Subsidized public health insurance programs face financial difficulties and are increasingly implementing policies to pass on greater costs to low-income enrollees. Results of a stratified, random sample of 1,153 enrollees and disenrollees of a state program after introduction of increased cost sharing revealed three main reasons for disenrollment, which varied by enrollee income: finding other coverage, becoming financially ineligible, or dropping coverage as too expensive. Seventeen percent of disenrollees cited cost sharing as a reason for disenrollment. Persons who disenrolled were more likely to be younger adults, male, and have fewer children. Persons who disenrolled reported greater subsequent out-of-pocket costs, more difficulty providing coverage for children, and less access to care than persons who stayed enrolled. Most enrollees stayed enrolled despite the cost sharing increases, and persons who did disenroll left for a variety of reasons, only one of which was cost. Implications for state health insurance policies are discussed.
Thirty bone-in hams from market weight hogs were divided equally into groups:( I ) brine-cured, frozen and stored (FIS) at -2OC for 90 days prior to heat processing (smoking); (2) similarly cured and frozen, but not stored (FINS). thawed immediately, and heat processed; (3) cured and heat processed without frozen srorage (NF/NS~. F/S hams had greater overall weight loss and total moisture (r, < 0.05). Smokehouse losses did not differ sign$cantly. FIS hams had higher (r, < 0.05) L values (lightness), while b values (yellowness) for FIS hams exceeded (p < 0.05) the other treatments. N o differences (p > 0.05) were found in shear values or lipid oxidation analysis. Ten sensory panelists found FIS hams to be less JTrm and paler in color than other treatments (p < 0.01).
It is essential that nurse researchers use the most precise and valid data collection instruments available to obtain trustworthy data when conducting research in education and practice. Today, there is a vast selection of existing quantitative data collection instruments from which to choose. Existing instruments can be located through reports of their use in the literature and at conferences, through internet searches and by word of mouth. Once the nurse researcher locates a potential data collection instrument for a given study, the instrument must be systematically appraised for use in that study. This article introduces a comprehensive Step-by-Step Guide that will enable users to quickly and thoughtfully appraise quantitative measurement instruments. The results from the use of this critical appraisal guide will assist researchers to objectively discuss, compare and make informed decisions before adopting a specific data collection instrument for use in a research study. The underlying principles of the Step-by-Step Guide for the Critical Appraisal and Selection of Data Collection Instruments are based on the tenets of measurement theory, literature, and experience of the authors in education and practice research.
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