Attitudes toward risk among emergency physicians and advanced practice clinicians in Massachusetts

Objective Risk aversion is a personality trait influential to decision making in medicine. Little is known about how emergency department (ED) clinicians differ in their attitudes toward risk taking. Methods We conducted a cross-sectional survey of practicing ED clinicians (physicians and advanced practice clinicians [APCs]) in Massachusetts using the following 4 existing validated scales: the Risk-Taking Scale (RTS), Stress from Uncertainty Scale (SUS), the Fear of Malpractice Scale (FMS), and the Need for (Cognitive) Closure Scale (NCC). We used Cronbach\u27s α to assess the reliability of each scale and performed multivariable linear regressions to analyze the association between the score for each scale and clinician characteristics. Results Of 1458 ED clinicians recruited for participation, 1116 (76.5%) responded from 93% of acute care hospitals in Massachusetts. Each of the 4 scales demonstrated high internal consistency reliability with Cronbach\u27s αs ranging from 0.76 to 0.92. The 4 scales also were moderately correlated with one another (0.08 to 0.54; all P \u3c 0.05). The multivariable results demonstrated differences between physicians and APCs, with physicians showing a greater tolerance for risk or uncertainty (NCC difference, −3.58 [95% confidence interval, CI, −5.26 to −1.90]; SUS difference, −3.14 [95% CI: −4.99 to −1.29]) and a higher concern about malpractice (FMS difference, 1.14 [95% CI, 0.11–2.17]). Differences were also observed based on clinician age (a proxy for years of experience), with greater age associated with greater tolerance of risk or uncertainty (age older than 50 years compared with age 35 years and younger; NCC difference, −2.84 [95% CI, −4.69 to −1.00]; SUS difference, −4.71 [95% CI, −6,74 to −2.68]) and less concern about malpractice (FMS difference, −3.19 [95% CI, −4.31 to −2.06]). There were no appreciable differences based on sex, and there were no consistent associations between scale scores and the practice and payment characteristics assessed. Conclusion We found that risk attitudes of ED clinicians were associated with type of training (physician vs APC) and age (experience). These differences suggest one possible explanation for the observed differences in decision making

Identification of miRSNPs associated with the risk of multiple myeloma

Accepted articleMultiple myeloma (MM) is a malignancy of plasma cells usually infiltrating the bone marrow, associated with the production of a monoclonal immunoglobulin (M protein) which can be detected in the blood and/or urine. Multiple lines of evidence suggest that genetic factors are involved in MM pathogenesis, and several studies have identified single nucleotide polymorphisms (SNPs) associated with the susceptibility to the disease. SNPs within miRNA-binding sites in target genes (miRSNPs) may alter the strength of miRNA-mRNA interactions, thus deregulating protein expression. MiRSNPs are known to be associated with risk of various types of cancer, but they have never been investigated in MM. We performed an in silico genome-wide search for miRSNPs predicted to alter binding of miRNAs to their target sequences. We selected 12 miRSNPs and tested their association with MM risk. Our study population consisted of 1,832 controls and 2,894 MM cases recruited from seven European countries and Israel in the context of the IMMEnSE (International Multiple Myeloma rESEarch) consortium. In this population two SNPs showed an association with p<0.05: rs286595 (located in gene MRLP22) and rs14191881 (located in gene TCF19). Results from IMMEnSE were meta-analyzed with data from a previously published genome-wide association study (GWAS). The SNPs rs13409 (located in the 3UTR of the POU5F1 gene), rs1419881 (TCF19), rs1049633, rs1049623 (both in DDR1) showed significant associations with MM risk. In conclusion, we sought to identify genetic polymorphisms associated with MM risk starting from genome-wide prediction of miRSNPs. For some mirSNPs, we have shown promising associations with MM risk. What's new? Even though deregulation of miRNA expression has been associated with human cancers little information is available regarding their relation with MM susceptibility. We performed an in silico genome-wide search for miRSNPs and selected the most promising ones for an association study. The SNPs with the strongest associations with MM risk are localized in genes which have never been related with MM.This work was partially funded by: intramural funds of German Cancer Research Center (DKFZ), Grant ref. HUS412A1271 from the “Gerencia Regional de Salud de la Junta de Castilla y Léon”. This work was supported by grants from the Instituto de Salud Carlos III (Madrid, Spain; PI12/02688). Catalan Government DURSI grant 2014SGR647 and Instituto de Salud Carlos III, co7funded by FEDER funds –a way to build Europe– grants PI11701439 and PIE13/00022info:eu-repo/semantics/publishedVersio

Kiat Muslihat Mossad

21cm;428ha

Private Information Storage (Extended Abstract)

We consider the setting of hiding information through the use of multiple databases that do not interact with one another. In this setting, there are k 2 &quot;databases&quot; which can be accessed by some &quot;users&quot;. Users do not keep any state information, but wish to access O(n) bits of &quot;data&quot;. Previously, in this setting solutions for retrieval of data in the efficient manner were given, where a user achieves this by interacting with all the databases. We consider the case of both writing and reading . While the case of reading was well studied before, the case of writing was previously completely open. In this paper, we show how to implement both read and write operations, with the following strong security guarantees: all the information about the read/write operation is information-theoretically hidden from all the databases (i.e. both the value of the bit and the address of the bit). As in the previous papers, we measure, as a function of k and n the amount of communication ..

Private Information Storage

We consider the setting of hiding information through the use of multiple databases that do not interact with one another. Previously, in this setting solutions for retrieval of data in the efficient manner were given, where a user achieves this by interacting with all the databases. We consider the case of both writing and reading. While the case of reading was well studied before, the case of writing was previously completely open. In this paper, we show how to implement both read and write operations. As in the previous papers, we measure, as a function of k and n the amount of communication required between a user and all the databases for a single read/write operation, and achieve efficient read/write schemes. Moreover, we show a general reduction from reading database scheme to reading and writing database scheme, with the following guarantees: for any k, given a retrieval only k-database scheme with communication complexity R(k,n) we show a (k+1) reading and writing database scheme with total communication complexity O(R(k,n) * (log n)^{O(1)}). It should be stressed that prior to the current paper no trivial (i.e. sub-linear) bounds for private information storage were known

Private Information Storage (Extend Abstract)

This paper deals with the problem of efficiently and privately storing and retrieving information that is distributively maintained in several databases that do not communicate with one another. The goal is to minimize the communication complexity while maintaining privacy (i.e., so that individual databases do not get any information about the data or the nature of the users&apos; queries). The question of private retrieval from multiple databases was introduced in a very nice paper of Chor, Goldreich, Kushilevitz and Sudan (FOCS &apos;95), but the question whether it is possible to perform both reading and writing in a communication-efficient manner remained open. In this paper, we answer this question in the affirmative, and show that efficient read/write schemes are indeed possible. In fact, we show a general information-theoretic reduction from reading and writing to any read-only scheme that preserves the communication..