How Will the Affordable Care Act Affect the Use of Health Care Services?

In January 2014, the Affordable Care Act extended access to health insurance coverage to an estimated 30 million previously uninsured people. This issue brief provides state-level estimates of the increased demand for physician and hospital services that is expected to result from expanded access and assesses the sufficiency of the existing supply of providers to accommodate the anticipated increase in demand. We project that primary care providers will see, on average, 1.34 additional office visits per week, accounting for a 3.8 percent increase in visits nationally. Hospital outpatient departments will see, on average, 1.2 to 11.0 additional visits per week, or an average increase of about 2.6 percent nationally. Increases of the magnitude likely to be generated by the Affordable Care Act will have modest effects on the demand for health services, and the existing supply of providers should be sufficient to accommodate this increased demand

How Much of a Factor Is the Affordable Care Act in the Declining Uninsured Rate?

Issue: While the number of uninsured has decreased substantially since the Affordable Care Act (ACA) expanded coverage in 2014, questions remain about how much the economic recovery and other changes might have influenced this decline. Goal: Assess the direct impact of the ACA marketplaces and the Medicaid expansion on the uninsured rate among nonelderly adults. Methods: Analysis of insurance coverage rates before and after the ACAís first open enrollment period (fall 2013 to spring 2014) using the National Health Interview Survey (NHIS) and the Behavioral Risk Factor Surveillance Survey (BRFSS). Key findings: Based on NHIS data, enrollment in ACA-related coverage options explains about 76 percent of the 4-percentage-point decline in the uninsured rate during the first open enrollment period. Marketplace enrollments reduced the adult uninsured rate by an estimated 1.7 percentage points to 2.3 percentage points. The effects were substantially more pronounced among adults eligible for income-related subsidies. Medicaid expansions in participating states further reduced the uninsured rate by an estimated 0.76 points to 1.0 points. Conclusion: The great majority of nonelderly adults who enrolled during the first open enrollment period would likely not have held health coverage without the ACA expansions

Performance analysis of a parallel, multi-node pipeline for DNA sequencing

Post-sequencing DNA analysis typically consists of read mapping followed by variant calling and is very time-consuming, even on a multi-core machine. Recently, we proposed Halvade, a parallel, multi-node implementation of a DNA sequencing pipeline according to the GATK Best Practices recommendations. The MapReduce programming model is used to distribute the workload among different workers. In this paper, we study the impact of different hardware configurations on the performance of Halvade. Benchmarks indicate that especially the lack of good multithreading capabilities in the existing tools (BWA, SAMtools, Picard, GATK) cause suboptimal scaling behavior. We demonstrate that it is possible to circumvent this bottleneck by using multiprocessing on high-memory machines rather than using multithreading. Using a 15-node cluster with 360 CPU cores in total, this results in a runtime of 1 h 31 min. Compared to a single-threaded runtime of similar to 12 days, this corresponds to an overall parallel efficiency of 53%

A monolithic resonant terahertz sensor element comprising a metamaterial absorber and micro-bolometer

In this article a monolithic resonant terahertz sensor element with a noise equivalent power superior to that of typical commercial room temperature single pixel terahertz detectors and capable of close to real time read-out rates is presented. The detector is constructed via the integration of a metamaterial absorber and a micro-bolometer sensor. An absorption magnitude of 57% at 2.5 THz, a minimum NEP of inline image and a thermal time constant of 68 ms for the sensor are measured. As a demonstration of detector capability, it is employed in a practical Nipkow terahertz imaging system. The monolithic resonant terahertz detector is readily scaled to focal plane array formats by adding standard read-out and addressing circuitry enabling compact, low-cost terahertz imaging

Sensitivity and specificity of the ankle–brachial index to diagnose peripheral artery disease: a structured review

The ankle—brachial index (ABI) is a simple, inexpensive diagnostic test for peripheral artery disease (PAD). However, it has shown variable accuracy for identification of significant stenosis. The authors performed a structured review of the sensitivity and specificity of ABI ≤ 0.90 for the diagnosis of PAD. MEDLINE, EMBASE, Cochrane databases, Science Citation Index database, and Biological Abstracts database were searched for studies of the sensitivity and specificity of using ABI ≤ 0.90 for the diagnosis of PAD. Eight studies comprising 2043 patients (or limbs) met the inclusion criteria. The result indicated that, although strict inclusion criteria on studies were formulated, different reference standards were found in these studies, and methods of ABI determination and characteristics of populations varied greatly. A high level of specificity (83.3—99.0%) and accuracy (72.1—89.2%) was reported for an ABI ≤ 0.90 in detecting ≥ 50% stenosis, but there were different levels of sensitivity (15—79%). Sensitivity was low, especially in elderly individuals and patients with diabetes. In conclusion, the test of ABI ≤ 0.90 can be a simple and useful tool to identify PAD with serious stenosis, and may be substituted for other non-invasive tests in clinical practice

Five pillars for stakeholder analyses in sustainability transformations: The global case of phosphorus.

Phosphorus is a critical agricultural nutrient and a major pollutant in waterbodies due to inefficient use. In the form of rock phosphate it is a finite global commodity vulnerable to price shocks and sourcing challenges. Transforming toward sustainable phosphorus management involves local to global stakeholders. Conventional readings of stakeholders may not reflect system complexity leaving it difficult to see stakeholder roles in transformations. We attempt to remedy this issue with a novel stakeholder analysis method based on five qualitative pillars: stakeholder agency, system roles, power and influence, alignment to the problem, and transformational potential. We argue that our approach suits case studies of individual stakeholders, stakeholder groups, and organisations with relationships to sustainability challenges

A Non-Restrictive Weight Loss Diet Focused on Increasing Fiber and Lean Protein: Results of a Pilot Trial

Objective. The vast majority of diets are not only multicomponent but also restrictive. Dietary fiber or protein can reduce hunger and enhance satiety; they also exert clinical benefits. We examined feasibility and acceptability of a non-restrictive diet combining the two for weight loss. Population and Methods. Fifteen patients were enrolled in the trial (2 men, 13 women, mean age=48 y and mean BMI = 36 kg/m2) to attend 6 bi-weekly individual counselling sessions for the diet during the 12-week study period. The goals of the intervention were to attain a daily goal of higher fiber (\u3e35g)/ and lean protein (120g). 24-hour diet recalls and body weight were collected at baseline, 6- and 12-week assessments. Results. All participants completed 6-week assessment, one participant dropped from the study before 12-week assessment. At 12 weeks, 93% of participants liked the diet much/very much, 92% were very/extremely confident in adhering to the diet and 85% did not feel hungry on the diet. Mean fiber intake increased by 9.4 g/day (95% CI: 5.9, 12.8) at 6 weeks, and by 6.9 g/day (CI: 3.3, 10.5) at 12 weeks. Protein intake increased by a mean of 13.7 g/day (CI: 4.8, 22.6) at 6 weeks, and by 6.0 g/day (CI: -3.3, 15.3) at 12 weeks. % of calories from saturated fat decreased by 2.0% (CI: 0.5, 3.4) at 6 weeks and by 2.7% (CI: 0.5, 3.4) at 12 weeks. Alternative Healthy Eating Index score increased by 9.7 (CI: 5.3, 14.0) at 6 weeks and by 6.1 (CI: 1.5, 10.7) at 12 weeks. Mean weight loss was -2.7 lbs (CI: -4.9, 0.6) at 6 weeks and -4.7 lbs (CI: -8.0, -1.4) at 12 weeks. Conclusion. Participants liked the diet prescribed, and significantly increased their fiber and lean protein intake, resulting in significant weight loss with improvement to dietary quality

Design and methods for testing a simple dietary message to improve weight loss and dietary quality

BACKGROUND: The current food pyramid guidelines have been criticized because of their complexity and the knowledge required for users to understand the recommendations. Simplification of a dietary message to focus on a single key aspect of dietary quality, e.g., fiber intake, may make the message much easier to comprehend and adhere, such that respondents can achieve greater weight loss, better dietary quality and overall metabolic health. METHODS AND DESIGN: This is a randomized controlled clinical trial with two equal sized arms. In total, 240 obese adults who meet diagnostic criteria for the metabolic syndrome will be randomized to one of the two conditions: 1) a high fiber diet and 2) the American Heart Association (AHA) diet. In the high fiber diet condition, patients will be given instruction only on achieving daily dietary fiber intake of 30 g or more. In the AHA diet condition, patients will be instructed to make the several dietary changes recommended by the AHA 2006 guidelines. The trial examines participant weight loss and dietary quality as well as changes in components of the metabolic syndrome, inflammatory biomarkers, low-density lipoprotein cholesterol levels, insulin levels, and glycosolated hemoglobin. Potential mediators, i.e., diet adherence and perceived ease of the diet, and the intervention effect on weight change will also be examined. DISCUSSIONS: The purpose of this paper is to outline the study design and methods for testing the simple message of increasing dietary fiber. If the simple dietary approach is found efficacious for weight loss; and, improves dietary quality, metabolic health, and adherence, it might then be used to develop a simple public health message. TRIAL REGISTRATION: NCT00911885

Simple messages to improve dietary quality: A pilot investigation

Public health recommendations for a healthy diet often involve complex messages, requiring in-depth knowledge for understanding and compliance. The present study compared the feasibility and initial efficacy of two simple messages (a high fiber diet or a low saturated fat diet) to a combination message (high fiber and low saturated fat) on the potential to impact dietary quality and metabolic health. Conclusions: A simple dietary message appears to improve overall dietary quality and aid in weight management. Simple messages are a novel approach which could make a significant impact on the prevention and treatment of chronic disease as well as weight management. Results support the need for a larger randomized controlled trial that is powered to examine the efficacy of a simplified dietary recommendation for dietary quality and metabolic health. It would be worth exploring the impact of simple messages in a larger trial to determine their usefulness as simple public health messages as an alternative the current complex recommendations