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Articles 1 - 23 of 23
Full-Text Articles in Medicine and Health Sciences
Astrocytes From The Contused Spinal Cord Inhibit Oligodendrocyte Differentiation Of Adult Oligodendrocyte Precursor Cells By Increasing The Expression Of Bone Morphogenetic Proteins., Yaping Wang, Xiaoxin Cheng, Qian He, Yiyan Zheng, Dong H Kim, Scott R Whittemore, Qilin L Cao
Astrocytes From The Contused Spinal Cord Inhibit Oligodendrocyte Differentiation Of Adult Oligodendrocyte Precursor Cells By Increasing The Expression Of Bone Morphogenetic Proteins., Yaping Wang, Xiaoxin Cheng, Qian He, Yiyan Zheng, Dong H Kim, Scott R Whittemore, Qilin L Cao
Journal Articles
Promotion of remyelination is an important therapeutic strategy to facilitate functional recovery after traumatic spinal cord injury (SCI). Transplantation of neural stem cells (NSCs) or oligodendrocyte precursor cells (OPCs) has been used to enhance remyelination after SCI. However, the microenvironment in the injured spinal cord is inhibitory for oligodendrocyte (OL) differentiation of NSCs or OPCs. Identifying the signaling pathways that inhibit OL differentiation in the injured spinal cord could lead to new therapeutic strategies to enhance remyelination and functional recovery after SCI. In the present study, we show that reactive astrocytes from the injured rat spinal cord or their conditioned …
Partial Volume Correction Incorporating Rb-82 Positron Range For Quantitative Myocardial Perfusion Pet Based On Systolic-Diastolic Activity Ratios And Phantom Measurements., Nils P Johnson, Stefano Sdringola, K Lance Gould
Partial Volume Correction Incorporating Rb-82 Positron Range For Quantitative Myocardial Perfusion Pet Based On Systolic-Diastolic Activity Ratios And Phantom Measurements., Nils P Johnson, Stefano Sdringola, K Lance Gould
Journal Articles
BACKGROUND: Quantitative myocardial PET perfusion imaging requires partial volume corrections.
METHODS: Patients underwent ECG-gated, rest-dipyridamole, myocardial perfusion PET using Rb-82 decay corrected in Bq/cc for diastolic, systolic, and combined whole cycle ungated images. Diastolic partial volume correction relative to systole was determined from the systolic/diastolic activity ratio, systolic partial volume correction from phantom dimensions comparable to systolic LV wall thicknesses and whole heart cycle partial volume correction for ungated images from fractional systolic-diastolic duration for systolic and diastolic partial volume corrections.
RESULTS: For 264 PET perfusion images from 159 patients (105 rest-stress image pairs, 54 individual rest or stress images), …
Multicentric Hepatic Ebv-Associated Smooth Muscle Tumors In An Aids Patient: A Case Report, Investigation Of Mtor Activation And Review Of The Literature., Qi Shen, Wei Feng, Michael S Long, Xiuzhen Duan, Siraya Jaijakul, Cesar A Arias, Robert E Brown, Bihong Zhao
Multicentric Hepatic Ebv-Associated Smooth Muscle Tumors In An Aids Patient: A Case Report, Investigation Of Mtor Activation And Review Of The Literature., Qi Shen, Wei Feng, Michael S Long, Xiuzhen Duan, Siraya Jaijakul, Cesar A Arias, Robert E Brown, Bihong Zhao
Journal Articles
Epstein-Barr virus (EBV) - associated smooth muscle tumors (EBV-SMT) are a rare, recently recognized distinct group of mesenchymal tumors that develop exclusively in patients with immunosuppression. It is believed that tumorigenesis is, at least in part, through the activation of the Akt/mammalian target of rapamycin (mTOR) signal pathway. We describe the clinicopathologic and immunohistochemical features of a multifocal hepatic EBV-SMT in a 34-year-old acquired immunodeficiency syndrome (AIDS) patient and investigate the activation status of the mTOR signal pathway in this tumor. In addition, we provide a review of the literature on the clinicopathologic findings of hepatic EBV-SMT in adult AIDS …
Hepatocellular Carcinoma Survival In Uninsured And Underinsured Patients., John A Harvin, George Van Buren, Kuojen Tsao, Putao Cen, Tien C Ko, Curtis J Wray
Hepatocellular Carcinoma Survival In Uninsured And Underinsured Patients., John A Harvin, George Van Buren, Kuojen Tsao, Putao Cen, Tien C Ko, Curtis J Wray
Journal Articles
BACKGROUND: The incidence of hepatitis C virus (HCV) and hepatocellular carcinoma (HCC) is increasing. The purpose of this study is to establish baseline survival in a medically-underserved population and to evaluate the effect of HCV seropositivity on our patient population.
MATERIALS AND METHODS: We reviewed clinicopathologic parameters from a prospective tumor registry and medical records from the Harris County Hospital District (HCHD). Outcomes were compared using Kaplan-Meier survival analysis and log-rank tests.
RESULTS: A total of 298 HCC patients were identified. The median survival for the entire cohort was 3.4 mo. There was no difference in survival between the HCV …
Learning Curve For Robotic-Assisted Laparoscopic Colorectal Surgery., Malak B Bokhari, Chirag B Patel, Diego I Ramos-Valadez, Madhu Ragupathi, Eric M Haas
Learning Curve For Robotic-Assisted Laparoscopic Colorectal Surgery., Malak B Bokhari, Chirag B Patel, Diego I Ramos-Valadez, Madhu Ragupathi, Eric M Haas
Journal Articles
BACKGROUND: Robotic-assisted laparoscopic surgery (RALS) is evolving as an important surgical approach in the field of colorectal surgery. We aimed to evaluate the learning curve for RALS procedures involving resections of the rectum and rectosigmoid.
METHODS: A series of 50 consecutive RALS procedures were performed between August 2008 and September 2009. Data were entered into a retrospective database and later abstracted for analysis. The surgical procedures included abdominoperineal resection (APR), anterior rectosigmoidectomy (AR), low anterior resection (LAR), and rectopexy (RP). Demographic data and intraoperative parameters including docking time (DT), surgeon console time (SCT), and total operative time (OT) were analyzed. …
Progenitor Cells As Remote "Bioreactors": Neuroprotection Via Modulation Of The Systemic Inflammatory Response., Peter A Walker, Phillip A Letourneau, Supinder Bedi, Shinil K Shah, Fernando Jimenez, Charles S Cox Jr
Progenitor Cells As Remote "Bioreactors": Neuroprotection Via Modulation Of The Systemic Inflammatory Response., Peter A Walker, Phillip A Letourneau, Supinder Bedi, Shinil K Shah, Fernando Jimenez, Charles S Cox Jr
Journal Articles
Acute central nervous system (CNS) injuries such as spinal cord injury, traumatic brain injury, autoimmune encephalomyelitis, and ischemic stroke are associated with significant morbidity, mortality, and health care costs worldwide. Preliminary research has shown potential neuroprotection associated with adult tissue derived stem/progenitor cell based therapies. While initial research indicated that engraftment and transdifferentiation into neural cells could explain the observed benefit, the exact mechanism remains controversial. A second hypothesis details localized stem/progenitor cell engraftment with alteration of the loco-regional milieu; however, the limited rate of cell engraftment makes this theory less likely. There is a growing amount of preclinical data …
Molecular Mechanism By Which The Nucleoid Occlusion Factor, Slma, Keeps Cytokinesis In Check., Nam Ky Tonthat, Stefan T Arold, Brian F Pickering, Michael W Van Dyke, Shoudan Liang, Yue Lu, Tushar K Beuria, William Margolin, Maria A Schumacher
Molecular Mechanism By Which The Nucleoid Occlusion Factor, Slma, Keeps Cytokinesis In Check., Nam Ky Tonthat, Stefan T Arold, Brian F Pickering, Michael W Van Dyke, Shoudan Liang, Yue Lu, Tushar K Beuria, William Margolin, Maria A Schumacher
Journal Articles
In Escherichia coli, cytokinesis is orchestrated by FtsZ, which forms a Z-ring to drive septation. Spatial and temporal control of Z-ring formation is achieved by the Min and nucleoid occlusion (NO) systems. Unlike the well-studied Min system, less is known about the anti-DNA guillotining NO process. Here, we describe studies addressing the molecular mechanism of SlmA (synthetic lethal with a defective Min system)-mediated NO. SlmA contains a TetR-like DNA-binding fold, and chromatin immunoprecipitation analyses show that SlmA-binding sites are dispersed on the chromosome except the Ter region, which segregates immediately before septation. SlmA binds DNA and FtsZ simultaneously, and the …
Immunopathology Of Postprimary Tuberculosis: Increased T-Regulatory Cells And Dec-205-Positive Foamy Macrophages In Cavitary Lesions., Kerry J Welsh, Semyon A Risin, Jeffrey K Actor, Robert L Hunter
Immunopathology Of Postprimary Tuberculosis: Increased T-Regulatory Cells And Dec-205-Positive Foamy Macrophages In Cavitary Lesions., Kerry J Welsh, Semyon A Risin, Jeffrey K Actor, Robert L Hunter
Journal Articles
Postprimary tuberculosis occurs in immunocompetent people infected with Mycobacterium tuberculosis. It is restricted to the lung and accounts for 80% of cases and nearly 100% of transmission. Little is known about the immunopathology of postprimary tuberculosis due to limited availability of specimens. Tissues from 30 autopsy cases of pulmonary tuberculosis were located. Sections of characteristic lesions of caseating granulomas, lipid pneumonia, and cavitary stages of postprimary disease were selected for immunohistochemical studies of macrophages, lymphocytes, endothelial cells, and mycobacterial antigens. A higher percentage of cells in lipid pneumonia (36.1%) and cavitary lesions (27.8%) were positive for the dendritic cell marker …
Compromised Osseous Healing Of Dental Extraction Sites In Zoledronic Acid-Treated Dogs., M. R. Allen, D. J. Kubek, D. B. Burr, S. L. Ruggiero, T. M. G. Chu
Compromised Osseous Healing Of Dental Extraction Sites In Zoledronic Acid-Treated Dogs., M. R. Allen, D. J. Kubek, D. B. Burr, S. L. Ruggiero, T. M. G. Chu
Journal Articles
UNLABELLED: The goal of this study was to document how treatment with high doses of zoledronic acid affects dental extraction healing. Our results, showing significantly compromised osseous healing within the socket as well as presence of exposed bone and development of a sequestrum in one animal, provide a building block toward understanding osteonecrosis of the jaw.
PURPOSE: The goal of this study was to document how treatment with a bisphosphonate affects the bone tissue following dental extraction.
METHODS: Skeletally mature female beagle dogs were either untreated controls (CON) or treated with intravenous zoledronic acid (ZOL). Following the extraction of the …
Management Of Hypertension Among Patients With Coronary Heart Disease, O. Olafiranye, F. Zizi, P. Brimah, G. Jean-Louis, A. N. Makaryus, S. Mcfarlane, G. Ogedegbe
Management Of Hypertension Among Patients With Coronary Heart Disease, O. Olafiranye, F. Zizi, P. Brimah, G. Jean-Louis, A. N. Makaryus, S. Mcfarlane, G. Ogedegbe
Journal Articles
Evidence suggests that coronary heart disease (CHD) is the most common outcome of hypertension. Hypertension accelerates the development of atherosclerosis, and sustained elevation of blood pressure (BP) can destabilize vascular lesions and precipitate acute coronary events. Hypertension can cause myocardial ischemia in the absence of CHD. These cardiovascular risks attributed to hypertension can be reduced by optimal BP control. Although several antihypertensive agents exist, the choice of agent and the appropriate target BP for patients with CHD remain controversial. In this succinct paper, we examine the evidence and the mechanisms for the linkage between hypertension and CHD and we discuss …
Noninvasive Ventilation In Acute Respiratory Failure Due To H1n1 Influenza: A Word Of Caution, A. Singh, J. Singh
Noninvasive Ventilation In Acute Respiratory Failure Due To H1n1 Influenza: A Word Of Caution, A. Singh, J. Singh
Journal Articles
No abstract provided.
Intravenous Erythropoietin In Patients With St-Segment Elevation Myocardial Infarction - Reveal: A Randomized Controlled Trial, S. S. Najjar, S. V. Rao, C. Melloni, S. V. Raman, T. J. Povsic, L. Melton, G. W. Barsness, K. Prather, L. Gruberg, R. A. Harrington, +10 Additional Authors
Intravenous Erythropoietin In Patients With St-Segment Elevation Myocardial Infarction - Reveal: A Randomized Controlled Trial, S. S. Najjar, S. V. Rao, C. Melloni, S. V. Raman, T. J. Povsic, L. Melton, G. W. Barsness, K. Prather, L. Gruberg, R. A. Harrington, +10 Additional Authors
Journal Articles
Context: Acute ST-segment elevation myocardial infarction (STEMI) is a leading cause of morbidity and mortality. In experimental models of MI, erythropoietin reduces infarct size and improves left ventricular (LV) function. Objective: To evaluate the safety and efficacy of a single intravenous bolus of epoetin alfa in patients with STEMI. Design, Setting, and Patients: A prospective, randomized, double-blind, placebo-controlled trial with a dose-escalation safety phase and a single dose (60 000 U of epoetin alfa) efficacy phase; the Reduction of Infarct Expansion and Ventricular Remodeling With Erythropoietin After Large Myocardial Infarction (REVEAL) trial was conducted at 28 US sites between October …
Inside And Out: An Epicardial Lead Gone Astray, S. N. Hong, B. Rosenzweig, G. A. Crooke, I. Kronzon, M. B. Srichai
Inside And Out: An Epicardial Lead Gone Astray, S. N. Hong, B. Rosenzweig, G. A. Crooke, I. Kronzon, M. B. Srichai
Journal Articles
No abstract provided.
Association Of Retinoic Acid Receptor Genes With Meningomyelocele., Phong X Tran, Kit Sing Au, Alanna C Morrison, Jack M Fletcher, Kathryn K Ostermaier, Gayle H Tyerman, Hope Northrup
Association Of Retinoic Acid Receptor Genes With Meningomyelocele., Phong X Tran, Kit Sing Au, Alanna C Morrison, Jack M Fletcher, Kathryn K Ostermaier, Gayle H Tyerman, Hope Northrup
Journal Articles
BACKGROUND: Neural tube defects (NTDs) occur in as many as 0.5-2 per 1000 live births in the United States. One of the most common and severe neural tube defects is meningomyelocele (MM) resulting from failed closure of the caudal end of the neural tube. MM has been induced by retinoic acid teratogenicity in rodent models. We hypothesized that genetic variants influencing retinoic acid (RA) induction via retinoic acid receptors (RARs) may be associated with risk for MM.
METHODS: We analyzed 47 single nucleotide polymorphisms (SNPs) that span across the three retinoic acid receptor genes using the SNPlex genotyping platform. Our …
Complete Genome Sequence Of Treponema Paraluiscuniculi, Strain Cuniculi A: The Loss Of Infectivity To Humans Is Associated With Genome Decay., David Smajs, Marie Zobaníková, Michal Strouhal, Darina Cejková, Shannon Dugan-Rocha, Petra Pospíšilová, Steven J Norris, Tom Albert, Xiang Qin, Kym Hallsworth-Pepin, Christian Buhay, Donna M Muzny, Lei Chen, Richard A Gibbs, George M Weinstock
Complete Genome Sequence Of Treponema Paraluiscuniculi, Strain Cuniculi A: The Loss Of Infectivity To Humans Is Associated With Genome Decay., David Smajs, Marie Zobaníková, Michal Strouhal, Darina Cejková, Shannon Dugan-Rocha, Petra Pospíšilová, Steven J Norris, Tom Albert, Xiang Qin, Kym Hallsworth-Pepin, Christian Buhay, Donna M Muzny, Lei Chen, Richard A Gibbs, George M Weinstock
Journal Articles
Treponema paraluiscuniculi is the causative agent of rabbit venereal spirochetosis. It is not infectious to humans, although its genome structure is very closely related to other pathogenic Treponema species including Treponema pallidum subspecies pallidum, the etiological agent of syphilis. In this study, the genome sequence of Treponema paraluiscuniculi, strain Cuniculi A, was determined by a combination of several high-throughput sequencing strategies. Whereas the overall size (1,133,390 bp), arrangement, and gene content of the Cuniculi A genome closely resembled those of the T. pallidum genome, the T. paraluiscuniculi genome contained a markedly higher number of pseudogenes and gene fragments (51). In …
Spinal Cord Injury Causes Sustained Disruption Of The Blood-Testis Barrier In The Rat., Jennifer N Dulin, Meredith L Moore, Kevin W Gates, Joanna H Queen, Raymond J Grill
Spinal Cord Injury Causes Sustained Disruption Of The Blood-Testis Barrier In The Rat., Jennifer N Dulin, Meredith L Moore, Kevin W Gates, Joanna H Queen, Raymond J Grill
Journal Articles
There is a high incidence of infertility in males following traumatic spinal cord injury (SCI). Quality of semen is frequently poor in these patients, but the pathophysiological mechanism(s) causing this are not known. Blood-testis barrier (BTB) integrity following SCI has not previously been examined. The objective of this study was to characterize the effects of spinal contusion injury on the BTB in the rat. 63 adult, male Sprague Dawley rats received SCI (n = 28), laminectomy only (n = 7) or served as uninjured, age-matched controls (n = 28). Using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), BTB permeability to the …
The Hylefm Gene In Phylefm Of Enterococcus Faecium Is Not Required In Pathogenesis Of Murine Peritonitis., Diana Panesso, Maria C Montealegre, Sandra Rincón, Maria F Mojica, Louis B Rice, Kavindra V Singh, Barbara E Murray, Cesar A Arias
The Hylefm Gene In Phylefm Of Enterococcus Faecium Is Not Required In Pathogenesis Of Murine Peritonitis., Diana Panesso, Maria C Montealegre, Sandra Rincón, Maria F Mojica, Louis B Rice, Kavindra V Singh, Barbara E Murray, Cesar A Arias
Journal Articles
BACKGROUND: Plasmids containing hylEfm (pHylEfm) were previously shown to increase gastrointestinal colonization and lethality of Enterococcus faecium in experimental peritonitis. The hylEfm gene, predicting a glycosyl hydrolase, has been considered as a virulence determinant of hospital-associated E. faecium, although its direct contribution to virulence has not been investigated. Here, we constructed mutants of the hylEfm-region and we evaluated their effect on virulence using a murine peritonitis model.
RESULTS: Five mutants of the hylEfm-region of pHylEfmTX16 from the sequenced endocarditis strain (TX16 [DO]) were obtained using an adaptation of the PheS* system and were evaluated in a commensal strain TX1330RF to …
Hypertensive Nephropathy Treatment By Heart-Protecting Musk Pill: A Study Of Anti-Inflammatory Therapy For Target Organ Damage Of Hypertension., Dengke Tian, Shuang Ling, Gangling Chen, Yajuan Li, Jun Liu, Murad Ferid, Ka Bian
Hypertensive Nephropathy Treatment By Heart-Protecting Musk Pill: A Study Of Anti-Inflammatory Therapy For Target Organ Damage Of Hypertension., Dengke Tian, Shuang Ling, Gangling Chen, Yajuan Li, Jun Liu, Murad Ferid, Ka Bian
Journal Articles
This study was designed to investigate the protective effect of the heart-protecting musk pill (HMP) on inflammatory injury of kidney from spontaneously hypertensive rat (SHR). Male SHRs aged 4 weeks were divided into SHR model group, HMP low-dosage group (13.5 mg/kg), and HMP high-dosage group (40 mg/kg). Age-matched Wistar-Kyoto rats were used as normal control. All rats were killed at 12 weeks of age. Tail-cuff method and enzyme-linked immunosorbent assay were used to determine rat systolic blood pressure and angiotensin II (Ang II) contents, respectively. Renal inflammatory damage was evaluated by the following parameters: protein expressions of inflammatory cytokines, carbonyl …
Chondrosarcoma Of The Mobile Spine And Sacrum., Ryan M Stuckey, Rex A W Marco
Chondrosarcoma Of The Mobile Spine And Sacrum., Ryan M Stuckey, Rex A W Marco
Journal Articles
Chondrosarcoma is a rare malignant tumor of bone. This family of tumors can be primary malignant tumors or a secondary malignant transformation of an underlying benign cartilage tumor. Pain is often the initial presenting complaint when chondrosarcoma involves the spine. In the mobile spine, chondrosarcoma commonly presents within the vertebral body and shows a predilection for the thoracic spine. Due to the resistance of chondrosarcoma to both radiation and chemotherapy, treatment is focused on surgery. With en bloc excision of chondrosarcoma of the mobile spine and sacrum patients can have local recurrence rates as low as 20%.
Probing The Mechanical Properties Of Tnf-Α Stimulated Endothelial Cell With Atomic Force Microscopy., Sei-Young Lee, Ana-Maria Zaske, Tommaso Novellino, Delia Danila, Mauro Ferrari, Jodie Conyers, Paolo Decuzzi
Probing The Mechanical Properties Of Tnf-Α Stimulated Endothelial Cell With Atomic Force Microscopy., Sei-Young Lee, Ana-Maria Zaske, Tommaso Novellino, Delia Danila, Mauro Ferrari, Jodie Conyers, Paolo Decuzzi
Journal Articles
TNF-α (tumor necrosis factor-α) is a potent pro-inflammatory cytokine that regulates the permeability of blood and lymphatic vessels. The plasma concentration of TNF-α is elevated (> 1 pg/mL) in several pathologies, including rheumatoid arthritis, atherosclerosis, cancer, pre-eclampsia; in obese individuals; and in trauma patients. To test whether circulating TNF-α could induce similar alterations in different districts along the vascular system, three endothelial cell lines, namely HUVEC, HPMEC, and HCAEC, were characterized in terms of 1) mechanical properties, employing atomic force microscopy; 2) cytoskeletal organization, through fluorescence microscopy; and 3) membrane overexpression of adhesion molecules, employing ELISA and immunostaining. Upon stimulation …
Alterations In Content And Localization Of Defensins In Rat Ileum And Jejunum Following Ischemia-Reperfusion. Specific Peptides, In Specific Places, For Specific Jobs?, Rosemary A Kozar, Rachel J Santora, Brian J Poindexter, Stephen M Milner, Roger J Bick
Alterations In Content And Localization Of Defensins In Rat Ileum And Jejunum Following Ischemia-Reperfusion. Specific Peptides, In Specific Places, For Specific Jobs?, Rosemary A Kozar, Rachel J Santora, Brian J Poindexter, Stephen M Milner, Roger J Bick
Journal Articles
Objective: To determine alterations in quantities and distributions of natural antimicrobials following ischemia-reperfusion injury. We hypothesized that these compounds would be upregulated in areas of small intestine where changes in permeability and cellular disruption were likely and where protective mechanisms would be initiated. Methods: Rats with ischemia-reperfusion underwent superior mesenteric artery clamping and reperfusion. Shams were subjected to laparotomy but no clamping. Ileum and jejunum were harvested and sectioned, and subjected to fluorescence deconvolution microscopy for determinations of content and localization of rat beta defensins, 1, 2, 3; rat neutrophil protein-1; and cathelicidin LL-37. Modeling was performed to determine cellular …
Case Of "Slow" Stroke From Carotid Artery Occlusion Treated By Delayed But Cautious Endovascular Intervention., Kachi Illoh, Emilio Supsupin, Hashem M Shaltoni, Edwin D Cacayorin
Case Of "Slow" Stroke From Carotid Artery Occlusion Treated By Delayed But Cautious Endovascular Intervention., Kachi Illoh, Emilio Supsupin, Hashem M Shaltoni, Edwin D Cacayorin
Journal Articles
In a challenging case of carotid occlusion with slowly evolving stroke, we used brain imaging to facilitate endovascular revascularization resulting in the relief of the patient's symptoms. Patients with carotid occlusion and continued neurological worsening or fluctuations present enormous treatment challenges. These patients may present "slow" strokes with subacute infarcts that present significant challenges and risks during attempts at revascularization of the occluded artery. We present such a case in which we used multimodal imaging techniques, including MR-perfusion, to facilitate endovascular revascularization. Our approach of delayed but cautious intra-arterial thrombolytic therapy, guided by brain imaging, and followed by stent placement …
Comparison Of Clinical Knowledge Management Capabilities Of Commercially-Available And Leading Internally-Developed Electronic Health Records., Dean F Sittig, Adam Wright, Seth Meltzer, Linas Simonaitis, R Scott Evans, W Paul Nichol, Joan S Ash, Blackford Middleton
Comparison Of Clinical Knowledge Management Capabilities Of Commercially-Available And Leading Internally-Developed Electronic Health Records., Dean F Sittig, Adam Wright, Seth Meltzer, Linas Simonaitis, R Scott Evans, W Paul Nichol, Joan S Ash, Blackford Middleton
Journal Articles
BACKGROUND: We have carried out an extensive qualitative research program focused on the barriers and facilitators to successful adoption and use of various features of advanced, state-of-the-art electronic health records (EHRs) within large, academic, teaching facilities with long-standing EHR research and development programs. We have recently begun investigating smaller, community hospitals and out-patient clinics that rely on commercially-available EHRs. We sought to assess whether the current generation of commercially-available EHRs are capable of providing the clinical knowledge management features, functions, tools, and techniques required to deliver and maintain the clinical decision support (CDS) interventions required to support the recently defined …