of a system of differential equations to analyze the functioning of a catalytic bio macromolecule under non equilibrium conditions.

The aim of the work is to analyze the response of a biomolecule to an external influence based on the study of its hidden states by identifying differential equations with constant coefficients. The relevance of the work lies in the fact that often the main reaction of an object to an external action can be represented as a sum of various exponential functions with a common starting point and a material balance equation. In this case, the response of an object to an external action corresponds to a system of differential equations with constant coefficients. This character of the main reaction may be due to the influence of the hidden properties of the object, which play the role of regulatory parameters. The problem is that the hidden factors and the system of differential equations are not identified. As an object, isolated reaction centers (RC) of the bacteria Rhodobacter sphaeroides , which possess the above properties, has used. Their structure is well studied. As result of studying of photo excitation processes of the reaction center has shown that electron transfer kinetics (the main reaction) can be approximated by three normalized exponential functions. Program was developed to identify for four differential equations of electron transfer and the balance equation, the behavior of hidden states of the reaction center. It was concluded that time the dependence the probability density of finding an electron in different conformational states of the reaction center characterizes the space-time changes in the structure of the reaction center.

Intramolecular Mobility Affects the Energy Migration from Quantum Dots to Reaction Centers of Photosynthesizing Bacterium Rb. sphaeroides.

The temperature dependence of the efficiency of energy migration from the CdSe/CdS/ZnS quantum dots (QDs) with a fluorescence maximum at 580 nm to the reaction centers (RCs) of the bacteria Rb. sphaeroides is practically constant over the temperature range from 100 to ~230-240 K but then decreases 2.5-3 times as temperature further increases to 310 K. The analysis on this dependence on the basis of Förster's theory showed that the major changes in the energy transfer efficiency are associated with the temperature change in the quantum yield of QD fluorescence, which is due to the activation of intramolecular mobility in the RC structure.

Relaxation processes accompanying electron stabilization in the quinone acceptor part of Rb. sphaeroides reaction centers.

The temperature dependence of the dark recombination rate in photooxidized bacteriochlorophyll (P) and photoreduced quinone acceptors (ubiquinones) QA and QB of photosynthetic reaction centers of purple bacteria Rhodobacter sphaeroides (Rb. sphaeroides) was studied. Photoinduced changes in the absorption were detected in the Qx absorption band of photooxidized bacteriochlorophyll at 600 nm and in the bands corresponding to the redox changes of ubiquinones at 335 and 420-450 nm. Kinetic analysis was used to evaluate the activation energy and the characteristic time of the transient process of relaxation accompanying electron stabilization at the final quinone acceptor. A comparative study of the kinetics of oxidation-reduction reactions of photoactive bacteriochlorophyll RC purple bacteria and quinone acceptors in their individual absorption bands is an informative approach to studying the mechanisms of this stabilization. The analysis of the revealed kinetic differences makes it possible to estimate the activation energy and the characteristic times of the transition relaxation processes associated with the stabilization of the electron in the quinone acceptor part of RC. Purple bacterial reaction centers have fundamental similarities with PSII reaction centers. Such a similarity represents evolutional closeness between the two types of RC. So it is possible that the photoinduced charge separation in PSII RC, as well as in purple bacteria RC, is also accompanied by definite conformational changes. The possible role of hydrogen bonds of surrounding protein in the relaxation processes accompanying the electron transfer to quinone acceptors is discussed.

Temperature Dependence of Tryptophan Fluorescence Lifetime in Aqueous Glycerol and Trehalose Solutions.

The temperature dependences of tryptophan fluorescence decay kinetics in aqueous glycerol and 1 M trehalose solutions were examined. The fluorescence decay kinetics were recorded in the spectral region of 292.5-417.5 nm with nanosecond time resolution. The kinetics curves were approximated by the sum of three exponential terms, and the spectral distribution (DAS) of these components was determined. An antisymbatic course of fluorescence decay times of two (fast and medium) components in the temperature range from -60 to +10°C was observed. The third (slow) component showed only slight temperature dependence. The antisymbatic behavior of fluorescence lifetimes of the fast and medium components was explained on the assumption that some of the excited tryptophan molecules are transferred from a short-wavelength B-form with short fluorescence lifetime to a long-wavelength R-form with an intermediate fluorescence lifetime. This transfer occurred in the indicated temperature range.

Generation of radical form of dipyridamole at illumination of photosynthetic reaction centers of Rb. sphaeroides.

The study of the effect of vasodilator, antiplatelet agent, and inhibitor P-glycoprotein dipyridamole (DIP) on the functioning of the transmembrane protein of the reaction center (RC) of Rb. sphaeroides showed that the activation of RC by constant light generates the DIP radical cation, which significantly affects the kinetics of recombination of charges divided between photoactive bacteriochlorophyll and quinone acceptors. Thus, the antioxidant properties of DIP may affect the functional activity of membrane proteins, and this apparently should be taken into account in the studies of the mechanisms of therapeutic action of this drug.

Influence of trehalose on high-temperature stability of the photosynthetic reaction centers.

The effect of heating at 65°C for 20 min on the absorption spectra and kinetics of the dark recombination of charges separated between photoactive bacteriochlorophyll and quinone acceptors was studied in dry films of bacterial photosynthetic reaction centers (RCs), RC films in polyvinyl alcohol, and trehalose. A pronounced protective effect of trehalose against pheophytinizaiton of molecules bacteriochlorophylls in RC structure and in maintaining their higher photochemical activity was found.

The kinetic model for slow photoinduced electron transport in the reaction centers of purple bacteria.

The present work is related to the investigation of slow kinetics of electron transport in the reaction centers (RCs) of Rhodobacter sphaeroides. Experimental data on the absorption kinetics of aqueous solutions of reaction centers at different modes of photoexcitation are given. It is shown that the kinetics of oxidation and reduction of RCs are well described by the sum of three exponential functions. This allows to suggest a two-level kinetic model for electron transport in the RC as a system of four electron-conformational states which correspond to three balance differential equations combined with state equation. The solution of inverse problem made it possible to obtain the rate constant values in kinetic equations for different times and intensities of exciting light. Analysis of rate constant values in different modes of RC excitation allowed to suggest that two mechanisms of structural changes are involved in RC photo-oxidation. One mechanism leads to the increment of the rate of electron return, another one-to its drop. Structural changes were found out to occur in the RCs under incident light. After light was turned off, the reduction of RCs was determined by the second mechanism.

Temperature dependence of protein fluorescence in Rb. sphaeroides reaction centers frozen to 80 K in the dark or on the actinic light as the indicator of protein conformational dynamics.

The differences in the average fluorescence lifetime (τav) of tryptophanyls in photosynthetic reaction center (RC) of the purple bacteria Rb. sphaeroides frozen to 80 K in the dark or on the actinic light was found. This difference disappeared during subsequent heating at the temperatures above 250 K. The computer-based calculation of vibration spectra of the tryptophan molecule was performed. As a result, the normal vibrational modes associated with deformational vibrations of the aromatic ring of the tryptophan molecule were found. These deformational vibrations may be active during the nonradiative transition of the molecule from the excited to the ground state. We assume that the differences in τav may be associated with the change in the activity of these vibration modes due to local variations in the microenvironment of tryptophanyls during the light activation.

Investigation of Stability of Photosynthetic Reaction Center and Quantum Dot Hybrid Films.

The efficiency of interaction (efficiency of energy transfer) between various quantum dots (QDs) and photosynthetic reaction centers (RCs) from the purple bacterium Rhodobacter sphaeroides and conditions of long-term stability of functioning of such hybrid complexes in film preparations were investigated. It was found that dry films containing RCs and QDs and maintained at atmospheric humidity are capable to keep their functional activity for at least some months as judging by results of measurement of their spectral characteristics, efficiency of energy transfer from QDs to RCs, and RC electron-transport activity. Addition of trehalose to the films giving them still greater stability is especially expressed for films maintained at low humidity. These stable hybrid film structures are promising for further biotechnological studies for developing new phototransformation devices.

Properties of hybrid complexes composed of photosynthetic reaction centers from the purple bacterium Rhodobacter sphaeroides and quantum dots in lecithin liposomes.

Quantum dots (QDs) can absorb ultraviolet and long-wavelength light energy much more efficiently than natural light-harvesting proteins and transfer the excitation energy to photosynthetic reaction centers (RCs). Inclusion into liposomes of RC membrane pigment-protein complexes combined with QDs as antennae opens new opportunities for using such hybrid systems as a basis for artificial energy-transforming devices that potentially can operate with greater efficiency and stability than devices based only on biological components. RCs from Rhodobacter sphaeroides and QDs with fluorescence maximum at 530 nm (CdSe/ZnS with hydrophilic covering) were embedded in lecithin liposomes by extrusion of a solution of multilayer lipid vesicles through a polycarbonate membrane or by dialysis of lipids and proteins dispersed with excess detergent. The dimensions of the resulting hybrid systems were evaluated using dynamic light scattering and by transmission cryoelectron microscopy. The efficiency of RC and QD interaction within the liposomes was estimated using fluorescence excitation spectra of the photoactive bacteriochlorophyll of the RCs and by measuring the fluorescence decay kinetics of the QDs. The functional activity of the RCs in hybrid complexes was fully maintained, and their stability was even increased.

The effects of spatial offset, temporal offset and image speed on sensitivity to global motion in human amblyopia.

The presence of a general global motion processing deficit in amblyopia is now well established, although its severity may depend on image speed and amblyopia type, but its underlying cause(s) is still largely indeterminate. To address this issue and to characterize further the nature of the global motion perception deficit in human amblyopia, the effects of varying spatial offset (jump size-Δs) and temporal offset (delay between positional updates-Δt) in discriminating global motion for a range of speeds (1.5, 3 and 9°/s) in both amblyopic and normal vision were evaluated. For normal adult observers (NE) and the non-amblyopic eye (FE) motion coherence thresholds measured when Δt was varied were significantly higher than those when Δs was varied. Furthermore when Δt was varied, thresholds rose significantly as the speed of image motion decreased for both NEs and FEs. AE thresholds were higher overall than the other eyes and appeared independent of both the method used to create movement and speed. These results suggest that the spatial and temporal limits underlying the perception of global motion are different. In addition degrading the smoothness of motion has comparatively little effect on the motion mechanisms driven by the AE, suggesting that the internal noise associated with encoding motion direction is relatively high.

[On the mechanism for stabilizing a long-living charge separated state of photosynthetic reaction centers frozen under intensive illumination].

It is shown that freezing of the photosynthetic reaction centers from purple bacteria Rhodobacter sphaeroides under intensive illumination leads to the appearance of long-living charge separated states of reaction centers (P(+)QA-). This implies that the recombination reactions is blocked or charge separated state is stabilized. Experimental data are presented. It is also shown that this stabilization effect is caused by the structural relaxation of reaction centers to a new equilibrium state, and the free energy difference decreases as a result of this relaxation. The possible mechanism of such relaxation is determined by the effect of the polar water molecules orientation in the semiquinone local electrostatic field. The detailed analysis of the stabilization effect has been carried out, and its result supports a hypothesis of non equilibrium state of many electron transfer reactions in biological systems.

Visual deficits in amblyopia constrain normal models of second-order motion processing.

It is well established that amblyopes exhibit deficits in processing first-order (luminance-defined) patterns. This is readily manifest by measuring spatiotemporal sensitivity (i.e. the "window of visibility") to moving luminance gratings. However the window of visibility to moving second-order (texture-defined) patterns has not been systematically studied in amblyopia. To address this issue monocular modulation sensitivity (1/threshold) to first-order motion and four different varieties of second-order motion (modulations of either the contrast, flicker, size or orientation of visual noise) was measured over a five-octave range of spatial and temporal frequencies. Compared to normals amblyopes are not only impaired in the processing of first-order motion, but overall they exhibit both higher thresholds and a much narrower window of visibility to second-order images. However amblyopia can differentially impair the perception of some types of second-order motion much more than others and crucially the precise pattern of deficits varies markedly between individuals (even for those with the same conventional visual acuity measures). For the most severely impaired amblyopes certain second-order (texture) cues to movement in the environment are effectively invisible. These results place important constraints on the possible architecture of models of second-order motion perception in human vision.

Study of effect of molecular mobility in chromatophore membranes of the bacterium E. shaposhnikovii on processes of photoinduced electron transport using the NMR-spin-echo method with isotope substitution and dehydration.

The effect of dehydration and (2)H2O/H2O isotope substitution on electron transport reactions and relaxation of proton-containing groups was studied in chromatophore membranes of Ectothiorhodospira shaposhnikovii. During dehydration (including isotope substitution of hydrate water) of preliminarily dehydrated isolated photosynthetic membranes there was a partial correlation between hydration intervals within which activation of electron transport from high-potential cytochrome c to photoactive bacteriochlorophyll dimer P890 of photosynthetic reaction center and variation of spin-lattice and spin-spin proton relaxation time was observed. Partial correlation between hydration intervals can be considered as evidence of correlation between mobility of non-water proton-containing groups with proton relaxation frequency approximately 10(8) sec(-1) with efficiency of electron transfer at the donor side of the chain.

The effect of acetaminophen (four grams a day for three consecutive days) on hepatic tests in alcoholic patients--a multicenter randomized study.

BACKGROUND: Hepatic failure has been associated with reported therapeutic use of acetaminophen by alcoholic patients. The highest risk period for alcoholic patients is immediately after discontinuation of alcohol intake. This period exhibits the largest increase in CYP2E1 induction and lowest glutathione levels. Our hypothesis was that common liver tests would be unaffected by administration of the maximum recommended daily dosage of acetaminophen for 3 consecutive days to newly-abstinent alcoholic subjects. METHODS: Adult alcoholic subjects entering two alcohol detoxification centers were enrolled in a prospective double-blind, randomized, placebo-controlled trial. Subjects were randomized to acetaminophen, 4 g/day, or placebo for 3 consecutive days. The study had 95% probability of detecting a 15 IU/L difference in serum ALT. RESULTS: A total of 443 subjects were enrolled: 308 (258 completed) received acetaminophen and 135 subjects (114 completed) received placebo. Study groups did not differ in demographics, alcohol consumption, nutritional status or baseline laboratory assessments. The peak mean ALT activity was 57 +/- 45 IU/L and 55 +/- 48 IU/L in the acetaminophen and placebo groups, respectively. Subgroup analyses for subjects presenting with an elevated ALT, subjects fulfilling a diagnosis of alcoholic hepatitis and subjects attaining a peak ALT greater than 200 IU/L showed no statistical difference between the acetaminophen and control groups. The one participant developing an increased international normalized ratio was in the placebo group. CONCLUSION: Alcoholic patients treated with the maximum recommended daily dose of acetaminophen for 3 consecutive days did not develop increases in serum transaminase or other measures of liver injury. Treatment of pain or fever for 3 days with acetaminophen appears safe in newly-abstinent alcoholic patients, such as those presenting for acute medical care.