A case study of adapting a health insurance decision intervention from trial into routine cancer care

OBJECTIVE: This study adapted Improving Cancer Patients\u27 Insurance Choices (I Can PIC), an intervention to help cancer patients navigate health insurance decisions and care costs. The original intervention improved knowledge and confidence making insurance decisions, however, users felt limited by choices provided in insurance markets. Using decision trees and frameworks to guide adaptations, we modified I Can PIC to focus on using rather than choosing health insurance. The COVID-19 pandemic introduced unforeseen obstacles, prompting changes to study protocols. As a result, we allowed users outside of the study to use I Can PIC (\u3e 1050 guest users) to optimize public benefit. This paper describes the steps took to conduct the study, evaluating both the effectiveness of I Can PIC and the implementation process to improve its impact. RESULTS: Although I Can PIC users had higher knowledge and health insurance literacy compared to the control group, results were not statistically significant. This outcome may be associated with systems-level challenges as well as the number and demographic characteristics of participants. The publicly available tool can be a resource for those navigating insurance and care costs, and researchers can use this flexible approach to intervention delivery and testing as future health emergencies arise

The nature of teachers' qualitative judgements: A matter of context and salience. Part Two: Out-of-context judgements

This second paper also takes up the issue of how teachers make judgements of primary students' writing. Once again, we examine the evidence base used by two teachers in their judgements, using qualitative techniques for mapping the inter-relationships among the indexes that teachers rely on to formulate judgements. Of special interest in this paper is how the teachers enacted judgements of student writing in the absence of knowledge about the institutional and pedagogical settings in which the writing had been produced, and also without knowledge of the student writer. The authors recommend that readers consider the discussion and findings offered in this paper in conjunction with paper one which precedes it

Factors used in the detection of elder financial abuse: A judgement and decision-making study of social workers and their managers

This is the author's accepted manuscript. The final published article is available from the link below. Copyright @ 2011 Sage Publications Ltd.Factors social workers use in practice to detect elder financial abuse are currently unknown. A critical incident technique was applied within a judgement analysis approach to elicit cue use. Only three factors were key to decision-making: who raises concern, the elder’s mental capacity and the nature of the financial anomaly occurring.Economic and Social Research Counci

Transverse Sizes of CIV Absorption Systems Measured from Multiple QSO Sightlines

We present tomography of the circum-galactic metal distribution at redshift 1.7 to 4.5 derived from echellete spectroscopy of binary quasars. We find CIV systems at similar redshifts in paired sightlines more often than expected for sightline-independent redshifts. As the separation of the sightlines increases from 36 kpc to 907 kpc, the amplitude of this clustering decreases. At the largest separations, the CIV systems cluster similar to Lyman-break galaxies (Adelberger et al. 2005a). The CIV systems are significantly less correlated than these galaxies, however, at separations less than R_1 ~ 0.42 +/- 0.15 h-1 comoving Mpc. Measured in real space, i.e., transverse to the sightlines, this length scale is significantly smaller than the break scale estimated from the line-of-sight correlation function in redshift space (Scannapieco et al. 2006a). Using a simple model, we interpret the new real-space measurement as an indication of the typical physical size of enriched regions. We adopt this size for enriched regions and fit the redshift-space distortion in the line-of-sight correlation function. The fitted velocity kick is consistent with the peculiar velocity of galaxies as determined by the underlying mass distribution and places an upper limit on the outflow (or inflow) speed of metals. The implied time scale for dispersing metals is larger than the typical stellar ages of Lyman-break galaxies (Shapley et al. 2001), and we argue that enrichment by galaxies at z > 4.3 played a greater role in dispersing metals. To further constrain the growth of enriched regions, we discuss empirical constraints on the evolution of the CIV correlation function with cosmic time. This study demonstrates the potential of tomography for measuring the metal enrichment history of the circum-galactic medium.Comment: 22 pages, 15 figures, 1 tabl

Double chambered right ventricle with severe calcification of the tricuspid valve in an elderly woman: a case report

<p>Abstract</p> <p>Introduction</p> <p>Double chambered right ventricle is a rare congenital cardiac anomaly in which the right ventricle is divided into two chambers by an anomalous muscle bundle. The diagnosis of this disorder is difficult in adults. Calcification of the tricuspid valve is extremely rare, and very few cases have been reported. Most cases of tricuspid valve calcification had a congenital disorder with high pressure in the right ventricle.</p> <p>Case presentation</p> <p>We report a rare case of a 71-year-old Japanese woman who presented with chest discomfort, and was found to have a double chambered right ventricle with severe calcification of the tricuspid valve. This abnormality was found by echocardiography, and the diagnosis was confirmed by multislice cardiac computerized tomography, cardiac magnetic resonance imaging, and cardiac catheterization. Our patient rejected surgical repair, and medical therapy with carvedilol was effective to reduce her symptoms.</p> <p>Conclusion</p> <p>Calcification of the tricuspid valve is extremely rare, and considered to be due to high pressure in the right ventricle. To the best of our knowledge, there are no other reported cases of this combination of double chambered right ventricle and calcification of the tricuspid valve.</p

Gas Accretion in Star-Forming Galaxies

Cold-mode gas accretion onto galaxies is a direct prediction of LCDM simulations and provides galaxies with fuel that allows them to continue to form stars over the lifetime of the Universe. Given its dramatic influence on a galaxy's gas reservoir, gas accretion has to be largely responsible for how galaxies form and evolve. Therefore, given the importance of gas accretion, it is necessary to observe and quantify how these gas flows affect galaxy evolution. However, observational data have yet to conclusively show that gas accretion ubiquitously occurs at any epoch. Directly detecting gas accretion is a challenging endeavor and we now have obtained a significant amount of observational evidence to support it. This chapter reviews the current observational evidence of gas accretion onto star-forming galaxies.Comment: Invited review to appear in Gas Accretion onto Galaxies, Astrophysics and Space Science Library, eds. A. J. Fox & R. Dav\'e, to be published by Springer. This chapter includes 22 pages with 7 Figure

Exploring policy-makers' perspectives on disinvestment from ineffective healthcare practices

Objectives: Many existing healthcare interventions diffused before modern evidence-based standards of clinical- and cost-effectiveness. Disinvestment from ineffective or inappropriately applied practices is growing as a priority for international health policy, both for improved quality of care and sustainability of resource allocation. Australian policy stakeholders were canvassed to assess their perspectives on the challenges and the nature of disinvestment. Methods: Senior health policy stakeholders from Australia were criterion and snow-ball sampled (to identify opinion leaders). Participants were primed with a potential disinvestment case study and took part in individual semistructured interviews that focused on mechanisms and challenges within health policy to support disinvestment. Interviews were taped and transcribed for thematic analysis. Participant comments were de-identified. Results: Ten stakeholders were interviewed before saturation was reached. Three primary themes were identified. (i) The current focus on assessment of new and emerging health technologies/practices and lack of attention toward existing practices is due to resource limitations and methodological complexity. Participants considered a parallel model to that of Australia's current assessment process for new medical technologies is best-positioned to facilitate disinvestment. (ii) To advance the disinvestment agenda requires an explicit focus on the potential for cost-savings coupled with improved quality of care. (iii) Support (financial and collaborative) is needed for research advancement in the methodological underpinnings associated with health technology assessment and for disinvestment specifically. Conclusions: In this exploratory study, stakeholders support the notion that systematic policy approaches to disinvestment will improve equity, efficiency, quality, and safety of health care, as well as sustainability of resource allocation.Adam G. Elshaug, Janet E. Hiller and John R. Mos

Gas Accretion via Lyman Limit Systems

In cosmological simulations, a large fraction of the partial Lyman limit systems (pLLSs; 16<log N(HI)<17.2) and LLSs (17.2log N(HI)<19) probes large-scale flows in and out of galaxies through their circumgalactic medium (CGM). The overall low metallicity of the cold gaseous streams feeding galaxies seen in these simulations is the key to differentiating them from metal rich gas that is either outflowing or being recycled. In recent years, several groups have empirically determined an entirely new wealth of information on the pLLSs and LLSs over a wide range of redshifts. A major focus of the recent research has been to empirically determine the metallicity distribution of the gas probed by pLLSs and LLSs in sizable and representative samples at both low (z2) redshifts. Here I discuss unambiguous evidence for metal-poor gas at all z probed by the pLLSs and LLSs. At z<1, all the pLLSs and LLSs so far studied are located in the CGM of galaxies with projected distances <100-200 kpc. Regardless of the exact origin of the low-metallicity pLLSs/LLSs, there is a significant mass of cool, dense, low-metallicity gas in the CGM that may be available as fuel for continuing star formation in galaxies over cosmic time. As such, the metal-poor pLLSs and LLSs are currently among the best observational evidence of cold, metal-poor gas accretion onto galaxies.Comment: Invited review to appear in Gas Accretion onto Galaxies, Astrophysics and Space Science Library, eds. A. J. Fox & R. Dav\'e, to be published by Springe