Sensitivity to patient's psychosocial concerns: Relationships among ratings by primary care and traditional internal medicine house officers and patient self-assessments

This study examined house officers' sensitivity to patients' psychosocial concerns. Primary care house officers, traditionally trained internal medicine house officers, a social worker, and 104 ambulatory care patients independently completed an assessment instrument to indicate the extent to which a set of 20 defined psychosocial issues concerned the patients. We examined the magnitude of difference and extent of correlation in the independent reports of the patient, house officer, and social worker. These analyses were conducted on both the individual psychosocial issues and on sets of concerns derived from an oblique rotation factor analysis of the patients' responses. Primary care trainees' assessments of their patients' concerns correlated more frequently with the independent assessments of the patients and social worker than did the judgments of the traditionally trained house officers. The factor analysis identified six factors that accounted for 64.4% of the variance in patients' responses. The correlations between the primary care trainees' and patients' assessments were statistically significant on five of these six factors; the correlations between the traditionally trained residents' and patients' assessment were statistically significant on two of the factors. These results provide evidence of the primary care house officer training program's achievement of the goal of enhanced physician awareness of patients' psychosocial concerns. The results also support training efforts aimed at increasing physicians' ability to assess their patients' psychosocial concerns.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/28949/1/0000786.pd

The weak password problem: chaos, criticality, and encrypted p-CAPTCHAs

Vulnerabilities related to weak passwords are a pressing global economic and security issue. We report a novel, simple, and effective approach to address the weak password problem. Building upon chaotic dynamics, criticality at phase transitions, CAPTCHA recognition, and computational round-off errors we design an algorithm that strengthens security of passwords. The core idea of our method is to split a long and secure password into two components. The first component is memorized by the user. The second component is transformed into a CAPTCHA image and then protected using evolution of a two-dimensional dynamical system close to a phase transition, in such a way that standard brute-force attacks become ineffective. We expect our approach to have wide applications for authentication and encryption technologies.Comment: 5 pages, 6 figer

A cross-sectional evidence-based review of pharmaceutical promotional marketing brochures and their underlying studies: Is what they tell us important and true?

BACKGROUND: A major marketing technique used by pharmaceutical companies is direct-to-physician marketing. This form of marketing frequently employs promotional marketing brochures, based on clinical research, which may influence how a physician prescribes medicines. This study's objective was to investigate whether or not the information in promotional brochures presented to physicians by pharmaceutical representatives is accurate, consistent, and valid with respect to the actual studies upon which the promotional brochures are based. METHODS: Physicians in five clinics were asked to consecutively collect pharmaceutical promotional brochures and to send them all to a centralized location. The brochures for any class of medication were collected on a continuous basis until 20 distinct promotional brochures were received by a central location. Once the brochure was received, the corresponding original study was obtained. Two blinded reviewers performed an evidence-based review of the article, comparing data that was printed on the brochure to what was found in the original study. RESULTS: Among the 20 studies, 75% of the studies were found to be valid, 80% were funded by the pharmaceutical company, 60% of the studies and the corresponding brochures presented patient-oriented outcomes, and 40% were compared to another treatment regimen. Of the 19 brochures that presented the data as graphs, 4 brochures presented a relative risk reduction while only 1 brochure presented an absolute risk reduction. 15% of the promotional marketing brochures presented data that was different from what was in the original published study. CONCLUSION: Given the present findings, physicians should be cautious about drawing conclusions regarding a medication based on the marketing brochures provided by pharmaceutical companies

The Use of Flow-Injection Analysis with Chemiluminescence Detection of Aqueous Ferrous Iron in Waters Containing High Concentrations of Organic Compounds

An evaluation of flow-injection analysis with chemiluminescence detection (FIA-CL) to quantify Fe2+(aq) in freshwaters was performed. Iron-coordinating and/or iron-reducing compounds, dissolved organic matter (DOM), and samples from two natural water systems were used to amend standard solutions of Fe2+(aq). Slopes of the response curves from ferrous iron standards (1 – 100 nM) were compared to the response curves of iron standards containing the amendments. Results suggest that FIA-CL is not suitable for systems containing ascorbate, hydroxylamine, cysteine or DOM. Little or no change in sensitivity occurred in solutions of oxalate and glycine or in natural waters with little organic matter

Heterologous Overexpression and Mutagenesis of the Human Bile Salt Export Pump (ABCB11) Using DREAM (Directed REcombination-Assisted Mutagenesis)

Homologous recombination in Saccharomyces cerevisiae is a well-studied process. Here, we describe a yeast-recombination-based approach to construct and mutate plasmids containing the cDNA of the human bile salt export pump (BSEP) that has been shown to be unstable in E. coli. Using this approach, we constructed the necessary plasmids for a heterologous overexpression of BSEP in the yeast Pichia pastoris. We then applied a new site-directed mutagenesis method, DREAM (Directed REcombination-Assisted Mutagenesis) that completely bypasses E. coli by using S. cerevisiae as the plasmid host with high mutagenesis efficiency. Finally, we show how to apply this strategy to unstable non-yeast plasmids by rapidly turning an existing mammalian BSEP expression construct into a S. cerevisiae-compatible plasmid and analyzing the impact of a BSEP mutation in several mammalian cell lines

Nurses' perceived barriers to the implementation of a Fall Prevention Clinical Practice Guideline in Singapore hospitals

BackgroundTheories of behavior change indicate that an analysis of barriers to change is helpful when trying to influence professional practice. The aim of this study was to assess the perceived barriers to practice change by eliciting nurses\u27 opinions with regard to barriers to, and facilitators of, implementation of a Fall Prevention clinical practice guideline in five acute care hospitals in Singapore.MethodsNurses were surveyed to identify their perceptions regarding barriers to implementation of clinical practice guidelines in their practice setting. The validated questionnaire, \u27Barriers and facilitators assessment instrument\u27, was administered to nurses (n = 1830) working in the medical, surgical, geriatric units, at five acute care hospitals in Singapore.ResultsAn 80.2% response rate was achieved. The greatest barriers to implementation of clinical practice guidelines reported included: knowledge and motivation, availability of support staff, access to facilities, health status of patients, and, education of staff and patients.ConclusionNumerous barriers to the use of the Fall Prevention Clinical Practice Guideline have been identified. This study has laid the foundation for further research into implementation of clinical practice guidelines in Singapore by identifying barriers to change in acute care settings.<br /