The Impact Of The Medicaid Coverage Expansion And The Removal Of Cost-Sharing Under The Affordable Care Act On Mammography And Pap Tests

Background: The Affordable Care Act (ACA) aimed at making health care affordable and accessible including the use of preventive care services. To achieve these aims, the ACA expanded Medicaid coverage to population with income below 138% of FPL and removed cost-sharing when using preventive care services recommended by the USPSTF. This study tried to assess the impact of these provisions on the rate of mammography and Pap tests among women. Methods: Data was obtained from the Medical Expenditure Panel Survey - Household Component MEPS-HC. A difference-indifference design was used to determine the effect of Medicaid eligibility expansion on the outcomes and a counterfactual analysis was used to determine the effect of removing cost-sharing from preventive care services on the outcomes. Results: The difference-indifference estimate show that likelihood of utilizing mammograms did not change significantly among low-income women after the implementation of the Medicaid expansion (DID coefficient -0.0476 with t-statistics at -1.26), Pap test decreased (coefficient -0.0615, t-statistics -2.76), and Medicaid enrollment has increased significantly among low-income women living in expansion states (coefficient 0.0889 with t-value of 3.68). The counterfactual analysis show that the utilization of mammogram and pap test did not improve following the ACA. Conclusion: The ACA was associated with increased Medicaid enrollment but did not yield near-term improvement in use of mammography and Pap tests among women. Factors beyond health insurance coverage may be important in determining the likelihood of obtaining vi these screening procedures and policy makers should try to identify other barriers to cancer screening services utilization among the low-income women in the USA

Barriers in Implementing Communicative Language Teaching Approach: EFL Learners’ Perspective

Over the last few decades, foreign language teaching has changed, favouring a more communicative-focused approach. However, researchers have reported a number of barriers that may hinder its successful implementation. This study, then, investigates the difficulties that affect the smooth implementation of Communicative Language Teaching (CLT) in Saudi EFL classrooms, specifically from the learners’ point of view, as well as the reasons behind them, in order to provide suitable and practical recommendations to different EFL contexts. A mixed-method research, which included a written questionnaire and follow-up interviews, was conducted with 74 Saudi EFL students, all of whom were undergraduate students in their first level and enlisted on a speaking and listening course that adhered to the principles of the Communicative Approach (CA). The results revealed that students had positive attitudes towards conducting communicative activities in their English classes. The study further reported various barriers that students encountered whilst participating in communicative classroom activities: difficulty expressing themselves and organising ideas, low levels of participation, foreign language inhibition, anxiety, an inability to understand others, limited teaching time, and excessive mother tongue use. Moreover, the findings highlighted different reasons for these barriers, such as limited English proficiency, a lack of motivation, teacher and activity-related reasons, and previous instructional practices in schools. Finally, implications for pedagogy were presented based on the findings. These implications should be taken into consideration in order to more effectively implement CLT. Finally, this essay suggests various practical recommendations that educators, teachers, and policy makers can implement in order to maximise the effectiveness of the CLT approach. Keywords: Communicative Language Teaching, EFL classroom, Saudi learners. DOI: 10.7176/JEP/12-9-01 Publication date:March 31st 202

Users' performance in lab and non-lab environments through online usability testing:A case of evaluating the usability of digital academic libraries' websites

The factors related to the environment in which users operate may be of a vital importance when trying to understand how they experience a particular system. It is required that we find out how we can get to know those factors to investigate if they affect the users' performance in usability testing. An online usability study has emerged that can be attempted by a large, varied pool of users' anywhere with an Internet connection. Would the usage of an online usability study help to give comprehensive insight and an understanding of the whole user experience? That is especially interesting if the user operates remotely, as we are unaware of what the users might experience while performing the test (e.g., distractions and type of device used to attempt the test). Accordingly, a pilot study of ongoing research was conducted. An identical online usability-testing tool (Loop 11) through which to apply the online usability study was used in two environments: unrestricted (the user's natural environment), and totally restricted (a simulated lab environment). Ten subjects completed the test in the restricted environment and 20 completed it in the unrestricted environment. All of the subjects were asked to perform predefined search tasks on digital libraries' websites. Their performance was analyzed and compared against the two different environments. The results showed that online usability testing is a feasible method to gain comprehensive insight into how users attempt usability testing in a non-lab environment. The results of whether different environments affect test performance show no valuable differences in most of the study's measurements. The test subjects were frequently multitask while they performed the usability testing in an unrestricted environment, but they were highly distracted if they personally interrupted. The results encourage the researcher to conduct a formal version of this study to further examine the learned lessons from the pilot study

Saad Elkhadem's The Plague in English: A Study of the Translation Strategies used to Recreate the Egyptian Ethos

This thesis focuses on translation as a transcultural activity. It studies the foreignizing and domesticating translation strategies used to recreate the Egyptian ethos in the translation of Elkhadems The Plague from Arabic to English. Five theories are incorporated in the analysis. These are Venutis Domesticating and Foreignizing Theory; Tourys DTS; Genettes Paratexts; Pedersens taxonomy of strategies for rendering culture-bound references and his classification of culture-bound elements; and Vermeers Skopos Theory. Three types of analysis are conducted: a literary analysis of the source text; a microanalysis of the target text, further divided into an analysis of the novel's paratexts and a descriptive analysis of ninety-eight culture-bound references; and finally, a macro-analysis of the overall norms and of the skopos of the translation showing how both affect the transmission of the Egyptian ethos. Overall, this thesis provides some insight into the influence of translation on cultural identity

Implications of Applying Usability Testing with Remote Users

Some studies in the literature on remote asynchronous usability testing have indicated the existence of contextual factors related to remote-uncontrolled environments. Typically, in these environments, users take part in the usability test at any time although uncontrolled contextual factors might be present. Moreover, such settings might induce different interactions with the evaluated products, which consequently may influence the data collected in the usability test. Therefore, this research aims to explore these kinds of interactions to determine whether they differ from users’ interactions in the laboratory and, if so, how. The findings of this research are intended to contribute new knowledge about the implications of applying asynchronous usability testing to remote users. To meet this goal, three main studies are conducted: the first exploratory study is aimed at exploring what happens during testing sessions in users’ natural environments. The second empirical study involves two participant samples: one sample performed the test in their natural environment, and the other sample performed the text in a lab. The performances of both groups are compared to explore their differences. User-reported data regarding contextual factors are also explored. In the third controlled experimental study, stimulating contextual factors are applied during usability testing sessions to explore the users’ interactions. The results showed that usability testing outcomes were independent of the method itself. With respect to physical environments, contextual factors were the most influential in the outcomes of usability testing. Although interruptions had the highest negative influence, the extent of this influence differed based on the type of interruption applied. In-person interruptions were the most disruptive because they influenced, not only the number of errors and task-load measurements, but also the time taken to perform tasks. Instant messaging increased the number of errors and the task load. Phone interruptions did not have noticeable effects on performance, but increased stress, time pressure and frustration. Based on our results, we concluded that if remote asynchronous usability testing is used, then the influence of contextual factors should be expected. Hence, these factors should be collected during testing because awareness of them is vital in improving data interpretation

Achievement flourishes in larger classes: Secondary school students in most countries achieved better in literacy in larger classes

There is no consensus among academics about whether children benefit from smaller classes. We analysed the data from the 2012 Programme for International Student Assessment (PISA) to test if smaller classes lead to higher performance. Advantages of this data set are not only its size (478,120 15-year old students in 63 nations) and representativeness, but also that the 2012 PISA data set for the first time includes the class size for each participating child. We found that in most countries, children in smaller classes had a lower performance score in solving reading comprehension problems than those in larger classes. We further analysed the relation between class size and factors that can explain this paradoxical phenomenon. Although grouping of students by ability and the socioeconomic status of parents played some role in some countries, these factors cannot fully explain this effect. We finish discussing the overlooked potential advantages of larger classes

Impact of Removing Cost Sharing Under the Affordable Care Act (Aca) on Mammography and Pap Test Use

Background The Affordable Care Act (ACA) required private insurers and Medicare to cover recommended preventive services without any cost sharing to improve utilization of these services. This study is an attempt to identify the impact of removing cost sharing on mammography and pap test utilization rates. Methods Counterfactual analysis was used to predict what would have been the screening rates in post-ACA if ACA was not there. This was done by estimating a model that examines determinants of dependent variable for the pre-ACA year (pre-ACA year is 2009). The estimated model was then used to predict the dependent variable for the post-ACA year using individual characteristics and other relevant variables unlikely to be affected by ACA (post-ACA year is 2016). Effect of ACA is defined as the difference between the values of dependent variables in post-ACA and the predicted values of dependent variables in the post-ACA year using counterfactual. Results The counterfactual analysis show that the utilization of mammogram and pap test did not improve following ACA. Conclusion Removal of cost-sharing under the ACA did not improve mammography or pap test rates. Therefore, financial barrier may not be an important factor in affecting utilization of the screening tests and policy makers should focus on other non-financial barriers in order to improve coverage of the tests

Impact of Medicaid Coverage Expansion Under the Affordable Care Act on Mammography and Pap Tests Utilization Among Low-Income Women

Introduction The Affordable Care Act (ACA) expanded the coverage of Medicaid to include entire population with income below 138% of federal poverty line. It remains unclear whether this policy change has improved access to and utilization of health care, particularly use of mammography and Pap tests among poor women. Methods We used a difference-in-difference (DID) design to estimate the impact of Medicaid expansion on mammography and Pap tests utilization among low-income women. Expansion states are the treatment group and non-expansion states are the control group. The years 2012–13 are the pre-expansion period and 2015–16 are the post-expansion period for the purpose of estimating the DID parameters. Results The difference-in-difference estimate show that likelihood of utilizing mammograms did not change significantly among low-income women after the implementation of Medicaid expansion (DID coefficient -0.0476 with t-statistics at -1.26), Pap test decreased (coefficient -0.0615, t-statistics -2.76), and Medicaid enrollment has increased significantly among low-income women living in expansion states (coefficient 0.0889 with t-value of 3.68). Conclusion Expansion of Medicaid was associated with increased Medicaid enrollment but did not yield near-term improvement in use of mammography and Pap tests among low-income women. Factors beyond health insurance coverage may be important in determining the likelihood of obtaining these screenings. Policy makers should try to identify other barriers to cancer screenings among low-income women in the USA

Survival Benefit for Individuals with Constitutional Mismatch Repair Deficiency Syndrome and Brain Tumors Who Undergo Surveillance Protocol. A Report from the International Replication Repair Consortium

BACKGROUND Constitutional mismatch repair deficiency syndrome (CMMRD) is a severe cancer predisposition syndrome resulting in early onset central nervous system (CNS) and other cancers. International guidelines for surveillance exist but no study has systematically evaluated the efficacy of this protocol. METHODS We surveyed all confirmed CMMRD patients in the International Replication Repair Deficiency Consortium. A surveillance protocol consisting of frequent biochemical, endoscopic and imaging (CNS and total body MRI) studies were employed. Survival analyses and efficacy of each method were assessed. RESULTS Surveillance data were collected from 105 CMMRD individuals from 41 countries. Of the 193 malignant tumors, CNS malignancies were the most common (44%). The surveillance protocol uncovered 49 asymptomatic tumors including 16 glioblastomas and medulloblastomas. Five-year overall survival was 89% for tumors discovered by surveillance, and 61% for symptomatic tumors (p\u3c0.004). Similarly, 5-year survival was 82+/-11% and 24+/-6% for surveillance and non-surveillance of brain tumors (p=0.005). Yearly total body and q6 month brain MRI detected asymptomatic cancers in all but 3 symptomatic CNS gliomas. These were tumors uncovered when time between scans was \u3e6 months as per protocol. Finally, of the low grade tumors identified asymptomatically, 5 were low grade gliomas. All of the low grade gliomas, which were not resected transformed to high grade tumors at a median of 1.6 ± 0.9 years. CONCLUSION These data support a survival benefit in CMMRD patients undergoing a surveillance protocol. Adherence to protocol and resection of lower grade lesions may improve survival for patients with CNS tumors

Determinants of Overweight and/or Obesity and Factors Associated among School among Secondary School Students at Makkah in Saudi Arabia 2022

Background: The prevalence of overweight/obesity in children in Saudi Arabia is among the highest in the world. The prevalence of dental caries is also high in Saudi children. Studies on the relationship between caries and obesity in Saudi adolescents are lacking. the World Health Organization (WHO) defines obesity as “abnormal or excessive fat accumulation that may impair health,” while overweight is defined as “a body mass index (BMI) of 25 kg/m2 or more.”1 Overweight and obesity can negatively affect the physiological and psychological well-being of the affected individual,  and both have become a global The prevalence of overweight/obesity in high school adolescents. The Overweight and impaired metabolic health might strongly, and independently of other comorbidities, partner with expanded danger diseases . The study aimed: To Determinants of overweight and/or obesity and factors associated among school among   secondary school students at Makah in Saudi Arabia 2022.Method: An online cross-sectional survey was utilized Secondary school students at in Makah Al-Mukarramah in Saudi Arabia 2022 during the April to June, 2022, a total of 200 student aged 12–18 years,  available students of secondary school children  were included in the study. A structured online self-reported questionnaire sheet was used To assessment of prevalence and factors associated with obesity among   secondary school students at Makkah in Saudi Arabia 2022 Result: show the total number of participants was 200  regarding the age most  participants were classified into 3 age groups, most of them were (45.0%) in the  more than 16  years regarding gender of  participated female were (63.0%). Regarding Income level in study the most of participant\u27s Below 5000 SR were (31.0%).  Regarding Educational level in study the most of participant\u27s Intermediate school were (22.0%) regarding Sources of information about obesity most of participant\u27s educational films were (32.0%) Conclusion: with a high obesity prevalence in boys and in children attending  schools. The prevalence was not associated with BMI or WC we report a negative independent association between BMI and subsequent academic performance among female high-school students in Saudi Arabia. The current findings highlight the need for community and school programmes targeting overweight/obesity among high school students