The Impact of Patient Portals on Release of Information Requests

Patient portals are no longer a thing of the past. The government has issued a mandate that all covered entities who are reimbursed under Medicare payments must implement patient portals as a part of the Meaningful Use initiative or suffer penalties. The objective of this study is to review the data to see if there is a decrease in the number of release of information (ROI) requests at facilities that have implemented patient portals. A survey was conducted to determine if there was any change in the number of ROI requests that facilities received prior to implementation of patient portal compared to ROI requests received after the implementation of patient portal. The response rate for the survey was very low, however, the information will still be valuable to the ROI professionals

Sepsis: Do the Clinical Criteria Support the Medical Coding?

Background: Sepsis is a condition that can be very costly and very deadly. Diagnosing sepsis can be challenging as there is not one specific test that will identify whether a patient has sepsis and there are varying opinions as to the true definition of sepsis. The definition of sepsis used for this research is a combination of System Inflammatory Response Syndrome (SIRS) with an identified infection. Medical Coders must review the documentation provided in a medical record to accurately assign an ICD-10-CM code. Administrative data is then used to provide statistical information for research purposes. When coded data is not accurate, this leads to errors in administrative data and inaccuracies in research. Objectives: The main goal of this study was to identify the accuracy of medical coding for sepsis patients. There were six research questions that guided the research. These included 1) Are cases coded as sepsis that are not clinically supported as sepsis; 2) Are infection cases not coded as sepsis clinically supported as sepsis; 3) Are there any variances for certain physicians; 4) Are there any variances for certain physician specialties; 5) Are there any variances for certain payers; 6) Are there any variances for certain medical coders? Methods: We used a convenience sampling of patient records from 4th quarter 2019 from Erlanger Health Systems that were coded as sepsis and a sampling that were coded as an infection without sepsis. Research Design and Study Procedures: Following Institutional Review Board (IRB) approval from both Erlanger Health Systems and the University of Tennessee Health Science Center (UTHSC), a chart review was conducted. Clinical indicators identified in the created data abstraction tool were abstracted from the patient records. Results: Data analysis concluded that the accuracy rate of medical coding for the sepsis patient records based on the clinical documentation was 98.5%. Physician specialty and payer type had no impact on the accuracy of medical coding on these records. Data analysis concluded the accuracy rate of medical coding for the infection patient records based on clinical documentation was 59%. Logistical regression also identified there were no variances in the coding for the infection patients based on the payer type, medical coder years of inpatient coding experience and the medical coders education level. Analysis determined there was a variance in coding accuracy of the infection patients group based on physician specialty

Laboratory tests and design of plant for treatment of gold ore

The object of this work was to determine methods and design plants best adapted for the estraction sic of gold from a given ore in the most profitable manner. In the following sheets are given in detail the work carried out and our conclusions as to the best method of treating this particular ore --page ii

Nucleoporin98-96 Function Is Required for Transit Amplification Divisions in the Germ Line of Drosophila melanogaster

Production of specialized cells from precursors depends on a tightly regulated sequence of proliferation and differentiation steps. In the gonad of Drosophila melanogaster, the daughters of germ line stem cells (GSC) go through precisely four rounds of transit amplification divisions to produce clusters of 16 interconnected germ line cells before entering a stereotypic differentiation cascade. Here we show that animals harbouring a transposon insertion in the center of the complex nucleoporin98-96 (nup98-96) locus had severe defects in the early steps of this developmental program, ultimately leading to germ cell loss and sterility. A phenotypic analysis indicated that flies carrying the transposon insertion, designated nup98-962288, had dramatically reduced numbers of germ line cells. In contrast to controls, mutant testes contained many solitary germ line cells that had committed to differentiation as well as abnormally small clusters of two, four or eight differentiating germ line cells. This indicates that mutant GSCs rather differentiated than self-renewed, and that these GSCs and their daughters initiated the differentiation cascade after zero, or less than four rounds of amplification divisions. This phenotype remained unaffected by hyper-activation of signalling pathways that normally result in excessive proliferation of GSCs and their daughters. Expression of wildtype nup98-96 specifically in the germ line cells of mutant animals fully restored development of the GSC lineage, demonstrating that the effect of the mutation is cell-autonomous. Nucleoporins are the structural components of the nucleopore and have also been implicated in transcriptional regulation of specific target genes. The nuclear envelopes of germ cells and general nucleocytoplasmic transport in nup98-96 mutant animals appeared normal, leading us to propose that Drosophila nup98-96 mediates the transport or transcription of targets required for the developmental timing between amplification and differentiation

Differential Roles of HOW in Male and Female Drosophila Germline Differentiation

The adult gonads in both male and female Drosophila melanogaster produce gametes that originate from a regenerative pool of germline stem cells (GSCs). The differentiation programme that produces gametes must be co-ordinated with GSC maintenance and proliferation in order to regulate tissue regeneration. The HOW RNA-binding protein has been shown to maintain mitotic progression of male GSCs and their daughters by maintenance of Cyclin B expression as well as suppressing accumulation of the differentiation factor Bam. Loss of HOW function in the male germline results in loss of GSCs due to a delay in G2 and subsequent apoptosis. Here we show that female how mutant GSCs do not have any cell cycle defects although HOW continues to bind bam mRNA and suppress Bam expression. The role of HOW in suppressing germ cell Bam expression appears to be conserved between sexes, leading to different cellular outcomes in how mutants due to the different functions of Bam. In addition the role in maintaining Cyclin B expression has not been conserved so female how GSCs differentiate rather than arrest

Dynein light chain 1 functions in somatic cyst cells regulate spermatogonial divisions in Drosophila

Stem cell progeny often undergo transit amplifying divisions before differentiation. In Drosophila, a spermatogonial precursor divides four times within an enclosure formed by two somatic-origin cyst cells, before differentiating into spermatocytes. Although germline and cyst cell-intrinsic factors are known to regulate these divisions, the mechanistic details are unclear. Here, we show that loss of dynein-light-chain-1 (DDLC1/LC8) in the cyst cells eliminates bag-of-marbles (bam) expression in spermatogonia, causing gonial cell hyperplasia in Drosophila testis. The phenotype is dominantly enhanced by Dhc64C (cytoplasmic Dynein) and didum (Myosin V) loss-of-function alleles. Loss of DDLC1 or Myosin V in the cyst cells also affects their differentiation. Furthermore, cyst cell-specific loss of ddlc1 disrupts Armadillo, DE-cadherin and Integrin-βPS localizations in the cyst. Together, these results suggest that Dynein and Myosin V activities, and independent DDLC1 functions in the cyst cells organize the somatic microenvironment that regulates spermatogonial proliferation and differentiation

Pyogenic Flexor Tenosynovitis in an Infant

Pyogenic flexor tenosynovitis is a rare though well known infectious process of the flexor tendon sheath of the hand. This condition is generally diagnosed in adults by the observance of the four Kanavel signs. Application of the Kanavel signs to diagnosis in the pediatric population, however, is of unknown utility. We present the case of a 13-month-old male with pyogenic flexor tenosynovitis who presented with all four of the Kanavel signs

Instructions and telegraphic correspondence relating to Mr. Buchanan's mission to Venezuela.

Mr. Buchanan was given the commission to represent the President "with full power to confer with the government of Venezuela, in all matters relating to the reestablishment of diplomatic relations between the United States and Venezuela."At head of title: Confidential [blotted out]Cover title.Mode of access: Internet