Chart Smart: A Need for Documentation and Billing Education Among Emergency Medicine Residents?

Objective: The healthcare chart is becoming ever more complex, serving clinicians, patients, third party payers, regulators, and even medicolegal parties. The purpose of this study was to identify our emergency medicine (EM) resident and attending physicians’ current knowledge and attitudes about billing and documentation practices. We hypothesized that resident and attending physicians would identify billing and documentation as an area in which residents need further education.Methods: We gave a 15-question Likert survey to resident and attending physicians regarding charting practices, knowledge of billing and documentation, and opinions regarding need for further education.Results: We achieved a 100% response rate, with 47% (16/34) of resident physicians disagreeing or strongly disagreeing that they have adequate training in billing and documentation, while 91% (31/34) of residents and 95% (21/22) of attending physicians identified this skill as important to a resident’s future practice. Eighty-two percent (28/34) of resident physicians and 100% of attending physicians recommended further education for residents.Conclusion: Residents in this academic EM department identified a need for further education in billing and documentation practices. [West J Emerg Med. 2010;11(2): 116-119.

Stigma, health and incarceration: Turning the tide for children with a parent in prison

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A Super-Earth Transiting a Naked-Eye Star

We have detected transits of the innermost planet "e" orbiting 55 Cnc (V=6.0), based on two weeks of nearly continuous photometric monitoring with the MOST space telescope. The transits occur with the period (0.74 d) and phase that had been predicted by Dawson & Fabrycky, and with the expected duration and depth for the crossing of a Sun-like star by a hot super-Earth. Assuming the star's mass and radius to be 0.963_{-0.029}^{+0.051} M_sun and 0.943 +/- 0.010 R_sun, the planet's mass, radius, and mean density are 8.63 +/- 0.35 Mearth, 2.00 +/- 0.14 Rearth, and 5.9_{-1.1}^{+1.5} g/cm^3. The mean density is comparable to that of Earth, despite the greater mass and consequently greater compression of the interior of 55 Cnc e. This suggests a rock-iron composition supplemented by a significant mass of water, gas, or other light elements. Outside of transits, we detected a sinusoidal signal resembling the expected signal due to the changing illuminated phase of the planet, but with a full range (168 +/- 70 ppm) too large to be reflected light or thermal emission. This signal has no straightforward interpretation and should be checked with further observations. The host star of 55 Cnc e is brighter than that of any other known transiting planet, which will facilitate future investigations.Comment: ApJ Letters, in press (v3) Minor changes/clarifications; (v2) Revised after fixing an error in the data reduction pipeline; for details see http://web.mit.edu/~jwinn/www/55cnc_response.tx

Ariel - Volume 12(13) Number 4

Co-Editors Gary Fishbein Lynn Solomon Business Manager Rich Davis Assistant Business Manager Jeff Lavanier Layout Editors Paul J. Berlin Tracy A. Glauser Photography Editor Ben Alma

Impact of handgrip exercise intensity on brachial artery flow-mediated dilation.

PURPOSE: Previous studies that have examined the impact of exercise intensity on conduit artery endothelial function have involved large muscle group exercise which induces local and systemic effects. The aim of this study was to examine flow-mediated dilation (FMD) before and after incremental intensities of handgrip exercise (HE), to assess the role of local factors such as blood flow and shear rate on post-exercise brachial artery function. METHODS: Eleven healthy men attended the laboratory on three occasions. Subjects undertook 30 min of handgrip exercise at three intensities (5, 10 or 15 % MVC). Brachial artery FMD, shear and blood flow patterns were examined before, immediately after and 60 min post exercise. RESULTS: Handgrip exercise increased mean and antegrade shear rate (SR) and blood flow (BF) and reduced retrograde SR and BF (all P < 0.01). Exercise intensity was associated with a dose-dependent increase in both mean and antegrade BF and SR (interaction, P < 0.01). Post-hoc tests revealed that, whilst handgrip exercise did not immediately induce post-exercise changes, FMD was significantly higher 60 min post-exercise following the highest exercise intensity (5.9 ± 2.8-10.4 ± 5.8 %, P = 0.01). CONCLUSIONS: Handgrip exercise leads to intensity-and time-dependent changes in conduit artery function, possibly mediated by local increases in shear, with improvement in function evident at 1 h post-exercise when performed at a higher intensity

TarO : a target optimisation system for structural biology

This work was funded by the UK Biotechnology and Biological Sciences Research Council (BBSRC) Structural Proteomics of Rational Targets (SPoRT) initiative, (Grant BBS/B/14434). Funding to pay the Open Access publication charges for this article was provided by BBSRC.TarO (http://www.compbio.dundee.ac.uk/taro) offers a single point of reference for key bioinformatics analyses relevant to selecting proteins or domains for study by structural biology techniques. The protein sequence is analysed by 17 algorithms and compared to 8 databases. TarO gathers putative homologues, including orthologues, and then obtains predictions of properties for these sequences including crystallisation propensity, protein disorder and post-translational modifications. Analyses are run on a high-performance computing cluster, the results integrated, stored in a database and accessed through a web-based user interface. Output is in tabulated format and in the form of an annotated multiple sequence alignment (MSA) that may be edited interactively in the program Jalview. TarO also simplifies the gathering of additional annotations via the Distributed Annotation System, both from the MSA in Jalview and through links to Dasty2. Routes to other information gateways are included, for example to relevant pages from UniProt, COG and the Conserved Domains Database. Open access to TarO is available from a guest account with private accounts for academic use available on request. Future development of TarO will include further analysis steps and integration with the Protein Information Management System (PIMS), a sister project in the BBSRC Structural Proteomics of Rational Targets initiative.Publisher PDFPeer reviewe

The Photoeccentric Effect and Proto-Hot Jupiters I. Measuring photometric eccentricities of individual transiting planets

Exoplanet orbital eccentricities offer valuable clues about the history of planetary systems. Eccentric, Jupiter-sized planets are particularly interesting: they may link the "cold" Jupiters beyond the ice line to close-in hot Jupiters, which are unlikely to have formed in situ. To date, eccentricities of individual transiting planets primarily come from radial velocity measurements. Kepler has discovered hundreds of transiting Jupiters spanning a range of periods, but the faintness of the host stars precludes radial velocity follow-up of most. Here we demonstrate a Bayesian method of measuring an individual planet's eccentricity solely from its transit light curve using prior knowledge of its host star's density. We show that eccentric Jupiters are readily identified by their short ingress/egress/total transit durations -- part of the "photoeccentric" light curve signature of a planet's eccentricity --- even with long-cadence Kepler photometry and loosely-constrained stellar parameters. A Markov Chain Monte Carlo exploration of parameter posteriors naturally marginalizes over the periapse angle and automatically accounts for the transit probability. To demonstrate, we use three published transit light curves of HD 17156 b to measure an eccentricity of e = 0.71 +0.16/-0.09, in good agreement with the discovery value e = 0.67+/-0.08 based on 33 radial-velocity measurements. We present two additional tests using actual Kepler data. In each case the technique proves to be a viable method of measuring exoplanet eccentricities and their confidence intervals. Finally, we argue that this method is the most efficient, effective means of identifying the extremely eccentric, proto hot Jupiters predicted by Socrates et al. (2012).Comment: ApJ, 756, 122. Received 2012 April 5; accepted 2012 July 9; published 2012 August 2