Enhancement of protein detection on cultural heritage samples after SYPRO™ Ruby staining by optical microscopy and micro-FTIR spectroscopy.

The paper investigates SYPRO™ Ruby staining in combination with external reflection micro-FTIR spectroscopy, for the detection of proteinaceous media in paint layers on cultural heritage, from unembedded micro-fragments and samples embedded in cross-sections. Combining FTIR spectroscopy with staining helped to verify that the FTIR mapping is accurate when performed by the integration of the main amide I and II bands, despite their naturally occurrent distortions due to the specular component and material absorption/surface properties. The research filled some gaps in the published literature on SYPRO™ Ruby interaction with different Cultural Heritage materials, including identifying drawbacks, e.g. swelling mechanisms in the sample after staining. The effects of the staining were investigated on different reference samples containing rabbit skin glue (proteinaceous), and samples from cultural heritage case studies undergoing technical examination as part of research projects, where identification of protein is an important aspect of understanding the sequence of complex multi-layers within a sample. Results showed that, when external reflection µ-FTIR is performed after the staining, the contribution from amide I and II, which occurs at higher wavenumbers than in transmission or attenuated total reflection, is more resolved and therefore easier to determine. When inorganic or organic compounds are present in the same layer, variation in the position of amide bands can occur. However, they can be used for chemical mapping using simple data-treatment strategies, as validated with the positive staining. This type of data processing gives a good estimation of the protein distribution in the layers, both in terms of morphology and thickness, on mock-up samples and cross-sections from real case studies.

The implementation of an integrated information system for substance use screening in general medical settings.

UNLABELLED: The Massachusetts Screening, Brief Intervention and Referral to Treatment (MASBIRT) Program, a substance use screening program in general medical settings, created a web-based, point-of-care (POC), application--the MASBIRT Portal (the "Portal") to meet program goals. OBJECTIVES: We report on development and implementation of the Portal. METHODS: Five year program process outcomes recorded by an independent evaluator and an anonymous survey of Health Educator's (HEs) adoption, perceptions and Portal use with a modified version of the Technology Readiness Index are described. [8] Specific management team members, selected based on their roles in program leadership, development and implementation of the Portal and supervision of HEs, participated in semi-structured, qualitative interviews. RESULTS: At the conclusion of the program 73% (24/33) of the HEs completed a survey on their experience using the Portal. HEs reported that the Portal made recording screening information easy (96%); improved planning their workday (83%); facilitated POC data collection (84%); decreased time dedicated to data entry (100%); and improved job satisfaction (59%). The top two barriers to use were "no or limited wireless connectivity" (46%) and "the tablet was too heavy/bulky to carry" (29%). Qualitative management team interviews identified strategies for successful HIT implementation: importance of engaging HEs in outlining specifications and workflow needs, collaborative testing prior to implementation and clear agreement on data collection purpose, quality requirements and staff roles. DISCUSSION: Overall, HEs perceived the Portal favorably with regard to time saving ability and improved workflow. Lessons learned included identifying core requirements early during system development and need for managers to institute and enforce consistent behavioral work norms. CONCLUSION: Barriers and HEs' views of technology impacted the utilization of the MASBIRT Portal. Further research is needed to determine best approaches for HIT system implementation in general medical settings.

Substance abuse treatment and HIV services: Massachusetts' policies and programs.

States and communities use many strategies and policies to facilitate the integration of HIV and AIDS services with alcoholism and drug abuse treatment and prevention programs. Massachusetts' policy initiatives that promoted collaboration between substance abuse programs and AIDS services are outlined. The review begins with an overview of the HIV epidemic in Massachusetts and reflects on the initial challenges of building system capacity so that HIV and substance abuse services could become more closely integrated. The discussion summarizes specific policy strategies implemented to encourage system development and to develop program and staff skills for working with men and women with HIV/AIDS and at risk of infection. The initiatives included integration of alcoholism and drug abuse treatment programs, expansion of Medicaid reimbursement for substance abuse treatment, training and skills development for counselors, and coordinated service development and advocacy for substance abuse and development for counselors, and coordinated service development and advocacy for substance abuse and AIDS/HIV services.

Ethics, standards, and TQM.

The most important ethical issue for our profession is the responsibility to assure the care delivered by our colleagues and ourselves meets a self-imposed standard of excellence. There is anecdotal and experimental evidence that we have not fulfilled this obligation. Peer review has proven, for a number of reasons, to be ineffective; however, improvements in the epidemiologic sciences should provide better standards and total quality management (TQM) might prove to be of value in monitoring, comparing and improving the decisions made by physicians. Its promise lies in its emphasis on statistical analysis, its focus on systematic rather than human error, and its use of outcomes as standards. These methods, however, should not diminish our other professional responsibilities: Altruism, peer review, and in Hippocrates' words "to prescribe regimens for the good of our patients-and never do harm to anyone."

Evaluating M.D.-level competence in internal medicine.

The faculty of the Department of Medicine at the University of Hawaii John A. Burns School of Medicine defines M.D.-level competence as the capability of undertaking the first day of a primary care internship. The implementation of a clinical clerkship in internal medicine that was flexible in time required that a new evaluation program be developed to assess the progress of students toward defined end points of competence. The four measures used are an objective test of basic medical knowledge, simulations to assess intellectual skills in problem-solving, a clinical skills examination with written standards to help the evaluator make discriminations between levels of performance, and a criterion-referenced rating scale to assess professional habits and attitudes. The progress of the classes of 1979 and 1980 toward achievement of predetermined levels of mastery is presented.

MD-level competence in internal medicine. Objectives and the flexible clerkship.

The faculty of the Department of Medicine at the John A. Burns School of Medicine, University of Hawaii, Honolulu, defined MD-level competence as the capability of undertaking the first day of a primary-care internship. To meet this goal, a curriculum was developed that used a written statement of expected competencies and objective measurements of student performance. The duration of the clinical clerkship was made flexible to acknowledge the normal variation in the rate at which students learn. Six weeks of ambulatory patient care were included in the basic third-year clerkship to fulfill objectives otherwise unmet.