Optically active P5-deltacyclenes: selective oxidation, ligand properties, and a diastereoselective rearrangement reaction.

Cage-chiral tetra-tert-butyl-P5-deltacyclene is accessible as a pair of highly enriched enantiomers and . The only secondary phosphorus atom P1 of the cage can be selectively oxidized by reaction with t-BuOOH. The P1-oxo species and , allow the direct determination of their ee values. Oxidation occurs with the complete retention of the optical activity of the compounds. The chiroptical properties of and are strongly dominated by their cage chirality, the oxygen atom does not contribute significantly. Elemental sulfur and selenium oxidize P5 with high preference to yield P5-thio- and P5-seleno-P5-deltacyclenes and of the intact cages again. Longer reaction time and more than stoichiometric amounts of selenium, leads to tri-seleno-P5-tetracycloundecane , a partially opened oxidized rearrangement product. The ligand properties of racemic were determined. Diphosphetane phosphorus atom P2 of is the active donor center to bind a Cr(CO)5 fragment, but a tautomerization of takes place if [(benzene)RuCl2]2 is added. A hydrogen atom migrates from P1 to the oxygen atom to form a phosphinous acid ligand. The lone pair of P1 is regenerated and acts as the active ligand function of the cage in this case. As for , the base n-BuLi induces an efficient cage rearrangement reaction of , where P1 and the neighboring carbon atom C4 containing its t-Bu substituent change places. C4 moves to its new position without breaking the bond with P5, this way forming the novel P1-oxo-P5-norsnoutene cage in a highly diastereoselective process.

Challenges and solutions to implementing drug-resistant tuberculosis programmes for children in Central Asia.

Guidelines for children with drug-resistant tuberculosis (DR-TB) tend to focus on individual patient care; there is little guidance for national tuberculosis programmes (NTPs) on how to plan, implement and integrate DR-TB services for children. In 2013, through the paediatric tuberculosis (TB) programme started by the Tajikistan Ministry of Health and Médecins Sans Frontières in 2011, 21 children became the first to be treated for multidrug-resistant tuberculosis (MDR-TB) in Tajikistan. We describe the challenges encountered in establishing the programme and the solutions to these challenges, and propose a framework to guide the implementation of paediatric DR-TB care. This framework could prove useful for other NTPs in resource-limited settings.

Les directives relatives aux enfants atteints de tuberculose pharmacorésistante (TB-DR) ont tendance à se focaliser sur la prise en charge des patients individuels; il y a par contre peu de directives destinées aux programmes nationaux de lutte contre la TB (PNT) sur la manière de planifier, mettre en œuvre et intégrer les services de TB-DR destinés aux enfants. En 2013, dans un programme de prise en charge de la TB pédiatrique démarré par le Ministère de la Santé et Médecins Sans Frontières en 2011, 21 enfants ont été les premiers à être traités pour TB-MDR (TB multi-résistante) au Tadjikistan. Nous décrivons les défis de la mise en œuvre d'un programme et de leurs solutions et proposons un cadre conceptuel d'aide à la mise en œuvre de la prise en charge de la TB-DR pédiatrique. Notre cadre pourrait s'avérer utile pour d'autres PNT dans des contextes de ressources limitées.

Las directrices sobre el manejo de los niños con diagnóstico de tuberculosis drogorresistente (TB-MDR) suelen centrarse en la atención del paciente individual; existe poca orientación dirigida a los Programas Nacionales contra la Tuberculosis (PNT) en materia de planeamiento, ejecución e integración de los servicios que se ocupan de la TB-DR en los niños. El Ministerio de Salud y Médecins Sans Frontières iniciaron en el 2011 un programa de TB dirigido a los niños y en el 2013, por primera vez, 21 niños recibieron tratamiento contra la TB-MDR (multidrogorresistente) en Tayikistán. En el presente artículo se describen los obstáculos encontrados durante la introducción del programa, las soluciones que se aportaron y se propone un marco de trabajo encaminado a orientar la ejecución de la atención pediátrica de la TB-MDR. Este marco será útil a otros PNT en entornos con recursos limitados.

Treatment expectations of men with ED and their female partners: an exploratory qualitative study based on grounded theory.

Erectile dysfunction (ED) can impair the quality of life and the relationship. An early treatment is necessary to avoid the development of comorbid complaints. To arise the help-seeking behavior and to improve the treatment of affected men, it is necessary to be aware of the treatment expectations. The objective of this study was to investigate the treatment expectations of men with ED and their female partners. This is an explorative qualitative study using semistructured telephone interviews with 12 men with ED and their female partners. Interviews were tape-recorded, transcribed and analyzed on the basis of the grounded theory. We could identify various treatment expectations, which could be differentiated into expectations according to the conditions (for example, low costs and an early access), the handling of the practitioner (for example, showing interest and taking the patient seriously or incorporate the female partner), the treatment itself (for example, clearing the causes and helpful medication) and the treatment outcome (for example, having no ED and more sexual desire). Considering the identified expectations could increase treatment motivation and compliance. We derive five theses from our data, how to implement our findings.

Acute alcohol intoxication reduces mortality, inflammatory responses and hepatic injury after haemorrhage and resuscitation in vivo.

BACKGROUND AND PURPOSE: Haemorrhagic shock and resuscitation (H/R) induces hepatic injury, strong inflammatory changes and death. Alcohol intoxication is assumed to worsen pathophysiological derangements after H/R. Here, we studied the effects of acute alcohol intoxication on survival, liver injury and inflammation after H/R, in rats. EXPERIMENTAL APPROACH: Rats were given a single oral dose of ethanol (5 g·kg(-1) , 30%) or saline (control), 12 h before they were haemorrhaged for 60 min and resuscitated (H/R). Sham groups received the same procedures without H/R. Measurements were made 2, 24 and 72 h after resuscitation. Survival was assessed 72 h after H/R. KEY RESULTS: Ethanol increased survival after H/R three-fold and also induced fatty changes in the liver. H/R-induced liver injury was amplified by ethanol at 2 h but inhibited 24 h after H/R. Elevated serum IL-6 levels as well as hepatic IL-6 and TNF-α gene expression 2 h after H/R were reduced by ethanol. Ethanol enhanced serum IL-1ß at 2 h, but did not affect increased hepatic IL-1ß expression at 72 h after H/R. Local inflammatory markers, hepatic infiltration with polymorphonuclear leukocytes and intercellular adhesion molecule 1 expression decreased after ethanol compared with saline, following H/R. Ethanol reduced H/R-induced IκBα activation 2 h after H/R, and NF-κB-dependent gene expression of MMP9. CONCLUSIONS AND IMPLICATIONS: Ethanol reduced H/R-induced mortality at 72 h, accompanied by a suppression of proinflammatory changes after H/R in ethanol-treated animals. Binge-like ethanol exposure modulated the inflammatory response after H/R, an effect that was associated with NF-κB activity.

Evaluation of zebrafish Danio rerio as a model for enteric septicemia of catfish (ESC).

Zebrafish (also known as zebra danio) Danio rerio were injected intramuscularly with Edwardsiella ictaluri at doses of 6 x 10(3), 6 x 10(4), or 6 x 10(5) colony-forming units per gram (CFU/g) or sterile phosphate-buffered saline (sham) or were not injected. Mortality occurred from 2 to 5 d postinjection (dpi) at rates of 0, 76.6, and 81.3% for the low, medium, and high doses, respectively, and E. ictaluri was isolated from dead fish. Survivors were sampled at 10 dpi and E. ictaluri was not isolated. Sham-injected and noninjected controls did not suffer mortality. Histopathology trials were performed in which zebrafish were injected with 1 x 10(4) CFU/g or sham-injected and sampled at 12, 24, 48, 72, and 96 h postinjection for histological interpretation. Collectively, these zebrafish demonstrated increasing severity of splenic, hepatic, cardiac, and renal interstitial necrosis over time. To evaluate the progression of chronic infection, zebrafish were injected with 1 x 10(2) CFU/g and held for 1 month postinjection. Beginning at 12 dpi and continuing for an additional 2 weeks, zebrafish demonstrated abnormal spiraling and circling swimming behaviors. Histopathology demonstrated necrotizing encephalitis. In immersion trials, zebrafish were exposed to low, medium, and high doses (averaging 1.16 x 10(5), 1.16 x 10(6), and 1.16 x 10(7) CFU/mL of tank water) of E. ictaluri for 2 h. Mortality occurred from 5 to 9 d postexposure at rates of 0, 3.3, and 13.3% for the low, medium, and high doses, respectively; E. ictaluri was isolated from dead fish. Channel catfish Ictalurus punctatus exposed to the medium doses suffered 100% mortality, and E. ictaluri was isolated from these fish. This study demonstrates the potential use of zebrafish as a model for E. ictaluri pathogenesis.

A preliminary study of the feasibility of wound telecare for the elderly.

We have developed a method for remote wound assessment in the elderly. Wound images were taken with a digital camera at a resolution of 640x480 pixels. JPEG compression was then used to produce images of about 100 kByte. Selected clinical data were transmitted by email, together with standardized digital images of wounds. The remote physician then read the clinical data and viewed the digital images on a 38 cm colour display monitor, at a resolution of 800x600 pixels, in 16-bit colour, using standard software. Three elderly inpatients with pressure sores or leg ulcers had both bedside and remote examinations, by different physicians. The diagnosis and therapeutic recommendations proposed after each of the two examinations were compared qualitatively. There was reasonable agreement between the two physicians in the assessment of wound size, anatomical classification, wound bed and status of infection. However, the lack of palpation represented a major limitation to remote wound assessment, despite the use of probes to delineate the depth of any opening in the wound bed.

Switch to efavirenz in a protease inhibitor-containing regimen.

PURPOSE: This report evaluated the efficacy and safety of switching from a protease inhibitor (PI)-containing HIV treatment regimen to an efavirenz (EFV)-containing regimen. METHOD: We retrospectively analyzed data from 64 patients, with a plasma viral load (VL) less than 50 copies/mL and CD4+ counts >200 cells/mL at baseline, who had been taking a regimen consisting of a PI and two nucleoside reverse transcriptase inhibitors (NRTIs; d4T/3TC [n = 45]; AZT/3TC [n = 19]) for a median of 27.5 months (range, 6-41 months) and who chose to substitute EFV for the PIs in the regimens. Statistical analyses were performed by Wilcoxon test. Fat atrophy was evaluated by physician's assessment and patients' subjective self-estimation with the criteria of well being and body state. RESULTS: 57 patients completed 36 weeks on the EFV regimen; 4 patients changed therapy but continued EFV, 2 moved to another area, and 1 discontinued EFV. During the first weeks of therapy, 56.3% of patients suffered from moderate nervous system symptoms. The plasma VL of 63 patients remained at <50 copies/mL at final analysis. Compared with time of switching to EFV, analysis at 36 weeks showed no statistically significant change from 626+/-283 to 643+/-296 cells/mL in mean absolute CD4+ cells and a statistically significant increase from 26.8+/-9.6% to 28.0+/-9.1% in relative CD4+ cells. There was a statistically significant reduction in relative CD8+CD38+ from 62.2+/-16.3% at time of switching to EFV to 55.1+/-15.0% at week 36. At baseline, 27 patients suffered from lipodystrophy, including fat atrophy and fat accumulation. After 36 weeks, nine patients showed intensified fat atrophy. In contrast, five patients improved their state concerning fat redistribution and 13 patients showed no alterations. CONCLUSION: The switch to a non-PI-containing regimen with EFV offers a good drug alternative for patients with suppressed viral load, problems of adherence, and/or adverse events due to PIs but not for patients suffering from lipoatrophy caused by nucleoside reverse transcriptase inhibitors. The intention of such a switch aims at the avoidance of fatal mutations in HIV.

[Selected aspects of the life situation of elderly women and men in West and East Germany]. / Ausgewählte Aspekte der Lebenssituation älterer Frauen und Männer in West- und Ostdeutschland.

The current and future expected aging process of the population in Germany affects women more than men. This is equally true for West and East Germany. The demographic development in Germany will cause a confrontation with the problems of aging persons in our society to be ever more essential. This also includes the analysis of the living situation of older women and men. In this contribution two significant aspects of the living situation of older persons in West- and East Germany are being discussed; the income situation and household- and marital status structures. A German-German comparison shows that older women in the new federal states already have higher pension qualifying periods than women in the old federal states. Decisive causes for this are different personal labour force biographies. In total, the income situation of the elderly in East Germany is less favourable as a result of formerly no or at best, minimal possibilities for investments. In addition, it is evident (and this applies to all of Germany) that women have poorer financial starting positions for arranging their life situation in old age than do men. Additionally, there are more women than men who live alone in old age. One-person households of the aged are predominantly female households. Differences according to sex which are analyzed in the article result in different consequences for life in old age. Precisely what this might look like in the final analysis depends not only on the old people themselves, but also on the opportunities that the society in which they live provides for them.(ABSTRACT TRUNCATED AT 250 WORDS)

[Life expectancy in Germany today and tomorrow--and the consequences]. / Lebenserwartung in Deutschland heute und morgen--und die Folgen.

PIP: The increase in life expectancy in Germany over the past century is reviewed, and projected changes up to the year 2019 are examined. Implications of demographic aging for areas such as health care costs, long-term care, and old-age security are discussed.^ieng

[Demographic aging in the member countries of the European Union]. / Die demographische Alterung in den Landern der Europaischen Union.

"Despite all remaining political, economical and cultural differences in the member countries of the European Union...population ageing is a common phenomena of all these countries.... Many spheres of socio-economic life in the countries of the European Union are already affected by this shifting process.... Most of the social security and welfare systems of the industrialized countries in the European Union are mainly based on intergenerational solidarity, a solidarity which is highly burdened by the demographic development. In this respect policy makers have to take into consideration the expected changes in the age structure of the economically active population, changing patterns of labour force participation as well as changes in family and household structures in their task to modify existing systems or to build new systems of social security and welfare under the growing burden of an ageing society." (SUMMARY IN ENG)

Population projections for the countries of the European Community.

"Methods and results of different population projections for the countries of the European Community [EC] are...presented. First of all the aims and contents of population projections are discussed. Secondly the methods and assumptions of different population projections for the countries of the EC are compared. Finally the results of such projections are shown and discussed."

Population-relevant policies before and after unification of Germany.

PIP: The author reviews changes in population policy in Germany from 1949, when the two separate German states were formed, to the present. After a comparison of policy strategies in the two countries, she examines the policy needs of post-unification Germany, focusing on child care, immigration law, fertility, and demographic aging.^ieng

Mortality in the two Germanies in 1986 and trends 1976-1986.

"Mortality data of the Federal Republic of Germany and the GDR [German Democratic Republic] are compared by age, sex and cause of death....Within the period from 1976 to 1986 life expectancy has risen in the Federal Republic of Germany, whereas in the GDR it increased to a minor extent only, so that the gap between the two parts of Germany has clearly enlarged. This enlarged gap in life expectancy largely depends on a higher mortality in the GDR due to diseases of the circular system and the respiratory organs, external influences and 'other' causes of death. The last-mentioned two groups also 'contain' the normally [separately] reported causes of death 'cirrhosis of the liver', 'suicide', 'accidents', and some diseases of the digestive system." (SUMMARY IN FRE)

[Is the demography of developing countries a relevant topic for European research centers?]. / Demographie der Entwicklungslander: eine Aufgabe fur europaische Forschungsinstitute?

PIP: This is an overview of organizations that research the demographic problems of developing countries. Reasons for the neglect of this research field in Austria and the Federal Republic of Germany are discussed. (SUMMARY IN ENG)^ieng

The changing family in the Federal Republic of Germany.

PIP: Changes in family structure in the Federal Republic of Germany are analyzed. Family characteristics are first reviewed, followed by an outline of family policy and legislation. Data are from official and other published sources and concern selected years from 1900 to 1985, with an emphasis on the period since 1950.^ieng

Population policies in advanced societies: pronatalist and migration strategies.

PIP: This paper gives examples of pronatalist and migration policies adopted by several European countries, and evaluates their effectiveness: migration is the only practical means of preventing population stagnation. The pronatalist policies of France, German Democratic Republic, Hungary and Romania range from a system of family support so complicated that a special bureau has been set up to interpret it in France, through increasing benefits such as paid maternity leave in GDR, to an inconsistent support system in Hungary to coercive measures in Romania. In 1966 Romania severely restricted abortion and divorce, and even screened working women for pregnancy to prevent abortion. It has been estimated that the effect of these policies has been marginal and temporary: 0.2-0.3 children per woman in France, 0.1 in GDR, and 0.2 in Romania. Childbearing fell to former levels rapidly in Romania, probably a result of illegal abortion. Probably other social policies, such as housing infrastructure and child-care facilities, affect childbearing as much or more so than pronatalist measures. The migration policies of the United Kingdom, Federal Republic of Germany and Switzerland are described. Most have varied over the years, entailing several rationales, such as humanitarianism, recruitment of workers, providing asylum to refugees, as well as maintaining population levels. Success of policies depends on economic conditions, social tensions regarding integration of foreigners and naturalization policies. Pronatalist policies in general are not very effective unless extremely costly and continuous, but they do provide social justice for parents. The solution to prevent harsh changes in population age structure is ultimately to allow migration from less developed countries. To make either of these policies effective, emancipation of (especially male) parents, and education of people about other cultures will be required.^ieng

Family policy implications of the family life cycle concept.

PIP: The author examines the implications of using the classic family life cycle concept for the development of family policy. She reviews worldwide research on the family life cycle, and discusses problems arising from the tendency to assume that most families resemble an ideal family type.^ieng