Decision making in health care: limitations of the substituted judgement principle

The substituted judgement principle is often recommended as a means of promoting the self-determination of an incompetent individual when proxy decision makers are faced with having to make decisions about health care. This article represents a critical ethical analysis of this decision-making principle and describes practical impediments that serve to undermine its fundamental purpose. These impediments predominantly stem from the informality associated with the application of the substituted judgement principle. It is recommended that the principles upon which decisions are made about health care for another person should be transparent to all those involved in the process. Furthermore, the substituted judgement principle requires greater rigour in its practical application than currently tends to be the case. It may be that this principle should be subsumed as a component of advance directives in order that it fulfils its aim of serving to respect the self-determination of incompetent individuals.

Secondary bonding in para-substituted diphenyltellurium dichlorides (p-XC6H4)2TeCl2 (X = H, Me, MeO) probed by 125Te MAS NMR spectroscopy. Crystal and molecular structure of (p-MeC6H4)2TeCl2

The solid-state structures of the previously known para-substituted diphenyltellurium dichlorides, (p-XC₆H₄)₂TeCl₂ (X=H (1), Me (2), MeO (3)) were investigated by ¹²⁵Te MAS NMR spectroscopy and in case of 2 by single crystal X-ray diffraction. The ¹²⁵Te-NMR shielding anisotropy (SA) was studied by tensor analyses based on relative intensities of the observed spinning sidebands. Solid-state NMR parameters, namely the isotropic chemical shift (δ_iso), anisotropy (ζ) and asymmetry (η), were discussed in relation to the molecular structures established by X-ray crystallography. The asymmetry (η) was found to be particularly sensitive to structural differences stemming mostly from the diverse secondary Te...Cl interactions, but no correlation with geometric parameters could be established.

Synthesis and molecular structure of [n-Bu2(F)SnOSn(F)t-Bu2]2 - an unsymmetrically substituted tetraorganodistannoxane

The dimeric tetraorganodistannoxane [n-Bu₂(F)SnOSn(F)t-Bu₂]₂ (1) was prepared by the reaction of (t-Bu₂SnO)₃ with n-Bu₂SnF₂ and characterized in solution by multinuclear NMR spectroscopy and ESI MS spectrometry and in the solid state by ¹¹⁹Sn MAS NMR spectroscopy and single crystal X-ray diffraction.

Substituted consent : from lunatics to corpses

This analysis traces the origins and evolution of the doctrine of surrogate or substituted judgment, especially its application to medical treatment, including non-therapeutic sterilisation, decisions regarding life and death choices, and more recently, removal of sperm or eggs from incompetent, dying or dead males and females. It argues that the doctrine, which has been acknowledged to be a legal fiction, has an effect of devolving legal and moral responsibility for life and death choices, as well as non-consensual, non-beneficial intrusive procedures, from the competent decision-makers to the incompetent patient. It focuses on the subjective nature of the substituted judgment standard; the problematic nature of evidence propounded to establish the putative choices of the incompetent person; lack of transparency relating to the conflict of interest in the process of substituted judgment decision-making; and the absence of voluntariness, which is an essential element of a valid consent.

Synthesis and reactivity of para-substituted benzoylmethyltellurium(II and IV) compounds: observation of intermolecular C-H-O hydrogen bonding in the crystal structure of (p-MeOC6H4COCH2)2TeBr2

Bis(p-substituted benzoylmethyl)tellurium dibromides, (p-YC₆H₄COCH₂)₂TeBr₂, (y=H (1a), Me (1b), MeO (1c)) can be prepared
either by direct insertion of elemental Te across CRf-Br bonds (where C_Rf refers to α-carbon of a functionalized organic moiety) or by the oxidative addition of bromine to (p-YC₆H₄COCH₂)₂Te (y = H (2a), Me (2b), MeO (2c)). Bis(p-substituted benzoylmethyl)tellurium dichlorides, (p-YC₆H₄COCH₂)₂TeCh (y = H (3a), Me (3b), MeO (3c)), are prepared by the reaction of the bis(p-substituted benzoylmethyl)tellurides 2a--c with S0₂Cl₂, whereas the corresponding diiodides (p-YC₆H₄COCH₂)₂Teh (y = H
(4a), Me (4b), MeO (4c)) can be obtained by the metathetical reaction of la--c with KI, or alternatively, by the oxidative addition of
iodine to 2a--c. The reaction of 2a--c with allyl bromide affords the diorganotellurium dibrornides la--c, rather than the expected
triorganotelluronium bromides. Compounds 1-4 were characterized by elemental analyses, IR spectroscopy, ¹H, ^l3C and ¹²⁵Te
NMR spectroscopy (solution and solid-state) and in case of Ie also by X-ray crystallography. (p-MeOC₆H₄COCH₂)₂TeBr₂ (1c) provides, a rare example, among organotellurium compounds, of a supramolecular architecture, where C-H-O hydrogen bonds appear to be the non-covalent intermolecular associative force that dominates the crystal packing.

Observation of Te···π and X···X Bonding in para-Substituted Diphenyltellurium Dihalides, (p-Me2NC6H4)(p-YC6H4)TeX2(X=Cl, Br, I; Y=H, EtO, Me2N)-

The supramolecular association of the previously described para-dimethylaminophenyl-substituted diorganotellurium dihalides (p-Me₂NC₆H₄)₂TeX₂ (X = Cl (1), Br (2), I (3)) and (p-Me₂NC₆H₄)RTeCl₂ (R = Ph (4), p-EtOC₆H₄ (5)), was investigated by X-ray crystallography. Unlike almost all other structurally characterized diorganotellurium dihalides, (p-Me₂NC₆H₄)₂TeX₂ (X = Cl (1), Br (2), I (3)) reveal no secondary Te∙∙∙X interactions, but X∙∙∙X interactions. The structure of (p-Me₂NC₆H₄)PhTeCl₂ (4) resembles that of Ph₂TeCl₂ and shows one secondary Te∙∙∙Cl contact, whereas (p-Me₂NC₆H₄)(p-EtOC₆H₄)TeCl₂ (5) exhibits neither secondary Te∙∙∙Cl nor Cl∙∙∙Cl interactions. The unusual structural characteristics of 1–5 are attributed to the occurrence of intermolecular Te∙∙∙π and π∙∙∙π contacts associated with quinoid π-electron delocalization across the para-dimethylaminophenyl (1–5) and para-ethoxyphenyl (5) groups.

N3-substituted xanthines as irreversible adenosine receptor antagonists

8-Cyclopentyl-3-(3-(4-fluorosulfonylbenzoyl)oxy)propyl-propylxanthine (44, FSCPX) has been reported to exhibit potent and selective irreversible antagonism of the A1 adenosine receptor when using in vitro biological preparations. However, FSCPX (44) suffers from cleavage of the ester linkage separating the reactive 4-(fluorosulfonyl)phenyl moiety from the xanthine pharmacophore when used in in vivo biological preparations or preparations containing significant enzyme activity, presumably by esterases. Cleavage of the ester linkage renders FSCPX (44) inactive in terms of irreversible receptor binding. In order to obtain an irreversible A1 adenosine receptor antagonist with improved stability, and to further elucidate the effects of linker structure on pharmacological characteristics, several FSCPX (44) analogues incorporating the chemoreactive 4-(fluorosulfonyl)phenyl moiety were targeted, where the labile ester linkage has been replaced by more stable functionalites. In particular, ether, alkyl, amide and ketone linkers were targeted, where the length of the alkyl chain was varied from between one to five atoms. Synthesis of the target compounds was achieved via direct attachment of the N-3 substituent to the xanthine. These compounds were then tested for their biological activity at the A1 adenosine receptor via their ability to irreversibly antagonise the binding of [3H]-8-cyclopentyl-1,3-dipropylxanthine ([3H]DPCPX, ( 9) to the A1 adenosine receptor of DDT1 MF-2 cells. For comparison, the xanthines were also tested for their ability to inhibit the binding of [3H]-4-(2-[7-amino-2-{furyl} {1,2,4}- triazolo{2,3-a} {1,3,5}triazin-5-ylamino-ethyl)]phenol ([3H]ZM241385, 36) to the A2A adenosine receptor of PC-12 cells. The results suggest that the length and chemical composition of the linker separating the reactive 4-(fluorosulfonyl)phenyl moiety from the xanthine ring contribute to the potency and efficacy of the irreversible A1 adenosine receptor ligands. Like FSCPX (44, IC50 A1 = 11.8 nM), all derivatives possessed IC50 values in the low nM range under in vitro conditions. Compounds 94 (IC50 A1 = 165 nM), 95 (IC50 A1 = 112 nM) and 96 (IC50 A1 = 101 nM) possessing one, three and five methylene spacers within the linkage respectively, exhibited potent and selective binding to the A1 adenosine receptor versus the A2A adenosine receptor. Compound 94 did not exhibit any irreversible binding at A1 adenosine receptors, while 95 and 96 exhibit only weak irreversible binding at A1 adenosine receptors. Those compounds containing a benzylic carbonyl separating the 4-(fluorosulfonyl)phenyl moiety from the xanthine ring in the form of an amide (119, IC50 A1 = 24.9 nM, and 120, IC50 A1 = 21 nM) or ketone (151, IC50 A1 = 14 nM) proved to be the most potent, with compound 120 exhibiting the highest selectivity of 132-fold for the A receptor over the A2A receptor. compounds 119, 120 and 151 also strongly inhibited the binding of [3H]DPCPX irreversibly (82%, 83% and 78% loss of [3H]DPCPX binding at 100 nM respectively). compounds 120 and 151 are currently being evaluated for use in in vivo studies. Structure-activity studies suggest that altering the 8-cycloalkyl group of A1 selective xanthines for a 3-substituted or 2,3-disubstituted styryl, combined with N-7 methyl substitution will produce a compound with high affinity and selectivity for the A2A adenosine receptor over the A1 adenosine receptor. Compound 167 (IC50 A2A = 264 nM) possessing 8-(m-chloro)styryl substitution and the reactive 4-(fluorosulfonyl)phenyl moiety separated from the xanthine ring via an amide linker in the 3-position (as for 119 and 120), exhibited relatively potent binding to the A2A adenosine receptor of PC-12 cells, with a 16-fold selectivity for that receptor over the A1 adenosine receptor. However, compound 167 exhibited only very weak irreversible binding at A2A adenosine receptors. Overall, at this stage of biological testing, compound 120 appears to possess the most advantageous characteristics as an irreversible antagonist for the A1 adenosine receptor. This can be attributed to its high selectivity for the A1 adenosine receptor as compared to the A2A adenosine receptor. It also has relatively high potency for the A1 adenosine receptor, a concentration-dependent and selective inactivation of A1 adenosine receptors, and unbound ligand is easily removed (washed out) from biological membranes. These characteristics mean compound 151 has the potential to be a useful tool for the further study of the structure and function of the A1 adenosine receptor.

Approaches to the synthesis of peptide substituted frameworks

The 1,3 dipolar cycloaddition between carbonyl ylids (generated from cyclobutene epoxides flanked by esters) and norbornyl alkenes – the ACE reaction – offers a facile method for the construction of polynorbornyl molecular frameworks. This reaction has, as described in this dissertation, underpinned the construction of molecular frameworks that have peptides and amino acids attached. Such highly rigid peptide-frameworks are of use in the field of peptidomimetics; the template molecule governs the final positioning of any attached groups such that a precise arrangement of amino acids can be achieved without the need to construct entire proteins. In the course of any ACE reaction the ester flanked cyclobutene epoxide is transformed to a 1,3 dipole, the esters serve to stablise this reactive intermediate and are as a consequence incorporated in the reaction product. Modification of these esters provides pseudo-equatorial points for peptide attachment. These methyl esters were replaced with tert-butyl esters to provide pseudo-axial attachment points that could be selectively addressed. The optimal strategy for peptide-framework construction involved direct condensation of carboxyl protected amino acids to bicyclo[2.2.1]hept-5-ene-2-endo-carboxylic acid as well as condensation of amino acids to cyclobutene epoxides derived from this acid. The ACE reaction of (±) bicycloheptene-2-endo-carboxylic acid derivatives with cyclobutene epoxides synthesised from such racemic acid derivatives provided a mixture of enantiomers and meso compounds. In order to control the position of the attachment points – and hence the final location of the attached peptides – the ACE reaction required chiral starting materials. Accordingly, all peptidoframeworks were derived from the chiral (2S)-(-)-bicycloheptene carboxylic acid. The ACE reaction of this (S)-norbornene with the (S)-epoxide provided a peptide framework in which the attached amino acids were positioned pseudo-axially. Deprotection of the amino acid allowed peptide chain building in the pseudo-axial direction. Using this strategy a framework with an alanine residue and a triglycine peptide was synthesised. By combining this strategy with the ter-butyl ester variant a framework with pseudo-axial alanine and pseudo-equatorial glycine residues was manufactured.

Making a finding : guardianship and construction of substituted decisions about women's health and fertility

Substituted decisions about health and fertility of women deemed incompetent, because of a disability, expose the constitutive power of knowledge about the female, disabled body and its stereotypical place in social relations. This study addresses issues about the self of modern citizenship and feminist politics in a changing policy climate.

Characterisation and impedance spectroscopy of substituted Li1.3Al0.3Ti1.7(PO4)3−x(ZO4)x (Z=V, Nb) ceramics*1

Lithium ion conducting ceramics based on the lithium aluminium titanium phosphate (LATP) NASICON structure have been prepared with various substitutions of the phosphorous. The effect of the processing method has been shown to be the key factor in determining the conductivity, both bulk and grain boundary, as well as the conductivity trends observed as a function of substitution.

Structure and transport properties in an N,N-substituted pyrrolidinium tetrafluoroborate plastic crystal system

The structure and transport of N-propyl-N-methylpyrrolidinium tetrafluoroborate (P₁₃BF₄) has been investigated over a wide temperature range in consequence to exhibiting properties suitable for potential solid-state superionic electrolyte applications. Prior to melting, the organic salt, P₁₃BF₄, transforms into a plastic crystal phase. Intrinsic conductivity in this solid, phase I (45–65 °C), is comparable to that in the melt (_~10⁻³ S cm⁻¹). Ionic motion and transport properties were investigated by ¹H and ¹¹B nuclear magnetic resonance (NMR) spectroscopy. Pressure-induced plastic flow in this system may accommodate volume changes in device application and to this extent, X-ray diffraction (XRD) has been used. Scanning electron microscopy (SEM) revealed complex surface morphology and lattice imperfections associated with the strong orientational disorder of the plastic state.

Synthesis and characterisation of rare earth complexes supported by para-substituted Cinnamate Ligands

The preparations and characterisations of a range of lanthanoid 4-(R)-substituted (4-Rcinn, R = OH, OMe, NO2, Cl), known to have good anticorrosion properties, are reported. The crystal structure of [Ce(4-OHcinn)3(MeOH)2(H2O)]·MeOH is a polymer, in which the cerium atoms are nonacoordinate, and adjacent cerium atoms are bridged by either two bridging bidentate or two bridging tridentate carboxylate ligands. Each cerium atom also has one monodentate 4-hydroxycinnamate ligand, one aqua ligand, and two methanol ligands.

Why is it so? The 1H-NMR CH2 splitting in substituted propanes

Nuclear magnetic resonance (NMR) spectroscopy is an important tool in the structural analysis of both organic and inorganic molecules. Proton NMR spectra can yield information about the chemical or bonding environment surrounding various protons, the number of protons in those environments, and the number of neighbouring protons around each proton. However, there is a common misconception about the relationship between the splitting of signals due to the neighbouring protons and the (n+1) rule. This paper discusses how the appearance of deceptively simple spectra has led to this misconception and the correct interpretation and application of the (n+1) rule.

Substituted naphthoquinones as novel amino acid sensitive reagents for the detection of latent fingermarks on paper surfaces

In this paper, we present our preliminary studies into naphthoquinones as novel reagents for the detection of latent fingermarks on paper. Latent fingermarks deposited on paper substrates were treated with solutions of selected naphthoquinones in ethyl acetate/HFE-7100, with subsequent heating. The selected compounds were 1,4-dihydroxy-2-naphthoic acid, 1,2-naphthoquinone-4-sulfonate, 2-methoxy-1,4-naphthoquinone and 2-methyl-1,4-naphthoquinone. All of the tested compounds yielded purple-brown visible fingermarks, which also exhibited photoluminescence when illuminated with a high intensity filtered light source at 555nm and viewed through red goggles. Indirect heat using an oven at 150 ◦C for 1 h was found to be superior to direct heat with an iron, which while providing faster development lead to increased levels of background colouration. Luminescence spectrophotometry revealed differences in photoluminescence characteristics for fingermarks developed with the different naphthoquinones, with excitation over the range 530–590 nm. Luminescence spectrophotometry of developed lysine, glycine and serine spots on paper was used to confirm that the naphthoquinones were reacting with amino acids in the latent fingermark.