Using Clinical Decision Support to Maintain Medication and Problem Lists: A Pilot Study to Yield Higher Patient Safety

To Investigate Whether Clinical Decision Support that Automates the Matching of Ordered Drugs to Problems (Clinical Diagnoses) on the Problem List Can Enhance the Maintenance of Both Medication and Problem Lists in the Electronic Medical Record, We Designed a Clinical Decision Support System to Match Ordered Drugs on the Medication List and Ongoing Problems on the Problem List. We Evaluated the Capability and Performance of This Clinical Decision Support System in Medication-Problem Matching using Physician Expert Chart Audits to Match Ordered Drugs to Ongoing Clinical Problems. a Clinical Decision Support System Was Shown to Be Useful in Improving Medication-Problem Matches in 140 Randomly Selected Audited Patient Encounters in Three Inpatient Units. Enhanced Maintenance of Both the Medication and Problem Lists Can Permit the Exploitation of Advanced Decision Support Strategies that Yield Higher Patient Safety. © 2008 IEEE

'Parasitic invasions' or sources of good governance: constraining foreign competition in Hong Kong banking, 1956-81

This paper investigates the operation and impact of the moratorium on new banking licences imposed in Hong Kong in 1965 and the claims that foreign banks destabilised the banking system and drained resources from the colony. First it examines foreign banks' attempts to circumvent the moratorium through claims of special circumstances and buying interests in local banks, and secondly it examines the efforts of incumbents to extend barriers to non-bank financial institutions and to branches of foreign banks. The general conclusions are that while the moratorium was aimed at increasing the stability of the banking system, it had the effect of decreasing the regulatory breadth of the government, and reducing incentives for mergers and acquisitions that might have improved governance

The Solar Neighborhood XIII: Parallax Results from the CTIOPI 0.9-m Program -- Stars with mu >= 1"/year (MOTION Sample)

We present the first set of definitive trigonometric parallaxes and proper motions from the Cerro Tololo Inter-American Observatory Parallax Investigation (CTIOPI). Full astrometric reductions for the program are discussed, including methods of reference stars selection, differential color refraction corrections, and conversion of relative to absolute parallax. Using data acquired at the 0.9-m at CTIO, full astrometric solutions and $VRIJHK_s$ photometry are presented for 36 red and white dwarf stellar systems with proper motions faster than 1\farcs0/yr. Of these, thirty three systems have the first ever trigonometric parallaxes, which comprise 41% of MOTION systems (those with proper motions greater than 1\farcs0/yr) south of $\delta$ $=$ 0 that have no parallaxes. Four of the systems are new members of the RECONS 10 pc sample for which the first accurate trigonometric parallaxes are published here: DENIS J1048-3956 (4.04 $\pm$ 0.03 pc), GJ 1128 (LHS 271, 6.53 $\pm$ 0.10 pc), GJ 1068 (LHS 22, 6.97 $\pm$ 0.09 pc), and GJ 1123 (LHS 263, 9.02 $\pm$ 0.16 pc). In addition, two red subdwarf-white dwarf pairs, LHS 193AB and LHS 300AB, are identified. The white dwarf secondaries fall in a previously uncharted region of the HR diagram.Comment: 40 pages, 7 figures, accepted to The Astronomical Journal (scheduled for April 2005 issue), Re-submit, Table 2 running off the bottom of the page has been fixe

MV3: A new word based stream cipher using rapid mixing and revolving buffers

MV3 is a new word based stream cipher for encrypting long streams of data. A direct adaptation of a byte based cipher such as RC4 into a 32- or 64-bit word version will obviously need vast amounts of memory. This scaling issue necessitates a look for new components and principles, as well as mathematical analysis to justify their use. Our approach, like RC4's, is based on rapidly mixing random walks on directed graphs (that is, walks which reach a random state quickly, from any starting point). We begin with some well understood walks, and then introduce nonlinearity in their steps in order to improve security and show long term statistical correlations are negligible. To minimize the short term correlations, as well as to deter attacks using equations involving successive outputs, we provide a method for sequencing the outputs derived from the walk using three revolving buffers. The cipher is fast -- it runs at a speed of less than 5 cycles per byte on a Pentium IV processor. A word based cipher needs to output more bits per step, which exposes more correlations for attacks. Moreover we seek simplicity of construction and transparent analysis. To meet these requirements, we use a larger state and claim security corresponding to only a fraction of it. Our design is for an adequately secure word-based cipher; our very preliminary estimate puts the security close to exhaustive search for keys of size < 256 bits.Comment: 27 pages, shortened version will appear in "Topics in Cryptology - CT-RSA 2007

Changes in insulin sensitivity over time and associated factors in HIV-infected adolescents

OBJECTIVE: To compare prevalence of insulin resistance between perinatally HIV-infected (PHIV+) and perinatally HIV-exposed, but uninfected adolescents (PHEU), determine incidence of and contributory factors to new and resolved cases of insulin resistance in PHIV+, and evaluate glucose metabolism. DESIGN: Cross-sectional design for comparison of prevalence among PHIV+ and PHEU. Longitudinal design for incidence and resolution of insulin resistance among PHIV+ at risk for these outcomes. METHODS: The source population was adolescents from pediatric HIV clinics in the United States and Puerto Rico participating in the Pediatric HIV/AIDS Cohort Study, an ongoing prospective cohort study designed to evaluate impact of HIV infection and its treatment on multiple domains in preadolescents and adolescents. Insulin resistance was assessed by homeostatic model assessment of insulin resistance. Those with incident insulin resistance underwent 2-h oral glucose tolerance test and HbA1c. Baseline demographic, metabolic, and HIV-specific variables were evaluated for association with incident or resolved insulin resistance. RESULTS: Unadjusted prevalence of insulin resistance in PHIV+ was 27.3 versus 34.1% in PHEU. After adjustment for Tanner stage, age, sex, and race/ethnicity, there was no significant difference between groups. Factors positively associated with developing insulin resistance included female sex, higher BMI z score, and higher waist circumference; those associated with resolving insulin resistance included male sex and lower BMI z score. CONCLUSION: Prevalence of insulin resistance in PHIV+ and PHEU was substantially higher than that reported in HIV-uninfected nonoverweight youth, but similar to that in HIV-uninfected obese youth. Factors associated with incident or resolved insulin resistance among PHIV+ were similar to those reported in HIV-negative obese youth. However, a contributory role of HIV infection and/or its treatment to the incident risk of insulin resistance cannot be excluded