α-Substituierte Phosphonate. 43. Synthese und Reaktivität von 1,2,3,4-Tetrahydroisochinolin-1-phosphonaten

α-Substituted Phosphonates. 43. Synthesis and Reactivity of 1,2,3,4-Tetrahydroisochinolin-1-phosphonates N-Alkyl- and N-arylsubstituted 1,2,3,4-tetrahydroisochinolin-1-phosphonates 1 have been synthesized from the corresponding 3,4-dihydroisochinoliniumbromides 7 and triethyl-phosphite. The N-unsubstituted 1,2,3,4-tetrahydroisochinolin-1-phosphonate 10 is available starting from the 1,2,3,4-tetrahydroisochinolin-1-phosphonic acid by esterification with triethylformate and splitting off the formyl group of the primarily formed N-formyl derivative 14 . – N-Quarternated tetrahydroisochinolines 19 and the 1-phosphorylated derivatives 17 , respectively react with triethyl-phosphite in an unexpected way by dealkylation and not by splitting off the isochinolinring. – By Horner-synthesis with 1 the 1-aralkylidene-isochinolines 23 are available in moderate yields.     

Flexible Blade‐Coated Multicolor Polymer Light‐Emitting Diodes for Optoelectronic Sensors

A method to print two materials of different functionality during the same printing step is presented. In printed electronics, devices are built layer by layer and conventionally only one type of material is deposited in one pass. Here, the challenges involving printing of two emissive materials to form polymer light‐emitting diodes (PLEDs) that emit light of different wavelengths without any significant changes in the device characteristics are described. The surface‐energy‐patterning technique is utilized to print materials in regions of interest. This technique proves beneficial in reducing the amount of ink used during blade coating and improving the reproducibility of printed films. A variety of colors (green, red, and near‐infrared) are demonstrated and characterized. This is the first known attempt to print multiple materials by blade coating. These devices are further used in conjunction with a commercially available photodiode to perform blood oxygenation measurements on the wrist, where common accessories are worn. Prior to actual application, the threshold conditions for each color are discussed, in order to acquire a stable and reproducible photoplethysmogram (PPG) signal. Finally, based on the conditions, PPG and oxygenation measurements are successfully performed on the wrist with green and red PLEDs.     

Nonlinear modeling of transformers

The performance of classical transformer models under nonsinusoidal excitation is investigated and two novel models for such analysis, both of which account for the transformer core magnetic nonlinearities, are presented. All analytical results are compared with experimental data     

A nurse practitioner intervention model to maximize efficient use of telemetry resources

BACKGROUND: Telemetry monitoring is widely used in hospitals; the importance of being able to monitor and examine dysrhythmias has been universally accepted. Yet it is often used for patients who do not actually require this technology. A model to improve the efficiency of telemetry use entailed the use of an advanced practice nurse (APN; identical to a nurse practitioner) to provide concurrent review and intervention of floating telemetry, which is available for patients independently of the floor location and who do not need an intensive care unit bed. ADDRESSING OVERUSE: The demand for floating telemetry at Hackensack University Medical Center had equaled or exceeded the telemetry availability virtually 100% of the time, even after local guidelines had been disseminated in 1998. The APN carried out concurrent monitoring and intervened with the attending physician when patients were on telemetry for longer than 48 hours and did not meet the local telemetry guidelines. RESULTS: The mean number (standard error [SE]) of hours per patient declined from 65.2 +/- 0.7 hours (95% confidence interval, 63.8 to 66.6 hours) for the 11 months before the intervention to a mean of 49.6 +/- 0.4 hours (95% confidence interval, 48.7 to 50.2 hours) for the 29 months after intervention--representing a decrease of 34% (p < 0.0001). This decrease led to an increase in the number of patients per month put on telemetry. DISCUSSION: The APN model, an aggressive approach that induced change almost immediately, was then applied to other quality improvement projects.     

Implementing evidence-based recommendations for health care: a roundtable comparing European and American experiences

BACKGROUND: A roundtable held October 5-6 1999, in Maidstone, Kent, United Kingdom, was convened to identify current strategies and ongoing challenges in implementing evidence-based practice guidelines in health care. Despite numerous new medical research findings for improving health care and despite the dissemination of many practice guidelines, the recommendations from these efforts are not being uniformly adopted. Overuse, underuse, and misuse plague the practice of medicine today. IMPLEMENTING GUIDELINES: Multiple implementation strategies are more likely to succeed that a single implementation method; local selection and adaptation of guidelines are critical; and reminders, educational outreach (for prescribing), and interactive educational workshops are generally effective. EXPERIENCE IN EUROPE: In most countries, guideline development has progressed from consensus conference, to evidence-based statements, and finally to evidence-based guidelines that also consider cost-effectiveness. Guideline development is the most advanced in The Netherlands, where physicians have coordinated their efforts with the government to achieve more uniformity than is found elsewhere. EXPERIENCE IN THE UNITED STATES: Designing systems that will facilitate change--not changing physician behavior--should be the focus. The concern for effecting improvement in health care is now more acute because of the increased attention being given to medical errors and patient safety. SUMMARY STATEMENT: Multifaceted approaches are clearly the most important method for improving care. Such approaches may include many improvement methods, none of which work well alone most of the time or any of the time.     

Link between heart disease, cholesterol, and Alzheimer's disease: a review

Increased prevalence of Alzheimer's disease-like beta-amyloid deposits in the neuropil and within neurons occurs in the brains of non-demented individuals with heart disease. Heart disease is a prevalent finding in Alzheimer's disease, and may be a forerunner to the dementing disorder. In the cholesterol-fed rabbit model of human coronary heart disease there is production and accumulation of beta-amyloid in the brain. This accumulation of beta-amyloid can be reversed by removing cholesterol from the rabbits' diet. In culture cells, a cholesterol challenge has been shown to increase production of beta-amyloid, and dramatic reductions of cholesterol produced by HMG Co-A reductase inhibitors decrease production of beta-amyloid. Increased beta-amyloid production is also produced by dietary cholesterol in a number of transgenic mouse models of Alzheimer's disease. Administration of HMG Co-A reductase inhibitors may block beta-amyloid production caused by dietary cholesterol in rabbits. Clinical trials testing the benefit of HMG Co-A reductase inhibitors in the treatment of Alzheimer's disease are underway.     

Thermal Expansion of La1.85Sr0.15CuO4 in Magnetic Fields up to 14 Tesla

We present thermal expansion measurements on a La_1.85Sr_0.15CuO₄ single crystal in external magnetic fields. Clear anomalies of the thermal expansion are observed at the superconducting transition. We have studied in detail the anisotropic influence of external fields on the anomalies. As expected, the field dependence is maximum for B c and minimum for B c. The measured angular dependence corresponds to that of an anisotropic 3d superconductor with an anisotropy parameter 18.     

Role of the liver and gut in systemic diphenhydramine clearance in adult nonpregnant sheep

We investigated the contribution of the liver and gut to systemic diphenhydramine (DPHM) clearance in adult nonpregnant sheep in two separate studies. In the first study, a simultaneous 50-mg bolus each of DPHM and its deuterium-labeled analog ([2H10]DPHM) was administered to five sheep via the femoral (i.v.) and the portal venous (p.v.) routes in a randomized manner. Arterial plasma concentrations of DPHM, [2H10]DPHM, and their deaminated metabolites, DPMA (diphenylmethoxyacetic acid) and [2H10]DPMA, were measured using gas chromatography-mass spectrometry. The hepatic first-pass extraction of DPHM after p.v. administration was 94.2 +/- 3.7%. However, the area under the plasma concentration versus time profile of the metabolite after i.v. dosing was only 32.5 +/- 14.0% relative to that after p.v. administration. Thus, only approximately 32.5% of the i.v. dose is metabolized in the liver and a significant extrahepatic systemic clearance component is evident. Using the calculated total hepatic blood flow values, it was found that 98.6 +/- 9.2% of the i.v. dose eventually was delivered to the "hepatoportal" system. Because the drug delivered to the hepatoportal system is almost completely eliminated in a single pass (hepatic extraction approximately 94%), this indicates a lack of any significant pulmonary drug uptake. Also, because only approximately 32.5% of the i.v. dose is metabolized in liver, the gut is most likely responsible for the clearance of the remainder. This gut contribution to systemic DPHM clearance was confirmed in a separate direct study in four sheep where the steady-state DPHM gut extraction ratio was 49.0 +/- 3.0%. Thus, gut accounts for a significant proportion (>/=50%) of DPHM systemic clearance in sheep in spite of a very high hepatic drug extraction efficiency.     

In vivo local determination of tissue optical properties: applications to human brain

Local and superficial near-infrared (NIR) optical-property characterization of turbid biological tissues can be achieved by measurement of spatially resolved diffuse reflectance at small source-detector separations (<1.4 mm). However, in these conditions the inverse problem, i.e., calculation of localized absorption and the reduced scattering coefficients, is necessarily sensitive to the scattering phase function. This effect can be minimized if a new parameter of the phase function gamma, which depends on the first and the second moments of the phase function, is known. If gamma is unknown, an estimation of this parameter can be obtained by the measurement, but the uncertainty of the absorption coefficient is increased. A spatially resolved reflectance probe employing multiple detector fibers (0.3-1.4 mm from the source) is described. Monte Carlo simulations are used to determine gamma, the reduced scattering and absorption coefficients from reflectance data. Probe performance is assessed by measurements on phantoms, the optical properties of which were measured by other techniques [frequency domain photon migration (FDPM) and spatially resolved transmittance]. Our results show that changes in the absorption coefficient, the reduced scattering coefficient, and gamma can be measured to within +/-0.005 mm(-1), +/-0.05 mm(-1), and +/-0.2, respectively. In vivo measurements performed intraoperatively on a human skull and brain are reported for four NIR wavelengths (674, 811, 849, 956 nm) when the spatially resolved probe and FDPM are used. The spatially resolved probe shows optimum measurement sensitivity in the measurement volume immediately beneath the probe (typically 1 mm(3) in tissues), whereas FDPM typically samples larger regions of tissues. Optical-property values for human skull, white matter, scar tissue, optic nerve, and tumors are reported that show distinct absorption and scattering differences between structures and a dependence on the phase-function parameter gamma.