Does the Adoption of EMR Systems Inflate Medicare Reimbursements?

The adoption of EMR systems has been argued to lead to physicians “upcoding” their patients to inflate insurance reimbursements. In this paper, we examine if the adoption of the Clinical Physician Order Entry (CPOE) system is associated with an increase in the complexity of the patients\u27 case mix that hospitals report (termed upcoding ). We make use of a staggered roll-out of the Recovery Audit Program to combat upcoding as a natural experiment to assess the impact of the adoption of the CPOE systems on the case mix that a hospital reports. We find that on average the adoption of CPOE systems is associated with an increase in the reported case mix of hospitals, and that the Audit program has had an effect on reducing the case mix that hospitals report to Medicare for reimbursement. Implications for preventing inflated reimbursements due to upcoding are discussed

Improvement in Field CBR Values of Subgrade Soil Using Construction-Demolition Materials

Many countries suffer from the stacks of construction and demolition (CD) materials as they cause environmental and health problems in society. The city of Mosul in Iraq suffers from a huge amount of demolition materials resulting from destruction of most of the infrastructure. In the present study, attempts have been made to assess the influence of three types of CD materials (dragged asphalt, DA; crushed brick, CB; and crushed concrete, CC) on the response of a low-plasticity clay (CL) for use as a road subgrade layer. An intensive series of both experimental and numerical studies on the CL with 10% CD materials was carried out using field California bearing ratio (CBR) tests performed in a large-scale model box. The results showed significant improvement in the CBR values upon the addition of CD materials to the CL soil. The CBR values increased by 12.4, 13.7, and 49.7% with the addition of DA, CB, and CC, respectively. The CBR values improved between 1.1 and 1.7 times, corresponding to an increase in the layer thickness from 50 to 100 cm. Further increases in CBR values range from 1.5 to 1.8 times attendant with increasing the thickness of layer from 50 cm to 150 cm. The addition of CC is more active and gives higher CBR values. A good match was observed between the CBR values obtained from the experimental results and the numerical analysis using the PLAXIS 2D package

Plasma Levels of Tumor Necrosis Factor-Alpha and Interleukin-6 in Obsessive Compulsive Disorder

Aim. Recent research implicated place of an immune mechanism in the pathophysiology of obsessive-compulsive disorder (OCD). Despite increasing evidence involvement of cytokine release in OCD, results of the studies are inconsistent. The aim of this study was to evaluate the plasma levels of the cytokines; tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in OCD patients. Methods. Plasma concentrations of TNF-α and IL-6 were measured in 31 drug-free outpatients with OCD, and 31-year age and sex-matched healthy controls. TNF-α and IL-6 concentrations in blood were determined by enzyme-linked immunosorbent assay (ELISA). Results. Both TNF-α and IL-6 levels showed statistically significant increases in OCD patients compared to controls (P < .000, P < .001, resp.). In addition, the age of onset was negatively correlated with TNF-α level (r = −.402, P = .025) and duration of illness was weakly correlated with IL-6 levels (r : .357; P : .048) in patients group. Conclusion. OCD patients showed increases in TNF-α and IL-6 levels compared to the healthy controls. This study provides evidence for alterations in the proinflamatory cytokines which suggest the involvement of the immune system in the pathophysiology of OCD

An innovative tailored instructional design for computer programming courses in engineering

Industry 4.0 and 5.0 topics are emerging fields and have seen rising demand recently. There is a critical need, on the other hand, for improved methods of instructing programming languages since a growing lack of student motivation during the pandemic has had a deleterious influence on the education of programmers. In this context, online/hybrid computer programming courses must be addressed with innovative solutions to support the field with well-educated professionals. In this paper, we present a case study to propose an innovative tailored instructional design for the online/hybrid learning environments for programming courses in engineering faculties. To develop the instructional design, the Kemp Instructional Design Model was followed. The instructional design is a result of the main outputs of the RECOM “Redesigning Introductory Computer Programming Using Innovative Online Modules” project, which aims to bridge the gap between the existing course design in programming courses and the needs of "Covid” and “post-Covid” generation students

Os odontoideum with bipartite atlas and segmental instability: a case report

We report on the case of a 15-year-old adolescent who presented with a transient paraplegia and hyposensibility of the upper extremities after sustaining a minor hyperflexion trauma to the cervical spine. Neuroimaging studies revealed atlantoaxial dislocation and ventral compression of the rostral spinal cord with increased cord signal at C1/C2 levels caused by an os odontoideum, as well as anterior and posterior arch defects of the atlas. The patient underwent closed reduction and posterior atlantoaxial fusion. We describe the association of an acquired instability secondary to an os odontoideum with an anteroposterior spondyloschisis of the atlas and its functional result after 12 months. The rare coincidence of both lesions indicates a multiple malformation of the upper cervical spine and supports the theory of an embryologic genesis of os odontoideum

Deep Structural Analysis of Myriads of Omicron Sub-Variants Revealed Hotspot for Vaccine Escape Immunity

The emergence of the Omicron variant has reinforced the importance of continued SARS-CoV-2 evolution and its possible impact on vaccine effectiveness. Specifically, mutations in the receptor-binding domain (RBD) are critical to comprehend the flexibility and dynamicity of the viral interaction with the human agniotensin-converting enzyme 2 (hACE2) receptor. To this end, we have applied a string of deep structural and genetic analysis tools to map the substitution patterns in the S protein of major Omicron sub-variants (n = 51) with a primary focus on the RBD mutations. This head-to-head comparison of Omicron sub-variants revealed multiple simultaneous mutations that are attributed to antibody escape, and increased affinity and binding to hACE2. Our deep mapping of the substitution matrix indicated a high level of diversity at the N-terminal and RBD domains compared with other regions of the S protein, highlighting the importance of these two domains in a matched vaccination approach. Structural mapping identified highly variable mutations in the up confirmation of the S protein and at sites that critically define the function of the S protein in the virus pathobiology. These substitutional trends offer support in tracking mutations along the evolutionary trajectories of SAR-CoV-2. Collectively, the findings highlight critical areas of mutations across the major Omicron sub-variants and propose several hotspots in the S proteins of SARS-CoV-2 sub-variants to train the future design and development of COVID-19 vaccines

Do trauma cue exposure and/or PTSD symptom severity intensify selective approach bias toward cannabis cues in regular cannabis users with trauma histories?

Trauma cue-elicited activation of automatic cannabis-related cognitive biases are theorized to contribute to comorbid posttraumatic stress disorder and cannabis use disorder. This phenomenon can be studied experimentally by combining the trauma cue reactivity paradigm (CRP) with cannabis-related cognitive processing tasks. In this study, we used a computerized cannabis approach-avoidance task (AAT) to assess automatic cannabis (vs. neutral) approach bias following personalized trauma (vs. neutral) CRP exposure. We hypothesized that selective cannabis (vs. neutral) approach biases on the AAT would be larger among participants with higher PTSD symptom severity, particularly following trauma (vs. neutral) cue exposure. We used a within-subjects experimental design with a continuous between-subjects moderator (PTSD symptom severity). Participants were exposed to both a trauma and neutral CRP in random order, completing a cannabis AAT (cannabis vs. neutral stimuli) following each cue exposure. Current cannabis users with histories of psychological trauma (n = 50; 34% male; mean age = 37.8 years) described their most traumatic lifetime event, and a similarly-detailed neutral event, according to an established interview protocol that served as the CRP. As hypothesized, an AAT stimulus type x PTSD symptom severity interaction emerged (p = .042) with approach bias greater to cannabis than neutral stimuli for participants with higher (p = .006), but not lower (p = .36), PTSD symptom severity. Contrasting expectations, the stimulus type x PTSD symptoms effect was not intensified by trauma cue exposure (p = .19). Selective cannabis approach bias may be chronically activated in cannabis users with higher PTSD symptom severity and may serve as an automatic cognitive mechanism to help explain PTSD-CUD co-morbidity.</p

LBA18_PRDurable clinical benefit with nivolumab (NIVO) plus low-dose ipilimumab (IPI) as first-line therapy in microsatellite instability-high/mismatch repair deficient (MSI-H/dMMR) metastatic colorectal cancer (mCRC)

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