Search

OBJECTIVE: To establish an enterprise initiative for improving health and health care through interoperable electronic health record (EHR) innovations. MATERIALS AND METHODS: We developed a unifying mission and vision, established multidisciplinary governance, and formulated a strategic plan. Key elements of our strategy include establishing a world-class team; creating shared infrastructure to support individual innovations; developing and implementing innovations with high anticipated impact and a clear path to adoption; incorporating best practices such as the use of Fast Healthcare Interoperability Resources (FHIR) and related interoperability standards; and maximizing synergies across research and operations and with partner organizations. RESULTS: University of Utah Health launched the ReImagine EHR initiative in 2016. Supportive infrastructure developed by the initiative include various FHIR-related tooling and a systematic evaluation framework. More than 10 EHR-integrated digital innovations have been implemented to support preventive care, shared decision-making, chronic disease management, and acute clinical care. Initial evaluations of these innovations have demonstrated positive impact on user satisfaction, provider efficiency, and compliance with evidence-based guidelines. Return on investment has included improvements in care; over $35 million in external grant funding; commercial opportunities; and increased ability to adapt to a changing healthcare landscape. DISCUSSION: Key lessons learned include the value of investing in digital innovation initiatives leveraging FHIR; the importance of supportive infrastructure for accelerating innovation; and the critical role of user-centered design, implementation science, and evaluation. CONCLUSION: EHR-integrated digital innovation initiatives can be key assets for enhancing the EHR user experience, improving patient care, and reducing provider burnout.

The impact of biodiversity loss on soil functions is well established via laboratory experiments that generally consider soil biota groups in isolation from each other, a condition rarely present in field soils. As a result, our knowledge about anthropogenic-induced changes in biodiversity and associated soil functions is limited. We quantified an array of soil biological constituents (plants, earthworms, nematodes, bacteria, and fungi) to explore their interactions and to characterize their influence on various soil functions (habitat for soil organisms, air and water regulation, and recycling of nutrients and organic waste) along a legacy Cu pollution gradient. Increasing Cu concentrations had a detrimental impact on both plant growth and species richness. Belowground soil biota showed similar responses, with their sensitivity to elevated Cu concentrations decreasing in the order: earthworms > bacteria > nematodes > fungi. The observed loss of soil biota adversely affected natural soil bioturbation, aggregate formation and stabilization, and decomposition and mineralization processes and therefore resulted in compacted soil with narrow pore size distributions and overall smaller pores, restricted air and water storage and flow, and impeded C, N, and P cycling. The simultaneous evolution of soil biodiversity and functions along the Cu gradient emphasized the key role of soil life in controlling ecosystem services. Furthermore, results indicated that different soil biodiversity and functional indicators started to decline (10% loss) within a Cu concentration range of 110 to 800 mg total Cu kg−1.

A range of environmental problems including loss of biodiversity, desertification, and compromised water quality persist across many arid and semi-arid environments despite a good technical understanding of both the processes involved and likely solutions. Reforestation is an emerging method of carbon mitigation and this carbon investment may thus provide a means of addressing these environmental problems and achieving landscape scale changes. A possible negative outcome of large scale land-use change may be depletion of food production. In south-western Australia several approaches have been used to integrate carbon mitigation with food production and to value the various environmental services (e.g. water quality and yield, carbon mitigation) produced from reforestation. This paper describes three case studies: (1) a large-scale commercial carbon reforestation scheme project which integrates strips of eucalypts with cereal farming, (2) reforestation of salinized and abandoned farmland and (3) watershed scale modeling that uses an existing hydrologic model to predict water yield and quality impacts of reforestation. Although reforestation is also likely to result in other environmental benefits these are often not valued. In contrast, where hydrologic models exist, these allow the valuation of water benefits. In the latter example, the value of several products of reforestation (wood, carbon, water) were assessed and compared to the value of products from the existing farming system.

A range of environmental problems including loss of biodiversity, desertification, and compromised water quality persist across many arid and semi-arid environments despite a good technical understanding of both the processes involved and likely solutions. Reforestation is an emerging method of carbon mitigation and this carbon investment may thus provide a means of addressing these environmental problems and achieving landscape scale changes. A possible negative outcome of large scale land-use change may be depletion of food production. In south-western Australia several approaches have been used to integrate carbon mitigation with food production and to value the various environmental services (e.g. water quality and yield, carbon mitigation) produced from reforestation. This paper describes three case studies: (1) a large-scale commercial carbon reforestation scheme project which integrates strips of eucalypts with cereal farming, (2) reforestation of salinized and abandoned farmland and (3) watershed scale modeling that uses an existing hydrologic model to predict water yield and quality impacts of reforestation. Although reforestation is also likely to result in other environmental benefits these are often not valued. In contrast, where hydrologic models exist, these allow the valuation of water benefits. In the latter example, the value of several products of reforestation (wood, carbon, water) were assessed and compared to the value of products from the existing farming system.

We hypothesized that the administration of the superoxide dismutase (SOD) mimetic Tempol (4-hydroxy-2, 2, 6, 6-tetramethylpiperidine 1-oxyl) may reverse diabetes-induced erectile dysfunction. To test this hypothesis, reactive oxygen species-related genes (SOD1, SOD2, GP x 1, CAT, NOS2, NOS3) were tested, erectile functional studies and immunohistochemical analysis were carried out in diabetic rats treated with or without Tempol. Thirty Sprague-Dawley (3-4 months old) rats were divided into three groups (n=10 each), 20 with diabetes (diabetic control and Tempol treatment) and 10 healthy controls. At 12 weeks after the induction of diabetes by streptozotocin and Tempol treatment, all groups underwent in vivo cavernous nerve stimulation. Rat crura were harvested and the expression of antioxidative defense enzymes were examined by semi-quantitative reverse transcriptase PCR (RT-PCR). To confirm the RT-PCR results, we carried out immunohistochemistry (IHC) for catalase (CAT) and iNOS (NOS2). Nitration of tyrosine groups in proteins was also examined by IHC. Mean intracavernous pressure in the diabetic group was significantly lower than in the healthy controls (P <0.001) and was reversed by Tempol treatment (P <0.0108). NOS2 protein expression was significantly increased in diabetic animals compared with healthy controls and Tempol restored NOS2 protein level. Nitrotyrosine was also higher in diabetic animals and although Tempol treatment decreased its formation, it remained higher than that found in healthy controls. This study suggests that Tempol treatment increased erectile function through modulating oxidative stress-related genes in diabetic rats. This is the first report about the relationship between diabetes-induced erectile dysfunction and oxidative stress, and antioxidative therapy using the superoxide dismutase mimetic, Tempol, to restore erectile function.

We hypothesized that the administration of the superoxide dismutase (SOD) mimetic Tempol (4-hydroxy-2, 2, 6, 6-tetramethylpiperidine 1-oxyl) may reverse diabetes-induced erectile dysfunction. To test this hypothesis, reactive oxygen species-related genes (SOD1, SOD2, GP x 1, CAT, NOS2, NOS3) were tested, erectile functional studies and immunohistochemical analysis were carried out in diabetic rats treated with or without Tempol. Thirty Sprague-Dawley (3-4 months old) rats were divided into three groups (n=10 each), 20 with diabetes (diabetic control and Tempol treatment) and 10 healthy controls. At 12 weeks after the induction of diabetes by streptozotocin and Tempol treatment, all groups underwent in vivo cavernous nerve stimulation. Rat crura were harvested and the expression of antioxidative defense enzymes were examined by semi-quantitative reverse transcriptase PCR (RT-PCR). To confirm the RT-PCR results, we carried out immunohistochemistry (IHC) for catalase (CAT) and iNOS (NOS2). Nitration of tyrosine groups in proteins was also examined by IHC. Mean intracavernous pressure in the diabetic group was significantly lower than in the healthy controls (P <0.001) and was reversed by Tempol treatment (P <0.0108). NOS2 protein expression was significantly increased in diabetic animals compared with healthy controls and Tempol restored NOS2 protein level. Nitrotyrosine was also higher in diabetic animals and although Tempol treatment decreased its formation, it remained higher than that found in healthy controls. This study suggests that Tempol treatment increased erectile function through modulating oxidative stress-related genes in diabetic rats. This is the first report about the relationship between diabetes-induced erectile dysfunction and oxidative stress, and antioxidative therapy using the superoxide dismutase mimetic, Tempol, to restore erectile function.