Severe Difficulty Research Articles

Long-term sequelae of SARS-CoV-2 two years following infection: exploring the interplay of biological, psychological, and social factors.

Severe fatigue and cognitive complaints are frequently reported after SARS-CoV-2 infection and may be accompanied by depressive symptoms and/or limitations in physical functioning. The long-term sequelae of COVID-19 may be influenced by biomedical, psychological, and social factors, the interplay of which is largely understudied over time. We aimed to investigate how the interplay of these factors contribute to the persistence of symptoms after COVID-19. RECoVERED, a prospective cohort study in Amsterdam, the Netherlands, enrolled participants aged⩾16 years after SARS-CoV-2 diagnosis. We used a structural network analysis to assess relationships between biomedical (initial COVID-19 severity, inflammation markers), psychological (illness perceptions, coping, resilience), and social factors (loneliness, negative life events) and persistent symptoms 24 months after initial disease (severe fatigue, difficulty concentrating, depressive symptoms and limitations in physical functioning). Causal discovery, an explorative data-driven approach testing all possible associations and retaining the most likely model, was performed. Data from 235/303 participants (77.6%) who completed the month 24 study visit were analysed. The structural model revealed associations between the putative factors and outcomes. The outcomes clustered together with severe fatigue as its central point. Loneliness, fear avoidance in response to symptoms, and illness perceptions were directly linked to the outcomes. Biological (inflammatory markers) and clinical (severity of initial illness) variables were connected to the outcomes only via psychological or social variables. Our findings support a model where biomedical, psychological, and social factors contribute to the development of long-term sequelae of SARS-CoV-2 infection.

Financial Difficulty Over Time in Young Adults With Breast Cancer

Young adults aged 18 to 39 years represent the minority of breast cancer diagnoses but are particularly vulnerable to financial hardship. Factors contributing to sustained financial hardship are unknown. To identify financial hardship patterns over time and characterize factors associated with discrete trajectories; it was hypothesized that treatment-related arm morbidity, a key source of expense, would be associated with long-term financial difficulty. This cohort study included US young adults aged 40 years or younger treated between 2006 and 2016. Eligible patients were treated for stage 0 to stage III breast cancer at institutions participating in the Young Women's Breast Cancer Study, which included a specialized cancer institute and 12 other academic and community hospitals. Patients who responded at baseline and returned a 1-year survey were included in analysis. Data were analyzed in March 2024. Trajectory modeling classified patterns of financial difficulty from baseline through 10 years postdiagnosis using the Cancer Rehabilitation Evaluation System (CARES) scale. Multinomial regression examined characteristics, including treatment-related arm morbidity, associated with each trajectory. A total 1008 patients were included (median [IQR] age at diagnosis, 36 [33-39] years; 60 Asian [6.0%], 35 Black [3.5%], 47 Hispanic [4.7%], 884 White [87.7%]); 840 patients were college graduates (83.3%), 764 were partnered at baseline (75.8%), 649 were nulliparous (64.4%), and 908 were without comorbidities at enrollment (90.1%). Patients' tumors were primarily stage I-II (778 [77.2%]), estrogen receptor/progesterone receptor-positive (754 [74.8%]), and ERBB2-negative (formerly HER2) (686 [68.1%]). Patients were more frequently treated with mastectomy than breast conservation (771 [76.5%] vs 297 [29.5%]; P < .001). A majority of patients received radiation therapy (627 [62.2%]), chemotherapy (760 [75.4%]), and endocrine therapy (610 [60.6%]). A total of 727 patients (72.1%) reported arm symptoms within 2 years of surgery. Three distinct trajectories of experiences with finances emerged: 551 patients (54.7%) had low financial difficulty (trajectory 1), 293 (29.1%) had mild difficulty that improved (trajectory 2), and 164 (16.3%) had moderate to severe difficulty peaking several years after diagnosis before improving (trajectory 3). Hispanic ethnicity (OR, 3.71; 95% CI, 1.47-9.36), unemployment at baseline and 1 year (OR, 2.66; 95% CI, 1.63-4.33), and arm symptoms (OR, 1.77; 95% CI, 1.06-2.96) were associated with increased odds of experiencing trajectory 3. Having a college degree (OR, 0.20; 95% CI, 0.12-0.34) or being partnered (OR, 0.24; 95% CI, 0.15-0.38) were associated with increased odds of experiencing trajectory 1. In this cohort study of young adults with breast cancer, we identified a subset of patients who experienced a high degree of financial difficulty persisting into early survivorship. Targeted interventions to mitigate financial toxicity-modifiable factors that include support for the employability or return to work support for those experiencing arm symptoms after treatment-are needed.

Premature mortality and disparities in kidney healthcare for people with chronic kidney disease and severe mental health difficulties.

People with severe mental health difficulties, including schizophrenia, bipolar disorder and psychosis, have higher risk of chronic kidney disease (CKD). Little was known regarding clinical outcomes and utilisation of kidney care for people with CKD and severe mental health difficulties. We conducted a retrospective cohort analysis of individuals with CKD attending a tertiary renal unit in London, between 2006 and 2019. Individuals with severe mental health difficulty diagnoses were identified, and differences between those with and without severe mental health difficulties were analysed. Of the 5105 individuals with CKD, 112 (2.2%) had a recorded severe mental health difficulty diagnosis. The mean lifespan of those with severe mental health difficulties was 13.1 years shorter than those without severe mental health difficulties, t(1269) = 5.752, p < 0.001. People with severe mental health difficulties had more advanced CKD at their first nephrology appointment. There were no statistically significant differences between groups in the rates of kidney failure, age at onset of kidney failure, or time elapsed between first appointment and death/kidney failure. The number of inpatient admissions was similar between groups, but those with severe mental health difficulties had higher rates of emergency and ICU admissions. Among individuals on renal replacement therapy (RRT), those with severe mental health difficulties were less likely to receive a kidney transplant and peritoneal dialysis. For patients receiving haemodialysis, those with severe mental health difficulties had a higher proportion of shortened sessions, greater mean weight loss during sessions, and a higher proportion of serum potassium and phosphate levels outside normal ranges. Findings illustratea number of disparities in kidney healthcare betweenpeople with and without severe mental health difficulties, underscoring the need for interventions which prevent premature mortality and improve kidney care for this population.

First documented case of Smith-Lemli-Opitz syndrome in Syria: clinical presentation, diagnosis, and experimental management with simvastatin

Abstract Smith-Lemli-Opitz syndrome (SLOS) is a rare genetic disorder that affects cholesterol synthesis and causes various physical and mental abnormalities. The case is a 25-day-old male infant who presented with multiple congenital anomalies, such as microcephaly, facial dysmorphism, syndactyly, hypospadias, and other organ malformations. He also had severe vomiting, feeding difficulty, irritability, dehydration, and hyponatremia. Laboratory tests showed low serum cholesterol, in addition to genetic tests, confirming the diagnosis of SLOS. The infant was treated with simvastatin, which improved his irritability and was well tolerated. The paper discusses the clinical features, diagnosis, and management of SLOS, and highlights the importance of early recognition and intervention for this rare case. It is also considered the first documented case in Syria.

Exploring the Impact of Managerial Coaching, Emotional Intelligence and Social Support on Employee Retention: The Mediating Role of Employee Resilience in Malaysian Public Healthcare

This paper explores the correlation between managerial coaching, emotional intelligence, social support, employee resilience, and retention among healthcare workers in Malaysia's public healthcare sector. Retaining healthcare staff has become a severe difficulty in the BANI (Brittle, Anxious, Non-linear, Incomprehensible) environment, worsened by the COVID-19 epidemic. The study suggests that managerial coaching, emotional intelligence, and social support are essential for developing resilience among healthcare workers. This resilience, in turn, impacts their ability to stay in their jobs. The study will employ a quantitative cross-sectional survey approach to examine the links inside specific public hospitals in Malaysia. The results are anticipated to offer a vital understanding of how public healthcare in Malaysia can strategically improve staff resilience and retention, guaranteeing the long-term viability of the healthcare workforce in a world after the pandemic. This study enhances our comprehension of the intricate processes that impact staff retention in the public healthcare industry, providing practical implications for policymakers and healthcare managers.

Dynapenic abdominal obesity and activities of daily living disability among older adults residing in low- and middle-income countries

BackgroundDynapenic abdominal obesity (DAO) may be associated with an increased risk of disability. However, to date, this has not been investigated in low- and middle-income countries (LMICs), while the mediators are largely unknown.AimsTherefore, we aimed to investigate the association between DAO and activities of daily living (ADL) disability, and to identify potential mediators among older adults from six LMICs.MethodsCross-sectional, nationally representative data from the WHO Study on global AGEing and adult health were analyzed. Data on 20,198 adults aged ≥ 60 years were analyzed [mean (SD) age 69.3 (13.1) years; 54.1% females]. Dynapenia was defined as handgrip strength of < 26 kg for men and < 16 kg for women. Abdominal obesity was defined as waist circumference of > 88 cm for women and > 102 cm for men. DAO was defined as having both dynapenia and abdominal obesity. Disability was defined as severe or extreme difficulty in conducting at least one of six types of ADL. Multivariable logistic regression and mediation analysis were conducted.ResultsCompared to no dynapenia and no abdominal obesity, DAO was significantly associated with 2.08 (95%CI = 1.37–3.17) times higher odds for ADL disability Mediation analysis showed that diabetes (mediated percentage 4.7%), hypertension (7.2%), and angina (7.7%) were significant mediators in the association between DAO and ADL disability.ConclusionsDAO was associated with increased odds for ADL disability among older adults from LMICs. Future longitudinal studies are warranted to assess temporal associations, and whether addressing or preventing DAO can impact on future occurrence of disability.

Detection of Enteroviruses in a Pediatric Oncology Patient Population

Abstract Enteroviruses are responsible for around 10 to 15 million infections and tens of thousands of hospitalizations annually. Infants, children, and people with weakened immune systems are more likely to get hospitalized and can have serious complications from enterovirus infection. Non-polio enteroviruses like EV-D68 can cause mild to severe symptoms like wheezing, difficulty breathing and acute flaccid myelitis (AFM). Therefore, it is crucial to continue to monitor the prevalence of enteroviruses, especially those that can potentially cause severe symptoms like EV-D68. This study focused on determining the prevalence of enteroviruses in a pediatric oncology patient population. Residual Nasopharyngeal swabs (NPS) specimens, collected from pediatric patients (&amp;lt;18 years old) presenting to a cancer hospital in New York between September 2022 and December 2022, and September 2023 and December 2023 for cancer care were included in the study. Rhinovirus/Enterovirus (RV/EV) was detected using the BioFire FilmArray Respiratory Panel (bioMerieux, Inc.) or the ePlex Respiratory Pathogen Panel (GenMark/Roche Molecular). For Enterovirus identification, RNA was extracted from the RV/EV positive NPS using the KingFisher™ Flex Magnetic Particle Processors (Thermo Scientific, USA), followed by RT-PCR in the ABI 7500 Fast real-time PCR instrument (ThermoFisher, USA) for enteroviruses and EV-D68 using pan-Enterovirus and EV-D68 specific primers, respectively. A total of 880 and 694 NPS samples from patients &amp;lt;18 years old were tested during the study period in 2022 and 2023, respectively. Of these, 238 (238/880; 27%) and 225 (225/694; 32%) RV/EV positives NPS were detected in 2022 and 2023 respectively. A total of 370 (370/463; 80%) RV/EV positive samples (182 samples from 2022 and 188 samples from 2023) were selected for additional testing and 14 samples (14/370; 4%) were positive for Enteroviruses. Of note, EV-D68 was not detected. In this study, we report a high prevalence of RV/EV which is consistent with the higher detection rate in the fall seasons, when our samples were collected. The low prevalence of EV suggests a high prevalence of RV, although this was not tested. Despite a nationwide surge in the USA in 2022, there was no EV-D68 circulating in these patients. Further analysis, using Whole genome sequencing of the enteroviruses detected in this study will provide additional information on specific circulating Enterovirus genotypes.

Modeling the effects of health-related habits and lifestyle on the general health of university students.

The general health of undergraduate university students has long-term social and career implications. This study, involving a cross-sectional design, is aimed at modeling the impact of sleep quality, living condition, lifestyle, eating habit, financial situation and some demographic factors on the general health and wellbeing of university students. A sample of 699 undergraduate students who met the inclusion criteria where recruited from the Faculty of Education of the University of Nigeria, Nsukka, Nigeria for the study. Quantitative data were collected with the help of general heath questionnaire, sleep quality assessment questionnaire, lifestyle index, eating habit questionnaire, living condition questions, and demographic questions. Generalized linear regression analysis was used to evaluate the predictors of general health of the students while Chi-square measure of association was used to ascertain the relationship between sleep quality and living condition of the students. At 0.05 level of significance, the year of study, sex, Parents/guardians' financial status, student's financial situation last 1 month, living condition (living in overcrowded rooms), source of daily meals, number of times food is eating per day, change in eating habit, risky lifestyle and severe sleep difficulty have significant negative effect on the general health of the students. Eating 3 times a day improved the health of the students. Mitigating food insecurity, insufficient financial challenges and risky lifestyles of the students while improving the living conditions will improve the health and wellbeing of the students.

The Effects of the Expansion of Dental Care Coverage for the Elderly.

Expanding dental care coverage for the elderly is globally recommended but not widely implemented due to its high costs and intangible benefits. This study examined the impact of such an expansion in Korea using the imputation-based method proposed by Borusyak et al. We analyzed data from the Korea National Health and Nutrition Examination Survey (2007-2019) on dental service utilization and chewing ability among older adults. The policy resulted in a 13.5% increase in partial denture use and a 60.5% increase in dental implants among those aged 65 and above. These changes corresponded with reductions in severe chewing difficulty by 23.3% and 13.0%, respectively. No significant changes were observed in full denture use. The price elasticity of demand for partial dentures and dental implants was estimated to be -0.19 and -0.86, respectively. These findings underscore the critical role of affordability in enhancing the utilization of dental implants among the elderly and highlight the importance of appropriately expanding dental insurance coverage to improve oral health outcomes in this population.

A biomimetic micro-texture based on shark surface for tool wear reduction and wettability change

Aiming at the problems of severe tool wear and difficulty in ensuring machining surface quality during the cutting process of Ni-base superalloy, a micro-texture design method resembling a shark surface is proposed, which simplifies the skin teeth on the shark surface into a diamond shaped structure with ribs. Different micro-textured samples were prepared using femtosecond laser, and surface wettability characterization and friction and wear experiments were conducted to study the wear reduction and anti wear effects of micro-texture. The parameter combinations with the maximum contact angle and the minimum coefficient of friction were selected. The wear mechanism of YG8 carbide alloy and GH4742, as well as the wear reduction mechanism of microstructure were revealed. Biomimetic cutting tools were prepared and their effectiveness in controlling tool wear, reducing cutting forces, and improving machining quality was verified through milling experiments.

Functional Transitions Among Older Adults in Rural China: Examining the Differential Roles of Care From Daughters' and Sons' Families.

Informal care provided by adult children is of great importance for older adults' well-being in China. This paper investigates and compares the functional transitions among older adults living in rural areas who receive care from daughters' and from sons' families. This study utilizes the "Well-being of Elderly Survey in Anhui Province" (WESAP) from 2001 to 2021. Our sample included 2,797 individuals aged 60 years or older. Functional status was based on the activities of daily living and the instrumental activities of daily living. We employed a random-effects ordered logit model to examine the functional transitions among the older adults. Receiving care from daughters' families is significantly associated with a lower likelihood of functional decline compared to receiving care from sons' families in rural China. The advantage associated with daughter care becomes more pronounced among older individuals with a severe functional difficulty compared to those with a mild or moderate functional difficulty. The difference is prevalent among older adults aged 75 and older, with less wealth or multiple chronic diseases, or who live alone. Furthermore, among those with severe functional difficulties, the daughter advantage is more significant for fathers as compared to mothers. Nowadays, daughters' families can provide high-quality informal care, often surpassing that offered by sons' families. This daughter advantage becomes even more significant among older adults who have a higher need for family care, such as those with severe disabilities and limited financial resources.

Predictive Factors for Altered Quality of Life in Patients with Type 2 Diabetes Mellitus.

Objectives: To evaluate the quality of life (QoL) in a group of patients with type 2 diabetes (T2DM) and to identify predictive factors to apply the necessary measures to improve it. Methods: For this, 299 patients with T2DM were enrolled in a cross-sectional study, and their QoL was assessed using the EQ-5D-3L questionnaire. All patients underwent clinical exams, routine laboratory tests, and nerve conduction velocity (NCV) at the common peroneal nerve. Results: Patients had a median age of 66 (57; 70) years, median duration of T2DM of 10 (6; 15) years, median HbA1c of 8 (7; 9.3)%, and mean EQ-5D-3L score of 55%. In addition, 9.7% presented extreme difficulty in mobility, 18.5% severe difficulty in self-care, and 16.4% in usual activities. One-third presented with severe pain or discomfort, anxiety, or depression (level 3 EQ-5D-3L). DPN, heart failure (HF), cerebral stroke, and insulin therapy increased the likelihood of a reduced QoL (EQ-5D-3L < 50). The EQ-5D-3L score inversely correlated with serum creatinine, glycemic control, lipid profile, diabetes duration, age, mobility, self-care, pain/discomfort, usual activities, and anxiety/depression and positively correlated with NCV, HDLc, and eGFR. Conclusions: Preventing neuropathic complications, chronic kidney disease, stroke, and HF and obtaining the glycemic and lipid targets could improve the QoL in patients with T2DM.

Neuropsychological functioning after COVID-19: minor differences between individuals with and without persistent complaints after SARS-CoV-2 infection

Objective: It is unclear how self-reported severe fatigue and difficulty concentrating after SARS-CoV-2 infection relate to objective neuropsychological functioning. The study aimed to compare neuropsychological functioning between individuals with and without these persistent subjective complaints. Method: Individuals with and without persistent severe fatigue (Checklist Individual Strength (CIS) fatigue ≥ 35) and difficulty concentrating (CIS concentration ≥ 18) at least 3 months after SARS-CoV-2 infection were included. Neuropsychological assessment was performed on overall cognitive functioning, attention, processing speed, executive functioning, memory, visuo-construction, and language (18 tests). T-scores −1.5 SD below population normative data (T ≤ 35) were classified as “impaired”. Results: 230 participants were included in the study, of whom 22 were excluded from the analysis due to invalid performance. Of the participants included in the analysis, 111 reported persistent complaints of severe fatigue and difficulty concentrating and 97 did not. Median age was 54 years, 59% (n = 126) were female, and participants were assessed a median of 23 months after first infection (IQR: 16–28). With bivariate logistic regression, individuals with persistent complaints had an increased likelihood of slower information processing speed performance on the Stroop word reading (OR = 2.45, 95%CI = 1.02–5.84) compared to those without persistent complaints. Demographic or clinical covariates (e.g. hospitalization) did not influence this association. With linear regression techniques, persistent complaints were associated with lower t-scores on the D2 CP, TMT B, and TMT B|A. There were no differences in performance on the other neuropsychological tests. Conclusions: Individuals with subjective severe fatigue and difficulty concentrating after COVID-19 do not typically demonstrate cognitive impairment on extensive neuropsychological testing.

Sleep disorder experienced by healthcare nurses after terminating Zero-COVID-19 policy

ObjectiveMedical staff, especially nurses, suffered great anxiety and stress from the COVID-19 pandemic, which negatively affected their sleep quality. In this study, we aimed to analyze the sleep quality of nursing staff after terminating the Zero-COVID-19 policy in China.Methods506 participants were involved in our study. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the sleep status of the participants. Binary regression was performed to evaluate the impact factors related to sleep difficulty.ResultsThe majority of participants (96.44%) suffered from sleep disturbances. There were significant differences in age, education level and front-line activity between participants with good sleep quality and sleep difficulty. Younger age (16–25 years old) was independently associated with less sleep difficulty, while front-line activity was independently associated with severe sleep difficulty.ConclusionSleep disorder was very common among nurses after ending the Zero-COVID-19 policy in China. More front-line nurses suffered severe sleep difficulty in particular, which should be worthy of attention.

Comparison of Piezosurgery Devices and the Use of Rotatory Devices for the Extraction of Impacted Mandibular Third Molars

ABSTRACT The present study aimed to examine the extraction of impacted mandibular third molars by using rotatory and piezosurgery equipment. Twenty-five patients of both genders who required surgery to remove their third molars were split into two groups (control group and research group). In the surgical extraction of the impacted mandibular third molar, in the study group, a piezotome was used to remove the bone, while in the control group, a bur was used. Patients’ acceptance of bone cutting, the length of the operation, discomfort and bleeding during the procedure, postoperative pain, swelling, trismus, and wound healing were evaluated. A statistically insignificant difference was observed for age and difficulty index. The intraoperative bleeding was similar in both groups. Both the groups tolerated the bone cutting well, with slightly better values for the piezo group. Based on Pederson’s difficulty index, the scores of difficulty of extraction of the impacted tooth were measured between the groups. The slight difficulty was observed in 9 (36%) each in the study group and control group. The moderate difficulty in 14 (56%) of control group and 15 (60%) of study group. Severe difficulty was found among 2 (8%) in the control group and 1 (4%) in the study group. The difference was not significant (P &gt; 0.05). Intraoral bleeding was moderately seen in 25 in both groups. Among the study and control groups respectively no intraoperative pain was seen in 14 and 16, mild intraoperative pain in 11 and 7, and moderate intraoperative pain in 0 and 2. Among group I and II acceptance to bone cutting was comfortably seen in 24 and 23, bearable in 1 and 2 respectively. The difference was not significant (P &gt; 0.05). Piezosurgery and bur were comparable in evaluating patient acceptance, intraoperative duration, intraoperative bleeding and pain, postoperative pain, edema, trismus, and wound healing.

Inclusive apparel design framework for accommodating clothing needs of people with different levels of reach, dexterity, and mobility capabilities

ABSTRACT This study developed inclusive apparel design (IAD) framework to systematically analyse diverse clothing needs of people with different capabilities in reach, dexterity, and mobility, including people living with disabilities. The research critically examined two accessible design approaches, inclusive design framework and universal design framework, focusing on their similarities and distinctions as well as suitability for developing apparel products that cater to the needs of people with different capabilities in reach, dexterity, and mobility. Based on the analysis, three levels of difficulty in using clothing were proposed: (a) from no to minimal difficulty; (b) moderate difficulty; and (c) severe difficulty. For the three levels of difficulty, the IAD framework outlines three respective design strategies: (a) user-aware design, (b) modular design, and (c) special-purpose design. IAD framework can be used to guide future research and practitioner applications to meet the clothing needs of ability-diverse consumers.

GLA:D to Be Walking Better: Change in Self-Reported Difficulty Walking After Exercise Therapy and Education in Persons With Knee Osteoarthritis.

Difficulty walking is a primary reason that individuals with knee osteoarthritis (OA) seek care. We examined the change in self-reported difficulty walking after participating in the Good Life With Osteoarthritis in Denmark (GLA:D) 8-week education and exercise program and assessed patient factors associated with improvement in difficulty walking. This was a registry-based cohort study of individuals in Denmark with knee OA who enrolled in GLA:D. Assessments were administered at baseline, program completion (~3 months), and 12 months. Our prespecified primary outcome was change in self-reported difficulty walking assessed using the EuroQol 5-dimension 5-level walking item. Exposures included sociodemographic factors, measures of OA illness severity, comorbidities, and psychological factors. In those with baseline moderate/severe difficulty walking, using multivariable regression analysis, we assessed the relationship between exposures of interest and improvement to no/slight difficulty walking. We included 5262 participants. Of 2178 (41.4%) individuals with baseline moderate/severe difficulty walking, 51.4% and 58.3% reported no/slight difficulty walking at 3 and 12 months, respectively. Greater self-efficacy, younger age, female sex, lower BMI, less intense knee pain, and better function at baseline were associated with greater likelihood of improvement in difficulty walking, whereas severe difficulty walking at baseline and back pain intensity were associated with decreased likelihood of improvement. More than half of those with baseline difficulty walking experienced substantial improvement after completing GLA:D and this improvement was maintained at 12 months. Several patient factors were associated with the outcome, suggesting that some individuals may require additional support and extended treatment.

H8-BINOL-Derived Chiral η6-Benzene Ligands: New Opportunities for the Ruthenium-Catalyzed Asymmetric C-H Activation.

Given the tremendous success of (p-cymene)RuII-catalyzed C-H activation over the past 20 years, the community has long been aware that the development of chiral η6-benzene (Ben) ligands should be a potent strategy for achieving the attractive but incredibly underdeveloped ruthenium(II)-catalyzed asymmetric C-H activation. However, it has rarely been achieved due to the severe difficulty in developing proper chiral Ben ligands. In particular, designing chiral Ben ligands by connecting a benzene fragment to a chiral framework including benzene rings remained an unsolved challenge until this effort. Here we present a novel class of axially chiral Ben ligands derived from readily available (S)-5,5',6,6',7,7',8,8'-octahydro-1,1'-bi-2-naphthol ((S)-H8-BINOL) in 4-8 steps. Notably, when coordinated with ruthenium, such chiral Ben ligand containing three benzene rings only forms one of the three possible isomeric BenRuII complexes. The related chiral BenRuII catalysts could effectively catalyze the asymmetric C-H activation of N-sulfonyl ketimines with alkynes, affording a range of chiral spirocyclic sultams in up to 99 % yield with up to >99 % ee. These catalysts are expected to find broad applications in future.

H8‐BINOL‐Derived Chiral η6‐Benzene Ligands: New Opportunities for the Ruthenium‐Catalyzed Asymmetric C−H Activation

AbstractGiven the tremendous success of (p‐cymene)RuII‐catalyzed C−H activation over the past 20 years, the community has long been aware that the development of chiral η6‐benzene (Ben) ligands should be a potent strategy for achieving the attractive but incredibly underdeveloped ruthenium(II)‐catalyzed asymmetric C−H activation. However, it has rarely been achieved due to the severe difficulty in developing proper chiral Ben ligands. In particular, designing chiral Ben ligands by connecting a benzene fragment to a chiral framework including benzene rings remained an unsolved challenge until this effort. Here we present a novel class of axially chiral Ben ligands derived from readily available (S)‐5,5′,6,6′,7,7′,8,8′‐octahydro‐1,1′‐bi‐2‐naphthol ((S)‐H8‐BINOL) in 4–8 steps. Notably, when coordinated with ruthenium, such chiral Ben ligand containing three benzene rings only forms one of the three possible isomeric BenRuII complexes. The related chiral BenRuII catalysts could effectively catalyze the asymmetric C−H activation of N‐sulfonyl ketimines with alkynes, affording a range of chiral spirocyclic sultams in up to 99 % yield with up to &gt;99 % ee. These catalysts are expected to find broad applications in future.

Occurrence of major infectious diseases and healthcare seeking among young children with disabilities in Sierra Leone using cross-sectional population-based survey data

BackgroundChildren with disabilities are at risk of worse health outcomes compared to children without functional difficulties. Sierra Leone has one of the world’s highest prevalences of functional difficulties among children,...