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Highly birefringent liquid crystals are attractive for photorefractive applications but device operation, usually restricted to the Raman-Nath regime, can be degraded by small phase shifts between the optical and refractive index gratings and coarse grating spacings with narrow beam intersection angles. Having to apply external electric fields and tilt the cell at an angle to the grating k vector cause further complications. In this letter, two-beam coupling in a hybrid photorefractive cell comprising a nematic liquid crystal layer influenced by an Fe doped KNbO3 window is described. The KNbO3 window determines photorefractive properties while the liquid crystal amplifies the overall refractive index modulation. Full Bragg matched gain and large beam intersection angles, with perfect 90° phase shifts between the optical and refractive index gratings, at normal incidence, without the need for an external field are demonstrated. [ABSTRACT FROM AUTHOR]

It has come to the attention of The Institute of Physics that this article should not have been submitted for publication owing to its substantial replication of an earlier paper (G Cook, C A Wyres, M J Deer and D C Jones 2004 Hybrid organic-inorganic photorefractives SPIE Annual Meeting 2003: Organic Materials and Nanotechnology: Liquid Crystals VII, Proc. SPIE vol 5213, ed Iam-Choon Khoo (Bellingham, WA: SPIE) p 63). This article was submitted by M J Deer without the knowledge of the other authors. [ABSTRACT FROM AUTHOR]

Purpose: We investigated whether patient-centered instructions for chronic heart failure medications increase comprehension and memory for medication information in older adults diagnosed with chronic heart failure., Design and Methods: Patient-centered instructions for familiar and unfamiliar medications were compared with instructions for the same medications from a chain pharmacy (standard pharmacy instructions). Thirty-two adults (age, M = 63.8) read and answered questions about each instruction, recalled medication information (free recall), and then answered questions from memory (cued recall)., Results: Patient-centered instructions were better recalled and understood more quickly than the standard instructions. Instructions for the familiar medications also were better recalled. Patient-centered instructions were understood more accurately for the unfamiliar medications, but standard instructions were understood more accurately for the familiar medications. However, the recall measures showed that the advantage of the standard format for familiar medications was short lived., Implications: The findings suggest that the patient-centered format may improve printed medication instructions available in many pharmacies, which should help older adults to better understand how to take their medications.

Study Objective: To determine the relationship between adherence to diuretic therapy and health care utilization., Design: Prospective, observational study., Setting: University-affiliated medical center., Patients: Forty-two patients with heart failure., Intervention: Electronic monitoring of adherence to diuretic therapy (percentage of diuretic prescription container openings) and to scheduling (percentage of container openings within a specific time)., Measurements and Main Results: All patients were prescribed a diuretic, most commonly furosemide (88%). Patients varied widely in adherence to therapy (mu = 72% +/- 30%) and to scheduling (mu = 43% +/- 30%). Education was a predictor of drug-taking adherence (p=0.0062) but not of scheduling adherence. Log-linear models revealed that poor scheduling adherence was associated with increased cardiovascular-related hospitalizations (chi2 11.63, p=0.0006) and predicted more heart failure-related hospitalizations (chi2 4.04, p=0.0444). In contrast, neither measure was significantly associated with cardiovascular- or heart failure-related emergency department visits. We found a moderate correlation between scheduling adherence and taking adherence (r = 0.6513)., Conclusion: Patients taking a greater proportion of diuretic agents on schedule may decrease the risk of cardiovascular- and heart failure-related hospitalizations. If these findings are confirmed by a larger study, interventions to improve adherence and patient health outcomes should consider the timing of doses as well as the number of daily doses of a diuretic.

Health-related quality of life (HRQL) instruments have been used to measure HRQL in heart failure patients, but how different instruments compare in the same groups of patients is not known. The purpose of this study was to compare the reliability and validity of three HRQL measures in 211 heart failure patients recruited from clinics affiliated with an urban hospital. Two disease-specific instruments, the chronic heart failure questionnaire (CHQ) and the living with heart failure questionnaire (LHFQ), and one generic instrument, the short-form 12 (SF-12), were administered. Patients reported moderate to low HRQL scores. Floor or ceiling effects were noted in the disease-specific instruments. Internal consistency reliabilities of the CHQ and LHFQ were satisfactory. Construct, convergent, and discriminant validity were supported for each instrument. Each scale and subscale, except for the SF-12 mental component scale, differentiated between patients with New York Heart Association (NYHA) class I, II, and III plus IV; the LHFQ physical subscale was the only measure to differentiate between patients with NYHA class III and IV. All three instruments were satisfactory for measuring HRQL, but the disease-specific instruments were preferable to the generic instrument. The decision of which instrument to use depends on the purpose of the study.

Purpose: Because the bioavailability of oral furosemide is erratic and often incomplete, we tested the hypothesis that patients with heart failure who were treated with torsemide, a predictably absorbed diuretic, would have more favorable clinical outcomes than would those treated with furosemide., Patients and Methods: We conducted an open-label trial of 234 patients with chronic heart failure (mean [+/- SD] age, 64 +/- 11 years) from an urban public health care system. Patients received oral torsemide (n = 113) or furosemide (n = 121) for 1 year. The primary endpoint was readmission to the hospital for heart failure. Secondary endpoints included readmission for all cardiovascular causes and for all causes, numbers of hospital days, and health-related quality of life., Results: Compared with furosemide-treated patients, torsemide-treated patients were less likely to need readmission for heart failure (39 [32%] vs. 19 [17%], P <0.01) or for all cardiovascular causes (71 [59%] vs. 50 [44%], P = 0.03). There was no difference in the rate of admissions for all causes (92 [76%] vs. 80 [71%], P = 0.36). Patients treated with torsemide had significantly fewer hospital days for heart failure (106 vs. 296 days, P = 0.02). Improvements in dyspnea and fatigue scores from baseline were greater among patients treated with torsemide, but the differences were statistically significant only for fatigue scores at months 2, 8, and 12., Conclusions: Compared with furosemide-treated patients, torsemide-treated patients were less likely to be readmitted for heart failure and for all cardiovascular causes, and were less fatigued. If our results are confirmed by blinded trials, torsemide may be the preferred loop diuretic for patients with chronic heart failure.