Increased energy and protein requirements are frequently observed in disease [1] and can be difficult for patients to achieve with standard tube feeds. This is especially true for Home Enteral Tube Feeding (HETF) patients who can present with tolerance issues and impaired quality of life with larger volume tube feeds. A lower volume, nutrient- and energy-dense feed may therefore offer compositional, clinical and functional advantages.

The British Artificial Nutrition Survey (2011) suggests that over 26,600 adult patients receive home enteral tube feeding (HETF) in the UK [1], and that this population is a mix of those who are bed bound/sedentary and those who are very active. Anecdotal evidence from clinicians suggests that the use of bolus feeding regimens is increasing compared to continuous/overnight feeding, allowing feeding to fit in with patient and carer lifestyles, however there is very little published evidence and understanding of this growing practice in HETF in the UK. Therefore a preliminary survey to investigate and characterise the numbers and types of adult HETF patients receiving a bolus feeding regimen was undertaken. A survey of adult (≥18 years) tube fed patients (total n=1833), who were receiving part or all of their tube feeding via a bolus feeding regimen, was undertaken across 10 HETF services in the UK between November 2015 and May 2016. A standardised questionnaire, which included patient demographics (age, gender, primary diagnosis, residential status, working status, activity level), tube type and feeding regimen details (type of feed, method, duration) and reasons for bolus feeding, was completed for each patient from their dietetic notes. Patients with bolus tube feeding regimens represented 33% (n=609) of the total HETF population surveyed. Bolus fed patients (mean age 58 years (SD 20, range 18–97), 59% male), had an average time on tube feeding of 4 years 1 month (SD 4 years 6 months, range 2 months–23 years 7 months) and an average time on a bolus feeding regimen of 3 years 6 months (SD 3 years 11 months, range 26 days–20 years 4 months). The majority of patients (73%) were fed via percutaneous endoscopic gastrostomy (PEG), resided in their own/family homes (70%) or in nursing homes (23%), and most patients were either bed/chair bound or very sedentary (69%), with the majority of patients not working (61%) or being retired (34%). Only 2% of patients were working. The most common primary diagnosis was head and neck cancer (21%), followed by stroke (16%) and cerebral palsy (12%). The head and neck cancer population were found to be much more active (78%) than the rest of the bolus fed population (30%), (seated work – moderate exercise). Of the patients surveyed, the large majority (74%) were using bolus feeding as their primary method of tube feeding either via syringe (51%) or by gravity feeding (40%). The most common reasons for choosing a bolus feeding regimen were: to top up the oral diet (20%), to mimic meal times (16%), easy (15%) and quick (12%) to use. The most commonly used feeds for bolus feeding were oral nutritional supplements (59%), with the highest proportion of these (51%) being 2.4 kcal/ml compact-style supplements. We understand this to be the largest survey of its kind specifically assessing the demographics and feeding practices of adult bolus fed patients in the UK, and showing that 1/3 of HETF patients are bolus fed. This survey largely demonstrates similarities between the demographics of those on bolus feeding regimens and the total HETF population as reported in BANS [1], although there does appear to be a dominant subgroup of head and neck cancer patients, who may be bolus feeding for different reasons. Further research is required to understand this patient group, possibly with the inclusion of specific questions regarding bolus feeding being included in future BANS surveys. Reference [1] Smith T, Micklewright A, Hirst A, Stratton RJ, Baxter J. Annual BANS Report 2011. Artificial Nutrition Support in the UK 2000–2010. BAPEN.

The NCEPOD study of 2004 [1] reported that following percutaneous endoscopic gastrostomy (PEG) placement 43% of patients died within 1 week, 20% of PEG placements were futile or not indicated, and the most frequent critical incident was respiratory failure, concluding: ‘The decision to use a PEG requires an in-depth assessment of the potential benefits to the individual. All patients in whom PEG feeding is proposed should be reviewed by a multi-disciplinary team (MDT)’. Previously at Aneurin Bevan University Health Board (ABUHB, Wales) there was no coordinated MDT approach for assessment of patients referred for gastrostomy placement and urgent outpatient waiting times were on average 116 days (≥max 217 days) to see a Gastroenterologist, with 53% of patients waiting a further 28–7 days for endoscopy. An elective gastrostomy tube MDT pre-assessment service was developed to streamline referrals, reduce waiting times and provide a co-ordinated approach to patient assessment. A retrospective audit of the service was undertaken. The service was developed to facilitate a monthly clinic and an assessment proforma for completion by the MDT including –assessment of nutritional status, dysphagia risk, medical status and social circumstances, to identify and determine the potential risks and impact of tube placement. The MDT included a Dietitian, Speech Therapist, Nutricia Nurse and Consultant Gastroenterologist. To facilitate a patient centred approach, patients were provided with written information in advance and encouraged to lead the consultation to support an informed decision on whether to proceed with the procedure. All patients identified as low risk without significant respiratory compromise were signposted for PEG placement. Those identified at high risk with poor respiratory status were signposted for radiologically inserted gastrostomy (RIG) placement. All patients referred to the pre-assessment service between March 2012–February 2016 (n=68) were audited following retrospective review of patient records. Patients were reviewed for length of hospital stay post tube placement, versus a comparable group of (n=34) non pre-assessed patients referred from the acute setting. Of the n=68 patients referred to the service, n=35 were male and n=33 were female with a mean age of 68 years. The majority of patients (60%) had Motor neurone disease, 10% had Multiple sclerosis and the remaining 30% had a variety of diagnoses and other neurological conditions. The majority of patients agreed to have tubes placed n=51 (75%) of which n=36 had a PEG and n=15 had a RIG, with a 93% placement success rate (n=4 failures). The remaining n=13 (19%) declined a gastrostomy tube. The mean waiting time from pre-assessment to tube placement was 30 days (compared with 116–294 days point prevalence data for an urgent gastro clinic appointment and endoscopy wait (ABUHB data on file)). Mean post tube placement length of hospital stay was 11 days in those pre-assessed, compared with 63 days in the non pre-assessed acute comparator group (n=34). An elective gastrostomy tube MDT pre-assessment service was successfully implemented in ABUHB, which substantially reduced waiting times and length of hospital stay. Although only a small audit analysis was undertaken, this data indicates the positive impact that such a service can have on patients and key outcomes. The patient centred approach supports patients and carers to make an informed choice and understand the benefits and burdens of tube placement before making this difficult decision. The collaboration of the MDT and the Nutricia Nursing service to provide specialist nursing expertise was also key to the success of the service. Reference [1] NCEPOD Report 2004 – ‘Scoping our practice’. The 2004 Report of the National Confidential Enquiry into Patient Outcome and Death.

Event Abstract Back to Event No Records Found Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Google Google Scholar PubMed Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

1-Azatricyclo[3.3.1.1(3,7)]decan-2-one (3), the parent compound of a rare class of 90°-twisted amides, has finally been synthesized, using an unprecedented transformation. These compounds are of special interest as transition-state mimics for the enzyme-catalyzed cis-trans rotamer interconversion of amides involved in peptide and protein folding and function. The stabilization of the amide group in its high energy, perpendicular conformation common to both systems is shown for the rigid tricyclic system to depend, as predicted by calculation, on its methyl group substitution pattern, making 3 by some way the most reactive known "amide".

Abstract A manual in situ crystallization technique is described, for application on a κ-geometry area-detector instrument. The technique has been applied to grow crystals of some linear alkynes: 1-heptyne, 1-octyne, 1-nonyne and 1-decyne, C n H2 n–2 (n=7, 8, 9, 10). The structures with odd n (1-heptyne and 1-nonyne) crystallize in space group Pca21. The structures with even n (1-octyne and 1-decyne) crystallize in space group P21/c, with two molecules in the asymmetric unit (Z′=2) and an approximately orthorhombic metric. All of the structures contain layers of molecules with a square unit mesh of dimensions 5.7×7.2 Å, identical to the layers present in the previously published structures of 1,7-octadiyne and 1,9-decadiyne. The structures differ where the methyl groups meet, giving systematically greater packing efficiency for 1-heptyne and 1-nonyne, compared to 1-octyne and 1-decyne. This systematic alternation in crystal density is correlated with an alternation in melting points.

Reaction of the [Rh(η 5 -C 5 Me 5 )(NCMe) 3 ] 2+ ( 1 ) dication with the hexaosmium [Os 6 (CO) 17 ] 2− ( 2 ) dianion leads to the initial formation of [Os 6 (CO) 17 Rh(η 5 -C 5 Me 5 )] ( 3 ). This cluster readily adds CO to form [Os 6 (CO) 18 Rh(η 5 -C 5 Me 5 )] ( 4 ) which has been characterised crystallographically. 3 also adds dihydrogen to give [Os 6 H 2 (CO) 17 Rh(η 5 -C 5 Me 5 )] ( 5 ) and undergoes a substitution reaction with PPh 3 to form [Os 6 (CO) 16 (PPh 3 )Rh(η 5 -C 5 Me 5 )] ( 6 ). With the [Ru 6 (CO) 18 ] 2− ( 7 ) dianion, [Rh(η 5 -C 5 Me 5 )(NCMe) 3 ] 2+ ( 1 ) reacts to form three mixed-metal clusters [Ru 5 (CO) 15 Rh(η 5 -C 5 Me 5 )] ( 8 ), [Ru 6 (CO) 18 Rh(η 5 -C 5 Me 5 )] ( 9 ) and [Ru 6 (CO) 18 Rh 2 (η 5 -C 5 Me 5 ) 2 ] ( 10 ). The clusters have been characterised spectroscopically and the structures of 8 and 10 have been confirmed crystallographically. The cluster 8 undergoes a substitution reaction with P(OMe) 3 to form the disubstituted product [Ru 5 (CO) 13 (P(OMe) 3 ) 2 Rh((η 5 -C 5 Me 5 )] ( 11 ) which has also been characterised crystallographically.

Three independent indirect estimates based on structure-reactivity correlations indicate that ca. 20% of hydroxylamine exists in aqueous solution as ammonia oxide, NH(3)(+)-O(-).

A new and efficient desymmetrisation of succinic and glutaric cyclic meso-anhydrides is described, providing excellent yields and diastereoselectivities in most cases. Derivatisation of the desymmetrised products is demonstrated by their conversion into mono-protected 1,4-diols. General synthetic utility of the method is established by its application towards a key fragment in the total synthesis of the immunosuppressant antitumour natural product, rapamycin.

An enantioselective synthesis of the halogenated medium-ring ether natural product (+)-obtusenyne is reported which uses the ring expansion of a seven-membered ketene acetal by means of a Claisen rearrangement to construct the core nine-membered oxygen heterocycle. The trans substituents across the ether linkage were established by using a transition-metal-catalyzed intramolecular hydrosilation reaction of an exo-cyclic enol ether. In addition, a formal synthesis of ent-obtusenyne from 2-deoxy-D-ribose is reported. A number of interesting points regarding the chemistry of medium-ring oxygen heterocycles are highlighted.

The synthesis of five fused-bicyclic medium-ring lactones carrying identical ring-fusion to that in the polyether toxins is described using an enolate hydroxylation, intramolecular hydrosilation, Claisen rearrangement sequence.

2-Alkyl derivatives of butane-2,3-diacetal (BDA) protected glyceraldehyde were stereoselectively prepared by aza-Claisen rearrangement of N-allyl-enammonium ions or C-alkylation of enamines. This allows rapid and convenient access to densely functionalized chiral building blocks.

A series of novel digold complexes incorporating ethynyl pyridine derivatives as a spacer unit, [(R(3)P)Au(C[triple bond]C)X(C[triple bond]C)Au(PR(3))] (R = Ph, X = 2,5-pyridine (1); R = Cy (cyclohexane), X = 2,5-pyridine (2); R = Ph, X = 2,6-pyridine (3); R = Ph, X = 2,5'-bipyridine (4); R = Ph, X = 2,6'-bipyridine (5)), has been synthesised. All the complexes have been characterised spectroscopically and the structures determined by single-crystal X-ray crystallography. The central (C[triple bond]C)(X)(C[triple bond]C) unit is essentially linear for complexes 1, 2 and 4 and kinked for complexes 3 and 5, but only in 1, with the shortest spacer group and the less bulky phosphine ligand, is there evidence of d(10)...d(10) Au...Au interactions (Au-Au 3.351(2) A). The solution UV/visible absorption and emission spectra for all the complexes are similar to those of the free ligands suggesting that the spectra are dominated by pi-pi* ligand-centred transitions and this is confirmed by DFT calculations.

The crystal structures of the cyclic amines azetidine (C(3)H(7)N), pyrrolidine (C(4)H(9)N) and hexamethyleneimine (homopiperidine, C(6)H(13)N), of the series (CH(2))(n)NH, with n = 3, 4 and 6, respectively, have been determined at 170 K, following in situ crystallization from the melt. These structures provide crystallographic data to complete the homologous series of cyclic amines (CH(2))(n)NH, for n = 2-6. Azetidine and pyrrolidine contain chains propagating along 2(1) screw axes, in which the molecules are linked by co-operative N-H...N hydrogen bonds. Azetidine has two molecules in its asymmetric unit, while pyrrolidine has only one. Hexamethyleneimine contains tetrameric hydrogen-bonded rings formed about crystallographic inversion centres, with two molecules in its asymmetric unit. The observation of crystallographically distinct molecules in the hydrogen-bonded chains of azetidine and cyclic hydrogen-bonded motifs in hexamethyleneimine is consistent with expectations derived from comparison with monoalcohols forming chains or rings by co-operative O-H...O hydrogen bonds. The next member of the cyclic amine series, heptamethyleneimine, forms a cubic plastic phase on cooling from the melt.

Reduced intensity conditioning (RIC) for allogeneic stem cell transplantation allows stable donor cell engraftment with the maintenance of a graft versus malignancy effect. Many different regimens exist employing various combinations of chemotherapy, radiotherapy and T-cell depletion. We examined the role of non-T-cell depleted RIC regimens in 56 patients with haematological malignancies. Patients received fludarabine phosphate for 5 days (30 mg/m 2 in 35 patients, 25 mg/m 2 in 21 patients) and melphalan for 1 day (140 mg/m 2 in 36 patients, 100 mg/m 2 in 20 patients). Immunosuppression was with CyA alone in 33 patients and CyA/MTX in 23 patients. Twenty-four of the 26 patients with chimerism data showed >95% donor chimerism at 3 months post transplant. aGVHD occurred in 18% of patients receiving CyA/MTX compared to 53% of patients receiving CyA. The 100-day mortality rate was 0.16 (95%CI 0.08–0.28) and 1-year nonrelapse mortality was 0.24 (95%CI 0.13–0.38). Thirty-three patients remained alive and in CR at a median of 19 months post transplant (range 3–38 months). We have shown that patients transplanted with fludarabine phosphate, melphalan 100 mg/m 2 and with CyA/MTX as post transplant immunosuppression can achieve good disease control with an acceptable level of toxicity. Further studies are required to confirm these findings.

ADVERTISEMENT RETURN TO ISSUEPREVCommunicationNEXTHydroxylamine as an Oxygen Nucleophile. Structure and Reactivity of Ammonia OxideAnthony J. Kirby, John E. Davies, Tiago A. S. Brandão, Pedro F. da Silva, Willian R. Rocha, and Faruk NomeView Author Information University Chemical Laboratory, Cambridge CB2 1EW, U.K., Departamento de Química, Universidade Federal de Santa Catarina, Florianópolis, SC, 88040-900, Brazil. Departamento de Química, ICEX, Universidade Federal de Minas Gerais, Belo Horizonte, MG, 31270-901, Brazil Cite this: J. Am. Chem. Soc. 2006, 128, 38, 12374–12375Publication Date (Web):September 1, 2006Publication History Received28 July 2006Published online1 September 2006Published inissue 1 September 2006https://doi.org/10.1021/ja065147qCopyright © 2006 American Chemical SocietyRIGHTS & PERMISSIONSArticle Views2716Altmetric-Citations50LEARN ABOUT THESE METRICSArticle Views are the COUNTER-compliant sum of full text article downloads since November 2008 (both PDF and HTML) across all institutions and individuals. These metrics are regularly updated to reflect usage leading up to the last few days.Citations are the number of other articles citing this article, calculated by Crossref and updated daily. Find more information about Crossref citation counts.The Altmetric Attention Score is a quantitative measure of the attention that a research article has received online. Clicking on the donut icon will load a page at altmetric.com with additional details about the score and the social media presence for the given article. Find more information on the Altmetric Attention Score and how the score is calculated. Share Add toView InAdd Full Text with ReferenceAdd Description ExportRISCitationCitation and abstractCitation and referencesMore Options Share onFacebookTwitterWechatLinked InReddit Read OnlinePDF (39 KB) Get e-AlertsSupporting Info (2)»Supporting Information Supporting Information SUBJECTS:Ammonia,Oxides,Oxygen,Reactivity,Substitution reactions Get e-Alerts

An entry from the Cambridge Structural Database, the world’s repository for small molecule crystal structures. The entry contains experimental data from a crystal diffraction study. The deposited dataset for this entry is freely available from the CCDC and typically includes 3D coordinates, cell parameters, space group, experimental conditions and quality measures.

Reaction of [Os-3(mu-H)(2)(CO)(10)] with 1,4-dipyridylbuta-1,3-diyne yields two clusters, [Os-3(mu-H)(CO)(10){mu-eta(1):eta(1)-(C8H5N)-C-(C5H4N)}] 1 and [Os-3(mu-H)(CO)(10)-{mu(3)-eta(1):eta(1):eta(1)-(C5H4N)-C-C(C8H6N)}] 2, in which the diyne has rearranged to form a substituted indolizine ring system. Complex 1 converts slowly to 2 at room temperature, and may be decarbonylated to yield [Os-3(mu-H)(CO)(9){mu-eta(1):eta(2):eta(1)-(C8H5N)-C-(C5H4N)}] 3. An analogous reaction involving [Os-3(CO)(10)(MeCN)(2)] generates three products, [Os-3(mu-eta)(CO)(10){mu-eta(1):eta(1)(NC5H3)-C2C2-(C5H5N)}] 4 and [{Os-3(mu-eta)(CO)(10)}(2){mu-eta(1):eta(1)-(NC5H3)-C-2-}(2)] 5, both coordinated via orthometallated pyridyl rings, and a minor product [{Os-3(CO)(10)}(2){mu(3)-eta(1):eta(1):eta(1)-C-2-(NC5H4)}(2)] 6, coordinated via mu-carbene and sigma-N interactions, the linking ligand retaining its central Cequivalent toC bond. Complex 4 reacts with [Os-3(mu-eta)(2)(CO)(10)] to form the linked cluster [{Os-3(mu-eta)(CO)(10)}(2){mu-eta(1):eta(1), mu-eta(1): eta(1)-(C8H5N)-C-(C5H3N)}] 7, also forming an indolizine ring system. The structures of 1-3, 6, 6.2[CH2Cl2] and 7 have been established by X-ray crystallography.

We report the synthesis and photophysical study of a series of solution-processible phosphorescent iridium complexes. These comprise bis-cyclometalated iridium units [Ir(ppy)(2)(acac)] or [Ir(btp)(2)(acac)] where ppy is 2-phenylpyridinato, btp is 2-(2'-benzo[b]thienyl)pyridinato, and acac is acetylacetonate. The iridium units are covalently attached to and in conjugation with oligo(9,9-dioctylfluorenyl-2,7-diyl) [(FO)(n)] to form complexes [Ir(ppy-(FO)(n))(2)(acac)] or [Ir(btp-(FO)(n))(2)(acac)], where the number of fluorene units, n, is 1, 2, 3, approximately 10, approximately 20, approximately 30, or approximately 40. All the complexes exhibit emission from a mixed triplet state in both photoluminescence and electroluminescence, with efficient quenching of the fluorene singlet emission. Short-chain complexes, 11-13, [Ir(ppy-(FO)(n)-FH)(2)(acac)] where n = 0, 1, or 2, show green light emission, red-shifted through the FO attachment by about 70 meV, but for longer chains there is quenching because of the lower energy triplet state associated with polyfluorene. In contrast, polymer complexes 18-21 [Ir(btp-(FO)(n))(2)(acac)] where n is 5-40 have better triplet energy level matching and can be used to provide efficient red phosphorescent polymer light-emitting diodes, with a red shift due to the fluorene attachment of about 50 meV. We contrast this small (50-70 meV) and short-range modification of the triplet energies through extended conjugation, with the much more substantial evolution of the pi-pi* singlet transitions, which saturate at about n = 10. These covalently bound materials show improvements in efficiency over simple blends and will form the basis of future investigations into energy-transfer processes occurring in light-emitting diodes.

The ready elimination of phenol/phenoxide from the O-phenyl oxime 10E derived from S-dimethylamino-l-naphthaldehyde, necessarily involving proton transfer from carbon. is catalysed by the neighbouring NMe2 group at pH > 9. However, reaction is faster, rather than slower, at lower pH. It is shown that the step involving proton transfer is not cleanly rate determining at any pH: the preferred route involves synlanti isomerization to form the more reactive Z-isomer. The rate constant for the anti elimination cannot be extracted from the available data. so no reliable estimate of effective molarity (EM) is possible. Copyright (C) 2004 John Wiley Sons, Ltd.