Credit limits and heterogeneity in general equilibrium models with a finite number of agents

We introduce two-period general equilibrium models with heterogeneous producers and financial frictions. Any agent can borrow to realize their productive project but the debt repayment does not exceed a fraction (so-called credit limit) of the project's value. Our framework allows us to investigate the aggregate and distributional effects of credit limits and heterogeneity of agents. The connection between credit limits, welfare, and efficiency is also explored

Food insecurity in Detroit: exploring the relationship between patient-reported food insecurity and proximity to healthful grocery stores

Objective: The objective of the current study was to determine if patients of a large health care system in Detroit who self-identify as food insecure live further away from healthy grocery stores compared with food secure patients. Second, we explored whether food insecurity and distance to healthy grocery stores are related to ecological measures of vehicle availability in the area of residence. Design: A secondary data analysis that uses baseline data from a pilot intervention/feasibility study. Setting: Detroit, Michigan, USA. Participants: Patients of Henry Ford Health System were screened for food insecurity to determine eligibility for a pilot intervention/feasibility study (i.e. Henry’s Groceries for Health), conducted through a collaboration with Gleaners Community Foodbank of Southeastern Michigan. Only patients residing in Detroit city limits (including Highland Park and Hamtramck) were included in the secondary analysis. Of the 1,100 patients included in the analysis, 336 (31 %) were food insecure. Results: After accounting for socio-demographic factors associated with food insecurity, we did not find evidence that food insecure patients lived further away from healthier grocery stores, nor was this modified by ecological measures of vehicle access. However, some neighbourhoods were identified as having a significantly higher risk of food insecurity. Conclusions: Food insecure patients in Detroit are perhaps limited by social and political determinants and not their immediate neighbourhood geography or physical access to healthy grocery stores. Future research should explore the complexity in linkages between household socio-economic factors, socio-cultural dynamics and the neighbourhood food environment

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Nutrition Supports Deconstructed and Disrupted: An Evaluation of a Multilevel School-Based Intervention during the Time of COVID

The Best Food Forward (BFF) project aims to provide multiple nutrition supports and interventions to improve family food security (FS) and health outcomes associated with FS within two metropolitan school districts. A quasi-experimental time-series design guided a multilevel evaluation for BFF through surveys, biometric screenings, focus groups, and observations among a random sample of caregiver–child dyads. FS, utilization of school meal programs, and nutrition behaviors were observed and analyzed at three time points: preintervention, postintervention pre-COVID-19, and postintervention post-COVID-19. Participants included 122 parents and 162 youth. Families reported (1) an income less than $35,000 annually (48.8%) and (2) a COVID-19-related job loss (36.9%). Parents used Supplemental Nutrition Assistance Programs or Women, Infants, Children benefits prior to (51.1%) and following COVID-19 (50.0%). No significant differences in FS were found. RM-ANOVA indicated an increase in breakfast consumption at home and a decrease in use of the school breakfast program (F(1.78, 74) = 19.64, p < 0.001, partial η2 = 0.21) and school lunch program (F(1.51, 74) = 23.30, p < 0.001, partial η2 = 0.24). Rates of FS and eating behaviors did not change significantly over time. Correlations of program usage and eating behaviors demonstrate the importance of promoting participation in school meal programs. BFF may have prevented significant decreases in FS during COVID-19

Corner Stores as Community-Based Enterprises for Health Promotion: A Qualitative Case Study

This study identifies and describes the locally relevant understanding of healthy corner stores as community-based enterprises (CBEs) within eight suburban communities. In this study, CBEs are defined as a community-lead or community-oriented small businesses with a common goal to improve population health (Peredo and Chrisman, 2006). The 21 corner store owners assessed in this study were participants of the suburban Cook County Healthy HotSpot (HH) corner store pilot project. In collaboration with eight local community-based organizations (CBOs), owners facilitated increasing healthy food access within low-income communities. The aims of this study are: 1) to explicate the locally relevant understanding of corner stores as CBEs and health promoting agents, and 2) to theorize about the role of store owners’ CBE identities in the institutionalization of health promoting activities, to foster healthy eating over the long-term. In order to determine store owner alignment with a CBE identity, a qualitative case study design was used. Existing outcome data from all HH stores, via a market basket assessment, was reviewed to categorize stores into three typologies (low-mid-high) of increased healthy food access. Interviews from store owners, CBO staff and consumer focus groups were analyzed to determine how corner stores aligned with CBE characteristics, and how this influenced their health promoting activities. Owners that more closely associated with the CBE identity were more likely to value community health, have a positive, familial relationship with their consumers, view their store as a community resource and have an overall health promoting vision for their store in the community. Consumers and CBOs also valued the store presence in the community and had a positive view of the store owner. Study results can assist in theory development and intervention design in working with corner stores and other small businesses, as CBEs that promote healthy behaviors and economic vitality in low-income communities

Developing Community Capacity to Increase the Availability of Healthy Foods in Corner Stores

In 2010, the suburban Cook County, IL, Communities Putting Prevention to Work initiative (CPPW) commissioned a report on food access in suburban Cook County. The report identified a number of suburbs with low access to stores selling a variety of healthy foods. In response, the initiative developed a healthy corner store project to improve the availability of healthy foods in existing stores. Due to the size and sprawl of suburban Cook County, the project worked through local community institutions in ten municipalities to recruit corner stores and promote changes. This required training and support of the community-based staff partnering on the project. At the end of the project a program evaluation included interviews with key community staff working on the project in their communities. The evaluation found that training and project materials were helpful. The support of county CPPW initiative staff was particularly helpful to local partners. All partnering institutions faced organizational capacity limitations and staff worked part-time on the project. Institutions that had more financial or staffing uncertainty leaned more heavily on CPPW initiative staff for support. At the end of the project, three of the 8 partnering institutions were planning ways to continue with the project, or were looking for new funding to expand it in their service areas

Corner Stores as Community Members: Low-income residents perspectives

The United States experience with sustainable development is contrasted with the roots and current practices of the British and Australian approaches. This research identifies the convergence and divergence of sustainable development policies in London, Sydney and New York City, the lexicon of sustainable development tools and practices and the complex interplay of federal, state and local legislation and actions. Each city has launched its own version of a comprehensive sustainability plan in the last decade, setting ambitious goals to be achieved by 2025 or 2030, with important milestones established along the way