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General Chemistry is a high impact course at Benedictine University where a large enrollment of ~250 students each year, coupled with low pass rates of a particularly vulnerable student population from a retention point of view (i.e., first-year college students), make it a strategic course on which to focus innovative pedagogical development. Although our institution is not alone in the challenges that this particular course presents, we have prioritized implementing interventional strategies targeting academically underprepared students to increase their success by providing a preparatory course prior to this gateway course. Focusing on the persistence framework to guide curricular decisions, progress towards aligning our general chemistry curriculum to the academic profile of our students has afforded much higher pass rates than even two years ago.

A kinetic study of the autoxidation of iron(II) cyclidenes as functions of O2 pressure and O2-binding cavity size reveals a new mechanism for this reaction and for those of hemoglobin and myoglobin. Apart from the previously established inverse relation of O2 pressure to autoxidation rates, the study also shows that opening up the cavity allows more O2 to bind to iron, but that the O2 that oxidizes the iron(II) is not bound. This suggests a mechanism involving electron-transfer rather than superoxide dissociation or displacement. The same mechanism is observed for hemoglobin and myoglobin.

The autoxidation of iron cyclidenes (Fe(R3,R2,m-xyl)Cl)+ (R3 = Me, Ph; R2 = Me, Bz) in acetone-pyridine-water solvent system was investigated. UV-Vis and ESR spectral studies of the autoxidation of (FeII(Me,Me,m-xyl)Cl)+ indicated dependency on the oxygen pressure used which also applies for other iron(II) cyclidene complexes. The proposed rate-determining step was the subsequent interaction the superoxide from the primary electron transfer reaction.

Background: Aspirin may decrease colorectal cancer incidence, but its role as an adjunct to or substitute for screening has not been evaluated.Objective: To examine the potential cost-effectiveness of aspirin chemoprophylaxis in relation to screening.Design: Markov model.Data Sources: Literature on colorectal cancer epidemiology, screening, costs, and aspirin chemoprevention (1980-1999).Target Population: General U.S. population.Time Horizon: 50 to 80 years of age.Perspective: Third-party payer.Intervention: Aspirin therapy in patients screened with sigmoidoscopy every 5 years and fecal occult blood testing every year (FS/FOBT) or colonoscopy every 10 years (COLO).Outcome Measures: Discounted cost per life-year gained.Results Of Base-case Analysis: When a 30% reduction in colorectal cancer risk was assumed, aspirin increased costs and decreased life-years because of related complications as an adjunct to FS/FOBT and cost $149 161 per life-year gained as an adjunct to COLO. In patients already taking aspirin, screening with FS/FOBT or COLO cost less than $31 000 per life-year gained.Results Of Sensitivity Analysis: Cost-effectiveness estimates depended highly on the magnitude of colorectal cancer risk reduction with aspirin, aspirin-related complication rates, and the screening adherence rate in the population. However, when the model's inputs were varied over wide ranges, aspirin chemoprophylaxis remained generally non-cost-effective for patients who adhere to screening.Conclusions: In patients undergoing colorectal cancer screening, aspirin use should not be based on potential chemoprevention. Aspirin chemoprophylaxis alone cannot be considered a substitute for colorectal cancer screening. Public policy should focus on improving screening adherence, even in patients who are already taking aspirin. [ABSTRACT FROM AUTHOR]

Objective: Caring for the elderly with dementia imposes a substantial burden on family members and likely accounts for more than half of the total cost of dementia for those living in the community. However, most past estimates of this cost were derived from small, nonrepresentative samples. We sought to obtain nationally representative estimates of the time and associated cost of informal caregiving for the elderly with mild, moderate, and severe dementia.Design: Multivariable regression models using data from the 1993 Asset and Health Dynamics Study, a nationally representative survey of people age 70 years or older (N = 7,443).Setting: National population-based sample of the community-dwelling elderly.Main Outcome Measures: Incremental weekly hours of informal caregiving and incremental cost of caregiver time for those with mild dementia, moderate dementia, and severe dementia, as compared to elderly individuals with normal cognition. Dementia severity was defined using the Telephone Interview for Cognitive Status.Results: After adjusting for sociodemographics, comorbidities, and potential caregiving network, those with normal cognition received an average of 4.6 hours per week of informal care. Those with mild dementia received an additional 8.5 hours per week of informal care compared to those with normal cognition (P < .001), while those with moderate and severe dementia received an additional 17.4 and 41.5 hours (P < .001), respectively. The associated additional yearly cost of informal care per case was 3,630 dollars for mild dementia, 7,420 dollars for moderate dementia, and 17,700 dollars for severe dementia. This represents a national annual cost of more than 18 billion dollars.Conclusion: The quantity and associated economic cost of informal caregiving for the elderly with dementia are substantial and increase sharply as cognitive impairment worsens. Physicians caring for elderly individuals with dementia should be mindful of the importance of informal care for the well-being of their patients, as well as the potential for significant burden on those (often elderly) individuals providing the care. [ABSTRACT FROM AUTHOR]

Background: While the efficacy and safety of coronary artery bypass grafting (CABG) has been established in several clinical trials, little is known about its outcomes in Native Americans.Measurements and Main Results: We assessed clinical outcomes associated with CABG in 155 Native Americans using a national database of 18,061 patients from 25 nongovernmental, not-for-profit U.S. health care facilities. Patients were classified into five groups: 1) Native American, 2) white, 3) African American, 4) Hispanic, and 5) Asian. We evaluated for ethnic differences in in-hospital mortality and length of stay, and after adjusting for age, gender, surgical priority, case-mix severity, insurance status, and facility characteristics (volume, location, and teaching status). Overall, we found the adjusted risk for in-hospital death to be higher in Native Americans when compared to whites (odds ratio [OR], 3.8; 95% confidence interval [CI], 1.5 to 9.8), African Americans (OR, 3.4; 95% CI, 1.1 to 9.9), Hispanics (OR, 7.1; 95% CI, 2.5 to 20.3), and Asians (OR, 2.8; 95% CI, 1.1 to 7.0). No significant differences were found in length of stay after adjustment across ethnic groups.Conclusions: The risk of in-hospital death following CABG may be higher in Native Americans than in other ethnic groups. Given the small number of Native Americans in the database (n = 155), however, further research will be needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Objective: To determine clinical and economic consequences of alternative vaccination strategies for preventing hepatitis B virus infection (HBV).Methods: Decision analysis was used to evaluate costs, outcomes, and cost-effectiveness of three HBV management strategies ("no vaccination," "universal vaccination," and "screen and vaccinate") in four populations (newborns, 10-year-old adolescents, a high-risk adult population, and the general adult U.S. population). Information on HBV incidence and prevalence, clinical course, and management of acute illness and chronic sequelae was obtained from the literature and a panel of experts. Actual payments (costs) were obtained from Blue Cross/Blue Shield and local pharmacies. Incremental cost-effectiveness was calculated from the perspective of the payer of medical care and subjected to sensitivity analysis.Results: Vaccination (with or without screening) prevents more disease at somewhat increased cost than no vaccination for the neonatal, adolescent, and adult populations. Vaccination (with or without screening) is a dominant strategy in adult high-risk populations (lower cost and greater benefit than no vaccination). Optimal cost-effectiveness, with nonmonetary benefits not discounted, results if all pregnant women are screened for active HBV infection, and HBV vaccine and hepatitis B immune globulin are administered to babies born to mothers with positive screening tests. Then HBV vaccine is administered to all children at age 10 and again 10 years later (incremental cost-per-year-of-life-saved relative to the "no vaccination" strategy is $375). A strategy of universal newborn vaccination alone leads to an incremental cost-per-year-of-life saved of $3332. If adolescents are vaccinated at age 10, incremental cost-per-year-of-life saved is $13,938; for the general adult population, the incremental cost-per-year-of-life saved of universal vaccination is $54,524. Discounting benefits will increase cost-per-year-of-life saved 7 to 12 times for all strategies.Conclusions: HBV vaccine is most cost-effective when a strategy of screening newborns is combined with routine administration to 10-year-old children. The means to achieve substantial improvements in the health of the public in a cost-effective fashion are now available and should be pursued aggressively. [ABSTRACT FROM AUTHOR]

Reviews the literature connecting medical technology to the increase in health care costs. Impact of managed care on health care costs; Results of studies that examine plan-level data and studies that examine market-level data; Managed care's ability to reduce health care cost; Need to change the cost-increasing nature of new medical technology.