Perceptions of palliative care in Huntington's disease: A qualitative study.

INTRODUCTION: Palliative care focuses on improving patient and family quality of life by managing symptoms, psychosocial issues and spiritual concerns. Huntington's disease is a progressive neurodegenerative disorder with no current disease modifying therapy. Although the palliative care model has been postulated to be an integral part of HD care, there are gaps in knowledge about how this care should be implemented. This study aims to identify perceptions of palliative care in Huntington's Disease (HD), palliative care needs of people living with HD, and at what point they feel they would benefit from these resources. METHODS: Participants volunteered from a large academic institution patient base to be involved in semi structured interviews that explored patient and caregiver experience surrounding their diagnosis, disease management, quality of life, and areas for improvement. Inclusion criteria for participants was a diagnosis of Huntington's disease and/or a self-identified caregiver of a person living with the disease. RESULTS: A total of 12 independent patients, three independent caregivers, and five dyads completed the interviews. Themes identified included needs that would provide patient and caregiver centered treatment, current gaps in care, an openness and desire for palliative care, and knowledge about the desired timing of palliative care in treatment plans. CONCLUSION: People living with HD and caregivers of people with HD most desire access to treatment that would focus on symptom management, availability of social resources, advanced care planning and spiritual wellbeing. The preferred timing of this intervention for most individuals would be at the onset of symptoms.

Structure Making and Breaking Effects of Cations in Aqueous Solution: Nitrous Oxide Pump-Probe Measurements.

Ultrafast IR pump-probe responses resonant with the ν3 asymmetric stretch of nitrous oxide (N2O) at ∼2230 cm-1 are reported for 2 M aqueous salt solutions of MgCl2, CaCl2, NaCl, KCl, and CsCl at room temperature. The solvated cations of these chloride solutions span the range from strongly to weakly hydrating ions, and correspondingly are often categorized as structure makers and structure breakers, respectively. The observed salt dependent trends of the N2O ν3 vibrational energy relaxation (VER) and rotational reorientation anisotropy (R(t)) decays are consistent with the categorization of these cations as structure breakers or makers, and show evidence of effects on the water hydrogen bonding network beyond the first solvation shell of these ions. This N2O mode is resonant with the H2O bend-libration band region. The corresponding FTIR is fitted well by a two Gaussian plus sloping continuum baseline model that allows a framework for characterizing the salt perturbations of the solvent spectral density in the ν3 resonant region. Both coupling strengths and density of states effects appear to contribute the systematic cation dependent T1 effects reported here. R(t) decays follow bulk viscosity values. These results are contrasted with previous IR pump-probe studies predominantly based on the relaxation dynamics of the OH/OD vibrational stretch of HOD hydrogen bonded to anions in salt solutions.

Enantioselective synthesis of imperanene, a platelet aggregation inhibitor.

Both enantiomers of imperanene, a platelet aggregation inhibitor, have been synthesized in 82-90% ee. The key step of establishing the chiral center was achieved through stereoselective alkylation with benzyl chloromethyl ether using Enders' RAMP/SAMP chiral auxiliary method. The natural product was determined to be the (S)-enantiomer through comparison of optical rotation data. Reaction: see text.

Pelvic inflammatory disease: education for maintaining fertility.

PID is a serious health problem that affects the reproductive potential of women. Education regarding risk factors and prevention of PID are primary prevention strategies that can minimize loss of future fertility potential. Acute episodes of PID can be successfully managed by clinicians using a high index of suspicion and initiating prompt, aggressive treatment for patients and partners. Ongoing follow-up and counseling can minimize repetitive threats to reproductive loss and circumvent the need for reparative fertility surgery.

Dispersed three-pulse infrared photon echoes of nitrous oxide in water and octanol.

Dispersed IR three-pulse photon echoes due to the antisymmetric (ν3) stretch mode of N2O dissolved in H2O and 1-octanol at room temperature are reported and analyzed. The experimentally determined transition frequency-frequency correlation function (FFCF) in these two solvents is explained in terms of inertial solvent contributions, hydrogen bond network fluctuations, and, for octanol, the motions of the alkyl chains. The H2O hydrogen bond fluctuations result in 1.5 ps FFCF decay, in agreement with relaxation rates determined from photon echo based measurements of other aqueous solutions including salt solutions. In octanol, hydrogen bond fluctuations decay on a slower time scale of 3.3 ps and alkyl chain motions result in an inhomogeneous broadening contribution to the ν3 absorption spectrum that decays on a 35 ps time scale. Rotational reorientation of N2O is nearly 3 times faster in octanol as compared to water. Although the vibrational ν3 N2O absorption line shapes in water and octanol are similar, the line widths result from different coherence loss mechanisms. A hot band contribution in the N2O in octanol solution is found to have a significant effect on the echo spectrum due to its correspondingly stronger transition moment than that of the fundamental transition. The dephasing dynamics of the N2O ν3 stretch mode is of interest as a probe in ultrafast studies of complex or nanoconfined systems with both hydrophobic and hydrophilic regions such as phospholipids, nucleic acids, and proteins. These results demonstrate the value of the N2O molecule to act as a reporter of equilibrium fluctuations in such complex systems particularly due to its solubility characteristics and long vibrational lifetime.

Walking the line between feminism and infertility: implications for nursing, medicine, and patient care.

Traditionally infertility has been viewed as a medical condition and has been managed within the medical model of diagnosis, treatment, and cure. The prevalence of infertility has been medically explained by women's sexual promiscuity, pursuit of professional career advancement, and psychological immaturity. Although authors have recently recognized an equitable proportion of infertility problems attributable to male factors, the vast majority of infertility testing and treatment procedures remain directed toward women. Reproductive technologies and their potential for perpetual treatment create a scenario of vulnerability for the infertile woman, which demands the attention of care providers who advocate feminist values of health. In this article, we present a historical overview of infertility and offer a feminist perspective for providing physical and emotional health care to infertile women. Strategies for integrating feminist perspectives of health into infertility programs are discussed.