Women, men and coronary heart disease: a review of the qualitative literature

Aim. This paper presents a review of the qualitative literature which examines the experiences of patients with coronary heart disease. The paper also assesses whether the experiences of both female and male patients are reflected in the literature and summarizes key themes. Background. Understanding patients' experiences of their illness is important for coronary heart disease prevention and education. Qualitative methods are particularly suited to eliciting patients' detailed understandings and perceptions of illness. As much previous research has been 'gender neutral', this review pays particular attention to gender. Methods. Published papers from 60 qualitative studies were identified for the review through searches in MEDLINE, EMBASE, CINAHL, PREMEDLINE, PsychINFO, Social Sciences Citation Index and Web of Science using keywords related to coronary heart disease. Findings. Early qualitative studies of patients with coronary heart disease were conducted almost exclusively with men, and tended to generalize from 'male' experience to 'human' experience. By the late 1990s this pattern had changed, with the majority of studies including women and many being conducted with solely female samples. However, many studies that include both male and female coronary heart disease patients still do not have a specific gender focus. Key themes in the literature include interpreting symptoms and seeking help, belief about coronary 'candidates' and relationships with health professionals. The influence of social roles is important: many female patients have difficulties reconciling family responsibilities and medical advice, while male patients worry about being absent from work. Conclusions. There is a need for studies that compare the experiences of men and women. There is also an urgent need for work that takes masculinity and gender roles into account when exploring the experiences of men with coronary heart disease

Stereocontrolled Formation of Carbon-Carbon Bonds and Applications in the Total Synthesis of Unsymmetrically Oxidized Nuphar Thioalkaloids and Isotopically Labelled (+)-Anatoxin-a

The asymmetric formation of carbon-carbon bonds is a fundamentally important transformation in modern organic chemistry. Such methods enable the rapid generation of molecular complexity from simple precursors and are essential to the synthesis of natural product scaffolds and pharmaceuticals. This dissertation focuses on the development of novel approaches to the stereoselective construction of carbon-carbon bonds and their application toward the synthesis of complex, bioactive alkaloids.The first chapter of this dissertation focuses on a total synthesis of the Nuphar thioalkaloids, a series of hemiaminal containing dimeric sesquiterpenes isolated from yellow water lilies. Two critical stereocenters in the natural products were established through asymmetric (hetero)arylacetic acid alkylation, following a protocol developed previously in our group. The unique 2,2,4,4-tetrasubstituted thiolane core was forged through the Stevens rearrangement of a sulfonium ylide, generated in situ through the coupling of a spirocyclic thietane with a copper carbenoid. This biodivergent strategy was crucial to obtaining chemoselective access to two unsymmetrically oxidized congeners in this family, (+)-6-hydroxythiobinupharidine and (–)-6-hydroxythionuphlutine, with the latter being synthesized for the first time.The second chapter focuses on a systematic investigation into the Ireland-Claisen rearrangement of α-alkoxy esters. Our studies have shown the selectivity of the rearrangement to be highly sensitive to both the nature of the metal cation and the corresponding amide of the base used for enolate formation. We have demonstrated that, in many cases, both diastereomeric Ireland-Claisen products could be accessed from the same starting material, expanding the scope of this already powerful transformation and streamlining its application in organic synthesis.The third chapter outlines our asymmetric total synthesis of (+)-[13C4]-anatoxin-a. The unique requirements associated with isotope incorporation inspired a new, robust, and highly scalable route, providing access to substantial quantities of this valuable internal standard for use in the detection and precise quantification of anatoxin-a in freshwater. A highlight of the synthesis is a method that leverages a cyclic iminium ion rearrangement to achieve dynamic kinetic resolution in an enantioselective Morita-Baylis-Hillman (MBH) cyclization

Stereocontrolled Formation of Carbon-Carbon Bonds and Applications in the Total Synthesis of Unsymmetrically Oxidized Nuphar Thioalkaloids and Isotopically Labelled (+)-Anatoxin-a

The asymmetric formation of carbon-carbon bonds is a fundamentally important transformation in modern organic chemistry. Such methods enable the rapid generation of molecular complexity from simple precursors and are essential to the synthesis of natural product scaffolds and pharmaceuticals. This dissertation focuses on the development of novel approaches to the stereoselective construction of carbon-carbon bonds and their application toward the synthesis of complex, bioactive alkaloids.The first chapter of this dissertation focuses on a total synthesis of the Nuphar thioalkaloids, a series of hemiaminal containing dimeric sesquiterpenes isolated from yellow water lilies. Two critical stereocenters in the natural products were established through asymmetric (hetero)arylacetic acid alkylation, following a protocol developed previously in our group. The unique 2,2,4,4-tetrasubstituted thiolane core was forged through the Stevens rearrangement of a sulfonium ylide, generated in situ through the coupling of a spirocyclic thietane with a copper carbenoid. This biodivergent strategy was crucial to obtaining chemoselective access to two unsymmetrically oxidized congeners in this family, (+)-6-hydroxythiobinupharidine and (–)-6-hydroxythionuphlutine, with the latter being synthesized for the first time.The second chapter focuses on a systematic investigation into the Ireland-Claisen rearrangement of α-alkoxy esters. Our studies have shown the selectivity of the rearrangement to be highly sensitive to both the nature of the metal cation and the corresponding amide of the base used for enolate formation. We have demonstrated that, in many cases, both diastereomeric Ireland-Claisen products could be accessed from the same starting material, expanding the scope of this already powerful transformation and streamlining its application in organic synthesis.The third chapter outlines our asymmetric total synthesis of (+)-[13C4]-anatoxin-a. The unique requirements associated with isotope incorporation inspired a new, robust, and highly scalable route, providing access to substantial quantities of this valuable internal standard for use in the detection and precise quantification of anatoxin-a in freshwater. A highlight of the synthesis is a method that leverages a cyclic iminium ion rearrangement to achieve dynamic kinetic resolution in an enantioselective Morita-Baylis-Hillman (MBH) cyclization

A qualitative study of cardiac rehabilitation patients’ perspectives on making dietary changes

Background:  Making healthier food choices is recognised as being important in the secondary prevention of coronary heart disease (CHD) and the provision of information about making dietary changes should be included in cardiac rehabilitation (CR), a secondary prevention strategy. Studies indicate that patients do not always make the recommended dietary changes, although research on CR patients’ perspectives on dietary change appears to be limited. The present study aimed to explore CR patients’ perspectives on making and maintaining dietary changes. Methods:  Following ethical approval, in-depth, audiotaped, qualitative interviews were conducted with 15 post-myocardial infarction CR patients (11 men and four women) who had completed a hospital-based CR programme. Participants comprised White British individuals aged 42–65 years, from a variety of socioeconomic backgrounds. Interview topics included perspectives on CHD and lifestyle changes, including diet. Follow-up interviews with 10 patients, conducted approximately 9 months later, explored whether their perspectives had changed. Results:  Patients tended to only make and maintain dietary changes if they perceived their diet to be a cause of their CHD. The only dietary changes patients reported involved ‘cutting things out’ of their diet; patients did not make dietary changes if they considered that they did not need to ‘cut things out’. Conclusions:  These findings suggest that, despite receiving information about eating a balanced diet, CR patients may perceive dietary change in terms of whether or not they need to ‘cut things out’ of their diet. Greater emphasis may be needed in dietary information on increasing the proportion of healthy foods consumed and choosing healthier alternatives

Ottawa morning : AIDS in South Africa has reached a frightening stage; 25 June 2001

Meeting: UN General Assembly Special Session (UNGASS) on HIV / AIDS : a New Global AIDS and Health Trust Fund, 25-27 June 2001, New York, NY, USTranscription in PDF formatCommentary by IDRC personnel Christina Zarowsky on the occasion of the UN General Assembly Special Session on HIV / AIDS; introduction by CBC's John Lacharit

Stereodivergence in the Ireland–Claisen Rearrangement of α‑Alkoxy Esters

A systematic investigation into the Ireland–Claisen rearrangement of α-alkoxy esters is reported. In all cases, the use of KN­(SiMe₃)₂ in toluene gave rearrangement products corresponding to a <i>Z</i>-enolate intermediate with excellent diastereoselectivity, presumably because of chelation control. On the other hand, chelation-controlled enolate formation could be overcome for most substrates through the use of lithium diisopropylamide (LDA) in tetrahydrofuran (THF)

Total Synthesis of Unsymmetrically Oxidized Nuphar Thioalkaloids via Copper-Catalyzed Thiolane Assembly

An asymmetric total synthesis of (+)-6-hydroxy­thio­binupharidine (<b>1b</b>) and (−)-6-hydroxy­thio­nuphlutine (<b>2b</b>), a set of hemiaminal containing dimeric sesquiterpenes isolated from yellow water lilies of the <i>Nuphar</i> genus, is described. The central bis-spirocyclic tetrahydro­thiophene ring was forged through the Stevens rearrangement of a sulfonium ylide, generated in situ from the coupling of a copper-carbene with a spirocyclic thietane. This strategy diverges both from the proposed biosynthesis and previous syntheses of this family of alkaloids,, all of which employ dimerization of symmetric monomers to form the aforementioned thiaspirane. The coupling of unsymmetrical monomers allowed access to the unsymmetrically oxidized product <b>2b</b> for the first time