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Patient experience is one of key domains of value-based purchasing that can serve as a measure of quality and be used to improve the delivery of health services. The aims of this study are to explore patient perceptions of quality of health care and to understand how perceptions may differ by settings and condition. A systematic review of multiple databases was conducted for studies targeting patient perceptions of quality of care. Two reviewers screened and extracted data independently. Data synthesis was performed following a meta-narrative approach. A total of 36 studies were included that identified 10 quality dimensions perceived by patients: communication, access, shared decision making, provider knowledge and skills, physical environment, patient education, electronic medical record, pain control, discharge process, and preventive services. These dimensions can be used in planning and evaluating health care delivery. Future research should evaluate the effect of interventions targeting patient experience on patient outcomes.

The purpose of this study is to assess the effect of sulfasalazine and its metabolites on platelet function in patients with inflammatory arthritis (IA). One hundred thirty-five consecutive patients with an established diagnosis of IA were screened. Those with a history of cardiovascular disease (CVD), taking anti-platelet agents or non-steroidal anti-inflammatory drugs (NSAIDs) were excluded. A total of 32 patients were investigated, 15 taking sulfasalazine and 17 taking other disease-modifying anti-rheumatic drugs (DMARDs) and no sulfasalazine. These two cohorts were compared to 15 patients with stable CVD on long-term aspirin. The effect of sulfasalazine and its metabolites on arachidonic acid (AA)-induced platelet aggregation was also tested in vitro in samples from healthy donors (n = 18). Demographics, CVD risk factors and disease activity indices were similar in the sulfasalazine and other DMARD groups. AA-induced platelet aggregation was significantly inhibited in the sulfasalazine group (9 ± 7 %) and comparable to that in the aspirin group (10 ± 6 %). In contrast, there was no effect on AA-induced platelet aggregation in the other DMARDs group (77 ± 12 %) (p < 0.001). Furthermore, sulfasalazine therapy had no effect on platelet aggregation in response to multiple other agonists. Sulfasalazine and its metabolites (5-aminosalicylic acid and sulfapyridine) exerted an additive and dose-dependent inhibitory effect on AA-induced platelet aggregation in vitro (p < 0.001). The inhibition of AA-induced platelet aggregation by sulfasalazine is comparable to that achieved by aspirin and is dependent on both sulfasalazine and its metabolites. This represents a potential mechanism that may contribute to the known cardioprotective effect of sulfasalazine in patients with IA.

Objective : To describe the decision-making process of women who choose hysterectomy for treatment of benign disease or distressing symptoms. Design : Qualitative design based on grounded theory, using semistructured interviews. Setting : Participants were interviewed in their homes or at their place of employment. Participants : Ten women who were pre-menopausal prior to hysterectomy. Results : Decision making began when the women recognized abnormal body changes or bothersome symptoms. Four major processes were identified. "Seeking Solutions" was characterized by information seeking, information processing, and utilization of pharmacologic and nonpharmacologic treatments in an attempt to cure the disease and/or alleviate symptoms. "Holding On" included managing symptoms, rearranging activities of daily living to accommodate symptoms, and waiting. "Changing Course" was characterized by an abrupt change from Holding On to focusing on hysterectomy as the solution to the distressing symptoms. During "Taking Charge," the women displayed purposeful actions directed at arranging and preparing for surgery. Conclusions : Understanding the process of decision making will enable nurses to provide support for women who choose hysterectomy for treatment of benign gynecologic diseases and/or distressing gynecologic symptoms. Nurses' support of women's decision making should include referrals, education, and emotional support. In addition, nurses can help these women improve their quality of life by assisting them with symptom management.

Reaction of K2[PtCl4] with 2-mercaptobenzimidazole (HL2) and 2-mercaptoimidazole (HL3) in aqueous ethanol afforded the new, crystalline, square-planar platinum(II) complexes [Pt(HL2)4]Cl2.EtOH (4) and [Pt(HL3)4]Cl2.2H2O (5), the crystal and molecular structures of which are reported. In both complexes the ligands are present in the thione form with coordination taking place through the sulphur atom only. The Pt–S bond lengths are 2.304(4) and 2.312(3) A in complex (4) and 2.314(12) and 2.317(12) A in complex (5). The S–Pt–S bond angles are 90.33(13) and 89.67(13)° in complex (4) and 94.46(4) and 85.54(4)° in complex (5). Reaction of the ligands 4-hydroxy-2-mercaptopyrimidine (HL4) and 2-mercaptopyridine (HL5) with K2[PtCl4] gave the new, dimeric platinum(III) complex [Pt2(L4)4Cl2] (6) and [Pt2(L5)4Cl2]·EtOH (7) which is similar to a previously reported complex prepared by a different method. In these complexes the organic ligands are bridging N, S donors, the chlorides are terminally coordinated to each platinum and there is a platinum–platinum bond. The reaction of 4-amino-2-mercaptopyrimidine (HL6) with K2[PtCl4] gave the monomeric platinum(II) complex cis-[Pt(HL6)2Cl2]·2H2O (8) in which each HL6 ligand is coordinated to the metal ion via the exocyclic amino group. Reaction of 4,6-dihydroxy-2-methylmercaptopyrimidine (HL7) with K2[PtCl4] gave the dimeric platinum(II) complex of formula [Pt2(L7)2(HL7)2]Cl2 (9), which is suggested to contain bridging L7 and HL7 ligands.

The reaction of 3-aminophenylhydroxamic acid with CuSO4·5H2O in aqueous solution gives the novel helical polymer [Cu3(3-Apha)4(H2O)SO4]n·8H2O 1 the structure of which contains interlinked repeating units having three unique neutral, anionic and cationic copper(II) sites. In this complex the copper(II) sites are magnetically non-interacting. A similar reaction with 2-aminophenylhydroxamic acid gives the novel dimeric ‘metallacrown’ [Cu5(2-AphaH−1)4(μ-SO4)(H2O)2]2·10H2O 2 which has a ‘clam-like’ structure showing strong antiferromagnetic behaviour. In contrast to the above ligands, 4-aminophenylhydroxamic acid gives the monomeric square planar complex Cu(4-Apha)2·H2O 3 which exhibits paramagnetic behaviour. Crystal structures of all three complexes are reported.

Several cisplatin analogues of ethylenediamine-derived ligands containing alcohol, carboxylic acid and acetate substituents have been prepared and characterised, Oxidation of some of these square planar platinum(II) complexes using aqueous hydrogen peroxide gave octahedral platinum(IV) complexes, containing trans hydroxo ligands. Acetylation of the hydroxo ligands was achieved by reaction with acetic anhydride, giving complexes which are analogues of the antitumour drug, JM-216. Oxidation of the complex [Pt(H2L4)Cl-2], where H2L4 is ethylenediamine-N,N'-diacetic acid, with H2O2 gave the platinum(IV) complex [(PtLCl2)-Cl-4].H2O in which L-4 is tetradentate as shown by a crystal and molecular structure. This complex was previously reported to be [Pt(HL4)(OH)Cl-2] in which HL4 is tridentate. Several of the complexes were tested for antitumour activity against five human ovarian carcinoma cell lines. IC50 values range from 4.0 muM for cis,trans-PtCl2(OH)(2)(NH2CH2CH2NHCH2CH2OH) against the CH1 cell line to >25 muM indicating moderate to low activity relative to other platinum complexes.

Stability constants of iron(III), copper(II), nickel(II) and zinc(II) complexes of salicylhydroxamic acid (H2Sha), anthranilic hydroxamic acid (HAha) and benzohydroxamic acid (HBha) have been determined at 25.0 degrees C, I=0.2 mol dm(-3) KCl in aqueous solution. The complex stability order, iron(III)copper(II)nickel(II) approximately = zinc(II) was observed whilst complexes of H2Sha were found to be more stable than those of the other two ligands. In the preparation of ternary metal ion complexes of these ligands and 1,10-phenanthroline (phen) the crystalline complex [Cu(phen)2(Cl)]Cl x H2Sha was obtained and its crystal structure determined. This complex is a model for hydroxamate-peroxidase inhibitor interactions.

Background: The endoscopic brow lift procedure is gaining acceptance as an effective aesthetic procedure. Although several authors have described their techniques, none have objectively quantified their result at 1-year follow-up. Objective: The purpose of this study was to objectively evaluate the outcome after an endoscopic brow lift with a minimum of 1 year follow-up. Methods: The amount of brow elevation at three points along the brow, the outcome of corrugator ablation, changes in corrugator and frontalis furrows, sensory changes, temporal branch function, and patient satisfaction in 20 consecutive patients were evaluated. The average time at follow-up was 15 months, with a range of 12 to 23 months. Results: The brow at the lateral canthus was elevated 2.1 ± 2.8 mm (P < .001), 1.9 ± 2.5 mm (P < .001) at the lateral limbus, and 2.4 ± 3.0 mm (P

Treatment of ruthenium (III) chloride hydrate with N,N′-dicarboxamido-N,N′-dicarboxymethyl-1,2-diaminoethane (1) (EDTA–diamide) in refluxing HCl solution followed by cooling afforded the crystalline complex NH4[Ru(EDTA–H)Cl] · 2H2O (2), the EDTA–H ligand and the +NH4 cation resulting from the hydrolysis of the amide groups in 1. The crystal and molecular structure confirms that in this complex EDTA–H acts as a pentadentate ligand, bonded to the metal through the tertiary nitrogen atoms and three carboxylate oxygens. A chloride ligand completes octahedral geometry around the metal ion. Reaction of K2[PtCl4] with the same ligand in hot basic solution followed by acidification initially gave PtCl2[HOOCCH2(2HNOCCH2)NCH2CH2.

Numerous inland Australian streams contain density-stratified or saline pools. Saline pools consist of a layer of saline water underlying a layer of fresh water. They are associated with seasonal low flows and influxes of saline groundwater and have important water quality and environmental implications. A theoretical model of the dominant mixing process (flushing) associated with flows of fresh water across the top of the saline layer is presented. Laboratory results show that progressive removal of saline water from saline pools occurs because of a thin saline layer flowing up the downstream depression slope when the surface layer flows over the saline layer at a sufficiently high velocity. The behavior of this thin layer is controlled by a balance between shear and buoyancy forces that act on it. Experimental results describe the initiation of this outflow, the rate of the outflow, the composition of the outflow, and the range of scour hole geometries over which flushing is the dominant mixing process.

Treatment of K 2 [PtCl 4 ] with the anti-cancer drug razoxane (3,5-dioxopiperazin-1-yl-propane) in aqueous HCl solution gave the water-insoluble complex cis -PtCl 2 (razoxane), which is the first metal complex of razoxane to have been isolated. The crystal and molecular structure of the complex confirms that razoxane is present as a bidentate ligand, Pt-N = 2.095(11) and 2.080(9) A, and was not hydrolysed during complex formation as was previously observed in the presence of other metal ions. This is also one of the few examples in which platinum is bonded to a ligand via tertiary nitrogen atoms only. The presence in the complex of two cis chloride ligands, Pt-Cl = 2.299(4) and 2.277(3) A, and square planar geometry around the metal ion is also confirmed. Intermolecular hydrogen bonding between an imide oxygen atom of each molecule and an imide NH group of another results in a sheet-like ‘zig-zag’ structure. Crystal data for cis -PtCl 2 (razoxane): monoclinic, space group P 2 1 / c , a = 9.165(2), b = 16.573(3), c = 10.984(2) A, β = 114.60(3)°, Z = 4, R = 0.0341, R w = 0.0385.

In the crystal structure of the title compound, C7H6Cl2N2O2, the dihedral angle between the mean planes of the benzene ring and the hydroxamic acid group is 40.1 (1)°. The mol­ecules are linked via O—H⋯N/O and N—H⋯O/Cl hydrogen bonds, forming two-dimensional layers parallel to (100).

In the title compound, C7H7IN2O2, the dihedral angle between the mean planes of the benzene ring and the hydroxamic acid group is 39.12 (14)°. The mol­ecules are linked via N—H⋯O, O—H⋯N and C—H⋯O inter­actions, forming two-dimensional layers parallel to (100) in the crystal structure. There is an I⋯I inter­molecular van der Waals contact.

For the two mol­ecules in the asymmetric unit of the title compound, C8H9NO3, the dihedral angles between the mean planes of the benzene ring and the hydroxamic acid group are 4.50 (16) and 10.10 (11)°. The supra­molecular aggregation is effected by the formation of two-dimensional networks of N—H⋯O and O—H⋯O inter­actions in addition to C—H⋯O and π–π inter­actions.

In the crystal structure of the title compound, C10H11ClN2O2, the 1,3-diaza ring exists in the skew-boat conformation. Supra­molecular aggregation is effected by the formation of an infinite two-dimensional network of O—H⋯O and N—H⋯O inter­actions.

We present an unusual instance of juvenile xanthogranuloma occurring in the hand. A 23-month-old girl had a mass on the radial aspect of the right third finger at the distal interphalangeal joint that extended to the collateral ligament. The lesion was histologically diagnosed as a juvenile xanthogranuloma after resection of the mass. Juvenile xanthogranuloma is uncommon in the hand, and only three patients with this condition occurring in the digits have been reported in the English language literature. The clinical presentation, diagnosis, and treatment are discussed.

The salicylhydroxamic acid (H2Sha) complexes, Ni(HSha)2·2H2O, Cu(HSha)2·2H2O, Zn(HSha)2·1.5H2) and Fe(Sha)3·2H2O, in which the ligand is coordinated to the metal through the hydroxamate group have been synthesised. Acetylation of salicylhydroxamic acid with acetyl chloride in pyridine gave O-acetylsalicylhydroxamic acid (H2Sha-OAc) in which the hydroxamate oxygen is acetylated and from which the complexes Ni(HSha-OAc)2·H2O and Zn(Sha-OAc) were prepared. In the zinc complex the ligand is coordinated to the metal through the phenolate oxygen and the deprotonated nitrogen of the acetylhydroxamic group, the latter being an extremely rate type of coordination in the case of this metal ion. Attempted preparation of iron(III) and copper(II) complexes resulted in deacetylation of the ligand and the formation of salicylhydroxamate complexes.

The binding of the angiotensin-converting enzyme inhibitor lisinopril to zinc(II), copper(II) and nickel(II) has been investigated in solution by pH-metric methods and the crystal structure of the dimeric copper(II)–lisinopril complex, [Cu 2 (HA) 2 (H 2 O) 2 ][ClO 4 ] 2 (H 4 A 2+ = fully protonated lisinopril), has been determined. In the case of the metal ions investigated a major species present in neutral or weakly acidic solution is M(HA) + , the formation constants of which suggest that co-ordination to the metal ions occurs through the amino nitrogen, carboxylate oxygen and the amide oxygen atoms. The crystal structure of the dimeric copper complex shows that each copper is in a distorted square-pyramidal environment in which the basal plane is occupied by carboxylate (Cu–O 1.944 A) and carbonyl (Cu–O 1.996 A) oxygens, and an amino group nitrogen (Cu–N 1.989 A) from one ligand as well as the prolyl carboxylate of another ligand (Cu–O 1.909 A). An aqua ligand Cu–O (2.355 A) is axially bonded to each copper.

Numerous inland Australian streams contain density-stratified or saline pools, which are usually located on channel bends. Saline pools consist of a layer of saline water underlying a layer of fresh water. Saline pools generally form as a result of saline groundwater seeping into the stream and collecting in scour depressions during periods of low flow. Inflows of saline river water can also collect in scour depressions. Field and laboratory investigations of saline pool mixing by overflowing fresh water reveal that mixing depends on a balance between interfacial shear and buoyancy forces acting on a thin dense layer flowing up the downstream slope of the scour depression, and on the bend sharpness. Convection associated with surface cooling also causes mixing. A model for saline pools formed by groundwater inflows and mixed by fresh overflows is proposed and applied to several saline pools in the Wimmera River.

Reaction of 1,2-diaminoethane-N,N,N′,N′-tetra(N-methylacetamide), L, with potassium tetrachloroplatinate(II) in aqueous solution afforded the crystalline salt (2H+-L)[PtCl4] and the neutral platinum(IV) complex cis-Pt(LH−2)Cl2·2H2O. The crystal and molecular structure of the latter shows that the chloride ligands are cis, PtCl = 2.308(2) A, and that LH−2 is present as a tetradentate ligand coordinated through its two amino nitrogen atoms, PtN = 2.097(6) A, and two deprotonated amide nitrogens, PtN = 2.032(4) A which are trans to each other. This structure is the first of a platinum(IV) complex containing deprotonated amide ligands and may serve as a model for platinum(IV)-peptide/protein interactions. The fact that this complex is formed without any added oxidant other than air suggests that deprotonated amide groups facilitate the oxidation of platinum(II) to platinum(IV). The CN and CO bond distances in the coordinated, deprotonated amide groups are almost identical to those of the uncoordinated amide groups indicative of similar π electron delocalisation in the NCO groups in both cases. This is in contrast to the situation in a recently reported platinum(II)-amidate complex in which there is considerably greater π electron delocalisation than in the free amide. The crystal structure of (2H+-L)[PtCl4] is also reported, av. PtCl = 2.292 A. Crystal data: cis-Pt(LH−2C2·H2O, monoclinic space group P2/n, 1 = 11.764(4), b = 7.840(1), c = 11.829(3) A , β = 104.09(2)°, Z = 2 ; (2H+-L)[PtCl4], triclinic, space group P1, a = 9035(1), b = 9.316(1), c = 7.308(2) A , α = 100.88(1), β = 106.52(1), γ = 99.96(1)°, Z = 1 .

Hydroxamic acids, both natural and man-made, are a class of extensively studied compounds with a myriad of applications. Despite being known since 1869 with the discovery of oxalohydroxamic acid, most research has been garnered since the 1980s, which includes a significant accumulation of pharmacologically pertinent data. The biological profile of hydroxamic acids has provided us with chemotherapeutics for the treatment of cancer, cardiovascular disease, infectious agents, metal poisoning, and more. Most of their harnessed activity is attributed to their ability to inhibit many families of metalloenzymes containing Zn, Fe, or Ni ions in their catalytic domains. This chapter focuses on examples of hydroxamic acid inhibitors of the following enzymes: matrix metalloproteinases, carbonic anhydrases, histone deacetylases, ureases, cyclooxygenases, lipoxygenases, leukotriene A 4 hydrolases, and peptide deformylases.

The complex trans -bis (glycinehydroxamato) platinum (II) hydrate, trans -Pt (GHA) 2 ·H 2 O, in which the ligand is coordinated to the metal through its amino and deprotonated hydroxamate nitrogen atoms, has been synthesised. Reaction of this with HCl in aqueous solution produced crystals of trans -dichlorobis(glycine) platinum(II) dihydrate, trans -PtCl 2 (glyOH) 2 ·2H 2 O, resulting from hydrolysis of the glycinehydroxamate ligand. The crystal and molecular structures show that the complex is square planar with the chloride ligands trans to each other, as are the glycine ligands which are N-coordinated. The PtCl and Pt bond distances are 2.283 and 2.037 a, respectively. Extensive intermolecular hydrogen bonding in the crystal gives rise to a layer structure and each water molecule is involved in three hydrogen bonds. The complex trans -dichlorobis (glycylglycine) platinum(II) dihydrate was also prepared but attempts to oxidise it with H 2 O 2 resulted in hydrolysis of the peptide ligand as well as oxidation, giving trans,trans -dichlorobis(glycinato) platinum(IV), trans,trans -PtCl 2 (glyO) 2 . The crystal and molecular structures of this complex, one of the very few known platinum(IV)-amino acid complexes, have also been determined. The complex is octahedral with both glycinates and chlorides bonded trans to one another. In the crystal there are two chemically identical but crystallographically distinct molecules each of which occupies a special position in the crystallographic inversion centre. The average bond distances in this complex are, PtCl 2.305 A, PtN 2.051 A and PtO 1.987 A. In the crystal there is e extensive intermolecular hydrogen bonding, each complex molecule hydrogen bonded to six others giving a sheet-like structure.

Nolan, C.B.; Tufford, D.L., and Chalcraft, D.R., 2016. Needs assessment of coastal land managers for drought onset indicators in the southeastern United States. The ability to detect the onset of drought is important to coastal resource managers because the knowledge enhances preparedness and mitigation. Existing drought indicators, however, were generally designed with agricultural, hydrological, meteorological, socio-economic, or wildfire management in mind and generally quantify deficits in freshwater availability. It is unclear whether coastal resource managers find existing indicators adequate for managing coastal resources and, if not, what information would be most useful to manage resources under threat of drought. A needs assessment was conducted with 30 land managers and natural resource specialists of the coastal Carolinas region to enhance the understanding of drought indicators and to comprehend the indicators' utility for managing coastal natural resources. Eighty-three percent of p...