Altruism in medical education: assessing attitudes of hospital in-patients towards face-to-face contact with medical students during the COVID-19 pandemic

Abstract Background Limited research indicated patients were largely amenable to seeing medical students pre-pandemic. However, the COVID-19 pandemic has highlighted the potential risk of nosocomial transmission and harm to patients from students. Patient opinions regarding these risks remain unexplored, which impacts elicitation of informed consent. We aim to identify these, and explore whether reflection on the risks and benefits of direct student interaction influenced patients’ attitudes. For guidance, we further explored measures to reduce perceived infection risk. Method We designed an original questionnaire for a cross-sectional study, completed by 200 inpatients from 25 wards between 18/02 and 16/03/2022 at Derriford Hospital, Plymouth. Patients in intensive care, with active COVID-19 infection or unable to comprehend the study information were excluded. The responses of a guardian were recorded for inpatients under 16. 17 questions were included - the initial question, reporting willingness to talk with and be examined by students, was repeated following nine questions exploring risks and benefits of student interaction. A further four questions addressed reducing the perceived infection risk. Data is summarised using frequencies and percentages, and with Wilcoxon signed-rank and rank-sum tests of association. Results 85.4% (169/198) of participants gave an initial positive response to seeing medical students, and despite a third of participants changing their response 87.9% (174/197) remained willing after the survey resulting in no significant change. Furthermore, 87.2% (41/47) of those who perceived themselves at severe risk of harm from COVID-19 remained happy to see students. Participants reported reassurance knowing students were: fully vaccinated (76.0%); wearing masks (71.5%); lateral flow test negative within the last week (68.0%) and wearing gloves and gown (63.5%). Conclusion This study demonstrated the willingness of patients to engage in medical education despite recognised risks. Patient reflection on the risks and benefits of student interaction did not significantly reduce numbers willing to see students. Even those perceiving a risk of serious harm remained happy to have direct student contact – a demonstration of altruism in medical education. This suggests informed consent should include discussion of infection control measures, risks and benefits to patients and students, and offer alternatives to direct inpatient contact. </jats:sec

Investigating Steric and Electronic Factors in the Synthesis of Complexes Containing Tetravalent Cerium-Ligand Multiple Bonds

Complexes featuring multiple bonds between d-block transition metals and ligand fragments have well-established chemistry. These bonds have been shown to exhibit interesting catalytic transformations or act as important ancillary ligands. However, the chemistry of analogous complexes involving the rare-earth elements is under-developed. This dissertation explores the synthetic strategies that were employed in isolating unique examples of Ce=N complexes supported by the TriNOx3– ligand framework. We performed the first comprehensive study of a series cerium-imido complexes and documented the effects of capping alkali-metal cations on the solid state and electronic structures of Ce=N bond. Finally, preliminary reactivity studies on the alkali-metal capped Ce=N complexes afforded isolation of rare examples of complexes featuring Ce=O bonds

Investigating Steric and Electronic Factors in the Synthesis of Complexes Containing Tetravalent Cerium-Ligand Multiple Bonds

Complexes featuring multiple bonds between d-block transition metals and ligand fragments have well-established chemistry. These bonds have been shown to exhibit interesting catalytic transformations or act as important ancillary ligands. However, the chemistry of analogous complexes involving the rare-earth elements is under-developed. This dissertation explores the synthetic strategies that were employed in isolating unique examples of Ce=N complexes supported by the TriNOx3– ligand framework. We performed the first comprehensive study of a series cerium-imido complexes and documented the effects of capping alkali-metal cations on the solid state and electronic structures of Ce=N bond. Finally, preliminary reactivity studies on the alkali-metal capped Ce=N complexes afforded isolation of rare examples of complexes featuring Ce=O bonds

Cerium(IV) Imido Complexes: Structural, Computational, and Reactivity Studies

A series of alkali metal capped cerium­(IV) imido complexes, [M­(solv)_<i>x</i>]­[CeN­(3,5-(CF₃)₂C₆H₃)­(TriNOx)] (M = Li, K, Rb, Cs; solv = TMEDA, THF, Et₂O, or DME), was isolated and fully characterized. An X-ray structural investigation of the cerium imido complexes demonstrated the impact of the alkali metal counterions on the geometry of the [CeN­(3,5-(CF₃)₂C₆H₃)­(TriNOx)]⁻ moiety. Substantial shortening of the CeN bond was observed with increasing size of the alkali metal cation. The first complex featuring an unsupported, terminal multiple bond between a Ce­(IV) ion and a ligand fragment was also isolated by encapsulation of a Cs⁺ counterion with 2.2.2-cryptand. This complex shows the shortest recorded CeN bond length of 2.077(3) Å. Computational investigation of the cerium imido complexes using DFT methods showed a relatively larger contribution of the cerium 5d orbital than the 4f orbital to the CeN bonds. The [K­(DME)₂]­[CeN­(3,5-(CF₃)₂C₆H₃)­(TriNOx)] complex cleaves the SiO bond in (Me₃Si)₂O, yielding the [(Me₃SiO)­Ce^IV(TriNOx)] adduct. The reaction of the rubidium capped imido complex with benzophenone resulted in the formation of a rare Ce­(IV)–oxo complex, that was stabilized by a supramolecular, tetrameric oligomerization of the CeO units with rubidium cations

An Alkali Metal-Capped Cerium(IV) Imido Complex

Structurally authenticated, terminal lanthanide–ligand multiple bonds are rare and expected to be highly reactive. Even capped with an alkali metal cation, poor orbital energy matching and overlap of metal and ligand valence orbitals should result in strong charge polarization within such bonds. We expand on a new strategy for isolating terminal lanthanide–ligand multiple bonds using cerium­(IV) complexes. In the current case, our tailored tris­(hydroxyl­aminato) ligand framework, TriNOx^3–, provides steric protection against ligand scrambling and metal complex oligomerization and electronic protection against reduction. This strategy culminates in isolation of the first formal CeN bonded moiety in the complex [K­(DME)₂]­[CeN­(3,5-(CF₃)₂C₆H₃)­(TriNOx)], whose CeN bond is the shortest known at 2.119(3) Å