Healthcare Reform in Latino Rhode Island: Perspectives of Spanish speakers and Insurance Navigators

Latinos have the highest uninsurance rates of any ethnic or racial group in the US despite recent health insurance expansion reform. In addition to immigration and language barriers, health literacy and attitudes may impact coverage disparities. Focus groups with Spanish-speaking community members and semi-structured interviews with health insurance navigators were conducted to explore knowledge, awareness, and attitudes towards healthcare reform among Latinos in Rhode Island. Sessions were audio recorded, transcribed, and analyzed employing standard qualitative methods. Thirty-two focus group participants and six navigators were enrolled in the study. Spanish-speaking participants demonstrated limited knowledge of the cost implications of the Medicaid Expansion and of the role of health insurance exchanges. Common misconceptions included that insurance costs would increase regardless of income, that enrollment would compromise green card and citizenship applications, that documented non-permanent residents would be ineligible for subsidies, and that reform benefits would apply to undocumented workers. Our findings suggest that local initiatives and providers should target Latinos in a culturally sensitive manner to increase literacy regarding insurance eligibility, affordability, points of access as well as to address misconceptions related to insurance eligibility for documented immigrants

Virtual Surgical Planning in Subscapular System Free Flap Reconstruction of Midface Defects.

OBJECTIVES: Reconstruction of the midface has many inherent challenges, including orbital support, skull base reconstruction, optimizing midface projection, separation of the nasal cavity and dental rehabilitation. Subscapular system free flaps (SF) have sufficient bone stock to support complex reconstruction and the option of separate soft tissue components. This study analyzes the effect of virtual surgical planning (VSP) in SF for midface on subsite reconstruction, bone segment contact and anatomic position. MATERIALS AND METHODS: Retrospective cohort of patients with midface defects that underwent SF reconstruction at a single tertiary care institution. RESULTS: Nine cases with VSP were compared to fourteen cases without VSP. VSP was associated with a higher number of successfully reconstructed subunits (5.9 vs 4.2, 95% CI of mean difference 0.31-3.04, p = 0.018), a higher number of successful bony contact between segments (2.2 vs 1.4, 95% CI of mean difference 0.0-1.6, p = 0.050), and a higher percent of segments in anatomic position (100% vs 71%, 95% CI of mean difference 2-55%, p = 0.035). When postoperative bone position after VSP reconstruction was compared to preoperative scans, the difference in anteroposterior, vertical and lateral projection compared to the preoperative \u27ideal\u27 bone position was82% of measurements. There were no flap losses. CONCLUSION: VSP may augment SF reconstruction of the midface by allowing for improved subunit reconstruction, bony segment contact and anatomically correct bone segment positioning. VSP can be a useful adjunct for complex midface reconstruction and the benefits should be weighed against cost

Symmetry breaking from confined water wave fields propels an oscillating robot

We discover a new phenomenon in which a symmetrically oscillating, free-floating robot can be attracted to or repelled from a horizontal boundary. The device generates radially expanding gravity-capillary (GC) waves at the fluid surface. Visualization of the wave field dynamics reveals that when near a boundary, the complex interference of generated and reflected waves induces a wave amplitude asymmetry that generates a net radiation force that drives robot motion. Direct force measurements reveal that attraction increases as wave frequency increases or robot-boundary separation decreases. Theory on confined GC wave radiation dynamics developed by Hocking in the 1980s captures the observed parameter dependence due to these ``Hocking fields".Comment: 11 pages, 5 figures, 8 supplementary figure

Working Group on Chapter 1 of the Proposed Restatement of Employment Law: Existence of Employment Relationship

This article presents a critique of chapter 1 of the Proposed Restatement of Employment Law. The critique is organized to follow the organization of the proposed Restatement, which begins with a provision of black letter law, a series of comments and illustrations explaining the meaning and application of the black letter law, and the reporters\u27 notes providing support for the black letter law and the commentary. This critique will follow that structure, with each part focusing on a section of the chapter: the introductory note; section 1.01; section 1.02; section 1.03; and section 1.04. The subdivisions of the parts will, likewise, generally follow the subdivisions of the sections in the chapter, although sometimes a critique of the reporters\u27 notes will be its own subpart, and sometimes it will be discussed in the subsections analyzing the comments

Working Group on Chapter 1 of the Proposed Restatement of Employment Law: Existence of Employment Relationship

This article presents a critique of chapter 1 of the Proposed Restatement of Employment Law. The critique is organized to follow the organization of the proposed Restatement, which begins with a provision of black letter law, a series of comments and illustrations explaining the meaning and application of the black letter law, and the reporters\u27 notes providing support for the black letter law and the commentary. This critique will follow that structure, with each part focusing on a section of the chapter: the introductory note; section 1.01; section 1.02; section 1.03; and section 1.04. The subdivisions of the parts will, likewise, generally follow the subdivisions of the sections in the chapter, although sometimes a critique of the reporters\u27 notes will be its own subpart, and sometimes it will be discussed in the subsections analyzing the comments

A Pediatric Genetic Disorder Diagnosed in Adulthood

Church's case report is a reminder that "pediatric" genetic diseases are not limited to children