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

A Comparative Study of the Absolute Magnitude Distributions of Supernovae.

The Asiago Supernova Catalog is used to carry out a comparative study of supernova absolute magnitude distributions. An overview of the absolute magnitudes of the supernovae in the current observational sample is presented, and the evidence for subluminous and overluminous events is examined. The fraction of supernovae that are subluminous (MB\u3e -15) appears to be higher (perhaps much higher) than 1/5 but it remains very uncertain. The fraction that are overluminous (MB \u3e -20) is lower (probably much lower) than 0.01. The absolute magnitude distributions for each supernova type, restricted to events within 1 Gpc, are compared. Although these distributions are affected by observational bias in favor of the more luminous events, they are useful for comparative studies. We find mean absolute blue magnitudes (for H0 = 60) of -19.46 for normal Type la supernovae (SNe Ia), -18.04 for SNe Ibc, -17.61 and -20.26 for normal and bright SNe Ibc considered separately, -18.03 for SNe II-L, -17.56 and -19.27 for normal and bright SNe II-L considered separately, -17.00 for SNe II-P, and -19.15 for SNe IIn

The Intrinsically X-ray Weak Quasar PHL 1811. II. Optical and UV Spectra and Analysis

This is the second of two papers reporting observations and analysis of the unusually bright (m_b=14.4), luminous (M_B=-25.5), nearby (z=0.192) narrow-line quasar PHL 1811. The first paper reported that PHL 1811 is intrinsically X-ray weak, and presented a spectral energy distribution (SED). Here we present HST STIS optical and UV spectra, and ground-based optical spectra. The optical and UV line emission is very unusual. There is no evidence for forbidden or semiforbidden lines. The near-UV spectrum is dominated by very strong FeII and FeIII, and unusual low-ionization lines such as NaID and CaII H&K are observed. High-ionization lines are very weak; CIV has an equivalent width of 6.6A, a factor of ~5 smaller than measured from quasar composite spectra. An unusual feature near 1200A can be deblended in terms of Ly\alpha, NV, SiII, and CIII* using the blueshifted CIV profile as a template. Photoionization modeling shows that the unusual line emission can be explained qualitatively by the unusually soft SED. Principally, a low gas temperature results in inefficient emission of collisionally excited lines, including the semiforbidden lines generally used as density diagnostics. The emission resembles that of high-density gas; in both cases this is a consequence of inefficient cooling. PHL 1811 is very unusual, but we note that quasar surveys are generally biased against finding similar objects.Comment: Accepted for publication in ApJS. Full resolution figures available here: http://www.nhn.ou.edu/~leighly/phl1811_paper1.pd

Evidence-based choices of physicians: a comparative analysis of physicians participating in Internet CME and non-participants

<p>Abstract</p> <p>Background</p> <p>The amount of medical education offered through the Internet continues to increase, providing unprecedented access for physicians nationwide. However, the process of evaluating these activities is ongoing. This study is a continuation of an earlier report that found online continuing medical education (CME) to be highly effective in making evidence-based decisions.</p> <p>Methods</p> <p>To determine the effectiveness of 114 Internet CME activities, case vignette-based surveys were administered to U.S.-practicing physicians immediately following participation, and to a representative control group of non-participants. Survey responses were analyzed based on evidence presented in the content of CME activities. An effect size for each activity was calculated using Cohen's <it>d </it>to determine the amount of difference between the two groups in the likelihood of making evidence-based clinical decisions.</p> <p>Results</p> <p>In a sample of 17,142 U.S. physicians, of the more than 350,000 physicians who participated in 114 activities, the average effect size was 0.82. This indicates an increased likelihood of 48% that physicians participating in online activities were making clinical choices based on evidence.</p> <p>Conclusion</p> <p>Physicians who participated in online CME activities continue to be more likely to make evidence-based clinical choices than non-participants in response to clinical case vignettes.</p

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

Family physicians' information seeking behaviors: A survey comparison with other specialties

BACKGROUND: Using technology to access clinical information has become a critical skill for family physicians. The aims of this study were to assess the way family physicians use the Internet to look for clinical information and how their patterns vary from those of specialists. Further, we sought a better understanding of how family physicians used just-in-time information in clinical practice. METHODS: A fax survey was provided with 17 items. The survey instrument, adapted from two previous studies, was sent to community-based physicians. The questions measured frequency of use and importance of the Internet, palm computers, Internet CME, and email for information seeking and CME. Barriers to use were explored. Demographic data was gathered concerning gender, years since medical school graduation, practice location, practice type, and practice specialty. RESULTS: Family physicians found the Internet to be useful and important as an information source. They were more likely to search for patient oriented material than were specialists who more often searched literature, journals and corresponded with colleagues. Hand held computers were used by almost half of family physicians. CONCLUSION: Family physicians consider the Internet important to the practice of medicine, and the majority use it regularly. Their searches differ from colleagues in other specialties with a focus on direct patient care questions. Almost half of family physicians use hand held computers, most often for drug reference

On the Determination of N and O Abundances in Low Metallicity Systems

We show that in order to minimize the uncertainties in the N and O abundances of low mass, low metallicity (O/H less than or equal to solar/5) emission-line galaxies, it is necessary to employ separate parameterizations for inferring Te[N II] and Te[O II] from Te[O III]. In addition, we show that for the above systems, the ionization correction factor (ICF) for obtaining N/O from N+/O+, where the latter is derived from optical emission-line flux ratios, is = 1.08 +/- 0.09. These findings are based on state-of-the-art single-star H II region simulations, employing our own modeled stellar spectra as input. Our models offer the advantage of having matching stellar and nebular abundances. In addition, they have O/H as low as solar/50 (lower than any past work), as well as log(N/O) and log(C/O) fixed at characteristic values of -1.46 and -0.7, respectively. The above results were used to re-derive N and O abundances for a sample of 68 systems with 12 + log(O/H) less than or equal to 8.1, whose de-reddened emission-line strengths were collected from the literature. The analysis of the log(N/O) versus 12 + log(O/H) diagram of the above systems shows the following: (1) the largest group of objects forms the well-known N/O plateau with a value for the mean (and its statistical error) of -1.43 (+.0084/-.0085); (2) the objects are distributed within a range in log(N/O) of -1.54 to -1.27 in Gaussian fashion around the mean with a standard deviation of sigma = +.071 / -.084; and (3) a chi-square analysis suggests that only a small amount of the observed scatter in log(N/O) is intrinsic.Comment: 15 pages, 13 figures, 6 tables, accepted for publication in Ap

A comparative evaluation of the effect of internet-based CME delivery format on satisfaction, knowledge and confidence

<p>Abstract</p> <p>Background</p> <p>Internet-based instruction in continuing medical education (CME) has been associated with favorable outcomes. However, more direct comparative studies of different Internet-based interventions, instructional methods, presentation formats, and approaches to implementation are needed. The purpose of this study was to conduct a comparative evaluation of two Internet-based CME delivery formats and the effect on satisfaction, knowledge and confidence outcomes.</p> <p>Methods</p> <p>Evaluative outcomes of two differing formats of an Internet-based CME course with identical subject matter were compared. A Scheduled Group Learning format involved case-based asynchronous discussions with peers and a facilitator over a scheduled 3-week delivery period. An eCME On Demand format did not include facilitated discussion and was not based on a schedule; participants could start and finish at any time. A retrospective, pre-post evaluation study design comparing identical satisfaction, knowledge and confidence outcome measures was conducted.</p> <p>Results</p> <p>Participants in the Scheduled Group Learning format reported significantly higher mean satisfaction ratings in some areas, performed significantly higher on a post-knowledge assessment and reported significantly higher post-confidence scores than participants in the eCME On Demand format that was not scheduled and did not include facilitated discussion activity.</p> <p>Conclusions</p> <p>The findings support the instructional benefits of a scheduled delivery format and facilitated asynchronous discussion in Internet-based CME.</p

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