Who Guards the Guardians? Simplifying the Discovery of Electronic Medical Records

As medical errors reign as a leading cause of death and injury in the United States, the efficient and effective resolution of medical negligence disputes becomes increasingly necessary, albeit uncommon. Despite the frequency of medical errors, the quality of medical care in the United States has increased over the last several decades. This improvement has been due in no small part to the widespread adoption of Electronic Medical Records (EMRs) by healthcare providers across the country. While EMR systems have done their part to improve patient care, they are not designed for litigation. Indeed, the widespread use of EMR technology has created several unresolved legal issues that unnecessarily complicate the discovery process in medical negligence litigation. The substantial confusion surrounding the discovery of information within EMR systems invariably leads to an unnecessary motions practice that overburdens the judicial system\u27s limited resources. Three common and related legal problems include the Privilege Problem, the \u27Production Problem, and the Preservation Problem. The Privilege Problem concerns the possible interplay between HIPAA and the rules of discovery. The Production Problem refers to the undue costs and unreliability of a reproduced medical record for purposes of litigation. The Preservation Problem arises from the need to regularly update patient information. This Comment recommends that all litigants in a medical negligence action should have remote access to a patient\u27s EMR file and that certain changes should be made to the design of EMRs to ensure the integrity and reliability of the record during litigation

An Eye-Tracking Investigation of Facial Affect Recognition in Traumatic Brain Injury and Healthy Individuals

Traumatic Brain Injury (TBI) is considered a public health issue and affects millions of people worldwide. While individuals with TBI suffer from a variety of motor and cognitive deficits, this project focused on the social cognitive problems that individuals with TBI experience, specifically facial affect recognition. The primary goal of this study was to better understand facial affect recognition and how it is affected by attention abilities in individuals with TBI. In Experiment 1, we examined how facial affect recognition is associated with attentional abilities using correlational analyses in a sample of 28 participants. In Experiment 2, which was divided into 2 conditions, using a smaller sample size, we examined whether individuals with TBI process emotional faces fundamentally differently than healthy individuals using eye-tracking. Additionally in Experiment 2, we examined whether attentional abilities affected the way individuals with TBI process emotional faces using eye-tracking. In Condition 2A, participants had full attention in which they decided on what emotion a face was displaying. The hypothesis for Condition 2A was that TBI participants would perform worse on a facial affect recognition task than healthy controls (HC) and that gaze patterns would differ between TBI individuals and healthy controls. In Condition 2B, participants had divided attention as they also performed a distractor task while selecting what emotion was being displayed. The hypothesis for Condition 2B was both groups of participants would have a relatively worse performance on a facial affect recognition task when their attention was divided (compared to undivided), but TBI participants’ performance on the facial affect recognition task would decrease more significantly than healthy controls. Also in this condition, the hypothesis was that gaze patterns would differ between TBI individuals and healthy controls. Results for Experiment 1 showed a relationship between a measure of facial affect recognition abilities and two measures of attention. In Experiment 2, Condition 2A and 2B, we found significant differences in performance on the facial affect recognition task between TBI and HC participants as TBI participants were less accurate on correctly identifying the emotions that were displayed on faces compared to HC participants. In Condition 2A, we found a significant difference in the amount of total fixations in critical areas of the face that TBI and HC participants made while viewing an emotional face when they had full attention. In Experiment 2, Condition 2A and 2B, we found a significant difference in the amount of time TBI and HC participants viewed (dwelled on) critical areas of an emotional face as TBI participants viewed critical areas of the face for less time compared to HC participants. This research is important because it may serve as an example of how gaze patterns differ between TBI individuals and healthy individuals and be used to plan better treatments for individuals with TBI that suffer from impaired facial affect recognition abilities

Traumatic Bone Bruises in the Athlete’s Knee

Context: Mobile water within the bone marrow is a physiological phenomenon that is identifiable on magnetic resonance (MR) imaging, and signal changes can result from blood pooling, reactive hyperemia, edema, and microfracture. When these MR lesions are associated with an acute traumatic event, the findings are referred to as bone bruises and so represent a unique manifestation of injury. This review discusses bone bruises in anterior cruciate ligament (ACL) tears, patella dislocations, occult fractures, and contusions. Methods: A PubMed search of the literature from 1982 to December 2009 was conducted with the terms knee and bone bruise. Results:: Bone bruises are associated with ACL tears, patella dislocations, occult fractures, and contusions. For each injury, a unique pattern of bone bruising is found on MR imaging, which results from the acute trauma. When acute trauma produces a subchondral lesion with low T1-weighted and high T2-weighted signal intensity, the resulting bony contusion is best described as a bone bruise. Conclusions:: Bone marrow edema is identified using MR imaging and may result from traumatic or atraumatic causes. Bone bruises can be characterized by their pattern at presentation, by the mechanism of injury, and by their associated injuries. This type of bone edema can accompany contact and noncontact ACL ruptures as well as patella dislocations. Although increased marrow edema can be associated with an occult fracture, the long-term significance of these lesions is unclear

Preliminary evaluation of a robotic apparatus for the analysis of passive glenohumeral joint kinematics

Background: The shoulder has the greatest range of motion of any joint in the human body. This is due, in part, to the complex interplay between the glenohumeral (GH) joint and the scapulothoracic (ST) articulation. Currently, our ability to study shoulder kinematics is limited, because existing models isolate the GH joint and rely on manual manipulation to create motion, and have low reproducibility. Similarly, most established techniques track shoulder motion discontinuously with limited accuracy. Methods: To overcome these problems, we have designed a novel system in which the shoulder girdle is studied intact, incorporating both GH and ST motions. In this system, highly reproducible trajectories are created using a robotic actuator to control the intact shoulder girdle. High-speed cameras are employed to track retroreflective bone markers continuously. Results: We evaluated this automated system’s capacity to reproducibly capture GH translation in intact and pathologic shoulder conditions. A pair of shoulders (left and right) were tested during forward elevation at baseline, with a winged scapula, and after creation of a full thickness supraspinatus tear. Discussion The system detected differences in GH translations as small as 0.5 mm between different conditions. For each, three consecutive trials were performed and demonstrated high reproducibility and high precision

Design and manufacture of a novel system to simulate the biomechanics of basic and pitching shoulder motion

Objectives: Cadaveric models of the shoulder evaluate discrete motion segments using the glenohumeral joint in isolation over a defined trajectory. The aim of this study was to design, manufacture and validate a robotic system to accurately create three-dimensional movement of the upper body and capture it using high-speed motion cameras. Methods: In particular, we intended to use the robotic system to simulate the normal throwing motion in an intact cadaver. The robotic system consists of a lower frame (to move the torso) and an upper frame (to move an arm) using seven actuators. The actuators accurately reproduced planned trajectories. The marker setup used for motion capture was able to determine the six degrees of freedom of all involved joints during the planned motion of the end effector. Results: The testing system demonstrated high precision and accuracy based on the expected versus observed displacements of individual axes. The maximum coefficient of variation for displacement of unloaded axes was less than 0.5% for all axes. The expected and observed actual displacements had a high level of correlation with coefficients of determination of 1.0 for all axes. Conclusions: Given that this system can accurately simulate and track simple and complex motion, there is a new opportunity to study kinematics of the shoulder under normal and pathological conditions in a cadaveric shoulder model

The Database for Aggregate Analysis of ClinicalTrials.gov (AACT) and Subsequent Regrouping by Clinical Specialty

BACKGROUND: The ClinicalTrials.gov registry provides information regarding characteristics of past, current, and planned clinical studies to patients, clinicians, and researchers; in addition, registry data are available for bulk download. However, issues related to data structure, nomenclature, and changes in data collection over time present challenges to the aggregate analysis and interpretation of these data in general and to the analysis of trials according to clinical specialty in particular. Improving usability of these data could enhance the utility of ClinicalTrials.gov as a research resource. METHODS/PRINCIPAL RESULTS: The purpose of our project was twofold. First, we sought to extend the usability of ClinicalTrials.gov for research purposes by developing a database for aggregate analysis of ClinicalTrials.gov (AACT) that contains data from the 96,346 clinical trials registered as of September 27, 2010. Second, we developed and validated a methodology for annotating studies by clinical specialty, using a custom taxonomy employing Medical Subject Heading (MeSH) terms applied by an NLM algorithm, as well as MeSH terms and other disease condition terms provided by study sponsors. Clinical specialists reviewed and annotated MeSH and non-MeSH disease condition terms, and an algorithm was created to classify studies into clinical specialties based on both MeSH and non-MeSH annotations. False positives and false negatives were evaluated by comparing algorithmic classification with manual classification for three specialties. CONCLUSIONS/SIGNIFICANCE: The resulting AACT database features study design attributes parsed into discrete fields, integrated metadata, and an integrated MeSH thesaurus, and is available for download as Oracle extracts (.dmp file and text format). This publicly-accessible dataset will facilitate analysis of studies and permit detailed characterization and analysis of the U.S. clinical trials enterprise as a whole. In addition, the methodology we present for creating specialty datasets may facilitate other efforts to analyze studies by specialty groups

Building capacity for HIV/AIDS program leadership and management in Uganda through mentored Fellowships

Background: Around the world, health professionals and program managers are leading and managing public and private health organizations with little or no formal management and leadership training and experience. Objective: To describe an innovative 2-year, long-term apprenticeship Fellowship training program implemented by Makerere University School of Public Health (MakSPH) to strengthen capacity for leadership and management of HIV/AIDS programs in Uganda. Implementation process: The program, which began in 2002, is a 2-year, full-time, non-degree Fellowship. It is open to Ugandan nationals with postgraduate training in health-related disciplines. Enrolled Fellows are attached to host institutions implementing HIV/AIDS programs and placed under the supervision of host institution and academic mentors. Fellows spend 75% of their apprenticeship at the host institutions while the remaining 25% is dedicated to didactic short courses conducted at MakSPH to enhance their knowledge base. Achievements: Overall, 77 Fellows have been enrolled since 2002. Of the 57 Fellows who were admitted between 2002 and 2008, 94.7% (54) completed the Fellowship successfully and 50 (92.3%) are employed in senior leadership and management positions in Uganda and internationally. Eighty-eight percent of those employed (44/54) work in institutions registered in Uganda, indicating a high level of in-country retention. Nineteen of the 20 Fellows who were admitted between 2009 and 2010 are still undergoing training. A total of 67 institutions have hosted Fellows since 2002. The host institutions have benefited through staff training and technical expertise from the Fellows as well as through grant support to Fellows to develop and implement innovative pilot projects. The success of the program hinges on support from mentors, stakeholder involvement, and the hands-on approach employed in training. Conclusion: The Fellowship Program offers a unique opportunity for hands-on training in HIV/AIDS program leadership and management for both Fellows and host institutions

Blended learning for teacher professional learning

Lärare behöver professionellt lärande för att skolresultaten ska förbättras. För att det ska göra skillnad för alla elever så behöver alla lärare delta i den. Samtidigt visas en brist på organiserat professionellt lärande för lärare (Skolverket, 2013). Digitaliseringen skapar nya möjligheter. Lärande online kännetecknas av att vara flexibel tids- och rumsmässigt. Något som kan möta det tidsmässiga hinder som skolledare uttrycker (Skolinspektionen, 2015). Forskning, av Means et al. (2009), visar att lärande med blended learning; där undervisning och lärande i det fysiska rummet kombineras med undervisning och lärande online, ger bättre effekt än lärande helt fysiskt respektive helt online. Denna studie har tittat på hur de olika undervisningsmiljöerna i blended learning; fysiskt respektive online, kan tillämpas för att skapa förutsättningar för ett framgångsrikt professionellt lärande. Metoden metasyntes har använts för att sätta samman resultat från olika studier i syfte att skapa en samling vetenskapligt grundade råd; en best practice att luta sig på vid framtida planering. Studien är teoretiskt influerad av ett sociokulturellt perspektiv på lärande. Metasyntesen visar att blended learning kan vara en god form att tillämpa. Det är tydligt att de båda undervisningsmiljöerna; fysiskt och online, är viktiga. Vid de fysiska träffarna vårdas och stärks sociala relationer, medan onlinemiljön erbjuder en betydelsefull tids- och rumsmässig flexibilitet. Förutsättningar för ett framgångsrikt professionellt lärande med blended learning är att strukturella resurser som god IT-miljö och avsatt tid för lärandet finns. Metasyntesen är tänkt som ett stöd för skolledare och andra beslutsfattare inför planering av framtida professionellt lärande för grundskollärare.Teachers need professional learning opportunities to improve school results. To have impact for all students, all teachers need to participate. However, there is currently an acknowledged lack of organized professional learning for teachers (Skolverket, 2013). Technology creates new possibilities. Online learning is known to be flexible in terms of time and space, a feature that can help meet the time-related obstacles that school leaders report (Skolinspektionen, 2015). Research, by Means et al. (2009), shows that blended learning, a method where teaching and learning face-to-face is combined with teaching and learning online, has a better effect then exclusively face-to-face or online approaches. This study has explored how the different teaching environments in a blended learning approach; face-to-face and online, can be used to create successful professional learning opportunities. The method used is research synthesis to combine results from different studies in order to create an overarching account of best practice to draw on during future planning. The study is theoretical influenced by a sociocultural view of learning. The research synthesis shows that blended learning can be a promising approach. It is clear that both the teaching environments; face-to-face and online, are important. It shows that social relationships are particularly strengthened by face-to-face meetings, while online solutions offer increased flexibility in terms of time and space. The results also show that necessary conditions for successful blended learning initiatives include structural resources such as good ICT and allocated time for learning. This research synthesis is intended to support school leaders and policymakers in the planning of future teacher professional learning

ER Stress-Induced Aggresome Trafficking of HtrA1 Protects Against 1! Proteotoxicity

High temperature requirement A1 (HtrA1) belongs to an ancient protein family that is linked to various human disorders. The precise role of exon 1-encoded N-terminal domains and how these influence the biological functions of human HtrA1 remain elusive. In this study, we traced the evolutionary origins of these N-terminal domains to a single gene fusion event in the most recent common ancestor of vertebrates. We hypothesized that human HtrA1 is implicated in unfolded protein response. In highly secretory cells of the retinal pigmented epithelia, endoplasmic reticulum (ER) stress upregulated HtrA1. HtrA1 co-localized with vimentin intermediate filaments in highly arborized fashion. Upon ER stress, HtrA1 tracked along intermediate filaments, which collapsed and bundled in an aggresome at the microtubule organizing center. Gene silencing of HtrA1 altered the schedule and amplitude of adaptive signaling and concomitantly resulted in apoptosis. Restoration of wild-type HtrA1, but not its protease inactive mutant, was necessary and sufficient to protect from apoptosis. A variant of HtrA1 that harbored exon 1 substitutions displayed reduced efficacy in rescuing cells from proteotoxicity. Our results illuminate the integration of HtrA1 in the toolkit of mammalian cells against protein misfolding and the implications of defects in HtrA1 in proteostasis

The nuclear hormone receptor gene Nr2c1 (Tr2) is a critical regulator of early retina cell patterning.

Nuclear hormone receptors play a major role in the development of many tissues. This study uncovers a novel role for testicular receptor 2 (Tr2, Nr2c1) in defining the early phase of retinal development and regulating normal retinal cell patterning and topography. The mammalian retina undergoes an overlapping yet biphasic period of development to generate all seven retinal cell types. We discovered that Nr2c1 expression coincides with development of the early retinal cells. Loss of Nr2c1 causes a severe vision deficit and impacts early, but not late retina cell types. Retinal cone cell topography is disrupted with an increase in displaced amacrine cells. Additionally, genetic background significantly impacts phenotypic outcome of cone photoreceptor cells but not amacrine cells. Chromatin-IP experiments reveal NR2C1 regulates early cell transcription factors that regulate retinal progenitor cells during development, including amacrine (Satb2) and cone photoreceptor regulators thyroid and retinoic acid receptors. This study supports a role for Nr2c1 in defining the biphasic period of retinal development and specifically influencing the early phase of retinal cell fate