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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:

  • A 10% increase in the proportion of hospital staff nurses holding a bachelor's degree is associated with a 5% decrease in post-operative mortality.
  • Twenty-three percent of patients developed a complication following admission and 8.4% of them died. Fourteen out of every 1,000 of these patients could be expected to die in hospitals where 20% of the nurses had BSNs compared to 60%.
  • The findings are independent of the qualifications of patients' surgeons, the availability of technology, hospital teaching status, and nurse experience.
  • Almost one in four baccalaureate-prepared hospital nurses received a degree through continuing education following initial schooling, often facilitated by employer educational benefits, yet the trend is decreasing.

The study was funded by the NIH, the Agency for Healthcare Research and Quality, and The Robert Wood Johnson Foundation.



  Almanac, Vol. 50, No. 7, October 7, 2003