Stakeholders' perceptions of ways to support decisions about health insurance marketplace enrollment: a qualitative study.

BACKGROUND: Approximately 29 million individuals are expected to enroll in health insurance using the Patient Protection and Affordable Care Act (ACA) Marketplace by 2022. Those seeking health insurance struggle to understand insurance options and choose a plan that best suits their needs. METHODS: We interviewed stakeholders to identify the challenges associated with the ACA Marketplace health insurance enrollment and elicited feedback about what to include in health insurance decision support tools. Interviews were transcribed and themes were identified using inductive thematic analysis. RESULTS: Stakeholders stated that consumers felt frustrated by unclear terminology, high plan costs, and complex calculations required to assess costs. Consumers felt anxious about making the wrong choice and being unable to change plans within a calendar year. Stakeholders recommended using plain language tables defining complex terms, grouping information, and using engaging graphics to communicate information about health insurance. Stakeholders thought that narratives of how others made decisions about insurance might be helpful to consumers, but recommended that they be tailored to the needs of specific consumers. CONCLUSION: Strategies that clarify health insurance terms using plain language and graphics, acknowledge concern associated with making the wrong choice, calculate and enable cost comparison, and tailor information to consumers' unique needs could benefit those enrolling in ACA Marketplace plans, Narratives developed should be simple and inclusive enough for diverse populations.

Lattice Boltzmann study of convective drop motion driven by nonlinear chemical kinetics.

We model a reaction-diffusion-convection system which comprises a liquid drop containing solutes that undergo an Oregonator reaction producing chemical waves. The reactants are taken to have surfactant properties so that the variation in their concentrations induces Marangoni flows at the drop interface which lead to a displacement of the drop. We discuss the mechanism by which the chemical-mechanical coupling leads to drop motion and the way in which the net displacement of the drop depends on the strength of the surfactant action. The equations of motion are solved using a lattice Boltzmann approach.

Eliminating spurious velocities in the free-energy lattice Boltzmann method.

Spurious velocities are unphysical currents that appear close to curved interfaces in diffuse interface methods. We analyze the causes of these spurious velocities in the free-energy lattice Boltzmann algorithm. By making a suitable choice of the equilibrium distribution, and by finding the best way to numerically calculate derivatives, we show that these velocities may be decreased by an order of magnitude compared to previous models. Furthermore, we propose a momentum conserving forcing method that reduces spurious velocities by another factor of approximately 5. In three dimensions we find that 19 velocity vectors is the minimum number necessary.

Lattice Boltzmann simulations of phase separation in chemically reactive binary fluids.

We use a lattice Boltzmann method to study pattern formation in chemically reactive binary fluids in the regime where hydrodynamic effects are important. The coupled equations solved by the method are a Cahn-Hilliard equation, modified by the inclusion of a reactive source term, and the Navier-Stokes equations for conservation of mass and momentum. The coupling is twofold, resulting from the advection of the order parameter by the velocity field and the effect of fluid composition on pressure. We study the evolution of the system following a critical quench for a linear and for a quadratic reaction source term. Comparison is made between the high and low viscosity regimes to identify the influence of hydrodynamic flows. In both cases hydrodynamics is found to influence the pathways available for domain growth and the eventual steady states.

Leg ulceration in Portugal: prevalence and clinical history.

OBJECTIVE: To determine the prevalence and clinical history of leg ulceration in Portugal. DESIGN: Case identification of patients through health professionals providing care for patients with leg ulceration. SETTING: Clinical areas in hospital, community centres and patients' homes. PARTICIPANTS: Patients registered with five health centres within Lisbon suffering from ulceration of the leg receiving care from hospital and community staff. METHODS: Patients identified by health care professionals working in one area of Lisbon were asked to complete a simple proforma on each patient with leg ulceration. Patients were followed up prospectively to determine healing rates during this baseline period of evaluation. RESULTS: In total 263 patients were identified in a population of 186,000 (total prevalence 1.41 (95%CI 1.25-1.59) per 1000 population). The prevalence was similar between men and women (1.3 and 1.46 per 1000, respectively). As expected this was highly age dependent being most common in the patients aged over 80 years (6.5 and 4.9 per 1000, respectively). Median duration of ulceration was 18 months, with 158/240 (66%) present for longer than 1 year, and 40 (17%) for longer than 5 years. The cause of ulceration was unknown to the health professional treating the patient in 86 (33%) patients. Diagnosis of aetiology was usually on the basis of clinical examination alone (145, 56%), with 21 (8%) having undergone ankle to brachial pressure index (ABPI) measurements and a further eight undergoing either echo-Doppler or arteriography. Most care was provided by community services, with 145 (55%) treated in health centres and 77 (29%) treated in the patient's home. CONCLUSIONS: The prevalence of chronic leg ulceration is similar to other reported studies in western Europe, and indicates that approximately 14,000 patients suffer from leg ulceration at any one time in Portugal. Leg ulceration causes a considerable burden on both hospital and community services.

[Computerized tomography in agenesis of the corpus callosum: findings in 27 cases]. / Tomografia computadorizada na agenesia do corpo caloso: achados em 27 casos.

We describe a retrospective study of 27 cases of complete agenesis of the corpus callosum examined by CT and not associated to schizencephaly, holoprosencephaly and Dandy-Walker complex. Partial agenesis is also not included in the present study. The imaging findings are correlated to sex, age and symptoms.

Comparison of the results of a standardized AIDS prevention program in three geographic locations.

A standardized AIDS prevention program, Stop AIDS, was tested with gay and bisexual men in 3 different geographic locations: metropolitan Chicago; Orange County, California; and Phoenix, Arizona, employing a test of AIDS knowledge, attitudes, and behavior. Results indicted that the Chicago participants began with the most knowledge about AIDS but gained least in the workshop, ending lowest, while the Orange County participants started with the least knowledge and gained the most, ending highest. The same change pattern was demonstrated in terms of attitudes. However, all groups started the discussion group with approximately the same risk behavior for HIV transmission, and all groups committed to the same amount of change in risk behavior at workshop termination, demonstrating the independence of behavior change from knowledge and attitude changes. Additionally, all 3 groups had the same 8 of 15 significant correlations of measures with no correlation between knowledge about AIDS, attitudes toward AIDS, and post-workshop intentions regarding risk behavior. These results indicate that Stop AIDS is an effective prevention program in all 3 locations, but that this and other programs should emphasize actual risk-behavior change rather than knowledge increase or healthier attitudes to produce the greatest lethality reduction.