Stricter national standards are required for credentialing of endoscopic-retrograde-cholangiopan-creatography in the United States

Endoscopic-retrograde-cholangiopancreatography(ERCP) is now a vital modality with primarily therapeutic and occasionally solely diagnostic utility for numerous biliary/pancreatic disorders. It has a significantly steeper learning curve than that for other standard gastrointestinal(GI) endoscopies, such as esophagogastroduodenoscopy or colonoscopy, due to greater technical difficulty and higher risk of complications. Yet, GI fellows have limited exposure to ERCP during standard-three-year-GI-fellowships because ERCP is much less frequently performed than esophagogastroduodenoscopy/colonoscopy. This led to adding an optional year of training in therapeutic endoscopy. Yet many graduates from standard three-year-fellowships without advanced training intensely pursue independent/unsupervised ERCP privileges despite inadequate numbers of performed ERCPs and unacceptably low rates of successful selective cannulation of desired(biliary or pancreatic) duct. Hospital credentialing committees have traditionally performed ERCP credentialing, but this practice has led to widespread flouting of recommended guidelines(e.g., planned privileging of applicant with 20% successful cannulation rate, or after performing only 7 ERCPs);and intense politicking of committee members by applicants, their practice groups, and potential competitors. Consequently, some gastroenterologists upon completing standard fellowships train and learn ERCP 'on the job' during independent/unsupervised practice, which can result in bad outcomes: high rates of failed bile duct cannulation. This severe clinical problem is indicated by publication of ≥ 12 ERCP competency studies/guidelines during last 5 years. However, lack of mandatory, quantitative, ERCP credentialing criteria has permitted neglect of recommended guidelines. This work comprehensively reviews literature on ERCP credentialing;reviews rationales for proposed guidelines;reports problems with current system;and proposes novel criteria for competency. This work advocates for mandatory, national, written,minimum, quantitative, standards, including cognitive skills(possibly assessed by a nationwide examination), and technical skills, assessed by number performed(≥ 200-250 ERCPs), types of ERCPs, success rate(approximately ≥ 90%cannulation of desired duct), and letters of recommendation by program director/ERCP mentor. Mandatory criteria should ideally not be monitored by a hospital committee subjected to intense politicking by applicants, their employers, and sometimes even competitors, but an independent national entity,like the National Board of Medical Examiners/American Board of Internal Medicine.

Credentialing in radiology:Current practice and future challenges

Radiology has changed significantly in recent years. The volume of work has increased dramatically as has its complexity. Future radiologists need an adequate training and expertise in conventional practice as well as new techniques. This comes at a time when other stakeholders outside of radiology are voicing their own concerns. The rightly justified increasing focus on patient safety has placed even more emphasis on the demonstration of competent practice by all health care professionals. Credentialing has been put forward as a way to ensure a doctor is competent in specific areas. Credentialing may be an alien concept to many radiology trainees but moves are afoot in the United Kingdom to bring it to the forefront of its postgraduate medical training. Credentialing began in 20 th century North America where it was linked to the process of privileging. It subsequently garnered a strong patient safety focus and has become a part of the international healthcare agenda. Not everyone agrees with credentialing, it has many criticisms including the risk of speciality "turf wars" and the stifling of medical excellence to name just a couple. Is credentialing in radiology here to stay or will it pass by quietly? This paper reviews the global credentialing movement and discusses how this may impact on future radiology training, using the United Kingdom as its case example.

Discussion on the Implications of Expansion in Postgraduate Education

This paper explores the development of postgraduate education in China,including the overall situation of postgraduate education,the trend in enrollment expansion in professional degrees as well as in various academic fields;it also triggers the impact and discussion about the postgraduate enrollment expansion,such as over-education and credential inflation,as well as the concerns about the quality of education and talent cultivation and so forth.Although the expansion brings various problems,the challenges may also become new opportunities for higher education reform,this paper also provides some suggestions on the expansion of postgraduate education.

Construction and Implementation of a Privacy-Preserving Identity-Based Encryption Architecture

A recent proposal by Adams integrates the digital credentials (DC) technology of Brands with the identity-based encryption (IBE) technology of Boneh and Franklin to create an IBE scheme that demonstrably enhances privacy for users. We refer to this scheme as a privacy-preserving identity-based encryption (PP-IBE) construction. In this paper, we discuss the concrete implementation considerations for PP-IBE and provide a detailed instantiation (based on q-torsion groups in supersingular elliptic curves) that may be useful both for proof-of-concept purposes and for pedagogical purposes.

Agent based automated trust negotiation model

To enhance the practicability of the trust negotiation system, an agent based automated trust negotiation model （ABAM） is proposed. The ABAM introduces an agent to keep the negotiation process with no human intervention. Meanwhile, the ABAM specifies the format of a meta access control policy, and adopts credentials with flexible format to meet the requirements of access control policies instead of disclosing the whole contents of a certificate. Furthermore, the ABAM uses asymmetric functions with a high security intensity to encrypt the transmitting message, which can prevent information from being attacked. Finally, the ABAM presents a new negotiation protocol to guide the negotiation process. A use case is studied to illuminate that the ABAM is sound and reasonable. Compared with the existing work, the intelligence, privacy and negotiation efficiency are improved in the ABAM.

一种新的系统登录机制下USB key安全登录

为了防范人为恶意使用强行破解或密码盗取等手段获得操作系统权限,危害用户信息安全,提出了利用Vista,Win7登录的新机制Credential Provider,结合USB key特性,实现系统自动登录的一种新的方式.试验结果表明,这种在Credential与USB之间进行密码运算与交互验证的登录方式克服了口令登录的弱点,使使用木马等恶意软件盗取系统密码、人为清空磁盘密码区域和穷举系统密码等成为不可能,可很好地保证系统安全.

Is the ‘driving test’ a robust quality indicator of colonoscopy performance?

Colorectal cancer is a major cause of death in the western world and is currently the second commonest cause of death from malignant disease in the UK.Recently a "driving test" for colonoscopists wishing to take part in the National Health Service Bowel Cancer Screening Program has been introduced,with the aim of improving quality in colonoscopy.We describe the accreditation process and have reviewed the published evidence for its use.We compared this method of assessment to what occurs in other developed countries.To the authors' knowledge no other countries have similar methods of assessment of practicing colonoscopists,and instead use critical evaluation of key quality criteria.The UK appears to have one of the most rigorous accreditation processes,although this still has flaws.The published evidence suggests that the written part of the accreditation is not a good discriminating test and it needs to be improved or abandoned.Further work is needed on the best methods of assessing polypectomy skills.Rigorous systems need to be in place for the colonoscopist who fails the assessment.

Learning curve for double-balloon enteroscopy: Findings from an analysis of 282 procedures

AIM: To determine the learning curves for antegrade double-balloon enteroscopy (aDBE) and retrograde DBE (rDBE) by analyzing the technical success rates. METHODS: A retrospective analysis in a tertiary referral center. This study reviewed all cases from June 2006 to April 2011 with a target lesion in the small-bowel identified by either capsule endoscopy or computed tomography scan posted for DBE examinations. Main outcome measurements were: (1) Technical success of aDBE def ined by f inding or excluding a target lesion after achieving suff icient length of small bowel intubation; and (2) Technical success for rDBE was def ined by either f inding the target lesion or achieving stable overtube placement in the ileum. RESULTS: Two hundred and eighty two procedures fulf illed the inclusion criteria and were analyzed. These procedures were analyzed by blocks of 30 cases. Therewas no distinct learning curve for aDBE. Technical success rates for rDBE continued to rise over time, although on logistic regression analysis testing for trend, there was no signif icance (P = 0.09). The odds of success increased by a factor of 1.73 (95% CI: 0.93-3.22) for rDBE. For these data, it was estimated that at least 30-35 cases of rDBE under supervision were needed to achieve a good technical success of more than 75%. CONCLUSION: There was no learning curve for aDBE. Technical success continued to increase over time for rDBE, although a learning curve could not be proven statistically. Approximately 30-35 cases of rDBE will be required for stable overtube intubation in ileum.

The Mechanism about Key and Credential on Trusted Computing Platform and the Application Study

Trusted Computing technology is quickly developing in recent years. This technology manages to improve the computer security and archive a trusted computing environment. The core of trusted computing technology is cryptology. In this paper, we analyze the key and credential mechanism which is two basic aspects in the cryptology application of trusted computing. We give an example application to illustrate that the TPM enabled key and credential mechanism can improve the security of computer system.

A Workflow Authorization Model Based on Credentials

A workflow authorization model based on credentials was proposesed. It can nicely satisfy the features that workflows in actual application should satisfying. This model uses access control list based on task state which nicely ensure synchronizing authorization flow with workflow; specifies authorization policy not only based on user identifiers but also based on user qualifications and characteristics; defines a set of constraint rules for a task and seek the eligible users to execute the task according to the type of each constraint rule which realize dynamic separation of duty; and realizes the access granularity of authorization ranging from objects to specific parts of objects which ensure the least privilege constraints much more better.

Master’s Degree, a New Requirement to Become an RDN by 2024: A Comparison of Nutrition Graduate Programs Offered in the USA

Background: The registered dietetic four-year degree educational structure has been intact since 1926. Master level nutrition programs exist in the U.S., but are not standardized or accredited unlike four-year degrees. Academic requirements for nutrition graduate programs vary regionally across the nation. Objective: To 1) quantify and describe the availability of Master level nutrition programs regionally;and 2) examine the current M.A. and M.S. program requirements for a nutrition graduate degree in the U.S. Methods: Nutrition graduate programs (n = 201) were analyzed and compared by geographical region. Data were collected between August 2017 and May 2018. Inclusion criteria were defined as: nutrition graduate programs listed in the American Society of Nutrition (ASN) database that had a nutrition graduate program website. Descriptive statistical analysis measured evaluated variables. Results: A total of 201 nutrition graduate programs in the U.S. were identified. The title of the programs was categorized into 29 main themes. The most common nutrition graduate program title was a M.S. in Nutrition, 55 institutions (27.4%). A total of 181 institutions offered a M.S. with a required thesis, whereas 95 offered a M.S. with a non-thesis option, and only eight offered a M.A. Region 3-South offered the highest number of nutrition graduate programs (66), followed by region 2-Midwest with 49 programs, region 1-Northeast offered a total of 46 programs, and 37 programs were offered in region 4-West. Conclusion: In 2024, as part of the RD eligibility criteria, it will be required that students possess a master’s degree. To date, only one master’s program in the U.S. is accredited, which assures the student a measure of confidence of program rigor and accountability. Dietitians’ three major professional concerns: respect, recognition and rewards are predicated on rigorous educational programs that meet ACEND standards. It is unlikely that all U.S. master level programs will be accredited by 2024.

A Verifiable Credentials System with Privacy-Preserving Based on Blockchain

Decentralized identity authentication is generally based on blockchain, with the protection of user privacy as the core appeal. But traditional decentralized credential system requires users to show all the information of the entire credential to the verifier, resulting in unnecessary overexposure of personal information. From the perspective of user privacy, this paper proposed a verifiable credential scheme with selective disclosure based on BLS (Bohen- Lynn-Shacham) aggregate signature. Instead of signing the credentials, we sign the claims in the credentials. When the user needs to present the credential to verifier, the user can select a part of but not all claims to be presented. To reduce the number of signatures of claims after selective disclosure, BLS aggregate signature is achieved to aggregate signatures of claims into one signature. In addition, our scheme also supports the aggregation of credentials from different users. As a result, verifier only needs to verify one signature in the credential to achieve the purpose of batch verification of credentials. We analyze the security of our aggregate signature scheme, which can effectively resist aggregate signature forgery attack and credential theft attack. The simulation results show that our selective disclosure scheme based on BLS aggregate signature is acceptable in terms of verification efficiency, and can reduce the storage cost and communication overhead. As a result, our scheme is suitable for blockchain, which is strict on bandwidth and storage overhead.

Privacy-Preserving Trust Negotiation with Hidden Credentials and Hidden Policies in a Multi-Party Environment

Until now, there are numerous protocols that can achieve privacy-preserving trust negotiation between two parties involved, but there is no effective privacy-preserving trust negotiation schemes proposed between multi-users. In this paper, a privacy-preserving trust negotiation scheme with multi-parties is proposed, which can protect their credentials and access control policies during the procedure for establishing the trust between multi-strangers, and its privacy-preserving ability also is proved. These works extend the trust negotiation mechanism to multi-users, which can be thought as a substantial extension of the state-of-the-art in privacy-preserving trust negotiations between two parties involved.

SPCS: Secure and Privacy-Preserving Charging-Station Searching using VANET

Electric vehicle has attracted more and more attention all around the world in recent years because of its many advantages such as low pollution to the environment. However, due to the limitation of current technology, charging remains an important issue. In this paper, we study the problem of finding and making reservation on charging stations via a vehicular ad hoc network (VANET). Our focus is on the privacy concern as drivers would not like to be traced by knowing which charging stations they have visited. Technically, we make use of the property of blind signature to achieve this goal. In brief, an electric vehicle first generates a set of anonymous credentials on its own. A trusted authority then blindly signs on them after verifying the identity of the vehicle. After that, the vehicle can make charging station searching queries and reservations by presenting those signed anonymous credentials. We implemented the scheme and show that the credential signing process (expected to be the most time consuming step) can be completed within reasonable time when the parameters are properly set. In particular, the process can be completed in 5 minutes when 1024 bits of RSA signing key is used. Moreover, we show that our scheme is secure in terms of authentication and privacy-preserving.

Unlocking the power of blockchain in education:An overview of innovations and outcomes

Blockchain is a revolutionary technology that has the potential to revolutionize various industries,including finance,supply chain management,healthcare,and education.Its decentralized,secure,and transparent nature makes it ideal for use in industries where trust,security,and efficiency are of paramount importance.The integration of blockchain technology into the education system has the potential to greatly improve the efficiency,security,and credibility of the educational process.By creating secure and transparent platforms for tracking and verifying students’academic achievements,blockchain technology can help to create a more accessible and trustworthy education system,making it easier for students to showcase their skills and knowledge to potential employers.While the potential benefits of blockchain in education are significant,there are also several challenges that must be addressed in order to fully realize the potential of this technology in the educational sector.Some of the major challenges include adoption,technical knowledge,interoperability,regulation,cost,data privacy and security,scalability,and accessibility.The necessary equipment for the implementation of blockchain technology in education is diverse and critical to the success of this innovative technology.Organizations should carefully consider this equipment when planning their implementation of blockchain technology in education to ensure the efficient and secure transfer of educational data and transactions within the blockchain network.Blockchain technology has the potential to play a significant role in promoting sustainability education and advancing the sustainability goals of both individuals and organizations.Organizations should consider incorporating blockchain technology into their sustainability education programs,in order to enhance the transparency,verifiability,and efficiency of their sustainability-related activities.While the use of blockchain technology in education is still in its early stages,the available data suggest that it has significant potential to transform the education sector and improve the efficiency and transparency of educational systems.

Verifiable Badging System for scientific data reproducibility

Reproducibility can be considered as one of the basic requirements to ensure that a given research finding is accurate and acceptable.This paper presents a new layered approach that allows scientific researchers to provide a)data to fellow researchers to validate research and b)proofs of research quality to funding agencies,without revealing sensitive details associated with the same.We conclude that by integrating smart contracts,blockchain technology,and self-sovereign identity into an automated system,it is possible to assert the quality of scientific materials and validate the peer review process without the need of a central authority.