Difficulties and countermeasures in implementing age-friendly policies in primary health centers in Taiwan.

BACKGROUND: Taiwan is predicted to become a super-aged society by 2025, and primary health centers (PHCs) are set to play a crucial role in the care of older adults. The Taiwanese government has developed an age-friendly verification framework for PHC. The aims of this study were to explore the difficulties faced by PHC staff in the implementation of age-friendly policies and their solution strategies. METHODS: This study adopted a qualitative research method. The first stage involved conducting five focus groups with the responsible staff of PHCs (n = 41) that have been certified "age-friendly." The focus groups covered the effectiveness, difficulties, and resources of PHCs in regards to the introduction of age-friendly policies. In the second stage, in-depth interviews were conducted with executives of PHCs (n = 5), both certified and not certified as age-friendly, to further compare the difficulties faced by these two types of PHCs, thereby gaining perspectives for solution strategies. The principles of grounded theory were used for data analysis. RESULTS: Four major PHC strategies are employed in the promotion of age-friendliness. First, organizational management, through which managers apply management methods and analyze the present PHC-related health concerns; second, resource utilization, which refers to the tallying, linking, and integrating of resources; third, business operation process, in which work efficiency is improved through the combination of business operations and staff training; finally, hardware improvement, which is achieved through comprehensive cataloging of facility environments. CONCLUSION: The implementation of age-friendliness in PHCs requires the efforts of both the service units and government. With resources provided by the government, PHCs can integrate management methods, businesses operations, and essential resources. Moreover, PHC executives can lead their teams in promoting age-friendly policies, and closely monitor their effectiveness.

The Surgical Strategy in Massive Corrosive Injury in Digestive Tract: Is the Extensive Surgery Appropriate?

BACKGROUND: Corrosive ingestion results in necrosis of the digestive tract, spillage of intraluminal fluid, and spread of bacteria that threatens the lives of patients. Some authors advise extensive surgery, although others recommend conservative operation. This study presents the outcomes of the patients of corrosive injury who undergo emergent surgery. METHODS: We conducted a retrospective review including patients with corrosive injury from Jan 2007 to Dec 2013. We retrieved and analyzed the demographic characteristics, injury location and extent, endoscopic grade, presence of surgery, surgical timing and procedure, and mortality. RESULTS: The cohort consisted of 112 patients; 23 of the patients underwent an emergent operation. Patients who needed emergent surgery had the worse endoscopic severity and a higher mortality rate of 47.8% (12/23). Perforation of the digestive tract [odds ratio (OR) 13.5, p = 0.011] and unscheduled reoperation (OR 13.2, p = 0.033) were factors that predict mortality. CONCLUSION: Corrosive injury resulted in a dismal prognosis, especially when patients required an operation. The mortality is related to digestive tract perforation and unscheduled reoperation. Inadequate resection might lead to unscheduled reoperations, which lead to a dismal prognosis.

Reactions of [Cu(X)(BPEP-Ph)] (X = PF6, SbF6) with silyl compounds. Cooperative bond activation involving non-coordinating anions.

Bond activation of silyl compounds, assisted by the cooperative action of non-coordinating anions, is achieved using Cu(I) complexes coordinated with a PNP-pincer type phosphaalkene ligand, [Cu(X)(BPEP-Ph)] (X = PF6 (1a), SbF6 (1b); BPEP-Ph = 2,6-bis[1-phenyl-2-(2,4,6-tri-tert-butylphenyl)-2-phosphaethenyl]pyridine). Complexes 1a and 1b react with Me3SiCN to form Me3SiF and Cu(i) cyanide complexes of the formula [Cu(CN-EF5)(BPEP-Ph)] (E = P (2a), Sb (2b)), in which the CN ligand is associated with the EF5 group arising from EF6(-). Formation of the intermediary isonitrile complex [Cu(CNSiMe3)(BPEP-Ph)](+)SbF6(-) (3b) is confirmed by its isolation. Thus, a two-step reaction process involving coordination of Me3SiCN, followed by nucleophilic attack of SbF6(-) on the silicon atom of 3b is established for the conversion of 1b to 2b. Complex 1b cleaves the H-Si bond of PhMe2SiH as well. The isolation and structural identification of [Cu(BPEP-Ph)](+)BAr(F)4(-) (1c) (BAr(F)4 = B{3,5-(CF3)2C6H3}4) as a rare example of a T-shaped, three-coordinated Cu(i) complex is reported.

Facile N-H bond cleavage of ammonia by an iridium complex bearing a noninnocent PNP-pincer type phosphaalkene ligand.

A novel PNP-pincer type phosphaalkene complex of iridium bearing a dearomatized pyridine unit (3) has been prepared. Complex 3 rapidly reacts with ammonia at room temperature to afford a parent amido complex in high yield. DFT calculations indicate that the phosphaalkene unit with a strong π-accepting property effectively facilitates the N-H bond cleavage of ammonia via metal-ligand cooperation.

Palladium(II) complexes based on 1,8-naphthyridine functionalized N-heterocyclic carbenes (NHC) and their catalytic activity.

Palladium complexes containing 2,7-bis(mesitylimidazolylidenyl)naphthyridine (NHC-NP) have been synthesized and characterized. Reaction of [{Ag(3)(NHC-NP)(2)}(PF(6))(3)] with [Pd(PhCN)(2)Cl(2)] provided an unusual dipalladium complex bridged by two NHC-NP units, forming a 20-membered dinuclear metallacycle [{Pd(2)(NHC-NP)(2)Cl(2)}(PF(6))] (2) in high yield. Treatment of 2 with KI in acetone yielded a neutral species [Pd(2)(NHC-NP)I(4)] (3). Meanwhile, the pyridinyl N-heterocyclic carbene (NHC-Py) precursor, 1-(2-pyridinyl)-3-mesitylimidazolium chloride, reacted with Pd(2)(dba)(3) directly to form the mononuclear palladium complex [Pd(NHC-Py)Cl(2)] (4). These complexes were characterized by elemental analyses as well as NMR spectroscopy, and the structures of 3 and 4 were further identified by X-ray diffraction analysis. The use of these palladium complexes for Suzuki-Miyaura and Kumada-Corriu coupling reactions has been examined. There is no significant difference in catalytic activities between 2 and 4 in Suzuki-Miyaura coupling reactions. However, the catalytic activity of 2 in the Kumada-Corriu coupling of ArBr with cyclohexylmagnesium bromide is quite different from that of 4. Thus complex 2 is active for the cross coupling, but complex 4 is active for the reduction of aryl halides.

Synthesis, characterization and catalytic activity of saturated and unsaturated N-heterocyclic carbene iridium(i) complexes.

Both saturated and unsaturated N-benzyl substituted heterocyclic carbene (NHC) iridum(i) complexes were synthesized. The unsaturated carbene complex [(un-NHC-Bn)Ir(CO)(2)Cl] in the cis form was prepared via the carbene transfer from the corresponding silver complex to [Ir(COD)(2)Cl](2) followed by ligand substitution with CO, whereas the saturated complex was obtained via the transfer from (sat-NHC-Bn)W(CO)(5). The treatment of phosphines with (NHC)Ir(CO)(2)Cl complexes yielded the products with the phosphine ligand trans to the carbene moiety via substitution. X-Ray structural determination shows that distances of Ir-C((carbene)) in both (un-NHC-Bn)Ir(CO)(PR(3))Cl and (un-NHC-Bn)Ir(CO)(PR(3))Cl are essentially the same. Analyses of spectroscopic and crystal structural data of iridium complexes [(NHC)Ir(CO)(PR(3))Cl] and Vaska's complex show similar corresponding data in both types of complexes, suggesting that the studied NHC ligands and phosphines have similar bonding with Ir(i) metal center. All iridium complexes studied in this work illustrated their catalytically activity on N-alkylation of amine with alcohol via hydrogen transfer reduction. It appears no dramatic difference on the catalytic activity among these iridium carbene complexes; but the saturated carbene complex (sat-NHC-Bn)Ir(CO)(PR(3))Cl appears to be slightly more active. For example, the reaction of benzyl alcohol with aniline in the presence of catalyst (1 mol%) under basic conditions at 100 degrees C provided the secondary amine (N-benzylaniline) in 96% yield.

Coordination chemistry and catalytic activity of N-heterocyclic carbene iridium(I) complexes.

Iridium complexes [(CO)2Ir(NHC-R)Cl] (R = Et-, 3a; PhCH2-, 3b; CH3OCH2CH2-, 3c; o-CH3OC6H4CH2-, 3d; NHC: N-heterocyclic carbene) are prepared via the carbene transfer from [(NHC-R)W(CO)5] to [Ir(COD)Cl]2. By using substitution with 13CO, we are able to estimate the activation energy (G) of the CO-exchange in 3a-d, which are in the range of 12-13 kcal mol-1, significantly higher than those for the phosphine analog [(CO)2Ir(PCy3)Cl]. Reactions of 3b and 3d with an equimolar amount of PPh3 result in the formation of the corresponding [(NHC-R)Ir(CO)(PPh3)Cl] with the phosphine and NHC in trans arrangement. In contrast, the analogous reaction of 3a or 3c with phosphine undergoes substitution followed by the anion metathesis to yield the corresponding di-substituted [(NHC-R)Ir(CO)(PPh3)2]BF4 (5) directly. Treatment of 3b or 3d with excess of PPh3 leads to the similar product of disubstitution 5b and 5d. The analysis for the IR data of carbonyliridium complexes provides the estimation of electron-donating power of NHCs versus phosphines. The NHC moiety on the iridium center cannot be replaced by phosphines, even 1,2-bis(diphenylphohino)ethane (dppe). All the carbene moieties on the iridium complexes are inert toward sulfur treatment, indicating a strong interaction between NHC and the iridium centers. Complexes 3a-c are active on the catalysis of the oxidative cyclization of 2-(o-aminophenyl)ethanol to yield the indole compound. The phosphine substituted complexes or analogs are less active.