623 research outputs found
Formation of AP-3 transport intermediates requires Vps41 function
No full textTransport of a subset of membrane proteins to the yeast vacuole requires the function of the AP-3 adaptor protein complex. To define the molecular requirements of vesicular transport in this pathway, we used a biochemical approach to analyse the formation and content of the AP-3 transport intermediate. A vam3tsf (vacuolar t-SNARE) mutant blocks vesicle docking and fusion with the vacuole and causes the accumulation of 50–130-nanometre membrane vesicles, which we isolated and showed by biochemical analysis and immunocytochemistry to contain both AP-3 adaptors and alkaline phosphatase (ALP) pathway cargoes. Inactivation of AP-3 or the protein Vps41 blocks formation of this vesicular intermediate. Vps41 binds to the AP-3 δ-adaptin subunit, suggesting that they function together in the formation of ALP pathway transport intermediates at the late Golgi
A Case Study: Recall of Mathematical Facts Comparing Students Labeled Educable Mentally Retarded (EMR) with their Average Peers
No full textAs the number of inclusion classrooms continue sto grow across the country, educators are quickly noticing the enormous span in ability level among students in one classroom. Given the large number of learning disabilities, the well-known ones often overshadow the less commonly known disabilities. Programs designed to best suit the needs of a majority of students in an inclusion classroom can thus miss the needs of students with these uncommon disabilities. Educable Mental Retardation (EMR) is interpreted as a student who cannot function in society or a classroom without additional help. This case study is designed to understand the abilities of students who are identified as EMR so that programs can be designed to meet their needs in the classroom. The author examined a blended third/fourth grade classroom which included students with special needs and two students with EMR. The author asked:
Are Educable Mentally Retarded (EMR) students able to recall the same amount of mathematical information as average students? Which activities do the students who are EMR believe are most beneficial to them when learning multiplication? Students were taught multiplication facts using several different strategies designed to assist recall. Several tests were given to assess recall ability. Following the study, two random students and the two students with EMR with interviewed. The author found that the students with EMR were unable to recall the same amount of information as average students. Daily repetition of facts and strategies, as well as one-on-one support is found to be beneficial.SUNY BrockportEducation and Human DevelopmentMaster of Science in Education (MSEd)Education and Human Development Master's These
EMR Metadata Uses and E-Discovery
No full textIn this article, the author discusses how the metadata found in an Electronic Medical Record (EMR) can be used as evidence in litigation under the 2006 amended Rules of Civil Procedure and the Federal Rules of Evidence. The article first reviews how EMR metadata can profile the actions a physician takes when caring for a patient. The author then looks at the relevant changes to the Rules and analyzes case law concerning both electronic discovery (e-discovery) and metadata. Finally, the author examines how EMR metadata specifically impacts physicians who are involved in litigation, as metadata may be used as the standard for authentication of the EMR and can give insight into a patient\u27s clinical outcome
Class C Vps protein complex regulates vacuolar SNARE pairing and is required for vesicle docking/fusion
No full textIn yeast, the Class C Vps protein complex (C-Vps complex), composed of Vps11, Vps16, Vps18, and Vps33, functions in Golgi-to-vacuole protein transport. In this study, we characterized and purified this complex and identified its interaction with the syntaxin homolog Vam3. Vam3 pairs with the SNAP-25 homolog Vam7 and VAMP homolog Vti1 to form SNARE complexes during vesicle docking/fusion with the vacuole. The C-Vps complex does not bind to Vam3-Vti1-Vam7 paired SNARE complexes but instead binds to unpaired Vam3. Antibodies to a component of this complex inhibited in vitro vacuole-to-vacuole fusion. Furthermore, temperature-conditional mutations in the Class C VPS genes destabilized Vam3-Vti1-Vam7 pairing. Therefore, we propose that the C-Vps complex associates with unpaired (activated) Vam3 to mediate the assembly of trans-SNARE complexes during both vesicle docking/fusion and vacuole-to-vacuole fusion
Feasibility of Embedding a Randomised Clinical Trial (RCT) into an Electronic Medical Record (EMR) for Patients Admitted to an Intensive Care Unit (ICU)
No full textTo establish the feasibility of embedding an RCT into EMR in the ICU, we evaluated the route of phosphate replacement. The EMR screened 207 patients who met the inclusion criteria from 20 April 2022 to 30 June 2022. 162 patients were randomised and 145 patients allocated to treatment. Our study showed that it was feasible to embed screening, randomisation, and treatment allocation for an RCT within an EMR in the ICU
Professional Facing Coercive Work Formalization: Vicious Circle of the Electronic Medical Record (EMR) Implementation and Appropriation
No full textAbstractThis paper shows that, according to many studies, the implementation of the Electronic Medical Record (EMR) does not cause efficient uses as expected in hospitals. Authors suggest explanatory factors, including both generic factors related to the implementation of ERP and specific factors related to health sector, in particular to professional bureaucracies (professional autonomy, divergence of goals, lack of coordination). The paper highlights the risk of a vicious circle of clinical process computerization, similar to bureaucratic vicious circle described by Crozier (Crozier 1965). Specifically, the convergence of two information systems, the clinical one and the administrative one inside the EMR, is a source of conflict between two logics, one focused on the professional to manage the care of a given patient, and the other focused on the resources management for all patients. The dominance of the administrative logic, consisting in monitoring and promoting coercive formalization, is likely to reduce the professional adjustment and autonomy, to cause their resistance and, consequently, the absence of effective uses, which lead back a strengthening of the control logic. The author shows interest to consider this conflict to reverse the situation by enabling approach, using professional autonomy as lever
Understanding the mechanism of cargo recognition by the Ssh4-Rsp5 ubiquitin ligase complex at the yeast vacuole membrane
No full textThe preservation of a healthy proteome is important for all cellular function. Sequential protein quality control (QC) mechanisms along the endocytic pathway safeguard the identity of different organelles by eliminating damaged or mislocalized proteins. In Saccharomyces cerevisiae, the Rsp5 ubiquitin ligase is required for cargo ubiquitination at all steps of endocytic QC, and its activity is mediated by its recruitment to organelle membranes by specific adaptors. The ART adaptor network directs Rsp5 to the plasma membrane (PM), while the intracellular adaptor Ssh4 recruits it to the vacuole membrane (VM). This study shows that PM proteins mistargeted to the VM are recognized and sorted by the Ssh4-Rsp5 complex and that Ssh4 contains important features that facilitate its cargo sorting. Furthermore, Ssh4-Rsp5-mediated QC employs a seemingly promiscuous mechanism of cargo recognition at the VM. Finally, targeting Ssh4 to the PM induces some non-specific degradation of PM proteins that are accessible to Ssh4-Rsp5
Using EMR-enabled computerized decision support systems to reduce prescribing of potentially inappropriate medications: a narrative review
No full textPrescribing of potentially inappropriate medications (PIMs) that pose more risk than benefit in older patients is a common occurrence across all healthcare settings. Reducing such prescribing has been challenging despite multiple interventions, including educational campaigns, audits and feedback, geriatrician assessment and formulary restrictions. With the increasing uptake of electronic medical records (EMRs) across hospitals, clinics and residential aged care facilities (RACFs), integrated with computerized physician order entry (CPOE) and e-prescribing, opportunities exist for incorporating clinical decision support systems (CDSS) into EMR at the point of care. This narrative review assessed the process and outcomes of using EMR-enabled CDSS to reduce the prescribing of PIMs. We searched PubMed for relevant articles published up to January 2018 and focused on those that described EMR-enabled CDSS that assisted prescribers to make changes at the time of ordering PIMs in adults. Computerized systems offering only medication reconciliation, dose checks, monitoring for medication errors, or basic formulary information were not included. In addition to outcome measures of medication-related processes and adverse drug events, qualitative data relating to factors that influence effectiveness of EMR-enabled CDSS were also gathered from selected studies. We analysed 20 studies comprising 10 randomized trials and 10 observational studies performed in hospitals (n = 8), ambulatory care clinics (n = 9) and RACFs (n = 3). Studies varied in patient populations (although most involved older patients), type of CDSS, method of linkage with EMR, study designs and outcome measures. However, assuming little publication bias, the totality of evidence favoured EMR-enabled CDSS as being effective in reducing the prescribing of PIMs in hospitals, although results were more mixed for ambulatory care settings and RACFs. While absolute effects in most positive studies were modest, they suggest EMR-enabled CDSS are feasible and acceptable to clinicians, and if certain design features are adhered to, there is potential for even greater impact
ML-based Cyber Incident Detection for Electronic Medical Record (EMR) Systems
No full textAn upward trend in cyber incidents across both U.K. and U.S. hospitals has been observed since 2015. Attacks range from identity theft to insurance fraud and extortion/blackmail. The Electronic Medical Record (EMR) systems used in hospitals are targeted due to the sensitivity of data within a healthcare setting. This work is motivated by the necessity to protect patient information and to ensure the availability of such EMR systems. A failure in either case can have grave implications for patients being treated and practitioners using the system. In this research, we propose the application of Machine Learning (ML) and Time Series (TS) anomaly detection to the problem of confidentiality and availability attacks on EMR systems. The results presented in this paper indicate that confidentiality incident detection is fully achievable using ML, with Support Vector Machines obtaining the highest accuracy, precision and recall of a number of models tested. Results from the availability prototype show that the detection of a message surge is possible within 10 seconds, by using an Exponential Moving Average implementation to identify anomalies in message flow. This finding paves the way for an automated surge defence to be developed, presenting a significant advance over the manual method used today. The feasibility and practicality of implementing these detection systems in a clinical setting are also discussed with consideration of parameter tuning, skill-sets, and data protection
Perceptions of an Electronic Medical Record (EMR): Lessons from a French Longitudinal Survey
No full textAbstractThe goal of this longitudinal study is to examine the evolution of the perceptions, namely anxiety, ease of use, usefulness, misfit (not customization), trust and usefulness, related to an Electronic Medical Record (EMR) for the clinical staff in a French Teaching hospital. Two surveys were conducted first in September 2013 and second in December 2015, based on a questionnaire consisting of items on the Likert scale. As results, the correlation of all the variables between the two surveys is very significant (except for usefulness, for which the relationship is significant). This is not surprising, given previous studied focused on habits and learning related to technology adoption. Nevertheless, the increase is not spectacular and it makes necessary to evaluate EMR satisfaction and perceptions in order to elaborate a measure standard enabling comparisons and benchmarking among hospitals
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