Requiring adolescent informed assent in clinical research trials

For many years, the process of voluntary informed consent for adult clinical research subjects has been widely accepted, standardized, and federally regulated. In comparison, adolescent clinical research subjects were not afforded the same privileges. Within the past decade there has been an increase in the number of pediatric and adolescent clinical research trials in the United States (NCCF 2000). Consequently, the moral and ethical implications of clinical research on minors has become a widely discussed issue and the notion of adolescent assent- a minor's affirmative agreement to participate in a clinical research trial- has been recognized. The purpose of this paper is to discuss the current and future use of adolescent assent in clinical research trials.Master of Public Healt

Quality improvement and hospital financial performance

The objective of this study was to examine the association between the scope and intensity of Quality improvement (QI) implementation in hospitals and organizational performance. A sample of 1,784 community hospitals was used to assess relationships between QI implementation approach and two hospital-level performance indicators: cash flow and cost per case. Two-stage instrumental variables estimation, in which predicted values (instruments) of eight QI intensity and scope variables plus control (exogenous) variables were used to estimate hospital-level performance indicators. Our results suggest that QI has a measurable impact on global measures of organizational performance and that both control and leaning approaches to QI matter in these settings. Hospitals that implement QI effectively can reasonably expect to improve their financial and cost performance, or at least not place the hospital at risk for investing in quality improvement. These outcomes are specific to QI strategies that emphasize both control and learning. Copyright © 2006 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/55840/1/401_ftp.pd

Recent Applications of Acyclic (Diene)iron Complexes and (Dienyl)iron Cations in Organic Synthesis

Complexation of (tricarbonyl)iron to an acyclic diene serves to protect the ligand against oxidation, reduction, and cycloaddition reactions, whereas the steric bulk of this adjunct serves to direct the approaches of reagents to unsaturated groups attached to the diene onto the face opposite to iron. Furthermore, the Fe(CO)3 moiety can serve to stabilize carbocation centers adjacent to the diene (i.e. pentadienyl-iron cations). Recent applications of these reactivities to the synthesis of polyene-, cyclopropane-, cycloheptadiene-, and cyclohexenone-containing natural products or analogues are presented