Synthesis and crystal structure of the first 6a-thiathiophthen metal complex [Mo(CO)_5PPh_(2]2)(µ-C_5H_2S_3)

The first 6a-thiathiophthen metal complex was prepared by treating M(CO_)5[PPh_2CS_2CH_2C≡CH] with a catalytic amount of secondary amine or tertiary amine; the structure of the 6a-thiathiophthen molybdenum complex is confirmed by an X-ray diffraction analysis

3D Magneto-Hydrodynamic Simulations of Parker Instability with Cosmic Rays

This study investigates Parker instability in an interstellar medium (ISM) near the Galactic plane using three-dimensional magneto-hydrodynamic simulations. Parker instability arises from the presence of a magnetic field in a plasma, wherein the magnetic buoyant pressure expels the gas and cause the gas to move along the field lines. The process is thought to induce the formation of giant molecular clouds in the Galaxy. In this study, the effects of cosmic-ray (CR) diffusion are examined. The ISM at equilibrium is assumed to comprise a plasma fluid and a CR fluid at various temperatures, with a uniform magnetic field passing through it in the azimuthal direction of the Galactic disk. After a small perturbation, the unstable gas aggregates at the footpoint of the magnetic fields and forms dense blobs. The growth rate of the instability increases with the strength of the CR diffusion. The formation of dense clouds is enhanced by the effect of cosmic rays (CRs), whereas the shape of the clouds depends sensitively on the initial conditions of perturbation.Comment: 4 pages, Computer Physics Communications 2011, 182, p177-17

Is clopidogrel better than aspirin following breakthrough strokes while on aspirin? A retrospective cohort study.

ObjectiveThere is insufficient evidence on which to base a recommendation for optimal antiplatelet therapy following a stroke while on aspirin. The objective was to compare clopidogrel initiation vs aspirin reinitiation for vascular risk reduction among patients with ischaemic stroke on aspirin at the time of their index stroke.DesignRetrospective.SettingWe conducted a nationwide cohort study by retrieving all hospitalised patients (≥18 years) with a primary diagnosis of ischaemic stroke between 2003 and 2009 from Taiwan National Health Insurance Research Database.ParticipantsAmong 3862 patients receiving aspirin before the index ischaemic stroke and receiving either aspirin or clopidogrel after index stroke during follow-up period, 1623 were excluded due to a medication possession ratio <80%. Also, 355 were excluded due to history of atrial fibrillation, valvular heart disease or coagulopathy. Therefore, 1884 patients were included in our final analysis.InterventionsPatients were categorised into two groups based on whether clopidogrel or aspirin was prescribed during the follow-up period. Follow-up was from time of the index stroke to admission for recurrent stroke or myocardial infarction, death or the end of 2010.Primary and secondary outcome measuresThe primary end point was hospitalisation due to a new-onset major adverse cardiovascular event (MACE: composite of any stroke or myocardial infarction). The leading secondary end point was any recurrent stroke.ResultsCompared to aspirin, clopidogrel was associated with a lower occurrence of future MACE (HR=0.54, 95% CI 0.43 to 0.68, p<0.001, number needed to treat: 8) and recurrent stroke (HR=0.54, 95% CI 0.42 to 0.69, p<0.001, number needed to treat: 9) after adjustment of relevant covariates.ConclusionsAmong patients with an ischaemic stroke while taking aspirin, clopidogrel initiation was associated with fewer recurrent vascular events than aspirin reinitiation

Experiential learning of HIV self-test among student nurses: A qualitative study

Background: There is increasing demand for HIV self-tests, and nurses play an important role in counselling and assisting in the testing process. Traditional lecture-based nursing education has not typically focused on self-testing procedures, and there is little understanding of clients' experiences of self-testing. Objectives: To understand the experiential learning (EL)of student nurses during the process of self-testing for HIV. Design: This study used a qualitative design. Settings: A college in northern Taiwan. Participants: We recruited a purposive sample of 30 nursing students. Methods: The OraQuick self-test was used as the self-testing tool in this study. After participants used the OraQuick self-test, they underwent a semi-structured interview during the post-test counselling period. All interview data were subjected to line-by-line content analysis. Results: We extracted nine themes of nursing students' experiences during experiential learning of HIV self-test. In the pre-test stage, they recalled possible risk behaviors for HIV infection, decided to complete the self-test alone or asked for significant others to accompany them, and endured emotional fluctuations immediately prior to the test. When waiting for the test results, they felt isolated from the outside world. Some participants also began questioning the accuracy and safety of the test, and either viewed the results immediately or later on. In the post-test stage, some participants reported being uncertain about the results. Participants reported a greater understanding of the personal impact of testing and revealed their needs for support. Some identified a sense of loss and linked this to the rapid and direct delivery of test results. Conclusions: Our results can be used to guide HIV-related education courses and prevention programs. Experiential learning has the potential to improve HIV pre and post-test counselling, as nurses develop both clinical knowledge and personal insight of the testing process

Novel technique of neovagina creation with uterine serosa in the treatment of vaginal agenesis associated with mullerian agenesis

AbstractObjectiveOur aim was to create a neovagina with the least surgical morbidity and the best functional outcome.Materials and methodsWe hereby describe a new technique (Lee's neovaginoplasty) using a combined laparoscopic and vaginal approach in the creation of a neovagina using the uterine serosa layer from the rudimentary uterus and the peritoneum as a graft to line the vagina. This procedure was performed in three patients who were followed-up for a duration of 4 months to 2 years. Vaginal dilation was maintained with a vaginal mold daily for 3 months and three to four times a week thereafter.ResultsAdequate vaginal length of 6-7 cm and width of 2.5 cm was achieved postoperatively. There were no surgical complications and postoperative recovery was fast. Vaginal examination 1 month later showed healthy vaginal tissue with no necrosis or infection. Long-term follow-up did not show any shortening or stenosis of the vagina. Patients were able to have satisfactory sexual intercourse with no pain.ConclusionThe laparoscopic-vaginal approach of using a uterine serosa and peritoneal graft for creation of a neovagina is a simple and effective approach with minimal surgical morbidity that can create a passageway for satisfactory intercourse