Evidence-Based Medicine Instruction in Integrative Medical School Curricula: A Tale of Two Libraries

Background: Many academic health sciences libraries have been moving towards active participation in the curriculum at their institutions.1 At the same time, many medical schools have completed, are working upon or are considering movement to an integrative curriculum, (the melding of basic sciences and clinical learning), based on suggested AAMC competencies.2We will discuss how libraries at two New England medical schools have successfully embraced roles in the their school’s curriculum, which are at different stages of adoption of new integrative curricula. Methods: The teaching of Evidence-Based Medicine (EBM) is an area ripe for collaboration between a medical school and its library. The libraries at both Harvard Medical School (HMS) and the University of Massachusetts Medical School (UMMS) now offer EBM instruction within their medical school curricula. HMS is refining its new integrative curriculum while UMMS is in the planning stages with implementation targeted for AY 2010. Teaching time, location within the curriculum, general content and methods between the programs at these two schools will be examined and compared. Results: UMMS conducts all of its EBM instruction within a traditional 3rd year clerkship format. HMS covers similar content online in a 1st year combined basic science/clinical course. However, the libraries at both institutions have successfully facilitated the incorporation of this important topic into required coursework. Reflection: Reflections on the following themes are included in the poster on: Staff and resources/workload Adding content into a packed curriculum Library expertise In person vs. online instruction Progressive versus single encounter instruction Conclusions: While at different phases of curriculum redesign, the academic libraries at UMMS and HMS have demonstrated the effectiveness of varied methods of teaching Evidence-Based Medicine within a medical school curriculum. 1Burrows, Suzetta, et al. Developing an evidence-based medicine and use of the biomedical literature component as a longitudinal theme of an outcomes-based medical school curriculum: year 1. Journal of the Medical Library Association 91.1 (2003):34-41. 2Association of American Medical Colleges. The Education of Medical Students: Ten Stories of Curriculum Change. New York: Milbank Memorial Funds, 2000. Presented at the Northeast Group on Educational Affairs (NEGEA) Regional Conference on May 2, 2009, in Hershey, Pennsylvania

Libraries in Medical Education (LIME): A Special Interest Group of NEGEA

Purpose: Health science librarians play key roles in medical education by providing curriculum-integrated information skills instruction; by assisting faculty with research; by purchasing and maintaining collections of information resources; by participating in the development of standards and guidelines for educational outcomes; and by creating and managing libraries conducive to education. A group of medical librarians from northeastern medical schools proposed Libraries in Medical Education (LIME) Special Interest Group (SIG) to benefit all NEGEA (Northeast Group on Educational Affairs) members. The SIG will promote communication and collaboration between librarians and NEGEA members on research and curricular initiatives; enhance librarians knowledge and skills of current trends and issues of interest to the medical education community; recognize librarians as valued components of the medical education team; and increase the professional knowledge and skills of NEGEA members through programming delivered at annual meetings by librarians. Methods: In 2006, medical librarians drafted and submitted a proposal to become an official LIME SIG. Librarians have successfully implemented special interest groups within professional organizations. The Libraries in Medical Education SIG instituted within the Central Group on Education Affairs and the active Libraries/Educational Resources Section of American Association of Colleges of Pharmacy (AACP) served as models. Results: In 2007, the LIME was officially accepted by NEGEA as a special interest group. Conclusion: An enthusiastic LIME-SIG group looks forward to an exciting future of collaboration. Presented at the Northeast Group for Educational Affairs Annual Educational Retreat held in Stony Brook, NY, on June 8, 2007

Better Than Advertised: Improved Collision-Resistance Guarantees for MD-Based Hash Functions

The MD transform that underlies the MD and SHA families iterates a compression function $\mathsf{h}$ to get a hash function $\mathsf{H}$. The question we ask is, what property X of $\mathsf{h}$ guarantees collision resistance (CR) of $\mathsf{H}$? The classical answer is that X itself be CR. We show that weaker conditions X, in particular forms of what we call constrained-CR, suffice. This reduces demands on compression functions, to the benefit of security, and also, forensically, explains why collision-finding attacks on compression functions have not, historically, lead to immediate breaks of the corresponding hash functions. We obtain our results via a definitional framework called RS security, and a parameterized treatment of MD, that also serve to unify prior work and variants of the transform

Authenticated Encryption with Key Identification

Authenticated encryption with associated data (AEAD) forms the core of much of symmetric cryptography, yet the standard techniques for modeling AEAD assume recipients have no ambiguity about what secret key to use for decryption. This is divorced from what occurs in practice, such as in key management services, where a message recipient can store numerous keys and must identify the correct key before decrypting. To date there has been no formal investigation of their security properties or efficacy, and the ad hoc solutions for identifying the intended key deployed in practice can be inefficient and, in some cases, vulnerable to practical attacks. We provide the first formalization of nonce-based AEAD that supports key identification (AEAD-KI). Decryption now takes in a vector of secret keys and a ciphertext and must both identify the correct secret key and decrypt the ciphertext. We provide new formal security definitions, including new key robustness definitions and indistinguishability security notions. Finally, we show several different approaches for AEAD-KI and prove their security

Interoperability in End-to-End Encrypted Messaging

The Digital Markets Act (DMA) is a nascent European Union regulation adopted in May 2022. One of its most controversial provisions is a requirement that so-called “gatekeepers” offering end-to-end encrypted messaging apps, such as WhatsApp, implement “interoperability” with other messaging apps: in essence, encrypted messaging across service providers. This requirement represents a fundamental shift in the design assumptions of existing encrypted messaging systems, most of which are designed to be centralized. Technologists have not really begun thinking about the myriad security, privacy, and functionality questions raised by the interoperability requirement; given that the DMA’s interoperability mandate may take effect as soon as mid-2024, it is critical for researchers to begin understanding the challenges and offering solutions. In this paper, we take an initial step in this direction. We break down the DMA’s effects on the design of encrypted messaging systems into three main areas: identity, or how to resolve identities across service providers; protocols, or how to establish a secure connection between clients on different platforms; and abuse prevention, or how service providers can detect and take action against users engaging in abuse or spam. For each area, we identify key security and privacy requirements, summarize existing proposals, and examine whether proposals meet our security and privacy requirements. Finally, we propose our own design for an interoperable encrypted messaging system, and point out open problems

Context Discovery and Commitment Attacks: How to Break CCM, EAX, SIV, and More

A line of recent work has highlighted the importance of context commitment security, which asks that authenticated encryption with associated data (AEAD) schemes will not decrypt the same adversarially-chosen ciphertext under two different, adversarially-chosen contexts (secret key, nonce, and associated data). Despite a spate of recent attacks, many open questions remain around context commitment; most obviously nothing is known about the commitment security of important schemes such as CCM, EAX, and SIV. We resolve these open questions, and more. Our approach is to, first, introduce a new framework that helps us more granularly define context commitment security in terms of what portions of a context are adversarially controlled. We go on to formulate a new notion, called context discoverability security, which can be viewed as analogous to preimage resistance from the hashing literature. We show that unrestricted context commitment security (the adversary controls all of the two contexts) implies context discoverability security for a class of schemes encompassing most schemes used in practice. Then, we show new context discovery attacks against a wide set of AEAD schemes, including CCM, EAX, SIV, GCM, and OCB3, and, by our general result, this gives new unrestricted context commitment attacks against them. Finally, we consider restricted context commitment security for the original SIV mode, for which no prior attack techniques work (including our context discovery based ones). We are nevertheless able to give a novel $O(2^{n/3})$ attack using Wagner\u27s k-tree algorithm for the generalized birthday problem

Orca: Blocklisting in Sender-Anonymous Messaging

Sender-anonymous end-to-end encrypted messaging allows sending messages to a recipient without revealing the sender’s identity to the messaging platform. Signal recently introduced a sender anonymity feature that includes an abuse mitigation mechanism meant to allow the platform to block malicious senders on behalf of a recipient. We explore the tension between sender anonymity and abuse mitigation. We start by showing limitations of Signal’s deployed mechanism, observing that it results in relatively weak anonymity properties and showing a new griefing attack that allows a malicious sender to drain a victim’s battery. We therefore design a new protocol, called Orca, that allows recipients to register a privacy-preserving blocklist with the platform. Without learning the sender’s identity, the platform can check that the sender is not on the blocklist and that the sender can be identified by the recipient. We construct Orca using a new type of group signature scheme, for which we give formal security notions. Our prototype implementation showcases Orca’s practicality

OPTIKS: An Optimized Key Transparency System

Key Transparency (KT) refers to a public key distribution system with transparency mechanisms proving its correct operation, i.e., proving that it reports consistent values for each user\u27s public key. While prior work on KT systems have offered new designs to tackle this problem, relatively little attention has been paid on the issue of scalability. Indeed, it is not straightforward to actually build a scalable and practical KT system from existing constructions, which may be too complex, inefficient, or non-resilient against machine failures. In this paper, we present OPTIKS, a full featured and optimized KT system that focuses on scalability. Our system is simpler and more performant than prior work, supporting smaller storage overhead while still meeting strong notions of security and privacy. Our design also incorporates a crash-tolerant and scalable server architecture, which we demonstrate by presenting extensive benchmarks. Finally, we address several real-world problems in deploying KT systems that have received limited attention in prior work, including account decommissioning and user-to-device mapping

The relationship between leadership, teamworking, structure, burnout and attitude to patients on acute psychiatric wards

Contains fulltext : 99818.pdf (publisher's version ) (Open Access)Background: Conflict (aggression, substance use, absconding, etc.) and containment (coerced medication, manual restraint, etc.) threaten the safety of patients and staff on psychiatric wards. Previous work has suggested that staff variables may be significant in explaining differences between wards in their rates of these behaviours, and that structure (ward organisation, rules and daily routines) might be the most critical of these. This paper describes the exploration of a large dataset to assess the relationship between structure and other staff variables. Methods: A multivariate cross-sectional design was utilised. Data were collected from staff on 136 acute psychiatric wards in 26 NHS Trusts in England, measuring leadership, teamwork, structure, burnout and attitudes towards difficult patients. Relationships between these variables were explored through principal components analysis (PCA), structural equation modelling and cluster analysis. Results: Principal components analysis resulted in the identification of each questionnaire as a separate factor, indicating that the selected instruments assessed a number of non-overlapping items relevant for ward functioning. Structural equation modelling suggested a linear model in which leadership influenced teamwork, teamwork structure; structure burnout; and burnout feelings about difficult patients. Finally, cluster analysis identified two significantly distinct groups of wards: the larger of which had particularly good leadership, teamwork, structure, attitudes towards patients and low burnout; and the second smaller proportion which was poor on all variables and high on burnout. The better functioning cluster of wards had significantly lower rates of containment events. Conclusion: The overall performance of staff teams is associated with differing rates of containment on wards. Interventions to reduce rates of containment on wards may need to address staff issues at every level, from leadership through to staff attitudes

Community-acquired pneumonia in hospitalised patients: changes in aetiology, clinical presentation, and severity outcomes in a 10-year period

Staphylococcus aureus; Mortality; VirologyStaphylococcus aureus; Mortalidad; VirologíaStaphylococcus aureus; Mortalitat; VirologiaBackground and objective Community-acquired pneumonia (CAP) is a frequent cause of hospitalisation. Several factors, such as pandemics, vaccines and globalisation may lead to changes in epidemiology, clinical presentation, and outcomes of CAP, which oblige to a constant actualisation. We performed this study to analyse how these factors have evolved over a 10-year period. Materials and methods Patients diagnosed with CAP for two 1-year periods that were 10 years apart (2007–2008 and 2017–2018) were included. We compared microbiological information, clinical data and evolutive outcomes in the two periods. A mortality analysis was performed. Results 1043 patients were included: 452 during the first period (2007- 2008), and 591 during the second period (2017–2018). Bacterial aetiology did not change during the 10-year period, besides a slight increase in Staphylococcus aureus (0.9% vs 2.9%, p = 0.026). There was a decline in the proportion of bacteraemia in the second period (14.8% vs 9.6%, p = 0.012). The incidence of complicated pleural effusion and septic shock declined too (6.4% vs 3.6%, p = 0.04 and 15.5% vs 6.3%, p < 0.001). Respiratory failure and Intensive care unit (ICU) admission were similar in both periods. Variables independently associated with mortality were age and septic shock. Influenza vaccine was a protective factor against mortality in the second period. Conclusions We have not found relevant differences in the bacterial aetiology of CAP over this 10-year period. There has been a decline in septic complications of CAP such as septic shock, bacteraemia, and complicated pleural effusion. Influenza vaccination is an important tool to reduce mortality