Patient access to complex chronic disease records on the internet

Background: Access to medical records on the Internet has been reported to be acceptable and popular with patients, although most published evaluations have been of primary care or office-based practice. We tested the feasibility and acceptability of making unscreened results and data from a complex chronic disease pathway (renal medicine) available to patients over the Internet in a project involving more than half of renal units in the UK. Methods: Content and presentation of the Renal PatientView (RPV) system was developed with patient groups. It was designed to receive information from multiple local information systems and to require minimal extra work in units. After piloting in 4 centres in 2005 it was made available more widely. Opinions were sought from both patients who enrolled and from those who did not in a paper survey, and from staff in an electronic survey. Anonymous data on enrolments and usage were extracted from the webserver. Results: By mid 2011 over 17,000 patients from 47 of the 75 renal units in the UK had registered. Users had a wide age range (<10 to >90 yrs) but were younger and had more years of education than non-users. They were enthusiastic about the concept, found it easy to use, and 80% felt it gave them a better understanding of their disease. The most common reason for not enrolling was being unaware of the system. A minority of patients had security concerns, and these were reduced after enrolling. Staff responses were also strongly positive. They reported that it aided patient concordance and disease management, and increased the quality of consultations with a neutral effect on consultation length. Neither patient nor staff responses suggested that RPV led to an overall increase in patient anxiety or to an increased burden on renal units beyond the time required to enrol each patient. Conclusions: Patient Internet access to secondary care records concerning a complex chronic disease is feasible and popular, providing an increased sense of empowerment and understanding, with no serious identified negative consequences. Security concerns were present but rarely prevented participation. These are powerful reasons to make this type of access more widely available

Tracking Users across the Web via TLS Session Resumption

User tracking on the Internet can come in various forms, e.g., via cookies or by fingerprinting web browsers. A technique that got less attention so far is user tracking based on TLS and specifically based on the TLS session resumption mechanism. To the best of our knowledge, we are the first that investigate the applicability of TLS session resumption for user tracking. For that, we evaluated the configuration of 48 popular browsers and one million of the most popular websites. Moreover, we present a so-called prolongation attack, which allows extending the tracking period beyond the lifetime of the session resumption mechanism. To show that under the observed browser configurations tracking via TLS session resumptions is feasible, we also looked into DNS data to understand the longest consecutive tracking period for a user by a particular website. Our results indicate that with the standard setting of the session resumption lifetime in many current browsers, the average user can be tracked for up to eight days. With a session resumption lifetime of seven days, as recommended upper limit in the draft for TLS version 1.3, 65% of all users in our dataset can be tracked permanently.Comment: 11 page

Types of deception and underlying motivation: what people think

In computer-mediated communication, there are various types of possible deception such as category deception (gender switching), attractiveness deception, or identity concealment. The present article argues that it is meaningful to differentiate among these types of deception. More specifically, it is assumed that people attribute the various types of deception to different motivations and that these assumed motivations determine the evaluation of the deception. To examine whether individuals indeed attribute different types of deception to different underlying motivations, a scenario study was conducted. The results were in line with the expectations. For example, identity concealment was mainly attributed to privacy concerns, whereas gender switching was mainly perceived as playing with new roles and unknown aspects of the self. The assumed malicious intention predicted the evaluation of the deception

Biomarkers of Nutrition for Development (BOND)—Iron Review

This is the fifth in the series of reviews developed as part of the Biomarkers of Nutrition for Development (BOND) program. The BOND Iron Expert Panel (I-EP) reviewed the extant knowledge regarding iron biology, public health implications, and the relative usefulness of currently available biomarkers of iron status from deficiency to overload. Approaches to assessing intake, including bioavailability, are also covered. The report also covers technical and laboratory considerations for the use of available biomarkers of iron status, and concludes with a description of research priorities along with a brief discussion of new biomarkers with potential for use across the spectrum of activities related to the study of iron in human health. The I-EP concluded that current iron biomarkers are reliable for accurately assessing many aspects of iron nutrition. However, a clear distinction is made between the relative strengths of biomarkers to assess hematological consequences of iron deficiency versus other putative functional outcomes, particularly the relationship between maternal and fetal iron status during pregnancy, birth outcomes, and infant cognitive, motor and emotional development. The I-EP also highlighted the importance of considering the confounding effects of inflammation and infection on the interpretation of iron biomarker results, as well as the impact of life stage. Finally, alternative approaches to the evaluation of the risk for nutritional iron overload at the population level are presented, because the currently designated upper limits for the biomarker generally employed (serum ferritin) may not differentiate between true iron overload and the effects of subclinical inflammation

Service Equality in Virtual Reference

Research is divided about the potential of e-service to bridge communication gaps, particularly to diverse user groups. According to the existing body of literature, e-service may either increase or decrease the quality of service received. This study analyzes the level of service received by different genders and ethnic groups when academic and public librarians answer 676 online reference queries. Quality of e-service was evaluated along three dimensions: timely response, reliability, and courtesy. This study found no significant differences among different user groups along any of these dimensions, supporting the argument that the virtual environment facilitates equitable service and may overcome some challenges of diverse user groups