Using email reminders to engage physicians in an Internet-based CME intervention

BACKGROUND: Engaging practicing physicians in educational strategies that reinforce guideline adoption and improve the quality of healthcare may be difficult. Push technologies such as email offer new opportunities to engage physicians in online educational reinforcing strategies. The objectives are to investigate 1) the effectiveness of email announcements in engaging recruited community-based primary care physicians in an online guideline reinforcement strategy designed to promote Chlamydia screening, 2) the characteristics of physicians who respond to email announcements, as well as 3) how quickly and when they respond to email announcements. METHODS: Over a 45-week period, 445 recruited physicians received up to 33 email contacts announcing and reminding them of an online women's health guideline reinforcing CME activity. Participation was defined as physician log-on at least once to the website. Data were analyzed to determine participation, to compare characteristics of participants with recruited physicians who did not participate, and to determine at what point and when participants logged on. RESULTS: Of 445 recruited physicians with accurate email addresses, 47.2% logged on and completed at least one module. There were no significant differences by age, race, or specialty between participants and non-participants. Female physicians, US medical graduates and MDs had higher participation rates than male physicians, international medical graduates and DOs. Physicians with higher baseline screening rates were significantly more likely to log on to the course. The first 10 emails were the most effective in engaging community-based physicians to complete the intervention. Physicians were more likely to log on in the afternoon and evening and on Monday or Thursday. CONCLUSIONS: Email course reminders may enhance recruitment of physicians to interventions designed to reinforce guideline adoption; physicians' response to email reminders may vary by gender, degree, and country of medical training. Repetition of email communications contributes to physician online participation

Agent-based Social Psychology: from Neurocognitive Processes to Social Data

Moral Foundation Theory states that groups of different observers may rely on partially dissimilar sets of moral foundations, thereby reaching different moral valuations. The use of functional imaging techniques has revealed a spectrum of cognitive styles with respect to the differential handling of novel or corroborating information that is correlated to political affiliation. Here we characterize the collective behavior of an agent-based model whose inter individual interactions due to information exchange in the form of opinions are in qualitative agreement with experimental neuroscience data. The main conclusion derived connects the existence of diversity in the cognitive strategies and statistics of the sets of moral foundations and suggests that this connection arises from interactions between agents. Thus a simple interacting agent model, whose interactions are in accord with empirical data on conformity and learning processes, presents statistical signatures consistent with moral judgment patterns of conservatives and liberals as obtained by survey studies of social psychology.Comment: 11 pages, 4 figures, 2 C codes, to appear in Advances in Complex System

Direct Analysis of Spectra of the Unusual Type Ib Supernova 2005bf

Synthetic spectra generated with the parameterized supernova synthetic-spectrum code SYNOW are compared to spectra of the unusual Type Ib supernova 2005bf. We confirm the discovery by Folatelli et al. (2006) that very early spectra (about 30 days before maximum light) contain both photospheric-velocity (8000 km/s) features of He I, Ca II, and Fe II, and detached high-velocity (14,000 km/s) features of H-alpha, Ca II, and Fe II. An early spectrum of SN 2005bf is an almost perfect match to a near-maximum-light spectrum of the Type Ib SN 1999ex. Although these two spectra were at very different times with respect to maximum light (20 days before maximum for SN 2005bf and five days after for SN 1999ex), they were for similar times after explosion - about 20 days for SN 2005bf and 24 days for SN 1999ex. The almost perfect match clinches the previously suggested identification of H-alpha in SN 1999ex and supports the proposition that many if not all Type Ib supernovae eject a small amount of hydrogen. The earliest available spectrum of SN 2005bf resembles a near-maximum-light spectrum of the Type Ic SN 1994I. These two spectra also were at different times with respect to maximum light (32 days before maximum for SN 2005bf and four days before for SN 1994I) but at similar times after explosion - about eight days for SN 2005bf and 10 days for SN 1994I. The resemblance motivates us to consider a reinterpretation of the spectra of Type Ic supernovae, involving coexisting photospheric-velocity and high-velocity features. The implications of our results for the geometry of the SN 2005bf ejecta, which has been suggested to be grossly asymmetric, are briefly discussed.Comment: Accepted by PAS

Analytic philosophy for biomedical research: the imperative of applying yesterday's timeless messages to today's impasses

The mantra that "the best way to predict the future is to invent it" (attributed to the computer scientist Alan Kay) exemplifies some of the expectations from the technical and innovative sides of biomedical research at present. However, for technical advancements to make real impacts both on patient health and genuine scientific understanding, quite a number of lingering challenges facing the entire spectrum from protein biology all the way to randomized controlled trials should start to be overcome. The proposal in this chapter is that philosophy is essential in this process. By reviewing select examples from the history of science and philosophy, disciplines which were indistinguishable until the mid-nineteenth century, I argue that progress toward the many impasses in biomedicine can be achieved by emphasizing theoretical work (in the true sense of the word 'theory') as a vital foundation for experimental biology. Furthermore, a philosophical biology program that could provide a framework for theoretical investigations is outlined

Community syndicalism for the United States: preliminary observations on law and globalization in democratic production

two structural labor crises for developed economies: 1) The channeling of substantial investment into non-productive, paper commodities, reducing growth of production for use and therefore reducing available aggregate job creation; and 2) The continued exportation of industrial jobs to other lower cost jurisdictions, and outsourcing, automation, just-in-time production, and speed-ups associated with global supply chains. As a result, local communities and regional populations have destabilized and even collapsed with attendant social problems. One possible response is Community Syndicalism – local community finance and operating credit for industrial production combined with democratic worker ownership and control of production. The result would increase investment directly for production, retain jobs in existing population centers, promote job skilling, and retain tax bases for local services and income supporting local businesses, at the same time increasing support for authentic political democracy by rendering the exploitive ideology of the Public/Private distinction superfluous. Slowing job exportation may reduce the global race to the bottom of labor standards and differential wage rates reducing the return to producers of value and increasing the skew of income distribution undermining social wages and welfare worldwide. Community Syndicalism can serve as moral goal in an alternative production model focusing incentives on long term stability of jobs and community economic base

A Critical Perspective on Moral Neuroscience

In this paper, we highlight several historical developments in the neuroscience of ethics as well as recent advances that forecast the experimental research to come. We argue, in particular, that our understanding of the moral brain will benefit from the further use of a formal, mathematical approach to the construction and testing of alternative theories, such as that found in the field of neuroeconomics. The use of economic modeling to understand the psychological processes underlying distributional preferences and charitable giving is reviewed to illustrate this potential. We also consider some obstacles to such an approach, notably the challenge of capturing substantive moral values within a mathematical model

A web-based Alcohol Clinical Training (ACT) curriculum: Is in-person faculty development necessary to affect teaching?

<p>Abstract</p> <p>Background</p> <p>Physicians receive little education about unhealthy alcohol use and as a result patients often do not receive efficacious interventions. The objective of this study is to evaluate whether a free web-based alcohol curriculum would be used by physician educators and whether in-person faculty development would increase its use, confidence in teaching and teaching itself.</p> <p>Methods</p> <p>Subjects were physician educators who applied to attend a workshop on the use of a web-based curriculum about alcohol screening and brief intervention and cross-cultural efficacy. All physicians were provided the curriculum web address. Intervention subjects attended a 3-hour workshop including demonstration of the website, modeling of teaching, and development of a plan for using the curriculum. All subjects completed a survey prior to and 3 months after the workshop.</p> <p>Results</p> <p>Of 20 intervention and 13 control subjects, 19 (95%) and 10 (77%), respectively, completed follow-up. Compared to controls, intervention subjects had greater increases in confidence in teaching alcohol screening, and in the frequency of two teaching practices – teaching about screening and eliciting patient health beliefs. Teaching confidence and teaching practices improved significantly in 9 of 10 comparisons for intervention, and in 0 comparisons for control subjects. At follow-up 79% of intervention but only 50% of control subjects reported using any part of the curriculum (p = 0.20).</p> <p>Conclusion</p> <p>In-person training for physician educators on the use of a web-based alcohol curriculum can increase teaching confidence and practices. Although the web is frequently used for disemination, in-person training may be preferable to effect widespread teaching of clinical skills like alcohol screening and brief intervention.</p

The RISAP-study: a complex intervention in risk communication and shared decision-making in general practice

General practitioners (GPs) and patients find it difficult to talk about risk of future disease, especially when patients have asymptomatic conditions, and treatment options are unlikely to cause immediate perceptible improvements in well-being. Further studies in risk communication training are needed. Aim:1) to systematically develop, describe and evaluate a complex intervention comprising a training programme for GPs in risk communication and shared decision-making, 2) to evaluate the effect of the training programme on real-life consultations between GPs and patients with high cholesterol levels, and 3) to evaluate patients' reactions during and after the consultations. Methods/Design The effect of the complex intervention, based around a training programme, will be evaluated in a cluster-randomised controlled trial with an intervention group and an active control group with 40 GPs and 280 patients in each group. The GPs will receive a questionnaire at baseline and after 6 months about attitudes towards risk communication and cholesterol-reducing medication. After each consultation with a participating high cholesterol-patient, the GPs will complete a questionnaire about decision satisfaction (Provider Decision Process Assessment Instrument). The patients will receive a questionnaire at baseline and after 3 and 6 months. It includes questions about adherence to chosen treatment (Morisky Compliance Scale), self-rated health (SF-12), enablement (Patient Enablement Instrument), and risk communication and decision-making effectiveness (COMRADE Scale). Prescriptions, contacts to the health services, and cholesterol level will be drawn from the registers. In each group, 12 consultations will be observed and tape-recorded. The patients from these 24 consultations will be interviewed immediately after the consultation and re-interviewed after 6 months. Eight purposefully selected GPs from the intervention group will be interviewed in a focus group 6 months after participation in the training programme. The process and context of the RISAP-study will be investigated in detail using an action research approach, in order to analyse adaptation of the intervention model to the specific context. Discussion This study aims at providing GPs and patients with a firm basis for active deliberation about preventive treatment options, with a view to optimising adherence to chosen treatment. Trial registration ClinicalTrials.gov Protocol Registration System NCT0118705

The Happy Life Club™ study protocol: A cluster randomised controlled trial of a type 2 diabetes health coach intervention

The Happy Life Club™ is an intervention that utilises health coaches trained in behavioural change and motivational interviewing techniques to assist with the management of type 2 diabetes mellitus (T2DM) in primary care settings in China. Health coaches will support participants to improve modifiable risk factors and adhere to effective self-management treatments associated with T2DM