(p -Cymene)thioglycollatoruthenium(II) dimer; a complex with an ambi-basic S,O-donor ligand

The title compound was prepared from the (p-cymene)ruthenium chloride dimer and thioglycollic acid. The structure is a centrosymmetric dimer bridged by the soft-base S atoms, with the hard-base O atoms of the carboxylate group chelating to form a five-membered twisted-ring. The coordination of the ruthenium atoms is completed by a η6-p-cymene ligand, giving an 18-electron count. The Ru–S bonds are essentially equal at 2.396(1) Å

Platinum(II), palladium(II), nickel(II), and gold(I) complexes of the “electrospray-friendly” thiolate ligands 4-SC₅H₄N- and 4-SC₆H₄OMe-

The series of platinum(II), palladium(II), and nickel(II) complexes [ML₂(dppe)] [M = Ni, Pd, Pt; L = 4-SC₅H₄N or 4-SC₆H₄OMe; dppe = Ph₂PCH₂CH₂PPh₂] containing pyridine-4-thiolate or 4-methoxybenzenethiolate ligands, together with the corresponding gold(I) complexes [AuL(PPh3)], were prepared and their electrospray ionization mass spectrometric behavior compared with that of the thiophenolate complexes [M(SPh)₂(dppe)] (M = Ni, Pd, Pt) and [Au(SPh)(PPh₃)]. While the pyridine-4-thiolate complexes yielded protonated ions of the type [M + H]+ and [M + 2H]²+ ions in the Ni, Pd, and Pt complexes, an [M + H]+ ion was only observed for the platinum derivative of 4-methoxybenzenethiolate. Other ions, which dominated the spectra of the thiophenolate complexes, were formed by thiolate loss and aggregate formation. The X-ray crystal structure of [Pt(SC₆H₄OMe-4)₂(dppe)] is also reported

Modification of kraft wood-pulp fibre with silica for surface functionalisation

A new science strategy for natural fibre modification was devised in which glass surface properties would be imparted to wood-derived fibre. The enhancements known from addition of silane reagents to glass fibre–polymer composites could therefore be realised for modified cellulose fibre–polymer composites. A process is described whereby the internal void spaces and micropores of never-dried Kraft pulp fibre walls were impregnated with silica. This was achieved by initial dehydration of never-dried fibre through azeotropic distillation to achieve substitution of fibre water with the silicon chemical solution over a range of concentrations. Kraft fibres were stiffened and made resistant to collapse from the effect of the azeotrope drying. Specific chemical reaction of azeotrope-dried fibre with the reagent ClSi(OEt)3 followed by base-catalysed hydrolysis of the ester groups formed a fibre-bound silica composite. The physico-chemical substitution of water from micropores and internal voids of never-dried fibre with property-modifying chemicals offers possibilities in the development of new fibre characteristics, including fibres which may be hardened, plasticised, and/or stabilised against moisture, biodegradation or fire. The embedded silica may also be used as sites of attachment for coupling agents to modify the hydrophilic character of the fibre or to functionalise the fibre surface

Harnessing the electronic health care record to optimise patient safety in primary care: a framework for evaluating “electronic safety netting” tools

The management of diagnostic uncertainty is part of every primary care physician’s role. e–Safety-netting tools help health care professionals to manage diagnostic uncertainty. Using software in addition to verbal or paper based safety-netting methods could make diagnostic delays and errors less likely. There are an increasing number of software products that have been identified as e–safety-netting tools, particularly since the start of the COVID-19 pandemic. e–Safety-netting tools can have a variety of functions, such as sending clinician alerts, facilitating administrative tasking, providing decision support, and sending reminder text messages to patients. However, these tools have not been evaluated by using robust research designs for patient safety interventions. We present an emergent framework of criteria for effective e–safety-netting tools that can be used to support the development of software. The framework is based on validated frameworks for electronic health record development and patient safety. There are currently no tools available that meet all of the criteria in the framework. We hope that the framework will stimulate clinical and public conversations about e–safety-netting tools. In the future, a validated framework would drive audits and improvements. We outline key areas for future research both in primary care and within integrated care systems

Early diagnosis of cancer: systems approach to support clinicians in primary care

Georgia Black and colleagues argue that rather than focusing on the initial consultation efforts to reduce diagnosis times should look at the wider system

Evolution of Mid-Atlantic coastal and back-barrier estuary environments in response to a hurricane : implications for barrier-estuary connectivity

This paper is not subject to U.S. copyright. The definitive version was published in Estuaries and Coasts 39 (2016): 916-934, doi:10.1007/s12237-015-0057-x.Assessments of coupled barrier island-estuary storm response are rare. Hurricane Sandy made landfall during an investigation in Barnegat Bay-Little Egg Harbor estuary that included water quality monitoring, geomorphologic characterization, and numerical modeling; this provided an opportunity to characterize the storm response of the barrier island-estuary system. Barrier island morphologic response was characterized by significant changes in shoreline position, dune elevation, and beach volume; morphologic changes within the estuary were less dramatic with a net gain of only 200,000 m3 of sediment. When observed, estuarine deposition was adjacent to the back-barrier shoreline or collocated with maximum estuary depths. Estuarine sedimentologic changes correlated well with bed shear stresses derived from numerically simulated storm conditions, suggesting that change is linked to winnowing from elevated storm-related wave-current interactions rather than deposition. Rapid storm-related changes in estuarine water level, turbidity, and salinity were coincident with minima in island and estuarine widths, which may have influenced the location of two barrier island breaches. Barrier-estuary connectivity, or the transport of sediment from barrier island to estuary, was influenced by barrier island land use and width. Coupled assessments like this one provide critical information about storm-related coastal and estuarine sediment transport that may not be evident from investigations that consider only one component of the coastal system.Funding for this project was provided by the New Jersey Department of Environmental Protection and the US Geological Survey (USGS) Coastal and Marine Geology Program

GPs’ understanding and practice of safety netting for potential cancer presentations : a qualitative study in primary care

Background Safety netting is a diagnostic strategy used in UK primary care to ensure patients are monitored until their symptoms or signs are explained. Despite being recommended in cancer diagnosis guidelines, little evidence exists about which components are effective and feasible in modern-day primary care. Aim To understand the reality of safety netting for cancer in contemporary primary care. Design and setting A qualitative study of GPs in Oxfordshire primary care. Method In-depth interviews with a purposive sample of 25 qualified GPs were undertaken. Interviews were recorded and transcribed verbatim, and analysed thematically using constant comparison. Results GPs revealed uncertainty about which aspects of clinical practice are considered safety netting. They use bespoke personal strategies, often developed from past mistakes, without knowledge of their colleagues’ practice. Safety netting varied according to the perceived risk of cancer, the perceived reliability of each patient to follow advice, GP working patterns, and time pressures. Increasing workload, short appointments, and a reluctance to overburden hospital systems or create unnecessary patient anxiety have together led to a strategy of selective active follow-up of patients perceived to be at higher risk of cancer or less able to act autonomously. This left patients with low-risk-but-not-no-risk symptoms of cancer with less robust or absent safety netting. Conclusion GPs would benefit from clearer guidance on which aspects of clinical practice contribute to effective safety netting for cancer. Practice systems that enable active follow-up of patients with low-risk-but-not-no-risk symptoms, which could represent malignancy, could reduce delays in cancer diagnosis without increasing GP workload

How do GPs and patients share the responsibility for cancer safety netting follow-up actions? A qualitative interview study of GPs and patients in Oxfordshire, UK

Objective: To explore patients’ and General Practitioners' (GPs) accounts of how responsibility for follow-up was perceived and shared in their experiences of cancer safety netting occurring within the past 6 months. Design: In-depth interviews were recorded and transcribed verbatim. Data were analysed through an abductive process, exploring anticipated and emergent themes. Conceptualisations of ‘responsibility’ were explored by drawing on a transactional to interdependent continuum drawing from the shared decision-making literature. Settings and participants: A purposive sample of 25 qualified GPs and 23 adult patients in Oxfordshire, UK. Results: The transactional sharing approach involves responsibility being passed from GP to patient. Patients expected and were willing to accept responsibility in this way as long as they received clear guidance from their GP and had capacity. In interdependent sharing, GPs principally aimed to reach consensus and share responsibility with the patient by explaining their rationale, uncertainty or by stressing the potential seriousness of the situation. Patients sharing this responsibility could be put at risk if no follow-up or timeframe was suggested, they had inadequate information, were falsely reassured or their concerns were not addressed at re-consultation. Conclusion: GPs and patients exchange and share responsibility using a combination of transactional and interdependent styles, tailoring information based on patient characteristics and each party’s level of concern. Clear action plans (written where necessary) at the end of every consultation would help patients decide when to re-consult. Further research should investigate how responsibility is shared within and outside the consultation, within primary care teams and with specialist services

Attitudes towards faecal immunochemical testing in patients at increased risk of colorectal cancer: an online survey of GPs in England

Background: There is increasing interest in using a quantitative faecal immunochemical test (FIT) to rule out colorectal cancer (CRC) in patients with high-risk symptoms in primary care.  Aim: This study aimed to investigate GPs’ attitudes and willingness to use a FIT over an urgent 2-week wait (2WW) referral.  Design and setting: A cross-sectional online survey involving 1024 GPs working across England.  Method: Logistic regression models were used to explore the likelihood of GPs using a FIT instead of a 2WW referral, and reported using odds ratios (ORs) and 95% confidence intervals (95% CIs).  Results: Just over one-third of GPs (n = 365) preferred to use a FIT as a rule-out test over a 2WW referral. GPs were more willing if they were: aged 36–45 years (OR 1.59 [95% CI = 1.04 to 2.44]); 46–55 years (OR 1.99 [95% CI = 1.14 to 3.47]); thought a FIT was highly accurate (OR 1.63 [95% CI = 1.16 to 2.29]); thought patients would benefit compared with having a colonoscopy (OR 2.02 [95% CI = 1.46 to 2.79]); and were highly confident about discussing the benefits of a FIT (OR 2.14 [95% CI = 1.46 to 3.16]). GPs were less willing if they had had >10 urgent referrals in the past year (OR 0.62 [95% CI = 0.40 to 0.94]) and thought that longer consultations would be needed (OR 0.61 [95% CI = 0.44 to 0.83]).  Conclusion: The study findings suggest that the acceptability of using a FIT as a rule-out test in primary care is currently low, with less than half of GPs who perceived the test to be accurate preferring it over colonoscopy. Any potential guideline changes recommending a FIT in patients with high-risk symptoms, instead of urgent referral to rule out CRC, are likely to require intensive supporting educational outreach to increase GP confidence in the accuracy and application of a FIT in this context