Background: The Current Procedural Terminology (CPT) coding system for office visits, which has been in use since 1995, has not been well studied, but it is generally agreed that the system contains much room for error. In fact, the available literature suggests that only slightly more than half of physicians will agree on the same CPT code for a given visit, and only 60% of professional coders will agree on the same code for a particular visit. In addition, the criteria used to assign a code are often related to the amount of written documentation. The goal of this study was to evaluate two novel methods to assess if the most appropriate CPT code is used: the level of medical decision making, or the sum of all problems mentioned by the patient during the visit. Methods: The authors–a professional coder, a residency faculty member, and a PGY-3 family medicine resident–reviewed 351 randomly selected visit notes from two residency programs in the Northeast Tennessee region for the level of documentation, the level of medical decision making, and the total number of problems addressed. The authors assigned appropriate CPT codes at each of those three levels. Results: Substantial undercoding occurred at each of the three levels. Approximately 33% of visits were undercoded based on the written documentation. Approximately 50% of the visits were undercoded based on the level of documented medical decision making. Approximately 80% of the visits were undercoded based on the total number of problems which the patient presented during the visit. Interrater agreement was fair, and similar to that noted in other coding studies. Conclusions: Undercoding is not only common in a family medicine residency program but it also occurs at levels that would not be evident from a simple audit of the documentation on the visit note. Undercoding also occurs from not exploring problems mentioned by the patient and not documenting additional work that was performed. Family physicians may benefit from minor alterations in their documentation of office visit notes. Key Points: * All previous studies of CPT coding have audited the written encounter note. * Medical decision making (MDM) is the most appropriate basis for selecting the CPT code for an office visit, as long as the history or the physical exam documentation also support that level. * Using MDM to retrospectively audit office visit notes showed that 50% of visits were undercoded. A small amount of additional documentation would allow the higher code. * Addressing all patient-mentioned problems during the visit, although clearly more time-consuming, would allow a higher CPT code to be used for 80% of the audited visits.

No description available.

No description available.

The caving/sloughing of sandy layers into drilled shafts is a common and costly phenomenon in the drilling industry. A prototype soil-testing device known as the Pneumatic In-situ Soil Caving Index Sampler (PISCIS) has been developed to test sandy layers above the water table for their propensity to cave/slough into a drilled shaft during the drilling process. The PISCIS fits down a Cone Penetration Test (CPT) hole and uses air pressure to agitate a sample off of the hole wall that is then collected and weighed. Large-scale lab testing was conducted using sand under a variety of simulated overburden pressures and fines contents. The tests were conducted with a dual purpose in mind. First, the tests confirmed the functionality of the PISCIS prototype and its ability to collect samples in a consistent and repeatable manner. Second, the tests resulted in a calibration curve that shows a very strong (nearly exponential) relationship between collected sample weight and the fines content of the test sand; higher fines contents resulted in lower collection weights. The PISCIS was designed to supplement information found in a geotechnical report with information that would specifically inform drilling contractors about potential caving/sloughing hazards found in the stratigraphy.

High altitude is characterized by chronically low ambient temperatures and oxygen. To survive, highland native deer mice (Peromyscus maniculatus) are capable of high rates of prolonged thermogenesis due to elevated aerobic capacity (V̇O2max) in hypoxia. Deer mice primarily use fats to fuel their high metabolic rates for heat production. Carnitine palmitoyl-transferase 1 (CPT-1) is a rate-limiting step in mitochondrial fat oxidation, and a reduction in CPT-I sensitivity for its substrate L-carnitine is associated with a reduction in muscle fat use during high intensity exercise in mammals. Sensitivity of mitochondrial metabolism to ADP also changes with exercise. It is currently unknown whether similar mechanisms underpin regulation of fuel use during shivering, but I predicted that sensitivities to ADP and L-carnitine would be greater in highlanders than lowlanders and increase with acclimation. To address this question, I examined mitochondrial sensitivity to substrates involved in the fat oxidation pathway in low- and high- altitude deer mice born and raised in common laboratory conditions. Mice were also acclimated to high altitude condition of cold hypoxia to examine if the plasticity of these traits were affected by altitude ancestry. Consistent with previous findings, both high and lowland mice increased their cold-induced V̇O2max following cold hypoxia acclimation and rely primarily on lipids to fuel thermogenesis. High- and low-altitude deer mice responded differently to chronic cold hypoxia with highlanders showing a ~7-fold greater ADP sensitivity than lowlanders following acclimation. In contrast to the expected outcome, highlander deer mice tended to have a reduced sensitivity to L-carnitine compared to lowlanders that approached statistical significance. Neither sensitivity to palmitoylcarnitine sensitivity nor mitochondrial expression of FAT/CD36, thought to aid in mitochondrial fat delivery, showed differences between population or changes with acclimation, indicating that limitations to lipid oxidation during shivering likely occur at, or upstream of, CPT-I in the deer mouse. / Thesis / Master of Science (MSc) / Some animals can survive extremely harsh climates, such as high altitude. High altitude is characterized by unremitting cold and thin air, and these challenges can constrain aerobic activities in mammals. The North American deer mouse can thrive at high altitude by actively generating large amounts of body heat in a process known as thermogenesis. The deer mouse relies primarily on fats as fuel to support thermogenesis, but the cellular mechanisms that regulate the use of lipids to power thermogenesis remain unclear. To address this question, I induced shivering in deer mice from both high- and low-altitude populations that I exposed to simulated high- or low-altitude conditions. I then examined the effects of these treatments on the ability of shivering muscle to consume oxygen and fuel for thermogenesis. My thesis contributes to the current understanding of how mammals manage their energy supply to survive in a challenging environment.

A presente pesquisa, pautada por quase dez anos de constante aprendizado e prática artística no Centro de Pesquisa Teatral (CPT), aborda a Arte do ator pela perspectiva da prática formativa desenvolvida e aplicada por Antunes Filho. O estudo pretende refletir sobre a experiência proposta na formação dos atores no CPT e organizar o conceito de Manifestação elaborado pelo diretor. A dissertação analisa a origem da metodologia e contempla a investigação da recente prática formativa coordenada por Antunes, somando-se aos escassos, porém importantes, estudos sobre a trajetória do diretor, diferenciando-se desses por articular na análise do objeto de pesquisa a experiência cênica e a prática didática do pesquisador no contexto do CPT / This study, based on nearly ten years of constant learning and artistic practice at the Center of Theatre Research (CPT), discusses the Art of the actor through the perspective of formative practice developed and applied by Antunes Filho. The study aims to reflect about the experience proposed on the actor\'s training within the CPT and to organize the concept of Manifestation, created by the director. The dissertation examines the methodology\'s origin and contemplates the investigation of the recent formative practice leaded by Antunes, adding to the scarce, but important, studies on the director\'s trajectory, but differentiating from those by the articulation of the researcher\'s acting experience and teaching practice in the context of CPT.

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-06-07T18:48:31Z No. of bitstreams: 1 AlexsandroLucenaMota.pdf: 2757687 bytes, checksum: 04b1d52c9ca203ed571f49aacf10eeac (MD5) / Made available in DSpace on 2017-06-07T18:48:31Z (GMT). No. of bitstreams: 1 AlexsandroLucenaMota.pdf: 2757687 bytes, checksum: 04b1d52c9ca203ed571f49aacf10eeac (MD5) Previous issue date: 2014-09-30 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / The first studies on Lorentz-violating BPS vórtices were accomplished within the framework of the Standard Model Extension (SME). Specifically, it was studied the effects of the Lorentz violation in the vortex solutions presented in the Maxwell-Higgs electrodynamics. The formation of vórtices was also analyzed in (1+2)-dimensional models obtained by dimensional reduction of the SME Abelian sector. Among the several effects of the Lorentz violation we can mention: the control of both the amplitude as the width of the vortex, magnetic field reversion, magnetic flux quantization with explicit dependence on the Lorentz-violating coefficients. In this dissertation we study the existence of topological BPS vórtices in a Maxwell-Higgs model in which the covariant derivative is modified by the addition of a CPT-odd term, which breaks the CPT- and Lorentz symmetry due to the presence of a vectorial background. The interaction generating a set of self-dual or first-order equations includes a potential jφj4 and a derivative coupling j@iφj4. Although the self-dual equations are very different of those belonging to the usual MaxwellHiggs model, the new vortex solutions behave just like the Aharonov-Nielsen-Olesen ones, but the mass scale depends explicitly on the Lorentz-violating coefficient. / Os primeiros estudos sobre vórtices BPS no contexto da violação da simetria de Lorentz foram realizadas no marco teórico do modelo padrão estendido (MPE). Especificamente, foram estudados os efeitos da quebra de Lorentz sobre os vórtices existentes na eletrodinâmica de Maxwell-Higgs. Também, foram estudadas a formação de vórtices em modelos (1+2)-dimensionais obtidos via redução dimensional do setor Abeliano do MPE. Entre os diversos efeitos da quebra de Lorentz podemos citar: controle da amplitude e largura do vórtice, inversão do campo magnético, fluxo magnético quantizado com dependência explícita nos coeficientes da quebra de Lorentz, etc. Nesta dissertação estudamos a existência de vórtices topológicos em um modelo de MaxwellHiggs cuja derivada covariante é modificada pela inclusão de um termo CPT-ímpar, o qual quebra a simetria de Lorentz devido a presença de um campo de fundo vetorial. A interação, que gera um sistema de equações auto-duais de primeira ordem, inclui um potencial jφj4 e um acoplamento derivativo j@iφj4. A pesar das equações auto-duais serem bem diferentes daquelas do modelo de Maxwell-Higgs, os vórtices obtidos se comportam como aqueles de Aharonov-Nielsen-Olesen, mas a escala de massa depende explicitamente do coeficiente que controla a quebra de Lorentz.

A presente pesquisa, pautada por quase dez anos de constante aprendizado e prática artística no Centro de Pesquisa Teatral (CPT), aborda a Arte do ator pela perspectiva da prática formativa desenvolvida e aplicada por Antunes Filho. O estudo pretende refletir sobre a experiência proposta na formação dos atores no CPT e organizar o conceito de Manifestação elaborado pelo diretor. A dissertação analisa a origem da metodologia e contempla a investigação da recente prática formativa coordenada por Antunes, somando-se aos escassos, porém importantes, estudos sobre a trajetória do diretor, diferenciando-se desses por articular na análise do objeto de pesquisa a experiência cênica e a prática didática do pesquisador no contexto do CPT / This study, based on nearly ten years of constant learning and artistic practice at the Center of Theatre Research (CPT), discusses the Art of the actor through the perspective of formative practice developed and applied by Antunes Filho. The study aims to reflect about the experience proposed on the actor\'s training within the CPT and to organize the concept of Manifestation, created by the director. The dissertation examines the methodology\'s origin and contemplates the investigation of the recent formative practice leaded by Antunes, adding to the scarce, but important, studies on the director\'s trajectory, but differentiating from those by the articulation of the researcher\'s acting experience and teaching practice in the context of CPT.

The object of the thesis is soils that occur within the territory of Lithuania and may be used as basis for building foundations. The thesis studies the interpretation of the results of Dynamic Penetration Test (DPT) and Cone Penetration Test (CPT) of soils, reliability of direct (number of blows (Nx)) and de-rivative (dynamic point resistance (qd)) DPT parameters, analyses the result influencing factors and interrelation between DPT and CPT parameters. The data analysis has been performed by means of mathematical methods of statistics, also using analytical and empirical solutions. Having examined calculation data it was determined that the indirect parameter of Dy-namic Penetration Test – dynamic point resistance (qd) should not be used due to calculation de-faults and replaced with the direct parameter – number of blows (Nx). The analysis of DPT re-sults influencing factors shows that the lateral overburden pressure together with friction of rods are those with the greatest impact on penetration data. Within the scope of the work, it has re-vealed that the number of blows (Nx) and static cone resistance (qc) are closely correlated and it depends on the grain size distribution of soil, geotechnical properties and depth of occurrence. / Disertacijos objektas yra Lietuvos teritorijoje slūgsantys gruntai, kurie gali būti statinių pamatų pagrindu. Disertacijoje nagrinėjama grunto tyrimo dinaminiu (DPT) ir statiniu (CPT) zondavimu rezultatų interpretacija, tiesioginio (smūgių skaičiaus (Nx)) ir išvestinio (dinaminės kūgio smigos (qd)) DPT rodiklių patikimumas, analizuojami rezultatus įtakojantys veiksniai ir sąsajos tarp DPT bei CPT zondavimo rodiklių. Duomenų analizė atlikta matematiniais statistiniais metodais, taip pat panaudojant analitinius ir empirinius sprendinius. Išnagrinėjus skaičiavimo duomenis buvo nustatyta, kad netiesioginis dinaminio zonda-vimo rodiklis – dinaminė kūgio smiga (qd) dėl skaičiavimo trukumų yra nenaudotinas ir keisti-nas į tiesioginį rodiklį – smūgių skaičių (Nx). DPT rezultatus įtakojančių veiksnių analizė paro-dė, kad zondavimo duomenims didžiausią įtaką turi gruntų šoninis geostatinis slėgis ir kartu zondavimo štangų trintis į gruntą. Darbo metu buvo gauta, kad egzistuoja tamprus koreliacinis ryšys tarp smūgių skaičiaus (Nx) ir statinės kūgio spraudos (qc), kuris priklauso nuo grunto gra-nuliometrinės sudėties, mechaninių savybių ir slūgsojimo gylio.

Disertacijos objektas yra Lietuvos teritorijoje slūgsantys gruntai, kurie gali būti statinių pamatų pagrindu. Disertacijoje nagrinėjama grunto tyrimo dinaminiu (DPT) ir statiniu (CPT) zondavimu rezultatų interpretacija, tiesioginio (smūgių skaičiaus (Nx)) ir išvestinio (dinaminės kūgio smigos (qd)) DPT rodiklių patikimumas, analizuojami rezultatus įtakojantys veiksniai ir sąsajos tarp DPT bei CPT zondavimo rodiklių. Duomenų analizė atlikta matematiniais statistiniais metodais, taip pat panaudojant analitinius ir empirinius sprendinius. Išnagrinėjus skaičiavimo duomenis buvo nustatyta, kad netiesioginis dinaminio zonda-vimo rodiklis – dinaminė kūgio smiga (qd) dėl skaičiavimo trukumų yra nenaudotinas ir keisti-nas į tiesioginį rodiklį – smūgių skaičių (Nx). DPT rezultatus įtakojančių veiksnių analizė paro-dė, kad zondavimo duomenims didžiausią įtaką turi gruntų šoninis geostatinis slėgis ir kartu zondavimo štangų trintis į gruntą. Darbo metu buvo gauta, kad egzistuoja tamprus koreliacinis ryšys tarp smūgių skaičiaus (Nx) ir statinės kūgio spraudos (qc), kuris priklauso nuo grunto gra-nuliometrinės sudėties, mechaninių savybių ir slūgsojimo gylio. / The object of the thesis is soils that occur within the territory of Lithuania and may be used as basis for building foundations. The thesis studies the interpretation of the results of Dynamic Penetration Test (DPT) and Cone Penetration Test (CPT) of soils, reliability of direct (number of blows (Nx)) and de-rivative (dynamic point resistance (qd)) DPT parameters, analyses the result influencing factors and interrelation between DPT and CPT parameters. The data analysis has been performed by means of mathematical methods of statistics, also using analytical and empirical solutions. Having examined calculation data it was determined that the indirect parameter of Dy-namic Penetration Test – dynamic point resistance (qd) should not be used due to calculation de-faults and replaced with the direct parameter – number of blows (Nx). The analysis of DPT re-sults influencing factors shows that the lateral overburden pressure together with friction of rods are those with the greatest impact on penetration data. Within the scope of the work, it has re-vealed that the number of blows (Nx) and static cone resistance (qc) are closely correlated and it depends on the grain size distribution of soil, geotechnical properties and depth of occurrence.