Information and participation in decision-making about treatment: a qualitative study of the perceptions and preferences of patients with rheumatoid arthritis.

Objectives: To elicit the perceptions and preferences of patients with rheumatoid arthritis regarding information and participation in treatment decision-making. To analyse the patients’ narratives on the background of the ethical discourse on various approaches to treatment decisionmaking. Design: In-depth interviews with themes identified using principles of grounded theory. Participants: 22 patients with long-standing rheumatoid arthritis. Main outcome measures: Qualitative data on patients’ perceptions and preferences regarding information and participation in decision-making about treatment. Results: Decision-making about treatment has been described by the patients as a process consisting of different stages with shifting loci of control and responsibility. Patients initially received one treatment recommendation and were not aware of alternative treatment options. Those participants in this study who wanted information about negative effects of a treatment cited ‘‘interest in one’s own health’’ and the potential ‘‘use of information’’ as reasons for their preference. The physicians’ expert knowledge and clinical experience regarding the effects of medication were cited as arguments by patients for a treatment recommendation. Conclusions: The patients’ accounts of decision-making about treatment differ from models of physician–patient relationship that have been put forward in ethical discourse. These differences may be relevant with respect to the starting point of an ethical analysis of treatment decision-making. Patients’ accounts with respect to a lack of information on treatment alternatives point to ethically relevant challenges regarding treatment decision-making in clinical practice

Optical Properties and Modal Gain of InGaN Quantum Dot Stacks

We present investigations of the optical properties of stacked InGaN quantum dot layers and demonstrate their advantage over single quantum dot layer structures. Measurements were performed on structures containing a single layer with quantum dots or threefold stacked quantum dot layers, respectively. A superlinear increase of the quantum dot related photoluminescence is detected with increasing number of quantum dot layers while other relevant GaN related spectral features are much less intensive when compared to the photoluminescence of a single quantum dot layer. The quantum dot character of the active material is verified by microphotoluminescence experiments at different temperatures. For the possible integration within optical devices in the future the threshold power density was investigated as well as the modal gain by using the variable stripe length method.Comment: 9 Pages, 4 Figure

Stress of different types increases the proinflammatory load in rheumatoid arthritis

Stress in patients with chronic inflammatory diseases such as rheumatoid arthritis (RA) stimulates proinflammatory mechanisms due to the defect of stress response systems (for example, the sympathetic nervous system and the hypothalamic–pituitary–adrenal axis). Among other mechanisms, the loss of sympathetic nerve fibers in inflamed tissue and inadequate cortisol secretion in relation to inflammation lead to an enhanced proinflammatory load in RA. Stress and the subsequent stimulation of inflammation (systemic and local) lead to increased sensitization of pain and further defects of stress response systems (vicious cycle of stress, pain, and inflammation)

Synthese, Charakterisierung und Untersuchungen zur Reaktivität von Amidinaten, Formamidinaten und Triazeniden der s-Blockmetalle

Die Deprotonierungsreaktionen von zwei- (X = CH) und dreizähnigen (X = N) 1,3-azaallylischen Amidinen, Formamidinen und Triazenen mit Erdalkalimetallbasen führen zu Metallkomplexen unterschiedlicher Koordinationsmuster (homo-, heteroleptisch), Bindungsmodi (bi-, tridentat) und Konfigurationen der monoanionischen Liganden. Ausgeprägte Metall -Aren-Wechselwirkungen bewirken eine hohe kinetische Stabilität der heteroleptischen Komplexstrukturen und die Eignung der Pivalamidinate (E = C(tBu)) als Präkatalysatoren konnte am Beispiel der Cyclisierung von 2,2-Diphenylpent-4-en-amin gezeigt werden. Mechanistische Untersuchungen belegen eine stark Aktivierungsentropie-dominierte katalytische Effizienz. Unabhängig von der Polarität des verwendeten Lösungsmittels (THF, Toluen, C6D6), von der eingesetzten Stöchiometrie (1:1, 2:1, 1:2), von dem Metallionenradius (M = K, Cs, Na) sowie von der Säurestärke der verwendeten Alkalimetallbase (MN(SiMe3)2, KH, BnK) reagieren die Pival- (E = C(tBu)) und Benzamidine (E = C(Ph)) unter Abspaltung von 2-Vinylpyridin zu terminal metallierten Amidinaten mit polymeren Komplexstrukturen (Dehydroaminierungsreaktion). Durch tiefe Temperaturen, sekundäre M -Aren-Wechselwirkungen oder weniger ionogene M N-Wechselwirkungen (M = Li) lassen sich die unzersetzten Alkalimetall-Komplexe kinetisch stabilisieren. Die sterisch weniger anspruchsvollen Formamidine (E = C(H)) und Triazene (E = N) bilden dagegen mit Alkalimetallbasen ausschließlich dimere Komplexmidifikationen unter Erhalt der Ligandstruktur. Das unterschiedliche Reaktionsverhalten sowie das Koordinationsverhalten resultieren aus der Natur des Metallions (Kationenladungsdichte, Elektropositivität) in Kombination mit der Sterik des Rückgrats und der elektronischen Beschaffenheit der 1,3-azaallylischen Einheit NEN (E = C(tBu), C(Ph), C(H), N). Das Reaktionsverhalten wird weiterhin durch die zusätzliche Pyridylbase sowie durch das Aggregationsverhalten beeinflusst