Highly alkylated cyclohexanes. X-Ray crystal structures, force-field calculations, and conformations of cis/trans-1,4-disubstituted cyclohexane isomers

The structures of mesylated cis- and trans-tetramethylshisool cis- 2 and trans-2 have been elucidated by single-crystal X-ray techniques. In cis-2 the isopropenyl group adopts an axial position in the crystal, and the structural data obtained are in good agreement with those from force-field calculations. In trans-2 the two rotamers arising from rotation of the isopropenyl group were assigned by NOE measurements. Comparison of the spectroscopic data with those of other tetramethyllimonene derivatives showed that these can be classified into compounds with preferred equatorial and preferred axial position of the isopropenyl group

Studies on the physiology and enzymology of fructosan utilization in the tuber of Helianthus tuberosus L.

Imperial Users onl

Determining the psychometric properties of the Enhancing Decision-making Assessment in Midwifery (EDAM) measure in a cross cultural context

© 2016 Jefford et al. Background: The ability to act on and justify clinical decisions as autonomous accountable midwifery practitioners, is encompassed within many international regulatory frameworks, yet decision-making within midwifery is poorly defined. Decision-making theories from medicine and nursing may have something to offer, but fail to take into consideration midwifery context and philosophy and the decisional autonomy of women. Using an underpinning qualitative methodology, a decision-making framework was developed, which identified Good Clinical Reasoning and Good Midwifery Practice as two conditions necessary to facilitate optimal midwifery decision-making during 2nd stage labour. This study aims to confirm the robustness of the framework and describe the development of Enhancing Decision-making Assessment in Midwifery (EDAM) as a measurement tool through testing of its factor structure, validity and reliability. Method: A cross-sectional design for instrument development and a 2 (country; Australia/UK) x 2 (Decision-making; optimal/sub-optimal) between-subjects design for instrument evaluation using exploratory and confirmatory factor analysis, internal consistency and known-groups validity. Two 'expert' maternity panels, based in Australia and the UK, comprising of 42 participants assessed 16 midwifery real care episode vignettes using the empirically derived 26 item framework. Each item was answered on a 5 point likert scale based on the level of agreement to which the participant felt each item was present in each of the vignettes. Participants were then asked to rate the overall decision-making (optimal/sub-optimal). Findings: Post factor analysis the framework was reduced to a 19 item EDAM measure, and confirmed as two distinct scales of 'Clinical Reasoning' (CR) and 'Midwifery Practice' (MP). The CR scale comprised of two subscales; 'the clinical reasoning process' and 'integration and intervention'. The MP scale also comprised two subscales; women's relationship with the midwife' and 'general midwifery practice'. Conclusion: EDAM would generally appear to be a robust, valid and reliable psychometric instrument for measuring midwifery decision-making, which performs consistently across differing international contexts. The 'women's relationship with midwife' subscale marginally failed to meet the threshold for determining good instrument reliability, which may be due to its brevity. Further research using larger samples and in a wider international context to confirm the veracity of the instrument's measurement properties and its wider global utility, would be advantageous

4-Nitro­phenyl 4-bromo­benzoate

In the crystal structure of the title compound, C13H8BrNO4, mol­ecules are linked into chains along [101] by weak C—H⋯O hydrogen bonds and Br⋯O contacts [3.140 (4) Å]. The planes of the nitrated and brominated aryl rings form a dihedral angle of 64.98 (10)°, indicating a twist in the mol­ecule

Las manifestaciones de la doble vulnerabilidad a la violencia intrafamiliar en mujeres con discapacidad física

Trabajo final de graduación de 200 páginas en formato pdfAbordar el tema de la violencia intrafamiliar contra las mujeres con discapacidad, implica reconocer la dimensión paradigmática y la injusticia social estructural que subyacen detrás de su situación concreta de vida. Los servicios de atención en salud, fundamentados en el derecho de salud para todos(as), deben atender dichos determinantes. Además deben garantizar la prestación de servicios bajo los principios de igualdad de oportunidades, accesibilidad universal, participación y los valores de respeto a la diferencia, autonomía y solidaridad. Es sobre este marco que se realiza el presente estudio, el cual pretende dar respuesta al problema de investigación planteado:¿La prestación de los servicios en el Primer Nivel de Atención en Salud a la Violencia Intrafamiliar responde a la doble vulnerabilidad de las mujeres con discapacidad física, de 20 a 39 años de edad? Este problema se estudia específicamente en el Área de Salud de la Caja Costarricense de Seguro Social en Puerto Viejo de Sarapiquí, entre junio y noviembre del 2004. La investigación realizada es aplicada, cualitativa con carácter exploratorio descriptivo. De acuerdo con este enfoque se desarrolló un grupo focal con mujeres con discapacidad física entre los 20 y 39 años de edad, que habitan en el área. También, se realizaron entrevistas individuales semi-estructuradas a prestadores(as) de servicios de atención en salud a la violencia intrafamiliar. Además se efectuó un análisis documental sobre “las normas y el protocolo de atención a la violencia intrafamiliar” vigentes en la CCSS, las cuales constituyeron la fuente secundaria. Con relación a los resultados obtenidos se destacan, entre otros aspectos: a) La visión de la discapacidad sostenida por las mujeres como una construcción social caracterizada por la falta de oportunidades, accesibilidad y por prácticas discriminatorias en un mundo que considera a la persona con discapacidad como dependiente, infeliz y menos capaz. b) La dificultad en las mujeres para RESUMEN EJECUTIVO 1 visualizar la condición de género y la necesidad, expresada por ellas, para contar con información accesible sobre sus derechos. c) Las mujeres con discapacidad no escapan de las mismas manifestaciones y consecuencias de la violencia intrafamiliar a que se enfrentan las mujeres sin discapacidad. Sin embargo la doble condición diferencia su situación y su vulnerabilidad lo que conlleva a una demanda diferencial hacia la prestación de los servicios de atención en salud. d)Tanto las normas de atención a la violencia intrafamiliar como el protocolo vigentes, no establecen una atención desde el sistema de vigilancia epidemiológica para visualizar el determinante discapacidad. e) En el momento del estudio la escasez de recursos humanos, así como la falta de capacitación del mismo son limitantes fundamentales en el Área de Salud de Puerto Viejo de Sarapiquí, para que las acciones dirigidas hacia una atención a la violencia intrafamiliar sean de calidad. Además, las mujeres con discapacidad no son tomadas como un grupo prioritario en la prestación de los servicios. Los resultados encontrados conllevan a la conclusión que el reconocimiento de la doble discriminación de las mujeres con discapacidad no se trasciende hacia la prestación de los servicios de atención en salud a la violencia intrafamiliar en el Área de Salud de Puerto Viejo de Sarapiquí. Además, se considera que en el Área de Salud existe una violencia institucional hacia este grupo de población por la falta de servicios de rehabilitación, información y orientación, la cual es agravada por la falta de un proceso de capacitación continua en el tema de la discapacidad. Con base en los resultados y conclusiones se elaboran recomendaciones para articular la prestación de los servicios de atención, en el Área de Salud, con las manifestaciones de la doble vulnerabilidad detectadas. Estas recomendaciones tienen como fin incluir la perspectiva de las mujeres con discapacidad desde el enfoque de derechos e igualdad de oportunidades y van dirigidas hacia los(as) diferentes actores(as) vinculados con la prestación de los servicios a la Violencia Intrafamiliar, es decir: la Política Pública; las Normas y Protocolo de la CCSS, la prestación de los servicios de salud en el área.Universidad Estatal a Distancia de Costa Ric

Midwifery abdication – is it acknowledged or discussedwithin the midwifery literature: An integrative review

Aim: To explore the concept of ‘Midwifery Abdication’ and whether it is acknowledged or discussed within the midwifery literature.Method:A modified Whittemore and Knafl (2005) integrative review framework enabled consideration of quantitative and qualitative literature. A total of 1508 papers were located. Duplicate records were removed, leaving 1197 records. All titles, abstracts, or case facts were reviewed using a framework derived from the definition of ‘Midwifery Abdication’. Three qualitative studies were selected for analysis; the NICE Quality Appraisal Checklist was used to determine study quality. Key findings:Midwifery Abdication’ occurs within the wider midwifery literature as indicated in the three studies from different countries. However, the original constructs need to be widened to include: ‘external perceptions of midwifery practice’ and ‘how can reflection facilitate change?’ The extent of philosophy in these environments, lead to adoption of a midwifery philosophy failure. Such an environment impacts on a midwife’s ability to fully exercise their autonomy, and to advocate for normality and women. This renders ‘Midwifery Abdication’ almost inevitable or at least very difficult to stop. A midwife’s own midwifery identity, the environmental hierarchy and associated culture of social obedience, where acceptance and finding one’s place acted as an influential factor. Midwifery education needs to ensure midwives are prepared and able to embrace their professional status as autonomous practitioners. Promotion of reflexive practice to facilitate personal and professional change is warranted. Practice policies that are not supportive of a midwife’s professional autonomy and scope of practice reinforce a technocratic work environment

Solvent and substituent effects on the kinetics of thermolysis of cis-fused 1,2,4-trioxanes

The kinetics of the thermal decomposition reaction of cis-6-phenyl-5,6-(2- phenylpropyliden)-3,3-pentamethylene-1,2,4-trioxacyclohexane (Ia) were investigated in benzene and methanol solutions in the temperature and concentration ranges of 353.3-413.2 K and (1.1 - 13.1)×10-3 M, respectively. First-order rate constant values were obtained for up to at least ca. 20% conversions of that cyclic peroxide. The activation parameter values for the initial unimolecular homolysis of that molecule, results supported by the effect of the addition of di-tert-butyl-p-cresol as a free radical scavenger, indicate a stepwise reaction mechanism which is in keeping with the reaction products analysis. The corresponding activation parameters for the reaction of Ia in methanol (ΔH# = 20.2 ± 0.6 kcal mol-1; ΔS# = 0.1 ± 1.6 cal mol-1K-1; ΔG# = 20.2 ± 0.6 kcal mol-1 and in benzene (ΔH# = 15.4 ± 0.2 kcal mol-1; ΔS# = -13.2 ± 0.5 cal mol-1K-1; ΔG# = 20.5 ± 0.2 kcal mol-1 solutions are compared with values obtained for cis-6-phenyl-5,6-(2-phenylpropyliden)-3,3- tetramethylene-1,2,4-trioxacyclohexane (Ib) thermolysis in the same solvents. The thermolysis kinetics of Ia are less sensitive to solvent changes compared to the behaviour already reported for the analogous reactions of Ib. Because both molecules in solution are flexible structures due to their configurations, the relatively small solvent effect found on the former trioxane reaction is attributed to the extent of the chain of methylene groups attached on C-3 of the corresponding molecular rings. Furthermore, the pertinent substituent effect on the peroxidic bond strength of those molecules in solution was evaluated.Facultad de Ciencias Exacta