Enantioselective S-Alkylation of Sulfenamides by Phase-Transfer Catalysis.

A general phase-transfer catalyst (PTC) mediated enantioselective alkylation of N-acylsulfenamides is reported. Essential to achieving high selectivity was the use of the triethylacetyl sulfenamide protecting group along with aqueous KOH as the base under biphasic aqueous conditions to enable the reaction to be performed at -40 °C. With these key parameters, enantiomeric ratios up to 97.

Catalytic Enantioselective Sulfur Alkylation of Sulfenamides for the Asymmetric Synthesis of Sulfoximines.

Sulfoximines are increasingly incorporated in agrochemicals and pharmaceuticals, with the two enantiomers of chiral sulfoximines often having profoundly different binding interactions with biomolecules. Therefore, their application to drug discovery and development requires the challenging preparation of single enantiomers rather than racemic mixtures. Here, we report a general and fundamentally new asymmetric synthesis of sulfoximines.

A Nurse-Led Evidence-Based Practice Protocol to Reduce Postoperative Nausea and Vomiting in the Bariatric Surgery Patient.

Purpose: To create and implement a standard care bundle to reduce postoperative nausea and vomiting (PONV) in the bariatric surgery patient.

Design: Evidence-based quality improvement project.

Methods: A pre- and postintervention chart review identified high-risk indicators for PONV in patients with longer lengths of stay (LOS), which led to the development of targeted care bundle components.

Using Objective Structured Clinical Examination as a Teaching Tool in a Hybrid Advanced Health Assessment Course.

Background: Advanced health assessment is a required course in advanced practice RN (APRN) education, essential to providing the foundation for differential diagnosis (DD) skills and the ability to formulate a plan of care.

Problem: Feedback from clinical preceptors revealed that our doctor of nursing practice (DNP) students struggled to make a DD.

Approach: This educational quality improvement project collected data from 7 cohorts of DNP students in either the Family Nurse Practitioner or Adult Gerontology Nurse Practitioner program to evaluate their readiness for clinical practicums and to inform necessary curriculum revisions.

Meeting preceptor expectations to facilitate optimal nurse practitioner student clinical rotations.

Preceptors are essential to nurse practitioner (NP) students' transition from being a student to competent entry-level NP graduate. The literature is replete with data pertaining to the benefits of and barriers to preceptors engaging in the clinical education of NP students, and little has changed in the last two decades in this regard. Therefore, faculty solicited preceptor input to enhance curriculum revision and clinical training preparation.

Impact of a Plant-Based Diet and Support on Mitigating Type 2 Diabetes Mellitus in Latinos Living in Medically Underserved Areas.

Purpose: To determine the impact that a high-fiber, low-fat diet, derived from mostly plant-based sources, when coupled with support has upon self-management of type 2 diabetes mellitus in Latinos from medically underserved areas (MUAs).

Design: Experimental randomized controlled community pilot study.

Setting: Three community clinics in MUAs located within San Bernardino County, California.

Factors that influence diabetes self-management in Hispanics living in low socioeconomic neighborhoods in San Bernardino, California.

The growing incidence of diabetes among Hispanics is a serious public health concern. To identify factors that influence diabetes self-management in Hispanics, qualitative data gathered through five focus group interviews was examined using grounded theory methods. Four major themes emerged which were perceived by participants as enhancing or limiting factors: (1) access to resources, (2) struggle with diet, (3) self-efficacy, and (4) social support.

Percutaneous removal of spilled gallstones in a subhepatic abscess.

Abscess formation from spilled gallstones after laparoscopic cholecystectomy is infrequent. However, if an abscess does form and contains the spilled stones simple percutaneous drainage will not resolve the dilemma of a recurrent abscess. Open drainage has previously been recommended to remove the retained stones and decrease recurrent abscess formation.

Using a sterile disposable protective surgical drape for reduction of radiation exposure to interventionalists.

Objective: The purpose of this paper is to show the effectiveness of a new radiation protection method designed to decrease the amount of scatter radiation received by practitioners performing procedures under fluoroscopic guidance.

Materials And Methods: A sterile, disposable, lead-free surgical drape containing radiation protection material composed primarily of bismuth was evaluated for effectiveness in reducing radiation doses to health care personnel. Measurements of phantom scatter, patient scatter, skin entrance, and the effects of collimation, together with comparative monthly thermoluminescent dosimeter recordings, were taken to determine the effectiveness of X-ray beam attenuation using the bismuth drapes.

Aortoesophageal fistula after repair of descending aortic dissection.

The development of aortoesophageal fistula after aortic repair is rare. We describe a patient who presented with hematemesis 4 months after emergent repair of a descending thoracic aortic dissection using a prosthetic graft. Diagnosis was supported by computed tomographic, angiographic, and endoscopic findings.

MR 'hot nose sign' and 'intravascular enhancement sign' in brain death.

Three cases of MR with gadopentetate dimeglumine in patients diagnosed with cerebral death are presented. Observation of an MR "hot nose sign" and an "intravascular enhancement sign" provided additional imaging support in the clinical diagnosis of brain death. The MR findings in brain death include: 1) transtentorial and foramen magnum herniation, 2) absent intracranial vascular flow void, 3) poor gray matter/white matter differentiation, 4) no intracranial contrast enhancement, 5) carotid artery enhancement (intravascular enhancement sign), and 6) prominent nasal and scalp enhancement (MR hot nose sign).

Preoperative spinal angiography for lateral extracavitary approach to thoracic and lumbar spine.

Purpose: To establish the safety, efficacy, and value of preoperative angiography in the surgical management of thoracic and lumbar spine disease, in which it is important to avoid injury to the artery of Adamkiewicz or other vessels that supply the spinal cord.

Methods: Sixty-one patients were evaluated primarily using digital subtraction angiography, low-osmolar or nonionic contrast agents, selective catheterization limited to the region of disease, and careful angiographic techniques.

Results: Two minor (small hematomas of the groin) and no major complications of angiography were encountered.

Developmental capacity of mouse oocytes cryopreserved before and after maturation in vitro.

The survival and developmental capacity of cumulus cell-enclosed oocytes frozen (1) at the germinal vesicle (GV) stage, after maturation in vitro with (2) and without (3) FSH, and (4) after gonadotrophin-stimulated ovulation were assessed. Survival, defined as the number of morphologically normal oocytes, after freeze-thaw at the GV stage (69%), was lower than for oocytes frozen after ovulation (84%), and after maturation in vitro with FSH (88%) and without FSH (81%). Treatment with DMSO without freezing had no effect on survival when compared with untreated controls except in immature GV-stage oocytes for which there was a slight reduction.

Urinary hydroxyproline in infants with and without fractures/rickets.

Molar ratios of peptide-bound and free hydroxyproline:creatinine (OHPr:Cr) in urine were measured at 3, 6, 9, and 12 months of age in two groups of very-low-birthweight (VLBW less than or equal to 1500 g) infants. Group A (15 infants) had radiographically confirmed fractures and (or) rickets (F/R); Group B (17 infants) did not. The urinary peptide-bound OHPr:Cr ratio varied widely within groups and was greatest at three months in both groups: A = 0.

Bilateral adrenal hemorrhage.

The diagnosis of bilateral adrenal hemorrhage, a potentially fatal complication of anticoagulation therapy, can be made by computed tomography (CT) scan. We present a case of a heparinized patient with CT examination of the adrenal glands before and after the onset of acute adrenal insufficiency.

Cell surface characteristics of blastocysts from spontaneously ovulating and gonadotropin-treated mice.

Differences were found in the surface architecture of blastocysts from spontaneously ovulating and from gonadotropin-treated females of the BALB/cBy and the C57BL/6J strains of mice. Significantly fewer microvilli and a greater percentage of smooth areas were found on the surfaces of blastocysts from gonadotropin-treated females compared to those from spontaneously ovulating females. The differences were greater in blastocysts from gonadotropin-treated immature females than in blastocysts from similarly treated mature females.