Optical studies of 2-t-butyl-2-substituted biphenyls

Several 2-t-butyl-2'-substituted biphenyls have been prepared and resolved. The synthesis of these compounds was effected by heating with copper bronze a mixture of o-iodo-t-butylbenzene (or a derivative) and the appropriately substituted halogeno-benzene (or naphthalene) (Ullmann reaction). Large quantities of o-iodo-t-butylbenzene and methyl (or ethyl) 3-iodo-4-t-butylbenzoate have therefore been prepared. 6,6'-Di-t-butylbiphenyl-3"3lidicarboxylic acid was resolved through the brucine salt, and optically active 2,2'-di-t-butylbiphenyl has been obtained by decarboxylation of the optically active acid. 2',6 -Di-t-butylbiphenyl-3-carboxylic acid has been resolved through its strychnine salt and found to show high optical stability.An unsuccessful attempt was made to prepare 2,-nitro-6-t-butylbiphenyl-3-carboxylic acid, however, the synthesis of 2'-t-butyl-6-nitrobiphenyl-4-carboxylic acid succeeded and it was found that its strychnine salt underwent second-order asymmetric transformation in ethanol, and racemised in boiling chloroform solution. Racemisationof the optically active acid was studied at several temperatures between 51&deg; and 75&deg; and from the rates of racemisation the energy of activation was found to be 25.4 kcal.mole-1.Methyl 8-(2'-t-butylphenyl)-l-naphthoate was prepared by heating equimolecular proportions of0-iodo-t-butylbenzene and methyl 8-bromo-1-naphthoate.The acid obtained by hydrolysis of this ester was resolved through its strychnine salt, and racemisation of the optically active acid was studied. An attempt to prepare (2'-t-butylphenyl)-1-naphthalene from 8-(2'-t-butylphenyl)1-naphthoic acid by the Schmidt reaction resulted in the formation of the cyclisation product, 7-oxo-11-t-butylbenz[d e]anthracene. The benzanthracene obtained from the optically active acid was inactive.<p

Kenneth Gergen’s concept of multi-being : an application to the nurse–patient relationship

The nurse-patient relationship is of great significance for both nurses and patients. The purpose of this article is to gain an understanding of how the individual is constituted through a focus on the execution of the patient's and nurse's role in the joint relationship. The article represents a social-constructionist consideration using Kenneth Gergen's concept of multi-being. Gergen's notions of the self as a multi-being focuses on the individual's relational character through former relationships and social interactions. Gergen's concept is applied onto nurses and patients as individuals to gain an understanding of the broader institutional and social context of each role and their interactions within the nurse-patient relationship. The article focuses on the nurse-patient relationship in general with regard to specific challenges in the home care setting. Various demands and experiences from a myriad of past relationships merge as potential actions for nurses and patients during the forming of a relationship. Nurses as multi-beings see themselves confronted with guidelines and legal conditions, their own as well as the patients' expectations and the actual possible forming of a relationship in the light of daily nursing care. Patients as multi-beings experience an extended social environment that comprises the nurse-patient relationship while simultaneously having to cope with illness and increasing care dependency within their own homes. Discrepancies can be observed in the relationship with regard to the inherent human qualities, the demands of forming a relationship, and the actual relationship arising due to framework conditions

‘After mealtime is before mealtime’: an ethnographic exploration of nursing home residents’ practices of dealing with meal requirements

Background: In nursing homes, food is part of the care provided to residents, causing it to be strictly organised within the institutional framework. Moreover, once food has been integrated into the institutional logic, structural and economic aspects regarding organisation of food and eating may dictate individual and social needs, as a theoretical perspective informed by Goffman’s notion of the ‘total social institution’ suggests. This paper describes nursing home residents’ practices of dealing with meal requirements in two Austrian nursing homes, to understand how food integrates into the daily routine and how the institutional setting influences the social and material arrangement of food. Methods: An ethnographic design was chosen to gain an in-depth understanding. Two urban nursing homes were studied over 21 months (approx. 800 h of participant observation and ethnographic interviews collected). Data analysis took place iteratively, following Grounded Theory strategies. Results: As the thick descriptions resulting from this procedure show, observing everyday practices of eating in nursing homes reveals complex dimensions of residents being subject to institutional logics, and also demonstrates that residents develop elaborate strategies to deal with the institutional circumstances. Conclusion: A better understanding of the resulting tensions between the restrictions of living in a formal organisation and the agencies of residents described, may contribute to better understanding the effects of structural constraints and to designing more flexible processes

Geogenomic segregation and temporal trends of human pathogenic Escherichia coli o157:H7, Washington, USA, 2005-2014

The often-noted and persistent increased incidence of Escherichia coli O157:H7 infections in rural areas is not well understood. We used a cohort of E. coli O157:H7 cases reported in Washington, USA, during 2005–2014, along with phylogenomic characterization of the infecting isolates, to identify geographic segregation of and temporal trends in specific phylogenetic lineages of E. coli O157:H7. Kernel estimation and generalized additive models demonstrated that pathogen lineages were spatially segregated during the period of analysis and identified a focus of segregation spanning multiple, predominantly rural, counties for each of the main clinical lineages, Ib, IIa, and IIb. These results suggest the existence of local reservoirs from which humans are infected. We also noted a secular increase in the proportion of lineage IIa and IIb isolates. Spatial segregation by phylogenetic lineage offers the potential to identify local reservoirs and intervene to prevent continued transmission

Patients with Cancer and Family Caregivers: Management of symptoms caused by Cancer or Cancer Therapy at Home

People are diagnosed with cancer sooner nowadays thanks to increased awareness and improvements in cancer screenings. Patients are able to live longer due to cancer treatment regimens; however, they suffer the consequences of living with cancer and therapy-related symptoms. Symptom management is challenging for both patients and family caregivers. Therefore, family members must be integrated in the patient’s care plan. For this review, a literature search was conducted to determine what types of interventions were available that involved family members of cancer patients with the management of cancer and therapy-related symptoms. The following interventions were found that were designed for the family caregivers or both the patient and caregiver to aide with symptom management: pain intervention program, massage therapy, telephone intervention, self-efficacy improvement, coping enhancement and a multidimensional intervention. A positive effect was noted in all the studies, but several had no significance in the patient intervention group but did in the caregiver intervention group. However, studies indicated decreased symptom intensity for various symptoms, decreased symptom distress for both the patient and caregiver, increased self-efficacy of the family member, and increased satisfaction with certain interventions. Further research should be conducted on both existing interventions to better determine their effect and on family symptom management of cancer patients as they need support from healthcare professionals as well

Detection of delirium by family members in the intensive care unit: Translation, Cross-Cultural adaptation and validation of the Family Confusion Assessment Method for the German-Speaking area

Aim: The aim of this study was the translation, cross-cultural adaptation and validation of the Family Confusion Assessment Method in critically ill patients. Background: Delirium is a frequently unrecognized disorder in critically ill patients. Visiting family members might be the first to notice subtle changes in a patient's cognition and behaviour. The Family Confusion Assessment Method was developed to detect delirium by family members, but has not been available for the German-speaking area yet. Design: A prospective validation study was conducted between January 2020 and October 2020. Methods: The Family Confusion Assessment Method was translated into German according to the Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes. Subsequently, we compared the Family Confusion Assessment Method with the Confusion Assessment Method for the Intensive Care Unit in critically ill patients and their family members in a medical intensive care unit in Germany. Results: We included 50 dyads of critically ill patients and their family members. The prevalence of delirium measured by Confusion Assessment Method for the Intensive Care Unit was 44%. Cohen's kappa coefficient was 0.84. The German Family Confusion Assessment Method had a high sensitivity of 95.5% and specificity of 89.3%. The positive predictive value and negative predictive value were 87.5% and 96.2% respectively. Conclusions: These findings suggest that the German Family Confusion Assessment Method is an accurate assessment tool for delirium detection in the intensive care unit by family members. Furthermore, the results indicate that family members may identify delirium by the Family Confusion Assessment Method without prior training. Impact: Collaborating medical staff with patients' family members to detect delirium in the intensive care unit may lead to early recognition of delirium. Keywords: Family Confusion Assessment Method; delirium; family members; intensive care unit; nurses; validation study

German translation, cultural adaptation and testing of the Person‐centred Practice Inventory – Staff (PCPI‐S)

From Crossref via Jisc Publications RouterHistory: epub 2020-05-26, issued 2020-05-26Brendan McCormack - ORCID 0000-0001-8525-8905 https://orcid.org/0000-0001-8525-8905Aim The aim of this study was to translate and culturally adapt the PCPI‐S into German and to eventually test its psychometric properties in long‐term care settings.Background Person‐centred practice has been widely adopted internationally as a best‐practice model in nursing and health care. To ensure a sustainable implementation of this practice and to successively promote it, person‐centred practice should be evaluated on a regular basis. The Person‐centred Practice Inventory—Staff (PCPI‐S), which is based on McCormack & McCance's Person‐centred Practice Framework, is a new instrument for this purpose by assessing perceptions of person‐centredness among healthcare staff.Design A two‐phase research design was used involving the translation and cultural adaption of the PCPI‐S from English to German (PCPI‐S‐G; Phase 1) and a quantitative cross‐sectional survey (Phase 2).Methods Construct validity was evaluated using confirmatory factor analysis (CFA), and internal consistency was calculated using Cronbach's α .Results Phase 1 was conducted using an internationally recommended checklist for translations and cultural adaptations. In Phase 2, the PCPI‐S‐G was tested in 15 residential care homes in Austria with a sample of 255 staff members. The CFA showed good construct validity and supported the theoretical framework. The internal consistency for the three constructs of the PCPI‐S was excellent, revealing Cronbach's α ‐scores from 0.902–0.941.Funder: Office of the Provincial Government of Lower Austria7pubpub

Family caregivers' advocacy in voluntary stopping of eating and drinking : a holistic multiple case study

Aim: To gain insight into the experiences of family caregivers who accompanied a loved one during voluntary stopping of eating and drinking and to identify similarities and differences between cases of voluntary stopping of eating and drinking to develop a conceptual model. Design: A qualitative holistic multiple case study. Methods: We conducted narrative interviews with family caregivers (N = 17). We first analysed them inductively within the cases, followed by a cross-case analysis to merge the experiences into a conceptual model. Results: Family caregivers who could accept their loved one's wish to die stood up for the last will, especially when the cognitive abilities declined. They had to take on the role of an advocate to protect their self-determination from others who tried to interrupt the process. In their advocacy, they found themselves constantly in moral discrepancies. Usually without support, they provided nursing care until death. The subsequent processing phase was characterized by evaluating the dying situation and placing voluntary stopping of eating and drinking in their value scheme

Kinder und Jugendliche als pflegende Angehörige: Einblick in die Situation Betroffener und Möglichkeiten der Unterstüzung. T. 1, Einsicht in die Situation gegenwärtiger und ehemaliger pflegender Kinder in Österreich

Kinder und Jugendliche, die regelmäßig ein chronisch krankes Familienmitglied pflegen, sind ein globales Phänomen. In Österreich ist der Situation pflegender Kinder und Jugendlicher, mit Ausnahme einer größeren Anzahl von Diplomarbeiten am Institut für Pflegewissenschaft der Universität Wien, bisher noch wenig Aufmerksamkeit geschenkt worden. Es fehlt sowohl am Einblick in das Thema der sogenannten „Young Carers“ generell als auch an qualifizierten Hilfsangeboten. Ausgehend von einem parlamentarischen Entschließungsantrag hat das Bundesministerium für Arbeit, Soziales und Konsumentenschutz das Institut für Pflegewissenschaft der Universität Wien mit einer Studie beauftragt, die die Situation pflegender Kinder in Österreich untersuchen soll. Das Ziel der vorliegenden Studie besteht darin, Einsicht in die Situation pflegender Kinder zu nehmen. Diese Einsicht erfolgt in Form einer fundierten Zahlenbasis über die genaue Anzahl und die Situation gegenwärtig pflegender Kinder ebenso wie auf Grundlage der Beleuchtung der Situation ehemaliger pflegender Kinder und der Auswirkungen kindlicher Pflegeerfahrungen im Erwachsenenalter. Abgeleitet von den Ergebnissen und dem internationalen Diskurs werden Empfehlungen formuliert, auf deren Grundlage pflegende Kinder und Jugendliche unterstützt werden können