Research Roundup
Computer Scientists
Develop A 'Smart' Payment Card
Researchers at
Penn have one-upped "smart" credit
cards with embedded microchips. They've developed a technique
that lets ordinary card users program in their own spending parameters.
Dr. Carl A. Gunter, professor of computer and information
science, presented the work at the recent European Conference on
Object-Oriented Programming in Darmstadt, Germany. The technology
could let employers better manage spending on corporate cards or
permit parents to get teenage children emergency credit cards usable
only at locations like car repair shops, hotels or pay phones.
Programmable credit
cards could let cardholders limit expenditures, for instance,
to $100 a day or to spending
only on certain days or at certain establishments, Dr. Gunter said. The
programmable card's added layer of security could also help cut
fraudulent online use of credit cards, which has grown into a significant
problem for consumers and industry. The same technology could
be used in cell phones that use a smart card, Dr. Gunter said,
to provide owners with ways to regulate the use of the phone by
others.
The programmable
card developed by Dr. Gunter and his colleagues unites an array
of existing technologies, including
the microchips first built into credit cards more than 30 years
ago. An on-card verification system prevents unauthorized
users from tampering with limits programmed in by the card's rightful
owner. A commercial card-reader already on the market plugs
into a computer dock, letting users link card and computer to create
personalized restrictions using interfaces created by Dr. Gunter's
group.
Dr. Gunter is joined in this research, funded by
the NSF and Army Research Office, by Dr. Rajeev Alur, professor
of computer and information science, and Penn students, Alwyn Goodloe,
Michael McDougall, Jason Simas and Watee Arjsamat.
Penn is seeking
corporate partners and investors to commercialize this technology.
Additional information is available
by contacting Jennifer Choy in Penn's Center for Technology Transfer
at (215) 898-9273.
Refusing Medications Based on Quality of Life
A
caregiver's assessment
of an Alzheimer's patient's quality of life is the key factor in
determining if and why some caregivers decline to use a treatment
that slows progression of the patient's disease, according to a
new study from researchers at the Institute on Aging at Penn's
School of Medicine. Their findings—published in the October 3 edition
of the Journal of the American Geriatric Society—reveal
that caregivers are most likely to decline medications slowing
Alzheimer's disease if the caregiver assesses the patient's overall
quality of life as fair or poor. For example, a husband may decline
treatment of his wife when she can no longer remember family members
and can only communicate with them as strangers. When there is
risk to the medication, the number of caregivers who decline treatment
rises substantially.
"Caregivers have always played a vital role in
providing direct care. That is why we call them caregivers. They
also make decisions for patients," said Dr. Jason Karlawish, assistant
professor of medicine in geriatrics at the School of Medicine and
lead author of the study. "In fact, by the moderate to severe stages
of the disease, caregivers make most of the treatment decisions,
including when to say 'no' to a particular therapy."
Among the other
key study findings were that a caregiver's characteristics—mental health, financial burden and
race—also drove their decision to decline a treatment when there
was a risk or side-effect to the treatment. Caregivers suffering
from depression—which can be a result of the stress and burden
of caregiving—were more likely to decline a treatment. Financial
burden and race were also factors more likely to lead to declining
treatment: study participants who ranked themselves as having "just
enough" or "not enough" funds at the end of the month were more
likely to decline treatment, where prescriptions can cost a few
hundred dollars per month; non-whites were also more likely to
decline treatment, although no data confirmed why this was the
case.
"Understandably, we focus on starting treatment
early. But we need to think about the other side of treatment—stopping
it. Now that we understand why caregivers refuse a dementia-slowing
treatment, we can better plan for patient care and develop future
treatment guidelines that incorporates the caregiver's experience," said
Dr. Karlawish. "This planning could ultimately help caregivers
and physicians in determining an appropriate time to end treatment
for Alzheimer's disease, based on factors influencing quality of
life. It also shows that managing the health of the caregiver is
an integral part of treating a patient with Alzheimer's disease.
When you have one person with Alzheimer's disease, you have at
least two people to take care of."
Funding for this study was provided through a Paul
Beeson Physician Faculty Scholars Award and the National Institute
on Aging.
African-American Males and Prostate Cancer
Compared with Caucasian,
Asian, or Hispanic men, African American men have the highest
incidence of prostate cancer
in the world, are stricken at a younger age and, once diagnosed,
are more likely to suffer bad outcomes from the disease—including
death, impotence and incontinence.
To understand why African Americans have poorer
outcomes when they are diagnosed with prostate cancer, the National
Cancer Institute has awarded an $8.5 million grant to Dr. Timothy
R. Rebbeck, leader of the Cancer Epidemiology and Risk Reduction
Program of the Abramson Cancer Center, and an associate professor
of epidemiology and biostatistics at the School of Medicine.
The five-year study will enable researchers to
determine what factors influence bad outcomes among African American
men and how these factors may influence the disparity that exists
among African Americans and men of other races.
Researchers at
Penn will conduct four separate studies concurrently over five
years. One study will collect data
of the racial, ethical and sociological beliefs related to prostate
cancer awareness and screening: such as, "Why do African American
males avoid screening for prostate cancer?" and, "Why do they avoid
discussing the disease with their physicians?" Is it because they
fear the test results or are embarrassed about having the test,
or is there distrust of the medical community? It is likely that
these disparities result from a combination of many factors.
Another study will evaluate the biological profiles
of African American men as compared to other races. Analyses will
be performed to study differences in specific candidate genes that
may predispose African American men to poor prostate cancer outcomes.
A third study
will evaluate the physical environment of African American men
to determine if certain factors
limit their access to health care and the referring patterns for
cancer care among physicians treating this group. Treatment patterns
will be examined to see if there are racial disparities in the
diagnosis and treatment of prostate cancer: i.e., are African American
men with prostate cancer receiving surgery, or opting, instead,
for radiation therapy? Cases will also be re-examined to see if
physicians are recommending the proper treatment.
A fourth study
will evaluate patient behavior to determine whether lifestyle
impacts the manner in which African
American men seek care and treatment for the disease: i.e., do
social networks, such as family and friends, play and helping role
in recovery form prostate cancer and following through with their
physician's instructions?
More Patients Die After Common Surgeries
The education level
of hospital nurses may be as important as how many RNs are at
the bedside in determining whether
patients survive common surgeries, according to a School of Nursing
study in The Journal of the American Medical Association (JAMA).
In a study of 232,342
patients, researchers from the Center for Health Outcomes and
Policy Research found that raising
the percentage of bedside RNs with bachelor's degrees from 20 to
60 percent would save four lives for every 1,000 patients undergoing
common surgeries. Surprisingly, of 168 hospitals studied in Pennsylvania,
the percentage of university-trained RNs varied from 0 to 77 percent.*
A conservative estimate suggests the difference between best and
worst staffing and education scenarios could translate to 1,700
preventable deaths in Pennsylvania annually.
*There are three
ways to become a registered nurse: hospital-based "diploma schools," associate
degree programs, and Bachelor of Science in Nursing (BSN) or
baccalaureate programs
at universities.
The latest
findings show patients have the highest risk in hospitals where
nurses with less education care
for more patients: 24 deaths per 1,000 patients when 20% of nursing
staffs have BSNs care for an average of 8 patients, to 16 deaths
when hospital staffs with 60% BSNs care for four patients.
Specifically, the researchers found that: