Scalable and Phosphine-Free Conversion of Alcohols to Carbon-Heteroatom Bonds through the Blue Light-Promoted Iodination Reaction.

One of the fundamental and highly valuable transformations in organic chemistry is the nucleophilic substitution of alcohols. Traditionally, these reactions require strategies that employ stoichiometric hazardous reagents and are associated with difficulty in purification of the by-products. To overcome these challenges, here, we report a simple route toward the diverse conversion of alcohols via an SN2 pathway, in which blue light-promoted iodination is used to form alkyl iodide intermediates from simple unreactive alcohols. The scope of the process tolerates a range of nucleophiles to construct C-N, C-O, C-S, and C-C bonds. Furthermore, we also demonstrate that this method can be used for the preparation and late-stage functionalization of pharmaceuticals, as highlighted by the syntheses of thiocarlide, butoxycaine, and pramoxine.

Conductance features in point contact Andreev reflection spectra.

Point contact Andreev reflection (PCAR) spectroscopy is a common technique for determining the spin polarization of a ferromagnetic sample. The polarization is extracted by measuring the bias dependence of the conductance of a metallic/superconducting point contact. Under ideal conditions, the conductance is dominated by Andreev reflection and the Blonder-Tinkham-Klapwijk (BTK) model can be used to extract a value for the polarization. However, PCAR spectra often exhibit unwanted features in the conductance that cannot be appropriately modelled with the BTK theory. In this paper we isolate some of these unwanted features and show that any further extraction of the spin polarization from these non-ideal spectra proves unreliable. Understanding the origin of these features provides an objective criterion for rejection of PCAR spectra unsuitable for fitting with the modified BTK model.

CAM Curriculum Activities to Enhance Professionalism Training in Medical Schools.

Enhancing the professionalism of graduates is a major objective of most health care education institutions today. Educating conventional health care providers about complementary and alternative medicine (CAM) may directly and indirectly improve trainee professionalism by expanding trainees' knowledge and appreciation of diverse health care beliefs and practices, improving physician-patient communication, enhancing self-care, and increasing sense of competence and job satisfaction. A survey based on professional competencies proposed by the Consortium of Academic Health Centers for Integrative Medicine was administered to the grantees of the National Institutes of Health, National Center for Complementary and Alternative Medicine R-25 CAM education project initiative. The survey's aim was to identify project activities that taught professionalism skills. All projects reported curricular features that enhanced trainee professionalism, with substantial percentages of project effort directed toward professionalism-related activities.

An integrated program for dementia evaluation and care management.

The growth of the geriatric population and the emergence of managed care dictate new approaches to dementia care. Management of Alzheimer's disease (AD) is a critical issue for health care policy as well as quality of life for patients and caregivers. The Alzheimer's Disease Education Program (ADEP) seeks to improve the quality of care for individuals with AD and to reduce the burden of caregiving experienced by families. Objectives of ADEP include early detection of AD through dementia screening followed by caregiver education and support. This article outlines an effective method of dementia evaluation and management.

A comparison of Caucasian and Southeast Asian Hmong uterine fundal height during pregnancy.

BACKGROUND: Fundal height measurement is a standard clinical assessment tool used in prenatal care. This study compared the fundal heights growth curves of two ethnically distinct groups of pregnant women. We were motivated by our clinical experience with one group where fundal heights seemed 'small for date' and by the reluctance of this group to undergo further testing, especially ultrasound. METHODS: A prospective cohort study compared the fundal heights growth curve of 48 Caucasian and 40 Hmong women from two clinics in central Wisconsin (USA). RESULTS: Southeast Asian Hmong women were found to have a slower rate of fundal height growth than Caucasian women (significantly different average slopes of .88 vs. .95, respectively). An expectation of linear growth appeared more valid for Caucasian than Hmong women. At 40 weeks, regression based estimates overestimated the Caucasian sample by 1.3 weeks and the Hmong sample by 2.7 weeks. ANCOVA procedures remained significant while controlling for group differences in height. Fundal height measurements were moderately predictive of birth weight for the Hmong sample but not the Caucasian sample (multiple r=.39). CONCLUSIONS: Considerable differences emerged between fundal height measures for the Hmong and Caucasian samples. The improved ability to differentiate groups following control of variance due to height as well as the ability to predict birth weight from fundal height curve in the Hmong group argue for value of normative development using more homogeneous groups. Clinicians should consider the applicability of fundal height norms to their clinical populations and may be able to have more confidence in using fundal height as an evaluative tool with more appropriate norms.

The P1 component of the middle latency auditory potential may differentiate a brainstem subgroup of Alzheimer disease.

The P1 component of the middle latency auditory evoked potential (MLAEP) was found to be absent in 47.5% of 101 patients with Alzheimer disease (AD). Lack of a P1 component recently has been associated with a more rapid decline in cognitive performance. The blink reflex (BR) was tested in 36 patients with probable AD and 17 elderly control subjects. All subjects also underwent P1 recording. Patients lacking a P1 potential showed a significant increase in latency of the contralateral R2 response of the BR. The P1 component and the R2 response may differentiate a subgroup of AD patients with involvement of the brainstem, especially the reticular formation.

Tumor marker study: the Transamerica experience 1990-1995.

BACKGROUND: From the fall of 1990 through January 1995 Transamerica Occidental Life screened applicants for life insurance for cancer with Tumor Associated Antigen (TAA). RESULTS: 110,299 applicants were tested and in 13,829 positive levels of TAA were found. Of this latter number, 255 applicants were declined following various levels of evaluation. CONCLUSIONS: We concluded that TAA screening was neither sensitive, nor specific enough for a screening tool for life insurance.

The P1 component of the middle latency auditory evoked potential predicts a practice effect during clinical trials in Alzheimer's disease.

Thirty-five patients with probable Alzheimer's disease who were enrolled in an experimental drug trial of linopirdine underwent repeated testing that included recording the middle latency auditory evoked potential (MLAEP), the Mini-Mental State Examination (MMSE), and the Alzheimer's Disease Assessment Scale Cognitive Subscale (ADASCOG). Patients lacking the P1 component of the MLAEP exhibited a significantly greater decline in cognitive function as measured by the ADASCOG over 56 weeks. This decline appeared to be due to a less robust practice effect, which was maximal in all patients at 16 weeks. At the end of 56 weeks the entire group of patients was near baseline with respect to the ADASCOG. This lack of the annualized decline expected from other longitudinal studies may be explained by practice and placebo effects. The MMSE did not exhibit a practice effect and showed the expected decline in scores.

The WAMI Rural Hospital Project. Part 3: Building health care leadership in rural communities.

The WAMI Rural Hospital Project (RHP) intervention combined aspects of community development, strategic planning and organizational development to address the leadership issues in six Northwest rural hospitals. Hospitals and physicians, other community health care providers and local townspeople were involved in this intervention, which was accomplished in three phases. In the first phase, extensive information about organizational effectiveness was collected at each site. Phase two consisted of 30 hours of education for the physician, board, and hospital administrator community representatives covering management, hospital board governance, and scope of service planning. In the third phase, each community worked with a facilitator to complete a strategic plan and to resolve conflicts addressed in the management analyses. The results of the evaluation demonstrated that the greatest change noted among RHP hospitals was improvement in the effectiveness of their governing boards. All boards adopted some or all of the project's model governance plan and had successfully completed considerable portions of their strategic plans by 1989. Teamwork among the management triad (hospital, board, and medical staff) was also substantially improved. Other improvements included the development of marketing plans for the three hospitals that did not initially have them and more effective use of outside consultants. The project had less impact on improving the functioning of the medical chief of staff, although this was not a primary target of the intervention. There was also relatively less community interest in joining regional health care associations. The authors conclude that an intervention program tailored to address specific community needs and clearly identified leadership deficiencies can have a positive effect on rural health care systems.

The WAMI Rural Hospital Project. Part 4: Improving the financial health of rural hospitals.

Sound financial management has been identified as a critical component of effective hospital administration. Inadequate financial practices are a leading factor in the failure of hospitals. As part of the Rural Hospital Project (RHP), which operated in six rural Northwest communities from 1985 to 1988, detailed and extensive analyses of financial practices were conducted to identify strengths and weaknesses of the hospitals' financial management. In addition, 15 hours of formal education covering a variety of financial topics were presented to project participants. Results of the evaluation demonstrated that the greatest degree of change occurred in the financial management leadership capacity of the hospitals. All five hospitals, which either had no chief financial officer initially or subsequently experienced a turnover in the position, recruited individuals with strong qualifications. Vacancies in the administrator position in three of the four hospitals were filled by individuals with stronger financial management qualifications than their predecessors. Hospital board finance committees were formed in three of the four communities which previously did not have them. The biggest changes in financial practices occurred in the budgeting processes, which by 1989 better reflected the goals and strategies of the hospital's strategic plans. The financial performance of the six hospitals varied considerably over the study period. As a group, the RHP hospitals continued to require substantial nonoperating subsidies to remain solvent, despite improved financial practices. Despite the methodological limitations of this evaluation, we conclude that the intervention improved the capacity of the hospital administrations' financial leadership, as well as that of the governing boards, and led to substantial improvement in selected financial practices at all sites. Rural hospitals continue to operate in a hostile and precarious financial environment that limits their ability to sustain themselves on the basis of operating revenue alone.