Enantioselective Addition of α-Nitroesters to Alkynes.

By using Rh-H catalysis, we couple α-nitroesters and alkynes to prepare α-amino-acid precursors. This atom-economical strategy generates two contiguous stereocenters, with high enantio- and diastereocontrol. In this transformation, the alkyne undergoes isomerization to generate a RhIII -π-allyl electrophile, which is trapped by an α-nitroester nucleophile. A subsequent reduction with In powder transforms the allylic α-nitroesters to the corresponding α,α-disubstituted α-amino esters.

Synchronous communication facilitates interruptive workflow for attending physicians and nurses in clinical settings.

STUDY OBJECTIVE: Inter-clinician communication accounts for more than half of all information exchanges within the health care system. A non-participatory, qualitative time-and-motion observational study was conducted in order to gain a better understanding of inter-clinician communication behaviors, routine workflow patterns, and the use of information communication technologies (ICTs) within the clinical workspace. METHOD: Over a 5-day period, seven attending physicians and two nurses were shadowed for 2-4h at a time. Inter-clinician communication events were tracked in real-time using synchronized digital stopwatches. Observations were recorded on a paper-based, semi-structured observation tool and later coded for analysis. RESULTS: Nine hundred and eighty-seven communication events were observed over 2024.67 min. Clinicians were observed to spend the majority of their time on patient care (85.4% in this study) with about three-fourths of that time spent on indirect patient care (e.g. charting). Clinicians were observed to prefer using synchronous communication modes, which led to multitasking and created a highly interrupted workflow. Forty-two percent (n=415) of communication events were coded as interruptions and study participants were seen multitasking 14.8% of the time. Though each interruption was short-lived (on average 0.98+/-2.24 min for attending physicians), they occurred frequently. Both attending physicians and nurses were the recipients of more interruptions than they initiated. CONCLUSION: This study demonstrated that the clinical workspace is a highly interruptive environment. Multiple interruptions in the communication processes between clinicians consume time and have the potential to increase the risk of error. This workflow analysis may inform the development of communication devices to enhance inter-clinician communication by reducing interruptions or deferring interruptions to more appropriate times.