Nanoscale Periodic Trapping Sites for Interlayer Excitons Built by Deformable Molecular Crystal on 2D Crystal.

The nanoscale moiré pattern formed at 2D transition-metal dichalcogenide crystal (TMDC) heterostructures provides periodic trapping sites for excitons, which is essential for realizing various exotic phases such as artificial exciton lattices, Bose-Einstein condensates, and exciton insulators. At organic molecule/TMDC heterostructures, similar periodic potentials can be formed via other degrees of freedom. Here, we utilize the structure deformability of a 2D molecular crystal as a degree of freedom to create a periodic nanoscale potential that can trap interlayer excitons (IXs). Specifically, two semiconducting molecules, PTCDI and PTCDA, which possess similar band gaps and ionization potentials but form different lattice structures on MoS2, are investigated. The PTCDI lattice on MoS2 is distorted geometrically, which lifts the degeneracy of the two molecules within the crystal's unit cell. The degeneracy lifting results in a spatial variation of the molecular orbital energy, with an amplitude and periodicity of ∼0.2 eV and ∼2 nm, respectively. On the other hand, no such energy variation is observed in PTCDA/MoS2, where the PTCDA lattice is much less distorted. The periodic variation in molecular orbital energies provides effective trapping sites for IXs. For IXs formed at PTCDI/MoS2, rapid spatial localization of the electron in the organic layer toward the interface is observed, which demonstrates the effectiveness of these interfacial IX traps.

Radical Alkynylations with EthynylBenziodoXolones: from Photocatalysis to Direct Excitation.

Ethynylbenziodoxolones (EBXs) have recently emerged as potent reagents for the alkynylation of radicals. Their combination with photocatalysis allows the synthesis of valuable alkynes at room temperature. Herein, we discuss two photomediated strategies for the synthesis of internal alkynes. The first transformation is a 1,2-oxyalkynylation of N- and O-alkenes using 4ClCzIPN as a photocatalyst. The second strategy makes use of EBXs as strong photooxidants allowing the oxidation of a variety of substrates with no need for a photocatalyst.

Direct Photoexcitation of Ethynylbenziodoxolones: An Alternative to Photocatalysis for Alkynylation Reactions*.

Ethynylbenziodoxolones (EBXs) are commonly used as radical traps in photocatalytic alkynylations. Herein, we report that aryl-substituted EBX reagents can be directly activated by visible light irradiation. They act as both oxidants and radical traps, alleviating the need for a photocatalyst in several reported EBX-mediated processes, including decarboxylative and deboronative alkynylations, the oxyalkynylation of enamides and the C-H alkynylation of THF. Furthermore, the method could be applied to the synthesis of alkynylated quaternary centers from tertiary alcohols via stable oxalate salts and from tertiary amines via aryl imines. A photocatalytic process using 4CzIPN as an organic dye was also developed for the deoxyalkynylation of oxalates.

Photocatalysis with organic dyes: facile access to reactive intermediates for synthesis.

Organic dyes have emerged as a reliable class of photoredox catalysts. Their great structural variety combined with the easy fine-tuning of their electronic properties has unlocked new possibilities for the generation of reactive intermediates. In this review, we provide an overview of the available approaches to access reactive intermediates that employ organophotocatalysis. Our contribution is not a comprehensive description of the work in the area but rather focuses on key concepts, accompanied by a few selected illustrative examples. The review is organized along the type of reactive intermediates formed in the reaction, including C(sp3) and C(sp 2 ) carbon-, nitrogen-, oxygen-, and sulfur-centered radicals, open-shell charged species, and sensitized organic compounds.

Photocatalytic Umpolung of N- and O-substituted alkenes for the synthesis of 1,2-amino alcohols and diols.

We report an organophotocatalytic 1,2-oxyalkynylation of ene-carbamates and enol ethers using Ethynyl BenziodoXolones (EBXs). 1-Alkynyl-1,2-amino alcohols and diols were obtained in up to 89% yield. Photocatalytic formation of radical cations led to Umpolung of the innate reactivity of the alkenes, enabling addition of a nucleophilic benzoate followed by radical alkynylation.

Metal-Free Electrophilic Alkynylation of Sulfenate Anions with Ethynylbenziodoxolone Reagents.

Alkynyl sulfoxides are important building blocks with a unique reactivity in organic chemistry, but only a few reliable methods have been reported to synthesize them. A novel route to access alkynyl sulfoxides is reported herein by using ethynyl benziodoxolone (EBX) reagents to trap sulfenate anions generated in situ, via a retro-Michael reaction. The reaction takes place under metal-free and mild conditions. It is compatible with aryl, heteroaryl, and alkyl sulfoxides with up to 90% yield. This practical access to alkynyl sulfoxides is expected to facilitate the application of these useful building blocks in organic synthesis.

Picture this: a photovoice study of international students' food experience in Canada.

PURPOSE: International student enrolment in Canadian universities is increasing. As international university students acculturate, they experience a culture shock in which food plays a major role. International university students' Canadian food experiences therefore were explored. METHODS: A Photovoice methodology was used with 15 international undergraduate and graduate university students, who were recruited to take pictures of their food experiences. They also participated in two focus group discussions that included an analysis of their photos. RESULTS: Seven themes related to the significance of food in acculturation were revealed: the paradox of Canadian convenience, the equation of traditional foods with health, traditional food quality and accessibility, support networks, food consumption for comfort, ethnic restaurants, and the exploration of non-traditional foods. Maintaining cultural identity with traditional foods was an overarching theme related to acculturation. CONCLUSIONS: International students acculturating to Canada have emotional and physical needs, which can be met through food. Opportunities exist to improve their acculturation experiences. Canadian universities can incorporate food acculturation strategies into campus events and menus. Nutrition professionals on campus can facilitate a positive food environment and nurture culture identity formation.

Telemedicine in a rural memory disorder clinic-remote management of patients with dementia.

BACKGROUND: There are many reasons to develop telemedicine clinics for assessment and management of dementia. Time constraints, location, and poor weather conditions can all impact on the ability of patients and providers to attend rural clinics. The utility of telemedicine in the diagnosis of dementia and subsequent follow-up appears promising in the literature, as it provides a viable means of assessing cognition in patients in remote areas with limited access to medical specialists. METHODS #ENTITYSTARTX00026; RESULTS: This study explored the feasibility of introducing a telemedicine memory disorder follow-up clinic in a rural community. The evaluation of 32 clinic sessions found high levels of satisfaction, with over 90% of physicians and patients indicating that they'd be willing to use video conferencing again. Physicians overwhelmingly felt the sessions provided enough information to assist in clinical decision-making (96%), and patients and CCAC Case Managers/Geriatric Assessors felt able to present the same information by video conferencing as in person (92% for both groups). The telemedicine clinic provided a number of favourable results such as: timely access to specialist care in the patient's own community; fewer cancelled clinics; enhanced care transitions between the follow-up clinic and primary care with the support of a case manager/geriatric assessor; and enhanced follow-up for a complex patient population. In addition, the telemedicine initiative freed up spaces for "in-person" clinics. This allowed them to focus on new patient assessments. CONCLUSIONS: The high satisfaction rates amongst all key stakeholders affirm that telemedicine is a viable option and worth continued efforts at shaping and developing, particularly in regions where local physician specialists are a scare resource.

Difficulties encountered in collaborative care: logistics trumps desire.

INTRODUCTION: This study examines the development of collaborative relationships between family physicians (FPs) and Anticipatory And Preventative Team Care (APTCare) team members providing care to medically complex patients who have been identified as at-risk for negative health outcomes. METHODS: We undertook a qualitative study of a primary health care intervention in a family practice. Interviews were held with FPs and ATPCare intervention nurse practitioners (NPs) and pharmacists. Focus groups were conducted and a survey was administered to participating FPs, NPs, and pharmacists. NPs and pharmacists maintained a log recording their tasks and moments of collaboration. RESULTS: Scheduling demands rendered face-to-face collaboration difficult, leaving the team to rely on technological tools to keep in touch. Limited space meant the APTCare team had to work out of a downstairs office, limiting informal interactions with the practitioners on the main level. CONCLUSIONS: We demonstrate that the difficulties inherent in collaborative care are independent of the patient population being cared for. Regardless of the patient population and sector of health care, developing collaborative relationships and learning to work collaboratively is difficult and takes time. What many of these teams need is ongoing support and education about how to make these collaborative care practices work.

Feasibility of providing nephrology services to remote communities with videoconferencing.

We examined the feasibility of telemedicine clinics for patients with chronic kidney disease (not on dialysis) for a period of 18 months. Telemedicine clinics were run at two peripheral hospitals about 100 km from the specialist hospital in Ottawa. A total of 115 questionnaires were completed by patients and providers during the period March 2009 to July 2009. The participants were overwhelmingly positive and wanted telemedicine to continue. Some patients indicated they would discontinue follow-up care if they had to travel to Ottawa. The analysis of staff hours worked showed almost no increase following the introduction of telemedicine. Telemedicine is therefore feasible for follow-up care of remote chronic kidney disease patients.

Clinical pathways: adherence issues in complex older female patients with heart failure (HF).

HF is a leading health care concern, often under-recognized and under-treated in older women. Management of this complex condition frequently requires a multidisciplinary approach and a clinical pathway can be used to deliver coordinated care. This report is based on the intervention/treatment arm (n = 45) of a randomized controlled trial in older women who participated in a multidisciplinary clinic. We describe the development of a clinical pathway for HF and the variance reporting including factors affecting adherence with the pathway. Variances are patient or staff actions that did not meet the expected outcomes. Of the 45 intervention arm female patients, 5 were able to fully complete the program, meaning that all of the intended 12 visits were completed successfully. Thirteen women missed more than three clinic visits, and the rest attended most visits. Variance tracking identified that visits were interrupted most often by patient-related health issues, such as fatigue and pain, which may not be surprising given the expected multiple co-morbidities in this population. Transportation problems were identified as a barrier to attendance. Our study demonstrates that a clinical pathway can be implemented in an older, female population with HF. This report identifies some of the challenges and provides future recommendations for prospective pathway development.

Integration of nurse practitioners into a family health network.

A randomized controlled study called Anticipatory and Preventative Team Care (APTCare) explored a new role for nurse practitioners (NPs) within a multidisciplinary team. The aim of the study was to evaluate whether integrating NPs and a pharmacist was an effective approach for the management of patients living with multiple chronic illnesses. Over an 18-month period, three part-time NPs and a pharmacist became part of a rural Family Health Network (FHN). They established relationships with study patients and collaborated to provide optimum care. Each NP had 40 patients, all of whom received care in the home. Study results showed that an initial home visit was invaluable for establishing a care plan, developing a relationship with the patient and assessing the home environment. Ongoing monitoring at home, however, was found to be an inefficient use of the NP role. By the end of the study, all clinicians agreed that the NP role had been successfully integrated into the multidisciplinary team.

Interprofessional education in palliative care: a pilot project using popular literature.

A need to introduce the concepts of death and dying to the medical and health sciences undergraduate curriculum was identified at the University of Ottawa, Ontario, Canada. As care of the terminally ill is complex and requires the collaborative involvement of a diverse group of health care professionals, an interprofessional educational approach was utilized to address this need. A seminar course was developed using popular literature as the basis for learning, and offered to first and second year medical students, fourth year nursing students and graduate students in spiritual care. The discussion of roles and the provision of care within the context of works of selected literature provided a focus that enabled the students to transcend their disciplinary barriers, and to better understand the perspectives and contributions that other team members bring to patient care. Evaluation findings suggest that meaningful interprofessional education can be introduced effectively to students either prior to or while they are maturing in their professional roles.

Evaluation of in-hospital management of fracture risk in older patients: a chart review study of tertiary prevention.

Hip fractures are associated with considerable morbidity and mortality in the elderly. Both fall prevention strategies and bone integrity/osteoporosis assessment should be addressed in this population. This study's goal was to evaluate the management of potential re-fracture risk after a hip fracture in an acute care setting. This was a retrospective chart review of patients who were admitted with a hip fracture over the course of one year to the Ottawa Hospital, Civic Campus, Ottawa, Canada. The charts of 147 patients with hip fractures met the inclusion criteria. Use of sedatives on admission was significant (24.5%). Fifty (34%) had some form of osteoporosis management ordered during their hospital stay. The medication recommendations consisted of only 14% being prescribed Vitamin D and 15.6% being prescribed calcium supplementation. Merely 7 (4.8%) patients of the total sample were prescribed bisphosphonates at time of discharge. This study documents a significant care gap in re-fracture management at the time of acute hospitalization after an acute hip fracture. Interventions are required to increase the awareness that this problem is not being addressed at the time of hospitalization and that on discharge, patients will need follow-up by the treating community physician.

A continuing medical education initiative for canadian primary care physicians: the driving and dementia toolkit: a pre- and postevaluation of knowledge, confidence gained, and satisfaction.

This study examined the effect of the Driving and Dementia Toolkit on physician knowledge and confidence gained and the anticipated change in patient assessment and evaluated the extent to which physicians found the material to be useful. Before receiving the driving toolkit, 301 randomly selected primary care physicians received a copy of the pretest questionnaire; 145 responded and met the eligibility criteria. This group was then sent the toolkit, a satisfaction a survey, and a posttest questionnaire. Physicians were faxed the questionnaires (with up to three reminders) and telephoned if necessary. Changes in pre- and posttest results were analyzed using the McNemar test and Wilcoxon signed rank test nonparametric procedures included in SPSS, Version 10.0, and paired-samples t test. Pre- and posttest data were available and could be matched for 86 physicians (59.3%) response. Knowledge and confidence increased significantly (P