Related to TION
Discussion Our results suggest that inter-rater agreement in unstandardized, physician-coded problem lists is moderate at best. They further suggest that standardizing synonymous terms may lead to modest improvement in measured agreement, as may additional standardizing by granularity and general concept. Using UMLS as a controlled terminology may have contributed to this lackluster level of agreement. Its redundant representation of seemingly identical entities as distinct concepts may have led to some decreased performance in the raw problem lists. This is suggested by the modest improvement in performance in the synonym standardized data series in cases B and E in Figure 1. The synonym standardized series approximates what the measured similarity might have been if all reviewers had selected the same problem term where UMLS contained synonyms or near-synonyms as distinct concepts. UMLS and many of its source terminologies represent entities at varying levels of granularity, and our reviewers sometimes chose to express a given problem at different levels of granularity. The granularity and synonym standardized data series in Figure 1 approximates what the measured similarity might have been if all reviewers had enumerated their problem lists using the same level of granularity where a similar problem existed across multiple reviewers’ lists. The improvement in agreement seen from the synonym-standardized data series in cases D and E suggests that granularity differences may negatively affect inter-rater problem list agreement. The general concept standardized data series approximates what the measured similarity would be when taking into account only the highest-level unifying concept represented by the reviewers’ enumerated problems. This also led to a small improvement in agreement in cases B and C. When we conducted this experiment, SNOMED CT was not yet available in UMLS. As we mentioned above, SNOMED CT has recently been recommended to serve as the problem list terminology for the NHII. Although we performed the standardizations in this experiment manually, our results suggest that using SNOMED CT for coding problem lists might encourage and enable improved problem coding consistency. SNOMED CT largely circumvents the concept redundancy problem of UMLS since it is a true terminology and not a unifier of disparate terminologies. In addition, SNOMED CT contains a rich ontology that should allow for automated identification of common ancestors of related concepts. Thus, use of SNOMED CT has the potential to improve performance for problems coded at different levels of granularity and problems that represent different but related concepts. Our results suggest that standardization of synonymy, granularity, and general concept may achieve some improvement in measured cross-reviewer problem list agreement, yet even under the most forgiving conditions of standardization, overall agreement was still only moderate. From this observation we conclude what might seem self-evident: Different physicians can view the same clinical situation in different ways, leading to different problem lists. This is one root cause of problem list variation that may be difficult for controlled terminologies to address, potential solutions falling instead in the domain of medical education. Researchers and developers have devoted much work to the role of the problem list in the EHR. A major issue that has emerged is how and when electronic problem lists should be populated. Numerous published reports describe real-time problem list maintenance functionality for EHRs17-23, but it has been noted that clinicians’ maintenance of problem lists has been poor using these real-time tools. Others have reported automatically populating problem lists using post-facto approaches such as natural language processing of discharge summaries24 and inclusion of coder-assigned ICD-9 diagnoses. We suggest that the most useful problem lists are accurate, up-to-date, consistently coded, and available at the time of care. Post-facto approaches to problem list maintenance can effectively populate the problem list and may be useful for achieving compliance with JCAHO’s “summary list” requirement25; however, these approaches raise concern about the trustworthiness of problem lists that are not directly entered by clinicians in real-time. In addition, post-facto approaches do not provide the EHR with knowledge of the patient’s most current problems at the time of order entry, when they might be able to trigger decision support rules or otherwise drive the care process. For data collection in this study, we simulated a “problem-driven” approach using third-party reviewers. The core premise of the problem-driven approach is that the clinician enters the problem list in real-time using a controlled terminology and subsequently performs other clinical information activities (e.g., order entry and assessment and plan documentation) in the context of an explicitly stated problem15. By requiring the problem list in order to perform other clinical activities, the problem-driven approach may lead to improved real-time problem list maintenance.
Short Sales 1. Promptly after any short sales by any Series of the Fund, the Fund shall promptly deliver to the Custodian a Certificate specifying: (a) the Series for which such short sale was made; (b) the name of the issuer and the title of the Security; (c) the number of shares or principal amount sold, and accrued interest or dividends, if any; (d) the dates of the sale and settlement; (e) the sale price per unit; (f) the total amount credited to the Fund upon such sale, if any, (g) the amount of cash and/or the amount and kind of Securities, if any, which are to be deposited in a Margin Account and the name in which such Margin Account has been or is to be established; (h) the amount of cash and/or the amount and kind of Securities, if any, to be deposited in a Senior Security Account, and (i) the name of the broker through whom such short sale was made. The Custodian shall upon its receipt of a statement from such broker confirming such sale and that the total amount credited to the Fund upon such sale, if any, as specified in the Certificate is held by such broker for the account of the Custodian (or any nominee of the Custodian) as custodian of the Fund, issue a receipt or make the deposits into the Margin Account and the Senior Security Account specified in the Certificate.
Preparation and Delivery On or before the 15th business day following the date on which this Lease is fully executed by Landlord and Tenant (the “Working Drawings Delivery Deadline”), Tenant shall provide to Landlord for its approval working drawings, prepared by the Architect, of all improvements that Tenant proposes to install in the Premises; such working drawings shall include the partition layout, ceiling plan, electrical outlets and switches, telephone outlets, drawings for any modifications to the mechanical, electrical, life safety, plumbing and any other systems of the Building, and detailed plans and specifications for the construction of the improvements called for under this Exhibit in accordance with all applicable Laws and suitable for permitting and construction. The working drawings shall be prepared based upon the Space Plans, subject to (i) modifications necessary to obtain a building permit and other permits required by the City of Austin, and (ii) reasonable adjustments made by the Architect for purposes of safety, efficiency, cost, or other design considerations which could not be reasonably incorporated into the Space Plans given the level of detail involved. If Tenant fails to timely deliver such preliminary working drawings, then each day after the Working Drawings Delivery Deadline that such drawings are not delivered to Landlord shall be a Tenant Delay Day.
Negotiation In the event of a controversy, dispute or claim arising out of, in connection with, or in relation to the interpretation, performance, nonperformance, validity or breach of this Agreement or otherwise arising out of, or in any way related to this Agreement or the transactions contemplated hereby, including any claim based on contract, tort, statute or constitution (collectively, “Agreement Disputes”), the Party claiming such Agreement Dispute shall give written notice to the other Party setting forth the Agreement Dispute and a brief description thereof (a “Dispute Notice”) pursuant to the terms of the notice provisions of Section 7.1 hereof. Following delivery of a Dispute Notice, the general counsels of the relevant Parties and/or such other executive officer designated by the relevant Party shall negotiate for a reasonable period of time to settle such Agreement Dispute; provided that such reasonable period shall not, unless otherwise agreed by the Parties in writing, exceed forty-five (45) calendar days from the time of receipt by a Party of a Dispute Notice; provided further, that in the event of any arbitration in accordance with Section 6.3 hereof, the relevant Parties shall not assert the defenses of statute of limitations and laches arising during the period beginning after the date of receipt of the Dispute Notice, and any contractual time period or deadline under this Agreement to which such Agreement Dispute relates occurring after the Dispute Notice is received shall not be deemed to have passed until such Agreement Dispute has been resolved.
Acquisition For the purpose of this Warrant, “Acquisition” means any transaction or series of related transactions involving: (i) the sale, lease, exclusive license, or other disposition of all or substantially all of the assets of the Company (ii) any merger or consolidation of the Company into or with another person or entity (other than a merger or consolidation effected exclusively to change the Company’s domicile), or any other corporate reorganization, in which the stockholders of the Company in their capacity as such immediately prior to such merger, consolidation or reorganization, own less than a majority of the Company’s (or the surviving or successor entity’s) outstanding voting power immediately after such merger, consolidation or reorganization; or (iii) any sale or other transfer by the stockholders of the Company of shares representing at least a majority of the Company’s then-total outstanding combined voting power.
Execution and Delivery of Warrant Certificates Each Warrant Certificate, whenever issued, shall be in registered form substantially in the form set forth in Exhibit A hereto, shall be dated the date of its countersignature by the Warrant Agent and may have such letters, numbers, or other marks of identification or designation and such legends or endorsements printed, lithographed or engraved thereon as the officers of the Company executing the same may approve (execution thereof to be conclusive evidence of such approval) and as are not inconsistent with the provisions of this Agreement, or as may be required to comply with any law or with any rule or regulation made pursuant thereto or with any rule or regulation of any securities exchange on which the Warrants may be listed, or to conform to usage. The Warrant Certificates shall be signed on behalf of the Company by any of its present or future chief executive officers, presidents, senior vice presidents, vice presidents, chief financial officers, chief legal officers, treasurers, assistant treasurers, controllers, assistant controllers, secretaries or assistant secretaries under its corporate seal reproduced thereon. Such signatures may be manual or facsimile signatures of such authorized officers and may be imprinted or otherwise reproduced on the Warrant Certificates. The seal of the Company may be in the form of a facsimile thereof and may be impressed, affixed, imprinted or otherwise reproduced on the Warrant Certificates. No Warrant Certificate shall be valid for any purpose, and no Warrant evidenced thereby shall be exercisable, until such Warrant Certificate has been countersigned by the manual signature of the Warrant Agent. Such signature by the Warrant Agent upon any Warrant Certificate executed by the Company shall be conclusive evidence that the Warrant Certificate so countersigned has been duly issued hereunder. In case any officer of the Company who shall have signed any of the Warrant Certificates either manually or by facsimile signature shall cease to be such officer before the Warrant Certificates so signed shall have been countersigned and delivered by the Warrant Agent, such Warrant Certificates may be countersigned and delivered notwithstanding that the person who signed Warrant Certificates ceased to be such officer of the Company; and any Warrant Certificate may be signed on behalf of the Company by such persons as, at the actual date of the execution of such Warrant Certificate, shall be the proper officers of the Company, although at the date of the execution of this Agreement any such person was not such officer.
Treatment of Warrant at Acquisition A) Upon the written request of the Company, Holder agrees that, in the event of an Acquisition in which the sole consideration is cash, either (a) Holder shall exercise its conversion or purchase right under this Warrant and such exercise will be deemed effective immediately prior to the consummation of such Acquisition or (b) if Holder elects not to exercise the Warrant, this Warrant will expire upon the consummation of such Acquisition. The Company shall provide the Holder with written notice of its request relating to the foregoing (together with such reasonable information as the Holder may request in connection with such contemplated Acquisition giving rise to such notice), which is to be delivered to Holder not less than ten (10) days prior to the closing of the proposed Acquisition.
Injunction It is recognized and hereby acknowledged by the parties hereto that a breach by the Executive of any of the covenants contained in Article 6 of this Agreement will cause irreparable harm and damage to the Company, the monetary amount of which may be virtually impossible to ascertain. As a result, the Executive recognizes and hereby acknowledges that the Company shall be entitled to an injunction from any court of competent jurisdiction enjoining and restraining any violation of any or all of the covenants contained in Article 6 of this Agreement by the Executive or any of his affiliates, associates, partners or agents, either directly or indirectly, and that such right to injunction shall be cumulative and in addition to whatever other remedies the Company may possess.
Preparation Awarded Vendor shall not begin a project for which TIPS Member has not prepared the site, unless awarded Vendor does the preparation work at no cost, or until TIPS Member includes the cost of site preparation in a purchase order. Site preparation includes, but is not limited to: moving furniture, installing wiring for networks or power, and similar pre-installation requirements.