A Direct Arylation-Cyclisation Reaction for the Construction of Medium-Sized Rings

A strategy for assembling biaryls linked through a medium‐sized ring is herein presented. π‐Complexation of fluoroarenes to chromium tricarbonyl activates the molecule towards both C−H activation and nucleophilic aromatic substitution without covalently altering the molecular connectivity of the arene. The construction of bridged biaryl molecules with 6–10‐membered core rings is achieved through a one‐pot C−H arylation/nucleophilic aromatic substitution sequence. The methodology is applicable to the synthesis of heterocyclic as well as fully carbocyclic rings

Acuity, nurse staffing and workforce, missed care and patient outcomes. A cluster-unit-level descriptive comparison

Aim: To compare patient acuity, nurse staffing and workforce, missed nursing care and patient outcomes among hospital unit-clusters. Background: Relationships among acuity, nurse staffing and workforce, missed nursing care and patient outcomes, are not completely understood. Method: Descriptive design with data from four unit-clusters: medical, surgical, combined and stepdown units. Descriptive statistics were used to compare acuity, nurse staffing coverage, education and expertise, missed nursing care, and selected nurse-sensitive outcomes. Results: Patient acuity in general (medical, surgical and combined) floors is similar to step-down units, with an average of 5.6 required RN hours per patient day. In general wards, available RN hours per patient day reach only 50% of required RN hours to meet patient needs. Workforce measures are comparable among unit-clusters, and average missed nursing care is 21%. Patient outcomes vary among unit-clusters. Conclusion:Patient acuity is similar among unit-clusters, whilst nurse staffing coverage is halved in general wards. While RN education, expertise and missed care are comparable among unitclusters, mortality, skin injuries and risk of family compassion fatigue rates are higher in general wards. Implications for nursing management: Nurse managers play a pivotal role in hustling policy-makers to address structural understaffing in general wards, to maximize patient safety outcomes

Clinical subgroups in bilateral meniere disease

Meniere disease (MD) is a heterogeneous clinical condition characterized by sensorineural hearing loss, episodic vestibular symptoms, and tinnitus associated with several comorbidities, such as migraine or autoimmune disorders (AD). The frequency of bilateral involvement may range from 5 to 50%, and it depends on the duration of the disease. We have performed a two-step cluster analysis in 398 patients with bilateral MD (BMD) to identify the best predictors to define clinical subgroups with a potential different etiology to improve the phenotyping of BMD and to develop new treatments. We have defined five clinical variants in BMD. Group 1 is the most frequently found, includes 46% of patients, and is defined by metachronic hearing loss without migraine and without AD. Group 2 is found in 17% of patients, and it is defined by synchronic hearing loss without migraine or AD. Group 3, with 13% of patients, is characterized by familial MD, while group 4, that includes 12% of patients, is associated by the presence of migraine in all cases. Group 5 is found in 11% of patients and is defined by AD. This approach can be helpful in selecting patients for genetic and clinical research. However, further studies will be required to improve the phenotyping in these clinical variants for a better understanding of the diverse etiological factors contributing to BMD

Systematic review of outcome domains and instruments used in clinical trials of tinnitus treatments in adults

BACKGROUND: There is no evidence-based guidance to facilitate design decisions for confirmatory trials or systematic reviews investigating treatment efficacy for adults with tinnitus. This systematic review therefore seeks to ascertain the current status of trial designs by identifying and evaluating the reporting of outcome domains and instruments in the treatment of adults with tinnitus. METHODS: Records were identified by searching PubMed, EMBASE CINAHL, EBSCO, and CENTRAL clinical trial registries (ClinicalTrials.gov, ISRCTN, ICTRP) and the Cochrane Database of Systematic Reviews. Eligible records were those published from 1 July 2006 to 12 March 2015. Included studies were those reporting adults aged 18 years or older who reported tinnitus as a primary complaint, and who were enrolled into a randomised controlled trial, a before and after study, a non-randomised controlled trial, a case-controlled study or a cohort study, and written in English. Studies with fewer than 20 participants were excluded. RESULTS: Two hundred and twenty-eight studies were included. Thirty-five different primary outcome domains were identified spanning seven categories (tinnitus percept, impact of tinnitus, co-occurring complaints, quality of life, body structures and function, treatment-related outcomes and unclear or not specified). Over half the studies (55 %) did not clearly define the complaint of interest. Tinnitus loudness was the domain most often reported (14 %), followed by tinnitus distress (7 %). Seventy-eight different primary outcome instruments were identified. Instruments assessing multiple attributes of the impact of tinnitus were most common (34 %). Overall, 24 different patient-reported tools were used, predominantly the Tinnitus Handicap Inventory (15 %). Loudness was measured in diverse ways including a numerical rating scale (8 %), loudness matching (4 %), minimum masking level (1 %) and loudness discomfort level (1 %). Ten percent of studies did not clearly report the instrument used. CONCLUSIONS: Our findings indicate poor appreciation of the basic principles of good trial design, particularly the importance of specifying what aspect of therapeutic benefit is the main outcome. No single outcome was reported in all studies and there was a broad diversity of outcome instruments. PROSPERO REGISTRATION: The systematic review protocol is registered on PROSPERO (International Prospective Register of Systematic Reviews): CRD42015017525. Registered on 12 March 2015 revised on 15 March 2016. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13063-016-1399-9) contains supplementary material, which is available to authorized users

Mechanical performance after high-temperature exposure and Life Cycle Assessment (LCA) according to unit of stored energy of alternative mortars to Portland cement

Decoupling energy demand has led to the importance of energy storage for increasing the capacity of renewable energy power plants. In this field, Portland cement (PC) concrete is proving to be a promising way to store energy as it can be used as sensible thermal energy storage (TES) medium in concentrated solar power (CSP) technology. However, the high energy and water consumption involved in the PC manufacturing process makes it necessary to develop new alternatives. Thus, alkali-activated materials (AAM) and hybrid materials (HM) were manufactured using blast furnace slag and glass waste (GW) to replace the PC and the sand in concretes respectively in order to study their feasibility as TES media in parabolic through CSP systems. The viability of these proposed new systems was tested from a mechanical point of view, while taking into account the environmental aspect using Life Cycle Assessment (LCA) methodology to study carbon and water footprints. The new systems were exposed to high temperature (up to 500 °C), showing better performance than the ordinary PC under high temperatures, and their mechanical properties were not affected at all. After thermal treatment the alternatives show improvements of up to 79% compared to the PC reference sample. Furthermore, in terms of LCA analysis, it was concluded that TES systems with partial (HM) or total (AAM) substitution of PC by using by-products improve water use up to 40% when an AAM material includes GW as a recycled aggregate in its composition. Results likewise revealed a more than 100% reduction in the carbon footprint. These results open a new gate for the study of materials as TES since the alternatives to PC are more promising from an operational and environmental point of view.This study was funded by the Ministerio de Ciencia, Innovación y Universidades of Spain through project RTI2018-096428-B-I00 and by the Madrid Government (Comunidad de Madrid) under the Multiannual Agreement with UC3M in the line of "Fostering Young Doctors Research" (HORATSO-CM-UC3M) in the context of the V PRICIT (Regional Programme of Research and Technological Innovation). Funding for APC: Universidad Carlos III de Madrid (Read & Publish Agreement CRUE-CSIC 2022)

Additional file 2: of Systematic review of outcome domains and instruments used in clinical trials of tinnitus treatments in adults

TINNET WG5 master file. An editable version of the data master file. (XLSX 313 kb