Phosphorous(v) Lewis acids: water/base tolerant P3-trimethylated trications.

The water/base intolerance of the previously reported electrophilic phosphonium cations has been overcome by replacing the labile electron-withdrawing groups generally attached to phosphorus (e.g. -F, -OAr, -CF3) with methyl groups. Tri-phosphorus(v) tricationic species, accessible in one-pot from commercially available materials, are air and water/base tolerant, yet are sufficiently Lewis acidic for catalysis.

Air- and water-stable Lewis acids: synthesis and reactivity of P-trifluoromethyl electrophilic phosphonium cations.

A new class of electrophilic phosphonium cations (EPCs) containing a -CF3 group attached to the phosphorus(v) center is readily accessible in high yields, via a scalable process. These species are stable to air, water, alcohol and strong Brønsted acid, even at raised temperatures. Thus, P-CF3 EPCs are more robust than previously reported EPCs containing P-X moieties (X = F, Cl, OR), and despite their reduced Lewis acidity they function as Lewis acid catalysts without requiring anhydrous reaction conditions.

Double-outlet right ventricle with an intact interventricular septum and concurrent hypoplastic left ventricle in a calf.

A 3-day-old Hereford heifer calf presented for evaluation of lethargy and dyspnea, with persistent hypoxia despite supplemental oxygen therapy. A grade III/VI right apical systolic murmur was noted during cardiac auscultation. Echocardiography revealed a double-outlet right ventricle with an intact interventricular septum and concurrent hypoplastic left ventricle and tricuspid valve dysplasia. Post-mortem examination revealed additional congenital anomalies of ductus arteriosus, patent foramen ovale, and persistent left cranial vena cava. This report illustrates the use of echocardiographic images to diagnose a double-outlet right ventricle with an intact interventricular septum and a hypoplastic left ventricle in a calf.

Phosphorus Lewis acids: emerging reactivity and applications in catalysis.

Part of the renaissance in main group chemistry has been a result of the focus on reactivity. This has led to the development of applications in stoichiometric reactivity and catalysis. In this tutorial review, we focus attention on the role of phosphorus-based Lewis acids in such advances. While early literature recognizes the role of P(iii) and P(v) electrophiles in coordination chemistry, it has generally been more recent studies that have focused on applications of this Lewis acidity. Applications of these novel P-based Lewis acids in stoichiometric reactivity, Lewis acid catalysis and frustrated Lewis pair (FLP) reactivity are reviewed. These advances demonstrate that P-based Lewis acids are a powerful tool for further developments in metal-free catalysis.

Phase I trial and biochemical evaluation of tiazofurin administered on a weekly schedule.

Tiazofurin (2-B-D-Ribofuranosylthiazole-4-Carboxamide: NSC 286193) is a nucleoside antimetabolite that acts as a potent inhibitor of IMP dehydrogenase resulting in a guanine nucleotide deprivation. Recent in vivo biochemical observations in rats bearing hepatoma suggested a correlation between depletion of guanine nucleotides and antitumor effect. The present phase I trial utilized a weekly x 3 bolus infusion schedule, repeated every 5 weeks. Biochemical measurements of GTP and dGTP were performed in patients at each dose level. Twelve patients received 16 courses of the drug in doses ranging from 1100 to 2050 mg/m2 weekly x 3. The dose limiting toxicities were pericarditis and clinical symptoms suggestive of a more generalized serositis (chest and abdominal pain). Other toxicities included reversible elevations in CPK (MM band only) and SGOT, nausea, vomiting, and arthralgias. Neurotoxic effects were generally mild, including headaches, anxiety, and malaise. Only 1 of 6 patients evaluated for tiazofurin's biochemical activity showed a sustained depletion of guanine nucleotide pools. No antitumor activity was observed. The maximally tolerated dose of tiazofurin on this intermittent weekly x 3 schedule was 1650 mg/m2. Toxicity and the overall lack of biochemical and biologic effect at clinically achievable doses may preclude further clinical evaluation of this drug on a weekly schedule. The toxicities observed in our study were similar to those reported for phase I investigations using a considerably higher dose intensity with daily x 5 schedules.

A randomized trial of quality assurance in nursing homes.

Sixty nursing homes were randomly allocated to receive or not to receive a quality assurance intervention. The experimental intervention included the use of predeveloped quality assurance packages, the services of a quality assurance consultant, and the process of working through the quality assurance cycle with one of two principal indicator conditions. Two prevalent health problems, hazardous mobility and constipation, were selected as the principal indicator conditions. To detect co-intervention, one of two hidden secondary indicator conditions (potential skin breakdown and urinary incontinence) was assessed in each facility. In the control nursing homes, both the principal and secondary indicator conditions were hidden from staff. The care for 1,525 residents was examined before and after the intervention using a retrospective record review initiated for the study purposes. Improvement in management of the principal conditions, hazardous mobility and constipation, was greater in the experimental group (P less than 0.03 and P less than 0.005, respectively). Neither group changed its management of the hidden conditions. Behavior change was achieved using quality assurance-linked interventions. Further research should focus on refining quality assurance interventions that provide staff education and motivational strategies.

Pharmacists and their relationship with elderly patients.

A survey of 60 randomly selected pharmacists explored their relationship with elderly patients, including their information storage systems, dispensing practices and the major problems they encounter with these patients. Nearly all the pharmacists kept a medication profile for each elderly patient, and one third used a computer, which facilitated recording of additional information. However, few recorded the age of the patient. Many pharmacists counselled their elderly patients on the correct use of medications, but few provided counselling on the use of nonprescription drugs. Most of the pharmacists reported using techniques to improve compliance among elderly patients. More than 80% of the pharmacists reported apparently inappropriate prescribing by physicians at least occasionally.

Compliance with prescribed medication by elderly patients.

Factors contributing to improper use of medication were examined in 40 patients aged 65 years or more who were in a home care program. They reported taking an average of 3.8 prescription medications and 1.2 nonprescription medications each. Pill counts showed that they were actually taking 57% of the prescribed medications; compliance decreased with the number of medications concurrently prescribed. Poor labelling instructions, difficulty opening childproof containers and misunderstanding of verbal instructions contributed to this problem. The patients tended to rely more on physicians than on pharmacists or visiting nurses for advice problems with medication.

Hypothermia in hamilton: searching for a syndrome.

The purpose of this study was to examine the incidence of accidental hypothermia in people 65 years and older who were residing at home or were seen in emergency rooms of the four Hamilton hospitals between January 1 and March 31, 1980. For the purpose of this study, accidental hypothermia was defined as a rectal temperature or a core body temperature below 35°C. Persons with temperatures below 35.5°C were considered "at risk" of becoming hypothermic. Special low reading thermometers were supplied to professionals taking part in this study. No cases at risk of, or having, hypothermia were found at home. Nine people were found to be at risk and seven were found to be hypothermic in the emergency room group. None of these manifested the classical signs of hypothermia.

Placement of the elderly.

Placement of the elderly involves the person, family, treating professionals and those professionals who will provide future care. It must be based on accurate assessment of the person's abilities, interests and care needs. It requires knowledge of possible community support services and residential care facilities. The person must recognize, accept and adjust to the care needs and as far as possible, be allowed the final decision on placement. This requires that he or she be fully informed and given time to consider. There is often competition for resources; a system is needed to ensure identification of the optimal resource for each individual, equitable access to resources according to a recognized priority rating, and a certainty that every person will find a place appropriate to his need.

Prescribing of psychoactive drugs for chronically ill elderly patients.

The prescribing of psychoactive drugs for 1431 chronically ill elderly patients being assessed for long-term institutional or community care was surveyed. Psychoactive drugs had been prescribed for about one quarter of the patients; benzodiazepines were the most frequently prescribed group. Judging from the extensive prescribing of flurazepam and chloral hydrate, commonly used hypnotics, the main reason psychoactive drugs were prescribed was to provide night-time sedation. Antidepressants and drugs promoted as useful in improving cognitive function were infrequently prescribed. Commendable prescribing practices included the infrequent use of "cerebral vasodilators" and barbiturates. Questionable prescribing practices included the infrequent use of tricyclic antidepressants in severely depressed patients and the use of tranquilizers in patients described by their attending physician as markedly or extremely withdrawn.

Management of confusion in elderly persons.

Confusional states in the elderly are not uncommon and demand a high level of diagnostic and therapeutic skills in the physician. An immediate requirement is to provide protection and care while the cause is being elucidated. Tranquilizing medication is useful but the dosage must be both sufficient for the patient to gain control and monitored to prevent overdosage. Confusion may be due to disorder in various body systems with effects on the brain, or to a primary brain disorder. Careful evaluation of general health and also of cognitive, affective and social factors is necessary to clarify diagnosis and management.

Identifying needs and services for the aged.

The Assessment and Placement Service (APS) of the Hamilton-Wentworth District Health Council assists health professionals in identifying the needs of persons with chronic disabling diseases, and in finding appropriate resources or programs. More than 80 percent of the 9,300 persons referred between September 1971 and December 1975 were over the age of 64. Although most referrals were local, some came as far away as British Columbia and Florida for persons wishing placement locally. Of the 2,005 persons referred and placed in 1975, 1,063 came from acute disease hospitals, 201 from other institutions, 628 from the community within this District, and the remainder from elsewhere. There were 1,187 women, of whom 89.5 per cent were over the age of 64, and 811 men, of whom 65.8 per cent were over that age. In the opinion of their physicians, only 20 percent of all persons referred had normal memory, and only 13 percent had normal judgment. In the 64+ age group, 71.1 percent of the women were widows, and 25.9 percent of the men were widowers. One-third of those referred were living alone, and one-fourth with a spouse only. For placement, 453 patients went to private residences or boarding homes, often with the support of community services, and the remainder went to various institutions according to identified needs. Follow-up contact one month later showed conditions to be satisfactory in most instances. Deficiencies in the health care system were identified and reported to the Health Council.