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.

How do brassinosteroids fit in bud outgrowth models?

Advance Access Publication 17 October 2023. OnlinePublShort stature crops were developed during the green revolution mainly due to their resistance to falling over (lodging), improved crop harvestability and management, and a greater proportion of biomass in the grains, leading to superior yield. These crops were disrupted in the gibberellin (GA) pathway, which caused the reduced height (Gao and Chu, 2020). GA disruption can introduce unwanted effects in other important traits such as fertility, leaf expansion, seed quality, and stress response (Gao and Chu, 2020). Hence, there are currently efforts to uncouple negative side effects of GA-related short stature or utilize alternative dwarfing pathways, such as brassinosteroids (BRs).Jack H. Kelly and Philip B. Brewe

The Mass of the Black Hole in Arp 151 from Bayesian Modeling of Reverberation Mapping Data

Supermassive black holes are believed to be ubiquitous at the centers of galaxies. Measuring their masses is extremely challenging yet essential for understanding their role in the formation and evolution of cosmic structure. We present a direct measurement of the mass of a black hole in an active galactic nucleus (Arp 151) based on the motion of the gas responsible for the broad emission lines. By analyzing and modeling spectroscopic and photometric time series, we find that the gas is well described by a disk or torus with an average radius of 3.99 +- 1.25 light days and an opening angle of 68.9 (+21.4, -17.2) degrees, viewed at an inclination angle of 67.8 +- 7.8 degrees (that is, closer to face-on than edge-on). The black hole mass is inferred to be 10^(6.51 +- 0.28) solar masses. The method is fully general and can be used to determine the masses of black holes at arbitrary distances, enabling studies of their evolution over cosmic time.Comment: Accepted for publication in ApJ Letter

Pediatrician-Parent Conversations About Human Papillomavirus Vaccination: An Analysis of Audio Recordings

AbstractPurposeWe sought to establish which human papillomavirus (HPV) vaccine communication approaches by pediatricians were associated with same-day HPV vaccination of 11- to 12-year-olds by evaluating audio recordings of visits.MethodsVerilogue, a market research company maintaining a panel of primary care pediatricians, provided audio recordings and transcriptions of well-child visits for 11- to 12-year-old patients from January through June 2013. Seventy-five transcripts from 19 pediatricians were coded for use of presumptive language (i.e., words conveying assumption of vaccine delivery), offer of delay, recommendation strength, and information provision. Using logistic regression, we evaluated the association between pediatrician communication approaches and agreement to same-day HPV vaccination. Generalized estimating equations accounted for clustering of patients within pediatricians.ResultsSame-day agreement to HPV vaccination occurred in 29% of encounters. Pediatricians in the sample often provided parents with inconsistent, mixed messages and sometimes offered information about HPV or HPV vaccination that was inaccurate. Pediatricians used presumptive language in only 11 of 75 encounters; when used, presumptive language was associated with higher odds of accepting HPV vaccine (73% vs. 22%; odds ratio = 8.96; 95% confidence interval = 2.32–34.70). Pediatricians offered or recommended delay in most encounters (65%). HPV vaccine acceptance occurred far more often when pediatricians did not mention delaying vaccination (82% vs. 6%; odds ratio = 80.84; 95% confidence interval = 15.72–415.67). Same-day vaccination was not associated with strength of recommendation or pediatrician reference to vaccinating their own children.ConclusionsOur findings highlight the need to develop and evaluate physician-focused trainings on using presumptive language for same-day HPV vaccination

Steady-state solution for dark states using a three-level system in coupled quantum dots

Quantum dots (QDs) are one of the promising candidates of interconnection between electromagnetic field and electrons in solid-state devices. Dark states appear as a result of coherence between the electromagnetic fields and the discrete energy levels of the system. Here, we theoretically solve the steady-state solutions of the density matrix equations for a thee-level double QD system and investigate the condition of the appearance of a dark state. We also numerically show the appearance of the dark state by time-dependent current characteristics.Comment: 5 pages, 5 figure

A model independent null test on the cosmological constant

We use the Om statistic and the Genetic Algorithms (GA) in order to derive a null test on the spatially flat cosmological constant model $\Lambda$CDM. This is done in two steps: first, we apply the GA to the Constitution SNIa data in order to acquire a model independent reconstruction of the expansion history of the Universe $H(z)$ and second, we use the reconstructed $H(z)$ in conjunction with the Om statistic, which is constant only for the $\Lambda$CDM model, to derive our constraints. We find that while $\Lambda$CDM is consistent with the data at the $2\sigma$ level, some deviations from $\Lambda$CDM model at low redshifts can be accommodated.Comment: v1: 8 pages, 7 figures. v2: Typos corrected, sections 3,4 expanded, examples added, results unchanged. v3: changes match published versio

A single dose polyanhydride-based vaccine platform promotes and maintains anti-GnRH antibody titers

Traditionally, vaccination strategies require an initial priming vaccination followed by an antigen boost to generate adequate immunity. Here we describe vaccination against a self-peptide for reproductive sterilization utilizing a three-stage vaccine platform consisting of gonadotropin releasing hormone multiple antigenic peptide (GnRH-MAP) as a soluble injection coupled with subcutaneous administration of polyanhydride-immobilized GnRH-MAP and a cyto-exclusive implant containing GnRH-MAP dendrimer-loaded polyanhydride. This strategy generated and maintained cell-mediated and humoral immunity for up to 41 weeks after a single vaccination in mice with enhanced antibody avidity over time. All intact implants had a grossly visible tissue interface with neovascularization and lymphocytic aggregates. Despite detectable immunity, sterility was not achieved and the immune response did not lead to azoospermia in male mice nor prevent estrus and ovulation in female mice. However, the vaccine delivery device is tunable and the immunogen, adjuvants and release rates can all be modified to enhance immunity. This technology has broad implications for the development of long-term vaccination schemes

Appalachian Environmental Health Literacy: Building Knowledge and Skills to Protect Health

Environmental health literacy (EHL) is an emerging, multidisciplinary field that promotes understanding of how environmental exposures can affect human health. After discussing the regional relevance of environmental health knowledge and skills, this article describes three ongoing Appalachian projects that are focused on measuring and building EHL