Physician coding for mental illness reimbursement and the need for mental health parity

Many patients with anxiety and depression initially seek treatment from their primary care physicians. Changes in insurance coverage and current mental parity laws, make reimbursement for services a problem. This has led to a coding dilemma for physicians seeking payment for their services. This study seeks to determine first the frequency at which primary care physicians use alternative coding, and secondly, if physicians would change their coding practices, provided reimbursement was assured through changes in mental parity laws. A mail survey was sent to 260 randomly selected primary care physicians, who are family practice, internal medicine, and general practice physicians, and members of the Harris County Medical Society. The survey evaluated the physicians' demographics, the number of patients with psychiatric disorders seen by primary care physicians, the frequency with which physicians used alternative coding, and if mental parity laws changed, the rate at which physicians would use a psychiatric illness diagnosis as the primary diagnostic code. The overall response rate was 23%. Only 47 of the 59 physicians, who responded, qualified for the study and of those 45% used a psychiatric disorder to diagnose patients with a primary psychiatric disorder, 47% used a somatic/symptom disorder, and 8% used a medical diagnosis. From the physicians who would not use a psychiatric diagnosis as a primary ICD-9 code, 88% were afraid of not being reimbursed and 12% were worried about stigma or jeopardizing insurability. If payment were assured using a psychiatric diagnostic code, 81% physicians would use a psychiatric diagnosis as the primary diagnostic code. However, 19% would use an alternative diagnostic code in fear of stigmatizing and/or jeopardizing patients' insurability. Although the sample size of the study design was adequate, our survey did not have an ideal response rate, and no significant correlation was observed. However, it is evident that reimbursement for mental illness continues to be a problem for primary care physicians. The reformation of mental parity laws is necessary to ensure that patients receive mental health services and that primary care physicians are reimbursed. Despite the possibility of improved mental parity legislation, some physicians are still hesitant to assign patients with a mental illness diagnosis, due to the associated stigma, which still plays a role in today's society. ^

Improving the health and well-being of women at risk for neural tube defect recurrence

There is growing interest in providing women with internatal care, a package of healthcare and ancillary services that can improve their health during the period after the termination of one pregnancy but before the conception of the next pregnancy. Women who have had a pregnancy affected by a neural tube defect can especially benefit from internatal care because they are at increased risk for recurrence and improvements to their health during the inter-pregnancy period can prevent future negative birth outcomes. The dissertation provides three papers that inform the content of internatal care for women at risk for recurrence by examining descriptive epidemiology to develop an accurate risk profile of the population, assessing whether women at risk for recurrence would benefit from a psychosocial intervention, and determining how to improve health promotion efforts targeting folic acid use.^ Paper one identifies information relevant for developing risk profiles and conducting risk assessments. A number of investigations have found that the risk for neural tube defects differs between non-Hispanic Whites and Hispanics. To understand the risk difference, the descriptive epidemiology of spina bifida and anencephaly was examined for Hispanics and non-Hispanic Whites based on data from the Texas Birth Defects Registry for the years 1999 through 2004. Crude and adjusted birth prevalence ratios and corresponding 95% confidence intervals were calculated between descriptive epidemiologic characteristics and anencephaly and spina bifida for non-Hispanic Whites and for Hispanics. In both race/ethnic groups, anencephaly expressed an inverse relationship with maternal age and a positive linear relationship with parity. Both relationships were stronger in non-Hispanic Whites. Female infants had a higher risk for anencephaly in non-Hispanic Whites. Lower maternal education was associated with increased risk for spina bifida in Hispanics.^ Paper two assesses the need for a psychosocial intervention. For mothers who have children with spina bifida, the transition to motherhood can be stressful. This qualitative study explored the process of becoming a mother to a child with spina bifida focusing particularly on stress and coping in the immediate postnatal environment. Semi-structured interviews were conducted with six mothers who have children with spina bifida. Mothers were asked about their initial emotional and problem-based coping efforts, the quality and kind of support provided by health providers, and the characteristics of their meaning-based coping efforts; questions matched Transactional Model of Stress and Coping (TMSC) constructs. Analysis of the responses revealed a number of modifiable stress and coping transactions, the most salient being: health providers are in a position to address beliefs about self-causality and prevent mothers from experiencing the repercussions that stem from maintaining these beliefs. ^ Paper three identifies considerations when creating health promotion materials targeting folic acid use. A brochure was designed using concepts from the Precaution Adoption Process Model (PAPM). Three focus groups comprising 26 mothers of children with spina bifida evaluated the brochure. One focus group was conducted in Spanish-only, the other two focus groups were conducted in English and Spanish combined. Qualitative analysis of coded transcripts revealed that a brochure is a helpful adjunct. Questions about folic acid support the inclusion of an insert with basic information. There may be a need to develop different educational material for Hispanics so the importance of folic acid is provided in a situational context. Some participants blamed themselves for their pregnancy outcome which may affect their receptivity to messages in the brochure. The women's desire for photographs that affect their perception of threat and their identification with the second role model indicate they belong to PAPM Stage 2 and 3. Participants preferred colorful envelopes, high quality paper, intimidating photographs, simple words, conversational style sentences, and positive messages.^ These papers develop the content of risk assessment, psychosocial intervention, and health promotion components of internatal care as they apply to women at risk for recurrence. The findings provided evidence for considering parity and maternal age when assessing nutritional risk. The two dissimilarities between the two race/ethnic groups, infant sex and maternal education lent support to creating separate risk profiles. Interviews with mothers of children with spina bifida revealed the existence of unmet needs-suggesting that a psychosocial intervention provided as part of internatal care can strengthen and support women's well-being. Segmenting the audience according to race/ethnicity and PAPM stage can improve the relevance of print materials promoting folic acid use.^

The association between parity and selected structural birth defects

BACKGROUND: Parity is a risk factor in neonatal morbidity and mortality. This dissertation examined the association between first births and selected birth defects. The first aim was to assess the risk of 66 birth defects among first births and third or greater births. The second aim was to determine if maternal race, maternal age, infant sex or infant birth weight modify the association between first births and selected birth defects. METHODS: The Texas Birth Defects Registry provided data for 1999-2009. For the first aim, odds ratios were calculated for each birth defect. For the second aim, analysis was restricted to the ten birth defects significantly associated with first births. Stratified analyses were conducted and interaction terms were added to logistic regression models to assess whether differences in the odds ratios for the effect of first birth were statistically significant across strata. RESULTS: Findings for the first aim showed that first births had significantly increased odds of having an infant with 24 of the 66 birth defects. Third or greater births had significantly increased odds of having four of the 66 birth defects. For the second aim, a number of significant effect modifiers were observed. For patent ductus arteriosis, obstructive urinary defects and gastroschisis, the effect of first births was significantly modified by black or U.S.-born Hispanic mothers. The effect of first birth was also significantly modified among mothers ≥30 years for mitral valve insufficiency, atrial septal defect and congenital hip dislocation. The effect of first births was significantly modified among infants with low birth weight for hypospadias, congenital hip dislocation and gastroschisis. CONCLUSIONS: First births were associated with an elevated risk of 24 categories of birth defects. For some of the birth defects studied, the effect of first birth is modified by maternal age, maternal race and low birth weight. Knowledge of the increased risk for birth defects among women having their first birth allows physicians and midwives to provide better patient care and spur further research into the etiology of associated birth defects. This knowledge may bring about interventions prior to conception in populations most likely to conceive.^

Exchange Rate Stabilization and IMF High Interest Rate Policy: A Critical Reconsideration Using a Dynamic Model

This paper examines whether the IMF high interest rate policy was suitable for crisis-ridden East Asian economies. Using an "overshoot" model similar to that of Dornbusch's (1976), it shows that this sort of policy might cause an unnecessary deflationary adjusting process and have no effect on containing the real depreciation of exchange rates in the long run. The study also demonstrates that Thai economic data coincides quite well with the model presented here. Finally, it points out that the high interest policy itself might provoke high risk-premium, the existence of which, in turn, justifies the policy. This means that the policy has a self-fulfilling property. In conclusion, a "one-size-fits-all" adaptation of high interest rate policy in a currency crisis is very dangerous in general, and was inappropriate for East Asia. The desirable policy would have been to let currencies depreciate and keep interest rates stable.

Stark Broadening of Sn III Spectral Lines of Astrophysical Interest: Predictions and Regularities

The determination of the Stark broadening parameters of Sn ions is useful for astrophysicists interested in the determination of the density of electrons in stellar atmospheres. In this paper, we report on the calculated values of the Stark broadening parameters for 171 lines of Sn iii arising from 4d105sns (n= 6–9), 4d105snp (n= 5, 6), 4d105p2, 4d105snd (n= 5–7), 4d105s4f and 4d105s5g. Stark linewidths and line shifts are presented for an electron density of 1023 m−3 and temperatures T= 11 000–75 000 K. These have been calculated using a semi-empirical approach, with a set of wavefunctions obtained from Hartree–Fock relativistic calculations, including core polarization effects. The results obtained have been compared with available experimental data. These can be used to consider the influence of Stark broadening effects in A-type stellar atmospheres

Success possibilities of grid parity in particular cases in the new spanish regulatory framework

During the last 10 years the Spanish photovoltaic market has experienced one of the most important increases worldwide. The continuous raise on the price of the electricity in Spain, as in other European countries, USA and Japan, as well as the decrease of the cost of solar photovoltaic systems along this decade is opening a new way to reach grid parity point in some particular scenarios. A new Spanish legislation is being performed toward selfconsumption, and it is in this new context where the grid parity in a wide sense could be achieved. This work will study different cases in Spain, in order to determine whether grid parity would be possible along 2012. Keywords: grid parity, self-consumption, photovoltaic, net-metering

Reduced order modeling of some fluid flows of industrial interest

Some basic ideas are presented for the construction of robust, computationally efficient reduced order models amenable to be used in industrial environments, combined with somewhat rough computational fluid dynamics solvers. These ideas result from a critical review of the basic principles of proper orthogonal decomposition-based reduced order modeling of both steady and unsteady fluid flows. In particular, the extent to which some artifacts of the computational fluid dynamics solvers can be ignored is addressed, which opens up the possibility of obtaining quite flexible reduced order models. The methods are illustrated with the steady aerodynamic flow around a horizontal tail plane of a commercial aircraft in transonic conditions, and the unsteady lid-driven cavity problem. In both cases, the approximations are fairly good, thus reducing the computational cost by a significant factor.

Physiological features of Schizosaccharomyces pombe of interest in the making of white wines

This work studies the physiology of Schizosaccharomyces pombe strain 938 in the production of white wine with high malic acid levels as the sole fermentative yeast, as well as in mixed and sequential fermentations with Saccharomyces cerevisiae Cru Blanc. The induction of controlled maloalcoholic fermentation through the use of Schizosaccharomyces spp. is now being viewed with much interest. The acetic, malic and pyruvic acid concentrations, relative density and pH of the musts were measured over the entire fermentation period. In all fermentations in which Schizo. pombe 938 was involved, nearly all the malic acid was consumed and moderate acetic concentrations produced. The urea content and alcohol level of these wines were notably lower than in those made with Sacch. cerevisiae Cru Blanc alone. The pyruvic acid concentration was significantly higher in Schizo. pombe fermentations. The sensorial properties of the different final wines varied widely.

Blind reconiliation

Information reconciliation is a crucial procedure in the classical post-processing of quantum key distribution (QKD). Poor reconciliation e?ciency, revealing more information than strictly needed, may compromise the maximum attainable distance, while poor performance of the algorithm limits the practical throughput in a QKD device. Historically, reconciliation has been mainly done using close to minimal information disclosure but heavily interactive procedures, like Cascade, or using less e?cient but also less interactive ?just one message is exchanged? procedures, like the ones based in low-density parity-check (LDPC) codes. The price to pay in the LDPC case is that good e?ciency is only attained for very long codes and in a very narrow range centered around the quantum bit error rate (QBER) that the code was designed to reconcile, thus forcing to have several codes if a broad range of QBER needs to be catered for. Real world implementations of these methods are thus very demanding, either on computational or communication resources or both, to the extent that the last generation of GHz clocked QKD systems are ?nding a bottleneck in the classical part. In order to produce compact, high performance and reliable QKD systems it would be highly desirable to remove these problems. Here we analyse the use of short-length LDPC codes in the information reconciliation context using a low interactivity, blind, protocol that avoids an a priori error rate estimation. We demonstrate that 2×103 bits length LDPC codes are suitable for blind reconciliation. Such codes are of high interest in practice, since they can be used for hardware implementations with very high throughput.

Untainted puncturing for irregular low-density parity-check codes

Puncturing is a well-known coding technique widely used for constructing rate-compatible codes. In this paper, we consider the problem of puncturing low-density parity-check codes and propose a new algorithm for intentional puncturing. The algorithm is based on the puncturing of untainted symbols, i.e. nodes with no punctured symbols within their neighboring set. It is shown that the algorithm proposed here performs better than previous proposals for a range of coding rates and short proportions of punctured symbols.

Biofouling of crypts of historical and architectural interest at la Plata Cemetery (Argentina)

Cemeteries are part of the cultural heritage of urban communities, containing funerary crypts and monuments of historical and architectural interest. Efforts aimed at the conservation of these structures must target not only the abiotic stresses that cause their destruction, such as light and humidity, but also biofouling by biotic agents. The purpose of this study was to assess the development of biofouling of several historically and architecturally valuable crypts at La Plata Cemetery (Argentina). Samples obtained from the biofilms, lichens, and fungal colonies that had developed on the marble surfaces and cement mortar of these crypts were analyzed by conventional microbiological techniques and by scanning electron microscopy. The lichens were identified as Caloplaca austrocitrina, Lecanora albescens, Xanthoparmelia farinosa and Xanthoria candelaria, the fungi as Aspergillus sp., Penicillium sp., Fusarium sp., Candida sp. and Rhodotorula sp., and the bacteria as Bacillus sp. and Pseudomonas sp. The mechanisms by which these microorganisms cause the aesthetic and biochemical deterioration of the crypts are discussed.

Open-atmosphere structural depth profiling of multilayer samples of photovoltaic interest using laser-induced plasma spectrometry

The present work aims to assess Laser-Induced Plasma Spectrometry (LIPS) as a tool for the characterization of photovoltaic materials. Despite being a well-established technique with applications to many scientific and industrial fields, so far LIPS is little known to the photovoltaic scientific community. The technique allows the rapid characterization of layered samples without sample preparation, in open atmosphere and in real time. In this paper, we assess LIPS ability for the determination of elements that are difficult to analyze by other broadly used techniques, or for producing analytical information from very low-concentration elements. The results of the LIPS characterization of two different samples are presented: 1) a 90 nm, Al-doped ZnO layer deposited on a Si substrate by RF sputtering and 2) a Te-doped GaInP layer grown on GaAs by Metalorganic Vapor Phase Epitaxy. For both cases, the depth profile of the constituent and dopant elements is reported along with details of the experimental setup and the optimization of key parameters. It is remarkable that the longest time of analysis was ∼10 s, what, in conjunction with the other characteristics mentioned, makes of LIPS an appealing technique for rapid screening or quality control whether at the lab or at the production line.

Information reconciliation methods in secret key distribution

We consider in this thesis the problem of information reconciliation in the context of secret key distillation between two legitimate parties. In some scenarios of interest this problem can be advantageously solved with low density parity check (LDPC) codes optimized for the binary symmetric channel. In particular, we demonstrate that our method leads to a significant efficiency improvement, with respect to earlier interactive reconciliation methods. We propose a protocol based on LDPC codes that can be adapted to changes in the communication channel extending the original source. The efficiency of our protocol is only limited by the quality of the code and, while transmitting more information than needed to reconcile Alice’s and Bob’s sequences, it does not reveal any more information on the original source than an ad-hoc code would have revealed.---ABSTRACT---En esta tesis estudiamos el problema de la reconciliación de información en el contexto de la destilación de secreto entre dos partes. En algunos escenarios de interés, códigos de baja densidad de ecuaciones de paridad (LDPC) adaptados al canal binario simétrico ofrecen una buena solución al problema estudiado. Demostramos que nuestro método mejora significativamente la eficiencia de la reconciliación. Proponemos un protocolo basado en códigos LDPC que puede ser adaptado a cambios en el canal de comunicaciones mediante una extensión de la fuente original. La eficiencia de nuestro protocolo está limitada exclusivamente por el código utilizado y no revela información adicional sobre la fuente original que la que un código con la tasa de información adaptada habría revelado.

Efficient information reconciliation for Continuous-Variable QKD using Non-Binary Low-Density Parity-Check Codes

We present here an information reconciliation method and demonstrate for the first time that it can achieve efficiencies close to 0.98. This method is based on the belief propagation decoding of non-binary LDPC codes over finite (Galois) fields. In particular, for convenience and faster decoding we only consider power-of-two Galois fields.

A multi-level analysis of innovation diffusion: The case of solar photovoltaic systems in Germany and the disillusion of grid parity

¿Suministrarán las fuentes de energía renovables toda la energía que el mundo necesita algún día? Algunos argumentan que sí, mientras que otros dicen que no. Sin embargo, en algunas regiones del mundo, la producción de electricidad a través de fuentes de energía renovables ya está en una etapa prometedora de desarrollo en la que su costo de generación de electricidad compite con fuentes de electricidad convencionales, como por ejemplo la paridad de red. Este logro ha sido respaldado por el aumento de la eficiencia de la tecnología, la reducción de los costos de producción y, sobre todo, los años de intervenciones políticas de apoyo financiero. La difusión de los sistemas solares fotovoltaicos (PV) en Alemania es un ejemplo relevante. Alemania no sólo es el país líder en términos de capacidad instalada de sistemas fotovoltaicos (PV) en todo el mundo, sino también uno de los países pioneros donde la paridad de red se ha logrado recientemente. No obstante, podría haber una nube en el horizonte. La tasa de difusión ha comenzado a declinar en muchas regiones. Además, las empresas solares locales – que se sabe son importantes impulsores de la difusión – han comenzado a enfrentar dificultades para manejar sus negocios. Estos acontecimientos plantean algunas preguntas importantes: ¿Es ésta una disminución temporal en la difusión? ¿Los adoptantes continuarán instalando sistemas fotovoltaicos? ¿Qué pasa con los modelos de negocio de las empresas solares locales? Con base en el caso de los sistemas fotovoltaicos en Alemania a través de un análisis multinivel y dos revisiones literarias complementarias, esta tesis doctoral extiende el debate proporcionando riqueza múltiple de datos empíricos en un conocimiento de contexto limitado. El primer análisis se basa en la perspectiva del adoptante, que explora el nivel "micro" y el proceso social que subyace a la adopción de los sistemas fotovoltaicos. El segundo análisis es una perspectiva a nivel de empresa, que explora los modelos de negocio de las empresas y sus roles impulsores en la difusión de los sistemas fotovoltaicos. El tercero análisis es una perspectiva regional, la cual explora el nivel "meso", el proceso social que subyace a la adopción de sistemas fotovoltaicos y sus técnicas de modelado. Los resultados incluyen implicaciones tanto para académicos como políticos, no sólo sobre las innovaciones en energía renovable relativas a la paridad de red, sino también, de manera inductiva, sobre las innovaciones ambientales impulsadas por las políticas que logren la competitividad de costes. ABSTRACT Will renewable energy sources supply all of the world energy needs one day? Some argue yes, while others say no. However, in some regions of the world, the electricity production through renewable energy sources is already at a promising stage of development at which their electricity generation costs compete with conventional electricity sources’, i.e., grid parity. This achievement has been underpinned by the increase of technology efficiency, reduction of production costs and, above all, years of policy interventions of providing financial support. The diffusion of solar photovoltaic (PV) systems in Germany is an important frontrunner case in point. Germany is not only the top country in terms of installed PV systems’ capacity worldwide but also one of the pioneer countries where the grid parity has recently been achieved. However, there might be a cloud on the horizon. The diffusion rate has started to decline in many regions. In addition, local solar firms – which are known to be important drivers of diffusion – have started to face difficulties to run their businesses. These developments raise some important questions: Is this a temporary decline on diffusion? Will adopters continue to install PV systems? What about the business models of the local solar firms? Based on the case of PV systems in Germany through a multi-level analysis and two complementary literature reviews, this PhD Dissertation extends the debate by providing multiple wealth of empirical details in a context-limited knowledge. The first analysis is based on the adopter perspective, which explores the “micro” level and the social process underlying the adoption of PV systems. The second one is a firm-level perspective, which explores the business models of firms and their driving roles in diffusion of PV systems. The third one is a regional perspective, which explores the “meso” level, i.e., the social process underlying the adoption of PV systems and its modeling techniques. The results include implications for both scholars and policymakers, not only about renewable energy innovations at grid parity, but also in an inductive manner, about policy-driven environmental innovations that achieve the cost competiveness.