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A bridge from classroom to providing actual patient care: A study of the Regenstrief tEMR

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Anonymized real-world platform gives learners realistic experience with health IT

INDIANAPOLIS – As electronic medical records (EMRs) are increasingly used across the United States, the next generation of physicians, nurses, social workers, pharmacists and other clinicians need to acquire new knowledge and competencies related to use of EMRs early in their clinical education. But training is not routinely provided.

A new study presents the functions and application of the novel, scalable Regenstrief teaching electronic medical record (tEMR) platform which contains a unique, large, anonymized patient database enabling health professions students to learn how to use health information technology (HIT) to best manage the complex issues presented by real-world patients.

“HIPAA [Health Insurance Portability and Accountability Act of 1996] has restricted access to EMRs so, ironically, the more EMRs are used, the less access students have to patient data, but the more they need to know,” said Regenstrief Institute Research Scientist Debra Litzelman, M.D., M.A., corresponding author of the new study and a professor of medicine at Indiana University School of Medicine. “Regenstrief tEMR offers detailed, anonymized data on complex patients as well as unique real-world functionality including patient sharing among care team members.”

“Medical, nursing, social work and other clinical trainees who have early exposure to EMRs will think differently about patient care and about future EMR development because of that early exposure. It creates a different mindset.”

Regenstrief tEMR offers a realistic virtual patient care experience, which the study noted was especially helpful during the early months of the COVID pandemic when students’ access to patients in health care settings was limited. The tEMR platform also enables and encourages interprofessional collaboration between learners pursuing different careers at diverse locations working at the same or different times.

Professional schools often have simulation centers teaching various skills such as CPR, intubation or robotic surgery procedures which trainees need to learn before they are on the job. Similarly, Regenstrief tEMR provides real-life simulation which prepares individuals for the real-world health IT environments they will enter.

The Regenstrief tEMR was created by the Regenstrief Institute along with IU School of Medicine, Eskenazi Health and the American Medical Association (AMA). Since 2013, the Regenstrief tEMR has been used at 12 health profession educational institutions. More than 11,800 students have accessed the system.

“Regenstrief teaching electronic medical record (tEMR) platform: a novel tool for teaching and evaluating applied health information technology” is published in JAMIA Open. Co-authors in addition to Dr. Litzelman are Blaine Y. Takesue, M.D., of IU School of Medicine and Regenstrief Institute; William M. Tierney, M.D., of IU Fairbanks School of Public Health at IUPUI and IU School of Medicine; Peter J. Embí, M.D., and Burke W. Mamlin, M.D., of Regenstrief Institute and IU School of Medicine and Jeff Warvel of Regenstrief Institute.

“With the exponential growth of health-related data and the impact of health information technology (HIT) on work-life balance, it is critical for students to get early EHR skills practice and understand how EHRs work. The ultimate tEMR project aim is to create tools through which our students — future educators, administrators, practice leaders, and front-line physicians — can develop enough HIT savvy to influence how HIT should be used in health care rather than HIT dictating how health care is delivered,” the study authors concluded.

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This project was supported by funding from the American Medical Association Accelerating Change in Medical Education initiative, a program that has provided more than $14 million to innovative projects at 37 medical schools since 2013, and the Regenstrief Institute.

About Regenstrief Institute

Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its research scientists are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe.

About IU School of Medicine

IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability.

About Debra Litzelman, M.D., M.A.

Debra Litzelman, M.D., M.A., is the associate director of the Regenstrief Institute William M. Tierney Center for Health Services Research and Indiana University Center for Health Services and Outcomes Research. She is also the D. Craig Brater Professor of Global Health Education at Indiana University School of Medicine.

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Source: https://bioengineer.org/a-bridge-from-classroom-to-providing-actual-patient-care-a-study-of-the-regenstrief-temr/

Bioengineer

Novel interactions between proteins that help in recovering from brain injury

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Neuroinflammatory response-induced proteases impede the recovery process from brain injury; novel interactions between proteins (hevin and calcyon) help in the recovery of neurons in a mature brain

Patients with brain injury (caused by stroke or trauma) primarily rely on rehabilitation therapy for recovery, as there are no other known effective treatment methods. The rate of recovery from brain injury observed in adults is significantly slower (or the recovery is impossible) than that observed in young children. The consensus among researchers is that the number of excess neural stem cells capable of restoring brain functions is lower in a mature brain than that in the brain of young children.

A Korean research team reported a novel mechanism to describe the brain injury recovery process. The researchers reported that when the animal model experiment was conducted, the time taken to recover from a brain injury could be controlled by regulating the proteins. The Korea Institute of Science and Technology (KIST) has released an announcement that a team led by Dr. Eun Mi Hwang of the Brain Science Institute, KIST collaborated with another team led by Prof. Kyoungho Suk of the School of Medicine, Kyungpook National University and reported the presence of a novel interaction between proteins (hevin-calcyon); this interaction plays a critical role in the brain injury recovery process in adults. The researchers also revealed that this interaction plays an important role in the early stages of recovery.

The researchers working at KIST identified the calcyon protein as a novel interaction partner of hevin, a protein secreted by the glial cells present in the brain. They also reported that the interaction between the proteins played a critical role in the recovery process of neuronal cells present in an injured adult brain. As neurons are cells that directly influence brain activity, it is believed that brain diseases can be cured when they are recovered and/or treated.

*Glial cells : Cells that support the tissues of the central nervous system, provide nutrients to neurons inside the brain and spinal cord, and create a chemical environment suitable for the activities of neurons

The results from the experiments revealed that an increase in the number of hevin-calcyon interactions in the brain could promote synaptic contacts and reorganization, which could help in the early recovery of the impaired brain. The hevin-calcyon interaction and the expression of these proteins were confirmed by studying healthy brain tissues. It was also observed that the number of interactions in patients suffering from the condition of traumatic brain injury was significantly reduced.

Researchers at the Kyungpook National University studied the recovery process of brain injury by studying the hevin and calcyon interaction using a brain injury animal model. They reported that the neuroinflammatory response-induced proteases formed in the early stages of brain injury resulted in the fragmentation of hevin. This also impeded the generation of the hevin and calcyon interaction. Experiments were conducted using an animal model of brain injury. It was observed that the recovery time could be reduced to approximately 2 to 3 weeks (from 4 weeks) if an inflammatory response inhibitor was administered directly to the injured region of the brain. The rate of recovery could be further slowed by administering an additional inflammatory protein.

The joint research team reported that the absence of the hevin-calcyon interaction in the early stages (a critical period in the recovery process of brain injury) of the recovery process might negatively impact the effective recovery process. The reported result is the outcome of the five years of persistent efforts by the team led by Dr. Eun Mi Hwang of KIST (this team identified the novel interaction between proteins), team led by Dr. Hoon Ryu of KIST (this team investigated human traumatic brain injury), and team led by Prof. Kyoungho Suk of the Kyungpook National University (this team studied the properties of inflammation using various animal models). Each team contributed to the findings based on their area of expertise.

Dr. Eun Mi Hwang of KIST said, “The hevin-calcyon interaction can potentially help in treating brain diseases as brain injury and neurodegenerative diseases can result in the generation of inflammatory responses.” She also added, “The findings can potentially help in the development of procedures for treating refractory brain diseases caused by impaired synaptogenic activity.”

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This research was conducted as a part of the Core Technology Development Project in Neuroscience funded by the National Research Foundation of Korea and supported by the Ministry of Science and ICT (MSIT). The results were published in the latest issue of “Cell Death & Differentiation” (IF: 10.717, top 6.229% in JCR), an international academic journal.

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Source: https://bioengineer.org/novel-interactions-between-proteins-that-help-in-recovering-from-brain-injury/

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New study uncovers details behind the body’s response to stress

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Findings could lead to new treatments for post-traumatic stress disorder and other conditions

Study Highlights

  • New research reveals how key proteins interact to regulate the body’s response to stress
  • Targeting these proteins may help treat or prevent stress-related psychiatric disorders

The biological mechanisms behind stress-related psychiatric conditions, including major depressive disorder and post-traumatic stress disorder (PTSD), are poorly understood.

New research now details the interplay between proteins involved in controlling the body’s stress response and points to potential therapeutic targets when this response goes awry. The study, which was conducted by an international team led by investigators at McLean Hospital, appears in the journal Cell Reports.

“A dysregulated stress response of the body can be damaging for the brain and promote susceptibility to mood and anxiety disorders,” said lead author Jakob Hartmann, PhD. Hartmann is an assistant neuroscientist in the Neurobiology of Fear Laboratory at McLean and an instructor in psychiatry at Harvard Medical School.

“A key brain region involved in the regulation of the stress response is the hippocampus,” said Hartmann. “The idea for this study occurred to us when we noticed interesting distinctions in hippocampal localization of three important stress-regulating proteins.”

The researchers’ experiments in non-human tissue and postmortem brain tissue revealed how these proteins–the glucocorticoid receptor (GR), the mineralocorticoid receptor (MR), and the FK506-binding protein 51 (FKBP5)–interact with each other.

Specifically, MRs, rather than GRs, control the production of FKBP5 under normal conditions. FKBP5 decreases GRs’ sensitivity to binding stress hormones during stressful situations. FKBP5 appears to fine-tune the stress response by acting as a mediator of the MR:GR balance in the hippocampus.

“Our findings suggest that therapeutic targeting of GR, MR, and FKBP5 may be complementary in manipulating central and peripheral regulation of stress,” said senior author Kerry J. Ressler, MD, PhD. Ressler is the chief scientific officer at McLean Hospital, chief of McLean’s Division of Depression and Anxiety Disorders, and a professor in psychiatry at Harvard Medical School.

“Moreover, our data further underline the important but largely unappreciated role of MR signaling in stress-related psychiatric disorders,” added Ressler. “The findings of this study will open new directions for future research.”

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ABOUT McLEAN HOSPITAL:

McLean Hospital has a continuous commitment to put people first in patient care, innovation and discovery, and shared knowledge related to mental health. It is consistently named the #1 freestanding psychiatric hospital in the United States by U.S. News & World Report. McLean Hospital is the largest psychiatric affiliate of Harvard Medical School and a member of Mass General Brigham. To stay up to date on McLean, follow us on Facebook, YouTube, and LinkedIn.

https://www.mcleanhospital.org/news/new-study-uncovers-details-behind-bodys-response-stress

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Scientists detect signatures of life remotely

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Left hands and right hands are almost perfect mirror images of each other. But whatever way they are twisted and turned, they cannot be superimposed onto each other. This is why the left glove simply won’t fit the right hand as well as it fits the left. In science, this property is referred to as chirality.

Just like hands are chiral, molecules can be chiral, too. In fact, most molecules in the cells of living organisms, such as DNA, are chiral. Unlike hands, however, that usually come in pairs of left and right, the molecules of life almost exclusively occur in either their “left-handed” or their “right-handed” version. They are homochiral, as researchers say. Why that is, is still not clear. But this molecular homochirality is a characteristic property of life, a so-called biosignature.

As part of the MERMOZ project (see info box), an international team led by the University of Bern and the National Centre of Competence in Research NCCR PlanetS, has now succeeded in detecting this signature from a distance of 2 kilometers and at a velocity of 70 kph. Jonas Kühn, MERMOZ project manager of the University of Bern and co-author of the study that has just been published in the journal Astronomy and Astrophysics, says: “The significant advance is that these measurements have been performed in a platform that was moving, vibrating and that we still detected these biosignatures in a matter of seconds.”

An instrument that recognizes living matter

“When light is reflected by biological matter, a part of the light’s electromagnetic waves will travel in either clockwise or counterclockwise spirals. This phenomenon is called circular polarization and is caused by the biological matter’s homochirality. Similar spirals of light are not produced by abiotic non-living nature”, says the first author of the study Lucas Patty, who is a MERMOZ postdoctoral researcher at the University of Bern and member of the NCCR PlanetS,

Measuring this circular polarization, however, is challenging. The signal is quite faint and typically makes up less than one percent of the light that is reflected. To measure it, the team developed a dedicated device called a spectropolarimeter. It consists of a camera equipped with special lenses and receivers capable of separating the circular polarization from the rest of the light.

Yet even with this elaborate device, the new results would have been impossible until recently. “Just 4 years ago, we could detect the signal only from a very close distance, around 20 cm, and needed to
observe the same spot for several minutes to do so”, as Lucas Patty recalls. But the upgrades to the instrument he and his colleagues made, allow a much faster and stable detection, and the strength of the signature in circular polarisation persists even with distance. This rendered the instrument fit for the first ever aerial circular polarization measurements.

Useful measurements on earth and in space

Using this upgraded instrument, dubbed FlyPol, they demonstrated that within mere seconds of measurements they could differentiate between grass fields, forests and urban areas from a fast moving helicopter. The measurements readily show living matter exhibiting the characteristic polarization signals, while roads, for example, do not show any significant circular polarization signals. With the current setup, they are even capable of detecting signals coming from algae in lakes.

After their successful tests, the scientists now look to go even further. “The next step we hope to take, is to perform similar detections from the International Space Station (ISS), looking down at the Earth. That will allow us to assess the detectability of planetary-scale biosignatures. This step will be decisive to enable the search for life in and beyond our Solar System using polarization”, says MERMOZ principal investigator and co-author Brice-Olivier Demory, professor of astrophysics at the University of Bern and member of the NCCR PlanetS says.

The sensitive observation of these circular polarization signals is not only important for future life detection missions. Lucas Patty explains: “Because the signal directly relates to the molecular composition of life and thus its functioning, it can also offer valuable complementary information in Earth remote sensing.” It can for instance provide information about deforestation or plant disease. It might even be possible to implement circular polarization in the monitoring of toxic algal blooms, of coral reefs and the effects of acidification thereon.

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Publication details:

C.H. Lucas Patty et. Al., Biosignatures of the Earth I. Airborne spectropolarimetric detection of photosynthetic life, Astronomy & Astrophysics
https://doi.org/10.1051/0004-6361/202140845

SAINT-EX – Search and characterisation of exoplanets

The SAINT-EX research group (funded by the SNF Professorship of Prof. Brice-Olivier Demory) focuses on the:

    -detection of temperate Earth-sized exoplanets (SAINT-EX observatory),

    -remote sensing of life in planetary atmospheres/surfaces (MERMOZ),

    -instrumentation for non-invasive, in-vivo cancer diagnosis and staging (BrainPol).

The MERMOZ (Monitoring planEtary suRfaces with Modern pOlarimetric characteriZation) project aims to investigate whether we can identify and characterize Earth’s life from space, by building a benchmark library of surface feature signatures with remote full-Stokes spectro-polarimetry. In this framework, our planet is considered as a proxy for other solar system bodies and exoplanets.

MERMOZ is a project in partnership between the Universities of Bern, Leiden and Delft (NL).

The project’s feasibility study is funded by the Centre for Space and Habitability (CSH) and the NCCR PlanetS.

More information on the SAINT-EX/MERMOZ research group: https://www.saintex.unibe.ch/

NCCR PlanetS: Planet research made in Switzerland

In 2014, the Swiss National Science Foundation awarded the University of Bern the National Centre for Competence in Research (NCCR) PlanetS, which it manages together with the University of Geneva.

Since its involvement in the first moon landing in 1969, the University of Bern has been participating in space missions of the major space organizations, such as ESA, NASA, ROSCOSMOS and JAXA. It is currently co-leading the European Space Agency’s (ESA) CHEOPS mission with the University of Geneva. In addition, Bernese researchers are among the world leaders when it comes to models and simulations of the formation and development of planets.

With the discovery of the first exoplanet, the University of Geneva positioned itself as one of the leading institutions in the field. This led, for example, to the construction and installation of the HARPS spectrograph on ESO’s 3.6 m telescope at La Silla in 2003 under Geneva’s leadership. This was followed by the ESPRESSO instrument on ESO’s VLT telescope in Paranal. The “Science Operation Center” of the CHEOPS mission is also in Geneva.

ETH Zurich and the University of Zurich are also partner institutions in the NCCR PlanetS. Scientists from the fields of Astrophysics, Data Processing and Earth Sciences lead projects and make important contributions to NCCR PlanetS research. In addition, ETH is a world leader in instrumentation for various observatories and space missions.

The NCCR PlanetS is organized into the following research areas:

    -Early stages of planet formation

    -Architecture of planetary systems, their formation and evolution

    -Atmospheres, surfaces and the interior of planets

    -Determination of the habitability of planets.

More information: http://nccr-planets.ch/

Bernese space exploration: With the world’s elite since the first moon landing

When the second man, “Buzz” Aldrin, stepped out of the lunar module on July 21, 1969, the first task he did was to set up the Bernese Solar Wind Composition experiment (SWC) also known as the “solar wind sail” by planting it in the ground of the moon, even before the American flag. This experiment, which was planned and the results analyzed by Prof. Dr. Johannes Geiss and his team from the Physics Institute of the University of Bern, was the first great highlight in the history of Bernese space exploration.

Ever since Bernese space exploration has been among the world’s elite. The University of Bern has been participating in space missions of the major space organizations, such as ESA, NASA, ROSCOSMOS and JAXA. It is currently co-leading the European Space Agency’s (ESA) CHEOPS mission with the University of Geneva. In addition, Bernese researchers are among the world leaders when it comes to models and simulations of the formation and development of planets.

The successful work of the Department of Space Research and Planetary Sciences (WP) from the Physics Institute of the University of Bern was consolidated by the foundation of a university competence center, the Center for Space and Habitability (CSH). The Swiss National Fund also awarded the University of Bern the National Center of Competence in Research (NCCR) PlanetS, which it manages together with the University of Geneva.

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Source: https://bioengineer.org/scientists-detect-signatures-of-life-remotely/

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nTIDE May 2021 COVID Update: Minimal changes in unemployment reflect slow pace of recovery

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National Trends in Disability Employment (nTIDE) – issued semi-monthly by Kessler Foundation and the University of New Hampshire

East Hanover, NJ. June 18, 2021. The May numbers for furloughed workers remained relatively steady, according to today’s National Trends in Disability Employment (nTIDE) COVID Update.

This mid-month nTIDE follows two key unemployment indicators – furloughs, or temporary layoffs, and the number of people looking for work, comparing trends for people with and without disabilities. The COVID-19 pandemic precipitated an unprecedented rise in furloughs and people looking for work, prompting the addition of this mid-month nTIDE COVID Update in the spring of 2020.

As shown in the updated graphic, May unemployment numbers showed a small increase in furloughs for people with disabilities, and a small decline for people without disabilities. For both groups, the numbers looking for work rose slightly. These changes do not alter the overall picture, which remains one of slow progress toward recovery, according to economist Andrew Houtenville, PhD, research director of the University of New Hampshire Institute on Disability, and co-author of nTIDE. “Unemployment appears to be leveling off but at a higher level,” he noted. “We’re still seeing the same levels we saw in the summer and fall of 2020. Could this be a new normal? It’s too early to say.”

As the pandemic subsides and economic activity increases, employers are seeking workers. Dr. Houtenville anticipates more openings for workers as sectors like travel, sports, and entertainment return to their pre-pandemic schedules. “As job openings increase, we will see a lot of shifting in the labor market. Recovery will continue, most likely at a slow pace,” he predicted. “It will take time to reduce these chronically high unemployment numbers.”

Rebuilding the economy offers opportunities to change the landscape for employment in the U.S. Dr. Houtenville noted: “By ensuring that their hiring initiatives are based on diversity, employers will contribute to an American workforce that is truly inclusive.”

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Because of observance of the Juneteenth holiday, no webinar was scheduled for this June 18 nTIDE COVID Update. Register for next month’s nTIDE webinars: July 2, 2021 nTIDE Jobs Report, and our July 23, 2021 COVID Update at https://researchondisability.org/home/ntide

This COVID Update is an extra edition of National Trends in Disability Employment (nTIDE), a joint project of Kessler Foundation and the University of New Hampshire Institute on Disability, co-authored by Dr. Houtenville and John O’Neill, PhD, of Kessler Foundation. The nTIDE team closely monitors the job numbers, issuing semi-monthly nTIDE reports, as the labor market continues to reflect the many challenges of the pandemic.

Funding: Kessler Foundation and the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR) (90RT5037)

About Kessler Foundation

Kessler Foundation, a major nonprofit organization in the field of disability, is a global leader in rehabilitation research that seeks to improve cognition, mobility, and long-term outcomes — including employment — for people with neurological disabilities caused by diseases and injuries of the brain and spinal cord. Kessler Foundation leads the nation in funding innovative programs that expand opportunities for employment for people with disabilities. For more information, visit KesslerFoundation.org.

About the Institute on Disability at the University of New Hampshire

The Institute on Disability (IOD) at the University of New Hampshire (UNH) was established in 1987 to provide a coherent university-based focus for the improvement of knowledge, policies, and practices related to the lives of persons with disabilities and their families. For information on the NIDILRR-funded Employment Policy and Measurement Rehabilitation Research and Training Center, visit ResearchonDisability.org.

Interested in trends on disability employment? Contact Carolann Murphy to arrange an interview with our experts: [email protected]

https://kesslerfoundation.org/press-release/ntide-may-2021-covid-unemployment-recovery

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Source: https://bioengineer.org/ntide-may-2021-covid-update-minimal-changes-in-unemployment-reflect-slow-pace-of-recovery/

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