Addressing Mistreatment by Patients in Geriatric Subspecialties: A New Framework.

Mistreatment by patients is unfortunately common in clinical medicine, including geriatric subspecialties. Despite the prevalence of this problem, there are few standardized approaches for addressing it at both interpersonal and institutional levels. The "ERASE" framework is a novel, practical approach for addressing mistreatment by patients. "ERASE" includes Expecting and preparing for mistreatment by patients, Recognizing mistreatment, Addressing mistreatment in real time, Supporting members of the healthcare team who have been mistreated, and Establishing a positive institutional culture. The framework may prove particularly helpful and applicable to providers specializing in geriatrics and can be used by administrators, educators, and all members of the healthcare team to promote safe, dignified clinical care and learning environments.

Self-assembled thermoreversible gels of nonpolar liquids by racemic propargylic alcohols with fluorinated and nonfluorinated aromatic rings.

The synthesis and colloidal study of a new class of low molecular weight organogelators is reported. Racemic propargylic alcohols with perfluoroaryl and nonfluorinated aryl rings are capable of forming gels in alkane liquids and/or silicone oil. A full colloidal characterization of alkane gels prepared from (R/S)-1-pentafluorophenyl-3-phenylprop-2-yn-1-ol [(R/S)- 1] was conducted, including both structural [optical microscopy, scanning electron microscopy (SEM), powder X-ray diffraction (XRD), attenuated total reflectance infrared spectroscopy (ATR-IR)] and thermal stability [differential scanning calorimetry (DSC)] studies. A model of the organization of gelator molecules within gel fibers has been proposed primarily based on the correlation of diffraction data for the powder XRD pattern of a gel and a simulated powder pattern from a sublimed crystal of the gelator. Furthermore, structural requirements for propargylic alcohol gelators were investigated by subjecting derivatives with modified structures to gelation tests. An enantiomerically enriched sample [(R)- 1, 83% ee] fails to entrap the solvent under conditions where the racemate successfully forms a gel. The remaining racemic derivatives (with p-alkoxy or p-alkyl substituents on the nonfluorinated arene) form gels or partial gels in silicone oil and in some alkane preparations.

Enantioselective fluorescent recognition of chiral acids by cyclohexane-1,2-diamine-based bisbinaphthyl molecules.

The cyclohexane-1,2-diamine-based bisbinaphthyl macrocycles (S)-/(R)-5 and their cyclic and acyclic analogues are synthesized. The interactions of these compounds with various chiral acids are studied. Compounds (S)-/(R)-5 exhibit highly enantioselective fluorescent responses and high fluorescent sensitivity toward alpha-hydroxycarboxylic acids and N-protected amino acids. Among these interactions, (S)-mandelic acid (10(-3) M) led to over 20-fold fluorescence enhancement of (S)-5 (1.0 x 10(-5) M in benzene/0.05% DME) at the monomer emission, and (S)-hexahydromandelic acid (10(-3) M) led to over 80-fold fluorescence enhancement. These results demonstrate that (S)-5 is useful as an enantioselective fluorescent sensor for the recognition of the chiral acids. On the basis of the study of the structures of (S)-5 and the previously reported 1,2-diphenylethylenediamine-based bisbinaphthyl macrocycle (S)-4, the large fluorescence enhancement of (S)-5 with a chirality-matched alpha-hydroxycarboxylic acid is attributed to the formation of a structurally rigidified host-guest complex and the further interaction of this complex with the acid to suppress the photoinduced electron-transfer fluorescent quenching caused by the nitrogens in (S)-5.

Macrocyclic bisbinaphthyl fluorophores and their acyclic analogues: signal amplification and chiral recognition.

A series of optically active macrocyclic and acyclic bisbinaphthyls have been synthesized and characterized. The structure of one of the bisbinaphthyl macrocycles has been established by a single-crystal X-ray analysis. The UV and fluorescence spectra of these chiral compounds in various solvents and at different concentrations are studied. Formation of excimers is observed for the macrocyclic bisbinaphthyl compounds. Introduction of conjugated substituents to the 6,6'-positions of the binaphthyl units in the macrocycles leads to greatly amplified fluorescence signals. Using the 6,6'-substituted bisbinaphthyl macrocycles in place of the unsubstituted macrocycles allows a 2 orders of magnitude reduction in the sensor concentration for the fluorescence measurements. These macrocycles have exhibited highly enantioselective fluorescent enhancements in the presence of chiral alpha-hydroxycarboxylic acids and N-protected alpha-amino acids. They are useful as fluorescent sensors for chiral recognition. The macrocycles show much greater enantioselectivity in the substrate recognition than their acyclic analogues.