101 research outputs found
Integrated Results Reporting: Moving Toward Electronic Health Records
A key achievement marking the University of Texas Health Center at Tyler’s movement toward Electronic Health Records (EHR) is the establishment of an integrated results reporting capability. Clinicians will be able to view results from most ancillary departments anywhere and at any time. This case study outlines the steps they took, the outcomes they achieved, and some of the lessons they have learned in the process
Using the Task Technology Fit Model as a Diagnostic Tool for Electronic Medical Records Systems Evaluation
Electronic Medical Records (EMR) systems offer health care organizations numerous potential benefits. However, it can be difficult to ascertain whether users are satisfied with such systems, and if not, where concerns exist. Organizations wishing to evaluate a health care system implementation like an EMR system can choose from a variety of approaches that have been developed in the Information Systems (IS) discipline. After evaluating a number of alternatives, the researchers selected the Task Technology Fit (TTF) model and its associated instrument as a diagnostic tool to evaluate the implementation of the first phase of an EMR at a university hospital. A survey was administered and an analysis of the data found that the EMR system users, both physicians and nurses, were generally very pleased with the EMR implementation, and, therefore, it could be deemed a success. Based upon this study the TTF model and its associated instrument appears to be a useful diagnostic tool for evaluating a health care information systems implementation
Linking goniometer measurements to hyperspectral and multi-sensor imagery for retrieval of beach properties and coastal characterization
In June 2011, a multi-sensor airborne remote sensing campaign was flown at the Virginia Coast Reserve Long Term Ecological Research site with coordinated ground and water calibration and validation (cal/val) measurements. Remote sensing imagery acquired during the ten day exercise included hyperspectral imagery (CASI-1500), topographic LiDAR, and thermal infra-red imagery, all simultaneously from the same aircraft. Airborne synthetic aperture radar (SAR) data acquisition for a smaller subset of sites occurred in September 2011 (VCR\u2711). Focus areas for VCR\u2711 were properties of beaches and tidal flats and barrier island vegetation and, in the water column, shallow water bathymetry. On land, cal/val emphasized tidal flat and beach grain size distributions, density, moisture content, and other geotechnical properties such as shear and bearing strength (dynamic deflection modulus), which were related to hyperspectral BRDF measurements taken with the new NRL Goniometer for Outdoor Portable Hyperspectral Earth Reflectance (GOPHER). This builds on our earlier work at this site in 2007 related to beach properties and shallow water bathymetry. A priority for VCR\u2711 was to collect and model relationships between hyperspectral imagery, acquired from the aircraft at a variety of different phase angles, and geotechnical properties of beaches and tidal flats. One aspect of this effort was a demonstration that sand density differences are observable and consistent in reflectance spectra from GOPHER data, in CASI hyperspectral imagery, as well as in hyperspectral goniometer measurements conducted in our laboratory after VCR\u2711
If You Build It, Will They Come? Challenges in E-learning Delivery System Choice
This study incorporates principles derived from ‘mindful technology adoption’, instructional design, technology acceptance models, and target learner needs assessments in order to determine whether or not e-learning technologies would be used by multi-organizational health administrators in their re-accreditation processes. It was initially hypothesized that these nontraditional, geographically dispersed, computer literate learners would be likely to use the elearning technologies, due to course flexibility, their full time work status, age and other variables. Results indicate that the sample had lower than expected intentions to use online learning resources, predictions that they would to use online learning resources, and plans to use an online learning system. The design of this study and its results are a case study that lends support for the need for mindful adoption of e-learning technologies. A needs assessment addressing the likeliness of technology acceptance is a critical first step in designing e-learning delivery systems, in order to ensure that e-learning technology investments are worthwhile
Receptor Cross-Talk Spatially Restricts p-ERK during TLR4 Stimulation of Autoreactive B Cells
To maintain tolerance, autoreactive B cells must regulate signal transduction from the B cell receptor and Toll-like receptors. We recently identified that dendritic cells and macrophages regulate autoreactive cells during TLR4 activation by releasing IL-6 and soluble CD40L (sCD40L). These cytokines selectively repress antibody secretion from autoreactive, but not antigenically naïve, B cells. How IL-6 and sCD40L repress autoantibody production is unknown. In this paper, we show that IL-6 and sCD40L are required for low-affinity/avidity autoreactive B cells to maintain tolerance through a mechanism involving receptor crosstalk between the BCR, TLR4, and the IL-6 receptor or CD40. We show that acute signaling through IL-6 receptor or CD40 integrates with chronic BCR-mediated ERK activation to restrict pERK from the nucleus and repress TLR4-induced Blimp-1 and XBP-1 expression. Tolerance is disrupted in 2-12H/MRL/lpr mice where IL-6 and sCD40L fail to spatially restrict pERK and fail to repress TLR4-induced Ig secretion. In the case of CD40, acute signaling in B cells from 2-12H/MRL/lpr mice is intact, but the chronic activation of pERK emanating from the BCR is attenuated. Re-establishing chronically active ERK through retroviral expression of constitutively active MEK1 restores tolerance upon sCD40L, but not IL-6, stimulation indicating that regulation by IL-6 requires another signaling effector. These data define the molecular basis for the regulation of low-affinity autoreactive B cells during TLR4 stimulation, they explain how autoreactive but not naïve B cells are repressed by IL-6 and sCD40L, and they identify B cell defects in lupus-prone mice that lead to TLR4-induced autoantibody production
Proteomic Analysis of S-Acylated Proteins in Human B Cells Reveals Palmitoylation of the Immune Regulators CD20 and CD23
S-palmitoylation is a reversible post-translational modification important for controlling the membrane targeting and function of numerous membrane proteins with diverse roles in signalling, scaffolding, and trafficking. We sought to identify novel palmitoylated proteins in B lymphocytes using acyl-biotin exchange chemistry, coupled with differential analysis by liquid-chromatography tandem mass spectrometry. In total, we identified 57 novel palmitoylated protein candidates from human EBV-transformed lymphoid cells. Two of them, namely CD20 and CD23 (low affinity immunoglobulin epsilon Fc receptor), are immune regulators that are effective/potential therapeutic targets for haematological malignancies, autoimmune diseases and allergic disorders. Palmitoylation of CD20 and CD23 was confirmed by heterologous expression of alanine mutants coupled with bioorthogonal metabolic labeling. This study demonstrates a new subset of palmitoylated proteins in B cells, illustrating the ubiquitous role of protein palmitoylation in immune regulation
Adaptive Evolution of the Venom-Targeted vWF Protein in Opossums that Eat Pitvipers
The rapid evolution of venom toxin genes is often explained as the result of a biochemical arms race between venomous animals and their prey. However, it is not clear that an arms race analogy is appropriate in this context because there is no published evidence for rapid evolution in genes that might confer toxin resistance among routinely envenomed species. Here we report such evidence from an unusual predator-prey relationship between opossums (Marsupialia: Didelphidae) and pitvipers (Serpentes: Crotalinae). In particular, we found high ratios of replacement to silent substitutions in the gene encoding von Willebrand Factor (vWF), a venom-targeted hemostatic blood protein, in a clade of opossums known to eat pitvipers and to be resistant to their hemorrhagic venom. Observed amino-acid substitutions in venom-resistant opossums include changes in net charge and hydrophobicity that are hypothesized to weaken the bond between vWF and one of its toxic snake-venom ligands, the C-type lectin-like protein botrocetin. Our results provide the first example of rapid adaptive evolution in any venom-targeted molecule, and they support the notion that an evolutionary arms race might be driving the rapid evolution of snake venoms. However, in the arms race implied by our results, venomous snakes are prey, and their venom has a correspondingly defensive function in addition to its usual trophic role
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