Search

Climate change and its related impacts are fast becoming the dominant force in the housing market. The fundamental role that housing plays in people's lives makes these effects particularly pernicious, often impacting employment, school attendance, undermining physical and mental health, disrupting social networks, and contributing to food insecurity. The complexity of addressing these issues is compounded by the cyclical and reciprocal relationships among these factors, with housing inequalities frequently lying at the core and climate change impacts percolating throughout. I introduce the framework of acute, secondary, and pre‐emptive/reactive impacts to help understand these mechanisms. To understand and contextualize these connections, I provide a brief overview racial segregation in the United States and related inequalities that place some individuals, groups, and communities at greater risk. Other key sources of housing instability in the United States that are often closely related to housing segregation include lack of affordable housing, growing income inequality, housing discrimination, evictions, and foreclosures, all of which contribute to unequal housing outcomes. These factors are explored using the temporal framework to discuss their connection to climate change, which is in and of itself a major force of housing instability. [ABSTRACT FROM AUTHOR]

There are multiple factors regarding current health care delivery in the U.S. These factors include the high-priced medical care, hospitals, equipment, and pharmaceutical charges, and the private system of health insurance. This discussion looks at these factors' impact on Local County Hospital ranging from Obamacare to a host of other challenges. The hospital is going through difficult times as it struggles to make ends meet. Although it will take time to adjust to an inconsistent environment and changing health care industry, Local County Hospital continues to focus on the patients first and attempts to keep the region healthy. [ABSTRACT FROM AUTHOR]

Background: Hearing, visual, and olfactory impairments have been associated with cognitive impairment in older adults but less is known about associations with cognitive function in middle-aged adults.Methods: Sensory and cognitive functions were measured on participants in the baseline examination (2005-2008) of the Beaver Dam Offspring Study. Cognitive function was measured with the Trail Making tests A (TMTA) and B (TMTB) and the Grooved Peg Board test. Pure-tone audiometry, Pelli-Robson letter charts, and the San Diego Odor Identification test were used to measure hearing, contrast sensitivity, and olfaction, respectively.Results: There were 2,836 participants aged 21-84 years with measures of hearing, visual, olfactory, and cognitive function at the baseline examination. Nineteen percent of the cohort had one sensory impairment and 3% had multiple sensory impairments. In multivariable adjusted linear regression models that included all three sensory impairments, hearing impairment, visual impairment, and olfactory impairment were each independently associated with poorer performance on the TMTA, TMTB, and Grooved Peg Board (p < .05 for all sensory impairments in all models). Participants with a sensory impairment took on average from 2 to 10 seconds longer than participants without the corresponding sensory impairment to complete these tests. Results were similar in models that included adjustment for hearing aid use.Conclusion: Hearing, visual and olfactory impairment were associated with poorer performance on cognitive function tests independent of the other sensory impairments and factors associated with cognition. Sensory impairments in midlife are associated with subtle deficits in cognitive function which may be indicative of early brain aging. [ABSTRACT FROM AUTHOR]

This paper examines the types of neighborhoods that black and white homebuyers have secured loans in during the recent housing boom and subsequent bust. We expand upon and refine previous research on locational attainment using loan-level data from the 1992-2010 Home Mortgage Disclosure Act (HMDA) combined with tract- and metropolitan-level data from the 1990, 2000, and 2010 Census and the American Community Survey. Multilevel models show that black homebuyers are moving into considerably more racially segregated neighborhoods than their white counterparts and that their access to "whiter" neighborhoods did not expand during the housing boom, even after controlling for the racial composition of the metropolitan area and other key ecological factors. Conversely, new white homebuyers have been moving into neighborhoods with greater percent black residents, which may be a contributing factor in observed declines in segregation during the past few decades. Additionally, black homebuyers in metropolitan areas with greater suburban growth were on average accessing homes in more integrated neighborhoods. Finally, the models explained considerably more of the variation in the neighborhood racial composition of whites compared to blacks. These findings are suggestive of a dual housing market, one in which the experiences of blacks are still systematically different than those of whites, despite expanded access to homeownership. [ABSTRACT FROM AUTHOR]

Highlights: [•] Segregation trends for new black and white homebuyers, homeowners, and households. [•] Analysis employs HMDA data 1992–2010 combined with three decades of US Census data. [•] Black homebuyers are less segregated from whites than black homeowners overall. [•] Lending growth associated with declines in black homeowner and household segregation. [•] Subprime lending was related to increased homeowner segregation only. [Copyright &y& Elsevier]

The Financial Accounting Standards Board (FASB) and the International Accounting Standards Board (IASB) have been working to eliminate differences between US accounting rules and international financial reporting standards (IFRS). The FASB has undertaken initiates such as joint projects, short-term conversion projects, monitoring IASB projects, convergence research projects and others as initiatives to further convergence. The primary problems with convergence are the lack of requirements or guidance that currently exist between IFRS and generally accepted accounting principles (GAAP), the large number of differences such as definition, recognition, measurement, presentation and disclosure differences and the costs to eliminate these differences. Even with convergence, a single set of global accounting standards will continue to be subject to change as the IASB has an ongoing history of revising or changing their pronouncements. Given this history, multinational accountants must be vigilant to stay current with IFRSs. [ABSTRACT FROM AUTHOR]

This study examines whether the use of institutional (school-based) networks may help students from disadvantaged backgrounds secure summer employment opportunities that are on a par with those of their more advantaged classmates who may possess more resource-rich personal and familial networks. The study draws on unique data from the National Longitudinal Survey of Freshmen to examine the strategies that a national representative sample of nearly 4,000 white, black, Asian, and Hispanic students on 28 campuses used to obtain summer employment and the characteristics of these summer jobs. Multinomial logistic regression techniques are applied to examine the types of contacts students used and jobs they found, while OLS regression is employed to examine the wages and occupational prestige of summer positions. The study reveals that students who obtained their summer jobs through institutional contacts had significantly higher earnings and held positions with higher occupational prestige than students using most other methods (controlling for race/ethnicity, prior work experience, and parental education). I also found that minority students are at least as likely as white students to draw on these institutional networks. In addition, there were no differences by SES, suggesting that this type of capital is both accessible and accessed by a wide range of students. This study provides evidence that summer jobs obtained through institutional networks are more likely to be in desirable sectors, on average pay better, and have higher occupational prestige scores than jobs obtained by most other methods. [ABSTRACT FROM AUTHOR]

The article addresses the experience of racial and ethnic minorities on U.S. higher education campuses, specifically campuses of predominantly White institutions. The author states the need to understand what constitutes a successful transition to college for these students, as research indicates that the transition to college sets the stage for college success or failure. She notes that Black and Hispanic students are more likely to be first-generation college students than their White or Asian counterparts, and they are more likely to be from low socioeconomic status backgrounds. Other possible disadvantages listed include their minority status on a predominantly White campus. Social and academic connections are examined.

The Centers for Medicare and Medicaid Services has begun an ambitious recalibration of the inpatient prospective payment system, the first since its introduction in 1983. Unfortunately, inpatient nursing care has been overlooked in the new payment system and continues to be treated as a fixed cost and billed at a set per-diem "room and board" fee despite the known variability of nursing intensity across different care settings and diagnoses. This article outlines the historical influences regarding casting, billing, and reimbursement of inpatient nursing care and provides contemporary evidence about the variability of nursing intensity and costs at acute care hospitals in the United States. A remedy is proposed to overcome the existing limitations of the Inpatient Prospective Payment System by creating a new nursing cost center and nursing intensity adjustment by DRG for each routine- and intensive-care day of stay to allow independent costing, billing, and reimbursement of inpatient nursing care. [ABSTRACT FROM AUTHOR]

In this article we build on prior studies that have used audit methods to document continued discrimination against African Americans in U.S. housing markets. Whereas prior work focused primarily on measuring racial disparities in housing access, here we seek to determine which personal, ecological, and agent factors raise or lower discrimination. Our data come from phone-based audit studies of rental housing offered in the Philadelphia metropolitan market in the spring of 1999, the fall of 2000, and the spring of 2002. Male and female auditors called listings to inquire about the availability of units using white middle-class English, black-accented English, and Black English Vernacular. Results show that whites are more likely to be favored over black auditors of the same gender when the black auditor speaks Black English Vernacular compared with black-accented English. Access was also lower in suburbs than the central city and it decreased as distance from a predominantly black neighborhood fell. Blacks experienced much lower access to units marketed by private landlords rather than professional agents. Blacks are more likely to gain access to areas that already have high concentrations of blacks or in areas that are not in danger of black encroachment (i.e., further away from black concentrations). These mechanisms serve to reinforce and replicate segregation. [ABSTRACT FROM AUTHOR]

As events in the business sector have highlighted, companies can play by the rules and yet produce misleading financial statements. This study examines non-governmental organizations that provide a substantial portion of higher education in the United States. We seek to determine whether private colleges and universities take advantage of the discretion available to them under accounting and auditing standards to present an operating measure in their statement of activities. We find that nearly 60% of schools report an operating measure but the items included or excluded from operations vary widely. [ABSTRACT FROM AUTHOR]

Discusses the influence of income inequality on the socioeconomic status of the U.S. from 1950 to 2000. Difference between rich and poor communities; Information on trends with respect to the geographic segregation of families by income; Data on the distribution of families by income class.

Presents the properties of the entropy index to explore trends in segregation by race and ethnicity and income class for U.S. families from 1970 to 2000. Definition of segregation; Advantage of entropy-based measures; Aspects of income segregation.

In this paper, we specify and estimate a model of minority group entrepreneurship that incorporates individual, household, and metropolitan-level factors. Among the metropolitan factors we consider is residential segregation, which might be thought to enhance business opportunities by concentrating demand and creating protected market niches. Whereas some degree of geographic concentration may be beneficial for certain types of entrepreneurship, higher levels of residential segregation are likely to be detrimental to entrepreneurial endeavors because of the tendency for segregation to interact with skewed minority income distributions to concentrate poverty geographically. Using data from the 1990 U.S. Census, we estimate a model to measure the effect of segregation on the likelihood of entrepreneurship among different racial/ethnic groups in U.S. metropolitan areas. We find that beyond very moderate levels, segregation actually works to lower the odds of entrepreneurship. [ABSTRACT FROM AUTHOR]

In this paper we update earlier work on racial and ethnic segregation by income to test assertions made by some observers that segregation is now largely a matter of class rather than race. Using the Summary Tape Files of the 1990 Census of Population, we measure the segregation of Blacks, Hispanics, and Asians within four categories of income: poor, lower middle class, upper middle class, and affluent. For all metropolitan areas containing at least 5000 members of the group in question, we compute indices of dissimilarity and interaction between minority members of a certain income and Whites of all income, thus measuring the extent of overall racial/ethnic segregation by social class. We find that Black residential segregation persists at high levels across all income levels, and that the gap between Blacks and other minority groups actually increases as income rises. [ABSTRACT FROM AUTHOR]

Focuses on the credibility, independence, and accountability of audit departments of universities and colleges in the United States. Characteristics important for both external and internal credibility; Selection process for the internal auditor; Type of audit work performed; Access to decision makers and reports relied upon; Comparison of audit departments of private and public universities.

In the southern and southeastern United States, the 9-banded armadillo is an important reservoir for Mycobacterium leprae, the causative agent of leprosy (Hansen''s disease). Here, we describe a woman living in Georgia with borderline tuberculoid leprosy who worked for many years in a garden where armadillos burrowed or were buried. There was no history of foreign travel or known exposure to a person with leprosy. Treatment with 6 once-monthly combined doses of rifampin, ofloxacin, and minocycline was successful. [Copyright &y& Elsevier]

Background: Relationships between brain-derived neurotrophic factor (BDNF), insulin-like growth factor (IGF-1), aldosterone, and cognition in aging were evaluated in the population-based Epidemiology of Hearing Loss Study (1993 to present)., Methods: Beginning in 1998 to 2000, cognitive impairment was assessed by report of physician diagnoses and the Mini-Mental State Examination. In 2009 to 2010 and 2013 to 2016, information was collected on diagnosis of mild cognitive impairment/dementia. Decline in cognitive function was assessed by principal component analysis from additional tests administered during 2009 to 2010 and 2013 to 2016. BDNF, IGF-1, and aldosterone were measured in serum collected in 1998 to 2000., Results: There were 1970 participants (mean age=66.9 y; 59.1% female) without cognitive impairment at baseline. Among women, low BDNF was associated with 16-year incident cognitive impairment [hazard ratio=1.76; 95% confidence interval (CI)=1.04, 2.98]. Among men, increasing IGF-1 was associated with decreased risk [per SD: relative risk (RR)=0.57; 95% CI=0.35, 0.92], whereas increasing aldosterone levels were associated with increased risk (per SD: RR=1.28; 95% CI=1.01, 1.62) for 5-year incident mild cognitive impairment/dementia. Overall, low BDNF was associated with increased risk (RR=1.52; 95% CI=1.02, 2.26) for 5-year cognitive decline., Conclusion: Low levels of serum BDNF and IGF-1 were associated with poorer cognition during aging. There may be differential biomarker effects by sex.

Background: Sensorineural impairments and cardiovascular risk factors (CVRF) and disease (CVD) in midlife may be important predictors of future cognitive health, but longitudinal studies that include multiple sensorineural measures in middle-aged adults are lacking., Methods: Hearing, vision, and olfaction, and CVRF and CVD were measured at the Beaver Dam Offspring Study baseline (2005-2008) examination. The Mini-Mental State Examination and Trail Making Tests A and B were administered at all phases and additional cognitive function measures were obtained at 5 (2010-2013) and 10 years (2015-2017). Cox proportional hazards models were used to evaluate associations between baseline sensorineural impairments, CVRF, CVD, and 10-year cumulative incidence of cognitive impairment and decline., Results: There were 2,556 participants (22-84 years) without cognitive impairment at baseline and data from at least one follow-up. In a multivariable model including age, sex, education, and head injury, visual impairment (hazard ratio = 2.59, 95% confidence interval = 1.34, 5.02), olfactory impairment (hazard ratio = 3.18, 95% confidence interval = 1.53, 6.59), CVD (hazard ratio = 2.37, 95% confidence interval = 1.24, 4.52), and not consuming alcohol in the past year (hazard ratio = 2.21, 95% confidence interval = 1.16, 4.19) were associated with the 10-year cumulative incidence of cognitive impairment. Current smoking and diabetes were associated with increased risk, and exercise with decreased risk, of 10-year decline in cognitive function., Conclusions: Visual and olfactory impairments, CVRF, and CVD were associated with the 10-year cumulative incidence of cognitive impairment and decline in middle-aged adults. Identifying modifiable factors associated with cognitive decline and impairment in midlife may provide opportunities for prevention or treatment and improve cognitive health later in life., (© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To better understand how to educate patients and providers about study findings relevant to treatment guidelines, we assessed pre- versus post-Women's Health Initiative (WHI) differences in menopausal hormone therapy (MHT) initiation and continuation and their correlates, and in women's reasons for initiation and discontinuation., Methods: We analyzed survey data from up to 14 approximately annual visits over 17 years (1996-2013) from 3,018 participants in the Study of Women's Health Across the Nation, a prospective cohort study. We used logistic regression to compare pre- versus post-WHI associations of covariates with MHT initiation and continuation, and to compare pre- versus post-WHI reasons for initiation and continuation., Results: MHT initiation dropped from 8.6% pre-WHI to 2.8% post-WHI (P < 0.0001), and the corresponding decrease in MHT continuation was 84.0% to 62.0% (P < 0.0001). Decreases in MHT initiation and continuation occurred across a range of participant subgroups, consistent with wide dissemination of post-WHI recommendations. However, contrary to current guidelines, we found large declines in MHT use in subgroups for whom MHT is often recommended, that is, younger women and those with more vasomotor symptoms. Post-WHI, women's reasons for MHT initiation and discontinuation reflected concerns highlighted by WHI results. The largest declines in initiation reasons were for reducing risks of osteoporosis and heart disease, whereas the largest increases in discontinuation reasons were for media reports and provider advice., Conclusions: Immediate post-WHI recommendations for MHT use were widely adopted. MHT risks documented in older women, however, may have led younger symptomatic women to forgo MHT for symptom relief.

Background: The Organ Procurement Transplant Network Disease Transmission Advisory Committee (DTAC), a multidisciplinary committee, evaluates potential donor-derived transmission events (PDDTE), including infections and malignancies, to assess for donor transmitted events., Methods: Reports of unexpected PDDTE to Organ Procurement Transplant Network in 2013 were fully reviewed by DTAC. A standardized algorithm was used to assess each PDDTE from a given donor and to classify each individual recipient from that donor., Results: Of 443 total PDDTE submitted, 159 were triaged and not sent out to the full DTAC. Of 284 fully evaluated reports, 32 (11.3%) resulted in a proven/probable (P/P) transmission of infection, malignancy or other conditions to 42 recipients. Of 204 infection events, 24 were classified as P/P affecting 30 recipients, with four deaths. Bacteria were the most frequently reported type of infection, accounting for 99 reports but only 12 recipients from 11 donors experienced P/P transmission. There were 65 donors reported with potential malignancy events and 5 were classified as P/P transmissions with 8 affected recipients and 2 deaths. Additionally, there were 16 noninfection, nonmalignancy reports resulting in 3 P/P transmissions to 4 recipients and 1 death., Conclusions: There was a 43% increase in the number of PDDTE reported and reviewed in 2013 over 2012. However, the percent with P/P transmission remains low, affecting recipients from 32 donors especially when compared with the more than 14,000 donors recovered annually in the United States. The continued use of the new standard algorithm and triaging process will enhance the reproducibility of DTAC assessments and allow more robust analysis of our aggregate DTAC experience.

Background: Many factors influence the decision to retire including age, insurance, and pension availability along with physical and mental health. Hearing impairment may be one such factor., Purpose: The purpose of this study was to compare the 15 yr retirement rate among subjects with and without hearing impairment., Research Design: Prospective, population-based study., Study Sample: Subjects were participants in the Epidemiology of Hearing Loss Study (EHLS), a longitudinal investigation of age-related hearing loss. Participants who were working full- or part-time in 1993-1995 were included (n = 1410, mean age = 57.8 yr)., Data Collection and Analysis: Data from four EHLS phases (1993-1995, 1998-2000, 2003-2005, and 2009-2010) were analyzed in 2010-2012. Hearing impairment was defined as a pure tone threshold average (at 0.5, 1, 2, and 4 kHz) greater than 25 dB HL in the worse ear. Employment status was determined at each of the four phases. Kaplan-Meier estimates of the cumulative incidence of retirement were calculated, and Cox discrete-time modeling was used to determine the effect of hearing impairment on the rate of retirement., Results: The cumulative incidence of retirement was significantly (p < 0.02) higher in those with a hearing impairment (77%) compared to those without a hearing impairment (74%). After adjustment for age, gender, self-reported health, and history of chronic disease, there was no significant difference in the rate of retirement between those with and without a hearing impairment (hazard ratio [HR] = 0.9, 95% confidence interval (CI) = 0.7, 1.1). Similar results were observed when hearing aid users were excluded, when hearing impairment was based on the better ear thresholds, and when analyses were restricted to those under 65 yr of age and working full-time at baseline. Participants with a hearing impairment were less likely to state that the main reason for retirement was that the time seemed right., Conclusions: Hearing impairment was found to be associated with a higher rate of retirement, but the association was not independent of the effects of age, gender, and health., (American Academy of Audiology.)

The objective of this study was to determine the prevalence of olfactory impairment and associated risk factors and the effects of olfactory impairment on dietary choices and quality of life. Odor identification was measured in 2838 participants aged 21-84 years (mean 49 years) in the Beaver Dam Offspring Study. The overall prevalence of olfactory impairment was 3.8%, increased with age (from 0.6% in those<35 years to 13.9% among those≥65 years) and was more common in men than women. In a multivariate model age (odds ratio [OR]=1.48, 95% confidence interval [CI]=1.33, 1.64 for every 5-year increase), nasal polyps or deviated septum (OR=2.69, 95% CI=1.62, 4.48), ankle-brachial index<0.9 (OR=3.62, 95% CI=1.45, 9.01), and smoking (women only) (OR=2.43, 95% CI=1.19, 4.98 ever smoked vs. never) were associated with an increased odds of olfactory impairment, whereas higher household income, ≥$50,000 versus <$50,000 per year, was associated with a decreased odds of olfactory impairment (OR=0.48, 95% CI=0.31, 0.73). Participants with olfactory impairment were less likely to report that food tasted as good as it used to, or that they experienced food flavors the same. There was no association between olfactory impairment and general health-related quality of life, depressive symptoms, or dietary choices. The prevalence of olfactory impairment was low in this largely middle-aged cohort, and some factors associated with olfactory impairment are potentially modifiable.

Rationale: Studies have suggested heightened anxiety among adults with asthma; the mechanism of this association is not known., Objectives: To determine the association between post-traumatic stress disorder (PTSD) symptoms and asthma among adults, and to examine if this association is due to confounding by environmental and genetic factors., Methods: Data were obtained from twins in the Vietnam Era Twin Registry, which includes male veteran twin pairs born between 1939 and 1956 who served during the Vietnam era (1965-1975). Measurements included a symptom scale for PTSD, history of a doctor diagnosis of asthma, and sociodemographic and health confounding factors. Co-twin control analytic methods used mixed-effects logistic regression to account for the paired structure of the twin data and to examine the association between PTSD symptoms and asthma in all twins. Separate analyses were conducted within twin pairs and according to zygosity., Measurements and Main Results: PTSD symptoms were associated with a significantly increased likelihood of asthma (P(trend) < 0.001) even after adjustment for confounding factors. Among all twins, those in the highest quartile of PTSD symptoms were 2.3 times as likely (95% confidence interval, 1.4-3.7) to have asthma compared with those in the lowest quartile. These findings persist when examined within twin pairs and when stratified by zygosity., Conclusions: Symptoms of PTSD were associated with an elevated prevalence of asthma. Even after careful adjustment for familial/genetic factors and other potential confounding factors, an association between PTSD symptoms and asthma remains. Efforts to understand this comorbidity may be useful in identifying modifiable environmental risk factors contributing to this pattern and therefore in developing more effective prevention and intervention strategies.

Background: The extent of genetic influence on erectile dysfunction (ED) is unknown. This study determines the contribution of heredity to ED in a sample of middle-aged men., Methods: A classical twin study was conducted in the Vietnam Era Twin Registry, a national sample of male-male pairs (mean birth year, 1949) who served on active duty during the Vietnam era (1965-1975). A 1999 male health survey was completed by 890 monozygotic (MZ) and 619 dizygotic (DZ) pairs. The prevalence and heritability of 2 self-report indicators of ED, difficulty in having an erection and in maintaining an erection, are estimated., Results: The prevalence of difficulty in having an erection is 23.3% and in maintaining an erection is 26.7%. Twin correlations for dysfunction in having an erection are 0.35 (95% confidence interval [CI], 0.28-0.41) in MZ and 0.17 (95% CI, 0.09-0.27) in DZ pairs. For dysfunction in maintaining an erection, the twin correlations in MZ and DZ pairs are 0.39 (95% CI, 0.32-0.45) and 0.18 (95% CI, 0.09-0.27), respectively. The estimated heritability of liability for dysfunction in having an erection is 35% and in maintaining an erection is 42%. The heritable influence on ED remained significant after adjustment for ED risk factors., Conclusions: The present study demonstrates an ED-specific genetic component that is independent of genetic influences from numerous ED risk factors. The results suggest that future molecular genetic studies to identify ED-related polymorphisms are warranted.